Nese Kaklikkaya

Karadeniz Technical University, Atrabazandah, Trabzon, Turkey

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Publications (31)41.43 Total impact

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    R A Akdogan · O Ozgur · S Gucuyeter · N Kaklikkaya · U Cobanoglu · F Aydin
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    ABSTRACT: Helicobacter pylori causes various diseases such as chronic gastritis, peptic ulcer and gastric cancer. While majority of the people infected with H. pylori is asymptomatic, 15-20 % of them develop such diseases. The main factors, which determine the development of H. pylori related diseases might be bacterial virulence, host genetic and environmental factors.The aim of this study was to reveal the factors that play a role in the disease development in patients with reflux esophagitis and peptic ulcer, infected with Helicobacter pylori. Environmental factors such as medical agents, smoking and body mass index were evaluated. The factors specific to bacteria such as vacA, CagA, babA and iceA virulence genotypes and the host factors such as IL-1, IL-2, IL-4, IL-6, IL-10, IL-12, interferon-γ, TNF-α, ve TGF-β1 gene polymorphisms were compared between the two groups.H. pylori infected twenty five patients with reflux esophagitis and peptic ulcer were enrolled in the study. There was no statistical difference between the two groups regarding environmental factors. IL-2 -330T +166T (p=0.037) and IL10 -1082A; -819C (p=0.049) gene polymorphisms were significantly more common in the group of patients with peptic ulcer compared to the group with reflux esophagitis. In both groups of patients, either with reflux esophagitis or peptic ulcer, multiple H. pylori virulence genotypes (cagA, vacA, babA) (mean values 74 %, 78 %, 54 % respectively) were observed.In this study, we revealed that cytokine gene polymorphisms may play a role in the development peptic ulcer while H. pylori virulence genotypes seem to be crucial for the development of associated diseases (Tab. 4, Ref. 51). Keywords: Helicobacter pylori genotypes, single nucleotide polymorphisms, reflux oesophagitis, peptic ulcer.
    Preview · Article · May 2014 · Bratislavske lekarske listy
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    Full-text · Article · Oct 2013 · African journal of microbiology research
  • N. Kaklikkaya · G. Bayramoşlu · K. Buruk · I. Tosun · F. Aydin
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    ABSTRACT: Objective: Elevated serum procalcitonin levels are of diagnostic value in most systemic bacterial infections, especially sepsis. However, there are insufficient data on the use of serum procalcitonin levels in the diagnosis of Brucella and Salmonella bacteremia. The aim of this study was to evaluate the diagnostic value of the serum procalcitonin test for Brucella and Salmonella bacteremia. Material and Method: Thirty-one patients with Brucella bacteremia and 12 patients with Salmonella bacteremia were included. The control group consisted of 31 healthy blood donors. Procalcitonin levels were determined with the semiquantitative BRAHMS PCT-Q test using sera from the control subjects and sera from patients obtained concurrently with blood or bone marrow sampling. Results: No detectable procalcitonin (<0.05 ng/mL) was found in 15 (48.4%) of the 31 sera from patients with Brucella bacteremia. Another 15 (48.4%) had procalcitonin levels between ≥0.05 and <0.5 ng/mL. A serum procalcitonin level between ≥0.5 and <2 ng/mL was determined in one patient. Procalcitonin was at detectable levels in all the patients with Salmonella bacteremia. Levels were ≥0.05 and <0.5 in five patients, ≥0.5 and <2 ng/ mL in five and ≥2.0 and <10 ng/mL in two. Five (16.1%) of the 31 control samples had procalcitonin levels between ≥0.05 and <0.5 ng/mL, while the remaining 26 (83.9%) had no detectable (<0.05 ng/mL) procalcitonin. Sensitivity and specificity of procalcitonin test for Brucella bacteremia were 3.23% [95% Confidence Interval (CI); 0.54-16.76], 100% (95% CI; 88.68- 100), respectively; for Salmonella bacteremia were 58.33% (95% CI; 27.75-84.68), 100% (95% CI; 88.68-100), respectively, with a procalcitonin cut off level of ≥0.5 ng/mL. Conclusion: Our results suggested that procalcitonin test is not sensitive enough in diagnosing Brucella bacteremia but it can be usefull in dismissing the disease. In Salmonella bacteremia the diagnostic value of the procalcitonin test is higher, and therefore the procalcitonin test can be used as a helpful method for diagnosing Salmonella bacteremia.
    No preview · Article · Sep 2013 · Nobel medicus
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    ABSTRACT: It was recently proposed that Candida parapsilosis represents a complex composed of three closely related species, i.e., C. parapsilosis sensu stricto, C. orthopsilosis, and C. metapsilosis. The aim of this study was to describe the distribution of C. parapsilosis complex isolates among clinical samples. We also evaluated antifungal susceptibility profiles, in vitro presence of lipase and secreted aspartyl proteinase, as well as their ability to grow in total parenteral nutrition (TPN) solution, and biofilm production. A total of 413 non-C. albicans Candida isolates were obtained from various clinical samples between 2010 and 2011 in a Turkish Tertiary Care Hospital. Of them, 42 were identified as members of the C. parapsilosis complex. Among these, 38 (90.5%) were C. parapsilosis sensu stricto, 3 (7.1%) C. metapsilosis, and 1 (2.4%) C. orthopsilosis. All isolates recovered from blood were found to be C. parapsilosis sensu stricto and C. metapsilosis. In phenotypic tests, all 42 isolates grew in TPN solution and, although 26.2% of C. parapsilosis sensu stricto-isolates were capable of forming biofilms in vitro, neither C. orthopsilosis nor C. metapsilosis isolates were able to do so. Acid proteinase activity was detected in 31% of isolates and lipase activity in 33%. All isolates were sensitive to voriconazole, caspofungin, and anidulafungin, with only a single C. parapsilosis sensu stricto isolate showing dose-dependent susceptible to fluconazole. While the number of C. metapsilosis and C. orthopsilosis isolates remained low, there were no significant differences in antifungal MIC as compared to C. parapsilosis sensu stricto.
    Full-text · Article · Dec 2012 · Medical mycology: official publication of the International Society for Human and Animal Mycology
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    ABSTRACT: Mucosa associated lymphoid tissue (MALT) lymphoma (marginal zone B-cell lymphoma of MALT according to the World Health Organization classification) is one of the low-grade non-Hodgkin's lymphomas. The majority of nonHodgkin's lymphomas of the ocular adnexa are extranodal marginal zone B-cell lymphomas of the mucosa associated lymphoid tissue, also known as MALT lymphoma. In 8% of cases, it arises from the conjunctiva. Lymphoid tumors of the conjunctiva may appear as isolated neoplasms or a part of a systemic disease. In this study, we presented a case of primary conjunctival lymphoma and discussed the etiology, diagnosis and treatment with reference to previous studies and reviews.
    Preview · Article · Oct 2012 · Turkiye Klinikleri Journal of Medical Sciences
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    ABSTRACT: Background: In order to better understand the pathogenesis of risk of future sub-/infertility in children with undescended testes (UDT), we designed this prospective study to examine the oxidative stress, inflammatory response and autoimmunity in children with UDT. We examined the concentrations of malondialdehyde (MDA), interleukin-6 (IL-6) and antisperm antibodies (ASA) in children with UDT and healthy controls. Methods: The UDT group consisted of 88 boys (aged 1–14 years, unilateral in 67 and bilateral in 21 cases), and 44 boys with normal descended testes served as a control group. Clinical evaluation revealed no testicular or other system abnormalities. MDA was used as lipid peroxidation index. IL-6 levels were measured using a commercial enzyme-linked immunosorbent assay kit. ASA was determined with an anti-human spermatozoa immunoglobulin G test. Results: Mean age values ± SD were 4.6 ± 3.2 in the UDT group and 4.7 ± 3.4 in the control group (P= 0.872). MDA and IL-6 results for the UDT and control groups were significantly different (P= 0.003 and P= 0.019, respectively), but those for ASA were not (P= 0.473). The mean MDA and IL-6 values were significantly higher in bilateral cases than the respective values in the unilateral cases (MDA: 4.03 ± 3.68 vs 3.49 ± 5.22, P= 0.015; IL-6: 7.70 ± 6.86 vs 3.48 ± 6.50, P= 0.001) (P= 0.015). Conclusion: The results indicate that children with UDT are exposed to high levels of oxidative stress and inflammatory reaction. This could negatively affect the future fertility in these children.
    No preview · Article · Jul 2012 · Pediatrics International
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    ABSTRACT: To determine the hepatitis B virus (HBV) genotypes and subgenotypes in patients with HBV infection in the Eastern Black Sea region of Turkey. One hundred and thirty-seven patients' samples collected over 5 years (January 2005 to January 2010) at Farabi Hospital in Karadeniz Technical University, Trabzon, Turkey were included in the study. All patients were positive for hepatitis B surface antigen (HBsAg) and HBV DNA. The HBV genotypes were determined by the polymerase chain reaction - restriction fragment length polymorphism (PCR-RFLP) method using an amplified segment of the pre-S region of HBV. One hundred and twenty-five of the 137 HBV samples (91.3%) were identified as genotype D using the PCR-RFLP method. Twelve isolates had undefined patterns, 122 of the 125 samples (97.6%) were determined as subgenotype D2, 2 (1.6%) were subgenotype D1, and one (0.8%) was subgenotype D-del. Similar findings in the other parts of the Turkey, the predominant patterns of HBV prevailing among patients in the Eastern Black Sea region of Turkey were of genotype D and subgenotype D2.
    No preview · Article · Jun 2012 · Saudi medical journal
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    ABSTRACT: This study presents data on species distribution and antifungal susceptibility profiles of Candida bloodstream isolates obtained from a Turkish Tertiary Care Hospital during a 4-year period. All hospitalized patients who had ≥ 1 blood culture positive for yeast during their hospital stay from January 2005 through 2009 were included in this study. All isolates were identified to species level using CHROMagar and ID 32 C. Fluconazole and voriconazole antifungal susceptibility testing was performed using the disk diffusion method according to CLSI M44-A. In vitro activity of amphotericin B was determined by the Etest. Of all 166 yeast isolates, C. albicans was the dominant species (34.3%), followed by Candida parapsilosis (28.9%) and C. tropicalis (8.4%). All of the 48 C. parapsilosis strains were identified as C. parapsilosis sensu stricto. Resistance to fluconazole was more common among C. krusei isolates. Voriconazole resistance was absent. One C. lusitaniae strain showed a high amphotericin MIC (4 μg/ml). Our survey indicated an increase of some non-C. albicans Candida species in our hospital while antifungal resistance was uncommon.
    Full-text · Article · Apr 2011 · Medical mycology: official publication of the International Society for Human and Animal Mycology
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    ABSTRACT: Aim: The aim of this study was to investigate the associations between human leukocyte antigen (HLA)-DRB1 alleles with genetic susceptibility to rheumatoid arthritis (RA) and production of antibodies against cyclic citrullinated peptide (anti-CCP antibody) and rheumatoid factor (RF) in Turkish RA patients. Methods: We studied 291 RA patients and 253 controls. Genotyping was performed by polymerase chain reaction with sequence-specific oligonucleotide probes hybridization method. Serum levels of anti-CCP antibody, IgM-RF and high sensitive C-reactive protein titers were measured by commercial kits using immunological methods. Results: We found that HLA-DRB1*04 and *09 alleles were associated in anti-CCP+ and anti-CCP+ RA patients (P < 0.0001 and P < 0.001, respectively), while DRB1*01 and *04 were determined to be higher in RF+ RA patients (P < 0.001 and P < 0.0001, respectively). Moreover, DRB1*11 and DRB1*13 alleles were determined to be lower in RF and anti-CCP/RF+ RA patients (P < 0.001 for both). HLA-DRB1*04 was identified as a common responsible allele for susceptibility to the disease in anti-CCP, RF and anti-CCP/RF− RA patients (P = 0.0018, P = 0.0004 and P = 0.0023, respectively). HLA-DRB1*13 allele alone was found to be protective against to anti-CCP+ and RF− RA (P = 0.0003 and P = 0.006, respectively). On the contrary, there was no protective allele in anti-CCP/RF− RA as well as anti-CCP− RA patients. Conclusion: This study indicates that associate and protective HLA-DRB1 allele distributions are different in autoantibody (anti-CCP or RF or anti-CCP/RF)+ RA and autoantibody− RA patients, with exceptions of DRB1*04 and DRB1*13.
    Full-text · Article · Mar 2011 · International Journal of Rheumatic Diseases
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    ABSTRACT: Various viral infections are thought to play a role in the development of atherosclerosis. A number of studies suggest that certain viruses from the Herpesviridae family in particular may lead to atherosclerosis. We investigated the presence of human herpesvirus 6 (HHV-6), human herpesvirus 7 (HHV-7), and human herpesvirus 8 (HHV-8) DNA in carotid, iliac, and coronary artery specimens obtained from a group of adult autopsy cases by means of polymerase chain reaction (PCR) analysis and nested PCR techniques. A 28-subject study group with at least type IV atherosclerosis and a 25-subject control group with no visible atherosclerosis were enrolled. HHV-6 DNA was found in the carotid artery specimen of 1 subject with atherosclerosis, in an iliac artery specimen of another subject, and in the iliac artery specimen of one of the control subjects. HHV-7 or HHV-8 DNA was not found in either the atherosclerosis or control cases. This study is the first to demonstrate the presence of HHV-6 in atherosclerotic vascular tissues. HHV-7 and HHV-8 were not found in atherosclerotic tissues; however, further research on broader study groups and with different protocols is needed to determine whether these viruses play a role in the formation of atherosclerosis.
    No preview · Article · Oct 2010 · Heart Surgery Forum

  • No preview · Article · Apr 2010 · Saudi medical journal
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    ABSTRACT: The aim of this study was to investigate the concordance between COBAS Taqman 48 (Roche Molecular Systems, Pleasanton, CA, USA) and VERSANT HCV RNA 3.0 (Bayer Diagnostics, Terrytown, NY) test systems for the detection of hepatitis C virus (HCV) load. Plasma samples taken from 42 patients with chronic HCV infection between 15 May-15 June 2006, were included to the study, and HCV-RNA levels have been searched with the use of the two above mentioned systems. Thirteen of the samples (30.9%) yielded negative and 26 (61.9%) samples yielded positive results by both of the systems. Two samples that were found negative by COBAS system, displayed 3.38 and 3.41 log10 IU/ml HCV-RNA by VERSANT system, respectively, while one sample that was found negative by VERSANT system, displayed 2.52 log10 IU/ml HCV-RNA by COBAS system. The correlation and linearity of the tests were found high according to Pearson correlation analysis [(r = 0.904, p < 0.0005), (R2 = 0.817)]. The viral load values detected by COBAS AmpliPrep/COBAS Taqman 48, were higher than the values obtained by VERSANT HCV-RNA 3.0, with a mean of 0.33 log10 IU/ml. In conclusion, both of the systems yielded similar results, however, since HCV viral load values may differ in different systems, the follow-up of viral load should be done by the same system for a particular patient.
    No preview · Article · Oct 2009 · Mikrobiyoloji bülteni

  • No preview · Conference Paper · Oct 2008
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    ABSTRACT: The aim of this study was to estimate the prevalence and predictors of Chlamydia trachomatis infection among young adult low-risk women attending either of two inner-city family planning clinics in Trabzon, the most densely populated city in Turkey's Black Sea region. The study group comprised 150 sexually active women attending either of two family planning clinics. Two endocervical swabs were collected from each woman and tested for the presence of C. trachomatis by tissue culture and a commercially available enzyme immunoassay (ELISA). Multivariable logistic regression analysis was used to identify the associations of clinical factors for predicting C. trachomatis infection. C. trachomatis was detected in 19 of the samples (12.7%) by cell culture and in 15 (9.9%) by ELISA. None of the demographic characteristics could be associated with the state of infection, but the women preferring the withdrawal method for contraception accounted for a significantly higher percentage of the C. trachomatis-positive cases than women who used other contraceptive methods. The most frequent signs of cervical infection were vaginal discharge (RR = 4.86, 95% CI 1.60 and 14.79, P = 0.005) and cervical erosion (RR = 3.26, 95% CI 0.97 and 10.90, P = 0.056).
    Full-text · Article · Jun 2008 · Japanese journal of infectious diseases
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    ABSTRACT: This study investigated the effect of caffeic acid phenethyl ester (CAPE) on acute necrotizing pancreatitis (ANP) induced by glycodeoxycholic acid in rats. CAPE, an active component of honeybee propolis, has previously been determined to have antioxidant, anti-inflammatory, antiviral, and anticancer activities. Forty-eight rats were divided into four groups of 12. Group 1 animals received intraductal saline and intravenous saline infusion treatment. Group 2 was given intraductal saline and intraperitoneal CAPE infusion treatment. ANP was induced in the animals in group 3 (ANP with saline infusion), and group 4 had induced ANP plus CAPE infusion treatment (ANP with CAPE infusion). Sampling was performed 48 h after treatment. ANP induction significantly increased mortality rate, pancreatic necrosis, and bacterial infection in pancreatic and extrapancreatic organs. ANP also increased levels of amylase and alanine aminotransferase (ALT) in serum, increased levels of urea and lactate dehydrogenase in bronchoalveolar lavage fluid (BAL LDH), increased the activities of myeloperoxidase (MPO) and malondialdehyde (MDA) in pancreas and lung tissue, and decreased the serum calcium levels. The use of CAPE did not significantly reduce the mortality rate but significantly reduced the ALT and BAL LDH levels, the activities of MPO and MDA in the pancreas, the activity of MDA in the lungs, and pancreatic damage. The administration of CAPE did not reduce the bacterial infection. These results indicate that CAPE had beneficial effects on the course of ANP in rats and suggest that CAPE shows promise as a treatment for ANP.
    No preview · Article · Apr 2008 · Journal of Surgical Research
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    ABSTRACT: The rapid, simple and non-invasive diagnosis of Helicobacter pylori (H. pylori) infection is important in implementing chemotherapy in appropriate manner, and in assessing persistent H. pylori infection after eradication therapy. The ImmunoCard STAT! HpSA kit (Meridian Bioscience, Europe) is a lateral flow chromatography test which utilizes a monoclonal anti-H. pylori antibody. In this study, we investigated the usefulness of the ImmunoCard STAT! HpSA test before and after eradication therapy on patients referred to undergo upper gastrointestinal endoscopy. Sixty-five consecutive patients who were referred to undergo upper gastrointestinal endoscopy at the Department of Gastroenterology, Karadeniz Technical University Medical School, Turkey between February and August 2005 were included in this study. The ImmunoCard STAT! HpSA was compared with 4 invasive tests (histology, gram staining, rapid urease test, and culture). The reference method was defined as positive when 2 of the 4 invasive tests were positive. A negative H. pylori status was considered when all 4 tests present concordant negative results. Overall, the ImmunoCard STAT! HpSA test had 77.8% sensitivity, 79.3% specificity, 82.4% positive predictive value (PPV) and 74.2% negative predictive value (NPV) in all patients. With regard to pre-treatment values, the sensitivity was 70.6%, specificity 70.6%, PPV 100% and NPV 100% while on post-treatment group the sensitivity was 84.2%, specificity 64.7%, PPV 72.7% and NPV 78.6%. Our results indicate that the ImmunoCard STAT! HpSA test is a rapid, simple, and helpful procedure not only to determine H. pylori infection but also to assess the success of eradication therapy.
    Full-text · Article · Jul 2006 · Saudi medical journal
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    ABSTRACT: It has been suggested that Helicobacter pylori strains containing the cytotoxin-associated gene A (cagA), and s1m1 genotype of vacuolating cytotoxin gene A (vacA) may have been associated with peptic ulcer disease. The aim of the present study was to analyze such an association of cagA presence and vacA subtypes of H. pylori with histopathological findings in patients with gastritis. Sixty-five independent H. pylori strains isolated from Turkish patients with gastritis were analyzed. The antral biopsy specimens were processed for culture and histopathology. Histopathological features were recorded and graded according to updated Sydney system. The vacA subtypes and cagA gene were tested by polymerase chain reaction. Mild degree of antral density was associated with mild degree of gastric neutrophil infiltration (P = 0.010). Positive cagA status correlated significantly with the presence of atrophy (P = 0.035) and neutrophil infiltration (P < 0.001), but not with H. pylori density (P = 0.754) nor the degree of mononuclear cell infiltration (P = 0.945). The vacA subtypes were independent of gastric histopathology. The odds ratios for atrophy and neutrophil infiltration of cagA+ versus cagA- strains were 3.62 (95% confidence interval [CI]: 1.04-12.66) and 53.18 (95%CI: 11.08-255.23), respectively. The presence of the cagA gene is strongly associated with atrophic and active gastritis. Distinct vacA subtypes of H. pylori appear to have no association with histopathological findings of gastritis.
    No preview · Article · Jun 2006 · Journal of Gastroenterology and Hepatology
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    ABSTRACT: BACKGROUND AND INTRODUCTION: It has been suggested that chronic infections may have a role in both the initiation and progression of atherosclerosis. While the majority of available data are focused on coronary artery disease, our aim was to investigate the presence of Chlamydia pneumoniae and Helicobacter pylori in samples from aortoiliac occlusive disease. Aorta-iliac atherectomy specimens were collected under sterile conditions from 21 patients (19 male, 2 female) undergoing surgery for aortoiliac occlusive disease. Seventeen macroscopically healthy vessels (12 internal mammary arteries, 3 radial arteries, prepared for coronary artery bypass graft, and 2 traumatic artery specimens, one of which was a superficial femoral artery and the other was a radial artery) were used as control. Blood samples for serological assays were obtained immediately before surgery. The polymerase chain reaction (PCR) was employed to search for H. pylori and C. pneumoniae DNA in atherosclerotic plaques and healthy vessel samples. Group-specific chlamydial lipopolysaccharide (LPS) antigens in atherosclerotic plaques and in healthy vessel samples and serum IgG antibodies to chlamydial LPS were determined by using a commercially available enzyme-linked immunosorbent assay (ELISA). Antibodies to H. pylori were also tested in all cases by means of an in-house ELISA. Chlamydial LPS and DNA were detected in 6 of 21 (28.57%) atherosclerotic lesions using ELISA or PCR, respectively. There was no evidence of H. pylori DNA in any plaque specimens. All cases in which C. pneumoniae DNA was positive were also seropositive for antichlamydial LPS. Neither C. pneumoniae DNA nor antigen nor H. pylori DNA was found in the macroscopically healthy samples. Our results suggest that C. pneumoniae but not, as proposed, H. pylori may be involved in the pathogenesis of aortoiliac atherosclerosis.
    No preview · Article · Mar 2006 · Cardiovascular Pathology
  • Etem Alhan · S Türkyilmaz · C Erçin · N Kaklikkaya · B.V. Kural
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    ABSTRACT: The aim of this study was to investigate the influence of omega-3 fatty acids (omega3FA) on acute necrotizing pancreatitis (ANP) induced by glycodeoxycholic acid in rats. The induction of ANP resulted in significant increases in mortality rate, intestinal permeability, bacterial infection in pancreas and extrapancreatic organs, and serum activity of urea and amylase, alanine transferase (ALT), interleukin (IL)-6, tumor necrotizing factor-alpha (TNF-alpha), lactate dehydrogenase (LDH) in bronchoalveolar lavage (BAL) fluid, tissue activity of myeloperoxidase (MPO) and malondialdehyde (MDA) in the pancreas and lung, and a considerable decrease of concentrations of calcium, protein and albumin. The use of omega3FA reduced mortality, phenol sulfophthalein excretion in urine, bacterial infection in pancreas, liver, spleen, MPO and MDA levels in pancreatic and lung tissue, LDH level in BAL fluid and serum IL-6 and TNF-alpha values. Serum triglyceride increased only in the omega3FA groups. Serum amylase, ALT, calcium, urea, protein, IL-1, and degree of pancreatic damage indicated no difference between the pancreatitis groups. Increased intestinal permeability and cytokine levels, and free radical damage play an important role during the course of acute pancreatitis. The treatment with omega3FA improves these effects. omega3FA may be useful in the treatment during ANP in rats. Therefore, it can be beneficial in patients with pancreatitis.
    No preview · Article · Feb 2006 · European Surgical Research
  • M. Topbaş · İ Tosun · G. Çan · N. Kaklikkaya · F. Aydin
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    ABSTRACT: The aim of the present report was to evaluate the prevalent species of airborne fungi in the outdoor environment in the city of Trabzon, Turkey. The area is surrounded by high mountains running parallel to the Black Sea, and has a mostly rainy and temperate climate together with a most varied and widespread flora. Air samples were collected in four seasons by means of the gravitational settling method using petri dishes with SDA culture media. Those fungi colonies that formed after an incubation period of 7-10 days at 25°C were determined on the basis of micro and macromorphological features. With respect to seasons, it was found that in Summer Penicillium, Alternaria and Fusarium, in Autumn and Winter Penicillium and in Spring and Summer Alternaria were the most prevalent fungal genera.
    No preview · Article · Feb 2006 · Turkish Journal of Medical Sciences