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Objective: Neonatal cholestasis is a condition that begins in the first months of life and is accompanied by a direct increase in bilirubin and jaundice as a result of deterioration in bile production or excavation. Early and accurate diagnosis is important for treatment success and prognosis. In this study, we aimed to examine the demographic characteristics, etiological factors, clinical signs, treatment and final conditions of patients monitored for neonatal cholestasis and to determine the etiological factors of liver transplant patients. Methods: Patients who were diagnosed with cholestasis in the neonatal period (<6 months) and followed up in our clinic for at least six months between January 2005 and January 2018 were included in the study. The clinical course and final status of the patients were recorded retrospectively. Results: The median age of onset of jaundice in 131 patients (61.1% male) enrolled in the study was 6 days (range: 1-180 days). Ninety-nine (75.6%) patients were in the intrahepatic cholestasis group, and 32 (24.4%) were in the extrahepatic cholestasis group. In the intrahepatic cholestasis group, total parenteral nutrition-related cholestasis (27.3%) was the most common, and biliary atresia (71.9%) was the most common in the extrahepatic cholestasis group. Other main reasons were systemic (19.1%), metabolic (12.2%), hereditary cholestatic diseases (9.9%) and infectious (7.6%) causes. The median time of Kasai portoenterostomy in patients with biliary atresia was 64 days (range: 28-180 days). The highest (44%) mortality rate was in the patients with systemic disease-related cholestasis. Liver transplantation (n=21, 16%) was the most frequently performed in patients with biliary atresia. Conclusion: Early diagnosis and timely treatment are very important for the optimal prognosis in neonatal cholestasis. The presence of acholic stools, maturity, early onset of jaundice and high gamma-glutamyl transferase levels should suggest biliary atresia. Early surgical treatment is warranted once the diagnoses was made, and liver transplantation is a treatment method that increases survival rate in these patient groups. [ABSTRACT FROM AUTHOR]

Giriş: Organ nakli bekleyen hasta sayısı her yıl giderek artmaktadır. Hepatit B pozitif olan bireylerin organ vericisi olabilmesi umut vadedicidir. Ancak hepatit B virüsünün (HBV) bulaşma riski bir sorun olmaya devam etmektedir. Standart donörlerle karşılaştırıldığında benzer uzun vadeli sonuçlara rağmen bu durum özellikle hepatit B yüzey antijeni (HBsAg) pozitif donörler için geçerlidir. HBV bulaşma riskini azaltmak için donör riskinin değerlendirilmesi, alıcının aşılanması, uygun immünosüpresif rejim planlanması, profilaktik tedavinin optimize edilmesi ve nakil sonrası izlem gibi kapsamlı bir yaklaşıma ihtiyaç vardır. Olgumuz uygun profilaktik tedaviye ve aşılanmaya rağmen renal nakilden 8 sene sonra gelişen HBV enfeksiyonunu göstermektedir. Olgu: Bilinen hipertansiyon, nörojenik mesane, kronik böbrek yetmezliği (KBY), paratiroid adenom tanıları olan 48 yaşında kadın hastaya Aralık 2015 yılında eşinden renal nakil yapılmıştır. Rutin kullandığı ilaçlar içinde takrolimus, mikofenolik asit, prednisolon vardır. Donörde HBV enfeksiyonu olması nedeniyle nakil hastası HBV için aşılanmış ve 2015 yılında entekavir 1x0,5 mg oral başlanmıştır. Hasta dış merkezde belli aralıklarla karaciğer fonksiyon testleri, HBsAg ve HBV-DNA ile takip edilmiş ve takiplerinde bu değerler normal sınırlarda seyretmiştir. Kasım 2021 yılında tetkiklerinde kreatinin 1,48 mg/dl ve GFR 42 ml/dk olması üzerinde entekavir günaşırı 0,5 mg olarak düzeltilmiştir. Kasım 2023 yılında yapılan tetkiklerinde HBV-DNA 9412 IU/ml, anti-HBs 128 mIU/ml, HBc IgG negatif, HBsAg negatif, HBeAg negatif, anti-HBe negatif olarak saptanmıştır. Hastanın mevcut tedaviye rağmen HBV-DNA pozitifleşmesi ve KBY olması nedeniyle tedavisi tenofovir alefenamid 1x25 mg peroral olarak değiştirilmiştir. Bir ay sonra rutin kontrolünde HBVDNA saptanmamış ve karaciğer enzim değerlerinin normal bulunmuştur. Hasta mevcut tedavi ile kontrol altında devam etmektedir. Sonuç: Donördeki HBV enfeksiyonu, alıcı için bir risk faktörü olmasına rağmen donör ve alıcının HBV durumuna dikkat edilerek ve önleyici tedavi kullanarak HBV enfeksiyon riski en aza indirilebilir. Önceden HBV öyküsü olmayan ve donör HBV pozitif olan nakil hastaları aşılamadan ve profilaktik tedaviden bağımsız olarak de novo enfeksiyon gelişimi riski ve hızlı müdahale şansını yakalamak açısından yakından takip edilmelidir. HBsAg negatif olmasına rağmen HBV-DNA pozitifliğinin görülebileceği akılda tutulmalı ve HBV-DNA değerleri şüphe halinde yakın takip edilmelidir. Ayrıca KBY olan hastalarda, nefrotoksik olmaması ve ilaç doz düzenlenmesi gerektirmemesi nedeniyle tenofovir alafenamidin uygun bir seçenek olduğu aklında tutulmalıdır. [ABSTRACT FROM AUTHOR]

Introduction: BK virus (BKV) and cytomegalovirus (CMV) infections are common in renal transplant patients. In this retrospective study, we investigated the frequency of BKV and CMV infections and their effects on graft. Materials and Methods: The data of 118 renal transplant recipients who were transplanted and followed-up between January 2010 and January 2011 were reviewed. Demographic characteristics, biochemical data, BKV and CMV DNA levels by polymerase chain reaction (QIAGEN, Hilden, Germany) were investigated. The patients were followed-up monthly in the first six months and then every three months. Results: A total of 118 patients were included in the study. BK viraemia was detected in 12 (10.2%) patients and the DNA level of BKV was >104 copies/mL in five cases. Three patients with elevated creatinine and compatible renal biopsy findings were considered to have BKV-associated nephropathy (BKVAN). With the reduction of immunosuppressive treatment, viraemia was reduced and creatinine levels decreased within normal levels. Cytomegalovirus DNA was found to be positive in 23 (19.5%) patients, and was >500 copies/mL in 4 (3.4%) patients. The viraemia in these four patients has decreased after antiviral therapy. No CMV related disease were found in any of the patients. Cytomegalovirus DNA positivity at low levels were also detected in three patients who were diagnosed with BKVAN. None of the patients developed rejection. Conclusion: BK and CMV infections in kidney transplant patients are common and can be seen together. However, graft dysfunction and rejection rates are low with close monitoring, early diagnosis and treatment. Randomized, controlled studies with larger patient groups are necessary in order to determine the viral threshold levels associated with graft dysfunction or rejection, to decide the optimal management and to explain the role of concomitant infection. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to determine the rate and causes of wastage of blood and blood products (packed red cells, plasma, platelets, and cryoprecipitate) in Qazvin hospitals. Materials and Methods: The study was conducted in all hospitals in Qazvin, including 5 teaching hospitals, 2 social welfare hospitals, 3 private hospitals, 1 charity hospital, and 1 military hospital. This descriptive study was based on available data from hospital blood banks in the province of Qazvin. The research instrument was a 2-part questionnaire. The first part was related to demographic characteristics of hospitals and the second part elicited information about blood and blood component wastage. The collected data were then analyzed using descriptive statistic methods and SPSS 11.5. Results: Blood wastage may occur for a number of reasons, including time expiry, wasted imports, blood medically or surgically ordered but not used, stock time expired, hemolysis, or miscellaneous reasons. Data indicated that approximately 77.9% of wasted pack cell units were wasted for the reason of time expiry. Pack cell wastage in hospitals is reported to range from 1.93% to 30.7%. Wastage at all hospitals averaged 9.8% among 30.913 issued blood products. Overall blood and blood product (packed red cells, plasma, platelets, and cryoprecipitate) wastage was 3048 units and average total wastage per participant hospital for all blood groups was 254 units per year. Conclusion: Blood transfusion is an essential part of patient care. The blood transfusion system has made significant advancements in areas such as donor management, storage of blood, cross-matching, rational use of blood, and distribution. In order to improve the standards of blood banks and the blood transfusion services in Iran, comprehensive standards have been formulated to ensure better quality control in collection, storage, testing, and distribution of blood and its components for the identified major factors affecting blood product wastage. [ABSTRACT FROM AUTHOR]

Objective: In this study, we have examined the ambulance working order in the 3 years period between the years 2006-2008 in Gaziantep city. Materials and Methods: In this study, the number of personel working in 112 ambulances, daily number of emergency exit patients, period of time of arrival of patients and arrival at the nearest medical institution, transfer of patients according to their illness, range of cases according to sex and age, population per station and automatisation between 112 emergency command centers and hospitals have been examined. Results: According to gender, the number of male cases were found to be more than female cases. Female case number above 65 years old has been found greater than the male cases. The highest case number has been found in the 6-25 years old group for males and above 65 years old for females. It was determined that the case number is increasing every year. The reason for calls was determined as 54.6% medical cases and 16.3% traffic cases. According to pre-diagnosis, it was determined that trauma cases decreased and the cases concerning cardiovascular system increased gradually. It was seen that a great majority of the cases were reached within the first 20 minutes. It was seen that ambulance emergency exits comprised 62.5% hospital transfer, 13.5% timely intervention and 9.5% transfer inter-hospitals. It has been determined that ambulance exit numbers were increasing every passing year. Conclusion: With this study it is concluded that planning should be done to prevent delay in reaching emergency cases due to the increase in ambulance usage and also it was determined that the communication between command centers and inter-hospitals should be at the maximum level in order to minimize the delay period during transfer to hospitals, and frequent updates of used and empty bed lists of hospitals should be made. [ABSTRACT FROM AUTHOR]