Periton Diyalizi Hastalarında, Rezidüel Renal Fonksiyonların Kaybı Boylamsal Ürik Asit ve CRP Düzeyleri ile İlişkili midir?

Amaç: Periton diyalizi yapan hastalarda rezidüel renal fonksiyonların morbidite ve mortalite üzerinde olumlu etkileri vardır. Amacımız, periton diyalizi başlanmadan önceki bazal verilerin ve başlandıktan sonra ilk üç yıldaki boylamsal ürik asit ve C-reaktif protein (CRP) düzeyinin rezidüel renal fonksiyon kaybı üzerindeki etkilerinin araştırılmasıdır. Gereç ve Yöntem: Retrospektif kohort bir çalışmadır. Son dönem böbrek yetmezliği nedeni ile periton diyalizi başlanan 34 hasta çalışmaya dahil edildi. Primer sonlanım noktası rezidüel renal fonksiyon kaybıydı ve rezidüel idrar miktarının 200 mL/24 saatten az olması olarak tanımlandı. Hastalar, periton diyalizi başlandıktan sonra üç yıl boyunca veya RRF kaybı olana kadar takip edildi. Hastaların klinik ve laboratuvar verileri hasta dosyalarından kaydedildi. Bulgular: Takip süresi 32,7 (12,9-36) aydı. Periton diyalizi başlandıktan 22,1±9,8 ay sonra 10 hastada rezidüel renal fonksiyon kaybı oldu. Boylamsal ürik asit düzeyi 6,1±1,2 mg/dL ve boylamsal CRP düzeyi 0,5 (0,3-0,7) mg/dL idi. Rezidüel renal fonksiyon kaybı olan hastalarda, bazal sodyum, trigliserid düzeyleri daha düşük iken parathormon düzeyi daha yüksekti. Her iki grup arasında boylamsal ürik asit ve CRP düzeyi açısından fark yoktu. Periton diyalizi başlanmadan önceki parathormon [tehlike oranı (HR), 1.003; %95 güven aralığı (GA) 1.001-1.006; p=0,013], sodyum (HR 0,801; %95 GA 0,665-0,965; p=0,019) ve vücut kitle indeksi (HR 0,817; %95 GA 0,684-0,975; p=0,025) rezidüel renal fonksiyon kaybı için risk faktörüydü. Sonuç: Periton diyalizi hastalarında, bazal sodyum, trigliserid ve vücut kitle indeksi rezidüel renal fonksiyon kaybı için risk faktörü olarak bulunmuştur. Rezidüel renal fonksiyon kaybı ile boylamsal CRP ve ürik asit düzeyi arasında ilişki gösterilememiştir. İdeal ürik asit ve CRP düzeyinin belirlenmesi için prospektif çalışmalara ihtiyaç vardır

Kidney Transplant in a Human Immunodeficiency Virus-Positive Patient: Case Report of Drug Interactions

End-stage renal disease in the human immunodeficiency virus-positive population is increasing. Kidney transplant is the optimal therapy for this population rather than dialysis modalities if some criteria are met. These include undetectable plasma human immunodeficiency virus RNA, CD4 cell count over 200 cells/mu L, and the absence of any AIDS-defining illness. Here, we describe the first living-donor kidney transplant in a human immunodeficiency virus-positive recipient in Turkey. The patient, a 52-year-old male diagnosed as human immunodeficiency virus positive, was on antiretroviral therapy, which consisted of 400 mg twice daily darunavir, 100 mg/day ritonavir, and 50 mg/day dolutegravir. He had been negative for human immunodeficiency virus RNA for the past 3 years. The patient developed renal insufficiency without any known cause and started hemodialysis. A living donor transplant from his son was performed, and the patient received ATG Fresenius-S (Neovii Biotech, Rapperswil, Switzerland) induction and a maintenance immunosuppression therapy consisting of methylprednisolone, mycophenolate mofetil, and tacrolimus. There were no incidences of delayed graft function or acute rejection. Because of tacrolimus and ritonavir interaction, tacrolimus trough levels were too high. With tacrolimus withdrawn, tacrolimus trough level decreased to detectable levels 2 weeks later. Antiretroviral therapy was continued on the same dosage. At month 4 posttransplant, the patient's creatinine level was 1.01 mg/dL. At present, the patient has had no complications and no episodes of rejection. Kidney transplant is the most favorable replacement therapy for HIV-positive patients who are under controlled AIDS care with highly active antiretroviral therapy. However, drug interactions should be carefully evaluated

The effects of vertically coronally advanced flap and free gingival graft techniques on shallow vestibule: a randomized comparative prospective trial

Objectives: The present study aimed to compare the influence of vertically coronally advanced flap (V-CAF) and free gingival graft (FGG) techniques on shallow vestibule depth (VD). Materials and methods: Parallel-arm randomized clinical trial was conducted on 38 sites treated with either FGG or V-CAF. Periodontal variables (VD, recession depth and width, probing depth, clinical attachment level, keratinized tissue height (KTH), and tissue thickness (TT)), clinician- and patient-based subjective variables were assessed. Results: All periodontal variables showed significant improvements in both groups at all follow-up intervals compared to baseline (p < 0.05). Both groups increased VD compared to baseline. RC and CRC were similar after treatment for both techniques. FGG provided a greater increase in KTH (p < 0.001) and VD (VD1, p = 0.02 and VD2, p < 0.001) while V-CAF exhibited more TT gain (p = 0.002). Except overall tissue appearance that was better in V-CAF (p < 0.001), no inter-group significant difference existed in patient-based variables. Conclusions: Both techniques were significantly effective in VD increasing. While both techniques were equally successful in RC, V-CAF provided higher TT gain and better tissue appearance. V-CAF can be chosen instead of FGG in the treatment of recessions with shallow VD. Clinical relevance: It can be recommended to prefer V-CAF instead of FGG in the treatment of shallow vestibule. Trial registration number: NCT05777811 (clinicaltrials.gov)

Mycobacterium tuberculosis

WOS: 000176572100003PubMed ID: 12099981Tuberculosis (TB) is an unusual infection in transplant recipients. We evaluated (i) the frequency of TB, (ii) the duration to develop the TB infection, and (iii) clinical consequences, in 380 solid-organ recipients from January 1995 to December 2000. A total of 10 (2.63%) patients (eight renal, two liver transplant recipients) were found to have post-transplantation TB. The frequency of TB in this patient population is 8.5-fold higher than the prevalance in the general Turkish population. Tuberculosis developed within 2-33 months after transplantation, with a median of 15 months. In all of these 10 patients, Mycobacterium tuberculosis (MTB) was isolated from the culture. All the patients continued to have low dose immunosuppressive treatment, and also quadriple antituberculosis treatment [isoniazid (INH), rifampin (RIF), pyrazinamide (PRZ) and ethambutol (ETB)] has been given. The two recipients had died of disseminated form of TB. Relapse was detected in one patient 6 months after the completion of the treatment. As post-transplant TB infection develops mostly within the first year after transplantation, clinicians should be more careful for early and fast diagnosis and treatment should be started immediately