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COVID-19 Ricochets on Kidney Transplant and Hemodialysis Patients
(Selçuk Üniversitesi, 2023 Haziran) Göktepe, Mevlüt Hakan; Çizmecioğlu, Hilal Akay; Tuna, Ali Kürşat; Çizmecioğlu, Ahmet
Background/Aims: An impaired immune response affects Coronavirus 2019 (COVID-19) disease progression. Immunities of both hemodialysis (HD) and Kidney Transplant (KTx) patients have already been suppressed. This study evaluated the prognostic laboratory results in HD and KTx patients with COVID-19. Methods: This retrospective, case-control study was conducted with PCR (+) COVID-19 HD and KTx patients and a control group. All patients were divided into two subgroups according to disease severity. Patients’ demographic records and laboratory results were obtained from the follow-up files. Results: A total of 30 HD, 20 KTx patients, and 40 control groups were involved in the study. Gender and hospitalization duration did not differ between the groups. There was a 10% mortality rate in the KTx group and 27% in the HD group. Lung involvement in Computed Tomography (CT) was higher in HD patients (47%) than in KTx (25%). In subgroup evaluations, the most prominent laboratory values were fibrinogen in HD patients and LDH and Ferritin in KTx patients in determining disease severity. Conclusions: Early hospitalization and treatment implementations will be associated with a good prognosis in HD and KTx patients since CT and laboratory results are not predictive in these groups of patients during the COVID-19 pandemic.
Omeprazol ve Gliklazid İlaç Etkileşimine Bağlı Hipoglisemi Olgusu
(Selçuk Üniversitesi, 2017 Eylül) Baldane, Süleyman; İpekçi, Süleyman Hilmi; Kebapçılar, Levent
Dispeptik yakınmaların sık görülmesi nedeniyle diyabet hastaları reçeteli ya da reçetesiz olarak proton pompa inhibitörleri (PPİ) grubu ilaçları sık olarak kullanırlar. Farklı hastalıklar nedeniyle çeşitli ilaç gruplarının bir arada kullanılması, azalan sitokrom p450 enzim aktivitesi nedeniyle özellikle yaşlı hastalarda, ilaç-ilaç etkileşimi ve ilaç etkisinin değişmesi riskini artırmaktadır. Bu vaka sunumunda 82 yaşında diyabetik hastada omeprazol ve gliklazid ilaç etkileşimine bağlı gelişen hipoglisemi olgusu sunuldu.
Struma Ovarii Dokusunda Papiller Tiroid Mikrokarsinomu: Olgu Sunumu
(Selçuk Üniversitesi, 2017 Mart) Kıraç, Cem Onur; Baldane, Süleyman; İpekçi, Süleyman Hilmi; Kebapçılar, Levent
Struma ovarii is an uncommon ovarian neoplasm that more than half of itself is made up of thyroid tissue. In clinical trials about the disease, malign transformation has been detected at the rate of 0.5-5 percent. Because of the disease's rareness, there is no absolute agreement about diagnosis and treatment of the disease and general approach is that malign struma ovarii case is treated and followed up just like done in thyroid cancers. In this case report, it is aimed to represent the treatment and 1-year follow up of papillary microcarcinoma case which evolves with struma ovarii.
Dirençli Granülomatöz Polianjiitis Olgusu
(Selçuk Üniversitesi, 2019 Mart) Limon, Muhammet; Gülcemal, Semral; Kanat, Fikret; Yılmaz, Sema
Vaskülitler, kan damarlarının inflamatuvardestrüksiyonu ile karakterize heterojen bir grup hastalıktır. Vaskülitler tutulan damar özelliğine göre klinik bulgu verebilir. Primer vaskülitler damar tutulum özelliklerine göre büyük, orta ve küçük damar vasküliti olarak ayrılır. Granülomatöz polianjiitis(GPA) ANCA ilişkili küçük damar vaskülitidir. GPA sınırlı ve sistemik tutulumla seyredebilir. Bu olgu, akciğer tutulumu olan sistemik ve sınırlı GPA olgularında tedavive yan etkileri paylaşmak için sunulmuştur.
Renal Transplant Hastalarında İnfluenza ve Pnömokok Aşı Farkındalığı
(Selçuk Üniversitesi, 2019 Ocak) Bıyık, Zeynep
Amaç: İnfluenza ve pnömokok enfeksiyonları renal transplantasyonlu hasta grubunda önemli morbiditelere neden olmaktadır. Ülkemizde renal transplant hastalarının influenza ve pnömokok aşısı ile aşılanma oranları ve bunu etkileyebilecek faktörlerin araştırılması amaçlanmıştır. Gereç ve Yöntem: Çalışmaya Sağlık Bilimleri Üniversitesi Konya Eğitim ve Araştırma Hastanesi nefroloji polikliniğinde takipli 197 renal transplant hastası dahil edildi. Hastalara influenza ve pnömokok aşısı ile ilgili anket dolduruldu. Bulgular: Çalışma populasyonumuzda influenza aşı oranı %26.4, pnömokok aşı oranı % 2.5 idi. Aşı yaptırmamanın başlıca sebebi hastalara aşı yaptırması konusunda tavsiyede bulunulmaması idi (influenza aşısı için %45.6 iken pnömokok aşısında %95.4’ü buluyordu). Hastaların % 12.6’sı influenza aşının etkisine inanmadığı için, % 7.6’sı yan etkiden korktuğu için ve %7.1’i influenza enfeksiyonu geçirmediği için aşılanmamışlardı. Aşı yaptıran hastalarda kimin tavsiyesi ile yaptırdığı sorulduğunda en sık nakil merkezi veya takip eden nefroloji doktorlarının tavsiyesi ile aşılandıkları belirlendi (influenza aşısı için bu oran % 84.6 ve pnömokok aşısı için %100). Sonuç: Görüş birliği ve güçlü tavsiyelere rağmen renal transplant alıcılarında aşılanma oranları hedeflerin altındadır. Bu hassas hasta grubunda aşı ile önlenebilen hastalıklarla ilgili aşı farkındalığını ve aşılanma oranlarını artırabilmek için çaba gösterilmelidir.
İleri Yaş Monoartritle Başvuran Psödogut Olgusu
(Selçuk Üniversitesi, 2019 Mart) Limon, Muhammet; Gülcemal, Semral; Yılmaz, Sema
Kalsiyum pirofosfat dihidrat depolanma hastalığı (KPPD) olarak bilinen psödogut eklem aralığında kristal birikimi ile seyreden romatolojikbir hastalıktır. KPPD kristal depolanma hastalığı sıklıkla ileri yaşta aralıklı artrite neden olan bir hastalıktır. KPPD en sık olarak diz, el bileği, omuz ve kalça eklemlerini tutar. Hiperparatiroidizm, hemokromatozis, hipomagnezemi, hipofosfatemi KPPD ile ilişkilidir. İleri yaşta monoartritle başvuran hastalarda KPPD ayırıcı tanıda düşünülmelidir. Bu çalışmada KPPD ve paratiroid adenomu saptanan olgu sunulmaktadır.
Sjögren Sendromu ve Granülomatöz Polianjiitis Birlikteliği Gösteren Bir Olgu
(Selçuk Üniversitesi, 2019 Aralık) Tezcan, Dilek; Limon, Muhammet; Gülcemal, Semral; Yılmaz, Sema
Sjögren Sendromu (SjS) öncelikle gözyaşı ve tükrük bezleri olmak üzere tüm ekzokrin bezlerin lenfositit infiltrasyonu ile karakterize kronik, sistemik ve otoimmün bir hastalıktır. Kserostomi ve kseroftalmi tablosu hastalığın ana belirtisi olmakla ile birlikte kas iskelet, pulmoner, gastrointestinal, hematolojik, dermatolojik, böbrek ve sinir sistemine uzanan geniş bir yelpazede bozukluğa neden olur. Lökositoklastik vaskülit SjS de sık görülen kutanöz vaskülit tipidir. Granülamatöz polianjitis(GPA) nedeni belli olmayan, genellikle küçük veya orta boy damarları tuttuğu gibi sistemik tutulum da yapabilen, nekrotizan granülomatöz tipte bir vaskülittir. GPA, alt-üst solunum yolları, böbrek ve diğer organları tutabilmektedir. Özellikle deri lezyonları önemli bir tutulum şeklidir. Hastalık seyrinde optik sinir iskemisine bağlı retroorbital psödotümör gelişebilmektedir. Burada SjS tanısı ile takip edilirken lökositoklastik vaskülit gelişen beyin görüntülemesinde psödotümör orbita saptanmışolan 48 yaşında bir kadın hasta tartışılmıştır. SjS ve GPA birlikteliğine çok sık rastlanılmamaktadır. Bu olgu, bu nadir birlikteliğe değinilmek için sunulmuştur. Psödotümör orbita ile prezente olan hastalarda GPA‘nın ayırıcı tanıda akılda tutulması, erken teşhis, tedavi ve komplikasyonların önlenmesi açısından önemlidir.
Çocuklarda primer böbrek tümörlerinin klinik özellikleri, tedavi yaklaşımları ve tedavi sonuçları
(Selçuk Üniversitesi, 2021) Kara, Buket; Sarıkaya, Mehmet; Ertan, Kübra; Uğraş, Nevzat Serdar; Çiftci, İlhan; Yavaş, Güler; Köksal, Yavuz
Amaç: Bu çalışmanın amacı, çocuklarda primer malign böbrek tümörlerinin klinik özellikleri, tedavi yaklaşımları ve tedavi sonuçlarının değerlendirilmesidir. Gereç ve Yöntem: 2006 ile 2020 yılları arasında primer malign böbrek tümör tanısı alan ve izlenen çocuk hastaların onkoloji dosyaları geriye yönelik incelendi. Hastaların demografik ve klinik özellikleri ile tedavi yaklaşımları ve izlemleri not edildi. Bulgular: Bu yıllar arasında izlenen 950 malign hastalıklı çocuğun 49’unda(%5,2) primer malign böbrek tümörü vardı. Hastaların yaşı üç gün ile 13 yıl arasında değişiyordu (ortanca, 3 yıl). Erkek kız oranı 25/24’dü. En sık görülen semptom ve bulgu karında kitle idi. İki hastada bilateral hastalık vardı (%4,1). Patolojik tanılar, Wilms tümörü (n = 44, % 89,8), mezoblastik nefroma (n=2, % 4,1), böbreğin clear hücreli sarkomu (n=2, % 4,1) ve böbreğin primer sinovyal sarkomuydu (n=1, %2). Wilms tümörlü hastalardan sadece ikinde diffüz anaplazi vardı. Hastalarımızın risk grupları düşük (n = 4, % 8.3), orta (n = 35, % 72.9) ve yüksek riskli (n = 9, % 18.8) idi. Hastaların takip süreleri iki ay ile 15 yıl (ortanca, 5 yıl) arasında değişiyordu. Primer böbrek tümörlerinde genel ve olaysız sağ kalım oranları sırasıyla % 72,7 ve% 59,7 idi. Wilms tümörlü hastaların genel ve olaysız sağ kalım oranları %79 ve %63’dü. Sonuç: Primer malign böbrek tümörlerinde özellikle de Wilms tümöründe multidisipliner yaklaşımlarla başarı oranları yükselmiştir. Bundan sonra hem tedavi başarısının daha da artırılması hem de tedavi ilişkili yan etkilerin azaltılması üzerinde durulmalıdır.
Elevated Serum Uric Acid to HDL-Cholesterol Ratio is Related to Cardiovascular Risk in Patients Receiving Hemodialysis
(Selçuk Üniversitesi, 2022) Göktepe, Mevlut Hakan; Çizmecioğlu, Ahmet; Bıyık, Zeynep; Altıntepe, Lütfullah; Yavuz, Yasemin Coşkun; Çizmecioğlu, Hilal Akay
Aim: Chronic kidney disease (CKD) is a progressive disease in which frequent cardiovascular (CV) comorbidities. High uric acid to HDL-cholesterol ratio (UHR) results were quite notable in patients receiving peritoneal dialysis. Thus, in this study, we aimed to evaluate the UHR results in dialysis patients. Materials and Methods: This retrospective, multicenter, cross-sectional study was conducted with CKD patients, and the control group consisted of hypertensive patients with a normal glomerular filtration rate (GFR). Patients’ laboratory, ambulatory blood pressure monitoring, and demographic records were obtained from the follow-up cases of two university hospitals’ internal medicine and nephrology departments. The patients’ group then were divided into five subsets according to GFR. Results: A total of 124 CKD patients and 127 control participated in this study. All CKD patients were also identified as pre-dialysis and dialysis. The cases of UHR, non-dipper blood pressure pattern, and nocturnal heart rate (HR) were increased in CKD compared to the control group. Per disease progression, the non-dipper HR and nocturnal HR were more significant in patients receiving dialysis with high UHR than in the pre-dialysis subset. In diabetic patients with an on-targeted HbA1c, those with high UHRs still had nocturnal diastolic BP elevations. Finally, there was not an exact stagespecific result for pulse wave velocity. Conclusions: Based on our results, dialysis patients with high UHRs have higher non-dipper pulse rate, nocturnal heart rate, and nocturnal diastole blood pressure, associated with CV risk. Despite well-managed diabetes, elevated UHR in dialysis patients may be associated with non-dipper hypertension.
Impact of having family history of psoriasis or psoriatic arthritis on psoriatic disease
(WILEY, 2020) Solmaz, Dilek; Bakırcı, Sibel; Kimyon, Gezmiş; Günal, Esen K.; Doğru, Atalay; Bayındır, Özün; Dalkılıç, Ediz; Özişler, Cem; Can, Meryem; Akar, Servet; Çetin, Gözde Yıldırım; Yavuz, Şule; Kılıç, Levent; Tarhan, Emine F.; Küçükşahin, Orhan; Omma, Ahmet; Gönüllü, Emel; Yıldız, Fatih; Ersözlü, Emine D.; Çınar, Muhammet; Al-Onazi, Atallah; Erden, Abdulsamet; Tufan, Müge A.; Yılmaz, Sema; Pehlevan, Seval; Kalyoncu, Umut; Aydın, Sibel Z.
Objective Psoriatic arthritis (PsA) has a genetic background. Approximately 40% of patients with psoriasis or PsA have a family history of psoriasis or PsA, which may affect disease features. The aim of this study was to assess the effects of family history of psoriasis and PsA on disease phenotypes. Methods Data from 1,393 patients recruited in the longitudinal, multicenter Psoriatic Arthritis International Database were analyzed. The effects of family history of psoriasis and/or PsA on characteristics of psoriasis and PsA were investigated using logistic regression. Results A total of 444 patients (31.9%) had a family history of psoriasis and/or PsA. These patients were more frequently women, had earlier onset of psoriasis, more frequent nail disease, enthesitis, and deformities, and less frequently achieved minimal disease activity. Among 444 patients, 335 only had psoriasis in their family, 74 had PsA, and 35 patients were not certain about having PsA and psoriasis in their family, so they were excluded from further analysis. In the multivariate analysis, family history of psoriasis was associated with younger age at onset of psoriasis (odds ratio [OR] 0.976) and presence of enthesitis (OR 1.931), whereas family history of PsA was associated with lower risk of plaque psoriasis (OR 0.417) and higher risk of deformities (OR 2.557). Family history of PsA versus psoriasis showed increased risk of deformities (OR 2.143) and lower risk of plaque psoriasis (OR 0.324). Conclusion Family history of psoriasis and PsA impacts skin phenotypes, musculoskeletal features, and disease severity. The link between family history of psoriasis/PsA and pustular/plaque phenotypes may point to a different genetic background and pathogenic mechanisms in these subsets.
Association of depressive symptoms with 25(OH) vitamin D in hemodialysis patients and effect of gender
(SPRINGER, 2020) Yavuz, Yasemin Coşkun; Bıyık, Zeynep; Özkul, Durmuş; Abuşoğlu, Sedat; Eryavuz, Duygu; Dağ, Mikail; Körez, Muslu Kazım; Güney, İbrahim; Altıntepe, Lütfullah
Background Depression is common in chronic kidney disease ( CKD) patients and associated with significant increase in morbidity and mortality. In recent years, a relationship between vitamin D deficiency and depression has been shown. The aim of this study is to investigate the relationship between 25-hydroxy (OH) vitamin D and depression in hemodialysis patients. Methods A total of 140 patients were included in the study. Hamilton depression scale (HAM-D) was completed by all patients. 25(OH) vitamin D levels were compared between patients with and without depressive symptoms. Results Patients who had depressive symptoms had significantly lower 25(OH) vitamin D levels (13.70 [24.3-8.25] vs. 18.20 [29.2-11.7] ng/mL, p = 0.016). HAM-D score showed significant association with gender (p = 0.011) and 25(OH) vitamin D level (p = 0.011). Univariate logistic regression analysis showed that males had lower risk of depression by a ratio of 61.1% (OR 0.389, p = 0.012) and vitamin D-deficient patients had 2.88 times greater risk of depression compared to non-deficient patients (OR 2.885, p = 0.013). Multivariate logistic regression analysis showed that males had 53.7% less risk of depression (OR 0.463, p = 0.046) and vitamin D-deficient patients had 2.39 times greater risk of depression (OR 2.397, p = 0.047). When evaluated by gender, univariate logistic regression analysis showed that 25(OH) vitamin D and other variables were not associated with depression in females (p > 0.05), while only vitamin D level had a significant effect on depression in males (OR 8.207, p = 0.008). Conclusions We found a significant association between vitamin D level and depressive symptoms in hemodialysis patients. When analyzed according to gender, this association was found to stand independent of other variables only in males.
Beta-Hydroxy-Beta-Methyl-Butyrate, L-glutamine, and L-arginine supplementation improves Radiation-Induce acute intestinal toxicity
(Taylor and Francis Ltd, 2019) Yavaş, Çağdaş; Yavaş, Güler; Çelik, Esin; Büyükyörük, Ahmet; Büyükyörük, Cennet; Yüce, Deniz; Ata, Özlem
We aimed to evaluate effects of ?-hydroxy-?-methylbutyrate, L-glutamine, and L-arginine (HMB/GLN/ARG) on radiation-induced acute intestinal toxicity. Forty rats were divided into four groups: group (G) 1 was defined as control group, and G2 was radiation therapy (RT) control group. G3 and G4 were HMB/GLN/ARG control and RT plus HMB/GLN/ARG groups, respectively. HMB/GLN/ARG started from day of RT and continued until the animals were sacrificed 10 days after RT. The extent of surface epithelium smoothing, villous atrophy, lamina propria inflammation, cryptitis, crypt distortion, regenerative atypia, vascular dilatation and congestion, and fibrosis were quantified on histological sections of intestinal mucosa. Statistical analyses were performed using the analysis of variance (ANOVA) test. There were significant differences between study groups regarding extent of surface epithelium smoothing, villous atrophy, lamina propria inflammation, cryptitis and crypt distortion, regenerative atypia, vascular dilatation and congestion, and fibrosis (p values were 0.019 for fibrosis, <.001 for the others). Pair-wise comparisons revealed significant differences regarding surface epithelium smoothing, villous atrophy, lamina propria inflammation, cryptitis, vascular dilatation, and congestion between G2 and G4 (p values were <.001,.033, <.001,.007, and <.001, respectively). Fibrosis score was significantly different only between G1 and G2 (p =.015). Immunohistochemical TGF-? score of G2 was significantly higher than G1 and G3 (p values were.006 and.017, respectively). There was no difference between TGF-? staining scores of G2 and G4. Concomitant use of HMB/GLN/ARG appears to ameliorate radiation-induced acute intestinal toxicity; however, this finding should be clarified with further studies. © 2018, © 2018 Taylor & Francis Group, LLC.
The impact of spironolactone on the lung injury induced by concomitant trastuzumab and thoracic radiotherapy
(IJRR-IRANIAN JOURNAL RADIATION RES, 2019) Yavaş, Güler; Yavaş, Çağdaş; Çelik, Esin; Şen, E.; Ata, O.; Afşar, Rengin Elsürer
Background: To evaluate impact of spironolactone (S) on pulmonary toxicity of concomitant use of thoracic radiotherapy (RT) and trastuzumab (T). Materials and Methods: Eighty rats were divided into eight groups: group (G) 1 was control group; G2, G3 and G4 were RT, S and T groups; G5, G6, G7 and G8 were RT+T, T+S, RT+S and RT+T+S groups respectively. Rats were sacrificed at 6 hour, 21 and 100 day after RT and lung samples were retrieved. Results: By 100th days of RT inflammation score, lung fibrosis score and TGF- expression were significantly different within study groups (p values were 0.002, 0.001 and 0.043 respectively). Inflammation score of G8 was significantly lower than inflammation scores of G2 and G5 (p values: G2-G8=0.004, and G5-G8=0.022). Inflammation score of G2 was significantly higher than G7 (p=0.028). There were significant differences regarding to fibrosis scores between G2-G8 (p=0.015), G2-G7 (p=0.017) and G5-G8 (p=0.011). TGF-beta expression was higher in both G2 and G5 when compared to G8 (p = 0.038). Conclusion: Our results suggested that S is an effective treatment option for improving radiation-induced pulmonary fibrosis. These findings should be clarified with further preclinical and clinical studies.
The distribution of MEFV mutations in Turkish FMF patients: multicenter study representing results of Anatolia
(TUBITAK SCIENTIFIC & TECHNICAL RESEARCH COUNCIL TURKEY, 2019) Bilge, N. Şule Yaşar; Sarı, İsmail; Solmaz, Dilek; Şenel, Soner; Emmungil, Hakan; Kılıç, Levent; Oner, Sibel Yılmaz; Yıldız, Fatih; Yılmaz, Sedat; Bozkırlı, Duygu Ersözlü; Tufan, Müge Aydın; Yılmaz, Sema; Yazısız, Veli; Pehlivan, Yavuz; Bes, Cemal; Çetin, Gözde Yıldırım; Erten, Şükran; Gönüllü, Emel; Şahin, Fezan; Akar, Servet; Aksu, Kenan; Kalyoncu, Umut; Direskeneli, Haner; Erken, Eren; Kısacık, Bünyamin; Sayarlıoğlu, Mehmet; Çınar, Muhammed; Kaşifoğlu, Timuçin
Background/aim: The distribution of Mediterranean fever (MEFV) gene mutations in Turkish familial Mediterranean fever (FMF) patients varies according to geographic area of Turkey. There is a need for highly representative data for Turkish FMF patients. The aim of our study was to investigate the distribution of the common MEFV mutations in Turkish FMF patients in a nationwide, multicenter study. Materials and methods: Data of the 2246 FMF patients, from 15 adult rheumatology clinics located in different parts of the country, were evaluated retrospectively. The following mutations have been tested in all patients: M694V, M680I, M694I, V726A, and E148Q. Results: There were 1719 FMF patients with available genetic testing. According to the genotyping, homozygous M694V, present in 413 patients (24%), was the most common mutation . One hundred and fifty-four (9%) of patients had no detectable mutations. Allele frequencies of common mutations were: M694V (n = 1529, 44.5%), M680I (n = 423, 12.3%), V726A (n = 315, 9.2%), E148Q (n = 214, 1%), and M694I (n = 12, <1%). Conclusion: In this large-scale multicenter study, we provided information about the frequencies of common MEFV gene mutations obtained from adult Turkish IMF patients. Nearly half of the patients were carrying at least one M694V mutations in their alleles.
The cartonectin levels at different stages of chronic kidney disease and related factors
(TAYLOR & FRANCIS LTD, 2019) Yavuz, Yasemin Coskun; Altınkaynak, Konca; Sevinc, Can; Sebin, Saime Ozbek; Baydar, Idris
Introduction: Cartonectin was defined as a new adipokine released from rat and human adipocyte tissues, which is also known as CORS 26 or CTRP3 protein. Although there are several studies investigating the effects of cartonectin with obesity, anti-inflammatory mechanisms, and cardioprotective effects, there is no study about the effects of cartonectin in patients with chronic kidney disease yet. We aimed to investigate cartonectin levels in predialysis and dialysis patient groups, in other words, at different stages of chronic kidney disease, by comparing with the control group. In addition, we aimed to discuss the probable causes of the differences between the patient groups that would be determined, together with the factors that might be effective. Methods: A total of 150 patients, including 47 hemodialysis patients, 73 predialysis CKD patients, and 30 healthy individuals were enrolled in the study. Serum cartonectin levels were determined by using enzyme-linked immunosorbent assay (ELISA) method. Findings: Serum cartonectin levels were found to be significantly higher in the hemodialysis patient group compared to predialysis group and healthy individuals (p < 0.01). Furthermore, serum cartonectin levels were found to be negatively correlated with GFR, BMI, glucose, LDL, and platelet levels, whereas a positive correlation was observed with creatinine levels. Discussion: In our study, we found that the cartonectin levels increased as GFR decreased and were significantly higher in hemodialysis patients. Cartonectin is structurally closely related to adiponectin. It is remarkable that the level of cartonectin is also high in hemodialysis patients, like adiponectin.
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 Fişekci
Background 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.
Impact of Obesity on the Metabolic Control of Type 2 Diabetes: Results of the Turkish Nationwide Survey of Glycemic and Other Metabolic Parameters of Patients with Diabetes Mellitus (TEMD Obesity Study)
(KARGER, 2019) Sonmez, Alper; Yumuk, Volkan; Haymana, Cem; Demirci, Ibrahim; Barcin, Cem; Kiyici, Sinem; Guldiken, Sibel; Örük, Gonca; Ozgen Saydam, Basak; Baldane, Süleyman; Kutlutürk, Faruk; Küçükler, Ferit Kerim; Deyneli, Oğuzhan; Çetinarslan, Berrin; Sabuncu, Tevfik; Bayram, Fahri; Satman, Ilhan; TEMD Study Group
Background: Obesity is the main obstacle for metabolic control in patients with type 2 diabetes. Turkey has the highest prevalence of obesity and type 2 diabetes in Europe. The effect of obesity on the metabolic control, and the macro-and microvascular complications of patients are not apparent. Objectives: This nationwide survey aimed to investigate the prevalence of overweight and obesity among patients with type 2 diabetes and to search for the impact of obesity on the metabolic control of these patients. We also investigated the independent associates of obesity in patients with type 2 diabetes. Methods: We consecutively enrolled patients who were under follow-up for at least 1 year in 69 tertiary healthcare units in 37 cities. The demographic, anthropometric, and clinical data including medications were recorded. Patients were excluded if they were pregnant, younger than 18 years, had decompensated liver disease, psychiatric disorders interfering with cognition or compliance, had bariatric surgery, or were undergoing renal replacement therapy. Results: Only 10% of patients with type 2 diabetes (n = 4,648) had normal body mass indexes (BMI), while the others were affected by overweight (31%) or obesity (59%). Women had a significantly higher prevalence of obesity (53.4 vs. 40%) and severe obesity (16.6 vs. 3.3%). Significant associations were present between high BMI levels and lower education levels, intake of insulin, antihypertensives and statins, poor metabolic control, or the presence of microvascular complications. Age, gender, level of education, smoking, and physical inactivity were the independent associates of obesity in patients with type 2 diabetes. Conclusion: The TEMD Obesity Study shows that obesity is a major determinant of the poor metabolic control in patients with type 2 diabetes. These results underline the importance of prevention and management of obesity to improve health care in patients with type 2 diabetes. Also, the results point out the independent sociodemographic and clinical associates of obesity, which should be the prior targets to overcome, in the national fight with obesity. (c) 2019 The Author(s) Published by S. Karger AG, Basel
HLA-DQ2/DQ8 frequency in adult patients with celiac disease, their first-degree relatives, and normal population in Turkey
(AVES, 2019) Ozgenel, Safak Meric; Temel, Tuncer; Teke, Hava Uskudar; Yildiz, Pinar; Korkmaz, Huseyin; Ozakyol, Aysegul
Background/Aims: Celiac disease is an autoimmune, familial disease that results in susceptibility to gluten in cereal and cereal products in genetically susceptible individuals. The aim of the present study was to investigate the presence of HLA-DQ2/DQ8 in patients with celiac disease, their first-degree relatives, and healthy community. Materials and Methods: HLA-DQ2/DQ8 analysis was performed in adult patients with celiac disease >= 18 years old (94 patients), their first-degree relatives (89 people), and healthy group (102 individuals). Anemia, osteoporosis, and diarrhea were interrogated in the celiac patient group and also anti-tissue transglutaminase, anti-endomysium, and anti-gliadin antibodies were recorded. Results: There was a significant relationship between HLA-DQ2/DQ8 presence in all groups, and the distribution of HLA-DQ2/DQ8 in all groups was different (p=0.000). No statistically significant correlation was found between the HLA tissue groups and diarrhea (p=0.087), osteoporosis (p=0.215), anemia (p=1.000), tissue transglutaminase antibodies (p=0.295), anti-gliadin antibodies (p=0.104), and anti -endomysium antibodies (p=0.243) in the celiac patient group. Conclusion: HLA-DQ2/DQ8 can be used to diagnose celiac disease particularly when the tests are useless and to screen first-degree relatives.
Exon 2: Is it the good police in familial mediterranean fever?
(AVES, 2019) Yaşar Bilge, Şule; Solmaz, Dilek; Şenel, Soner; Emmungil, Hakan; Kılıç, Levent; Öner, Sibel Yılmaz; Yıldız, Fatih; Yılmaz, Sedat; Ersözlü Bozkırlı, Duygu; Aydın Tufan, Müge; Yılmaz, Sema; Yazısız, Veli; Pehlivan, Yavuz; Beş, Cemal; Yıldırım Çetin, Gözde; Erten, Şükran; Gönüllü, Emel; Şahin, Fezan; Akar, Servet; Aksu, Kenan; Kalyoncu, Umut; Direskeneli, Haner; Erken, Eren; Kısacık, Bünyamın; Sayarlıoğlu, Mehmet; Çınar, Muhammed; Kaşifoğlu, Timuçin; Sarı, İsmail
Objective: Familial Mediterranean fever (FMF) is the most common autoinflammatory disease. Most of the identified disease-causing mutations are located on exon 10. As the number of studies about the effect of the exonal location of the mutation and its phenotypic expression is limited, we aimed to investigate whether the exonic location of the Mediterranean fever (MEFV) mutation has an effect on the clinical manifestation in patients with FMF. Methods: Study population was derived from the main FMF registry that included 2246 patients from 15 different rheumatology clinics. We categorized the mutations according to their exon locations and retrieved the clinical and demographic information from the database. Results: Patients having the MEFV mutations on exon 2 or 10 (n: 1526) were divided into three subgroups according to the location of the MEFV mutations: Group 1 (exon 2 mutations), Group 2 (exon 10 mutations), and Group 3 (both exon 2 and exon 10 mutations). Group 2 patients were of a significantly younger age at onset, and erysipel-like erythema, arthritis, amyloidosis, and a family history of FMF were more common in this group. Conclusion: Patients with FMF and exon 10 mutations show more severe clinical symptoms and outcome. Exon 2 mutations tend to have a better outcome.
Konya ilinde sağlıklı bireylerin demografik özelliklerine ve antropometrik ölçümlerine göre lipid düzeylerinin değerlendirilmesi
(CUKUROVA UNIV, FAC MEDICINE, 2019) Kıraç, Cem Onur; Akşan, Serkan; Kaya, Ahmet
Purpose: The aim of this study was to determine serum lipid values of healthy individuals who applied to our internal medicine outpatient clinics in Konya and to compare these values with demographic factors and show their relationship with anthropometric measurements. Materials and Methods: A total of 200 healthy 18 individuals over 18 years of age who applied to internal medicine outpatient clinics were included in the study. Their anthropometric measurements were performed their demographic characteristics were questioned. In addition, total cholesterol(TC), low density lipoprotein(LDL), triglyceride(TG), high density lipoprotein (HDL), apolipoprotein A- 1 (Apo A-1), apolipoprotein B(Apo B) and lipoprotein (a) levels were studied from their blood samples. Results: Two hundred healthy volunteers, including 123 women and 77 men were participated in our study. TC levels were 183 +/- 40 mg/dl, LDL level 112 +/- 34 mg/dl, TG level 112 +/- 61 mg/dl, HDL level 47 +/- 11mg/dl, Apo A-1 level 133 +/- 22 mg/dl, Apo B level 79 +/- 22 mg/dl Lp(a) level 19 +/- 12 mg/dl. HDL and Apo B levels were higher in women however TG and TC/HDL ratio was significantly higher in males. Thirty one percent of participants had hypercholesterolemia (>= 200 mg/dl), 27% had increased levels of LDL (>= 130 mg/dl). TK, LDL and Apo B levels were significantly increasing with age. Conclusion: When we compared the extensive studies which were carried out in Turkey, lower TC, LDL, TG and higer HDL levels were detected in our study.

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