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Öğe Assessment of abdominal aortic calcification at different stages of chronic kidney disease(Springer, 2016) Biyik, Zeynep; Selcuk, Nedim Yilmaz; Tonbul, Halil Zeki; Anil, Melih; Uyar, MehmetVascular calcifications that may cause cardiovascular disease are highly prevalent in chronic kidney disease (CKD). In this study, we aimed to determine abdominal aorta calcifications (AAC) in predialysis and hemodialysis patients by lateral lumbar radiography and to investigate factors that were associated with the calcifications. Two hundred and fifty-nine adult chronic hemodialysis patients, 300 predialysis CKD patients and 60 healthy subjects with normal kidney function as a control group were enrolled in the study. Lateral lumbar radiography was used to measure AAC. Calcified deposits of the abdominal aorta wall at the level of the first through fourth lumbar vertebrae were graded by a 24-point scoring system. AAC prevalence (AAC score aeyen1) was significantly different in hemodialysis, predialysis and control groups (71.8, 45.7 and 33.3 %, respectively; p < 0.001). AAC prevalence in CKD stages 1, 2, 3, 4 and 5 predialysis patients was 26.6, 43.3, 40, 58.3 and 55 %, respectively. AAC scores of the hemodialysis group were higher than of the predialysis group (p < 0.001) and the control group (p < 0.001). AAC scores of the predialysis group were not higher than of the control group (p = 0.314). AAC scores of the hemodialysis group were significantly higher than of the control group (p < 0.001) and stage 1 (p < 0.001), stage 2 (p = 0.001) and stage 3 predialysis groups (p = 0.002). Age (p < 0.001), presence of diabetes mellitus (p < 0.001) and serum phosphorus levels (p = 0.011) were found to be independent predictors of calcification in the hemodialysis group. Age (p < 0.001), serum phosphorus levels (p = 0.007) and history of cardiovascular disease (p = 0.014) were found to be independent predictors of calcification in the predialysis group. Abdominal aortic calcification is highly prevalent in the hemodialysis population. Strict phosphorus control should be implemented to the predialysis and hemodialysis patients.Öğe Authors' Reply to the Letter to the Editor: Comprehensive Assessment of Inflammatory Indices to Predict Outcomes in Acute Pancreatitis(Taylor & Francis Inc, 2023) Biyik, Murat; Asil, Mehmet; Keskin, Muharrem; Biyik, Zeynep[Abstract Not Availabe]Öğe Colchicine Toxicity in End-Stage Renal Disease Patients: A Case-Control Study(Lippincott Williams & Wilkins, 2014) Solak, Yalcin; Atalay, Huseyin; Biyik, Zeynep; Alibasic, Hayrudin; Gaipov, Abduzhappar; Guney, Figen; Kucuk, AdemColchicine has been used in a number of disorders. Because colchicine is partially excreted from the kidney, there is a need for dose reduction in case of renal functional impairment. There are no data with regards to safe dosing schedule of colchicine in hemodialysis patients. We aimed to evaluate adverse effects of colchicine use in a hemodialysis cohort. We screened hemodialysis patients who were using colchicine for any reason. All patients were interviewed regarding possible toxicities of colchicine use and were examined with a special focus on neuromuscular system. Creatine kinase and myoglobin were used to detect any subclinical muscle injury or rhabdomyolysis, respectively. Twenty-two maintenance hemodialysis patients who were on colchicine for more than 6 months and 20 control hemodialysis patients not using colchicine were included in the study. Four of 22 patients were using 0.5 mg/day, 4 patients were using 1.5 mg/day, and 14 patients were using 1 mg/day colchicine. Mean duration for colchicine use was 8.9 +/- 8.2 years. There was no difference between the groups in terms of myoneuropathic signs and symptoms and blood counts except for white blood cell count, which was significantly higher in patients on colchicine. Serum creatine kinase (56.3 +/- 39.5 and 52.1 +/- 36.1 for colchicine and control groups, respectively, P = 0.72) and myoglobin (191.4 +/- 108.8 and 214.6+/-83.5 for colchicine and control groups, respectively, P = 0.44) levels were not different between the groups. We conclude that in a small number of haemodialysis patients who were apparently tolerating colchicine, detailed assessment revealed no evidence of sublinical toxicity when compared with controls.Öğe Drug Dose Adjustment in Dialysis Patients Admitted in Clinics Other Than Internal Medicine(Lippincott Williams & Wilkins, 2016) Solak, Yalcin; Biyik, Zeynep; Gaipov, Abduzhappar; Kayrak, Mehmet; Ciray, Hilal; Cizmecioglu, Ahmet; Tonbul, Halil ZekiMany drugs that are administered during hospitalization are metabolized or excreted through kidneys, consequently require dosage adjustment. We aimed to investigate inappropriate prescription of drugs requiring renal dose adjustment (RDA) in various surgical and medical inpatient clinics. We retrospectively determined dialysis patients hospitalized between January 2007 and December 2010. Inpatient clinics, including cardiology, pulmonary medicine, neurology, infectious diseases (medical clinics) and cardiovascular surgery, orthopedics, general surgery, obstetrics and gynecology, and neurosurgery (surgical clinics), were screened via electronic database. Total and RDA medications were determined. RDA drugs correctly adjusted to creatinine clearance were labeled as RDA-A (appropriate), otherwise as RDA-I (inappropriate). Renal doses of RDA medications were based on the American College of Physicians Drug Prescribing in Renal Failure, fifth Edition. Two hundred seventeen hospitalization records of 172 dialysis patients (92 men and 80 women) were included in the analysis. Mean age of patients was 59.4 +/- 14.6 years, and the mean hospitalization duration was 8.5 +/- 7.8 days. In total, 247 (84.3%, percentage in drugs requiring dose adjustment) and 175 (46.2%) drugs have been inadequately dosed in surgical and medical clinics, respectively. The percentage of patients to whom at least 1 RDA-I drug was ordered was 92% and 91.4% for surgical and medical clinics, respectively (P > 0.05). Nephrology consultation numbers were 8 (7.1%) in surgical and 32 (30.4%) in medical clinics. The most common RDA-I drugs were aspirin and famotidine. A significant portion of RDA drugs was ordered inappropriately both in surgical and medical clinics. Nephrology consultation rate was very low. Measures to increase physician awareness are required to improve results.Öğe Heparin-induced thrombocytopenia in a hemodialysis patient treated with fondaparinux: Nephrologists between two fires(Wiley-Blackwell, 2013) Solak, Yalcin; Demircioglu, Sinan; Polat, Ilker; Biyik, Zeynep; Gaipov, Abduzhappar; Acar, Kadir; Turk, SuleymanHeparin-induced thrombocytopenia (HIT) is caused by heparin exposure and presents with reduced platelet count. Patients undergoing hemodialysis (HD) treatment have increased risk of developing HIT due to prolonged exposure to unfractionated heparin or low-molecular weight heparin. We report a 79-year-old male patient with end-stage renal disease who developed type-II HIT during maintenance HD. Platelet count of the patient decreased gradually and antiplatelet factor IV antibody was found to be positive. The patient was treated with fondaparinux and continued heparin-free HD. Unfortunately, despite favorable initial response without any thrombotic episodes, the patient died due to severe sepsis complicated by gastrointestinal hemorrhage.Öğe Pregabalin versus gabapentin in the treatment of neuropathic pruritus in maintenance haemodialysis patients: A prospective, crossover study(Wiley, 2012) Solak, Yalcin; Biyik, Zeynep; Atalay, Huseyin; Gaipov, Abduzhappar; Guney, Figen; Turk, Suleyman; Covic, AdrianAim: Pruritus is common in dialysis patients. Peripheral neuropathy is also prevalent in this patient population. However, the role of neuropathy in the genesis of uraemic itch has not been adequately studied to date. Therefore, we aimed to investigate the effects of gabapentin and pregabalin on uraemic pruritus along with neuropathic pain in patients receiving haemodialysis. Methods: This is a 14 week long randomized, prospective, cross-over trial. Haemodialysis patients with established neuropathy and/or neuropathic pain were included. Fifty patients were randomly assigned to gabapentin 300 mg after each haemodialysis session and pregabalin 75 mg daily. After 6 weeks of treatment, cross-over was performed and patients received the other drug for another 6 weeks. Short Form of McGill Pain Questionnaire and Visual Analogue Scale were used to evaluate pain and pruritus, respectively. At each week's visit, patients were interrogated in terms of adverse effects of study drugs. Baseline laboratory data and demographic characteristics were recorded from patient charts. Results: Forty (12 males, 28 females) out of 50 patients completed the study. Mean age was 58.2 +/- 13.7. Overall, 29 out of 40 patients (72.5%) had pruritus symptoms at baseline evaluation. Fifteen patients (37.5%) were diabetic. Thirty-one out of 40 patients (77.5%) had electromyography (EMG)-proven peripheral neuropathy. Twenty three patients (57.5%) had both EMG-proven neuropathy and pruritus. Gabapentin and pregabalin improved both neuropathic pain and pruritus significantly. There was no difference between the study drugs in terms of efficacy against pain and pruritus. Conclusion: Treatment of neuropathic pain with either pregabalin or gabapentin effectively ameliorates uraemic itch.Öğe Renal dysfunctions in cirrhosis(Modestum Ltd, 2016) Biyik, Murat; Asil, Mehmet; Biyik, ZeynepKidney dysfunction is a common and potentially life-threating event in patients with cirrhosis, and underlying mechanisms for renal dysfunction are quite variable. Acute kidney injury (AKI) is relatively frequent encountered in approximately 20% of hospitalized patients with cirrhosis. Nevertheless, chronic kidney disease (CKD) occurs in almost 1% of all patients with cirrhosis. In this review various renal problems encountered in cirrhotic patients are discussed and strategies to prevent renal dysfunction are suggested.Öğe SARC-F is a Weaker Predictor Compared to Muscle Strength and a Stronger Predictor Compared to Muscle Mass for Mortality and Hospitalization in Hemodialysis Patients(Aves, 2022) Yavuz, Yasemin Coskun; Biyik, Zeynep; Korez, Muslu Kazim; Abusoglu, Sedat; Ahmadli, Nicat; Eryavuz, Duygu; Batur, ElifObjective: It is known that muscle strength and muscle mass decrease in hemodialysis patients. We aimed to compare the effect of SARC-F (strength, assistance with walking, rising from a chair, climbing stairs, and falls) questionnaire with that of handgrip strength and skeletal muscle mass/body mass index on 1-year mortality and hospitalization in hemodialysis patients. Methods: SARC-F test was filled for 67 hemodialysis patients, muscle strength was evaluated with handgrip strength, muscle mass was evaluated by performing bioimpedance analysis, and skeletal muscle mass/body mass index was evaluated by using the formula. Results: The end of 1 year revealed that 12 of 67 patients (17.9%) died. Of the patients, 38 (56.7%) were hospitalized. The number of hospitalizations was in the range of 0-9. The length of hospitalization varied between 2 and 77 days. The patients with low handgrip strength had a 9.86 times higher mortality risk (odds ratio = 9.862, 95% CI = 1.190-81.707, P =.034) and had a 5.27 times higher risk of hospitalization (odds ratio = 5.273, 95% CI = 1.828-15.207, P =.002). The patients who had lower SARC-F had a 3.88 times higher risk of hospitalization (odds ratio = 3.882, 95% CI = 1.340-11.252, P =.012). A positive statistically significant correlation was found between the patients' hospitalization periods and SARC-F scores (Spearman's rho = 0.329, P =.007), and a negative statistically significant correlation was found between the patients' hospitalization periods and handgrip strength scores. The duration of hospitalization was found to be significantly longer in the patients who had low handgrip strength (19.38 +/- 22.25). Conclusion: SARC-F appears to be a weaker parameter than handgrip strength and a stronger parameter than skeletal muscle mass/body mass index on hospitalization and mortality.Öğe Serum uric acid may predict development of progressive acute kidney injury after open heart surgery(Taylor & Francis Ltd, 2015) Gaipov, Abduzhappar; Solak, Yalcin; Turkmen, Kultigin; Toker, Aysun; Baysal, Ahmet Nihat; Cicekler, Humeyra; Biyik, ZeynepObjectives: Acute kidney injury (AKI) is a common complication of cardiac surgery developing in 25-35% cases. Recently, neutrophil gelatinase-associated lipocalin (NGAL) was shown to predict AKI development earlier than serum creatinine. Some studies demonstrated the predictive role of post-operative serum uric acid (SUA) as an early marker of AKI. We aimed to study the role of serum and urine NGAL as well as SUA to predict progression of AKI. Design and methods: This is a prospective observational study of patients undergoing cardiac surgery. Blood and urine samples for measurement of uric acid, serum and urine NGAL levels were collected prior to cardiac surgery (0 h), and in the time course at 2nd and 24th hours after surgery. Patients who developed AKI were divided into two subgroups as progressing and non-progressing AKI. Results: Sixty patients (42 males, 18 females) were included. After cardiac surgery, 40 patients developed AKI, 20 of whom non-progressing AKI, and 20 progressing AKI. All of the markers significantly increased in AKI patients. A receiver operator characteristics (ROC) curve analysis showed higher predictive ability of SUA for progressing AKI compared with serum and urine NGAL. When compared markers obtained at the second hour after surgery, UA had significantly large AUC than NGAL to predict AKI developed at 24 and 48 h, particularly in patients, who require renal replacement therapy (RRT). Conclusion: Uric acid seems to predict the progression of AKI and RRT requirement in patients underwent cardiac surgery better than NGAL.Öğe Soluble TWEAK independently predicts atherosclerosis in renal transplant patients(Biomed Central Ltd, 2013) Turkmen, Kultigin; Tonbul, Halil Zeki; Erdur, Fatih Mehmet; Toker, Aysun; Biyik, Zeynep; Ozbiner, Huseyin; Gaipov, AbduzhapparBackground: Cardiovascular risk is increased in the early stages of chronic kidney disease (CKD) and also found to be ongoing in renal transplant (Rtx) patients. As a sign of atherosclerosis, increased carotid intima-media thickness (CIMT) has been widely accepted as a strong predictor of cardiovascular disease (CVD) and mortality in CKD patients. A novel markers, soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) and neutrophil-to-lymphocyte ratio (NLR) were introduced as potential markers in inflammatory disorders including CKD. The role of Rtx in terms of atherogenesis is still unclear. We aimed to investigate the relationship between sTWEAK, NLR and CIMT in Rtx patients without overt CVD and to compare these results with those obtained from healthy subjects. Methods: Cross-sectional analysis in which CIMT measurements, NLR and serum TWEAK levels were assessed in 70 Rtx patients (29 females; mean age, 40.6 +/- 12.4 years) and 25 healthy subjects (13 females, mean age; 37.4 +/- 8.8 years). Results: sTWEAK levels were significantly decreased (p=0.01) and hs-CRP, NLR and CIMT levels of Rtx patients were significantly increased compared to healthy subjects (p<0.0001, p=0.001, p<0.0001, respectively). sTWEAK was also found to be decreased when eGFR was decreased (p=0.04 between all groups). CIMT was positively correlated with sTWEAK and NLR in Rtx patients (r=0.81, p<0.0001 and r=0.33, p=0.006, respectively). sTWEAK was also positively correlated with NLR (r=0.37, p=0.002). In the multivariate analysis only sTWEAK was found to be an independent variable of increased CIMT. Conclusion: sTWEAK might have a role in the pathogenesis of ongoing atherosclerosis in Rtx patients.Öğe Systemic Inflammation Response Index and Systemic Immune Inflammation Index Are Associated with Clinical Outcomes in Patients with Acute Pancreatitis?(Taylor & Francis Inc, 2022) Biyik, Murat; Biyik, Zeynep; Asil, Mehmet; Keskin, MuharremObjectives: The inflammatory response is critically important in acute pancreatitis (AP). Systemic immune-inflammation (SII) index and systemic inflammation response index (SIRI), which are novel inflammatory markers, have been linked to determining outcomes in various diseases. The goal of the current study was to examine the relation of the SII index and SIRI with disease severity and acute kidney injury (AKI) in subjects with AP. Methods: A total of 332 subjects with AP were analyzed retrospectively. SII index was calculated using the formula; platelet (P)xneutrophil (N)/lymphocyte (L), while SIRI was calculated as N x monocyte (M)/L count. Multivariate regression (MR) was done to determine the independent risk factors for AKI and severe AP (SAP). Results: Statistical analyses showed that both median SII index and median SIRI increased gradually with higher AP severity (p < 0.001). Both SII index and SIRI were higher in subjects with AKI compared to controls (p < 0.001). Using MR analysis, the SII index was found to independently predict both SAP (OR = 1.004, 95% CI: 1.001-1.008, p = 0.018) and AKI (OR = 1.005, 95% CI: 1.003-1.008, p < 0.001). ROC analysis showed that the SII index could accurately differentiate SAP (AUC = 0.809, p < 0.001) and AKI (AUC = 0.820, p = 0.001) in patients with acute pancreatitis. ROC analysis also showed that SIRI could also accurately differentiate SAP (0.782, p < 0.001) and AKI (AUC = 0.776, p = 0.001). Conclusions: SIRI and the SII indexes can be used as potential biomarkers in predicting both disease severity and AKI development in subjects with AP.Öğe Thrombotic thrombocytopenic purpura secondary to ABO group incompatible blood transfusion in a patient after cardiac surgery(Jaypee Brothers Medical Publishers Pvt Ltd, 2013) Solak, Yalcin; Selcuk, Nedim Yilmaz; Gaipov, Abduzhappar; Ucar, Ramazan; Biyik, Zeynep; Acar, KadirThe triggers of secondary thrombotic thrombopcytopenic purpura (TTP) include drug toxicity, radiation and high-dose chemotherapy, angioinvasive infections, surgery and acute graft versus host disease. TTP secondary to surgery have been reported in a number of cases. Most of the cases have been occurred after open heart surgery. Extensive endothelial damage is held responsible as the initiating mechanism in postoperative TTP cases. However, there is no report of secondary TTP describing development owing to ABO incompatible blood transfusion. Here, we describe a patient who developed TTP after transfusion of ABO incompatible blood during hospitalization for bypass surgery. We also propose a hypothesis which may account for the possible underlying mechanism.Öğe Thrombotic thrombocytopenic purpura secondary to ABO group incompatible blood transfusion reply(Medknow Publications & Media Pvt Ltd, 2014) Solak, Yalcin; Selcuk, Nedim Yilmaz; Gaipov, Abduzhappar; Ucar, Ramazan; Biyik, Zeynep; Acar, Kadir[Abstract Not Availabe]
