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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.

Rhabdomyolysis is a potentially life-threating syndrome which is caused by muscle injury and characterized by the leakage of muscle cell contents, including electrolytes, myoglobin and other sarcoplasmic proteins into circulation. Rhandomyolysis may develop from a variety of causes such as trauma, muscle disease, drugs and toxins etc. Acut kidney injury is the most frequent lethal complication of rhabdomyolysis. Seizures especially generalized tonic-clonic type can rarely cause rhabdomyolysis by the muscle forces generated during seizure episode. In this case, we represent a rarely seen case of acute renal failure due to rhabdomyolsis after seizure episodes with full recovery

Antiphospholipid syndrome (APS) is an autoimmune disease characterised by arterial and/or venous thrombosis and/or recurrent pregnancy loss in the presence of antiphospholipid (APL) antibodies. It is evaluated as APS when it develops associated with other systemic autoimmune diseases or primary APS if there is no concomitant disorder. In this study, we present a case of a 16-year-old male patient with primary APS. The patient was admitted with presumptive diagnosis of pneumonia, but multiple pulmonary thromboembolism (PTE) was observed on computerized tomography (CT) pulmonary angiography. APL antibodies positivity and thrombocytopenia developed in our patient. The patient was evaluated as primary APS since another etiology that could explain PTE was not found. Primary APS is a rare disease in children along with adolescents, compared with APS associated with other systemic autoimmune diseases. We present here a young male patient with primary APS and PTE to contribute to the literature. The patient initially had pneumonia but later developed PTE and thrombocytopenia.

Sağlık sistemlerinde ihtiyaç tespiti, hizmet planlanması ve finansmanı, hizmetin etkisinin değerlendirilmesi, beklenen yaşam süresinin hesaplanabilmesi, yerleşim yerleri, bölgeler ve ülkeler arası karşılaştırmalar için ölümlerle ilgili bilgiye gereksinim vardır. Tanımlayıcı tipteki bu çalışmada, HÜTF Erişkin Hastanesi’nde 2004 yılındaki 674 ölüm vakasından kayıtlarına ulaşılabilen 659 ölüm vakası (%97.8) incelenmiş, hastaların epikriz bilgileri ile Devlet İstatistik Enstitüsü (DİE) formuna işlenen bilgi arasındaki tutarlılık değerlendirilmiştir. Çalışma bulgularına göre, HÜTF Erişkin Hastanesi’nde ölüm kayıtlarının daha iyi tutulmalıdır ve epikriz formunu yazan hekim ve DİE formunu dolduran görevli daha dikkatli olmalıdır. Epikrizin hekimler tarafından “doğru ve eksiksiz olarak”, ölüm formunun da servis sekreteri tarafından epikrize bakılarak doldurulması olası hataları azaltacaktır

Kronik myeloid lösemi (KML), ilkel hematopoietik kök hücrelerinin neoplastik transformasyonu sonucu oluşan klonal myeloproliferatif bir hastalıktır. Spesifik BCR-ABL protein tirozin kinaz inhibitörü (TKİ) imatinib mesilat klinik uygulamaya girdikten sonra KML tedavisinde yeni bir dönem başlamıştır. Bugün KML tedavisinde imatinib mesilat ilk tercih edilen tedavi seçeneğidir ancak imatinib mesilat tedavisine yanıtsızlık ve intolerans gelişebilmektedir. Bu çalışmamızda TKİ tedavisi verilen KML hastalarında tedavi etkinliğinin ve prognozun değerlendirilmesi amaçlandı.Çalışmamızda Hacettepe Üniversitesi Tıp Fakültesi Erişkin Hastanesi Hematoloji Ünitesinde Kasım 1995 ile Aralık 2009 tarihleri arasında takip edilen 16 yaşından büyük 54 KML hastası değerlendirildi. Verilere retrospektif olarak hasta dosya kayıtlarından ulaşıldı. Hastaların TKİ başlandığı sıradaki hastalık evrelemesi Dünya Sağlık Örgütü (WHO) kriterlerine göre yapıldı. Tanı anındaki risk profili Sokal risk skorlamasına göre değerlendirildi. Yanıt oranları (hematolojik ve sitogenetik), relaps oranı ( hematolojik, sitogenetik ve moleküler relapstan herhangi birinin varlığı), relaps bağımsız sağkalım ve genel sağkalım değerlendirildi. Hastaların sağkalım eğrileri Kaplan Meier yöntemi ile değerlendirildi.Çalışmamızda hastaların %94.4' ünde tam hematolojik yanıt (THY) ve %75.9' unda tam sitogenetik yanıt (TSY) elde edildi. Çalışmamızda relaps oranı %31.5 olarak bulundu. Hastaların % 40' ında imatinib tedavisi sonlandırıldı. Bu hastaların %40' ında primer imatinib direnci, % 46.6' sında sekonder imatinib direnci ve % 13.4' ünde yan etki nedeniyle tedavi sonlandırıldı. 18 aylık ve 5 yıllık relaps bağımsız sağkalım sırasıyla % 86.7 ve % 56.2 idi. Genel sağkalım açısından değerlendirildiğinde, 3 ve 5 yıllık genel sağkalım oranı % 93.7 olarak hesaplandı.Sonuçta, imatinib tedavisinin tolere edilebilir etkin bir tedavi yöntemi olduğu ancak günümüzde daha yeni TKİ' lerin klinik uygulamaya girmesiyle birlikte, TKİ' leri veya kombinasyonlarını etkinlik ve tolerabilite açısından kıyaslayacak çalışmaların yapılmasıyla, KML tedavisinde en uygun tedavi seçeneğinin belirlenebileceği düşünüldü.Anahtar kelimeler: Kronik myeloid lösemi, imatinib mesilat, tirozin kinaz inhibitörü, tam sitogenetik yanıt, genel sağkalım Chronic myeloid leukemia (CML), is a clonal myeloproliferative disease due to neoplastic transformation of primitive hematopoietic stem cells. The introduction of imatinib mesylate, specific BCR-ABL tyrosine kinase inhibitor (TKİ), opens a new era in treatment of CML. Currently, imatinib is considered as the first line treatment regime for CML however nonresponse or intolerance to imatinib therapy may develop. The aim of our study is to evaluate the prognosis and the efficiacy of treatment in CML patients treated with TKİ.In the study, 16 years old and older 54 patients with CML who had been followed-up at Adult Hematology Department, Hacettepe University Hospitals between November 1995 and December 2009, were analyzed retrospectively. The disease phases of patients when the TKİ was started were defined according to criteria proposed by World Health Organisation (WHO). Risk profiles of patients at the time of diagnosis were determined by Sokal risk scoring system. Response rates (hematologic and cytogenetic), relapse rate (hematologic, cytogenetic or molecular relapse), relapse free survival and overall survival were evaluated. The survial curves were evaluated by Kaplan Meier method.İn our study, complete hematologic response (CHR) and complete cytogenetic response (CCR) rates were 94.4% and 75.9%, respectively. Relapse rate was 31.5%. Imatinib therapy was discontinued 40% of patients. Causes for imatinib discontinuation were primary imatinib resistance (40%), secondary imatinib resistance (46.6%) and side effects (13.4%). Estimated rate of relapse free survival was 86.7% at 18 months and 56.2% at 5 years. Estimated three-year and five-year overall survival rates were 93.7%.In conclusion, it was concluded that imatinib mesylate is an effective and tolerable treatment choice but further studies that compares TKİ? s or combinations in terms of efficiacy and tolerabilitiy, are required to decide the most appropriate treatment choice in CML treatment.Key words: Chronic myeloid leukemia, imatinib mesylate, tyrosine kinase inhibitor, complete cytogenetic response, overall survival 77

Purpose: Nosocomial infections develop after 48-72 hours of hospitalization. Gram negativebacilli are generally the causative agent. 25% of all nosocomial infections develop in theintensive care units. Therefore, patients in the intensive care units are at high risk. This studyaimed to determine the prevalence of nosocomial infections and causative gram negative bacilliin the Intensive Care Unit (ICU).Materials and Methods: 269 patients who were hospitalized in internal medicine intensivecare unit (IMICU) of Dicle University Faculty of Medicine between june 2010- December 2010were included in this study. Culture samples were taken from all of the patients who developsfever ( ≥38.5 C) after the hospitalization to the IMICU. Culture of blood, urine, sputum, centralvenous catheters, open wounds and deep tracheal aspirate were taken. Source and the prevalenceof infection and distribution of the isolated causative pathogens were determined in the patientswith 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 cathetertips ( 6.3%), deep tracheal aspirates (10%), sputum (2.2%) and wound stabs (2.2%). Nosocomialinfections were detected in 109 patients ( 40.5%). Pneumonia, urinary tract infections andgastrointestinal system infections were the most frequent infections respectively.Microorganisms were isolated from one sample in 97 patients, while 12 patients had more thanfocus. The most commonly isolated organisms were E.Coli (13.8%) and PseudomonasAeruginosa (7.4%), followed by Acinetobacter Baumannii (6.3%) and StenotrophomonasMaltophilia (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 measuresshould be taken to prevent the development of the ICU infections, Amaç: Nozokomial enfeksiyonlar hastaneye yatıştan 48-72 saat sonra gelişir. Etken geneldegram negative basillerdir. Tüm nozokomial enfeksiyonların %25’i yoğun bakım ünitelerindegelişir. Bu nedenle yoğun bakım ünitesindeki hastalar yüksek risklidir. Bu çalışmada amacımızYoğun Bakım Ünitesinde nozokomiyal enfeksiyon prevalansını ve etken gram negatif basilleribelirlemektir. Materyal ve metod: Çalışmaya Dicle Üniversitesi Tıp Fakültesi Genel Dahiliye Yoğun BakımÜnitemizde(GDYBÜ) 2010 yılı Haziran – Aralık ayları arasında yatan 269 hasta dahil edildi.GDYBÜ’ne yattıktan sonra ateş(≥38.5°C) gelişen tüm hastalardan kültür için örnekler alındı.Kültür için kan, idrar, balgam, santral venöz kateter ucu, açık yara ve derin trakeal aspirattanörnekler alındı. Alınan örneklerde gram negatif basil üreyen hastalarda enfeksiyon kaynağı,prevalansı ve izole edilen ajan-patojenlerin dağılımı belirlendi. Bulgular: Hastaların 158’i erkek (%58.7) ve 111’i kadın (%41.3) idi. Erkeklerin yaş ortalaması58,81±16,91, kadınların yaş ortalaması 56,44±19,16 yıl (p: 0,286) idi. Kültür için alınanörneklerin %16’sını kan, %8,6’sını idrar, %6,3’ünü santral venöz kateter ucu, %10’nu derintrakeal aspirat, %2,2’sini balgam ve %2,2’sini yara sürüntüsü oluşturdu.109(%40.5) hastadanozokomiyal enfeksiyon tespit edildi. İlk üç sırada pnömoni, üriner system enfeksiyonu vegastrointestinal yol enfeksiyonu olduğu saptandı. Hastaların 97’sinde bir örnektenmikroorganizma izole edilirken, 12 hastada birden çok odakta gram negatif basil izole edildi.En sık izole edilen mikroorganizmalar % 13,8 E.Coli ve % 7,4Psödomonas Aeruginosanın olduğu, bunları % 6,3 ileAcinetobacter Baumanii ve % 3,3 ile Stenotrophomonasmaltophilia’nın izlediği görüldü. Sonuç: Genel Dahiliye Yoğun Bakım Ünitesinde nozokomialenfeksiyonun ciddi bir sorun olduğu görüldü. Enfeksiyon etkeniolarak izole edilen ajan patojenlere yönelik sürveyans çalışmalarıyapılmalı ve yoğun bakım enfeksiyonu gelişimini önleyecektedbirler alınmalıdır

WOS:000614471900004 Background and Aims: Cancer patients are admitted to intensive care units (ICU) due to primary diseases, treatment-related conditions or comorbid diseases. Acute kidney injury (AKI) and infections appear to be factors affecting mortality and morbidity in ICU follow-up. Therefore, in our study, we investigated the effect of AKI and inflammation-based parameters on mortality in cancer patients admitted to the ICU. Materials and Methods: In this study, 386 patients diagnosed with malignancy hospitalized between 2010 and 2014 in Dicle University Medical Faculty Internal Medicine ICU were included. The study was designed retrospectively. The demographic characteristics and clinical information of the patients were obtained from the files. Subsequently, patients were classified as non-survivors (group 1) and survivors (group 2). Both groups were compared in terms of the presence and stage of AKI by KDIGO definition, neutrophil / lymphocyte ratio (NLR) and platelet / lymphocyte ratio (PLR). Results: Creatinine, CRP, neutrophil counts were found to be significantly higher and albumin, hemoglobin, platelet and lymphocyte counts were found to be lower in group 1 (n=276) compared to group 2 (n=110). Length of ICU was longer in group 2 patients. There was a positive correlation between mortality and KDIGO stages and NLR. Mortality rate was increased 1.9 fold in KDIGO stage 1, 2.3 fold in stage 2, 2.4 fold in stage 3 and 1.5 fold if NLR>5. There was no statistically significant relationship between PLR and mortality. Conclusion: The presence of AKI and elevated inflammation-based parameters were associated with mortality in oncologic patients admitted to the ICU.