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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. 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 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. 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.

Introduction: Hospital-acquired infections (HAI) occurring in intensive care units (ICUs) are an important risk factor for mortality and morbidity. In some patient groups followed in ICUs, the risk of developing nosocomial infections increases even more. Especially, patients with end-stage renal disease (ESRD) carry a serious risk for HAI when they are hospitalized in ICUs. Our aim is to determine the rate and incidence of hospital infection, the distribution of infections and the most common microorganisms in our ICU, to initiate appropriate empirical treatment and to prevent the development of antibiotic resistance. Material and Method: A total 158 patients with a diagnosis of hospital-acquired infection hospitalized between January 2017 and December 2019 at general internal medicine intensive care unit, were included in this study. The clinical findings, culture results and laboratory data of the patients were recorded. According to years, the HAI rate, density and infection agents in the ICU were determined. Results: 158 episodes of nosocomial infections were detected in 128 of 556 patients who were hospitalized within three years. The hospitalization day was 9048, and the three-year ICU HAI rate was calculated as 29.19%. HAI density was 17.45 in 1000 patient days. Bloodstream infection was the most common (30.38%), followed by ventilator-associated pneumonia (28.48%) and catheter-related urinary tract infection (24.68%). Gram-negative microorganisms were the most common infectious agents. Among the Gram-negative bacteria, the most frequently isolated bacteria were A. baumannii, K. pneumoniae and P. aeruginosa. Among Gram-positive bacteria, Enterococcus spp. was most frequently isolated Conclusion: The risk of HAI is high in patients hospitalized in ICUs. In order to control nosocomial infections, HAI incidences and rates should be evaluated, infectious agents, and prospective effective infection control strategies should be developed by taking necessary precautions according to surveillance results. These measures will significantly reduce the incidence of HAI.

Introduction: Human Immunodeficiency virus is a chronic infection that attacks the immune system of the human body, particularly CD4 T lymphocytes. Combined antiretroviral therapies are highly effective in virological suppression of human immunodeficiency virus infection. It has been shown that some retroviral therapies have a higher nephrotoxicity potential. As a result of renal injury, serum creatinine increases, and the estimated glomerular filtration rate is reduced. The aim of our study was to assess changes in kidney function during a 24-month period in HIV-positive patients who were begun on combined antiretroviral therapy. Material-method: A total of 127 HIV positive patients were enrolled. The patients were divided into five groups; patients who received no therapy were designated as Group 1; those that received Dolutegravir/Abacavir/Lamivudine combination as Group 2; those that received Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Fumarate combination as Group 3; those that received Emtricitabine/Tenofovir Disoproxil Fumarate/Dolutegravir combination as Group 4; and those that received Emtricitabine/Tenofovir Disoproxil Fumarate/Raltegravir combination as Group 5. We compared the effects of these drugs on estimated glomerular filtration rate during a 24-month follow-up period. Results: At the 24th month of therapy, a significant difference was observed between the eGFR levels of the study groups (p:0.05). Serum creatinine level was significantly higher in Groups 4 and 5 compared to the other groups (p

Data on health problems and fatal complications associated with coronavirus disease (COVID-19) have consistently been reported. Although immune thrombocytopenia has been associated with multiple viral infections, only few studies have shown its association with COVID-19. Here, we have reported a case series of two cases pertaining to patients diagnosed with COVID-19-associated immune thrombocytopenia, elaborating on the clinical course, management, and response to treatment.

Objective: The aim of this study is to examine and evaluate the clinical findings and affecting factors related to graft and patient survival in kidney transplant patients at Dicle University Hospital. Method: 72 patients who underwent kidney transplantation at Dicle University Medical Faculty Hospital between January 2012 and September 2019 were included in the study. Demographic characteristics of patients, transplantation types, clinical and laboratory findings, pre-transplant dialysis types, renal failure etiologies, post-transplant complications, average patient and graft survival times and patient characteristics at the time of diagnosis, laboratory values, and treatment modalities were investigated. Results: In this study, the data collected from 72 patients who had kidney transplantation and 68 donors was analysed. The mean age of the patients was 32,7±13,8 years. 31 of patients were female, 41 were male. 56 of the transplants were performed living donors and 12 from cadavers. 9 patients died. The mean of patient survival was 94±3,4 months. Graft loss occured in 15 patients. The mean of graft survival was 86±4,3 months. Acute rejection occured in 10 patients. Chronic allograft nephropathy occured in 19 patients. Chronic allograft nephropathy was found more frequently in patients with acute rejection (p=0.017). In addition, graft loss was more common in patients with chronic allograft nephropathy (p=0.002). The dialysis duration was less than 12 months, and the BMI of the recipient was below 30 had a positive effect on patient survival. Conclusion: Recipient obesity and long-term dialysis programs reduce patient survival. In addition, prevention of rejection has a positive effect on patient and graft survival. Amaç: Bu çalışmanın amacı Dicle Üniversitesi Hastanesi’nde böbrek nakli yapılan hastalarda greft ve hasta sağkalımına ilişkin klinik bulguları ve etki eden faktörleri incelemek ve değerlendirmektir. Yöntemler: Çalışmaya Ocak 2012- Eylül 2019 tarihleri arasında Dicle Üniversitesi Tıp Fakültesi Hastanesi’nde böbrek nakli yapılan 72 hasta dahil edildi. Çalışmaya dahil edilen hastaların demografik özellikleri, nakil tipleri, klinik ve laboratuvar bulguları, nakil öncesi diyaliz tipleri, böbrek yetmezliği etyolojileri, nakil sonrası gelişen komplikasyonlar, ortalama hasta ve greft sağkalım süreleri ve bu süreleri etkileyen tanı anındaki hasta özellikleri, laboratuvar değerleri, tedavi modaliteleri araştırıldı. Bulgular: Çalışmamızda böbrek nakli yapılan 72 hastanın ve 68 vericinin verileri analiz edildi. Hastaların ortalama yaşı 32,7±13,8 yıldı. 31 kadın, 41 erkek hasta vardı. Nakillerin 56’sı canlıdan, 12’si kadavradan yapılmıştı. Ortalama hasta sağkalımı 94±3,4 aydı. 15 hastada greft kaybı gelişmişti. 9 hasta eksitus olmuştu. Ortalama greft sağkalımı 86±4,3 aydı. 10 hastada akut rejeksiyon gelişmişti. 19 hastada kronik allograft nefropatisi gelişmişti. Kronik allograft nefropatisi, akut rejeksiyon gelişen hastalarda (p=0,017) daha sık saptandı. Ayrıca kronik allograft nefropatisi gelişen hastalarda greft kaybı daha sık olmaktaydı (p=0,002). Alıcının diyaliz süresinin ≤12 ay ve BKİ≤30 olması hasta sağkalımını olumlu etkilemişti. Sonuç: Alıcı obezitesi ve uzun süreli diyaliz programları hasta sağkalımını azaltmaktadır. Ayrıca rejeksiyonun önlenmesinin, hasta ve greft sağkalımına olumlu etkisi olmaktadır.

Amaç: Böbrek biyopsisi, böbrek parankimal hastalıkların histopatolojik tanısının konulmasında sıklıkla kullanılan altın standart bir yöntemdir. Böbrek biyopsi kayıtları ile böbrek hastalıklarının epidemiyolojisi belirlenir. Literatürdeki çalışmalar incelendiğinde proteinüri en sık böbrek biyopsi endikasyonu olarak karşımıza çıkmaktadır. Glomerulonefritler ise en sık (GN) görülen histopatolojik sonuçlar olmaktadır. GN histopatolojik alt tiplerinin dağılımı ise coğrafi bölge, yaş, etnik kökene göre değişebilmektedir. Bizde bu çalışmada bölgemizdeki böbrek biyopsi sonuçlarına göre erişkin nefropati profilini tespit etmeyi amaçladık. Çalışmanın sonuçları aynı zamanda GN olgularının yaş ve cinsiyete göre sıklığının belirlenmesine de yardımcı olacaktır. Yöntemler: Dicle Üniversitesi Tıp Fakültesi Nefroloji Kliniğinde Ocak 2011–Aralık 2017 yılları arasında ultrason eşliğinde perkütan böbrek biyopsisi yapılıp tanısı konulan 441 hastanın dosyası retrospektif olarak incelendi. Çalışmaya dahil edilen hastaların cinsiyet, yaş, biyopsi tarihi, histopatolojik tanısı değerlendirildi. Yıllara göre biyopsi yapılan hasta sayıları analiz edildi. Ayrıca cinsiyete ve yaşa göre biyopsi tanıları incelendi. Hastalar 18-39 yaş, 40-59 yaş ve 60 yaş üstü diye 3 gruba ayrıldı. Bulgular: Hastaların %53.7’si (n=237) erkek, %46.3 (n=204) kadındı. Ortalama yaş 37.4 olup erkeklerin yaş ortalaması 39.9, kadınların 34.5 yıl idi. Tüm yaş ve cinsiyet gruplarında en sık görülen histopatolojik tanılar FSGS (%21.8), Membranöz GN (%20.4) ve IgA Nefropatisi (%11.6) olup; erkeklerde en sık Membranöz GN (%21.9), kadınlarda en sık FSGS (%24) olarak saptandı. 18-39 yaş arası 225 hastada en sık FSGS, 40-59 yaş arası 164 hastada en sık Membranöz GN, 60 yaş üstü 52 hastada ise en sık KTIN tanısı konuldu. Sonuç: Bölgemizde erişkin böbrek biyopsi sonuçları göstermektedir ki FSGS, Membranöz GN ve IgA nefropatisi en sık görülen primer glomerülopatilerdir. Sekonder GN’ler içerisinde en sık Lupus Nefriti ve Amiloidoz görülmektedir. Yaşla birlikte glomeruler hastalıklar azalmaktayken, Kronik Tubulointertisyel hastalıkların ve Amiloidozun sıklığı artmaktadır. Çalışmamızdaki sonuçlar ülkemizdeki böbrek biyopsi verileri ile benzerdi.

INTRODUCTION: Sepsis is an important cause of mortality and morbidity, and inflammatory response and oxidative stress play major roles underlying its pathophysiology. Here, we evaluated the effect of intraperitoneal etanercept administration on oxidative stress and inflammation indicators in the kidney and blood of experimental sepsis-induced rats. METHODS: Twenty-eight adult Sprague Dawley rats were classified into Control (Group 1), Sepsis (Group 2), Sepsis+Cefazolin (Group 3), and Sepsis+Cefazolin+Etanercept (Group 4) groups. Kidney tissue and serum samples were obtained for biochemical and histopathological investigations and examined for the C reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), triggering receptor expressed on myeloid cells (TREM), and malondialdehyde (MDA) levels. RESULTS: The levels of TNF-α, TREM, and MDA in serum and kidney samples were significantly higher in rats from sepsis group than in rats from control group (p < 0.05). Group 3 showed a significant reduction in serum levels of TNF-α, CRP, and TREM as compared with Group 2 (p < 0.05). Serum TNF-α, CRP, TREM, and MDA levels and kidney TNF-α and TREM levels were significantly lower in Group 4 than in Group 2 (p < 0.05). Serum TNF-α and TREM levels in Group 4 were significantly lower than those in Group 3, and histopathological scores were significantly lower in Group 3 and Group 4 than in Group 2 (p < 0.05). Histopathological scores of Group 4 were significantly lower than those of Group 3 (p < 0.05). CONCLUSIONS: Etanercept, a TNF-α inhibitor, may ameliorate sepsis-induced oxidative stress, inflammation, and histopathological damage.

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.

WOS:000513527600001 PMID: 32029697 Background: The main cause of mortality among chronic kidney disease (CKD) patients is cardiovascular disease (CVD). Epicardial adipose tissue (EAT) is considered to be novel cardiovascular risk factor. We assessed EAT in non-dialyzed stage 5 CKD patients and explored the association of EAT with body composition as determined by multi-frequency BIA. Material/Methods: The present included 70 stage 5 CKD patients who had not undergone dialysis and 40 healthy control subjects. EAT thickness was assessed by echocardiography. Hydration status and body composition were evaluated by multi-frequency bioelectrical impedance analysis. Results: Stage 5 CKD patients had significantly higher EAT thickness than healthy subjects (6.56±1.18 vs. 4.05±1.45, p

INTRODUCTION: Diabetic chronic kidney disease has more fatal clinical progresses and this situation can be related to volume overload, which is seen more commonly in diabetic chronic kidney disease patients than in non-diabetic chronic kidney disease patients. Therefore, we examined the effect of diabetes mellitus on volume overload in newly diagnosed stage 5 chronic kidney disease patients whose volume overloads were not showing signs of improvement from renal replacement therapy. METHOD: One hundred and five patients (46 diabetic, 59 non-diabetic) with end-stage chronic kidney disease, who had glomerular filtration rate (GFR) under 15 mL/min for at least three months were enrolled in this prospective study. We determined the body volume overload and configuration using a bioimpedance device. NT-proBNP levels were recorded. RESULTS: There was a statistically significant difference between diabetic and non-diabetic groups according to overhydration (OH, p=0.003), extracellular water (ECW, p=0.045), intracellular water (ICW, p

European-Respiratory-Society (ERS) International Congress -- SEP 28-OCT 02, 2019 -- Madrid, SPAIN, erdogan, elif/0000-0002-2206-9928, WOS: 000507372405066, [No abstract available], European Respiratory Soc

BACKGROUND Pulmonary arterial hypertension (PAH) is common disease among hemodialysis (HD) patients and is associated with increased morbidity and mortality. However, its pathogenesis has not been completely elucidated. We aimed to evaluate the frequency of PAH in HD patients, as well as the relationship between fluid status and PAH. MATERIAL AND METHODS We enrolled 77 HD patients in this study. Multifrequency bioimpedance analysis (BIA) was used to assess fluid status. BIA was performed before and 30 min after the midweek of HD. Overhydration (OH)/extracellular water (ECW)% ratio was used as an indicator of fluid status. Fluid overload was defined as OH/ECW ≥7%. Echocardiographic examinations were performed before and after the HD. Pulmonary arterial hypertension was defined as systolic pulmonary artery pressure at rest (sPAP) higher than 35 mmHg. RESULTS PAH was found in 33.7% of the HD patients. OH/ECW and the frequency of fluid overload were significantly higher in HD patients with PAH than those without PAH, whereas serum albumin and hemoglobin levels were significantly lower. sPAP level was significantly higher in HD patients with fluid overload than in those without fluid overload after hemodialysis session. Furthermore, sPAP, OH/ECW levels, and the frequency of PAH were significantly reduced after HD. We also found a significant positive correlation between sPAP and OH/ECW. Multivariate logistic regression analysis demonstrated fluid overload to be an independent predictor of PAH after HD. CONCLUSIONS PAH is prevalent among HD patients. This study demonstrated a strong relationship between fluid overload and PAH in HD patients.

Aims. Sleep disorders have recently become a significant public health problem worldwide and have deleterious health consequences. Obstructive sleep apnea (OSA) is the most common type of sleep-related breathing disorders. We aimed to evaluate anthropometric measurements, glucose metabolism, and cortisol levels in patients with obstructive sleep apnea (OSA).Materials and Methods. A total of 50 patients with a body mass index ≥30 and major OSA symptoms were included in this study. Anthropometric measurements of the patients were recorded and blood samples were drawn for laboratory analysis. A 24-hour urine sample was also collected from each subject for measurement of 24-hour cortisol excretion. Patients were divided equally into 2 groups according to polysomnography results: control group with an apnea-hypopnea index (AHI) n=25) and OSA group with an AHI ≥5 (n=25).Results. Neck and waist circumference, fasting plasma glucose, HbA1c, late-night serum cortisol, morning serum cortisol after 1 mg dexamethasone suppression test, and 24-hour urinary cortisol levels were significantly higher in OSA patients compared to control subjects. Newly diagnosed DM was more frequent in patients with OSA than control subjects (32% versus 8%,p=0.034). There was a significant positive correlation between AHI and neck circumference, glucose, and late-night serum cortisol.Conclusions. Our study indicates that increased waist and neck circumferences constitute a risk for OSA regardless of obesity status. In addition, OSA has adverse effects on endocrine function and glucose metabolism.

Background: The importance of pulmonary hypertension [PHT] is newly recognised entity among hemodialysis [HD] patients and its prevelanceis reported 30 to 60%. Aim and Objectives: We aimed to investigate the relationship between fluid status and PHT in HD patients Methods: A total of 77 HD patients were enrolled in the study.Multifrequency bioimpedance analysis [BIA] was used to assess fluid status and performed just before and 30 minutes after the midweek HD.Fluid overload was defined as a OH/ECW ≥7%. Echocardiographic examinations were performed. PHT was defined as systolic pulmonary artery pressure [sPAP] higher than 35 mmHg at rest. Results: sPAP, OH/ECW levels and the frequency of PHT were significanly reduced after HD . OH/ECW and the frequency of fluid overload were significantly higher in patients with PHT than in those without, whereas serum albumin and haemoglobin levels were significantly lower . Conclusion: This study revealed that fluid overload is closely associated with PHT. Intervention to reduce excess volume in this patient cohort can reduce pulmonary hypertension.

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

Background and objective: Fluid overload is a common and serious problem that leads to severe complications in dialysis patients. We aimed to compare hydration status as measured with bioimpedance analysis (BIA) method in hemodialysis (HD) and peritoneal dialysis (PD) patients, as well as investigating the association between blood pressure, left ventricular mass index (LVMI) and hydration status. Materials and methods: We examined 43 HD and 33 PD patients. Blood pressure was recorded. In each group, echocardiographic examinations were performed on all patients. Hydration status was assessed using multifrequency bioelectrical impedance analysis. Overhydration was defined as an overhydration (OH)/extracellular water (ECW) ratio of &gt, 0.15. Results: The OH/ECW ratio was significantly higher in PD patients compared to post-HD patients. Overhydration was statistically more frequent in PD than in post-HD patients (30.3% vs. 11.6%, P = 0.043). Systolic blood pressure (SBP) in both post-HD and PD groups, and LVMI in the PD group were found to be significantly higher in overhydrated patients than non-overhydrated patients. In multiple linear regression analyses, increased OH/ECW ratio was independently associated with higher SBP and LVMI. Conclusions: Fluid overload may be an even more prevalent and serious problem in PD patients. Overhydration is closely associated with increased blood pressure and LVMI. OH/ ECW ratio, a derived parameter of fluid load measured by BIA, was a significant and independent determinant of SBP and LVMI.

Determination of fluid overload is important in chronic kidney disease. Early diagnosis and treatment of volume overload may decrease morbidity and mortality. We aimed to determine body composition by using bioelectrical impedance analysis, and studying other clinical characteristics, inferior vena cava diameter, and N-terminal pro-B natriuretic peptide associated with hydration status in chronic kidney disease Stages 34 and 5 in patients not undergoing dialysis.We examined 62 patients with Stages 34 and 68 patients with Stage 5 chronic kidney disease. Plasma NT-proBNP was measured and analyzed after log transformation. Inferior vena cave diameter was measured with echocardiography and indexed for body surface area. Hydration status was assessed using multi-frequency bioelectrical impedance analysis. Overhydration was defined as overhydration/extracellular water0.15.Overhydration was more frequent in Stage 5 than in Stages 34 patients. Systolic and diastolic blood pressure, inferior vena cava index, and log NT-proBNP were higher in overhydrated compared to non-overhydrated patients. A significant positive correlation existed between overhydration/extracellular water and log NT-proBNP, systolic and diastolic blood pressures, and inferior vena cava index. In multiple linear regression analysis, the variables associated with hydration status were male sex, extracellular water/total body water, and extracellular water/intracellular water (greater overhydration), while serum albumin levels had a negative association with overhydration.Overhydration is more prevalent in Stage 5 chronic kidney disease patients than in Stages 34 patients. Bioelectrical impedance analysis, inferior vena cava diameter, and NT-proBNP analysis in chronic kidney disease are useful methods to determine the volume overload.

Purpose: Response to infliximab treatment diminishes as body mass index (BMI) increases in patients with ankylosing spondylitis (AS). The purpose of the study was to determine if diminished response to infliximab treatment in patients with AS could be associated with increased visceral adipose tissue rather than increased BMI. Methods: Twenty six AS patients (21 males and five females) who fulfilled the modified New York criteria and who were currently receiving infliximab treatment were enrolled in the study. Pain was measured by the visual analogue scale (VAS). The disease activity and functional status were assessed by the Bath AS Disease Activity Index (BASDAI) and the Bath AS Functional Index (BASFI). The Bath AS Metrology Index (BASMI) was used to evaluate mobility restrictions. Weight and visceral body composition were measured without shoes in light indoor clothes using a bio-impedance meter. Results: There was a significant correlation between visceral adipose tissue amount and disease activity under infliximab treatment. In correlation analysis, visceral fat showed significant correlations between BASDAI (r=0.545, p=0.004) and VAS (r=0.458, p=0.019). Total body fat also showed a significant correlation with BASDAI (r=0.463, p=0.017). Conclusion: A significant correlation was found between visceral adipose tissue amount and disease activity in patients with AS.