The association between geriatric nutritional risk index variability and mortality in peritoneal dialysis patients.

BACKGROUND: The objective of this study is to examine the association between the Geriatric Nutritional Risk Index (GNRI) and overall mortality in this population. METHODS: GNRI values were calculated by using the serum albumin levels and body weight and the GNRI variability reflects the changes in GNRI change slopes in the follow-up. RESULTS: GNRI values showed a decrease from the median baseline GNRI of 106.3 (IQR, 95.0,113.4) to 98.4 (interquartile range [IQR], 91.9108.9) (p < 0.001). The median GNRI variability was 4.7 (IQR, 2.5, 10.3). Both baseline GNRI levels (adjusted odds ratio [OR]: 0.96, 95% confidence interval [CI]: 0.93, 0.99, p = 0.04) and more profoundly GNRI variability (adjusted OR: 1.23, 95% CI: 1.01, 1.44, p = 0.03) were independently associated with mortality. CONCLUSION: The monitorization of the changes in GNRI values as a variability index is an easy tool that might improve the predictive accuracy of mortality in peritoneal dialysis patients.

Causes of Granulomatous Inflammation in Native and Allograft Kidneys: Case Series from A Single Center and A Review of the Literature.

OBJECTIVE: Granulomatous interstitial nephritis is a rare finding, and etiology differs by geography. We aimed to investigate the distribution of causes of granuloma/granulomata in the kidney and renal survival of these patients in a tertiary care hospital in Western Turkey. MATERIAL AND METHOD: Medical records of adults who underwent a kidney biopsy procedure in our institution between January 2000 and June 2019 were reviewed. Pathology reports were searched for biopsies where a granuloma was identified. RESULTS: Nineteen of 1121 (1.7%) kidney biopsies included granuloma, 17 in native kidneys, and 2 in transplants. The majority of indications for native kidney biopsy was a rise in serum creatinine. Etiologies of granuloma included the following: pauci-immune vasculitis (n=11, 64.7%), tuberculosis (n=2, 11.8%), drug-induced (n=2, 11.8%), tubulointerstitial nephritis/uveitis (TINU) syndrome (n=1, 5.9%), and systemic-lupus erythematosus (n=1, 5.9%). Despite treatment, 6 of 11 (54.5%) patients with vasculitis developed end-stage kidney disease (ESKD) during the median follow-up of 16 months. Both of the patients with tuberculosis, and the patient with TINU syndrome developed ESKD months after the kidney biopsy, despite appropriate therapies. The only case with drug-induced granuloma and both cases with allograft kidney granuloma responded well to glucocorticoids, achieving a complete renal recovery. CONCLUSION: The majority of our series had granuloma in the kidney secondary to vasculitis and renal outcomes appear considerably unfavorable despite treatment, probably related to the primary diagnosis. Multicenter studies are needed to better determine the etiology and outcome of each granuloma etiology at different geographic locations.

The effect of diabetes on vitreous levels of adiponectin and inflammatory cytokines in experimental rat model.

BACKGROUND: Diabetic retinopathy is one of the most common eye diseases faced by diabetic patients. It is a slow-progressing complication that results from damage to the blood vessels of the retina. OBJECTIVES: To investigate the role of adiponectin and inflammatory cytokines in the vitreous of diabetic rats. MATERIAL AND METHODS: The study was conducted in 3-4-month-old male albino Wistar rats (180-240 g). The animals were divided into 2 groups (n = 40 in each group): the diabetes group and the control group. A single dose of streptozotocin (STZ) (45 mg/kg) in citrate buffer (0.1 M; pH 4.5) was intraperitoneally (ip.) injected into the diabetes group rats. A single dose of citrate buffer was injected ip. into the control group rats. All subjects were sacrificed under intramuscular (im.) Na-thiopental (50 mg/kg) anesthesia. The rats' eyelids were opened with an eye speculum and vitreous samples were collected with 20G needles 4 mm posterior to the limbus. The levels of vitreous adiponectin, tumor necrosis factor α (TNF-α), interferon γ (INF-γ), and matrix metalloproteinase (MMP)-2 and -9 were determined using a solid-phase sandwich enzyme-linked immunosorbent assay (ELISA). RESULTS: The levels of adiponectin, TNF-α, INF-γ, MMP-2, and MMP-9 in the rat vitreous were significantly higher in the diabetes group than in the control group (p < 0.05). CONCLUSIONS: Elevated adiponectin, TNF-α, and INF-γ levels in the vitreous may be diagnostically useful in diabetic retinopathy, and inflammatory cytokines in the vitreous may be pathogenically important in this concentration.

The value of C-reactive protein in infection diagnosis and prognosis in elderly patients.

BACKGROUND: The aim of this study was to determine the value of C-reactive protein level in the diagnosis and prognosis of infection in elderly patients. STUDY POPULATION: This prospective study included inpatients in the palliative care unit during the 1-year period between January 2016 and January 2017. Patients' demographic data, Acute Physiology and Chronic Health Evaluation score, and Charlson Comorbidity Index were recorded. RESULTS: A total of 233 patients were included in the study. A total of 199 instances of infection were diagnosed in 175 of those patients; 75.3% of the infections were detected at admission and 24.7% during hospitalization. At a cut-off value of 4.82, CRP value had 81.0% specificity and 75.4% sensitivity in the diagnosis of infection. Among the patients with infection, there was no difference between those who died and those who survived in terms of baseline CRP level, but a significant difference emerged in CRP level at 48 and 96 h. Factors which were found to significantly reduce survival time were the presence of chronic kidney disease, chronic obstructive pulmonary disease, hypoxia and tachycardia at admission, APACHE-II score over 20.5, initial albumin level below 2.44 g/dL, and serum CRP clearance rates of less than 11% at 48 h and 20% at 96 h. CONCLUSION: In elderly patients with infection, the initial CRP value alone does not have prognostic value, but changes observed in serial CRP measurement are a valid indicator of prognosis.

Autopsies in the elderly: Erzurum study.

INTRODUCTION: Clinical and forensic autopsies are the best methods for determining cause of death. The aim of this study was to determine demographic and etiologic characteristics in geriatric forensic cases analyzed in Erzurum, Turkey. MATERIALS AND METHODS: Autopsy reports and prosecution documents of decedents aged 65 and older autopsied in the Morgue Specialization Department of the Forensic Medicine Institute, Erzurum Division between January 1, 2010 and December 31, 2015 were screened retrospectively. RESULTS: The study included 399 subjects with a mean age of 74.38 ± 7.28 years. A large proportion of the subjects were in the young and middle old age group (n = 218, 54.63%) and male (n = 286, 71.68%). Autopsy was performed on 198 (49.62%) of the subjects, cause of death was determined by post-mortem external examination in 199 (49.87%), and documents were unavailable for 2 subjects. Cause of death was determined as natural in 130 (32.58%) of the decedents and unnatural in 269 (67.42%). The most common natural cause of death was cardiovascular disease (n = 94, 76.4%). Unnatural causes of death included accident in 223 (82.90%), suicide in 25 (9.30%) and homicide in 21 (7.80%) of the decedents. A large proportion of the accidents were traffic accidents (n = 120, 53.80%). The most common method of committing suicide was hanging (n = 15, 60%), whereas homicides were most often committed by blunt force trauma (n = 9, 42.86%). CONCLUSION: Our data are consistent with the literature, allowing for some variation based on regional sociocultural characteristics.

The impact of integrated obstetric and neonatal services on utilization of postpartum maternal health care services.

OBJECTIVE: Postnatal care is an important issue in maintaining and promoting maternal and neonatal health. However, utilization of postpartum maternal health care services is at a low rate in many countries. This study was aimed to investigate the impact of integrated obstetric and neonatal services on utilization rates of postnatal health care service among mothers. METHODS: This study was performed among a total of 4193 mothers who gave birth at Maternity Unit of Golcuk Necati Celik State Hospital of Kocaeli Province between 2010 and 2013. All mothers were called back to postnatal care clinic (PNC) for newborn hearing test (NHT) screenings, neonatal and maternal care within two weeks after delivery. The deliveries after, (n=3093) and before (n=1100) utilization of integrated services were compared as for postnatal service utilization rates. RESULTS: Utilization rates of neonatal health care, NHT and postpartum maternal health care services significantly increased after implementation of integrated services (p<0.0001). Especially maternal service utilization rates increased from 34% to 99 percent. CONCLUSION: Integration of newborn and maternal health care services as a unit increases the utilization of PNC services.

The role of the cytokines in the pathogenesis of pseudoexfoliation syndrome.

AIM: To examine the mechanism of the development of pseudoexfoliation (PSX) syndrome via both cytokine formation and endothelial vasorelaxing and growth factors that will provide us new therapeutic insights for the treatment. METHODS: This is a cross sectional study included two groups; Group 1: control patients with nuclear cataract (n=20, aged 51-80 years). Group 2: PSX patients with nuclear cataract (n=18, aged 50-90 years). Patients with other ophthalmic problems and systemic diseases were excluded. Vascular endothelial growth factor (VEGF), interleukin-6 (IL-6) and interleukin-1ß (IL-1ß) and nitrotyrosine levels were determined through serum samples by Enzyme-linked immunosorbent assay (ELISA) method. Nitrite-nitrate levels were measured with photometric endpoint determination. RESULTS: There were no significant differences between the groups in terms of age, VEGF, IL-1ß, nitrite-nitrate and nitrotyrosine. The significant results were the mean IL-6 levels that were higher in PSX group 2 (37.68±29.52 pg/mL) compared to that in control group 1 (15.32±10.08 pg/mL) (P<0.001). CONCLUSION: Several interacting and extending biochemical pathways may lead to the promotion of VEGF and IL-6 expressions. IL-6 which is the only altered marker in our study may indirectly cause an increase of vascular permeability and neovascularization. We suggest inflammation as a factor that can be involved in etiopathogenesis of PSX.

The role of oxidative stress and antioxidants in the pathogenesis of age-related macular degeneration.

OBJECTIVE: To investigate the role of oxidant/antioxidant status and protein oxidation in the development of age-related macular degeneration. METHOD: The activities of serum superoxide dismutase and glutathione peroxidase and the levels of serum malondialdehyde, advanced oxidation protein products, glutathione and vitamin C were measured in 25 patients with age-related macular degeneration and 25 control subjects without age-related macular degeneration. RESULT: The malondialdehyde and advanced oxidation protein product levels in the serum were significantly higher in the age-related macular degeneration patient group than in the control group (p<0.05). The superoxide dismutase activity in the serum was significantly lower in the age-related macular degeneration patient group than in the control group (p<0.05). The levels of vitamin C and glutathione and the activity of glutathione peroxidase in the serum were unchanged between groups (p>0.05). CONCLUSION: The results of the present study suggest that decreased effectiveness of the antioxidant defense system and increased oxidative stress may play a role in the pathogenesis of age-related macular degeneration.

The role of oxidative stress and antioxidants in the pathogenesis of age-related macular degeneration

OBJECTIVE: To investigate the role of oxidant/antioxidant status and protein oxidation in the development of age-related macular degeneration. METHOD: The activities of serum superoxide dismutase and glutathione peroxidase and the levels of serum malondialdehyde, advanced oxidation protein products, glutathione and vitamin C were measured in 25 patients with age-related macular degeneration and 25 control subjects without age-related macular degeneration. RESULT: The malondialdehyde and advanced oxidation protein product levels in the serum were significantly higher in the age-related macular degeneration patient group than in the control group (p<0.05). The superoxide dismutase activity in the serum was significantly lower in the age-related macular degeneration patient group than in the control group (p<0.05). The levels of vitamin C and glutathione and the activity of glutathione peroxidase in the serum were unchanged between groups (p>0.05). CONCLUSION: The results of the present study suggest that decreased effectiveness of the antioxidant defense system and increased oxidative stress may play a role in the pathogenesis of age-related macular degeneration.

The evaluation of the oxidative stress parameters in nondiabetic and diabetic senile cataract patients.

The aim of the present study was to evaluate the copper (Cu), zinc (Zn), malondialdehyde (MDA), glutathione (GSH), and advanced oxidation protein products (AOPP) levels and superoxide dismutase (SOD) activities in diabetic senile cataract. Ten patients with diabetic senile cataract and ten patients with nondiabetic senile cataract (control group) were included in this study. AOPP, MDA, and GSH levels and SOD activity were measured by a spectrophotometric method. Serum, lens Cu, and Zn levels were measured by an atomic absorption spectrophotometric method. Both the lens and serum Zn and Cu levels between the two groups were not significantly different (p > 0.05). GSH, AOPP, and MDA levels and the SOD activities in the diabetic senile cataract group were significantly increased as compared to the control group (p < 0.05). Oxidative stress is one of the major factors which may lead to the early cataract formation. Oxidative events are of great importance in diabetic complications and, particularly in the lens, may have a role in the pathogenesis of cataract associated with diabetes mellitus as exhibited in this study.

Sensorineural hearing loss in neurobrucellosis.

Neurobrucellosis (NB) is a rare clinical presentation of brucellosis. This form is hard to diagnose because of a lack of definite diagnostic criteria, and its treatment is also hard. The clinical spectrum may cover a span between non-specific neurological symptoms to a severe meningoencephalitis. We report 3 patients with NB, whose main complaint was sensorineural hearing loss (SNHL) who were followed up at our hospital for 3 years. We diagnosed NB by positive CSF cultures in 2 patients and by a positive brucella IgG agglutination titer in blood and CSF in the third. Sensorineural hearing loss is a rare complication of NB, which has not attracted enough attention among known manifestations. Neurologists and otologists should be aware of this symptom as a probable clinical presentation of brucellosis.

Evaluation of 121 adult cases of tuberculous meningitis.

OBJECTIVE: To evaluate serious complications of tuberculous meningitis (TBM), resulting from difficulties in diagnosis and treatment of the disease. METHODS: Clinical and laboratory findings of 121 patients with TBM followed-up between the years 1998 and 2005 were evaluated retrospectively in Haseki Training and Research Hospital, Istanbul, Turkey. The patients were diagnosed by history, physical examination findings, CSF findings, CSF culture, and radiological imaging techniques, and were treated with isoniazid, rifampicin, ethambutol, pyrazinamide, and dexamethasone. RESULTS: The age distribution of 121 patients was 15-70 (31+/-14.0 years). Most frequent complaint on admission was headache, and most frequent findings were nuchal rigidity, alteration in consciousness, and fever. Forty-four patients had active pulmonary tuberculosis, 33 had a history of pulmonary tuberculosis, 24 had a family member with active pulmonary tuberculosis, and one had HIV infection. Mycobacterium tuberculosis was isolated from CSF in 52 patients (43%). At cranial imaging, basal meningitis, tuberculoma, and hydrocephalus were the most common findings. Of 121 patients who were treated, 69 recovered completely, 40 recovered with neurological sequels, and 12 patients died. Ten of the deceased had stage III TBM. CONCLUSION: Tuberculous meningitis is one of the most severe clinical forms of tuberculosis. Mortality is directly related with the stage of the disease.

Evaluation of cases admitted to a center in Istanbul, Turkey in 2003 for rabies vaccination and three rabies cases followed up in the last 15 years.

We evaluated the cases of 7,266 individuals who applied to our hospital's Center for Rabies Vaccination between January and December 2003. Among 1,831 female and 5,435 male cases, 37% were given 3 doses of vaccination, 14% were given 5 doses, and in 24% of cases a 2-1-1 vaccination schedule was applied. Antirabies serum of horse origin was given in 179 cases. Regarding the wounds, 83% were superficial and 17% were deep. Most of the cases involved dog bites (74%). Of the dogs involved, 30% were pets (with owners). Only a few (6%) of those pets had been vaccinated. Of the 2 dogs investigated for rabies in Pendik Veterinarian Research Institute, none were found to harbor the disease. In the last 15 years, 3 cases were followed up with a diagnosis of human rabies in our clinic. Domestic animals (without owners, living a somewhat wild life in cities) are still the cause of many rabies cases. As rabies carries a very high fatality risk, public health precautions and education are important as well as post-exposure prophylaxis.