Clinical features and outcome of patients with amatoxin-containing mushroom poisoning

Objective. We aimed to determine clinical and laboratory findings that were different between those patients who died and those who survived and to look for factors associated with the mortality in amatoxin-containing mushroom poisoning. Methods. The mushroom poisoning patients who were admitted to our clinic between 1996 and 2009 were retrospectively evaluated. The diagnosis was based on a history of mushroom ingestion, clinical picture and the presence of serum alpha-amanitin. Patients were divided into two groups as the survival group and the fatality group. Clinical and laboratory findings were compared between the two groups. Relation between variables and clinical outcome was analyzed. Results. A total of 144 amatoxin poisoning patients were included in this study. Patients who died were more likely to have demonstrated low mean arterial pressure, encephalopathy, mucosal hemorrhage, oliguria-anuria, hypoglycemia, and thrombocytopenia during the hospitalization. Low sodium values and high urea, AST, ALT, total bilirubin, LDH, prothrombin time, international normalized ratio, and activated partial thromboplastin time values were associated with increased likelihood of mortality. Nineteen patients developed acute renal failure. Fourteen patients developed acute hepatic failure. All the 14 patients who died developed acute hepatic failure. The mortality rate was 9.7%. Conclusions. The factors associated with mortality determined in this retrospective study may be helpful for clinical outcome assessment and monitoring of patients with amatoxin-containing mushroom poisoning

Relationship Between Genomic Damage and Clinical Features in Dialysis Patients

Patients with end-stage renal disease display enhanced genomic damage. We investigated the presence of genomic damage in the peripheral lymphocytes by using the micronucleus (MN) test and the factors associated with the MN frequency in hemodialysis (HD) and peritoneal dialysis (PD) patients. We studied 121 dialysis patients (60 HD and 61 PD) and 129 age-and gender-matched healthy controls. The MN analysis, used as a biomarker of chromosomal/DNA damage, was performed in peripheral lymphocytes by the cytokinesis-block method. Univariate analysis showed a significantly higher MN frequency in all patients in comparison with the controls (7.6% +/- 0.3% vs. 4.9% +/- 0.2%, respectively, p < 0.001). Significantly higher frequency of MN was observed in both HD and PD patients compared to controls (7.7% +/- 0.5% vs. 4.9% +/- 0.2%, p < 0.001 and 7.5% +/- 0.5% vs. 4.9% +/- 0.2%, p < 0.001, respectively). Multivariate analysis was performed, and it showed that the low-density lipoprotein level was the only independent determinant of increasing MN frequency in our patients (beta = 0.16, t = 2.172, p < 0.05). There is no significant difference in terms of genomic damage between two dialysis modalities, which suggests that PD may not be a more reliable choice in terms of genomic damage

Progression of Coronary Artery Calcification in Living Kidney Donors: A Follow-Up Study

Background: Data on the long-term mortality and morbidity of living kidney donors are scarce. In the general population, coronary artery calcification (CAC) and progression of CAC are predictors of future cardiac risk. We conducted a study to determine the progression of CAC in renal transplant donors. Methods: We used multidetector computed tomography to examine CAC in 75 former renal transplant donors. A baseline and a follow-up scan were performed and changes in CAC scores were evaluated in each subject individually to calculate the incidence of CAC progression. Results: Baseline CAC prevalence was 16% and the mean CAC score was 5.3 +/- 25.8. At the follow-up scan that was performed after an average of 4.8 +/- 0.3 years, CAC prevalence increased to 72% and the mean CAC score to 12.5 +/- 23.4. Progression of the individual CAC score was found between 18.7 and 26.7%, depending on the method used to define progression. In patients with baseline CAC, the mean annualized rate of CAC progression was 2.1. Presence of hypertension, high systolic blood pressure and an increase in BMI were the determinants of CAC progression. Conclusions: The rate of CAC progression does not seem to be high in carefully selected donors. (C) 2014 S. Karger AG, Base

Temporary catheter infections in hemodialysis patients

In this study, we aimed to determine the frequencies of catheter exit-site infection (CESI), catheter-related bloodstream infection (CR-BSI) and catheter colonization (CC); causative microorganisms; and resistance patterns in patients with temporary hemodialysis catheters. From March 1999 to March 2000, 67 hemodialysis patients (38 males, 29 females; median age: 52, range: 17-84) were evaluated. The CDC criteria were used to diagnose CESI, CR-BSI and CC. The tips of catheters were cultured by Maki's method. At the same time, two different blood Cultures, one from peripheral vein and the other through the catheter lumen were drawn. Swab cultures from the catheter exit sites were also performed. The isolation and identification of bacteria were performed by conventional methods and the Susceptibility testing by the Kirby-Bauer method. CESI, CR-BSI and CC were found in, respectively, 20 (29.8%), 16 (23.8%) and 11 (16.4%) patients. The etiologic agents in CR-BSI were as follows: Staphylococcus aureus (5), coagulase-negative staphylococci (2), Enterococcus sp. (1), Escherichia coli (1), Acinetobacter sp. (1) and Proteus sp. (1). Methicillin-resistant coagulase-negative staphylococci and methicillin-resistant S. aureus were found in proportions of 45.5% and 63.6% in CESI and CR-BSI+CC. The only risk factor for the development of CR-BSI and CC was intravenous drug use. In our center, the majority of CESI, CR-BSI and CC were due to staphylococci and there was a high rate of methicillin resistance

Ultrasonographic maturation of native arteriovenous fistulae: A follow-up study

Background/aims. Ideal time needed for arteriovenous fistula (AVF) maturation is still. controversial. In this study, we aimed to investigate the natural course of AVF maturation and also investigated the factors affecting AVF maturation. Methods. We studied 31 (21M/10F, mean age 55.8 +/- 16.2) chronic renal failure patients. We evaluated the patients with color Doppler ultrasound examination before the fistula operation, at the first day, and at the first, second, third, and sixth months. Radial artery (RA) diameter, flow velocity, flow, resistance index, fistula vein diameter, flow velocity, and flow were measured. Results. Patency rates at the first post-operative day and the sixth month,here 87.1% and 67.1%, respectively. Cephalic vein flow was 451.2 +/- 248.6 mL/min at the first month and 528.6 +/- 316.5 mL/ min at the sixth month. Baseline RA diameter was lower in failing fistulas than that of patent fistulas. Failing fistulas were more common in women. Conclusion. Blood flow was enough for hemodialysis at the end of the first month. However, fistula maturation had continued until the end of the study; women and patients with low RA diameter are particularly prone to fistula failure. Therefore, especially in these patients, AVF must be created at least three or four months before the predicted hemodialysis initiation time

Trends in Renal Replacement Therapy in Turkey, 1996-2008

Background: National renal registry studies providing data for incidence, prevalence, and characteristics of end-stage renal disease and renal replacement therapy (RRT) serve as a basis to determine national strategies for the prevention and treatment of these diseases and identify new areas for special studies