Karaciğer transplantasyonuna hazırlanan sirotik hastalarda glukoz metabolizmasındaki değişiklilerin değerlendirilmesi

Bozulmuş glukoz toleransı sirotik hastalarda sık görülen, hastalık sürecince diabetes mellitusa dönüşebilen bir metabolik sorundur. Sirozun kendi kötü gidişatından dolayı komplikasyonları Tip 2 diyabetik hastalara kıyasla çok daha azdır. Açlık kan şekeriyle tanısı tam konulamamaktadır. Bu nedenle tanı amaçlı oral glukoz tolerans testi (OGTT) yapılması gerekmektedir. OGTT’nin sirotik hastalarda rutin muayenede kullanılmasını öneren yayınlar da vardır. Çalışmamızın amacı karaciğer transplantasyonuna aday hastalarda glukoz metabolizmasındaki değişiklikleri tespit edip, bu durumların hastanın klinik, laboratuar ve etiyolojisiyle ilgili olup olmadığını araştırmaktır. Başkent Üniversitesi Ankara Hastanesi Gastroenteroloji polikliniğine transplantasyon amaçlı başvuran, daha öncesinde diabetes mellitus tanısı olmayan, spontan bakteriyel peritonit veya aktif enfeksiyonu olmayan, karbonhidrat metabolizmasını bozacak diüretik veya beta blokör ilaçları en az 48 saat almayan, son bir yılda kilo değişimi olmayan, sağlıklı görünüşlü, biyopsi ve/veya radyolojik ve laboratuar olarak siroz tanısı alan 20 karaciğer sirozlu hasta ve Başkent Üniversitesi Ankara Hastanesi Dahiliye polikliniğine başvuran 20 kontrol grubu alındı. Bu kişilere OGTT de glukozla eş zamanlı insulinler de bakıldı. Karaciğer sirozlu hastaların transplantasyon öncesi rutin biyokimyasal tetkikleri de değerlendirildi. Imparied glucose tolerance is a metabolic issue which is often appeared in cirrhotic patients and transformes to diabetes mellitus during the illness. When it is compared with type 2 diabetic patients the complications of cirrhosis are much more less because of its unpleasened process. The fasting glucose level isn’t enough to diagnose glucose intolerance exactly. Therefore, it is necessary to make oral glucose tolerance test (OGTT) in order to diagnose.There are also articles which suggest that OGTT should be used in cirrhotic patients during routine examination. The aim of our study, by determining the varieties in glucose metabolism in candidate hepatic transplantation patients, is to search whether these situations are related to patients’ clinics, laboratories, etiologies. 20 cirrhotic patients who have apply to Baskent University Ankara Hospital Gastroenterology outpatients clinic for transplantation; are not diagnosed diabetus mellitus previously, has no spontoneus bacterial peritonitis or active infection, have healthy appearance, whose weight hasn’t changed within the one year, diagnosed cirrhosis with biopsies and/or radiologic and laboratory and 20 healthy control patients who have applied to Başkent University Ankara Hospital Internal Medicine Polyclinic are included. Both glucose and insulin of these patients are measued simultaneously in OGTT. Routine biochemical scrutinies of cirrhotic patients before transplantation are also evaluated

TEKRARLAYAN AFTÖZ ÜLSERASYONLAR VE TEDAVİSİNDE GÜNCEL YAKLAŞIMLAR

Tekrarlayan aftöz ülserler (TAÜ) en sık rastlanılan ağız mukozası hastalıklarından biridir ve toplumun yaklaşık %25’ini etkilemektedir. Tipik olarak tekrarlayan, sığ ve eritematöz bir hale ile çevrili, oldukça ağrılı ülserler ile karakterizedir. Lokal ve sistemik koşullar ile genetik, immünolojik ve mikrobiyal faktörler olası etiyolojik faktörler arasında gösterilmiş olmakla beraber, kesin bir etiyolojik faktörden söz edilememektedir. TAÜ tedavisi amacıyla çeşitli immün modülatörler, topikal ve sistemik steroidler, topikal analjezikler, topikal antibiyotikler ve çeşitli kaplayıcı ajanların başarılı bir şekilde uygulandığı gösterilmiş olmasına rağmen tekrarları önlemek mümkün olmamıştır. Bu makalede tekrarlayan aftöz ülserlerin etiyolojisi, klinik görünümü, ayırd edici özellikleri ve tedavi seçenekleri ele alınmıştı

Ecstasy (MDMA) and its effects on kidneys and their treatment: a review

WOS: 000391089600001PubMed: 27917269Ecstasy (MDMA; 3,4-methylenedioxymethylamphetamine) is an illicit drug that has been increasingly abused by young people. Its effects include euphoria, enhanced sociability and heightened mental awareness. These come about via the increase of serotonin in both the central nervous system and the sympathetic nervous system. Despite the drug's prevalent abuse, serious or adverse effects are rare. Due to personal pharmacokinetics, effects from the same dosage vary according to the individual. Fatal instances may include acute hyponatremia, hyperthermia (>42 degrees C), disseminated intravascular coagulation (DIC) resulting from hyperthermia affecting the kidneys, and non-traumatic rhabdomyolysis. However, it is seldom the case that hyponatremia and hyperthermia co-exist. Hyponatremia is thought to be caused by HMMA - a metabolite of MDMA. Hyponatremia is caused by the inappropriate secretion of arginine vasopressin (AVP) and the excessive intake of hypotonic liquid accompanied by increased hyperthermia. Symptomatic, even deadly hyponatremia is seen more frequently in females, with the effects of oestrogen on arginine vasopressin believed to be the cause. Onset in such cases is acute, and treatment should be given to symptomatic patients as quickly as possible, with 3% saline administered when necessary. Reasons for acute kidney injury may include rhabdomyolysis, malign hypertension, and necrotizing vasculitis

Relationship between the prognostic nutritional index and resistant hypertension in patients with essential hypertension

Objectives Immune system activation plays a role in resistant hypertension (RHTN) pathogenesis. The clinical effect of the prognostic nutritional index (PNI) on patients with RHTN remains unclear. The aim of this study investigated the possible correlation between PNI and RHTN. Methods In this cross-sectional study, we enrolled 180 adult subjects. In patients were classified into three groups according to their office and ambulatory blood pressure measurements (ABPM): RHTN (n = 60), controlled hypertension (CHTN, n = 60), and normotension-control (NT-C, n = 60). RHTN was defined as BP ≥140/90 mm Hg while taking ≥3 antihypertensive medications or BP <140/90 mm Hg while taking ≥4 medications. The PNI was calculated from the 10 x serum albumin (g/dL) + 0.005 x total lymphocyte count (/μL) formula. Results Office and ABPM were significantly higher in patients with RHTN. Patients in the RHTN (46.1 ± 5.3) had significantly lower PNI than that in the CHTN (54.9 ± 6.7) (P = .032), and PNIs of both hypertensive groups were significantly lower than the NT-C group (P = .019, for both). The ROC curve analysis performed to assess the predictive value of PNI for RHTN and using 50.9 optimal cutoff value of PNI for RHTN gave a sensitivity of 77% and a specificity of 68.5% (AUC = 0.73, 95% CI 0.69–0.96). Multivariate analysis indicated diabetes, 24-h ABPM SBP, CRP, pill burden, and PNI (<51.6) as independent predictors of RHTN. Conclusion This study showed that the level of PNI was significantly lower in patients with RHTN compared to patients with CHTN. PNI is independently related to RHTN

Tekrarlayan aftöz ülserasyonlar ve tedavisinde güncel yaklaşımlar

&lt;p&gt;Recurrent aphthous ulcer (RAU) is one of the most common oral mucosal diseases and it affects approximately %25 of the society. It is characterized with recurrent painful, round-shaped ulcers surrounded with erythemathosus halo. Local and systemic conditions together with genetic, immunologic and microbiological factors were shown to be possible etiological factors but there is no consensus for its etiology. Although several immunomodulators, topical and systemic steroid drugs, topical analgesics and antibiotics have shown to be effective for the treatment of RAU, it is not possible to eliminate the recurrence. In this article; etiology, clinical appearance, differential diagnosis and treatment methods are reviewed.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;&lt;strong&gt;ÖZET&lt;/strong&gt;&lt;/p&gt; &lt;p&gt;Tekrarlayan aftöz ülserler (TAÜ) en sık rastlanılan ağız mukozası hastalıklarından biridir ve toplumun yaklaşık %25’ini etkilemektedir. Tipik olarak tekrarlayan, sığ ve eritematöz bir hale ile çevrili, oldukça ağrılı ülserler ile karakterizedir. Lokal ve sistemik koşullar ile genetik, immünolojik ve mikrobiyal faktörler olası etiyolojik faktörler arasında gösterilmiş olmakla beraber, kesin bir etiyolojik faktörden söz edilememektedir. TAÜ tedavisi amacıyla çeşitli immün modülatörler, topikal ve sistemik steroidler, topikal analjezikler, topikal antibiyotikler ve çeşitli kaplayıcı ajanların başarılı bir şekilde uygulandığı gösterilmiş olmasına rağmen tekrarları önlemek mümkün olmamıştır. Bu makalede tekrarlayan aftöz ülserlerin etiyolojisi, klinik görünümü, ayırd edici özellikleri ve tedavi seçenekleri ele alınmıştır.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Anahtar Kelimeler:&lt;/strong&gt; Aftöz ülserler, etiyoloji, klinik görünüm, tedavi&lt;/p&gt

Dentinal Dysplasia Type I: A Case Report with a 6-Year Followup

Introduction. Dentin dysplasia is a rare disturbance of dentin formation characterized by normal enamel but atypical dentin formation with abnormal pulpal morphology that is inherited as an autosomal pulpal morphology. Case Presentation. A 7-year-old female who had problems in chewing function was referred to Oral and Maxillofacial Surgery Department at the Faculty of Dentistry in Ondokuz Mayıs University. In the radiographic examination, it was determined that some of the unerupted permanent teeth of the patient had short, blunted, and malformed roots with obliterated pulp chambers, although the bone below the teeth showed well-defined margins. This unusual case of generalized short roots presents a case demonstrating both classic and atypical features of dentinal dysplasia type I (DDI) in the mixed and permanent dentitions. Conclusion. There are still many issues in the diagnosis and management of patients with dentin dysplasia. Early diagnosis, clinical and radiographic findings, as well as treatment of this condition and the initiation of effective preventive strategies may help prevent or delay loss of dentition

Comparison of the postoperative analgesic effect of transversus abdominis plan block and quadratus lumborum block: A prospective randomized study

Abstract Background and Aims In this study, we aimed to compare the transversus abdominis plan block (TAP) and quadratus lumborum block (QL) efficacy for postoperative analgesia in patients undergoing varicocelectomy under spinal anesthesia. Methods American Society of Anesthesiologists (ASA) 1 and 2 patients, aged 18–45 years, who underwent varicocelectomy operation under elective conditions, were included. Eighty patients were divided into three groups as TAP group, QL group, and control group by prospective randomization. The patients were operated under spinal anesthesia. At the end of the operation, TAP was applied to the TAP group with a posterior approach using ultrasound (USG) in the supine position. To the QL group, the patient was placed in the lateral decubitus position and the lateral QL was applied via USG. No block type was applied to the control group. Patient‐controlled analgesia (PCA) device containing tramadol was administered intravenously at the end of the surgery in all groups. Visual analogue scale (VAS) score was questioned at 0, 2, 4, 6, 8, 10, 12, 18, 24 h in the follow‐up of the patients. Intravenous 1 g paracetamol was given over VAS 4. PCA usage time and usage amounts were recorded. Results As a result of comparing the groups according to the VAS scores at all hours were significantly different between the three groups (p  0.05). Conclusion TAP and QL, which are administered to evaluate the effectiveness of postoperative analgesia in patients undergoing varicocelectomy under spinal anesthesia, are both effective in reducing pain scores and the amount of analgesia consumption

A previously unreported etiology of trigger toe

Trigger toe is a rare entity, with only a few cases reported in the literature. It is usually seen in ballet dancers as a result of compression of the flexor hallucis longus tendon in the tarsal tunnel beneath the medial malleolus. We report a case of trigger toe due to a constricting lesion on the extensor hallucis longus tendon

The value of tests evaluating visual functions in detecting overt or subclinical optic neuritis in multiple sclerosis

WOS: 000432725300014PubMed ID: 2947119