Şükrü Ulusoy

Information, Attitude, and Behavior Toward Organ Transplantation and Donation Among Health Workers in the Eastern Black Sea Region of Turkey

AIM We sought to evaluate the information, attitude, and behaviors toward organ donation among health workers in the eastern Black Sea region of Turkey. METHOD This descriptive study was performed between December 2008 and November 2009. It involved 1,545 health personnel in 8 state hospitals in the eastern Black Sea region of Turkey, excluding the university hospitals in the towns of Trabzon, Rize, Gümüşhane, and Giresun. Educational seminars regarding organ transplantation and donation were arranged for the hospitals in the study. Questionnaires on the subject distributed to the participants were collected before the seminars began. They contained questions about occupation, gender, age, previous organ donation, whether the person would consider donating if they had not already volunteered (if not, the reasons why), whether any relatives had volunteered to donate organs, whether anyone close to them had volunteered to donate organs, whether they would donate organs in the event of a relatives death, and what they might think if they were to require an organ transplant. Following the seminars, participants were given the opportunity to obtain organ donation cards from a stand on site. Data were analyzed using the chi-square test. RESULTS Eighty-one participants (5.2%), including 46 women (5.2%) and 35 men (5.3%), had previously officially volunteered to donate organs (P = .875). One hundred thirty-seven health personnel were willing to donate organs by visiting the donation stand after the seminars. The main reasons for participants who had not volunteered to donate organs failing to do so were lack of information about donation and procedures (28.4%), lack of interest in the subject (23.2%), and Islamic religious beliefs and/or traditions (19.6%). One hundred eighty health personnel (11.7%) had family members or relatives who had volunteered to donate organs. Asked whether they would donate that persons organs in the event of the death of a relative, 93 doctors (67.6%), 225 nonphysician health personnel (41.1%), and 345 other participants (43.1%) stated that they would not (P < .0005). CONCLUSIONS Health workers play a key role to overcome the difficulties encountered regarding organ donation. This study showed the need for constant effective education seminars to enhance knowledge and sensitivity on the part of health workers.

Ramsay Hunt Syndrome in Renal Transplantation Recipient: A Case Report

Ramsay Hunt syndrome develops upon reactivation of a latent virus within the geniculate ganglion. The patient presents with acute facial paralysis, severe ear pain, and a vesicular eruption of the external auditory canal and concha. Varicella zoster virus seropositivity occurs among approximately 90% of members of society. In these persons, virus reactivation may occur especially with advancing age and immunosuppression. We present a case of Ramsay Hunt syndrome that developed in a 35-year-old male patient, who had undergone a renal transplantation 8 months prior and had received maintenance immunosuppression.

Fragmented QRS is associated with subclinical left ventricular dysfunction in patients with chronic kidney disease.

Objective We aimed to investigate the association of fragmented QRS (fQRS) with subclinical left ventricular (LV) dysfunction in patients with chronic kidney disease (CKD). Methods and results Patients with CKD who had a normal LV ejection fraction (≥ 50%) were enrolled. The tissue Doppler-derived Tei index was measured for all patients. A Tei index of ≥ 0.5 was considered abnormal. Subclinical LV dysfunction was defi ned as the presence of an abnormal Tei index in the absence of impaired LV ejection fraction (< 50%). The fQRS was defi ned as the presence of an additional R wave (R’) or notching of R or S wave or the presence of fragmentation in two contiguous ECG leads. The study group consisted of 82 patients (45 male, mean age 54 ± 14 years). Overall, prevalence of fQRS was 60% among CKD patients who had a preserved LV ejection fraction. Of these, 52 (63%) had an abnormal (≥ 0.5) and 30 (37%) a normal Tei index (< 0.5). The prevalence of fQRS was signifi cantly higher in patients with an abnormal Tei index than in patients with a normal Tei index (71% vs. 40%, P= 0.006). Patients with an abnormal Tei index had a lower E/A ratio as compared to patients with a normal Tei index (P = 0.03). Groups were similar with respect to all other variables. In multivariate logistic regression analysis, the presence of fQRS was independently associated (OR 3.52, 95% CI 1.28-9.64) with the presence of an abnormal Tei index after adjustment for potential confounders. Conclusion Fragmented QRS is independently associated with subclinical LV dysfunction in patients with CKD and normal ejection fraction.

A comparison of the effects of ramipril and losartan on blood pressure control and left ventricle hypertrophy in patients with autosomal dominant polycystic kidney disease

Background: Hypertension is frequently seen in autosomal dominant polycystic kidney disease (ADPKD), and it has a negative effect on renal progression. Hypertension and left ventricle hypertrophy (LVH) are related in terms of pathogenesis and their effects on renal progression. In this study, we aimed to compare the effects of losartan and ramipril on blood pressure (BP) control, LVH, and renal progression in patients with hypertensive ADPKD. Methods: Thirty-two ADPKD patients with ages ranging between 18 and 70 years who were stage 1–2 hypertensive were included in this study. Routine biochemical tests and echocardiography were obtained at first examination of the patients. Following these, the patients were randomized. One group was given losartan and the other ramipril. They were followed up for 1 year, and their echocardiographies and routine biochemical tests were repeated at the end of the year. Results: BP values decreased in both the groups at the end of the first year (p < 0.001). There was a statistically significant difference in LVH in both the groups at the end of the first year than at the beginning (losartan, p = 0.007; ramipril, p < 0.001). Conclusions: In this study, effective BP control was obtained with losartan and ramipril and LVH was found to be regressed significantly in the hypertensive patients with ADPKD. These two groups of antihypertensive drugs may also have beneficial effects on the retardation of renal progression and in reducing cardiovascular mortality in hypertensive patients with ADPKD.

Relationship between fragmented QRS complex and left ventricular systolic and diastolic function in kidney transplant patients

Background Kidney transplant is a most important replacement therapy. It reduces cardiovascular mortality and morbidity but does not fully correct impairments in cardiac function. Fragmented QRS (fQRS) complex includes various RSR′ patterns with different QRS complex morphologies on electrocardiograms. Objective To analyze fQRS frequency and the relationship between fQRS and left ventricular function in kidney transplant patients. Method After demographic data on 39 kidney transplant patients were recorded and biochemical parameters were investigated, electrocardiograms were evaluated for the presence of fQRS. Left ventricular ejection fraction, mitral annular plane systolic excursion, peak early diastolic mitral annular velocities, late diastolic mitral annular velocities, and systolic mitral annular velocity were analyzed. Results Fragmented QRS was detected in 16 patients. A history of hypertension was associated with the presence of fQRS. Patients with fQRS had significantly lower systolic and peak early diastolic mitral annular velocities, mitral annular plane systolic excursion, and left ventricular ejection fraction than did patients without fQRS (P = .03, .01, < .001, and .03, respectively). Conclusion Detection of fQRS on electrocardiograms may be useful in predicting systolic and diastolic dysfunction of the left ventricle in kidney transplant patients.

Rhabdomyolysis and Severe Muscle Weakness Secondary to Colistin Therapy

Rhabdomyolysis is a clinical condition that causes renal failure up to 40%. Rhabdomyolysis may be traumatic or nontraumatic. Colistin (polymyxin E) is an effective antibiotic. Nephrotoxicity is a frequently encountered side effect. The nephrotoxic effect of colistin is thought to be associated with increased membrane permeability, cell swelling and lysis, and the development of acute tubular necrosis. Here, we report a case of nontraumatic rhabdomyolysis associated with the use of colistin. There is only one report of rhabdomyolysis secondary to colistin in the literature, and there is no report of a case developing severe tetraparesis, as in our case.

Assessment of cardiovascular risk in hypertensive patients: a comparison of commonly used risk scoring programs

Several calculation modalities are used today for cardiovascular risk assessment. Cardiovascular risk assessment should be performed in all hypertensive patients. Risk assessment methods being based on the population in which the patient lives and the inclusion of factors such as ethnicity variations, socioeconomic status, and medication use will contribute to improvements in risk assessments. The results should be shared with the patient, and modifiable risk factors must be effectively treated.

Do physicians measure patients’ blood pressure, and are those measurements reliable?

To determine how and how often blood pressure (BP) measurement is performed in health institutions. The researchers observed whether or not 84 physicians performed BP measurement. Immediately after BP measurement by the physician, this was repeated by the researchers in a manner compatible with HT guidelines. The physicians’ and researchers’ BP measurement results were compared. Physicians measured BP in only 37% (427) of 1130 consecutive patient examinations. None of the physicians “BP measurements were fully compatible with the guidelines” BP measurement recommendations. Physicians who performed measurements determined the same SBP and DBP as the researchers in 34.3% of patients. Hypertension was determined in 18.9% of patients in clinics in which BP measurement was not performed by physicians. Not all physicians in our study measured BP, and the great majority of those who did failed to measure it reliably. We think that it is therefore vitally important for physicians across the world to receive regular, repeated, and effective training in the importance of BP measurement and how to perform it correctly.

Soluble endothelial protein C is associated with blood pressure variability and salt consumption but not mean blood pressure in patients with newly diagnosed primary hypertension

ABSTRACT Background: Hypertension is a widespread disease involving frequent thrombotic complications. Blood pressure variability (BPV) has recently been shown to be associated with end-organ damage and cardiovascular events. However, the pathogenesis of the relation between BPV and cardiovascular events has not yet been explained. Soluble endothelial protein C (sEPCR) exhibits a procoagulant effect by reducing the anticoagulant and anti-inflammatory effects of protein C and activated protein C. The purpose of this study was to evaluate sEPCR levels in hypertensive individuals and the parameters affecting that level, particularly BPV. Methods: Fifty-one newly diagnosed hypertensive subjects and 31 healthy individuals were included in the study. Twenty-four-hour ambulatory blood pressure monitoring (ABPM) was performed after office control, and simultaneous 24-h urine was collected. BPV was calculated with average real variability (ARV) from ABPM data. Blood specimens were collected under appropriate conditions for sEPCR levels and biochemical tests. sEPCR levels were compared between the patient and healthy groups, after which parameters affecting sEPCR elevation in the hypertensive group were evaluated. Results: sEPCR levels were significantly high in the hypertensive group (p < 0.05). At multivariate regression analysis in the hypertensive group, sEPCR was determined to be independently associated with 24-h systolic ARV (ß = 0.572, p < 0.05) and 24-h urine Na (ß = 0.428, p < 0.05). Conclusion: In our study, sEPCR was high in hypertensive individuals, and this elevation was related to ARV and urine Na excretion independently of mean blood pressure.

Is There Any Difference on Gastroscopic Findings Between Hemodialysis and Peritoneal Dialysis Patients

1 Gülsüm Özkan1, Şükrü Ulusoy1, Mehmet Arslan2, Kübra Kaynar1, Sami Fidan2, Bülent Yıldız3, Safiye Tuba Kaplan4 1Nefroloji Bilim Dalı, 2Gastroenteroloji Bilim Dalı, 3Onkoloji Bilim Dalı, 4İç Hastalıkları Ana Bilim Dalı, Karadeniz Teknik Üniversitesi Tıp Fakültesi, Trabzon, Türkiye Gastroskopik Bulgular ve Diyaliz / Gastroscopic Findings and Dialysis Is There Any Difference on Gastroscopic Findings Between Hemodialysis and Peritoneal Dialysis Patients?