Search

Background In this study, we compared the outcomes of three different surgical microscope–assisted end-to-side anastomosis techniques between the dominant and accessory renal arteries during living donor kidney transplant. Methods The demographics, serum creatinine levels, warm and cold ischemia times, rate of complications, and incidence of delayed graft function of 135 kidney recipients were analyzed according to the type of arterial anastomosis. Group A (n = 98) had one dominant renal artery (DRA) with one end-to-side anastomosis to the external iliac artery (EIA) using a surgical microscope. Group B (n = 17) had one DRA plus one accessory renal artery (ARA) with two separate end-to-side anastomoses to the EIA using a surgical microscope. Group C (n = 20) had one DRA with end-to-side anastomosis to the EIA and one ARA with an ex vivo on-bench end-to-side anastomosis to the DRA using a surgical microscope. Results Compared with groups A and B, the cold ischemia time and the rate of delayed graft function were significantly higher in group C (P ≤ .001). At 6 months after transplant, group B demonstrated a higher creatinine value (2.40 ± 3.41 mg/dL) than group A and group B (P = .032). Also, the decrease in creatinine at postoperative month 6 was limited in group B as compared with groups A and C. Conclusions An end-to-side anastomosis between ARA (group B) and DRA (group A) of the kidney graft using a surgical microscope on the bench ex vivo results in superior outcomes. Single arterial anastomosis techniques are associated with a better function in a 6-month follow-up than two separate arterial anastomoses.

Objectives We aimed to compare the once-daily and twice-daily formulation of tacrolimus concerning the efficiency and effects on graft function in de novo kidney transplant patients. Methods Twenty once-daily (TAC-OD) and twenty twice-daily (TAC-BID) tacrolimus administrated de novo kidney recipients who had received initial immunosuppressive therapy according to protocols at our institution (0.2 mg/kg of tacrolimus combined with 1000 milligrams of steroid taper plus 720 mg of mycophenolate and with 2.5mg/kg anti-thymocyte globulin) assessed concerning demographics, drug doses and blood concentration, and graft function. Results The mean tacrolimus blood concentration measurements were higher in the TAC-OD group in the first sixty days after transplantation, and the TAC-OD group showed more blood concentration overshoots/fluctuations in the first 30 days of the treatment. The initial drug dose was significantly higher in the TAC-OD group than the TAC-BID group (p=0.04). There was no meaningful difference among groups according to graft function (creatinine measurements) (p>0.05). Conclusion Between de novo kidney recipients, the new TAC-OD formulation presents a similar short-term efficacy profile as TAC-BID. However, a higher daily dosage of TAC-OD is needed to achieve similar blood concentrations in the early postoperative period.

WOS: 000461206800006, Objective: Bioimpedance spectroscopy (BIS) can be used to determine hypervolemia and malnutrition in chronic hemodialysis (HD) patients. In this prospective observational study, we investigated the survival predictability of impedance ratio (IR) calculated by BIS in HD patients (Clinical Trials Gov Identifier: NCT01468363). Materials and Methods: A total of 430 chronic HD patients, out of 500 prevalent chronic HD patients from the city of Zonguldak who met the inclusion criteria, were included in the study. With a mean follow-up of 32.2 +/- 14.4 months, BIS was performed in all patients. The IR percentage (IR%) was calculated by dividing the resistance values using the 200 kHz and 5 kHz impulses. Student's t-test, Cox regression analysis, and Kaplan-Meier survival analysis were performed, and a p

WOS: 000454539700011, PubMed ID: 30428648, Background/Aims: Many systems including the cardiovascular system (ischemic heart diseases, heart failure, and hypertension) may act as comorbidities that can be seen during the course of chronic obstructive pulmonary disease (COPD). Comorbidities affect the severity and prognosis of COPD negatively. Nearly 25% of patients with COPD die due to cardiovascular diseases. In this study, we aimed to evaluate the relationship between the blood pressure, inflammation, hypoxia, hypercapnia, and the severity of airway obstruction. Methods: We included 75 COPD patients in the study with 45 control cases. We evaluated age, sex, body mass index, smoking history, C-reactive protein levels, 24-hour ambulatory blood pressure Holter monitoring, arterial blood gas, and respiratory function tests of the patient and the control groups. Results: In COPD patients, the night time systolic, diastolic blood pressures and pulse per minute and the mean blood pressures readings were significantly elevated compared to the control group (p < 0.05). In the correlation analysis, night time systolic pressure was associated with all the parameters except forced expiratory volume in 1 second (FEV1%). Diastolic blood pressure was associated with pH and HCO3 levels. The mean night time, day time pulse pressures and 24-hour pulse per minute values were also associated with all the parameters except FEV1%. Conclusions: In this study we found that parameters of systolic and diastolic blood pressures and pulse pressures were significantly elevated in COPD patients compared to the control groups. Blood pressure was associated blood gas parameters and inflammation parameters in COPD patients. This, in turn, may cause understanding of the pathophysiology of COPD and its complications.

WOS: 000390981200011, PubMed: 28144263, Introduction: Chronic inflammation is a major risk factor in the pathogenesis of cardiovascular disease in end-stage renal disease (ESRD) patients. Epicardial adipose tissue (EAT) is the true visceral fat depot of the heart. The relationship between coronary artery disease and EAT was shown in healthy subjects and ESRD patients. In the present study we aimed to investigate the relationship between EAT and inflammation parameters including neutrophil-to-lymphocyte ratio (NLR) in hemodialysis (HD) patients. Material and methods: Forty-three HD patients (25 females, 18 males; mean age: 64.1 11.9 years) receiving HD and 30 healthy subjects (15 females, 15 males; mean age: 59.1 +/- 10.8 years) were enrolled in the study. Epicardial adipose tissue measurements were performed by echocardiography. Results: Neutrophil-to-lymphocyte ratio levels were significantly higher in HD patients than in the healthy control group. Hemodialysis patients were separated into two groups according to their median value of NLR (group 1, NLR < 3.07 (n = 21) and group 2, NLR 3.07 (n = 22)). Group 2 patients had significantly higher EAT, C-reactive protein and ferritin levels, while albumin levels were significantly lower in this group. In the bivariate correlation analysis, EAT was positively correlated with NLR (r = 0.600, p < 0.001) and ferritin (r = 0.485, p = 0.001) levels. Conclusions: Neutrophil-to-lymphocyte ratio was found to be an independent predictor of EAT in HD patients (odds ratio = 3.178; p = 0.008). We concluded that this relationship might be attributed to increased inflammation in uremic patients.

Lübnan'da ortaya çıkan Hizbullah örgütü, kurulduğu tarihten günümüze dek gelerek, Lübnan'da ve Ortadoğu'da önemli siyasi ve askeri aktör olmuştur. Bazı ülkeler tarafından `terörist` olarak değerlendirilen ve hem siyasi hem de askeri kanası olan Hizbullah örgütü, kuruluş ve büyüme aşamasında birtakım iç ve dış dinamiklerden etkilenmiştir. Örgütün yapısının ve etki gücünün daha iyi anlaşılması için, bu dinamiklerin tek tek incelenmesi gerekmektedir. Dış dinamikler açısından, Hizbullah hem kuruluş aşamasında hem de takip eden dönemde İran ile yoğun ilişkiler içerisinde olmuştur. Bu bağlamda, öncelikle iç ve dış dinamikler incelenecek, ardındansa örgütün ideolojik ve siyasi ortak paydası olan İran ilişkilerini özellikle Ahmadinejad döneminde (2005-2013) incelenecektir. Anahtar Sözcükler: Terörizm, Hizbullah, İran, Ahmedinejad, Lübnan The Hezbollah organization, which emerged in Lebanon, has been an important political and military actor in Lebanon and the Middle East since its inception. The Hezbollah organization, which was considered `terrorist` by some countries as both political and military, was influenced by a number of internal and external dynamics in the organization and growth phase. For a better understanding of the structure and impact power of the organization, these dynamics must be examined individually. In terms of external dynamics, Hezbollah has been in intense relations with Iran in both the founding phase and the following period. In this context, primarily the internal and external dynamics will be examined, and the Iranian relations, which are the ideological and political common denominators of the Organization, will be examined especially during the Ahmadinejad period (2005-2013).Key Words: Terrorism, Hezbollah, Iran, Ahmadinejad, Lebanon 112

WOS: 000461206800010, Objective: Permanent catheters are used for vascular access in some patients undergoing hemodialysis (HD). Our aim in this study was to evaluate the risk factors of permanent catheter thrombosis and the necessity of anti-coagulant and anti-aggregation drugs. Materials and Methods: In this retrospective study, 34 patients undergoing HD, with removed internal jugulary permanent catheters due to either thrombosis or maturation of operated arteriovenous fistulas, were included. Patients were divided into thrombotic and non-thrombotic, according to the catheter thrombosis status. Results: The mean age was 66.3 +/- 15.4 years, and the follow-up period was 10.9 +/- 8.5 (1-29) months. Catheter thrombosis was found in 12 patients. Albumin and total protein levels were lower in the baseline thrombotic group (3.53 +/- 0.46 g/dL and 6.64 +/- 0.92g/dL, respectively) than in the non-thrombotic group (3.95 +/- 0.41 and 7.37 +/- 0.46g/dL, respectively). In the non-thrombotic group, hemoglobin, hematocrit higher, and platelet count were lower at the catheter removal time compared to the catheter insertion time (hemoglobin 11.45 +/- 1.25, hematocrit 35.61 +/- 4.51, and platelet count 193.82 +/- 66.32 versus hemoglobin 10.33 +/- 1.37g/dL, hematocrit 31.38 +/- 3.79% and platelet count 231.77 +/- 71.7x103/uL, respectively), but in the thrombotic group, the ferritin levels significantly increased from 541.3 +/- 574.8ng/mL at the catheter insertion time to 745.1 +/- 406.5ng/mL at the catheter removal time. Conclusion: Anti-coagulant and anti-aggregation drugs and renal failure etiology did nothave any effect on permanent catheter thrombosis, but the albumin and total protein levels were related to it. Increased levels of ferritin and C-reactive protein seem to emerge as the acute phase reactants associated with thrombosis.

Objective. Sulphur, similar to phosphorus, is easily attached to organic compounds. The inadequate elimination of sulphate may cause high sulphate concentrations in hemodialysis (HD) patients because sulphate is low in free form in plasma. Although we are well aware of the accumulation of phosphorus in chronic dialysis patients, we do not have an adequate knowledge database about the sulphur compounds. This study was designed to determine the level of sulphate in hemodialysis patients.Materials and Methods. Ninety-four prevalent HD patients and 33 patients without renal failure were included in the study. The serum inorganic sulphate levels were measured by turbidimetric technique. Moreover, the serum level of urea, creatinine, albumin, calcium, phosphorus, and parathyroid hormone concentrations was simultaneously recorded.Results. Mean levels of plasma sulphate were significantly higher (0.56 ± 0.17 mM vs 0.31 ± 0.13 mM,p<0.001) in HD patients. Serum sulphate level correlated with patient’s age, serum albumin, serum BUN and creatinine, and serum phosphorus level in HD patients. Serum sulphate levels were not associated with serum parathyroid hormone levels.Conclusion. Serum sulphate levels were approximately twofold higher in HD patients than in the normal control group. Inorganic sulphate does not seem to accumulate in long-term dialysis patients, and mild increased serum levels of sulphate has no poor clinical outcome in these patients.

Background Serum amyloid A (SAA), which is produced in the liver, acts as an apoprotein of high-density lipoprotein (HDL) accumulation in extracellular matrix of tissues and organs. SAA elevations play a significant role in the development of amyloidosis. Microalbuminuria (MAU) is the early period of amyloidosis in patients with familial Mediterranean fever (FMF). We assessed the association between SAA as an important factor for the development of amyloidosis in patients with FMF and cytokines, HDL, and MAU. Methods A total of 40 FMF patients diagnosed with Tel-Hashomer criteria and making regular follow-up visits at the tertiary referral center from 2012 to 2013 were included in this study, besides 40 age- and sex-matched individuals as controls. Results Compared with controls, FMF patients had higher SAA (25.20 ± 45.78 vs. 1.68 ± 0.63 ng/ml; P = 0.002). Also, FMF patients had higher MAU than controls (23.20 ± 39.86 vs. 9.40 ± 5.32 mg/day; P = 0.036). HDL was significantly lower in the patient group than in controls (39.35 ± 10.45 vs. 47.82 ± 15.31 mg/dl; P = 0.023). Interleukin-1 beta (IL-1), IL-6, and tumor necrosis factor alpha (TNF-α) levels were higher in the FMF group than in controls (P < 0.0001, P = 0.009, P = 0.003, respectively). Conclusions Our results suggest that IL-1, IL-6, TNF-α, SAA, and HDL may serve as markers of subclinical inflammation in FMF patients. Due to increased plasma HDL levels, antiinflammatory and antioxidant effects may elevate in FMF patients.

WOS: 000374928100013, Hydatid cyst (CH), which is quite common in the world, mostly transmitted by dog faeces, is a parasitic disease caused by Echinococcus granulosus. CH often infects the liver and lungs. During the clinical course, renal involvement is rarely seen. In this article; due to liver hydatid disease, mezengioproliferatif glomerulonephritis case is presented.

OBJECTIVE: Hypervolemia and malnutrition are often undiagnosed risk factors for hemodialysis (HD). Our aim was to investigate the long-term effects of hypervolemia and malnutrition evaluated by bioimpedance spectroscopy (BIS) on survival. (Clinical Trials. Gov Identifier: NCT01468363). MATERIAL and METHODS: A total of 431 Prevalent HD patients were followed for 32.2±14.4 months. The patients underwent BIS measurement, a medical history was obtained, and routine tests were analyzed at the baseline and at the end of the study. Hospitalizations and complications of HD were recorded. RESULTS: The mean age was 59.4±14.6 (10-92) years with a total of 431 (53.6% males) patients of which 125 died. The percentage of diabetics was 47%, erythropoietin use 67%, and diuretic use 40%. Predialysis systolic blood pressure (BP) was 133.4±25.8 and diastolic BP 79.2±12.4 mm Hg. The rate of diabetes, and the number of hospitalizations and blood transfusions were higher in the patients who died. Diastolic BP as a clinical hypervolemia finding, BIS hypervolemia indicator of over hydration (OH), and extracellular water (ECW) were all increased, and fat tissue index as a malnutrition finding was decreased in patients who died. There were significant rates of anemia and hypoalbuminemia in this group as well. The cumulative survival was lower in hypervolemic patients as assessed by relative hydration status OH/ECW. CONCLUSION: Hypervolemia and malnutrition are the long-term mortality indicators in hemodialysis. Early diagnosis and treatment is important. Clinical findings may not be sufficient and laboratory and BIS methods can be used for diagnosis.

Objective: Body composition analysis is useful technique for assessing hydration, nutritional status and predicting clinical outcomes. Bioimpedance analysis (BIA) is a cheap and noninvasive tool for monitoring body composition but needs some improvements regarding measurement methods. We aimed to find out if body position has an effect on the BIA results. Material and Methods: Personal characteristics including age, gender, height, weight and blood pressure were recorded. Hydration and nutritional status measured by body composition monitor in supine and standing positions consequently for each individual. Results: Two hundred and one populations from various region in Turkey, 61% (n: 123) male, mean age was 46.3±12 years (18-76) of age, participated in this crossectional study. From supine to standing positions overhydration and extracellular water (ECW) were increased from 0.04±1.08 and 17.69±2.92 to 0.46±1.05 L and 17.84±2.90 L while intracellular water (ICW) decreased from 22.55±4.35 to 22.04±4.28 L significantly. Systolic and diastolic blood pressures were 131.3±18.1 and 75.1±12 decreased to 127.0±16.0 and 72.2±9.0 mmHg in supine to standing positions (p> 0.05). Conclusion: Supine and standing positions could affect the volume parameters of BIA due to shift of ECW and ICW by gravity but nutritional parameters also changes significantly. Protocols should be re evaluated in order to get more accurate results in bioimpedance measurements.

Aim: The aim of the study was to determine the prevalence and risk factors of bacterial urinary tract infection (UTI) in patients undergoing renal transplantation and to evaluate the possible bacterial agents that colonize the bladder in patients with or without micturition beforehand.Material and Methods: A total of 89 renal transplant patients were included in the study. Demographic characteristics of the patients such as age and gender, as well as the presence of micturition before transplantation, clinical findings, urine culture, and agents that showed growth were all retrospectively analyzed and the relevant data were recorded.Results: Of the total 89 patients, 17 (19.10%) developed a urinary tract infection within 12 months after transplantation. Eight of these patients required hospitalization for treatment, while four had at least two infection episodes. Escherichia coli and Klebsiella pneumonia were the two most common causative agents. A comparison of the groups with and without UTI revealed that micturition before transplantation was not a factor that affected the development of UTI (p > 0.05).Conclusion: Because UTI represents a severe problem for renal transplant patients, it must be evaluated in all patients. No correlation was found between preoperative micturition and postoperative UTI.

WOS: 000337256000005, PubMed: 24337212, Aim: Oxidative stress, which is widely recognised as an important feature of many diseases, can be defined as an increased formation of reactive oxygen species or decreased antioxidant defense. In this study we measured plasma vitamin E levels and total antioxidant activity (AOA) in patients with slow coronary flow (SCF). Methods: The plasma vitamin E levels and AOA were measured in 40 patients with angiographically diagnosed SCF. Forty subjects with normal coronary flow (NCF) served as the control group. SCF and NCF were analysed, and blood samples were taken for plasma vitamin E levels and AOA. Plasma vitamin E levels and AOA in patients with SCF were evaluated and compared to those of patients with NCF. Results: There was no significant difference between the two groups in terms of plasma AOA, lipid profile and C-reactive protein (CRP) levels but there was a significant difference in vitamin E levels between the two groups (p = 0.001). Conclusion: Vitamin E levels were found to be lowered in patients with SCF compared to the NCF group. The association between smoking and vitamin E levels is worth further investigating in larger samples.

Introduction: Overhydration is the main contributory factor of left ventricular hypertrophy and closely associated with cardiovascular events in end stage renal disease (ESRD) patients. The aim of this prospective-study was to investigate the impact of strict salt and volume control on hypertension and cardiac condition in ESRD patients. Methods: A total of 12 peritoneal dialysis (PD) and 15 prevalent hemodialysis (HD) patients were enrolled. All patients either PD or HD were allocated to intervention of strict salt restriction according to basal hydration state of empty abdomen in PD and midweek predialysis HD which were estimated by body composition monitor (BCM) and echocardiography. Results: Mean ages were 48.3±16.7 years for PD, and 48.8±18 for HD patients. Extracellular water/height was 10.04±2.70 and 10.39±1.53L/m in PD and HD groups. Systolic blood pressures decreased in PD and HD from 133.1±28 and 147.3±28.5 to 114.8±16.5 and 119.3±12.1mmHg, respectively, (p0.05). LVMI and LAI were not increased in both groups. Conclusion: Strict salt and volume control in ESRD patients after assessment of hydration status with either using BCM or echocardiography provides better management of volume control leading to more precise cardiovascular protection. © 2013 Informa Healthcare USA, Inc.

WOS: 000312869700007, PubMed ID: 22630818, Mean platelet volume (MPV) is a determinant of platelet activation. Atherogenic index of plasma (AIP), which is defined as the logarithm of the ratio of plasma level of triglycerides to the level of high-density lipoprotein (HDL)-cholesterol (log[TG/HDL-C]), has recently been used as a marker of atherogenicity. This study included 104 normotensive individuals. Mean platelet volume and AIP were measured in all patients. Nondipper individuals (8.6 +/- 0.9 fL, 0.3 +/- 0.2) demonstrated higher values of MPV and AIP compared with dippers (7.9 +/- 1.1 fL, 0.1 +/- 0.2) (P

“Tinea incognito” is a dermatophytic infection which modifies typical clinical presentation due to improper use of topical or systemic corticosteroids. In this report, we present three cases who had been treated with topical corticosteroid as a result of incorrect diagnosis. The first case, a 30-year-old male patient complained of localized, erythematous, scaling papules and plaques on his genitocrural crease and umbilical region for four months. The second case, a 40-year-old male patient had generalized, erythematous plaques with papules and pustules, and macular hyperpigmentation for one month. The third case, a 23-year-old male patient had erythematous macules with papules on his malar areas for three months. In all presented cases, direct microscopic examination was positive and, in the first and second cases, the fungal cultures were positive for Trichophyton rubrum. The lesions also showed complete resolution with antimycotic treatment. In this report, we have reviewed the recent medical literature about “tinea incognito”. Turkish Başlık: Üç Tinea İnkognito Olgusu Anahtar Kelimeler: Tinea inkognito; yüzeyel mantar infeksiyonu; topikal steroid; yanlış tedavi “Tinea inkognito” yanlış tanı ile topikal veya sistemik kortikosteroid tedavisi uygulanmasına bağlı tipik görünümün değiştiği dermatofit infeksiyonudur. Bu makalede, yanlış tanı ile topikal kortikosteroid tedavisi almış üç olguyu sunmaktayız. Birinci olgumuz olan 30 yaşındaki erkek hastanın yaklaşık dört aydır devam eden, bilateral inguinal ve periumbilikal bölgede lokalize eritemli, skuamlı papül ve plakları mevcuttu. İkinci olgumuz, 40 yaşındaki bir erkek hastadaydı; yaklaşık bir aydır devam eden, vücudunda yaygın olarak bulunan, eritemli zeminde yer yer papülopüstüler plaklara ve hiperpigmente maküler lezyonlara sahipti. Üçüncü olgumuz ise 23 yaşında bir erkek hastaydı ve üç aydır bilateral malar bölgede devam eden, eritemli maküler lezyonların üzerinde yer yer papüler lezyonları mevcuttu. Her üç olgumuzun da yapılan direkt mantar bakısı pozitifti ve ilk iki olgunun mantar kültürlerinde Trichophyton rubrum üredi. Ayrıca, her üç hastanın lezyonları da antimikotik sağaltıma tam yanıt verdi. Bu makale ile “tinea inkognito” ile ilgili son literatür bilgileri yeniden gözden geçirilmek istenmiştir., “Tinea inkognito” yanlış tanı ile topikal veya sistemik kortikosteroid tedavisi uygulanmasına bağlı tipik görünümün değiştiği dermatofit infeksiyonudur. Bu makalede, yanlış tanı ile topikal kortikosteroid tedavisi almış üç olguyu sunmaktayız. Birinci olgumuz olan 30 yaşındaki erkek hastanın yaklaşık dört aydır devam eden, bilateral inguinal ve periumbilikal bölgede lokalize eritemli, skuamlı papül ve plakları mevcuttu. İkinci olgumuz, 40 yaşındaki bir erkek hastadaydı; yaklaşık bir aydır devam eden, vücudunda yaygın olarak bulunan, eritemli zeminde yer yer papülopüstüler plaklara ve hiperpigmente maküler lezyonlara sahipti. Üçüncü olgumuz ise 23 yaşında bir erkek hastaydı ve üç aydır bilateral malar bölgede devam eden, eritemli maküler lezyonların üzerinde yer yer papüler lezyonları mevcuttu. Her üç olgumuzun da yapılan direkt mantar bakısı pozitifti ve ilk iki olgunun mantar kültürlerinde Trichophyton rubrum üredi. Ayrıca, her üç hastanın lezyonları da antimikotik sağaltıma tam yanıt verdi. Bu makale ile “tinea inkognito” ile ilgili son literatür bilgileri yeniden gözden geçirilmek istenmiştir.

WOS: 000340761700001, PubMed ID: 25177700, Objectives. Hypertension and hypervolemia relationship was proven among renal disease, although it is not known in normal population. Present study determines the fluid distribution defects in relation to blood pressure. Material and Methods. In a population-based survey in Turkey demographics, height, weight, blood pressure, urine analysis, and serum creatinine measurements were recorded. Bioimpedance measured with the Body Composition Monitor. Results. Total 2034 population of 71.6% male, mean age 47 +/- 12.6 (18-89) years, systolic blood pressure (SBP) 134.7 +/- 20, diastolic blood pressure 77.9 +/- 11.6 mmHg. Body mass index (BMI) was 28.5 +/- 4.5 (15.8-50.6) kg/m(2); overhydration was 0.05 +/- 1.05 L. There was a correlation between extracellular water (ECW)/height and SBP (r = 0.21, P < 0.001). Receiver operating characteristic (ROC) curve with the performance of 0.60 (P < 0.001) that showed cut-off value of ECW/height was 10.06 L/m, with the 69% sensitivity and 45% specificity for SBP: 140 mmHg values. Risk factors for high SBP were increase of ECW/Height, age, BMI and presence of diabetes. ECW/height, SBP, and fat tissue index (FTI) increased in BMI categories (low, normal, and obese) and in diabetics. SBP and FTI were lower in smokers. Conclusions. High blood pressure may be accompanied by increased extracellular volume indices. In the future volume status assessment could be of use in evaluating the effectiveness of pharmacological intervention in the treatment of hypertension.

WOS: 000337949800013, PubMed: 24673399, Background: In this present study, we aimed to investigate the association between therapeutic outcomes and vascular endothelial growth factor (VEGF) G-1154A and C-936T gene polymorphisms in patients with glomerulonephritis. Methods: Thirty-eight patients with glomerulonephritis diagnosed by renal biopsy were included to the study. All patients had proteinuria at least 1 gram (g)/day in urine analysis. At the end of a yearly therapy, patients with proteinuria less than 0.5 g/day were accepted as in complete remission and they were termed as group 1. The patients with proteinuria over 0.5 g/day were accepted as in no remission and they were termed as group 2. Results: The mean age of patients in group 1 and group 2 was 35.88 +/- 13.80 years and 37.30 +/- 13.89 years, respectively. There were nine (50%) male and nine (50%) female patients in group 1. In group 2, seven (35%) male and 13 (65%) female patients were present. Although VEGF G-1154A (GG) gene polymorphism was found in 55% of group 2 patients, and 22.2% of group 1 patients, but the differences did not reach statistical significance. There were no statistical differences between groups in terms of other gene polymorphisms. Namely, we obtained no statistical differences between therapeutic outcomes and gene polymorphisms. Conclusions: There is a significant difference between groups in terms of VEGF G-1154A (GG) gene polymorphism, but the minority of the patient population has led to not to reach statistical significance. So, this gene polymorphism has to be investigated in larger studies.

WOS: 000329806000001, PubMed ID: 24394695, Background: We investigated the changes in the values of carotid intima-media thickness (IMT) and Doppler index measurements in the autosomal dominant polycystic kidney disease (ADPKD), peritoneal dialysis (PD), and hemodialysis (HD) patients. Material/Methods: Twenty outpatients on HD (mean age 46.1 +/- 16.4), 27 outpatients on PD (mean age 45 +/- 12.4), and 26 normotensive outpatients with ADPKD (mean age 52.4 +/- 16.7) as the case groups and 21 healthy subjects (mean age 48.4 +/- 7.2), as the control group, were included. The participants underwent ultrasonography of the common, right, and left carotid arteries for the IMT and Doppler flow measurements. Results: Overall, compared to the normal group, in the study groups, the IMT and peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index (RI), and pulsatility index (PI) were significantly higher in common carotid arteries; however, their differences were not meaningful in internal carotid arteries (p

WOS: 000341430800022, PubMed ID: 24748065, Vascular access is vital for hemodialysis patients. A major factor that facilitates arteriovenous (AV) fistula failure is stenosis and thrombosis due to intimal hyperplasia developing in the venous segment of AV fistula. It has been reported that VEGF accelerated re-endothelialization, reduction in intimal thickening, and/or mural thrombus formed in the injured vascular structures. In this study, we aimed to identify the effect of the VEGF 936 gene polymorphism and vascular endothelial growth factor-A (VEGF-A) levels in the late period of AV fistula loss in hemodialysis patients. The study was carried out with a patient group of 42 individuals who experienced two or more fistula thrombosis in the late period after the AV fistula operation and also a control group of 38 patients who have not had any AV fistula thrombosis history for 3 years or more. All participants were assessed for VEGF-936C/T gene polymorphism and VEGF-A levels. VEGF-936C/T genotypes were determined in the large proportion in the control group (31.6 %), while VEGF-936C/C genotypes were determined in a large proportion in the patient group (90.5 %). Individuals carrying the VEGF-936C/C genotype had an increased risk of 5.54 for getting AV fistula thrombosis. The VEGF-A levels of patient group (27.3 +/- A 43.5 pg/ml) were significantly lower than those of the control group (70.7 +/- A 53.1 pg/ml). There is an increased risk of AV fistula thrombosis in individuals carrying the VEGF-936C/C genotype. The other renal replacement modalities should be considered in patients with this genotype. As a result, it will be possible to prevent the morbidity and mortality due to fistula failure.

WOS: 000346149200011, PubMed: 25491689, Background. Chronic obstructive pulmonary disease (COPD) is characterized by inhaled particles and gases inducing chronic inflammation of the airways accompanied by a not fully reversible airflow limitation. Systemic inflammation has an important role in the pathogenesis of COPD. In parallel, several comorbidites can be observed. Microalbuminuria is related to endothelial dysfunction. Microalbuminuria was increased in exacerbation periods of COPD. Objectives. The aim of the study was evaluate to the presence of microalbuminuria (MA) in patients with chronic obstructive pulmonary disease (COPD) and its relationship to inflammation, arterial blood gas parameters and 24-hour ambulatory blood pressure alterations. Material and Methods. Seventy COPD patients and 40 healthy volunteers were enrolled in the study. 24-h ambulatory blood pressure monitoring (ABPM) results, including pressure and pulse rates of the subjects were recorded and the cases were classified as "dipper" if a normal fall of more than 10% in blood pressure was observed at night and "non-dipper" if not. Routine renal function tests were performed, C-reactive protein (CRP) values were examined and urine samples were obtained to scrutinize the presence of MA. Patients were allocated into two groups, those with and without MA. The spirometry and arterial blood gas results of the patients were recorded. Results. The urinary albumin creatinin ratio (64.8 +/- 91.8), CRP (21 +/- 14.8), nocturnal systolic and diastolic blood pressure (118 +/- 14 and 72 +/- 10), nocturnal and diurnal pulse (87 +/- 17 and 90 +/- 14), nocturnal pulse pressure (49 +/- 11), mean pulse (89 +/- 15), mean pulse pressure (48 +/- 10) and the number of non-dipper subjects (65) were found significantly higher in the COPD group than in the control group (10.6 +/- 6, 5.4 +/- 2.4, 105 +/- 6 and 68 +/- 7, 70 +/- 10 and 78 +/- 11, 42 +/- 1, 75 +/- 11, 42 +/- 7 and 5, respectively); (p < 0.001, < 0.001, < 0.001 and 0.041, < 0.001 and < 0.001, < 0.001, < 0.001, < 0.001 and < 0.001, respectively). Nocturnal pulse (89 +/- 17) and CRP (23.5 +/- 14.8) were found to be significantly higher in COPD patients with MA than in COPD patients without MA (78 +/- 8 and 8.8 +/- 6.3, respectively); (p = 0.021 and < 0.001, respectively). Conclusions. The facts that CRP, a systemic inflammation marker, and mean nocturnal pulse pressure values were significantly higher in the group with MA among COPD patients, and that ambulatory blood pressure values did not differ between COPD patients with and without MA, suggest both a possible role of inflammation in MA development in COPD patients and a relationship between MA and increased heart rate.

WOS: 000278009800010, PubMed ID: 20424368, Clinical symptoms and findings of familial Mediterranean fever (FMF), occur as a result of autoimmune inflammation of the serous membrane which is also seen in systemic lupus erythematosus (SLE). Difficulties are sometimes encountered in the differential diagnosis of FMF because of similar clinical features with other autoimmune inflammatory diseases, and very rarely it can be seen with SLE. The association of FMF and SLE has been reported in one childhood case in Turkey. As far as we know, there is no report in the adult age group. Here, we present the first FMF and SLE association in an adult and discuss the pertinent literature in Turkey.

Lupus nephritis is an infl ammation of the kidney caused by systemic lupus erythematosus (SLE). Lupus nephritis is a frequent complication of SLE that increases mortality and morbidity. Minimal glomerular lesions, mesangial proliferative, focal proliferative, membranous and diffuse glomerulonephritis can be seen in renal biopsies of patients with lupus nephritis. It has been reported that non-lupus nephritis can also rarely occur in SLE. While non-lupus nephritis cases usually manifest as focal segmental glomerulosclerosis, they have been seen rarely as IgA nephropathy. In this paper, we have represented a SLE case with IgA nephropathy on renal biopsy., Yildiz, G.; Yesil Mahallesi, Aksemsettin Caddesi, Ada Sitesi, D-Blok, No:7, Zonguldak, Turkey; email: drgursel@yahoo.com

WOS: 000321809200007, Background: Cardiovascular death is decreasing in the general population; however, it appears in still higher rates and even increases gradually in hemodialysis (HD) patients. This situation has led to a debate about cardiovascular adverse effects of HD which lead to significant changes in cardiac and hemodynamic events. It is known that troponins are often elevated in HD patients, and high levels of troponin are associated with increased mortality. Therefore, it is difficult to interpret the value of elevations in chronic kidney disease patients. Methods: Echocardiographic and biochemical parameters of 41 patients treated with HD were evaluated before and after a HD session. Results: HD led to an increased heart rate, and tissue Doppler imaging parameters such as early diastolic mitral peak velocity (E)/early diastolic myocardial peak velocity (e) and septal e decreased significantly after HD. HD caused an increase in troponin I, myoglobin and cardiac creatine kinase (CK MB) levels (p = 0.019, p < 0.001 and p = 0.018, respectively). A decrease in the left ventricular peak systolic myocardial (LV S') velocity (p = 0.011) was detected in patients with increased levels of cardiac damage markers (group 2) compared to those without increased levels of cardiac damage markers (group 1) in HD. Conclusion: A decrease in LV S' velocity was found to be an independent predictor of an increase of myocardial injury enzymes in HD (odds ratio = 1.099; p = 0.039). We concluded that HD may lead to significant acute stress upon the myocardium. Copyright (c) 2013 S. Karger AG, Basel

50th European-Renal-Association - European-Dialysis-and-Transplant-Association Congress -- MAY 18-21, 2013 -- Istanbul, TURKEY, WOS: 000319498202399, …, European Renal Assoc (ERA), European Dialysis & Transplant Assoc (EDTA)

WOS: 000308686600002, PubMed ID: 22911280, Objective: The rate of reduction of nocturnal blood pressure (NBP) is lesser than normal in patients with type 2 diabetes mellitus (type 2 DM). Hyperhomocysteinemia (HHC) disrupts vascular structure and function, no matter the underlying causes. The risk of development of vascular disease is greater in diabetic patients with hyperhomocysteinemia than in patients with normal homocystein levels. The aim of the study was to investigate whether there are differences of homocystein levels in dipper and non-dippers patients with type 2 DM. Subjects and methods: We compared 50 patients (33 females, 17 males) with type 2 DM and 35 healthy individuals (18 females, 17 males 1 in a control group. Ambulatory blood pressure monitoring (ABPM) was performed and homocysteine levels were measured in all patients. Results: We found that the percentage of non-dipper pattern was 72% in patients with type 2 DM and 57% in control group. In diabetic and control individuals, homocystein levels were higher in non-dipper (respectively 13.4 +/- 8.1 mu mol/L and 11.8 +/- 5 mu mol/L) than in dipper subjects (respectively, 11.8 +/- 5.8 mu mol/L and 10.1 +/- 4.2 mu mol/L), but there was no significant difference between the two groups (respectively, p = 0.545, p = 0.294). Conclusion: In both groups, homocystein levels were higher in non-dipper than in dipper participants, but there was no significant difference between the groups. High homocystein levels and the non-dipper pattern increases cardiovascular risk. Therefore, the relationship between nocturnal blood pressure changes and homocystein levels should be investigated in a larger study. Arq Bras Endocrinol Metab 2012;56(5):285-90

Lupus eritematozus, sıklıkla deri bulgularıyla giden kronik, inflamatuvar bir hastalıktır. Kutane lupus eritematozus üç formda kategorize edilir: Kronik kutane lupus eritematozus, subakut kutane lupus eritematozus ve sistemik lupus eritematozus. Son yıllarda sağ kalım oranlarındaki iyileşmeye rağmen, hâlâ lupus eritematozuslu hastaların beklenen yaşam ömrü genel popülasyondan kısadır. Lupus eritematozuslu hastalarda, hastalık gidişatını değerlendirmek amacıyla organ spesifik ölçümlere ihtiyaç duyulmaktadır.Deri bulguları için, daha önce yayınlanmış ve onaylanmış olan revize kutane lupus eritematozus hastalık alan ve şiddet indeksi ölçeği kullanılmaktadır.Burada, revize kutane lupus eritematozus hastalık alan ve şiddet indeksinin Türkçe tercümesinin kullanılabilirliği ve lupus eritematozusun yaşam kalitesine etkisi incelenmiştir.Çalışmamız klinik veya patolojik olarak lupus eritematozus tanısı konumuş 93 hastayı kapsamaktadır. Her bir hastaya, Kısa Form-36, Skindeks-29+3 ve modifiye sağlık değerlendirme anketini içeren bir dizi soru soruldu. Ayrıca hastalar, kişisel demografik özellikleri ve hastalık geçmişleriyle ilişkili soruları cevapladılar. Aynı muayenede, hastalara revize kutane lupus eritematozus hastalık alan ve şiddet indeksi ölçeği uygulandı.Yaş, cinsiyet, hastalık süresi, hastalık alt tipi ve yüz tutulumu gibi birçok bağımsız faktörün revize kutane lupus eritematozus hastalık alan ve şiddet indeksi, Kısa Form-36 ve Skindeks-29+3 ile ilişkisi test edildi.Yüz tutulumu olan hastalar ile revize kutane lupus eritematozus hastalık alan ve şiddet indeksi aktivite skoru arasında pozitif bir korelasyon vardı. Kısa Form-36 alt grupları ile yaş ve erkek cinsiyet arasında pozitif bir korelasyon saptandı. Skindeks-29+3 alt skalaları ile hastalık alt tipi ve yüz tutulumu arasında pozitif; yaş ile negatif korelasyon görüldü.Revize kutane lupus eritematozus hastalık alan ve şiddet indeksi aktivite ve hasar skoru ile Skindeks-29+3 alt skalaları arasında orta düzeyde anlamlı bir ilişki bulundu.Bu çalışma bize, eklem tutulumu olan hastalarda modifiye sağlık değerlendirme anketi skorlarının belirgin olarak yüksek olduğunu gösterdi. Skindeks-29+3 fonksiyonel alt skalası ile modifiye sağlık değerlendirme anketi arasında pozitif korelasyon, Skindeks-29+3 fonksiyonel alt skalası ile Kısa Form-36 fiziksel fonksiyon arasında negatif korelasyon mevcuttu. Kısa Form-36 fiziksel fonksiyon alt skalası ile modifiye sağlık değerlendirme anketi arasında negatif bir korelasyon vardı.Çalışmamızın sonucunda, revize kutane lupus eritematozus hastalık alan ve şiddet indeksinin, lupus eritematozuslu hastalarda kutanöz aktivite ve hasarın hesaplanmasında kullanılabilecek etkili bir araç olduğu düşüncesindeyiz. Lupus erythematosus is a chronic autoimmune disease that frequently involves the skin. Cutaneous lupus erythematosus categorized into three groups: chronic cutaneous lupus erythematosus, subacute cutaneous lupus erythematosus, and systemic lupus erythematosus. Despite the improvement in the survival rates over the past few decades, lupus erythematosus patients still have a shorter life expectancy than the general population. Organ-specific measurements are needed to evaluate the progress of the disease in patients with lupus erythematosus.Previously approved and published instrument which is revised cutaneous lupus erythematosus disease area and severity index scale use for the skin findings.Herein, we investigated the availability of the Turkish translation of revised cutaneous lupus erythematosus disease area and severity index and the effects of lupus erythematosus on quality of life.The study included in clinically or pathologically diagnosed 93 lupus erythematosus patients. Each patients were asked to complete a series of questionnaires, including the Short Form-36, the Skindex-29+3 and modified Health Assessment Questionnaire. They also answered the questions which about their previous personal demographic characteristics and disease history. At the same visit, the physician applied revised cutaneous lupus erythematosus disease area and severity index scale.A number of independent factors which including age, gender, disease duration, disease subtype and facial lesions were tested for an association with revised cutaneous lupus erythematosus disease area and severity index, Short Form-36 and Skindex-29+3.There were positive correlations between revised cutaneous lupus erythematosus disease area and severity ındex activity scores and the patients with facial involvement. Short Form-36 subgroups showed positive correlations between age and male gender. Skindex-29+3 subscales showed positive correlations between disease subtype and facial lesions; showed negative correlaitons between age.We found a moderate correlation between revised cutaneous lupus erythematosus disease area and severity index activity and damage score with Skindex-29+3 subscales.This study show that modified health assessment questionnaire scores are clearly higher in patients with joint involvement findings. There was positive correlation between Skindex-29+3 functioning subscales with modified health assessment questionnaire and there was negative correlation between Skindex-29+3 functioning subscales with Short Form-36 pysical function. Short Form-36 pysical function and modified health assessment questionnaire showed negative correlations.At the result of our study we thought that; revised cutaneous lupus erythematosus disease area and severity index is an effective tool in assessing cutaneous activity and damage in patients with lupus erythematosus. 109

WOS: 000303668000023, PubMed: 22240157, Background: Early diagnosis of cardiovascular disease in diabetic patients may be important to introduce treatment early. Echocardiography is a method used to show the ventricular functions. A ventricular hormone, BNP is used to identify the changes in the ventricular function in early period. NT-proBNP which is a more stable compound with a longer half-life is used in measurement of BNP. Methods: Left ventricular diastolic dysfunction (LVDD) was detected and NT-proBNP levels were measured in forty-four asymptomatic patients with ages of 30-70 and type 2 DM and control group consisted of 40 healthy individuals from the same age group. Results: NT-proBNP levels were found as 566.7 +/- 738.5 pg/ml in the diabetics with LVDD detected, 166.3 +/- 137.1 pg/ml in the diabetics without LVDD and 134.5 +/- 77.2 pg/ml in the control group. Levels of NT-proBNP were significantly higher in the group with left ventricular diastolic dysfunction (p < 0.05). However, when the levels of NT-proBNP in the diabetic patients without LVDD were compared with the controls, the difference was not significant (p > 0.05). NT-proBNP levels were found significantly higher in LVDD group compared to the controls without a difference between the ejection fractions (p < 0.05). Conclusion: High levels of NT-proBNP was correlated tissue Doppler echocardiography findings in type 2 DM patients with preserved ejection fraction. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

WOS: 000287018600011, PubMed ID: 21220248, Objective: The nocturnal blood pressure (NBP) reduction is less than normal in the patients with type 2 diabetes mellitus (type 2 DM). L-carnitine deficiency may cause changes of NBP by leading to hyperglycemia, insulin resistance and endothelial dysfunction in patients with type-2 DM. The purpose of the study was to investigate whether there is a difference in levels of L-carnitine in dipper and nondippers patients with type 2 DM. Methods: This is a cross-sectional observational cohort study. We compared the 50 (33 females, 17 males) patients with type 2 DM and the 35 healthy persons (18 females, 17 males) as a control group. In all cases, ambulatory blood pressure monitoring (ABPM) was performed and L-carnitine was measured. The independent samples t test, Chi-square test, Mann-Whitney U test and Pearson correlation analysis were used in the statistical evaluation of data. Results: We found that the percentage of nondipper pattern was 72% in patients with type 2 DM. L-carnitine levels were lower in patients with type 2 DM (52.77+/-12.34 mu mol/L) than those of control group (79.18+/-10.59 mu mol/L), and these differences were statistically significant (p

WOS: 000288323700018, PubMed ID: 21401364, Although acute renal failure developing due to malignancies is a frequent condition, malignant renal infiltration is rarely observed among these causes. Among all malignant diseases, the hematolymphoid malignancies are the most prone to renal infiltration. Other types involved in cases with lymphoma are glomerulopathies, including immune-complex glomerular diseases such as minimal change disease, membranous glomerulonephritis, membranoproliferative glomerulonephritis, and focal segmental glomerulosclerosis. We present herein the rare case of a 22-year-old male with both membranous glomerulonephritis and CD20 (+) lymphoid infiltration related to Hodgkin's lymphoma in the renal interstitial tissue, as detected on biopsy. The patient was treated with adriamycin, bleomycin, vinblastine, and dacarbazine protocol after pulse corticosteroid treatment, and a dramatic improvement in renal function was observed after 2 days of treatment. In this article, an exceptional renal involvement of Hodgkin's lymphoma is discussed in light of the related literature.

WOS: 000287485800010, PubMed ID: 21332339, Background: In this study, we investigated the relationship between early arteriovenous fistula (AVF) thrombosis with angiotensin-converting enzyme (ACE) gene and thrombophilic factor gene polymorphisms. Methods: Thirty-five patients who suffered from three or more fistula thrombosis episodes in the early period after AVF operation and 33 control patients with no history of thrombosis for at least 3 years were enrolled in this study. Results: Factor V G1691A Leiden, factor V H1299R (R2), prothrombin G20210A, factor XIIIV34L, beta beta-fibrinogen-455 G-A, glycoprotein IIIa L33P human platelet antigens (HPA-1), methylenetetrahydrofolate reductase C677T, and methylenetetrahydrofolate reductase A1298C gene polymorphisms were similar in both groups (p > 0.05). Plasminogen activator inhibitor 1 (PAI-1) 4G//5G genotype in the study group and 4G//4G genotype in the control group were significantly higher (p == 0.014). No significant difference was detected in terms of the 5G//5G genotype. With regard to the ACE gene polymorphism, the control group showed more ID genotype (19//33, 57.6%%), whereas the study group showed more DD genotype (17//35, 48.6%%). II genotype was similar in both groups (x

WOS: 000284798000009, Objective: Markers of chronic inflammation, such as high-sensitive C-reactive protein (hs-CRP) or tumor necrosis factor-alpha (TNF-alpha) and interleukin (IL)-6, are predictive for cardiovascular mortality and morbidity in patients with chronic renal failure. Leptin stimulates angiogenesis and accelerates vascular calcification and it plays an active role in the process of atherosclerotic disease. This study investigated the relationship between leptin and inflammatory markers (hs-CRP,TNF-alpha ve IL-6) and leptin as an inflammatory marker in dialysis patients. Material and Methods: We examined the relationship of serum leptin levels with inflammatory markers in dialyzed patients. Serum CRP or TNF-alpha, IL-6 and leptin levels were determined as well as other metabolic parameters. Correlation studies and multivariate regression analysis were performed among variables. Results: Our patients showed elevated serum leptin and inflammatory markers. Serum leptin levels were positively correlated with CRP, TNF-alpha, IL-6 and body mass index (BMI). Serum CRP levels were directly related to leptin levels. Conclusion: Both hemodialysis and continuous ambulatory peritoneal dialysis patients showed high levels of chronic inflammation markers. Serum leptin levels were elevated in dialysis patients and significantly correlated with inflammatory markers.