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1.
Eur Rev Med Pharmacol Sci ; 26(13): 4884-4892, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35856381

RESUMO

OBJECTIVE: We aimed at determining the effectiveness of mechanical thrombectomy (MT) in patients with major vessel occlusion and infected with COVID-19, evaluating its clinical outcome and comparing it with non-COVID patients. PATIENTS AND METHODS: During the pandemic, 729 patients who underwent MT in stroke centers due to Acute Ischemic Stroke (AIS) with large vessel occlusion were evaluated. This study included 40 patients with a confirmed COVID-19 diagnosis by a positive PCR test between March 11, 2020, and December 31, 2020. These patients were compared to 409 patients who underwent MT due to major vessel occlusion between March 11, 2019, and December 31, 2019. RESULTS: Of the patients with AIS who are infected with COVID-19, 62.5% were males, and all patients have a median age of 63.5 ± 14.4 years. The median NIHSS score of the COVID-19 group was significantly higher than that of the non-COVID-19 groups. Dissection was significantly more in the COVID-19 group. The mortality rates at 3 months were higher in the COVID-19 groups compared to non-COVID-19 groups. CONCLUSIONS: This study revealed an increased frequency of dissection in patients with COVID-19. COVID-19-related ischemic strokes are associated with worse functional outcomes and higher mortality rates than non-COVID-19 ischemic strokes.


Assuntos
Isquemia Encefálica , COVID-19 , AVC Isquêmico , Acidente Vascular Cerebral , Idoso , Isquemia Encefálica/complicações , Teste para COVID-19 , Feminino , Humanos , AVC Isquêmico/epidemiologia , AVC Isquêmico/cirurgia , Masculino , Pessoa de Meia-Idade , Pandemias , Prognóstico , Estudos Retrospectivos , Acidente Vascular Cerebral/complicações , Trombectomia/efeitos adversos , Resultado do Tratamento
2.
Int J Psychiatry Clin Pract ; 25(4): 403-406, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34032542

RESUMO

OBJECTIVE: This study examines orexin A levels in adolescents with major depressive disorder (MDD). METHODS: Serum orexin A levels of adolescents with MDD (n = 40) were compared to healthy controls (n = 38) using ANCOVA test. In addition, the relationship between orexin A levels and MDD symptom severity (i.e., child depression inventory) was investigated in the MDD group using correlation and linear regression analyses. RESULTS: Orexin A levels of the subjects with MDD were similar to controls while controlling for age, gender, body mass index, and anxiety levels of the subjects. In addition, correlation and regression analyses did not reveal any relationship between orexin A and MDD symptoms. DISCUSSION: Adolescent MDD is not associated with orexin A according to the findings of this study. Future studies considering the effect of stress on this relationship would improve our understanding of this issue.Key PointsAdult studies exploring the relationship between orexin A and major depressive disorder reported contradictory findings.This study showed no relationship between serum orexin A levels and depressive symptom severity among adolescents with major depressive disorder.Orexin A levels of the subjects with major depressive disorder are not significantly different from healthy adolescents.


Assuntos
Transtorno Depressivo Maior , Orexinas , Adolescente , Estudos de Casos e Controles , Transtorno Depressivo Maior/sangue , Humanos , Orexinas/sangue
3.
J Eur Acad Dermatol Venereol ; 34(12): 2745-2756, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32124493

RESUMO

Autoimmune blistering skin diseases (AIBD) encompass a group of diseases characterised by cutaneous and/or mucocutaneous fragility. Multiple risk factors contributing to osteoporosis exist in AIBD patients, including use of long-term systemic corticosteroid therapy (SCT), decreased mobility and the presence of chronic inflammation. Despite this, there is no consensus on the prophylaxis of osteoporosis in AIBD, especially in the absence of SCT. To systemically review the current literature on the association between osteoporosis/osteopenia and AIBD, a comprehensive literature search was performed on six online databases with search terms related to bone mineral density (BMD) and AIBD. A total of 314 articles were screened by their abstract and/or full text. A total of 20 peer-reviewed full-text articles addressing BMD in patients with AIBD were identified. Eight articles examined the association between osteoporosis and pemphigus. Only two articles examined the association between osteoporosis and pemphigoid patients. Three articles examined the effectiveness of osteoporosis prophylaxis in AIBD patients. Seven papers examined the levels of vitamin D in AIBD patients. Few case-control studies examine osteoporosis in pemphigus in the context of SCT, with consistent findings. However, there is scarce literature examining the risk of osteoporosis in pemphigoid, or in AIBD without SCT. Prophylaxis and screening of osteoporosis in AIBD is suboptimal and more attention in this area is required to avoid future complications related to osteopenia and osteoporosis.


Assuntos
Doenças Autoimunes , Osteoporose , Pênfigo , Vesícula , Densidade Óssea , Humanos , Osteoporose/epidemiologia , Osteoporose/etiologia
4.
Niger J Clin Pract ; 23(2): 159-164, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32031089

RESUMO

BACKGROUND: There is an increased risk of long-term dental and periodontal disease in autoimmune bullous diseases (AIBD). AIMS: In this cross-sectional study, we aimed to determine whether the oral health-related quality of life status (OHRQoL) was associated with disease severity and activity in patients with AIBD. SUBJECTS AND METHODS: 67 patients with AIBD were enrolled in this study. Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) was used to evaluate the disease severity. The score was categorized as a significant course (≥17) and moderate course (<17). Oral health impact profile-14 (OHIP-14) questionnaire was filled to assess the OHRQoL. Self-reported oral health status and oral lesion related pain score were also evaluated in the study group. RESULTS: OHIP-14 score was significantly higher in active patients (42.28 ± 13.66) than inactive patients (29.08 ± 12.25) (P = 0.004) and it was correlated with the pain score (6.33 ± 2.78; r = 0.409, P = 0.013). Furthermore, OHIP-14 score was higher in patients with a significant disease course (45.18 ± 15.08) (P = 0.010) than in patients with a moderate course (36.09 ± 9.73). CONCLUSIONS: OHRQoL may be useful in the disease management and treatment. Since it can be affected by both presence of oral erosions and disease severity, a collaboration between dermatologists and dentists could be crucial to the disease management in AIBD.


Assuntos
Doenças Autoimunes/psicologia , Saúde Bucal , Higiene Bucal , Qualidade de Vida , Dermatopatias Vesiculobolhosas/psicologia , Adulto , Doenças Autoimunes/epidemiologia , Doenças Autoimunes/imunologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Periodontais/epidemiologia , Autorrelato , Índice de Gravidade de Doença , Dermatopatias Vesiculobolhosas/epidemiologia , Dermatopatias Vesiculobolhosas/imunologia , Inquéritos e Questionários , Turquia/epidemiologia
6.
Expert Rev Clin Pharmacol ; 12(10): 973-980, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31550941

RESUMO

Introduction: Pemphigus, an autoimmune disease group characterized by blisters and erosions of the skin and/or mucosal membranes has been treated with systemic corticosteroids (CS) and immunosuppressive therapies for the past few decades. Areas Covered: However, common adverse effects and complications of long-term CS and immunosuppressive drugs are limiting their long-term use. The disease results in death if not treated. Thus, currently, researchers are trying to develop new and safer therapeutic approaches. Specifically, targeted therapies to pathogenic immune pathways are under investigation. The B cell inhibitors which block CD20 and CD19 are the main new drugs investigated in clinical trials as alternatives to systemic steroids. Expert Opinion: Randomized controlled trial (RCT) Level evidence shows that rituximab and short course CSs are more effective and safer than standard CS treatment. Specific BTK inhibitors have shown promise in data from a phase II international open-label study. Further studies are ongoing.


Assuntos
Corticosteroides/administração & dosagem , Imunossupressores/administração & dosagem , Pênfigo/tratamento farmacológico , Corticosteroides/efeitos adversos , Corticosteroides/farmacologia , Tirosina Quinase da Agamaglobulinemia/antagonistas & inibidores , Animais , Desenvolvimento de Medicamentos/métodos , Humanos , Imunossupressores/efeitos adversos , Imunossupressores/farmacologia , Terapia de Alvo Molecular , Pênfigo/imunologia , Pênfigo/patologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Rituximab/administração & dosagem , Rituximab/efeitos adversos , Fatores de Tempo
7.
Eur Rev Med Pharmacol Sci ; 20(5): 906-11, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27010149

RESUMO

OBJECTIVE: Post-pericardiotomy syndrome (PPS) occurs in 10-40% of patients after cardiac surgery. PPS is considered an autoimmune phenomenon. The neutrophil-to-lymphocyte ratio (NLR) is a novel inflammatory marker that is associated with various cardiovascular diseases. Studies have reported that the NLR increases in certain autoimmune diseases. This study examined whether the NLR is helpful to predict the occurrence of PPS after elective on-pump coronary artery bypass graft (CABG) surgery. PATIENTS AND METHODS: The records of patients who underwent elective first-time on-pump CABG were reviewed retrospectively. In total, 72 patients with PPS were included in the study, and 100 patients who did not develop PPS were included as the control group. Peripheral blood samples collected preoperatively and on postoperative day 1 were used to calculate the NLR. RESULTS: No differences in preoperative white blood cell (WBC) count, neutrophil count, lymphocyte count, or NLR were observed between the patients with PPS and the control group. The WBC (p < 0.001) and neutrophil counts (p < 0.001) and NLR (p = 0.01) were significantly higher during the postoperative period in patients with PPS than in the control group. A receiver operating characteristic curve analysis showed that the postoperative NLR predicted PPS with 60% sensitivity and 59% specificity (area under the curve, 0.61; 95% confidence interval [CI], 0.51-0.70; p = 0.017), using a cut-off of 8.34. The postoperative WBC count (odds ratio [OR], 1.6; 95% CI, 1.36-2.03; p < 0.001) and NLR (OR, 3.3; 95% CI, 1.56-7.01; p = 0.002) were independently associated with PPS. CONCLUSIONS: The postoperative NLR may be useful to predict the development of PPS in patients undergoing on-pump CABG.


Assuntos
Linfócitos/patologia , Neutrófilos/patologia , Pericardiectomia/efeitos adversos , Síndrome Pós-Pericardiotomia/diagnóstico , Idoso , Biomarcadores/sangue , Ponte de Artéria Coronária/efeitos adversos , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Síndrome Pós-Pericardiotomia/sangue , Prognóstico , Estudos Retrospectivos
9.
J Eur Acad Dermatol Venereol ; 28(11): 1463-8, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24237476

RESUMO

BACKGROUND: There is a very limited amount of data available regarding the relationship between alopecia areata (AA) and psychiatric morbidity and quality of life (QoL) in children and adolescents. OBJECTIVES: The aim of this study was to determine the psychiatric state and health-related quality of life (HRQL) of children and adolescents with AA, as well as their relationships with clinical parameters. METHODS: The sample consisted of 74 children with AA aged 8-18 years. Questionnaires were used to evaluate the psychiatric status and HRQL of the patients. The study and control groups were divided into child and adolescent groups to exclude the effect of puberty on psychological condition. RESULTS: In the child group, patients had higher state anxiety and trait anxiety scores; they also had lower parent-rated psychosocial and total area HRQL scores than the controls did. In addition, the depression score was prone to show a positive relationship with having AA in the children. In the adolescent group, however, only the state anxiety score had a significant association with AA. All of the parent-rated HRQL scores were also prone to being lower compared with controls in this age group. Regarding determinants of HRQL, prolonged disease duration and later disease onset had positive effects, whereas severity of scalp involvement, trait anxiety and depression had negative effects, for the sample as a whole. CONCLUSIONS: Alopecia areata is associated with poor psychiatric status and QoL, especially in childhood. The impact of the disease on QoL occurs through both clinical and psychiatric parameters.


Assuntos
Alopecia em Áreas/psicologia , Ansiedade/epidemiologia , Depressão/epidemiologia , Qualidade de Vida/psicologia , Adolescente , Fatores Etários , Estudos de Casos e Controles , Criança , Feminino , Humanos , Incidência , Masculino , Testes Psicológicos , Psicologia
10.
Transplant Proc ; 44(6): 1764-6, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22841267

RESUMO

The demand for kidney transplantation due to improved recipient outcomes has stimulated surgeons to expand the criteria for usable donors, but still the use of organs from deceased donors with terminal acute renal failure is uncommon. We report 2 kidney transplant recipients from a cadaveric donor who was not accepted by other centers because of acute renal failure. The donor, a 24-year-old man with an intracerebral hemorrhage, displayed a serum creatinine (SCr) value of 0.6 mg/dL on hospital admission, which increased to 7.3 mg/dL on the fourth hospital day. After the diagnosis of brain death and refusal of the kidneys by other regional centers, we decided to transplant the 2 kidneys. Recipient 1, a 31-year-old man on an 11-year dialysis program, discontinued hemodialysis after 7 days of delayed graft function. The SCr level decreased gradually and was stable at 1.08 mg/dL on postoperative day (POD) 45. The contralateral graft was transplanted into a 30-year-old man (recipient 2) undergoing dialysis treatment for 7 years. After 10 days of delayed graft function, the SCr decreased gradually with continued hemodialysis until POD 24. The SCr level has been stable at 1.34 mg/dL on POD 52. At the end of the third month the SCr levels in recipients 1 and 2 were 1.1 mg/dL and 1.4 mg/dL, respectively. In conclusion, one may safely expand the donor pool with kidneys from deceased donors with acute renal failure (ARF) with good short-term outcomes.


Assuntos
Injúria Renal Aguda/etiologia , Seleção do Doador , Transplante de Rim , Necrose Tubular Aguda/etiologia , Doadores de Tecidos , Adulto , Biomarcadores/sangue , Morte Encefálica , Cadáver , Creatinina/sangue , Função Retardada do Enxerto/diagnóstico , Função Retardada do Enxerto/etiologia , Função Retardada do Enxerto/terapia , Humanos , Transplante de Rim/efeitos adversos , Masculino , Diálise Renal , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
11.
Eur J Pediatr ; 170(8): 1055-7, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21287357

RESUMO

Recently, a new set of criteria was established for the diagnosis of familial Mediterranean fever (FMF) in childhood. The aim of this study is to validate the new criteria set among heterozygous patients with clinical features of FMF. The study group consisted of FMF patients, who had a mutation at a single allele, who were followed in four pediatric nephrology-rheumatology centers in Turkey. Patients were evaluated by the new criteria set and also by the Tel Hashomer criteria. According to the new criteria, the diagnosis of FMF was established by the presence of two or more of five criteria (fever, abdominal pain, chest pain, arthritis, family history of FMF). The study group consisted of 110 FMF (54 male, 56 female) patients. Majority of the patients had heterozygous pM694V mutation (65%). The sensitivity of the new criteria set and that of the Tel Hashomer criteria in our study group were found to be 93% and 100%, respectively. In conclusion, this study designates that sensitivity of the new criteria set is also high in patients who had a mutation at a single allele.


Assuntos
Febre Familiar do Mediterrâneo/diagnóstico , Adolescente , Criança , Pré-Escolar , Proteínas do Citoesqueleto/genética , Diagnóstico Diferencial , Febre Familiar do Mediterrâneo/genética , Feminino , Heterozigoto , Humanos , Lactente , Masculino , Mutação , Pirina , Sensibilidade e Especificidade , Turquia , Adulto Jovem
12.
Clin Exp Dermatol ; 36(4): 360-5, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21198786

RESUMO

BACKGROUND: Only a limited number of studies have studied the relationship between vitiligo and psychiatric morbidity and quality of life (QOL) in children and adolescents. AIM: To determine levels of depression, anxiety and QOL in children and adolescents with vitiligo. METHODS: In total, 41 outpatients with vitiligo aged 8-18 years and a control group were assessed using the Child Depression Inventory (CDI), State-Trait Anxiety Inventories for Children (STAI-C) and Pediatric Quality of Life Inventory, Parent and Child versions (PedsQL-P and PedsQL-C). Both study and control groups were divided into child (8-12 years old) and adolescent (13-18 years old) groups to exclude the effect of puberty on psychological condition. RESULTS: Children with vitiligo scored higher on the CDI compared with controls; no other significant differences were found between the groups. Vitiligo severity correlated negatively with psychosocial score on PedsQL-P in the adolescent group. Duration of the illness was positively related to physical health score on PedsQL-P in the child group. Involvement of the face, head or neck in boys and involvement of the genital area and legs in girls were related to impaired QOL. CONCLUSIONS: Vitiligo relates to the severity of depression in children, but a similar effect was not observed in adolescents. We suggest that the location of the lesions is a significant factor that leads to QOL impairment, possibly because of its effects on identity development.


Assuntos
Ansiedade/etiologia , Depressão/etiologia , Qualidade de Vida/psicologia , Vitiligo/psicologia , Adolescente , Ansiedade/psicologia , Estudos de Casos e Controles , Criança , Depressão/psicologia , Feminino , Humanos , Masculino , Escalas de Graduação Psiquiátrica , Índice de Gravidade de Doença , Fatores de Tempo
13.
Transplant Proc ; 42(5): 1629-36, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20620489

RESUMO

We sought to expose the possible effect of hepatitis C virus (HCV) infection on oxidative stress indicators, nutritional status, and erythropoietin (rHuEPO) requirements in maintenance hemodialysis (MHD) patients. A total of 111 MHD patients (69 males, 42 females; mean age 51.3 +/- 13.0 years; MHD duration 78.5 +/- 52.1 months) and 46 healthy controls were enrolled in the study. We excluded patients with hepatitis B infection or malignancy. Indicators for oxidative status were studied in plasma samples obtained at the beginning of a clinically stable MHD session. Measurements were performed for plasma superoxide dismutase, glutathione peroxidase (antioxidative agents), and malonyldialdehyde (MDA; oxidative agent) by spectrophotometric methods. All patients were analyzed for the presence of anti-HCV; positive patients were also evaluated for the presence of HCV RNA. MHD patients were divided into three groups according to HCV infection status: group I (anti-HCV-positive, HCV-RNA-negative; n = 22); group II (anti-HCV-positive, HCV-RNA-positive; n = 22), and group III (anti-HCV-negative; n = 67). According to the analyses, MHD patients showed higher plasma oxidative stress indicators and lower antioxidative indicator levels compared to controls (P < .0001). MHD patients also displayed lower albumin and higher C-reactive protein (CRP) levels compared to controls (P < .0001). Antioxidant levels were decreased significantly from group I to III (P < .0001). MDA levels significantly increased from group I to III (P < 0.01). HCV-RNA-positive patients showed lowest albumin and highest CRP levels and rHuEPO requirements. Although alanine transferase (ALT) levels were in the normal range, group II patients had significantly higher ALT levels than the other groups (P < .01). In conclusion, we observed negative effects of active HCV infection on oxidative stress and rHuEPO requirements. In contrast, we detected that clinically inactive HCV infection was associated with reduced oxidative stress and rHuEPO requirements compared with active HCV infection and HCV-negative patients.


Assuntos
Eritropoetina/uso terapêutico , Hepatite C/complicações , Estresse Oxidativo/fisiologia , Adulto , Idoso , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Nitrogênio da Ureia Sanguínea , Proteína C-Reativa/metabolismo , Feminino , Glutationa Peroxidase/sangue , Hepatite C/epidemiologia , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/etiologia , Falência Renal Crônica/terapia , Falência Renal Crônica/virologia , Masculino , Pessoa de Meia-Idade , Estado Nutricional/fisiologia , Estresse Oxidativo/efeitos dos fármacos , Diálise Renal , Superóxido Dismutase/sangue
14.
Transplant Proc ; 39(10): 3035-40, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18089316

RESUMO

AIMS: We sought to evaluate influences of oxidative stress (OS) on rHuEPO requirements in hemodialysis patients without chronic inflammation. METHODS: Sixty-eight hemodialysis patients and 46 healthy controls underwent measurements plasma levels of antioxidative agents, such as glutathione peroxidase (GPX), superoxide dismutase (SOD), and oxidative compounds including malonyldialdehyde (MDA). We retrospectively analyzed the last 3 months' rHuEPO requirements, iron indices, and CRP levels. RESULTS: Plasma levels for SOD, GPX, and MDA were 974.4+/-216.4 U/gHb, 44.4+/-13.6 U/gHb, 10.0+/-2.0 nmol/mL, respectively yielding results that were different from healthy controls (P<.0001). Increased OS negatively correlated with hemoglobin levels (P<.0001) and positively correlated with rHuEPO requirements (P<.01). Increased antioxidative capacity positively correlated with hemoglobin levels (P<.0001) and negatively correlated with rHuEPO requirements (P<.0001). For further analyses, hemodialysis patients were subgrouped according to rHuEPO requirements as group I (lowest 1/3, n=23), group II (moderate 1/3, n=23) and group III (highest 1/3, n=22). Group III displayed the highest MDA (P<.05), the lowest SOD (P<.0001), and comparable GPX (P<.05) levels. Group III also had the highest CRP and the lowest albumin levels compared with the others (P<.01). CONCLUSION: OS has strong adverse influences on rHuEPO responses of HD patients with "normal" CRP levels, but it should not be forgotten that CRP levels in the "normal" range may still reflect ongoing microinflammation.


Assuntos
Proteína C-Reativa/metabolismo , Eritropoetina/uso terapêutico , Inflamação/fisiopatologia , Estresse Oxidativo/fisiologia , Diálise Renal , Adulto , Idoso , Estudos Transversais , Feminino , Glutationa Peroxidase/sangue , Humanos , Falência Renal Crônica/sangue , Falência Renal Crônica/terapia , Masculino , Malondialdeído/sangue , Pessoa de Meia-Idade , Estresse Oxidativo/efeitos dos fármacos , Proteínas Recombinantes/uso terapêutico , Valores de Referência , Estudos Retrospectivos , Superóxido Dismutase/sangue
15.
Transplant Proc ; 39(4): 990-2, 2007 May.
Artigo em Inglês | MEDLINE | ID: mdl-17524871

RESUMO

Cytomegalovirus (CMV) infection is a risk factor for arteriosclerosis in renal transplant recipients. We sought to investigate the effects of CMV infection on atherosclerotic events (AE) in renal transplant recipients. This retrospective analysis included 200 patients: 52 women and 148 men of overall mean age of 36.18 +/- 10.23 years who were transplanted at our center between 1998 and 2001. We analyzed demographic features, dialysis duration, diabetes, blood pressure level, body mass index (BMI), medications, and lipid parameters. CMV infection was diagnosed in 23.5% of patients in the first 2 years after transplantation; these patients were followed for 4 years. All patients had been assessed for AE, including previous myocardial infarction, angina, revascularization procedures, intermittent claudication, stroke, or transient ischemic attack. AE occurred in 13% during the follow-up period. CMV infection was more frequent among these patients compared to those without AE, namely 42.3% versus 20.6%, respectively. Although the gender, dialysis duration, serum cholesterol level, presence of acute rejection, and BMI were not associated with AE, age, hypertension, and CMV infection did show a relation. A multivariate analysis by logistic regression revealed mean age and CMV infection to be independent risk factors for AE: odds ratio (OR)=5.6, 95% confidence interval (CI)=1.3 to 24.6 (P=0.02) and OR=4, 95% CI = 1.3 to 12.3 (P=.01). This study suggested that the presence of CMV infection may be a triggering factor for AE in renal transplant recipients.


Assuntos
Aterosclerose/epidemiologia , Infecções por Citomegalovirus/epidemiologia , Transplante de Rim/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
Transplant Proc ; 39(4): 1023-6, 2007 May.
Artigo em Inglês | MEDLINE | ID: mdl-17524881

RESUMO

Hyperuricemia is a common complication in renal transplant recipients, and uric acid (UA) may play a role in renal dysfunction. The aim of this study was to evaluate the effects of UA on chronic allograft nephropathy (CAN) in renal transplant recipients. The 133 study subjects included 34 women and 99 men of overall mean age of 34.7 +/- 9.9 years. They underwent renal transplantation between 1998 and 2000. Serum UA levels were measured in the first month after transplantation and then at yearly intervals throughout a 3-year follow-up. In the first month after transplantation, 55.3% of recipients had hyperuricemia (UA >7 mg/dL in men; UA >6 mg/dL in women), but, 3 years after transplantation, 84.6% of the subjects had that disorder (P<.001). CAN was diagnosed in 31.5% of the patients at a mean onset of 31.8 +/- 14.3 months after transplantation. Fifty-two percent of these individuals experienced graft failure within 43.3 +/- 20.8 months after transplantation. UA levels were recorded before the development of CAN. There was no association between UA levels and CAN according to a Cox regression analysis (P>.05; relative risk, 1.082; 95% confidence interval [CI] 0.9-1.3). We concluded that the prevalence of hyperuricemia was higher among recipients than in healthy individuals, but that the UA level did not affect the development of CAN during first 3 years after transplantation.


Assuntos
Biomarcadores/sangue , Hiperuricemia/epidemiologia , Transplante de Rim/patologia , Complicações Pós-Operatórias/sangue , Ácido Úrico/sangue , Adulto , Feminino , Seguimentos , Rejeição de Enxerto/epidemiologia , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Transplante Homólogo/patologia
17.
Transplant Proc ; 39(1): 40-4, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17275471

RESUMO

BACKGROUND: Vitamin D receptor (VDR) gene polymorphisms have been widely studied, especially to analyze their effects on calcium-phosphorus metabolism and secondary hyperparathyroidism in patients on dialysis. In this study, we sought to investigate the possible effects of these polymorphisms on the anemia of renal failure and recombinant human erythropoietin (rHuEPO) responses among patients receiving hemodialysis. METHODS: One hundred twenty-eight patients (52 females/76 males) underwent genotyping for the insertion/deletion Bsml (B-->b, restriction site, exon VIII-->IX) and Tagl (T-->t, 352 exon IX) VDR gene polymorphisms. The mean value of the last 6 months' monthly evaluated laboratory values (C-reactive protein, hemoglobin, iron indices, PTH, and albumin) and clinical findings (rHuEPO requirement, cumulative iron supplementation doses, and body weight) were analyzed retrospectively excluding patients with chronic inflammation, hemolytic anemia, or active blood loss such as gastrointestinal bleeding. RESULTS: Mean age and dialysis durations were 41.5 +/- 11.8 years and 91.8 +/- 45.3 months, respectively. Polymorphism percentages were as follows: Bsml; BB/Bb/bb: 32.2/63.6/4.2 and Tagl; TT/Tt/tt: 40.5/55.4/4.1%, respectively. BB variant of Bsml gene was related to lower rHuEPO needs (P < .05) and also higher hemoglobin levels (P < .005) when compared with the Bb/bb variant. Considering Tagl variants, transferrin saturation levels were lower (P < .03) among patients with the Tt/tt variant, but there was no other significant difference in the mean values of other data between TT and Tt/tt variants. CONCLUSION: The BB variant of Bsml was related to decreased rHuEPO requirements to achieve higher hemoglobin levels among maintenance hemodialysis patients without chronic inflammation.


Assuntos
Eritropoetina/uso terapêutico , Falência Renal Crônica/terapia , Polimorfismo Genético , Receptores de Calcitriol/genética , Diálise Renal , Adulto , Feminino , Ferritinas/sangue , Genótipo , Hemoglobinas/metabolismo , Humanos , Hiperparatireoidismo Secundário/etiologia , Infusões Intravenosas , Ferro/administração & dosagem , Ferro/sangue , Ferro/uso terapêutico , Falência Renal Crônica/genética , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Reação em Cadeia da Polimerase , Transferrina/metabolismo
18.
Hepatogastroenterology ; 54(80): 2319-23, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18265656

RESUMO

BACKGROUND/AIMS: The mutations in the basal core promoter and precore region of hepatitis B virus genome in hepatitis B e antigen-positive and -negative chronic hepatitis B patients have been described. The reports about their prevalence and clinical significance in the Mediterranean region where D is the predominant genotype, are very limited. METHODOLOGY: The serum samples were collected from 44 naive chronic hepatitis B patients. For detection of the mutations basal core promoter and precore regions of HBV genome were amplified and sequenced. RESULTS: All samples were determined as genotype D. Before initiation of treatment basal core promoter mutations were found as 55% (11/20) and 46% (11/24) in HBeAg-positive and -negative patients, respectively (p > 0.5). HBeAg-negative samples were associated with precore mutations (G1896A and G1899A). Three of 20 (15%) patients of HBeAg-positive and seven of 24 (29%) of HBeAg-negative populations showed sustained response to therapy at the 24th month of initiation. CONCLUSIONS: The presence of precore stop codon mutant in those with sustained response was 89%, overall at the end of therapy. At initiation of therapy basal core promoter mutations were more common in non-responders than responders (65% vs. 20%; p < 0.001). While 23% of cases totally showing sustained response, absence of mutations in the basal core promoter region of hepatitis B virus genotype D may be related to sustained response in patients with chronic hepatitis B.


Assuntos
Vírus da Hepatite B/genética , Hepatite B Crônica/genética , Mutação/genética , Regiões Promotoras Genéticas/genética , Proteínas do Core Viral/genética , Códon de Terminação/genética , Eletroforese em Gel Bidimensional , Feminino , Regulação Viral da Expressão Gênica , Genótipo , Antígenos E da Hepatite B/análise , Humanos , Masculino , Turquia , Carga Viral
19.
Transplant Proc ; 38(2): 529-32, 2006 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-16549166

RESUMO

Diabetes mellitus appearing after kidney transplantation--posttransplant diabetes mellitus (PTDM)--is a common complication associated with poor graft and patient survival. The purpose of the current study was to determine the risk factors for developing PTDM in 204 renal transplant recipients who had been followed for at least 30 months. Posttransplant diabetes mellitus was diagnosed according to the American Diabetic Association/WHO criteria, or a requirement for insulin, an oral hypoglycemic agent, or both. Analyses of possible risk factors for PTDM included demographic features, dialysis and posttransplantation duration, smoking, body mass index, medications, co-morbid diseases, HLA mismatches, as well as laboratory metrics of serum creatinine, albumin, calcium, phosphorus, C-reactive protein, parathyroid hormone, and lipid profiles. Twenty-six patients displayed PTDM. Univariate analysis showed that older age, greater body mass index, presence of hepatitis C virus (HCV) infection, and smoking at the time of renal transplantation were associated with PTDM development. In a multivariate analysis, HCV infection, smoking, and patient age at the time of transplantation were independent risk factors for PTDM. In conclusion, the presence of HCV infection or a smoking habit in addition to older age at the time of transplantation were the main predictors for developing PTDM. Patients should be closely followed regarding their smoking habit and weight gain as modifiable risk factors for PTDM.


Assuntos
Diabetes Mellitus/epidemiologia , Transplante de Rim/efeitos adversos , Adulto , Análise de Variância , Índice de Massa Corporal , Feminino , Seguimentos , Hepatite C/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Complicações Pós-Operatórias/epidemiologia , Diálise Renal , Fatores de Risco , Fatores de Tempo
20.
Transplant Proc ; 38(2): 537-40, 2006 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-16549168

RESUMO

We aimed to define the prevalence of anemia and possible causes for it in a group of renal transplant recipients. A total of 229 recipients (65 women; age 36.1 +/- 11.8 years; minimum posttransplant duration, 3 years) were included. Patients with iron, vitamin B(12), and folic acid deficiencies were excluded. Patients were grouped according to number of posttransplant years completed with functioning grafts (3, 5, or 10 years). Demographic data, donor information, HLA mismatches, acute rejection episodes, biochemical parameters, and medications received during the 3 months before transplant and at 3, 5, and 10 years posttransplant were collected retrospectively. The anemia threshold was 13 g/dL for men and 12 g/dL for women. Anemia prevalence was 41.5%, 35.3%, and 93.2% at 3, 5, and 10 years, respectively. Anemic patients had higher creatinine levels for all years. In the anemic patients, hemoglobin values were lower in the pretransplant period than at 3 and 5 years. Anemic patients had higher HLA mismatches for the same years. Three-year hemoglobin levels were positively correlated with pretransplant hemoglobin and negatively correlated with creatinine levels and HLA mismatches. Five-year hemoglobin levels were positively correlated with pretransplant hemoglobin and albumin levels. Ten-year hemoglobin levels were positively correlated with pretransplant hemoglobin and albumin values but negatively correlated with creatinine levels and HLA mismatches. The prevalence of anemia in renal transplant recipients increases in parallel with posttransplant duration. Hemoglobin levels in these patients are closely related with pretransplant hemoglobin, follow-up creatinine levels, and HLA mismatches.


Assuntos
Anemia/epidemiologia , Transplante de Rim/efeitos adversos , Adulto , Anemia/etiologia , Análise Química do Sangue , Feminino , Seguimentos , Teste de Histocompatibilidade , Humanos , Transplante de Rim/fisiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Prevalência , Estudos Retrospectivos , Fatores de Tempo , Doadores de Tecidos , Turquia
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