Effect of Educational Level on Oral Health in Peritoneal and Hemodialysis Patients

Background. In previous studies, the oral and dental health statuses were compared in hemodialysis (HD) and peritoneal dialysis (PD) patients without taking into account the effect of educational levels on oral health. Hence we aimed to make a comparison of these parameters based upon the subjects educational levels. Patients and Methods. 76 PD (33 males, 43 females-mean age: 44 ± 12 years) and 100 HD (56 males, 44 females-mean age: 46 ± 14 years) patients were included. The number of decayed, missing and filled teeth were detected, DMFT index was calculated and plaque index (PI) values were assessed. Results. Significantly higher numbers of filled teeth (P < .001) and lower PI values (P < .01) in the PD group were detected with higher educational levels, whereas no significance was detected in the HD group. Higher DMFT index values were assessed in the lower educated and high school levels in PD than HD patients (P < .05). Higher numbers of filled teeth (P < .05) were detected in the secondary school level in PD patients. This difference was even more significant in the high school level (P < .001). Conclusion. We assume that PD patients, who were found to be in a higher educational level, are more caring for their oral health as compared to HD patients

Difficulties in diagnosis and treatment in cases with neuroglycopenia symptoms: A case of insulinoma

47 yaşında bayan hastada gözlerde kayma, terleme, son 6 aydır tekrarlayan bayılmalar, idrarını kaçırma, dilini ısırma şikayetleri mevcuttu. Diyabet öyküsü yoktu. Konvülziyon esnasında ölçülen kan şekeri 30mg/dl bulundu. Oral glikoz tolerans testinde üçüncü saat kan şekeri değeri 44mg/dl olarak düşük bulundu ve hipoglisemi belirtileri saptandı. Simultan ölçülen insulin düzeyi 36U/ml (1-25U/ml) ve C-peptid düzeyi 6.2 ng/ml (0.9-4ng/ml) olarak yüksek bulundu. Üst batın magnetik rezonans incelemesinde; pankreas uncinate proces infero-medial komşuluğunda yaklaşık iki santimetrelik kontrast tutulumu olan kuşkulu nodüler alan görüldü. Selektif çölyak angiografisinde pankreas başı lokalizasyonunda hipervasküler karakterde solid nodüler kitle tespit edildi. Hastadan tümöral kitle çıkarıldı. Patolojisinde belirgin gland yapısının bulunmadığı soliter yapıda tümör dokusu izlendi. Yapılan immunhistokimyasal panelde synaptophysin, nöronspesifik enolaz, kromogranin ve insülin ile pozitif boyanma gösterdiği saptandı. Ciddi nöroglikopenik semptomları bulunan ve diyabet öyküsü bulunmayan olguların ayırıcı tanısında mutlaka insulinoma düşünülmelidir.A 47 year-old female patient presented with complaints of strabismus, sweating, enuresis tongue biting and repetitive fainting in the last 6 months. She had no history of diabetes. A blood glucose level measured during an acute episode was 30 mg/dL. In the oral glucose tolerance test, the blood glucose level at 3 h was found to be with 44 mg/dL and the signs of hypoglycemia were detected. Simultaneously measured insulin and C-peptide levels were found to be high at 36 U/ml (1-25 U/ml) and 6.2 ng/ml (0.9-4 ng/ml), respectively). On the examination of the upper abdomen using magnetic resonance imaging, a suspicious nodular area with approximately 2cm of contrast involvement was detected neighboring the inferomedial side of the uncinate process of the pancreas. By selective celiac angiography, a solid nodular mass with a hypervascular character located in the head of pancreas was detected. The tumoral mass was excised and tissue of solitary structure with no glandular structure was observed in the pathology. It stained positively with synaptophysine, neuronspecific enolase, chromogranine and insulin.In the differential diagnosis of the patients with serious neuroglycopenic symptoms without diabetes history, insulinoma should always be considered

Diarrhoea following renal transplantation

In this study, we retrospectively evaluated all attacks of diarrhoea in our renal transplant recipients that came to our medical attention between 1985 and 2000. Also, the clinical features of patients with diarrhoea were compared with the features of recipients without diarrhoea. We diagnosed 41 attacks of diarrhoea in 39 (12.6%) of 308 renal transplant recipients during this time period. An aetiology was detected in 33 (80.5%) of all diarrhoeal episodes and in seven (17.1%) of those the specific agent was diagnosed with the help of stool microscopy. The most frequent causes of diarrhoeal attacks were infectious agents (41.5%) and drugs (34%). Six (14.6%) episodes of diarrhoea were chronic and six were nosocomial. About two-thirds of diarrhoea developed within the late post-transplant period (> 6 months). When recipients with diarrhoea were compared with those without diarrhoea, it was seen that diarrhoeal patients had significantly higher creatinine and significantly lower albumin levels when compared with the latter group (p < 0.05). Also, the frequency of antibiotic usage was significantly higher in diarrhoeal patients than in the control group (p < 0.05). Four (10.2%) patients with diarrhoea died despite institution of the appropriate therapy. Two of these deaths were primarily related to diarrhoea and the aetiological agent was Clostridium difficile in both these cases. During the 15-yr study period, 3.6% of all deaths and 5.1% of infection-related deaths in transplant recipients were secondary to diarrhoea. As a result, we observed that infections and drugs were the most frequent causes for diarrhoea in our series of renal transplant recipients. Also, diarrhoea was an important cause of mortality in this patient population

Effect of Educational Level on Oral Health in Peritoneal and Hemodialysis Patients

Background. In previous studies, the oral and dental health statuses were compared in hemodialysis (HD) and peritoneal dialysis (PD) patients without taking into account the effect of educational levels on oral health. Hence we aimed to make a comparison of these parameters based upon the subjects educational levels. Patients and Methods. 76 PD (33 males, 43 females-mean age: 44 +/- 12 years) and 100 HD (56 males, 44 females-mean age: 46 +/- 14 years) patients were included. The number of decayed, missing and filled teeth were detected, DMFT index was calculated and plaque index (PI) values were assessed. Results. Significantly higher numbers of filled teeth (P < .001) and lower PI values (P < .01) in the PD group were detected with higher educational levels, whereas no significance was detected in the HD group. Higher DMFT index values were assessed in the lower educated and high school levels in PD than HD patients (P < .05). Higher numbers of filled teeth (P < .05) were detected in the secondary school level in PD patients. This difference was even more significant in the high school level (P < .001). Conclusion. We assume that PD patients, who were found to be in a higher educational level, are more caring for their oral health as compared to HD patients. Copyright (C) 2009 Gulsen Bayraktar et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

ACUTE KIDNEY INJURY IN HOSPITALIZED COVID-19 PATIENTS: A MULTICENTRE STUDY BY TURKISH SOCIETY OF NEPHROLOGY

BackgroundAcute kidney injury (AKI) is common in coronavirus disease-2019 (COVID-19) and theseverity of AKI is linked to adverse outcomes. In this study, we investigated the factors asso-ciated with in-hospital outcomes among hospitalized patients with COVID-19 and AKI.MethodsIn this multicenter retrospective observational study, we evaluated the characteristics andin-hospital renal and patient outcomes of 578 patients with confirmed COVID-19 and AKI.Data were collected from 34 hospitals in Turkey from March 11 to June 30, 2020. AKI defini-tion and staging were based on the Kidney Disease Improving Global Outcomes criteria.Patients with end-stage kidney disease or with a kidney transplant were excluded. Renaloutcomes were identified only in discharged patients.ResultsThe median age of the patients was 69 years, and 60.9% were males. The most frequentcomorbid conditions were hypertension (70.5%), diabetes mellitus (43.8%), and chronic kid-ney disease (CKD) (37.6%). The proportions of AKI stages 1, 2, and 3 were 54.0%, 24.7%,and 21.3%, respectively. 291 patients (50.3%) were admitted to the intensive care unit.Renal improvement was complete in 81.7% and partial in 17.2% of the patients who weredischarged. Renal outcomes were worse in patients with AKI stage 3 or baseline CKD. Theoverall in-hospital mortality in patients with AKI was 38.9%. In-hospital mortality rate was notdifferent in patients with preexisting non-dialysis CKD compared to patients without CKD(34.4 versus 34.0%, p = 0.924). By multivariate Cox regression analysis, age (hazard ratio[HR] [95% confidence interval (95%CI)]: 1.01 [1.0–1.03], p = 0.035], male gender (HR [95%CI]: 1.47 [1.04–2.09], p = 0.029), diabetes mellitus (HR [95%CI]: 1.51 [1.06–2.17], p =0.022) and cerebrovascular disease (HR [95%CI]: 1.82 [1.08–3.07], p = 0.023), serum lac-tate dehydrogenase (greater than two-fold increase) (HR [95%CI]: 1.55 [1.05–2.30], p =0.027) and AKI stage 2 (HR [95%CI]: 1.98 [1.25–3.14], p = 0.003) and stage 3 (HR [95%CI]:2.25 [1.44–3.51], p = 0.0001) were independent predictors of in-hospital mortality.ConclusionsAdvanced-stage AKI is associated with extremely high mortality among hospitalizedCOVID-19 patients. Age, male gender, comorbidities, which are risk factors for mortality inpatients with COVID-19 in the general population, are also related to in-hospital mortality inpatients with AKI. However, preexisting non-dialysis CKD did not increase in-hospital mor-tality rate among AKI patients. Renal problems continue in a significant portion of thepatients who were discharged.&nbsp;</div