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Öğe Acute pancreatitis due to hypertriglyceridaemia in pregnancy(2015) Gök, Funda; Köker, Selçuk; Kılıçaslan, Alper; Sarkılar, Gamze; Yosunkaya, Alper; Otelcioğlu, ŞerefGebelik sırasında hypertrigliseridemiye bağlı akut pankreatit nadir fakat hem anne hem de bebek için ölümcül sonuçlara neden olabilen ciddi klinik bir tablodur. Otuz yedi yaşında 31 haftalık familial hypertrigliseridemi ve diabetes mellitusu olan gebede akut pankreatit gelişti. İntrauterin bebek ölümü gelişen hastanın gebeliği sonlandırıldı. Tedavide insülin, octreotidin yanısıra double membrane filtration ile plasmaferez uygulanarak trigliseritlerin hızla düşürülmesi sağlandı. Trigliserid düzeyi 24 saat sonunda 9742 mg dL-1den 432 mg dL-1 düzeyine geriledi. Hasta 5 gün sonra yoğun bakımdan, 32 gün sonra hastaneden sağlıklı olarak taburcu edildi. Bu yazıda gebe vakada ciddi hipertrigliserideminin başarılı tedavisi sunulmuştur.Öğe Comparison of Calculated and Measured Energy Expenditure Determination Methods(Galenos Publ House, 2023) Dayioglu, Muruvvet; Yosunkaya, AlperObjective: Indirect calorimetry (IC) is considered the gold standard in the accurate determination of energy consumption in intensive care patients. This study compared measured energy expenditure (MEE) with estimated energy expenditure (EEE), calculated from predictive equations, in mechanically ventilated patients. Materials and Methods: This study was conducted on 40 patients hospitalized in our medical/ surgical intensive care unit. Twenty four-hour energy consumption measured by IC and energy consumption calculated by adding correction factors for actual and corrected weights using Harris-Benedict, Schofield, Ireton-Jones and Swinamer equations were compared. Results: MEE was 2697.9 +/- 606.0 kcal/day. All of the EEE values, calculated using equations were moderately correlated with MEE and correlations were stronger with adjusted body weights, however, Bland-Altman statistics represent wide limits of agreement. From another perspective, EEE corresponding to between 80% and 110% of MEE was considered an adequate feeding range and provided the best levels of proficiency using adjusted body weight and Long factors; however, at least, 20% of patients remained at under-or overfeeding risk. Conclusion: It was concluded that the estimation equations are unreliable in determining energy consumption in mechanically ventilated intensive care patients due to wide limits of agreement. Estimates falling in the range of 80-110% of MEE also indicate the possibility of malnutrition. Our study supports previous studies, which indicated that nutrition management requires an individual approach.Öğe Comparison of pupillometer, critical care pain observation scale, and vital findings in the evaluation of pain in intensive care patients without oral communication(Kare Publ, 2023) Yaman Gulper, Rabia; Reisli, Ruhiye; Arican, Sule; Yosunkaya, Alper; Tuncer Uzun, SemaObjectives: The aim of this study was to investigate the effects of portable infrared Pupillometer, Critical Care Pain Observation Scale (CPOT), and vital sign changes during painful procedures on patients with mechanical ventilators in the intensive care unit (ICU), and comparing the efficacy of these methods to detect the presence of pain. Methods: In 50 patients who could not verbally state pain, admitted to Necmettin Erbakan University Meram Faculty of Medicine ICU, aged 18-75 years, and connected to a mechanical ventilator, vital sign changes, CPOT scale assessments, and pain evaluation with a portable infrared pupillometer were performed during endotracheal aspiration and position changes, which are defined as painful stimuli. Results: Data were collected from 50 patients with a mean age of 57.4 +/- 17.9 years and 48% of males. The systolic, diastolic, and mean arterial pressure and heart rate values, CPOT scores, and pupillometric measurements of the patients increased significantly at the time of aspiration and change of position (p<0.05). Neurological pupil index scores showed a significant decrease at the time of painful stimulation (p<0.05). Conclusion: It was found that pupil diameter changes evaluated using a portable infrared pupillometric measuring device can be used effectively and reliably in pain assessment in patients who are treated in the ICU, supported by mechanical ventilation and who cannot communicate verbally.Öğe Comparison of pupillometer, critical care pain observation scale, and vital findings in the evaluation of pain in intensive care patients without oral communication(Kare Publ, 2023) Yaman Gulper, Rabia; Reisli, Ruhiye; Arican, Sule; Yosunkaya, Alper; Tuncer Uzun, SemaObjectives: The aim of this study was to investigate the effects of portable infrared Pupillometer, Critical Care Pain Observation Scale (CPOT), and vital sign changes during painful procedures on patients with mechanical ventilators in the intensive care unit (ICU), and comparing the efficacy of these methods to detect the presence of pain. Methods: In 50 patients who could not verbally state pain, admitted to Necmettin Erbakan University Meram Faculty of Medicine ICU, aged 18-75 years, and connected to a mechanical ventilator, vital sign changes, CPOT scale assessments, and pain evaluation with a portable infrared pupillometer were performed during endotracheal aspiration and position changes, which are defined as painful stimuli. Results: Data were collected from 50 patients with a mean age of 57.4 +/- 17.9 years and 48% of males. The systolic, diastolic, and mean arterial pressure and heart rate values, CPOT scores, and pupillometric measurements of the patients increased significantly at the time of aspiration and change of position (p<0.05). Neurological pupil index scores showed a significant decrease at the time of painful stimulation (p<0.05). Conclusion: It was found that pupil diameter changes evaluated using a portable infrared pupillometric measuring device can be used effectively and reliably in pain assessment in patients who are treated in the ICU, supported by mechanical ventilation and who cannot communicate verbally.Öğe Comparison of the effect of the Trendelenburg and passive leg raising positions on internal jugular vein size in critically ill patients(E-Century Publishing Corp, 2015) Gok, Funda; Sarkilar, Gamze; Kilicaslan, Alper; Yosunkaya, Alper; Uzun, Sema TuncerCentral vein catheterization is a common procedure performed on patients under intensive care. The safe and successful placement of the central venous catheter depends on vein size. Although used for this purpose, the Trendelenburg position can be hazardous in some patients. The aim of this study was to compare the effects of the Trendelenburg and passive leg raising (PLR) positions on the size of the right internal jugular vein (IJV) in mechanically ventilated patients under intensive care. Seventy-eight mechanically ventilated patients under intensive care were included into the study. Sonographic images of the right IJV were recorded in supine (control), 10 degrees Trendelenburg and 40 degrees PLR positions. Anterior-posterior and transverse diameter, cross-sectional area (CSA), and depth were calculated from the recorded images. The size of the right IJV (CSA, transverse and vertical diameters) was significantly larger in the Trendelenburg and PLR positions than in supine position. An increase of 26% in the IJV CSA was obtained in the Trendelenburg position and 23% in the PLR position, compared to the supine position. There was no significant difference between the measurements obtained from the Trendelenburg and PLR positions. The study shows that the Trendelenburg and PLR positions increase the size of the IJV to a similar extent in mechanically ventilated patients under intensive care.Öğe Diaphragm and Lung Ultrasonography During Weaning From Mechanical Ventilation in Critically Ill Patients(Springernature, 2021) Gok, Funda; Mercan, Aysel; Kilicaslan, Alper; Sarkilar, Gamze; Yosunkaya, AlperAim: Optimum Liming is crucial to avoid negative outcomes of weaning. We aimed to investigate predictive values of diaphragmatic thickening fraction (DTF), diaphragmatic excursion (DE), and anterolateral lung ultrasound (LUS) scores in extubation success and compare with rapid shallow breathing index (RSBI) in patients extubated under traditional parameters. Methods: Patients undergoing mechanical ventilation for >48 hours were included in the study. In patients planned for extubation, sonographic evaluations of the diaphragm and lung were performed at the T-tube stage. RSBI was achieved in the pressure support (PS) ventilation stage. Predictive values of DTF, DE, and anterolateral LUS scores were compared with RSBI in extubation success. Results: Sixty-two patients were enrolled in the study. The study population consisted mostly of trauma patients (77%). A cut-off value of 64 was obtained for RSBI. The positive predictive value (PPV) was found at 97% in extubation success. Cut-off values of 27.5 for DTF, 1.3 cm for the DE, and 6.5 for LUS scores were obtained al the T-tube stage, respectively. PPVs of all sonographic parameters were found over 90%. At the first stage, weaning and extubation failures were determined as 35 and 9.6%, respectively. RSBI was found as a powerful parameter in determining extubation success (r=0.774, p <= 0.001) and moderately correlated with sonographic parameters. Conclusion: Investigating the lung and diaphragm via ultrasound provides real-time information to increase extubation success. Cut-off values of 64 for RSBI, 27.5 for DTF, 1.3 cm for the DE, and 6.5 for LUS scores were obtained, respectively, and PPVs of all sonographic parameters were found over 90%. We consider that sonographic evaluations accompanied by an RSBI will increase extubation success in the weaning process.Öğe THE EFFECT OF ULTRASOUND GUIDANCE ON CENTRAL VENOUS CATHETER-ASSOCIATED BLOODSTREAM INFECTION IN CRITICAL CARE PATIENTS(Carbone Editore, 2013) Gok, Funda; Kilicaslan, Alper; Sarkilar, Gamze; Kandemir, Bahar; Yosunkaya, AlperBackground and aims: The central venous catheterization can be performed according to anatomical references points or by using ultrasound guidance. In this study, our aim was to perform a comparison between the application of these two methods for internal vein catheterization, especially with regards to the incidence of catheter-related bloodstream infections. Materials and methods: 97 critical care patients who underwent real-time USG-guided cannulation (Grup 1) of the internal jugular vein were prospectively compared with 97 critical care patients in whom the landmark technique (Grup 2) was used. The parameters studied included average access time, time for insertion, attempts required, mechanical complications and catheter-related bloodstream infections. Results: There was no difference between the two groups with regards to demographic data (p>0.05). The mean skin-vein period, the total period of insertion, the number of attempts, the rate of mechanical complications, and the incidence of catheter-related bloodstream infections were significantly lower in Group 1 in comparison to Group 2 (p<0.0.5). Conclusions: USG-guided internal jugular vein catheterization reduced the number of attempts, and was more advantageous than the conventional method in terms of allowing a lower incidence of mechanical complications and catheter-related bloodstream infections.Öğe The effects of the administration of subfacial levobupivacaine infusion with the ON-Q pain pump system on postoperative analgesia and tramadol consumption in cesarean operations(Kare Publ, 2010) Tuncer, Sema; Aysolmaz, Gokhan; Reisli, Ruhiye; Erol, Atilla; Yalcin, Naime; Yosunkaya, AlperObjectives: In this study, the effects of administration of subfacial levobupivacaine infusion with the ON-Q pain pump system were investigated in elective cesarean operations for postoperative pain control and tramadol-sparing effect. Methods: Fifty ASA I-II patients scheduled for cesarean operation were enrolled into this study. Patients were randomly divided into two groups: Group I served as a control group, without the ON-Q pain pump system, whereas Group II received the ON-Q pain pump system with subfacial 0.25% levobupivacaine infusion for 24 hours at 4 ml/hour. All patients received a standard anesthetic protocol. At the end of the surgery, all patients received tramadol i.v. via a PCA (Patient Controlled Analgesia) device. Pain scores were assessed at 2, 6, 12 and 24 hours postoperatively. Tramadol consumption and adverse effects were noted in the first 24 hours following surgery. Results: The pain scores were significantly lower in the levobupivacaine group when compared with the control group (p<0.05). The cumulative tramadol consumption was lower in the levobupivacaine group than in the control group (p<0.05). Group II used less antiemetic and had less postoperative nausea and vomiting, and the difference was statistically significant (p<0.05). Conclusion: No complication occurred as a result of the ON-Q pain pump system. Subfacial levobupivacaine infusion with the ON-Q pain pump system diminished postoperative pain and the need for tramadol use following cesarean operations.Öğe Fulminant Liver Failure Due to Amanita Phalloides Toxicity Treated with Emergent Liver Transplantation(Modestum Ltd, 2015) Gok, Funda; Topal, Ahmet; Hacibeyoglu, Gulcin; Erol, Atilla; Biyik, Murat; Kucukkartallar, Tevfik; Yosunkaya, AlperThe clinical picture secondary to amanita phalloides, which began with gastrointestinal complaints, advanced to fulminant hepatic failure in two days. Emergency liver transplantation was decided for the case of a 48-year-old male patient, who at the same time had renal failure and acute pancreatitis. Bridge treatment with plasma diafiltration was applied until the liver transplantation, which was successfully performed on the fifth day of admission to the hospital. Acute pancreatitis and renal failure also resolved and the patient was discharged in a healthy condition on the 30th day of admission. The timing of the transplant in fulminant liver failure and criteria used to select the timing are particularly important. Transplantation should be performed not too early, nor too late. In addition, the development of multiple organ failure during the period until transplantation may result in the death of the patient. Therefore, extra corporeal liver support systems are suggested as an important treatment tool at this stage.Öğe Fulminant Liver Failure Due to Amanita Phalloides Toxicity Treated with Emergent Liver Transplantation(Modestum Ltd, 2015) Gok, Funda; Topal, Ahmet; Hacibeyoglu, Gulcin; Erol, Atilla; Biyik, Murat; Kucukkartallar, Tevfik; Yosunkaya, AlperThe clinical picture secondary to amanita phalloides, which began with gastrointestinal complaints, advanced to fulminant hepatic failure in two days. Emergency liver transplantation was decided for the case of a 48-year-old male patient, who at the same time had renal failure and acute pancreatitis. Bridge treatment with plasma diafiltration was applied until the liver transplantation, which was successfully performed on the fifth day of admission to the hospital. Acute pancreatitis and renal failure also resolved and the patient was discharged in a healthy condition on the 30th day of admission. The timing of the transplant in fulminant liver failure and criteria used to select the timing are particularly important. Transplantation should be performed not too early, nor too late. In addition, the development of multiple organ failure during the period until transplantation may result in the death of the patient. Therefore, extra corporeal liver support systems are suggested as an important treatment tool at this stage.Öğe Koroner arter cerrahisinde yüksek doz alfentanil ile düşük doz alfentanil-isoflurane tekniklerinin plazma kortizol düzeyine ve hemodinamik parametrelere etkilerinin karşılaştırılması(Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi, 1994) Yosunkaya, AlperBu çalışma, Selçuk Üniversitesi Tıp Fakültesi Anesteziyoloji ve Reanimasyon Anabilim Dalında, 1993-1994 yıllan arasında, elektif olarak coroner arter bypass greftlemesi yapılacak 24 hasta üzerinde yapıldı. Çalışmamızda koroner arter cerrahisinde yüksek doz alfentanil ile düşük doz alfentanil-ısoflurane tekniklerinin plazma kortizol düzeyine ve hemodinamik parametrelere etkilerini karşılaştırarak değerlendirmeyi amaçladık. Kardiyak patolojileri,hipertansiyon ve diabetes mellitustan başka bir sistemik hastalığı bulunmayan, ASA II - III grubuna giren, ventrikül fonksiyonları normal ve ejeksiyon fraksiyonları % 46' nın üzerinde, koroner arter greftlemesi yapılacak 24 hasta 12 'er kişilik iki gruba ayrıldı. Bütün hastalara ameliyat öncesi ; gece İ.M. 10 mg diazem ve ameliyata girmeden 1 saat önce de İ.M. 50mg meperidin ile premedikasyon yapıldı. Arter ve santral venöz kateterizasyonlan yapılan hastalarda Swan - Ganz kateteri ve termodilüsyon tekniği ile tüm hemodinamik parametreler moniterize edildi. I. grup hastalara indüksiyonda 150 y.% I kg yükleme dozunda alfentanil 15 dk' da gidecek şekilde uygulandı. Alfentanil infüzyonuna entübasyondan sonra CPB 'a kadar 6 /*g / kg /dk, daha sonra ise 3 \ı% I kg /dk dozunda devam edildi. II. grup hastalara indüksiyonda 75 \ıg / kg yine 15 dk' da gidecek şekilde yükleme dozu uygulandı. Hastaların bilinci kaybolduktan sonra % 1 konsantrasyonda indüksiyona ısoflurane ilave edildi. Entübasyondan sonra alfentanil infüzyonu CPB 'a kadar 3 \ı% I kg / dk daha sonra ise 1.5 ]ig I kg / dk dozunda devam edildi. CPB haricinde, operasyon süresince kan basıncını 90 mmHg 'nın altına düşmeyecek şekilde % 0-1 lik konsantrasyonda ısoflurane inspire edilen gaz karışımına ilave edildi. Her iki grup hastaya indüksiyonda 0.03 mg / kg flunitrazepam ve 0.1 mg / kg vecuronium bromide uygulandı. Vecuronium bromide' nin idamesi daha sonra gerektiğinde 0,02 mg / kg dozunda uygulandı. Hasta uyanıkken ( kontrol ), indüksiyondan, entübasyondan, cilt insizyonundan, sternotomiden, aort root disseksiyonundan 3 dk sonra ve pompadan çıktıktan 20 dk77- sonra hemodinamik ve plazma kortizol düzeyi ölçümleri yapıldı. Çalışmamızda anestezi ve operasyonun değişik periyotlarında, her iki grup arasında plazma kortizol düzeyi ve hemodinamik parametreler bakımından istatistiksel önemli bir fark yoktur. Her iki grupta CO, CI, MAP, HR, SVI ve LVSW1 değerleri indüksiyondan sonra istatistiksel olarak anlamlı şekilde düştü. CO 'da; I. grupta %23, II. grupta %55, MAP 'da 1. grupta %22, II. grupta %35, HR 'de I. grupta %18, II. grupta %16, SVI 'de I.grupta %9, II. grpta %22 ve LVSWI 'de I.grupta % 34, II. grupta %46 oranında düştü. SVI ve LVSWI değerleri düşük doz alfentanil-ısoflurane grubuna göre, yüksek doz alfentanil grubunda operasyon süresince daha yüksek seyretti ve operasyon sonunda daha çabuk toparlanarak, ventrikül fonksiyonunu daha az etkiledi. Yüksek doz alfentanil tekniği indüksiyon esnasında daha fazla oranda dopamin ve atropine ihtiyaç gösterdi. PVR ve S VR her iki grupta stabil ve paralel seyretti. PCWP ve MPAP 'ları operasyon esnasında her iki grupta minimal olarak etkilendi. CVP ise genellikle stabil seyretmesine rağmen, kas rijiditesine bağlı indüksiyon esnasında yüksek doz alfentanil grubunda daha fazla olmak üzere yükseldi. Her iki yöntemde plazma kortizol düzeyini indüksiyondan sonra düşürerek operasyon boyunca cerrahi stresse hormonal cevabı iyi olarak baskıladı. Çalışmamızda koroner arter bypass greftlemesi operasyonu yapılan hastalarda, yüksek doz alfentanil ve düşük doz alfentanil-ısoflurane teknikleri, hemen hemen benzer oranda myokardiyal depresyon oluşturmasına rağmen ; her iki teknik de cilt insizyonu, sternotomi ve aort root disseksiyonu gibi majör cerrahi uyaranlara hemodinamik ve hormonal yanıü yeterli şekilde baskılayarak, peroperatif stabil bir hemodinami ve güvenli bir anesteziye olanak vermektedir. Sonuç olarak düşük doz alfentanil-ısoflurane tekniği, yüksek doz alfentanil tekniğine göre, yüksek doz opioidlerin problemlerine ( solunum depresyonu, rijidite ve konvülsiyon ) daha az sebep olarak ve indüksiyon esnasında daha az hipotansiyona yol açarak, koroner arter cerrahisinde yüksek doz opioid tekniğine bir alternatif olarak kabul edilebileceği kanısına vardık.Öğe Management of a patient with Opalski's syndrome in intensive care unit(Wiley, 2017) Aynaci, Ozer; Gok, Funda; Yosunkaya, AlperKey Clinical Message Opalski syndrome is a rare vascular brainstem syndrome which is accepted as a variant of Wallenberg syndrome. Opalski syndrome should be considered in acute conditions in which typical symptoms of lateral medullary infarct are accompanied by ipsilateral hemiparesis. Other brain stem syndromes are distinguished from Opalski syndrome by the presence of contralateral hemiparesis.Öğe Nöromiyelitis optika(2014) Saritaş, Tuba Berra; Yosunkaya, Alper; Hale , Borazan; Keçecioğlu, AhmetNöromyelitis optika, nadir görülen ancak oldukça ciddi bir demiyelinizan hastalıktır. Optik sinirlerin ve spinal kordun akut ya da tekrarlayan demiyelinizan enflamasyonu ile görülür. Yirmibir yaşında, kadın hasta, akut görme kaybı, tetrapleji ve solunum arresti nedeniyle yoğun bakım ünitesine kabul edildi. Beyin omurilik sıvısında pleositoz, ve artmış protein seviyesi tespit edildi. Ig G ye bağlı oligoklonal bant formasyonu negatifti. Kraniyal manyetik rezonans görüntülemesinde periventriküler bölgede, mezensefalonda ve sol temporal lob subkortikal bölgede demyelinizasyon mevcuttu. Aynı zamanda servikomeduller bileşkeden servikal vertebra 2. seviyeye kadar uzanan demiyelinizasyon vardı. Hasta steroid ve azotiyopirin tedavisine cevap vermedi. Ancak plazmaferez olgunun kliniğinde dramatik bir iyileşme sağladıÖğe Ocular Surface Disorders in Intensive Care Unit Patients(Hindawi Publishing Corporation, 2013) Saritas, Tuba Berra; Bozkurt, Banu; Simsek, Baris; Cakmak, Zeynep; Ozdemir, Mehmet; Yosunkaya, AlperPatients in intensive care units (ICU) are at increased risk of corneal abrasions and infectious keratitis due to poor eyelid closure, decreased blink reflex, and increased exposure to pathogenic microorganisms. The aim of this retrospective study was to evaluate the ocular surface problems in patients who stayed in ICU more than 7 days and were consulted by an ophthalmologist. There were 26 men and 14 women with a mean age of 40.1 +/- 18.15 years (range 17-74 years). Conjunctiva hyperemia, mucopurulent or purulent secretion, corneal staining, and corneal filaments were observed in 56.25%, 36.25%, 15%, and 5% of the eyes, respectively. Keratitis was observed in 4 patients (10%) who were treated successfully with topical antibiotics. Mean Schirmers test results were 7.6 +/- 5.7 mm/5 min (median 6.5 mm/5 min) in the right, and 7.9 +/- 6.3 mm/5 min (median 7 mm/5 min) in the left eyes. Schirmers test results were <5 mm/5 min in 40% of the subjects. The parameters did not show statistically significant difference according to mechanical ventilation, sedation, and use of inotropes. As ICU patients are more susceptible to develop dry eye, keratopathy, and ocular infections, they should be consulted by an ophthalmologist for early diagnosis of ocular surface disorders.Öğe Olanzapine Bağlı Gelişen Nöroleptik Malign Sendrom(2014) Sarıtaş, Tuba Berra; Çankaya, Barış; Yosunkaya, AlperNöroleptik malign sendrom (NMS), antipsikotiklerle tedavi sonrasında ortaya çıkabilen, bilinç değişikliği, yüksek ateş, otonom fonksiyon bozukluğu ve kas rijiditesi belirtileri ile kendini gösterir. Nadir, fakat ölüm olasılığı bulunan idiosenkratik bir reaksiyondur. Etiyolojisi tam olarak bilinmemektedir. NMS ile ilişkili mortalite ve morbidite erken tanı, kullanılan ilacın hemen kesilmesi ve agresif bir tedavi ile azaltılabilir. Olanzapin, thienobenzodiazepin sınıfından yapısı ve nörotransmitter üzerine etkisi klozapine benzer atipik antipsikotik bir ilaçtır Burada bipolar bozukluk nedeniyle 5 yıldır düzenli olarak olanzapin tedavisi altındaki bir hastada rijidite olmadan gelişen bir NMS vakasını sunmayı amaçlanmıştır. Hastanın tedavisinde erken sıvı tedavisi ve hemodiyafiltrasyonun önemini vurguladık.Öğe Olanzapine-Induced Malignant Neuroleptic Syndrome(Aves, 2014) Saritas, Tuba Berra; Cankaya, Baris; Yosunkaya, AlperNeuroleptic malignant syndrome (NMS), caused by antipsychotic therapy, shows itself with mental status alteration, high fever, autonomic dysfunction, and muscle rigidity. It is a rare idiosyncratic reaction with mortality risk. The etiology is still unknown. NMS- related mortality and morbidity can be decreased by cessation of the used drug and aggressive treatment. Olanzapine is a thienobenzodiazepine, a member of atypical antipsychotic drugs; its structure and effects on neurotransmitters resemble clozapine. Here we report a case of bipolar disorder receiving olanzapine therapy for 10 years, who developed NMS without rigidity. We emphasized the importance of early hydration and hemodiafiltration therapy.Öğe Part of the Covid 19 puzzle: Acute parkinsonism(W B Saunders Co-Elsevier Inc, 2021) Akilli, Nazire Belgin; Yosunkaya, AlperParkinsonism developed owing to viruses is one of the important causes of secondary parkinsonism. After the Spanish flu pandemic, the increase in the number of parkinsonian cases in the long term has drawn attention on the relationship between viruses and parkinsonism. For this reason, the relationship between influenza and parkinsonism has been studied most. Nowadays in which we are experiencing the COVID-19 pandemic, scientists, based on the experiences gained from the Spanish flu pandemic, have drawn attention to the fact that the third wave of the pandemic might be parkinsonism. However, as we have reviewed in the literature, acute parkinsonism due to COVID-19 was not reported during this pandemic. Here, we present a case in which signs of acute parkinsonism developed on the 3rd day of the illness and neurological symptoms regressed with convalescent plasma treatment. (C) 2021 Elsevier Inc. All rights reserved.Öğe Ratlarda sepsise bağlı akut böbrek hasarının önlenmesindeuzak iskemik önkoşullanma(Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi, 2020) Cihan, Eyüp Fatih; Yosunkaya, AlperBu çalışmanın amacı, kısa iskemik aralıklarla, tek taraflı alt ekstemiteye uygulanan uzak iskemik önkoşullamanın (UİÖK); ratlarda sepsise bağlı akut böbrek hasarı (ABH) üzerindeki etkilerini histopataolojik incelemeyle, kan ve idrar belirteçleriyle değerlendirmektir. Yöntem Ratlar altı gruba ayrıldı. Her grupta on adet Wistar Albino cinsi sıçan kullanıldı. Sepsis modelini oluşturmak için çekal ligasyon ve ponksiyon (CLP) yöntemi kullanıldı. Grup1 (Sham)'de sadece abdominal insizyon yapıldı ve CLP uygulanmadı. Grup2 ve Grup3'te CLP işlemi uygulandı ve sırasıyla 24. Saatte ve 48.saatte işlem sonlandırıldı. Grup 4'te UİÖK uygulandı, CLP uygulanmadı. Grup 5 ve 6'da CLP işlemi öncesinde UİÖK uygulandı ve sırasıyla 24. ve 48. Saatte işlem sonlandırıldı. Kan, idrar ve doku örnekleri alınarak prosedür sonunda ratlar sakrifiye edildi. Bütün girişimsel işlemler anestezi altında ratların spontan solunumları korunarak gerçekleştirildi. Sonuçların ilaca bağlı böbrek hasarı ile karışmaması için hayvanlara antibiyotik tedavisi uygulanmadı. Kan örneklerinden kreatinin ve laktat değerleri çalışıldı. IGFBP-7 (Insulin Like Growth Factor Binding Protein-7) ve TIMP-2 (Tissue İnhibitör of Metalloproteinaze-2) düzeyleri idrardan ELISA yöntemi ile ölçüldü. Histopatolojik değerlendirme bütün ratların sol böbreğinden gerçekleştirildi. Bulgular Böbrek histomorfolojik hasar toplam skoru Sham grubunda, diğer gruplara göre anlamlı olarak düşük bulundu (p<0,01). Tübüler Hasar Skoru sham grubuna göre sepsisin 24. ve 48. Saatinde (Grup2 ve 3'te) istatistiksel olarak anlamlı derecede artmıştır ve en fazla hasar skoru Grup3'te (sepsisin 48.saati grubunda) görülmüştür. UİÖK uygulanan ratlarla uygulanmmayanların kıyaslamasında da sepsis sonrası 24. saat ve 48.saat gruplarında; UİÖK yapılanlarda (Grup5 ve 6'da) tübüler hasarın azalması ileri derecede anlamlı şekilde bulunmuştur (p<0,001), apoptozisin azalması da anlamlı bulunmuştur (p<0,05). İdrar numunesinden ölçülen hücre siklus arrest biyobelirteçleri, hem IGFBP-7 hem de TIMP-2 sepsis sonrası 24.saat ve 48. Saat gruplarında (Grup2 ve 3 'te); sham grubuna ve birbirlerine göre anlamlı artış gösterdi. (p<0.05). Ayrıca sepsis sonrası 24. ve 48. saatlerde; işlem öncesi UİÖK yapılan gruplarda (Grup5 ve 6'da), yapılmayanlara göre IGFBP7*TIMP2 değerlerinde anlamlı azalma görülmüş (p<0.05), kreatinin ve laktat değerlerindeki değişim anlamsız bulunmuştur. (p>0,05) Sonuç Yapmış olduğumuz bu deneysel hayvan çalışmasında UİÖK'nın, sepsise bağlı akut böbrek hasarında tübüler hasarı ve apoptozisi azaltarak böbrekleri koruduğu sonucuna vardık.Öğe Toxic Epidermal Necrolysis in a Patient with Allopurinol, Colchicine and Alcohol Use(Emergency Medicine Physicians Assoc Turkey, 2020) Daye, Munise; Temiz, Selami Aykut; Arslan, Sevket; Yosunkaya, Alper; Gumus, Selim; Uyanik, Orkun; Nursen, Hayri Ahmet BurakIntroduction: Toxic epidermal necrolysis is a severe, acute, mucocutaneous, life-threatening hypersensitivity syndrome with high mortality and bullous lesions on the skin, eyes and mucous membranes. It often develops due to drugs. Sulfonamide group antibiotics and antiepileptic drugs are the most commonly responsible agents. Allopurinol is a common cause of toxic epidermal necrolysis as in most drug reactions. Colchicine is widely used in dermatology and rheumatology and is generally known as an agent with a broad safety profile. Case report: Here we present a case of toxic epidermal necrolysis in our case with allopurinol, colchicine and alcohol use in order to draw attention to the increased risk of drug coexistence. Conclusion: Again, we wanted to draw attention to the management of our case and the efficacy and safety of high-dose intravenous immunoglobulin therapy.Öğe Ultrasonography in the Diagnosis of Pneumothorax Not Detected by Chest Radiography: Case Report(Galenos Yayincilik, 2019) Gok, Funda; Kilicaslan, Alper; Yosunkaya, AlperIn patients with acute respiratory distress syndrome (ARDS), many factors, especially barotrauma may cause pneumothorax. Early detection of pneumothorax is critical in ARDS patients. When pneumothorax is suspected, chest radiography is usually preferred as the first line imaging modality. Recently, ultrasonography has been used by intensive care physicians in many fields, even in imaging of pneumothorax. We present a 75-year-old female patient with ARDS complicated by pneumothorax, in whom chest radiography was not diagnostic but ultrasound was used for diagnosis and follow-up.
