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