An update review of post-transplant diabetes mellitus: Concept, risk factors, clinical implications and management.

OBJECTIVE: Kidney transplantation is the gold standard therapeutic alternative for patients with end-stage renal disease; nevertheless, it is not without potential complications leading to considerable morbidity and mortality such as post-transplant diabetes mellitus (PTDM). This narrative review aims to comprehensively evaluate PTDM in terms of its diagnostic approach, underlying pathophysiological pathways, epidemiological data, and management strategies. METHODS: Articles were retrieved from electronic databases using predefined search terms. Inclusion criteria encompassed studies investigating PTDM diagnosis, pathophysiology, epidemiology, and management strategies. RESULTS: PTDM emerges as a significant complication following kidney transplantation, influenced by various pathophysiological factors including peripheral insulin resistance, immunosuppressive medications, infections, and proinflammatory pathways. Despite discrepancies in prevalence estimates, PTDM poses substantial challenges to transplant. Diagnostic approaches, including traditional criteria such as fasting plasma glucose (FPG) and HbA1c, are limited in their ability to capture early PTDM manifestations. Oral glucose tolerance test (OGTT) emerges as a valuable tool, particularly in the early post-transplant period. Management strategies for PTDM remain unclear, within sufficient evidence from large-scale randomized clinical trials to guide optimal interventions. Nevertheless, glucose-lowering agents and life style modifications constitute primary modalities for managing hyperglycemia in transplant recipients. DISCUSSION: The complex interplay between PTDM and the transplant process necessitates individualized diagnostic and management approaches. While early recognition and intervention are paramount, modifications to maintenance immunosuppressive regimens based solely on PTDM risk are not warranted, given the potential adverse consequences such as increased rejection risk. Further research is essential to refine management strategies and enhance outcomes for transplant recipients.

Metabolically healthy obesity and chronic kidney disease risk: exploring the dynamics.

Obesity represents a prevalent global health concern with significant implications for various diseases, including chronic kidney disease (CKD). Within this landscape, the phenomenon of metabolically healthy obesity has emerged, challenging traditional notions about the health risks associated with excess weight. While traditional CKD risk factors involve obesity, metabolic syndrome, diabetes, and hypertension, the metabolically healthy obese (MHO) subgroup disrupts these assumptions. Our main objective in this study is to integrate existing literature on CKD in MHO individuals. In this endeavor, we delve into the pathophysiological foundations, the transition between obesity phenotypes and their impact on renal health, examine the implications of their metabolic resilience on mortality within a renal context, and explore potential management strategies specifically designed for MHO individuals. Offering a comprehensive overview of the pathophysiology, we cover various factors contributing to the risk of CKD in the metabolically healthy obese setting, including inflammation, cytokines, hemodynamics, and the renin-angiotensin-aldosterone system, gastrointestinal microbiota, diet, exercise, adipose distribution, and lipotoxicity. Through this synthesis, we aim to provide a comprehensive understanding of the risk of CKD in those classified as MHO.

Native nephrectomy in polycystic kidney disease patients on transplant lists: how and when?

Autosomal dominant polycystic kidney disease (ADPKD), the most common hereditary kidney disease, accounts for approximately 10% of the patients on kidney transplantation waitlists. High rates of complications including hemorrhage, infections, nephrolithiasis and kidney size-related compressive complaints have been reported among ADPKD patients. Therefore, the need for routine native nephrectomy and timing of such procedure in ADPKD patients being prepared for transplantation are debated. Even though pre-transplant nephrectomy has the potential to provide fewer infectious complications due to lack of immunosuppressive medication use, such procedure has been associated with longer hospital stay, loss of residual kidney function and need for dialysis. Although simultaneous nephrectomy and transplantation could potentially lead to longer perioperative duration, perioperative complications and need for blood transfusions, this was not confirmed in cohort studies. Therefore, some institutions routinely perform simultaneous unilateral nephrectomy and kidney transplantation. In this narrative review, our aim is to evaluate the current evidence regarding the need and timing of nephrectomy in ADPKD patients in relation to kidney transplantation.

Imlifidase in kidney transplantation.

Kidney transplantation, the gold-standard therapeutic approach for patients with end-stage kidney disease, offers improvement in patient survival and quality of life. However, broad sensitization against human leukocyte antigens often resulting in a positive crossmatch against the patient's living donor or the majority of potential deceased donors in the allocation system represents a major obstacle due to a high risk for antibody-mediated rejection, delayed graft function and allograft loss. Kidney-paired donation and desensitization protocols have been established to overcome this obstacle, with limited success. Imlifidase, a novel immunoglobulin G (IgG)-degrading enzyme derived from Streptococcus pyogenes and recombinantly produced in Escherichia coli, is a promising agent for recipients with a positive crossmatch against their organ donor with high specificity towards IgG, rapid action and high efficacy in early pre-clinical and clinical studies. However, the rebound of IgG after a few days can lead to antibody-mediated rejection, making the administration of potent immunosuppressive regimens in the early post-transplant phase necessary. There is currently no comparative study evaluating the efficiency of imlifidase therapy compared with conventional desensitization protocols along with the lack of randomized control trials, indicating the clear need for future large-scale clinical studies in this field. Besides providing a practical framework for the clinical use of the agent, our aim in this article is to evaluate the underlying mechanism of action, efficiency and safety of imlifidase therapy in immunologically high-risk kidney transplant recipients.

COVID-19 associated bacterial infections in intensive care unit: a case control study.

We described the secondary bacterial infections (SBI) among COVID-19 patients in comparison with non-COVID-19 patients. We performed a retrospective case-control study between January 01, 2020 and April 01, 2022. Including the adult patients, who stayed ≥ 72 h in intensive care unit (ICU). In total 405 patients were included, 135 had (33.3%) COVID-19, with similar age and gender. The length of stay in ICU was not different (11.4 vs 8.2, p = 0.109), however mean intubation days were higher among COVID-19 cases (6.5 vs 3.8, p = 0.005), SBI were more common among COVID-19 cases (34% vs 10.7%, p < 0.001). Among the patients with pneumonia, the rate of gram-positive bacteria was higher in COVID-19 group than the control group (39% vs 5%, p = 0.006). The predictors for SBI were having COVID-19 (OR: 2.3, Cl 1.25-4.32, p = 0.008), days of intubation (OR: 1.05, Cl 1.01-1.10, p = 0.004), and being male (OR: 2, Cl 1.12-3.58, p = 0.018). The predictors of mortality were COVID-19 (OR: 2.38, Cl 1.28-4.42, p = 0.006), days of intubation (OR: 1.06, Cl 1.03-1.09, p < 0.001), active hematologic malignancy (OR: 3.1, Cl: 1.33-7.28, p = 0.09), active solid tumors (OR: 2.44, Cl 1.21-4.91, p = 0.012), and coronary artery diseases (OR: 1.8, Cl 1.01-3.52, p = 0.045). The most common SBI in COVID-19 patients were methicillin-sensitive Staphylococcus aureus. No carbapenem-resistant Enterobacterales related infections were detected in COVID-19 patients.

The challenges in the monitoring of infectious diseases after the earthquake in Türkiye in 2023.

After the devastating earthquake in Türkiye and Syria in February, 2023, the long-term failure to meet the need for shelter, unfavourable living conditions in tent settlements, poor access to clean drinking water, water suitable for personal hygiene, and sanitary facilities, as well as interruptions in provision of primary health-care services, have emerged as the most important risk factors contributing to the spread of infectious diseases. 3 months after the earthquake, most of these problems persist in Türkiye. Data on the control of infectious diseases are scarce according to the reports prepared by medical specialist associations based on observations of health-care providers working in the region and statements made by the local health authorities. According to these unsystematised data, and considering the conditions in the region, faecal-oral transmissible gastrointestinal infections, as well as respiratory and vector-borne infections, are the main challenges. Vaccine-preventable diseases, such as measles, varicella, meningitis, and polio can be spread in temporary shelters due to interrupted vaccine services and crowded living conditions. In addition to controlling risk factors for infectious diseases, sharing data on the status and control of infectious diseases in the region with the community, health-care providers, and relevant expert groups should be a priority to improve the understanding of the effects of interventions and prepare for possible infectious disease outbreaks.

The Effect of Vaccination with Pfizer-BioNTech or CoronaVac on Disease Prognosis Among Hospitalized COVID-19 Patients.

Objective: The Turkish Ministry of Health offered two types of vaccines by January 13, 2021, which are CoronaVac (Sinovac Biotech, China) and Pfizer-BioNTech. We aimed to describe the impact of the CoronaVac and Pfizer-BioNTech vaccines on clinical outcomes among hospitalized patients during a six-month period. Methods: We included patients older than 18 years old and hospitalized because of COVID-19 when the vaccines were available. We conducted the study at Koç University Hospital and American Hospital between June 2021, six months after the vaccination started, and December 2021. Results: In total, 444 RT-PCR confirmed hospitalized patients were included. The mean age of the patients was 59 (standard deviation [SD]=18), and 42.8% were female. The most common comorbidity was hypertension (39%), followed by diabetes mellitus (27%), cardiovascular diseases (18.4%), chronic lung diseases (14.6%), cancer (9.2%), and chronic renal diseases (8%). In multivariate analysis, no vaccination (OR=4.7, CI=2.25-10.06; p<0.001), age >65 (OR=5.2, CI=2.25-11.98; p<0.001), cancer (OR=7.6, CI=3.04-19.31; p<0.001), and chronic kidney disease (OR=3.1, CI=1.14-8.74; p=0.026) significantly increased mortality in COVID-19 patients. Eighteen percent of patients were in the intensive care unit (ICU). One hundred eighty-one patients (40.8%) were non-vaccinated before their admission, and their mortality (17.6%) was higher compared to the patients who were vaccinated with at least one type of vaccine (p=0.002). None of the patients who received two doses of Pfizer-BioNTech vaccines died. Conclusion: Among the inpatients with COVID-19, the predictors for mortality were being unvaccinated, older age, cancer, chronic kidney disease, and cardiovascular diseases. Among the vaccinated inpatients, having two doses of the Pfizer-BioNTech vaccine was the only effective protective measure against mortality, and two doses of the CoronaVac vaccine had no significant effect in preventing fatality.

ANTIBACDUS-PAN: Antibacterial Utilization among Adult Patients Before and During COVID-19 Pandemic within 12-Months Period: A Tertiary Hospital Pharmacoepidemiology Study.

Objective: Irrational use of antibacterials is a concern during the COVID-19 pandemic. Hospital pharmacoepidemiology studies are important for evaluating the rational use of medicines, especially antibacterials, during pandemics. Defined daily doses (DDD) and drug utilization 90% (DU90%) are established methods for the evaluation of drug utilization. We aimed to evaluate antibacterial utilization in a tertiary hospital setting at Koç University Hospital (KUH). Materials and Methods: This cross-sectional, descriptive study was retrospectively conducted with data extracted from KUH Inpatient Electronic Order System (CP) and was carried out for a period of one year. Antibacterial utilization of adult (aged ≥ 18 years) inpatients, who were prescribed at least one type of systemic antibacterial (ATC code J01), was evaluated using the recommended parameter DDD/100 admission and compared between 6 months before COVID-19 and during COVID-19 periods. March 11, 2020, the very first COVID-19 diagnosed case in Turkey, was set as the cutoff date of the 6-month period for the selection of the compared antibacterials using the DU90% method. Results: Finally, 3280 of 5942 and 2605 of 4942 prescriptions for pre-COVID-19 and COVID-19 periods were included, respectively. Antibacterial utilization according to DDD/100 admissions increased from 193.96 to 201.26 DDD/100 admissions after the initiation of COVID-19 pandemic. The most utilized antibacterials were piperacillin and enzyme inhibitors in pre-COVID-19 period, whereas meropenem was utilized the most during COVID-19 period. Azithromycin utilization increased by 656.24%, whereas clarithromycin utilization decreased by 52.12%. Antibacterials were utilized most in general surgery department, with an increase of 17.57%. Conclusion: There is an increase in antibacterial utilization in KUH during COVID-19 pandemic, especially reserved antibacterials, which is a concern for antibacterial resistance.