Başkent Üniversitesi Makaleler

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Burn Injury Following Noninvasive Radiofrequency Lipolysis: A Rare Complication Highlighting Regulatory and Medico-legal Issues
(Başkent Üniversitesi, 2024-06) Mohammad R. Goodarzi; James E. T. Wokes
ABSTRACT OBJECTIVES: The escalating demand for nonsurgical body contouring and skin rejuvenation has led to a surge in the use of radiofrequency techniques. Despite their popularity, scientific investigations of devices and parameters remain inadequate, resulting in a lack of evidence-based clinical trials. In this case report, we have highlighted the potential hazards of noninvasive radiofrequency fat reduction by presenting a severe burn case. Our objective was to underscore the importance of scientific rigor in establishing treatment parameters and the need for regulatory oversight in the aesthetic industry. MATERIALS & METHODS: A 47-year-old female underwent radiofrequency therapy at an unregulated aesthetic clinic, resulting in a full-thickness deep tissue burn. We have outlined the patient’s history, treatment details, and subsequent care, emphasizing the absence of medical supervision during the procedure. RESULTS: The patient developed a 6 cm × 6-cm full-thickness burn, necessitating operative management. Despite initial nonoperative measures, the burn progressed, leading to a permanent scar and contour irregularity. CONCLUSIONS: This case highlights the urgent need for improved regulation, training, and safety protocols in the aesthetic industry, especially concerning radiofrequency devices. The Montgomery principle emphasizes the necessity of informed consent, and the complexities of medical device regulations and indemnity considerations warrant increased regulatory oversight. Collaborations among legal experts, regulatory bodies, medical professionals, and nonmedical practitioners are essential to ensure patient safety in an evolving aesthetic landscape.
Burn Prevention Strategies at Baskent University Facilities
(Başkent Üniversitesi, 2021-06) Mehmet Haberal
Calciphylaxis-Associated Second Renal Graft Failure and Patient Loss: a Case Report and Review of the Literature
(Başkent Üniversitesi, 2008-12) Aabed, Gamal; Helmy, Ahmed; Ghamedi, Abdulla Al; Mana, Hadeel Al; Al-Lehbi, Ali; Furayh, Othman Al
Objectives: Calciphylaxis is a small vessel disease that affects 1% to 4% of patients undergoing dialysis. Only 21 cases of postrenal transplant calciphylaxis have been reported, but none has been associated with primary graft failure or has occurred in a second graft. We present the first case of second renal graft calciphylaxis leading to primary graft failure and death. Materials and Methods: We reviewed the 22 cases, including ours, and assessed risk factors, management, and mortality for these cases. Results: The mean age was 34.2 ± 10.6 years, 11 patients were males (50%), and 13 (57.9%) underwent a deceased-donor renal transplant. The mean pretransplant dialysis period was 35.7 ± 39.3 months, 22 patients (100%) were on steroid therapy, 8 (36.4%) had a rejection, 18 (81.8%) underwent postcalciphylaxis parathyroidectomy, and 11 patients died (50%). Acute graft rejection and its management in the presence of high parathormone and divalent ion levels may be associated with postrenal transplant calciphylaxis. Conclusions: If the high parathormone levels are not adequately suppressed with medical treatment, prerenal transplant preparation should include parathyroidectomy. In addition, steroids and other immunosuppressive medications should be tapered quickly in calciphylaxis patients, especially if a patient’s life is at risk.
Calcium and Phosphorus Metabolism in Stable Renal Transplant Recipients
(Başkent Üniversitesi, 2007-12) Khosroshahi, Hamid T.; Ardalan, Mohammad R.; Etemadi, Jalal; Safa, Javid; Tubbs, R. Shane; Azar, Sima Abedi; Shoja, Mohammadali M.
Objectives: This study sought to elucidate the status of calcium, phosphorus, and parathyroid hormone in patients following kidney transplant. Materials and Methods: In this cross-sectional study, 20 renal transplant recipients were evaluated. For each patient, age, sex, time since transplant, and body weight were recorded. Inclusion criteria were age > 14 years and good allograft function defined as a serum creatinine level < 132.6 µmol/L for at least 6 months after transplant. Exclusion criteria were immunosuppressive therapy other than the standard triple regimen (cyclosporine, prednisolone, and mycophenolate mofetil or azathioprine) and use of any drug known to alter calcium hemostasis. Levels of 24-hour urine calcium, phosphorus, creatinine, and uric acid, as well as concentrations of hemoglobin, serum creatinine, calcium, and phosphorus were measured. To obtain a mean value of serum intact parathyroid hormone in transplant recipients at our center, serum intact parathyroid hormone levels were additionally quantitated in another group of 30 renal transplant recipients. Results: The mean hemoglobin level was 135.6 ± 17.7 g/L, the mean serum creatinine level was 105.0 ± 15.3 µmol/L, and the mean serum calcium and phosphorus levels were 2.25 ± 0.17 mmol/L (normal range, 2.02-2.60 mmol/L) and 1.28 ± 0.24 mmol/L (normal range, 0.81-1.61 mmol/L), respectively. The mean serum intact parathyroid hormone level was 33.17 ±14.67 ng/L (normal range, 10-60 ng/L). Mean 24-hour urine calcium and phosphorus values were 2.32 ± 1.68 mmol/day (normal, 2.49-6.24 mmol/day) and 19.77 ± 8.31 mmol/day (normal, 12.91-41.98 mmol/day), respectively. A positive correlation was found between serum calcium and alkaline phosphatase levels (r = +0.71, P = .006). Hemoglobin level was negatively correlated with serum phosphorus level (r = –0.65, P = .003) and sex (r = –0.57, P = .003) and positively correlated with urine creatinine levels (r = +0.69, P = .001). Conclusions: Renal transplant recipients with stable allograft function may have normal serum calcium, phosphorus, and intact parathyroid hormone levels. However, presence of hypocalciuria and elevated serum alkaline phosphatase levels might imply impaired calcium metabolism in these patients.
Can Immunonutrients Reduce Rejection Rates in African Americans?
(Başkent Üniversitesi, 2005-12) Alexander, J Wesley; Goodman, Hope R; Alloway, Rita R; Woodle, E Steve
Objectives: African-American kidney allograft recipients have higher rates of rejection than do white patients. This study was performed to determine whether the use of immunonutrients may reduce the incidence of rejection in African Americans. Materials and Methods: Two studies have been done at our institution that demonstrate that immunonutrients can reduce the incidence of rejection, calcineurin inhibitor toxicity, and cardiovascular risk factors. The data were analyzed to determine whether or not a preferential benefit exists for race. Results: Twenty-four African-American patients received supplements and 28 did not. One patient (4.2%) who had received supplements had a rejection episode in the first year compared with 7 patients (25%) who did not receive supplements (P < .011). This compares with our rejection rate of 25% (14/56) for African Americans on other protocols without concurrent immunonutrients (P < .003). Conclusions: Immunonutrients appear to have a preferential beneficial response in reducing rejection in African-American patients. A randomized, prospective, clinical trial is warranted to further elucidate these results.
Can Renal Scan Findings Predict Biopsy-Proven Allograft Rejection?
(Başkent Üniversitesi, 2005-06) Qureshi, JI; Al-Saeedy, AR; Barret, J.; Al-Ghamdi, G.; Al-Flaiw, A.; Hejaili, F.; Taher, S.; Raza, H.; Jumani, A.; Ghalib, M.; Al-Khader, A.
Objectives: To assess the usefulness of isotopic renogram in diagnosing acute renal graft rejection. Materials and Methods: Degree of perfusion and allograft uptake of tracer were correlated with the clinical and biopsy diagnoses in 15 postrenal transplant patients with varying degrees of renal impairment. Renographic findings and perfusion calculations were done by a blinded observer. Results: A strong correlation was found between renal histology and renal scan findings in 13 of 15 patients. Sensitivity and specificity of renal scanning in diagnosing acute rejection were 85% and 50% respectively (using renal biopsy findings as the gold standard). Conclusion: Our results demonstrate a strong correlation between blinded perfusion assessment and biopsy-proven acute rejection. We conclude, therefore, that single renal flow scan with DTPA (noninvasive/nonnephrotoxic) allows a physician to tailor therapy for acute renal graft dysfunction. We suggest that in cases with a renographic diagnosis of AR, the patient should receive standard antirejection therapy. Renal biopsy should be reserved for those instances when the renographic findings are not definitive and those when the patient fails to respond to a standard methylprednisolone therapy.
Cardiac Transplant in a Child with Recurrent Thrombosis Due to Congenital Thrombophilic Mutations
(Başkent Üniversitesi, 2009-09) Ozbek, Namik; Aslamaci, Sait; Ozkan, Suleyman; Atac, F. Belgin; Ozcobanoglu, Salih; Uguz, Emrah; Sezgin, Atilla; Verdi, Hasibe
A modified Blalock-Taussig shunt had been implanted 3 times to treat cyanosis to a patient who has uncorrectable congenital cardiac deformity. We repaired the entire pulmonary artery, from one hilus to the other, to prevent future stenosis while making cardiac transplant. Our patient was also heterozygous for 2 thrombophilic mutations: methylene tetrahydrofolate reductase C677T and Factor V A4070G. Congenital risk factors should be evaluated in patients who have experienced a thromboembolic event before cardiac surery.
CASE REPORT Role of Burn Teams in Management of Inflammatory Skin Reactions: Report of 2 Cases
(Başkent Üniversitesi, 2022-06) A. Ebru Abali; Cem Aydogan; Santiago J. Santelis; Nesibe Deren Ozcan; Ozlem Ozbek; Mehmet Haberal
ABSTRACT Several manifestations of inflammatory skin reactions have been described. Toxic epidermal necrolysis is an acute skin inflammatory reaction. It is generally triggered by upper respiratory tract infections or by medications such as nonsteroid anti-inflammatory drugs, antibiotics, and anticonvulsants. It is associated with a significant mortality of 30% to 50% and long-term sequelae. Here, we present 2 cases of toxic epidermal necrolysis who were treated by a multidisciplinary team involving burn professionals.
Causes of Acute Thrombotic Microangiopathy in Patients Receiving Kidney Transplantation
(Başkent Üniversitesi, 2004-12) Jumani, Abdul; Hala, Kfoury; Tahir, Saadi; Al-Ghamdi, Ghormullah; Al-Flaiw, Ahmed; Hejaili, Fayez; Qureshi, Junaid; Raza, Hammad; Ghalib, Muhammed; Al-Khader, Abdullah
Objectives: Thrombotic microangiopathy is a well-known problem in patients following renal transplantation. In postrenal transplantation, thrombotic microangiopathy is often a reflection of hemolytic uremic syndrome. We aimed to determine the causes of thrombotic microangiopathy in a population of renal transplantation recipients and discuss the literature. Materials and Methods: We investigated the causes of thrombotic microangiopathy during a 1year period, from June 2003 to June 2004, at the King Fahad National Guard Hospital in Riyadh, Saudi Arabia, by reviewing the slides of all transplant biopsies (n = 25) performed during this interval. Pre- and posttransplant crossmatching was done when possible. Results: Five cases of thrombotic microangiopathy were found. Three of these cases were from the 25 transplantations performed at King Fahad National Guard Hospital, while the other 2 transplantations had been performed abroad and were referred to us for follow-up. Three cases were related to cyclosporine, and 1 case was secondary to both cyclosporine and tacrolimus. The fifth case had features of thrombotic microangiopathy related to an antiphospholipid syndrome in a patient with systemic lupus erythematosus. Conclusions: In the literature, the most-frequent cause of hemolytic uremic syndrome in patients following renal transplantation is recurrence of the hemolytic uremic syndrome. Other causes include drug-related (cyclosporine, tacrolimus) toxicity, procoagulant status, and antibody-mediated rejection. We found that the most-frequent cause of thrombotic microangiopathy was drug related, secondary mainly to cyclosporine. In the current study, the frequency of thrombotic micro-angiopathy was similar to the percentage reported in the literature (20%).
Changes in Health-Related Quality of Life in Greek Adult Patients 1 Year After Successful Renal Transplantation
(Başkent Üniversitesi, 2006-12) Balaska, Aikaterini; Moustafellos, Panagiotis; Gourgiotis, Stavros; Pistolas, Dimitrios; Hadjiyannakis, Evangelos; Vougas, Vassilis; Drakopoulos, Spiros
Objectives: This study was undertaken to compare and to evaluate the health-related quality of life (HRQOL) in Greek adult transplant recipients before and 1 year after successful renal transplantation (RT) and to examine which parameters had the greatest effects on their HRQOL. The SF-36 survey score was used. Materials and Methods: Eighty-five Greek hemodialysis patients underwent RT at the Transplant Unit of Evangelismos General Hospital of Athens, including 44 men and 41 women (mean age, 43.8 years; range, 21-59 years). Thirty-nine patients had received a kidney from a living-related donor, and 46 from a cadaver. The scale scores of a Greek version of the SF-36 survey were compared between the transplant and the hemodialysis patients. We also examined the relationships of the scale scores with the patients’ age and the type of donor. Results: According to the SF-36 health survey, transplant recipients had better results for general health perception (P <= .001), role-physical functioning (P <= .01), role-emotional functioning (P <= .01), and vitality (P <= .01). In addition, the scale scores of physical functioning, general health, and vitality of the patients who were younger than 30 years old at the time of transplantation were significantly higher than those of the patients who were older than 30 years, while the scores of bodily pain, general health, and physical functioning were significantly lower in cadaveric graft recipients compared with living-related graft recipients. Conclusions: The SF-36 health survey is a validated and comprehensive instrument for evaluating renal transplant patients’ HRQOL. Our data demonstrate an improvement in HRQOL in renal transplant patients from before to 1 year after successful RT. The data also confirm that the recipients’ age at transplantation and the type of donor were important factors affecting the HRQOL.
Changes Produce Changes: The Current Situation of Major Burns Treatment in Chile
(Başkent Üniversitesi, 2021-03) Jorge Villegas
ABSTRACT OBJECTIVES: Population, gross domestic product, life expectancy, and public spending on health in Chile have significantly changed over the past few decades. However, as of 2004, the fatality rate among major burn patients had remained constant at 76%. In this study, events that have affected the reduced fatality rates of patients with large burns in Chile over the recent decades were reviewed. MATERIALS AND METHODS: Publications on fatality rates, the new law that guarantees care for pathologies with the highest burden of disease (GES Law), and official documents on interventions for large burns from the National Reference Center were reviewed. In addition, immediate results, incorporation of large burns to the GES Law and its consequences, emergence of new needs, and creation of new burn units and outcomes were reviewed. Lethality rate was the primary endpoint. RESULTS: Reasons for persistent high fatality rates have included (1) conservative surgical index protocols designed to classify severity groups as a predictor of survival and (2) the late incorporation (in 2003) of intensive therapy to severe burn treatment. The promulgation of the 2004 Explicit Health Guarantee law, establishment of burn services at the Public Hospital of Urgent Care and National Reference Center in 2005, incorporation of major burns into the GES Law in 2007, and development of new burn units in 2012 have together generated a process that has allowed the fatality rate to be reduced to 6%. CONCLUSIONS: Changes from conservative treatment to proactive treatment have been of great value. Significant structural and financial support provided by the GES Law has made it possible to offer coverage to patients at major burn units in Chile and to continue to improve the quality of the care. Development of new units has been stimulated through practical learning and through the use of infrastructure and human resources already available.
Characteristics of Patients With Banff Borderline Changes in Renal Allograft Biopsies
(Başkent Üniversitesi, 2009-12) Wafa, Ehab W.; Ghoneim, Mohamed A.; El-Agroudy, Amgad E.; El-Baz, Mahmoud; Gheith, Osama A.; El-Husseini, Amr; Abbas, Tarek M.
Objectives: The aim of this retrospective study was to characterize the patients who experienced borderline rejection. Materials and Methods: Patients with a minimum follow-up of 2 years were enrolled in this study. Forty-seven patients out of 106 patients with borderline rejection (after exclusion of those with associated chronic interstitial fibrosis) were compared with patients with acute cellular rejection grade 1 (n=650), and patients free of rejection episodes (n=444) regarding the different characteristics. Results: Patients aged 20 years or younger were frequently in borderline rejection group than other groups (which was statistically significant) (P = .001). Significant differences were found in recipient and donor ages, consanguinity, pretransplant blood transfusion, and immunosuppression plan. Most patients in borderline rejection group received triple immunosuppression therapy than other groups (P = .001). Univariate and multivariate regression analysis of different variables on graft survival in borderline rejection patients revealed that none of them was statistically significant. Conclusions: Borderline rejection is a frequent finding in biopsy-proven acute rejection after kidney transplant. Time of occurrence, frequency, treatment or not, and response to therapy were not predictors to graft survival.
Characteristics of Recipients Whose Kidney Allograft Has Functioned for More Than 20 Years
(Başkent Üniversitesi, 2008-06) El-Agroudy, Amgad E.; Ghoneim, Mohamed A.; Shokeir, Ahmed A.; Ismail, Amani M.; Abbass, Tarek M.; El-Dahshan, Khaled
Objectives: To study the characteristics of, and predictors for, survival in renal transplant recipients with an allograft functioning for more than 20 years. Materials and Methods: Of 144 renal transplants done between 1976 and 1985, 31 allografts were still functioning for more than 20 years (range, 21-28.5 years). The characteristics of the patients and determinants of the outcomes were obtained by reviewing the patients’ medical records. Results: Fourteen patients were treated with cyclosporine, while 17 patients had primary immunosuppression with azathioprine-based regimens. Episodes of acute rejection occurred in 17 patients (58%), 7 of these experienced 2 or more episodes. At most-recent follow-up, the mean serum creatinine level was 132 ± 44 µmol/L . Four patients were assessed by graft biopsy 15 or more years after the transplant, revealing 2 cases of mild glomerulosclerosis and 2 cases of moderate chronic allograft nephropathy. The most common complication was hypertension (54%). The independent determinants of long-term graft survival were donor age and source, hypertension both before and after renal transplant, and histopathological findings of chronic allograft nephropathy. Conclusions: Renal transplant offers a near-normal life to patients with end-stage renal disease soon after transplant and for upwards of 20 years and more. We found no significant benefit to cyclosporine-based immunosuppression on long-term graft survival.
Chemical Contact Burn With Ready-Mixed Concrete: A Case Report
(Başkent Üniversitesi, 2021-06) Emin Turk; Erdal Karagulle; Halil İbrahim Taşcı; Mehmet Haberal
Chemical burns, and particularly alkali burns, constitute a very small fraction of burn unit admissions. It is generally unknown that ready-mixed concrete can cause chemical burns. However, prolonged contact with ready-mixed concrete may cause serious burns. Raising awareness of the need for taking necessary measures against burns from ready-mixed concrete among workers would be effective for the prevention of this type of burn. Here, we report a case of a full-thickness burn that occurred in a worker who was working unprotected with ready-mixed concrete.
Children With Burn Contractures in Rural Areas of Northern Bangladesh: Etiology, Acute Burn Management, and Recommendations of the Parents
(Başkent Üniversitesi, 2024-03) Myrthe H. Simon; Ahmed Asif; Mahbub Ur Rahman Ujjal; Claire van Hövell tot Westerflier; Corstiaan C. Breugem; Matthijs Botman; Annebeth Meij-de Vries
ABSTRACT OBJECTIVES: Burn contractures severely affect quality of life. In this study, we examined burn causes, acute management, and caregiver recommendations for children with contractures from burns in rural northern Bangladesh. MATERIALS & METHODS: We conducted a mixed-methods retrospective study using both quantitative and qualitative data. Questionnaire surveys were administered to 22 children with burn contractures who received surgical care at the Friendship Emirates Floating Hospital in rural northern Bangladesh. Seven caregivers were selected for in-depth interviews. RESULTS: The study included 22 children (age range of 6 months to 12 years) with contractures affecting joints like the hand, foot, neck, axilla, and elbow. Burns from hot fluids (n = 9; 40.9%) were most common, often occurring during cooking. Immediate cooling for more than 5 minutes was absent in 41% of cases. Most caregivers sought care from village doctors or traditional healers. Recommendations from caregivers included promoting safe cooking practices to prevent burns. CONCLUSIONS: High burn injury rates in young children and resulting contractures underscored the need for improved burn management in rural Bangladesh. The study highlighted a lack of initial cooling and a knowledge gap among caregivers and local health care providers in seeking effective treatment. Targeted burn prevention campaigns based on caregiver insights could reduce injury rates and contractures, improving children’s quality of life.
Chronic Rejection: Prospects for Therapeutic Intervention in Fibroproliferative Vascular Disease
(Başkent Üniversitesi, 2003-06) Häyry, Pekka; Aavik, Einari; Sarwal, Minnie; Toit, Daniel du; Vamvakopoulos, Joannis
Vascular disease, manifesting as either transplant arteriopathy or native atherosclerosis, is currently the main obstacle to successful transplant outcome. In addition, vascular restenosis following balloon angioplasty or stenting continues to limit the long-term efficacy of these procedures. Neointimal hyperplasia is refractory to conventional immunosuppression although newer agents, such as rapamycin, have shown considerable promise in controlling it. By allowing large-scale study of gene expression during vascular remodelling, the emerging field of genomics is poised to revolutionise the drug discovery process. Here we summarise our initial experience using genomic methods to identify new targets for therapeutic intervention in vascular disease.
Clinical Presentation and Outcomes of Burn Patients With Diabetes: A 5-Year Single-Center Experience
(Başkent Üniversitesi, 2022-09) Santiago J. Santelis; Cem Aydogan; Ayse Ebru Abali; Hasan Turkoglu; Mehmet Haberal
ABSTRACT OBJECTIVES: Diabetes mellitus is one of the most important independent risk factor for poor outcomes in patients with burn injuries. In this study, we aimed to determine the demographics characteristics, clinical presentation, and outcomes of burn patients with preexisting diabetes mellitus seen over the previous 5 years at a single burn center. MATERIALS AND METHODS: We conducted a retrospective study that included all burn patients ≥18 years of age with a diagnosis of diabetes who were admitted to our unit over the previous 5 years (2018 to 2022). We collected demographics and relevant clinical data from medical records. Patients were evaluated by age subgroups and time interval between occurrence of injury and admission to a medical center. RESULTS: Our study included 52 patients, with male-to-female ratio of 0.86:1 and mean age of 62.7 ± 12.4 years (range, 33-85 y). Scalding was the most common cause of the burn injury. A total of 32.7% of the patients had burns affecting their hands, either as part of a more extensive burn or as an isolated injury. The median extent of burns was 1.0% total body surface area (range, 0.05%-10%). We found an association between age and burn etiology and age and burn site. A high number of patients with injuries in the lower extremity sought medical care after day 1 but before day 4 postinjury. Delayed admission was found to be an important factor causing an increase in complication frequency. CONCLUSIONS: There are many factors associated with age that affect the incidence and outcomes of burn injuries. Risk factors leading to burns are preventable, and the physical and psychological consequences of people who survive burn injuries can be life-threatening and often devastating. The best way to treat a burn is to prevent it from happening in the first place.
Clinical Relevance of Curcumin-induced Immunosuppression in Living-Related Donor Renal Transplant: An In Vitro Analysis
(Başkent Üniversitesi, 2010-06) Guleria, Sandeep; Mehra, Narinder K.; Bharti, Alok C.; Panigrahi, Arundhati; Sharma, Prabhat K.; Gupta, Nivedita; Kumar, Rakesh; Shukla, Shirish; Bhowmik, Dipankar M.; Agarwal, Sanjay K.
Objectives: In this study, we assessed the immunosuppressive potential of curcumin, a pharmacologically safe and cost-effective naturally occurring polyphenolic phytochemical, on the induction of Th1 cytokines that are frequently overexpressed in patients experiencing rejection after renal transplant. Materials and Methods: Peripheral blood lymphocytes obtained from 68 renal transplant recipients and 17 healthy controls were treated with curcumin before stimulation with phorbol myristate acetate and were analyzed with flow cytometry for interferon-γ and interleukin 4 positive cells. Results: Patients experiencing acute rejection exhibited a high level of interferon-γ (38.3% ± 11.2%) and a low level of interleukin 4 (4.2% ± 2.0%) in their activated peripheral blood lymphocytes. The use of curcumin dose-dependently decreased interferon-γ induction in cultures from healthy controls (28.1% ± 4.8% - 10.7% ± 5.3%, P < .001), patients experiencing acute rejection (38.3% - 18.3%, P < .001), and those experiencing chronic rejection (40.6% - 12.9%, P = .01) when compared with corresponding untreated cultures. In contrast, curcumin exerted only a marginal effect on interleukin 4 expression. Interestingly, curcumin was found to inhibit nuclear factor kappa beta activation by blocking the degradation of the inhibitory unit I kappa B alpha. We also noted the synergistic inhibitory effect of in vitro treatment with curcumin in combination with cyclosporine on the peripheral blood lymphocytes of patients experiencing acute rejection. Conclusions: These data provide a rationale for the use of curcumin as an affordable, pharmacologically safe, adjuvant immunosuppressant when used with cyclosporine and suggest that curcumin can effectively suppress Th1 cytokine induction after renal transplant.
Clinicoepidemiologic Study of Posttransplant Diabetes After Living-Donor Renal Transplant
(Başkent Üniversitesi, 2008-03) Elmagd, Mogahid M Abu; Wahab, Ahmad M abd El; AMetwally, Abdel Hameed; Bakr, Mohammed A.
Objectives: We sought to evaluate posttransplant diabetes mellitus with regard to its incidence, risk factors for occurrence, complications, impact on graft function, and impact on patient and graft survival rates. Materials and Methods: A total of 1580 patients received living-donor renal allografts at Mansoura University, Egypt, between March 1976 and November 2004. Of these, 286 recipients developed diabetes after transplant (diabetic group). These patients were matched with 316 kidney transplant recipients who did not develop diabetes after transplant (control group). A complete clinical history was obtained and a clinical examination was done. Laboratory analyses including urine analysis, complete blood count, total serum cholesterol, fasting and 2-hour postprandial plasma glucose, Hb A1c, serum creatinine, and creatinine clearance were obtained in all patients. In each patient, presence of hepatitis B and C was determined with polymerase chain reaction, and a graft biopsy was obtained to diagnose renal allograft rejection. Results: The onset of diabetes mellitus among our recipients occurred primarily during the first 6 months after transplant (in 52.4% of the patients). Significant correlations were found between posttransplant diabetes mellitus and the recipients’ age (P = .0001), obesity (P = .001), positive family history of diabetes mellitus (P = .001), hepatitis C virus infection (P = .039), cumulative dose of steroids in the first 3 months (P = .047), and calcineurin inhibitor-based immunosuppressive therapy (P = .001). Moreover, posttransplant diabetes mellitus significantly affected rates of coronary heart disease (P = .001), hypertension (P = .02), and hypercholesterolemia (P = .001). Graft survival was similar in both groups until 15-year follow-up, at which time graft survival began to decrease in patients with diabetes mellitus compared with those without diabetes mellitus (43.5% vs 53.6%, P = .013). Similarly, patient survival was similar until 8-year follow-up, at which time survival rates began to decline in patients with diabetes as compared with patients without diabetes (79.9% vs 86.1%, P = .001); this trend continued to the 15-year follow-up (60.6% vs 77.8%, P = .001). Conclusions: Posttransplant diabetes mellitus is a major problem that endangers patient and graft survival. In our population, the incidence of posttransplant diabetes mellitus was 18.2%. Further studies are recommended to screen for patients with impaired fasting glucose and impaired glucose tolerance for prediction, early detection, and better management of posttransplant diabetes mellitus.
Codified Protocol for Systematic Data Collection on Burns
(Başkent Üniversitesi, 2022-12) Fortunato Benaim
ABSTRACT Details about the origin, content, and subsequent development of the Codified Protocol for the Collection of Data on Burns are presented. Reference is made for its progressive development, which began with only 3 groups of data until it reached the current protocol and which now consists of 14 groups of data. Because it was created in Argentina, the original protocol is in Spanish language, but some of the data has been translated to English. We look forward to its total translation in the near future, to allow its use in other countries.ABSTRACT Details about the origin, content, and subsequent development of the Codified Protocol for the Collection of Data on Burns are presented. Reference is made for its progressive development, which began with only 3 groups of data until it reached the current protocol and which now consists of 14 groups of data. Because it was created in Argentina, the original protocol is in Spanish language, but some of the data has been translated to English. We look forward to its total translation in the near future, to allow its use in other countries.ABSTRACT Details about the origin, content, and subsequent development of the Codified Protocol for the Collection of Data on Burns are presented. Reference is made for its progressive development, which began with only 3 groups of data until it reached the current protocol and which now consists of 14 groups of data. Because it was created in Argentina, the original protocol is in Spanish language, but some of the data has been translated to English. We look forward to its total translation in the near future, to allow its use in other countries.