Didem Demircioğlu’s research while affiliated with Kahramanmaraş Sütçü İmam University and other places

BACKGROUND: Cognitive impairment is common among hemodialysis (HD) patients and is associated with poor treatment compliance and mortality. The aim of this study is to evaluate relatively young HD patients with less comorbidities using the Montreal Cognitive Assessment (MoCA) and identify clues for earlier detection of cognitive impairment with the help of cognitive subscale scores. MATERIALS AND METHODS: A total of 103 chronic HD patients (mean age 48.3 years) and 37 stage-3 to 5 chronic kidney disease (CKD) patients with similar demographics were included. Patients with cerebrovascular disease, dementia, depression, malignancy, and infections were excluded. All participants were tested with MoCA. Patients with an MoCA global score < 24/30 were considered cognitively impaired. Groups were compared for MoCA subscales and clinical features. RESULTS: 75 patients (72.8%) in the HD group and 19 in the CKD group (51.3%) had impaired cognition. The number of patients with cognitive impairment was significantly higher in the HD group compared with the CKD group (p = 0.024). The mean total MoCA score was lower in the HD group (p = 0.043). MoCA subscale analysis revealed that the mean score for visuospatial/executive domain was significantly lower in the HD group (p = 0.001). CONCLUSION: In this study, we showed that cognitive impairment was more common in HD patients compared with predialytic CKD patients. This difference was predominantly related to the difference in executive scores. We may think that young HD patients with less comorbidities are also at risk for cognitive impairment. Noticing progressive declines in MoCA cognitive domains, before the development of global cognitive impairment, could be beneficial for HD patients. .

Objective: Iron preperations are frequently used in hemodalysis (HD) patients and iron may accumulate liver and other tissues. Noninvasively methods are needed to detect liver iron accumulation in HD patients. Hepatic iron accumulation with Fibroscan was shown in non-renal population. In this study, we aim to investigate whether or not the hepatic iron load can be determined with Fibroscan in hemodialysis patients. Material and Methods: 42 chronic HD patients included this study. Serum iron, iron binding capasity, ferritin and transferrin saturation were used to determine iron status. Liver stiffness was measured by an experienced gastroenterolog with Fibroscan device. Results: While mean Fibroscan value was 9,15 kPa, ferritin was 565,99 mg/dl. Fibroscan value were positive correlated with transferrin saturation and ferritin but negative correlated with albumin. In multiple regression analysis, it was observed that only ferritin and albumin levels related with Fibroscan value. Conclusion: This study showed that the stiffness of the liver increasing while the ferritin value increasing. This result might be due to iron accumulation in the liver.

Objective: To investigate the effect of gonadotropin, sex hormone levels and insulin resistance (IR) on thyroid functions and thyroid volume (TV) in polycystic ovary syndrome (PCOS). Subjects and methods: 69 new diagnosed PCOS patients (age 24.82 ± 6.17) and 56 healthy control female (age 26.69 ± 5.25) were involved to the study. Fasting plasma glucose, lipid profile, insulin, thyroid stimulating hormone (TSH), free thyroxine (fT4), estradiol (E2), luteinizing hormone (LH), follicle stimulating hormone levels and urine iodine were measured in all participants. Thyroid and pelvic ultrasound were performed in all participants. Results: Insulin, HOMA-IR, LH, E2 and TV were higher in PCOS group (p < 0.05). TV was significantly higher in PCOS patients with IR compared to non-IR PCOS patients (p < 0.001), while TSH, fT4, and urine iodine levels were similar between these groups (p > 0.05). There was a negative correlation between E2 and TSH (p < 0.05) and a positive correlation between TSH and TV (p < 0.05). There was a significant positive correlation between TV and LH, insulin, HOMA-IR (p < 0.05). Conclusion: This study showed that TV was increased in patients with insulin resistance but differences in TSH and LH levels may affect TV changes as well.

OBJECTIVE: Renal transplantation is the best treatment method of end-stage renal disease. Unfortunately, renal transplantation rates have not reached the desired level yet in our country. In this study, we aimed to evaluate the willingness, knowledge levels and expectation of hemodialysis patients about renal transplantation. MATERIAL and METHODS: Patients older than 18 years of age and treated with hemodialysis for at least 3 months were enrolled in the study. Twenty-three questions were asked and the answers evaluated. RESULTS: We determined that most patients have insufficient information about transplantation but are willing to undergo kidney transplantation and have expectations from physicians and the society about transplantation. CONCLUSION: Hemodialysis patients should be informed and encouraged regarding renal transplantation.

Tubulointerstitial nephritis and uveitis syndrome is characterized by a combination of acute tubulointerstitial nephritis and uveitis. It is thought to be an autoimmune disease. Currently, 200 cases have been described in the literature. Most patients with this syndrome are young women and adolescents although it may occur in adults and older patients. In this report, we describe two patients with the TINU syndrome who were followed-up at our hospital.

The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a cause of euvolemic hyponatremia. Neoplasms, infections and some drugs are the most frequent reasons of SIADH. Brucella melitensis is an infectious microorganism that is frequently seen in some regions of our country. It may cause multisystemic disease or nonspecific symptoms. A 44-year-old female patient, who presented with hyponatremia and fever, was diagnosed with SIADH due to brucellosis-related encephalitis and she recovered with treatment of the brucellosis. SIADH due to brucellosis-related encephalitis is a quite rare cause of hyponatremia.

Hyperlipidemia is a component of the nephrotic syndrome and should be treated for increased risk of cardiovascular diseases. Statins are first choice in treatment. However, gastrointestinal side effects are commonly seen in patients with statin therapy. A 73-year-old man who used statin therapy for hyperlipidemia due to nephrotic syndrome presented to our clinic with muscle weakness and rhabdomyolysis and thrombocytopenia was detected. The patient's complaints improved after discontinuation of statin therapy. We report the case of thrombocytopenia and rhabdomyolysis associated with statin therapy in this patient, as it is a rare entity.

Patients treated with hemodialysis are predisposed to infections. Catheter-related infections are the most common infections in patients who have a central venous hemodialysis catheter. These infections may lead to bacteremia or metastatic infection. Cutaneous vasculitis is a form of vasculitis characterized by purpuric eruption localized to the lower extremity. This entity may be related to drugs, infections or have an unknown etiology. Here we present two chronic hemodialysis patients who had fever and increased infection parameters such as leukocytosis and C-reactive protein (CRP). During follow-up, they developed purpuric eruptions on the legs. Infection-related cutaneous vasculitis was diagnosed in these patients and they were successfully treated with antimicrobial therapy.