1
|
Yenigun EC, Turgut D, Cevher SK, Yucel C, Aypak C, Dede F. Blood pressure response to exercise in unaffected relatives of autosomal dominant polycystic kidney disease patients: an observational study. Int Urol Nephrol 2023; 55:2313-2319. [PMID: 36872421 DOI: 10.1007/s11255-023-03535-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 02/21/2023] [Indexed: 03/07/2023]
Abstract
INTRODUCTION Hypertension is an early finding of autosomal dominant polycystic kidney disease (ADPKD) and is related to different mechanisms. Cyst expansion-related renin secretion or early endothelial dysfunctions are some of these hypotheses. In addition, the underlying genetic factor is thought to play a role in the inheritance of hypertension. The differential course of hypertension in ADPKD preoccupies that relatives of ADPKD patients may also be at risk for this underlying mechanisms with a genetically determined abnormal endothelial-vascular state. In this study, we aimed to evaluate blood pressure response to exercise as an initial vascular problem in unaffected and normotensive relatives of hypertensive ADPKD patients. METHODS This is an observational study including unaffected and normotensive relatives (siblings and children) of ADPKD patients (relative group) and healthy controls (control group) who performed an exercise stress test. A 6-lead electrocardiogram was recorded and blood pressure was measured automatically with a cuff worn on the right arm, immediately before the test and every 3 min during the exercise and the recovery phase. Participants continued the test until their age-specific target heart rate was reached or symptoms occurred that required discontinuation of the test. The highest blood pressure and pulse values during exercise were noted. In addition, as a marker for endothelial function, nitric oxide (NO) and asymmetric dimethylarginine (ADMA) levels were measured at baseline and post-exercise. RESULTS There were 24 participants in the relative group (16 female, mean age 38.45 years) and 30 participants in the control group (15 female, mean age 37.96 years). Two groups were similar in terms of age, gender, body mass index (BMI), smoking status, resting systolic blood pressure (SBP)/diastolic blood pressure (DBP) and biochemical parameters. Mean SBP and DBP were similar in both groups during 1st, 3rd and 9th minutes of exercise (1st minute: 136.25 ± 19.71 mmHg vs 140.36 ± 30.79 mmHg for SBP, p = 0.607, 84.05 ± 14.75 mmHg vs 82.60 ± 21.60 mmHg for DBP, p = 0.799; 3rd minute: 150.75 ± 30.39 mmHg vs 148.54 ± 27.30 mmHg for SBP, p = 0.801, 98.95 ± 26.92 mmHg vs 85.92 ± 17.93 mmHg for DBP, p = 0.062; 9th minute: 156.35 ± 30.84 mmHg vs 166.43 ± 31.90 mmHg for SBP, p = 0.300, 96.25 ± 21.99 mmHg vs 101.78 ± 33.11 mmHg for DBP, p = 0.529 for control and relatives, respectively). During the recovery phase, SBP decreased in both groups in 6th minute (119.85 ± 14.06 mmHg vs 122.86 ± 16.76 mmHg, p = 0.538 for control and relatives respectively); however, in the relatives of ADPKD patients DBP remained high at the end of the 6th minute (78.95 ± 11.29 mmHg vs 86.67 ± 9.81 mmHg p = 0.025 for control and relatives, respectively). Baseline and post-exercise NO and ADMA levels were similar in both groups (Baseline p = 0.214 and p = 0.818, post-exercise p = 0.652 and p = 0.918 for NO and ADMA, respectively). CONCLUSION Abnormal blood pressure response to exercise was observed in unaffected normotensive relatives of ADPKD. Although its clinical significance needs to be demonstrated by additional research, it is an important finding that unaffected relatives of ADPKD may be at risk for an altered arterial vascular network. Furthermore, these data are the first to demonstrate that relatives of ADPKD patients may also be under risk with a genetically determined abnormal vascular state.
Collapse
Affiliation(s)
| | | | | | - Cigdem Yucel
- Gülhane EAH, Ankara Gulhane Egitim ve Arastirma Hastanesi, Ankara, Turkey
| | - Cenk Aypak
- Ankara Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi, Saglik Bilimleri Universitesi Diskapi Yildirim Beyazit Egitim ve Arastirma Hastanesi, Ankara, Turkey
| | | |
Collapse
|
2
|
Oguz EG, Paydas S, Hasbal NB, Turgut D, Sahin H, Kaya B, Bicik Bahcebasi Z, Yadigar S, Gok S, Ayli MD. Plasma Exchange in the Treatment of Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis: A Retrospective Analysis. Turk J Nephrol 2022. [DOI: 10.5152/turkjnephrol.2022.21119175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
3
|
Erdogmus S, Kendi Celebi Z, Turgut D, Sayin B, Ozdemir FN, Colak T, Haberal M. Sensitization status of patients on the deceased donor kidney transplant waiting list: A single center experience. Turk J Nephrol 2022. [DOI: 10.5152/turkjnephrol.2022.2183123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
4
|
Bajpai D, Turgut D, Arce-Amare F, Shingada K A, Lerma V E, Bek Gokcay S. POS-988 INTERACTIVE ONLINE QUIZZES AS AN EFFECTIVE EDUCATIONAL TOOL ON SOCIAL MEDIA IN NEPHROLOGY. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.1031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
5
|
Turgut D, Sayin B, Soy EA, Topcu Dİ, Ozdemir BH, Haberal M. Tacrolimus intrapatient variability in BK virus nephropathy and chronic calcineurin toxicity in kidney transplantation. Saudi J Kidney Dis Transpl 2022; 32:348-354. [PMID: 35017328 DOI: 10.4103/1319-2442.335446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Intrapatient variability (IPV) in tacrolimus has been increasingly acknowledged as a risk factor for poor graft survival after kidney transplantation. Although past studies have mainly accounted for IPV in acute or chronic rejection states as due to underimmunosuppression, this is not yet clear. So far, tacrolimus IPV for BK virus-associated nephropathy (BKVN) and chronic calcineurin inhibitor toxicity (CNIT) has not been investigated. Here, we evaluated IPV in tacrolimus for BKVN and chronic CNIT, which are mainly considered as overimmunosuppression states. In this case-control study, kidney allograft biopsies conducted between 1998 and 2018 were included, with patients grouped by biopsy results as BKVN alone group, CNIT alone group, and normal graft function (control group). IPV was estimated as mean absolute deviation. Our study groups included 25 kidney transplant recipients with BKVN alone, 91 patients with CNIT alone, and 60 patients with normal 5-year graft survival (control group). In analyses of IPV in tacrolimus six months before graft biopsy, IPV was highest in the BKVN group (P = 0.001). The BKVN group also had the highest IPV in tacrolimus at 12 months after biopsy (P = 0.001), with all pairwise comparisons statistically different between groups. At 12 months after biopsy, five patients (20%) in the BKVN group and 10 patients (10.9%) in the CNIT group had graft loss. Among other risk factors, BKVN and chronic CNIT are consequences related to high IPV. Quantification of IVP for tacrolimus in clinical practice would help to optimize kidney transplant outcomes.
Collapse
Affiliation(s)
- Didem Turgut
- Department of Internal Medicine, Division of Nephrology, Baskent University Ankara Hospital, Ankara, Turkey
| | - Burak Sayin
- Department of Internal Medicine, Division of Nephrology, Baskent University Ankara Hospital, Ankara, Turkey
| | - Ebru Ayvazoglu Soy
- Department of General Surgery, Division of Transplantation, Baskent University Ankara Hospital, Ankara, Turkey
| | - Deniz İlhan Topcu
- Department of Biochemistry, Baskent University Ankara Hospital, Ankara, Turkey
| | | | - Mehmet Haberal
- Department of General Surgery, Division of Transplantation, Baskent University Ankara Hospital, Ankara, Turkey
| |
Collapse
|
6
|
Claure-Del Granado R, Anandh U, Lerma E, Conjeevaram A, Arce-Amaré F, dos Santos ACS, Basu G, Bek S, Dhakal AK, Gawad MA, AkL A, Turgut D, Karam S, Bajpai D, Pecoits-Filho R, Parikh N. Challenges and Opportunities of a Virtual Nephrology Meeting: The ISN World Congress of Nephrology 2021. Kidney Int Rep 2021; 7:133-137. [PMID: 35036661 PMCID: PMC8743140 DOI: 10.1016/j.ekir.2021.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Rolando Claure-Del Granado
- Division of Nephrology, Hospital Obrero No 2—CNS, Cochabamba, Bolivia
- Universidad Mayor de San Simon, School of Medicine, Cochabamba, Bolivia
- Correspondence: Rolando Claure-Del Granado, Division of Nephrology, Hospital Obrero No 2—CNS, School of Medicine, Universidad Mayor de San Simon, Avenida Blanco Galindo Km 5 ½, Cochabamba, Bolivia.
| | - Urmila Anandh
- Division of Nephrology, Yashoda Hospitals Secunderabad, Secunderabad, India
| | - Edgar Lerma
- University of Illinois at Chicago College of Medicine/Advocate Christ Medical Center, Oak Lawn, Illinois, USA
| | | | - Fernanda Arce-Amaré
- International Society of Nephrology Social Media Team, The International Society of Nephrology, Brussels, Belgium
| | | | - Gopal Basu
- Renal Medicine, The Alfred, Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Sibel Bek
- Department of Nephrology, Kocaeli University Hospital, Kocaeli, Turkey
| | - Ajaya Kumar Dhakal
- Department of Pediatrics, KIST Medical College and Teaching Hospital, Lalitpur, Nepal
| | | | - Ahmed AkL
- Urology & Nephrology Center, Mansoura University, Egypt
| | - Didem Turgut
- Department of Nephrology, Ankara City Hospital Ankara, Turkey
| | - Sabine Karam
- Department of Medicine, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Divya Bajpai
- Department of Nephrology, Seth Gordhandas Sunderdas Medical College and the King Edward Memorial Hospital, Mumbai, India
| | - Roberto Pecoits-Filho
- School of Medicine, Pontifical Catholic University of Parana, Curitiba, Brazil
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Namrata Parikh
- Division of Nephrology, The Ottawa Hospital, Ontario, Canada
| |
Collapse
|
7
|
Gungor O, Ulu S, Hasbal NB, Onan E, Turgut D, Arici M. Do Hemodialysis Patients Need Immune Boosting with Vitamin, Mineral, and Probiotic Supplementation during COVID-19 Pandemic? Turk J Nephrol 2021. [DOI: 10.5152/turkjnephrol.2021.21143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
8
|
Turgut D, Topcu DI, Alperen CC, Baskın E. Serum growth differentiation factor-15 analysis as a malnutrition marker in hemodialysis patients. Turk J Med Sci 2021; 51:1984-1993. [PMID: 34247467 PMCID: PMC8569774 DOI: 10.3906/sag-2103-62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background/aim Growth differentiation factor (GDF)-15 is related to inflammation and mortality in many conditions. We aimed to determine if an elevated serum GDF-15 level is related to nutritional status of patients on hemodialysis (HD) and mortality. Materials and methods Routine HD patients (n = 158) were included in the study and followed for 18 months. Some malnutrition/inflammation scoring indexes (malnutrition/inflammation score (MIS), controlling nutritional status (CONUT) score, and prognostic nutritional index (PNI)), biochemical parameters, and GDF-15 were used to build Cox regression multivariate models to study the association with mortality. Results Among the patients, 90 (57 %) had a high MIS (≥8), which associates with worse status. The serum GDF-15 level was higher in the same group (p = 0.003). The serum GDF-15 level differentiated malnutrition/inflammation according to the MIS (p = 0.031). Age, GDF15, and C-reactive protein (CRP) were significantly associated with higher all-cause mortality risk. Patients with both age and GDF-15 above the mean had a hazard ratio of 2.76 (p = 0.006) when compared with those both < mean. Conclusion In HD patients, the GDF-15 level is increased in worse nutritional status. Beyond the MIS, age, GDF-15 and CRP would be used together to estimate the worse clinical outcome in these patients.
Collapse
Affiliation(s)
- Didem Turgut
- Division of Nephrology, Department of Internal Medicine, Başkent University Ankara Hospital, Ankara, Turkey
| | - Deniz Ilhan Topcu
- Department of Biochemistry, Başkent University Ankara Hospital, Ankara, Turkey
| | - Cemile Cansu Alperen
- Department of Internal Medicine, Başkent University Ankara Hospital, Ankara, Turkey
| | - Esra Baskın
- Division of Nephrology, Department of Pediatrics, Başkent University Ankara HospitalAnkara, Turkey
| |
Collapse
|
9
|
Kendi Celebi Z, Turgut D, Erdogmus S, Avsaroglu E, Musabak HU, Colak T. The Mutation Identified in TWEAK-Fn14 Pathway May Affect the Clinical Course of IgA Nephropathy/Henoch- Schönlein Purpura Nephritis: A Case Report. Turk J Nephrol 2021; 30:250-252. [DOI: 10.5152/turkjnephrol.2021.21113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
10
|
Turgut D, Piskinpasa SV, Keskin H, Agbaht K, Coskun Yenigun E, Dede F. Occult Adrenal Insufficiency in Renal Amyloidosis Patients. Medeni Med J 2021; 36:52-57. [PMID: 33828890 PMCID: PMC8020191 DOI: 10.5222/mmj.2021.93902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/17/2021] [Indexed: 11/29/2022] Open
Abstract
Objective Systemic amyloidosis may affect many organs, and may cause endocrinologic problems which may result in adrenal insufficiency. However, assessment of adrenocortical reserve is challenging in amyloidosis patients with renal involvement. We aimed to evaluate adrenocortical reserve with various methods of cortisol measurement to determine any occult clinical condition. Methods Patients with renal amyloidosis and healthy subjects were evaluated in this cross-sectional study. Basal cortisol, corticosteroid-binding globulin (CBG), and albumin levels were measured. Serum free cortisol (cFC) level was calculated. Cortisol response tests performed after ACTH stimulation test (250 μg, intravenously) were evaluated, and free cortisol index (FCI) was calculated. Results Twenty renal amyloidosis patients, and 25 healthy control subjects were included in the study. Patients and control subjects had similar median serum baseline cortisol levels [258 (126-423) vs 350 (314-391) nmol/L, p=0.169)] whereas patients’ stimulated cortisol levels at the 60th minute were lower [624 (497-685) vs 743 (674-781) nmol/L, p=0.011)]. The 60th-minute total cortisol levels of 8 of the 20 (40%) amyloidosis patients were <500 nmol/L, but only three of these 8 patients had stimulated FCI <12 nmol/mg suggesting an adrenal insufficiency (15%). Conclusion ACTH stimulation test and cortisol measurements should be considered in renal amyloidosis patients with severe proteinuria to avoid false positive results if only ACTH stimulation test is used. It will be appropriate to evaluate this group of patients together with estimated measurements as FCI.
Collapse
Affiliation(s)
- Didem Turgut
- Baskent University Ankara Hospital, Department of Internal Medicine, Division of Nephrology, Ankara, Turkey
| | | | - Havva Keskin
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Internal Medicine, Istanbul, Turkey
| | - Kemal Agbaht
- Defne Hospital, Division of Endocrinology and Metabolism, Hatay, Turkey
| | - Ezgi Coskun Yenigun
- University of Health Sciences, Ankara Bilkent City Hospital, Division of Nephrology, Ankara, Turkey
| | - Fatih Dede
- University of Health Sciences, Ankara Bilkent City Hospital, Division of Nephrology, Ankara, Turkey
| |
Collapse
|
11
|
Hasbal NB, Turgut D, Oguz EG, Ulu S, Gungor O. Effect of Calcineurin Inhibitors and Mammalian Target of Rapamycin Inhibitors on the Course of COVID-19 in Kidney Transplant Recipients. Ann Transplant 2021; 26:e929279. [PMID: 33707409 PMCID: PMC7962418 DOI: 10.12659/aot.929279] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 12/15/2020] [Indexed: 12/20/2022] Open
Abstract
Coronavirus disease 19 (COVID-19) has been an ongoing pandemic since December 2019. Unfortunately, kidney transplant recipients are a high-risk group during the disease course, and scientific data are still limited in this patient group. Beyond the dosage of immunosuppressive drugs, pharmacological immunosuppression may also alter the infection response in the COVID-19 course. The effects of immunosuppressive agents on the development and process of infection should not be decided only by determining how potent they are and how much they suppress the immune system; it is also thought that the direct effect of the virus, increased oxidative stress, and cytokine storm play a role in the pathogenesis of COVID-19 disease. There are data about immunosuppressive drugs like calcineurin inhibitors (CNI) or mammalian target of rapamycin inhibitors (mTORi) therapy related to their beneficial effects during any infection course. Limited data suggest that the use of CNI or mTORi may have beneficial effects on the process. In this hypothetical review, the probable impacts of CNI and mTORi on the pathogenesis of the COVID-19 were investigated.
Collapse
Affiliation(s)
- Nuri Baris Hasbal
- Clinic of Nephrology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Didem Turgut
- Department of Nephrology, Baskent University School of Medicine, Ankara, Turkey
| | - Ebru Gok Oguz
- Department of Nephrology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Sena Ulu
- Department of Nephrology, Afyonkarahisar Health Sciences University School of Medicine, Afyonkarahisar, Turkey
| | - Ozkan Gungor
- Department of Nephrology, Kahramanmaras Sutcu Imam University School of Medicine, Kahramanmaras, Turkey
| |
Collapse
|
12
|
Ulu S, Gungor O, Gok Oguz E, Hasbal NB, Turgut D, Arici M. COVID-19: a novel menace for the practice of nephrology and how to manage it with minor devastation? Ren Fail 2020; 42:710-725. [PMID: 32713282 PMCID: PMC7470161 DOI: 10.1080/0886022x.2020.1797791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/13/2020] [Accepted: 07/13/2020] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 19 (COVID-19) became a nightmare for the world since December 2019. Although the disease affects people at any age; elderly patients and those with comorbidities were more affected. Everyday nephrologists see patients with hypertension, chronic kidney disease, maintenance dialysis treatment or kidney transplant who are also high-risk groups for the COVID-19. Beyond that, COVID-19 or severe acute respiratory syndrome (SARS) due to infection may directly affect kidney functions. This broad spectrum of COVID-19 influence on kidney patients and kidney functions obviously necessitate an up to date management policy for nephrological care. This review overviews and purifies recently published literature in a question to answer format for the practicing nephrologists that will often encounter COVID-19 and kidney related cases during the pandemic times.
Collapse
Affiliation(s)
- Sena Ulu
- Department of Nephrology, Afyonkarahisar Health Sciences University School of Medicine, Afyonkarahisar, Turkey
| | - Ozkan Gungor
- Department of Nephrology, Kahramanmaras Sutcu Imam University School of Medicine, Kahramanmaras, Turkey
| | - Ebru Gok Oguz
- Department of Nephrology, Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Nuri Baris Hasbal
- Department of Nephrology, Hakkari State Hospital, Merkez, Hakkari, Turkey
| | - Didem Turgut
- Department of Nephrology, Baskent University School of Medicine, Ankara, Turkey
| | - Mustafa Arici
- Department of Nephrology, Hacettepe University School of Medicine, Ankara, Turkey
| |
Collapse
|
13
|
Turgut D, Pişkinpaşa SV, Çoşkun Yenigün E, Aydemir N, Dede F. Urinay neutrophil gelatinase-associated lipocalin as a biomarker in different renal problems. Turk J Med Sci 2020; 50:1566-1572. [PMID: 32927927 PMCID: PMC7605094 DOI: 10.3906/sag-2002-130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 09/08/2020] [Indexed: 11/18/2022] Open
Abstract
Background/aim Neutrophil gelatinase-associated lipocalin (NGAL) is used previously to estimate the etiology, severity, and clinical outcomes of acute kidney injury (AKI). However, the role of urinary NGAL (uNGAL) in the postrenal setting is not clear. In our study, we aimed to discover the cut-off value of uNGAL that can be used in the differential diagnosis of underlying AKI etiologies. Materials and methods In this prospective cross-sectional study, we examined 82 subjects in four groups: patients that had (1) postrenal AKI; (2) AKI other than postrenal etiologies; (3) stable chronic kidney disease; and (4) healthy subjects. A renal function assessment was carried out by measuring serum creatinine (sCr) and uNGAL at the time of diagnosis [0th min (T0)]. We followed the study group for three months. Results At the time of diagnosis, sCr (T0) was highest in the postrenal AKI and AKI groups in contrast to stable chronic kidney disease patients and healthy subjects (P < 0.001), as expected. T0 median uNGAL was highest in the postrenal group (P < 0.001). Area under curve (AUC) of uNGAL to estimate postrenal AKI presence was 0.957 (95% CI, 0.897–1.000; P < 0.001). The cut-off point of uNGAL was 42.625 ng/mL for this estimation. Conclusion Patients with AKI must be classified according to the underlying etiologies as soon as possible. uNGAL may be useful to estimate the etiologies, and whether the problem is acute or chronic in the course. In postrenal kidney problems, to plan the urgency of the urologic procedures, it is crucial.
Collapse
Affiliation(s)
- Didem Turgut
- Division of Nephrology, Department of Internal Medicine, Başkent University Ankara Hospital, Ankara, Turkey
| | | | - Ezgİ Çoşkun Yenigün
- Department of Nephrology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Nihal Aydemir
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Fatih Dede
- Department of Nephrology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| |
Collapse
|
14
|
Tatar E, Oygar D, Seyahi N, Eren N, Cantürk Y, Güngör Ö, Derici Ü, Sipahioğlu M, Yıldız A, Karadağ S, Sumnu A, Odabas AR, Turgut D, Cavdar C, SAHIN G, Dursun B, Guven Taymez D, Yılmaz Aydın F, Ulu MS, Basturk T, Yadigar S, Bozaci I, Behlül A, Sipahi S, Bicik Bahçebaşı Z. P0496THE IMPORTANCE OF COMPLEMENT LEVELS AND CLINICAL CHARACTERISTICS OF PRIMARY MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS IN TURKEY. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
Membranoproliferative glomerulonephritis (MPGN) may be caused by disturbances in the complement system. Hypocomplementemia is a characteristic of MPGN. Among these patients frequency of hypocomplementemia and their relation with clinical and histopathological findings are still not clearly known. The aim of this study is to evaluate the hypocomplementemia frequency among the primary MPGN patients in Turkey and its relation with histopathological subtypes, findings and demographic characteristics.
Method
The data was obtained from national multicentered (47 centers) records of primary glomerular diseases in Glomerulonephritis Study Group of the Turkish Society of Nephrology database from May 2009 to June 2019. Primary MPGN cases were evaluated and divided into 2 groups with and without hypocomplementemia.
Results
In total, 193 cases were included in the study. The indications for renal biopsy were isolated nephrotic syndrome (55.4%), nephritic syndrome (21.2%), nephrotic syndrome with a nephritic component (6.2%) and asymptomatic urinary findings (17.2%). 34.2% of the cases were reported as immune complex type, another 34.2% of the cases were reported as C3 glomerulopathy. 31.6% of patients were not specified. 82 (42.4%) of the cases presented hypocomplementemia. Hypocomplementemic patients were younger (34±14 vs 41±15, p=0.002) and most frequently female (56% vs 41%, p=0.03). At same time, serum albumin and hemoglobin levels were lower and anemic patient rates were higher (p<0.001). In this group, the nephrotic syndrome rates were higher (72% vs 54%, p=0,01). Hypocomplementemia rate in the C3 glomerulopathy was 52% (in DDD 40%, in C3GN 55% ) whereas in immune complex type 41% and in non specified type 34%. In the pathological evaluation; among the hypocomplementemic group the endocapillary proliferation and glomerular exudative differentiation rates presented significant increase. However the chronicity index were lower in the kidney biopsy (Table 1).
Conclusion
This multicenter study provided important data about the epidemiology of MPGN with importance of hypocomplementemia in Turkey. Hypocomplementemia is associated with both subtypes of MPGN patern, anemia and nephrotic syndrome. At the same time, hypocomplementemia is a valuable parameter for active MPGN pattern in the histopathological evaluation. This may be important in determining the treatment.
Collapse
Affiliation(s)
- Erhan Tatar
- Bozyaka Eğitim Ve Araştırma Hastanesi, nephrology, izmir, Turkey
| | - Deren Oygar
- Burhan Nalbantoglu State Hospital, nephrology, Lefkoşa
| | - Nurhan Seyahi
- Cerrahpaşa Tıp Fakültesi Hastanesi, nephrology, Turkey
| | - Necmi Eren
- Kocaeli Üniversitesi Tıp Fakültesi, nephrology, koaceli, Turkey
| | | | - Özkan Güngör
- Kahramanmaraş Sütçüimam University School of Medicine, nephrology, Kahramanmaraş, Turkey
| | - Ülver Derici
- Gazi University Faculty of Medicine, nephrology, Ankara, Turkey
| | - Murat Sipahioğlu
- Erciyes Üniversitesi Tıp Fakültesi Hastaneleri, nephrology, Kayseri, Turkey
| | - Abdülmecit Yıldız
- Uludag University Medical Faculty Hospital, nephrology, Bursa, Turkey
| | - Serhat Karadağ
- Haseki Eğitim ve Araştırma Hastanesi, Nephrology, İstanbul, Turkey
| | - Abdullah Sumnu
- İstanbul Medipol University, Nephrology, İstanbul, Turkey
| | - Ali Riza Odabas
- Sağlık Bilimleri Üniversitesi Sultan Abdülhamid Han Eğitim ve Araştırma Hastanesi, nephrology, İstanbul, Turkey
| | - Didem Turgut
- Başkent University Ankara Hospital, Nephrology, Ankara, Turkey
| | - Caner Cavdar
- Dokuz Eylul University Hospital, nephrology, İzmir, Turkey
| | - Garip SAHIN
- Eskişehir Osmangazi University Hospital, nephrology, Eskişehir, Turkey
| | - Belda Dursun
- Pamukkale Üniversitesi Hastanesi, nephrology, Denizli, Turkey
| | | | | | - Memnune Sena Ulu
- Afyon Kocatepe Universitesi Tip Fakultesi, nephrology, afyon, Turkey
| | - Taner Basturk
- Şişli Hamidiye Etfal Eğitim ve Araştırma Hastanesi, Nephrology, İstanbul, Turkey
| | - Serap Yadigar
- Kartal Dr. Lütfi Kırdar Training and Research Hospital, Nephrology, İstanbul, Turkey
| | - Ilter Bozaci
- Bozyaka Eğitim Ve Araştırma Hastanesi, nephrology, izmir, Turkey
| | - Ahmet Behlül
- Burhan Nalbantoglu State Hospital, nephrology, Lefkoşa
| | - Savaş Sipahi
- Sakarya Eğitim Araştırma Hastanesi, Nephrology, Sakarya, Turkey
| | | |
Collapse
|
15
|
Turgut D, Alperen C, Topcu D, Celebi Z, Baskın E. SUN-246 ASSOCİATİON OF GROWTH DİFFERENTİATİON FACTOR 15 WİTH MALNUTRİTİON İN HEMODİALYSİS PATİENTS. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
16
|
Turgut D, Colak A, Koksal Cevher S, Coskun Yenigun E, Dede F. SUN-381 GLOMERULAR AREA İN PRİMARY GLOMERULAR DİSEASES. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
17
|
Anandh U, Gopal B, Conjeevaram A, Cortes C, Gleeson S, Madariaga H, Malina M, Arce-Amare F, Lerma E, Turgut D, Bek S, Nair S, Paunic Z, Desai T, Pastor A. SAT-484 Trends in Twitter Coverage of Nephrology Conferences through Novel Indices of Impact. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
18
|
Turgut D, Coskun Yenigun E, Kundi H, Ozkayar N, Dede F. Subclinical Cardiovascular Risk Factors in Chronic Kidney Disease: Abnormal Heart Rate Recovery. Turk J Nephrol 2020. [DOI: 10.5152/turkjnephrol.2020.3633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
19
|
Yalcintas A, Sayin B, Turgut D, Atay G, Colak T, Haberal M. Risk Factors of Antibody-Mediated Rejection and Predictors of Outcome in Kidney Transplant Recipients. EXP CLIN TRANSPLANT 2020; 18:29-31. [PMID: 32008489 DOI: 10.6002/ect.tond-tdtd2019.o1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Kidney transplant is the treatment of choice for patients with end-stage renal disease. Antibody-mediated rejection is associated with higher rates of graft loss in kidney transplant recipients. Determining the risk factors of antibody-mediated rejection is vital for its prevention, early diagnosis, and appropriate treatment, as these factors may be important in maintaining long-term graft survival in transplant recipients. In our study, we analyzed the risk factors of antibody-mediated rejection in kidney transplant recipients and the negative impact of antibody-mediated rejection on graft function. MATERIALS AND METHODS We analyzed demographic and clinical data of 124 kidney transplant recipients (37 female [30%] and 87 male [70%] patients) who were diagnosed with antibody-mediated rejection at transplant biopsy. We compared graft outcomes of this patient cohort versus 75 kidney transplant recipients (24 female [32%] and 51 male [68%] patients) who were not diagnosed with antibody-mediated rejection. RESULTS Mean ages of patients with and without antibody-mediated rejection were 38.2 ± 13.6 and 34.4 ± 13.0 years, respectively. Mean ages of donors for patients with antibody-mediated rejection was significantly higher (48.0 ± 13.2 y) than for donors of patients without antibody-mediated rejection (47.1 ± 11.4 y; P < .05). Rate of graft loss was 15.3% in patients with antibody-mediated rejection; patients without antibody-mediated rejection had no graft loss (P < .05). Positive panel reactive antibody levels and blood transfusion before transplant were found to be risk factors of antibody-mediated rejection in kidney transplant recipients. However, recipients who received tacrolimus had less antibody-mediated rejection episodes than recipients who received sirolimus or cyclophosphamide. CONCLUSIONS Antibody-mediated rejection is associated with high rates of graft loss in kidney transplant recipients. Avoiding blood transfusion, lowering panel reactive antibody levels, choosing younger donors, and using tacrolimus in high-risk kidney transplant recipients may reduce antibody-mediated rejection rates and provide better graft survival.
Collapse
Affiliation(s)
- Aysenur Yalcintas
- From the Department of Internal Medicine, Baskent University Faculty of Medicine, Ankara, Turkey
| | | | | | | | | | | |
Collapse
|
20
|
Yenigun EC, Aypak C, Turgut D, Aydin MZ, Dede F. MP325EFFECT OF METABOLI˙C ASCIDOSIS ON QT INTERVALS IN PATIENTS WITH CHRONIC KIDNEY DISEASE. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw189.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
21
|
Dede F, Ayli D, Gonul I, Yuksel O, Ozturk R, Yildiz A, Yenigun E, Piskinpasa S, Turgut D, Koc E, Odabas AR. The effect of Helicobacter pylori eradication on proteinuria in patients with primary glomerulonephritis. Arch Med Sci 2015; 11:764-9. [PMID: 26322088 PMCID: PMC4548018 DOI: 10.5114/aoms.2013.37013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 09/07/2011] [Accepted: 10/19/2011] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Glomerulonephritis is still the primary cause among the diseases causing end stage renal disease. Helicobacter pylori (HP), also having a local proinflammatory effect on gastric mucosa, can trigger a local and systemic inflammatory response, and consequently have a role in the development of extragastrointestinal defects. MATERIAL AND METHODS The study was composed of patients diagnosed with primary glomerulonephritis who had dyspeptic complaints throughout the diagnosis. Patients who received endoscopic biopsy upon the determination of pathologic findings in their upper gastrointestinal endoscopy were HP positive in their biopsy material. A triple eradication therapy was initiated for HP. RESULTS The study included 14 female and 19 male patients, 33 in total, whose biopsy material was determined to be HP positive. Before the eradication for HP, we found serum albumin to be 34.0 (19.0-51.0) g/l, serum total protein 58.6 ±12.9 g/l, serum creatinine 0.9 (0.5-1.2) and proteinuria 3069 (652-12392) mg/day in 24-hour urine. After the eradication, however, serum albumin was found to be 40 (20-52) g/l, serum total protein 62.3 ±11.1 g/l, serum creatinine 1.02 (0.6-1.29) mg/dl and proteinuria was 2850 (172-15181) mg/day in 24-hour urine. A comparison of the results showed that a statistically significant difference is established between the serum albumin, total protein and creatinine values (p = 0.001, p = 0.001 and p = 0.021, respectively), but not between proteinuria values in 24-hour urine (p = 0.990). CONCLUSIONS Patients with primary glomerulonephritis, HP eradication treatment has an effect on serum albumin levels.
Collapse
Affiliation(s)
- Fatih Dede
- Department of Nephrology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Deniz Ayli
- Department of Nephrology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Ipek Gonul
- Department of Pathology, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Osman Yuksel
- Department of Gastroenterology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Ramazan Ozturk
- Department of Nephrology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Ayla Yildiz
- Department of Gastroenterology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Ezgi Yenigun
- Department of Nephrology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Serhan Piskinpasa
- Department of Nephrology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Didem Turgut
- Department of Nephrology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Eyup Koc
- Department of Nephrology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Ali Riza Odabas
- Department of Nephrology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
22
|
Piskinpasa S, Agbaht K, Akoglu H, Akyel F, Ozkayar N, Yenigun Coskun E, Turgut D, Koc E, Odabas AR, Dede F. Unknown aspect of the old disease: does dyslipidemia in systemic AA amyloidosis differ from the dyslipidemia in primary glomerulonephritis? Ren Fail 2015; 37:1273-9. [PMID: 26181645 DOI: 10.3109/0886022x.2015.1065427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIM To investigate the nature of dyslipidemia and its diversity in patients with systemic AA amyloidosis. METHODS The reports of the kidney biopsies performed due to nephrotic proteinuria (>3.5 g/day/1.73 m(2)) with preserved renal function [glomerular filtration rate (GFR) >60 mL/min/1.73 m(2)] were reviewed. Clinical and laboratory data of the patients with systemic AA amyloidosis and primary glomerulonephritis (PG) were analyzed. RESULTS A total of 104 (systemic AA amyloidosis: 43, PG: 61) patients were included in the study. Proteinuria and GFR levels were similar in both the groups. Patients with systemic AA amyloidosis group had lower serum albumin (p = 0.002), lower hemoglobin levels (p = 0.001), higher platelet counts (p = 0.002) and higher C-reactive protein levels (p = 0.001) compared to patients in PG group. Although the frequency of dyslipidemia was similar in the groups (86.0 vs. 93.4%), patients with systemic amyloidosis had both lower values of LDL-C (4.56 ± 2.05 vs. 5.49 ± 2.23 mmol/L, p = 0.028) and HDL-C (1.19 ± 0.36 vs. 1.35 ± 0.39 mmol/L, p = 0.035). Serum lipid levels were correlated with serum total protein, albumin and proteinuria levels in PG group. However, in the systemic amyloidosis group, only one clear correlation between serum lipid and hemoglobin levels was estimated. A multivariate analysis demonstrated that LDL-C was independently associated with the etiology of nephrotic proteinuria, serum total protein, serum albumin (inversely) and hemoglobin levels. CONCLUSIONS Although dyslipidemia is closely associated with serum total protein, albumin and proteinuria in patients with PG, there is no clear such association in patients with systemic amyloidosis. Correlation between serum lipid and hemoglobin levels in this group and other findings point out that probably complex mechanisms take place in dyslipidemia of nephrotic syndrome caused by systemic AA amyloidosis.
Collapse
Affiliation(s)
- Serhan Piskinpasa
- a Department of Nephrology , Ankara Numune Educational and Research Hospital , Ankara , Turkey and
| | - Kemal Agbaht
- b Department of Endocrinology and Metabolic Diseases , Balikesir State Hospital , Balikesir , Turkey
| | - Hadim Akoglu
- a Department of Nephrology , Ankara Numune Educational and Research Hospital , Ankara , Turkey and
| | - Fatma Akyel
- a Department of Nephrology , Ankara Numune Educational and Research Hospital , Ankara , Turkey and
| | - Nihal Ozkayar
- a Department of Nephrology , Ankara Numune Educational and Research Hospital , Ankara , Turkey and
| | - Ezgi Yenigun Coskun
- a Department of Nephrology , Ankara Numune Educational and Research Hospital , Ankara , Turkey and
| | - Didem Turgut
- a Department of Nephrology , Ankara Numune Educational and Research Hospital , Ankara , Turkey and
| | - Eyup Koc
- a Department of Nephrology , Ankara Numune Educational and Research Hospital , Ankara , Turkey and
| | - Ali Riza Odabas
- a Department of Nephrology , Ankara Numune Educational and Research Hospital , Ankara , Turkey and
| | - Fatih Dede
- a Department of Nephrology , Ankara Numune Educational and Research Hospital , Ankara , Turkey and
| |
Collapse
|
23
|
Yenigun EC, Dede F, Ozturk R, Turgut D, Koc E, Piskinpasa SV, Ozkayar N, Odabas AR. Non-Diabetic renal disease in Diabetes Mellitus: clinical features and renal biopsy findings. Hippokratia 2015; 19:148-152. [PMID: 27418764 PMCID: PMC4938106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
AIM Renal diseases in diabetes mellitus (DM) patients, include diabetic nephropathies (DN) and non-diabetic renal diseases (NDRD). The clinical differentiation among them is usually not so clear and effective. Aim of this study which examined renal biopsies in patients with type-2 DM was to identify the prevalence and the nature of NDRD. MATERIALS AND METHODS We recorded the clinical and laboratory finding alongside with the histopathological examination of the renal biopsies obtained from 71 type-2 DM patients who underwent renal biopsy in our center. Based on the renal biopsy findings patients were classified into two groups (DN and NDRD) and data was compared between the two groups. RESULTS There were 42 women and 29 men; aged 55 ± 12 years. In patients with DN (n: 34), diabetic retinopathy was more common [16 (47.1 %) vs. 6 (16.2 %) respectively, p =0.01], duration of DM was longer (108.8 ± 58.8 months vs 57.8 ± 55.9 months respectively, p <0.001) and the degree of proteinuria was more severe (6 ± 4.3 g/day vs. 4.5 ± 4.6 g/day respectively, p =0.04) compared to the patients with NDRD. Regression analysis revealed that diabetes duration >60 months, presence of diabetic retinopathy and proteinuria >3.5 g/day were independent predictors of DN with 79.4 % sensitivity and 86.5% specificity. Focal segmental glomerulosclerosis was the most frequent diagnosis in patients with NDRD. CONCLUSIONS The prevalence of NDRD is remarkably frequent in DM patients in whom nephrologists consider renal biopsy an appropriate measure. Short duration of DM, degree of proteinuria and absence of retinopathy were predictors of NDRD. Hippokratia 2015; 19 (2):148-152.
Collapse
Affiliation(s)
- E C Yenigun
- Nephrology Department of Numune Education and Research Hospital, Ankara, Turkey
| | - F Dede
- Nephrology Department of Numune Education and Research Hospital, Ankara, Turkey
| | - R Ozturk
- Nephrology Department of Numune Education and Research Hospital, Ankara, Turkey
| | - D Turgut
- Nephrology Department of Numune Education and Research Hospital, Ankara, Turkey
| | - E Koc
- Nephrology Department of Numune Education and Research Hospital, Ankara, Turkey
| | - S V Piskinpasa
- Nephrology Department of Numune Education and Research Hospital, Ankara, Turkey
| | - N Ozkayar
- Nephrology Department of Numune Education and Research Hospital, Ankara, Turkey
| | - A R Odabas
- Nephrology Department of Numune Education and Research Hospital, Ankara, Turkey
| |
Collapse
|
24
|
Ozkayar N, Akyel S, Dede F, Akyel F, Turgut D, Bulut M, Odabaş AR. Evaluation of heart rate recovery in patients with primary nephrotic syndrome. Hippokratia 2015; 19:109-113. [PMID: 27418757 PMCID: PMC4938099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND/AIM Abnormal heart rate recovery after an exercise stress test is a strong predictor of cardiovascular death in healthy subjects and various patient groups. The aim of the present study was to investigate heart rate recovery (HRR), a cardiovascular risk factor, in patients with primary nephrotic syndrome (NS). MATERIAL AND METHODS Forty patients with primary NS (mean age 39.6 ± 9.3 years) and 42 healthy subjects (mean age 36.0 ± 7.9) were included in the study. HRR was calculated by subtracting the heart rates in the first, second, and third minutes of the recovery period from the maximum heart rate, reached during the exercise stress test. RESULTS The HRR in the first minute was significantly slower in the NS group compared with the control group (25.5 ± 10.1 and 32.4 ± 11.1, respectively; p =0.004). The HRR in the second and third minutes was also slower in the NS group, but the difference was not statistically significant. When a comparative analysis of HRR and the etiology of NS was carried out, no difference was found at any time point. CONCLUSIONS Impaired first minute HRR was identified in patients with NS. This suggests that primary NS patients should be monitored due to the potential increased risk of cardiovascular disease. Hippokratia 2015; 19 (2):109-113.
Collapse
Affiliation(s)
- N Ozkayar
- Nephrology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - S Akyel
- Cardiology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - F Dede
- Nephrology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - F Akyel
- Nephrology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - D Turgut
- Nephrology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - M Bulut
- Nephrology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - A R Odabaş
- Nephrology Department, Istanbul Medeniyet University Medical Faculty, Istanbul, Turkey
| |
Collapse
|
25
|
Ozturk R, Yenigun EC, Dede F, Koc E, Turgut D, Piskinpasa SV, Ozkayar N, Odabas AR. Prognostic factors in crescentic glomerulonephritis: a single-center experience. Iran J Kidney Dis 2015; 9:31-38. [PMID: 25599734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 05/24/2014] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Crescentic glomerulonephritis (CGN) is a fatal disease, rapidly leading to end-stage renal disease. Diagnosis should be accurate and treatment should be started immediately. We investigated the factors associated with the renal prognosis in CGN patients. MATERIALS AND METHODS Forty-one patients with CGN who were followed up at the Nephrology Clinic of Ankara Numune Education and Research Hospital were divided into 2 arms of the dialysis-dependent group after treatment and the group that was followed up without dialysis. Demographic and clinical features along with biopsy findings during time of diagnosis were evaluated for both groups. RESULTS The mean age was 41.3 ± 17.2 years old and 26 were men. Twenty patients developed end-stage renal disease, requiring long-term dialysis. The dialysis-dependent group had higher serum creatinine levels (8.2 ± 3.6 mg/dL versus 2.6 ± 2.5 mg/dL) and percentages of glomeruli with crescent (83.1 ± 19.1% versus 56.4 ± 11.9%), were more likely to have oligoruia-anuria (90.5% versus 9.5%) and be dialysis-dependent at admission (86.4% versus 13.6%), and had longer elapsed time until the beginning of treatment (18.9 ± 10.4 days versus 10.6 ± 3.0 days) after treatment. At admission, their serum creatinine was greater than 4.2 mg/dL and the rate of crescentic glomeruli was greater than 63%. CONCLUSIONS In patients with CGN, renal prognosis is poor and the time of admission to the hospital, degree of renal insufficiency, presence of oligo-anuria, dialysis requirement, and the percentage of crescentic glomeruli on biopsy are closely related to progression to end-stage renal disease.
Collapse
Affiliation(s)
| | - Ezgi Coskun Yenigun
- Ankara Numune Education and Research Hospital, Department of Nephrology, Ankara, Turkey.
| | | | | | | | | | | | | |
Collapse
|
26
|
Yenigun EC, Dede F, Ozkayar N, Turgut D, Piskinpasa SV, Ozturk R, Koc E, Odabas AR. Coexistence of autosomal dominant polycystic kidney disease and amyloidosis in a patient with nephrotic-range proteinuria. Iran J Kidney Dis 2014; 8:243-245. [PMID: 24878950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Accepted: 09/15/2013] [Indexed: 06/03/2023]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is an inherited disorder characterized by the development and growth of cysts in the kidneys. Non-nephritic-range proteinuria is a common presentation in ADPKD patients; however, nephrotic syndrome is a rare coincidence. A 52-year-old man is described who was diagnosed with secondary amyloidosis with ADPKD. To our knowledge, this is the first case of amyloidosis associated with frequently infected renal cysts. Patients with ADPKD who show massive proteinuria should be investigated in terms of concomitant glomerular disease.
Collapse
Affiliation(s)
- Ezgi Coskun Yenigun
- Department of Nephrology, Ankara Numune Research and Education Hospital, Ankara, Turkey.
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Ozkayar N, Koc E, Piskinpasa S, Yenigun EC, Turgut D, Dede F. Late Onset Retroperitoneal Hemorrhage Associated with Cephoperazone-Sulbactam: Case Report. Istanbul Med J 2014. [DOI: 10.5152/imj.2014.87699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
28
|
Gok Oguz E, Bulut M, Erek M, Ozkayar N, Piskinpasa S, Yenigun E, Turgut D, Dede F. A Rare Complication in Hemodialysis Patients Due To Use of Low Molecular Weight Heparin; Abdominal Rectus Sheath Hematoma. Istanbul Med J 2013. [DOI: 10.5152/imj.2013.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
29
|
Ozkayar N, Piskinpasa S, Akyel F, Dede F, Yildirim T, Turgut D, Koc E, Haznedaroglu IC. Evaluation of the mean platelet volume in secondary amyloidosis due to familial Mediterranean fever. Rheumatol Int 2013; 33:2555-9. [PMID: 23673449 DOI: 10.1007/s00296-013-2775-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 05/04/2013] [Indexed: 11/24/2022]
Abstract
Familial Mediterranean fever (FMF) is an inflammatory disorder that is leading cause of secondary amyloidosis (AA). This study was designed to investigate the level of mean platelet volume (MPV) in AA. Seventy-four FMF, 29 AA patients and 180 healthy controls, were included. There was no significant difference between the cases in terms of sex and age. MPV levels were measured in all groups. In the FMF group, MPV level was significantly higher when compared to the control group. MPV level was significantly lower in AA group in comparison with the FMF and healthy control groups. In summary, our present study showed low MPV values in AA due to FMF.
Collapse
Affiliation(s)
- Nihal Ozkayar
- Nephrology Department, Ankara Numune Training and Research Hospital, Ankara, Turkey,
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Piskinpasa S, Akoglu H, Ozkayar N, Turgut D, Akyel F, Demir M, Cimen K, Turhan T, Koc E, Odabas AR, Ascioglu S, Dede F. Seroprevalance of the Hepatitis B and C in Patients with Chronic Kidney Disease without History of Renal Replacement Therapy. ACTA ACUST UNITED AC 2013. [DOI: 10.5262/tndt.2013.1002.07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
31
|
Bantis C, Heering P, Kouri NM, Siekierka-Harreis M, Stangou M, Schwandt C, Efstratiadis G, Rump LC, Ivens K, Haddiya I, Houssaini Squalli T, Laouad I, Ramdani B, Bayahia R, Dimas GG, Tegos TJ, Spiroglou SG, Pitsalidis CG, Sioulis AS, Karamouzis IM, Savopoulos CG, Karamouzis MI, Orologas AG, Hatzitolios AI, Grekas DM, Maixnerova D, Jancova E, Rychlik I, Rysava R, Merta M, Reiterova J, Kolsky A, Honsova E, Skibova J, Tesar V, Kendi Celebi Z, Calayoglu R, Keven K, Kurultak I, Mescigil P, Erbay B, Karatan O, Duman N, Erturk S, Nergizoglu G, Kutlay S, Sengul S, Ates K, Marino F, Martorano C, Bellantoni M, Tripepi R, Zoccali C, Ishizuka K, Harita Y, Kajiho Y, Tsurumi H, Asano T, Nishiyama K, Sugawara N, Chikamoto H, Akioka Y, Yamaguchi Y, Igarashi T, Hattori M, Bantis C, Heering PJ, Kouri NM, Stangou M, Siekierka-Harreis M, Efstratiadis G, Rump LC, Ivens K, Sahay M, Monova DV, Monov SV, Wang YY, Cheng H, Wang GQ, Dong HR, Chen YP, Wang CJ, Tang YL, Buti E, Dervishi E, Bergesio F, Ghiandai G, Mjeshtri A, Paudice N, Caldini AL, Nozzoli C, Minetti EE, Sun L, Feng J, Yao L, Fan Q, Ma J, Wang L, Kirsanova T, Merkusheva L, Ruinihina N, Kozlovskaya N, Elenshleger G, Turgutalp K, Karabulut U, Ozcan T, Helvaci I, Kiykim A, Kaul A, Bhadhuaria D, sharma R, Prasad N, Gupta A, Clajus C, Schmidt J, Haller H, Kumpers P, David S, Sevillano AM, Molina M, Gutierrez E, Morales E, Gonzalez E, Hernandez E, Praga M, Conde Olasagasti JL, Vozmediano Poyatos C, Illescas ML, Tallon S, Uson Carrasco JJ, Roca Munoz A, Rivera Hernandez F, Ismail G, Jurubita R, Andronesi A, Bobeica R, Zilisteanu D, Rusu E, Achim C, Sevillano AM, Molina M, Gutierrez E, Morales E, Huerta A, Hernandez E, Caro J, Gutierrez-Solis E, Praga M, Pasquariello A, Pasquariello G, Innocenti M, Grassi G, Egidi MF, Ozturk O, Yildiz A, Gul CB, Dilek K, Monov SV, Monova DV, Tylicki L, Jakubowska A, Weber E, Lizakowski S, Swietlik D, Rutkowski B, Postorino A, Costa S, Cristadoro S, Magazzu G, Bellinghieri G, Savica V, Buemi M, Santoro D, Lu Y, Shen P, Li X, Xu Y, Pan X, Wang W, Chen X, Zhang W, Ren H, Chen N, Mitic BP, Cvetkovic T, Vlahovic P, Velickovic Radovanovic R, Stefanovic V, Kostic S, Djordjevic V, Ao Q, Ma Q, Cheng Q, Wang X, Liu S, Zhang R, Ozturk S, Ozmen S, Akin D, Danis R, Yilmaz M, Hajri S, Barbouche S, Okpa H, Oviasu E, Ojogwu L, Fotouhi N, Ghaffari A, Hamzavi F, Nasri H, Ardalan M, Stott A, Ullah A, Anijeet H, Ahmed S, Kohli HS, Rajachandran R, Rathi M, Jha V, Sakhuja V, Yenigun E, Dede F, Turgut D, Koc E, Akoglu H, Piskinpasa S, Ozturk R, Odabas A, Bajcsi D, Abraham G, Kemeny E, Sonkodi S, Legrady P, Letoha A, Constantinou K, Ondrik Z, Ivanyi B, Lucisano G, Comi N, Cianfrone P, Summaria C, Piraina V, Talarico R, Camastra C, Fuiano G, Proletov I, Saganova E, Galkina O, Bogdanova E, Zubina I, Sipovskii V, Smirnov A, Bailly E, Pierre D, Kerdraon R, Grezard O, Gnappi E, Delsante M, Galetti M, Maggiore U, Manenti L, Hasan MJ, Muqueet MA, Mostafi M, Chowdhury I, Haque W, Khan T, Kang YJ, Bae EJ, Cho HS, Chang SH, Park DJ, Li X, Xu G, Lin H, Hu Z, Yu X, Xing C, Mei C, Zuo L, Ni Z, Ding X, Li D, Chen N, Ren H, Shen P, Li X, Pan X, Zhang Q, Feng X, Lin L, Zhang W, Chen N. Clinical nephrology - miscellaneous. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
32
|
Yenigun EC, Bardak S, Piskinpasa SV, Öztürk R, Turgut D, Koc E, Dede F. Acute Thrombotic Thrombocytopenic Purpura Following Orthopedic Surgery: Case Report and Review of the Literature. Ren Fail 2012; 34:937-9. [DOI: 10.3109/0886022x.2012.692750] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
|
33
|
Turgut D, Kalan I, Dede DS, Dogan E, Altundag K. Ipsilateral axillary recurrence of breast cancer 22 years after primary surgery: the latest recurrence in the literature. J BUON 2011; 16:571. [PMID: 22006772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
34
|
Altınbaş A, Ergünay K, Calık Başaran N, Alp A, Turgut D, Hasçelik G, Uzun Ö, Unal S. [Investigation of occult hepatitis B in HIV infected patients]. MIKROBIYOL BUL 2011; 45:353-358. [PMID: 21644079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Due to their shared transmission route, hepatitis B virus (HBV) or hepatitis C virus (HCV) co-infections can be observed in human immunodeficiency virus (HIV)-infected cases and are associated with more severe clinical courses. The detection of HBV DNA despite HBV surface antigen (HBsAg) seronegativity is defined as occult HBV infections. According to the current seroepidemiological data, Turkey is classified as an intermediate HBV, low HIV endemic region. Occult HBV infections have previously been reported from Turkey but has not been investigated previously in HIV infected cohorts. The aim of this study was to identify occult HBV infections in HIV-infected persons. Twenty-eight HIV-positive cases followed-up at Hacettepe University Hospital, Infectious Diseases Unit were included in the study after informed consent. For the detection of HBsAg, anti-HBs and anti-HCV, commercial ELISA tests (Architect System, Abbott Diagnostics, USA) were employed. Absolute CD4+ and CD8+ T-cell counts were determined via flow cytometry. HIV viral load was calculated via COBAS TaqMan HIV-1 Real-time PCR (Roche Diagnostics, USA) and the presence of HBV DNA was evaluated via COBAS TaqMan HBV Real-time PCR (Roche Diagnostics, USA), in addition to a nested PCR assay targeting HBV S gene. The mean age of the study group was 43.2 (range between 27-65) years, 64.3% (18/28) of them were males and the mean duration of HIV infection was 4.2 (2-11) years. Mean CD4+ ve CD8+ T-cell counts were 414 ± 267 cells/mm3 and 854 ± 293 cells/mm3, respectively. Twenty-six (92.8%) cases were under highly-active anti-retroviral therapy at the time of the study, 88.5% of which included HBV-active drugs (lamivudine or tenofovir). HIV RNA were found negative in 11 (39.3%) patients, of those nine (81.8%) were the cases who treated with HBV-active antiretroviral therapy. HBsAg were negative in all of the 28 patients, while the positivity rates of anti-HBs and anti-HCV were 39.3% (11/28) and 3.6% (1/28), respectively. All samples were negative for HBV DNA via the commercial real-time PCR and in-house nested PCR assays. The absence of occult HBV in the study group may indicate the absence of occult HBV or suppression of viral replication due to the anti-retroviral therapy. In conclusion, further large-scale studies are required to fully understand the impact of occult HBV in HIV-infected patients in Turkey.
Collapse
Affiliation(s)
- Akif Altınbaş
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Aybal Kutlugün A, Arıcı M, Yıldırım T, Turgut D, Yılmaz R, Altındal M, Altun B, Erdem Y, Yasavul Ü, Turgan Ç. Daily Sodium Intake in Chronic Kidney Disease Patients during Nephrology Clinic Follow-Up: An Observational Study with 24-Hour Urine Sodium Measurement. ACTA ACUST UNITED AC 2011; 118:c361-6. [DOI: 10.1159/000323392] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 11/24/2010] [Indexed: 11/19/2022]
|
36
|
Kalan I, Turgut D, Aksoy S, Dede DS, Dizdar O, Ozisik Y, Altundag K. Clinical and pathological characteristics of breast cancer patients with history of cesarean delivery. Breast 2009; 19:67-8. [PMID: 19913417 DOI: 10.1016/j.breast.2009.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 10/21/2009] [Accepted: 10/22/2009] [Indexed: 11/20/2022] Open
|
37
|
Aksoy S, Dizdar Ö, Turgut D, Sener Dede D, Arslan Ç, Harputluoglu H, Altundag K. Zoledronic acid and atrial fibrillation in cancer patients with bone metastases. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e20591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20591 Background: Treatment with a bisphosphonate was linked with a significantly increased risk for atrial fibrillation (AF) in a few studies. Once-yearly infusions of intravenous zoledronic acid (ZA) was also significantly increased serious AF in postmenopausal women with osteoporosis. This study was conducted to determine the frequency of atrial fibrillation among cancer patients receiving the standard treatment of ZA. Methods: One hundred and twenty-four cancer patients who had bone metastasis receiving ZA were included in this study. All patients have been receiving 4 mg ZA at 4-week intervals; with each dose administered over 15 minutes. Patients who presented outpatient clinic for any reason (routine control, chemotherapy, ZA administration) a short survey completed and standard 12-lead ECG recordings were obtained. Results: One hundred and twenty-four cancer patients with documented bone metastases were evaluated. Mean age of the patients was 55 ± 13.0 years, 60% of the patients were female. Forty-one percent of the patients had breast cancer and 17% non-small cell lung cancer and the remainder had other solid tumors. Mean duration of ZA administration was 13.4 ± 15.0 months/patients. Mean total cumulative dose was 54 ± 15.0 mg per patients. 60 (48%) of the patients were treated with antracycline including regimens, and 37 (30%) were treated with mediastinal radiotherapy that might effect the heart. Twenty-three percent of the patients had hypertension, 10% diabetes mellitus, 7% currently smoker and 32% exsmoker, 3.7% myocardial infarction history, 1.9% congestive heart failure, and 1% valvular disease. On ECG evaluation; we observed sinus rhythm in 58%, sinus tachycardia in 15%, sinus bradicardia in 3.2%, ventricular exracystole in 5.7% of the patients. There were no AF. Conclusions: Although most of the patients were also having potentially cardiotoxic treatment, there was no increase in AF frequency in cancer patients who were treated with intravenous ZA. We believe that the risk of AF is small and may increase with age and comorbidity. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- S. Aksoy
- Hacettepe University Institute of Oncology, Ankara, Turkey; Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ö. Dizdar
- Hacettepe University Institute of Oncology, Ankara, Turkey; Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - D. Turgut
- Hacettepe University Institute of Oncology, Ankara, Turkey; Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - D. Sener Dede
- Hacettepe University Institute of Oncology, Ankara, Turkey; Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ç. Arslan
- Hacettepe University Institute of Oncology, Ankara, Turkey; Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - H. Harputluoglu
- Hacettepe University Institute of Oncology, Ankara, Turkey; Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - K. Altundag
- Hacettepe University Institute of Oncology, Ankara, Turkey; Hacettepe University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
38
|
Turgut D, Summerlin E. Evaluation of the computer-based training module for the Marine medic. J Biocommun 2002; 28:18-20. [PMID: 11826470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
This is a follow-up article (found in JBC Vol. 25, No. 4, 1998) discussing the evaluation of the Computer-based Training Module (CBT) presented to the trainers of the medical first responders of the health care division of the Marine medics at Camp Pendelton, California. Their specific comments are embodied in the text of the article. The suggestions provided were to expand the existing CBT Module to include enhanced features.
Collapse
Affiliation(s)
- D Turgut
- Center for Advanced Engineering Systems and Automation Research (CAESAR), University of Texas at Arlington, USA
| | | |
Collapse
|
39
|
Summerlin E, Turgut D, Gates C. How a computer-based training module for the marine medic was developed. J Biocommun 1999; 25:6-9. [PMID: 9924688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
This article is a discussion of how a prototype Computer-based Training (CBT) program module was developed by a team of people representing different nationalities and from various professions including nursing, engineering, and medical graphics. Multimedia solutions that would facilitate the training of Marine corpsmen to perform their mission as first responder in combat incidents were examined. Three separate software models were evaluated. The prototype chosen was selected because of its simplicity, user-friendliness, and cost effectiveness.
Collapse
Affiliation(s)
- E Summerlin
- School of Nursing, University of Texas at Arlington, USA
| | | | | |
Collapse
|