Başkent Üniversitesi Yayınları
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Item Influence of Renal Graft Function on Mycophenolic Acid Pharmacokinetics During the Early Period After Kidney Transplant(Başkent Üniversitesi, 2008-12) Mohammadpur, Amir-Houshang; Naghibi, Massih; Abtahi, Bahareh; Nazemian, FatemehObjectives: Mycophenolate mofetil, the prodrug of mycophenolic acid, is widely used for maintenance immunosuppressive therapy in renal transplant recipients. The effect of renal graft function on mycophenolic acid pharmacokinetics parameters is still controversial. The aim of this study is to investigate the impact of renal graft function on mycophenolic acid pharmacokinetics during the early posttransplant period. Materials and Methods: Our study was done on 13 patients with severe renal impairment (glomerular filtration rate < 30 mL/min, impaired group) and 13 patients with normal graft function (glomerular filtration rate > 70 mL/min, control group), at a steady mycophenolic acid plasma level, during the first month after transplant. All patients received a fixed dose of mycophenolate mofetil (1 g twice daily) in combination with cyclosporine and steroids. Mycophenolic acid plasma levels were determined by a validated high-performance liquid chromatography method. Mycophenolic acid area under the time-concentration curve from 0 to 12 hours and apparent mycophenolic acid plasma clearance (CL/f) were measured for each patient. Results: Mycophenolic acid area under the time-concentration curve (0-12 h), mycophenolic acid area under the time-concentration curve (6-10 h), first peak concentration (Cmax1), and secondary peak concentration (Cmax2) were higher in the impaired group, while mycophenolic acid plasma clearance was higher in the control group (P < .05). Trough levels (C0) were similar for both groups (P > .05). There was a negative correlation between glomerular filtration rate and area under the time-concentration curve (r=-0.422, P = .04), while there was a positive correlation between glomerular filtration rate and mycophenolic acid plasma clearance (r=0.463, P = .02). Conclusions: Mycophenolic acid pharmacokinetics parameters in normal renal function patients and severe renal impairment patients are different, and renal graft function correlates with total mycophenolic acid area under the time-concentration curve and apparent mycophenolic acid plasma clearance. However, the necessity of dosage adjustment based on renal graft function requires further studies.Item A Monocentric Observational Study of Darbepoetin Alfa in Anemic Hepatitis-C-Virus Transplant Patients Treated With Ribavirin(Başkent Üniversitesi, 2008-12) Kamar, Nassim; Rostaing, Lionel; Esposito, Laure; Ribes, David; Guitard, JoëlleObjectives: Darbepoetin alfa is used to treat renal anemia; however, little information is available concerning its use during the posttransplant period, especially in HCV-positive patients treated with ribavirin for active hepatitis C. Materials and Methods: This study investigated the efficacy and safety of using darbepoetin alfa in this population during a 6-month treatment period. All anemic patients were HCV/RNA-positive, treated with ribavirin, and had impaired renal function. Patients (n=7) who had not been treated previously with recombinant human erythropoietin (rHuEPO) were placed in “group no rHuEPO.” Patients previously with recombinant human erythropoietin (n=16; “group rHuEPO”) were switched to darbepoetin alfa according to the European summary of product characteristics. Results: Seventy-three percent of the patients were men. The mean creatinine clearance at baseline was 58.7 ± 21.5 mL/min. All patients received an immunosuppressive treatment. Although mean hemoglobin levels remained stable in group no rHuEPO and increased in group rHuEPO, the difference was not statistically significant. Also, the median darbepoetin-alfa–weighted dose in group no rHuEPO increased while it remained stable in group rHuEPO, as did the median daily dosage of ribavirin; however, these differences were not statistically significant. Creatinine levels and creatinine clearance levels remained stable throughout the study. No significant medical events related to the treatment were reported during the study. Conclusions: Darbepoetin alfa was found to be efficient and well tolerated in correcting renal anemia in transplant recipients treated with ribavirin for active hepatitis C.Item Pulmonary Complications and Mortality After Liver Transplant(Başkent Üniversitesi, 2008-12) Bozbas, Serife Savas; Haberal, Mehmet; Karakayali, Hamdi; Sevmis, Sinasi; Arslan, Nevra Gullu; Ergur, Figen Ozturk; Eyuboglu, Fusun OnerObjectives: Pulmonary complications after liver transplant significantly affect mortality and morbidity; however, their relation has not been clearly established. We sought to determine pulmonary complications during the early and late term after liver transplant and identify risk factors for mortality. Materials and Methods: At our institution, 130 liver transplant patients (mean age, 40.1 ± 14.6 years; 71.1% male) were retrospectively evaluated, and 114 adult orthotopic liver transplant patients were included. Cause of liver disease, pulmonary function test results, arterial blood gas analyses, surgery duration, length of stay in the intensive care unit and the hospital, pulmonary complications, and mortality causes were noted. Results: Pulmonary complications were detected in 48 patients (42.1%), pneumonia in 24 patients (21.1%), and pleural effusion in 21 patients (18.4%). Development of pulmonary complications was found to be significantly related to survival (P = .001). Fifty-two patients (45.6%) were smokers, a significant predictor of pulmonary complications (P = .03). There was no relation between pulmonary function test results and orthodeoxia and pulmonary complications and mortality. Early and late survival rates were significantly lower in patients in whom a microorganism was isolated on deep tracheal aspirate culture, while early survival was significantly reduced in the presence of a pleural effusion (P < .005). Conclusions: Pulmonary complications after liver transplant are common. Care must be taken to determine preoperative risk factors, and patients should be observed closely for development of respiratory complications after liver transplant.Item Effect of D-Penicillamine on Liver Fibrosis and Inflammation in Wilson Disease(Başkent Üniversitesi, 2008-12) Kazemi, Kourosh; Malek-Hosseini, Seyed Ali; Dehghani, Seyed Mohsen; Kakaei, Farzad; Dehghani, Masood; Nejatollahi, Seyed Mohammad Reza; Bahador, Ali; Salahi, Heshmatollah; Nikeghbalian, Saman; Geramizadeh, BitaBackground: Wilson disease is a disorder of copper metabolism characterized by copper overload. A mutation in the ATP7B gene causes dysfunction of ATP7B protein and a reduction in copper excretion into the bile in hepatocytes. Excess copper accumulation leads to liver injury. D-penicillamine primarily can inhibit fibrogenesis and prevent the appearance of scar lesions in the liver. We studied this phenomenon in our patients. Materials and Methods: Pathology slides from the explanted livers of 26 patients diagnosed as having Wilson disease with hepatoneurologic manifestations between 2000 and 2008 who had undergone a liver transplant were investigated retrospectively. Patients were divided into 2 groups according to their history of D-penicillamine use before transplant. The degree of fibrosis and inflammation were classified as mild (1), moderate (2), and severe (3), and were reviewed by an impartial hepatopathologist. Results: Of 26 patients (20 male, 6 female) who had Wilson disease with a mean age of 17.6 ± 8.6 years, 69% (18/26) had a history of D-penicillamine use before liver transplant from 6 months to 9 years (mean, 3.4 ± 2.7 years). In the D-penicillamine group, 14 patients (77%) had grade 1 fibrosis. Grade 2 and 3 fibrosis was seen in 5.6% and 16% of patients, respectively. In D-penicillamine group, inflammation was grade 3 in 44% (8/18), grade 2 in 44% (8/18), and grade 1 in 11% of the patients (2/18). In the non–D-penicillamine group (8 patients), grades of fibrosis were grade 3 (62%), grade 2 (25%), and grade 1 (12%); 87% of the patients had grade 2 and 3 inflammation. The degree of fibrosis was significantly lower in the D-penicillamine group than it was in the non–D-penicillamine group (P < .05). Conclusion: D-penicillamine may reduce the rate of liver fibrogenesis in patients with Wilson disease.Item The Role of Portal Vein Clamping for Cytokine Release and Neutrophils Activity During Liver Resection and Transplant(Başkent Üniversitesi, 2008-12) Studzinski, Arthur; Juettner, Bjoern; Becker, Thomas; Weissig, Annette; Stenger, Katja; Scheinichen, DirkObjectives: Uncontrolled release of cytokines has been linked to graft dysfunction or rejection and contributes to an increase in mortality and morbidity. We argue that temporary vascular clamping of the hepatic pedicle during major hepatic surgery is a potential stimulus for an excessive release of cytokines and the activity of neutrophils. Materials and Methods: Thirty patients underwent partial liver resection or transplant. Samples were drawn preoperatively, immediately before portal vein clamping, at the early reperfusion period, and on days 1, 3, 5, and 7 after the operation. Central venous plasma concentrations of IL-6, IL-8, and TNF-α were compared to portal venous plasma. The influence of neutrophils on metabolic activity was measured by flow cytometry. Results: In both patient groups, no significant differences in cytokine concentrations between central and portal venous plasma were found. However, significant differences of neutrophils activity were observed in patients undergoing partial liver resection compared to patients after transplant. Conclusion: Portal vein stasis induced by clamping the hepatic pedicle has no influence on the local release of IL-6, IL-8, and TNF-α. However, preoperatively increased plasma levels of TNF-α play a decisive role in the metabolic activity of neutrophils in patients with final-stage liver disease.Item Do We Need To Maximize the Knowledge and Attitude Level of Physicians and Nurses Toward Organ Donation and Transplant?(Başkent Üniversitesi, 2008-12) Bener, Abdulbari; Al-Maslamani, Yousuf; El-Shoubaki, HatemObjectives: We sought to assess the knowledge level, attitudes, and personal views of physicians and nurses toward organ donation and transplant. Materials and Methods: This is a cross-sectional survey, carried out from November 2007 to June 2008 in the intensive care units and accident and emergency departments of the hospitals of the Hamad Medical Corporation. A representative sample of 685 health care professionals working in the hospitals was approached; 521 agreed to participate in the study (76.1%). Face-to-face interviews were based on a questionnaire that included sociodemographic information, knowledge level, and personal views toward organ donation and transplant. Results: Of the 521 participants, there were 268 physicians (51.4%) and 253 nurses (48.6%). The knowledge level of nurses was significantly lower for most of the questions related to organ donation, compared with physicians. Mean ± standard deviation for the score reflecting knowledge level was higher for physicians (4.9 ± 1.9) than it was for nurses (4.4 ± 2.0). The majority of the nurses believed, more than physicians, that brain-dead persons are eligible for organ donation (71.5% vs 63.1%), and that certain organs can be donated while the person is living, including kidneys, lobes of livers, and lungs (71.5% vs 62.3%). Many physicians (72.4%) and nurses (74.7%) did not know that brain death can be described as death. Most physicians and nurses supported organ donation (91.8% vs 79.8%), although a lower proportion of physicians and nurses were willing to donate a kidney to a family member in need (64.6% vs 68.0%). More than physicians (23.9%), nurses (61.3%) agreed that they lacked sufficient information about organ donation. Conclusions: Although the physicians and nurses had an acceptable level of knowledge about organ donation, the mean knowledge score for physicians showed significantly better understanding of the criteria for organ donation and procurement.Item A Fast and Safe Living-Donor "Finger-Assisted" Nephrectomy Technique: Results of 225 Cases(Başkent Üniversitesi, 2008-12) Hakim, Nadey S.; Canelo, Ruben; Papalois, VassiliosRenal transplant remains the treatment of choice for end-stage renal disease. It improves both the quality of life and the quantity of life in recipients. We present a living-donor nephrectomy technique that is less invasive than the conventional open flank incision. This technique involves only 1 incision and is smaller than the one used in the laparoscopic technique. We have successfully introduced this new technique at our center. The procedure may be done safely and is applicable in all potential donors regardless of the body mass index of the donor or the size of the surgeon’s hands. It provides excellent grafts and has allowed us to expand our living-donor program.Item Bir Grup Üniversite Öğrencisinin E-Sağlık Okuryazarlığı Düzeylerinin ve Sağlıklı Yaşam Biçimi Davranışlarının Belirlenmesi(Başkent Üniversitesi, 2025-04-25) Salimoğlu,Serap; Durukan,ElifAmaç: Gençlerde E-sağlık okuryazarlığı üzerinde önemle durulması gereken konulardan biridir. Toplum sağlığının korunması ve geliştirilmesinde, sağlıklı yaşam biçimi davranışlarının kazandırılması dolayısıyla yüksek sağlık okuryazarlığı düzeyi önemlidir. Bu araştırmanın amacı, bir grup üniversite öğrencinin e-sağlık okuryazarlığı düzeylerini ve sağlıklı yaşam biçimi davranışlarını belirlemek, bazı değişkenler ile ilişkisini incelemektir. Gereç ve Yöntem: Tanımlayıcı tipteki araştırmanın evrenini, 2020-2021 öğretim yılında bir vakıf üniversitesinin Sağlık Hizmetleri Meslek Yüksekokulu’na devam eden 922 öğrenci oluşturmuştur. Örneklem seçimine gidilmeyerek araştırmaya katılmayı kabul eden 528 öğrenciye web tabanlı anket formu uygulanmıştır. Araştırmada; soru formu, Adolesanlarda e-sağlık okuryazarlığı ölçeği ve Sağlıklı Yaşam Biçimi Davranışları Ölçeği II kullanılmıştır. Etik kurul onayı alınmıştır. Bulgular: Öğrencilerin Adolesanlarda E-Sağlık Okuryazarlığı Ölçeği puanlarının ortalaması 29,37±6,79 olarak bulunmuştur. Sağlığı hakkında karar vermede, internetin yararlı olduğunu düşünenlerin oranı %41,7’dir. İnternetteki sağlık kaynaklarına erişebilmenin önemli olduğunu düşünenlerin oranı %54,4’tür. Cinsiyet, medeni durum, çalışma durumu, yaşanılan yer, baba eğitim durumu, anne eğitim durumu ve aile ekonomik durumu değişkenlerine göre Adolesanlarda E-Sağlık Okuryazarlığı Ölçeği puanları arasında istatistiksel olarak anlamlı fark bulunmamıştır (p>0,05). Öğrencilerin Sağlıklı Yaşam Biçimi Davranışları Ölçeği II puanlarının ortalaması 140,88±24,87 olarak bulunmuştur. Öğrencilerin yaklaşık yarısı egzersiz yapmadıklarını, sağlıklı beslenmediklerini ve yeterli uyumadıklarını belirtmiştir. E-Sağlık Okuryazarlığı ile Sağlıklı Yaşam Biçimi Davranışları arasında pozitif yönde orta düzeyde (r=0,442, p<0,001) ilişki saptanmıştır. Sonuç: İnternet üzerinden doğru ve güvenilir sağlık kaynaklarına erişim ve kullanım becerilerini geliştirmeye yönelik eğitim programlarının uygulanması, gençlerin sağlıklı yaşam biçimi davranışları benimsemelerine ve dolayısıyla toplum sağlığının korunmasına ve geliştirilmesine katkı sağlayacaktır.Item Genç Bireylerin Beslenme Okuryazarlığı ile Beslenme Durumlarının Değerlendirilmesi(Başkent Üniversitesi, 2025-04-25) Öztürk,Kübra; Türker,PerimBu çalışma, 14-18 yaş aralığındaki gençlerin beslenme okuryazarlığı ile beslenme durumlarını değerlendirmek amacıyla 2023-2024 eğitim-öğretim yılı bahar döneminde bir özel lisede öğrenim gören 150 öğrenci (80 kız, 70 erkek) ile yürütülmüştür. Çalışmaya katılan öğrencilerin yaş ortalaması 15.7±1.30 olarak bulunmuştur. Adölesan Beslenme Okuryazarlığı Ölçeği puanlarına göre erkek öğrenciler 68.3±13.3, kız öğrenciler ise 66.4±10.37 puan almış ve cinsiyetler arasında istatistiksel olarak anlamlı fark saptanmamıştır (p=0.336). Mikro besin ögeleri alımında folik asit (kızlarda 3.7±5.74 mcg, %1.2; erkeklerde 3.8±2.83 mcg, %2.4), D vitamini (kızlarda 2.7±2.58 mcg, %18.0; erkeklerde 3.1±2.47 mcg, %20.8) ve kalsiyum (kızlarda 553.3±217.84 mg, %42.5; erkeklerde 694.2±309.45 mg, %53.4; p=0.001) alımları yetersiz bulunmuştur. Erkeklerin kalsiyum ve çinko alımları istatistiksel olarak anlamlı derecede daha yüksek bulunmuştur (p<0.05). Adölesanların beslenme okuryazarlığı düzeyini geliştirmek ve yetersiz makro ve mikro besin ögesi alımlarını iyileştirmek amacıyla, bunların önemini vurgulayan eğitimler daha fazla düzenlenmeli sonucuna varılmıştır.Item Transplantation of Insulin-Producing Clusters Derived From Adult Bone Marrow Stem Cells to Treat Diabetes in Rats(Başkent Üniversitesi, 2008-09) Gabr, Mahmoud M.; Ghoneim, Mohamed A.; Refaie, Ayman F.; Zakaria, Mahmoud M.; Sobh, Mohamed M.Objectives: Recent findings suggest that bone marrow stem cells can differentiate into numerous cell types. This would provide a potentially unlimited source of isletlike cells for transplantation and a promising therapy for diabetes mellitus. Here, we studied the differentiation ability of adult bone marrow hematopoietic-rich stem cells to form glucose-regulating insulin-producing cells. Their ability to treat chemically induced diabetes in rats was then tested. Materials and Methods: Hematopoietic-rich stem cells were obtained from the long bones of rats and cultured in a serum-free medium containing 1% dimethyl sulfoxide for 3 days. The cells were cultured for 7 days in a glucose-rich medium supplemented with pancreatic extract. Thereafter, cultures were done in a medium (low concentration of glucose and 5% fetal bovine serum) supplemented with nicotinamide and exendin-4 for 7 more days. Results: At day 17 of culture, the cells formed isletlike clusters. These were distinctly stained crimson red by diphenylthiocarbazone and expressed insulin and endocrine-specific transcription genes. Insulin was secreted in a dose-response manner as a function of increasing glucose concentrations. When transplanted in the testes of diabetic rats, the differentiated cells could normalize blood glucose levels for 3 months in 80% of the treated rats. The therapeutic benefits were reversed after orchidectomy. Conclusions: Hematopoietic-rich stem cells may include pancreatic progenitor cells capable of differentiating into functioning endocrine hormone-producing cells. This finding suggests a possible means of treating diabetes mellitus.