Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Differential Influence of Vitamin D Analogs on Left Ventricular Mass Index in Maintenance Hemodialysis Patients(2014) Sezer, Siren; Tutal, Emre; Bal, Zeynep; Uyar, Mehtap Erkmen; Bal, Ugur; Cakir, Ulkem; Acar, Nurhan Ozdemir; Haberal, Mehmet; https://orcid.org/0000-0002-7326-8388; https://orcid.org/0000-0002-9446-2518; https://orcid.org/0000-0002-3462-7632; 24619898; JYQ-2550-2024; AAZ-5795-2021; AAK-4322-2021; AAJ-8097-2021Purpose: Secondary hyperparathyroidism (SHPT) is a common feature in maintenance hemodialysis (MHD) patients. Inadequate treatment of SHPT has been associated with cardiovascular complications, and vitamin D therapy might influence the development of cardiovascular diseases. In the present study, we aimed to evaluate the effects of intravenous paricalcitol and calcitriol treatments on left ventricular mass index changes in MHD patients. Methods: We conducted an observational study with a 12-month follow-up duration to compare the outcomes of intravenous paricalcitol and calcitriol treatments in MHD patients. Eighty patients with moderate to severe SHPT were enrolled in the study. All the patients had normalized total serum Ca concentration <10.5 mg/dL, serum calcium-phosphorus product (Ca x P) <75, and parathyroid hormone level (PTH) level >= 300 pg/mL at the begining of the follow-up period. Results: The patients were divided into a paricalcitol group (n = 40) and a calcitriol group (n = 40). The demographic, clinical, and biochemical characteristics of the patients were similar at baseline. We observed significantly superior control of SHPT; lesser frequency of hypercalcemia and hyperphosphatemia, and Ca x P level elevations; and interruption of vitamin D treatment in the paricalcitol group. Moreover, we found no significant change in left ventricular mass index in the paricalcitol group, but found a significantly increased left ventricular mass index in the calcitriol group during the follow-up period (from 136.6 +/- 35.2 g/m(2) to 132.9 +/- 40.4 g/m(2) vs. from 137.2 +/- 30.1 g/m(2) to 149.4 +/- 31.0 g/m(2); p<0.044). Conclusion: We observed that, compared with calcitriol therapy, paricalcitol therapy reduced the PTH concentrations more effectively without causing hypercalcemia and hyperphosphatemia and might have a substantial beneficial effect on the development of left ventricular hypertrophy.Item Management of Symptomatic Arterial and Venous Aneurysms in Hemodialysis Patients Related To Arteriovenous Fistulas(2018) Avci, Tevfik; Yabanoglu, Hakan; Moray, Gokhan; Haberal, Mehmet; https://orcid.org/0000-0001-5225-959X; https://orcid.org/0000-0002-1161-3369; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-3462-7632; AAF-1698-2021; AAJ-7865-2021; AAE-1041-2021; AAJ-8097-2021AIM: Our aim in this study is to present the management of the symptomatic aneurysms that are related to AVF. MATERIAL AND METHODS: Between January 2011 and January 2017, 50 patients who were operated due to symptomatic AVF aneurysms were evaluated. Forty-four (88%) patients' fistulas were closed for symptomatic venous aneurysm. In 6 (12%) patients true brachial artery aneurysm were present and a segmental artery resection with its repair was performed. RESULTS: The most common symptomatic aneurysm was seen on the brachiocephalic fistula (n=32, 64%). The symptoms of the patients were; aneurysm thrombosis (n=15, 30%), steal syndrome (n=9, 18%), rupture/massive bleeding (n=7, 14%), infection (n=7, 14%), skin necrosis (n=5, 10%), venous hypertension (n=4, 8%) and high output cardiac failure (n=1, 2%). Nine (18%) patients had two or more symptoms. While the mean duration of dialysis of patients who underwent venous aneurysmectomy was 69 +/- 4.2 years, patients who underwent arterial aneurysmectomy and brachial artery repair was 11.7 +/- 3.6 years (p = 0.012). DISCUSSION: Arterial aneurysm is a rare complication of vascular access. Although it causes serious symptoms including those of related such as thrombosis, ischemia, nerve compression, the most important complication is aneurysm rupture. Therefore, preoperative evaluation and appropriate surgical interventions will prevent morbidities that may arise. CONCLUSION: The choice of a treatment modality in patients with a symptomatic arteriovenous fistula aneurysms is to maintain the continuity of the arteriovenous fistula but when acute bleeding occurs in an unstable patient, ligation of fistula should be considered.Item Influence of Social, Economic, Familial, Marital Status, and Disease Adaptation on the Physical and Mental Health Dimensions of Patients Who Are Candidates for Renal Transplant(2018) Ozdemir, Aydan Akyuz; Sayin, Cihat Burak; Erdal, Rengin; Ozcan, Cihangir; Haberal, Mehmet; 0000-0002-7329-7576; 0000-0001-7220-7244; 0000-0001-8287-6572; 0000-0002-3462-7632; 29528005; ABH-7372-2020; AAK-2334-2021; AAK-1788-2021; AAJ-8097-2021Objectives: End-stage renal disease is a disease with a long duration, requiring patients to live with the limitations imposed by their condition. Stressors associated with this disease are demanding, with patients dependent on support from their social environment. Here, we aimed to show the influences of familial, social, economic, and marital status on quality of life in patients with end-stage renal disease. Materials and Methods: Patients (190 women/188 men) who were under hemodialysis treatment and on transplant wait lists were included in the study. To evaluate the quality of life, patients completed the Short Form 36 health survey questionnaire voluntarily while undergoing hemodialysis treatment. All Short Form 36 questionnaire components were analyzed separately, and all social, economic, and business life dimensions were examined with another questionnaire. Results: Significant differences were observed between single and married patients regarding physical and mental health dimensions (P < .001), with quality of life higher in single patients than in married. Patients who lived in villages had lower health quality than patients who resided in cities or towns (P < .01). Patients who were home owners and who had a job had higher degrees of health quality than those who did not (P < .01). The lowest Short Form 36 scores were in housewives and farmers (P < .001). Comparisons between patients who went home after hemodialysis versus those who went to work showed better Short Form 36 scores in working patients (P < .001). Patients with private insurance and family support had better Short Form 36 scores (P < .001). Patients who did not comply with their doctor and dietician showed the lowest health quality (P < .05). Regular or irregular drug use did not affect scores. Conclusions: Familial, social, economic, and marital statuses, in addition to the influence of disease adaptation, independently affected the well-being of patients with end-stage renal disease.Item The Economics of Organ Transplantation(2018) Altinors, Nur; Haberal, Mehmet; 0000-0002-3462-7632; 29528004; AAJ-8097-2021To determine the cost effectiveness of transplantation, we analyzed the financial economics of the organ and tissue transplant process. We compared the cost of this process with traditional modalities for treating end-stage liver and kidney disease. Medical, surgical, legal, social, ethical, and religious issues are important in organ transplant procedures. Government, health insurance companies, and uninsured individuals are affected by the financial economics of organ transplantation. The distribution of financial burden differs among countries and is dependent on the unique circumstances of each country.Item Factors Predisposing to the Use of Complementary Therapies in Patients With Chronic Renal Failulre(2018) Ozdemir, Aydan Akyuz; Erdal, Rengin; Haberal, Mehmet; 0000-0002-7329-7576; 0000-0002-3462-7632; ABH-7372-2020; AAK-2334-2021; AAJ-8097-2021Objectives: Our aim was to gather information about complementary medicine applications used by chronic renal failure patients and their relation to demographic factors. Materials and Methods: Of 1750 chronic renal disease patients who were undergoing hemodialysis, only 450 patients attended in the study. Among 450 patients, 388 gave consent and were interviewed using a previously tested questionnaire. Questions about complementary and alternative medicine use, a list of commonly used methods, and the sources of knowledge about these were asked of all patients. Results: We observed a significant difference in the patients who were using complementary and alternative medicines before and after diagnosis of chronic renal disease (P <.001). We noted that 87% of the patients used complementary and alternative medicines before diagnosis and 49.8% used these after diagnosis. Among the patients who used complementary and alternative medicines, 76% had faith in these therapies. Of patients who used complementary and alternative medicines, 95% believed that the remedies or processes used were beneficial to their health. Furthermore, 71% of users had great confidence in these therapies and had no belief that these could be harmful. Of those who used complementary and alternative therapies, 51% had no idea whether these therapies were harmful. The source of knowledge was mass media tools (47%), social life (friends, relatives, neighbors, colleagues; 45%), and other patients with chronic renal disease (8%). Conclusions: Complementary and alternative medicine therapies have a significant impact on patients with chronic renal disease. Doctors can warn patients about possible dangers of complementary and alternative medicine remedies and treatments.Item Surgical Interventions for Late Complications of Arteriovenous Fistulas(2014) Belli, Sedat; Yabanoglu, Hakan; Aydogan, Cem; Parlakgumus, Alper; Yildirim, Sedat; Haberal, Mehmet; 25058786Our aim was to determine the most effective surgical treatment for arteriovenous fistula (AVF) complications after all other methods of salvage have failed. We evaluated 110 patients for 139 complications that occurred after the initial AVF placement and for whom surgical intervention was the last hope for retaining fistula access. Vascular steal syndrome and venous hypertension were the most common complications seen in our patients. The anastomoses of 17 of the vascular steal syndrome cases were narrowed either by stitches or by a polytetrafluoroethylene graft. The second most performed revision surgery was excision of the aneurysm and repair with primary suturing, followed by excision of the aneurysm and interposition grafting. Successful surgical outcomes were achieved in 111 of 139 procedures after revision surgery without constructing a new AVF. AVF salvage surgery is of paramount importance in order to increase the patency rate, which prolongs survival and increases the patient's quality of life.Item Effects of HCV-RNA positivity on serum IL-1 beta levels in chronic hemodialysis patients(Gazi Medical Journal ,12 ,4 ,155-158, 2001) Yücel, Ayşegül; Köseoğlu, Hamide; Yücel, Ahmet Eftal; Özdemir, Nurhan; Haberal, MehmetHepatitis C virüs (HCV) positivity and inflammatory cytokines such as interleukin(IL)-} beta, tumor necrosis factor-alpha and IL-6 secreted by activated macrophages are known to be important morbidity factors in chronic hemodialysis (HD) patients. in this preliminary stııdy, we aimed to compare serum IL-1 beta levels of 20 HCV-RNA-positive and 23 HCV-RNA-negative chronic HD patients. Methods: HCV-RNA-positivity and serum IL-1 beta levels were studied using nested reverse transcriptase-polymerase chain reaction and ELISA methods, respectively. Results: We could detect no statistically signifıcant difference between serum IL-1 beta levels in HCV-RNA-positive and HCV-RNA-negative groups (p>0.05). Conclusion: To our knowledge, this is the fırst study to examine the relationship between serum IL-1 beta level and HCV infection in HD patients. We had expected the level of IL-1 beta to be higher in HCV-RNA-positive group, and believe that the blood-dialyzer interaction strongly activated mononuclear cells, thus generating elevated levels of IL-1 beta in both groups. This could explain why HCV infection apparently did not affect serum IL-1 beta levels.