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Öğe Adjunctive Hyperbaric Oxygen Therapy or Alone Antibiotherapy? Methicillin Resistant Staphylococcus aureus Mediastinitis in a Rat Model(Soc Brasil Cirurgia Cardiovasc, 2015) Kurt, Tolga; Vural, Ahmet; Temiz, Ahmet; Ozbudak, Ersan; Yener, Ali Umit; Sacar, Suzan; Sacar, MustafaObjective: In the post-sternotomy mediastinitis patients, Staphylococcus aureus is the pathogenic microorganism encountered most often. In our study, we aimed to determine the efficacy of antibiotic treatment with vancomycin and tigecycline, alone or in combination with hyperbaric oxygen treatment, on bacterial elimination in experimental S. aureus mediastinitis. Methods: Forty-nine adult female Wistar rats were used. They were randomly divided into seven groups, as follows: non-contaminated, contaminated control, vancomycin, tigecycline, hyperbaric oxygen, hyperbaric oxygen + vancomycin and hyperbaric oxygen + tigecycline. The vancomycin rat group received 10 mg/kg/day of vancomycin twice a day through intramuscular injection. The tigecycline group rats received 7 mg/kg/day of tigecycline twice a day through intraperitoneal injection. The hyperbaric oxygen group underwent 90 min sessions of 100% oxygen at 2.5 atm pressure. Treatment continued for 7 days. Twelve hours after the end of treatment, tissue samples were obtained from the upper part of the sternum for bacterial count assessment. Results: When the quantitative bacterial counts of the untreated contaminated group were compared with those of the treated groups, a significant decrease was observed. However, comparing the antibiotic groups with the same antibiotic combined with hyperbaric oxygen, there was a significant reduction in microorganisms identified (P<0.05). Comparing hyperbaric oxygen used alone with the vancomycin and tigecycline groups, it was seen that the effect was not significant (P<0.05). Conclusion: We believe that the combination of hyperbaric oxygen with antibiotics had a significant effect on mediastinitis resulting from methicillin-resistant Staphylococcus aureus. Methicillin-resistant Staphylococcus aureus mediastinitis can be treated without requiring a multidrug combination, thereby reducing the medication dose and concomitantly decreasing the side effects.Öğe An evaluation of rivaroxaban and clopidogrel in a rat lower extremity ischemia-reperfusion model: An experimental study(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2019) Ozbudak, Ersan; Eraldemir, Fatma Ceyla; Arikan, Ali Ahmet; Sahin, Deniz; Kir, Hale Maral; Kurt, Tolga; Gulasti, Omer FarukBackground: This study aims to compare clopidogrel and rivaroxaban against ischemia-reperfusion injury after a long reperfusion time and to investigate its effects on various tissues. Methods: A total of 40 Wistar rats were included in the study and were randomly divided into four groups (n=10 per group). Groups were defined as follows: control (Group 1), sham (Group 2), clopidogrel pre-treatment (Group 3), and rivaroxaban pre-treatment (Group 4). Ischemia (6 h) and reperfusion (8 h) were induced at the lower hind limb in Groups 2, 3, and 4. The ischemic muscle, heart, kidney, liver, and plasma tissues of the subjects were obtained to test for the oxidant (malondialdehyde) and antioxidants (glutathione, superoxide dismutase, and nitric oxide). Results: Malondialdehyde levels were significantly higher in the sham group, compared to the controls in all tissues. Clopidogrel and rivaroxaban pre-treatment significantly decreased malondialdehyde levels, compared to the heart, ischemic muscle, liver, and blood tissues of the sham group. Kidney malondialdehyde levels were reduced only by rivaroxaban. Group 4 had significantly decreased malondialdehyde levels, compared to Group 3 in ischemic muscle (p<0.010). The glutathione reduction, compared to sham group, in the kidney was only significant for Group 4 (p<0.050). With clopidogrel and rivaroxaban pretreatment, nitric oxide levels significantly decreased only in the heart tissue, compared to sham group (p<0.001 and p<0.050, respectively). Conclusion: The study results suggest that rivaroxaban and clopidogrel are effective in reducing ischemia-reperfusion injury in the heart, ischemic muscle, liver, and blood. Rivaroxaban also protects the kidneys and is superior to clopidogrel in ischemic muscle protection.Öğe Can the ankle brachial pressure index (ABPI) and carotis intima media thickness (CIMT) be new early stage markers of subclinical atherosclerosis in patients with rheumatoid arthritis?(Springer Wien, 2015) Kurt, Tolga; Temiz, Ahmet; Gokmen, Ferhat; Adam, Gurhan; Ozcan, Sedat; Ozbudak, Ersan; Sacar, MustafaIt takes years for atherosclerosis to manifest symptoms. However, it needs to be identified earlier because of the premature cardiovascular risk factors in patients with rheumatoid arthritis (RA). In this study, we aimed to investigate the effect of atherosclerosis on the ankle brachial pressure index (ABPI) and carotis intima media thickness (CIMT) in patients with RA. RA patients attending the rheumatology clinic were examined retrospectively; then we called them for the measurements of ABPI and CIMT prospectively. Subjects were divided into four groups, as follows (Table 1): group 1 comprised RA patients with an ABPI less than 0.9; group 2 included RA patients with an ABPI between 0.9 and 1.2; group 3 was made up of RA patients with an ABPI greater than 1.2; and group 4 included patients without RA with an ABPI between 0.9 and 1.2 as a control group. Patients' demographic data were recorded. Hypertension (HT), diabetes mellitus, ABPI and CIMT measurements were taken by specialists. Duration of RA and disease scores (disease activity score-28, health assessment questionnaire score and visual assessment score) were recorded. The prevalence of peripheral vascular disease in patients with RA was twice as high as that in the normal population of equivalent age. Patients in group 2, with RA and normal ABPI, exhibited a significant higher mean in CIMT (mm) compared with the control group (p < 0.01), despite having normal ABPI. This confirms that these patients have a higher risk of stroke compared with the control group. Group 1's newly diagnosed HT (p < 0.01) and systolic blood pressure (SBP) values (p < 0.01) were higher and statistically significant when compared with the group 4 (control group); in addition, significant plaque levels were observed in the carotid arteries (p < 0.01). Group 3 patients had a similar history of HT and increased SBP compared with patients in group 4 (p < 0.01), and had similar characteristics to with group 1. No statistically significant differences were found between the groups in terms of inflammatory markers such as C-reactive protein and rheumatoid factor, anti-cyclic citrullinated peptide and white blood cell counts. Based on the present findings, patients with RA need to be evaluated in the early stage of the disease for subclinical peripheral artery disease using the ABPI, as well as CIMT, which is also a non-invasive technique, in terms of cerebrovascular events. Inflammatory markers exhibited no statistically significant difference. We think that the atherosclerotic process stems not only from the inflammatory effects of RA, but also perhaps from its immunological nature.Öğe HOW IMPORTANT IS EARLY DIAGNOSIS OF SUBCLINICAL ATHEROSCLEROSIS IN PRIMARY SJOGREN'S SYNDROME PATIENTS?(Carbone Editore, 2015) Kurt, Tolga; Gokmen, Ferhat; Adam, Gurhan; Ozcan, Sedat; Ozbudak, Ersan; Akbal, Ayla; Temiz, AhmetIntroduction: Cardiovascular (CV) disease is observed with increasing frequency in patients with systemic vasculitis. The use of carotid intima media thickness (CIMT) and ankle brachial pressure index (ABPI) may help to identify high-risk primary Sjogren's syndrome (PSS) patients. The objective of this study is to determine abnormal ABPI and CIMT values in the patient group with PSS and compare them clinically and serologically with a control group. Materials and methods: Our study comprised a total of 124 patients who were diagnosed with PSS according to the American-European Consensus Group Sjogren's syndrome classification criteria and monitored for more than 3 years, and a control group. CIMT and ABPI measurements were completed by specialists. The patients were also evaluated serologically. Results: All of the PSS patients had xerophthalmia findings, the second most common symptom was xerostomia. The mean disease duration was 80.4 +/- 25.6 months. Nine PSS patients (41%) had ABPI less than 0.9. In the control group II (II%) patients had ABPI less than 0.9. When the two groups were compared, the difference was found to be significant (p<0.05). PSS patients also exhibited a statistically significant increase in mean CIMT values (mm; p<0.05). When the PSS patients with ABPI less than 0.9 were compared with other PSS patients and the control group, there was no significant difference in terms of anti-Sjogren's syndrome related antigen A (anti-SSA) and anti-Sjogren's syndrome related antigen B (anti-SSB), C-reactive protein (CRP), rheumatoid factor (RF) or Anti-Cyclic Citrullinated Peptide (anti-CCP) positivity (p>0.05). Conclusion: Similar to patients with systemic vasculitis, PSS patients should be assessed for subclinical peripheral arterial diseases in the early stage and monitored closely with ABPI and CIMT measurements. The atherosclerotic process observed in PSS patients may be due not only to the inflammatory effect, but to many multifactorial issues such as immunological and genetic effects.Öğe How important is early diagnosis of subclinical atherosclerosis in primary Sjogren's syndrome patients?(Acta Medica Mediterranea, 2015) Kurt, Tolga; Gokmen, Ferhat; Adam, Gurhan; Ozcan, Sedat; Ozbudak, Ersan; Akbal, Ayla; Temiz, AhmetIntroduction: Cardiovascular (CV) disease is observed with increasing frequency in patients with systemic vasculitis. The use of carotid intima media thickness (CIMT) and ankle brachial pressure index (ABPI) may help to identify high-risk primary Sjogren's syndrome (PSS) patients. The objective of this study is to determine abnormal ABPI and CIMT values in the patient group with PSS and compare them clinically and serologically with a control group. Materials and methods: Our study comprised a total of 124 patients who were diagnosed with PSS according to the American-European Consensus Group Sjogren's syndrome classification criteria and monitored for more than 3 years, and a control group. CIMT and ABPI measurements were completed by specialists. The patients were also evaluated serologically. Results: All of the PSS patients had xerophthalmia findings, the second most common symptom was xerostomia. The mean disease duration was 80.4±25.6 months. Nine PSS patients (41%) had ABPI less than 0.9. In the control group 11 (11%) patients had ABPI less than 0.9. When the two groups were compared, the difference was found to be significant (p<0.05). PSS patients also exhibited a statistically significant increase in mean CIMT values (mm; p<0.05). When the PSS patients with ABPI less than 0.9 were compared with other PSS patients and the control group, there was no significant difference in terms of anti-Sjogren's syndrome related antigen A (anti-SSA) and anti-Sjogren's syndrome related antigen B (anti-SSB), C-reactive protein (CRP), rheumatoid factor (RF) or Anti-Cyclic Citrullinated Peptide (anti-CCP) positivity (p>0.05). Conclusion: Similar to patients with systemic vasculitis, PSS patients should be assessed for subclinical peripheral arterial diseases in the early stage and monitored closely with ABPI and CIMT measurements. The atherosclerotic process observed in PSS patients may be due not only to the inflammatory effect, but to many multifactorial issues such as immunological and genetic effects.Öğe LEFT ATRIAL MYXOMA WITH ATYPICAL CLINICAL PRESENTATION(Carbone Editore, 2014) Kurt, Tolga; Ozcan, Sedat; Temiz, Ahmet; Ozbudak, Ersan; Gazi, Emine; Sacar, MustafaMyxoma is the most commonly seen primary cardiac tumour, with an incidence of 80-90% in the left atrium, followed by the right atrium and ventricle. Patients with atrial myxomas present with intracardiac obstruction, embolization to the pulmonary and systemic circulation, or constitutional symptoms. Hepatomegaly and increase of the liver transaminases levels involvement in myxomas are rare, has been described to cause hepatic insufficiency. We describe an interesting case of a 47-year-old patient with systemic findings and symptoms, which was primary symptomatially treated for several months in psychiatry, neurology and chest diseases clinics in other centres but never diagnosed, and undergoing emergency surgery in our clinic following determination of left atrial myxoma at tests performed by our cardiology department. The patient had no symptoms at examinations performed 6 months and 1 year postoperatively, and no pathological findings were determined.Öğe Mitral Yetmezlik Semptomlarıyla Bulgu Veren Sol Atriyal Miksoma(2014) Ozbudak, Ersan; Halıcı, Ümit; Kurt, Tolga[Abstract Not Available]
