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Background and Aim: Many clinical studies have shown that the COVID-19 case fatality rate is higher in older patients, those with comorbidities, those with immunosuppressive conditions, and those who stay in the intensive care unit. This study aims to evaluate the clinical outcomes of 66 liver transplant (LT) patients with primary liver cancer who were exposed to COVID-19 infection., Methods: Demographic and clinical data of 66 patients with primary liver cancer (hepatocellular carcinoma = 64, hepatoblastoma = 1, cholangiocarcinoma = 1) who underwent LT in our institute and were exposed to COVID-19 infection between March 2020 and November 2021 were analyzed in this cross-sectional study. The following data of the patients were recorded: age, sex, body mass index (kg/m 2 ), blood group, underlying primary liver disease, smoking, tumor characteristics, post-transplant immunosuppressive agents, COVID-19 symptoms, hospitalization, intensive care unit stay, intubation, and other clinical features., Results: There were 55 (83.3%) male and 11 (16.7%) female patients, with a median age of 58 years. Sixty-four patients were exposed to COVID-19 only once, whereas the remaining 2 patients were exposed 2 and 4 times, respectively. After exposure to COVID-19, it was determined that 37 patients used antiviral drugs, 25 were hospitalized, 9 were followed in the intensive care unit, and 3 were intubated. One intubated patient was under hospital follow-up because of biliary complications before exposure to COVID-19, and this patient died from sepsis., Conclusion: The low mortality rate of LT patients with primary liver cancer exposed to COVID-19 infection can be attributed to background immunosuppression that prevents cytokine storm. However, it is appropriate to support this study with multicenter studies to make strong comments on this issue., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: The primary aim of this study was to compare liver transplant (LT) recipients with and without hepatocellular carcinoma (HCC) in terms of COVID-19-related depression, anxiety, and stress., Method: A total of 504 LT recipients with (HCC group; n = 252) and without HCC (non-HCC group; n = 252) were included in the present case-control study. Depression Anxiety Stress Scales (DASS-21) and Coronavirus Anxiety Scale (CAS) were used to evaluate the depression, stress, and anxiety levels of LT patients. DASS-21 total and CAS-SF scores were determined as the primary outcomes of the study. Poisson regression and negative binomial regression models were used to predict the DASS and CAS scores. The incidence rate ratio (IRR) was used as a coefficient. Both groups were also compared in terms of awareness of the COVID-19 vaccine., Results: Poisson regression and negative binomial regression analyses for DASS-21 total and CAS-SF scales showed that the negative binomial regression method was the appropriate model for both scales. According to this model, it was determined that the following independent variables increased the DASS-21 total score: non-HCC (IRR: 1.26; p = 0.031), female gender (IRR: 1.29; p = 0.036), presence of chronic disease (IRR: 1.65; p < 0.001), exposure to COVID-19 (IRR: 1.63; p < 0.001), and nonvaccination (IRR: 1.50; p = 0.002). On the other hand, it was determined that the following independent variables increased the CAS score: female gender (IRR:1.75; p = 0.014) and exposure to COVID-19 (IRR: 1.51; p = 0.048). Significant differences were found between the HCC and non-HCC groups in terms of median DASS-21 total ( p < 0.001) and CAS-SF ( p = 0.002) scores. Cronbach's alpha internal consistency coefficients of DASS-21 total and CAS-SF scales were calculated to be 0.823 and 0.783, respectively., Conclusion: This study showed that the variables including patients without HCC, female gender, having a chronic disease, being exposed to COVID-19, and not being vaccinated against COVID-19 increased anxiety, depression, and stress. High internal consistency coefficients obtained from both scales indicate that these results are reliable.

Objective: Patients with chronic disease whose treatments are limited may experience depression, anxiety, and stress-related symptoms, as well as an increase in the levels of these conditions. This study aims to determine the factors affecting the depression, stress, and anxiety levels of hepatocellular carcinoma (HCC) patients due to the fear of COVID-19 exposure., Patients and Methods: 118 patients with advanced HCC treated with non-transplant treatment options or on the waiting list due to the lack of a donor were enrolled. To evaluate the stress, depression, and anxiety levels during the COVID-19 process, Depression Anxiety Stress Scales (DASS-21) and the Coronavirus Anxiety Scale (CAS) were administered to 118 patients through a face-to-face interview. Sociodemographic and clinical characteristics were recorded, and the primary endpoint measure was the total score of DASS. In addition, the multilayer perceptron (MLP) model was constructed to predict the scores of the DASS-21 total., Results: There were significant differences between DASS depression (p=0.010; p=0.030) DASS anxiety (p=0.010; p=0.010) and DASS total (p=0.046; p=0.023) scores in terms of gender and protective effect of the vaccine. Also, a significant difference between gender for the CAS scale was determined (p=0.044). The median score of the DASS total in the COVID-19 group was higher than in the non-COVID-19 group; however, the increase was not significant. MLP model revealed that chronic disease, gender, age, place of residence, smoking, type of vaccine, and COVID-19 exposure were the most important predictors for the DASS total., Conclusions: Chronic disease, gender, and age were prominent factors in predicting the DASS-21 total score in HCC patients. Therefore, the crucial factors were clinically considered for managing depression, stress, and anxiety in HCC patients.

Objective: The aim of this study was to assess the knowledge, attitudes, and practices of nurses in Turkiye concerning organ donation., Methods: This survey-based, descriptive cross-sectional study was conducted from January 2020 to March 2020, recruiting 560 of 850 nurses currently working in a tertiary university hospital with a face-to-face interview technique. The questionnaire consisted of 35 questions evaluating sociodemographic features, organ donation knowledge level, attitude, and nurses' awareness., Results: This study showed that only 6.5% of the nurses donated their organs. While 31.9% stated that they are willing to consider organ donation in the future, 41.3% were not decided about organ donation yet, and 27% rejected organ donation in any condition. Among the nurses who refused organ donation, 69.6% had no specific reason and 10.6% worried that their organs might be taken without proper diagnosis of brain death. About 10% denied organ donation for religious beliefs, and 5% were because of concerns about body integrity. Hesitation about procuring organs for commercial purposes was present in 7.2% of the nurses. Following a possible diagnosis of brain death of a relative, 33.8% of the nurses said that they would consent for organ donation to him/her, whereas 47.1% were not sure about this issue. Among the nurses, 76.6% agreed on a possible living-related organ donor for a close relative, 53.3% accepted receiving an organ from a close relative if required. Furthermore, this investigation showed that nurses who reported attending previous seminars, conferences, or training programs about organ donation have significantly better donation rates and stronger attitudes toward organ donation. Nurses who donated their organs are found to know better about brain death irreversibility, understand better the related national legal regulations for organ donation, and are more informed about the compatibility of organ donation with religious beliefs., Conclusion: This study showed that nurses have a relatively positive attitude toward donation and transplantation but are unwilling to bequeath their organs. This study underlines the indispensable contribution of nurses promoting organ donation and highlights the need for well-structured educational programs to enhance their role in organ donation and transplantation., Competing Interests: No conflict of interest was declared by the authors., (© Copyright 2022 by Istanbul Provincial Directorate of Health.)

It is important to vaccinate individuals working in the field of health who are more at risk compared to society during the pandemic period. The aim of this study was to evaluate the vaccine hesitancy and anxiety levels of hospital cleaning staff and caregivers during the COVID-19 pandemic. This descriptive type cross-sectional study was conducted with 460 hospital cleaning staff and caregivers. Demographic and social characteristics form, Coronavirus Anxiety Scale (CAS), and Vaccine Hesitancy Scale (VHS) adapted to the pandemic were used in the questionnaire form used to collect the data of the study. It was determined that the rates of hesitation against the COVID-19 vaccine and childhood vaccine were 42.2% (n = 194) and 10.9% (n = 50), respectively. Less than half of the participants (44.6%) believe that the COVID-19 vaccine is protective. COVID-19 anxiety (CAS score ≥ 9 point) was detected in 19.6% of participants and statistically significant differences were found between patients with (n = 90) and without (n = 370) anxiety regarding gender (p < 0.001), working unit (p = 0.002), vaccination status (p = 0.023) and history of psychological disease (p = 0.023). It has been shown that the VHS-total scores of those who are not vaccinated, those who are hesitant about vaccination, those who do not think that the vaccine is protective, and those who state that there is no need for a legal obligation in vaccination are higher. When participants were asked about the most anxious situation during the COVID-19 period, the highest response rate was 62.4% for my parents’ exposure to COVID-19. The most anxious situation among participants is their parents’ exposure to COVID-19. Although participants are highly vaccinated, they have serious hesitancy about the COVID-19 vaccine. This study also showed that there was a parallel relationship between COVID-19 anxiety and vaccine hesitancy.

Objective: This survey study aimed to evaluate medical students' attitudes, knowledge, and awareness toward organ donation., Methods: For this questionnaire-based cross-sectional study, 1000 medical students were interviewed, out of which 950 students agreed to participate in the study and were enrolled. A questionnaire form consisting of 29 questions was used to determine the students' socio-demographic characteristics and rate their knowledge, attitudes, and behaviors about organ donation., Results: While 95.5% (n = 907) of the students stated that they had not donated organs, 41.1% stated that they had not yet decided to donate organs, and 59.7% stated that they had no specific reason for them not donating organs. Out of the participants, 68.1% stated that organ donation complies with the Islamic rules; 40.7% stated that the Directorate of Religious Affairs issued a fatwa on organ donation, and 39.4% stated that there are legal regulations on organ donation in the country. While 22.1% of the students stated that a person with brain death could come back to life, 19.7% stated that they did not know about this issue. The students who had donated organs and who did not show significant differences regarding the answers given to the questions about whether organ donation complies with religious rules (p < 0.001), where one must apply to donate organs (p = 0.032), the will to donate the organs of a relative with brain death (p = 0.004), and whether preaching in mosques and foundations is needed to increase organ donation rates (p = 0.042). Although there was a correlation between the students' grade and their attitude and knowledge about organ donation, this correlation was weak and showed no parallelism with increasing grades., Conclusion: This study indicates that medical students have inadequate knowledge, attitudes, and behaviors about organ donation. In our opinion, it is of paramount importance to provide physician candidates, who should set an example for society, with periodic training on organ donation throughout their academic life in shaping the national organ donation policy in the future., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background and Aim: The most important factors affecting organ donation are socioeconomic, educational, and cultural factors. The aim of this study was to evaluate the attitudes, knowledge levels, and behaviors of school teachers toward organ donation METHODS: This study surveyed 2400 school teachers working in official public schools. Turkey was divided into 26 regions based on the similarity of social, economic, and geographic factors identified by the Turkish Statistical Institute. Teachers were distributed equally in the city center and towns based on population. The survey procedures were carried out using computer-assisted personal interviewing., Results: Among teachers, 89.6% had a bachelor's degree and 8.5% had a master's degree. In addition, 32.5% worked in primary schools, 33.1% worked in secondary schools, and 34.4% worked in high schools. Furthermore, 0.7% had donated an organ; 66.5% were not considering organ donation in the future, of whom 9.0% indicated religion as the reason for not donating an organ, and 34.8% did not indicate any reason. In addition, 96.6% considered organ donation to be proper behavior for humanity and 68% believed that organ donation is appropriate in religious terms., Conclusions: This study showed that school teachers have inadequate knowledge and attitudes toward organ donation. Encouraging children and adolescents to make a well-informed decision about organ donation and to register this choice will depend largely on preparing school teachers with adequate knowledge and motivation toward creating generations with a positive attitude toward organ donation., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Depression, anxiety, and altered self-care ability are among the most important factors affecting the quality of life of liver transplant recipients. Depending on the severity of the underlying liver disease, signs and symptoms of anxiety and depression may become more pronounced., Aim: To evaluate the factors affecting depression, anxiety and self-care abilities of liver transplant recipients., Methods: Recipients who are ≥ 18 years and who underwent liver transplantation at Inonu University Liver Transplantation Institute were included in this descriptive and cross-sectional study. Sample size analysis showed that the minimum number of recipients should be 301 (confidence level = 95%, confidence interval = 2.5, population = 1382). Three hundred and twenty recipients were interviewed and 316 recipients that have answered the questionnaires accurately were analyzed. The dependent variables were the Beck Depression Scale, State-Trait Anxiety Scale (Form I and II), and Self-Care Agency Scale. The independent variables of the study were sociodemographic characteristics, biliary complications, hepatocellular carcinoma, recommending liver transplantation to other patients, and the interval of out-patient clinic visits., Results: Self-care ability scores were lower ( P = 0.002) and anxiety scores were higher ( P = 0.004) in recipients with biliary complications. On the other hand, in recipients with hepatocellular carcinoma, self-care scores were lower ( P = 0.006) while depression ( P = 0.003) and anxiety scores ( P = 0.009) were higher. Liver transplantation recipients with a monthly income < 3000 Turkish liras had higher depression ( P < 0.001) and anxiety ( P = 0.003) scores. The recipients who stated that they would not recommend liver transplantation to others had lower self-care scores ( P = 0.002), higher depression ( P < 0.001), higher state anxiety ( P = 0.02), and trait anxiety ( P < 0.001) scores., Conclusion: Presence of biliary complications and hepatocellular carcinoma, low income level, and an obligation for monthly visits to the outpatient clinic are factors that are found to affect self-care capability, depression, and anxiety., Competing Interests: Conflict-of-interest statement: The authors declare no conflicts of interest regarding this manuscript., (©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.)

Introduction: Complications in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) cause serious morbidity and mortality. Predicting patients at risk in advance and changing the symptomatic care and/or preparation regimen according to this risk assessment have been emphasized recently. Several single-nucleotide polymorphisms have been studied, and some were found to be responsible for early complications. Glutathione S-transferase P1 (GSTP1) is an enzyme involved in the detoxification process that reduces oxidative stress by reducing the number of free oxygen radicals., Aim: This study aimed to investigate the relationship between GSTP1 polymorphism and early complications of allo-HSCT, iron parameters, overall survival (OS), and transplantation-related mortality (TRM)., Materials and Methods: A total of 50 patients diagnosed with acute myeloid leukemia (n = 23) or acute lymphoblastic leukemia (n = 27) who underwent allo-HSCT between May 2008 and February 2011 at Gazi University Faculty of Medicine, Stem Cell Transplantation Unit, were included., Results: Of the 50 patients, 24 (48%) were women and 26 (52%) were men. The median age of the patients was 26 (16-74) years. GSTP1 polymorphism was detected in 23 (46%) patients, and 27 (54%) had no polymorphism (wild type). The two groups were compared in terms of early toxicity after transplantation, according to the preparation regimen. The group with GSTP1 polymorphism was found to have a high transferrin saturation index (P < 0.05). Patients with no GSTP1 polymorphism showed a high grade III-IV anemia ratio (P < 0.05). The presence of sinusoidal obstruction syndrome and graft-versus-host disease was similar in both groups (P > 0.05). OS and TRM were higher in the GSTP1 polymorphism group, but no statistical difference was found between the two groups (P > 0.05)., Conclusions: TSI was higher in the GSTP1 polymorphism group. GSTP1 polymorphism had no effect on early transplantation complications. Although the OS and TRM ratios were higher in the GSTP1 polymorphism group, no statistically significant difference was found between the groups. Further studies with larger sample size are needed., Competing Interests: None

Aim: The aim of the to determine the risk factors associated with increased risk of peptic ulcer perforation (PUP)., Material and Methods: The demographic, clinic, and biochemical parameters of 65 patients (PUP group) who underwent PUP surgery at our clinic between June 2009 and September 2016 were compared with the data of 134 patients (control group) who underwent endoscopy at a gastroenterology clinic for dyspeptic complaints. The control group were matched at random in a 1 : 2 ratio with the PUP group. Univariate analyses were used to compare different variables and variables with clinical significance, and p ≤ 0.05 was used in the backward stepwise logistic regression model., Results: This study included 65 patients with peptic ulcer perforation aged 17 to 92 years (PUP group) and 134 patients with dyspeptic complaints aged 18 to 87 years (control group). Univariate analysis showed that statistically significant differences were found between groups in terms of non-steroidal anti-inflammatory drugs usage ( p = 0.042; OR = 1.868), smoking ( p < 0.001; OR = 5.124), old age ( p = 0.003), low body mass index (BMI) ( p < 0.001), and low hemoglobin (Hb) ( p = 0.002). However multivariate analysis showed that increasing age ( p = 0.004; OR = 1.035), smoking ( p = 0.007; OR = 3.591), decreasing Hb ( p = 0.042; OR = 1.277), and decreasing BMI ( p < 0.001; OR = 1.669) were independent clinically significant risk factors for development of PUP., Conclusions: This study showed that decreased BMI, decreased Hb, increased age, and smoking were independent risk factors for development of PUP. Thus, this group of patients needs particular attention paid to suggestive symptoms with early diagnosis and optimal management of peptic ulcer disease., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Termedia.)

Background: With advancements in the treatment of chronic liver disease (CLD), including liver transplantation (LT), quality of life and satisfaction after LT have become an important issue for pediatric patients and their parents. More evidence-based information is needed to describe and assess the impact of pediatric CLD on parents and the satisfaction of parents with treatment to better understand their needs., Aim: To assess the satisfaction of parents of pediatric LT patients and that of parents of pediatric CLD patients., Methods: During this survey, data were collected from parents of pediatric patients who underwent LT between January 2010 and April 2017 (LT group; n = 91) and parents of pediatric patients with chronic liver disease (CLD group; n = 94). Group comparisons were made based on the pediatric health-related quality of life (PedsQL) health care parent satisfaction scale, impact on family scale (IFS) and demographic characteristics. The PedsQL was administered to parents during a phone interview and the results were used to assess the health care-related satisfaction of parents. The IFS was used to assess the impact of the child's CLD status on the family. Demographic variables such as education level (elementary vs middle vs high vs university), monthly income (low vs middle vs high), and place of residence (village vs town vs city) were compared between CLD and LT parent groups. Finally, PedsQL and IFS results were also analyzed according to demographic variables., Results: A total of 185 parents aged 19 to 65 years were included. There were statistically significant differences between the LT and CLD groups in terms of career ( P < 0.001), monthly income ( P = 0.016), and education level ( P = 0.041). According to the PedsQL results, family inclusion, communication, technical skills, emotional needs, and overall satisfaction were significantly different between the groups; the LT group had consistently higher scores ( P < 0.001). Additionally, scores for the IFS parameters of financial impact, familial-social impact, personal strain, and total impact were consistently higher for the LT group ( P < 0.001). There were statistically significant relationships between education level, monthly income, and place of residence according to the IFS results but not the PedsQL results. There were inverse relationships between the difficulties that parents experience because of their child's health and education levels, monthly income, and place of residence. However, no relationship was found between education level, monthly income, or place of residence and satisfaction with health care services provided in the hospital according to the PedsQL results., Conclusion: Parents of children who underwent LT were very satisfied with the health care services provided to their children. However, they had more difficulties than parents of children with CLD., Competing Interests: Conflict-of-interest statement: The authors declare no conflicts of interest regarding this manuscript., (©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background: The most important factors affecting attitudes on organ donation are socioeconomic, educational, cultural, and religious factors in many countries., Aim: To evaluate the attitudes, awareness, and knowledge levels of the Turkish adult population toward organ donation., Methods: This nationwide study surveyed 3000 adults (≥ 18 years) in Turkey. To ensure a representative sample, the Nomenclature of Territorial Units for Statistics-II (modified for Turkey) was used. Turkey was divided into 26 regions based on social, economic, and geographic criteria as identified by the Turkish Statistical Institute. A stratified sampling method was used with an even distribution of adults across cities and towns based on population data. Data were collected by the PRP Research and Consultancy Company using computer-assisted personal interviews., Results: Out of 3000 individuals represented in the study population, 1465 (48.8%) were male and 1535 (51.2%) female. The results showed that most participants were under 45 years (59.0%) and married (72.1%), some had a bachelor's degree or higher (21.9%), and very few (1.5%) had any direct experience with organ transplantation - whether in the family, or a family member on a transplantation waiting list. Most of the study population (88.3%) had not considered donating an organ, however, most (87.9%) said that they would accept an organ from a donor if they needed one. Among the individuals surveyed, 67% were willing to donate an organ to a close relative, while 26.8% would donate an organ to an unrelated person. Only 47.2% said they had adequate information about brain death, and 85.2% refused to consent to donating organs of family members declared brain dead. Only 33.9% thought they had adequate information about organ donation. The main source of information was the television. The two main reasons for refusing organ donation were that it was too soon to think about organ donation and the importance of retaining the integrity of the dead person's body., Conclusion: This study showed that Turkey's adult population has inadequate knowledge about organ donation. The study advocates for public education programs to increase awareness among the general population about legislation related to organ donation., Competing Interests: Conflict-of-interest statement: The authors declare no conflicts of interest regarding this manuscript., (©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background: The most important factors affecting the decision of organ donation are socioeconomic, educational, cultural, and religious factors., Aim: To evaluate Islamic religious officials' attitudes and behaviors toward and level of knowledge on organ donation and transplantation., Methods: This study surveyed 2350 Islamic religious officials in Turkey. To ensure a representative sample, we used and modified the Nomenclature of Territorial Units for Statistics. Based on the Nomenclature of Territorial Units for Statistics-II, Turkey was divided into 26 regions. The number of Islamic religious officials in each city and town in each of the 26 regions was proportionate to the population. A stratified sampling method based on demographic factors, such as age, marital status, and educational level, was used. Data were collected by PRP Research and Consultancy Company using computer-assisted personal interviewing., Results: Of the 2350 religious officials surveyed, 59.9% were in the age group of 35-54 years; 84.7% had either a bachelor's or a master's degree; 99.7% never donated an organ; and 75.4% were not considering donating in the future. About 22% of the religious officials said religious belief was their reason for not donating; 45.3% did not indicate any reason. Although 41.5% of participants considered cadaveric organ donation as the best source of organ transplantation, 36.3% deemed living donor transplantation as the best option. Meanwhile, 52.9% of participants considered donating an organ from a brain dead relative in case they were asked for permission; 80.1% considered donating to a relative, if necessary; 81.6% considered undergoing organ transplantation, if necessary. About 83.7% of participants deemed organ donation as a proper human behavior; 60.5% believed that it is allowed by Islam; 55% said they preach for organ donation at their mosque; and 41.1% said their views of organ donation were influenced by their leaders in society., Conclusion: Religious officials are unsure whether or not organ donation is respectful of their religious belief, but they consider donating an organ if a relative need to undergo organ transplantation., Competing Interests: Conflict-of-interest statement: The authors declare no conflicts of interest regarding this manuscript., (©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.)

Familial Mediterranean fever (FMF) is an important and preventable cause of chronic kidney disease due to secondary amyloidosis. Although colchicine is the first-line therapy in patients with FMF with 60% to 65% complete remission rates, 5% to 10% of patients are colchicine-resistant and 5% to 10% of them are intolerant to the therapy. Anti-interleukin-1 agents, such as anakinra and canakinumab, are safe and efficient therapeutic options in patients with colchicine resistance or intolerance. However, the data on management of these targeted agents is limited in recipients of kidney transplant (RKT). In this case series, we aim to share our experience on canakinumab therapy of 4 RKTs with FMF-related amyloidosis, who were followed up in our clinic between 2010 and 2017. All of the 4 patients with end-stage renal disease were colchicine- resistant and on other alternative therapies, which provided poor disease control. For efficient control of secondary amyloidosis, canakinumab therapy was initiated in 1 of the patients before the renal transplant, and for the remaining patients after renal transplant. Any serious adverse effect, development of proteinuria, or graft dysfunction has not been observed in any of the patients. Under the canakinumab treatment, complete clinical responses, prevent typical familial Mediterranean fever attacks with fever and arthritis and abdominal pain, normalized serum amyloid A and C-reactive protein levels were achieved in all patients. Canakinumab treatment is a safe and effective therapeutic option for RKTs with FMF who are resistant or intolerant to colchicine and anakinra., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: High panel-reactive antibody (PRA) levels limit patients' access to kidney transplantation from potential living donor candidates and decrease renal graft survival by causing acute antibody-mediated rejection (AAMR). In this article, we report our experiences about the efficiency of plasmapheresis (PP) and intravenous immunoglobulin (IVIG) in reduction of serum PRA levels in candidates for renal transplantation and in patients with AAMR., Methods: We examined retrospectively 47 patients with high PRA levels (18 for desensitization (DS) and 29 with AAMR) at Ankara University. The reduction in PRA class 1 and PRA class 2 levels before and after the PP, IVIG, and rituximab or eculizumab therapy were evaluated., Results: In the DS group, mean reduction in PRA class I ± SD was 28.0 ± 9.10 to 22.1 ± 8.14 (P <.05), and mean reduction in PRA class II ± SD was 40.3 ± 6.89 to 32.2 ± 5.68 (P < .05). In the AAMR group; mean reduction in PRA class I ± SD was 23.9 ± 9.56 to 17.8 ± 8.64 (P > .05), and mean reduction in PRA class II ± SD was 28.1 ± 8.37 to 26.7 ± 7.96 (P > .05). In total, mean reduction in PRA class I was 25.7 ± 6.66 to 19.7 ± 6.00 (P < .01). Mean reduction in PRA class II was 33.8 ± 5.93 to 29.2 ± 4.96 (P > .05). In the DS group, 3 (16.7%) patients were treated with rituximab. In the AAMR group, 9 (31.0%) patients were treated with rituximab, and 1 (5.5%) patient received eculizimab.In the DS group, the mean follow-up period in years ± SD was 5.06 ± 3.01 and no patient had graft loss. In the AAMR group, the mean follow-up period in years was 5.06 ± 2.74 and 6 (33.3%) patients had graft loss with acute rejection., Conclusions: PP and IVIG treatment provide significant reduction in PRA levels and can be used in DS protocols., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Understanding micro-seismicity is a critical question for earthquake hazard assessment. Since the devastating earthquakes of Izmit and Duzce in 1999, the seismicity along the submerged section of North Anatolian Fault within the Sea of Marmara (comprising the "Istanbul seismic gap") has been extensively studied in order to infer its mechanical behaviour (creeping vs locked). So far, the seismicity has been interpreted only in terms of being tectonic-driven, although the Main Marmara Fault (MMF) is known to strike across multiple hydrocarbon gas sources. Here, we show that a large number of the aftershocks that followed the M 5.1 earthquake of July, 25 th 2011 in the western Sea of Marmara, occurred within a zone of gas overpressuring in the 1.5-5 km depth range, from where pressurized gas is expected to migrate along the MMF, up to the surface sediment layers. Hence, gas-related processes should also be considered for a complete interpretation of the micro-seismicity (~M < 3) within the Istanbul offshore domain.