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Öğe Antibody Response to Hepatitis B Vaccination in Isolated Anti-Hbc IgG Positive Cases(Galenos Yayincilik, 2012) Kazak, Esra; Yilmaz, Emel; Mistik, Resit; Akalin, Halis; Akgoz, Semra; Goral, GuherObjective: We aimed to investigate the antibody response secondary to 1 dose of hepatitis B vaccine and factors affecting this response in isolated cases of anti-HBc IgG positive cases. Materials and Methods: Fortyone people who were positive for isolated anti-HBc and negative for other markers of hepatitis B were recruited in the study. The level of anti-HBs was measured at the 10th and 30th day after the administration of hepatitis B vaccine to these 41 people. HBV-DNA was searched with PCR in people who did not developed a secondary antibody response to one dose of vaccination at Day 10 and 30. Results: Anti-HBs was found to be at protective levels (>= 10 IU/mL) in 27 (65.8 %) out of 41 people included in the study. The antibody response developed in 27 people with one dose of vaccination was thought to be a secondary response, and the 14 people who did not form anti-HBs and were found to be negative for HBVDNA by PCR were thought to have false anti-HBc positivity and be inactive HBs Ag carriers (HBs Ag falling below the measurable level in time and presence of antiHBe or preS, S, precor, cor mutant strain infection). There was a highly significant correlation between antibody levels at Day 10 and Day 30 (p< 0.001). In addition, when the antibody levels of people who developed secondary response at Day 10 were investigated, antibody levels of non-smokers were found to be (0-1000 IU/mL; 194.3 +/- 327.2 IU/mL) significantly higher compared to smokers (0-70 IU/mL; 12 +/- 21.8 IU/mL) (p= 0.015). No statistically significant difference was determined between the antibody responses at Day 10 and Day 30 of people with a history of diabetes mellitus (DM), malignity, chronic diseases, alcohol consumption, previous HBsAg positivity and HBV-DNA positivity, anti-HCV positivity, and hepatitis B carriers in the family (p> 0.05). Conclusion: An anamnestic response is suggested in people who give anti-HBs response to one dose of hepatitis B vaccine. However, a false anti-HBc IgG positivity or undetectable levels of HBs Ag should be considered in people who do not give antibody response. According to our results smoking affects the level of antibody response negatively. But we need further studies involving more people.Öğe Comparison of fragmented QRS and myocardial perfusion-gated SPECT findings(Lippincott Williams & Wilkins, 2013) Ozdemir, Semra; Tan, Yusuf Ziya; Colkesen, Yuecel; Temiz, Ahmet; Turker, Fatmanur; Akgoz, SemraAimFragmented QRS (fQRS) complex is an ECG parameter that has recently been introduced and investigated. It is assumed that fQRS occurs because of disruptions in ventricular conduction due to ventricular infarction and ischemia. Therefore, in this article, we aimed to investigate the relationship between the detection of infarction and ischemia on myocardial perfusion-gated single-photon emission computed tomography images and appearance of fQRS on ECG.Materials and methodsWe retrospectively reviewed the records of patients with a diagnosis of coronary artery disease who were referred to our institution for myocardial perfusion scintigraphy. In total, 261 patients (122 women and 139 men, with a mean age of 6110.33 years) with and without fQRS (136 and 125, respectively) were included in the present study. The myocardial perfusion scintigraphy results were evaluated for the presence or absence of myocardial ischemia and infarction by visual and quantitative (summed stress score, summed rest, summed difference score, summed motion score, and summed thickening score) assessments. Statistical analysis was performed to determine the relationship between the presence of fQRS and myocardial ischemia and/or infarction. Student's t-test and the Mann-Whitney U-test were used for comparing the results. Pearson's (2)-test and Fisher's exact tests were also used to compare the distribution of variables between the two groups.ResultsThe prevalence of ischemia and infarction were found to be, respectively, 4.38-fold and 5.95-fold higher in patients with fQRS compared with the control group. Moreover, the prevalence of both ischemia and infarction was found to be 10.54-fold higher in patients with fQRS compared with the control group.ConclusionThere is a highly statistically significant possibility of detecting ischemia and infarction in perfusion myocardial scintigrams of patients whose ECGs have fQRS. (C) 2013 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.Öğe Hepatitis B Seroprevalance Among Health care Workers in a Tertiary Hospital(Galenos Yayincilik, 2013) Alper Akçalı; Sener, Alper; Otkun, Muserref Tatman; Akgoz, Semra; Otkun, Ali MetinObjective: In this study it is aimed, to determine the seroprevalence of HBV in health care workers in our hospital and to determine the factors that affect the epidemiology of transmission. Materials and Methods: Serum samples were taken from those of the hospital employees between June 2009-June 2010 and a questionnaire was held. Samples were tested for HBsAg, antiHBs and antiHBc total with MEIA method with an autoanalyser. Results: The mean age of the study group was 30.9 (+/- 6.9) and 100 men, 156 women participated on a voluntary basis. Professions were grouped as, 95 doctors, 60 nurses, midwives, 26 technicians, 16 laboratory technicians, biologists, 13 nurses, 19 cleaners, 27 administrative and technical staff. 188 people under 10 years, and 68 people over ten years worked in the field of health care. In this study, 22 people found contacted with HBV (8.6%), 234 persons (91.4%) were not contacted with HBV, 166 of them (64.8%) were vaccinated. One person (0.4%) were positive for HBsAg. None of the nursing aides was vaccianted, 26.3% of cleaning workers were found to be vaccinated. According to the results of laboratory tests, among needle injured person in the last year, being vaccinated (25 persons, 89.3%) and to have prior infection (27 people, 96.4%) rates were significantly higher (p = 0.003). By multivariate multinomial logistic regression analysis to determine the factors that affect transmission of hepatitis B, none of the variables was observed as a significant factor (p> 0.05). Conclusion: HBsAg seroprevalence is very low compared to other studies in our hospital. Vaccination rate is high. However, nurses and cleaning personnel vaccination rate found particularly low. Considering that these services are carried out in health care settings by frequently changing personnel, training and vaccination of these individuals should be planned before starting the work. While needlestick and sharp injuries were seen mostly by people those previously infected or vaccinated, this suggest that these people must be trained and informed again about bloodborne infectious agents like HBV and others.Öğe The cardiopulmonary effects of sevoflurane, isoflurane and halothane anesthesia during spontaneous or controlled ventilation in dogs(Ankara Univ Press, 2009) Cecen, Goeksen; Topal, Ayse; Gorgul, O. Sacit; Akgoz, SemraThe objective of this study was to investigate the cardiopulmonary effects of sevoflurane (SEV), isoflurane (ISO) and halothane (HAL) anesthesia during spontaneous ventilation (SV) or controlled ventilation (CV) in dogs. An experimental study was designed. Sixty healthy cross breed dogs were used for the study. Dogs were randomly allocated to six anesthesia groups (n = 10 in each group): SEV/SV; SEV/CV; ISO/SV; ISO/CV; HAL/SV; HAL/CV. After premedication with xylazine HCl, anesthesia was induced with thiopental sodium. Inhalation anesthesia was maintained for 90 minutes with SEV, ISO, or HAL. Cardiopulmonary parameters [heart rate (HR), respiratory rate (RR), mean arterial blood pressure (MAP), end tidal carbon dioxide level (ETCO2), oxygen saturation (SpO(2)), central venous pressure (CVP), body temperature, arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), and arterial pH] were measured after induction of anesthesia; the first measurement was taken one minute after the loss of consciousness with SEV, ISO, or HAL and the others were done at 15th, 30th, 45th, 60th and 90th minutes. There was not any significant difference in HR between anesthetics among SV and CV. RR decreased significantly during ISO and HAL anesthesia in SV (p < 0.001). MAP decreased significantly in all groups but there was not any significant difference between the ventilation modes. There was a significant decrease in ETCO2 during CV compared to SV (p < 0.001). The CVP values during anesthesia with SEV in SV were lower than those of other anesthetics (p < 0.001). Body temperature decreased significantly during ISO and HAL anesthesia compared to SEV anesthesia (p < 0.001). Compared with SV, CV prevented the increase in PaCO2 (p < 0.001) and no decrease in pH was observed (p < 0.05). It is concluded that SEV anesthesia was appeared to have minimum complications on cardiopulmonary parameters in the healthy dogs which were premedicated with xylazine HCL and inducted with thiopental sodium. In the study, the use of CV was not associated with cardiovascular embarrassment during inhalation anesthesia and it was provide a more stable plane of anesthesia.Öğe The effect of blood albumin and total lymphocyte count on short-term results in elderly patients with hip fractures(Turkish Assoc Trauma Emergency Surgery, 2009) Ozturk, Alpaslan; Ozkan, Yuksel; Akgoz, Semra; Yalcin, Nazan; Aykut, Serkan; Ozdemir, Mehmet RecaiBACKGROUND A study was performed to deter-mine the effects of blood albumin and total lymphocyte count on the postoperative one-year period in 74 elderly hip fracture patients. METHODS In 2006, 74 patients (52 female, 22 male) with hip fracture who were 65 years of age or older were included in the study. Admission albumin levels and total lymphocyte counts were recorded. The outcomes examined were mortality, length of hospital stay and ambulatory ability. Ambulatory ability was assessed according to Parkland and Palmer criteria. RESULTS There were 61 patients aged 65-84 years, and 13 patients aged 85-105 years. Forty-one patients (55.4%) had hypoalbuminemia and 23 patients (31.1%) had low total lymphocyte count. Low albumin and total lymphocyte counts were associated with higher mortality (p=0.011). Patients with low albumin levels had longer length of hospital stay (p=0.002). Patients with normal albumin and total lymphocyte counts had higher mobility score meaning better function (p=0.012). Multivariate analysis yielded that low total lymphocyte count, American Society of Anesthesiologists (ASA) 3-4 and female gender remained significant independent predictors of one-year mortality. No single blood parameter was found to be effective on ambulatory status. CONCLUSION Risk of mortality in elderly hip fracture patients increases with female gender, ASA 3-4 and low total lymphocyte counts. Hypoalbuminemia is associated with longer hospitalization. Identification of these risk factors can help in the case management for a more favorable outcome.Öğe The evaluation of left ventricular dyssynchronization in patients with hypertension by phase analysis of myocardial perfusion-gated SPECT(Springer, 2015) Ozdemir, Semra; Kirilmaz, Bahadir; Barutcu, Ahmet; Tan, Yusuf Ziya; Celik, Fatmanur; Akgoz, SemraPurpose Hypertension is one of the most important risk factors for cardiovascular disease. However, hypertension may also result in left ventricular dyssynchrony (LVD) which is characterized by delayed activation of certain ventricular segments leading to uncoordinated contraction. The aim of this study was to evaluate the LVD measured by phase analysis of gated single-photon emission computed tomography (SPECT) imaging in patients with hypertension. Methods We retrospectively reviewed the records of the patients who have referred to our institution for myocardial perfusion imaging (MPI) with a diagnosis of cardiovascular disease. In this study, total of 196 patients (127 females and 69 males, with a mean age of 59.62 +/- 10.27 years) with and without hypertension (123 and 73, respectively) were included. Phase analysis parameters were compared in patients with and without hypertension which are derived using Emory Cardiac Toolbox. Among these 196 patients, 72 had echocardiography results. The findings of echocardiographic and phase analysis were also compared. Student's t test, Kruskal-Wallis, Mann-Whitney U test and Spearman correlation test were used to compare the results. Results There were statistically significant differences in the phase standard deviation (p = 0.005) and histogram bandwidth (p < 0.001) parameters of the phase analysis between the patients with and without hypertension groups, respectively. Furthermore, echocardiographic findings were significantly correlated with the result of the phase analysis. Conclusion This study suggested that routine use of phase analysis-gated SPECT imaging will be beneficial for the diagnosis of LVD.Öğe The influence of ?-adducin gene polymorpism on response of blood pressure to exercise in patients with hypertension(Aves Yayincilik, 2010) Alioglu, Emin; Ercan, Ertugrul; Tengiz, Istemihan; Turk, Ugur Onsel; Ergun, Metin; Akgoz, Semra; Islegen, CetinObjective: Clinical studies have indicated that an excessive response of blood pressure (BP) to exercise predicts risk of cardiovascular mortality. Although the mechanism responsible for the excessive BP response to exercise has not been revealed, there are some plausible mechanisms linking with underlying structural abnormalities in the cardiovascular system. Carriers of the Trp460 allele of the alpha-adducin Gly460Trp polymorphism have an increased risk of hypertension. The aim of the present study was to examine the influence of alpha-adducin gene polymorphism on response of BP to exercise in patients with hypertension. Methods: The cross-sectional observational study consisted of 49 hypertensive patients (29 women and 20 men; mean age, 53.1 +/- 8.8 years). All participants underwent a multistage exercise treadmill test according to the Bruce protocol. Arterial BPs were compared at rest, peak exercise and end of the recovery phase. Patients were classified according to their alpha-adducin gene polymorphisms; Gly460Gly homozygotes - Group 1 (n=28) and Trp460Trp homozygotes and Gly460Trp heterozygotes - Group 2 (n=21). Statistical analysis was performed using Chi-square, unpaired t, Mann-Whitney U and ANCOVA tests. Results: Mean exercise duration and mean exercise capacity in metabolic equivalents were not different between Group 1 and 2. The major finding of the study was that systolic BP responses at peak exercise and recovery period (3. min) were significantly higher (p=0.036) in hypertensive patients carrying at least one Trp460 allele of the alpha-adducin gene. Conclusion: Our results suggest that genetic variants that alter renal function and/or vasoreactivity are logical candidates to explain some of the individual variability in the BP response to exercise. (Anadolu Kardiyol Derg 2010; 10: 400-4)Öğe The role of diffusion-weighted MRI in the classification of liver hydatid cysts and differentiation of simple cysts and abscesses from hydatid cysts(Aves, 2010) Oruc, Esra; Yildirim, Nalan; Topal, Naile Bolca; Kilicturgay, Sadik; Akgoz, Semra; Savci, GurselPURPOSE The purpose of this study is to identify the role of diffusion-weighted magnetic resonance imaging (DW-MRI) in the classification of liver hydatid cysts (HCs) and their differentiation from simple cysts and liver abscesses. MATERIALS AND METHODS Twenty-two patients that were sent to our department with preliminary diagnoses of HCs or abscess were included in the study. Thirty lesions were evaluated. MRI included T1-weighted fast gradient echo, T2-weighted half-Fourier acquisition single-shot turbo spin echo, and DW single-shot echo planar pulse sequencing (b, 0, 50, and 1000 s/mm(2)). The apparent diffusion coefficient (ADC) values (mm(2)/s) of the HCs, asscesses, and simple cysts were calculated. RESULTS No statistically significant difference was found between the ADC values of type 1 and 3 (P>0.05) HCs and of simple cysts and type 1 HCs (P>0.05). The ADC values of abscesses were significantly lower than those of type 1 and type 3 HCs, and simple cysts. No statistically significant difference was found between the ADC values of abscesses and type 4 HCs (P>0.05). Type 4 lesions exhibited significantly lower ADC values in comparison to type 1 and 3 HCs. CONCLUSION DW-MRI helps differentiate type 4 lesions from other cysts and can distinguish abscesses from hydatid cysts other than type 4 as well as from simple cysts. Type 1 HCs cannot be differentiated from simple cysts using ADC values alone, and type 4 lesions are indistinguishable from abscesses.Öğe Unusual autopsy finding: Simon's bleeding(Slovene Medical Soc, 2013) Eren, Bulent; Turkmen, Nursel; Akgoz, Semra; Cetin, Selcuk; Eren, Filiz; Gundogmus, Umit NaciObjective: To determine whether or not hanging had taken place before or after the death of the victim is quite important in the identification of criminal cases pretended to be suicidal attempts. Material and Methods: Evidence for Simon's bleeding was searched in cases included in the study group after retracting soft tissue and organs away from the field of interest for full exposure of the region of lumbar spinal veretebrae without macroscopic grading of the severity of bleeding, and determining the lumbar level of bleeding. The cases autopsied in Bursa Morgue Department between 2009 and 2011 were retrospectively investigated and evaluated. Results: A total of 848 cases (664 males, and 184 females, male/female ratio, 3.6 :1) were included in the study. A total of 270 (31.8 %) cases had Simon's bleeding. A significant difference in the frequency of Simon's bleeding exists among various causes of death. A 28.5 % (n = 77) of the cases with Simon's bleeding were in the group with hanged death cases (p < 0.001). Conclusion: Splinter bleedings identified originally by Simon on the ventral, and later dorsal aspects of the spinal disci in cases of hanging were also observed later in deaths not related to hanging, however it was concluded that these types of bleeding could not be detected in cases of postmortem hanging. When we evaluated all groups, the results we obtained do not support the assertion that the incidence of Simon's bleeding decreases with aging. Instead, when compared with all other groups, the incidence of Simon's bleeding was also higher in cases of hanging with the highest mean age.
