Gülay Ulusal Okyay

The aim of this study was to investigate the characteristics of de novo malignancies arising in kidney transplant recipients followed in a tertiary hospital in Turkey and to examine the tumors in the head and neck region as a subgroup. Data from kidney transplant recipients treated at our institution between January 2010 and July 2022 were retrospectively analyzed in this single-center study. Data regarding malignancies were noted according to the pathologists' reports. In situ malignancies and those arising after graft loss were not evaluated. The study population comprised 231 patients (165 men; 71.4%) with a median follow-up of 11 years (2853 patient-years). The recipients had a higher cancer risk than the general population (standardized incidence rate = 3.04; 95% CI, 1.82-4.26). Thirty de novo malignant tumors were detected in 24 patients (10.4%). The mean age at diagnosis of cancer was 54.88 ± 11.44 years. The median time from transplant to cancer diagnosis was 11.5 years (range, 7-18.8 y). Nonmelanoma skin cancers (56.7% of all tumors) were the most common malignancies. Twenty-two lesions (73.3%) that developed in 17 patients (7.4%) were localized to the head and neck region: 15 (68.2%) were cutaneous and 7 (31.8%) were noncutaneous. The median time from transplant to head and neck cancer diagnosis was 12 years (range, 7.5-17.5 y). Mortality rate was higher in cancer patients (10 [41.7%] vs 17 [8.2%]; P < 0.01). The incidence of de novo malignancy in kidney transplant recipients was relatively higher compared with previous data. Nonmelanoma skin cancers were the most common type. Three-quarters of all lesions were in the head and neck region, and two-thirds were of cutaneous origin.

Synthetic cannabinoid (SC) products are called “Spice” in Europe, “K2” in the United States and “Bonsai” in Turkey and sold under the counter. Widespread uses of these substances and lack of specific regulations about them cause serious problems. It is not very clear what these psychoactive products contain and how much and how often they can be given. Their metabolic effects are not known well either. There is not much known about the effects of SCs other than the ones on the neurological and cardiovascular systems. In this report, we presented two cases of rhabdomyolysis developing after bonsai consumption and requiring dialysis. Two bonsai users have been brought to our emergency department in an unconscious state. Their physical examinations were normal except tachicardia. Laboratory investigations revealed increased urea, serum creatinine, creatinine phosphokinase, lactate dehydrogenase and transaminase levels. The histories of the cases suggested that they had rhabdomyolysis due to cannabinoid use. A single session hemodialysis was performed for both cases. Their clinical appearance reached to stabilisation in the second hospital day and blood tests were normalised in one week. The patients were discharged at the end of the week with the normal laboratory results and psyciatric recommendations. These two cases underline the risk of rhabdomyolysis development, apart from well-known side effects of SCs.

Epicardial adipose tissue (EAT) is a cardiovascular risk predictor in general population. However, its value has not been well validated in maintainance hemodialysis (MHD) patients. We aimed to assess associations of EAT with cardiovascular risk predictors in nondiabetic MHD patients. In this cross-sectional study, we measured EAT thickness by transthoracic echocardiography in 50 MHD patients (45.8 +/- 14.6 years of age, 37 male). Antropometric measurements, bioimpedance analysis, left ventricular (LV) mass, carotis intima media thickness, blood tests, homeostasis model assessment for insulin resistance (HOMA-IR) and hemodialysis dose by single-pool urea clearence index (spKt/V) were determined. The mean EAT thickness was 3.28 +/- 1.04mm. There were significant associations of EAT with body mass index (=0.590, P<0.001), waist circumference (=0.572, P<0.001), body fat mass (=0.562, P<0.001), percentage of body fat mass (=0.408, P=0.003), percentage of lean tissue mass (=-0.421, P=0.002), LV mass (=0.426, P=0.002), carotis intima media thickness (=0.289, P=0.042), triglyceride/high-density lipoprotein cholesterol ratio (=0.529, P0.05). Body mass index, waist circumference, body fat mass, percentage of lean tissue mass, LV mass, triglyceride/high-density lipoprotein cholesterol ratio, HOMA-IR, and spKt/V appeared as independent predictors of EAT. EAT was significantly associated with body fat measures, cardiovascular risk predictors, and dialysis dose in MHD patients.