Influence of long term erythropoietin therapy on the hypothalamic-pituitary-thyroid axis in patients undergoing CAPD

Objective: Treatment of anemia with recombinant human erythropoietin (rHuEpo) in hemodialysis patients has been associated with improvement of several abnormalities in hypothalamic-pituitary function. The aim of the present study is to investigate the effects of long term erythropoietin therapy on the hypothalamic-pituitary-thyroid hormone axis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Design: Single center, prospective study. Patients and methods: Ten patients who were clinically stable and had been on CAPD were evaluated. Eleven age and sex matched healthy volunteers were chosen as controls. All of the patients were clinically euthyroid. All patients were on CAPD therapy and none of them had received rHuEpo treatment previously. In all patients after basal estimations of free T-3, free T-4, TSH, GH and prolactin levels, a bolus of 400 mug TRH was administered intravenously. Levels of TSH, GH and prolactin were measured in blood samples collected every 30 min of the 3 h test period. After the treatment with rHuEpo, TRH test with the same protocol was repeated. Results: Before the improvement in serum hemoglobin levels with rHuEpo treatment, the patients on CAPD showed abnormal hypothalamic-pituitary-thyroidal functions, including delayed and prolonged TSH (NS), paradoxically elevated GH (p < 0.001) and increased and prolonged prolactin (p = 0.001) responses to TRH. After improvement of anemia with rHuEpo no significant difference was found between the patients and control groups for baseline TSH levels. In the patients peak TSH level and AUC of TSH secretion were significantly reduced after the treatment (p < 0.05 for both). Furthermore the improvement in anemia did not eliminate the paradoxic GH and prolonged prolactin responses to TRH administration. Conclusion: Some hypothalamic-pituitary-thyroid function abnormalities including delayed and blunted TSH, increased and prolonged prolactin and paradoxical GH responses to TRH administration were observed in uremic patients treated with CAPD and the improvement in anemia with rHuEpo seems to cause slight changes on the hypothalamic-pituitary-thyroid axis and peripheral thyroid hormones

1980-1996 yılları arasında yabancı pop müziğinin Türk Pop Müziği üzerindeki etkisi

Ankara : İhsan Doğramacı Bilkent Üniversitesi İktisadi, İdari ve Sosyal Bilimler Fakültesi, Tarih Bölümü, 2015.This work is a student project of the The Department of History, Faculty of Economics, Administrative and Social Sciences, İhsan Doğramacı Bilkent University.by Taş, Ebru Sönmez

Acute kidney injury in Turkey: epidemiological characteristics, etiology, clinical course, and prognosis

Background This study aimed to evaluate the etiologies, comorbidities, and outcomes of acute kidney injury (AKI) in Turkey and determine any potential differences among different geographical parts of the country. Methods This prospective observational study was conducted by the Acute Kidney Injury Working Group of the Turkish Society of Nephrology. Demographical and clinical data of patients with AKI at the time of diagnosis and at the 1(st) week and 1(st), 3(rd), and 6(th) months of diagnosis were evaluated to determine patient and renal survival and factors associated with patient prognosis. Results A total of 776 patients were included (54.7% male, median age: 67 years). Prerenal etiologies, including dehydration, heart failure, and sepsis, were more frequent than other etiologies. 58.9% of the patients had at least one renal etiology, with nephrotoxic agent exposure as the most common etiology. The etiologic factors were mostly similar throughout the country. 33.6% of the patients needed kidney replacement therapy. At the 6(th) month of diagnosis, 29.5% of the patients had complete recovery; 34.1% had partial recovery; 9.5% developed end-stage kidney disease; and 24.1% died. The mortality rate was higher in the patients from the Eastern Anatolian region; those admitted to the intensive care unit; those with prerenal, renal, and postrenal etiologies together, stage 3 AKI, sepsis, cirrhosis, heart failure, and malignancy; those who need kidney replacement therapy; and those without chronic kidney disease than in the other patients. Conclusion Physicians managing patients with AKI should be alert against dehydration, heart failure, sepsis, and nephrotoxic agent exposure. Understanding the characteristics and outcomes of patients with AKI in their countries would help prevent AKI and improve treatment strategies

Acute Systemic Toxicity in a Patient After a Single Dose of Diclofenac

Non steroid antiinflammatory drugs (NSAIDs) have been known to be a cause of acute hemolytic anemia, acute hepatic failure and acute renal failure for a long time. We report a 50 years old woman with lomber disc hernia who had been injected a single dose diclofenac sodium because of lomber pain and afterwards in 24 hour period observed deterioration in general health status. Her bichemical evaluation was consistent with acute hemolysis, acute hepatic injury and acute renal failure. After supportive therapy her general health status and biochemical parameters started to ameliorate and on the twentyfirst day of administration the patient was discharged with normal hematologic, liver and kidney parameters. It should be remembered by the clinicians that NSAIDs can cause multisystemic toxicities as hemolytic anemia, liver disfunction and kidney failure. Hence, immediate therapeutic interventions after the diagnosis can be life-saving. Key Words: Hemolysis, acute liver failure, acute renal failure, diclofenac. Bir Hastada Tek Doz Diklofenak Kullanımı Sonrası Gelişen Akut Sistemik Toksisite Non sterid antienflamatuar ilaçlar (NSAİİ)&apos;ın hemolitik anemi, karaciğer yetmezliği ve böbrek yetmezliğine neden olduğu uzun zamandır bilinmektedir. Bu yazımızda, lomber disk hernisi nedeniyle tek doz diklofenak enjeksiyonu yaptıran ve sonrasında genel sağlık durumu bozulan 50 yaşındaki bir kadın hastayı sunuyoruz. Hastanın laboratuar değerlendirmesi hemoliz, akut karaciğer ve böbrek yetmezliği ile uyumluydu. Yapılan tedavi sonrasında genel durumu ve laboratuar değerleri normale dönen olgu takibinin yirmibirinci gününde taburcu edildi. Klinisyenler NSAİİ&apos;ların sistemik toksik etkileri olabileceğini akılda tutmalıdırlar. Çünkü tanı sonrası acil tedavi müdahaleleri hayat kurtarıcı olabilmektedir. Anahtar Kelimeler: Hemoliz, akut karaciğer yetmezliği, akut böbrek yetmezliği, diklofenak