Effect of Dual Blockade of Renin-Angiotensin Aldosterone System on Proteinuria in Patients with Diabetic Nephropathy and Advanced Azotemia

Purpose: To investigate the dual effect of angiotensin blockade by irbesartan and enalapril on proteinuria in diabetic patients with azotemia.Methods: Patients with diabetes of > 5 years duration, proteinuria at a nephrotic level and serum creatinine > 1.5 mg/dL were enrolled in the study. Forty-five enrolled patients were divided into three groups, those receiving enalapril , irbesartan, or enalapril plus irbesartan, respectively, over a period of 24 weeks. Urinary protein excretion and serum level of albumin, creatinine, potassium were measured before and after treatmentResults: In patients receiving enalapril, irbesartan, and both drugs concomitantly, mean urinary protein excretion level decreased significantly at the end of 6 months from 6.46 ± 4.66 to 3.36 ± 1.60, 5.89 ± 5.34 to 3.22 ± 1.72 and 5.99 ± 3.77 to 2.10 ± 2.22 g/day, respectively (p = 0.001). Decrease in proteinuria in the group receiving the combined therapy was more significant than the other two groups (p = 0.025). During the period of therapy, serum albumin increased and mean arterial pressure decreased significantly (p = 0.02 and p = 0.002, respectively) but serum creatinine and potassium and creatinine clearance values showed insignificant increases (p = 0.28 and p = 0.57, respectively).Conclusion: The combined use of enalapril and irbesartan, in patients with diabetic nephropathy associated with azotemia, is more effective in decreasing proteinuria without causing any substantial increase in serum potassium levels. The combined use of these two drugs shows a more pronounced anti-proteinuric effect.Keywords: Angiotensin-converting enzyme inhibitor, Angiotensin receptor blocker, Diabetic nephropathy, Azotemia, Proteinuria, Aldosterone, Renin, Blood pressur

Assessment of State and Trait Anxiety Level of Physical Education and Sports' Students before the Term Final Examinations: Example of Halic University

Abstract The purpose of this study was to evaluation of state and trait anxiety levels of students in Halic University, School of Physical Education and Sports, during final exams according to their age, department and year in school. For this research, 469 students (mean age 21,17 ±2,27) studying in 2014-2015-spring term were chosen randomly. As data collection tools, personal information form and Spielberger's State-Trait Anxiety Inventory which consists of 40 questions; 20 to evaluate state anxiety and 20 for trait was used. Statistical analysis of the obtained data was evaluated by SPSS 20.0 Windows program with Frequency, T-Test and Anova Analysis. As a result of the research; state and trait anxiety of students in Halic University, School of Physical Education and Sports differed in few factors. The both levels were shown differences according to the year of the students studied (p<0.05). Based on years; first, second and third year students have higher state anxiety levels than fourth whereas for trait anxiety fourth year students have the highest level (P<0,05). In conclusion, students who were in graduate situation had more anxiety level than the others

Performance status of patients is the major prognostic factor at all stages of pancreatic cancer

The aim of this study was to identify and evaluate the clinicopathologic factors and to elucidate the clinical importance of performance status on the outcome of patients with pancreatic cancer