Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
Browse
7 results
Search Results
Item Machine Learning Insights Into Uric Acid Elevation With Thiazide Therapy Commencement and Intensification(2023) Ozdede, Murat; Guven, Alper T.; 38274913Background Elevated serum uric acid, associated with cardiovascular conditions such as atherosclerotic heart disease, hypertension, and heart failure, can be elevated by thiazide or thiazide-like drugs (THZ), essential in hypertension management. Identifying clinical determinants affecting THZ-related uric acid elevation is critical. Methods In this retrospective cross-sectional study, we explored the clinical determinants influencing uric acid elevation related to THZ, focusing on patients where THZ was initiated or the dose escalated. A cohort of 143 patients was analyzed, collecting baseline and control uric acid levels, alongside basic biochemical studies and clinical data. Feature selection was conducted utilizing criteria based on mean squared error increase and enhancement in node purity. Four machine learning algorithms - Random Forest, Neural Network, Support Vector Machine, and Gradient Boosting regressions - were applied to pinpoint clinical influencers. Results Significant features include uncontrolled diabetes, index estimated Glomerular Filtration Rate (eGFR) level, absence of insulin, action of indapamide, and absence of statin treatment, with absence of Sodium -glucose cotransporter 2 inhibitors (SGLT2i), low dose aspirin exposure, and older age also being noteworthy. Among the applied models, the Gradient Boosting regression model outperformed the others, exhibiting the lowest Mean Absolute Error (MAE), Mean Squared Error (MSE), Root Mean Squared Error (RMSE) values, and the highest R2 value (0.779). While Random Forest and Neural Network regression models were able to fit the data adequately, the Support Vector Machine demonstrated inferior metrics. Conclusions Machine learning algorithms are adept at accurately identifying the factors linked to uric acid fluctuations caused by THZ. This proficiency aids in customizing treatments more effectively, reducing the need to unnecessarily avoid THZ, and providing guidance on its use to prevent instances where uric acid levels could become problematic.Item Baseline Sodium-Glucose Cotransporter-2 Inhibitor Use Strongly Attenuates the Uric Acid-Elevating Effect of Thiazide Exposure(2023) Guven, Alper Tuna; Ozdede, Murat; Sener, Yusuf Ziya; 0000-0002-6310-4240Objective: Thiazide diuretics are among the major anti-hypertensive medications. However, their hyperuricemic effect restricts their use in patients with gout. Sodium glucose co-transporter 2 inhibitor (SGLT-2i) initiation lowers serum uric acid (SUA) levels. It is not known whether existing SGLT-2i use affects the SUA increasing effect of thiazides. Methods: Post-hoc data analysis of our published study was conducted. Hypertensive patients who were initiated on thiazide diuretics or whose dose escalated were included (thiazide exposure). Demographic, clinical, and laboratory data were acquired via an electronic database. Patients were grouped according to SGLT-2i presence at the time of thiazide exposure. Since the number of SGLT-2i users was low, bootstrapping via simple random sampling was performed. Results: 144 patients were included in the study, of whom 13 were on SGLT-2i. Initial sample analysis revealed that while baseline SUA levels were similar between groups, SUA change was significantly lower after thiazide exposure among patients receiving SGLT-2i (0.6 vs. 0.2, p = 0.039). Similarly, baseline SUA levels were similar, but SUA change after thiazide exposure was significantly lower among patients receiving SGLT-2 on bootstrapped data (0.13 [-0.25 - 0.57, 95%CI], vs. 0.61 [0.45 - 0.78, 95%CI], mean difference = 0.48, [0.04 - 0.91, 95%CI], p = 0.029). Conclusion: This study revealed that thiazide diuretics may be a safe anti-hypertensive medication in terms of hyperuricemia among patients using SGLT-2i. Further studies with similar outcomes may result in the elimination of restrictive recommendations for the use of thiazides in patients with hyperuricemia or gout, provided patients are on SGLT-2i.Item The Safety and Tolerability of Nebivolol in Hypertensive Patients with Coronary Artery Disease and Left Ventricular Ejection Fraction >= 40%: A Population-Based Cohort Study (Nebivolol-TR Study)(2022) Altin, Cihan; Okyay, Kaan; Kocaba, Umut; Coner, Ali; https://orcid.org/0000-0001-6134-8826; https://orcid.org/0000-0002-5711-8873; 36317659; AAK-7355-2020; ABD-7321-2021Background: This study aimed to assess the safety and tolerability of nebivolol in hypertensive patients with coronary artery disease and left ventricular ejection fraction >= 40% in a Turkish cohort. Methods: A total of 1015 hypertensive patients and coronary artery disease with left ventricular ejection fraction >= 40% were analyzed from 29 different centers in Turkey. Primary outcomes were the mean change in blood pressure and heart rate. Secondary outcomes were to assess the rate of reaching targeted blood pressure (<130/80 mmHg) and heart rate (<60 bpm) and the changes in the clinical symptoms (angina and dyspnea). Adverse clinical events and clinical outcomes including cardiovascular mortality, cardiovascular hospital admissions, or acute cardiac event were recorded. Results: The mean age of the study population was 60.3 +/- 11.5 years (male: 54.2%). During a mean follow-up of 6 months, the mean change in blood pressure was -11.2 +/- 23.5/-5.1 +/- 13.5 mmHg, and the resting heart rate was -12.1 +/- 3.5 bpm. Target blood pressure and heart rate were achieved in 76.5% and 37.7% of patients. Angina and functional classifications were improved by at least 1 or more categories in 31% and 23.2% of patients. No serious adverse events related to nebivolol were reported. The most common cardiovascular side effect was symptomatic hypotension (4.2%). The discontinuation rate was 1.7%. Cardiovascular hospital admission rate was 5% and hospitalization due to heart failure was 1.9% during 6 months' follow-up. Cardiovascular mortality rate was 0.1%. Conclusion: Nebivolol was well tolerated and safe for achieving blood pressure and heart rate control in hypertensive patients with coronary artery disease and heart failure with preserved or mildly reduced ejection fraction.Item Pneumococcal and Influenza Vaccines in Dialysis Patients: Vaccination Information, Rates, and Patient Awareness(2022) Kara, Sibel; Torun, Dilek; Oruc, Ebru; Habesoglu, Mehmet Ali; Akcay, Muserref Sule; GVT-0626-2022Objective: Pneumococcal and influenza vaccination rates are still far below the desired levels in dialysis patients. We aimed to determine the pneumococcal and influenza vaccination information, rates, and knowledge levels of dialysis patients. Methods: The study is a descriptive cross-sectional study in which 307 dialysis patients between 2020 and 2021 were analyzed retrospectively. Demographic characteristics of all patients and vaccination information were obtained from the face-to-face questionnaire and hospital medical records. Results: Of the participants, 52.4% were males, and the mean age was 56 +/- 15.45 years. The pneumococcal vaccination rate was 37.1%, and the influenza vaccination rate was 58.6%. Of 114 patients who had received a pneumococcal vaccine, 91.2% had received a single dose of the vaccine. While the type of vaccine could not be determined in 86.8% of the patients in this group, the rate of vaccination with the 2 types of the pneumococcal vaccine was only 8.8%. Annual vaccination was given to all those who were vaccinated against influenza. In the whole group, the rate of those who had never heard of the pneumococcal vaccine was 24.4%, while this rate was 6.5% for the influenza vaccine. The patients had a very low level of knowledge of both vaccines (41% and 53.7%, respectively). Conclusion: Pneumococcal and influenza vaccination rate of dialysis patients was low. Influenza vaccination had been performed in compliance with the recommended scheme, but the doses of the pneumococcal vaccine were incomplete. Although the level of patient knowledge was low for both vaccines, patients were more aware of the influenza vaccine.Item Systemic arterial hypertension and flight(2021) Okyay, Kaan; 34464291Hypertension is the major preventable cause of cardiovascular disease and all-cause death. Given its overall high prevalence, hypertension would be one of our major concerns in commercial flights. Hence, the management of hypertension is of great importance. Herein, we discuss the pathophysiological factors for elevated blood pressure during flight, and we make recommendations which should be followed by the passengers and the flight crew and the physicians for trouble-free air travel.Item COVID-19: a novel menace for the practice of nephrology and how to manage it with minor devastation?(2020) Ulu, Sena; Gungor, Ozkan; Gok Oguz, Ebru; Hasbal, Nuri Baris; Turgut, Didem; Arici, Mustafa; 0000-0001-7474-5927; 32713282; AAI-9418-2021Coronavirus 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 timesItem Abnormal circadian blood pressure regulation in children with nocturnal enuresis(2016) Yuce, Ozge; Bayrakci, Umut Selda; Gulleroglu, Kaan; Baskin, Esra; 27056252Introduction: To investigate autonomic nervous system function in enuretic children by performing ambulatory blood pressure monitor (ABPM) for 24h. Methods: Twenty-eight children ranging in age from 6 to 15 years with primary nocturnal enuresis and 27 age-matched healthy controls were enrolled and they get 24h ABPM. Hypertension was defined as standard deviation score (SDS)>1.64 (i.e., >95th percentile) adjusted for gender and height. Urinalysis, urine electrolyte levels, urinary culture, and urinary system ultrasound were carried out in all children. They have also requested to have a diary about daily fluid intake and urine volume. Results: Although the mean 24-h and daytime diastolic blood pressure (BP) did not differ between the groups, systolic BP (SBP) was significantly higher in enuretic children (p<0.05). The mean night-time SBP, DBP values, SDS and BP loads were found to be significantly higher than those in the controls (p<0.01). A lack of nocturnal decrease was more prevalent in the enuretic children compared with the control subjects, the difference was statistically significant for DBP but not for SBP. Patients with elevated night-time BP load was found to have higher frequency of urinary incontinence per week as well as per night when compared with enuretic children with normal night-time BP load (r=0.72, r=0.69, p<0.01, respectively). Conclusion: Subtle abnormalities of circadian BP regulation in enuretic children indicated by a selective elevation of nocturnal SBP, DBP, and MAP, and attenuated nocturnal dipping may reflect sympathetic hyper activation and its possible role in pathogenesis of enuresis.