The aim of the study is to develop a noble biomaterial that can accelerate the healing process without the risk of infection by loading tetracycline hydrochloride and collagen hemostatic agent into the chitosan tissue scaffold. After the trials, a good tissue scaffold was obtained from chitosan and PVA by electro spinning. To increase the hemostatic features of this biomaterial, 10% (by weight) collagen hemostatic agent was added to the PVA chitosan blend. After the amount of collagen hemostatic agent in the chitosan tissue scaffold was set, various amounts of tetracycline were added and 5 different biomaterials were developed to augment the antibacterial and wound healing properties. Antibiotic concentration in the biomaterial was IV 10% in the first, 15% in the second, 20% in the third, 25% in the fourth and 30% in the fifth sample. Finally, the effects of the obtained biomaterials on the nosocomial bacteria (gram positive: Staphylococcus Aureus, gram negative: Pseudomonas Aeruginosa) were analyzed with in-vitro tests at Kahramanmaras Sutcu Imam University, School of Medicine Department of Microbiology laboratories. As a result of the examination, it was examined how much the biomaterial should be and how effective it was against bacterial growth on the first, third and fifth days. It is thought that biomaterial will be very effective in emergencies and surgical procedures.
Bu çalışmada diyaliz tedavi programındaki hastalarda cilt lezyonlarının sıklığını, cilt lezyonlarının tedavi süresi, diyaliz yeterliliği, altta yatan hastalık ile ilişkisinin varlığını saptamayı amaçladık.Gereç ve Yöntemler: Çalışmaya 244 hemodiyaliz hastası dâhil edildi. Hastalar aylık muayeneleri yapılırken gönüllü dermatoloji uzmanı tarafından muayene edildi. Veriler dosyalarından retrospektif olarak kaydedildi.Bulgular: Çalışmaya yaş ortalaması 58±18.2 olan 244 (%58 erkek, % 42 kadın) hasta alındı. Ortalama hemodiyaliz tedavi süresi 4.2 yıldı. En sık cilt bulgusu kserozis olup hastaların %60.6'sında mevcuttu. Diğer sık görülen cilt bulguları ise sıklık sırası ile pruritis (%53), kıllarda azalma (%49.5), saç değişiklikleri (%47.9), tırnak değişiklikleri (%42.5), ekzema (%20.9) ve hiperpigmentasyon (%8.6) olarak saptandı. Kserozis sıklığı diyabetik hasta grubunda non-diyabetik hastalara göre daha fazlaydı (p<0.001). Hastalarda saptanan cilt lezyonlarından pruritis ve kserozis ile diyaliz yeterliliği arasında (Kt/V) istatistiksel anlamlı korelasyon olduğu saptanırken (p=0.01), kalsiyum (Ca), fosfor (P), CaxP, parathormon (PTH), ferritin, albümin düzeyleri ile istatistiksel anlamlı korelasyon saptanmadı. Diyabetik ve diyabetik olmayan hastalar karşılaştırıldığında ise pruritis oranının diyabetik hasta grubunda istatistiksel anlamlı olarak daha yüksek olduğu saptandı (p=0.01). Tırnak değişiklikleri kategorisine dâhil edilen onikomikoz oranının diyabetik hasta grubunda non-diyabetik hasta grubundan istatistiksel anlamlı olarak daha yüksek oranda gözlendiği saptandı (p=0.01). Diyabetik hasta grubunda 7, diyabetik olmayan grupta ise 2 hastada olası premalign lezyon tespit edildi.Sonuç: KBY hastalarında cilt lezyonları yaygın olarak görülmekte, cilt bulgularının prevalansı farklılık göstermekle birlikte hem prediyaliz hemde diyaliz hastalarında en sık kserozis ve pruritis olduğu bizim çalışmamızda olduğu gibi birçok çalışmada gösterilmiştir. Hemodiyaliz hasta grubunda sık karşılaşılan cilt lezyonlarının tanınması erken tanı ve tedavi olanağı sağlayarak hastaların yaşam kalitesini artıracaktır.
Background: Polyomavirus BK virus infection is a significant complication of renal transplantation and is an important cause of allograft loss. Today, despite the innovations in the pharmaceutical industry, a curative treatment against the BK virus has not been developed. The management is not standardized and is generally based on reported experience from transplantation centers. However, the literature on the subject with large samples is limited. Therefore, we designed a study to present our countrywide experience with BK virus nephropathy (BKVN) in renal transplant recipients. Methods: Our study was conducted with thirty kidney transplant centers from all provinces of Turkey. Only cases with BKVN proven by allograft biopsy were included in our study. Demographic characteristics and laboratory values of the patients were obtained from the archives and electronic databases of the centers. Results: A total of 13.857 patients from 30 transplantation centers were screened. 207 BKVN cases proven by allograft biopsy were identified and included in the study. The mean age was 46.4±13.1, and 146 (70.5%) patients were male. Twenty-six patients did not receive any induction therapy, 144 patients received anti-T lymphocyte globulin (ATLG), and 37 patients received basiliximab after transplantation. 23.6% of the patients had acute rejection history in the first six months of renal transplantation. all were treated with pulse steroids, and 46 were also treated with ATLG. The mean time to diagnosis of BKVN was 15.8±22.2 months after transplantation. At the time of diagnosis, the patients’ mean creatinine level was 1.8±0.7 mg/dl, and the mean estimated glomerular filtration rate was 45.8±19.6 ml/min. While BKVN was solely reported in 181 cases, there were cellular rejection findings in 21 biopsy specimens and humoral rejection in 4 biopsy specimens. In addition of dose reduction or discontinuation of immunosuppressive drugs, eighteen patients were treated with cidofovir, 11 patients with leflunomide, 17 patients with quinolones, 15 patients with intravenous immunoglobulin (IVIG), five patients with cidofovir+IVIG, and 12 patients with leflunomide+IVIG. None of the patients who received leflunomide and leflunomide+IVIG had allograft loss. Allograft loss was observed in 12 (15%) of 78 patients treated with antivirals or immunomodulators. Allograft loss occurred in 32 patients (15%) during follow-up out of 207 patients with BKVN. Five patients were retransplanted, and none developed BKVN during the follow-up. Conclusions: BKVN is still a significant cause of allograft loss in kidney transplantation, which has not been fully elucidated. Leflunomide appears to be an effective treatment in these patients.
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