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

Yesterday, today, tomorrow; environmental refugees

Migrations, which are as old as the history of mankind, have taken place for many reasons and have increased with the addition of new ones. Although wars and economic concerns are among the main causes, environmental problems have been one of the reasons that should be accepted in today's world. Environmental problems that threaten the lives of all living beings, especially human beings, pose numerous risks. Moreover, these risks have reached unlimited and global dimensions. One of these risks is the forced migration of people due to various environmental problems, especially climate change. Those who have experienced this migration are defined as "environmental refugees", and they occupy an important place in recent literature. While many of the problems associated with the millions of migrants are still unresolved today, the fact that environmental refugees are being added with increasing momentum clearly demonstrates the importance of including this issue in research agendas. It is also a fact that migration poses serious problems not only for the migrants who are its subjects, but also for the countries of emigration. The importance of the subject from both sides and the fact that it is pregnant with many problems, which can be seen with the domino effect, made it necessary to study the subject in detail. Based on these considerations, in the study; the history of environmental refugees, its causes, problems, environmental refugees mobility in recent years, possible future scenarios, socio-social-economic dimensions are discussed, evaluation and solutions are given

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Tekrarlama ve Sunum Türünün Semantik Bellekte Almanca Sözcüklerin Kodlanmasına Etkisi

Bu araştırmanın amacı yabancı dil öğrenmede çalışma ve semantik belleğin rollerini artırmak için verilen kavramların yazıyla tekrar edilmesinin veya edilmemesinin etkisini incelemektir. Bilişsel psikolojide kavramın tekrar edilmesinin uzun süreli bellekte kalıcılığı artırdığı öne sürülmektedir. Ancak bu durumun yabancı dilde kavramlar için söz konusu olup olmadığı belli değildir. Ayrıca, yeni öğrenilen kavramların görsel ve yazılı olarak sunulmasının da etkisi bu araştırmada incelenmektedir. Sunumun görsel olmasının ve tekrarlanmasının çalışma belleğinin yükünü hafifletmesi ve aynı zamanda semantik bellekte yeni kavramların veya şemaların oluşumunu artırması beklenilmektedir. Bu araştırmada daha önce hiç Almanca bilmeyen katılımcılara Almanca dilinde yazılı veya hem yazılı hem de resimli uyaranlar 3 saniye aralıklarla sunulmuştur. Bu sunumdan sonra katılımcıların yarısı sunulan uyaranları hatırlayabildikleri kadar yazmıştır. Kontrol koşulunda bulunan katılımcılara bu tür bir alıştırma yapılmamıştır. Araştırmanın sonuçları sunum türünün yabancı dilde hatırlamada bir etkisinin olmadığını göstermektedir. Buna ek olarak, yazma alıştırması yapanların yapmayanlara göre hatırlama performansı yaklaşık % 40 daha fazladır. Bu bulgular çalışma belleği ve semantik bellekte aktivasyon açısından tartışılmaktadır

Treatment Results of Patients With Lupus Nephritis: A Single Center’s Experience

Objective: Lupus nephritis (LN) is a type of organ involvement of systemic lupus erythematosus (SLE) that leads to disease-related morbidity and mortality. Lack of good treatments for LN continues to be problematic. Many different treatment protocols are applied in treatment centers. Not every treatment protocol is successful. Moreover, patients who reached remission may present with exacerbations. In this study, we aimed to evaluate the treatment results of our patients and investigate their remission rates as well as factors that affect remissions.Materials and Methods: We retrospectively investigated the results of 41 patients who were diagnosed with lupus nephritis after kidney biopsy in the Nephrology and Immunology-Rheumatology departments of Atatürk University Medical Faculty Training Hospital between January 2000 and December 2008. Demographic information, clinical history and laboratory results were collected from each patient’s records. The relationships among clinical, laboratory, demographic parameters and remissions were investigated. The patients were grouped in terms of urine protein levels; patients with urine protein 0.05). We compared class 3 LN patients at the 6th and 12th months according to treatment protocols. Azathioprin or mycophenolate mophetil were significantly better at placing urine protein levels in remission as compared to cyclophosphamide (p<0.05).Conclusion: According to our study, no relationship was found between basal clinical and laboratory parameters and patient remission. Response rates of our LN patients were similar to those in the literature. However, complete remission is still a problem in LN. The results of the protocols used in the treatment of LN show similarities. Although there are some data suggesting that MMF used in recent years is effective, it should be supported by prospective multicenter studies. It is important to note that it is difficult to achieve complete remission in LN patients

Can keto/amino acids reduce oxidative stress in peritoneal dialysis patients with hypoalbuminemia?

Introduction There is no consensus on an ideal marker of oxidative stress (OS). Disruption of the balance between free radical and antioxidant activity production by increasing oxidative markers results in OS. In this study, we aimed to investigate how OS, which increases mortality and morbidity due to various reasons, is affected by keto/amino therapy in patients with hypoalbuminemia undergoing peritoneal dialysis