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Ekemen S, Bilir E, Soultan HEA, Zafar S, Demir F, Tabandeh B, Toprak S, Yapicier O, Coban C. The Programmed Cell Death Ligand 1 and Lipocalin 2 Expressions in Primary Breast Cancer and Their Associations with Molecular Subtypes and Prognostic Factors. Breast Cancer (Dove Med Press) 2024; 16:1-13. [PMID: 38192518 PMCID: PMC10771776 DOI: 10.2147/bctt.s444077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/21/2023] [Indexed: 01/10/2024]
Abstract
Purpose Breast cancers exhibit molecular heterogeneity, leading to diverse clinical outcomes and therapeutic responses. Immune checkpoint inhibitors targeting PD-L1 have shown promise in various malignancies, including breast cancer. Lipocalin 2 (LCN2) has also been associated with tumor aggressiveness and prognostic potential in breast cancers. However, the expression of PD-L1 and LCN2 in breast cancer subtypes and their prognostic implications remains poorly investigated. Methods A retrospective analysis of 89 primary breast cancer cases was conducted to assess PD-L1 and LCN2 expressions using immunohistochemistry. Cases were classified into four different molecular subtypes based on ER, PR, HER2, and Ki-67 status. Associations between PD-L1 and LCN2 expressions and various prognostic factors were examined. Results Although low expression of LCN2 (Allred score of <3) was observed even in normal breast tissue, LCN2 expression with increasing Allred score (≥3) positively correlated with the histological grade, high Ki-67 proliferation index, and ER/PR negativity. Significant elevations of LCN2 and PD-L1 expressions were observed in triple-negative and HER2-positive breast cancers. Conclusion The results of the study highlight the association of LCN2 with known prognostic factors and molecular subtypes. To identify potential immunotherapy recipients, it would be useful to evaluate LCN2 as well as PD-L1 immune targets in different subgroups of breast cancer patients. Further studies with larger patient numbers are warranted to validate these observations and establish standardized scoring criteria for LCN2 expression assessment.
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Affiliation(s)
- Suheyla Ekemen
- Vocational School of Health Services, Acibadem University, Istanbul, Turkey
- Division of Malaria Immunology, Department of Microbiology and Immunology, Institute of Medical Science (IMSUT), the University of Tokyo, Tokyo, Japan
| | - Ebru Bilir
- Residency Program, Bahcesehir University School of Medicine, Istanbul, Turkey
| | | | - Sadia Zafar
- Residency Program, Bahcesehir University School of Medicine, Istanbul, Turkey
| | - Figen Demir
- Department of Public Health, Acibadem University School of Medicine, Istanbul, Turkey
| | - Babek Tabandeh
- Department of General Surgery, Bahcesehir University School of Medicine, Istanbul, Turkey
| | - Sadik Toprak
- Department of Forensic Medicine, Istanbul University School of Medicine, Istanbul, Turkey
| | - Ozlem Yapicier
- Department of Pathology, Bahcesehir University School of Medicine, Istanbul, Turkey
| | - Cevayir Coban
- Division of Malaria Immunology, Department of Microbiology and Immunology, Institute of Medical Science (IMSUT), the University of Tokyo, Tokyo, Japan
- Immunology Frontier Research Center (IFReC), Osaka University, Osaka, Japan
- International Vaccine Design Center, Institute of Medical Science (IMSUT), the University of Tokyo, Tokyo, Japan
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Gonultas F, Akbulut S, Sarici KB, Toprak S, Kilci B, Bilgic Y, Kose A, Yakupogullari Y, Garzali IU, Yilmaz S. Management of wet ascitic type of peritoneal tuberculosis: single center experience. Eur Rev Med Pharmacol Sci 2023; 27:980-987. [PMID: 36808343 DOI: 10.26355/eurrev_202302_31192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
OBJECTIVE We aimed to present our experience with the management of 17 patients with ascites who underwent diagnostic laparoscopy or laparotomy, and histologic confirmation of wet ascitic type of peritoneal tuberculosis (TB). PATIENTS AND METHODS Between January 2008 and March 2019, 17 patients whose ascites were investigated by a gastroenterologist and who were thought to have non-cirrhotic ascites were referred to our Surgery clinic for peritoneal biopsy. The clinical, biochemical, radiological, microbiological, and histopathological data of the patients who underwent diagnostic laparoscopy or laparotomy were analyzed retrospectively. Histopathological examination of peritoneal tissue samples in hematoxylin-eosin-stained preparations revealed necrotizing granulomatous inflammation with caseous necrosis and Langhans type giant cells. Ehrlich-Ziehl-Neelsen (EZN) staining was studied with the suspicion of TB. Acid-fast bacilli (AFB) were detected in EZN stained slide. Histopathological findings were also considered. RESULTS Seventeen patients aged 18 to 64 years were included in this study. The most common symptoms were ascites and abdominal distention, weight loss, night sweats, fever and diarrhea. Radiological examination revealed peritoneal thickening, ascites, omental cacking, and diffuse lymphadenopathy. Histopathologically, necrotizing granulomatous peritonitis consistent with peritoneal TB were detected. While direct laparoscopy was preferred in sixteen patients, laparotomy was preferred in the remaining one due to previous surgical procedures. However, seven were converted to open laparotomy. CONCLUSIONS Diagnosis of abdominal TB requires high index of suspicion, and the treatment should be prompt to reduce the morbidity and mortality associated with delay in treatment.
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Affiliation(s)
- F Gonultas
- Department of Surgery, Department of Pathology, Department of Gastroenterology, Department of Infectious Diseases and Clinical Microbiology, Department of Medical Microbiology, Faculty of Medicine, Liver Transplant Institute, Inonu University, Malatya, Turkey.
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Dilege E, Celik B, Toprak S, Sucu S, Agcaoglu O, Falay O, Kapucuoglu N. SPECT/CT lymphoscintigraphy can accurately localize the sentinel lymph nodes and the clipped node in breast cancer patients undergoing targeted axillary dissection after neoadjuvant chemotherapy. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01389-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Varkal MA, Gulenc B, Yildiz I, Kandemir I, Bilgili F, Toprak S, Kilic A, Unuvar E. Vitamin D level, body mass index and fracture risk in children: vitamin D deficiency and fracture risk. J Pediatr Orthop B 2022; 31:e264-e270. [PMID: 33741834 DOI: 10.1097/bpb.0000000000000867] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of this study was to determine the impacts of preventable causes of fracture, such as vitamin D deficiency, disturbed calcium homeostasis and obesity on fracture occurrence in minor traumas. In this way, the effects of relevant parameters on fracture may be further elucidated. A prospective case-control study in children aged 2-18 years children with and without fractures was performed. Participants with a pediatric trauma score higher than 10 presenting to minor trauma were included to exclude the significant impact of severe trauma on fracture. The effects of obesity, parameters associated with vitamin D and Ca homeostasis on fracture occurrence were evaluated. Univariate and multivariate analyses were used to test for associations between fracture status and the assessed variables. The relationships between the variables and the odds of fracture occurrence were examined using logistic regression models. The sample consisted of 76 patients and 50 controls. There were no significant differences between the patients and controls in terms of age, sex, trauma type and pubertal period. The patients had a significantly higher mean BMI percentile (61.2 ± 30.7, 36.7 ± 30.7; P < 0.001). Likewise, patients were more likely than controls to have a lower mean 25(OH)D level and mean phosphorus level (respectively, 13.4 ± 7.0, 17.3 ± 7.8; P = 0.004, and 4.6 ± 0.7, 5.1 ± 0.8; P < 0.001). Moreover, fractures were substantially more frequent in children with vitamin D deficiency (<20 ng/mL, χ2: 7.781, df: 1, P = 0.005). In the multivariate logistic model, BMI percentile and vitamin D levels remained significantly associated with increased odds of fracture [1.02 (1.01-1.04), P < 0.001 and 0.93 (0.89-0.98), P = 0.01]. The present study supports an association of high BMI and vitamin D deficiency with an increased odds of fracture occurrence in children. The findings may help physicians to reduce the risk factors of fracture by preventive efforts. Thus, unexpected health costs and morbidity may be minimized.
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Affiliation(s)
| | | | | | | | | | - Sadik Toprak
- Department of Forensic Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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5
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Toprak S, Can EY, Altinsoy B, Hart J, Dogan Z, Ozcetin M. Social media video analysis methodology for sarin exposure. Forensic Sci Res 2020; 7:279-284. [PMID: 35784424 PMCID: PMC9246001 DOI: 10.1080/20961790.2020.1825061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
As social media becomes increasingly ubiquitous, many events are recorded and released on social media platforms, including chemical weapon attacks. We develop an objective tool in order to evaluate brief and unstructured social media videos for analysing sarin exposure from a civilian medical pathology perspective. We developed and validated this new questionnaire using a standardized procedure that includes content domain specification, item pool generation, content validity evaluation, a pilot study, and assessment of reliability and validity. In total, 51 sarin attacks and 48 matched videos were analysed. Cronbach’s α for all 20 items was 0.75, which indicates adequate internal reliability. The test–retest reliability was 0.96, which indicates good internal reliability. The inter-observer intraclass correlation coefficient was 0.97. After verifying sampling adequacy with the Kaiser–Meyer–Olkin measure and the factorability of the items with Barlett’s test of sphericity, a factor analysis was performed. According to the principal axis factoring, a six-factor solution explained 51.86% of the total variance. The receiver-operating characteristic curve analysis showed that the Video Score Questionnaire has a sensitivity of 0.817, a specificity of 0.478, and an efficiency of 65.3. Therefore, the Video Score Questionnaire is reliable and valid for evaluating sarin attacks from brief and unstructured social media videos.Key points Chemical weapons are still used as a method of warfare. Social media videos are an important source of information. We developed a validated scale which can analyse sarin exposure in short and unstructured videos.
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Affiliation(s)
- Sadik Toprak
- Department of Forensic Medicine, Istanbul University, Istanbul, Turkey
| | - Emine Yilmaz Can
- Department of Medical Pharmacology, Bulent Ecevit University, Zonguldak, Turkey
| | - Bulent Altinsoy
- Department of Pulmonary Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - John Hart
- James Martin Center for Nonproliferation Studies, Monterey, CA, USA
| | - Zekeriya Dogan
- Department of Civil Engineering, Bulent Ecevit University, Zonguldak, Turkey
| | - Mustafa Ozcetin
- Department of Pediatrics, Istanbul University, Istanbul, Turkey
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Toprak S, Kahriman F, Dogan Z, Ersoy G, Can EY, Akpolat M, Can M. The potential of Raman and FT-IR spectroscopic methods for the detection of chlorine in human nail samples. Forensic Sci Med Pathol 2020; 16:633-640. [PMID: 32984922 DOI: 10.1007/s12024-020-00313-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 11/29/2022]
Abstract
Although chlorine (Cl2) has been used as a chemical warfare agent since World War I there is no known specific and reliable biomarker to indicate the presence of chlorine. We distinguished chlorinated human nails from unchlorinated ones using Raman spectroscopy and Fourier Transform Infrared (FT-IR) Spectroscopy. This research was carried out between October 2018 and July 2019 on two nail samples taken from 55 male and 104 female volunteers. One sample from each participant was chlorinated, while the second sample was used as a control. Spectral data were collected from chlorinated and unchlorinated (control) human nails using Raman and FT-IR spectroscopy. Raman measurements were made between 100 and 3200 cm-1, while FT-IR measurements were recorded over the range of 650 to 4000 cm-1. Partial least squares regression-discriminant analysis (PLS-DA) was used to develop classification models for each spectral instrument. Results showed that the control and chlorinated nail samples were successfully discriminated with similar results achieved with both instruments. Minor differences were observed in the performance of classification models. The FT-IR spectroscopy model (sensitivity = 95%, specificity = 99%, accuracy = 97%) was found to be more successful with a smaller margin of error (sensitivity = 95%, specificity = 99%, accuracy = 96%) compared to the Raman spectroscopy model. This method can be used successfully for both ante-mortem and post-mortem diagnosis of chlorine exposure.
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Affiliation(s)
- Sadik Toprak
- Istanbul Medical Faculty, Department of Forensic Medicine, Istanbul University, Istanbul, Turkey
| | - Fatih Kahriman
- Faculty of Agriculture, Department of Field Crops, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Zekeriya Dogan
- Civil Engineering Department of Materials Science, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Gokhan Ersoy
- Institute of Forensic Science and Legal Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Emine Yilmaz Can
- Department of Medical Pharmacology, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Meryem Akpolat
- Faculty of Medicine, Department of Histology and Embryology, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Murat Can
- Department of Biochemistry, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
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7
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Ilhan O, Uslu A, Cengiz Seval G, Tap E, Basarir U, Civriz Bozdag S, Toprak S, Kurt Yuksel M, Topcuoglu P, Arslan O, Ozcan M, Demirer T, Akan H, Gurman G. AGE IS NOT IMPORTANT IN FIT ELDERLY PATIENTS WITH AGGRESSIVE LYMPHOMA. Hematol Oncol 2019. [DOI: 10.1002/hon.87_2631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- O. Ilhan
- Hematology; Ankara University School of Medicine; Ankara Turkey
| | - A. Uslu
- Hematology; Ankara University School of Medicine; Ankara Turkey
| | - G. Cengiz Seval
- Hematology; Ankara University School of Medicine; Ankara Turkey
| | - E. Tap
- Hematology; Ankara University School of Medicine; Ankara Turkey
| | - U. Basarir
- Hematology; Ankara University School of Medicine; Ankara Turkey
| | | | - S. Toprak
- Hematology; Ankara University School of Medicine; Ankara Turkey
| | - M. Kurt Yuksel
- Hematology; Ankara University School of Medicine; Ankara Turkey
| | - P. Topcuoglu
- Hematology; Ankara University School of Medicine; Ankara Turkey
| | - O. Arslan
- Hematology; Ankara University School of Medicine; Ankara Turkey
| | - M. Ozcan
- Hematology; Ankara University School of Medicine; Ankara Turkey
| | - T. Demirer
- Hematology; Ankara University School of Medicine; Ankara Turkey
| | - H. Akan
- Hematology; Ankara University School of Medicine; Ankara Turkey
| | - G. Gurman
- Hematology; Ankara University School of Medicine; Ankara Turkey
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Hazar Bodrumlu E, Demiriz L, Toprak S. Relationship between Severe Early Childhood Caries and dental development. Eur J Paediatr Dent 2018; 19:156-160. [PMID: 29790781 DOI: 10.23804/ejpd.2018.19.02.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM Severe early childhood caries (sECC) is a public health problem that continues to affect infants and preschool children worldwide. Knowledge of the changes in dental development is important for paediatric dentists in order to determine a treatment plan. The aim of this study was to investigate dental development in children with sECC, compared to age and gender-matched controls, by calculating the dental age (DA). MATERIALS AND METHODS A total of 300 children (144 females, 156 males) with sECC aged 5 years were studied and compared with 300 control subjects (caries-free), case-matched for gender and age. The dental development was assessed using the DA estimation method of Demirjian et al. [1973], and data were statistically analysed using a 2-sided t test and chi-squared test. RESULTS The mean differences between the DA and chronological age (CA) in the sECC females and males were 0.67±0.6 years and 0.98±0.6 years, respectively, whereas the results of the case controls were 1.44±0.8 years for the females and 1.57±0.6 years for the males. The differences between the sECC and case control groups were significant for both genders (p<0.001). CONCLUSION Children with severe early childhood caries have lower rates of dental development when compared to normal children.
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Affiliation(s)
- E Hazar Bodrumlu
- Assistant Professor, PhD, Bülent Ecevit University, Faculty of Dentistry, Department of Pediatric Dentistry, Zonguldak, Turkey
| | - L Demiriz
- Assistant Professor, PhD, Bülent Ecevit University, Faculty of Dentistry, Department of Pediatric Dentistry, Zonguldak, Turkey
| | - S Toprak
- Associate Professor, PhD, Bülent Ecevit University, Faculty of Medicine, Department of Forensic Medicine, Zonguldak, Turkey
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Saribas S, Demirci M, Toprak S, Ozer N, Caglar E, ortakoylu G, Yuksel P, Ayaz G, Bonabi E, Bahar Tokman H, Kiraz N, Kocazeybek B. Diagnostic performance of RT-qPCR method by targeting 85B mRNA in the laboratory diagnosis of Mycobacterium tuberculosis infection: A preliminary study in Turkish patients. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Bozlak S, Varkal MA, Yildiz I, Toprak S, Karaman S, Erol OB, Yekeler E, Unuvar A, Kilic A, Oguz F, Unuvar E. Cervical lymphadenopathies in children: A prospective clinical cohort study. Int J Pediatr Otorhinolaryngol 2016; 82:81-7. [PMID: 26857321 DOI: 10.1016/j.ijporl.2016.01.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 12/31/2015] [Accepted: 01/03/2016] [Indexed: 12/12/2022]
Abstract
AIM Cervical lymphadenopathy (LAP) is a common sign and may raise fears about serious illnesses. The aim of our study was to evaluate the patients with cervical LAPs in a general pediatrics clinic setting, and to evaluate follow-up results for potential causes and risk factors for malignancies. MATERIAL AND METHODS Two hundred-eighteen patients aged between 79.4±46.7 months with LAP were enrolled in this prospective cohort study. The patients were examined in terms of demographics, clinical, radiologic and serologic aspects like Epstein-Barr virus (EBV), cytomegalovirus (CMV), parvovirus B19. A lymph node biopsy was performed in selected patients. The patients were followed-up for 8 weeks and risk factors for malignancy were evaluated. RESULTS Seventy patients (41.3%) had specific etiology and 6 (2.7%) had malignant causes. The causes were as follows: 27% (n=59) infections; 2.7% (n=6) malignancies; 11.4% (n=25) other causes. EBV was responsible for 27% of infectious causes. The other common infectious etiologies were CMV 4.3%, parvovirus B-19 2.9%, and group-A beta-hemolytic streptococcus (GAS) 10.8%. Four of the six malignancies were lymphomas. Predictive factors for malignancy were having LAP larger than 30mm, rubbery lymph node, high serum CRP and LDH values, no hilum in ultrasonography, and enlargement of lymph node in follow-up. High uric acid levels and leucopenia were also common in the malignancy group. CONCLUSION Etiology of cervical LAPs was diagnosed in 41.3% patients. Infectious causes were the most common cause with 27%. Malignancy was diagnosed in 2.7% and lymphoma was the most common malignancy.
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Affiliation(s)
- Serdar Bozlak
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Istanbul, Turkey.
| | - Muhammet Ali Varkal
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Division of Ambulatory Pediatrics, Istanbul, Turkey.
| | - Ismail Yildiz
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Division of Ambulatory Pediatrics, Istanbul, Turkey.
| | - Sadik Toprak
- Bulent Ecevit University, Faculty of Medicine, Department of Forensic Medicine, Zonguldak, Turkey.
| | - Serap Karaman
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology & Oncology, Istanbul, Turkey.
| | - Oguz Bülent Erol
- Istanbul University, Istanbul Faculty of Medicine, Department of Radiology, Division of Pediatric Radiology, Istanbul, Turkey.
| | - Ensar Yekeler
- Istanbul University, Istanbul Faculty of Medicine, Department of Radiology, Division of Pediatric Radiology, Istanbul, Turkey.
| | - Ayşegul Unuvar
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology & Oncology, Istanbul, Turkey.
| | - Ayse Kilic
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Division of Ambulatory Pediatrics, Istanbul, Turkey.
| | - Fatma Oguz
- Istanbul University, Institute of Child Health, Istanbul, Turkey.
| | - Emin Unuvar
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Division of Ambulatory Pediatrics, Istanbul, Turkey.
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Toprak S, Ersoy G, Hart J, Clevestig P. The pathology of lethal exposure to the Riot Control Agents: towards a forensics-based methodology for determining misuse. J Forensic Leg Med 2014; 29:36-42. [PMID: 25572084 DOI: 10.1016/j.jflm.2014.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 08/20/2014] [Accepted: 11/28/2014] [Indexed: 10/24/2022]
Abstract
The aim of this is to review deaths associated with the use of Riot Control Agents (RCAs) and to assess how the presenting pathologies is such cases may better inform cause of death conclusions upon autopsy. We also sought to present which additional steps should be added to the Minnesota protocol and the European harmonization of medico-legal autopsy rules in suspected cases of deaths associated with the use of RCAs. We included 10 lethal cases in our study. In three cases, RCAs were found to be the sole cause of death, in three cases RCAs were ruled a secondary cause of death due asphyxia or asthma subsequent to exposure to RCAs and in four cases RCAs were contributory factors to death. In three cases the responsible agents were identified as Chloroacetophenone (CN), Chlorobenzylidene malononitrile (CS) and Oleoresin capsicum (OC) and in the remaining 7 cases, the agent was OC alone. As there are no specific findings in suspected cases of death associated with RCA use, establishing cause of death and whether RCAs are the sole cause or only a contributory factor will be based on the elimination of other possible causes of death. For this reason, a specifically structured autopsy is essential. This specifically structured autopsy should contain basic principles of the Minnesota Protocol and the European harmonization of medico-legal autopsy rules with the following additional steps taken: examination of clothing, eyes, and skin; examination of pharyngeal, tracheobronchial, and eusophegeal mucosas; and a thorough recording of the steps taken by the party conducting the arrest, including other possible causes of in-custody death, as well as a detailed medical history of the deceased.
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Affiliation(s)
- Sadik Toprak
- Department of Forensic Medicine, Bulent Ecevit University, Zonguldak, Turkey.
| | - Gokhan Ersoy
- Istanbul University, Institute of Forensic Medicine, Istanbul, Turkey.
| | - John Hart
- Stockholm International Peace Research Institute, Signalistgatan 9, 169 70 Solna, Sweden.
| | - Peter Clevestig
- Stockholm International Peace Research Institute, Signalistgatan 9, 169 70 Solna, Sweden.
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12
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Yildiz I, Unuvar E, Zeybek U, Toptas B, Cacina C, Toprak S, Kilic A, Aydin S. The role of vitamin D in children with recurrent tonsillopharyngitis. Ital J Pediatr 2012; 38:25. [PMID: 22682426 PMCID: PMC3453523 DOI: 10.1186/1824-7288-38-25] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 05/07/2012] [Indexed: 12/31/2022] Open
Abstract
Background The exact etiology of recurrent tonsillopharyngitis in children is not clear. Recurrent tonsillitis in children has multifactorial etiology like most of the diseases in childhood. In this study, our aim was to determine the potential role of vitamin D in recurrent tonsillitis by measuring serum 25-OH vitamin D levels and determining the vitamin D receptor polymorphism among children with recurrent tonsillitis. Methods Eighty-four children with recurrent tonsillitis and seventy-one healthy children aging between 2 and 10 years were enrolled in this study. Serum 25-OH vitamin D level was measured with ELISA and vitamin D receptor gene polymorphism (Apa1, Taq 1, Fok1) was determined by PCR. Serum 25-OH vitamin D level below 50 nmol/L was accepted as deficiency. The vitamin D receptor gene polymorphism in each group was compared. Results The mean age was 5.6 ± 2.4 and 6.1 ± 2.7 years in study and control group, respectively. The average serum 25-OH vitamin D level was 142.7 ± 68.1 nmol/L in study group and 192.3 ± 56.1 nmol/L in control group. There was significant difference between the groups (p < 0.01). In study group, 4.7% (n = 4) of children had serum 25 OH vitamin D levels below 50 nmol/L. None of the children in control group had serum 25-OH vitamin D level below 50 nmol/L. There was no significant differences in vitamin D receptor gene polymorphisms between groups. Conclusion Serum 25-OH vitamin D levels in recurrent tonsillitis group were lower than those in healthy children. But, there was no difference in the incidence of vitamin D receptor gene polymorphism between the two groups.
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Affiliation(s)
- Ismail Yildiz
- Istanbul Medical Faculty, Department of Pediatrics, Istanbul University, Istanbul, Turkey
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Toprak S, Cetin I, Guven T, Can G, Demircan C. Self-harm, suicidal ideation and suicide attempts among college students. Psychiatry Res 2011; 187:140-4. [PMID: 21040980 DOI: 10.1016/j.psychres.2010.09.009] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Revised: 09/18/2010] [Accepted: 09/26/2010] [Indexed: 11/18/2022]
Abstract
Self-harm, suicidal ideation, and suicide attempts are well represented behaviours in the general population of both developed and developing countries. These behaviours are indicative of underlying risk factors that show a strong interdependent correlation. In this study we attempted to define correlates for and prevalence of self-harm, suicidal ideation, and suicide attempts among Turkish college students. This 2006 study included 636 students from two Turkish state universities. Our results showed that the lifetime prevalence of self-harm was 15.4%, the prevalence of suicidal ideation was 11.4%, and the prevalence of suicide attempts was 7.1%. We uncovered correlates for self-harm, including low income, unsatisfying familial relationships, smoking, and alcohol, inhalant, and tranquilizer abuse. Tranquilizer abuse shared a dual role as a correlate for suicide ideation and as a means to attempt suicide. Additionally, we found that drug abusers and adolescents who practise self-harm presented the highest suicide risk.
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Affiliation(s)
- Sadik Toprak
- Forensic Medicine Department, Zonguldak Karaelmas University, 67600 Zonguldak, Turkey.
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Hakverdi S, Güngören A, Yaldiz M, Hakverdi AU, Toprak S. Immunohistochemical analysis of p16 expression in uterine smooth muscle tumors. EUR J GYNAECOL ONCOL 2011; 32:513-515. [PMID: 22053664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The expression of p16 as a tumor suppressor protein was evaluated in a retrospective analysis of paraffin-embedded tissue specimens of leiomyosarcoma (LMS), leiomyoma (LM) and normal myometrium. In this study, we investigated by immunohistochemistry p16 expression in 15 LMSs, 15 LMs and ten normal myometrium. Strong expression of p16 was found in 12 of the 15 LMSs and in three cases weak expression; three LMs had focal and weak p16 staining but none of the normal myometrium. A statistically significant difference regarding the frequency of p16 protein expression was observed between LMS and LM (p: 0.0001). We concluded that the results of this study confirm the overexpression of p16 in LMS. Therefore, the present study suggests that p16 might be a useful immunohistochemical marker which could help in distinguishing uterine LMS from LM and its benign variants.
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Affiliation(s)
- S Hakverdi
- Department of Pathology, Faculty of Medicine, Mustafa Kemal University,of Medicine, Mustafa Kemal University, Antakya, Hatay, Turkey.
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Unuvar E, Tamay Z, Yildiz I, Toprak S, Kilic A, Aydin S, Kilic G, Guler N, Oguz F, Sidal M. Effectiveness of erdosteine, a second generation mucolytic agent, in children with acute rhinosinusitis: a randomized, placebo controlled, double-blinded clinical study. Acta Paediatr 2010; 99:585-9. [PMID: 20055782 DOI: 10.1111/j.1651-2227.2009.01646.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To evaluate whether mucolytic agents have an adjuvant role with antibiotics in the treatment of children with rhinosinusitis. METHODS Ninety-two children with rhinosinusitis were recruited for this randomized, placebo controlled, double-blinded clinical trial. Mean age was 8.5 +/- 3.2 years. Erdosteine (5-8 mg/kg/day) was administered to 49 children, and 43 children received placebo. Changes in symptoms were recorded with the standard S5 scoring for 14 days. Complete resolution of symptoms on day 14 was considered to be clinical improvement. RESULTS Eighty-one participants completed the study. Forty-one were in the treatment group and 40 in the placebo group. The average S5 scoring value at the onset of study was 11.0 in treatment group and 12.1 in placebo group. On day 14, mean scores were 3.1 in the treatment group and 2.8 in the placebo group. Complete improvement was 78% in the treatment group and 74.4% in the placebo group. There was no significant difference between the groups. There were no clinically detected serious side effects or complications in both groups. CONCLUSION Use of erdosteine as a mucolytic agent in children with acute rhinosinusitis does not directly affect the success of treatment.
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Affiliation(s)
- E Unuvar
- Department of Pediatrics, Istanbul School of Medicine, Istanbul University, Capa, Istanbul, Turkey.
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Cetin I, Egri M, Celbis O, Toprak S, Ozag K. The relationship between terrorist activities and cases of malaria in the eastern and south-eastern regions of Turkey, 1984–1998. Trans R Soc Trop Med Hyg 2008; 102:255-8. [DOI: 10.1016/j.trstmh.2007.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Revised: 12/04/2007] [Accepted: 12/04/2007] [Indexed: 11/15/2022] Open
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Unuvar E, Yildiz I, Kilic A, Toprak S, Aslan SS, Aydin S, Badur S, Oguz F, Sidal M. Is acetaminophen as effective as an antihistamine-decongestant-acetaminophen combination in relieving symptoms of acute nasopharyngitis in children? A randomised, controlled trial. Int J Pediatr Otorhinolaryngol 2007; 71:1277-85. [PMID: 17560664 DOI: 10.1016/j.ijporl.2007.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2007] [Revised: 04/30/2007] [Accepted: 05/02/2007] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To determine the efficiency of drugs, which include antihistaminic-decongestant-acetaminophen agents versus only acetaminophen in symptomatic treatment of acute nasopharyngitis in children. METHODS This clinical, randomized, controlled, single blind drug efficacy comparison research was conducted in 148 patients with acute nasopharyngitis between ages 2 and 12 years. After randomization, Group-1 consisted of cases (n: 86), which used OTC drugs [acetaminophen+diphenhydramine+pseudoephedrin] and Group-2 consisted of cases (n: 62), which used only acetaminophen. After receiving nasal swab for showing the viral etiology, symptoms were scored clinically on admission and then on 10 days follow-up period, and re-evaluated on the third and fifth days of the drug therapy with the same scoring scale. Any complications were noted during the 1-month follow-up period after taking the drugs. RESULTS The virus isolation rate in Group-1 was 27.9% and in Group-2 was 22.6%. At the first day of study, before medication, clinic scores of the groups did not show a significant difference (Group-1 1.7 versus Group-2 2.0). Clinic scores in both groups on the third (Group-1 4.0 versus Group-2 4.1) and fifth days of therapy (Group-1 1.7 versus Group-2 2.0) were not different either. Also, the complication rate was not different during the 1-month follow-up period (Group-1 2.3% versus Group-2 8.0%, p: 0.12). The family response for the drug satisfaction in both groups was similar and positive. CONCLUSION For relieving symptoms of acute nasopharyngitis in children, acetaminophen without any combination is as effective as OTC drugs containing acetaminophen, decongestant, and antihistaminics.
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Affiliation(s)
- Emin Unuvar
- Department of Pediatrics, Istanbul University, Istanbul Medical Faculty, Capa, TR-34390, Istanbul, Turkey.
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Unuvar E, Ahmadov H, Kiziler AR, Aydemir B, Toprak S, Ulker V, Ark C. Mercury levels in cord blood and meconium of healthy newborns and venous blood of their mothers: clinical, prospective cohort study. Sci Total Environ 2007; 374:60-70. [PMID: 17258795 DOI: 10.1016/j.scitotenv.2006.11.043] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2006] [Revised: 11/20/2006] [Accepted: 11/28/2006] [Indexed: 05/13/2023]
Abstract
OBJECTIVES The purpose of this study is to investigate the chronic mercury intoxication in pregnant women and newborns living in Istanbul, Turkey. METHODS The research was carried out as a prospective with 143 pregnant women and their newborns. Venous blood from the mother, cord blood from the neonate, and meconium were collected for mercury analysis. Frequency of fish and vegetable-eating and the number of teeth filled were investigated. Analyses were made in cold vapor Atomic Absorption Spectrophotometer (AAS, microg/L). RESULTS Mercury levels were 0.38+/-0.5 microg/L (0-2.34) in venous blood of pregnant women, 0.50+/-0.64 microg/L (0-2.36) in umbilical cord blood and 9.45+/-13.8 microg/g (0-66.5) in meconium. Maternal blood mercury level was lower than the known toxic limit for humans (EPA, 5 microg/L). Mercury levels of the maternal venous blood were significantly correlated with umbilical cord blood. The primary risk factors affecting mercury levels were eating fishmeals more than twice a week and having filled teeth more than five. The fact that the mother had a regular vegetable diet everyday reduced the mercury levels. Increased levels of mercury in the mother and umbilical cord blood could lead to retarded newborns' weight and height. CONCLUSION Pregnant women living in Istanbul may be not under the risk of chronic mercury intoxication. Fish consumption more than twice per week and tooth-filling of mother more than five may increase mercury level. On the contrary, regular diet rich in vegetable decreases the mercury level.
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Affiliation(s)
- Emin Unuvar
- Istanbul University, Department of Pediatrics, Istanbul, Turkey.
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Abstract
The species composition and seasonal abundance of sand flies (Diptera: Phlebotominae) were studied in the years 2000-2002 in the Sanliurfa region, which is the largest focus of cutaneous leishmaniasis in south-eastern Turkey. Sixteen species were identified among 29 771 specimens collected at 17 different sites by light traps, sticky papers and aspirators. The most common species were Phlebotomus papatasi (Scopoli) (45.4%), P. perfiliewi Parrot (21.9%), and P. sergenti Parrot (19.4%). The other species found were P. major Adler & Theodor (3%), P. neglectus Leger & Pesson (2.2%), P. brevis Theodor & Mesghali (2%), P. alexandri Sinton (1.9%), P. galilaeus Theodor (1.6%), P. halepensis Theodor (0.84%), Sergentomyia adleri Theodor (0.78%), S. dentata Sinton (0.49%), S. minuta Rondani (0.42%), S. theodori Parrot (0.16%), P. kazeruni Theodor & Mesghali (0.001%) and P. mascitti Grassi (0.001%) and one unidentified Phlebotomus species. Among these species P. galilaeus, S. minuta and S. dentata are the first records for this area. All species showed seasonal fluctuations, with the period of highest abundance between May and October.
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Affiliation(s)
- S Toprak
- Biology Department, Harran University, Sanliurfa, Turkey
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Keleş I, Onat A, Toprak S, Avci GS, Sansoy V. Family income a strong predictor of coronary heart disease events but not of overall deaths among Turkish adults: a 12-year prospective study. Prev Med 2003; 37:171-6. [PMID: 12855217 DOI: 10.1016/s0091-7435(03)00112-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this study was to assess whether family income affected future deaths and coronary heart disease (CHD) events. DESIGN A prospective population-based survey (the Turkish Adult Risk Factor study) was used. SETTING The setting was numerous communities in all geographic regions of Turkey surveyed between 1990 and 2001/2002. SUBJECTS The subjects were a random sample of 2704 men and women 20 years of age or over at baseline examination. METHOD Monthly family incomes were categorized by the participants into four increasing brackets. Information on the mode of deaths was obtained from first-degree relatives and/or health personnel of the local heath office. The diagnosis of definite or suspected CHD among survivors was based on history, physical examination of the cardiovascular system, and Minnesota coding of resting ECGs. CHD event was defined as newly developed fatal or nonfatal myocardial infarction, new onset stable angina, and/or myocardial ischemia following the baseline survey. After exclusion of participants with CHD at onset, 250 deaths and 297 fatal and nonfatal CHD occurred among 2704 men and women (mean age 41.6+/-15) during a mean 10.0 years of follow-up. MAIN RESULTS All-cause deaths failed to be significantly associated with income brackets in logistic regression analysis when adjusted for age, sex, and three major risk factors. Systolic blood pressure and cigarette smoking were significant independent predictors of overall mortality. In regard to fatal and nonfatal CHD, even after adjusting for age, sex and three major risk factors, a significant excess was noted in the two lowest brackets as opposed to the high income bracket (relative risk 1.56 and 1.75, respectively, P<0.03). CONCLUSIONS Family income in the Turkish community was not predictive of overall mortality, but was strongly predictive of future CHD events independent of age, sex, and three major factors, posing a huge coronary risk on the individual and the society.
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Affiliation(s)
- Ibrahim Keleş
- Turkish Society of Cardiology, Ministry of Justice, Istanbul, Turkey
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Onat A, Hergenç G, Sansoy V, Fobker M, Ceyhan K, Toprak S, Assmann G. Apolipoprotein C-III, a strong discriminant of coronary risk in men and a determinant of the metabolic syndrome in both genders. Atherosclerosis 2003; 168:81-9. [PMID: 12732390 DOI: 10.1016/s0021-9150(03)00025-x] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIMS Apolipoprotein C-III (apoC-III) has been recognized as a useful marker of triglyceride-rich lipoproteins (TRLs) metabolism and proposed as an indicator of prognosis for coronary risk in healthy subjects. We studied cross-sectionally in a population having low cholesterol levels, but a high prevalence of the metabolic syndrome, whether serum levels of total apoC-III or its sub-fractions were independent markers of prevalent coronary heart disease (CHD) or were related to variables reflecting the metabolic syndrome. METHODS AND RESULTS In 857 unselected participants of the representative population sample of the Turkish Adult Risk Factor Survey in 2001, apoC-III as well as other risk variables were evaluated, and CHD was diagnosed based on clinical findings and Minnesota coding of resting electrocardiograms. The sample consisted of men and women, aged 33-82 years, having a mean waist circumference of 89.4 and 92.9 cm, respectively, 42% of whom had the metabolic syndrome identified by criteria of the ATP III. ApoC-III values were measured by turbidimetric immunoassay. Mean concentrations for non-high-density lipoprotein (nonHDL) apoC-III in men and women were 6.4 and 6.2 mg/dl, respectively, and for apoC-III in HDL were 6.2 and 6.3 mg/dl, respectively. NonHDL apoC-III was similar to, and apoC-III in HDL was higher than that in Western populations. Both fractions of apoC-III were significantly correlated with lipids, lipoproteins, apoB, anthropometric measures, and blood pressures in both genders. Correlations for both were high with serum triglycerides (r(s)=around 0.70) and apoB (r(p)=around 0.37). Total apoC-III as well as both fractions were significantly correlated in women also with levels of inflammatory risk markers: strongly (r=0.40-0.45, P<0.001) with complement C3, and weakly (r(s)=around 0.20, P<0.001) with C-reactive protein. A cutoff of >7.0 mg/dl as opposed to lower levels of nonHDL apoC-III indicated the presence of hypertriglyceridemic hyperapo B with an age-adjusted odds ratio (OR) of 13.8; it indicated the presence of metabolic syndrome with 4.66-fold likelihood. Total apoC-III and nonHDL apoC-III proved to be significantly (P-trend <0.05 and 0.002) and strongly associated with prevalent CHD in men even after adjustment for age, low-density lipoprotein-cholesterol (LDL-C) and high-density lipoprotein-cholesterol (HDL-C): OR gradients across upper and lower quartiles were 3.88-fold (CI: 1.3; 11.4) and 8.8-fold (CI: 2.6; 29.8), respectively. CONCLUSIONS In a population among whom the metabolic syndrome prevails, total- and nonHDL apoC-III are each a determinant in both genders of the metabolic syndrome and of hypertriglyceridemic hyperapo B. Each is a powerful significant marker of prevalent CHD in men independent of LDL- and HDL-C levels. In women, despite being correlated with inflammatory risk markers, the significant association of elevated levels of apoC-III with CHD did not prove to be independent of age.
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Affiliation(s)
- Altan Onat
- Turkish Society of Cardiology, Istanbul University, Nisbetiye cad. 37/24, Etiler, Turkey.
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Yol S, Belviranli M, Toprak S, Kartal A. Endoscopic clipping versus band ligation in the management of bleeding esophageal varices. Surg Endosc 2003; 17:38-42. [PMID: 12364992 DOI: 10.1007/s00464-002-9033-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2002] [Accepted: 06/06/2002] [Indexed: 01/29/2023]
Abstract
BACKGROUND The effectiveness of endoscopic clipping in the hemostasis of bleeding esophageal varices and the eventual variceal eradication was compared with that of band ligation. METHODS Forty patients were enrolled in the study in a prospective manner, 19 of whom received endoscopic clipping (group I) and the remaining (n = 21 patients) received endoscopic band ligation (group II). All patients in this study presented with bleeding from esophageal varices. The patient characteristics (age, sex, Child-Pugh score, variceal grade) were comparable in the two groups. After initial hemostasis, the patients were assigned one of the two forms of endoscopic therapy which was continued in the follow-up sessions until varices were eradicated. Early and late results were compared. RESULTS Initial hemostasis was achieved in all patients in group I but two patients in group II required clip ligation for initial hemostasis because of the failure in band ligation. Those two were treated with band ligation in the follow-up sessions. A total of 224 clips in 53 treatment sessions and 296 bands in 82 treatment sessions were placed in group I and group II, respectively. The rates of complete variceal eradication were 89% and 76% in group I and group II, respectively (p > 0.05). The median number of required treatment sessions for complete eradication of the varices was significantly lower in group I than group II (3 versus 4, p = 0.013). Three patients from group I (15%) and seven patients from group II (33%) were readmitted for variceal bleeding during the follow-up period (p > 0.05). CONCLUSIONS With the advantages of high initial hemostasis rate, decreased risk of rebleeding, and fewer treatment sessions needed for variceal eradication, endoscopic clipping is as effective as band ligation, or perhaps more effective in the treatment of bleeding esophageal varices.
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Affiliation(s)
- S Yol
- Department of General Surgery, Faculty of Medicine, Selçuk University, 42200, Konya, Turkey.
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Onat A, Hergenec G, Sansoy V, Fobker M, Ceyhan K, Toprak S, Assmann G. 2P-0333 Apo C-III, a strong discriminant of coronary risk in men and a determination of the metabolic syndrome in both genders. ATHEROSCLEROSIS SUPP 2003. [DOI: 10.1016/s1567-5688(03)90476-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Onat A, Ceyhan K, Başar O, Erer B, Toprak S, Sansoy V. Metabolic syndrome: major impact on coronary risk in a population with low cholesterol levels--a prospective and cross-sectional evaluation. Atherosclerosis 2002; 165:285-92. [PMID: 12417279 DOI: 10.1016/s0021-9150(02)00236-8] [Citation(s) in RCA: 211] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED The prevalence and the excess coronary heart disease (CHD) risk of the metabolic syndrome (MS) and its components were investigated in the Turkish Adult Risk Factor Study in both a prospective and a cross-sectional manner. In a population sample, representative of Turkish adults who have low levels of high- and low-density lipoprotein-cholesterol (HDL-C and LDL-C), MS was identified in conformity with the definition used in the recent NCEP guidelines. Prospective analysis was based on 2398 men and women (mean age at baseline 49.1+/-13 years) who had a baseline examination in 1997/98 and were followed-up for a mean of 3 years. CHD was diagnosed based on clinical findings and Minnesota coding of resting electrocardiograms. Fatal and nonfatal CHD developed in 126 subjects. 27% of men and 38.6% of women were found to have MS at baseline examination. When adjusted for age, MS was an independent predictor of subsequent overall fatal and nonfatal CHD in both genders, displaying an RR of 1.71. At the final cross-sectional evaluation, coronary risk associated with MS in men was primarily accounted for by standard MS components (largely inherent in glucose intolerance, hypertension and in a surrogate of small, dense LDL particles), in addition to a minor independent contribution by C-reactive protein (CRP). In women with MS, a substantial residual coronary risk remained after controlling for five components, which was partly accounted for by levels of LDL-C and CRP. It was estimated that MS was the culprit in just over half the cases of CHD in Turkey. CONCLUSION MS was the major determinant of CHD risk in a population having generally low levels of HDL-C and LDL-C in middle-aged and elderly adults, extending to three out of every eight adults, and imposing an overall excess CHD risk of approximately 70%. In contrast to men, a substantial residual coronary risk is retained in Turkish women after controlling for five MS components.
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Affiliation(s)
- Altan Onat
- Turkish Society of Cardiology, Istanbul, Turkey.
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Toprak S, Yönem A, Cakir B, Güler S, Azal O, Ozata M, Corakçi A. Insulin resistance in nonobese patients with polycystic ovary syndrome. Horm Res 2001; 55:65-70. [PMID: 11509861 DOI: 10.1159/000049972] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Most patients with polycystic ovary syndrome (PCOS) are obese and known to have insulin resistance. Obesity per se is a cause of insulin resistance. This study was performed to determine whether insulin resistance occurs in patients with PCOS in the absence of obesity and acanthosis nigricans. METHOD For this purpose, an euglycemic hyperinsulinemic clamp study was performed in 12 nonobese patients with PCOS and in 10 healthy control subjects matched for age and weight. RESULTS The mean serum testosterone and luteinizing hormone (LH) levels were significantly elevated (4.09 +/- 1.32 vs. 1.18 +/- 0.53 pg/ml, p < 0.001, and 11.63 +/- 5.37 vs. 4.98 +/- 2.73 mIU/ml, p < 0.001, respectively), and the serum sex hormone binding globulin level was significantly reduced (40.96 +/- 14.94 vs. 73.98 +/- 30.40 nmol/l, p < 0.001) in patients with PCOS as compared with the values in control subjects. The mean serum insulin level was also elevated in patients with PCOS as compared with control subjects (32.33 +/- 4.98 vs. 19.56 +/- 2.21 microU/ml, p < 0.05). The insulin sensitivity was lower in patients with PCOS as compared with the control subjects (200 +/- 27.8 vs. 427.8 +/- 88.9 micromol x kg(-1) x min(-1), p < 0.001). In patients with PCOS, the serum levels of free testosterone (r = -0.89, p < 0.001) and LH were inversely correlated with the insulin sensitivity (r = -0.63, p < 0.05). Serum follicle-stimulating hormone, prolactin, and dehydroepiandrosterone sulfate levels were similar in both groups. CONCLUSIONS These results indicate that a significant degree of insulin resistance exists in nonobese patients with PCOS and that this insulin resistance is significantly related to serum LH and free testosterone levels. Thus, measures to decrease insulin resistance may have to be considered earlier to decrease the potential risks of developing diabetes mellitus and coronary artery disease at later ages of life in these patients.
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Affiliation(s)
- S Toprak
- Department of Endocrinology and Metabolism, Gülhane School of Medicine, Ankara, Turkey
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Ozkan H, Ay N, Ozaksoy D, Ercal D, Erata Y, Durak H, Evyapan O, Toprak S. Congenital chylothorax. Turk J Pediatr 1996; 38:113-7. [PMID: 8819631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Congenital chylothorax is a rare condition in which chyle accumulates in the pleural space because of an intrauterine obstruction or anomalies of the thoracic duct. This paper presents a case of congenital chylothorax diagnosed antepartum echographically. The patient's history revealed a previous sibling with a similar diagnosis. The baby developed respiratory distress after delivery and the diagnosis was established by thoracentesis. Computed tomography of the chest and nuclear lymphangiography were obtained to evaluate the origin of the pleural effusion, but a congenital fistula or other pathology of the thoracic duct could not be demonstrated. Management of the baby consisted of ventilatory support in the delivery room, repeated thoracentesis and thoracostomy tube drainage, total parenteral nutrition and formula containing medium-chain triglycerides. The infant was discharged six weeks after birth in good condition.
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Affiliation(s)
- H Ozkan
- Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
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