Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Feasibility of the Interferon-Gamma Enzyme-Linked Immunospot Assay in Chronic Renal Failure Patients and Immunocompetent Subjects: A Head-To-Head Comparison(2015) Dilektasli, Asli Gorek; Durukan, Elif; Eyuboglu, Fusun Oner; 0000-0002-8579-5564; 0000-0002-5525-8207; 25387208; AAJ-8621-2021; AAR-4338-2020Diagnosis of latent Mycobacterium tuberculosis infection (LTBI) by the tuberculin skin test (TST) is hampered due to anergy and impaired sensitivity in chronic renal failure (CRF) patients. We aimed to compare the diagnostic performance of the TST with that of interferon-gamma immunospot (T-SPOT.TB (R)) assay in diagnosing LTBI in CRF and immunocompetent (IC) patients. A total of 74 CRF and 75 IC patients prospectively underwent the TST and T-SPOT. TB. Latent M. tuberculosis infection estimated by TST and T-SPOT. TB was detected in 69% and 43 of CRF; 52 and 35% of IC patients, respectively. The sensitivity and specificity of the T-SPOT. TB were 73 and 74% in IC, whereas 50 and 55% in CRF patients. In conclusion, the prevalence of LTBI was noteworthy in both IC and CRF patients. T-SPOT. TB was less sensitive and specific than the IC group in CRF patients. Both T-SPOT. TB and TST were not associated with the TB exposure.Item Multiple Brain Abscesses Due to Phialemonium in a Renal Transplant Recipient: First Case Report in the Literature(2015) Aydin, Mehtap; Ozcelik, Umit; Cevik, Halime; Cinar, Ozlem; Evren, Ebru; Demirag, Alp; 0000-0003-1073-2494; 0000-0003-4044-9366; 26640919; AAG-8651-2021; HLX-0937-2023; JAZ-1759-2023Fungal brain abscesses are a rare but serious complication in transplant recipients. Phialemonium organisms are rare causes of invasive mold infections. Here, we present the first case of a renal transplant recipient with multiple brain abscesses caused by Phialemonium infection A. A 51-year-old female kidney transplant recipient was admitted with pneumonia of an unknown cause and treated with empiric intravenous antibiotics. Her treatment was uneventful, and she was discharged 1010 days later. After 5 days, she was readmitted with fever, cerebral palsy, and speech disorder. The patient had undergone living-donor renal transplant 7 months earlier. A cranial computed tomography and magnetic resonance imaging were performed for a possible cerebro vascular pathology. The magnetic resonance imaging scan showed multiple brain abscesses located at the left parietal, frontal and occipital lobes; right parietal and occipital lobes; right basal ganglia; and left cerebellum. The patient received meropenem, linezolid, sulfamethoxazole and trimethoprim, and AmBisome for probable pathogenic infection, and immunosuppressive agents dosage was reduced increasingly immuno suppressed. We identified Phialemonium in cerebrospinal fluid culture. The patient received voriconazole 200 mg twice daily. Lesions could not be drained due to lack of capsula formation. The patient died on the 30th day of antifungal therapy. Phialemonium organisms, although a rare cause of fungal infections, are associated with a high mortality rate in immunocompromised patients. To our knowledge, this is the first case report in the literature describing multiple brain abscesses due to Phialemonium in a transplant recipient. Clinicians recipient should be alert about these rare opportunistic fungi in the differential diagnosis of brain abscess, and bronchoscopy and broncho alveolar lavage are recommended for transplant patients when they are admitted with pneumonia exclude fungal infections.Item Delaying Renal Transplant after Radical Prostatectomy for Low-Risk Prostate Cancer(2015) Ozcelik, Umit; Bircan, Huseyin Yuce; Karakayali, Feza; Moray, Gokhan; Demirag, Alp; 0000-0002-1874-947X; 0000-0003-1073-2494; 0000-0003-2498-7287; 26640918; AAB-3888-2021; AAG-8651-2021; AAE-1041-2021; R-6394-2019To minimize the recurrence of a previously treated neoplasm in organ recipients, a period of 2 to 5 years without recurrence is advocated for most malignancies. However, prostate cancer is different because of its biological properties, diagnosis, and treatment. Most prostate cancers are detected at a low stage and demonstrate slow growth after detection. Definitive treatment with radical prostatectomy affords excellent results. Renal transplant candidates with early-stage prostate cancer have a higher risk of dying on dialysis than dying from prostate cancer; therefore, renal transplant candidates with organ-confined prostate cancer should be immediately considered for transplant.Item Development of an Information Model for Kidney Transplant Wait List(2015) Bircan, Huseyin Yuce; Ozcelik, Umit; Uysal, Nida; Demirag, Alp; Haberal, Mehmet; 0000-0003-1073-2494; 0000-0002-3462-7632; 26640914; R-6394-2019; AAG-8651-2021; AAJ-8097-2021Objectives: Deceased-donor kidney transplant is unique among surgical procedures that are an urgent procedure performed in an elective population. It has not been possible to accurately determine when a given patient will be called for transplant. Patients on the active transplant list can be called for a transplant at any time. As a result, every effort must be made to optimize their health according to best practices and published clinical practice guidelines. Materials and Methods: Once the patient is placed on the transplant wait list after undergoing an initial extensive evaluation, continued surveillance is required. Therefore, we developed a kidney transplant wait list surveillance software program that alerts organ transplant coordinator on time regarding which patients need a work-up. Results: The new designed software has a database of our waiting patients with their completed and pending controls. The software also has built-in functions to warn the responsible staff with an E-mail. If one of the controls of a recipient delayed, the software sends an automated E-mail to the staff regarding the patients delayed controls. The software is a Web application that works on any platform with a Web browser and Internet connection and allows access by multiple users. The software has been developed with NET platform. The database is SQL server. The software has the following functions: patient communication info, search, alert list, alert E-mail, control entry, and system management. Conclusions: As of January 2014, a total of 21 000 patients were registered on the National Kidney Transplant wait list in Turkey and the kidney transplant wait list had been expanding by 2000 to 3000 patients each year. Therefore computerized wait list programs are crucial to help to transplant centers to keep their patients up-to-date on time.Item Pregnancy and Its Outcomes in Hemodialysis Patients in Turkey(2022) Tekkarismaz, Nihan; 34844294Background/aim: This study aimed to investigate pregnancy frequency and evaluate the factors affecting live births in hemodialysis (HD) patients. Materials and methods: Female HD patients whose pregnancy was retrospectively reported between January 1, 2014, and December 31, 2019. The duration of HD, primary disease, and the information on whether the pregnancy resulted in abortion, stillbirth, or live birth, whether the HD duration was prolonged after diagnosing the pregnancy and whether it accompanied preeclampsia were recorded. Results: In this study, we reached 9038 HD female patients' data in the study. A total of 235 pregnancies were detected in 145 patients. The mean age was 35.42 (35 +/- 7.4) years. The mean age at first gestation was 30.8 +/- 6.5 years. The average birth week was 32 (28 -36) weeks. A total of 53.8% (no = 78) of the patients had live birth, 51.7% (no = 70) had at least one abortion in the first 20 weeks, and 13.1% (no = 19) had at least one stillbirth after 20 weeks. The rate of patients' increased numbers of dialysis sessions during pregnancy was 71.7%. The abortion rate was 22.4% in those with increased HD sessions, whereas 79.3% in those not increased HD sessions (p < 0.001). Live birth frequency was 67.2% in the increased HD sessions group and 3.4% in those who did not differ in HD sessions (p < 0.001). Conclusion: For the first time, we reported pregnancy outcomes in HD female patients, covering all regions of Turkey. It has been observed that; increasing the number of HD sessions in dialysis patients will decrease fetal and maternal complications and increase live birth rates.Item Acoustic Radiation Force Impulse Elastography Findings of Achilles Tendons in Patients on Chronic Hemodialysis and in Renal Transplant Patients(2021) Rahatli, Feride Kural; Turnaoglu, Hale; Haberal, Kemal Murat; Kirnap, Mahir; Fidan, Cihan; Sayin, Cihat Burak; Uslu, Nihal; Haberal, Mehmet; 0000-0002-8211-4065; 0000-0002-9093-1524; 0000-0002-9093-1524; 30398098; R-9398-2019; F-5830-2019; F-5830-2019Objectives: The Achilles tendon, which is composed of tendinous parts of gastrocnemius and soleus muscles, is the strongest and the largest tendon in the human body. Chronic renal disease can lead to reduced physical activity and exercise capacity. Spontaneous rupture of the Achilles tendon can occur in patients with chronic renal failure, with recurrent microtraumas, hypoxia, and chronic acidosis as predisposing factors. Here, we assessed and compared the elastographic findings in the Achilles tendon using acoustic radiation force impulse elastography in patients on chronic hemodialysis, in renal transplant patients, and in healthy volunteers. Materials and Methods: Our study included 25 patients on chronic hemodialysis, 25 renal transplant patients, and 25 healthy individuals (control group). The thickness and shear wave velocity of the Achilles tendons were measured bilaterally by ultrasonography and acoustic radiation force impulse elastography. Results: The mean shear wave velocity was 3.67 m/s in the right and 3.64 m/s in the left Achilles tendon in the hemodialysis group. In the renal transplant group, the mean shear wave velocity was 4.29 and 4.25 m/s for the right and left Achilles tendon, respectively. In the control group, the mean shear wave velocity was 6.68 and 6.59 m/s, respectively for the right and left Achilles tendon. A statistically significant difference in shear wave velocities was shown among the groups (P<.05). Conclusions: Achilles tendons in patients with chronic renal failure and on hemodialysis were softer than in renal transplant patients and softer than in the control group. Chronic tendinopathy causes softening of the tendon. In the renal transplant group, stiffness of the Achilles tendon was increased versus the hemodialysis group but still softer than the control group, which could be explained as a positive clinical effect of renal transplant. Acoustic radiation force impulse elastography is an objective, easy, and noninvasive method to assess Achilles tendinopathy.Item Outcomes of Total Parathyroidectomy with Autotransplantation versus Subtotal Parathyroidectomy Techniques for Secondary Hyperparathyroidism in Chronic Renal Failure(2020) Sari, Ramazan; Yabanoglu, Hakan; Hargura, Abdirahman Sakulen; Kus, Murat; Arer, Ilker Murat; 0000-0001-6529-7579; 0000-0002-1161-3369; 0000-0003-3492-9953; 0000-0003-0268-8999; 31931926; AAJ-7870-2021; AAG-1897-2021; AAJ-7865-2021; AAK-2011-2021Objective: To compare the safety and the effectiveness of total parathyroidectomy with autotransplantation versus subtotal parathyroidectomy for refractory secondary hyperparathyroidism in patients with chronic kidney disease. Study Design: A comparative study. Place and Duration of Study: Baskent University, Adana Medical and Research Center, Adana, Turkey, from January 2012 to November 2018. Methodology: Patients operated upon for refractory secondary hyperparathyroidism by the general surgery team were inducted. Overall, 25 (40%) patients underwent total parathyroidectomy with autotransplantation (Group 1), whereas 37 (60%) patients underwent subtotal parathyroidectomy (Group 2). Patient files were retrospectively analysed for recurrence or persistence of hyperparathyroidism. Results: A total of 62 patients, 32 (52%) of whom were females, with a mean age of 41.4 +/- 15.8 years for group 1; and 30 patients were males with a mean age of 43.1 +/- 16.7 years for group 2 were assessed in this study. The presenting complaints were bone pains and malaise supported by laboratory values that showed consistently elevated parathyroid hormone levels (>200 pg/ml). In the postoperative follow-up, 29 patients (46.8%) had transient hypocalcemia, while 3 (5%) had persistent hypoparathyroidism. In Group 1, one (4%) patient had a recurrence, while 4 (16%) patients had persistent hyperparathyroidism. In contrast, two (5.6%) patients in Group 2 had recurrence, whereas 8 (22%) patients had persistent hyperparathyroidism. Conclusion: Both surgical options can be safely utilised in the management of refarctory secondary hyperparathyroidism. Moreover, regardless of the procedure used, all the parathyroid glands must be explored. However, due to high morbidity and failure rates of subsequent surgeries, the surgeon should be keen and thorough in the initial procedure.Item Incidence and Immunologic Analysis of Coronavirus Disease (COVID-19) in Hemodialysis Patients: A Single-Center Experience(2020) Arslan, Hande; Musabak, Ugur; Soy, Ebru H. Ayvazoglu; Azap, Ozlem Kurt; Sayin, Burak; Akcay, Sule; Haberal, K. Murat; Akdur, Aydincan; Yildirim, Sedat; Haberal, Mehmet; 0000-0001-8287-6572; 0000-0003-1511-7634; 0000-0002-5735-4315; 0000-0002-0993-9917; 0000-0002-8726-3369; 0000-0002-3171-8926; 0000-0002-8360-6459; 0000-0002-3462-7632; 0000-0002-8211-4065; 32519618; J-3707-2015; AAU-1810-2020; AAF-4610-2019; AAC-5566-2019; AAA-3068-2021; AAK-4089-2021; AAB-5175-2021; AAJ-8097-2021; R-9398-2019Objectives: COVID-19 is a great threat to the modern world and significant threat to immunocompromised patients, including patients with chronic renal failure. We evaluated COVID-19 incidence among our hemodialysis patients and investigated the most probable immune mechanisms against COVID-19. Materials and Methods: Baskent University has 21 dialysis centers across Turkey, with 2420 patients on hemodialysis and 30 on peritoneal dialysis. Among these, we retrospectively evaluated 602 patients (257 female/345 male) with chronic renal failure receiving hemodialysis as renal replacement therapy; 7 patients (1.1%) were infected with SARS-CoV-2. We retrospectively collected patient demographic characteristics, clinical data, and immunological factors affecting the clinical course of the disease. We divided patients into groups and included 2 control groups ( individuals with normal renal functions): group I included COVID-19-positive patients with normal renal function, group II included COVID-19-positive hemodialysis patients, group III included COVID-19-negative hemodialysis patients, and group IV included COVID-19-negative patients with normal renal function. Lymphocyte subsets in peripheral blood and typing of human leukocyte antigens were analyzed in all groups, with killer cell immunoglobulin-like receptor genes analyzed only in COVID-19-positive patients and healthy controls. Results: No deaths occurred among the 7 COVID-19-positive hemodialysis patients. Group I patients were significantly older than patients in groups II and III ( P = .039, P = .030, respectively) but not significantly different from group IV (P = .060). Absolute counts of natural killer cells in healthy controls were higher than in other groups (but not significantly). Activated T cells were significantly increased in both COVID-19-positive groups versus COVID-19-negative groups. Groups showed significant differences in C and DQ loci with respect to distribution of alleles in both HLA classes. Conclusions: Although immunocompromised patients are at greater risk for COVID-19, we found lower COVID-19 incidence in our hemodialysis patients, which should be further investigated in in vitro and molecular studies.Item Impact of surgeon factor on radiocephalic fistula patency rates(2016) Arer, Ilker Murat; Yabanoglu, Hakan; 26900457Introduction: Hemodialysis with arteriovenous fistula (AVF) has been widely accepted treatment modality for patients with chronic renal failure (CRF). Radiocephalic fistulas are considered to be the most desirable for the initial vascular access. The aim of this study is to investigate the surgeon factor on radiocephalic fistula patency rates. Methods: A total of 186 patients with diagnosis of CRF underwent Radiocephalic fistula for hemodialysis access were included. Patients were divided into 2 groups according to operating surgeon. Patients were evaluated according to demographic characteristics, secondary patency rates, second AVF creation and complications. Results: Mean age was 57.7 +/- 14.8 years. The most common etiology of CRF was idiopathic (66.6%). 40 (75.5%) patients in group 1 and 122 (91.7%) patients in group 2 were pre-dialysis patients (p < 0.05). Overall secondary patency rate was 77.4%. Patients in group 1 and group 2 have secondary patency rates of 83% and 75.2%, respectively (p = 0.458). Second AVF creation was done in 2 (3.8%) patients in group 1 and 23 (17.3%) patients in group 2 (p < 0.05). Postoperative complication rate was 9.6%. Conclusion: Operating surgeon is not a major factor of secondary patency in radiocephalic arteriovenous fistulas. (C) 2015 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Limited.Item Listeriosis in a Patient Undergoing Hemodialysis: A Case Report and Review of the Literature(2017) Tekkarismaz, Nihan; Ozelsancak, Ruya; Torun, Dilek; Aliskan, Hikmet Eda; 0000-0001-7631-7395; 0000-0001-9060-3195; 0000-0002-0788-8319; 0000-0002-6267-3695; AAD-9088-2021; AAE-2282-2021; AAD-5716-2021; AAD-9111-2021Listeria monocytogenes (L. monocytogenes) infection is an uncommon manifestation in patients with chronic renal failure. In this article, we present a case of L. monocytogenes bacteremia in a patient undergoing hemodialysis. In addition, we are also present the listeriosis cases in hemodialysis patients reported so far in the literature. The patient was a 58-year-old man who was undergoing hemodialysis and had been admitted to hospital with fever. On the 5th day of admission, L. monocytogenes was detected in his blood cultures. He responded dramatically to ampicillin treatment. Listeriosis is a disease that requires careful microbiological laboratory examination. If the patient cultures are not analyzed carefully, the disease can be misdiagnosed. Only early diagnosis and adequate treatment can ensure a good prognosis.