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Öğe Accelerated atherosclerosis in patients with common variable immunodeficiency: Is it overlooked or absent?(Churchill Livingstone, 2015) Ucar, Ramazan; Arslan, Sevket; Turkmen, Kultigin; Caliskaner, Ahmet ZaferCommon variable immunodeficiency (CVID) is a heterogeneous primary deficiency characterized by hypogammaglobulinemia, recurrent infections, and an increased risk of autoimmune disease and malignancy, and so chronic inflammation. Cardiovascular disease is the leading cause of mortality in the general population. Recent studies have suggested that chronic inflammation is an important player in the pathogenesis of CVID. Accelerated atherosclerosis due to ongoing inflammation from recurrent infections and autoimmunity is an expected clinical entity in patients with CVID. However, cardiovascular mortality as a cause of death in CVID series is either absent or minor. We hypothesized that accelerated atherosclerosis and cardiovascular disease are overlooked by clinicians, or atherosclerosis is really lower than that in the general population that may be prevented by some factors such as life-long immunoglobulin replacement treatment. (C) 2015 Elsevier Ltd. All rights reserved.Öğe Alstrom syndrome with liver cirrhosis: First case from Turkey(Turkish Soc Gastroenterology, 2013) Biyik, Murat; Ucar, Ramazan; Gungor, Gokhan; Ozer Cakir, Ozlem; Esen, Hasan; Aksan, Serkan; Ataseven, HuseyinAlstrom syndrome is a rare autosomal recessive genetic disorder characterized by cone-rod dystrophy, hearing loss, childhood truncal obesity, insulin resistance and hyperinsulinemia, type 2 diabetes, hypertriglyceridemia, short stature in adulthood, cardiomyopathy, and progressive pulmonary, hepatic, and renal dysfunction. Alstrom syndrome is a very rare cause of liver cirrhosis. Post-mortem biopsies of patients with Alstrom syndrome show relevant fibrosis in multiple organs especially in the liver, kidneys, heart, and lungs. We report the case of a patient with Alstrom syndrome who presented to emergency department with esophageal variceal bleeding and who was not known to have hepatic cirrhosis before.Öğe Common Variable Immunodeficiency and Pulmonary Amyloidosis: A Case Report(Springer/Plenum Publishers, 2015) Arslan, Sevket; Ucar, Ramazan; Yavsan, Dudu Mehmet; Esen, Hasan; Maden, Emin; Reisli, Ismail; Caliskaner, Ahmet ZaferCommon variable immunodeficiency is the most common symptomatic primary immune deficiency characterized by hypogammaglobulinemia, recurrent infections, and increased risk of autoimmune disease and malignancy. Secondary amyloidosis develops from chronic inflammatory conditions. The co-existence of CVID (especially in patients with bronchiectasis) and secondary amyloidosis has been reported rarely. We describe the first case of pulmonary hypertension secondary to pulmonary amyloidosis in a patient with CVID.Öğe Contact dermatitis to cobalt chloride with an unusual mechanism(Sage Publications Ltd, 2015) Arslan, Sevket; Aksan, Serkan; Ucar, Ramazan; Caliskaner, Ahmet ZaferBackground: Contact dermatitis is a frequent inflammatory skin disease. A suspected diagnosis is based on clinical symptoms, a plausible contact to allergens and a suitable history of dermatitis. Therefore, careful diagnosis by patch testing is of great importance because the patch testing is important to find out which allergen/material causes the complaints. Metallic allergens such as cobalt are among the most common causes of allergic contact dermatitis, but frequencies of contact dermatitis to these allergens may vary in different skin areas. Here, we report an unusual case of cobalt allergy on the skin contact with the prosthetic leg of a 30-year-old female patient. Case description and methods: The patient developed maculopapular and vesicular lesions on her contact region of residual limb to prosthetic leg. Findings and outcome: She underwent standard patch testing, which resulted in a strong positive reaction to cobalt chloride. Conclusion: This case report may serve to remind doctors to be aware of potential allergic reactions to prostheses and to enable them to recognize a metal allergy if it appears. Prosthetists should also be reminded of potential allergic reactions. Clinical relevance Cobalt can be used as an accelerator in making a prosthetic socket. Several cases have been reported concerning allergies to components of the prosthetic socket. This is the first report of sensitization to cobalt which is used in making a prosthetic leg.Öğe Could aluminum be a new hidden allergen in type 1 hypersensitivity reactions when used as a drug additive?(Termedia Publishing House Ltd, 2016) Kutlu, Ali; Ucar, Ramazan; Aydin, Ersin; Arslan, Sevket; Caliskaner, Ahmet Zafer[Abstract Not Availabe]Öğe Epicardial Adipose Tissue and Atherosclerosis In Patients With Familial Mediterranean Fever(Wiley-Blackwell, 2013) Kucuk, Adem; Solak, Yalcin; Akilli, Hakan; Yildirim, Oguzhan; Guler, Ibrahim; Ucar, Ramazan; Aribas, Alpay[Abstract Not Availabe]Öğe How effective are the 6 European Society of Immunodeficiency warning signs for primary immunodeficiency disease?(Elsevier Science Inc, 2016) Arslan, Sevket; Ucar, Ramazan; Caliskaner, Ahmet Zafer; Reisli, Ismail; Guner, Sukru Nail; Sayar, Esra Hazar; Baloglu, IsmailBackground: The European Society of Immunodeficiency (ESID) developed 6 warning signs to promote the awareness of adult primary immunodeficiency disease (PID). Objective: To screen adult patients for the presence of PID using these 6 warning signs to determine the effectiveness of this protocol. Methods: Questions related to the ESID warning signs for adult PID were added to the standard outpatient clinic file system and asked of 3,510 patients who were admitted to our clinic for any reason. Patients with signs and/or suspicion of PID based on their medical history underwent immunologic investigation. Results: In total, 24 patients were diagnosed as having a PID. The most common reason that patients with PID were admitted was frequent infection (n = 18 [75%]), and the most common PID subgroup was common variable immunodeficiency (n = 12 [50%]). Twenty patients with PID had at least one positive finding according to the ESID warning signs. Two patients with gastrointestinal concerns and 2 with dermatologic symptoms were also diagnosed as having a PID, although they did not have any of the ESID warning signs. Conclusion: The ESID warning signs do not specify the need for symptoms to diagnose a PIDs and do not include a comprehensive list of all signs and symptoms of PIDs. As a result, more than infection-centric questions are needed to identify adult patients with immunodeficiencies. (C) 2016 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.Öğe Hypomagnesemia Among Outpatient Long-Term Proton Pump Inhibitor Users(Lippincott Williams & Wilkins, 2017) Biyik, Murat; Solak, Yalcin; Ucar, Ramazan; Cifci, Sami; Tekis, Dilek; Polat, Ilker; Goktepe, Mevluet HakanProton pump inhibitors (PPIs) are extensively prescribed drugs usually used for a long period. Recent reports linked PPI use with development of hypomagnesemia. However, there is still uncertainty regarding risk of hypomagnesemia in outpatients who were on long-term PPI use. Thus, we aimed to evaluate frequency of hypomagnesemia among a well-defined outpatient patient cohort with no other possible risk factors affecting serum magnesium levels. This was a case-control study carried out at the outpatient gastroenterology clinic of a University hospital. Patients who were on PPI therapy for at least 6 months without diuretic use and chronic kidney disease were included. Patients who were subjected to the same inclusion and exclusion criteria and not using PPI were included as control subjects. One hundred fifty-four patients and 84 control subjects were included. The mean duration of PPI use was 27.5 +/- 2.5 months. Mean serum magnesium levels of PPI users and nonusers were 2.17 +/- 0.20 mg/dL and 2.19 +/- 0.15 mg/dL, respectively. None of the patient had a serum magnesium level below laboratory lower range of 1.7 mg/dL. Our results showed that for typical gastroenterology outpatient clinic patients with no other risk factors affecting serum magnesium levels, long-term PPI use did not affect serum magnesium levels.Öğe IgE-Mediated Reaction to Metamizole: Evaluation of a Patient with Severe Anaphylaxis(Aves, 2016) Arslan, Sevket; Ucar, Ramazan; Caliskaner, Ahmet ZaferMetamizole, a non-steroidal anti-inflammatory drug with weak anti-inflammatory and spasmolytic effects, is used as an analgesic and antipyretic agent. Many adverse reactions to metamizole, such as early or late-onset systemic reactions and bone marrow suppression, have been identified. In this report, we present a case of systemic reaction after the application of parenteral metamizole (Novalgin (R) ampoule; Sanofi Aventis, Istanbul, Turkey) and discuss the mechanism underlying the reaction.Öğe IMPACT OF ON-PUMP CIRCULATION ON HEMOTOLOGIC PARAMETERS OF PATIENTS WITH ACUTE KIDNEY INJURY AFTER OPEN HEART SURGERY(Oxford Univ Press, 2015) Gaipov, Abduzhappar; Solak, Yalcin; Kilicaslan, Alper; Pektas, Fatih; Ucar, Ramazan; Dossov, Mukhit; Kayrak, Mehmet[Abstract Not Availabe]Öğe IRRITABLE BOWEL SYNDROME PREVALENCE IN PATIENTS WITH FAMILIAL MEDITERRANEAN FEVER(Carbone Editore, 2015) Kucuk, Adem; Biyik, Murat; Solak, Yalcin; Ucar, Ramazan; Polat, Ilker; Pektas, Fatih; Gungor, GokhanIntroduction: Patients with Familial Mediterranean Fever (FMF) and Irritable bowel syndrome (IBS) share some clinical features including abdominal pain, constipation and diarrhea. Furthermore, some patients with FMF do not have typical abdominal pain and fever attacks rather they have nonspecific symptoms. This makes the diagnosis of FMF harder and lead to a delay in starting the colchicine treatment. Both diseases lack specific diagnostic tests. We aimed to determine the prevalence of IBS in patients with established diagnosis of FMF. Materials and methods: FMF patients who had been diagnosed according to Tel-Hashomer criteria in Rheumatology clinic of a university hospital were included in the study between January 2011 and December 2011. 10 point IBS questionnaire according to Rome III criteria was used to determine the presence of IBS. Patients with recent FMF attack and abdominal pain from other reasons were excluded. Results: One-hundred and thirteen patients (67 females and 46 males) with an established diagnosis of FMF were included in the study. The mean duration of FMF was 6.4 +/- 6.7 years. IBS prevalence based on Roma III criteria was 40.7% (n=46). IBS prevalence was 30.4% (n=14) in male patients and 47.8 % (n=32) in female patients (p=0.06). In female patients IBS subtypes were as follows; IBS mixed type (IBS-M) 37% (n=12), IBS diarrhea predominant (IBS-D) 22% (n=7), IBS unsubtyped (MS-U) 22% (n=7), and IBS constipation predominant (IBS-C) 19% (n=6), whereas in male patients, IBS-M 57% (n=8), IBS-C 29% (n=4), IBS-D 7% (n=1) and IBS-U 7% (n=1). The most common subtype of IBS was IBS-M in both sexes. Conclusion: IBS is frequent in FMF patients when Rome HI criteria are used for diagnosis. The question to be answered is whether increased frequency or merely the failure of Rome III criteria to differentiate IBS in such patient groups with abdominal discomfort.Öğe Magnetic Resonance Imaging May Be a Valuable Radiation-Free Technique for Lung Pathologies in Patients with Primary Immunodeficiency(Springer/Plenum Publishers, 2016) Arslan, Sevket; Poyraz, Necdet; Ucar, Ramazan; Yesildag, Mihrican; Yesildag, Ahmet; Caliskaner, Ahmet ZaferPurpose In some primary immunodeficiency (PID) patients, especially in the subgroup with common variable immunodeficiency (CVID), radiosensitivity is a concern and avoidance of repeated radiation exposure has been recommended. To investigate the use of lung Magnetic resonance imaging (MRI) instead of Computed Tomography (CT) for the diagnosis and follow-up of various lesions in the lung parenchyma and airways, especially in PID patients in whom x-ray exposure should be limited. Methods The study enrolled 23 patients with PID who underwent thorax CT within the last 3 months and/or who will undergo initial radiological assessment. Lung MRI was performed in all patients to compare the pulmonary findings with CT images. Results MRI performance was weaker at detecting bronchiectasis extension, and a low concordance was found between MRI and CT in the assessment of the number of bronchial generations. CT better identified peripheral airway abnormalities, while CT and MRI gave similar results for detecting the presence and extension of consolidation, bullae, mucus plugging, bronchial wall thickening, bronchiectasis severity and nodules. Conclusions Despite the low spatial resolution, higher cost, and low availability, we suggest MRI as a possible radiation-free alternative to CT in selected patients with PID.Öğe The Predictive Value of Platelet/Lymphocyte Ratio in Hemodialysis Patients With Erythropoietin Resistance(Wiley-Blackwell, 2016) Taymez, Dilek Guven; Ucar, Esma; Turkmen, Kultigin; Ucar, Ramazan; Afsar, Baris; Gaipov, Abduzhappar; Turk, SuleymanThe most important cause of anemia in CKD is relative deficiency of erythropoietin (EPO) secretion from the diseased kidney and EPO therapy has become the standard treatment for anemia of CKD. However, some patients do not respond well to erythropoiesis stimulating agent (ESA), so-called ESA resistance. One of the most important causes of ESA resistance is chronic inflammation in hemodialysis (HD) patients. ESA hyporesponsiveness index (EHRI), calculated as the weekly dose of EPO divided by kilograms of body weight divided by the hemoglobin level, and has been considered useful to assess the EPO resistance. Neutrophil/lymphocyte (NLR) ratio and platelet/lymphocyte ratio (PLR) were also found to be associated with inflammation in HD patients. However, the relationship between NLR, PLR and EHRI has not been investigated before. HD patients underwent medical history taking, physical examination, calculation of dialysis adequacy and biochemical analysis and calculation of EHRI. Logarithmically converted EHRI (logEHRI) was correlated only with hemoglobin (r -0.381, P< 0.0001) and PLR (r= 0.227, P=0.021) but not with NLR. Comparison of PLR among 25th, 50th and 75th percentile of EHRI showed that PLR levels increased going from the 25th to 75(th) percentile (P=0.032). Posthoc analysis revealed that 25-75th percentile (P=0.014) and 50-75th percentile (P=0.033) were different with respect to PLR. In linear regression analysis, PLR (standardized = 0.296, confidence interval: 0.000-0.001, P=0.003) was independently associated with logEHRI. We found that PLR was independently associated with EHRI in HD patients. PLR, which is quite a simple and cheap method, may guide clinicians for detecting EPO resistance.Öğe The Prevalence Of Sjogren's Syndrome In Patients With Ankylosing Spondylitis(Wiley-Blackwell, 2013) Balkarli, Ayse; Kucuk, Adem; Temel, Sahin; Gungor, Tayfun; Ucar, Ramazan; Cobankara, Veli[Abstract Not Availabe]Öğe Primary immunodeficiency masquerading the diagnosis of chronic lymphocytic leukemia: a case of selective immunoglobulin A deficiency(Bilimsel Tip Yayinevi, 2015) Arslan, Sevket; Ucar, Ramazan; Caliskaner, A. ZaferThe awareness of the probability of primary immunodeficiency in adults has been increased. However, careful differential diagnosis is necessary before a final diagnosis of primary immunodeficiency is made. In this report, a patient with a preliminary diagnosis of primary immunodeficiency due to recurrent pulmonary infections and selective IgA deficiency who was finally diagnosed as chronic lymphocytic leukemia was presented.Öğe Renal artery embolization in severe nephrotic syndrome(Wiley-Blackwell, 2016) Solak, Yalcin; Koc, Osman; Ucar, Ramazan; Ozbek, Orhan; Ergenc, Hasan; Gaipov, Abduzhappar; Turk, SuleymanIntroduction Severe nephrotic syndrome is associated with increased morbidity and mortality. Renal artery embolization (RAE) has been used in a number of renal diseases such as renal tumors, arteriovenous fistulas etc. However, data regarding benefits of RAE in patients with symptomatic severe proteinuria is limited. We decided to evaluate role of RAE in the setting of severe symptomatic nephrotic syndrome. Methods Eight patients who had undergone transcatheter renal artery embolization with polyvinyl alcohol (PVA) were included. Clinico-demographic characteristics as well as baseline laboratory data including level of proteinuria, serum albumin, C-reactive protein and LDL cholesterol levels were recorded for each patient. After RAE, outpatient clinic control laboratory values were also assessed. Findings All patients except one underwent bilateral RAE (four simultaneous or three sequential). Two patients experienced postembolization syndrome characterized by flank pain, fever, and leukocytosis, which was self-limited and responded to analgesics in all patients. There was no technical complications associated with RAE procedure. All patients became anuric except one. Serum albumin levels increased and serum LDL-cholesterol levels decreased considerably in treated patients. Discussion Renal artery embolization with the purpose of amelioration in nephrotic syndrome complications was effective and free of major technical complications in our patients.Öğe Thrombotic thrombocytopenic purpura secondary to ABO group incompatible blood transfusion in a patient after cardiac surgery(Jaypee Brothers Medical Publishers Pvt Ltd, 2013) Solak, Yalcin; Selcuk, Nedim Yilmaz; Gaipov, Abduzhappar; Ucar, Ramazan; Biyik, Zeynep; Acar, KadirThe triggers of secondary thrombotic thrombopcytopenic purpura (TTP) include drug toxicity, radiation and high-dose chemotherapy, angioinvasive infections, surgery and acute graft versus host disease. TTP secondary to surgery have been reported in a number of cases. Most of the cases have been occurred after open heart surgery. Extensive endothelial damage is held responsible as the initiating mechanism in postoperative TTP cases. However, there is no report of secondary TTP describing development owing to ABO incompatible blood transfusion. Here, we describe a patient who developed TTP after transfusion of ABO incompatible blood during hospitalization for bypass surgery. We also propose a hypothesis which may account for the possible underlying mechanism.Öğe Thrombotic thrombocytopenic purpura secondary to ABO group incompatible blood transfusion reply(Medknow Publications & Media Pvt Ltd, 2014) Solak, Yalcin; Selcuk, Nedim Yilmaz; Gaipov, Abduzhappar; Ucar, Ramazan; Biyik, Zeynep; Acar, Kadir[Abstract Not Availabe]
