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ABSTRACT: Compared with the general population, patients with chronic renal failure have increased tuberculosis (TB) prevalence and mortality rates. In this study, we aimed to investigate tuberculin skin test (TST) positivity rates in hemodialysis (HD) and peritoneal dialysis (PD) patients and the factors influencing TST positivity. Ninety-two HD patients and 44 PD patients who had been on HD and PD treatment for at least 3 months were recruited into the study. TST was administered in all patients. Positivity was defined as an induration diameter >10 mm. At least 5 mm of induration following skin testing together with a chest radiography indicating previous infection was defined as latent TB infection. TST positivity rates, diameter of TST indurations, and serum albumin levels in HD patients were higher than the PD patients. TST induration size was not correlated with any other parameters in both HD and PD groups. TST-positive patients had higher albumin levels and lower leukocyte count than the TST-negative patients. In TST-positive patients, albumin level was correlated with the duration of dialysis but TST induration size was not correlated with the lymphocyte count and albumin level. In our study, TST positivity of patients was found in 30.4% of HD patients, 9% of PD patients, and 23.5% of total patients. It is still recommended to use TST for the screening test of TB. We found a significant relationship between TST and albumin level. It should be remembered that TST response may be lower in PD patients, especially in cases in which TB is suspected.
Renal Failure 01/2012; 34(3):304-7. · 0.82 Impact Factor
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ABSTRACT: Hemodialysis patients are at increased risk of latent tuberculosis infection (LTBI) compared with the general population. QuantiFERON-TB Gold (QFT-G) for LTBI detection is more promising than tuberculin skin test (TST) in hemodialysis patients. The aim of this study is to determine whether the QFT-G is more sensitive than the TST in hemodialysis patients in LTBI. Eighty nine hemodialysis patients were evaluated for latent tuberculosis infection with the TST and QFT-G. Blood was obtained for QFT-G, and then TST was administered to all patients. Demographic information, laboratory tests, chest radiography results and BCG vaccination status were collected on standardized patient medical files. Forty patients had positive QFT-G results. 56 patients had TST induration above 5 mm, 28 patients above 10 mm. 61 patients had BCG vaccination scar. Statistically significant correlation was detected between TST and QFT-G (p< 0.05). In the BCG non-vaccinated subgroup, TST was positive in 8 (29%) patients and the QFT-G was positive in 11 (39%). Among the 21 non vaccinated patients with results for both tests, the concordance between the TST and QFT-G was 82%, k= 0.61, p= 0.001. We found good agreement between the TST and QFT-G test for LTBI in non vaccinated hemodialysis patients, whereas we found poor agreement in vaccinated patients. Because BCG vaccination is widely used in our country, the QFT-G test might be more useful for the diagnosis of LTBI than TST in hemodialysis patients who are suspected to have LTBI.
Tuberkuloz ve toraks 06/2011; 59(2):105-10.
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ABSTRACT: The aim of this study was to determine the prevalence of atrial fibrillation in long-term hemodialysis patients and to identify clinical and echocardiographic risk factors.
The study included 183 patients (93 males, 90 females; mean age 52+/-17 years) who had been on long-term hemodialysis treatment (mean 41.6+/-39.8 months) and had preserved systolic function. Atrial fibrillation was determined electrocardiographically and the patients were divided into two groups depending on the presence or absence of atrial fibrillation. Conventional and tissue Doppler echocardiographic examinations were performed on interdialytic days. Clinical, laboratory, and echocardiographic parameters were compared.
Twenty-four patients (13.1%) had atrial fibrillation. Patients with atrial fibrillation significantly differed in terms of higher age (64.9+/-9.8 vs. 49.9+/-16.6 years; p<0.001), higher frequency of coronary artery disease (37.5% vs. 10.7%; p=0.008), and lower serum albumin level (3.6+/-0.4 vs. 3.9+/-0.5 mg/dl; p=0.015). Echocardiographic examination showed significantly increased left and right atrial diameters (p<0.05), higher incidence of mitral and/or aortic calcification (p=0.033), increased systolic pulmonary artery pressure (38.1+/-6.1 vs. 28.5+/-5.5 mmHg, p<0.001) and E/E' ratio (11.8+/-3.8 vs. 8.8+/-4.7, p=0.008) in patients with atrial fibrillation. In multivariate logistic regression analysis, age (OR 1.09; 95% CI 1.00-1.17; p=0.036) and right atrial diameter (OR 1.19; 95% CI 1.05-1.35; p=0.008) were independent risk factors for the development of atrial fibrillation.
Our findings highlight age and right atrial diameter as independent predictors of atrial fibrillation in hemodialysis patients. In addition, the E/E' ratio and pulmonary artery pressure may be considered new risk factors of atrial fibrillation in this population.
Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir 01/2010; 38(1):8-13.
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ABSTRACT: Aim: Restless legs syndrome (RLS) is characterized by symptoms of spontaneous, continuous leg movements associated with unpleasant paresthesias. RLS is common among dialysis patients, with a reported incidence of 6.6 to 6.8 percent. This study is an attempt to find out the prevalence of RLS in our hemodialysis patients. We compared several demographic and clinical characteristics of RLS patients identified by the International Restless Legs Syndrome Study Group (IRLSSG) criteria with those of individuals without RLS. Materials and methods: We studied 76 patients with end-stage renal disease (ESRD) on hemodialysis (34 females and 42 males, mean age: 52.28 ± 18.13, range: 18–83 years). RLS patients' diagnoses were confirmed using the IRLSSG criteria. RLS is diagnosed when a patient answered positively to all of the 4 questions. Hemoglobin, ferritin, iron, iron binding capacity, PTH, and Kt/V ratio values were measured. Results: We found an RLS frequency of 14.5% in our sample. There was no significant difference in terms of serum iron, ferritin, creatinine, iPTH, hemoglobin, and Kt/V between groups of hemodialysis patients with and without RLS (P = 0.89, 0.87, and 0.37, respectively). Conclusion: The 14.5% prevalence of RLS in hemodialysis patients was lower than that has been reported previously. The variability in RLS prevalence rates among hemodialysis patients may result from some racial, regional, socioeconomic, or ethnic differences. These findings need to be confirmed in larger studies. Bir hemodiyaliz ünitesinde huzursuz bacak sendromunun prevalansı ve risk faktörleri Amaç: Huzursuz bacak sendromu (HBS); bacaklarda rahatsızlık hissi nedeniyle sürekli spontan bacak hareketleri ile karakterize bir durumdur. HBS hemodiyaliz hastalarında sık görülür, insidansı % 6,6 -% 6,8 arasındadır. Bu çalışma hemodiyaliz hastalarımızdaki HBS sıklığını saptamak için planlandı. HBS semptomu olmayanlar ile uluslararası HBS çalışma grubunun kriterleri ile HBS olduğu düşünülen hastalar arasındaki klinik ve demografik özellikleri karşılaştırdık. Yöntem ve gereç: Çalışmaya76 hemodiyaliz hastası alındı. Hastaların yaş ortalaması 52,28 ± 18,13 (18–83) yıldı, ve hastaların 34'ü kadın, 42'si erkekti. Hastalara huzursuz bacak sendromu tanısı uluslararası huzursuz bacak sendromu çalışma grubunun kriterlerine göre kondu. Tüm sorulara olumlu cevap veren hastalar HBS olarak değerlendirildi. Hemoglobin, ferritin, demir, demir bağlama kapasitesi, PTH, ve Kt/V değerleri ölçüldü. Bulgular: HBS sıklığı % 14,5 idi. HBS olan hastalarla olmayan hastalar serum demir, ferritin, kreatinin, PTH, hemoglobin ve Kt/V açısından karşılaştırıldığında anlamlı fark saptanmadı (sırasıyla P = 0,89, 0,87, ve 0,37).
Turk J Med Sci. 01/2010; 40:443-446.
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ABSTRACT: Prognosis in patients with gastric cancer is determined by the tumor itself, as well as certain patient-related factors.
In this study, 138 patients with high-grade gastric adenocarcinoma who were admitted to our hospital between September 1999 and April 2002 were retrospectively evaluated in terms of the effects of clinicopathological parameters and treatment approaches on survival by single and multiple variable analyses. Patients histopathologically diagnosed as having gastric adenocarcinomas with stage IV M0 (without distant organ metastasis) or stage IV M1, (with distant organ metastasis) were included in the study.
Overall median survival time was 3.1 months and three-year survival rate was 8%. With single variable analysis, body mass index (BMI), clinical stage, surgery, type of surgery, and serum level of albumin were significant prognostic factors related to overall median survival time. Gender, clinical stage, surgery, type of surgery, hemoglobin concentration, and serum level of albumin were found to be significant prognostic factors related to survival without progression (p < 0.05). No surgical treatment, palliative surgery (compared with radical surgery), and BMI below 20 were found to be the statistically significant poor prognostic factors related to survival in multiple variable analysis. In terms of both overall survival and survival without progression, performing surgery or not was statistically the most significant independent prognostic factor.
No surgical treatment, palliative surgery instead of radical surgery, and BMI below 20 on first admission were determined as poor prognostic factors related to survival in patients with high-grade gastric adenocarcinoma.
Medical science monitor: international medical journal of experimental and clinical research 06/2006; 12(5):CR221-9. · 1.70 Impact Factor
