Eozinofili ve sistemik semptomlarla ilac reaksiyonu [Drug rash with eoshinophilia and systemic symptoms (DRESS)] sendromu nadir gorulen, yaklasik %10 oraninda mortal seyredebilen ilac reaksiyonlarindan biridir DRESS sendromu, klinik olarak yaygin makulopapuler ekzantem, cesitli hematolojik anormallikler, karaciger ve bobrek fonksiyon bozukluklari, ates ve lenfadenopati ile karakterizedir DRESS sendromunun etiyolojisinde pek cok ilac bulunup Fenitoin, Karbamazepin, fenobarbital, Allopurinol, Abakavir ve Sulfonamidler en cok bildirilenlerdendir Hidroksiklorokin , in vitro gosterilen antiviral etkileri nedeni ile koronavirus hastaligi-2019 [coronavirus disease-2019 (COVID-19)] hastaligina karsi tedavide kullanilmaktadir Hidroksiklorokinin, literaturde bildirilen dermatolojik yan etkilerinden bazilari;alopesi, ciltte hiperpigmentasyon ve kasinti olup, asiri duyarlilik reaksiyonlari olan Steven-Johnson sendromu/toksik epidermal nekroliz, akut generalize ekzantematoz pustuloz ve DRESS sendromu da bildirilmistir Biz burada, COVID-19 hastaligi tedavisi sirasinda gelisen yaygin cilt dokuntusu ve sistemik bulgulari ile DRESS sendromu tanisi koydugumuz bir olgumuzu, pandemi doneminde gelisebilecek ilac reaksiyonlari ve COVID-19’a bagli deri tutulumlarina dikkat cekmek acisindan sunmak istedik Ayni zamanda, COVID-19 hastaligi seyrindeki ilac reaksiyonu ve cilt tutulumu karmasasina dikkat cekmek istedik Alternate abstract:Drug rash with eoshinophilia and systemic symptoms (DRESS) syndrome is one of the rare drug reactions with a mortality rate of approximately 10% Clinically the DRESS syndrome is characterized by diffuse maculopapular exanthema, various hematological abnormalities, liver and kidney dysfunction, fever, and lymphadenopathy There are many drugs in the etiology of DRESS syndrome, and Phenytoin, Carbamazepine, phenobarbital, Allopurinol, Abacavir and Sulfonamides are among the most reported Hydroxychloroquine is used in the treatment of COVID-19 disease due to its antiviral effects shown in vitro Some of the dermatological side effects of Hydroxychloroquine reported in the literature are alopecia, hyperpigmentation and itching of the skin, as well as Steven-Johnson syndrome/toxic epidermal necrolysis, acute generalized exantomatous pustulosis, DRESS syndrome, which are hypersensitivity reactions Here, we wanted to present a patient who was diagnosed as DRESS syndrome due to his widespread skin rash and systemic signs that developed during the treatment of COVID-19 disease in order to draw attention to the drug reactions that may develop during the pandemic and skin involvement due to COVID-19 At the same time, we wanted to draw attention to the complexity of drug reaction or skin involvement in the course of COVID-19 disease
Eozinofili ve sistemik semptomlarla ilaç reaksiyonu [Drug rash with eoshinophilia and systemic symptoms (DRESS)] sendromu nadir görülen, yaklaşık %10 oranında mortal seyredebilen ilaç reaksiyonlarından biridir. DRESS sendromu, klinik olarak yaygın makülopapüler ekzantem, çeşitli hematolojik anormallikler, karaciğer ve böbrek fonksiyon bozuklukları, ateş ve lenfadenopati ile karakterizedir. DRESS sendromunun etiyolojisinde pek çok ilaç bulunup Fenitoin, Karbamazepin, fenobarbital, Allopürinol, Abakavir ve Sülfonamidler en çok bildirilenlerdendir. Hidroksiklorokin , in vitro gösterilen antiviral etkileri nedeni ile koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID-19)] hastalığına karşı tedavide kullanılmaktadır. Hidroksiklorokinin, literatürde bildirilen dermatolojik yan etkilerinden bazıları; alopesi, ciltte hiperpigmentasyon ve kaşıntı olup, aşırı duyarlılık reaksiyonları olan Steven-Johnson sendromu/toksik epidermal nekroliz, akut generalize ekzantematöz püstüloz ve DRESS sendromu da bildirilmiştir. Biz burada, COVID-19 hastalığı tedavisi sırasında gelişen yaygın cilt döküntüsü ve sistemik bulguları ile DRESS sendromu tanısı koyduğumuz bir olgumuzu, pandemi döneminde gelişebilecek ilaç reaksiyonları ve COVID-19'a bağlı deri tutulumlarına dikkat çekmek açısından sunmak istedik. Aynı zamanda, COVID-19 hastalığı seyrindeki ilaç reaksiyonu ve cilt tutulumu karmaşasına dikkat çekmek istedik.
Objective: Organic phosphates (OP) bind covalently to acetylcholinesterase (AChE) and acetylcholine (Ach) accumulates in the synaptic cleft. Administering oximes before aging process causes breakage of the covalent bond between OP-AChE, and allows reactivation of AChE. Pralidoxime (PAM) is the most commonly used oxime. The purpose of this study is to determine the best PAM regimen for the length of hospitalization, the need for mechanical ventilation and reduction of the duration of mechanical ventilation in patients presenting with OP poisoning. Material and Methods: Thirty four patients included in this study were organized according to the order of enrollment, randomized and divided into two groups. Seventeen patients in the group I were given a single dose of 2 g/20 min PAM infusion (bolus dose), while 17 patients in group II were administered a dose of 2 g/20 min followed by 6 g/24 hours PAM infusion (bolus and infusion). Clinical signs and symptoms as well as the serum butyrylcholinesterase (BCHE) levels were used to verify the patients’ diagnoses. Results: There were no significant differences between the groups. Conclusion: We suggest that PAM bolus plus infusion therapy does not have any advantage over a single dose of bolus PAM therapy the in treatment of OP poisoning.
Objective: The objective of the present study is to examine how melatonin supplementation affects lipid peroxidation in the brain tissue of diabetic rats subjected to acute swimming exercise. Material and Methods: The study was carried out on 80 Spraque-Dawley type adult male rats, which were equally allocated to 8 groups: Group 1, general control; Group 2, melatonin-supplemented control; Group 3, melatonin-supplemented diabetic control; Group 4, swimming control; Group 5, melatonin-supplemented swimming; Group 6, melatonin-supplemented diabetic swimming; Group 7, diabetic swimming; and Group 8, diabetic control. The animals were injected with 40 mg/kg subcutaneous streptozotocin (STZ). The same dose was repeated after 24 hours. The rats were supplemented with 3 mg/kg/day intraperitoneal (ip) melatonin for 4 weeks. Brain tissue samples were collected from the animals, which were decapitated at the end of the study, to determine malondialdehyde (MDA) (nmol/gram/protein) and glutathione (GSH) (mg/dL/gram protein) levels. Results: The highest MDA values in brain tissue were in Group 7 and 8. Groups 3 and 6 had the highest brain GSH values. Brain GSH values in Group 2 were lower than the values in Groups 3 and 6, but higher than those in all other groups. The lowest GSH values in brain tissue were established in Groups 7 and 8. Conclusion: Results of the present study indicate that the oxidative stress caused by diabetes and acute swimming exercise in rat brain tissue can be offset by melatonin supplementation.
Objective: The aim of the study was to determine effectiveness of intratympanic methyl prednisolone injection as a salvage therapy for sudden sensorineural hearing loss in patients who did not have complete recovery with systemic treatment. Material and Methods: Sixteen patients with sudden hearing loss who did not have complete recovery or had a partial recovery with systemic treatment enrolled in this prospective study. After the topical anesthesia, 0.4-0.5 mL of methyl prednisolone (40 mg/mL) was administered into the middle ear from the postero-inferior quadrant of the tympanic membrane. Pure tone audiometry test was performed before each injection and after the final injection. A change more than 10 dB in the pure tone average was considered as an alteration in hearing (improvement or worsening). Complete recovery was accepted when the pure tone average was 20 dB or lower. Results: The mean onset of intratympanic methyl prednisolone treatment after the hearing loss was 16±6.6 days (range: 7 -30 days). The average number of injections was 3.8±1.3 (range: 2-6). The improvement in pure tone average was statistically significant [initial median of pure tone average was 85 dB (minimum 28 dB, maximum 107 dB), final median of pure tone averages was 42.5 dB (minimum 12 dB, maximum 107dB), p=0.007]. Eleven (68.75%) patients improved, but no change was observed in 5 (31.25%) patients. Two (12.5%) patients attained complete recovery. Four (25%) patients improved to 30 dB or less in pure tone average. Statistically significant improvement was also obtained at 250, 500, 1,000, 2,000, 4,000 and 6,000 Hz frequencies. Conclusion: These results suggested that intratympanic methyl prednisolone treatment for sudden hearing loss in patients who did not respond to systemic therapy appears to be a good alternative for better hearing results.
Objective: This study evaluates whether the stapler size used in esophagojejunostomy affects development of anastomotic leak or stricture. Material and Methods: Data of patients who underwent esophagojejunostomy with a stapler between August 2009 and January 2011 were obtained. Patients who underwent a stapled esophagojejunostomy anastomosis were divided into two groups. In Group A (n=30), a 28-mm-diameter stapling device was used whereas group B (n=30) a 25-mm-diameter stapler was used in esophagojejunostomy anastomosis. The differences between groups A and B were analyzed. Results: No statically significant differences were found in terms of age, gender, body mass index or albumin levels between the groups. One anastomotic leak and one stricture was detected in each group. There was no significant difference in the rate of leakage or stricture between groups A and B. Conclusion: There was no significant relationship between the size of the stapler used in esophagojejunostomy and anastomotic leak or the development of stricture.
External auditory canal tick bites are quite rare conditions. Ticks are arthropods that mediate transmission of many diseases including Crimean-Congo hemorrhagic fever. Climatic changes caused by global warming, seasonal changes and geographic location are factors facilitating the reproduction of tick population and increasing the occurence of tick borne diseases. The aim of this report was to present patients who presented to our clinic with tick bite. One patient presented with a sense of mobile foreign body in the ear and another one with ear obstruction. While the third patient had excessive itching, the fourth one had an earache. The patients did not have other systemic or local complaints. The examination of the external auditory canal revealed a tick attached to the posterior upper part of the right external auditory canal in the first patient. A tick was attached to the left tympanic membrane in the second patient with ear obstruction, in the third and the fourth patients, ticks were close to the skin of the left external auditory canal. Ticks were removed carefully from the external auditory canal and they were obtained alive. The patients were monitored in an outpatient setting for 14 days after being informed about the complaints. No additional problems developed on follow-up. The technique of removal of the ticks from the body and follow up measures were presented in this paper.
Objective: To evaluate the characteristics and clinical course of the neonates with group B streptococcus (GBS) infection in neonatal intensive care unit (NICU). Material and Methods: Between January 2010 and December 2010, we retrospectively evaluated demographic features, treatment and clinical course of patients with GBS infection. Diagnosis of GBS infection was made when blood cultures were positive for GBS plus clinical and/or laboratory findings also supported GBS infection. Results: Ten (7 males and 3 females) of 8055 patients (0.124%) had culture-proven GBS infection. The median gestational age was 36 years (range 26-40 years) and birth weight was 3015 gr (range 1000-3830 gr). The presenting symptom was dyspnea in 7 patients, feeding disturbance in one and fever in one patient. Infection site was pneumonia in 5 patients, meningitis in 1 patient and could not be detected in 4 patients. Treatment with penicillin G 400.000 u/kg/d was initiated in one patient with meningitis and 200.000 u/kg/d in the remaining patients. One premature infant died while the remaining 9 patients completely recovered and were discharged after hospitalization for a median of 12.5 days (range 3-55 days). Conclusion: This study showed the importance of considering GBS infection in differential diagnosis of newborns with dyspnea and initiating appropriate treatment as soon as possible. Early and rapid diagnosis and antibiotic treatment in appropriate doses provides control of GBS infections.
Objective: This study was conducted with the aim of analyzing nutritional habits and obesity conditions of adolescents in 16-18 age group. Material and Methods: This descriptive study was carried out with 250 volunteer students in a highschool in Istanbul. A questionnaire form including questions about demographic features and nutritional habits of the students was used in the research. Results: Of 250 students participated in the study, 124(49.6%) were girls and 126(50.4%) were boys who aged between 16-18 years. Of the students, 55.2% ate three meals a day regularly, 26.8% did not eat lunch, 9.2% did not eat dinner and 8% did not eat breakfast and lunch. Of the students in the study group, 58.8% were determined to eat breakfast every day but 22% skipped breakfast. Out of total 33.2% of the students were consuming coke and 38.4% were consuming fastfood every day. Additionally, only 35.6% of the students were actively involved in sports. When body mass index-percentiles according to gender were evaluated, it was seen that 84.9% of the boys had normal weight, 13.5% were overweight, 0.8% were obese; 82.3% of the girls had normal weight, 13.7% were overweight, 1.6% were obese. Conclusion: Although the prevalence of obesity was found high in girls (13.7% overweight, 1.6% obese) compared to boys (13.5% overweight, 0.8% obese), only a small percent (1.2%) of the students were were obese. Although ratio of obesity is not very high, according to this result, instructive seminars should be given in schools in order to inform students and families about healthy nutrition, obesity and outcomes of obesity. By increasing their awareness, it would be possible to prevent future generations from being overweight and obese.
Myxedema coma is an emergency condition caused by severe hypothroidism. This case report illustrates the difficulties in treating patients with untreated hypothyroidism following emergency surgery. Two patients with myxedema coma, one after appendectomy and the other after carotid endarterectomy are presented in this case report. In the differential diagnosis, Addison crisis, prolongation of duration of muscle relaxant or an intracranial event should be considered. Rapid response to levothyroxine makes diagnosis clear when clinical and laboratory assessments support myxedema coma. It is strongly recommended for the physicians to measure the thyroid hormone levels in patients with risk factors. If myxedema occurs, immediate use of intravenous levothyroxine is effective for this lethal complication.
Objective: We aimed to investigate the relationship between climate changes and the most commonly diagnosed three diseases according to ICD-10 coding registry of Ataturk University Hospital, located in Erzurum city center. Material and Methods: Between January 1 and December 31, 2009, 913 108 patients applied to Ataturk University Hospital outpatient clinics (including applications to the emergency unit). Data of 601 184 cases (65.8%) with an age range of 18-110 years were included in the study. The most common three diagnoses according to the ICD-10 codes were selected. These were "Other chest pain (R07.3)", "Headache (R51)", and "Pain in joint (M25.5)". Analyses were done to investigate the relationship between daily number of diagnoses and the studied meteorological values. Results: Mean age was 46.6 +/- 17.6 years. Yearly averages of temperature, dew point, humidity, and atmospheric pressure were 5.50 +/- 9.56 degrees C(-28-22), -0.48 +/- 7.30 degrees C (-31-12), 69.27 +/- 15.0% (31-98)and 1017.28 +/- 4.81 hPa (1000-1033), respectively. Pearson correlation analysis showed a significant positive correlation between M25.5 and temperature (r= 0.364, p< 0.001), dew point (r= 0.330, p<0.001), and atmospheric pressure (r= 0.140, p= 0.007) and a significant negative correlation between M25.5 and humidity (r= -0.234, p<0.001). There was no significant correlation between R07.3 as well as R51 and the meteorological variables (p> 0.05). In a linear regression analysis, temperature and atmospheric pressure were found as significant independent variables affecting number of daily admissions with M25.5. Conclusion: Meteorological variables affect daily admissions to hospital outpatient clinics with a diagnosis of "Pain in joint - M25.5". Contrary to classical knowledge, daily number of admissions due to "Pain in. joint" has a negative correlation with humidity and has a positive correlation with atmospheric pressure.
Vitamin B12 deficiency due to malabsorption and malnutrition leads to severe neurologic complications like pernicious anemia, peripheral neuropathy, bilateral cerebral dysfunction, optic neuropathy, memory loss, personality changes and subacute combined degeneration of the spinal chord (SCD). SCD is a rapidly progressive myelopathy related to vitamin B12 deficiency. Severe neurologic deficits including progressive sensory abnormalities, ascending paresthesia, weakness, ataxia, loss of sphincter control and gait disorder are seen in the patients. Treatment with vitamin B12 provides improvement in many patients, however complete cure is seen in only a small number of patients. In this paper, we presented a case with vitamin B12 deficiency-related ataxic gait and impaired proprioception in the lower extremity.
Objective: To present the characteristic clinical, angiographic, electrophysiologic and optic coherence tomographic findings in eight patients with Bietti's crystalline dystrophy. Material and Methods: All patients had detailed ophthalmologic examination. Visual field examination, fluorescein angiography, electroretinography, electrooculography recordings, and optic coherence tomography were performed in all patients. Results: Best-corrected visual acuity ranged from 2/10 to 10/10. On fundoscopic examination, the reflective yellow deposits located especially in the posterior pole of the retina with the mottling of retina pigment epithelium were seen in all patients whereas in some of the cases pigment deposition, retina pigment epithelium and choriocapillaris atrophy were also noted. Corneal crystals were observed in the limbus in three cases. Central and paracentral scotomas were detected in perimetric examination. Arden ratios in electrooculography and the results of electroretinography recordings were different. Fluorescein angiography showed island like hypoflourescence corresponding to the geographic areas of retinal pigment epithelium and choriocapillary atrophy in the posterior pole. In addition to this fluorescein angiographic findings, in diffuse type cases, diffuse hypofluorescence that extended to the midperiphery was detected. Optic coherence tomographic examination disclosed multiple hyperreflective lesions in the retina and acoustic shadowing behind these hyperreflective lesions and a hyperreflective white band. Conclusion: Common characteristics of clinical, angiographic, electrophysiologic and optic coherence tomographic findings in patients with Bietti's crystalline dystrophy were described.
Objective: Insulin- like growth factor-1 (1GF-1) regulates a number of cellular functions such as proliferation and differentiation. On the other hand, insulin-like growth factor binding protein-3 (IGFBP-3) is a putative tumor suppressor and inhibits the proliferative activity of IGF-1. Therefore most studies report that IGF-1 and IGFBP-3 may promote and inhibit rumor growth, respectively. In this study we aimed to evaluate the importance of IGF-1 and IGFBP-3 in advanced stage non-small cell lung cancer (NSCLC) and to find out whether they contribute to clinical evaluations. Material and Methods: We measured the pretreatment serum levels of IGF-1 and IGFBP-3 in 80 men between July 2007 and June 2008 by chemiluminescent immunometric assay. Serum samples were obtained from 50 patients with inoperable advanced stage NSCLC at Dr. Suat Seren Pulmonary Diseases Hospital and 30 healthy controls at Izmir Tepecik Research Hospital, All 80 men had a smoking history of minimum 20 pack/years. Results: Contrary to the results of many reports, the serum IGF-1 levels were lower in the patients and the difference between the groups reached a statistical significance (p=0.025). IGF-1/IGFBP-3 ratio was also significantly lower in lung cancer patients (p=0.016). The histological subtype of rumor was correlated with IGF-1 level (p=0.005). Conclusion: Our result showed that serum level of IGF-1/IGFBPs may be useful markers for diagnosing and identifying tumor subtypes in NSCLC. In addition, IGF-1 and IGFBP-3 levels in serum might serve a clinical significance in patients with advanced stage NSCLC. However, further studies comprising more cases are needed to investigate the clinical significance of IGF-1 and IGFBP-3 in NSCLC.
Adult respiratory distress syndrome (ARDS) remains a great challenge for physicians in intensive care units with high mortality rates. Although protective lung ventilation is the main - stay of ARDS therapy, it may lead to intractable hypercapnia. Pumpless extracorporeal lung-assist was suggested as an invasive alternative to conventional treatment when gas exchange is not opti - mized with rigorous mechanical ventilation alone. Here, we report the treatment of a patient with extracorporeal lung-asist in the course of pneumonia-related ARDS due to intractable hypercapnia as a result of failure of protective ventilation strategy and her outcome after treatment. Interven - tional Lung Assist device (iLA) contains a specially designed low resistance lung membrane, which uses the pressure difference between the arterial and venous circulation. This system enables the use of high airway pressures for oxygenation in combination with very low tidal volumes to avoid ventilator-induced lung injury and this gives time to patient for lung recovery.
Renal arteriovenous malformation is a rare condition. It is usually asymptomatic. When symptomatic, it presents with hematuria, flank pain, a mass on renal imaging and abnormal radiologic findings. It can mimic renal cell carcinoma. The diagnosis and treatment of renal arteriovenous malformations are different from those of renal cell carcinoma. We described a renal arteriovenous malformation mimicking renal cell carcinoma. A 35-year old man was admitted to the hospital with a history of right flank pain. Computerized tomography scan of the patient revealed a right renal mass, enhancing on contrast imaging. The patient underwent right simple nephrectomy. Pathologic examination of the nephrectomy specimen revealed a congenital cystic arteriovenous malformation. We suggest that it is essential to make a differential diagnosis of any lesion mimicking renal cell carcinoma.
