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Öğe Assesment of long term cardiovascular effects of unileteral nephrectomy(Oxford Univ Press, 2017) Özkurt, Sultan; Karavelioğlu, Yusuf; Kalçık, Macit; Doğan, İsmail Çağrı; Musmul, Ahmet; Yetim, Mücahit; Karaarslan, Osman; Çelik, Oğuzhan; Ekinözü, İsmail[Abstract Not Available]Öğe Assessment of long-term cardiovascular effects of unilateral nephrectomy(Springer Netherlands, 2017) Özkurt, Sultan; Karavelioğlu, Yusuf; Kalçık, Macit; Musmul, AhmetPurpose: There is conflicting evidence regarding long-term effects of unilateral nephrectomy such as cardiovascular diseases. Excessive increase in blood pressure (BP) during exercise called “hypertensive response to exercise” may be a sign of unborn hypertension and increased cardiovascular risk. Decrease in glomerular filtration rate (GFR) in patients with unilateral nephrectomy may be associated with disturbance of circadian BP changes without affecting the absolute levels of BP. We aimed to investigate the circadian BP changes and hypertensive response to exercise in normotensive patients with preserved renal functions who had undergone unilateral nephrectomy for other causes rather than organ donation. Methods: This study enrolled 32 patients (mean age 43.4 ± 9.9 years, male 15) with unilateral nephrectomy and 40 healthy controls (mean age 47 ± 6.1 years, male 17). All patients were undergone both office and ambulatory BP measurements and treadmill stress test. Results: The median time since nephrectomy was 12 (9–22) years in the patient group. The median GFR of the patient group was lower than that of the controls without significance [85.1 (76.0–97.9) vs. 93.2 (84.5–104.9), respectively; p = 0.14]. There was no significant difference between groups in terms of office BP measurements, night time diastolic and systolic BP, mean arterial pressure (MAP), night/day time ratio of MAP in ambulatory BP measurements. The results of treadmill stress tests and hypertensive response to exercise ratios were also similar between the groups. Conclusion: This study revealed that there was no increase in long-term cardiovascular risks one decade after unilateral nephrectomy based on circadian BP changes and hypertensive response to exercise in normotensive patients. © 2017, Springer Science+Business Media Dordrecht.Öğe Bel Ağrılı Genç Erişkinlerde Lomber ve Servikal Manyetik Rezonans Görüntüleme Bulgularının Karşılaştırılması(2018) Türk, Ayla Çağlıyan; Okan, Sevil; Fidan, Nurdan; Musmul, Ahmet; Şahin, FüsunAmaç: Servikal bölgede ağrısı olmayan bel ağrılı genç erişkinlerin, lomber bölge manyetik rezonans görüntüleme (MRG) bulguları ile servikal bölge MRG bulgularını karşılaştırmak ve bu bulguların risk faktörleriyle ilişkisini saptamaktır. Gereç ve Yöntemler: Çalışmaya yaş aralığı 20-40 yıl olan, bel ağrısı olan, boyun ağrısı olmayan 60 hasta alındı. Bel ağrısının süresi, sigara içimi, travma öyküsü, düzenli egzersiz yapıp yapmadığı, boyu, kilosu ve mesleği sorgulandı. Beden kitle indeksi (BKİ) hesaplandı. Ağrı, vizüel analog skala (VAS) ile değerlendirildi. MRG’de; herniasyon, dejenerasyon ve anüler yırtık kaydedildi. Dejenerasyon derecelendirildi. Bulgular: Hastaların ortalama yaşı 29,82±5,59 yıl, BKİ 25,36±3,82 kg/m2 , bel ağrısı süresi 32,02±29,97 ay, bel ağrısı VAS 6,83±1,45 idi. Herniasyon lomber bölgede en fazla L4-5 ve L5-S1 düzeyinde olup; bulging (%45- 36,7), protrüzyon (%41,7-51,7), ekstrüzyon (%8,3-6,7) şeklinde dağılım gösterirken, servikal bölgede ise en fazla C5-6 ve C4-5 seviyesinde olup; bulging (%51,7-30) ve protrüzyon (%13,3-11,7) şeklinde dağılım gösterdi. Lomber bölgede 188 (%52,2) seviye normal, 172 (%47,7) seviyede disk hernisi bulgusu, servikalde ise 234 (%65) seviye normal, 126 (%35) seviyede disk hernisi bulgusu mevcuttu. Dejenerasyon en fazla L5-S1, L4-5 ile C3-C4, C4-5 seviyelerindeydi. Lomber bölgede Gr8’e, servikalde Gr5’e ulaşan dejenerasyon saptandı. Lomber disk hernisi (r=0,303) ve dejenerasyonu (r=0,398) kilo ile servikal bölge disk hernisi (r=0,279) ve disk dejenerasyonu (r=0,273) yaş ile pozitif ilişkili idi. Lomber ve servikal bölge herni ve dejenerasyon skorları arasında korelasyon yoktu. Sonuç: Servikal ağrı şikâyeti olmayan genç erişkinlerde de pozitif MRG bulguları olabilmektedir. Omurganın farklı bölümleri risk faktörlerinden farklı etkilenebilmektedir. Yaş ve BKİ omurga sağlığını etkileyen risk faktörleri arasında sayılabilmektedir.Öğe Comparison of shoulder Magnetic Resonance Imaging findings between patients with stage 4 chronic kidney disease and hemodialysis patients with healthy controls(Ios Press, 2020) Turk, Ayla Cagliyan; Fidan, Nurdan; Ozcan, Oguzhan; Ozkurt, Sultan; Musmul, Ahmet; Sahin, FusunBACKGROUND: Shoulder involvement is frequently observed in chronic renal disease (CRD) and hemodialysis patients. OBJECTIVE: Our aim is to compare shoulder Magnetic Resonance Imaging (MRI) findings of stage 4 CRD patients naive to dialysis, hemodialysis patients and healthy controls. METHODS: Twenty hemodialysis patients with shoulder pain (Group 1), 30 hemodialysis patients without shoulder pain (Group 2), 20 patients with stage 4 CRD (Group 3) and 30 healthy controls (Group 4) were enrolled. Urea, creatinine and beta 2 microglobulin were measured. Thickness, homogeneity and integrity of rotator cuff and presence of effusion were examined by MRI. RESULTS: Supraspinatus tendon was thicker in Group 1 compared to other groups, whereas infraspinatus tendon was thicker in Group 1 compared to Groups 2 and 4. Although all tendons thickness was higher in Group 3 than Group 4, there was no significant difference. Most effusion areas were present in Group 1, followed by Groups 2 and 3. There was a significant correlation between glomerular filtration rate and thickness of supraspinatus, infraspinatus tendons and between beta 2 microglobulin and thickness of infraspinatus, subscapularis tendons and total number of areas with effusion. CONCLUSIONS: Increased shoulder tendon thickness and effusion were detected in symptomatic dialysis patients, while greater effusion areas were detected in asymptomatic dialysis patients and in stage 4 CRD patients who do not require dialysis compared to healthy controls.Öğe Dream anxiety in hemodialysis and peritoneal dialysis patients(Kare Yayıncılık, 2017) Özkurt, Sultan; Yazla Asaf, Ece; Musmul, AhmetIntroduction: Sleep disorders are frequently reported in hemodialysis and peritoneal dialysis patients, but there are no studies investigating the dreams of these patients. This study was an examination of differences in the level of dream anxiety between hemodialysis patients and peritoneal dialysis patients. A comparison of depression and anxiety symptoms, sleep quality, and sleepiness between these 2 groups was also performed.Methods: In this observational, cross-sectional study, 49 hemodialysis patients and 29 peritoneal dialysis patients treated at an outpatient nephrology clinic were enrolled. A sociodemographic data collection form, the Van Dream Anxiety Scale, the Pittsburgh Sleep Quality Index, the Insomnia Severity Index, and the Beck Depression and Anxiety Inventories were administered, and hemoglobin level and fractional clearance of body water by dialysis (Kt/V urea) were measured.Results: There were no significant differences between the groups in terms of dream anxiety (p=0.517), depression (p=0.889), sleep quality (p=0.221), insomnia severity (p=0.152) or hemoglobin level (p=0.505).Discussion and Conclusion: We did not find any significant difference in the level of depression, anxiety, sleep quality, or insomnia severity between hemodialysis and peritoneal dialysis patients in our study. Similarly, the level of dream anxiety was consistent with these findings.Öğe Dream anxiety in renal transplant recipients(Taylor and Francis Ltd, 2015) Yazla Asaf, Ece; Özkurt, Sultan; Musmul, AhmetObjective: Although low quality of sleep has been reported in kidney transplant patients with functioning allografts, there are no previous studies investigating the dreams of these patients. We aimed to investigate the differences in dream anxiety level between renal transplant patients and healthy control subjects. We also planned to compare depression and anxiety symptoms, sleep quality and sleepiness level between these two groups. Methods: Twenty-two living-donor renal transplant recipients followed at an outpatient nephrology clinic and 22 healthy controls were enrolled in this observational cross-sectional study. Sociodemographic Data Collection Form, and the Van Dream Anxiety Scale (VDAS), the Pittsburg Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), Beck Depression and Anxiety Inventories were used for the assessment of the necessary features. Hemoglobin (Hb), blood urea nitrogen (BUN), creatinine (Cr) and glucose levels were measured. Results: There were no significant differences between the groups in terms of dream anxiety (p = 0.45), depression (p = 0.76), sleep quality (p = 0.8), insomnia severity (p = 0.08) and Hb (p = 0.11) and glucose levels (p = 0.14). Although, BUN (p = 0.00) and creatinine (p = 0.00) levels differed significantly between the two groups, both parameters were found to be within their normal range. Conclusions: In our study, chronic renal failure patients with a successful kidney transplant were found to be able to completely return to normal in terms of metabolic parameters, sleep quality and mood. Similar levels of dream anxiety are also consistent with these findings. © 2015 Informa Healthcare USA, Inc. All rights reserved.Öğe Echocardiographic evaluation of epicardial adipose tissue in non-diabetic, non-hypertensive hemodialysis patients(2013) Özkurt, Sultan; Karavelioğlu, Yusuf; Musmul, AhmetPurpose: It has been found out that the epicardial adipose tissue (EAT) measured by echocardiography is related with various metabolic parameters. Being accepted as the new cardiovascular risk indicator, there have been few studies on EAT in relation to the patients with end-stage renal failure. In our study, we aim to evaluate EAT and carotid intima media thickness (CIMT) in non-diabetic, non-hypertensive hemodialysis (HD) patients. Methods: Our study recruited 47 non-diabetic, non-hypertensive HD patients (22 males, 25 females, median age 54 (44.3-60.8) years) and an age-gender matched control group consisting 41 healthy subjects (17 males, 24 females, median age 52 (48-56) years). In all patients, EAT was measured by echocardiography and CIMT by ultrasonography; and routine laboratory parameters were studied. Results: In our study, we obtained laboratory findings matching with the profiles of uremic patients among HD patients and CIMT values of HD patients are significantly higher than that of the control group [0.79 (0.64-0.93) vs. 0.6 (0.53-0.68) p < 0.001], and EAT values are similar [0.5 (0.33-0.6) vs. 0.4 (0.4-0.53) p > 0.05]. Conclusions: EAT is not a cardiovascular risk indicator in HD patients without diabetes mellitus and hypertension. Besides, echocardiographic measurement of EAT is easy, non-invasive, cheap and credible method. © 2013 Informa Healthcare USA, Inc.Öğe Evaluation of potential long-term changes in endothelial functions and basic echocardiographic parameters in unilateral nephrectomy patients(Blackwell Publishing Inc., 2017) Özkurt, Sultan; Karavelioğlu, Yusuf; Kalçık, Macit; Doğan, İbrahim; Musmul, AhmetAim: Decreased nephron count may result in lower glomerular filtration rate (GFR) and cardiorenal injury in the absence of compensatory hyperfunction. In this study, we aimed to evaluate long-term effects of 50% nephron loss on endothelial functions and cardiac morphology in nondonor nephrectomy patients. Methods: This study comprised 26 patients (median age: 44 [37.5–50] years, male: 14) with unilateral nephrectomy and 25 healthy controls (median age: 47 [42–50] years, male: 9). Echocardiography was performed in all patients. Endothelial function was examined by measuring ischemia-induced flow-mediated dilation (FMD) of the brachial artery. Results: The mean nephrectomy time was 12.5 (8.75–23.25) years. Estimated glomerular filtration rate (eGFR [CKD-EPI]) was significantly lower in the patient group than controls (85.54±16.27 vs 96.35±11.68 mL/min, P=0.009). Uric acid levels were significantly higher in the patient group than controls (5.7±1.3 vs 4.5±0.8, P<0.001). Percentage of FMD was significantly lower in the unilateral nephrectomy patients than the control group (11.6±6.2 vs 16.1%±7.9%; P=0.029). Left ventricular posterior wall thickness (LVPWT) (P<0.001), interventricular septal thickness (IVST) (P<0.001), left ventricular (LV) mass (P=0.014), and left ventricular mass index (P=0.014) were significantly higher in the patient group. Conclusion: In conclusion, 50% decrease in nephron mass due to unilateral nephrectomy may result in decreased eGFR, impaired endothelial functions and cardiac hypertrophy. What triggers endothelial dysfunction and cardiac hypertrophy in the event of mild decrease in GFR when creatinine has not been elevated yet remains unclear, but uric acid may be playing a role in this process necessitating large-scaled studies. © 2017, Wiley Periodicals, Inc.Öğe Pseudoexfoliation syndrome in chronic kidney disease patients(Informa Healthcare, 2015) Niyaz, Leyla; Özkurt, Sultan; Musmul, AhmetThis study was performed to determine whether chronic kidney disease (CKD) is associated with an increased risk of pseudoexfoliation (PEX) syndrome. This is an age-matched case control study evaluating frequency of PEX in patients over age 40 with the diagnosis of stage 1–4 CKD and those undergoing hemodialysis (HD). Subjects over age 40 with hypertension and/or diabetes mellitus (DM) and normal kidney functions were studied as a control group. CKD was diagnosed as decreased glomerular filtration rate (GFR) of less than 60?mL/min/1.73?m2 for at least 3 months. Study groups were arranged as group 1 consisting of HD receiving CKD patients, group 2 consisting of CKD patients who do not need HD and group 3 as a control. Demographic properties and the prevalence of PEX were evaluated and compared between groups. Because of the effect of DM on PEX occurrence, it was also evaluated after exclusion of diabetic patients. A total of 101 cases in group 1, 106 cases in group 2 and 117 cases in group 3 were included in the study. Pseudoexfoliation was found in 7 (6.9%) patients in group 1, 5 (4.7%) patients in group 2 and 7 (5.9%) patients in group 3 (p?>?0.05). After exclusion of diabetic patients the prevalence of PEX changed as 4 (5.6%) in group 1, 2 (4.4%) in group 2 and 1 (1.8%) in group 3 (p?>?0.05). In conclusion, CKD was not associated with increased prevalence of PEX in this study.Öğe Pulmonary Function, Aerobic Capacity and Related Variables in Patients With Ankylosing Spondylitis(2019) Çağlıyan Türk, Ayla; Arslan, Sertaç; Karavelioğlu, Yusuf; Kalçık, Macit; Özel, Sumru; Musmul, Ahmet; Şahin, FüsunObjectives: This study aims to evaluate the cardiopulmonary functions and exercise performance of patients with ankylosing spondylitis (AS) and to investigate the relationship between these parameters and disease activity, spine mobility and quality of life (QoL). Patients and methods: Forty-five patients with AS (group 1; 33 males, 12 females; mean age 43.1±12.1 years; range 22 to 70 years) and 30 control subjects (group 2; 23 males, 7 females; mean age 42.8±10.0; range 23 to 70 years) were included in the study. Disease activity was assessed with the Bath Ankylosing Spondylitis Disease Activity Index and spinal mobility measures with the Bath Ankylosing Spondylitis Metrology Index (BASMI). The Ankylosing Spondylitis Quality of Life (ASQoL) Questionnaire and the Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) were used. The pulmonary function test (PFT) and cardiopulmonary exercise testing (CPET) were performed. Results: There was no significant difference between groups 1 and 2 in terms of mean age. The peak expiratory flow value in PFT was significantly lower in group 1 (p<0.05). In group 1, the duration of CPET was significantly shorter, and maximum work load and metabolic equivalent were significantly lower than in group 2 (p<0.001). Maximum oxygen uptake (VO2max) in peak responses, work and heart rate were significantly lower in group 1. The duration of CPET and maximum work were negatively correlated with age and BASMI (p<0.001). VO2max was negatively correlated with age, MASES and ASQoL (p<0.05). Conclusion: There was no significant difference in PFT parameters between the groups. On the other hand, CPET parameters were significantly lower in the AS group. While CPET parameters are affected by spinal mobility, declining aerobic capacity affects QoL.Öğe Serum ADMA, endothelial dysfunction, and atherosclerosis in hypervolemic hemodialysis patients(TÜBİTAK, 2018) Doğan, İbrahim; Eser, Barış; Özkurt, Sultan; Yayar, Özlem; Özgür, Bülent; Kayadibi, Hüseyin; Doğan, Tolga; Musmul, Ahmet; Soydan, MehmetBackground/aim: Asymmetric dimethyl arginine (ADMA) is a strong predictor of cardiovascular disease and mortality in patients under hemodialysis treatment. We aimed to investigate the relationship among volume status, endothelial dysfunction, and ADMA in hemodialysis patients. Materials and methods: A total of 120 patients with a history of hemodialysis treatment were included. ADMA and CRP were measured. Echocardiographic evaluation and carotid artery intima–media thickness (CIMT) measurements were performed. Patients were divided into two groups according to clinical evaluation, ultrafiltration rate, vena cava inferior diameter (VCI), and cardiothoracic index (CTI); the two groups were hypervolemic and normovolemic. Results: The hypervolemic group included 61 patients while the normovolemic group included 59 patients. CIMT was higher in the hypervolemic group, but this result was not statistically significant (0.95 mm versus 0.85 mm, P = 0.232). There was a statistically significant difference between the hypervolemic and normovolemic groups in terms of ADMA (P < 0.001) (0.69 ± 0.57 µmol/L and 0.41 ± 0.04 µmol/L, respectively). Positive correlations were observed between serum ADMA, VCI, CTI, CRP, CIMT, and cardiac mass (P < 0.001, P = 0.016, P < 0.001, P = 0.006, P = 0.022, respectively), and negative correlations were observed between ADMA and ejection fraction and albumin (P = 0.024, P = 0.024, respectively). In multiple linear regression analysis, ADMA was independently associated with age, systolic blood pressure, CTI, and volume status. Conclusion: ADMA may be a potential determinant of hypervolemia as well as atherosclerosis in patients under hemodialysis treatment. © TÜBİTAK.Öğe The effects of cholecalciferol treatment on mineral metabolism and inflammation markers in Turkish hemodialysis patients(2013) Özkurt, Sultan; Musmul, AhmetObjectives: To evaluate the effects of 25-hydroxycholecalciferol (25-[OH] D) on bone mineral metabolism and inflammation parameters in hemodialysis patients. Methods: The study was carried out at Hitit University Corum Education and Research Hospital, Corum, Turkey between July and September 2012. All of the 36 patients that underwent treatment in our hemodialysis unit were included in this study. Four patients were excluded from the study due to other complications. Of the remaining 32 patients, 28 patients (mean age; 52 ± 18 years; 15 males and 13 females) with a 25- (OH) vitamin D level of <30 ng/mL were included in the study. Four of the 32 remaining patients were excluded as their 25-(OH) vitamin D levels was >30 ng/ml. Patients with a 25-(OH) D level of <30 ng/mL were treated with 20,000 IU oral cholecalciferol once a week for 12 weeks. The level of vitamin D, mineral metabolism markers, and C-reactive protein (CRP) were evaluated. Results: After the treatment, the 25-(OH) D levels increased to >30 ng/mL in all patients (12.5±7.1 ng/mL versus 59.9±15.5 ng/mL; p<0.001). While there was a significant, but not life-threatening, increase in calcium levels (7.9 [7.26 to 8.32] mg/dL versus 8.48 [7.55 to 9.25] mg/dL, p<0.001), a statistically significant decrease was observed in CRP levels (9.34±4.4mg/L versus 4.4±1.6mg/L; p<0.001). Alkaline phosphatase, phosphorus, and parathyroid hormone levels did not change. Conclusion: Vitamin D deficiency is a common problem in HD patients. Short-term weekly cholecalciferol treatment is safe and effective in this patient group, and cholecalciferol treatment had a positive effect on inflammatory markers.Öğe The Frequency Of Fibromyalgia In Female Patients With Impaired Fasting Blood Glucose: Crosssectional Study(2020) Türk, Ayla Çağlıyan; Okan, Sevil; Özel, Sumru; Musmul, Ahmet; Bağlıcakoğlu, Murat; Küçükler, Ferit Kerim; Şahin, FüsunObjectives: To assess the frequency of fibromyalgia among women with impaired fasting glucose. Materials and Methods: The sample was selected from the female patients who applied to the Internal Medicine clinic and whose fasting blood glucose level were 100-126 in their routine examination (Group1) and patients whose fasting blood glucose were less than 100 constituted the control group (Group2). Oral glucose tolerance test (OGTT) has been applied to patients with impaired fasting glucose (IFG) and whose 2nd hour OGTT levels were under 140 has been included. Functional status was assessed by using the Fibromyalgia Impact Questionnaire (FIQ). Pain Location Inventory (PLI), and Symptom Impact Questionnaire (SIQR) were evaluated for the diagnosis of fibromyalgia. Results: Mean age was 48.99±7.50 in Group1 (n=73) and 47.84±7.92 in Group2 (n=73) with no significant difference between them. Mean BMI (body mass index) was 30.41±5.01 in Group1 and 28.00±4.61in Group2, this difference was significant (p<0.05). 26% of the patients in Group1, 11% of the patients in Group2 were diagnosed with fibromyalgia and difference was highly significant (p<0.001). Mean FIQ was 44.27±21.98 in Group1 and 24.95±21.49 in Group2, this difference was also significant (p<0.001). Glucose level was associated with PLI (r=0.368, p<0.001), SIQR (r=0.322 p<0.001) and FIQ (r= 0.287, p<0.001). Conclusion: Fibromyalgia is more prevalent in female patients with IFG than in patients with normal fasting glucose levels. Glucose level is associated with both PLI, SIQR and functionality. Although not a clinical disease, IFG is not only a risk factor for development of diabetes but also a risk factor for fibromyalgia in women.
