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  • Küçük Resim
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    Increased QT Dispersion and High Risk of Ventricular Arrhythmias is Associated with Hyperuricemia in Individuals with Normal Renal Function
    (2021) Huddam, Bülent; Alp, Alper; Genek, Dilek Gibyeli; Azak, Alper; Karakuş, Volkan
    Background and aim: Uric acid elevation has been shown to be an important risk factor for cardiovascular and cerebrobascular disease. QT dispersion (QTd) is a parameter that shows the heterogeneity of ventricular repolarization and can be calculated noninvasively from surface electrocardiography. Increased QTd has been associated with severe arrhythmia and risk of sudden death in many patients and disease groups. In this context, we aimed to investigate the effect of uric acid levels on QTd and the effects of decrease in uric acid levels on QTd. Metb-ods: A total of 225 patients with normal renal function were included in the study; 133 of these patients were hyperuricemic (>7 mg/dL), and the remaining 72 patients were normouricemic (Group 1). The hyperuricemic patients were randomly divided into 2 groups, one group (n = 67) was given placebo (Group 2) for 4 months, and the remaining 66 patients were given allopu- rinol 300 mg/day (Group 3). Results: Hyperuricemic patients had higher hsCRP and QTd and lower eGFR values compared to the normouricemic control group. After 4 months of treatment, 66 patients treated with allopurinol showed a significant decrease in serum uric acid, systolic and diastolic blood pressure, and hsCRP levels, and a significant increase in eGFR. Although the QTd values in the treatment group did not decrease to the same levels as in the normouricemic control group, a statistically significant decrease was found compared to their baseline values. In hyperuricemic control and normouricemic control patients, there were no differences in the levels of uric acid, hsCRP, eGFR, systolic and diastolic blood pressure, and QTd values compared to baseline values. Conclusions: There was a significant association between elevated serum uric acid and QTd, as well as with inflammatory biomarkers. Also, patients who had received hypouricemic therapy during the follow-up period presented a significant decrease in inflam- matory markers as well as QTd. This indicates the beneficial effects of decreasing uric acid levels in decreasing the risk for future major adverse events related to ventricular arrhythmias.
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    Serum soluble Fas-ligand levels and flow-mediated vasodilation in patients undergoing peritoneal dialysis
    (2022) Huddam, Bülent; Azak, Alper; Karakuş, Volkan; Alp, Alper; Genek, Dilek Gibyeli; Koçak, Meral Gülay Kadıoğlu; Dere, Yelda; Soysal, Dilek Ersil; Duranay, Murat
    Flow-mediated vasodilation (FMD) has been demonstrated to be a useful, non-invasive tool for the detection ofendothelialdysfunction in atherosclerotic cardiovascular disease, the leading cause of mortality in end-stage kidney disease. The Fas/Fas ligand system of apoptosis resulting from activation of the caspase cascade- contributes to the pathophysiology of atherosclerosis. This ‘apoptotic’ system plays a central role in immune homeostasis. Vascular endothelial cells and inflammatory cells are the main resources of the Fas ligand. In this study, we aimed to investigate the role of soluble Fas ligand (sFasL) as a marker of FMD in peritoneal dialysis (PD) patients. Methods. A total of 43 patients undergoing maintenance PD and 40 healthy donors were enrolled in this cross-sectional observational study. Demographics, anthropometric measurements and clinical examinations were obtained. Endothelial function was evaluated by FMD of the brachial artery with high-resolution ultrasonography. Serum sFasL concentrations were measured with an enzyme-linked immunosorbent assay kit. Results. The enrolled partisipants were devited on 2 groups: PD patients who had been treated at least 12 weeks (group 1; mean age 41±14 years, M/F: 22/21) and gender matched 40 healthy controls (group 2; mean age 50±12 years, M/F: 19/20). The forearm FMD and serum sFasL levels were significantly lower in PD patients (3.95±2.01 vs 8.83 ± 6.17; p<0.001 and 54 ± 24 vs 73 ± 30; p=0.001). Forearm FMD was correlated with sFasL (r=0.289; p=0.008), age, BMI and uric acid (r= 0,32; p=0.003, respectively), hemoglobin (r= 0,293; p=0.007), calcium (r= 0,26; p=0.016), phosphate (r=- 0,250; p=0.023), magnesium (r= 0,255; p=0.020), 24 h SBP (r=- 0,257; p=0.019), creatinine and iPTH (r=- 0.50 and r=- 0,45; p[removed]
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    Öğe
    The effects of tacrolimus and mycophenolate mofetil on regression of encapsulating peritoneal sclerosis in a rat model
    (Asoc Regional Dialisis Trasplantes Renales, 2021) Huddam, Bulent; Sasmaz, Simge; Haberal, Nihan; Azak, Alper; Genek, Dilek Gibyeli; Kocak, Gulay; Karakus, Volkan
    Objective: Encapsulating peritoneal sclerosis (EPS) is a rare, but potentially fatal complication of peritoneal dialysis. Currently, treatment of peritoneal fibrosis is not fully possible yet. In this study, we aimed to demonstrate the effects of tacrolimus therapy on peritoneal fibrosis and inflammation when administered alone or with mycophenolate mofetil (MMF) in the EPS model induced in rats. Methods: Thirty six Wistar albino rats were separated into six equal groups. Group I was the control group. Group II-VI were administered intraperitoneal chlorhexidine (CH) for induced EPS model in rats. Group II, IV, V, VI were administered isotonic liquid, tacrolimus, tacrolimus and concurrently with CH, tacrolimus and MMF together, respectively. Group III was not administered any drug. All peritoneal samples were stained immunohistochemically with matrix metalloproteinase-2 (MMP-2) antibody. Thickness of peritoneal fibrosis, subserosal large collagen fibers, subserosal fibroblast proliferation and subserosal fibrotic matrix deposition were evaluated. Results: Comparing the experimentally induced EPS groups, the best histopathological results and the largest staining with MMP-2 were achieved in Group VI. Furthermore, in all treatment groups (IV, V, VI) more staining with MMP-2 was detected compared to non-treatment groups (I, II, III) but no statistically significant differences were found among all groups. A statistically significant remission was observed in all histopathological parameters, primarily peritoneal thickness in rats that were administered MMF with tacrolimus, compared to rats which were administered tacrolimus only. Conclusion: Concurrent use of tacrolimus and MMF in the treatment of EPS may be a promising approach.