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Öğe Association of fetuin - A levels with carotid intima media thickness and valvular calcification in hemodialysis and peritoneal dialysis patients(2013) Solak Y.; Inal A.; Atalay H.; Kayrak M.; Biyik Z.; Türkmen K.; Yeksan M.Background: Fetuin-A is a negative acute-phase reactant which prevents vascular calcification. Coronary artery disease (CAD) is the most important cause of mortality in patients undergoing renal replacement therapy (RRT). The key element of cardiovascular disease (CVD) seen in end-stage renal disease patients who are on dialysis treatment is accelerated calcific atherosclerosis. There are a limited number of studies in which HD and PD is compared in terms of fetuin-A level. OBJECTIVE: We aimed to investigate the association of serum fetuin-A level with valvular calcification and predictors of CAD in hemodialysis (HD) and peritoneal dialysis (PD) patients. MATERIAL and METHODS: 39 HD (24 males, 15 females) and 39 PD (25 males, 14 females) patients were included in the study. We determined carotid artery intima media thickness (CIMT) and evaluated heart valve calcification via echocardiography. We also measured serum fetuin-A level, CRP, ferritin, fibrinogen and serum albumin level. According to fetuin-A level, patients were stratified into quartiles. RESULTS: Fetuin-A level was significantly lower in HD patients when compared with that of PD patients (28.6±5.934 ng/ml, 32±4.8 ng/ml respectively p<0.001). There was a significant negative correlation between CIMT and fetuin-A level. CIMT was found to be lower in PD patients than in HD patients. We found a positive correlation between fetuin-A and dialysis adequacy and albumin level. There was a negative correlation of fetuin-A with age, fibrinogen, ferritin and CRP. Fetuin-A level was lower in patients with aortic calcification. Conclusion: Fetuin-A level was found to be lower in HD patients. Fetuin-A may be a novel marker for CVD in patients undergoing RRT.Öğe Dilated cardiomyopathy in a patient with antibody-negative Goodpasture's syndrome and pulmonary relapse.(2010) Solak Y.; Selcuk N.Y.; Polat I.; Atalay H.; Turkmen K.The Goodpasture's syndrome, also known as anti-GBM disease, is an uncommon disease, responsible for 20% of all cases of rapidly progressive glomerulonephritis. Anti-GBM antibodies are directed against non-collagenous domain (NC-1) of the alpha-3 chain of type IV collagen. When conventional ELISA assays are used, these antibodies can be detected in almost all the patients. Nevertheless, some reports have described antibody-negative relapsing disease. Some aggravating factors, namely, smoking, pulmonary infection and hypervolemia, may expose embedded antigenic target and may be responsible for the relapse. In addition, these antibody-negative relapses also respond to standard treatment, which comprises of plasma exchange, pulse steroids and cyclophosphamide. Herein, we report a patient who presented at the Selcuk University Meram School of Medicine, Meram, Konya, Turkey, with the pulmonary-renal syndrome. He was also found to have idiopathic dilated cardiomyopathy (DCM). To our knowledge, this is the first report describing co-existence of DCM and anti-GBM disease. There is growing evidence showing strong relation of both DCM and anti-GBM disease with HLA. Although not proven, this might have occurred in our patient. In our opinion, volume overload was facilitated by anuria and DCM and led to an antibody-negative pulmonary relapse. The relapse was treated just as the first episode and the patient improved satisfactorily.Öğe Efficiency of silver coated urinary catheter in catheter-associated urinary tract infection in critical care unit(AVES, 2010) Teke T.; Yavuz Z.; Atalay H.; Maden E.; Solak Y.; Uzun K.Aim: Urinary tract infection (UTI) is the most prevalent cause of nosocomial infections, with an incidence of 40%. The incidence of urosepsis occurs in approximately 16% of the ICU patient populations. The purpose of this study was to determine the efficacy of a silver coated urinary catheter in prevention of catheter-associated UTI. Material and Methods: We investigated 21 patients (mean age with 71.4±9.0 year and 14 M, 7 F) foley silicon urinary catheter and 20 patients (mean age with 67.6±8.7 year and 15 M, 5 F) with silver coated urinary catheter. In all patients, foley urinary catheters were changed with silver coated catheter in critical care unit. Results: The most common cause of infection was Klebsiella (33%). The susceptibility of gram negative microorganisms against antimicrobial agents were amicacin, piperacillin-tazobactam and carbapenem. The cost of antibiotic was higher in foley catheter group than silver coated group (p<0.001). Conclusion: Silver coated urinary catheter is expensive, it is cost effect according to urinary infection and antibiotic cost.Öğe Evaluation of adrenal function in chronic obstructive pulmonary disease patients receiving invasive and noninvasive mechanical ventilation(AVES, 2010) Atalay H.; Teke T.; Yavuz Z.; Maden E.; Kiyici A.; Solak Y.; Uzun K.Stress and severe disease states in the intensive care unit (ICU) cause release of adrenocorticoid hormone from the hypophysis and cortisol from the adrenal cortex by activating hypothalamo-pituitary adrenal axis. While adrenal insuffi ciency (AI) is seen in less than 0.01% of the normal population, its frequency is over 28% of cases in intensive care units (ICU). The aim of this study was to evaluate adrenal function in 36 cases with COPD, in pulmonary diseases ICU, receiving invasive mechanical ventilation (IMV) (n:23) and noninvasive mechanical ventilation (NIMV) (n:13). For this purpose, after obtaining a blood sample for baseline cortisol level, 1mg ACTH was given to patients in the fi rst day of admission to ICU. Cortisol levels were checked at the 30th and 60th minutes of ACTH test. Of all cases, mean age was 67.3±9.2, duration of hospitalization 12.9±9.3 days, APACHE II score 20.9±5.4, systolic blood pressure (bp) 103.5±28.2 mmHg, diastolic bp 64.6±19.2, mean arterial blood pressure 81.5±20.5 mmHg, sodium 138.3 ±6.3, potassium 4.3±1.2, urea 83.8±62.5 and creatinine was1.38±0.9 respectively. According to baseline cortisol levels, AI was present in 22 (45%) patients. Of these cases, 11 were in NIMV and 11 in IMV groups. When the baseline, 30th minute and 60th minute cortisol levels were compared, a statistically signifi cant difference was present (p<0.05, for all). In conclusion, we consider that adrenal insuffi ciency is encountered frequently in COPD patients with respiratory failure and further studies are needed tobetter delineate this association.Öğe First case of peritonitis due to Ablotrophia defectiva [9](2006) Arslan U.; Guney I.; Yuksekkaya S.; Atalay H.; Turk Dag? H.[Abstract not Available]Öğe Infuenza A/H1N1 infection in a renal transplant recipient: Early recognition prevented unfavorable results(2011) Solak Y.; Selçuk N.Y.; Atalay H.; Öbek O.; Genç N.Influenza A/H1N1 2009 rapidly created a pandemic after it was first reported in April 2009. This virus caused a wave of panic around the world because of the rapidity of transmission and the characteristics of the dying victims, which were apparently healthy young adults. The pandemic caused thousands of laboratory-confirmed cases and many deaths. Despite this high prevalence, few reports of infection and clinical results in renal transplant recipients have been described in the literature. Early recognition and prompt administration of oseltamivir may prevent severe respiratory disease. Here we describe a renal transplant recipient who presented early after symptom onset who was successfully treated with oseltamivir and broad spectrum antibiotics without dire clinical consequences.Öğe Thyroid hormon levels in patients with acute exacerbation of chronic obstructive pulmonary disease(2007) Uzun K.; Atalay H.; Inal A.Aim; The severity of airway obstruction in chronic obstructive pulmonary diseases (COPD) is associated with impairment of thyroid gland function. Methods; We evaluated thyroid abnormalities in patients with COPD and relationship between pulmonary function tests, arterial blood gases and thyroid functions. Results; There was no significant difference in mean levels of TSH, FT3 and FT4 between COPD and control group. Serum level of TSH was lower than normal limits in 20 of 62 patients with COPD. Serum level of FT3 was higher than normal limits in 2 of 20 patients with lower TSH level. In control group, TSH was lower than normal limits in 2 patients, but FT3 was normal in these patients. There was significant difference according to percentage of cases with TSH less than minimum values and FT3 higher than maximum values between COPD and control group. Conclusion; we have demonstrated that both clinic and subclinic hyperthyroidism were higher in patients with COPD exacerbations than cases without COPD.Öğe Utility of double filtration plasmapheresis in acute antibody mediated renal allograft rejection: Report of three cases(2011) Solak Y.; Atalay H.; Polat I.; Anil M.; Türkmen K.; Biyik Z.; Yeksan M.Plasmapheresis is an extracorporeal procedure, which is often employed to rapidly lower circulating titers of autoantibodies, immune complexes or toxins. There are two types of plasmapheresis namely, regular plasmapheresis (RPP) by centrifugation and membrane filtration, and double filtration plasmapheresis (DFPP) which is a special form of membrane filtration in which two membranes called as plasma separator and plasma fractionator are employed to filter macromolecules more selectively. DFPP have several advantages over RP. Despite widespread utilization of DFPP in the setting of ABO blood group incompatible kidney transplantation, there is no report regarding DFPP in patients with antibody mediated acute renal allograft rejection who are good candidates for beneficial effects of DFPP. Here we report three renal transplant recipients in whom DFPP was applied as a component of anti-rejection treatment regimen.
