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Headache is one of the most frequently encountered neurological symptoms during hemodialysis. According to International Classification of Headache criteria dialysis-related headache was defined as the headache occurring during hemodialysis with no specific characteristic. It resolves spontaneously within 72 hours after the hemodialysis session ends. There are few studies in the literature investigating the clinical features of dialysis headache. The pathophysiology of hemodialysis-related headache is not known, but various triggering factors have been identified, including changes in blood pressure, serum sodium and magnesium levels during hemodialysis sessions, caffeine deprivation and stress. The aim of this article is to evaluate and analyze features of headache in patients undergoing hemodialysis.

Invasive fungal infections are a leading cause of morbidity and mortality in immunocompromised patients, especially in cases requiring a prolonged stay in the intensive care unit. A total of 99 yeast strains were isolated from 42 postmortem cases. In this study, virulence factors and antifungal susceptibility of these species were evaluated. The isolates were identified as Candida albicans (54), C. tropicalis (15), C. glabrata (12), C. parapsilosis (6), C. lipolytica (3), C. utilis (3), C. krusei (2), C. kefyr (1), and Cryptococcus neoformans (3). The most commonly isolated species was C. albicans, and no resistant species were determined. Despite the equal number of specimens, no secretion of significant virulence factors was associated with the postmortem specimen in the Candida species. Postmortem fungal investigations in forensic autopsies are useful in explaining cause of death in such cases, also may lead to protocols for the treatment of fungal infections and contribute to fungal pathogenesis and epidemiological data.

Background Aspergillus species cause a wide range of diseases in humans, including allergies, localized infections, or fatal disseminated diseases. Rapid detection and identification of Aspergillus spp. facilitate effective patient management. In the current study we compared conventional morphological methods with PCR sequencing, rep-PCR, and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) for the identification of Aspergillus strains. Materials and Methods A total of 24 consecutive clinical isolates of Aspergillus were collected during 2012–2014. Conventional morphology and rep-PCR were performed in our Mycology Laboratory. The identification, evaluation, and reporting of strains using MALDI-TOF-MS were performed by BioMerieux Diagnostic, Inc. in Istanbul. DNA sequence analysis of the clinical isolates was performed by the BMLabosis laboratory in Ankara. Results Samples consisted of 18 (75%) lower respiratory tract specimens, 3 otomycosis (12.5%) ear tissues, 1 sample from keratitis, and 1 sample from a cutaneous wound. According to DNA sequence analysis, 12 (50%) specimens were identified as A. fumigatus, 8 (33.3%) as A. flavus, 3 (12.5%) as A. niger, and 1 (4.2%) as A. terreus. Statistically, there was good agreement between the conventional morphology and rep-PCR and MALDI-TOF methods; kappa values were κ = 0.869, 0.871, and 0.916, respectively (P < 0.001). Conclusion The good level of agreement between the methods included in the present study and sequence method could be due to the identification of Aspergillus strains that were commonly encountered. Therefore, it was concluded that studies conducted with a higher number of isolates, which include other Aspergillus strains, are required.

Restless legs syndrome (RLS) is characterized by unpleasant sensations, pain in the legs along with irresistible urges to move the legs when at rest. It is often accompanied by sleep disturbance. The purpose of this study was to assess the association of anxiety and sleepiness with sexual function in hemodialysis patients with and without RLS. Sociodemographic parameters, laboratory data of hemodialysis patients from three dialysis centers were collected prospectively. Anxiety, sleepiness, sexual function, and presence of RLS symptoms were assessed with standardized questionnaires as the RLS Diagnosis and Scale, Hamilton Anxiety Rating Scale, Epworth Sleepiness Scale (ESS), Arizona Sex Experiences Scale (ASEX). Univariate, regression tree method were used for statistical analysis. RLS was observed in 45.9% (n = 113) of hemodialysis patients (n = 246). The mean age of patients and duration of hemodialysis were 59.7 ± 14.0 and 4.9 ± 4.2 years, respectively. The correlation between Arizona Sexual Experiences Scale (ASEX) and sociodemographic features was significant (P

WOS: 000344165000004 PubMed: 24766311 Headache is one of the most frequently encountered neurological symptoms during hemodialysis. According to International Classification of Headache criteria dialysis-related headache was defined as the headache occurring during hemodialysis with no specific characteristic. It resolves spontaneously within 72 hours after the hemodialysis session ends. There are few studies in the literature investigating the clinical features of dialysis headache. The pathophysiology of hemodialysis-related headache is not known, but various triggering factors have been identified, including changes in blood pressure, serum sodium and magnesium levels during hemodialysis sessions, caffeine deprivation and stress. The aim of this article is to evaluate and analyze features of headache in patients undergoing hemodialysis.

Aim: Peritoneal dialysis patients with ultrafiltration failure frequently have fluid overload. It is known that the increase in the ultrafiltration is associated with decrease in the left ventricle (LV) dysfunction. This study was designed to examine the potential effects of serum brain natriuretic peptide (BNP) on cardiac functions and to determine the relationship between BNP and cardiac parameters in continuous ambulatory peritoneal dialysis (CAPD) patients with ultrafiltration failure. Methods: Twenty-eight patients with high or high-average membrane permeability as indicated by the peritoneal equilibration test were enrolled and randomized to receive either once or twice daily icodextrin. Serum BNP levels and echocardiographic measurements were evaluated at baseline and at the end of the eighth week. The correlations between the percentage changes of parameters from baseline were also studied. Results: In both groups there was a significant decrease in serum BNP, LV mass, heart rate (HR) and cardiothoracic index (CTI) and an improvement in ejection fraction (all P

Central venous cannulation is a common procedure for acute hemodialysis. Hiccups are a rare complication of internal jugular venous catheterization. In this case, hiccups appeared after the vena jugularis interna catheterization for acute hemodialysis in a patient with acute renal failure and was treated with the reposition of the catheter.

ultrasound and MRI defined further enlargment of ventricular width (14 mm) and the absence of parieto-occipital fissure, calcarine fissure and cingulate sulcus. The couple after extensive counseling opted for continuing pregnancy. At the moment the pregnancy is ongoing. Unilateral borderline ventriculomegaly, as an isolated finding, is a common sign during ultrasound scan in midgestation, and reports describe it is as minimally effective on developmental outcome. The control of malformations of cortical development with different sulcal and gyral patterns may be associated with specific diagnoses, and provide accurate parental counseling.

Objectives: The term macrocephaly signifies a head circumference (HC) that is more than 2 standard deviations above the mean or exceeds the 97th percentile. Benign familial macrocephaly is a dominantly or recessively inherited disorder in which the head size of otherwise normal newborn. In this study we report prenatal diagnosis of a benign familial macrocephaly case. Methods: The patient was a 20-year-old woman, gravida 1. She had an ultrasound examination at 11 weeks’ gestation. Ultrasound scanning at 18 weeks’ gestation showed a HC measurement above 97th percentile. Femoral length and abdomen circumference measurement were above 50th percentiles. Results: The serial scans demonstrated that HC had continued to growth above 97th percentile. Paternal HC was 62 cm (above 97th percentile) and family pedigree showed more than 14 other affected members with this disorder. At gestational age of 37+5 weeks, because of the large head size and premature rupture of membranes Cesarean section was performed and evaluation of the male infant at birth showed a HC 39 cm (above 98th percentile). No other physical abnormalities were detected. Follow-up evaluation by MRI and physical examination at 6 months of age showed a normal neurologic evaluation but persistent macrocephaly. Conclusion: In this disorder, serial measurement of HC demonstrates a proportional rather than an excessive rate of growth. In this condition, measurements of parental head size often reveal macrocephaly in one parent. This case report highlights the necessity of combining appropriate family history and serial measurement of HC for diagnosis of benign familial macrocephaly.

Lesioning using radiofrequency (RF) current has been increasingly used in clinical practice for the treatment of pain syndromes. Although formation of heat causing "thermocoagulation" of the nervous tissues is thought to be responsible of the clinical outcome, a more recent modality of RF application named pulsed radiofrequency (PRF) delivers the RF current without producing destructive levels of heat. In our study, we compared the effects of conventional RF (CRF) and PRF on rabbit dorsal root ganglion (DRG) morphology, including also control and sham operated groups. The setting of the experiment and the RF parameters used were similar to those used in current clinical practice. The specimens were analyzed both with light microscopy and electron microscopy, two weeks after the procedure. At the light microscopic level, all groups had preserved the normal DRG morphology and no differences were observed between them. In the electron microscopic analysis there were no pathological findings in the control and sham operated groups. But the ganglion cells in the RF groups had enlarged endoplasmic reticulum cisterns and increased number of cytoplasmic vacuoles which were more evident in the CRF group. Some of the ganglion cells in the CRF group had mitochondrial degeneration, nuclear membrane disorders or loss of nuclear membrane and neurolemma integrity. The myelinated and unmyelinated nerve fibers were of normal morphology in all groups. Our results suggest that PRF application is less destructive of cellular morphology than CRF at clinically used "doses". Before making certain judgements, more experimental and clinical studies should be planned.

The incidence of active tuberculosis among patients on long- term dialysis is higher than the rate in the general population. Case: 39-year-old male patient with ESRD was admitted to hospital with dyspnea, weight loss, cough without sputum and hemoptysis, and a palpable painless mass under the right areola. He was on maintenance hemodialysis three times a week for the last six months. PPD was negative. Chest X-ray examination revealed a hyperdense lesion. On the computerized tomography a cystic mass at the inferior lobe superior segment near the thorasic vertebra was detected. Fine needle aspiration from each of the mass lesions revealed granulomas and acido-resistant bacteria. Anti-tuberculous therapy was initiated. After eight months he came back with paraplegia. Magnetic resonance imaging (MRI) revealed that the lesion which previously has been described by CT was extending to the spinal duct and pressing on the spinal cord. After a biopsy, granuloma was seen; however, mycobacterium tuberculosis did not grow in the culture. Discussion: Extrapulmonary tuberculosis is common in patients with ESRD. In the present case we established that the patient who presented a mass on the chest wall without pulmonary tuberculosis findings had indeed a tuberculous cavity mass. It is interesting to note that in this case this mass had no relationship to the tuberculous cavity in the lung tissue. Moreover, it is also interesting that paraspinal lesion occured during the period in which the patient was under treatment and it quickly progressed and led to paraplegia. Tissue biopsy with invasive procedures may be necessary. Thus, in areas with a high prevalence of tuberculosis, renal patients in high-risk group (renal transplant recipients, hemodialysis and CAPD patients) should be examined periodically to exclude silent infection and reduce morbidity and mortality.