INTRODUCTION: Type II diabetes or diabetes mellitus type II (previosly called non–insulin-dependent diabetes mellitus, NIDDM), or adult-onset diabetes is a disorder that is charcterized by high blood glucose in the context of relative insulin deficienncy and insulin resistance. Type II diabet is often initially managed by life style disorders, inadequate exercise and dietary modifications. As the condition progresses, medications are typically requeried. There are many factors which can potentially give raise or exacerbate type II diabetes, especially metabolic syndrome. Multifactorial changes that complex and very often lead to damage and irreversible function defect of many organs, most significantly the reno- vascular system so with this condition has been resulted that serios quantty end stage renal disease (ESRD). In this researche we aim the assesment of etiology incidence and prevalence state of being widespread in type II diabetes mellitus and other etiology in the end stage renal disease patients in addition to compare with Albumin, PTH, K, CaxP in the blood serum.
METHODS: In Private Konya Huzur Dialysis Center set point bloods measurement had been determined in otoanalysir for 70 adult ESRD in period 25 month. All the patients etiology of ESRD was determined in eight groups. Furthermore was determined blood levels Ca, K, P, PTH, CaxP in all the groups and this condition has been worked statisticaly. All the patient’s bloods are taken prehemodialysis. The blood serum has been analysed, Vitros FS 5.1 ile Vitros 950 apparatus and Abott Architect 2000 SR in with Beckman Coulter Access 2 in with apparatus.
RESULTS: As type II diabetes group other groups were differently determined that Albumin, K, PTH ve CaxP in the blood adult hemodialysis patients (value statisticaly, p < 0,05).
DISCUSSION AND CONCLUSION: K differently an result which expected (because type II dm), together PTH, CaxP differently if secondary hyperparatroidsm has been interpereted while becoming a laboratory diagnosis. The statistically value that albumin levels in the blood serum (p<0.05). So albumin besides proteine in hemodialysis patients that the subject is investigated.

INTRODUCTION: Microalbuminuria is an early sign of diabetic nephropathy. In this retrospective study we investigated the factors that playing role in development and progression of microalbuminuria in patients with diabetes mellitus.
METHODS: A total of 66 diabetes patients (48 females/18male, age 62.5 ± 10.3 years) were included. Patients were grouped as normoalbuminuric and microalbuminuric based on baseline readings of urinary albumin excretion. Available laboratory data from five years before was compared with current data to determine the presence and predictors of renal disease.
RESULTS: At baseline there were 51 normoalbuminuric and 15 microalbuminuric patients. After 5 years, in the normoalbuminuric group 16% developed microalbuminuria and 2% progressed to macroalbuminuria. In the microalbuminuric group, 40% regressed to normoalbuminuria and 7% progressed to macroalbuminuria. Regression analysis determined HbA1c as the most significant predictor of albuminuria progression (p=0.034).
DISCUSSION AND CONCLUSION: In diabetic normoalbuminuric patients HbA1c is the most important parameter for estimating the fifty year albuminuria value.

INTRODUCTION: Recent studies have demonstrated gender differences in neurological outcome after stroke and women were found to have poorer prognosis. In our study, we examined gender differences in clinical presentation, risk factors and early outcome.
METHODS: Patients older than 80 years with acute ischemic stroke, admitted to Haydarpafla Numune Trainig and Research Hospital, Department of 1st Neurology in a 5-year-period (2005-2009) were examined. Clinical features, stroke subtypes, risk factors, localisation of infarcts, length of acute ward stay, acute ward morbidity and mortality were compared in females and males. Prognosis was evaluated by modified Rankin Scale at the 10th day.
RESULTS: 196 patients (116 female and 80 male) older than 80 years were examined. Hemiparesis was the most common clinical presentation and hyper tension and cardiac disease were the most common risk factors in both of the groups. Atrial fibrilation was more common in women, whereas cigarette smoking was common in men. Carotid artery infarctions were most frequent in both of the groups and the most common etiologic factor was atherothrombosis. There was not a statistical difference due to clinical presentation and localization (p>0.05). Prognosis was poor in 58.2% of the patients and fasting blood glucose (p<0.001), leukocyte count (p=0.01), NIHSS score (p<0.001) at admission and length of acute ward stay (p=0.01) were found to be in relation with poorer prognosis but gender was not in relation with prognosis (p>0.05). There was also no relationship with the remaining risk factors and prognosis (p>0.05).
DISCUSSION AND CONCLUSION: Early prognosis is poor in elderly patients with ischemic stroke. Gender do not have effects on clinical presentation, localization and prognosis.

INTRODUCTION: Though, reactive thrombocytosis induced by iron deficiency or other factors have usually a benign course, it sometimes may have more severe and fatal complications and may have a role in the development of cerebral infarction. In our study, we aimed to investigate the ratio of iron deficiency anemia in the patients with ischemic stroke and the role of it as an etiological factor for stroke.
METHODS: 1194 patients with acute ischemic stroke treated and followed in the Department of 1st Neurology, Haydarpafla Numune Training and Research Hospital between 2004 and 2007 were investigated. Detailed neurological and systematic examinations were made and the patients were questioned for the medical history of iron deficiency anemia. All the patients were examined by routine biochemical blood tests, total blood count, vitamin B12, iron, ferritin blood tests, carotid and vertebral artery Doppler USG, ECG, echocardiography, and if appropiate, vasculitis tests and blood smear were done. Cranial CT/MRI were applied and the etiology was classified due to TOAST classification.
RESULTS: Hypochrome microcytic iron deficiency anemia was detected in 79 patients (6.61%). Thirtyeight of these patients had cardioembolic, 16 patients had large artery disease an 7 had small artery disease as accompanying etiologic factor for ischemic stroke. One of the patients with iron deficiency anemia had anticardiolipin antibody positivity, 1 had protein C deficiency and 1 pattient had antithrombin III deficiency. Reactive thrombocytosis due to iron deficiency anemia was observed in 15 patients and no features to explain the etiologic factor was found on laboratory and imaging tests.
DISCUSSION AND CONCLUSION: If vascular, cardiac or coagulation pathologies do not exist, it must be kept in mind that iron deficiency anemia may be a risc factor for ischemic stroke. Reactive thrombocytosis induced by iron deficiency anemia is easily treated by iron replacement therapy. The treatment of anemia is important to prevent the cerebrovascular complications in patients that either have risc factors for stroke or not.

Vitamin B12 deficiency is a systemic disease that often affects the nervous system and peripheral neuropathy is frequently seen in symptomatic patient. In our study, neurologically asymptomatic patients with vitamin B12 deficiency were included. Nerve conduction study and tibial somatosensory evoked potentials (SEP) were performed. Patients that have another reason for polyneuropathy or another disease that can effect nerve conduction studies and tibial SEP were excluded. Twenty patients with vitamin B12 deficiency ( 12 women, 8 men) and 15 healthy subjects were examined. The median patient age was 47.65±16.08. The mean vitamin B12 level was 163.65±26 pg/ml (N: 180-900 pg/ml) in the patient group and 292.30±15.86 pg/ml in the control group. There was a statistically significant difference in distal latency, nerve conduction velocity and F wave latency of the common peroneal nerve (p=0.04, p=0.005 and p=0.000 respectively) between patient and control groups. There was a negative correlation between the latency and conduction velocity of the sural nerve with vitamin B12 levels (p=0.04). There was not a correlation between tibial SEP and vitamin B12 levels (p>0.05). In conclusion, nerve conduction study may show pathological findings in patients with vitamin B12 deficiency neurological syndrome although asymptomatic and nerve conduction study is a method for detection of early peripheral neuropathy in vitamin B12 deficiency.

Hypertension may play a role in the development of polyneuropathy in patients with unexplained polineuropathy etiology. To test this hypothesis, we selected our group of 54 subjects (36 hypertensive and 18 controls) among subjects in whom factors that may contribute to neuropathy (like diabetes, renal insufficiency, vitamin B12 insufficiency, hypothyroidism, monoclonal gammapathy, paraneoplastic phenomenon, spinal and hereditary reasons) were ruled out. After detailed neurological examination, electrophysiological investigations were carried out As a result of this study, especially the lower extremity sensory amplitudes were found to be significant lower in the study group. The differences of the study group and the control group of sural and peroneal sensory amplitudes were statistically significant (p<0,05). Similarly, ulnar and median sensory amplitudes were lower in the study group (p<0,05). The change in the sensory amplitudes was found to be more significant in patients whose history of hypertension was longer than five years. Also, Neuropathy Symptom Score (NSS) was found to be higher in the hypertensive group as compared with the rest of the study group (p<0,05). This study has suggested strongly that a long history of high blood pressure is one of the factors contributing to the development of polyneuropathy. Future clinical studies will help us to include the notion of “hypertensive neuropathy” in our clinical practice. Further studies will also show whether good control of hypertension would decrease the risk of developing this type of neuropathy.

Nowadays, nutritional status of patients cannot be left to be uncontrolled as well as nutritional support cannot be left to coincidences and to the flow of daily habits. Clinical dimensions of nutritional support include research, interpretation, calculation of needs, determination and then monitoring of nutritional path for each patient. If needs of patients cannot managed properly, a potential of defective or excessive treatment are likely to emerge. However, clinical process can be directed effectively with a powerful infrastructure. Clinical team needs to comprehend various elements that include effective service provision. The presentation, which has no obvious effect on this clinical agenda, depends on gathering disciplines including financing and senior management together. In this study, we aimed to execute an organizational chart by discussing how the nutritional requirements of patients can be met with an organization which developed specifically for Haydarpafla Numune Education and Research Hospital and how this process can be managed effectively. We hope that it will be discussed and developed.

A mature style of handwriting results from years of practice and it is affected by many factors. Written communication is of great importance in medical practice and illegible handwriting may cause serious problems. Illegible handwritten prescriptions are well-recognized for increasing the risk of medication errors, including prescribing, dispensing, and administration. A 65-year-old woman underwent operation for the treatment of mitral valve failure on 20 December 2005. She was given her prescription on 28 December 2005 when she was discharged. Just after her discharge, she bought her prescription from a pharmacy. When she finished taking one box of the prescribed medicine and went to another pharmacy to buy her prescription, it turned out that she had been given Famodin, an H2 antagonist, instead of Coumadin, an anticoagulant, before. She visited her doctor on 12th January 2006 for a check-up and the investigations showed an INR (International Normalized Ratio) of 0.7. On echocardiography, there was mitral valve thrombosis. The patient was infused heparin. When the INR reached 3,6, the patient was operated. On operation, a lot of thrombus in the left atrium was taken away and fibrin and thrombus were removed from the dysfunctional prosthetic valve. However, the patient died and the body of the person was buried without making autopsy. Relatives complained about the pharmacist who had given the wrong drug at that time. Approximately one year later, the Court asked the cause of death for this case to the First Specialization Board of Council of Forensic Medicine. We present that the case had a mistake of drug dispensing due to an illegible prescription. Illegible handwriting may increase the risk of malpractice in medicine and damage to patients. The patient couldn’t get the treatment which was vital for her and consequently died since the patient who must receive anticoagulant treatment following her heart surgery was given a drug which has a different medical effect due to a fault caused by mistaken reading of the prescription. For these reasons, prescriptions and other medical documents should be legible. Medical students and health professionals should be offered training about illegible handwriting prescriptions that can cause problems. All medical documents including prescriptions should be written in computers so that illegible handwriting of medical professionals can be prevented.

A 46-year-old male underwent coronary angiography because of angina. During diagnostic cardiac catheterization, the left main coronary artery, the left anterior descending artery, the left circumflex artery and the right coronary artery (RCA) were found normal. Nevertheless, the patient had a ventricular fibrillation is probable to be caused by contrast media extravasations through ruptured side branch while right coronary angiography was being performed. The patient was resuscitated successfully. It was estimated that ventricular fibrillation may be the result of extravasations of contrast media through ruptured side branch of RCA during the contrast media injection into RCA (Figure 1). Trans-thoracic echocardiography showed us there was a small amount of pericardial effusion. Fortunately, the pericardial effusion reached a moderate size and it stopped growing. It showed us that it was a perfo ration of side branch rather than coronary fistulae. And it was agreed that the operation was not necessary because the pericardial effusion restricted itself. The perforation of side branch in the coronary angiography has two probable etiologies, one of which is selective intubation of side branch and the other one is the delivery of contrast media into the main coronary artery with a higher pressure than the normal range. We encountered one case of the side branch perforation during diagnostic coronary angiography depending on the selective intubation of side branch in the literature (1). In our case, either of these etiologies might have caused the perforation of the side branch. Consequently, it should be noted that the intubation of side branch selectively or the contrast media injection with a higher pressure into the main coronary artery may cause the side branch rupture and the further complications such as ventricular fibrillation afterwards.