Banu Yilmaz

Psychoeducation for children and adults after the Marmara earthquake: an evaluation study

Education about the psychological reactions in the aftermath of a traumatic event may help reduce the adverse effects by providing a cognitive framework for ones experience, and provides the survivors of trauma view their reactions as expectable; recognize the circumstances under which they should consider seeking further counseling; increase use of adaptive ways of coping; increase ability to help family members cope. This type of psychosocial intervention was used to reach the parents and children in the earthquake affected region after the Marmara earthquakes. The major aim of the present study is to make an assessment of the impact of these interventions. The assessment procedure consists of a satisfaction survey of the parents and children who attended the seminars. A comparison is also made between those who attended the seminars and those who did not, in terms of their opinions on issues regarding the psychological effects of the earthquakes. This report represents the data from a total of 463 parents and 774 students. In the parents group, 326 were in the comparison group and 137 were in the study group. Among the students, 181 were in the comparison group and 593 in the study group. Two questionnaires were used to collect data from the participants in the study. One questionnaire was for children over 12 years of age, and the other was for the parents. The results in general showed that, the seminars were helpful for parents and children to learn about the psychological reactions people have after earthquakes. However, they also showed that, to be more effective, there is a need for improvement in the way the seminars are conducted. Language: en

AA amyloidosis associated with systemic lupus erythematosus: impact on clinical course and outcome

Secondary amyloidosis (AA amyloidosis) has rarely been described in patients with systemic lupus erythematosus (SLE). We, herein, present a 56-year-old female patient, who developed AA amyloidosis following a 22-year history of SLE. She developed severe mitral regurgitation complicated with chordae tendinea rupture that led to acute congestive heart failure and went on a mitral valve replacement, where no flare symptoms of SLE were present. Three months after the operation, she presented with a nephrotic-range proteinuria, acute renal failure, and severe sepsis. She was found to have new vegetations on replaced valve and multi-organ failure caused her death. Re-evaluation of the excised mitral valve revealed AA amyloid deposition. Post-mortem biopsies from the kidney and bone marrow also revealed secondary amyloidosis.

Predictors of Left Ventricular Hypertrophy in Patients with Chronic Kidney Disease

The aim of the present study is to determine the prevalence and predictors of left ventricular hypertrophy in patients with stage 3 or 4 chronic kidney disease. Thirty-four patients were included. In addition to hematological and biochemical evaluations, echocardiography and ambulatory blood pressure monitoring were performed both at the beginning and at the end of the first year. Echocardiographic left ventricular mass was calculated and indexed to body surface area to calculate left ventricular mass index (LVMI). Left ventricular hypertrophy was diagnosed if LVMI >131 g/m2 in male and >100 g/m2 in female patients. During the follow-up period, estimated glomerular filtration rate decreased from 36.6±11.7 to 31.0±14.0 mL/min (p = 0.03), while LVMI increased from 130.2±35.6 to 140.5±30.5 g/m2 (p = 0.055). Left ventricular hypertrophy was detected in 67.6% of the patients at the baseline and in 89.7% at the end of the study (p = 0.011). The independent predictors of the final LVMI were age (p = 0.035), baseline day-time systolic blood pressure (p = 0.01), baseline C-reactive protein (p = 0.001), and the decrease in glomerular filtration rate during the follow-up (p = 0.002). Left ventricular hypertrophy is quite frequent among patients with stage 3 or 4 chronic kidney disease, and its prevalence increases while glomerular filtration rate decreases during the follow-up. The early detection of left ventricular hypertrophy and both prevention of the deterioration of renal function and aggressive blood pressure control may help to achieve a decrease in cardiovascular morbidity and mortality in these patients.

Decrease of Urotensin II activity can impact on the volume status in predialysis chronic kidney disease

Abstract Urotensin II (U-II) was thought to be one of the mediators of primary renal sodium retention due to effects on renal sodium excretion. For this purpose, the relationship between U-II and overhydration was investigated. A total of 107 patients were enrolled in the study. According to body compositor monitor analysis, fluid overload up to 1.1 L, was considered normohydration. Patients were divided according to hydration status; overhydrate (n = 42) and normohydrate (n = 65) were studied in both groups. Pulse waveform velocity propagation for arterial stiffness and blood pressure analysis and echocardiographic left ventricular and left atrial indices were performed with known fluid overload-related parameters. U-II levels were measured by using Human ELISA kit. In overhydrated group, U-II levels were significantly lower. All parameters (blood pressure, arterial stiffness parameters, echocardiographic data, age, gender, diabetes, U-II, hemoglobin) correlated with overhydration, were determined by linear regression model (method = enter), when considered together, U-II was found to be an independent predictor from other conventional overhydration-related parameters. Male sex, left ventricular mass index, left atrial volume index, hemoglobin value were found to be independent predictors for overhydration. Considering the association of low U-II levels with adverse cardiovascular events and its role in sodium retention, we think that low U-II levels can be accepted as a potential therapeutic target in patients with hypervolemic cardio-renal syndrome.

Eculizumab experience in an adult patient with atypical hemolytic uremic syndrome

Atypical hemolytic-uremic syndrome is a disease characterized by nonimmune hemolytic anemia, thrombocytopenia, and renal failure. In this study, we present a case of a patient with atypical hemolytic-uremic syndrome treated successfully with eculizumab. A 20-year-old female was admitted with clinical signs of atypical hemolytic syndrome. The laboratory findings were as follows: hemoglobin 9.2 g/dL, platelet count 18 × 103/μL, creatinine 4.69 mg/dL, schistocytes were in peripheral blood smear, lactate dehydrogenase 2080 U/L, and emergency plasmapheresis procedure with fresh frozen plasma were initiated. The patient was anuric within 12 h of her admittance. ADAMTS13 activity was normal. Her mothers cousin developed acute rejection immediately after receiving a renal transplant and died two months later. As she did not respond to the treatment and considering her family history, eculizumab was initiated which resulted in platelet counts starting to rise on day 5, and the patient no longer needed dialysis after 22 days.

ß-2 microglobulin level is negatively associated with global left ventricular longitudinal peak systolic strain and left atrial volume index in patients with chronic kidney disease not on dialysis.

Objective: There are many factors related to high left atrial volume index (LAVI) and global left ventricular longitudinal peak systolic strain (GLS-%) decline in chronic kidney disease. The purpose of our study is to investigate the relation between the β-2 microglobulin (β-2µ) and GLS-% and LAVI in patients with chronic kidney disease not yet on dialysis. Methods: Our study was a non-randomized, controlled, prospective study. We included 87 consecutive patients with eGFR levels below 60 ml/min/m2 not on dialysis and 82 normal healthy individuals with complaints of atypical chest pain and negative stress tests as control group in our study. Patients with hospitalization related to dialysis or heart failure attacks within 3 months, active malignancy, malnutrition, pregnancy, and uncontrolled hypertension were excluded. Brachial pulse wave velocity (PWV), augmentation index, augmentation pressure and central hemodynamics, and PWV analysis were performed in order to assess the arterial stiffness and blood pressure. According to the distribution of data, Spearman and Pearson correlations and multiple linear regression were used to determine significant and independent factor associated with high LAVI and low GLS-%. Results: There were significant correlations between β-2µ with LAVI (r=0.313, p=0.004) and with GLS-% (r=–0.222, p=0.04). In multiple linear regression, the relationship between β-2µ with GLS-% [β=–0.037, 95% CI (–0.062, –0.013), p=0.004] and LAVI [β=4.522, 95% CI (2.806, 6.238), p<0.001] was independent of age, PWV, central and peripheral blood pressures, parathormone, CalciumXPhospor, Hgb levels, and eGFR. Conclusion: Increasing β-2µ levels were found to be associated with increased LAVI and decreased GLS-%. Additional experimental studies are needed to clarify these relationships.