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Öğe Gece sistolik kan basıncı yükselmelerinin santral hemodinamikler ve arteriyel sertleşme ile ilişkisi(2012) Çelik, Gülperi; Gündoğdu, Ali; Elsürer, Rengin Afşar; Şahin, FatihAMAÇ: Bu çalışmanın amacı, gece KB yükselen hastaların santral hemodinamik ve arteriyel sertleşme göstergelerini incelemektir. GEREÇ ve YÖNTEMLER: Bu geriye dönük çalışmada, 252 hipertansif hastanın ayaktan kan basıncı (KB) izlemi Mobil-O-Graph Arteriograph cihazı kullanılarak yapıldı. BULGULAR: Toplam 252 hastanın 174'ü (%69,0) kadın, 78'i (%31) erkek ve yaş ortalamaları 54,514,4 idi. Pearson korelasyon testi uyguladığımızda; sistolik kan basıncında gece düşmeleri, yaş (r-0,169, p0,008), 24 saat (24s) sürecinde periferik direnç (r-0,171, p0,007), gündüz nabız dalga hızı (NDH) (r-0,179, p0,005), gece diyastolik kan basıncında (DKB) azalma (r0,790, p0,001), gece santral sistolik kan basıncı (SKB) (r-0,410, p0,001), gece santral DKB (r-0,387, p0,001), gece arttırma indeksi (Aix@75) (r-0,215, p0,001), gece periferal direnç (r-0,321, p0,001) ile ilişkiliydi. Hastaları sistolik kan basıncında gece düşmelerine göre; kan basıncında %10 ve daha fazla düşme olanlar, %10'dan daha az düşme olanlar ve gece kan basıncı artanlar olmak üzere üç gruba ayırdığımızda gruplar arasında hemoglobin düzeyi (p0,033), gece nabız basıncı (p0,001), gece DKB düşmesi (p0,001), gece Aix@75 (p0,001), gece periferal direnç (0,001) göstergeleri arasında istatistiksel olarak anlamlı fark vardı. SONUÇ: Gece kan basıncı yükselen ve %10'dan az düşen hastaların arteriyel sertleşmeye neden olan geleneksel risk faktörlerinin sıkı izleminin ve hipertansiyon tedavilerinde kronoterapinin kullanılmasının yararlı olabileceğini düşünüyoruz.Öğe How should procalcitonin and C-reactive protein levels be interpreted in haemodialysis patients?(WILEY, 2018) Demir, Nazlım A.; Sümer, Sua; Çelik, Gülperi; Afşar, Rengin Elsürer; Demir, Lütfi S.; Ural, OnurBackground: Procalcitonin (PCT) and C-reactive protein (CRP) are used most widely in the diagnosis/treatment of bacterial infections. These are not infection-specific and may also show increases in other inflammation-causing cases. Aim: To establish a new cut-off value for PCT and CRP to eliminate confusion in the diagnosis and treatment of bacterial infections in haemodialysis (HD) patients. Methods: A total of 1110 patients, 802 with undocumented infection and 308 with documented infection, was included in the study. Results: A total of 802 patients with undocumented infection had a mean CRP value of 12.2 +/- 9.6 mg/dL and a mean PCT value of 0.51 +/- 0.96 ng/mL and the 308 patients with documented infection had a mean CRP value of 125.9 +/- 83.3 mg/dL and a mean PCT value of 13.9 +/- 26.9 ng/mL at the time of admittance. In HD patients, the cut-off values for CRP was determined as 19.15 mg/dL and for PCT as 0.685 ng/mL in the presence of infection. The use of these two parameters in combination (CRP = 19.15 mg/dL and PCT = 0.685 ng/mL) was found to have 95% positive predictive value (PPV) and 93% negative predictive value (NPV) for the diagnosis of infectious diseases in HD patients. When CRP = 100 mg/dL and PCT = 5 ng/mL, this was found to have 100% PPV and 94% NPV for the diagnosis of sepsis in HD patients. Conclusion: We specified PCT and CRP cut-off values with high PPV and NPV for revealing the presence of bacterial infection and sepsis in HD patients.Öğe Is nocturnal systolic blood pressure rise associated with central hemodynamics and arterial stiffness? [Gece Sistolik Kan Basinci Yükselmelerinin Santral Hemodinamikler ve Arteriyel Sertleşme ile Ilişkisi](2012) Çelik, Gülperi; Gündoğdu, Ali; Afşar, Rengin Elsürer; Şahin, FatihOBJECTIVE: The aim of this study was to assess central hemodynamics and parameters of arterial stiffness of cases with nocturnal blood pressure rise. MATERIAL and METHODS: In this retrospective study, ambulatory blood pressure monitoring of 252 hypertensive patients was performed with the Mobil-O-Graph Arteriograph. RESULTS: 174 (%69.0) out of 252 patients were female and 78 (%31) were male and the mean age was 54.5±14.4. When Pearson's correlation test was performed, the nocturnal systolic blood pressure (SBP) decline was associated with age (r=-0.169, p=0.008), diurnal pulse wave velocity (PWV) (r=-0.179, p=0.005), nocturnal diastolic blood pressure (DBP) decline (r=0.790, p<0.001), nocturnal central SBP (r=-0.410, p<0.001), and nocturnal augmentation index (Aix@75) (r=-0.215, p=0.001). When patients were divided into three groups as 10 % or more nocturnal SBP decline, less than 10 % nocturnal SBP decline and nocturnal SBP increase, there were statistically signifi cant differences regarding nocturnal pulse pressure (p<0.001), nocturnal DBP decline (p<0.001, nocturnal Aix@75 (p<0.001), and nocturnal peripheral resistance (p<0.001). CONCLUSION: We believe that strict follow up of conventional risk factors causing arterial stiffness in patients with less than 10 % nocturnal BP decline or increase and also the use of chronotherapy may be useful.Öğe Is Sleep and Life Quality of Caregivers Affected as Much as That of Hemodialysis Patients?(Oxford Univ Press, 2012) Çelik, Gülperi; Annagür, Bilge Burcak; Yılmaz, Mümtaz; Demir, Tarık; Kara, Fatih[Abstract not Available]Öğe Nondipping heart rate and associated factors in patients with chronic kidney disease(SPRINGER, 2019) Bıyık, Zeynep; Yavuz, Yasemin Coşkun; Altıntepe, Lütfullah; Çelik, Gülperi; Güney, İbrahim; Oktar, Sevil FişekciBackground Nondipping heart rate (NHR) is a condition reported to be associated with cardiovascular events and cardiovascular mortality recently. We aimed to search whether there is difference among hypertensive patients with and without chronic kidney disease (CKD) in terms of NHR pattern and the factors associated with NHR in patients with CKD. Methods The study included 133 hypertensive patients with normal kidney functions, 97 hypertensive patients with predialysis CKD, and 31 hypertensive hemodialysis patients. Heart rate, blood pressure and pulse wave velocity (PWV) were measured by 24-h ambulatory blood pressure monitorization. NHR was defined as a decrease of less than 10% at night mean heart rate when compared with daytime values. Results NHR pattern was established as 26.3% in non-CKD hypertensive group, 43.3% in predialysis group and 77.4% in dialysis group. Among patients with CKD, when NHR group was compared with dipper heart rate group, it was seen that they were at older age, there were higher prevalence of diabetes mellitus and more female sex, and while the value of urea, creatinine, phosphorus, intact parathyroid hormone, and PWV were significantly higher, the value of hemoglobin, albumin and calcium were significantly lower. By multivariate analysis, hemoglobin [odds ratio (OR) 0.661; 95% CI 0.541-0.806; p < 0.001] and PWV (OR 1.433; 95% CI 1.107-1.853; p = 0.006) were established as independent determinants of NHR pattern. Conclusions NHR pattern is significantly more frequently seen in hypertensive CKD patients than in hypertensive patients with non-CKD. Anemia and increased arterial stiffness are seen independently associated with NHR in CKD patients.Öğe Regressive Course of Oxalate Deposition in Primary Hyperoxaluria After Kidney Transplantation(Informa Healthcare, 2010) Çelik, Gülperi; Şen, Sait; Sipahi, Savaş; Akkın, Cezmi; Tamsel, S.; Toz, Hüseyin; Hoşcoşkun, C.Primary hyperoxaluria (PH) is a rare autosomal recessive disease caused by the functional defect of alanine-glyoxylate aminotransferase (AGT) enzyme in the liver and it is characterized by the deposition of diffuse calcium oxalate crystals. A 38-year-old male patient presented with history of recurrent nephrolithiasis and has received chronic hemodialysis treatment for 2 years. Cadaveric renal transplantation was applied to the case. The patient was reoperated on postoperative day 13 because of the collection surrounding the urethra. During this operation, kidney biopsy was made due to late decrease in creatinine levels. Deposition of diffuse oxalate crystal was detected in allograft kidney biopsy, whereas in the 0-hour biopsy there were no oxalate crystals. Oxalate level was found to be high in a 24-hour urine specimen (118 mg/L, normal level: 7-44 mg/L). The patient was identified with primary hyperoxaluria and followed up in terms of systemic oxalate deposition as well as allograft kidney. In the kidney biopsy taken after 18 months, we detected that oxalate crystals almost entirely disappeared. In our case, bilateral preretinal, intraretinal, and intravascular diffuse oxalate crystals were detected, and argon laser photocoagulation treatments were needed for choroidal and retinal neovascularization. Repeated ophthalmic examinations showed the regressive nature of oxalate depositions. In the 18th month, fundus examination and fluorescein angiography revealed that oxalate crystals were significantly regressed. To increase the quality of life and slow down the systemic effects of oxalosis, kidney-only transplantation is beneficial.Öğe The Relationship Between Gamma-Glutamyl Transpeptidase and Pulse Wave Analysis in Hypertensive Patient Population(OXFORD UNIV PRESS, 2012) Elsürer, Rengin; Demir, Tarık; Çelik, Gülperi; Yavaş, Melek; Yavaş, Özlem[Abstract not Available]Öğe The Relationship Between Glutathione Peroxidase and Bioimpedance Parameters in Nondiabetic Hemodialysis Patients(WILEY-BLACKWELL, 2012) Çelik, Gülperi; Yöntem, Mustafa; Cilo, Mustafa; Bilge, Murat; Mehmetoğlu, İdris; Ünaldı, MustafaThere is growing evidence from experimental and clinical studies that oxidative stress is involved in the pathogenesis of malnutrition. This cross-sectional study aimed to investigate the relationship between glutathione peroxidase (GPx) levels as a marker of antioxidant status and the nutritional status assessed by bioimpedance analysis (BIA). Ninety-seven nondiabetic stable outpatient uremic adults undergoing chronic hemodialysis (HD) were recruited for this study. Impedance measurements were performed using a multifrequency bioelectrical impedance analyzer after dialysis. GPx levels correlated with intracellular water (ICW) (r?=?0.341, P?=?0.011), ICW/total body weight (r?=?0.320, P?=?0.017), lean body mass (r?=?0.300, P?=?0.026) and total body cell mass (r?=?0.339, P?=?0.011). When patients were divided into two groups according to mean GPx levels (83.9 U/gr hemoglobin), the patients with higher GPx (GPx?>?83.9?U/gr hemoglobin) had higher albumin (P?=?0.038), lean body mass (P?=?0.026), ICW (P?=?0.011), and total body cell mass (P?=?0.011) compared with those with lower GPx (GPx?=?83.9 U/gr hemoglobin). Furthermore, in the patients with higher GPx, body fat; extracellular water/total body water; illness marker and body fat mass index were lower than other group. In conclusion, our results reveal correlation indicating a relationship between antioxidant status (as measured by GPx) and nutritional status as assessed by BIA in nondiabetic HD patients.Öğe The Role of Prohepcidin and Hepcidin in Anemia Associated with Behcet's Disease(AKAD DOKTORLAR YAYINEVI, 2012) Dağlı, Mehmet; Yılmaz, Sema; Sivrikaya, Abdullah; Çelik, GülperiThe aim of the study is to investigate the role of circulating prohepcidin and hepcidin, which are homeostatic regulators of iron metabolism and mediators of inflammation, in anemia associated with Behcet's disease (BD) and the differential diagnosis of healthy controls. Twenty patients with BD and twenty healthy controls were included in this prospective study. Laboratory tests including. complete blood count, serum prohepcidin, hepcidin, iron, total iron binding capacity (TIBC), transferrin, ferritin, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were determined. Serum prohepcidin and hepcidin levels in patients with BD were significantly higher than healthy group. In the group with BD positive correlation was determined between the values of serum prohepcidin, hepcidin, hemoglobin, total binding capacity and ferritine. Serum prohepcidin and hepcidin levels are closely associated with disease activity in patients and might play a role in the pathobiology of chronic disease anemia associated with patients with BD.