1
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Sahutoglu T, Danis R, Pembegul I, Ozturk I, Huzmeli C, Tugcu M, Oguz EG, Bora F, Islam M, Ayar Y, Yilmaz Z, Tanburoglu DB, Genc F, Bindal ME, Tuglular S, Kazancioglu R. Resilience and challenges of peritoneal dialysis survivors in the aftermath of the 2023 Kahramanmaraş earthquake. Ther Apher Dial 2024. [PMID: 38647140 DOI: 10.1111/1744-9987.14130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 03/29/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Peritoneal dialysis (PD) remains understudied in disaster nephrology. This retrospective multicenter study explores the experiences of PD survivors following the February 6, 2023, Kahramanmaraş Earthquake. METHODS Adult PD patients from 11 affected cities were analyzed to assess challenges faced during and postearthquake, alongside clinical outcomes. RESULTS Among 101 participants (median age: 45 years, median PD duration: 24 months), 57 were female, with 79 on continuous ambulatory PD. Challenges included power outages and water shortages, with primary shelter in kin's houses (33%) and homes (28%). Twelve patients experienced PD program delays, and three lacked assistance postdisaster. Sixteen patients changed PD modalities, with seven experiencing postearthquake peritonitis. Clinical parameters remained stable, except for a slight decrease in hemoglobin levels. CONCLUSION Despite challenges, PD survivors exhibited resilience, highlighting the importance of addressing peritonitis and unusual pathogens in disaster preparedness initiatives.
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Affiliation(s)
- Tuncay Sahutoglu
- Department of Nephrology, Mehmet Akif Inan Education and Research Hospital, Sanliurfa, Turkey
| | - Ramazan Danis
- Department of Nephrology, Diyarbakır Gazi Yaşargil Education Research Hospital, Diyarbakir, Turkey
| | - Irem Pembegul
- Department of Nephrology, Malatya Training and Research Hospital, Malatya, Turkey
| | - Ilyas Ozturk
- Department of Nephrology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Can Huzmeli
- Department of Nephrology, Hatay Education and Research Hospital, Hatay, Turkey
| | - Murat Tugcu
- Division of Nephrology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Ebru Gok Oguz
- Department of Nephrology, Etlik City Hospital, Health Sciences University, Ankara, Turkey
| | - Feyza Bora
- Department of Nephrology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Mahmud Islam
- Department of Nephrology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Yavuz Ayar
- Nephrology Department, Bursa City Health Application Research Center, Bursa Faculty of Medicine, University of Health Sciences, Bursa, Turkey
| | - Zulfikar Yilmaz
- Department of Nephrology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | | | - Fatih Genc
- Department of Nephrology, Faculty of Medicine, Elazig University, Elazig, Turkey
| | - Mehmet Emin Bindal
- Department of Nephrology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Serhan Tuglular
- Division of Nephrology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Rumeyza Kazancioglu
- Department of Nephrology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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2
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Demir E, Ucar ZA, Dheir H, Danis R, Yelken B, Uyar M, Parmaksiz E, Artan AS, Sinangil A, Merhametsiz O, Yadigar S, Dirim AB, Akin B, Garayeva N, Safak S, Turkmen A. COVID-19 in Kidney Transplant Recipients: A Multicenter Experience from the First Two Waves of Pandemic. BMC Nephrol 2022; 23:183. [PMID: 35550025 PMCID: PMC9097147 DOI: 10.1186/s12882-022-02784-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 04/01/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Kidney transplant recipients have an increased risk of complications from COVID-19. However, data on the risk of allograft damage or death in kidney transplant recipients recovering from COVID-19 is limited. In addition, the first and second waves of the pandemic occurred at different times all over the world. In Turkey, the Health Minister confirmed the first case in March 2020; after that, the first wave occurred between March and August 2020; afterward, the second wave began in September 2020. This study aims to demonstrate the clinical presentations of kidney transplant recipients in the first two waves of the pandemic in Turkey and explore the impact of COVID-19 on clinical outcomes after the initial episode. METHODS Patients with COVID-19 from seven centers were included in this retrospective cohort study. Initially, four hundred and eighty-eight kidney transplant recipients diagnosed with COVID-19 between 1 March 2020 to 28 February 2021 were enrolled. The endpoints were the occurrence of all-cause mortality, acute kidney injury, cytokine storm, and acute respiratory distress syndrome. In addition, longer-term outcomes such as mortality, need for dialysis, and allograft function of the surviving patients was analyzed. RESULTS Four hundred seventy-five patients were followed up for a median of 132 days after COVID-19. Forty-seven patients (9.9%) died after a median length of hospitalization of 15 days. Although the mortality rate (10.1% vs. 9.8%) and intensive care unit admission (14.5% vs. 14.5%) were similar in the first two waves, hospitalization (68.8% vs. 29.7%; p < 0.001), acute kidney injury (44.2% vs. 31.8%; p = 0.009), acute respiratory distress syndrome (18.8% vs. 16%; p = 0.456), and cytokine storm rate (15.9% vs. 10.1%; p = 0.072) were higher in first wave compared to the second wave. These 47 patients died within the first month of COVID-19. Six (1.4%) of the surviving patients lost allografts during treatment. There was no difference in the median serum creatinine clearance of the surviving patients at baseline (52 mL/min [IQR, 47-66]), first- (56 mL/min [IQR, 51-68]), third- (51 mL/min [IQR,48-67]) and sixth-months (52 mL/min [IQR, 48-81]). Development of cytokine storm and posttransplant diabetes mellitus were independent predictors for mortality. CONCLUSIONS Mortality remains a problem in COVID-19. All the deaths occur in the first month of COVID-19. Also, acute kidney injury is common in hospitalized patients, and some of the patients suffer from graft loss after the initial episode.
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Affiliation(s)
- Erol Demir
- Department of Internal Medicine, Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Zuhal Atan Ucar
- Department of Internal Medicine, Division of Nephrology, Florence Nightingale Hospital, Bilim University, Istanbul, Turkey
| | - Hamad Dheir
- Department of Internal Medicine, Division of Nephrology, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Ramazan Danis
- Department of Internal Medicine, Division of Nephrology, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Berna Yelken
- Department of Internal Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey
| | - Murathan Uyar
- Department of Internal Medicine, Division of Nephrology, T.C. Istanbul Yeni Yuzyil University, Gaziosmanpasa Hospital, Istanbul, Turkey
| | - Ergun Parmaksiz
- Department of Internal Medicine, Division of Nephrology, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Ayse Serra Artan
- Department of Internal Medicine, Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ayse Sinangil
- Department of Internal Medicine, Division of Nephrology, Florence Nightingale Hospital, Bilim University, Istanbul, Turkey
| | - Ozgur Merhametsiz
- Department of Internal Medicine, Division of Nephrology, T.C. Istanbul Yeni Yuzyil University, Gaziosmanpasa Hospital, Istanbul, Turkey
| | - Serap Yadigar
- Department of Internal Medicine, Division of Nephrology, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Burak Dirim
- Department of Internal Medicine, Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Baris Akin
- Department of Internal Medicine, Division of Nephrology, Florence Nightingale Hospital, Bilim University, Istanbul, Turkey
| | - Nurana Garayeva
- Department of Internal Medicine, Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Seda Safak
- Department of Internal Medicine, Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydin Turkmen
- Department of Internal Medicine, Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
- Department of Internal Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey
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3
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Danis R, Gunay E, Yuksel E, Kaya S, Kılıc J, Kacar E, Senol A, Deniz Altıntas D, Yıldırım MS. Successful Treatment of COVID-19-Related Immune- Complex Glomerulonephritis, Case Report. Iran J Kidney Dis 2022; 16:147-151. [PMID: 35489083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 06/14/2023]
Abstract
Acute kidney injury (AKI) , proteinuria in the nephrotic or subnephrotic range and hematuria might be seen in patients with coronavirus disease 2019 (COVID-19) infection. In this case study we present a 59 years old manwho was diagnosed with immune-complex glomerulonephritis after development of rapidly progressive kidney failure accompanied by pulmonary hemorrhage, 2 months after COVID-19 infection. The patient was hospitalised with the diagnosis of acute kidney injury and nephrotic syndrome. Hemodialysis was performed due to uremic symptoms. Cyclophosphamide, methylprednisolone and plasmapheresis were started. Pathologic examination of kidney biopsy revealed features compatible with immune complex-related acute glomerulonephritis. Cyclophosphamide and plasmapheresis were discontinued , and treatment with 1 mg/kg/day methylprednisolone was continued. Immune-complex glomerulonephritis can be seen following COVID-19 infection. İt is important to diagnose this disease entity as soon as possible . Steroidtherapy and other supportive modalities might be sufficient in the treatment. DOI: 10.52547/ijkd.6527.
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Affiliation(s)
| | - Emrah Gunay
- University of Health Sciences, Gazi Yasargil Training and Research Hospital, Nephrology Department , Diyarbakir, Turkey.
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4
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Danis R. Will Long-Time Diving Lead to Chronic Kidney Disease? Turk J Nephrol 2021. [DOI: 10.5152/turkjnephrol.2021.4735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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5
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Gunay E, Ozan M, Kaya S, Ocal E, Kutlu Z, Senol A, Danis R, Baysal E, Kalin BS, Dincyurek HD, Demir C. Pregnancy-related atypical hemolytic uremic syndrome with renal, cardiac and obstetric complications and a satisfactory recovery: a case report. Ren Fail 2021; 43:460-462. [PMID: 33657972 PMCID: PMC7935114 DOI: 10.1080/0886022x.2021.1893187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Emrah Gunay
- Department of Nephrology, Health Sciences University of Turkey, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Mahsum Ozan
- Department of Internal Medicine, Health Sciences University of Turkey, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Seyhmus Kaya
- Department of Pathology, Health Sciences University of Turkey, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Ece Ocal
- Department of Perinatology, Health Sciences University of Turkey, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Zeynep Kutlu
- Department of Internal Medicine, Health Sciences University of Turkey, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Ayhan Senol
- Department of Interventional Radiology, Health Sciences University of Turkey, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Ramazan Danis
- Department of Nephrology, Health Sciences University of Turkey, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Erkan Baysal
- Department of Cardiology, Health Sciences University of Turkey, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Burhan Sami Kalin
- Department of Intensive Care, Health Sciences University of Turkey, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Huseyin Derya Dincyurek
- Department of Haematology, Health Sciences University of Turkey, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Cengiz Demir
- Department of Haematology, Health Sciences University of Turkey, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
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6
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Tang WW, McGee P, Lachin JM, Li DY, Hoogwerf B, Hazen SL, Nathan D, Zinman B, Crofford O, Genuth S, Brown‐Friday J, Crandall J, Engel H, Engel S, Martinez H, Phillips M, Reid M, Shamoon H, Sheindlin J, Gubitosi‐Klug R, Mayer L, Pendegast S, Zegarra H, Miller D, Singerman L, Smith‐Brewer S, Novak M, Quin J, Genuth S, Palmert M, Brown E, McConnell J, Pugsley P, Crawford P, Dahms W, Gregory N, Lackaye M, Kiss S, Chan R, Orlin A, Rubin M, Brillon D, Reppucci V, Lee T, Heinemann M, Chang S, Levy B, Jovanovic L, Richardson M, Bosco B, Dwoskin A, Hanna R, Barron S, Campbell R, Bhan A, Kruger D, Jones J, Edwards P, Bhan A, Carey J, Angus E, Thomas A, Galprin A, McLellan M, Whitehouse F, Bergenstal R, Johnson M, Gunyou K, Thomas L, Laechelt J, Hollander P, Spencer M, Kendall D, Cuddihy R, Callahan P, List S, Gott J, Rude N, Olson B, Franz M, Castle G, Birk R, Nelson J, Freking D, Gill L, Mestrezat W, Etzwiler D, Morgan K, Aiello L, Golden E, Arrigg P, Asuquo V, Beaser R, Bestourous L, Cavallerano J, Cavicchi R, Ganda O, Hamdy O, Kirby R, Murtha T, Schlossman D, Shah S, Sharuk G, Silva P, Silver P, Stockman M, Sun J, Weimann E, Wolpert H, Aiello L, Jacobson A, Rand L, Rosenzwieg J, Nathan D, Larkin M, Christofi M, Folino K, Godine J, Lou P, Stevens C, Anderson E, Bode H, Brink S, Cornish C, Cros D, Delahanty L, eManbey ., Haggan C, Lynch J, McKitrick C, Norman D, Moore D, Ong M, Taylor C, Zimbler D, Crowell S, Fritz S, Hansen K, Gauthier‐Kelly C, Service F, Ziegler G, Barkmeier A, Schmidt L, French B, Woodwick R, Rizza R, Schwenk W, Haymond M, Pach J, Mortenson J, Zimmerman B, Lucas A, Colligan R, Luttrell L, Lopes‐Virella M, Caulder S, Pittman C, Patel N, Lee K, Nutaitis M, Fernandes J, Hermayer K, Kwon S, Blevins A, Parker J, Colwell J, Lee D, Soule J, Lindsey P, Bracey M, Farr A, Elsing S, Thompson T, Selby J, Lyons T, Yacoub‐Wasef S, Szpiech M, Wood D, Mayfield R, Molitch M, Adelman D, Colson S, Jampol L, Lyon A, Gill M, Strugula Z, Kaminski L, Mirza R, Simjanoski E, Ryan D, Johnson C, Wallia A, Ajroud‐Driss S, Astelford P, Leloudes N, Degillio A, Schaefer B, Mudaliar S, Lorenzi G, Goldbaum M, Jones K, Prince M, Swenson M, Grant I, Reed R, Lyon R, Kolterman O, Giotta M, Clark T, Friedenberg G, Sivitz W, Vittetoe B, Kramer J, Bayless M, Zeitler R, Schrott H, Olson N, Snetselaar L, Hoffman R, MacIndoe J, Weingeist T, Fountain C, Miller R, Johnsonbaugh S, Patronas M, Carney M, Mendley S, Salemi P, Liss R, Hebdon M, Counts D, Donner T, Gordon J, Hemady R, Kowarski A, Ostrowski D, Steidl S, Jones B, Herman W, Martin C, Pop‐Busui R, Greene D, Stevens M, Burkhart N, Sandford T, Floyd J, Bantle J, Flaherty N, Terry J, Koozekanani D, Montezuma S, Wimmergren N, Rogness B, Mech M, Strand T, Olson J, McKenzie L, Kwong C, Goetz F, Warhol R, Hainsworth D, Goldstein D, Hitt S, Giangiacomo J, Schade D, Canady J, Burge M, Das A, Avery R, Ketai L, Chapin J, Schluter M, Rich J, Johannes C, Hornbeck D, Schutta M, Bourne P, Brucker A, Braunstein S, Schwartz S, Maschak‐Carey B, Baker L, Orchard T, Cimino L, Songer T, Doft B, Olson S, Becker D, Rubinstein D, Bergren R, Fruit J, Hyre R, Palmer C, Silvers N, Lobes L, Rath PP, Conrad P, Yalamanchi S, Wesche J, Bratkowksi M, Arslanian S, Rinkoff J, Warnicki J, Curtin D, Steinberg D, Vagstad G, Harris R, Steranchak L, Arch J, Kelly K, Ostrosaka P, Guiliani M, Good M, Williams T, Olsen K, Campbell A, Shipe C, Conwit R, Finegold D, Zaucha M, Drash A, Morrison A, Malone J, Bernal M, Pavan P, Grove N, Tanaka E, McMillan D, Vaccaro‐Kish J, Babbione L, Solc H, DeClue T, Dagogo‐Jack S, Wigley C, Ricks H, Kitabchi A, Chaum E, Murphy M, Moser S, Meyer D, Iannacone A, Yoser S, Bryer‐Ash M, Schussler S, Lambeth H, Raskin P, Strowig S, Basco M, Cercone S, Zinman B, Barnie A, Devenyi R, Mandelcorn M, Brent M, Rogers S, Gordon A, Bakshi N, Perkins B, Tuason L, Perdikaris F, Ehrlich R, Daneman D, Perlman K, Ferguson S, Palmer J, Fahlstrom R, de Boer I, Kinyoun J, Van Ottingham L, Catton S, Ginsberg J, McDonald C, Harth J, Driscoll M, Sheidow T, Mahon J, Canny C, Nicolle D, Colby P, Dupre J, Hramiak I, Rodger N, Jenner M, Smith T, Brown W, May M, Lipps Hagan J, Agarwal A, Adkins T, Lorenz R, Feman S, Survant L, White N, Levandoski L, Grand G, Thomas M, Joseph D, Blinder K, Shah G, Burgess D, Boniuk I, Santiago J, Tamborlane W, Gatcomb P, Stoessel K, Ramos P, Fong K, Ossorio P, Ahern J, Gubitosi‐Klug R, Meadema‐Mayer L, Beck C, Farrell K, Genuth S, Quin J, Gaston P, Palmert M, Trail R, Dahms W, Lachin J, Backlund J, Bebu I, Braffett B, Diminick L, Gao X, Hsu W, Klumpp K, Pan H, Trapani V, Cleary P, McGee P, Sun W, Villavicencio S, Anderson K, Dews L, Younes N, Rutledge B, Chan K, Rosenberg D, Petty B, Determan A, Kenny D, Williams C, Cowie C, Siebert C, Steffes M, Arends V, Bucksa J, Nowicki M, Chavers B, O'Leary D, Polak J, Harrington A, Funk L, Crow R, Gloeb B, Thomas S, O'Donnell C, Soliman E, Zhang Z, Li Y, Campbell C, Keasler L, Hensley S, Hu J, Barr M, Taylor T, Prineas R, Feldman E, Albers J, Low P, Sommer C, Nickander K, Speigelberg T, Pfiefer M, Schumer M, Moran M, Farquhar J, Ryan C, Sandstrom D, Williams T, Geckle M, Cupelli E, Thoma F, Burzuk B, Woodfill T, Danis R, Blodi B, Lawrence D, Wabers H, Gangaputra S, Neill S, Burger M, Dingledine J, Gama V, Sussman R, Davis M, Hubbard L, Budoff M, Darabian S, Rezaeian P, Wong N, Fox M, Oudiz R, Kim L, Detrano R, Cruickshanks K, Dalton D, Bainbridge K, Lima J, Bluemke D, Turkbey E, der Geest ., Liu C, Malayeri A, Jain A, Miao C, Chahal H, Jarboe R, Nathan D, Monnier V, Sell D, Strauch C, Hazen S, Pratt A, Tang W, Brunzell J, Purnell J, Natarajan R, Miao F, Zhang L, Chen Z, Paterson A, Boright A, Bull S, Sun L, Scherer S, Lopes‐Virella M, Lyons T, Jenkins A, Klein R, Virella G, Jaffa A, Carter R, Stoner J, Garvey W, Lackland D, Brabham M, McGee D, Zheng D, Mayfield R, Maynard J, Wessells H, Sarma A, Jacobson A, Dunn R, Holt S, Hotaling J, Kim C, Clemens Q, Brown J, McVary K. Oxidative Stress and Cardiovascular Risk in Type 1 Diabetes Mellitus: Insights From the DCCT/EDIC Study. J Am Heart Assoc 2018. [PMCID: PMC6015340 DOI: 10.1161/jaha.117.008368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Hyperglycemia leading to increased oxidative stress is implicated in the increased risk for the development of macrovascular and microvascular complications in patients with type 1 diabetes mellitus.
Methods and Results
A random subcohort of 349 participants was selected from the
DCCT
/
EDIC
(Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications) cohort. This included 320 controls and 29 cardiovascular disease cases that were augmented with 98 additional known cases to yield a case cohort of 447 participants (320 controls, 127 cases). Biosamples from
DCCT
baseline, year 1, and closeout of
DCCT
, and 1 to 2 years post‐
DCCT
(
EDIC
years 1 and 2) were measured for markers of oxidative stress, including plasma myeloperoxidase, paraoxonase activity, urinary F
2α
isoprostanes, and its metabolite, 2,3 dinor‐8
iso
prostaglandin F
2α
. Following adjustment for glycated hemoblobin and weighting the observations inversely proportional to the sampling selection probabilities, higher paraoxonase activity, reflective of antioxidant activity, and 2,3 dinor‐8
iso
prostaglandin F
2α
, an oxidative marker, were significantly associated with lower risk of cardiovascular disease (−4.5% risk for 10% higher paraoxonase,
P
<0.003; −5.3% risk for 10% higher 2,3 dinor‐8
iso
prostaglandin F
2α
,
P
=0.0092). In contrast, the oxidative markers myeloperoxidase and F
2α
isoprostanes were not significantly associated with cardiovascular disease after adjustment for glycated hemoblobin. There were no significant differences between
DCCT
intensive and conventional treatment groups in the change in all biomarkers across time segments.
Conclusions
Heightened antioxidant activity (rather than diminished oxidative stress markers) is associated with lower cardiovascular disease risk in type 1 diabetes mellitus, but these biomarkers did not change over time with intensification of glycemic control.
Clinical Trial Registration
URL
:
https://www.clinicaltrials.gov
. Unique identifiers:
NCT
00360815 and
NCT
00360893.
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Affiliation(s)
- W.H. Wilson Tang
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Paula McGee
- The Biostatistics Center, George Washington University, Rockville, MD
| | - John M. Lachin
- The Biostatistics Center, George Washington University, Rockville, MD
| | - Daniel Y. Li
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | | | - Stanley L. Hazen
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
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Ay N, Kaya S, Anil M, Alp V, Beyazit U, Yuksel E, Danis R. Pulmonary Involvement in Brucellosis, a Rare Complication of Renal Transplant: Case Report and Brief Review. EXP CLIN TRANSPLANT 2016; 16:757-760. [PMID: 27210230 DOI: 10.6002/ect.2015.0324] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Brucellosis, a disease endemic in many countries including Turkey, is a systemic infectious disease. Brucellosis is rare in renal transplant recipients. Only 4 cases have been reported in the literature. In this report, we describe the clinical manifestations and laboratory findings of a brucellosis case with pulmonary involvement in a renal transplant recipient. A 20-year-old man who had a living-donor kidney transplant 4 months earlier presented to our transplant clinic with fever, cough, and right flank pain. Clarithromycin and ceftriaxone were started for the diagnosis of pneumonia. However, piperacillin/tazobactam, meropenem plus teicoplanin, and antituberculosis treatment were continued because the patient was unresponsive to the initial therapy. Serum Brucella agglutination titer was found to be 1/320. Treatment was started with a 6-week course of oral doxycycline and rifampin, resulting in cure. Brucellosis and especially its pulmonary involvement are rare after kidney transplant. However, in endemic areas,it should be considered as it mimics several other infectious diseases.
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Affiliation(s)
- Nurettin Ay
- From the Transplantation Center, Diyarbakır Education and Research Hospital, Diyarbakır, Turkey
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Ay N, Kaya S, Anil M, Alp V, Sevuk U, Danis R. Management of a Resistant Hypotension Developing After Reperfusion of a Living-Donor Kidney Transplant. EXP CLIN TRANSPLANT 2016; 16:96-98. [PMID: 26788727 DOI: 10.6002/ect.2015.0179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We present a case of hypotension developing after reperfusion of a living-donor kidney transplant and performing a graft nephrectomy and successful retransplant with the same kidney 12 hours later. Preemptive kidney transplant was performed on a 51-year-old woman who had a chronic kidney disease because of hypertension. Her 55-year-old husband was the living kidney donor. The patient was stable before reperfusion. After declamping, pink color of the transplanted kidney, thrill from the renal artery, and urinary output were seen. But shortly after reperfusion, the invasive arterial blood pressure of the patient abruptly decreased from 130/70 mm Hg to 70/40 mm Hg, her pulse was approximately 80 to 110 beats/minute. The thrill disappeared from the renal artery, but blood flow continued. A graft nephrectomy was performed 45 minutes after reperfusion. Invasive arterial blood pressure of the patient was stabilized at approximately 110/70 mm Hg in the intensive care unit, and the patient was retransplanted with the same kidney. The patient was well, with a serum creatinine level of 1.4 mg/dL, 12 months after the operation. Resistant hypotension that occurs after kidney transplant may cause a loss of the graft and the patient. To prevent graft loss, and to stabilize the patient, a graft nephrectomy and retransplant of the graft under suitable circumstances may be considered.
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Affiliation(s)
- Nurettin Ay
- From the Diyarbakir Education and Research Hospital, Transplantation Center, Diyarbakir, Turkey
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Kaya S, Aksoz S, Baysal B, Ay N, Danis R. Evaluation of telaprevir-containing triple therapy in the treatment of chronic hepatitis C in hemodialysed patients. Infect Dis (Lond) 2015; 47:658-61. [PMID: 25936530 DOI: 10.3109/23744235.2015.1034769] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Hepatitis C virus (HCV) infection is associated with increased morbidity and mortality in patients undergoing hemodialysis for end-stage renal disease (ESRD). Eradication of HCV before transplantation is therefore of utmost importance in HCV-infected patients with ESRD who are candidates for kidney transplantation. The appropriate treatment for HCV infection in patients with ESRD and suboptimal response rates is still unclear. Here, we present our data from five cases who were being monitored by two healthcare centers for ESRD and HCV infection, who were candidates for kidney transplantation and were treated with a triple regimen containing telaprevir. All patients were started on triple therapy from the beginning including pegylated interferon-alfa2a (135 μg once a week), ribavirin (200 mg three times a week), and telaprevir (750 mg three times a day). Rapid virologic response was observed in all of the patients but treatment was discontinued in one patient at week 6 because the patient developed nausea and vomiting and was unable to feed orally. For the remaining four patients, side effects included weakness, lack of appetite, metallic taste, and mild anemia. The triple therapy with telaprevir seemed to be successful in HCV-infected patients who were candidates for renal transplantation.
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Affiliation(s)
- Safak Kaya
- Department of Infectious Diseases, Gazi Yasargil Training and Research Hospital , Diyarbakir , Turkey
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Danis R, Bonete Llacer J, García Bouza R. Fibromyalgia and Multiple Psychiatric Diagnosis. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)30380-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Ates G, Ozekinci T, Yildiz T, Danis R. Comparison of Interferon-Gamma Release Assay Versus Tuberculin Skin Test for Latent Tuberculosis Screening in Hemodialysis Patients. BIOTECHNOL BIOTEC EQ 2014. [DOI: 10.1080/13102818.2009.10817646] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Bantis C, Heering P, Kouri NM, Siekierka-Harreis M, Stangou M, Schwandt C, Efstratiadis G, Rump LC, Ivens K, Haddiya I, Houssaini Squalli T, Laouad I, Ramdani B, Bayahia R, Dimas GG, Tegos TJ, Spiroglou SG, Pitsalidis CG, Sioulis AS, Karamouzis IM, Savopoulos CG, Karamouzis MI, Orologas AG, Hatzitolios AI, Grekas DM, Maixnerova D, Jancova E, Rychlik I, Rysava R, Merta M, Reiterova J, Kolsky A, Honsova E, Skibova J, Tesar V, Kendi Celebi Z, Calayoglu R, Keven K, Kurultak I, Mescigil P, Erbay B, Karatan O, Duman N, Erturk S, Nergizoglu G, Kutlay S, Sengul S, Ates K, Marino F, Martorano C, Bellantoni M, Tripepi R, Zoccali C, Ishizuka K, Harita Y, Kajiho Y, Tsurumi H, Asano T, Nishiyama K, Sugawara N, Chikamoto H, Akioka Y, Yamaguchi Y, Igarashi T, Hattori M, Bantis C, Heering PJ, Kouri NM, Stangou M, Siekierka-Harreis M, Efstratiadis G, Rump LC, Ivens K, Sahay M, Monova DV, Monov SV, Wang YY, Cheng H, Wang GQ, Dong HR, Chen YP, Wang CJ, Tang YL, Buti E, Dervishi E, Bergesio F, Ghiandai G, Mjeshtri A, Paudice N, Caldini AL, Nozzoli C, Minetti EE, Sun L, Feng J, Yao L, Fan Q, Ma J, Wang L, Kirsanova T, Merkusheva L, Ruinihina N, Kozlovskaya N, Elenshleger G, Turgutalp K, Karabulut U, Ozcan T, Helvaci I, Kiykim A, Kaul A, Bhadhuaria D, sharma R, Prasad N, Gupta A, Clajus C, Schmidt J, Haller H, Kumpers P, David S, Sevillano AM, Molina M, Gutierrez E, Morales E, Gonzalez E, Hernandez E, Praga M, Conde Olasagasti JL, Vozmediano Poyatos C, Illescas ML, Tallon S, Uson Carrasco JJ, Roca Munoz A, Rivera Hernandez F, Ismail G, Jurubita R, Andronesi A, Bobeica R, Zilisteanu D, Rusu E, Achim C, Sevillano AM, Molina M, Gutierrez E, Morales E, Huerta A, Hernandez E, Caro J, Gutierrez-Solis E, Praga M, Pasquariello A, Pasquariello G, Innocenti M, Grassi G, Egidi MF, Ozturk O, Yildiz A, Gul CB, Dilek K, Monov SV, Monova DV, Tylicki L, Jakubowska A, Weber E, Lizakowski S, Swietlik D, Rutkowski B, Postorino A, Costa S, Cristadoro S, Magazzu G, Bellinghieri G, Savica V, Buemi M, Santoro D, Lu Y, Shen P, Li X, Xu Y, Pan X, Wang W, Chen X, Zhang W, Ren H, Chen N, Mitic BP, Cvetkovic T, Vlahovic P, Velickovic Radovanovic R, Stefanovic V, Kostic S, Djordjevic V, Ao Q, Ma Q, Cheng Q, Wang X, Liu S, Zhang R, Ozturk S, Ozmen S, Akin D, Danis R, Yilmaz M, Hajri S, Barbouche S, Okpa H, Oviasu E, Ojogwu L, Fotouhi N, Ghaffari A, Hamzavi F, Nasri H, Ardalan M, Stott A, Ullah A, Anijeet H, Ahmed S, Kohli HS, Rajachandran R, Rathi M, Jha V, Sakhuja V, Yenigun E, Dede F, Turgut D, Koc E, Akoglu H, Piskinpasa S, Ozturk R, Odabas A, Bajcsi D, Abraham G, Kemeny E, Sonkodi S, Legrady P, Letoha A, Constantinou K, Ondrik Z, Ivanyi B, Lucisano G, Comi N, Cianfrone P, Summaria C, Piraina V, Talarico R, Camastra C, Fuiano G, Proletov I, Saganova E, Galkina O, Bogdanova E, Zubina I, Sipovskii V, Smirnov A, Bailly E, Pierre D, Kerdraon R, Grezard O, Gnappi E, Delsante M, Galetti M, Maggiore U, Manenti L, Hasan MJ, Muqueet MA, Mostafi M, Chowdhury I, Haque W, Khan T, Kang YJ, Bae EJ, Cho HS, Chang SH, Park DJ, Li X, Xu G, Lin H, Hu Z, Yu X, Xing C, Mei C, Zuo L, Ni Z, Ding X, Li D, Chen N, Ren H, Shen P, Li X, Pan X, Zhang Q, Feng X, Lin L, Zhang W, Chen N. Clinical nephrology - miscellaneous. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Danis R, Ozmen S, Arikan S, Gokalp D, Alyan O. Predictive value of serum NT-proBNP levels in type 2 diabetic people with diabetic nephropathy. Diabetes Res Clin Pract 2012; 95:312-6. [PMID: 22018780 DOI: 10.1016/j.diabres.2011.09.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 09/19/2011] [Accepted: 09/26/2011] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The serum N-terminal fragment of pro brain natriuretic peptide (NT-proBNP) level in type 2 diabetic subjects with or without diabetic nephropathy (DN) is still unclear. We aimed to evaluate the relationship between serum NT-proBNP levels and different stages of diabetic nephropathy, and identify probable factors predicting serum NT-proBNP level. SUBJECTS AND METHODS This cross-sectional study included 20 normoalbuminuric (Group-I), 28 microalbuminuric (Group-II), 20 macroalbuminuric type 2 diabetic patients (Group-III), and 20 healthy volunteers (Group-IV). Serum NT-proBNP levels were measured with highly sensitive and specific immunoassay. RESULTS Mean NT-proBNP levels were 32 ± 55, 91 ± 95, 331 ± 297, 42 ± 34 pg/ml for Groups I-IV, respectively. When patients with LVH were excluded, mean logNT-proBNP was still significantly higher in Group-III than all other groups. The three diabetic groups were similar in age, BMI, HbA1c, fasting serum glucose, and GFR. In a multivariate linear regression model, adjusting for factors significantly correlated with NT-proBNP levels, the patient group, presence of LVH, and hemoglobin remained as an independent predictor of serum NT-proBNP. These variables explained 68% of the variability of NT-proBNP (adjusted R(2)=0.683). CONCLUSIONS Mean serum NT-proBNP level of macroalbuminuric diabetic patients was higher than normoalbuminuric and microalbuminuric diabetic patients, and healthy control subjects even after exclusion of LVH. NT-proBNP may be a useful and predictive marker of diabetic nephropathy.
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Affiliation(s)
- Ramazan Danis
- Department of Nephrology, University of Dicle, School of Medicine, Diyarbakir, Turkey
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Danis R, Akbulut S, Altintas A, Ozmen S, Ozmen CA. Unusual presentation of eosinophilic fasciitis: two case reports and a review of the literature. J Med Case Rep 2010; 4:46. [PMID: 20181119 PMCID: PMC2830980 DOI: 10.1186/1752-1947-4-46] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Accepted: 02/08/2010] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Eosinophilic fasciitis is an uncommon disorder with unknown etiology and a poorly understood pathogenesis. We present the cases of two patients with eosinophilic fasciitis with unusual presentation, and describe the clinical characteristics and laboratory findings related to them. CASE PRESENTATION The first case involves a 29-year-old Turkish man admitted with pain, edema and induration of his right-upper and left-lower limbs. Unilateral edema and stiffness with prominent pretibial edema was noted upon physical examination. A high eosinophil count was found on the peripheral smear. The second case involves a 63-year-old Turkish man who had pain, edema, erythema, and itching on his upper and lower extremities, which developed after strenuous physical activity. He had cervical lymphadenopathy and polyarthritis upon physical examination, and rheumatoid factor and antinuclear antibody upon laboratory examination. CONCLUSION Eosinophilic fasciitis can present with various symptoms. When patients exhibit eosinophilia, arthralgia and myalgia, eosinophilic fasciitis should be considered as a possible diagnosis.
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Affiliation(s)
- Ramazan Danis
- Department of Nephrology, Diyarbakir Education and Research Hospital, 21400, Diyarbakir, Turkey
| | - Sami Akbulut
- Department of Surgery, Diyarbakir Education and Research Hospital, 21400, Diyarbakir, Turkey
| | - Abdullah Altintas
- Department of Hematology, Dicle University, Faculty of Medicine, 21380, Diyarbakir, Turkey
| | - Sehmus Ozmen
- Department of Nephrology, Diyarbakir Education and Research Hospital, 21400, Diyarbakir, Turkey
| | - Cihan Akgul Ozmen
- Department of Radiology, Dicle University, Faculty of Medicine, 21380, Diyarbakir, Turkey
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Ates G, Yildiz T, Danis R, Akyildiz L, Erturk B, Beyazit H, Topcu F. Incidence of Tuberculosis Disease and Latent Tuberculosis Infection in Patients with End Stage Renal Disease in an Endemic Region. Ren Fail 2010; 32:91-5. [DOI: 10.3109/08860220903367528] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gungor Ates
- University of Dicle, Faculty of Medicine, Department of Chest Disease, Diyarbakir, Turkey
| | - Tekin Yildiz
- University of Dicle, Faculty of Medicine, Department of Chest Disease, Diyarbakir, Turkey
| | - Ramazan Danis
- Department of Nephrology, Diyarbakir State Hospital, Diyarbakir, Turkey
| | - Levent Akyildiz
- Department of Pulmonology, MardinPark Hospital, Mardin, Turkey
| | | | - Huseyin Beyazit
- University of Dicle, Faculty of Medicine, Department of Chest Disease, Diyarbakir, Turkey
| | - Fusun Topcu
- University of Dicle, Faculty of Medicine, Department of Chest Disease, Diyarbakir, Turkey
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Danis R, Akbulut S, Ozmen S, Arikan S. Rhabdomyolysis-induced acute renal failure following fenofibrate therapy: a case report and literature review. Case Rep Med 2010; 2010:537818. [PMID: 20811485 PMCID: PMC2926591 DOI: 10.1155/2010/537818] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Accepted: 06/25/2010] [Indexed: 02/07/2023] Open
Abstract
Fenofibrate, a fibric acid derivative, is used to treat diabetic dyslipidemia, hypertriglyceridemia, and combined hyperlipidemia, administered alone or in combination with statins. Rhabdomyolysis is defined as a pathological condition involving skeletal muscle cell damage leading to the release of toxic intracellular material into circulation. Its major causes include muscle compression or overexertion; trauma; ischemia; toxins; cocaine, alcohol, and drug use; metabolic disorders; infections. However, rhabdomyolysis associated with fenofibrate is extremely rare. Herein we report a 45-year-old female patient who was referred to our department because of generalized muscle pain, fatigue, weakness, and oliguria over the preceding 3 weeks. On the basis of the pathogenesis and clinical and laboratory examinations, a diagnosis of acute renal failure secondary to fenofibrate-induced rhabdomyolysis was made. Weekly followups for patients who are administered fenofibrate are the most important way to prevent possible complications.
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Affiliation(s)
- Ramazan Danis
- 1Department of Nephrology, Diyarbakir Education and Research Hospital, 21400 Diyarbakir, Turkey
| | - Sami Akbulut
- 2Department of Surgery, Diyarbakir Education and Research Hospital, 21400 Diyarbakir, Turkey
- *Sami Akbulut:
| | - Sehmus Ozmen
- 1Department of Nephrology, Diyarbakir Education and Research Hospital, 21400 Diyarbakir, Turkey
| | - Senay Arikan
- 3Department of Endocrinology and Metabolism, Faculty of Medicine, Dicle Universiy, 21280 Diyarbakir, Turkey
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Ozmen S, Danis R, Akin D, Batun S. Anticardiolipin antibodies in hemodialysis patients with hepatitis C and their role in fistula failure. Clin Nephrol 2009; 72:193-198. [PMID: 19761724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND/AIMS Several conflicting results are presently reported regarding raised IgG and IgM-anticardiolipin antibodies (ACA) titers in hemodialysis (HD) patients and their role in vascular access dysfunction. We aimed to determine the prevalence of both IgM and IgG-ACA titers and to analyze retrospectively their role in primary and secondary arteriovenous fistula (AVF) failure in a homogeneous group of HD patients with chronic hepatitis C. METHODS This study included 103 adults on maintenance hemodialysis with chronic hepatitis C infection. All participants had blood samples drawn predialysis and after an overnight fast. Analysis included biochemistry, IgG and IgM ACA, Anti-HCV, HBsAg, serum HCV RNA and HCV genotyping. RESULTS The prevalence of IgG-ACA was 14.6% (15/103). No patient had a positive value of the IgM-ACA test. HCV replication was detected in 52 of 76 patients. The most common HCV genotype was genotype 1 (90%). The percentage of females was higher in ACA(+) group (p = 0.038). There were no significant differences between subjects with and without ACA-IgG regarding other parameters studied. No difference in regard to AVF survival was detected between ACA(+) and ACA(-) groups (p > 0.05). CONCLUSION We found no significant differences in primary or secondary AVF failure between patients with elevated and normal ACA. Therefore, we conclude that AVFF may be caused by factors other than ACA in these patients. More prospective studies are needed to confirm this observation.
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Affiliation(s)
- S Ozmen
- Department of Nephrology, Dicle University School of Medicine, Diyarbakir, Turkey.
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Ozmen S, Kaplan MA, Kaya H, Akin D, Danis R, Kizilkan B, Yazanel O. Role of lean body mass for estimation of glomerular filtration rate in patients with chronic kidney disease with various body mass indices. ACTA ACUST UNITED AC 2009; 43:171-6. [DOI: 10.1080/00365590802502228] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | | | - Halil Kaya
- Nuclear Medicine, Dicle University School of Medicine, Diyarbakir, Turkey
| | | | | | - Berfin Kizilkan
- Nuclear Medicine, Dicle University School of Medicine, Diyarbakir, Turkey
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Abstract
It is often difficult to distinguish acute renal failure clinically from chronic renal failure, especially in patients who do not have records of their medical history. We investigated the magnitude of iPTH increase in ARF and the potential role of iPTH as a marker for differential diagnosis of ARF and CRF in new patients referred to our renal unit. We prospectively analyzed 122 (ARF n = 64, CRF n = 58) patients referred to our renal unit with serum creatinine higher than 2 mg/dL. ROC curve analysis was performed to investigate role of iPTH for differentiating ARF from CRF. The sensitivity, specificity, and positive predictive value of iPTH in discrimination of ARF and CRF were calculated. There was no statistically significant difference regarding the means of age, sex distribution, and serum chemistry between patients with ARF or CRF. But serum iPTH (p < 0.0001) levels were lower in patients with ARF than in those with CRF. A cutoff, set at 170 pg/mL for iPTH to discriminate patients with CRF, yielded a sensitivity of 88% and a specificity of 89%. This study confirms that the iPTH measurement is of clinical value in differentiating acute from chronic renal failure.
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Affiliation(s)
- S Ozmen
- Department of Nephrology, Dicle University School of Medicine, Diyarbakir, Turkey.
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Pasa S, Bayan K, Kucukoner M, Tuzun Y, Altintas A, Cil T, Danis R, Ayyildiz O. The effects of nonsteroidal anti-inflammatory drugs on platelet function and severity of upper gastrointestinal haemorrhage. J Thromb Thrombolysis 2008; 28:83-9. [PMID: 18696215 DOI: 10.1007/s11239-008-0263-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Accepted: 07/29/2008] [Indexed: 11/25/2022]
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) cause gastrointestinal (GI) damage primarily due to the inhibition of prostaglandin synthesis in gastric mucosa, which is an important factor in mucosa protection. Platelets are a cardinal feature of vascular repair. A variety of angiogenic stimulators are stored in platelets and are released during clotting at the wound. When there is a defect in any of these functions and/or platelet number, haemostasis is usually impaired and there may be an associated increased risk and severity of bleeding. While the mechanism of mucosal injury and bleeding are well documented with the use of NSAIDs, very little is known about the platelet function abnormalities and their effects on severity of upper GI bleedings. We performed a prospective analysis of 49 patients who had a history of NSAIDs use to investigate the association between the platelet function impairment associated with NSAIDs and severity of upper GI haemorrhages. Thirty-six of 49 patients (73.5%) had deteriorated platelet function. Mean severity score of patients with deteriorated platelet functions was 3.39, and that of patients with normal platelet functions was 2.46. Mean severity score was statistically significantly higher in patients with deteriorated platelet functions. In conclusion, impaired platelet functions associated with NSAIDs may cause more severe upper GI bleeding. Clinicians should be alert for GI complications especially in older patients and in those with a history of ulcer bleeding.
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Affiliation(s)
- Semir Pasa
- Department of Hematology, Medicine Faculty, Dicle University, Diyarbakir, Turkey.
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Yasan A, Danis R, Tamam L, Ozmen S, Ozkan M. Socio-cultural features and sex profile of the individuals with serious suicide attempts in southeastern Turkey: a one-year survey. Suicide Life Threat Behav 2008; 38:467-80. [PMID: 18724795 DOI: 10.1521/suli.2008.38.4.467] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Our objective was to elucidate potential causes of higher rates of suicide attempts in females compared to males in southeastern Turkey through a 1-year survey. Gender-related differences observed in 96 subjects who attempted suicide by poisoning for the first time were as follows: in comparison to male, females were predominantly within the age interval of 15-24 years, experienced more stressful events in the previous week before suicide attempt, had lower education level, and had a lower rate of employment. One year after the suicide attempt, unfavorable attitude of family, lack of support, persisting unfavorable lifestyle comparable with that prior to the first attempt, and higher rates of domestic violence were more pronounced in females compared to males. These findings might be contributing factors to the higher suicide attempt rates observed in females compared to the males.
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Affiliation(s)
- Aziz Yasan
- Department of Psychiatry, Dicle University Faculty of Medicine, Diyarbakir, Turkey.
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Pasa S, Altintas A, Cil T, Ustun C, Bayan K, Danis R, Urakci Z, Tuzun Y, Ayyildiz O. Two cases of bacterial meningitis accompanied by thalidomide therapy in patients with multiple myeloma: is thalidomide associated with bacterial meningitis? Int J Infect Dis 2008; 13:e19-22. [PMID: 18621563 DOI: 10.1016/j.ijid.2008.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 04/08/2008] [Accepted: 04/09/2008] [Indexed: 10/21/2022] Open
Abstract
Morbidity and mortality in multiple myeloma is often attributed to life-threatening infections. A defect in humoral immunity has been proposed for the predisposition to bacterial infections. Most of the infections are of bacterial origin, and the most serious are septicemia, meningitis, and pneumonia. Thalidomide is a drug with pleiotropic effects. The immunomodulatory effects of thalidomide are at least partially mediated through its ability to down-regulate the pathogenic over-production of tumor necrosis factor-alpha (TNF-alpha). TNF-alpha is a cytokine that plays a central role in the regulation of the host immune and inflammatory response to infection. In the central nervous system, TNF-alpha is involved in induction of a fever response and triggers the release of other cytokines, and may also influence transport of compounds into the brain, leading to cerebrospinal fluid leukocytosis, increased protein influx, and lactate accumulation. Thalidomide has been shown to down-regulate the production of TNF-alpha. On the other hand, knowledge of the effects of thalidomide on granulocyte functions is limited. Thalidomide has been shown to attenuate neutrophil adhesion and chemotaxis. We present herein two cases of Streptococcus pneumoniae bacterial meningitis that developed soon after the initiation of thalidomide treatment, and discuss the effect of thalidomide on the immune system. Although, it is not clear whether thalidomide caused the development of the bacterial infections and meningitis, or what its pathogenetic mechanisms are, physicians should be alert for signs and symptoms of meningitis in patients with multiple myeloma who are treated with thalidomide, especially those in neutropenic states.
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Affiliation(s)
- Semir Pasa
- Department of Hematology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
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Iltumur K, Karahan Z, Ozmen S, Danis R, Toprak N. Spontaneous coronary artery dissection during hemodialysis in the post-abortion period. Int J Cardiol 2008; 127:e45-7. [PMID: 17467825 DOI: 10.1016/j.ijcard.2007.01.105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Accepted: 01/04/2007] [Indexed: 11/30/2022]
Abstract
Spontaneous coronary dissection (SCAD) is an unusual cause of acute myocardial infarction with complex pathophysiology. We present a case of acute inferior myocardial infarction resulting from spontaneous coronary artery dissection of the right coronary artery in a 33-year-old woman during the hemodialysis due to a recent abortion and consequent curettage at first trimester of her pregnancy. This report describes a previously healthy woman without traditional cardiovascular risk factors who presented with an acute inferior myocardial infarction. Spontaneous coronary artery dissection (SCAD) should be considered as a cause of the acute myocardial infarction in young patients without traditional risk factors for coronary artery disease, in females in the both peri-partum and post-abortion period.
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Pasa S, Altintas A, Cil T, Danis R, Subasi M, Ayyildiz O, Muftuoglu E. Successful total hip replacement in a patient with severe haemophilia A with inhibitors using recombinant factor VIIa. Haemophilia 2008; 14:863-5. [PMID: 18445012 DOI: 10.1111/j.1365-2516.2008.01758.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pasa S, Altintas A, Cil T, Danis R, Ayyildiz O. The efficacy of rituximab in patients with splenectomized refractory chronic idiopathic thrombocythopenic purpura. J Thromb Thrombolysis 2008; 27:329-33. [PMID: 18311541 DOI: 10.1007/s11239-008-0208-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Accepted: 02/18/2008] [Indexed: 01/19/2023]
Abstract
The most difficult problem a physician encounters is the management of patients with idiopathic thrombocytopenic purpura (ITP), who has persistent severe thrombocytopenia after failure of initial treatment with glucocorticoids and splenectomy. Most of the patients refractory to corticosteroids and splenectomy will become refractory to other available agents, such as intravenous immunoglobulin (IVIg), danazol or chemotherapy. In this study, we investigated the effect of rituximab on 17 splenectomized refractory chronic ITP patients. Here, we showed that the anti-CD20 antibody, rituximab, induces a clinically significant response in severe chronic ITP patients, who are unresponsive to other therapeutic options. After sixth month, 10 out of 14 responders were still maintaining their durable and significant platelet responses (platelet counts >50 x 10(9)/l), without requirement to any other ITP medication. Therefore, we suggest that, rituximab is an effective treatment option in splenectomized refractory or relapsed ITP patients. Rituximab was well tolerated without severe side effects.
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Affiliation(s)
- Semir Pasa
- Department of Hematology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey.
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Pasa S, Altintas A, Devecioglu B, Cil T, Danis R, Isi H, Bayan K, Tuzun Y, Ecer S, Batun S, Ayyildiz O. Familial Mediterranean fever gene mutations in the Southeastern region of Turkey and their phenotypical features. Amyloid 2008; 15:49-53. [PMID: 18266121 DOI: 10.1080/13506120701815456] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Familial Mediterranean fever (FMF) is an autosomal recessive disease characterized by recurrent inflammatory attacks of serosal membranes. Several studies have focused on the differences between frequency of the mutations and their phenotypical manifestations. The aim of this study was to evaluate whether or not this phenotypical variation is associated with the existence of particular mutations. Twelve MEFV (Mediterranean fever) gene mutations were investigated in 119 patients suffering from FMF. Heterozygote M694V (21/119), heterozygote E148Q (21/119), homozygote M694V (17/119) and heterozygote V726A (12/119) mutations were the most common mutations. Patients were grouped according to the presence of the M694V mutation: group I was M694V/M694V, group II was M694V/others, and group III was other/other. Mean severity scores for the groups were 13.94 +/- 4.10, 10.79 +/- 3.01 and 8.31 +/- 2.26, respectively. There were statistically significant differences between the mean severity scores of groups I and II (p = 0.029), groups I and III (p < 0.0001), and groups II and III (p < 0.0001). Diagnosis of amyloidosis was established in four (23%) patients of group I, and three (8%) patients of group II, but in none of the patients in group III. There was also a statistically significant difference between groups I and III (p = 0.046), but not between groups II and III (p = 0.083) and groups I and II (p = 0.317) in terms of amyloidosis development. In conclusion, we found a higher disease severity score and higher prevalence of amyloidosis in FMF patients who were M694V mutation carriers. Many ethnic groups live in Anatolia and more ethnic origin-based studies are needed to determine the real effect of these mutations on disease severity and amyloidosis.
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Affiliation(s)
- Semir Pasa
- Department of Hematology-Oncology, Internal Medicine, Dicle University, Turkey.
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Altintas A, Cil T, Pasa S, Danis R, Kilinc I, Ayyildiz O, Muftuoglu E. Clinical significance of elevated antinuclear antibody test in patients with Hodgkin's and Non-Hodgkin's lymphoma: a single center experience. Minerva Med 2008; 99:7-14. [PMID: 18299692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIM There is an increased risk of lymphoma subsequent to autoimmune conditions. Autoimmune disorders may occur in the course of lymphomas. In this study, the association of autoimmunity and related autoantibodies within non-Hodgkin's (NHL) and Hodgkin's lymphoma (HL) patients has been investigated. METHODS The study enrolled 119 patients affected by NHL and 60 patients affected by HL for the presence of autoantibodies and autoimmune diseases. Afterwards, the results between the two lymphoma groups have been confronted. RESULTS Autoimmune diseases were diagnosed in eight (6.7%) patients with NHL and three patients with HL (5%) (P=0.651). Thirty-four (28.5%) patients with NHL and 14 (23.3%) patients with HL displayed autoantibody positivity (P=0.083). As regards HL cases, antinuclear antibodies (ANA) were detected in 12 (20%) and anti PM-Scl in two patients (3.3%). None the patients had anti Jo-1, anti Scl-70, anti Sm, anti nRNP/Sm, anti single-stranded DNA (anti-ssDNA), anti double-stranded DNA (anti-dsDNA), antihistones, antinucleosomes, anti SS-A, anti SS-B or anti CENP-B autoantibodies. In patients affected by NHL ANA was detected in 16 (13.4%), anti SS-A and anti SS-B in two (1.7%), anti CENP-B in eight (6.7%) and anti PM-Scl in eight patients (6.7%). None of the patients had anti Jo-1, anti Scl-70, anti Sm, anti nRNP/Sm, anti ssDNA, antihistones or antinucleosome antibodies. There was a statistically significant difference between patients with HL and NHL in terms of anti CENP-B positivity (P=0.040). CONCLUSION In conclusion, ANA and related autoantibodies can frequently be detected during lymphoma treatment. However, the majority of lymphoma patients with positive ANA did not display autoimmune diseases, demonstrating the lack of a strict correlation between the presence of ANA and autoimmune diseases.
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Affiliation(s)
- A Altintas
- Department of Hematology-Oncology, Internal Medicine, Dicle University, Diyarbakir, Turkey.
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Pasa S, Altintas A, Cil T, Danis R, Ayyildiz O, Muftuoglu E. A case of essential mixed cryoglobulinemia and associated acquired von-Willebrand disease treated with rituximab. J Thromb Thrombolysis 2008; 27:220-2. [DOI: 10.1007/s11239-008-0195-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2007] [Accepted: 01/04/2008] [Indexed: 11/27/2022]
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Abstract
Renal failure is an important complication of snakebite and a major cause of mortality. We aimed to study the clinical profile of snake envenomation in Southeast Anatolia, Turkey, in an adult population. We retrospectively analyzed the records of 200 snakebite victims from 1998 to 2006 at the Dicle University School of Medicine, Diyarbakir, Turkey. Sixteen patients (8%) developed AKI (acute kidney injury). Of those, 25% required dialysis and 18% died. There was no difference between groups in age, arrival time to hospital, and hospital stay time. Both groups received similar hydration and therapy at admission. Disseminated intravascular coagulation (DIC) was observed in 25% of the AKI group and was significantly higher than the non-AKI group (7.1%; p = 0.014). There was no significant difference regarding hemoglobin, platelet levels, and prothrombin time at admission. The prevalence of thrombocytopenia (<150,000 K/UL ) was 60% in the AKI group and 40% in the non-AKI group (p > 0.05). WBC count was significantly higher in the AKI group than in those without AKI (p = 0.001); serum albumin was significantly lower in the AKI group than in those without AKI (p = 0.013). AKI is an important complication of snakebite that may lead to mortality. Despite some troublesome aspects due to its retrospective design, this is a large series from Southeast Anatolia of Turkey in an adult population. Subjects with high WBC, low albumin, and DIC should be closely followed up for the development of AKI.
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Affiliation(s)
- Ramazan Danis
- Department of Nephrology, Dicle University School of Medicine, Diyarbakir, Turkey.
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Danis R, Ozmen S, Akin D, Ozekinci S, Altintas A, Cil T, Pasa S, Kilinc I. Thrombosis of temporal artery and renal vein in Kimura-disease-related nephrotic syndrome. J Thromb Thrombolysis 2007; 27:115-8. [PMID: 18066701 DOI: 10.1007/s11239-007-0178-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Accepted: 11/26/2007] [Indexed: 02/07/2023]
Abstract
Kimura disease (KD) is an angiolymphoid proliferative disorder of unknown etiology, occurs mainly in Asian patients, presenting with subcutaneous slowly growing masses, with a predilection for preauricular and submandibular regions. The clinical course of the disease is thought to be benign. Concomitant peripheral blood eosinophilia and elevated serum immunoglobulin E levels are often observed. Main systemic manifestation of the KD is renal involvement. Renal abnormalities, notably proteinuria and nephrotic syndrome have been found to be associated with KD. We report a 42-year-old man with KD and a steroid-sensitive membraneous nephrotic syndrome with bilaterally temporal artery and renal vein thrombosis. This is the first reported case of KD associated nephrotic syndrome complicated with wide arterial and venous thrombosis from Anatolia.
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Affiliation(s)
- Ramazan Danis
- Department of Nephrology, Internal Medicine, Medicine Faculty, Dicle University, 21280, Diyarbakir, Turkey.
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Arikan S, Tuzcu A, Gokalp D, Bahceci M, Danis R. Hyperthyroidism may affect serum N-terminal pro-B-type natriuretic peptide levels independently of cardiac dysfunction. Clin Endocrinol (Oxf) 2007; 67:202-7. [PMID: 17547691 DOI: 10.1111/j.1365-2265.2007.02861.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM It is known that NT-proBNP levels increase in cardiac failure. However, NT-proBNP levels in different thyroid states are still unclear. We aimed to evaluate serum NT-proBNP levels in both hyperthyroid and hypothyroid patients without cardiac insufficiency. SUBJECTS AND METHODS Thirty-six patients with hyperthyroidism (42.9 +/- 16.7 years), 25 patients with hypothyroidism (35.4 +/- 13.9 years) and 34 age-matched euthyroid subjects (41.4 +/- 13.8 years) were included in the study. After anthropometric evaluations, body fat analyses were determined by bioelectrical impedance. Electrocardiography and echocardiography were used in cardiac evaluations. Serum NT-proBNP was measured by immunoassay. RESULTS Mean serum NT-proBNP levels in hyperthyroid patients were higher than in both control subjects (13.65 +/- 13.02 vs. 6.50 +/- 4.83 pmol/l, P = 0.002) and hypothyroid patients (13.65 +/- 13.02 vs. 5.98 +/- 5.08 pmol/l, P = 0.003). However, mean serum NT-proBNP levels in hypothyroid patients were not different from those in control subjects. There was a positive correlation between serum NT-proBNP and thyroid hormones (NT-proBNP and FT3: r = 0.324, P = 0.001; NT-proBNP and FT4: r = 0.269, P = 0.009, respectively). Serum NT-proBNP levels were positively correlated with left ventricle end-diastolic diameters (r = 0.232, P = 0.04), interventricular septum thickness (r = 0.315, P = 0.006), and negatively correlated with left ventricular ejection fraction (r = -0.238, P = 0.04). CONCLUSIONS Serum NT-proBNP levels may increase in hyperthyroidism independently of cardiac insufficiency. Therefore, hyperthyroidism may lead to cardiac ultrastructural changes undetermined by conventional echocardiography and these changes may be responsible for elevation of NT-proBNP levels. In contrast to decreased thyroid hormones, excess thyroid hormones may have a more pronounced effect on serum NT-proBNP levels.
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Affiliation(s)
- Senay Arikan
- University of Dicle, School of Medicine, Departments of Endocrinology and Nephrology, Diyarbakir, Turkey
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Chew E, Strauber S, Beck R, Aiello LP, Antoszyk A, Bressler N, Browning D, Danis R, Fan J, Flaxel C, Friedman S, Glassman A, Kollman C, Lazarus H. Randomized trial of peribulbar triamcinolone acetonide with and without focal photocoagulation for mild diabetic macular edema: a pilot study. Ophthalmology 2007; 114:1190-6. [PMID: 17544778 PMCID: PMC2465806 DOI: 10.1016/j.ophtha.2007.02.010] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2006] [Revised: 02/08/2007] [Accepted: 02/09/2007] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To provide pilot data on the safety and efficacy of anterior and posterior sub-Tenon injections of triamcinolone either alone or in combination with focal photocoagulation in the treatment of mild diabetic macular edema (DME). DESIGN Prospective, phase II, multicenter, randomized clinical trial. PARTICIPANTS One hundred nine patients (129 eyes) with mild DME and visual acuity 20/40 or better. METHODS The participants were assigned randomly to receive either focal photocoagulation (n = 38), a 20-mg anterior sub-Tenon injection of triamcinolone (n = 23), a 20-mg anterior sub-Tenon injection followed by focal photocoagulation after 4 weeks (n = 25), a 40-mg posterior sub-Tenon injection of triamcinolone (n = 21), or a 40-mg posterior sub-Tenon injection followed by focal photocoagulation after 4 weeks (n = 22). Follow-up visits were performed at 4, 8, 17, and 34 weeks. MAIN OUTCOME MEASURES Change in visual acuity and retinal thickness measured with optical coherence tomography (OCT). RESULTS At baseline, mean visual acuity in the study eyes was 20/25 and mean OCT central subfield thickness was 328 mum. Changes in retinal thickening and in visual acuity were not significantly different among the 5 groups at 34 weeks (P = 0.46 and P = 0.94, respectively). There was a suggestion of a greater proportion of eyes having a central subfield thickness less than 250 mum at 17 weeks when the peribulbar triamcinolone was combined with focal photocoagulation. Elevated intraocular pressure and ptosis were adverse effects attributable to the injections. CONCLUSIONS In cases of DME with good visual acuity, peribulbar triamcinolone, with or without focal photocoagulation, is unlikely to be of substantial benefit. Based on these results, a phase III trial to evaluate the benefit of these treatments for mild DME is not warranted.
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Fakiris A, Lo S, Henderson M, Witt T, Worth R, Danis R, Timmerman R. 1113. Int J Radiat Oncol Biol Phys 2006. [DOI: 10.1016/j.ijrobp.2006.07.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Yalcin K, Danis R, Degertekin H, Alp MN, Tekes S, Budak T. The lack of effect of therapeutic vaccination with a pre-S2/S HBV vaccine in the immune tolerant phase of chronic HBV infection. J Clin Gastroenterol 2003; 37:330-5. [PMID: 14506391 DOI: 10.1097/00004836-200310000-00012] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS Even if the results are controversial and preliminary, several reports suggest that the HBV vaccine might be effective in treating HBV infection. In this study, we aimed to evaluate the efficacy and safety of specific anti-HBV vaccination for the immune tolerance phase of chronic HBV infection in a randomized, controlled study. PATIENTS AND METHODS The 47 subjects included patients that were treatment-naive with hepatitis B e antigen positivity, active hepatitis B virus replication as measured by hepatitis B virus DNA levels, persistently normal alanine transaminase levels, and with minimal or absent disease activity by liver biopsy. Thirty patients were given three intramuscular injections of 20 micro g of a pre-S2/S vaccine (GenHevac-B) on days 0, 30, and 60, and the remaining 17 patients were included in the control group. The efficacy of vaccination was evaluated by testing for loss of serum HBV DNA or decrease in its level and for HBeAg seroconversion. A significant decrease in HBV DNA levels was accepted as a decrease of >50% of initial values. The complete response was defined as loss of HBV DNA in serum with HBeAg seroconversion. Postvaccination follow-up lasted 12 months after the first dose. RESULTS No significant effects were observed in the vaccination population in the reduction of HBV DNA to undetectable levels, or to <50% of prevaccination levels, in HBeAg/anti-HBe seroconversion, or in transaminase levels. There was an early clearance/decrease in HBV DNA levels in five vaccinated patients by 3 months, and none in controls (P = 0.143), and two of them had sustained responses later. At the end of follow-up, complete response is almost similar in study as well as control group (13% vs. 12%, P > 0.05). Disappearance of serum HBV DNA was more frequently observed in those patients who had pretreatment viremia of <100 pg/mL in both groups. The median levels of HBV DNA and alanine transaminase activity between baseline and 12 months did not differ significantly in both groups. All patients remained HBsAg positive and none developed anti-HBs. No serious adverse event was encountered in vaccinated patients, and the therapy was well tolerated. Follow-up lasted a median of 16 months (range 12-30 months) for the study group and 18 months (range 12-31months) for the control group. CONCLUSIONS Immunotherapy with specific anti-HBV vaccine in the immune tolerance phase of chronic HBV infection did not offer additional benefit. New immunotherapeutic strategies to control HBV infection by specific HBV vaccines in chronically infected subjects are needed.
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Affiliation(s)
- Kendal Yalcin
- Division of Hepatology, Department of Internal Medicine, Dicle University School of Medicine, Diyarbakir, Turkey.
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Ayotte P, Giroux S, Dewailly E, Hernández Avila M, Farias P, Danis R, Villanueva Díaz C. DDT spraying for malaria control and reproductive function in Mexican men. Epidemiology 2001; 12:366-7. [PMID: 11338320 DOI: 10.1097/00001648-200105000-00022] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yung CW, Harris A, Massicotte S, Chioran G, Krombach G, Danis R, Wolf S. Retinal blood flow indices in patients infected with human immunodeficiency virus. Br J Ophthalmol 1996; 80:723-7. [PMID: 8949717 PMCID: PMC505589 DOI: 10.1136/bjo.80.8.723] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
AIMS/BACKGROUND Abnormal blood flow dynamics are believed to contribute to the development of retinal microvascular disease in patients infected with human immunodeficiency virus (HIV). In this study, the scanning laser ophthalmoscope (SLO) was used, combined with fluorescein angiography, to measure retinal blood flow indices in HIV seropositive patients. METHODS Arteriovenous passage time (AVP) and perifoveal capillary blood flow velocity (CFV) were measured in 23 HIV infected patients and 23 control subjects with SLO fluorescein angiography. RESULTS No significant difference in AVP was found between the two groups. However, CFV was significantly reduced in HIV infected patients (p = 0.013). CONCLUSION Patients infected with HIV show abnormal haemodynamics at the level of the perifoveal capillaries.
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Affiliation(s)
- C W Yung
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, USA
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Abstract
BACKGROUND Exercise acutely lowers intraocular pressure (IOP) and raises arterial pressure. We wondered whether the resultant increase in ocular perfusion pressure would alter retinal blood flow. METHODS To investigate this question, 11 healthy volunteers each performed progressive cycle ergometer exercise until exhaustion was reached in 5-10 min. Immediately after exercise, retinal blood flow and arteriovenous passage time were determined by video fluorescein angiography. Ten other volunteers performed repeated episodes of cycle ergometer exercise at approximately 60% of the maximal aerobic capacity, immediately prior to estimates of macular leukocyte velocity and density via blue-field stimulation. RESULTS Progressive exercise lowered IOP and elevated calculated ocular perfusion pressure. Within the retinal circulation, this exercise tended to raise mean dye velocity, as it significantly narrowed the superior temporal artery and vein; as a result, calculated retinal blood flow was unchanged. Simultaneously, retinal arteriovenous passage time was substantially shortened. Blue-field simulation showed that exercise increased macular leukocyte velocity while leaving leukocyte density unchanged. CONCLUSIONS These results show that the normal retinal hemodynamic response to increases in perfusion pressure on dynamic exercise includes vasoconstriction that normalizes flow and faster capillary and overall retinal blood transit.
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Affiliation(s)
- A Harris
- Department of Physiology and Biophysics, Indiana University School of Medicine, Indianapolis 46202-5175, USA
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Harris A, Wolf S, Arend O, Shoemaker JA, Sponsel WE, Danis R, Martin BJ. 912 EXERCISE HASTENS RETINAL ARTERIOVENOUS PASSAGE TIME. Med Sci Sports Exerc 1994. [DOI: 10.1249/00005768-199405001-00914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Gurevitz M, Weber T, Danis R, Cradock T, Grosfeld J, Ternberg JL, Schwarz KB. Sodium homeostasis in infants with biliary drainage procedures. Am J Dis Child 1986; 140:535-8. [PMID: 3706230 DOI: 10.1001/archpedi.1986.02140200045024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We studied biliary excretion of sodium and chloride in 17 infants with external bile drainage through a "biliostomy" and describe four additional children who became ill from sodium depletion following external biliary drainage procedures for biliary tract anomalies. In the 17 infants, the mean +/- SD bile sodium concentration was 122 +/- 15 mEq/L. The mean +/- SD serum sodium concentration was low (132 +/- 7 mEq/L) (normal, 138 to 145 mEq/L). The mean +/- SD bile volume was 388 +/- 317 mL/day at one year following surgery (range, 40 to 1,000 mL/day). In the four children, clinical manifestations of sodium depletion (lethargy, anorexia, dehydration, and malnutrition) necessitated hospital admission. At that time, the serum sodium concentration ranged from 109 to 129 mEq/L, and the simultaneous urinary sodium concentration ranged from 0 to 5 mEq/L. Although dietary sodium was normal, biliary losses exceeded dietary intake, resulting in salt and water depletion despite renal conservation. Children with biliary drainage procedures are at risk for sodium depletion and should be monitored closely and supplemented accordingly until biliostomy closure is performed.
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Danis R, Appen RE. Optic atrophy and the Wyburn-Mason syndrome. J Clin Neuroophthalmol 1984; 4:91-5. [PMID: 6233329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
A 14-year-old girl developed impaired vision and optic atrophy of the left eye as a manifestation of an orbital and parachiasmal arteriovenous malformation. Despite the lack of a retinal arteriovenous malformation, this condition appears to be a variant of the Wyburn -Mason syndrome, representing a vascular dysgenesis of the orbit and midbrain resulting in focal arteriovenous communications without interposed capillaries.
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Shaw A, Danis R. Dangers of hydrogen peroxide in enemas or lavage. Pediatrics 1967; 39:146. [PMID: 6016225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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