36 research outputs found
Böbrek nakli sonrası kemik mineral yoğunluğundaki değişiklikler
Aim: The aim of this study was to evaluate changes in lumbar and femoral bone mineral
density (BMD) in the post-transplant period.
Material and Methods: A total of 69 consecutive adult (>18 years of age) patients who
underwent kidney transplantation between Jan 2016 and Jul 2019 were included in this
retrospective study. The demographic features and laboratory findings of the patients (serum
corrected calcium, phosphorus, alkaline phosphatase, creatinine, eGFR, i-parathormone and
25(OH) D vitamin levels) were recorded. BMD was evaluated by dual energy X-ray
absorptiometry (DEXA).
Results: According to the DEXA results, lumbar and femoral T scores were -1.1±1.3
and -1.1±1.1, respectively. Lumbar assessment revealed osteoporosis in 12 (17.4%) patients
and osteopenia in 24 (34.8%) patients. Femoral assessment revealed osteoporosis in 7 (10.1%)
patients and osteopenia in 29 (42.0%) patients. The first year, 1-2 year and >2 years follow up
data revealed osteoporosis in 4.3%, 5.8% and 7.2% of patients in the lumbar region and in
2.9%, 2.9% and 4.3% of patients in the femoral region, respectively. There was no significant
difference in cumulative steroid dose between patients with BMD loss in the lumbar (p=0.197)
and femoral (p=0.971) region and patients with normal BMD measurement. In addition, no
significant relation was observed between the induction therapy and loss of BMD in the lumbar
region (p=0.671) and femur (p=0.126).
Conclusion: As a result, 25(OH) D vitamin deficiency is quite common in transplant patients
and the loss of BMD is observed especially in the lumbar region in the first year after
transplantation
Personel Selection based on Talent Management
AbstractDue to the globalization, organizations need professional human resources. Qualified personel which has high performances on capability, knowledge, skill, and other abilities play significant roles in the success of an organization. On the other hand having an improper personel might cause many problems such as affecting productivity, precision, flexibility and quality of the products/service negatively. Nowadays organizations try to employ much more qualified personel on management level and they want to find out firstly inside of them. As a new concept talent management deals with this kind of situations.Right using of talents make the work much more successful and making the work right bring the success to the organization. The subject of this study is to promote a personel dealing with talent management as General Manager (GM) under personel selection problem. There exist six criteria and three candidates for the selection process. In this study, a hybrid model which employs multi attribute decision making methods together, is proposed for the personel selection problem
Hyponatremia in the outpatient setting: clinical characteristics, risk factors, and outcome
Purpose Hyponatremia is a common disorder and
hyponatremia in the outpatient setting is not extensively
studied. Our aim was to investigate the characteristics of
hyponatremia in ambulatory patients.
Methods Seventy-six adult outpatients with hyponatremia
were enrolled in this prospective study. Demographic features,
presenting symptoms and signs, associating morbidities,
medications, laboratory findings, mortalities, and
length of hospital stay, were recorded.
Results Mean age was 74.7 ± 12.7 years, and 52 (68.4 %)
were female whereas 24 (31.6 %) were male. Mean sodium
concentration was 123.6 ± 6.6 mEq/L. Leading cause was
thiazide diuretic use (n = 37, 48.7 %) and approximately
half of the patients (n = 40, 52.6 %) had a multifactorial
etiology. Severe hyponatremia (sodium < 125 mEq/L)
was identified in 37 (48.7 %). Thiazide diuretic use, vomiting,
and apathy were independent predictors of severe
hyponatremia. Eight (10.5 %) patients had a mortal course.
A relatively younger age, male gender, presenting sign of
lethargy, associating morbidities of malignancy, chronic
liver disease, and hypoalbuminemia were risk factors for
mortality.
Conclusions Hyponatremia is prevalent among elderly,
especially in women and with thiazide diuretics. Apart
from the trend toward sodium depletion observed in healthy elderly which occurs due to changes in the tubular
handling of sodium, a multifactorial etiology including thiazides
seems to predict the occurrence and the severity of
hyponatremia. Hyponatremia may be a significant cause of
mortality in seniors. A relatively younger age, male gender,
association of cirrhosis, malignancy, and hypoalbuminemia
predict mortality. In elderly outpatients, identification of
the risk factors for hyponatremia and close monitoring are
imperative to reduce the related mortality and morbidity
Renal transplant alıcılarında transplant sonrası nötrofil-lenfosit oranı ve trombosit-lenfosit oranı ile graft fonksiyonu arasındaki ilişki
Aim: The aim of this study was to evaluate the association of neutrophil-to-lymphocyte ratio
(NLR) and platelet-to-lymphocyte ratio (PLR) with acute rejection after kidney
transplantation.
Material and Methods: A total of 36 adult renal transplant recipients (33 males, 3 females)
with a median age of 41 (range, 19-64) years were included in this retrospective study
conducted between January 2016 and January 2019. Data on patient demographics and
laboratory findings (neutrophil, lymphocyte, platelet, creatinine, eGFR, serum uric acid and
C-reactive protein) were recorded. Acute rejection was defined via renal biopsy in accordance
with Banff criteria.
Results: Acute rejection occurred in 16 (44.4%) patients. NLR (median 3.75 vs. 1.99, p=0.001)
and PLR (median 125.59 vs. 99.23, p=0.008) values were significantly higher in the acute
rejection group than in the control group. Area under the curve was calculated to be 0.822 for
NLR and to be 0.759 for PLR. Cut-off values were determined to be >2.5 (75% sensitivity and
75% specificity) for NLR and to be >108 (81% sensitivity and 65% specificity) for PLR.
Univariate analysis revealed a strong correlation of acute rejection both with NLR >2.5 (Odds
Ratio (OR)=0.267, 95% Confidence Interval (CI)=0.089-0.803, p=0.019) and PLR >108
(OR=0.231, 95% CI=0.066-0.810, p=0.022).
Conclusion: In kidney transplant patients, there is a strong relationship between high NLR
and PLR values and the development of acute rejection. As simple, easy-to-access, inexpensive
and non-invasive methods, PLR, and particularly NLR, may be potential tests to diagnose posttransplant acute rejectio
Warfarın increases the risk of vascular calcification in haemodialysis patients a multicenter case-control study
57th ERA-EDTA CongressERA, EDT
Mechanical properties of impregnated and heat treated oriental beech wood
The main purpose of this study was to investigate mechanical properties
such as the modulus of rupture (MOR) and compression strength parallel
to grain (CSPG) of impregnated and heat-treated Oriental beech (Fagus
orientalis L.) wood. Some copper and boron containing impregnation
chemicals such as Wolmanit CX-8 (WCX-8) and Celcure AC-500 (CAC500) were used. Wood specimens were impregnated 2% aqueous solution
of the chemicals according to ASTM D1413-07e1 standard. The wood
specimens were heated at 150 and 175 °C for 4 and 8 h, respectively.
Results showed that both impregnation and heat treatment decreased the
MOR and CSPG of Oriental beech wood. The MOR losses of Oriental
beech after both treatments were higher than CSPG losses. The largest
reduction of MOR and CSPG were observed with 51.5% and 15.5% for
CAC-500 impregnated and heated at 175 °C for 8 h. Except for WCX-8
impregnation and heat treatment at 150 °C for 4 and 8 h, the MOR values
of impregnated and heat-treated Oriental beech wood were lower than
only heat-treated Oriental beech wood. It was also found that the CSPG
values of impregnated and heat-treated Oriental beech wood were higher
than only heat-treated Oriental beech wood, except for impregnation and
heat treatment at 175 °C for 8 h
A multicenter study of the clinical, laboratory characteristics and potential prognostic factors in patients with aa amyloidosis on hemodialysis
Introduction While light chain (AL) amyloidosis is more common in western countries, the most common type of amyloidosis is amyloid A (AA) amyloidosis in Eastern Mediterranean Region, including Turkey. Although worse prognosis has been attributed to the AL amyloidosis, AA amyloidosis can be related to higher mortality under renal replacement therapies. However, there are no sufficient data regarding etiology, clinical presentation, and prognostic factors of AA amyloidosis. The objective of our study is to evaluate the clinical, laboratory characteristics, and possible predictive factors related to mortality in patients with AA amyloidosis undergoing hemodialysis (HD). Methods This multicenter, cross-sectional study was a retrospective analysis of 2100 patients on HD. It was carried out in 14 selected HD centers throughout Turkey. Thirty-two patients with biopsy-proven AA amyloidosis and thirty-two control patients without AA amyloidosis undergoing HD were included between October 2018 and October 2019. There was no significant difference between the groups in terms of age and dialysis vintage. Causes of AA amyloidosis, treatment (colchicine and/or anti-interleukin 1 [IL] treatment), and the number of familial Mediterranean fever (FMF) attacks in the last year in case of FMF, systolic and diastolic blood pressures, biochemical values such as mean CRP, hemoglobin, serum albumin, phosphorus, calcium, PTH, ferritin, transferrin saturation, total cholesterol levels, EPO dose, erythropoietin-stimulating agents resistance index, interdialytic fluid intake, body mass indexes, heparin dosage, UF volume, and Kt/V data in the last year were collected by retrospective review of medical records. Findings Prevalence of AA amyloidosis was found to be 1.87% in HD centers. In amyloidosis and control groups, 56% and 53% were male, mean age was 54 +/- 11 and 53 +/- 11 years, and mean dialysis vintage was 104 +/- 94 and 107 +/- 95 months, respectively. FMF was the most common cause of AA amyloidosis (59.5%). All FMF patients received colchicine and the mean colchicine dose was 0.70 +/- 0.30 mg/day. 26.3% of FMF patients were unresponsive to colchicine and anti-IL-1 treatment was used in these patients. In AA amyloid and control groups, erythropoietin-stimulating agents resistance index were 7.88 +/- 3.78 and 5.41 +/- 3.06 IU/kg/week/g/dl, respectively (p = 0.008). Additionally, higher CRP values (18.78 +/- 18.74 and 10.61 +/- 10.47 mg/L, p = 0.037), lower phosphorus (4.68 +/- 0.73 vs. 5.25 +/- 1.04 mg/dl, p = 0.014), total cholesterol (135 +/- 42 vs. 174 +/- 39 mg/dl, p < 0.01), and serum albumin (3.67 +/- 0.49 mg/dl, 4.03 +/- 0.22, p < 0.01) were observed in patients with AA amyloidosis compared to the control group. Discussion In this study, we found that long-term prognostic factors including higher inflammation, malnutritional parameters, and higher erythropoietin-stimulating agents resistance index were more frequent in AA amyloidosis patients under HD treatment
Cardiac complications of secondary hyperparathyroidism in chronic hemodialysis patients
Aim: To evaluate the eff ects of intact parathormone (iPTH) on left ventricular function using transthoracicechocardiography on chronic hemodialysis (HD) patients with secondary hyperparathyroidism. In HD patients,mortality is high and is frequently due to cardiac complications. Secondary hyperparathyroidism, high levels ofphosphate (PO4), and high calcium phosphate product (Ca × PO4) are related to cardiac complications.Materials and methods: We examined 20 patients with normal iPTH levels (Group 1) and 20 patients with high iPTHlevels (Group 2). Intact parathormone levels were measured in serum with a Coat-A-Count kit (Diagnostic ProductsCorporation, Los Angeles, CA, USA) using an immunoradiometric assay. Th e normal level of iPTH was 0.8-5.2 pmol/L.In patients with end-stage renal disease, iPTH levels should be 1.5 to 3 times higher than the normal range in order tomaintain the bone mass; thus, patients with iPTH levels 4 or more times higher than the normal range (PTH ? 20.8pmol/L) were defi ned as Group 2 while patients who had normal iPTH levels were defi ned as Group 1.Results: In both groups, Doppler parameters indicated diastolic dysfunction. However, mitral annular E velocity waslower in Group 2 than in Group 1 (6.1 ± 1.1 cm/s and 7.5 ± 1.6 cm/s, respectively; P = 0.034). It is well known thatleft ventricular hypertrophy (LVH) increases mortality rates. Left ventricle mass index and relative wall thickness areparameters refl ecting LVH, and both were higher in Group 2 (294.4 ± 103.0 g/m² and 53.5 ± 11.7%) when comparedwith Group 1 (179.2 ± 104.2 g/m² and 41.8 ± 8.9%). Th ese diff erences were found to be statistically signifi cant (P <0.001).Conclusion: Th is study demonstrates that high levels of iPTH contribute to diastolic dysfunction and LVH inhemodialysis patients
Efficacy and safety of low-dose valganciclovir prophylaxis among renal transplant recipients
Purpose: Cytomegalovirus (CMV) infection is one of the
most common infections observed following kidney
transplantations. Transplantations between
cytomegalovirus (Immunoglobulin G)-seropositive donor
and CMV-seropositive recipient (D+/R+) are considered
to be of moderate risk. In our study, we investigated the
efficacy of low-dose (450 mg/g) valganciclovir in CMV
chemoprophylaxis in renal transplant patients over their
first post-transplant year.
Materials and Methods: A total of 68 consecutive
patients aged over 18 years who underwent renal
transplantation between January 2016 and June 2019 were
included in this retrospective study. All patients were
administered valganciclovir 450 mg/g, for 100 days. The
efficacy of low-dose valganciclovir was determined by
whether the patients developed a CMV disease during their
first post-transplant year.
Results: Only one patient (n=1/68) (1.5%) developed
CMV disease. CMV DNA titer was positive on posttransplant day 134 of the patient who had unexplained loss
of GFR. CMV disease-related acute rejection, graft loss,
leukopenia, post-transplant diabetes mellitus,
opportunistic infection, or patient loss was not observed.
Conclusion: There are many studies comparing CMV
prophylaxis with low and standard dose (450 vs. 900 mg/g)
valganciclovir treatment in transplant patients. The results
of this study show that low-dose valganciclovir is sufficient
for the prophylaxis of CMV disease in D+/R+ mediumrisk patients without leading to any side effects. Further
clinical studies with larger patient participation are needed
Changes in Bone Mineral Density after Kidney Transplantation
Aim: The aim of this study was to evaluate changes in lumbar and femoral bone mineral
density (BMD) in the post-transplant period.
Material and Methods: A total of 69 consecutive adult (>18 years of age) patients who
underwent kidney transplantation between Jan 2016 and Jul 2019 were included in this
retrospective study. The demographic features and laboratory findings of the patients (serum
corrected calcium, phosphorus, alkaline phosphatase, creatinine, eGFR, i-parathormone and
25(OH) D vitamin levels) were recorded. BMD was evaluated by dual energy X-ray
absorptiometry (DEXA).
Results: According to the DEXA results, lumbar and femoral T scores were -1.1±1.3
and -1.1±1.1, respectively. Lumbar assessment revealed osteoporosis in 12 (17.4%) patients
and osteopenia in 24 (34.8%) patients. Femoral assessment revealed osteoporosis in 7 (10.1%)
patients and osteopenia in 29 (42.0%) patients. The first year, 1-2 year and >2 years follow up
data revealed osteoporosis in 4.3%, 5.8% and 7.2% of patients in the lumbar region and in
2.9%, 2.9% and 4.3% of patients in the femoral region, respectively. There was no significant
difference in cumulative steroid dose between patients with BMD loss in the lumbar (p=0.197)
and femoral (p=0.971) region and patients with normal BMD measurement. In addition, no
significant relation was observed between the induction therapy and loss of BMD in the lumbar
region (p=0.671) and femur (p=0.126).
Conclusion: As a result, 25(OH) D vitamin deficiency is quite common in transplant patients
and the loss of BMD is observed especially in the lumbar region in the first year after
transplantation