SUMMARY PURPOSE In this prospective observational study, we aimed to investigate the role of the maximum compressed (MC) and uncompressed (UC) thickness of the quadriceps femoris muscle (QFMT) measured by ultrasonography (USG) in the detection of nutritional risk in intensive care patients (ICPs) with different volume status. METHODS 55 patients were included. Right, left, and total ucQFMT and mcQFMT measurements were obtained by a standard USG device within the first 48 hours after ICU admission. Clinical examination and the USG device were used to determine the volume status of the patients. SOFA, APACHE II, modified NUTRIC scores, and demographic data were collected. RESULTS There was a significant difference between the nutritional risk of patients in terms of left, right, and total mcQFMT measurements (p=0.025, p=0.039; p=0.028, respectively), mechanical ventilation requirement (p=0.014), presence of infection (p=0.019), and sepsis (p=0.006). There was no significant difference between different volume statuses in terms of mcQFMT measurements. In the multi-variance analysis, mcQFMT measurements were found to be independently associated with high nutritional risk (p=0.019, Exp(B)=0.256, 95%CI=0.082-0.800 for modified NUTRIC score ≥ 5), and higher nutritional risk (p=0.009, Exp(B)=0.144, 95%CI=0.033-0.620 for modified NUTRIC score ≥ 6). a Total mcQFMT value below 1.36 cm was a predictor for higher nutritional risk with 79% sensitivity and 70% specificity (AUC=0.749, p=0.002, likelihood ratio=2.04). CONCLUSION Ultrasonographic measurement of total mcQFMT can be used as a novel nutritional risk assessment parameter in medical ICPs with different volume statuses. Thus, patients who could benefit from aggressive nutritional therapy can be easily identified in these patient groups.

Background Kidney transplantation (KT) recipients are at increased risk of low bone density (LBD) and fractures. In this retrospective study, we investigated bone mineral density (BMD), vertebral fractures, calculated risk for major osteoporotic fractures (MOF), and hip fractures in the KT recipients. Patients-method Patients who completed at least one year after KT were included in the analysis. Demographic, clinical, and laboratory data were recorded. Measurements of BMD were performed by dual-energy X-ray absorptiometry. Vertebral fractures were assessed using semi-quantitative criteria with conventional radiography. The ten-year risk for MOF and hip fracture were calculated using the FRAX@ tool with BMD. Results One hundred fifty-three KT recipients were included in the study. The population included 77 women. The mean age at evaluation was 46,5±11,9 years. Seventy-eight (50.9%) patients had normal femoral neck BMD while osteoporosis and osteopenia at the femoral neck were present in 12 (7.8%) and 63 (41.1%) of the patients, respectively. Age at evaluation was the risk factor for LBD (OR 1.057; 95% CI 1.024–1.091; p = 0.001). In female KT recipients, LBD was principally affected by menopausal status whereas in males, mammalian target of rapamycin (mTOR) inhibitor use and lower BMI levels were the risk factors. The prevalent vertebral fracture was found in 43.4% of patients. In multivariate analysis, only steroid use (OR 0.121; 95% CI 0.015–0.988; p = 0.049) was found to be associated with prevalent fracture. Among all KT recipients, 1.9% had a high MOF probability (≥20% risk of fracture), and 23.5% had high hip fracture probability (≥3% risk of hip fracture) according to FRAX. Conclusion Exploring the prevalence of LBD and vertebral fracture and the risk factors would help clinicians to modify long-term follow-up strategies. Furthermore, the high hip fracture risk probability in our cohort suggested that there is a need for longitudinal studies to confirm the validity of the FRAX tool in the transplant population.

Background In this study, we evaluated 3-month clinical outcomes of kidney transplant recipients (KTR) recovering from COVID-19 and compared them with a control group. Method The primary endpoint was death in the third month. Secondary endpoints were ongoing respiratory symptoms, need for home oxygen therapy, rehospitalization for any reason, lower respiratory tract infection, urinary tract infection, biopsy-proven acute rejection, venous/arterial thromboembolic event, cytomegalovirus (CMV) infection/disease and BK viruria/viremia at 3 months. Results A total of 944 KTR from 29 different centers were included in this study (523 patients in the COVID-19 group; 421 patients in the control group). The mean age was 46 ± 12 years (IQR, 37–55), and 532 (56.4%) of them were male. Total number of death was 8 [7 (1.3%) in COVID-19 group, 1 (0.2%) in control group; p = 0.082]. The proportion of patients with ongoing respiratory symptoms [43 (8.2%) vs. 4 (1.0%); p < 0.001)] was statistically significantly higher in the COVID-19 group compared to the control group. There was no significant difference between the two groups in terms of other secondary endpoints. Conclusion The prevalence of ongoing respiratory symptoms increased in the first three months post-COVID in KTRs who have recovered from COVID-19, but mortality was not significantly different.

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OBJECTIVE: Helicobacter pylori (H. pylori) infection is an important risk factor for chronic gastritis and peptic ulcer. Ghrelin is mostly secreted by gastric mucosa. The aim of the study is to examine the relationship between H. Pylori and ghrelin levels in uremic patients.MATERIAL and METHODS: A total of 91 patients [control group (CG, n=29), hemodialysis group (HD, no=21), peritoneal dialysis group(PD, no=12), predialysis group(PreG, n=29)] were involved. Patients using drugs active on H. pylori and/or gastric acidity were excluded. Besides demographic and biochemical parameters, patients were examined endoscopically; and H. Pylori was searched histopathologically.RESULTS: H. pylori was found to be positive in 62 patients (68.1%). Those patients were not different from H. pylori negative group regarding demographic and biochemical parameters. H. pylori positivity was statistically similar in patient groups. Ghrelin levels of uremic groups (HD, PD and PreG) were significantly higher than that of CG (4.22±1.00ng/ml vs. 2.81±0.37ng/ml, p<0.001). Ghrelin level was higher in the predialysis group compared with the HD group (4.49±1.18ng/ml vs. 3.81±0.98ng/ml, p=0.040). Ghrelin levels of H. pylori positive and negative patients were not different (3.83±1.2ng/ml vs. 3.65±1.0ng/ml, p=0.50).CONCLUSION: Ghrelin levels are elevated in uremia, but there is no relationship between ghrelin level and H. pylori positivity in uremic patients