The frequency of gestational diyabetes mellitus in a maternity hospital antepartum clinic

Objectives: The aim of this study was to determine gestational diabetes mellitus (GDM) frequency and age related frequency with GDM screening tests in patients whom referred to our hospital’s antepartum clinic for routine follow-up.Materials and methods: Totally, 2617 pregnant women who did not have any risk factors for GDM and attended to our antepartum clinic for routine follow-up between August 2009 and March 2011 enrolled in this study. A 50-g glucose challenge test (GCT) applied at 24-28 weeks’ gestation. The patients who had a value of blood glucose ≥ 140 mg/dl undergone 100-g oral glucose tolerance test (OGTT). Patients who had a value of ≥200 mg/dl blood glucose in GCT or one value of ≥200 mg/dl in OGTT or had two values exceeded normal ranges in OGTT were accepted as GDM. Age related GDM frequency was also determined.Results: Of the 2617 pregnant women 110 patients diagnosed as GDM (4.2%). For the age related frequency, there was a tendency towards GDM after the age of 33. The age 44 was the most risky with a 33% ratio of GDM occurrence rate.Conclusion: In this study the GDM frequency in our hospital’s routine follow-up clinic was found as compatible with the 1% to 6% frequency reported in the literature. The higher frequency of GDM was found in advanced age pregnancies

Clinical outcomes and mortality in elderly peritoneal dialysis patients

OBJECTIVES: To evaluate the clinical outcomes and identify the predictors of mortality in elderly patients undergoing peritoneal dialysis. METHODS: We conducted a retrospective study including all incident peritoneal dialysis cases in patients ≥65 years of age treated from 2001 to 2014. Demographic and clinical data on the initiation of peritoneal dialysis and the clinical events during the study period were collected. Infectious complications were recorded. Overall and technique survival rates were analyzed. RESULTS: Fifty-eight patients who began peritoneal dialysis during the study period were considered for analysis, and 50 of these patients were included in the final analysis. Peritoneal dialysis exchanges were performed by another person for 65% of the patients, whereas 79.9% of patients preferred to perform the peritoneal dialysis themselves. Peritonitis and catheter exit site/tunnel infection incidences were 20.4±16.3 and 24.6±17.4 patient-months, respectively. During the follow-up period, 40 patients were withdrawn from peritoneal dialysis. Causes of death included peritonitis and/or sepsis (50%) and cardiovascular events (30%). The mean patient survival time was 38.9±4.3 months, and the survival rates were 78.8%, 66.8%, 50.9% and 19.5% at 1, 2, 3 and 4 years after peritoneal dialysis initiation, respectively. Advanced age, the presence of additional diseases, increased episodes of peritonitis, the use of continuous ambulatory peritoneal dialysis, and low albumin levels and daily urine volumes

Nefrotik sendromda albuminle inkübasyon furosemidin etkisini potansiyelize eder mi?

Bu tezin, veri tabanı üzerinden yayınlanma izni bulunmamaktadır. Yayınlanma izni olmayan tezlerin basılı kopyalarına Üniversite kütüphaneniz aracılığıyla (TÜBESS üzerinden) erişebilirsiniz.ÖZET Furosemid (F) plazma albuminine yüksek oranda bağlanarak taşındığından, hipoalbuminemide renal tübüllere daha az diüretik ulaştığı ve nefrotik sendromda furosemidin diüretik etkisinin azaldığı ileri sürülmektedir. Inoue, analbuminemik sıçanlarda albumin ve furosemidin tek başlarına natriüretik etkisinin olmadığını, furosemidin albumin ile inkübasyonu ile oluşan kompleksin infuzyonu ile natriürezde belirgin artış olduğunu göstermiştir. İnsanlarda kontrollü çalışma olmamasına rağmen, diüretik etkiyi artırmak için furosemidin albumin ile kombine edilmesi tavsiye edilmektedir. Nefrotik sendromlu, hipoalbuminemik ödemli hastalarda, infuzyon öncesi inkube edilen furosemid ile albuminin natriüretik etkisini tek başına furosemid ile karşılaştırmak amacıyla bu klinik çalışma yapıldı. Çalışmaya, serum albumin düzeyi 1.0-3.0 g/dl arasında, serum kreatinin2.0 mg/dl olan, ödemli 10 nefrotik sendromlu hasta alındı. Çalışma 3 evreden oluştu: 1. evre : 60 mg F, 50 mi şalin içinde 15 dakikada infuze edildi, 2. evre : 60 mg F, 50 mi %20'lik albumin solüsyonu içine karıştırılarak 10 dakika süreyle oda sıcaklığında inkübe edildi (FA); hemen sonra 15 dakikada infuze edildi, 3. evre : 60 mg F, 50 mi şalin içinde 15 dakikada infuze edildi (1. evrenin aynısı). Her evre öncesi vücut ağırlıkları arasında 0.5 kg'dan fazla fark olmaması için evreler arası 1-3 gün süre bırakıldı. İnfuzyonlardan sonraki 6 saatlik dönem natriürez (Una) ve idrar miktarı (V) açısından değerlendirildi. Sonuçlar tabloda gösterilmiştir. Kontrol F FA UNa(mmol/st) 1.1+0.3 17.7 ±2.4 20.7 + 3.5* V(ml/st) 39 ±5 196 + 21 204 ±28* *ns Furosemid tek başına güçlü diüretik ve natriüretik etki göstermiştir; albumin ile inkübe edilmesi furosemidin yaptığı diüretik ve natriüretik etkiye anlamlı katkıda bulunmamıştı

Cerebral Amyloid Angiopathy: A Case Report and Literature ...

Cerebral amyloid angiopathy (CAA) is a condition characterized by accumulation of amyloid-beta peptide in the walls of the small and medium-sized arteries of the brain and leptomeninges. This condition disrupts the structure of the vessel wall and makes it prone to bleeding. This is an important cause of intracerebral hemorrhage in elderly accompanying to Alzheimer’s disease or to a familial syndrome. Clinically, it usually presents with spontaneous lobar hemorrhage, as well as transient neurological signs, seizures, cognitive disorders, headache, incidental findings like microhaemorrhages and hemosiderosis observed on magnetic resonance (MR) imaging. Herein, we report a hypertensive patient diagnosed with CAA who presented with the complaints of balance disorder while walking. CAA should be suspected in patients with lobar hemorrhage aged 65 years and over. Surgical treatment should not be performed because it could worsen the condition. Clinical improvement can be expected from supportive management, monitoring hypertension, and steroid - immunosuppressive therapies

Osteoprotegerin/RANKL Axis and Progression of Coronary Artery Calcification in Hemodialysis Patients

Background and objectives Vascular calcification is associated with increased cardiovascular mortality in chronic hemodialysis patients. This prospective study investigated the relationship between serum osteoprotegerin, receptor activator of NF-kappa B ligand, inflammatory markers, and progression of coronary artery calcification score

Clinical outcomes and mortality in elderly peritoneal dialysis patients

OBJECTIVES: To evaluate the clinical outcomes and identify the predictors of mortality in elderly patients undergoing peritoneal dialysis. METHODS: We conducted a retrospective study including all incident peritoneal dialysis cases in patients ≥65 years of age treated from 2001 to 2014. Demographic and clinical data on the initiation of peritoneal dialysis and the clinical events during the study period were collected. Infectious complications were recorded. Overall and technique survival rates were analyzed. RESULTS: Fifty-eight patients who began peritoneal dialysis during the study period were considered for analysis, and 50 of these patients were included in the final analysis. Peritoneal dialysis exchanges were performed by another person for 65% of the patients, whereas 79.9% of patients preferred to perform the peritoneal dialysis themselves. Peritonitis and catheter exit site/tunnel infection incidences were 20.4±16.3 and 24.6±17.4 patient-months, respectively. During the follow-up period, 40 patients were withdrawn from peritoneal dialysis. Causes of death included peritonitis and/or sepsis (50%) and cardiovascular events (30%). The mean patient survival time was 38.9±4.3 months, and the survival rates were 78.8%, 66.8%, 50.9% and 19.5% at 1, 2, 3 and 4 years after peritoneal dialysis initiation, respectively. Advanced age, the presence of additional diseases, increased episodes of peritonitis, the use of continuous ambulatory peritoneal dialysis, and low albumin levels and daily urine volumes (<100 ml) at the initiation of peritoneal dialysis were predictors of mortality. The mean technique survival duration was 61.7±5.2 months. The technique survival rates were 97.9%, 90.6%, 81.5% and 71% at 1, 2, 3 and 4 years, respectively. None of the factors analyzed were predictors of technique survival. CONCLUSIONS: Mortality was higher in elderly patients. Factors affecting mortality in elderly patients included advanced age, the presence of comorbid diseases, increased episodes of peritonitis, use of continuous ambulatory peritoneal dialysis, and low albumin levels and daily urine volumes (<100 ml) at the initiation of peritoneal dialysis