Erciyes Üniversitesi Tıp Fakültesi Hastaneleri

OBJECTIVES: Non-radiographic axial SpA (nr-axSpA) comprises those patients who may have clinical and laboratory features of SpA but do not have definite radiographic sacroiliitis. Bone loss (osteopenia or osteoporosis) is well recognized in AS, however, bone status in nr-axSpA is unclear. The aims of this study were to investigate BMD in patients with nr-axSpA and compare them with age- and sex-matched patients with mechanical low back pain (mLBP). The relationship between inflammation on MRI of the lumbar spine and BMD was also assessed in nr-axSpA. METHODS: Patients with chronic LBP were consecutively recruited. Patients who met the Assessment of SpondyloArthritis International Society (ASAS) criteria for axial SpA but without definite radiographic sacroiliitis were defined as nr-axSpA. Spinal and femoral BMD was assessed with DXA. Lumbar spinal MRI was examined for the presence of bone oedema (BO; inflammatory lesions). RESULTS: Forty-six patients with nr-axSpA had worse spinal but similar hip BMD, T and Z scores compared with 29 patients with LBP. 25(OH)D3 and parathyroid hormone levels and thyroid function tests were similar between groups. Twenty nr-axSpA patients with inflammation on lumbar MRI had worse spinal and femoral BMD, T and Z scores compared with the patients without inflammation. CONCLUSION: Patients with nr-axSpA had significant bone loss at the lumbar spine compared with patients with mLBP. Inflammation on MRI is closely associated with low bone mass in patients who are in the very early stage of the disease.

Ama: almann amac Erciyes niversitesi Tp Fakltesi Dnem I rencilerinin sigara ime durumlarn saptamak ve "Ttn rnlerinin Zararlarnn nlenmesi ve Kontrol Hakkndaki Kanuna" ilikin baz

BACKGROUND/AIMS: Several studies have emphasized the role of genetic factors in susceptibility to non-alcoholic fatty liver disease. The aim of this study was to examine the possible influence of human leukocyte antigen in the development of non-alcoholic fatty liver disease. METHODS: Between January 2000 and January 2008, data of 655 donor candidates were examined from routinely performed abdominal ultrasonography and for aspartate aminotransferase, alanine aminotransferase, hepatitis B virus, hepatitis C virus, cytomegalovirus, human immunodeficiency virus, hepatic functions, and human leukocyte antigen class I and II antigens; data of 116 healthy candidates were also included in this study. To reduce the influence of possible confounding factors, we excluded diseases known to be associated with non-alcoholic fatty liver disease like obesity, diabetes mellitus, coronary artery disease, hyperlipidemia, and metabolic syndrome. Non-alcoholic fatty liver disease was diagnosed in 66 individuals (33 male, median age: 53.8 [range, 32-77 years]) by means of ultrasonography data, and 50 individuals, whose ultrasonography data did not show hepatosteatosis, comprised the control group (20 male, median age: 44.6 [range, 26-71 years]). RESULTS: Human leukocyte antigen-B65 (28.8% vs 0%, p<0.001) and DQ5 (40.7% vs 16.1%, p<0.05) were found to be expressed significantly more in non-alcoholic fatty liver disease compared with controls. Serum alanine aminotransferase (27.1 IU/L vs 20 IU/L, p<0.05) was significantly higher in the study group. CONCLUSIONS: Our preliminary study suggests that human leukocyte antigen plays a role in the pathogenesis of non-alcoholic fatty liver disease; however, more studies are needed to clarify these data.

The prevalence of asymptomatic bacteriuria and the relation of bacteriuria to pyuria, glycosuria and HbA1c in patients with diabetes mellitus were investigated. The study population included 110 diabetic patients and 100 healthy persons (control group). The ratio of bacteriuria was found as 25.5% (31.3% in women, 17.4% in men) in the diabetic group and as 9% (16% in women, 0% in men) in the control group. The prevalence of asymptomatic bacteriuria was significantly higher in the diabetic patients than in the control group (p less than 0.05). There was a significant relation between bacteriuria, pyuria and HbA1c levels (p less than 0.05). But, there wasn't any important correlation between bacteriuria and glycosuria.

Journal Article Recovery of adrenocortical function following treatment of tuberculous Addison's disease Get access F Keleştimur F Keleştimur >Erciyes Üniversitesi Tip Fakültesi, Ic Hastaliklari Klinigi, Kayseri 38039, Turkey Search for other works by this author on: Oxford Academic Google Scholar Postgraduate Medical Journal, Volume 69, Issue 816, October 1993, Page 832, https://doi.org/10.1136/pgmj.69.816.832 Published: 01 October 1993

Küçük çocuklarda kısa mesafeli yüksekten düşmeler çok nadir olsa da ciddi lezyonlara neden olabilmektedir. Bir çocuk ağır bir klinik tablo ve kısa mesafeden düşme şikayeti ile getirilmiş ise hikaye çok iyi sorgulanmalıdır. Retinal kanama veya subdural kanama varlığında ayırıcı tanıda sarsılmış bebek sendromu (SBS) muhakkak düşünülmelidir. Bu çalışmada son bir yıl içerisinde Erciyes Üniversitesi Tıp Fakültesi Çocuk Acil Servisine konvulziyon şikayeti ile getirilen ve daha sonra hikayede kısa mesafeli yüksekten düşme olduğu belirtilen altı olgu incelendi. Göz dibi muayenelerinde iki olguda tek taraflı retinal kanama, bir olguda papil ödemi tespit edildi. Yapılan kranial inceleme sonucu üç olguda intrakranial kanama, bir olguda intrakranial kanama+kafa kemik kırığı, bir olguda serebellar ve serebral atrofi tespit edildi. Düştükleri iddia edilen mesafenin yüksekliğinin 50-100 cm arasında olduğu belirtildi. Konvulziyon şikayeti ile getirilen ve hikayesinde kısa mesafeden düşme ifadesi bulunan çocukların anamnez, fizik muayene ve radyolojik bulguları SBS açısından değerlendirilmelidir.

In recent years, various studies are conducted on the availability of some classifying, decisive softwares and tools that're new and assistant upon diagnosis of the diseases. Using Artificial Neural Networks (ANN) is one of these tools. It is obvious that, these kind of systems which could be helpful for the diagnosis, and which have benefits like shortening of the diagnosis period, time gain and increased efficiency, contributes a lot to medical R&D. In this study, diagnosis of Chronic Obstructive Pulmonary Disease (COPD) with Artificial Neural Networks is objected. Dataset used in the study comprises 15 Variables, 4 COPD Disease Levels (Mild, Moderate, Severe; Very Severe), and the data of 507 patients. Within the study, (Matlab Code with 2 hidden layers); 5 layered crossvalidation method is used. Mean Squared Error (MSE) and Mean Absolute Error (MAE) of the test samples are calculated and mean of 5 layer errors are given as the results. In conclusion MSE and MAE values are found to be 0,00996, and 0,02478 respectively. Accuracy rates are found to be 99 %. Ultimately founded results show that very high accuracy rates are achieved with 15 variables. Consequently, Artificial Neural Networks seem to have a successful usage in COPD classification. This allows a system that would help the physician to determine COPD level more rapidly with high performance.

Nervous system involvement is a rare manifestation of brucellosis. We describe our experience of the diagnosis, treatment and final outcome of patients with neurobrucellosis at the Erciyes University Gevher Nesibe Hospital, a tertiary referral centre in Central Anatolia, Turkey. Thirty-six adult patients were diagnosed with neurobrucellosis from January 1997 to December 2006. Headache and fever were the most common symptoms. Neck stiffness was present in 25 patients. Brucella spp was isolated from the blood of nine patients and from the cerebrospinal fluid of 11. Doxycycline (by mouth) plus rifampin (by mouth) with ceftriaxone (intravenously) were the most common treatment choices. Three patients died as a result of problems other than neurobrucellosis and relapse occurred in one patient. Neurobrucellosis presents with hetoregenous clinical signs.

Introduction: Systemic juvenile arthritis -a rare chronic disease. Registerit's an important tool to monitor the effectiveness and safety of GIBP. Objectives: Our aim was to study features of the drug therapy of children with systemic juvenile idiopathic arthritis (sJIA) Methods: We conducted a retrospective data analysis included in the Register of sJIA cases, for the period from 2002 to 2015 Results: The indicators of 384 children with sJIA are studied. Prior to the diagnosis verification, all patients were prescribed to intake antipyretic agents, 98% -antibiotics. After the diagnosis, non-steroidal anti-inflammatory drugs (NSAIDs) were intaken by 282 (73.4%) patients: diclofenac sodiumby 163 (40.1%), nimesulideby 88 (22.9%) patients. The average duration of NSAID intake from 2002 to 2015 decreased from 81.5 115.3 to 3.3 3.7 months (p < 0.001). Prior to the diagnosis verification, glucocorticoids were received intravenously or intramuscularly by 265 (69.0%) patients, orally -176 (45.8%). Totally, glucocorticoids were received by 330 (85.9%) patients: methylprednisolone -300 of 384 (78.1%), prednisolone -174 (45.3%), there were totally 1855 prescriptions in 668 cases. The average duration of glucocorticoid intake from 2002 to 2015 decreased from 13.7 26.7 to 5.0 3,8 months (p < 0.001). As a disease-modifying drug, methotrexate was intaken by 237 (61.7%), Cyclosporinby 193 (50.6%) patients. There were totally 809 cases of genetically engineered biological preparations (GIBP) in 430 patients: in 2002-2005-8, in 2011-2015-602 in 397 cases (p = 0.001). Tocilizumab is intaken by 210 (52.9%) of 397 patients, kanakinumab -37 (9.3%) patients. The disease duration from the manifestation to the prescription of immunosuppressive drugs from 2002 to 2015 decreased from 27.3 23.9 to1.0 0 months (p < 0.001), GIBP prescriptionsfrom 70.7 26.3 to 0.5 0.7 months, respectively (p < 0.001) Conclusion: In 13 years there have been positive changes in the antirheumatic therapy in children with sJIAthe duration of NSAIDs and glucocorticoids intake reduced, the period between diagnosis verification and immunosuppressants and GIBP prescription decreased. However, it is still widely used antibiotics, non-selective NSAIDs and glucocorticoids.

Objectives: Methicillin resistance of S.aureus strains sourced from hospitals and community-acquired has been increasing. The aim of this cross-sectional study is to determine the resistance rates to alternative antibiotics of meticilline resistant S.aureus (MRSA) strains, where the multiple resistances are encountered the most. Materials and methods: A total of 100 MRSA strains iso&amp;amp;amp;shy;lated consequently from the clinical samples of hospital&amp;amp;amp;shy;ized patients in Erciyes University Medical Faculty Hos&amp;amp;amp;shy;pitals between September 2008 and October 2009 were included in the study. According to “Clinical and Labora&amp;amp;amp;shy;tory Standards Institude (CLSI)” criteria, antimicrobial susceptibility testing was performed by Kirby-Bauer disk diffusion method. Results: The rates of resistance to antibiotics of the MRSA strains included within the study were 77% to erythromy&amp;amp;amp;shy;cin, 1% to trimethoprim/sulfamethoxazole (TMP-SXT), 90% to rifampin, 63% clindamycin, 84% to gentamicin and 0% to teicoplanin and vancomycin. Conclusion: All MRSA strains were susceptible to van&amp;amp;amp;shy;comycine and teicoplanin. On the other hand, TMP-SXT seems to be alternative agent for treatment of MRSA in&amp;amp;amp;shy;fections. Key words: Antibiotic resistance, Staphylococcus au&amp;amp;amp;shy;reus, methicillin-resistance

Aim. In this study it was aimed to determine the general approach,attitude,behaviour and knowledge of the nurses working in Sivas city center on donating organs. Methods. 750 nurses were planned to take part in this study; however, it was completed with the participating of 641 nurses (Access ratio:85%). It is descriptive and cross-sectional study. The data were collected by a questionnaire and the percentages were specified and analyzed by chi-square test. Results. The mean age of the 641 nurses participated in the study was 29.2 ± 4.9 years. 95.3 percent of the nurses were female, 40.2% were between 26-30 years old and 68.2% had a bachelor&amp;#039;s degree. 98.1% of the nurses stated that they had never donated any organs and 53.5% also stated that they hadn’t had sufficient information on the subject. 88.8% of the nurses stated that they could give necessary organs to one family member, and 18.4% point out that they could donate necessary organs to a stranger patient if needed. 31.0% of the nurses thought that their families didn’t have a right to appeal after their death when they had donated their organs and 2.3% thought that the process of organ donation was paid. When asked where organ donation may be made, 87.4% of the nurses responded organ donation centers. When asked about the organs which were possible to donate and 98.1% of nurses replied that it was kidney The nurses who thought that the first-degree relatives should give the decision of organ donation on the behalf of deceased person were 88.0%. The rate of the nurses who stated that help should be recieved from the religious officials to increase organ donation was 75.2%, 1.9% of the nurses stated that they had donated organs. When the organ donation status were evaluated by sex; 1.6% of female and 6.7% of male had made organ donation and the difference between the goups was significant. The organ donation rate was much higher among those who considered organ donation was suitable in religious aspects (p

Right atrial thrombus formation is a known mechanical complication of central venous catheter insertion, with an incidence of between 1.9% and 42%. There is an increased risk of thromboembolism following renal transplantation. However, a right atrial thrombosis is rarely reported in renal transplant recipients. Here, we report two cases of renal transplant recipients in whom a right atrial thrombus developed after kidney transplantation. One of them required surgery, whereas the other patient recovered after being given an anticoagulant therapy with warfarin.

PURPOSE: To emphasize the importance of anticipation of pressure-induced stromal keratopathy (PISK) in eyes with a previous history of LASIK. CASE REPORT: A 40-year-old man developed LASIK-related pressure-induced stromal keratopathy after uneventful phacoemulsification (Phaco) and intraocular lens (IOL) implantation in his left eye. With immediate discontinuation of the steroid drops and initiation of antiglaucoma medication, his visual acuity, interface edema, and haze improved rapidly. One year later, during Phaco with IOL implantation in his other eye, with anticipation of a similar LASIK-related pressure-induced stromal keratopathy, a very brief course of soft steroid therapy was given together with antiglaucoma medication. Intraocular pressure elevation was avoided, and no interface edema or haze was observed. CONCLUSIONS: This case illustrates that the risk for LASIK-related pressure-induced stromal keratopathy may be reduced with appropriate precautions.

Amaç: Bu çalışmada, vajinal akıntı şikayeti olan hastalarda Trichomonas vaginalis yaygınlığının çeşitli yöntemlerle araştırılması ve sonuçların farklı parametrelerle karşılaştırılması amaçlanmıştır. Gereç ve Yöntemler: Erciyes Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Polikliniğine vajinal akıntı şikayetiyle başvuran 535 kadın ile akıntı şikayeti olmayan 482 kadında T.vaginalis araştırılmıştır. Vajinal simir örnekleri alınan 1017 kadında direkt mikroskobik bakı, Giemsa boyama, akridin oranj boyama ve Cysteine-peptone-liver-maltose besiyerine ekim yöntemleriyle parazit araştırılmıştır. Bulgular: Vajinal akıntılı hastaların 11'inde (%2.06), kontrol grubunun ise ikisinde (%0.41) T.vaginalis'e rastlanmıştır. Hastaların yaşları ve sosyal durumları ile parazit görülmesi arasında istatistiksel olarak anlamlı bir fark saptanmamıştır. Akıntı şekline göre parazit varlığı karşılaştırıldığında; yeşil-kötü kokulu akıntıya sahip olma ile parazit görülme arasında istatistiksel olarak anlamlı bir ilişki saptanmıştır. İki olguda (%15.5) direkt mikroskobik bakı, üç olguda (%23.1) Giemsa boyama ve altı olguda (%46.2) akridin oranj boyama yöntemi ile parazit negatif bulunmasına rağmen, kültür yöntemiyle pozitif bulunmuştur. Sonuç: Cinsel yolla bulaşan bir hastalık olan trichomoniosisin yaygınlığını araştıran insidans çalışmalarının belirli aralıklarla yapılması, ayrıca asemptomatik kişilerin de taranarak bu etkeni taşıyanların saptanması gerektiği ve tanıda direkt inceleme ile boyamanın yanında kültür yöntemlerinin de uygulanmasının yararlı olacağı kanısındayız.

Amaç: Prostat kanseri erkeklerde en sık görülen kanserlerdendir. İleri evre olmadan belirti vermeyen prostat kanserinde, erken tanı ve taramalarla iyi sonuçlar elde edilebilir. Bu çalışma erkeklerin prostat kanseri taramalarına ilişkin bilgi düzeylerini tespit etmek amacıyla yapılmıştır.Gereç ve Yöntem: Araştırma bir üniversite hastanesinin üroloji polikliniğine başvuran 120 erkek hasta ile yapılmıştır. Araştırmanın yapılabilmesi için etik kurul onayı, kurum izni ve bireylerden sözlü ve yazılı onam alınmıştır. Araştırmanın verileri; literatür taranarak oluşturulan Kişisel Bilgi Formu ve Weinrich ve arkadaşları tarafından geliştirilen “Prostat Kanseri Taramaları Bilgi Testi”(PKTBT) kullanılarak toplanmıştır.Bulgular: Araştırmada bireylerin yaş ortalaması 63.26 ± 2.24, %91.7’si evli, %58.3’ü ilköğretim mezunu ve %70.8’i emekliydi. Bireylerin daha önce %38.3’ünün prostat ile ilgili sorun yaşadığı, %39.2’sinin prostat muayenesi olduğu, %30’nun PSA testi yaptırdığı ve %28.3’ünün yakınlarında prostat kanseri olduğu belirlenmiştir. Bireylerin sadece %21.7’sinin prostat kanseri hakkında bilgi aldığı, bilgi alanların %30.8’inin bilgiyi sağlık personelinden aldığı tespit edilmiştir. Araştırmaya katılan bireylerin “Prostat Kanseri Taramaları Bilgi Testinden” ortalama 4.81 ± 2.24 puan aldığı ve “düşük düzeyde bilgili” oldukları saptanmıştır. Prostat kanseri taramaları konusunda daha önce bilgi alan erkeklerin PKTBT puanlarının daha yüksek olduğu belirlenmiştir. Daha önce prostat kanserine yönelik bilgi alan erkekler ile almayanların PKTBT puanları arasındaki farkın istatistiksel olarak ileri derecede anlamlı olduğu tespit edilmiştir. Sonuç: Bu araştırmanın sonucunda riskli grupta yer alan erkeklerin prostat kanseri ve taramalara ilişkin bilgi düzeylerinin düşük olduğu saptanmıştır. Bu konuda halka yönelik kamu spotu çalışmalarıyla erkeklerin dikkatinin çekilmesi ve bilgilendirmelerinin yapılması önerilmektedir.

OBJECTIVE: In this study, we aimed to compare serum creatinine, blood urea, and glomerular filtration rate (GFR) levels of patients at baseline and 48 h after the administration of radiocontrast agent in the emergency department. METHOD: We prospectively enrolled 114 patients who underwent contrast-enhanced computed tomography scan and had a baseline creatinine level of 1.5 mg/dl or less. Serum creatinine and blood urea levels were measured at baseline and 48 h after the administration of radiocontrast agent. GFR and Mehran risk score were calculated at baseline and 48 h after the administration of radiocontrast agent. RESULTS: Baseline mean serum creatinine was 1.03±0.25 mg/dl. Forty-eight hours after the administration of radiocontrast agent, mean serum creatinine was 1.04±0.31 mg/dl, baseline mean blood urea was 8.14±4.04 mmol/l, mean blood urea was 8.42±4.42 mmol/l, baseline mean GFR was 76.74±27.08 ml/min, and mean GFR was 77.21±27.92 ml/min. There were no significant differences between baseline and 48 h after the administration of radiocontrast agent serum creatinine, blood urea levels, and GFR (P>0.05). CONCLUSION: There was no statistically significant difference between basal and 48 h after the administration of radiocontrast agent serum creatinine and GFR levels of patients who were enrolled in this study. Results had shown that administration of intravenous radiocontrast agent (≤100 ml) for emergency imaging in the emergency department did not produce a risk for contrast-induced nephropathy in patients with serum creatinine levels of 1.5 mg/dl or less.

OBJECTIVES: We aimed to investigate whether there were any differences in the percentages of CD14(+) monocytes between subgroups of acute coronary syndromes (ACS). CD14(+) is a monocyte surface receptor that plays a role in the innate immune system. CD14(+) monocytes are associated with complications of atherosclerosis. METHODS: In total we enrolled 115 patients with ACS: 24 with unstable angina (UA); 29 with non-ST elevation myocardial infarction (NSTEMI); and 62 with ST elevation myocardial infarction (STEMI). The levels of C-reactive protein and percentage of CD14(+) monocyte were measured on admission. RESULTS: CD14(+) monocyte percentages were observed to be different between groups by analysis of variance test. The percentages of CD14(+) monocyte were 81.24+/-10.04% in the UA group; 89.40+/-5.84% in the NSTEMI group; and 87.22+/-11.75% in the STEMI group (P=0.013). The differences between the UA and the NSTEMI and between the UA and the STEMI groups with Bonferroni posthoc testing were significant (P=0.014 and P=0.049 respectively). Moreover, no significant difference was found between the NSTEMI and STEMI groups (P=1.000). The C-reactive protein levels in the UA group were detected to be significantly low with Bonferroni posthoc testing compared with both the NSTEMI and STEMI groups (for both comparisons, P<0.002). CONCLUSIONS: A significant difference in CD14(+) monocyte percentages between subgroups of ACS was determined. CD14(+) monocyte percentages can be a useful parameter in differentiating between the subgroups of ACS, especially between UA and myocardial infarction.

Introduction: Datura inoxia is an ornamental plant belonging to the Solanaceae family.Ingestion of the plant's flowers, leaves, or seeds can result in serious intoxication and even death.Datura inoxia can cause acute anticholinergic poisoning.Case: We report a case of female who had ingested Datura inoxia (moonflower) seed tea to protect from H1N1 infection and presented to the emergency department with a decreased level of consciousness and difficulty to speech.Conclusion: As a result, poisons due to vary plants increased.Datura inoxia intoxication should be considered in case of patients who presented with agitation, seizures and delirium.

Splenectomy is the frequently used surgical method for the treatment of traumatic splenic injuries. In this study, the patients who had traumatic splenic injuries were investigated and the results of surgical treatments were evaluated. There were 225 patients with traumatic splenic injuries, which contains 55 (24%) female and 170 (76%) male. The mean age was 29 (range 16-71) years. Severity of splenic injury was classified according to Moore organ injury scaling and there were 23 (10%) patients in grade 1, 96 (43%) in grade II, 75 (33%) in grade III, 24 (11%) in grade IV and 7 (3%) in grade V. Splenectomy was performed in 203 (90%) patients, splenoraphy in 18 (8%) and partial splenectomy in 4 (2%) patients. The overall mortality was 12%. A positive correlation was estimated between the combined trauma and the mortality (Fisher's Chi-Square test; chi 2 = 9,538, p < 0.002). In conclusion, non-operative treatment methods may prevent unnecessary splenectomies, especially in grade I and II blunt or penetrating splenic injuries. Combined injuries are the major factor increasing the mortality.

Malaria is a major worldwide public health problem. In the last years, no domestic cases of malaria have been detected and cases of imported malaria exist only in Turkey. In this study, clinical and laboratory findings of five Plasmodium falciparum (P. falciparum) malaria patients who were admitted to the emergency department between January 2013 and December 2015 were retrospectively presented. One of the patients was an African student, and the other patients had a history of travelling to Africa. Ring formation was observed when Giemsa staining was performed on the blood smears of all patients, and in three patients, P. falciparum was also detected using multiplex polymerase chain reaction (PCR) (Bio-Rad, United States of America). P. falciparum was not detected by PCR in the other two patients. Malaria should be primarily considered in febrile patients who have a history of travelling to endemic regions, and peripheral blood smears should definitely be examined.