Erciyes Medical Journal - 2010; 32(2) - Current Issue

In vitro and in vivo Evaluation of Moringa Gum As a Carrier for Buccal Drug Delivery

Chellan Vijaya Raghavan, Sekar Vasanthakumar, Akkaiyan Ramakrishnan — 2010-06-01

Purpose: The objective of the study was to evaluate the naturally available Moringa gum as drug carrier and mucoadhesive component in buccal delivery and to compare the bioavailability of Propranolol Hydrochloride buccal tablet with the oral tablet in healthy human volunteers. Material and Methods: The buccal tablets containing various concentration (Formulation1: 10, F2: 20, F3: 30 and F4: 40 mg) of Moringa gum were prepared and coated with 5% (w/v) ethyl cellulose on one face and oral tablet (F5) without polymer were formulated using a direct compression technique. The muco-adhesion of the polymer was evaluated using porcine buccal mucosa as a model tissue under simulated buccal conditions. The tablets were subjected to in vitro drug release studies at pH 6.8 phosphate buffer and the bioavailability study was conducted with the 16 healthy human volunteers. Results: The forces of detachment for the tablets were 10.21, 12.12, 14.31 and 15.42 (From F1 formulation to F4 formulation, respectively). The cumulative percentage release of propranolol in pH 6.8 phosphate buffer were found to be 97.l3, 98.12 and 100.1 (F3, F4 and F5, respectively). The bio-availability of buccal tablet (F2, F3 and F4) and oral (F5) tablet was found to be 2491.69, 4292.17, 4244.9 and 2196 ng.hr/ml., respectively. Conclusion: The study indicates that the Moringa gum in the concentrations of 30 (F3) and 40 mg (F4) not only gives higher bioavailability but also have sufficient mucoadhesive property for clinical application.

The Relationship Between Fibronectine Levels and Oxidation - Glycosylation End Products in Type 1 Diabetic Patients

2010-06-01

Purpose: Fibronectin might play an important role in pathogenesis and progression of chronic diabetic complications. The aim of this study is to estimate the plasma concentrations of fibronectin, AGEs (Advanced Glycosylation End Products), AOPPs (Advanced Oxidation Protein Products) T1DM (Type 1 Diabetes Mellitus) patients as well as the relationship between each other and diabetic complications. Material and Methods: Fourty T1DM patients attending to the Diabetes and Endocrinology outpatient clinic in Haseki Hospital and 17 healthy volunteers as control group were included in this study. AGEs and AOPPs were measured spectrophotometrically and fibronectin was measured with nephelometric method. Results: Fibronectin levels of diabetic patients were significantly higher than control group (p<0.05). There was not any significant difference in fibronectin levels between patients with and without diabetic complications. In addition, no statistically significant difference was observed in AGE and AOPP levels among diabetic patients and control group. No correlation was determined between plasma fibronectin and AGE and AOPP levels (r=0.4) either. Conclusion: No significant correlation was determined between fibronectin levels and AGE and AOPP which play an important role in progression of diabetic complications in T1DM. The lack of significant difference between healthy controls and patients with T1DM suggests that treatment counteracts the increase in free radical production.

Intermittent Pamidronate Treatment in Thalassaemia-induced Osteoporosis

2010-06-01

Purpose: In this study, we determined osteoporosis by Dual Energy X-Ray (DXA) and the effectiveness of pamidronate treatment in 24 thalassaemic patients in the Pediatric Hematology Unit of Erciyes University. Material and Methods: Twenty-four thalassaemic patients with an age range of 6-22 years (14 girl, 10 boy, mean age: 11.20 � 3,9) were included in the study. Bone mineral densities of lumbar vertebrae L1-L4 and femur neck were measured by DXA method. Z score of bone mineral densities of vertebrae L1-L4 was below -2.5 in 9 patients (37.5 %), -1 to -2.5 in 14 patients (58.3%) and was normal in one patient. Pamidronate treatment (15 mg/dose for patients at age 15 below, 30 mg/dose at age above 15, per three months for one year) was given to 23 osteoporotic (Z score below -2,5) and osteopenic (Z score -1 to -2,5) patients with bone pain and history of bone fracture. Results: The mean Z score of L1-L4 was -2.34 � 0.77 (Mean BMD: 0.555 � 0.106) at the beginning and -2.17 � 0.88 (Mean BMD: 0.587 � 0.107) after one year. There was a statistically significant difference between results of BMD at the beginning and after 12 months. Conclusion: Pamidronate treatment is effective in thalassaemia-induced osteoporosis.

The Effects of Tracheal Intubation on Changes of Intraocular Pressure after Sevoflurane- N2O Anaesthesia Induction in Children without Use of Muscle Relaxants

Abdullah �zk�r��, Recep Aksu, Cihangir Bi�er, Elvan Tercan — 2010-06-01

Purpose: Laryngoscopy and tracheal intubation may be associated with an acute increase in intraocular pressure and arterial blood pressure. We aimed to investigate the effects of laryngoscopy and tracheal intubation after anaesthesia induction with 8% sevoflurane in O₂ -N₂ O mixture without muscle relaxant, on the blood pressure, heart rate and intraocular pressure in children. Material and Methods: This study was performed in 30 children, undergoing elective non-ophthalmic surgery. Anaesthesia was induced (8%) and maintained (2-3%) with sevoflurane in nitrous oxide and oxygen. No muscle relaxant was used. IOP was measured first after induction, then 1, 3, 5 min after intubation, and just 1 min before and 1, 3 min after extubation. heart rate, arteriel blood pressure, peripheral oxygen saturation values were recorded after anesthesia induction, after intubation 1st, 3rd and 5th minute, just before extubation and 1, 3 and 5 minute later. Results: The average age was 35.82�0.17 months and average weight was 14.57�4.23 kgs. Changes for intraocular pressure was not significantly different (p>0.05). Any complication such as respiratory depression, nausea-vomiting, laryngospasm were not observed after induction, intubation and extubation in the children. Conclusion: Although we did not administer any muscle relaxant, increase in IOP has not been observed during laryngoscopy and intubation.

Factors Affecting Prognosis in Upper Urinary System Urothelial Tumors: 15 Years’ Clinical Experience

2010-06-01

Purpose: It is aimed to determine retrospectively evaluate oncological results of cases with upper urinary system urothelial tumors in our clinic for the last 15 years. Material and Methods: Records of 32 cases in our clinic January 1992-December 2006 were evaluated retrospectively. Evaluated parameters are age, complaint; tumor localization, grade and stage, applied treatment choice, follow-up period, lifetime without illness, time until tumor recurrence. Results: Median age was 60 (30-82 years), mean follow-up period was 23 months (3-118 months). In follow-up period, tumor recurred in fourteen cases. Tumor was defined as low and high grades in twenty two (69%) (%68,75) and ten (31%) (%31,25) cases, respectively; and tumor was determined in fourteen (44%) (%43,75), five(16%) (%15,63), six(18%) (%18,75), five(16%) (%15,63) and two cases (6%) (%6,26), in Ta, T1, T2, T3, T4 stages, respectively. Seven patients (22%) (%21,88) are still alive and mean follow-up period is 39 months (11-118 months). Nineteen patients (60%) (%59,38) whose mean follow-up period was 24 months (0.5-56 months) died because of the illness. When their durations of survival are considered, it was found there was a statistically significant difference between tumor stage and survival duration and that, however, there was no meaningful difference between tumor grade and survival duration. Conclusion: Tumor stage was defined as the most important prognostic factor for upper urinary system urothelial tumors.

Opinions of Primary Care Health Workers on Family Medicine Legislation

Funda Sevencan, G�ledal Bozta�, Fehminaz Temel, Muhterem Akbay, Sarp �ner — 2010-06-01

Purpose: The aim was to get some adopt on Family Medicine Legislation of primary care health workers working in a district where this legislation has not been yet started. Material and Methods: This descriptive study was conducted in 2006, in all of the primary care centers in one district of a city. The propositions on three basic areas, which are planning, organization and financing of health services considering the Family Medicine Legislation were evaluated. The answers to the propositions were scored, and the highest scores indicate that the Family Medicine Legislation is supported by the primary health care workers. Results: The mean scores of the doctors on organization, financing and utilization of health services were 44.9�16.1, 34.1�17.5 and 57.0�20.1, respectively. The mean scores of nurses/midwives on the same areas were 41.8�12.9, 26.5�16.3 and 54.1�15.9, respectively. Health services financing area scores of the doctors were significantly higher than the other health workers (p<0,001). The mean scores of the doctors and the nurses on propositions apparently different and similar in two legislations were significantly different for doctors and nurses (p<0,001). Conclusion: The mean scores on propositions which agreed on the Family Medicine Legislation practice were low. This result may show that the health workers have not adopted the principles of this legislation yet.

Metabolic Regulation and Related Factors in Diabetic Patients Referred to a Primary Health Center in Provincial Center of Kayseri

R�za ��t�l, Yusuf �zt�rk, Osman G�nay — 2010-06-01

Purpose: Metabolic regulation may affect diabetic complications and life quality. The purpose of this investigation is to assess the level of metabolic regulation in the diabetic patients and the some factors related to metabolic regulation. Material and Methods: This investigation was performed in a primary health center in the provincial center of Kayseri, between December 2006 and May 2007. A total of 294 self–reported diabetic patients were taken into the study. A questionnaire containing 53 questions was applied. Additionally, HbA1c measures were taken. Chi-square test, logistic regression method and Spearman’s correlation were used for statistical analysis. Results: The numbers of male and female cases were equal, mean age was 57.6�9.7 years and mean duration of diabetes was 6.8�6.2 years. Metabolic regulation was poor in 45.9%, intermediate in 29.3% and good in 24.8% of the patients. The percentage of the patients having good metabolic regulation has decrease by age (p<0.05) and duration of diabetes (p<0.001), increase by educational level (p<0.05). Metabolic regulation of the patients using insulin is worse than the others (p<0.001). Conclusion: Metabolic regulation of diabetic patients was generally poor. There are numerous medical and social factors related to metabolic regulation. Both the patients and the health professionals should attach importance to this subject.

Torsion of Gallbladder : a Case Report

Imtiaz Wani — 2010-06-01

The author is reporting a case of torsion of gallbladder. The patient used to have episodes of intermittent torsion and there was no acute presentation. Patient was presented with abdominal swelling which was misdiagnosed as a mesenteric cyst. Distended gallbladder, free floating type, tortuous cystic artery with the mesentry were factors responsible for torsion. Gallbladder exhibited 180 degrees of clockwise rotation. Detorsion followed by cholecystectomy was done.

Cutaneous Metastases From Transitional Cell Carcinoma of the Bladder (In a Case with Two Primaries)

Gamze Ugurluer, Erkan Dogan, Nedim Turan — 2010-06-01

Cutaneous metastases from primary genitourinary malignancies are rare and, like all metastases, have a poor prognosis. Very few cases of skin metastases from urothelial carcinoma have been reported in the past and most of them were treated with chemotherapy. Here we present a case of cutaneous metastases from a primary bladder transitional cell carcinoma who was admitted to our clinic with pain and bleeding of the lesion on the dorsum of the hand which did not respond to chemotherapy and was treated with palliative radiotherapy.

Spontaneous Prostatic Abscess in a Young Man

2010-06-01

Prostatic abscess is a very rare prostatic disease. The most frequent microorganisms in that situation are E. Coli and the other coliform bacteria. History, physical examination and imaging modalities are used for the diagnosis of this disease. The basic treatment of prostatic abcess is adequate drainage and proper use of antibiotic therapy. In recent years, transrectal ultrasonography guided drainage of prostatic abscess has been also preferred for the treatment of prostatic abscess. It has the advantages of easy performance and low complication rates. In this case report, similarity and differentiation of the prostatic abscess, which has been seen in elderly men and adults was discussed.

Recurrent Salmonella Enteritidis Bacteremia in a Renal Transplant Recipient

Serap �ahin, G�khan Metan, G�khan Metan, B�lent S�merkan — 2010-06-01

The most common clinical presentation of salmonellosis is gastroenteritis. The less frequent but the more serious complications are bacteremia and focal infections. Although recurrent bacteremia is rare, it is a potential problem for patients receiving immunosuppressive therapy. Here, we report a case of recurrent Salmonella enteritidis bacteremia in a renal transplant patient. Although the patient received a 10-day therapy with ciprofloxacin and 14-day therapy with imipenem, recurrent bacteremia with S.enteritidis was detected. In endemic areas, screening stool and urine for Salmonella carriage before and after the transplatation could be useful to avoid recurrent bacteremia in renal transplant recipients.

Treatment of Patent Ductus Arteriosus by Transcatheter Procedure in an Adult Patient

2010-06-01

A forty-year-old woman suffering from palpitation for six months was admitted to cardiology clinic. Continuous murmur was heard on left subclavian space on physical examination. Normal sinus rhythm and left ventricular hypertrophy signs were present in her electrocardiography. In echocardiographic examination left cardiac chamber dilatation and shunt from aorta to pulmonary artery were revealed by color Doppler imaging. Diagnosis of patent ductus arteriosus was confirmed with transoesophagial echocardiography. Patent ductus arteriosus was closed by using 8x5 mm Amplatzer ductal occluder with transcatheter procedure by cardiac catheterization. No complications occurred during and after the procedure and the patient was discharged.

The Management of Severe Tetanus in the Intensive Care Unit

Aliye Esmao�lu �oruh, Aynur Ak�n, Adnan Bayram — 2010-06-01

Despite widespread immunization programmes, tetanus remains an important cause of mortality in the developing world. In tetanus, the severe muscle spasms and autonomic instability affect the respiratory and cardiovascular systems, generally requiring treatment in the intensive care unit. This is the case study of a 59 year-old female patient who developed sever tetanus because tetanus immunopropyhlaxis guidelines were not followed. The patient had generalized muscular spasms which ended with respiratory distress; was entubated, sedated and relaxed. The autonomic instability which is the main cause of mortality in tetanus was treated. On day 50 she was weaned from ventilation and later discharged.

Mediastinal Ectopic Parathyroid Adenoma in a Patient with Renal Failure: Case Report

2010-06-01

In a 69-year-old female patient with end-stage renal disease due to hypertension, parathormone level was found to be 2349 pg/ml. Corrected serum calcium and phosphorus levels were 9.9 mg/dl and 5.2 mg/dl, respectively. The findings of hand-wrist radiogram were consistent with hyperparathyroidism. In Tc-99m MIBI parathyroid scintigraphy, a focal increased activity consistent with an ectopic parathyroid adenoma was observed on upper mediastinum. Also in computerized thorax tomography nodular formation was observed on upper mediastinum. She was operated and the mass measuring 3x3 cm on upper mediastinum was totally excised. Histopathological evaluation confirmed parathyroid adenoma. Post-operative parathormone level decreased to 309 pg/ml.

Mesenchymal Stem Cell Experience in Acute Graft Versus Host Disease

Fatih Erbey, �brahim Bayram, Sema Y�lmaz, Erc�ment Oval�, Atila Tanyeli — 2010-06-01