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Amaç: Böbrek nakli alıcılarında günde tek doz uzamış salınımlı takrolimus (tac-ER) kullanımı, erken salınımlı takrolimus (tac-IR) kullanımına benzer etkinlik ve daha iyi ilaç uyumu sağlaması amacıyla geliştirilmiştir. Ancak uzamış salınımlı takrolimus ile ilgili deneyimler daha çok nakil sonrası dönemde yapılan “switch” protokollerine dayanmaktadır. Bu çalışmada böbrek alıcılarında de novo tac-ER kullanımı ile ilgili deneyimlerimizi ve 1 yıllık sonuçları sunmayı amaçladık.Gereç ve Yöntem: Bu tek merkezli retrospektif çalışmaya Ocak 2022-Ocak 2021 arasında yapılan 72 de novo böbrek nakli hastası dahil edilmiştir. Hastalar tac-ER ve tac-IR alan iki gruba ayrıldı. Bir yıllık allogreft fonksiyonları ve sağ kalımları, hastaların günlük ilaç dozları ve bunların akut rejeksiyon atakları ile ilişkileri karşılaştırıldı. Allogreft fonksiyonları ve akut rejeksiyon atakları üzerine etki eden faktörler incelendi.Bulgular: Toplam 69 hastanın (uzamış salınımlı grupta 30 hasta ve erken salınımlı grupta 39 hasta) verileri incelendi. Üç hasta posttransplant erken dönemde öldüğü için analize dahil edilmedi. Nakil sonrası 12 aylık izlem boyunca her iki grup arasında serum kreatinin ve takrolimus çukur değerler bencer bulundu (p>0,05). İlk 3 ay içinde hedef takrolimus değerlere ulaşmak için, tac-ER grubunda daha yüksek günlük dozlar (milligra/gün ve milligram/gün/kg) gerekti (p, Aim: Once daily extended-release tacrolimus (tac-ER) was introduced to support medication adherence in kidney transplant (KTx) recipients, with similar efficacy to immediate-release tacrolimus (tac-IR). However, most of the experiences regarding tac-ER efficacy were obtained from the switches from tac-IR to tac-ER in kidney transplant recipients (KTRs). In this study, we aimed to demonstrate 1-year outcomes of de novo use of tac-ER in KTRs.Material and Method: This single-center retrospective study included 72 de novo KTRs between January 2020 and January 2021. KTRS were divided into two groups who received a tac-ER or tac-IR. 1-year allograft functions, allograft survival, daily doses of tacrolimus in milligram/day and milligram/kg/day, trough levels, and acute rejection episodes were compared between the two groups. The factors that might have an impact on allograft functions and acute rejection episodes also were investigated.Results: A total of 69 de novo kidney allograft recipients (30 recipients in the tac-ER and 39 recipients in the tac-ER groups); were evaluated. Three KTRs were excluded due to the deaths within the early posttransplant period. Serum creatinine and tacrolimus trough levels were similar for 12 months after transplantation (p>0.05). More daily tacrolimus doses (in milligram/day and milligram/kg/day) were required to obtain a targeted trough level up to 3 months in the tac-ER group. Acute rejection rates also were found similar between the two groups (p=0.281). Univariate regression analysis demonstrated that higher total daily tacrolimus doses within a posttransplant month 1 may (milligram/kg/day) have an impact on lower acute rejection episode(s) independent of tacrolimus trough levels (p=0.02).Conclusion: De novo use of extended-release tacrolimus Advagraf® is as effective as immediate-release tacrolimus in preventing acute rejection episode(s) and provides satisfactory 1-year allograft function and survival.

Background: Subclinical hypothyroidism (SCH) is a term to define a mild and early thyroid deficiency. Some reports claim SCH has an association with increased cardiovascular disease (CVD), especially in individuals 4 mIU/L TSH levels were labelled for SCH group. Both groups were evaluated for MPV, lipid profiles and epidemiological features. Results: SCH group had higher levels of MPV, total cholesterol (TC) and LDL cholesterol (LDL-C) levels (P

Aim: It has been indicated that COVID-19 is related to many endocrinological abnormalities. The aim of this study is to demonstrate whether there is an impact of COVID-19 and COVID-19 vaccines on development of subacute thyroiditis (SAT). Material and Method: This retrospective single-center study includes individuals with SAT who were diagnosed between March 2020 and August 2021. Patients were evaluated for a recent Covid-19 history and SARS-CoV-2 vaccination. SAT was diagnosed based on the clinical presentation and laboratory tests; including thyroid function tests, sedimentation rate, C-reactive protein, and thyroid ultrasound. SARS-CoV-2 PCR results of patients with past COVID-19 were obtained from the Ministry of Health electronic patient data system. Type, number, and dates of vaccine doses were recorded for each participant. Results: A total of 31 patients were included in the study. Six patients (19.4%) were diagnosed with SAT following a COVID-19 vaccination schedule. Four patients with SAT had received two inactive (CoronaVac) + one dose of mRNA vaccines (Pfizer-BioNTech). The other 2 patients had received either two doses of inactive vaccine or two doses of mRNA vaccine. Five patients were diagnosed with SAT after the second dose of the vaccine. The median interval between last vaccination dose and diagnosis of SAT was 25.8 days. In one patient, SAT developed 28 days after the mRNA vaccine. Seven patients (22.6%) were diagnosed with SAT after COVID-19 disease. The median interval from the diagnosis of COVID-19 disease to SAT was 27.3 days. All cases of post-COVID-19 and post-vaccination SAT patients exhibited similar clinical presentation and findings to idiopathic SAT. Conclusion: Covid-19 itself and Covid-19 vaccines might let a tendency to development of subacute thyroiditis. This study has to be supported by further studies.

Rivaroxaban associated spontaneous hemothorax Rivaroxaban is a highly selective direct thrombin inhibitor indicated in stroke prevention, non-valvular atrial fibrilation, treatment of pulmonary embolism and deep vein thrombosis, prevention of recurrent venous thromboembolism and VTE after elective hip/knee replacement surgery and secondary prevention after acute coronary syndrome. Hemorrhage is the major concern of the drug use. Subdural hematoma, cerebral hemorrhage, GIS hemorrhage, and also intra-articular bleeding has been published in postmarketing reports. Here, we report a case of spontaneous hemothorax under rivaroxaban treatment. A 73-year-old of man was consulted due to acute dyspnea and palpitation. His x-ray pulmonary images and thorax computed tomography were compatible with hemothorax, consequently, we performed thoracentesis, and macroscopic appearance, cell count revealed hemothorax. There was no sign of any disease, such as low pleural fluid pH and glucose, leucocytic dominance, dysplastic cell, which would indicate an another cause of the bleeding. He was taking rivaroxaban (15 mg Daily) due to chronic atrial fibrillation. Hemorrhage was drained and the drug was cessated. Hemothorax did not relapse in the three month-follow-up periods. Rivaroxaban (Xarelto) is a member of new anticoagulant drug class and has become favorable in the patient carrying systemic embolism risk with nonvalvular atrial fibrillation. It has predictable pharmacokinetics features, fewer food interactions, bleeding risk, and contrast to warfarin it does not need frequent INR monitoring. Despite promising features, serious hemorrhagic complications have been reported and bleeding risk is still its major challenge in clinical use. Cases of subdural hematoma, cerebral hemorrhage, GIS hemorrhage, and also intra-articular bleeding has been published (1). Hemothorax was assumed as a rare complication until recently published case reports (2, 3). Here, we announce our case to keep in mind that rivaroxaban is a cause of spontaneous hemothorax, as not uncommonly

Objective: The mortality was seen in the early period after kidney transplantation is one of the most undesirable consequences of kidney transplant treatment. This study was aimed to evaluate the factors affecting the 1st-year mortality in patients who underwent living donor kidney transplantation (LDKT) in our center. Material and Methods: Adult patients who underwent LDKT developed mortality within the 1st-year in our center between 2008 and 2020. Mortality group and the control group are compared according to donor and recipient characteristics. The risk factors that have an adjusted effect on 1st-year mortality after kidney transplantation were evaluated by cox regression survival analysis. Results: Total mortality incidence was 8.35% and the 1st-year mortality incidence was 1.67%. Median dialysis duration (13 months vs. 3 months) was longer in the mortality-group, p=0.022. Cardiovascular disease (CVD) was more common in the mortality-group (50% vs. 31.1%), p=0.037. Median HLA mismatch numbers was higher in the mortality-group (4 vs. 3), p=0.027. According to Model 1, in terms of 1st- year mortality, each 1 year increment in recipient's age increases the mortality by 1,034 times, and dialysis treatment increases the mortality 2.5 times. According to Model 2, in terms of 1st-year mortality, each 1 year increment in recipient's age increase the mortality by 1,039 times, dialysis treatment increases the mortality 2.8 times and each 1 mismatch increase in HLA mismatch numbers increases the mortality by 1.3 times. Receiver operating characteristic analysis showed that the moderate predictive power for recipient age was AUC 0.734 (95% CI 0.623-0.844, p

Objective: Delayed graft function (DGF) is related to enhanced acute rejection attacks in the short term and reduced graft survival and reduced overall survival in the long-term. In this study, we desired to ascertain the outcomes of DGF. Material and Methods: This study is a retrospective cohort study. Two hundred seventy-four patients who underwent a kidney transplant from a deceased donor were included. DGF was described as obtaining dialysis treatment within the first week of transplant. The kidney recipients were divided into groups DGF+ (Group 1) and DGF- (Group 2). Two groups were compared in terms of risk factors which were based on donor and recipient characteristics. Short-term outcomes, long-term graft survival and recipient survival results were compared. Results: The incidence of DGF was 50.3%. The rate of donors with expanded criteria donor (ECD) was 37.3%. Mean glomerular filtration rate (GFR) at one year after kidney transplantation was 57.5 ml/dk/1.73m2 for Group 1, and 73 ml/dk/1.73m2 for Group 2 (p

It is not clear fasting during Ramadan affects the kidneypatients. The real scientific evidence absent in this regard, as serious scientific studiesare generally carried out in the western society and there is no such worshipwhere widespread individuals participate at the same time in western society., Ramazan ayında yapılan oruç ibadetinin böbrek hastalarınınasıl etkilediği tam olarak bilinmemektedir. Kabul gören ciddi bilimselçalışmaların genelde batı toplumunda yürütülmesi ve batı toplumunda genişkitlelerin aynı anda katıldığı böyle bir ibadetin olmamasından dolayı bu konudagerçek bilimsel veriler eksiktir.