Long-term outcomes following double kissing crush or mini-culotte stenting for complex coronary bifurcation lesions: the EVOLUTE-CRUSH IV study.

BACKGROUND: This study aimed to evaluate the long-term outcomes of double kissing crush stenting (DKC) and mini-culotte technique (MCT) in patients with complex bifurcation lesions. METHODS: This retrospective study enrolled 236 patients who underwent percutaneous coronary intervention (PCI) for complex coronary bifurcation disease between January 2014 and November 2022. The primary endpoint was target lesion failure (TLF), defined as the combination of cardiac death, myocardial infarction (MI), or clinically driven target lesion revascularization (TLR). The secondary endpoint was major cardiovascular and cerebral events (MACCE) including all-cause death, MI, TLR, stroke, or stent thrombosis. The regression models were adjusted by applying the inverse probability weighted (IPW) approach to reduce treatment selection bias. RESULTS: The initial management strategy was DKC in 154 (65.3%) patients and MCT in 82 (34.7%) patients (male: 194 [82.2%], mean age: 60.85 ± 10.86 years). The SYNTAX scores were similar in both groups. The rates of long-term TLF and MACCE rates were 17.4% and 20%, respectively. The rate of TLF (26.8% vs. 12.3%, p = 0.005) was higher in patients treated with MCT than those treated with the DKC technique, mainly driven by more frequent TLR (15.9% vs. 7.1%, p = 0.035). The long-term TLF and MACCE rates were notably lower in the DKC group compared to the others: adjusted hazard ratio (HR; IPW): 0.407, p = 0.009 for TLF, and adjusted HR(IPW): 0.391 [95% CI: 0.209-0.730], p = 0.003 for MACCE. CONCLUSION: At long-term follow-up, the rates of TLF and MACCE were 17.4% and 20%, respectively. However, long-term TLF was significantly higher in patients treated with MCT than those treated with the DKC technique, primarily due to a more frequent occurrence of clinically driven TLR.

Clinical predictors of incipient vertebral fractures and bone mineral density in kidney transplant patients.

PURPOSE: Kidney transplant recipients are prone to metabolic bone diseases and consequent fractures. This study aimed to evaluate the incidence of incipient vertebral fractures, osteopenia, osteoporosis, and the clinical factors associated with incipient vertebral fractures in a group of kidney transplant patients. METHODS: Two hundred sixty-four patients (F/M 124/140, 45.3 ± 13 years) who had undergone kidney transplantation in tertiary care centers were included. Vertebral fractures were assessed semiquantitatively using conventional thoracolumbar lateral radiography in 202 of the patients. RESULTS: Vertebral fractures were observed in 56.4% (n = 114) of the study group. The frequency of osteoporosis was 20.0% (53 of 264 patients), and osteopenia was 35.6% (94 of 264 patients). Bone mineral density (BMD) levels were in the normal range in 40.3% (n = 46) of the subjects with vertebral fractures. It was in the osteoporotic range in 20.1% (n = 23) and the osteopenic range in 40.3% (n = 46). Vertebral fractures were associated with age, duration of hemodialysis, BMI, and femoral neck Z score (R2 37.8%, p = 0.027). CONCLUSION: As incipient vertebral fractures can be observed in patients with normal BMD levels in kidney transplant recipients, conventional X-ray screening for vertebral fractures may be beneficial for a proper therapy decision of metabolic bone disease in kidney transplant recipients.

Preschoolers' learning of information from fantastical narrative versus expository books.

This study investigated preschool children's learning from expository and fantastical narrative books and whether the children would show a tendency for learning from expository books in cases of conflicting information. Over three testing sessions, 71 3- and 5-year-olds were individually read one expository book and one fantastical narrative book. These books contained four types of information units: narrative-only, expository-only, conflicting, and consistent. Children were asked questions that tapped these information units. Results showed a main effect of age, with 5-year-olds learning more information from both books than 3-year-olds. When the information in the narrative and expository books conflicted, 5-year-olds showed a tendency to report information from the expository book, but 3-year-olds were at chance level for prioritizing information learned from either book.

Evaluation of kidney function tests in HIV-positive patients receiving combined antiretroviral therapy.

INTRODUCTION: Human immunodeficiency virus is a chronic infection that attacks the immune system of the human body, particularly CD4 T lymphocytes. Combined antiretroviral therapies are highly effective in virological suppression of human immunodeficiency virus infection. It has been shown that some retroviral therapies have a higher nephrotoxicity potential. As a result of renal injury, serum creatinine increases and the estimated glomerular filtration rate is reduced. The aim of our study was to assess changes in kidney function during a 24-month period in HIV-positive patients who were begun on combined antiretroviral therapy. MATERIAL AND METHODS: A total of 127 HIV-positive patients were enrolled. The patients were divided into five groups; patients who received no therapy were designated as group 1; those who received Dolutegravir/Abacavir/Lamivudine combination as group 2; those who received Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Fumarate combination as group 3; those who received Emtricitabine/Tenofovir Disoproxil Fumarate/Dolutegravir combination as group 4; and those who received Emtricitabine/Tenofovir Disoproxil Fumarate/Raltegravir combination as group 5. We compared the effects of these drugs on estimated glomerular filtration rate during a 24-month follow-up period. RESULTS: At the 24th month of therapy, a significant difference was observed between the estimated glomerular filtration rate (eGFR) levels of the study groups (P < .001). eGFR level was significantly higher in group 4 compared with groups 1, 2 and 3 (P = .009, P < .001, P < .001, respectively), whereas it was significantly lower in group 5 than groups 1, 2 and 3 (P = .005, P < .001, P < .001, respectively). No significant eGFR difference was found between group 4 and group 5 (P > .05). Serum creatinine level was significantly higher in groups 4 and 5 compared with the other groups (P < .001). CONCLUSION: The use of TDF-containing regimens causes renal dysfunction. Therefore, we recommend close monitoring of renal function, especially in patients treated with TDF.

The effect of RAAS inhibitors on acute hypoxemic respiratory failure and in-hospital mortality in the hypertensive Covid-19 patients.

INTRODUCTION: We have aimed to investigate the relationship between use of angiotensin-converting-enzyme inhibitor (ACEI) or angiotensin-receptor-blocker (ARB) drugs and acute hypoxemic respiratory failure (AHRF) and in-hospital mortality in hypertensive Covid-19 patients. MATERIAL AND METHOD: Consecutive 1345 patients diagnosed with Covid-19 between April and October 2020 who met inclusion criteria were divided into two groups based on presence and absence of AHRF and mortality. The groups were compared regarding epidemiological, clinical, radiological, laboratory findings and treatments methods. The patient groups ACEI, ARB and other antihypertensive drugs (non-ACEI/ARB) were compared regarding same parameters. RESULTS: Median age was 68 (60-76) years in the patient group including 805 (59.9.1%) females. Of the patients, 475 (35.3%), 644 (47.9%) and 226 (16.8%) were using ACEIs, ARBs and non-ACEI/ARB, respectively. AHRF and in-hospital mortality developed in 1053 (78.3%) and 290 (21.6%) patients, respectively. Age, gender, coronary artery disease, diabetes mellitus (DM), neutrophil, lymphocyte, creatinine, D-dimer, C-reactive protein (CRP), ACEI, beta blocker and aspartate transaminase (AST) found statistically significant in the univariable logistic regression performed to identify independent predictors of mortality were included multivariable logistic regression model. Age (OR: 1.066, 95%CI: 1.049-1.083; p < .001), DM (OR: 1.682, 95%CI: 1.238-2.286; p = .001), neutrophil (OR: 1.041, 95%CI: 1.007-1.077; p = .019), creatinine (OR: 1.178, 95%CI: 1.048-1.325; p = .006), CRP (OR: 1.008, 95%CI: 1.006-1.010; p < .001), ACEI (OR: 0.718, 95%CI: 0.521-0.988; p = .042), AST (OR: 1.005, 95%CI: 1.001-1.010; p = .010) were found associated with in-hospital mortality. CONCLUSION: In our study, it was not detected clinically significant difference between three groups with regard to their relation with in-hospital mortality.

The efficiency and safety of oxygen-supplemented accelerated transepithelial corneal cross-linking.

PURPOSE: To investigate the impact of oxygen delivery on the clinical outcomes of accelerated transepithelial corneal cross-linking (A-TE CXL). METHODS: Fifty-seven eyes of 44 progressive keratoconus (KCN) patients were randomly separated into two age-sex-matched groups. Twenty-nine eyes of 23 KCN patients that underwent oxygen-supplemented A-TE CXL formed the study group and 28 eyes of 21 patients treated with the same procedure but under room air conditions formed the control group. All patients were examined preoperatively, one, six and twelve months after the procedure. The logMAR spectacle-corrected distance visual acuity (CDVA), maximum keratometry (Kmax), mean keratometry, apical posterior keratometry, cylindrical power, minimum central corneal thickness, keratoconus vertex front and back, ocular aberrations, endothelial cell density (ECD), demarcation line depth (DLD) and proportion measures were recorded for statistical analysis. RESULTS: The preoperative, 1st, 6th and 12th months mean Kmax values of the study group were 55.14 ± 3.99D, 54.85 ± 3.82D, 54.37 ± 3.84D and 54.40 ± 3.86, respectively, and 54.47 ± 3.17D, 54.52 ± 2.97D, 54.25 ± 2.95D and 54.20 ± 2.97 in the control group. The mean Kmax value was decreased significantly more in the oxygen-supplemented group after 12 months compared to the control group (p = 0.019). The mean DLD was also significantly deeper in the study group (320 ± 17 µm) compared to the control group (269 ± 19 µm). There was no significant difference between the two groups in terms of ECD alterations at any of the time intervals (p > 0.05). CONCLUSION: Keratoconus progression was significantly halted in both groups 12 months after the treatment. In addition, oxygen supplementation during A-TE CXL further significantly increased clinical outcomes compared to room air conditions without any significant change in ECD measures.

The impact of hybrid contact lenses on keratoconus progression after accelerated transepithelial corneal cross-linking.

PURPOSE: To investigate the effect of hybrid contact lenses (HCLs) on keratoconus (KCN) progression after accelerated transepithelial cross-linking (A-TE CXL). METHODS: Thirty-five eyes of 26 patients who preferred Ultrahealth HCLs for an optical correction after A-TE CXL formed the study group, and 45 eyes of 34 patients who preferred spectacle correction were age- and sex-matched to form the control group. Corrected distance visual acuity (CDVA), maximum keratometry, mean keratometry, apical posterior keratometry, cylindrical power, minimum corneal thickness, keratoconus vertex indices and curvature asymmetry indices obtained by Scheimpflug corneal topography were compared before, 6 and 12 months after the procedure. Anterior segment optic coherence tomography (AS-OCT) was performed to measure the apical corneal clearance of HCL-wearing patients. RESULTS: The median pre-CXL CDVA value of the patients in the HCL group was logMAR 0.30 (0.20-1.0), and it was logMAR 0.30 (0.10-1.0) in the spectacle-corrected group. There was a significant increase in CDVA 6 and 12 months after CXL procedure in both groups (p < 0.001, 0.003, respectively). The median front curve asymmetry index (FCAsym) significantly improved after A-TE CXL in the HCL group. The pre-CXL and 12th-month topographic comparisons of the spectacle-corrected group revealed no significant difference. In addition, no significant difference was observed between topographic alterations of two groups (p > 0.05). CONCLUSION: The CDVA significantly improved, and KCN progression was halted in patients wearing HCL 12 months after A-TE CXL. Besides, FCAsym indices can be considered for follow-up of the HCL-wearing patients as an assistive parameter to AS-OCT measurements.

Relationship Between Epicardial Adipose Tissue and Body Composition as Determined by Multi-Frequency Bioelectrical Impedance Analysis in Patients with Stage 5 Chronic Kidney Disease.

BACKGROUND The main cause of mortality among chronic kidney disease (CKD) patients is cardiovascular disease (CVD). Epicardial adipose tissue (EAT) is considered to be novel cardiovascular risk factor. We assessed EAT in non-dialyzed stage 5 CKD patients and explored the association of EAT with body composition as determined by multi-frequency BIA. MATERIAL AND METHODS The present included 70 stage 5 CKD patients who had not undergone dialysis and 40 healthy control subjects. EAT thickness was assessed by echocardiography. Hydration status and body composition were evaluated by multi-frequency bioelectrical impedance analysis. RESULTS Stage 5 CKD patients had significantly higher EAT thickness than healthy subjects (6.56±1.18 vs. 4.05±1.45, p<0.001). Fat tissue mass, systolic blood pressure (SBP), age, fat tissue index, and body mass index were positively correlated with EAT thickness in the CKD patient group (p<0.05). Lean tissue mass, lean tissue index (LTI), and high-density lipoprotein (HDL) were negatively correlated with EAT thickness in the CKD patient group (p<0.05). Stepwise multiple regression analysis showed that age, SBP, and LTI were independently associated with EAT thickness in CKD patients. CONCLUSIONS We found significantly higher EAT thickness in stage 5 CKD patients who were not on dialysis compared to healthy controls. EAT was significantly associated with age, SBP, and LTI in CKD patients. Interventions to reduce the risk factors associated with EAT thickness might protect against CVD disease in CKD patients.

Cranial dural arteriovenous shunts. Part 1. Anatomy and embryology of the bridging and emissary veins.

We reviewed the anatomy and embryology of the bridging and emissary veins aiming to elucidate aspects related to the cranial dural arteriovenous fistulae. Data from relevant articles on the anatomy and embryology of the bridging and emissary veins were identified using one electronic database, supplemented by data from selected reference texts. Persisting fetal pial-arachnoidal veins correspond to the adult bridging veins. Relevant embryologic descriptions are based on the classic scheme of five divisions of the brain (telencephalon, diencephalon, mesencephalon, metencephalon, myelencephalon). Variation in their exact position and the number of bridging veins is the rule and certain locations, particularly that of the anterior cranial fossa and lower posterior cranial fossa are often neglected in prior descriptions. The distal segment of a bridging vein is part of the dural system and can be primarily involved in cranial dural arteriovenous lesions by constituting the actual site of the shunt. The veins in the lamina cribriformis exhibit a bridging-emissary vein pattern similar to the spinal configuration. The emissary veins connect the dural venous system with the extracranial venous system and are often involved in dural arteriovenous lesions. Cranial dural shunts may develop in three distinct areas of the cranial venous system: the dural sinuses and their interfaces with bridging veins and emissary veins. The exact site of the lesion may dictate the arterial feeders and original venous drainage pattern.

Evaluation of volume overload by bioelectrical impedance analysis, NT-proBNP and inferior vena cava diameter in patients with stage 3&4 and 5 chronic kidney disease.

BACKGROUND: Determination of fluid overload is important in chronic kidney disease. Early diagnosis and treatment of volume overload may decrease morbidity and mortality. We aimed to determine body composition by using bioelectrical impedance analysis, and studying other clinical characteristics, inferior vena cava diameter, and N-terminal pro-B natriuretic peptide associated with hydration status in chronic kidney disease Stages 3&4 and 5 in patients not undergoing dialysis. METHOD: We examined 62 patients with Stages 3&4 and 68 patients with Stage 5 chronic kidney disease. Plasma NT-proBNP was measured and analyzed after log transformation. Inferior vena cave diameter was measured with echocardiography and indexed for body surface area. Hydration status was assessed using multi-frequency bioelectrical impedance analysis. Overhydration was defined as overhydration/extracellular water >0.15. RESULTS: Overhydration was more frequent in Stage 5 than in Stages 3&4 patients. Systolic and diastolic blood pressure, inferior vena cava index, and log NT-proBNP were higher in overhydrated compared to non-overhydrated patients. A significant positive correlation existed between overhydration/extracellular water and log NT-proBNP, systolic and diastolic blood pressures, and inferior vena cava index. In multiple linear regression analysis, the variables associated with hydration status were male sex, extracellular water/total body water, and extracellular water/intracellular water (greater overhydration), while serum albumin levels had a negative association with overhydration. CONCLUSION: Overhydration is more prevalent in Stage 5 chronic kidney disease patients than in Stages 3&4 patients. Bioelectrical impedance analysis, inferior vena cava diameter, and NT-proBNP analysis in chronic kidney disease are useful methods to determine the volume overload.

Evaluation of fluid status related parameters in hemodialysis and peritoneal dialysis patients: Clinical usefulness of bioimpedance analysis.

BACKGROUND AND OBJECTIVE: Fluid overload is a common and serious problem that leads to severe complications in dialysis patients. We aimed to compare hydration status as measured with bioimpedance analysis (BIA) method in hemodialysis (HD) and peritoneal dialysis (PD) patients, as well as investigating the association between blood pressure, left ventricular mass index (LVMI) and hydration status. MATERIALS AND METHODS: We examined 43 HD and 33 PD patients. Blood pressure was recorded. In each group, echocardiographic examinations were performed on all patients. Hydration status was assessed using multifrequency bioelectrical impedance analysis. Overhydration was defined as an overhydration (OH)/extracellular water (ECW) ratio of >0.15. RESULTS: The OH/ECW ratio was significantly higher in PD patients compared to post-HD patients. Overhydration was statistically more frequent in PD than in post-HD patients (30.3% vs. 11.6%, P=0.043). Systolic blood pressure (SBP) in both post-HD and PD groups, and LVMI in the PD group were found to be significantly higher in overhydrated patients than non-overhydrated patients. In multiple linear regression analyses, increased OH/ECW ratio was independently associated with higher SBP and LVMI. CONCLUSIONS: Fluid overload may be an even more prevalent and serious problem in PD patients. Overhydration is closely associated with increased blood pressure and LVMI. OH/ECW ratio, a derived parameter of fluid load measured by BIA, was a significant and independent determinant of SBP and LVMI.

Comparison of choroidal thickness, superficial and deep retinal vascular indices, and foveal avascular zones: Martial Arts Athletes vs Healthy Non-Athletes.

AIM: The study aims to compare choroidal thickness, deep and superficial retinal capillary plexuses, and foveal avascular zone (FAZ) parameters in elite martial arts athletes and a healthy sedentary control group. METHODS: The study included martial arts athletes (32 individuals, 64 eyes) and healthy sedentary persons (43 individuals with healthy sedentary lifestyles, 86 eyes) aged 18-35 years. In this single non-repeated observational and cross-sectional study, choroidal thickness, superficial and deep retinal capillary plexuses, and FAZ measurements were measured using Swept-source optical coherence tomography angiography (SS-OCTA) and compared between groups. RESULTS: No statistically significant differences were found (p>0.05) in age, IOP, AL (axial length), and best-corrected visual acuity (BCVA) parameters between groups. There were no statistically significant differences between the groups in choroidal thickness, superficial and deep retinal capillary plexuses, and FAZ parameters determined by the OCTA method (p>0.05). CONCLUSION: In our study, we observed that the retinal and choroidal structures of martial art athletes and healthy sedentary individuals were similar. This observation implies that the putative microvascular effects on the choroid and retina in martial arts, especially those based on the anaerobic energy system, may reflect similar outcomes to those observed in individuals with sedentary lifestyles characterized by healthiness.

Clinical and histopathological characteristics of primary focal segmental glomerulosclerosis in Turkish adults.

The data regarding primary FSGS (pFSGS) from different parts of the world differ. While the prevalence of pFSGS has been increasing in Western countries like the USA, it follows an inconsistent trend in Europe and Asia and a decreasing trend in Far Eastern countries such as China in the last two decades. There are undetermined factors to explain those national and geographic discrepancies. Herein, we aimed to reveal the current prevalence with clinical and histopathological characteristics of pFSGS in Turkish adults. This study includes the biopsy-proven pFSGS patients data recorded between 2009 and 2019, obtained from the national multicenter primary glomerulonephritis registry system of the Turkish Society of Nephrology Glomerular Diseases (TSN-GOLD) database. 850 of the 3875 primer glomerulonephritis patients(21.9%) have pFSGS. The mean age is 40.5 ± 14.2 and 435 (51.2%) of patients are male. Nephrotic syndrome is the most common biopsy indication (59.2%). 32.6% of patients have hematuria, 15.2% have leukocyturia and 7.8% have both. Serum creatinine, albumin, and proteinuria are 1.0 mg/dL (IQR = 0.7-1.4) mg/dl, 3.4 ± 0.9 g/dl, 3400 mg/day(IQR, 1774-5740), respectively. Females have lower mean arterial pressure (- 2.2 mmHg), higher eGFR (+ 10.0 mL/min/1.73 m2), and BMI (+ 1.6 kg/m2) than males. Thickened basal membrane(76.6%) and mesangial proliferation (53.5%) on light microscopy are the major findings after segmental sclerosis. IgM (32.7%) and C3 (32.9%) depositions are the most common findings on immunofluorescence microscopy. IgM positivity is related to lower eGFR, serum albumin, and higher proteinuria. The prevalence of pFSGS is stable although slightly increasing in Turkish adults. The characteristics of the patients are similar to those seen in Western countries.

Retrobulbar Blood Flow Parameters in Patients With Anisometropic Amblyopia.

Introduction We aim to compare retrobulbar blood flow parameters between the amblyopic eye and the fellow eye in patients with anisometropic amblyopia. Methods Peak systolic velocity (PSV) and end-diastolic velocity (EDV) of the ophthalmic artery (OA), central retinal artery (CRA), and posterior ciliary artery (PCA) were measured by color Doppler imaging (CDI), and the resistivity index (RI) and pulsatility index (PI) were calculated in 62 patients aged 12-40 years with anisometropic amblyopia. Results The mean PSV values of OA, CRA, and PCA in amblyopic and fellow eyes were 30.38 ± 10.34, 8.45 ± 2.27, and 8.03 ± 2.77, and 33.73 ± 14.46, 8.35 ± 2.05, and 8.81 ± 2.77, respectively. The mean EDV values of OA, CRA, and PCA in amblyopic and fellow eyes were 6.86 ± 2.64, 1.47 ± 1.59, and 1.94 ± 2.03, and 8.57 ± 4.30, 1.80 ± 1.73, and 2.32 ± 1.20, respectively. The mean RI values of OA, CRA, and PCA in amblyopic and fellow eyes were 0.77 ± 0.10, 0.85 ± 0.14, and 0.78 ± 0.15, and 0.75 ± 0.07, 0.79 ± 0.20, and 0.74 ± 0.13, respectively. OA-PSV and OA-EDV values were significantly lower in the amblyopic eye than in the healthy eye (p < 0.05). OA-RI values were significantly higher (p < 0.05) in the amblyopic eye than in the healthy eye. Conclusions Considering the decrease in PSV and EDV and the increase in RI, which are the blood flow parameters of the amblyopic eye, our study may provide guidance to focus on increasing blood flow in the treatment of amblyopia.

Left ventricular global longitudinal strain can detect subclinical left ventricular systolic dysfunction in adult patients with primary nephrotic syndrome.

It has been shown that there is an increased risk of cardiovascular events such as heart failure and death in nephrotic syndrome. Left ventricle global longitudinal strain (LVGLS) is a more sensitive measure of assessing myocardial dysfunction and is more reproducible than left ventricle ejection fraction (LVEF%). LVGLS can detectsubclinical deterioration in the left ventricle early. In this study, we aimed to investigate LVGLS in Primary Nephrotic Syndrome (PNS) patients with normal LVEF%. Patients with histopathologically confirmed PNS were evaluated for this prospective single-center study. Patients with similar age and gender characteristics without nephrotic syndrome were included as the control group. LVGLS measurements were performed by 2D speckle tracking echocardiography. A total of 171 patients, 57 with PNS and 114 in the control group, were included in the study. The mean age was 38±12 years in the study population, and 95(56%) of the patients were women. LVEF% was 60.2±4.2 in the PNS group and 61.1±3.2 in the control group, and there was no significant difference between the two groups (p=0.111). LVGLS was found to be significantly lower in the PNS group (-19.3±2.3% vs.-20.8±1.5 %, p<0.001). A significant relationship was observed between PNS and LVGLS in the multivariable linear regression analysis (ß= 4.428, CI 95% =0.57?1.48, p<0.001). A significant relationship was observed between PNS and LVGLS, and LVGLS was found to be lower in PNS patients. In patients with PNS, subclinical left ventricular systolic dysfunction may be detected in the early period by measuring LVGLS.

Evaluation of whole blood thiamine pyrophosphate concentrations in critically ill patients receiving chronic diuretic therapy prior to admission to Turkish intensive care units: A pragmatic, multicenter, prospective study.

BACKGROUND/OBJECTIVES: Thiamine plays a pivotal role in energy metabolism. The aim of the study was to determine serial whole blood TPP concentrations in critically ill patients receiving chronic diuretic treatment before ICU admission and to correlate TPP levels with clinically determined serum phosphorus concentrations. SUBJECTS/METHODS: This observational study was performed in 15 medical ICUs. Serial whole blood TPP concentrations were measured by HPLC at baseline and at days 2, 5 and 10 after ICU admission. RESULTS: A total of 221 participants were included. Of these, 18% demonstrated low TPP concentrations upon admission to the ICU, while 26% of participants demonstrated low levels at some point during the 10-day study period. Hypophosphatemia was detected in 30% of participants at some point during the 10-day period of observation. TPP levels were significantly and positively correlated with serum phosphorus levels at each time point (P < 0.05 for all). CONCLUSIONS: Our results show that 18% of these critically ill patients exhibited low whole blood TPP concentrations on ICU admission and 26% had low levels during the initial 10 ICU days, respectively. The modest correlation between TPP and phosphorus concentrations suggests a possible association due to a refeeding effect in ICU patients requiring chronic diuretic therapy.

Could mesangial C3 deposition be an independent prognostic marker in immunoglobulin A nephropathy?

BACKGROUND: Immunoglobulin A nephropathy (IgAN) is a common primary glomerulonephropathy. There is evidence that mesangial C3 deposition plays a role in the development of the disease. The aim of this study was to examine the effect of C3 deposition on the prognosis of IgAN patients. METHOD: The study included 1135 patients with biopsy-confirmed IgAN from the database of the Turkish Nephrology Association Glomerular Diseases Working Group (TSN-GOLD). Patients were excluded from the study if they were aged < 18 or > 75 years or if C3 staining had not been performed in the immunofluorescent analysis. C3 deposition was defined as an immunofluorescence intensity of C3 ≥ 2 + within the mesangium. The primary endpoints were the development of end-stage renal disease, a 30% decrease in glomerular filtration rate compared to the basal value or an elevation in proteinuria to a nephrotic level (3.5 gr/day). RESULTS: Mesangial C3 deposition was observed in 603 (53.1%) patients. No statistically significant difference was found at baseline between the groups with and without mesangial C3 deposition, as for age, sex, BMI, proteinuria level, or the presence of hypertension. In the follow-up period with a mean duration of 78 months, no significant difference was found between the two groups regarding the primary endpoints (p = 0.43). A significant correlation between C3 deposition and segmental glomerulosclerosis (S1) according to the Oxford MEST-C classification was found (p = 0.001). CONCLUSION: Although a correlation was observed between mesangial C3 deposition and the S1 MEST-C classification, mesangial C3 deposition was not a prognostic factor in IgAN.

The relationship between serum vitamin D levels and health-related quality of life in peritoneal dialysis patients.

INTRODUCTION: We aimed to investigate the relationship between Vitamin D level and quality of life in patients undergoing peritoneal dialysis as renal replacement therapy. METHODS: 50 peritoneal dialysis patients aged between 18 and 73 years were included in this study. KDQOL-36 questionnaire was applied to rate the quality of life of the patients. This questionnaire consisted of 36 questions divided into five subscales. The patients were divided into two groups according to serum vitamin D levels. Patients with a serum 25(OH) D level < 20 ng/mL were identified as vitamin D deficiency group and those with a serum 25(OH)D level ≥ 20 ng/mL were identified as normal vitamin D group. RESULTS: The patients had a mean age of 41.16 ± 16.05 years, 56% of them were females. The mean 25(OH) D levels of patients with 25 (OH) D levels < 20 ng/mL and those with ≥ 20 ng/mL were 10.50 ± 4.62 ng/mL and 25.55 ± 4.11 ng/mL, respectively. We found that all subscales of KDQOL-36 were lower with statistically significance in the group with Vitamin D (Vit-D) deficiency. Hemoglobin level was detected as independent risk factor for Symptom and problem list subscales and SF-12 physical component summary subscale (PCS) (P = 0.029, P = 0.047). Vit-D deficiency was detected as independent risk factors for kidney disease burden subscale and PCS (P = 0.035, P = 0.019). Hypertension was detected as independent risk factor for kidney disease burden subscale (P = 0.015). CONCLUSION: Our study is the first to investigate the relationship between serum Vit-D level and quality of life by KDQOL-36 scale in peritoneal dialysis patients. We revealed that patients with low Vit-D levels had worse quality of life in all subscales.

Comparison of the Treatment Efficacy of Continuous Renal Replacement Therapy and Intermittent Hemodialysis in Patients With Acute Kidney Injury Admitted to the Intensive Care Unit.

Introduction and aim Acute kidney injury (AKI) is part of the multiple organ dysfunction syndrome in critically ill patients and is a common condition in intensive care units (ICUs). Renal replacement therapy (RRT) is the cornerstone of treatment for AKI in critically ill patients. This patient population has a high mortality rate despite RRT. There are two methods of RRT for patients in ICUs: intermittent hemodialysis (IHD) and continuous renal replacement therapy (CRRT). Both CRRT and IHD similarly provide adequate metabolic control. We aimed to compare these two RRT modalities in terms of ICU stay, mortality, and laboratory recovery in these patients with high mortality. Materials and methods A total of 120 patients with AKI who needed RRT in the ICU were included in the study (CRRT, n:40; IHD, n:80). Acute Physiology and Chronic Health Evaluation (APACHE) II, Sepsis-related Organ Failure Assessment (SOFA), and Simplified Acute Physiology Score (SAPS)-II scores at the time of admission to the ICU were calculated. Mean arterial pressure, urea, creatinine, sodium, potassium, calcium, pH, lactate, and bicarbonate levels were measured before and after dialysis. Patients were classified as living and deceased. Factors affecting the length of stay in the intensive care unit and 30-day mortality were evaluated. The variability in laboratory parameters between groups before and after dialysis was examined. The groups were compared with these parameters. Results Sixty-one point seven percent (61.7%, n:74) of the patients were female. The mean age was 62.90±13.64 years. At the time of admission to the ICU, the patients' SAPS II score was 45.05±12.76, APACHE II score was 22.05±6.32, and SOFA score was 8.26±2.48. 66.7% (n:80) of the patients included in the study died, and the length of stay of these patients in the ICU was 12.85±10.23 days. When the groups were compared, SAPS II, APACHE II scores, and SOFA scores were significantly higher in the CRRT group than in the IHD group (p:0.038, p:0.015, p:0.027, respectively). Although the length of stay in the ICU was shorter in the CRRT group, it was not statistically significant (p:0.075). There was no statistically significant difference between the groups in terms of mortality (p: 0.891). SAPS-II, APACHE II, and SOFA score affected 30-day mortality while age, gender, and RRT modalities were not associated with mortality. The improvement in laboratory parameters between the pre and post-RRT groups was statistically more significant in the IHD group (p<0.001). It was determined that there was a statistically greater decrease in mean arterial pressure in the IHD group (p<0.001). Conclusions It was determined that there was no difference between the CRRT and IHD modalities applied in patients with AKI admitted to the ICU in terms of mortality and length of stay in the ICU. It was observed that both modalities improved on laboratory parameters, but the improvement was greater in the IHD group. However, it was determined that there was a statistically greater decrease in mean arterial pressure in the IHD group.

Serum 25-Hydroxy Vitamin D, Vitamin B12, and Folic Acid Levels in Progressive and Nonprogressive Keratoconus.

PURPOSE: To evaluate the serum 25-hydroxy vitamin D, vitamin B12, and folic acid (FA) levels in progressive and nonprogressive patients with keratoconus (KCN). METHODS: Fifty-five patients with KCN (28 progressive and 27 nonprogressive) who were followed up for at least 12 months were recruited and separated into 2 groups according to corneal topographic progression criteria. Age- and sex-matched 30 healthy individuals formed the control group. Serum vitamin D, B12, FA, and Ca levels were compared among control, nonprogressive, and progressive groups. The effect of gender, age, vitamin D, B12, and FA parameters on KCN progression was investigated. RESULTS: Serum vitamin D levels were 12.77 ± 5.52, 11.78 ± 4.32, and 17.40 ± 5.12 ng/mL in nonprogressive, progressive, and control groups, respectively. The serum vitamin D levels in KCN groups (nonprogressive and progressive) were significantly lower than the control group (P = 0.002 and P < 0.001, respectively). There was no significant difference between all groups in serum vitamin B12, FA, and Ca levels (P > 0.05). Decreased vitamin D levels significantly increased nonprogressive KCN probability 1.23 times and progressive KCN probability 1.29 times more than the control group (P = 0.002, 95% confidence interval, 0.708-0.925; P < 0.001, 95% confidence interval, 0.668-0.888, respectively). CONCLUSIONS: Serum vitamin D levels were significantly decreased in both KCN groups. However, serum vitamin B12, FA, and Ca levels were similar in all groups. Serum vitamin D evaluation of patients with KCN at onset and follow-up examinations may help to predict the course of the disease.