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RISS 인기검색어
- 검색키워드
- 저자 : ( Hanife Usta Atmaca ) (검색결과 8 건)
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( Hanife Usta Atmaca ),( Feray Akbas ),( Ilker Nihat Okten ),( Eda Nuhoglu Kantarci ),( Berrin Belcik Inal ),( Mustafa Boz ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Obesity is a disease known to stimulate low grade infl ammation. N/L ratio has been started to be used as an indicator of systemic infl ammation. This study aims to examine the relationship between obesity and N/L ratio over anthropometric measurements, obesity grade, and some biochemical parameters. Methods: 96 obese patients (mild-moderate and severe) who are being monitored in obesity outpatient clinic, who have no concomitant disease, and who do not have a history of smoking and drug use, and as the control group, 20 patients of normal weight with the same characteristics were included in the study. Anthropometric measurements were recorded, and BMI was calculated. Biochemical tests and total blood counts were performed. N/L ratio was obtained by dividing neutrophil count by lymphocyte count. The results were evaluated using SPSS statistical analysis program. Results: A signifi cant increase was present in neutrophils and lymphocyte counts of morbid obese group compared to control groups. Due to both increased neutrophil and lymphocyte counts, even though L/N ratio increased, it was not found statistically signifi cant. The increase in total leucocyte count of morbid obese was statistically signifi cant compared to mild obese. While N/L ratio demonstrated a strongly positive correlation with total leucocyte count and neutrophil count, it demonstrated a weakly positive correlation with waist circumference and with hip circumference. Conclusions: N/L ratio increases by obesity grade and reveals that concomitant infl ammatory response increases. High count of circulating neutrophil in obese patients might be considered as an acute infl ammatory response to a chronic infl ammatory state. Therefore, N/L ratio might be used as an infl ammatory marker in obese patients, and might be helpful in the prediction of cardiovascular and metabolic risks for the patient.
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( Hanife Usta Atmaca ),( Feray Akbas ),( Yesim Karagoz ),( Ebru Pekguc ),( Mustafa Boz ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Introduction: Agenesis of IVC (inferior vena cava) is a rare congenital anomaly which is generally incidentally found in asymptomatic patients. In patients with congenital intra-abdominal venous malformation, extreme care must be taken during radiological or surgical interventions. Case Report: A 35-year-old male patient was presented with nausea and vomiting following abdominal CT- performed for chronic abdominal pain-, presenting a subsequent decrease in urine output, and elevation of blood urea and creatinine. The patient had suffered from disseminated varicosities since the age of 15. In physical examination, intense subcutaneous venous collaterals on both lower extremities and abdomen and hepatosplenomegaly were observed. Grade 2 hydronephrosis in the right kidney and grade 4 hydronephrosis with decreased parenchymal thickness in the left kidney were present on renal ultrasonography. CT scan revealed discontinuity of contrast in the left portal vein compatible with portal vein thrombosis. On the left, ureteral continuity was not found. MR venography revealed an abnormally narrow IVC. The diagnosis was established as contrast induced nephropathy and the patient underwent hemodialysis. After 3 sessions, serum urea and creatinine levels, renal functions, and urine excretion returned to normal. The patient was discharged and a follow-up was planned. Discussion: Recognition of vascular abnormalities is important to prevent related complications. Agenesis of IVC enhances the risk of acute renal failure; regarding decreased renal fi ltration due to insuffi ciency of venous return and the mass effect on ureters, Extreme caution or even total abstinence for contrast media injection is necessary. Surgeons and interventional radiologists should be warned against potential complications.
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( Hanife Usta Atmaca ),( Feray Akbas ),( Yesim Karagoz ),( Betul Borku Uysal ),( Mustafa Boz ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Case report: 64 year-old male patient was presented with cough, fever and sputum production. His medical history was unremarkable. He was producing and selling pickled vegetables. Only pathological fi nding in his physical examination was the reduction of pulmonary sounds in the lower part of left lung. Hemogram showed; leukocyte:5500/mm³ (neutrophil 65%, lymphocyte 30%), platelet: 287000/mm³, hematocrit 28%. Biochemical tests revealed normal, serum CRP level was 11,7 mg/dl. Pleural effusion was present in chest X-ray. Pleural ponction was performed. Gram-positive cocci and high concentration of leukocytes were seen in gram-staining in the exudative pleural fi uid. In the culture Leuconostoc mesenteroides was grown. CT showed pleural effusion and a consolidation containing air bronchogram. The patient was diagnosed with pleural empyema and drainage treatment with thorax tube and 2 grams of ceftriakson and 1 gr claritromycin daily were started. The symptoms regressed beginning from the fourth day. On the fourteenth day, CRP level returned to normal. The treatment was stopped at twenty-fi rst day with full recovery. Discussion: Leuconostocs are members of the family Streptococcacae and have only recently been recognized as potential pathogens. Infections by Leuconostoc species bacteria are uncommon, and usually affect patients with an underlying disease, or those fi tted with a venous catheter or subjects previously treated with vancomycin. Bacterias are found naturally in plants and vegetables and are used in milk, pickle and wine industries. While an underlying factor is needed for those organisms to become pathogenic, our case was completely healthy and had no invasive procedure previously. Because he was selling and directly producing pickles, it was considered that the organism could have passed directly. This case points out that; Leuconostoc mesenteroides should be considered as a causative agent in nasocomial infections, also in non- immunocompromised patients.
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( Feray Akbas ),( Hanife Usta Atmaca ),( Cigdem Alkac ),( Betul Borku Uysal ),( Burak Alkac ),( Mustafa Boz ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Atherosclerotic coronary artery disease is an important health issue and a leading mortality reason in developed countries. In this study; we aimed to diagnose diabetes and other glucose disturbances early by evaluating the glycemic profile in hyperlipidemic patients and to decrease the cardiovascular morbidity and mortality by an early intervention. Methods: 46 female and 19 male, totally 65 hyperlipidemic normoglycemic patients were included in the study. Patients had no history of diabetes and normal fasting blood glucose levels and were diagnosed with hyperlipidemia during routine blood tests. There were no limitations for age, gender or body mass index. Coronary heart disease risk factors were questioned and findings were used to determine the pathological low density lipoprotein (LDL) levels. 2-hour oral glucose tolerance test (OGTT) was performed for all patients. Results were evaluated according to American Diabetes Association (ADA) 1997 criteria. Results: Mean total cholesterol level of patients was 236±41 mg/dl, mean trigliserid level was 223±141 mg/dl and mean LDL level was 153±38 mg/dl. According to OGTT results ; mean fasting blood glucose level was 95±13 mg/dl and mean 2nd hour glucose level was 128±34 mg/dl. According to ADA 97 criteria; OGTT of 33 (51%) patients were normal. 2 (3%) patients had impaired fasting glucose (IFG), 11 (17%) patients had impaired glucose tolerance (IGT) and 19 patients (29%) had diabetes. Conclusions: Hyperlipidemia and diabetes are important risk factors for cardiovascular disease and they usually coexist. Identification and early intervention of these risk factors are prognostically important. Thus; patients who are diagnosed with hyperlipidemia should be screened for glucose disturbances as a secondary risk factor and by early intervention of both risk factors, cardiovascular morbidity and mortality should be decreased.
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( Feray Akbas ),( Hanife Usta Atmaca ),( Ilker Nihat Okten ),( Eda Nuhoglu ),( Mustafa Boz ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Home glucose monitoring is vital for diabetic patients to maintain acceptable glucose levels. We aimed to demonstrate how effective home glucose monitoring was among diabetic patients who were followed in internal medicine outpatient clinics of our hospital. Methods: Randomly selected 89 diabetic patients who were admitted to internal medicine outpatient clinic in a week and who had glucometers were included in the study and a questionnaire was administered. The answers were categorized and the results were evaluated with SPSS. Results: The questions and the percentage of answers are shown in Table 1. Although diabetes duration of the patients was mostly more than 5 years, only half of them had a glucometer for that period. Most of the patients didn`t calibrate their devices. Most strikingly, only 25% of the patients in general were given a proper education for the usage of glucometers. 72% of patients who claimed to have been educated were mostly given instructions by a pharmacist that cannot be considered as education and only 35% of this group were educated by a diabetes nurse or a doctor. Only 40% of the patients monitored their glucose levels regularly, rest of the patients used their glucometers rarely or none. Conclusions: Home monitoring of glucose levels for diabetic patients would approve blood glucose levels by making necessary treatment adjustments available. Providing the optimal treatment would prevent/delay diabetes related complications, improve quality of life and contribute to decrease health costs. Thus; it`s necessary to educate and follow our diabetic patients better and assure that they use their glucometers more effectively and frequently. To include the patients to the treatment and to monitoring of diabetes seems to be the only way to achieve a better outcome of the disease.
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( Feray Akbas ),( Hanife Usta Atmaca ),( Sennur Kose ),( Sevda Bag ),( Mustafa Boz ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Depression is a co-morbidity whose identifi cation and intervention can be vital in chronic kidney failure. Case report: 36-year- old male patient was brought to ER with palpitation. He had been diagnosed with chronic kidney failure for 9 months and on dialysis for 6 months. Physical examination showed 220/minutes HR and ECG tachycardia with high T waves, broad QRS and P wave, prolonged PR distance which were consistent with severe hyperkalemia. His K level was 9.55 mEq/L and received an emergency dialysis. Control ECG was normal and K level was 4.86 mEq/L. The reason for fatal increase in K level was overconsumption of apricots. He didn`t follow his diet although warned at dialysis sessions. He was given education about his diet again. The following day, his K level was 7.48 mEq/L and received another emergency dialysis. He`d been eating grapes aware of the consequences. The patient was on dialysis in 3 months after his diagnosis and lost his job because of his dialysis sessions and was still unemployed. He had socioeconomical problems and learned that overconsumption of fruits could kill him. In the light of those fi ndings; he was considered to have major depression with suicidal ideation and was emergently referred to a psychiatry clinic for observation and treatment. Conclusion: Chronic kidney failure consists many physical and psychological problems. Dialysis patients depend on machines, invasive procedures and health workers, generally cannot keep a full time job. There is also a serious food and drink restriction. Thus; depression is common and there is a higher suicide rate. Still; depression is underdiagnosed and undertreated in dialysis patients. To check dialysis patients for depression signs and start therapy if needed will improve the quality of life and prevent possible suicide attempts.
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( Feray Akbas ),( Hanife Usta Atmaca ),( Berrin Inal ),( Yasin Yuksel ),( Emin Piskinpasa ),( Mustafa Boz ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Recent studies have shown that microalbuminuria (MAU) refl ected in a higher probability of cardiovascular disease for cardiovascular risk assessment. We aimed to question the availability of microalbuminuria in metabolically healthy obese patients as a predictor of diastolic dysfunction to assess the cardiovascular risk. Methods: 100 obese patients without accompanying diseases were included in the study. They were screened for any signs of acute/chronic inflammation and those having any were excluded. None of the patients were on any medications infl uencing diastolic dysfunction. Blood glucose, HbA1c, urea, creatinine, total cholesterol, LDL, HDL, triglyceride and 24-hour-urine microalbuminuria and creatinine clearance (GFR) levels were studied. Two-dimensional doppler echocardiography was performed. Data was statistically analyzed using SPSS Windows 11.5. Results: Statistical analysis showed that there was no signifi cant difference between patients with diastolic dysfunction and normal echocardiograpghy fi ndings when compared for MAU and also for BMI. In all groups, there was no relation between MAU and BMI according to correlation analysis. There was statistically significant difference for age (p<0,0001), glucose (p=0,019), total cholesterol (p=0,009) and LDL (p=0,019) and no difference for gender, smoking, HbA1c, HDL, systolic and diastolic blood pressure, creatinine, GFR and triglyceride (p>0,05) between groups. Conclusions: Microalbuminuria found in obese patients can be related with diastolic dysfunction which might refl ect subclinical cardiac damage with a simple method and in advance. The lack of demonstration of this relationship in our study might be due to limited number of patients included and especially low percentage of patients with microalbuminuria. But the relationship found for blood glucose and lipid parameters still can show metabolic tendency. If an approval of this relationship can be achieved by studies with a higher number of patients, an easy and non-invasive method to predict obesity cardiomyopathy might be possible.
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( Betul Borku Uysal ),( Feray Akbas ),( Esma Altunoglu ),( Gulhan Ipek Deniz ),( Duygu Uysal ),( Harun Uysal ),( Hanife Usta Atmaca ),( Yasin Yuksel ),( Hale Aral ),( Guven Cetin ),( M Cem Ar ),( Must 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Anemia is an accelerating problem among patients with heart failure. In this study, we investigated whether anemia in heart failure was related to hepcidin level. Methods: Totally 70 patients; 50 patients with heart failure and 20 otherwise healthy subjects with no history of a chronic illness including heart failure as control group, were included in the study. Heart failure was verifi ed by echocardiography in each subject and patients were defi ned as ones with reduced ejection fraction (HFrEF) if EF = 40% and with preserved ejection fraction (HFpEF) if EF 40-50%. Exclusion criteria included presence of kidney failure (serum creatinine level>1.4), history of hemorrhage (gastrointestinal or severe menstrual bleeding), chronic liver disease (ALT>2 folds), hematologic disease, iron replacement therapy or blood transfusion in the past six months, hypothyroidism, autoimmune disease and manifest infection. Results: There was no correlation between hepcidin concentration and age, weight, creatinine, iron, vitamin B12, folate, white blood cell (WBC), platetelet, mean corpuscular volume, ESR, ejection fraction (EF) (p > 0,05). There was a positive correlation between hepcidin level and urea, ferritin, hemoglobin, hematocrite, C-reactive protein (p < 0,05). Hepcidin levels of anemic heart failure patients were signifi cantly lower than the non-anemic heart failure patients (p < 0,05). Conclusions: We found that serum hepcidin level in anemic patients with heart failure was lower than in heart failure patients without anemia. Previously, progression of heart failure was found to be associated with decline in circulating hepcidin and the development of iron defi ciency and low hepcidin level was related to unfavorable out come. We believe that iron defi ency occurs as a result of infl ammatory process in heart failure and therefore hepcidin concentrations decrease as a response. However, long-term follow up studies are needed.
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