Murat Sungur

Publications of Murat Sungur

• Effects of endosulfan intoxication on pituitary functions.

  Authors: Ramazan Coskun, Kursat Gundogan, Fatih Tanriverdi, Muhammet Guven, Murat Sungur

  Clinical toxicology (Philadelphia, Pa.). 04/2012;

  Context. We investigated the effects of endosulfan intoxication on pituitary functions in three patients. Methods. This is an observational case series including three patients with endosulfanContext. We investigated the effects of endosulfan intoxication on pituitary functions in three patients. Methods. This is an observational case series including three patients with endosulfan intoxication. Patients were evaluated 3 months after the acute event. Results. Based on the baseline hormonal values and dynamic endocrine tests, one patient had hypothalamo-pituitary-adrenal axis impairment and was diagnosed as ACTH deficiency (peak cortisol level was found 13.12 μg/dl after low dose ACTH stimulation test), and another one had GH-IGF-I axis impairment and was diagnosed as GH deficiency (peak GH level was found 1.06 μg/L after glucagon stimulation test). Conclusions. Endosulfan intoxication might cause pituitary hormone deficiencies after the acute phase. Therefore, patients with endosulfan toxicity should be followed for possible pituitary gland dysfunction.

• Changing pattern of antibiotic susceptibility in intensive care units: ten years experience of a university hospital.

  Authors: Emine Alp, Bilge Kiran, Dilek Altun, Gamze Kalin, Ramazan Coskun, Murat Sungur, Aynur Akin, Duygu Percin, Mehmet Doganay

  Anaerobe. 05/2011; 17(6):422-5.

  The study was performed to assess microorganisms and antibiotic susceptibility patterns during ten years in intensive care units of a University Hospital. Infection Control Committee has active,The study was performed to assess microorganisms and antibiotic susceptibility patterns during ten years in intensive care units of a University Hospital. Infection Control Committee has active, prospective surveillance in ICUs for thirteen years. Ten years data of ICUs was evaluated retrospectively from surveillance forms. Microorganisms and their antibiotic resistance were recorded according to the years. During ten years, gram negative microorganisms were the most frequent isolated microorganisms from clinical specimens. Acinetobacter baumannii (21.8%), Pseudomonas aerigunosa (16%), Escherichia coli (10.4%) and Klebsiella pneumoniae (8%) were the most common gram negative microorganisms. However, Staphylococcus aureus was the most prevalent gram positive microorganism, the incidence decreased from 18.6% to 4.8% during ten years. Also antibiotic susceptibility of microorganisms changed during ten years. Carbapenem resistance increased from 44% to 92% in A. baumannii and ciprofloxacin resistance increased in E. coli from 28% to 60% and in K. pneumoniae from 21% to 55% during ten years. However, methicilin resistance decreased in S. aureus from 96% to 54%. In conclusion, antibiotic resistance is growing problem in ICUs. Rationale antibiotic policies and infection control measures will prevent the development of resistance.

• 2009 H1N1 influenza and experience in three critical care units.

  Authors: Turgut Teke, Ramazan Coskun, Murat Sungur, Muhammed Guven, Taha T Bekci, Emin Maden, Emine Alp, Mehmet Doganay, Ibrahim Erayman, Kursat Uzun

  International journal of medical sciences. 01/2011; 8(3):270-7.

  We describe futures of ICU admission, demographic characteristics, treatment and outcome for critically ill patients with laboratory-confirmed and suspected infection with the H1N1 virus admitted toWe describe futures of ICU admission, demographic characteristics, treatment and outcome for critically ill patients with laboratory-confirmed and suspected infection with the H1N1 virus admitted to the three different critical care departments in Turkey. Retrospective study of critically ill patients with 2009 influenza A(H1N1) at ICU. Demographic data, symptoms, comorbid conditions, and clinical outcomes were collected using a case report form. Critical illness occurred in 61 patients admitted to an ICU with confirmed (n=45) or probable and suspected 2009 influenza A(H1N1). Patients were young (mean, 41.5 years), were female (54%). Fifty-six patients, required mechanical ventilation (14 invasive, 27 noninvasive, 15 both) during the course of ICU. On admission, mean APACHE II score was 18.7±6.3 and median PaO(2)/FIO(2) was 127.9±70.4. 31 patients (50.8%) was die. There were no significant differences in baseline PaO(2)/FIO(2 )and ventilation strategies between survivors and nonsurvivors. Patients who survived were more likely to have NIMV use at the time of admission to the ICU. Critical illness from 2009 influenza A(H1N1) in ICU predominantly affects young patients with little major comorbidity and had a high case-fatality rate. NIMV could be used in 2009 influenza A (H1N1) infection-related hypoxemic respiratory failure.

• Acute amitraz poisoning in adults: clinical features, laboratory findings, and management.

  Authors: Levent Avsarogullari, Ibrahim Ikizceli, Murat Sungur, Erdogan Sözüer, Okhan Akdur, Murat Yücei

  Clinical toxicology (Philadelphia, Pa.). 02/2006; 44(1):19-23.

  BACKGROUND: Amitraz is a formamidine pesticide widely used in agriculture and veterinary medicine as an insecticide and acaricide. Reports on amitraz poisoning in humans are not as prevalent as thoseBACKGROUND: Amitraz is a formamidine pesticide widely used in agriculture and veterinary medicine as an insecticide and acaricide. Reports on amitraz poisoning in humans are not as prevalent as those in animals. Of human intoxications in the medical literature, the majority of intoxications are in children. The number of adult intoxications with amitraz is limited. METHODS: In this study, we discuss the clinical features, laboratory findings, and management of 23 adults with amitraz poisoning cared for in our center. Data were extracted from the charts retrospectively, and included age, gender, mode of poisoning, initial symptoms, time to appearance of initial symptoms, clinical and laboratory findings, management, and prognosis. RESULTS: Fourteen of 23 patients were female (61%). Ages ranged from 16 and 78 years (mean 38.6 +/- 19.8 years). Twenty-one patients ingested amitraz orally while one was exposed through skin contact and one probably through skin contact and/or inhalation. Seven patients ingested amitraz with intent to commit suicide and 11 patients accidentally. Vomiting, altered consciousness, and drowsiness were the predominant initial symptoms. Initially, hypotension was present in seven patients (30%), bradycardia in two (8.7%), myosis in six (26%), and mydriasis (without atropine administration) in three (13%). Time to appearance of the initial symptoms ranged from 5 to 120 minutes. Laboratory findings included an initial blood glucose level higher than 120 mg/dL in 62% of patients (mean 191 +/- 70 mg/dL) and elevations in AST levels in four patients (81 +/- 28 U/L) and ALT levels in three (60 +/- 14 U/L). Ten patients had central nervous system depression, which resolved spontaneously. Five patients required mechanical ventilation for respiratory depression (mean duration of mechanical ventilatory support: 50 +/- 16 hours). Six patients were thought to have been poisoned with an organophosphate and three with a carbamate pesticide due to confusing clinical picture; four of these nine patients received pralidoxim. CONCLUSIONS: In spite of a rapidly progressing and life-threatening clinical picture, amitraz intoxication in humans carries a low morbidity and mortality when appropriate supportive treatment is given. No antidote has been developed for use in more serious cases. To prevent accidental ingestions, prominent and clear warning labels should be placed on its containers.

• The role of plasma exchange in HELLP syndrome.

  Authors: Bulent Eser, Muhammet Guven, Ali Unal, Ramazan Coskun, Fevzi Altuntas, Murat Sungur, Ibrahim Serdar Serin, Ismail Sari, Mustafa Cetin

  Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis. 04/2005; 11(2):211-7.

  Plasma exchange therapy has been successfully used in selected patients with hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome who have organ failure or refractory to treatment.Plasma exchange therapy has been successfully used in selected patients with hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome who have organ failure or refractory to treatment. There is no prospective study regarding plasma exchange and its effect in HELLP syndrome. The aim of this study was to investigate the effects of early postpartum use of plasma exchange in patients with HELLP syndrome on outcomes. The mortality rate and the recovery times were compared in patients with HELLP syndrome treated with plasma exchange and historic control group of patients treated conservatively. During a 3-year period (between April 2000 and December 2003), 29 consecutive patients with HELLP syndrome were treated with single or multiple plasma exchange by using fresh-frozen plasma at post-partum period. The control group consist of 26 patients with HELLP syndrome treated between 1993 and 1999. Maternal mortality rate was 23.1% in the control group; there was no death in plasma exchange group; and the mortality rate was significantly higher in the control group (p=0.006). The length of stay at the intensive care unit was shorter in the plasma exchange group (p<0.0001). Rapid improvement of the platelet, aspartate aminotransferase, alanine aminotransferase, and lactic dehydrogenase levels were observed in the plasma exchange group. This study showed that postpartum early plasma exchange therapy improves treatment outcomes in patients with severe HELLP syndrome.

• An analysis of 682 adult poisonings in Central Anatolia of Turkey.

  Authors: Zeynep Kekec, Nurullah Gŭnay, Erdogan M Sozuer, Muhammed Gŭven, Murat Sungur

  Veterinary and human toxicology. 01/2005; 46(6):335-6.

  We defined patient demographics, type of the poisoning, distribution according to month, route and reason for exposure, mortality causes and rates from 682 poisonings admitted to University HospitalWe defined patient demographics, type of the poisoning, distribution according to month, route and reason for exposure, mortality causes and rates from 682 poisonings admitted to University Hospital in Kayseri, Turkey to evaluate whether they follow the pattern of other countries. Poisoning were drugs (54.5%), inhalational poisonings including carbon monoxide (13.7%), food (12.4%), alcohol (7%), pesticides (5.4%) and corrosives (2.1%). In drug ingestions, psychoactive drugs most common; psychoactive, analgesic, and anti-inflammatory drugs were most frequent agents in multiple drug poisonings. Drugs were the most used poison while pesticides, mushrooms, methanol and carbon monoxide caused more deaths. The mortality rate was 2%.

• The effects of octreotide in dilated cardiomyopathy: an open-label trial in 12 patients.

  Authors: Namlk Kemal Eryol, Muhammed Güven, Ramazan Topsakal, Murat Sungur, Ibrahim Ozdogru, Tugrul Inanç, Abdurrahman Oguzhan

  Japanese heart journal. 08/2004; 45(4):613-21.

  Octreotide, a somatostatin analogue, has been found effective in the treatment of acromegalic cardiomyopathy. We investigated whether intermittent octreotide therapy had beneficial effects inOctreotide, a somatostatin analogue, has been found effective in the treatment of acromegalic cardiomyopathy. We investigated whether intermittent octreotide therapy had beneficial effects in patients with ischemic or idiopathic dilated cardiomyopathy, which are refractory to conventional therapy. Twelve patients with ischemic or idiopathic dilated cardiomyopathy were enrolled in the study. In addition to conventional treatment, octreotide (first 50 microg and then 25 microg three times per day for 4 days) was administered and repeated after 1, 2, and 3 months. The patients were evaluated 3 times, before and immediately after the first treatment and after 3 months of treatment, using echocardiography, exercise stress testing, ambulatory ECG, right ventricular catheterization, cardiac enzymes, and the Minnesota living with heart failure questionnaire for quality of life. There were no significant changes in parameters after the first treatment. However, after 3 months of treatment, there were significant improvements in the left ventricular ejection fraction, left ventricular posterior wall thickness, hemodynamics, exercise capacity, and quality of life. Additionally, ischemic burden and the number of ventricular premature beats also decreased slightly. Intermittent octreotide therapy led to significant improvements in patients with ischemic and idiopathic dilated cardiomyopathy refractory to conventional treatment. We believe that this therapy should be attempted as an adjunctive therapy in these patients, and that in this respect, randomized, double-blind, clinical, and large-scale studies are required before regular usage is undertaken.

• The effect of plasmapheresis on plasma cholinesterase levels in a patient with organophosphate poisoning.

  Authors: Muhammet Güven, Murat Sungur, Bülent Eser

  Human & experimental toxicology. 08/2004; 23(7):365-8.

  OBJECTIVE: To describe the role of plasmapheresis in management of organophosphate poisonings. DESIGN: Case report. SETTING: A medical intensive care unit of a medical faculty. PATIENT: A patientOBJECTIVE: To describe the role of plasmapheresis in management of organophosphate poisonings. DESIGN: Case report. SETTING: A medical intensive care unit of a medical faculty. PATIENT: A patient with organophosphate poisoning whose cholinesterase levels continuously decline and then increase up to a normal level after plasmapheresis is performed for his sepsis. INTERVENTIONS: Plasmapheresis with fresh frozen plasma. MEASUREMENTS AND MAIN RESULTS: Baseline plasma cholinesterase (ChE) level was 4001 IU/L (normal values: 4000-10000 IU/L). Aspiration pneumonia was developed on day 3, and sepsis occurred on day 5. During this period, ChE levels gradually decreased. On day 5, plasmapheresis was performed for sepsis. Interestingly, plasma ChE levels increased from 2101 IU/L to 6144 IU/L after plasmapheresis. Atropine and pralidoxime were stopped, and a high level of ChE continued during hospitalization. The patient was successfully weaned from mechanical ventilation 3 days after plasmapheresis. CONCLUSION: Plasma exchange therapy may be considered for patients with organophosphate poisoning unresponsive to atropine and pralidoxime.

• Efficacy of five days of subcutaneous octreotide treatment after sclerotherapy in preventing rebleeding from esophageal varices.

  Authors: Mehmet Yücesoy, Mevlüt Başkol, Muzaffer Keklik, Muhammed Güven, Murat Sungur, Şebnem Gürsoy, Kadri Güven, Ömer Özbakır

  The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology. 02/2004; 15(3):137-143.

  BACKGROUND/AIMS: Acute variceal bleeding is the most severe consequence of portal hypertension. Mortality due to bleeding among cirrhotic patients is high; between 30 and 50% die within six weeks ofBACKGROUND/AIMS: Acute variceal bleeding is the most severe consequence of portal hypertension. Mortality due to bleeding among cirrhotic patients is high; between 30 and 50% die within six weeks of the first bleeding episode. This dismal outcome has led to attempts both to stop acute bleeding and to prevent rebleeding. The aim of this study was to investigate the efficacy of subcutaneous octreotide treatment, administered after emergency sclerotherapy, in preventing rebleeding of esophageal varices METHODS: After a bolus injection of 50 microgram octreotide, 34 patients, forming the standard therapy (ST) group, received octreotide infusion at a rate of 50 microgram/h until endoscopic sclerotherapy performed within 36 hours. The same procedure was applied to another 27 patients in the maintenance therapy (MT) group in which octreotide was given at 100 microgram/8h via subcutaneous (sc) route after sclerotherapy for five days. In both groups, sclerotherapy was repeated on the 5th-7th day. Patients were followed for three weeks for rebleeding. RESULTS: Nine patients rebled in the ST group but only one patient bled in the MT group (3.7% vs. 26.5% vs. 3.7%; p<0.05). Transfusion requirement and duration of hospitalization period were similar in both groups. CONCLUSIONS: This study suggests that maintenance subcutaneous octreotide therapy is effective in controlling rebleeding episodes.

• The effects of fresh frozen plasma on cholinesterase levels and outcomes in patients with organophosphate poisoning.

  Authors: Muhammet Güven, Murat Sungur, Bülent Eser, Ismail Sari, Fevzi Altuntaş

  Journal of toxicology. Clinical toxicology. 02/2004; 42(5):617-23.

  OBJECTIVE: The aim of this study is to determine the effects of fresh frozen plasma, as a source of cholinesterase, on butyrylcholinesterase (BuChE; plasma or pseudo cholinesterase) levels andOBJECTIVE: The aim of this study is to determine the effects of fresh frozen plasma, as a source of cholinesterase, on butyrylcholinesterase (BuChE; plasma or pseudo cholinesterase) levels and outcomes in patients with organophosphate poisoning. MATERIALS AND METHODS: This prospective study was performed at the Department of Intensive Care of Erciyes University Medical School. Over 2 yrs, patients admitted to the ICU for OP poisoning were entered into the study. OP poisoning was diagnosed on the basis of history and BuChE levels. All patients received atropine. Fresh frozen plasma was given to 12 patients. The study was approved by the Ethical Committee, and verbal informed consent was obtained. RESULTS: Thirty-three patients were included in the study. BuChE levels measured at admission and the pralidoxime and atropine doses administered were not different between groups (p>0.05). Although intermediate syndrome developed in 28.6% of patients receiving pralidoxime, there were no intermediate syndrome cases in patients receiving plasma prior to developing intermediate syndrome. The mortality rates were 14.3% in the pralidoxime group and 0% in the plasma+atropine+pralidoxime group. Two patients received plasma after developing the intermediate syndrome, and one patient who received only atropine died. BuChE levels of fresh frozen plasma were 4069.5 +/- 565.1 IU/L. Every two bags of plasma provided an increase in BuChE levels of approximately 461.7 +/- 142.1 IU/L. CONCLUSION: Fresh frozen plasma therapy increases BuChE levels in patients with organophosphate poisonings. The administration of plasma may also prevent the development of intermediate syndrome and related mortality. Plasma (fresh frozen or freshly prepared) therapy may be used as an alternative or adjunctive treatment method in patients with organophosphate pesticide poisoning, especially in cases not given pralidoxime. Further randomized controlled and animal studies are required to infer a definitive result.

• Transforming growth factor beta-1 level in pleural effusion.

  Authors: Berrin Bagci Ceyhan, Emel Demiralp, Zuha L Karakurt, Sait Karakurt, Murat Sungur

  Respirology (Carlton, Vic.). 09/2003; 8(3):321-5.

  OBJECTIVE: Transforming growth factor-beta1 is an important immunomodulator. The diagnostic role of TGF-beta1 has not been systematically investigated in pleural effusion. METHODOLOGY: A prospectiveOBJECTIVE: Transforming growth factor-beta1 is an important immunomodulator. The diagnostic role of TGF-beta1 has not been systematically investigated in pleural effusion. METHODOLOGY: A prospective clinical study of 45 patients (23 men, 22 women; mean age 49 +/- 21 years) with pleural effusion was performed. Of these patients, 19 had malignant pleural effusion, 14 had tuberculous pleural effusion, seven had empyema/parapneumonic pleural effusion, and five had transudative pleural effusion due to congestive heart failure. The concentrations of TGF-beta1 were measured by ELISA in all pleural fluid samples and in serum samples only from patients with malignant and tuberculous pleural effusions. RESULTS: The median TGF-beta1 levels of malignant, tuberculous and empyema/parapneumonic pleural effusions were 7.25 ng/mL, 7.81 ng/mL, and 9.75 ng/mL, respectively. There was no significant difference between them. The median TGF-beta1 level was 5.62 ng/mL in the transudate pleural effusion group and it was significantly lower than that in the empyema/parapneumonic group (P < 0.05). The pleural fluid TGF-beta1 levels did not correlate with cell profiles of the pleural fluid. The median serum TGF-beta1 levels in malignant and tuberculous pleural effusion groups were 7.38 ng/mL and 7.38 ng/mL, respectively. There was no significant difference between the levels of TGF-beta1 in paired samples of serum and pleural fluid. CONCLUSIONS: This study shows that TGF-beta1 concentrations in exudative pleural effusions are higher than those in transudative effusions secondary to congestive heart failure but TGF-beta1 concentrations do not assist in differentiating exudative effusions.

• Bronchial hyperreactivity and allergic status in inflammatory bowel disease.

  Authors: Berrin Bagci Ceyhan, Sait Karakurt, Hikmet Cevik, Murat Sungur

  Respiration; international review of thoracic diseases. 70(1):60-6.

  BACKGROUND: Despite the known systemic manifestations of inflammatory bowel disease (IBD) and a large number of reports associating lung disease and IBD, the frequency of atopy and bronchialBACKGROUND: Despite the known systemic manifestations of inflammatory bowel disease (IBD) and a large number of reports associating lung disease and IBD, the frequency of atopy and bronchial hyperreactivity (BHR) in IBD remains obscure. OBJECTIVES: The aim of this study was to investigate the prevalence of abnormal pulmonary function tests, BHR and the atopic status in patients with IBD. METHODS: Thirty patients with IBD (19 with ulcerative colitis and 11 with Crohn's disease; 19 male, 11 female) and 16 controls without any gastrointestinal disease (9 female, 7 male) were included. Patients were questioned with respect to pulmonary and allergic symptoms; subsequently, lung function tests, BHR, skin prick test positivity, peripheral eosinophilia and serum IgE levels were evaluated and compared with those of control subjects. RESULTS: The mean duration of IBD was 5.3 +/- 4.8 years. IBD patients had significantly more often respiratory symptoms in comparison with controls (odds ratio, OR: 9.0, p < 0.04). A previous diagnosis of asthma and antiasthmatic drug treatment were noted in 3/30 (10%) IBD patients. Allergic symptoms were more prevalent in IBD patients in comparison with the controls (OR: 13, p < 0.007), particularly in patients with ulcerative colitis (OR: 16, p < 0.004). The mean FEV(1 )was 3.1 +/- 0.9 liters (96 +/- 18% predicted), mean methacholine PD(20): 14.7 +/- 3.6 mg/ml, mean IgE: 190.5 +/- 305.6 IU/ml (normal value <94 IU/ml) and the percentage of peripheral eosinophils was 3.1 +/- 3.3% in the IBD patients. These values did not result in statistically significant differences in comparison with controls. Furthermore, abnormal lung function and BHR were observed in 8/30 (27%) and 5/30 (17%) IBD patients, respectively. Abnormal lung function tests were more prevalent in the IBD patients than in the controls (OR: 12, p < 0.04). Skin prick tests were positive in 15/30 (50%) IBD patients. The risk of a positive skin prick test increased in the IBD patients in comparison with the controls (OR: 7.0, p < 0.02). Duration and activity of IBD did not influence the prevalence of BHR, allergic and respiratory symptoms, abnormal lung function, high serum IgE levels and skin test positivity. CONCLUSIONS: Allergic symptoms, respiratory symptoms, abnormal lung function tests and skin prick test positivity were more common among the IBD patients in comparison with the controls.