Are There Standardized Cutoff Values for Neutrophil-Lymphocyte Ratios in Bacteremia or Sepsis?

( Gonul Gurol ),( Ihsan Hakki Ciftci ),( Huseyin Agah Terzi ),( Ali Riza Atasoy ),( Ahmet Ozbek ),( Mehmet Koroglu ) 한국미생물 · 생명공학회 2015 Journal of microbiology and biotechnology Vol.25 No.4

Bacteremia and sepsis are common causes of morbidity and mortality worldwide, with incorrect or delayed diagnoses being associated with increased mortality. New tests or markers that allow a more rapid and less costly detection of bacteremia and sepsis have been investigated. The aim of this study was to clarify the cutoff value of the neutrophillymphocyte ratio (NLR) according to procalcitonin (PCT) level in the decision-making processes for bacteremia and sepsis. In addition, other white blood cell subgroup parameters, which are assessed in all hospitals, for bacteremia and sepsis were explored. This retrospective study included 1,468 patients with suspected bacteremia and sepsis. Patients were grouped according to the following PCT criteria: levels <0.05 ng/ml (healthy group), 0.05-0.5 ng/ml (local infection group), 0.5-2 ng/ml (systemic infection group), 2-10 ng/ml (sepsis group), and >10 ng/ml (sepsis shock group). One important finding of this study, which will serve as a baseline to measure future progress, is the presence of many gaps in the information on pathogens that constitute a major health risk. In addition, clinical decisions are generally not coordinated, compromising the ability to assess and monitor a situation. This report represents the first study to determine the limits of the use of NLR in the diagnosis of infection or sepsis using a cutoff value of <5 when sufficient exclusion criteria are used.

Severe hyponatremia and repeated intestinal resections for intestinal dysmotility mimicking congenital aganglionic megacolon due to delay in the diagnosis of congenital hypothyroidism

Gonul Buyukyilmaz,Demet Baltu,Tutku Soyer,Murat Tanyıldız,Huseyin Demirbilek 대한소아내분비학회 2016 Annals of Pediatirc Endocrinology & Metabolism Vol.21 No.4

Congenital hypothyroidism (CH) may present with nonspecific signs and symptoms, though, majority of infants can be asymptomatic. Therefore, understimation and delay in diagnosis may result in severe complications. A 5-month-old female admitted to our clinic with the history of repeated surgical operations due to the diagnosis of congenital aganglionic megacolon. Investigations performed in our clinic revealed the diagnosis of congenital (primary) hypothyroidism due to thyroid agenesis. Histopathologic evaluation of previously resected colon sample revealed normal ganglionic cell included colon. During follow-up she developed severe hyponatremia with a plasma sodium level of 106 mEq/L. Eunatremia was maintained following achievement of euthyroid state. In conclusion, since presenting symptoms can be variable and nonspecific, hypotyhroidism should be kept in mind in the differential diagnosis of patients with persistent abdominal distention mimicking aganglionic megacolon and severe hyponatremia of unknown origin.

Clinical and Laboratory Findings of Pigmented Purpuric Dermatoses

( Muzeyyen Gonul ),( Seray Kulcu Cakmak ),( Nimet Ozcan ),( Isil Deniz Oguz ),( Ulker Gul ),( Zeynep Bıyıkll ) 대한피부과학회 2014 Annals of Dermatology Vol.26 No.5

Background: Pigmented purpuric dermatoses (PPD) are chronic, recurrent group of disorders characterized by petechial and pigmentary macules usually localized on the lower limbs. Its etiopathogenesis is unknown. There are very few clinical and etiological studies on PPD in the literature. Objective: We aim to examine the etiopathogenetic factors of PPD retrospectively. Methods: Demographic characteristics, history of co-morbid disorders and drug usage, hepatitis markers, levels of serum lipids, findings of Doppler ultrasonography in lower extremities, and patch test resultsof the 24 patients of PPD were examined retrospectively. The patch test results, history of drug use, and co-morbid disorders of the patients were compared with those of thecontrol groups. Results: The male-to-female ratio was 1 : 2, and 83.3% of the patients had Schamberg disease. Seventeen patients had co-morbid disorders and 16 used various drugs, but there was no statistically significant difference between the controls and patients. One patient was positive for hepatitis B surface antigen and 1, for anti-hepatitis C virus antibody. Nine had elevated total cholesterol levels, and 5 had elevated triglyceride levels. Further, 30% of them were positive for at least 1 allergen, while 16% of the controlsubjects were positive for at least 1 allergen, but statistically significant difference was not found between the 2 groups. Variable degrees of venous insufficiency were detected in 75% of the patients on Doppler ultrasonography of the lower extremities. Conclusion: Venous insufficiency and hypercholesterolemiamight be the basic predisposing factors for PPD. Further studies are needed to show if diabetes mellitus and hypertension may cause perivascular inflammation in PPD. (Ann Dermatol 26(5) 610∼614, 2014)

Mortality-Related Risk Factors in Geriatric Patients with Hip Fracture

Rıdvan Gonul,Pınar Tosun Tasar,Kutsi Tuncer,Omer Karasahin,Dogan Nasır Binici,Can Sevinc,Mustafa Turgut,Sevnaz Sahin 대한노인병학회 2023 Annals of geriatric medicine and research Vol.27 No.2

Background: Mortality rates after hip fractures increase by up to 30% with age. This study investigated the contribution of various parameters to prognosis and mortality. Methods: Our study prospectively examined patients with hip fracture aged 65 years and over who applied to the Atatürk University Medical Faculty Hospital Orthopedics Service in 2020–2021. Results: The 120 patients included in the study had a mean age of 79.71±7.27 years, and 51.7% were female. Twenty patients (16.7%) died within the first 30 days after a hip fracture. They had a significantly lower median Lawton–Brody instrumental activities of daily living (IADL) scale score (p=0.045) and a higher rate of malnutrition according to the Mini Nutritional Assessment (MNA) score (p=0.016). Additionally, these patients with 30-day mortality had a significantly lower rate of surgical treatment (p=0.027) and a longer time from injury to surgery (p=0.014). The time to surgery was a significant independent risk factor for 30-day mortality, with each 1-hour delay increasing the odds of mortality by 1.066 (odds ratio [OR]=1.066; 95% confidence interval [CI], 1.001–1.013; p=0.013). In addition, the presence of malnutrition was another independent risk factor that increased the odds of mortality by 4.166 times (OR=4.166; 95% CI, 1.285–13.427; p=0.017). Conclusion: We recommend placing more importance on supportive treatment in patients presenting with hip fractures, especially in those with malnutrition; performing surgical intervention as early as possible; and more closely following up with patients with the aforementioned risk factors.

Orthodontic bonding to acid- or laser-etched prebleached enamel

Ozdemir, Fulya,Cakan, Umut,Gonul, Nese,Cakan, Derya Germec The Korean Association Of Orthodontists 2013 대한치과교정학회지 Vol.43 No.3

Objective: Bonding forces of brackets to enamel surfaces may be affected by the procedures used for bleaching and enamel etching. The aim of this study was to investigate the bonding strength of orthodontic brackets to laser-etched surfaces of bleached teeth. Methods: In a nonbleached control group, acid etching (group A) or Er:YAG laser application (group B) was performed prior to bracket bonding (n = 13 in each group). Similar surface treatments were performed at 1 day (groups C and D; n = 13 in each subgroup) or at 3 weeks (groups E and F; n = 13 in each subgroup) after 38% hydrogen peroxide bleaching in another set of teeth. The specimens were debonded after thermocycling. Results: Laser etching of bleached teeth resulted in clinically unacceptable low bonding strength. In the case of acid-etched teeth, waiting for 3 weeks before attachment of brackets to the bleached surfaces resulted in similar, but not identical, bond strength values as those obtained with nonbleached surfaces. However, in the laser-etched groups, the bonding strength after 3 weeks was the same as that for the nonbleached group. Conclusions: When teeth bleached with 38% hydrogen peroxide are meant to be bonded immediately, acid etching is preferable.

Prevalence of herbal therapy usage in patients with psoriasis in Turkey

Keseroglu, Havva Ozge,Gonul, Muzeyyen,Kurmus, Gokce Isil Cellmed Orthocellular Medicine and Pharmaceutical 2015 셀메드 (CellMed) Vol.5 No.2

Many patients with psoriasis look for treatment options other than conventional treatment to control their disease with less side effects. We evaluated the prevalence and characteristics of herbal therapy usage among patients with psoriasis in Turkey. A self-prepared questionnaire about herbal therapies was applied to the psoriatic patients attended our dermatology clinic between October 2013 and December 2013. A total of 100 patients (55 male, 45 female; 7 - 80 years of age) were included in this study. Fortynine percent of patients used at least one form of herbal therapies. Juniperus oxycedrus and Aloe vera were found to be the most frequently used plants. 36.7% of the patients get benefit from herbal therapy. Only 12.2% of patients had informed their clinicians during or after herbal therapy usage. 22.4% of the patient had continued conventional treatment during herbal therapies. Side effects related with herbal therapy were developed in 26.5% of the patients. The risk of side effects was found to be 5.23 times more in patients using phytotherapies systemically compared with ones using topically. Our results show that herbal therapy usage is common among patients with psoriasis in Turkey. Since herbal therapies have the potential of interacting with the medical treatment modalities and causing life threatening allergic reactions, clinicians should be aware of plants used in psoriasis and possible adverse reactions related with them and also should not forget asking about herbal therapy history.

Serotonin Expression in Lichen Planus Lesions and Its Relationship with Depression/Anxiety

( Gokce Isil Kurmus ),( Muzeyyen Gonul ),( Filiz Canpolat ),( Demet Yilmazer ),( Eylem Sahin Cankurtaran ) 대한피부과학회 2019 Annals of Dermatology Vol.31 No.2

Background: Psychological factors such as stress, depression, and anxiety have been documented to contribute to the development of lesions in lichen planus (LP). Objective: To evaluate the relationship between serotonin expression in LP lesions and depression/anxiety. Methods: Forty patients (22 females, 18 males) with LP and 20 healthy control subjects were included in this study. The severity of LP was assessed with the palmar method (using the measurement of affected body surface area [BSA]). The depression and anxiety scores were measured with Beck's depression inventory (BDI) and Beck's anxiety inventory (BAI). The expression of serotonin was determined via immunohistochemistry in LP lesions and in the control group skin using a monoclonal antibody to serotonin. Results: The skin biopsies of the LP patients had significantly higher levels of serotonin than those of the control subjects (p<0.001). In the LP patients, and there was a positive correlation between serotonin expression and LP severity (p=0.022). Based on the results from the BDI and BAI, there was a significant relationship between the severity of depression/anxiety and intensity of serotonin expression (p <0.001). Conclusion: Data from this study suggest that serotonin may have a possible role in the pathogenesis of LP. Further, the relationship between serotonin expression in acute cutaneous lesions and the depression/anxiety scores indicates that serotonin may be a mediator for the association of LP and depression/anxiety simultaneously. There is a need for more specific studies showing the expression of serotonin in the lichen planus to demonstrate the cause or effect. (Ann Dermatol 31(2) 146∼153, 2019)

Effect of IL-18 binding protein on hepatic ischemiareperfusion injury induced by infrarenal aortic occlusion

Mustafa Ozsoy,Yucel Gonul,Ahmet Bal,Ziya Taner Ozkececi,Ruchan Bahadir Celep,Fahri Adali,Omer Hazman,Ahmet Kocak,Murat Tosun 대한외과학회 2015 Annals of Surgical Treatment and Research(ASRT) Vol.88 No.2

Purpose: Severe local and systemic tissue damage called ischemia/reperfusion (IR) injury occurs during the period of reperfusion. Free oxygen radicals and proinflammatory cytokines are responsible for reperfusion injury. IL-18 binding protein (IL-18BP) is a natural inhibitor of IL-18. The balance between IL-18 and IL-18BP has an important role in the inflammatory setting. The present study aimed to investigate whether IL-18BP had a protective role in remote organ hepatic IR injury. Methods: Wistar-Albino rats were divided into three groups that contained seven rats. Group I (sham): Laparotomy and infrarenal abdominal aorta (AA) dissection were done but no clamping was done. Group II (I/R): The infrarenal AA was clamped by atraumatic microvascular clamp for 30 minutes and then was exposed to 90 minutes of reperfusion. Group III (IR + IL-18BP): 75 μg/kg of IL-18BP in 0.9% saline (1 mL) was administered 30 minutes before infrarenal AA dissection and clamping; 30 minutes of ischemia was applied and then was exposed to 90 minutes of reperfusion. Results: Serum AST, ALT, and LDH levels were remarkably higher in IR group and returned to normal levels in treatment group. The proinflammatory cytokine levels had decreased in treatment group, and was statistically significant compared with the IR group. Serum levels of total oxidant status and oxidative stress index decreased and levels of total antioxidant status increased by IL-18BP. Conclusion: This study suggested that IL-18BP has antioxidant, anti-inflammatory and hepatoprotective effects in cases of IR with infrarenal AA induced liver oxidative damage.

A spontaneous pregnancy and live birth in a woman with primary infertility following the excision of an ovarian adrenal rest tumor: A rare case

Uyanikoglu, Hacer,Ozer, Gonul,Kahraman, Semra The Korean Society for Reproductive Medicine 2020 Clinical and Experimental Reproductive Medicine Vol.47 No.4

Adrenal rest tumors are a rare extra-adrenal complication of congenital adrenal hyperplasia (CAH) in women although they are more commonly found in the testes of male patients with CAH. An ovarian adrenal rest tumor (OART) may coexist with CAH or imitate its symptoms without CAH. In this case report, we present the case of a woman with OART without CAH, whose main complaint was infertility and who had a baby after successful surgical treatment.

Endoscopic Ultrasonography in Pediatric Patients with Pancreatobiliary Disease: Single-Center Trial

Demirbas, Fatma,Kaymazli, Mustafa,Caltepe, Gonul,Abbasguliyev, Hasan,Kalayci, Ayhan Gazi,Bektas, Ahmet The Korean Society of Pediatric Gastroenterology 2021 Pediatric gastroenterology, hepatology & nutrition Vol.24 No.2

Purpose: The use of Endoscopic ultrasonography (EUS) in pediatric patients is not as common as in adults. The aim of this study is to evaluate the role of EUS in the diagnosis of pancreatobiliary disease in childhood. Methods: Between December 2016 and January 2018, the findings of patients who underwent EUS were evaluated retrospectively. Results: Of the 41 patients included in the study 25 were girls (61.0%), mean age was 12.2±4.2 years. EUS was performed for biliary colic in 21 (51.2%), for recurrent pancreatitis in 12 (29.2%), for cholecystitis/cholangitis in 5 (12.2%), and for acute pancreatitis in 3 (7.4%) patients. EUS had a significant clinical effect in the decision of treatment and follow-up of 6/21 biliary colic cases, in diagnosis and follow-up of 6/12 recurrent pancreatitis cases, in decision-making and monitoring of invasive procedures (ERCP/surgery) of 3/5 acute cholecystitis/cholangitis and 2/3 of acute pancreatitis cases as well as in follow-up of the other cases. The effectiveness of EUS in determining direct treatment and invasive intervention was 43.9%. None of the patients had complications related to the EUS procedure. Conclusion: Although current guidelines show that EUS can be used in pediatric patients, this is limited to a few published studies. In this study, it is shown that EUS is a safe method for the diagnosis, follow-up and treatment of common pancreatobiliary pathologies in childhood.