Introduction: Hepatit B virus (HBV) is one of the main causes of liver related morbidity and mortality in worldwide. This condition is also a significant healthcare problem in Turkey. Entecavir (ETV) and tenofovir (TDF) are potent nucleos(t)ide analogues (NAs) recommended for the treatment of chronic HBV (CHB) infection. As the data on this topic is limited, we aimed to study the association of NAs and nephrotoxicity in our CHB cohort. Method: Between the January 2011 and February 2016, there were 294 patients who had been treated with TDF (n=194) and ETV (n=100). Clinical and laboratory data such as demographics, serological markers for HBV, pathology scores and routine blood tests were recorded from the charts. Glomerular filtration rate (GFR) was calculated by using the Modification of Diet in Renal Disease (MDRD) method. Kidney function tests were assessed at baseline and follow-up visits. Results: There were 294 patients in the total group. The mean age was 32±11 years, 66% (n=194) of the group was male. The mean follow-up period was 66±18 months. Age and sex distributions and baseline assessments including liver function tests, creatinine, GFR, HBV DNA values and pathology scores (HAI and fibrosis) were similar between TDF (n=194) and ETV (n=100) groups. Creatinin and GFR assessed at the last visit were 0.81±0.01 g/dl and 102.94+19.78 ml/min for TDF and 0.81±0.013 g/dl and 104.65±19.05 ml/min for ETV. These values were not significant between the both treatment groups. In terms of nephrotoxicity, none of the patients had significant changes in terms of creatinine and GFR that may require dose adjustment. Conclusion: Herein we showed that the use of both drugs led to a decrease in GFR that was not clinically important in chronic hepatitis B patients with normal baseline renal tests and without co-morbidity. Key words: Entecavir, Tenofovir, GFR, Chronic hepatitis B

Case presentation In this case, we are presenting 26-year-old young patients, who took 60-gram metformin plus 900 mg pioglitazone, presenting with abdominal pain, nausea, confusion, and lethargy. And lactic acidosis was treated with continuous hemodialysis >15 hours. Our aim, in this case, is to highlight the importance of continuous hemodialysis in the treatment of metformin poisoning. Discussion Metformin is an oral antidiabetic drug which is used as a first line treatment in the treatment of DM. Metformin poisoning is a rare condition seen by clinicians. One of the severe side effects of metformin poisoning is lactic acidosis and it can be fatal without on-time treatment due to acidosis-related complications. Conclusion Metformin toxication is a rare condition seen in clinical practice. Metformin associated lactic acidosis is one of the expected complication. The continous dialysis can be effective to treat the lactic acidosis caused by metformin toxication. What’s already known about this topic? Lactic acidosis might be caused by metformin toxicity. Without on-time treatment for metformin toxicity, it can cause life-threatening condition. What does this article add? The treatment of hemodialysis, especially continous hemodialysis, might be beneficial to treat the patients with metformin toxicity. Key words: Metformin Toxicity, Dialysis, Lactic acidosis

Object: Our aim is to evaluate the elevation of pancreatic enzymes in COVID-19 patients and their relationship with severity of COVID-19. Method: In this study, 1378 patients with COVID-19 infection were included. Relation of elevated amylase and lipase levels and co-morbid conditions with the severity of COVID-19 were checked. The effect of hemodynamic parameters and organ failures on pancreatic enzymes and their relations with prognosis were statistically analyzed. Results: There were 678 (%49,2) female patients and 700 (50,8%) male patients. Of all patients, 687 (49,9%) had mild, 691 (50,1%) severe COVID-19 infections. Elevated amylase levels were detected in 23% of patients (n:316). 19% (261) of them had a slight (1-3 times) increase in amylase levels, while 4% (55) had a more than 3 times increase in amylase than normal. Only 6% of patients with elevated amylase leves had the acute pancreatitis according to Atlanta criteria. According to univariate and multivariate analyses, elevated amylase levels was found statistically related with severity of COVID-19 (OR:4,37-p <0,001). And also diabetes mellitus (DM) (OR:1,82-p:0,001), kidney failure (OR:5,18- p< 0,001), liver damage (OR:6,63 p < 0,001), hypotension (OR:6,86-p< 0,001), sepsis (OR:6,20-p:0.008) were found to related to death of COVID-19. Conclusions: Elevated pancreatic enzyme levels in COVID-19 infections is to related to severity of COVID-19 infection and hemodynamic instability. Similar to other organs, the pancreas can be affected by severe COVID-19 infection.

McArdle disease (Glycogen storage disease type V, GSDV ) is an inherited disorder of glycogen metabolism affecting only skeletal muscles. A 56-year-old male patient with McArdle disease had the symptoms such as fatigue, muscle weakness since he was 8 years old in his history. A Pre-emptive kidney transplant from his wife was performed on the patient who has gone through rhabdomyolysis attacks during his life period. As far as known, this is the first case in the literature. We aim to share this process before and after the transplantation.

Objective: This study aims to investigate the mortality factors in hemodialysis patients and kidney transplant patients with COVID-19 patients. Method: The demographic, clinic, laboratory, and radiologic signs of the kidney transplant and hemodialysis patients diagnosed with COVID-19 between 11 March 2020-11 March 2021 were evaluated. Results: To this study, 72 hemodialysis (median age, 57.5 Q1-Q3:43-65; female:36/50%) and 58 kidney transplant (median age, 44.5 Q1-Q3:28.75-55.25; female:21/36.2%) were included. Fifteen HD patients (20.8%) died. To identify the independent predictors of in-hospital mortality, multivariable logistic regression analyses were performed using the variables in the univariate analyses including age, female gender, diabetes mellitus, ferritin, d-dimer, albumin, CRP, procalcitonin, dyspnea. Age (OR:1.12, 95% [CI]: 1.03-1.21, p=0.004), and dyspnea (OR: 9,7 95% CI 1.80-52.2, p=0.008) were found to be associated with in-hospital mortality. Nine (15.5%) of transplant patients died. The median time from the beginning of symptoms to the time of admission was 3 days (2-5). And this rate was 2 (2-3) and 5 (4-5.75) days, respectively, for patients followed up in our center and the external centers (p<0.001). Although an increase in CRP, ferritin, D-dimer levels, dyspnea, and bilateral involvement in CT images was statistically significant in the univariate analysis, no single factor was found to be related to mortality in multivariate analysis. Conclusion: Both HD and renal transplant patients should be followed closely. Early admission of HD and RT patients might be life-saving when suspected. Early inclusion of these patients into the vaccination program might reduce mortality. However, large-scale prospective randomized studies are needed.