Ertapenem Related Neurotoxicity Presented with Visual Halusinations in Chronic Kidney Failure Patient

During the follow-up of patients with renal failure, many medications may be required due to the clinical condition and comorbidities. Care should be taken in terms of the nephrotoxic effect of these drugs used or the accumulation of renally excreted drugs in the body and causing toxic effects. One of the most important side effects of carbapenems is neurotoxicity. Although Imipenem is the most frequently mentioned in this respect, similar side effects can be seen due to other carbapenems. Even if the dose is adjusted according to the glomerular filtration rate, these side effects can be seen. When the literature is examined, it has been determined that neurotoxicity due to ertapenem is seen more frequently than expected. In this study, we wanted to draw attention to this issue by presenting our case of visual hallucination observed after the use of ertapenem in a patient with chronic renal failure

Dijagnostička točnost sastojaka mlijeka kod dijagnostike gravidnosti u krava srednje i kasne laktacije

The aims of this study were to establish a cut-off point by evaluating the usability of the somatic cell count (SCC) and milk components (fat, fat-free dry matter (FFDM), protein, lactose, freezing point, electrical conductivity and pH) to observe the pregnancy status, and to determine the practical usage of these parameters as diagnostic biomarker of pregnancy status. In the present study, primiparous Holstein cows (n=133) were included in the mid and late lactation. Milk samples were collected in sterile tubes for SCC and milk components analysis. In each lactation period, SCC, milk yield and milk component parameters were analysed by Student\u27s t test according to pregnancy status. Receiver operating characteristic curves were used to determine the predictive threshold using SCC and milk component parameters to discriminate between pregnant and non-pregnant cows. SCC levels were similar for all cows in the mid and late-lactation. In the mid lactation, FFDM, protein, lactose and electrical conductivity were higher and milk yield, fat, freezing point and pH were lower in pregnant cows (p<0.05). In the late lactation, FFDM, protein, lactose and electrical conductivity were significantly higher and milk yield, fat and pH were significantly lower in pregnant cows (p<0.05). Furthermore, fat, FFDM, protein, lactose, freezing point, electrical conductivity, and pH were the best predictors for pregnancy diagnosis in mid-lactating cows with the AUC values of 0.840, 0.768, 0.780, 0.772, 0.693, 0.792, and 0.901 respectively. Furthermore, fat, FFDM, protein, lactose, electrical conductivity, and pH could be useful diagnostic tools for pregnancy determination in late lactating cows with the AUC values of 0.869, 0.684, 0.661, 0.689, 0.756, and 0.841 respectively. In conclusion, the milk components could be used as rapid, easily accessible, and inexpensive markers for the evaluation of the diagnosis of pregnancy status in primiparous Holstein cows.Ciljevi ove studije bili su utvrditi granične vrijednosti procjenom mogućnosti upotrebe broja somatskih stanica (SCC) i pojedinih fizikalno-kemijskih parametara mlijeka (udio masti, bezmasne suhe tvari (FFDM), proteina, laktoze, točke zamrzavanja, električne vodljivosti i pH) za promatranje statusa gravidnosti kao i u svrhu korištenja navedenih parametara kao bioloških markera u dijagnozi statusa gravidnosti. U ovu su studiju bile uključene prvotelke holstein pasmine (n=133) u srednjoj i kasnoj laktaciji. Uzorci mlijeka sakupljani su u sterilne epruvete za analizu SCC i fizikalno-kemijskih parametara. U svakom razdoblju laktacije, SCC, prinos mlijeka i fizikalno-kemijski parametri analizirani su Student t-testom u odnosu na status gravidnosti. Za određivanje prediktivnog praga korištene su krivulje odnosa specifičnosti i osjetljivosti klasifikatora (ROC), korištenjem SCC i fizikalno-kemijskih parametara mlijeka za razlikovanje gravidnih i negravidnih krava. Za sve krave u srednjoj i kasnoj laktaciji razine SCC bile su slične. Sredinom laktacije, FFDM, udjeli proteina i laktoze te električna vodljivost bili su viši, a prinos mlijeka, udio masti, točka ledišta i pH bili su niži u gravidnih krava (p<0,05). U kasnoj laktaciji, FFDM, udjeli proteina i laktoze te električna vodljivost bili su značajno viši, a prinos mlijeka, udio masti i pH bili su značajno niži u gravidnih krava (p<0,05). Udjeli masti, proteina i laktoze, FFDM, točka ledišta, električna vodljivost i pH bili su najbolji prediktori za dijagnozu gravidnosti kod krava u srednjoj laktaciji s vrijednostima površina ispod ROC krivulje (AUC) 0,840, 0,768, 0,780, 0,772, 0,693, 0,792 i 0,901. Udjeli masti, proteina i laktoze, FFDM, električna vodljivost i pH mogu biti korisni dijagnostički alati za određivanje gravidnosti kod krava u kasnoj laktaciji s AUC vrijednostima 0,869, 0,684, 0,661, 0,689, 0,756 i 0,841. Zaključno, komponente mlijeka mogu se koristiti kao brzi, lako dostupni i jeftini markeri za procjenu dijagnoze statusa gravidnosti kod prvotelki holstein krava

The efficacy of cinacalcet in the treatment of hyperparathyroidism in Turkish hemodialysis patient population

WOS: 000393291900012OBJECTIVE: Cinacalcet reduces parathyroid hormone levels by increasing the sensitivity of the parathyroid gland to calcium. in this study, we firstly aimed to evaluate the efficacy of cinacalcet in Turkish hemodialysis patients. MATERIAL and METHODS: 4483 hemodialysis patients were screened and 469 patients who had used cinacalcet were included in the study. the patients were divided into 4 groups according to drug usage durations (Group 1: 3 months, Group 2: 6 months, Group 3: 9 months and Group 4: 12 months). the patients' Parathormone, Ca, P and CaxP levels at the 3rd, 6th, 9th and 12th months were compared to the start of treatment and previous months. RESULTS: the levels of Parathormone, Ca, P and CaxP significantly decreased compared to their initial levels in all groups (from 1412 pg/ml to 1222 pg/mL for Parathormone, p< 0,001) in the 3rd month. However, this reduction was not continued in the subsequent months (Parathormone: 1381 pg/ml for the 12th month). CONCLUSION: Cinacalcet may not provide adequate benefit in control of hyperparathyroidism in Turkish hemodialysis patient population

Respiratory Health Symptoms among Students Exposed to Different Levels of Air Pollution in a Turkish City

In this study, we aimed to investigate the frequency of respiratory health symptoms among high school students attending schools at industrial, urban and rural areas in a Turkish city. Three schools located in different zones of the city having different pollution characteristics were chosen based on the pollutant distribution maps using Geographical Information Systems (GIS) software. A cross-sectional survey was performed among 667 high school students in the schools. Outdoor and indoor nitrogen dioxide (NO2) and ozone (O3) concentrations were also measured by passive samplers in the same schools to investigate possible routes of exposure. Chronic pulmonary disease (OR = 1.49; 95%CI: 1.11–1.99; p = 0.008), tightness in the chest (OR = 1.57; 95%CI: 1.22–2.02; p = 0.001), morning cough (OR = 1.81 95%CI: 1.19–2.75; p = 0.006) were higher among students in the industrial zone where nitrogen dioxide and ozone levels were also highest. There were no indoor sources of nitrogen dioxide and ozone exists in the schools except for the dining hall. As a conclusion, this study has noticed that air pollution and respiratory health problems among high school students are high in industrial zones and the use of passive samplers combined with GIS is an effective tool that may be used by public health researchers to identify pollutant zones and persons at risk

İnvestigate the risk of development of thyroid malignancies among the kidney recipients

Böbrek nakli (BN), son dönem böbrek yetmezliği (SDBY) tedavisinde en seçkin yöntemdir. Böbrek nakli sonrası, erken dönemde akut rejeksiyon (AR) ve enfeksiyonlar sık görülürken, geç dönemde malignite gelişimi ve kardiyovasküler komplikasyonlar daha sıktır. SDBY hastalarında tiroid hormon metabolizmasına ait pek çok değişiklik görülür, ancak böbrek nakli sonrası ilk 6 ay içerisinde hormon değişikliklerinde denge sağlanır. Bu hastalar böbrek nakli sonrası guatr, tiroid nodülü ve tiroid malignitesi gelişimi açısından risk altındadırlar. Biz bu çalışmada Dokuz Eylül Üniversitesi Hastanesi erişkin Nefroloji Bilim Dalı'nda takip edilen böbrek nakli hastalarının tiroid fonksiyonlarını değerlendirmeyi ve malignite gelişimi riskini araştırmayı amaçladık. Çalışmaya 122 böbrek nakli hastası alındı. Hastaların 76' sı erkek, 46' sı kadın, yaş ortalamaları 39.8 ± 12.1 yıl, nakil sonrası takip süresi iseæ 59.9 ± 49.5 (6-372) ay idi. Laboratuar incelemelerindeæ 108 hasta ötiroid (%88.5), 2 hasta subklinik hiportiroidi, 10 hasta subklinik hipertiroidi, 2 hasta da ise sadece fT3 düşüklüğü saptandı. Bütün hastalarda tiroid otoantikorları negatif olarak bulundu. Tiroid ultrasonografisindeæ tiroid hacimleri ortalama 14.2 ± 7.2 mL olup, 112 (% 91.8) hastada guatr, 49 (% 40.2) hastada tiroid nodülü saptandı. Tiroid nodulü saptanan hastalarınæ yaş ortalaması 42.1 ± 10.8 yıl olup, böbrek nakli sonrası dönemde takip süreleriæ 54.7 ± 38.7 ay olarak belirlendi. Tiroid nodülü saptanan hastaların incelemesindeæ 43 (% 87.8) hasta ötiroid, 1 hasta subklinik hiportiroidi, 4 hasta subklinik hipertiroidi, 1 hastada ise sadece T3 düşüklüğü saptandı. 24 (% 48.9) hastaya tiroid ince iğne aspirasyon biyopsisi (İİAB) yapıldı. Diğer hastalar ise ultrasonografik olarak takibe alındı. 2 hasta malignite şüphesiyle operasyona verildi. Hastaların sadece 1 (% 0.8) ‘inde tiroid papiller Ca saptandı ve total tiroidektomi yapıldı. Sonuçæ tiroid kanserleri genellikle asemptomatik seyrettiği için, böbrek nakli hastalarının izlemde yıllık tiroid ultrasonografisi ile değerlendirilmesi gerektiği düşüncesindeyiz. Kidney transplantation is the most privileged choice of the treatment of end stage renal failure (ESRD). While the most common early complications after transplantation are acute rejection (AR) and infections, late complications include malignancies and cardiovascular complications. Thyroid metabolism shows alterations in the course of end stage renal failure, however it reverses during the 6 month period of posttransplantation. Kidney recipients are at risk of goiter, thyroid nodules and thyroid cancers. This study was conducted to asses thyroid functions as well as to investigate the risk of development of thyroid malignancies among the kidney recipients of our center. 122 kidney recipients were enrolled in this study. 76 of them were men while 46 were women. The mean age of the study group was 39.8±12.1 and the mean follow-up period posttransplantation was 59.9±49.5 (6-372) months. The laboratory findings revealed euthyroid function in 108 (88.5%), subclinical hypothyroidism in 2, subclinical hyperthyroidism 10 and solely low T3 in 2 patients. Thyroid antibodies were negative in all patients. The mean thyroid volumes were 14.2±7.2 ml. Goiter was detected in 112 (91.8%) patients while 49 (40.2%) had at least one thyroid nodule. The mean age of patients with any thyroid nodule was 42.1±10.8 years and the mean posttransplantation follow up period was 54.7±38.7 months. Among the patients with any thyroid nodule, 43 (87.8%) were euthyroid, 1 had subclinical hypotiroidism, 4 had subclinical hyperthyroidism and 1 had a low T3 syndrome. 24 (48.9%) patients underwent a thyroid fine needle aspiration. The remaining patients were followed up by ultrasonography. 2 patients underwent thyroid surgery for the suspicion of thyroid cancer. Only 1 patient (0.8%) was diagnosed for thyroid papillary cancer and underwent total thyroidectomy. In conclusionæ because thyroid malignancies go along asymptomatic, kidney recipients should be yearly screened by thyroid ultrasonography

Böbrek nakli hastalarında serum tweak ve FGF-23 düzeylerinin karotid aterosklerozu ile ilişkisi

Böbrek nakli (BN), son dönem böbrek yetmezliği (SDBY) tedavisinde en başarılı renal replasman tedavi metodudur. Kardiyovasküler nedenler böbrek nakli sonrasındaki en sık ölüm nedenini oluşturmaktadır. Karotis arter intima media kalınlığı (KA-İMK) aterosklerozun güvenilir bir göstergesi olup kardiyovasküler hastalıkların öngörücüsüdür. Tumor Necrosis factor- Like Weak Inducer of Apoptosis (TWEAK) ve Fibroblast Growth Factor-23 (FGF-23) son zamanlarda gündeme gelen ve sırası ile ateroskleroz ve vasküler kalsifikasyonla ilişkilendirilen iki moleküldür. Biz bu kesitsel çalışmada, böbrek nakli hastalarında TWEAK ve FGF-23 düzeylerinin KA-İMK ile olan ilişkisini araştırdık. Çalışmaya 117 erişkin BN hastası alındı. Hastaların %52'si erkek, yaş ortalamaları 39.6 ± 9.6 yıl, nakil sonrası takip süresi 76.1 ± 59.1 (6-350) ay ve ortalama serum kreatinin değerleri 1.9 ± 1.2 mg/dl idi. Ortalama TWEAK düzeyi 595 ± 225 pg/ml (158-1140) idi ve TWEAK ile kreatinin klirensi, serum albümin, kalsiyum, hemoglobin, hematokrit ve KA-İMK değerleri arasında pozitif, proteinüri, serum fosfor, kalsiyum- fosfor çarpanı, üre, kreatinin, parathormon düzeyleri arasında negatif ilişki saptandı. Ortalama FGF 23 düzeyi 92 ± 123 RU/ml (9.6-1006) olup transplant sonrası izlem süresi, sistolik ve diyastolik kan basıncı, serum parathormon, üre, kreatinin, ürik asit, fosfor, kalsiyum-fosfor çarpanı, alkalen fosfataz, proteinüri değerleri ile pozitif, kreatinin klirensi, albümin, kolesterol, hemoglobin, hematokrit düzeyleri arasında negatif ilişki saptandı. Hastaların ortalama KA-İMK değeri 0.62 ± 0.11 mm (0.40-0.98) olup KA-İMK ile, yaş, kardiyovasküler hastalık öyküsü, sigara öyküsü, diyaliz süresi, TWEAK, albümin, kalsiyum, hemoglobin, hematokrit değerleri arasında pozitif, fosfor ve kreatinin değerleri ile negatif ilişki saptandı. Lineer regresyon analizinde yaş ve TWEAK düzeylerinin KA-İMK için belirleyici olduğu görüldü. Sonuç; BN hastalarında KA-İMK ile TWEAK arasında pozitif ilişki varken, FGF-23 ile ilişki bulunmamıştır, konunun netliğe kavuşması için prospektif çalışmalara ihtiyaç bulunmaktadır