Cigdem Caglayan

Depressive Symptoms and Proinflammatory Cytokine Levels in Chronic Renal Failure Patients

Background/Aims: Cytokine secretion is known to play an important role in the pathophysiology of depression, and levels of proinflammatory cytokines are increased in chronic renal failure (CRF) patients. The objective of this study was to examine the correlation between levels of proinflammatory cytokines in CRF patients and degree of depression. Methods: 31 patients on hemodialysis, 31 patients on continuous ambulatory peritoneal dialysis, and 31 conservatively managed chronic kidney disease (CKD) patients were enrolled in this study. Depressive symptoms were measured with the Beck Depression Inventory (BDI), and ‘elevated symptoms of depression’ were defined as a BDI score ≧17. IL-6 and TNFα cytokine levels were measured by ELISA. Results: ‘Elevated symptoms of depression’ occurred in 37 of 93 patients (40%). IL-6 and TNFα levels were not significantly different among CRF patients with and without elevated depressive symptoms (p = 0.937 and p = 0.414, respectively). When analyzed by treatment subgroup, proinflammatory cytokine levels were not significantly different in patients with and without elevated symptoms of depression. Conclusion: In patients with CRF, elevated symptoms of depression were not associated with increased cytokine levels.

Adipocytokines Leptin and Adiponectin, and Measures of Malnutrition-Inflammation in Chronic Renal Failure: Is There a Relationship?

BACKGROUND Serum levels of adipocytokines such as leptin and adiponectin are significantly elevated in patients with chronic renal failure (CRF). The effect of such adipocytokines on malnutrition in the CRF population has been of substantial interest. We sought to determine the relationship between plasma leptin and adiponectin levels and malnutrition-inflammation status in end-stage renal disease patients. METHODS Thirty patients (15 women and 15 men; mean [+/-SD] age, 50 +/- 14 years) on hemodialysis, and 30 patients (12 women and 18 men; mean [+/-SD] age, 47 +/- 16) on continuous ambulatory peritoneal dialysis, were enrolled in this study. Adipocytokine levels were measured by enzyme-linked immunosorbent assay. Inflammatory markers, such as high-sensitivity serum C-reactive protein (hs-CRP), ferritin, and a nutritional inflammatory scoring system known as the malnutrition-inflammation score (MIS), were also measured in all patients. RESULTS Serum leptin had negative correlations with ferritin (r = -0.33, P = .016) and MIS (r = -0.39, P = .003). Adiponectin had a weak positive correlation with MIS (r = 0.26, P = .050), indicating that an increased level of serum adiponectin was associated with a worse nutritional status. Levels of hs-CRP, serum albumin, cholesterol, and triglycerides did not correlate with nutritional status. CONCLUSIONS Serum leptin concentration seems to be a marker of good nutritional status, rather than an appetite-suppressing uremic toxin, in patients with CRF. However, the positive correlation between serum adiponectin and worse nutritional-inflammatory status suggests that elevated adiponectin levels may contribute to the pathogenesis of malnutrition in such patients.

Serum fetuin-A concentrations are inversely related to cytokine concentrations in patients with chronic renal failure

BACKGROUND/AIMS A close relationship exists between inflammation and vascular calcification. Although fetuin-A is known to be an inhibitor of calcification, studies correlating levels of this glycoprotein to markers of inflammation are limited. To understand these relationships, we investigated the relationship between serum fetuin-A and proinflammatory cytokine levels in patients with chronic renal failure (CRF). METHODS Thirty-two patients on haemodialysis (HD), 32 conservatively managed chronic kidney disease (CKD) patients and a control group of 25 subjects with normal renal function were enrolled in this study. Serum fetuin-A, IL-1beta, IL-6 and TNF-alpha levels were measured by ELISA. Correlations between serum fetuin-A and IL-1beta, IL-6 and TNF-alpha concentrations were investigated by the Spearman correlation test. RESULTS In 64 CRF patients (on HD and with CKD), serum fetuin-A was significantly and inversely related to IL-1beta (P<0.001), IL-6 (P=0.025) and TNF-alpha levels (P=0.007), respectively. The serum fetuin-A levels of the control subjects were not significantly correlated to levels of the inflammatory markers IL-1beta, IL-6 and TNF-alpha (P=0.551, 0.985 and 0.984, respectively). CONCLUSION The negative correlation between serum fetuin-A and cytokine concentrations in CRF patients supports the hypothesis of inflammation-dependent down-regulation of fetuin-A expression.

Working conditions and health status of child workers: cross-sectional study of the students at an apprenticeship school in Kocaeli.

Background:  Child labor remains a widespread phenomenon in todays world. The purpose of the present study was to describe the working conditions and health status of child workers in Kocaeli.

Traffic Accidents Resulting in Death and Injury on an International Road Passing Through a City in Kocaeli, Turkey

ABSTRACT Deaths and injuries linked to traffic accidents are important public health issues. In this descriptive study, the accidents resulting in death and injury between 2000 and 2004 on the city portion of the D-100 were compared with those on the other roads within the city. The D-100 had a fatality risk approximately 2 times higher than that of the other roads within the city. The percentage of trucks of the total vehicles involved in accidents that occurred on the D-100 resulting in death and injury was 14.87% in 2002, 13.18% in 2003, and 9.88% in 2004. The main proposals of this study are to limit the use of the D-100s city portion to city traffic, and prevent heavy cargo vehicles from using the road as a transit route.

Epidemiology of sepsis in intensive care units in Turkey: a multicenter, point-prevalence study

BackgroundThe prevalence and mortality of sepsis are largely unknown in Turkey, a country with high antibiotic resistance. A national, multicenter, point-prevalence study was conducted to determine the prevalence, causative microorganisms, and outcome of sepsis in intensive care units (ICUs) in Turkey.MethodsA total of 132 ICUs from 94 hospitals participated. All patients (aged > 18 years) present at the participating ICUs or admitted for any duration within a 24-h period (08:00 on January 27, 2016 to 08:00 on January 28, 2016) were included. The presence of systemic inflammatory response syndrome (SIRS), severe sepsis, and septic shock were assessed and documented based on the consensus criteria of the American College of Chest Physicians and Society of Critical Care Medicine (SEPSIS-I) in infected patients. Patients with septic shock were also assessed using the SEPSIS-III definitions. Data regarding demographics, illness severity, comorbidities, microbiology, therapies, length of stay, and outcomes (dead/alive during 30 days) were recorded.ResultsOf the 1499 patients included in the analysis, 237 (15.8%) had infection without SIRS, 163 (10.8%) had infection with SIRS, 260 (17.3%) had severe sepsis without shock, and 203 (13.5%) had septic shock. The mortality rates were higher in patients with severe sepsis (55.7%) and septic shock (70.4%) than those with infection alone (24.8%) and infection + SIRS (31.2%) (p < 0.001). According to SEPSIS-III, 104 (6.9%) patients had septic shock (mortality rate, 75.9%). The respiratory system (71.6%) was the most common site of infection, and Acinetobacter spp. (33.7%) were the most common isolated pathogen. Approximately, 74.9%, 39.1%, and 26.5% of Acinetobacter, Klebsiella, and Pseudomonas spp. isolates, respectively, were carbapenem-resistant, which was not associated with a higher mortality risk. Age, acute physiology and chronic health evaluation II score at ICU admission, sequential organ failure assessment score on study day, solid organ malignancy, presence of severe sepsis or shock, Candida spp. infection, renal replacement treatment, and a nurse-to-patient ratio of 1:4 (compared with a nurse-to-patient ratio of 1:2) were independent predictors of mortality in infected patients.ConclusionsA high prevalence of sepsis and an unacceptably high mortality rate were observed in Turkish ICUs. Although the prevalence of carbapenem resistance was high in Turkish ICUs, it was not associated with a higher risk for mortality.Trial registrationClinicalTrials.gov ID NCT03249246. Date: August 15, 2017. Retrospectively registered.

An analysis of the environmental threats posed by industry in Kocaeli, turkey

Purpose – This paper has been produced to enumerate and discuss threats which are caused by industry and may affect health in the province of Kocaeli.Design/methodology/approach – Industries in the province, depending on their function, were grouped into sectors. Air, water and solid waste pollutants produced by each sector were assessed for each region of the province.Findings – Of the 7,400 industries in the province, only 1,198 are registered with the Kocaeli Chamber of Industry and of this number only a minority are subject to controls by the Ministry of the Environment through the Kocaeli Provincial Directorate of the Environment (KPDE). Data on pollutants were obtained from the KPDE. Liquid waste was controlled in 370 firms (5 per cent) of all industries in the province, air quality in 444 (6 per cent) and dangerous waste in 4 (0.06 per cent). A total of 41 firms were designated as having dangerous pollution profiles.Practical implications – These figures suggest that industrial development in the p...