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Cumhurbaşkanlığı Hükümet Sistemine geçişle birlikte anayasada milli güvenlikle ilgili iki önemli değişiklik yapılmıştır. Bu değişiklerden ilki, anayasanın 104. maddesinin 13. fıkrasıyla Cumhurbaşkanına milli güvenlik politikalarını belirleme ve gerekli tedbirleri alma yetkisinin verilmesi, diğeri ise anayasanın 117. maddesinin ikinci fıkrasıyla milli güvenliğin sağlanmasından TBMM’ye karşı Cumhurbaşkanının sorumlu tutulmasıdır. 2017 yılı sonrası kamu politikası konusu haline gelmiş olan milli güvenlik, 1 sayılı Cumhurbaşkanlığı Kararnamesiyle çerçevesi belirlenen politika oluşturma sürecine dahil edilerek yeni politika aktörlerinin danışmanlığında Cumhurbaşkanınca tek başına belirlenen bir politika konusu haline gelmiştir. Ancak bu durum 1982 anayasasının hazırlık aşamasından bu yana milli güvenlik siyasetinin hazırlanmasında yürütme organına danışmanlık yapan MGK’nin milli güvenlik politikasının oluşturulmasında görevli olup olmadığı sorusunu gündeme getirmiştir. Öte yandan 117. maddede milli güvenliğin sağlanmasından TBMM’ye karşı Cumhurbaşkanının sorumlu olduğunun düzenlenmiş olması, halk tarafından seçilen Cumhurbaşkanının TBMM’ye karşı sorumsuz olduğu olgusuna dayanan Cumhurbaşkanlığı Hükümet sisteminde, sorumluluk hükmünün uygulanabilirliği konusunda belirsizlik yaratmıştır.

The aim of this study was to determine the frequency and the risk factors of acute and chronic nephrotoxicity in patients who received cisplatin due to malignancy. Medical records of all patients who received cisplatin-based chemotherapy regimen between January 2013 and July 2019 were retrospectively evaluated. The data of 203 patients who met the study criteria were examined. The patients were evaluated for acute nephrotoxicity at 48 h and late nephrotoxicity at 3rd month after first course of cisplatin. Early and late nephrotoxicity were defined by NCI CTCAE Version 4.0 criteria. The mean age of the study patients was 56.44 ± 12.69 years, 78.8% were males and 21.2% were females. It is revealed that the incidence of cisplatin-induced acute nephrotoxicity was 9.2% and chronic nephrotoxicity was 37.9%. While the development of acute nephrotoxicity was associated with female gender, history of diabetes mellitus, history of ischemic heart disease and use of antiplatelet drug, the development of chronic nephrotoxicity was associated with older age, female gender and using of diuretics. High serum creatinine, urea and low eGFR value before treatment were found to be associated with both early and late nephrotoxicity (p

Calprotectin is a protein molecule that is released from inflammatory cells. Measurement of calprotectin in various body fluids has recently gained significant importance for differentiating inflammatory and noninflammatory events. The subject has aroused interest in the field of nephrology and some renal pathologies in which urinary calprotectin levels have been studied. In this study, the measurement of urinary calprotectin level and its use for determining acute cisplatin nephrotoxicity in a group of patients with non-small cell lung cancer who received cisplatin-based oncological treatments have been investigated. The study included 41 patients who received cisplatin-based treatments for non-small cell lung cancer between January 2019 and January 2020. The patients were excluded from this study who were with estimated glomerular filtration rate (eGFR)60 mL/min/1.73 m2, serum creatinine (sCr)1.5 mg/dL, a history of urinary tract infection, and nephrotoxic drug use in the past month. Baseline and 48-hour sCr values and baseline, 6-hour, 12-hour, 24-hour, and 48-hour urinary calprotectin levels of all patients were measured. Four of the 41 patients who received cisplatin treatment were excluded because their 48-hour sCr values could not be accessed. The control group included 29 patients. While there was no difference between the cisplatin group and the control group in terms of baseline sCr and eGFR values, the cisplatin group had significantly higher urinary calprotectin values. Of the 37 patients treated with cisplatin, 7 (18.9%) developed cisplatin-induced nephrotoxicity. The comparison of groups with (group 1) and without cisplatin nephrotoxicity (group 2) showed comparable mean age and male sex ratio. Baseline sCr and eGFR values were similar in both groups. The cisplatin-induced nephrotoxicity group had significantly higher 48-hour sCr and significantly lower 48-hour eGFR values. Baseline, 12-hour, 24-hour, and 48-hour urinary calprotectin levels were similar in groups with and without cisplatin nephrotoxicity. Recent studies have demonstrated that urinary calprotectin level measurement can be used to distinguish intrinsic acute kidney disease from prerenal kidney disease. However, the comparison of groups with and without cisplatin nephrotoxicity in our study showed no difference in urinary calprotectin levels. However, there is a need for large-scale studies using combined urinary biomarkers.

Patients diagnosed with chronic kidney disease (CKD) have a greater rate of cardiovascular mortality when compared with the general population. The soluble form of TNF-like weak inducer of apoptosis (TWEAK) and monocyte chemoattractan protein 1 (MCP-1) play important roles in cellular proliferation, migration and apoptosis. The current study aimed to analyze whether soluble TWEAK (sTWEAK) and MCP-1 levels are associated with the severity of coronary arterial disease (CAD) in CKD patients.Ninety-seven patients diagnosed with CKD stages 2-3 according to their estimated glomerular filtration rate and the presence of kidney injury were included in the study. Plasma sTWEAK and MCP-1 concentrations were determined using commercially available ELISA kits. Coronary angiographies were performed through femoral artery access using the Judkins technique.Correlation analysis of sTWEAK and Gensini scores showed significant association (p 0.01, r(2) = 0.287). Also significant correlation has been found in MCP-1 levels and Gensini scores (p 0.01, r(2) = 0.414). When patients were divided into two groups with a limit of 17 according to their Gensini score, sTWEAK levels indicated a statistically significant difference (p 0.01).Our findings support a relationship between sTWEAK and MCP-1 levels and CAD in CKD stages 2-3 patients.

Encapsulated peritoneal sclerosis (EPS) is a rare complication of long-term peritoneal dialysis usually associated with the inadequacy and early termination of dialysis modality. Adequate treatment of peritoneal fibrosis has not been achieved by medical intervention so far. Mycophenolate mofetil (MMF), which inhibits inosine monophosphate dehydrogenase reversibly and highly selectively, is the most widely used drug for maintenance immunosupression in renal transplantation. Recent studies have shown that MMF has also antifibrotic effects. In this study, we evaluated the effects of MMF on EPS model in rats based on antifibrotic effects.Twenty-four Wistar albino rat have been randomly divided into four groups. Group I (control group) received isotonic saline intraperitoneally (i.p) 2 ml/day for (0-3rd weeks). Group II (chlorhexidine (CG) group) received CG 2 ml/day i.p. for (0-3rd weeks). Group III (chlorhexidine + MMF group) received CG (2 ml/day) i.p. for (0-3rd weeks) plus MMF 30 mg/kg/day peroral (4th-6th weeks). Group IV (resting group) received CG 2 ml/day) i.p. (0-3rd weeks) plus peritoneal resting without any treatment (4th-6th weeks) At the end of the sixth weeks, all of the rats were killed. All of the groups were analyzed in terms of peritoneal thickness, degree of inflammation, vasculopathy, neovascularization and fibrosis. Also, the parietal peritoneal tissue samples were evaluated for matrix metalloproteinase 2 (MMP-2) by using the immunohistochemical analysis.When the CG group was compared with the MMF group, the medication resulted in a statistically significant reduction in peritoneal thickness, inflammation and fibrosis score (53.23 ± 16.24 vs. 17.22 ± 3.62, 1 ± 1.225 vs. 1 ± 0, 1.6 ± 0.548 vs. 0.2 ± 0.447, respectively, all p0.05). In the resting group, no beneficial effects on morphological abnormality of the peritoneum were observed as compared with MMF group. However, according to immunohistochemical analysis of the expression of MMP-2 on peritoneal samples, the highest expression of MMP-2 was observed in the MMF group.MMF was effective for the treatment of encapsulating peritoneal fibrosis in our rat model. Most recently, MMF may be first choice for EPS due to antifibrotic effect.

guidelines for the prevention and treatment of catheter- related infections and peritonitis in pediatric patients re- ceiving peritoneal dialysis: 2012 update. Perit Dial Int 2012;32:32-86, tedavisi başlanmıştır. SAPD ilişkili mantar peritonitleri nadir olmakla beraber çok yüksek ölüm riski ile beraber‐ dir. Literatürde daha önce bildirilmiş olmakla beraber Aspergillus Niger’e bağlı mantar peritonitisi oldukça nadirdir. Tedaviye uyumsuzluk ve kronik alkol bağımlılı‐ ğı bu olguda mantar peritonitine yol açan önde gelen nedenler olarak yorumlanmıştır.