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Background: A good glycemic regulation should be provided to reduce mortality and morbidity in patients with end-stage renal failure due to diabetes mellitus. However, the use of insulin therapies in patients with renal failure is troublesome due to the increased rate of side effects. In our study, we investigated the frequency of hypoglycemia and its symptoms in patient groups receiving intensive and mixed insulin therapies. Materials and methods: This prospective study included 89 hemodialysis patients with DM-related stage 5 chronic kidney disease who were followed up in a nephrology clinic of a university hospital between January 2013 and August 2015. Our study group was divided into two groups as those receiving intensive insulin therapy and mixed insulin therapy. Group 1 and group 2 consisted of 46 patients and 43 patients, respectively. Hypoglycemia (glucose < 70 mg/dl) was investigated in patients with HbA1c levels that decreased below 7% after treatment, and the symptoms were evaluated according to the hypoglycemic scale. The results between the groups were evaluated using chi-square and Student's t test Results: A total of 89 patients were included in the study. HbA1c was 6.83% in the group receiving intensive insulin therapy and 6.95% in the group receiving mixed insulin therapy (p > 0.05). Hypoglycemia was detected in 27 patients (58.7%) in the intensive insulin therapy group and 14 patients (32.6%) in the mixed insulin therapy group. There was a significant level of hypoglycemia in the group receiving intensive insulin therapy (p < 0.05). In our study, the group receiving intensive insulin therapy had higher frequency and severity of common hypoglycemia symptoms such as confusion, sweating, weakness, dysphasia, palpitations, blurred vision, and feeling hungry. Conclusion: There was a higher frequency of hypoglycemia under intensive insulin therapy in patients undergoing dialysis due to chronic kidney failure, which suggests that mixed insulin therapy is the ideal treatment to avoid hypoglycemia in this group of patients. [ABSTRACT FROM AUTHOR]

Karabuk is located in the Northwestern Black Sea and surrounded by Zonguldak to the west, the Black Sea to the north, Kastamonu to the east, Cankırı to the south. Ucboluk (Ilbarit) Village that located 20 km southeast of Safranbolu district of Karabuk, is a historic settlement founded on the slopes of Soganli Valley. Within the scope of the scientific project "Surveys in Roman and Byzantine Periods of Karabuk Province and its Districts", which started for the first time in 2017, research has been carried out in Safranbolu and surrounding settlements. Through this study, finding the rock-cut tomb, altar and wine presses, columns, double columns, column headings, inscriptions dated to Roman and Early Byzantine Periods and many archaeological data around Ucboluk (Ilbarıt) Village in Soganli Valley were examined and recorded. Archeological artifacts found in Ucboluk Village, which included in the borders of the region called Paphlagonia in history, shed light on the historical, architectural and socio-economic structure of the area from the Roman and Early Byzantine Periods. Ucboluk village and surrounding areas, which attracted the attention of many researchers and travellers since the 19th century such as Leonhard (1915), Gökoğlu (1952), Belke (1996), Dökü (2008), Laflı and Christof (2009, 2012), were examined in detail by us with together archaeological and art history experts for the first time in 2017. When evaluation on historical data of Ucboluk Village, having abundant water resources, which located on the southern slope of the Soganli Valley is considered to be an intensive agricultural activity based on wine production in the region. The finding vine branches and agricultural tools on the rock-cut tombs and grave stalks and especially rock-cut wine presses in Ucboluk (Ilbarıt) and around it, are indicative of this. Within the scope of this paper, the rock-cut tombs previously found and the rock-cut wine presses, rock-cut altar, cross sacred rock structure and architectural plastic artifacts that were first detected by us in Ucboluk village, which is one of the rural settlements in southern Paphlagonia, are evaluated in general perspective. Also, under the light of those finding artifacts, the architecture, the religious and social economic structure of the rural settlements in the region during the Roman and Early Byzantine periods were tried to be identified. [ABSTRACT FROM AUTHOR]

The late antique, early Byzantine settlement area locates at 12 km. distance to southwest of Karabuk Central District, on a sloping land with an altitude of 700 meters piedmont of Keltepe mountain. This settlement area, called as Zora, Zara, Zopran, Sora, Sopran or some other similar names by the researchers, locates within the boundaries of Akören (Kaleköy) and Zopran today. This area is one of the five central eparchies bounded to Paphlagonia district of Gangra (Çankırı). Various column headers, inscriptions, sculptures, Hellenistic sepulchres and architectural ruins belonging to Roman age are identified there. The settlement area called as Sora since the 4th century is observed by Doublet (1889), Mendel (1901), Gökoğlu (1952), Marek (1993, 2003), Belke (1996) and Umar (2007), and they found out that it used to be called Zobran in the records of 16th century Ottoman archive. Within the scope of this research, Sora is observed in details for the periods of Roman, Byzantine and Ottoman. The life of St. Autonomous, who had came there in the 4th century to proselytize Christianity and became a martyre, their sepulchre constructions, the bishops of the city, architectural plastic works and scriptures are all researched. Moreover, the problem of naming the area which was confusing for many years is tried to be solved by this research beside documenting the present condition of the architectural ruin on their original places. [ABSTRACT FROM AUTHOR]

7.00 x 8.25 m. measured place which is located between housing ruins in the eastern part of the Metropolis Theatre is called reception hall. This place decorated with colorful mosaics and a wall painting also having a good handcrafted floor is dated back to Roman Empire period. Besides Dionysos, Ariadne, Meinad, and Eros holding a wineglass figures related with Dionysos cult on the mosaic; theatre masks, fish and bird figures all together demonstrate that it could be used as a banquet hall for official invitations during theatre plays. These fish and bird figures have great importance to analyze the nutrition habits of antique cities, especially metropolis, which has few materials that could be read. The various fish and bird figures on the reception hall were examined by expert zoologists to try to identify the factors such as, this fish and birds' species, their habitats and if they were eatable or not. The paper also tries to find out the nutrition habits of Metropolis community using the found data from ancient sources and obtained from this research. [ABSTRACT FROM AUTHOR]

Objectives: The early diagnosis of volume overload in chronic kidney disease (CKD) is very important. N-terminal probrain natriuretic peptide (NT-proBNP) is a valuable biomarker for this purpose. Our study aimed to detect the relationship between NT-proBNP and left ventricular hypertrophy (LVH), hypertension (HT), GFR, and proteinuria among diabetic patients with stage 3-4 CKD. Methods: 160 diabetic patients with stage 3-4 CKD [80 patients in stage 3 CKD (group 1) and 80 patients in stage 4 CKD (group 2)] were enrolled. NT-proBNP levels were evaluated in serum, and proteinuria was determined from 24-hour collected urine. Left ventricular hypertrophy was evaluated by M-mode echocardiography. NT-proBNP levels were compared according to their left ventricular hypertrophy, hypertension, and proteinuria levels. Results: NT-proBNP levels was significantly higher, and GFR was lower in group 2 compared to group1 (p < 0.05). NTproBNP was higher in patients with LVH (+) HT (+) and proteinuria = 1gr/d than patients with LVH (-), HT (-), and proteinuria < 1g/d (p < 0.05). We found a significant correlation between NT-proBNP levels and left ventricular posterior wall thickness, diastole (LVPWTd), proteinuria, SBP, and DBP. Proteinuria was the major contributor to increased NTproBNP levels among the independent variables. Conclusion: We detected that NT-proBNP levels are increased during the progression of CKD, and proteinuria is the major cause of increased NT-proBNP levels among the independent variables. [ABSTRACT FROM AUTHOR]

Objectives: The early diagnosis of volume overload in chronic kidney disease (CKD) is very important. N-terminal probrain natriuretic peptide (NT-proBNP) is a valuable biomarker for this purpose. Our study aimed to detect the relationship between NT-proBNP and left ventricular hypertrophy (LVH), hypertension (HT), GFR, and proteinuria among diabetic patients with stage 3-4 CKD. Methods: 160 diabetic patients with stage 3-4 CKD [80 patients in stage 3 CKD (group 1) and 80 patients in stage 4 CKD (group 2)] were enrolled. NT-proBNP levels were evaluated in serum, and proteinuria was determined from 24-hour collected urine. Left ventricular hypertrophy was evaluated by M-mode echocardiography. NT-proBNP levels were compared according to their left ventricular hypertrophy, hypertension, and proteinuria levels. Results: NT-proBNP levels was significantly higher, and GFR was lower in group 2 compared to group1 (p < 0.05). NTproBNP was higher in patients with LVH (+) HT (+) and proteinuria = 1gr/d than patients with LVH (-), HT (-), and proteinuria < 1g/d (p < 0.05). We found a significant correlation between NT-proBNP levels and left ventricular posterior wall thickness, diastole (LVPWTd), proteinuria, SBP, and DBP. Proteinuria was the major contributor to increased NTproBNP levels among the independent variables. Conclusion: We detected that NT-proBNP levels are increased during the progression of CKD, and proteinuria is the major cause of increased NT-proBNP levels among the independent variables. [ABSTRACT FROM AUTHOR]

Non-steroidal anti-inflammatory drugs (NSAIDs) are often used in the treatment of chronic and acute pain and inflammation as an analgesic and anti-inflammatory agent. They inhibit the synthesis of prostaglandins which have influence on glomerular capillaries, vasa recta and tubular functions. They lead to significant complications such as hyperkalemia, hyponatremia, edema and hypertension. Usage of NSAIDs is a risk factor for acute kidney injury in some conditions such as advanced age, dehydration, vomiting, diuretics, ACE/ARB therapy, heart failure, nephrotic syndrome, cirrhosis and chronic kidney disease. Acute interstitial nephritis is not dependent on the drug dose and it is characterized by immunological inflammatory reaction and a decrease in creatinine clearance. Besides the classical findings, glomerules can be involved and minimal change disease or membranous glomerulonephritis can develop. Analgesic nephropathy is characterized by interstitial nephritis and papillary necrosis. Metabolites of NSAIDs are accumulated in renal medulla which has lowest oxygen pressure in kidney and they disrupt the renal parencymal perfusion by vasoconstriction. Respectively, papillar necrosis, glomerular sclerosis, interstitial fibrosis and cortical atrophy can develop insidiously. [ABSTRACT FROM AUTHOR]

Purpose: Nosocomial infections develop after 48-72 hours of hospitalization. Gram negative bacilli are generally the causative agent. 25% of all nosocomial infections develop in the intensive care units. Therefore, patients in the intensive care units are at high risk. This study aimed to determine the prevalence of nosocomial infections and causative gram negative bacilli in the Intensive Care Unit (ICU). Materials and Methods: 269 patients who were hospitalized in internal medicine intensive care unit (IMICU) of Dicle University Faculty of Medicine between june 2010- December 2010 were included in this study. Culture samples were taken from all of the patients who develops fever ( ≥38.5 C) after the hospitalization to the IMICU. Culture of blood, urine, sputum, central venous catheters, open wounds and deep tracheal aspirate were taken. Source and the prevalence of infection and distribution of the isolated causative pathogens were determined in the patients with gram negative bacilli reproduction. Results: 158 of the patients were male ( 58.7%) and 111 of the patients were female ( 41.3%). The mean ages of men and female were 58.81±16.91 and 56.44±19.16 years, respectively (p= 0.286). culture samples were taken from blood (16%), urine ( 8.6%), central venous catheter tips ( 6.3%), deep tracheal aspirates (10%), sputum (2.2%) and wound stabs (2.2%). Nosocomial infections were detected in 109 patients ( 40.5%). Pneumonia, urinary tract infections and gastrointestinal system infections were the most frequent infections respectively. Microorganisms were isolated from one sample in 97 patients, while 12 patients had more than focus. The most commonly isolated organisms were E.Coli (13.8%) and Pseudomonas Aeruginosa (7.4%), followed by Acinetobacter Baumannii (6.3%) and Stenotrophomonas Maltophilia (3.3%). Conclusion: Nosocomial infections in intensive care units have proved to be a serious problem. Surveillance studies should be performed for the isolated causative pathogens and measures should be taken to prevent the development of the ICU infections. [ABSTRACT FROM AUTHOR]

The common variable immunodeficiency disease (CVID) is the most common symptomatic primary antibody deficiency. It is the most frequently observed cause of panhypogammaglobulinemia in adults. Here, we present a case of systemic amyloidosis that developed secondary to the common variable immunodeficiency disease causing recurrent infections in a young female patient. A 24-year-old female patient, who was under treatment at the gynecology and obstetrics clinic for pelvic inflammatory disease, was referred to our clinic when she was observed to have swellings in her legs, hands, and face. She had proteinuria at a rate of 3.5 gr/day, and her serum albumin was 1.5 gr/dl. The levels of immunoglobulins are IgG: 138 mg/dl, IgA: 22,6mg/dl, and IgM: 16,8mg/dl. The renal USG revealed that the kidneys were observed to be enlarged. Since the patient had recurrent infections, hypogammaglobulinemia, nephrotic range proteinuria, and enlarged kidneys in the renal USG, she was thought to have type AA amyloidosis and therefore underwent a renal biopsy. The kidney biopsy revealed amyloid (+). So the patient was diagnosed with AA type of amyloidosis secondary to common variable immunodeficiency disease. A treatment regimen (an ACE inhibitor and a statin) with monthly administration of intravenous immunoglobulin was started. [ABSTRACT FROM AUTHOR]

Trombotik mikroanjiopatiler; klinik olarak birbirine benzeyen iki hastalığı, trombotik trombositopenik purpura (TTP) ve hemolitik uremik sendromu (HUS) icerir. HUS diyareli ve diyaresiz olarak ikiye ayrılır, ayrıca Faktor H mutasyonuna da bağlı gelişebilir. TTP’nin etyolojisinde ADAMTS13 gen mutasyonu mevcuttur. Hemolitik anemi, mikrovaskuler tromboz ve trombositopeni ortak klinik bulgulardır. HUS’te diyare onemli bir bulgudur. Diyare (+) olgular genellikle yaz ve sonbahar mevsimlerinde ortaya cıkar. Başta escherichia coli O157: H7 olmak uzere bircok bakteri tarafından uretilen toksinler tarafından kaynaklanmaktadır. Bu calışmamızda kliniğimize başvuran HUS tanılı hastaların klinik sonuclarını sunmak istedik. [ABSTRACT FROM AUTHOR]

In the present study, coumarin and some coumarin derivatives (esculetin, scoparone, and 4-methylumbelliferone) were investigated for their lipid-lowering effect in rats. Male Sprague–Dawley rats (150–200 g) were divided into six groups and each group comprised of five rats. Hepatic injury-dependent hyperlipidemia was induced by carbon tetrachloride (CCl4, 1.25 ml/kg). Coumarin and coumarin derivatives esculetin (35 mg/kg), scoparone (35 mg/kg), 4-methylumbelliferone (35 mg/kg), or coumarin (30 mg/kg) were administered to experimental groups at 12-h intervals. Animals received the derivatives esculetin, scoparone or 4-methylumbelliferone prior to the administration of a single toxic dose of CCl4. Serum total cholesterol (TC), triglyceride (TG), very low-density lipoprotein cholesterol (VLDL-C), and low-density lipoprotein cholesterol (LDL-C) levels significantly increased in CCl4-treated group (p < 0.05, p < 0.01, p < 0.01, and p < 0.05, respectively), while levels of serum high-density lipoprotein cholesterol (HDL-C) decreased (p < 0.01). 4-Methylumbelliferone had no recovery effects on serum TC levels, however, significantly prevented CCl4-induced hyperlipidemia by reducing TG and VLDL-C levels (p < 0.05 and p < 0.05, respectively). In addition, coumarin had no recovery effect on any of the serum lipid parameters against CCl4-induced hyperlipidemia. Among the coumarin derivatives only esculetin and scoparone significantly prevented serum HDL-C in CCl4-induced dyslipidemia. The results from this study indicate that the chemical structure of coumarins plays an important role on the regulation of serum lipid profiles. [ABSTRACT FROM AUTHOR]

Objective: Acute kidney injury (AKI) is an important clinical entity that is known to increase mortality in patients with sepsis. Erythrocyte maturation and proliferation are inhibited by pro-inflammatory cytokines; these cytokines exert effects on red cell distribution width (RDW) well. Based on this knowledge; our aim in this study was to evaluate the impact of RDW on acute kidney injury in patients with sepsis. Methods: 120 patients diagnosed with sepsis and admitted to intesive care unit (ICU) and treated between 2009-2013 were retrospectively evaluated. Patients were divided into two groups as follows: group 1 (RDW≥16.8) and group 2 (RDW<16.8). Multiple logistic regression analysis was used to determine the association between RDW and AKI and mortality. Results: There was a statistically significant relationship between AKI and RDW (p<0.001, OR=11.52) but there were no statistically significant relationship between AKI and sex, age, serum lactate levels as well as SOFA score. Also, there were statistically significant relationship between mortality and RDW (p=0.044, OR=5), serum lactate levels (p=0.030) and SOFA score (p<0.001). RDW was found associated with both AKI and mortality. Conclusions: Results suggest that RDW is an important parameter for predicting development of AKI and mortality in ICU patients with sepsis. [ABSTRACT FROM AUTHOR]

Amaç: Ventrikuler taşikardi, sıklıkla akut myokard enfarktusu, dilate kardiyomyopati gibi yapısal kalp hastalıklarına eşlik eden uc veya daha fazla ardışık 3 prematur vurunun olması olarak tanımlanır. Bununla beraber hipomagnezemi durumunda spontan olarak da meydana gelebilir. Bu bildiriyi sunmamızdaki amac Non-hodgkin lenfoma tanılı bir hastada gelişen ventrikuler taşikardinin nadir ve olumcul olabilen bir nedenini paylaşmaktır. [ABSTRACT FROM AUTHOR]

Objective: The purpose of the present study is twofold: (a) to investigate the etiology of disseminated intravascular coagulopathy (DIC) caused by obstetrical conditions and (b) to present parameters that can be used in predicting DIC-related mortality in obstetrical patients.Material and Method: Obstetrical patients who had a delivery at or were referred (after delivery) to Obstetrics and Gynecology Clinic of Dicle University between July 2006 and December 2013 were retrospectively analyzed in this study. Those patients diagnosed with DIC were included in the study.Results: Fifty-six obstetrical patients carrying the diagnosis of DIC were included in this study. The overall mortality rate was 25% among these patients. More specifically, the mortality rate was 10.7% among patients with a DIC score ≤5 and 40.7% among those with a DIC score > 5. Multiple logistic regression analysis resulted in the finding that international normalized ratio (INR) and urea were among those factors affecting mortality in obstetrical DIC [OR: 8.44 (CI: 1.9-36.8), OR: 1.05 (CI: 1.0-1.1), respectively].Conclusion: DIC is a syndrome that might be caused by obstetrical conditions. It is associated with high mortality and morbidity rates. In obstetrical DIC, urea is the most important factor affecting mortality. In addition, we are of the opinion that DIC score might guide mortality predictions as a determinant of prognosis. [ABSTRACT FROM AUTHOR]

Objective: Acromegaly is a syndrome characterized by growth hormone (GH) and insulin like growth factor-1 (IGF-1) over secretion. It was aimed to sharing detected metabolic disorders of the patients with acromegaly who have been under follow-up at our clinic. Methods: One hundred five patients, who were diagnosed as acromegaly in our clinic between 2010 and 2015, were enrolled to the study. The age, gender, involvement feature additional systemic and metabolic diseases were recorded and laboratory findings. Results: A total of 105 patients included in the study, 56 women (53.3%) and 49 men (46.7%), respectively. Patient's' ages ranged 23-78 (mean 42.1±16.7). 34 patients (32.3%), hypertension in 20 (19.04%), diabetes mellitus, and is 11 (10.4%) had impaired glucose tolerance. Conclusion: Somatic disfigurement (hand and foot enlargement etc.) is the major characteristic of the disease but the prognosis is determined by cardiovascular, respiratory and metabolic complications. In acromegaly, hypertension and diabetes are common, cardiovascular disease is the principal cause of death. We believe that our study will contribute to the determination of our country's data. [ABSTRACT FROM AUTHOR]

Giriş: Yoğunbakım hastalarında solunum yetmezliği ve mortalitesi yük-sek olan akut respiratuar distress sendromu (ARDS) gelişebilmektedir.Bu bildiride amacımız ARDS ile takip edilen hastalarda recruitmentmanevrasının önemini vurgulamaktır. [ABSTRACT FROM AUTHOR]

Amniotic fluid embolism is a rare but a leading cause of maternal and fetal mortality. Etiopathogenesis is still unknown; it is an obstetric emergency with high mortality rates at birth or shortly after birth, characterized by the sudden onset of hypotension, hypoxia and severe coagulopathy. In this article a 35 year old woman whose preterm pregnancy resulted in maternal and fetal death was presented. We aimed to present a case of amniotic fluid embolism whose rare causes are associated with wide cranial and pulmonery embolism for differential diagnosis during pregnancy. (Yoğun Bakım Derg 2013; 4: 32-6) [ABSTRACT FROM AUTHOR]

Amaç: Hemofagositik sendrom yoğun bakım hastalarında nadir gorulen ve mortalitesi cok yuksek olan bir hastalıktır.Hemofagositik sendrom spesifik olmayan semptomlarla karakterize olabileceği gibi şiddetli klinik tablo ile de karşımıza cıkabilir. Bu bildiriyi sunmamızdaki amac spesifik olmayan semptomlarla ortaya cıkan bir hemofagositik sendrom olgusunu paylaşmaktır. [ABSTRACT FROM AUTHOR]

Amaç: Amniyotik sıvı embolisi ani başlangıçlı hipotansiyon, hipoksi veşiddetli koagulopati ile karakterize, etyopatogenezi henüz tam aydınlatı-lamamış mortalitesi yüksek obstetrik bir acil durumdur. Insidansı 1/8000ile 1/80000, mortalite oranı %61 -86 arasındadır. Bu olguda amacımız10.gebeliğinde servikal serklajı açılıp spontan travayda izlenirken ani-den hipotansiyon, hipoksi, nöbet ve taşipne gelişen hastada amniyonmai embolisinin tanı, kliniği ve sonucunu tartışmaktır. [ABSTRACT FROM AUTHOR]