Background/aim: Asymmetric dimethyl arginine (ADMA) is a strong predictor of cardiovascular disease and mortality in patients under hemodialysis treatment. We aimed to investigate the relationship among volume status, endothelial dysfunction, and ADMA in hemodialysis patients. Materials and methods: A total of 120 patients with a history of hemodialysis treatment were included. ADMA and CRP were measured. Echocardiographic evaluation and carotid artery intima-media thickness (CIMT) measurements were performed. Patients were divided into two groups according to clinical evaluation, ultrafiltration rate, vena cava inferior diameter (VCI), and cardiothoracic index (CTI); the two groups were hypervolemic and normovolemic. Results: The hypervolemic group included 61 patients while the normovolemic group included 59 patients. CIMT was higher in the hypervolemic group, but this result was not statistically significant (0.95 mm versus 0.85 mm, P = 0.232). There was a statistically significant difference between the hypervolemic and normovolemic groups in terms of ADMA (P < 0.001) (0.69 ± 0.57 μmol/L and 0.41 ± 0.04 μmol/L, respectively). Positive correlations were observed between serum ADMA, VCI, CTI, CRP, CIMT, and cardiac mass (P < 0.001, P = 0.016, P < 0.001, P = 0.006, P = 0.022, respectively), and negative correlations were observed between ADMA and ejection fraction and albumin (P = 0.024, P = 0.024, respectively). In multiple linear regression analysis, ADMA was independently associated with age, systolic blood pressure, CTI, and volume status. Conclusion: ADMA may be a potential determinant of hypervolemia as well as atherosclerosis in patients under hemodialysis treatment.

Background and Objectives: Chronic kidney disease (CKD) is a global public health issue with rising incidence linked to substantial morbidity and mortality. Selenium, an antioxidant trace element, has been linked to low serum levels in end-stage renal disease. Restless Leg Syndrome (RLS), a sleep disorder, is prevalent in CKD patients and significantly impacts their quality of life. The objective of this study was to examine the correlation between serum selenium levels and the prevalence of restless leg syndrome in individuals with chronic kidney disease. Materials and Methods: Forty-six CKD patients undergoing serum selenium level assessments between 1 January 2020 and 28 February 2022, at the Hitit University Faculty of Medicine Department of Nephrology Outpatient Clinic or Hemodialysis Unit, were included. Patients over 18 years of age with no history of hematological or oncological diseases or acute or chronic inflammatory conditions were included in the study groups. Patients taking selenium supplements were excluded. Demographic data, comorbidities, and laboratory values were collected, and RLS presence and severity were evaluated. Statistical analyses include descriptive statistics, correlation analysis, the Mann–Whitney U test, Student’s t test, and Chi-square test. Results: Among the 46 patients, 16 (34.78%) had RLS symptoms. The patient group included 34.78% predialysis, 34.78% peritoneal dialysis, and 30.44% hemodialysis patients, with a median age of 47.98 years. There was no difference in age, gender, and Charlson comorbidity between patients with or without RLS (p = 0.881, p = 0.702, p = 0.650). RLS prevalence varied across CKD subgroups, with hemodialysis patients having a higher prevalence (p = 0.036). Clinical parameters such as blood urea nitrogen, creatinine, calcium, phosphorus, platelet counts, and parathyroid hormone levels exhibited significant differences between patients with and without RLS (p < 0.05). Serum selenium levels were not significantly different between patients with and without RLS (p = 0.327). Conclusions: With an increased comorbidity burden, CKD poses a significant healthcare challenge. When accompanied by RLS, this burden can be debilitating. The difference in CKD stages between groups has shed light on a critical determinant of RLS in this population, emphasizing the role of the chronic kidney disease stage. In our study, serum selenium levels were not associated with the presence and severity of RLS. However, prospective studies with larger numbers of participants are needed to draw a definitive conclusion.

Amaç: Enterokoklar insan florasında bulunurlar ve oldukça düşük virulansa sahiptirler. Ancak, enterokoklar hastane ve toplum kaynaklı enfeksiyonlara neden olmakta ve son yıllarda bu enfeksiyonlarda antibiyotik direnç oranlarında artış gözlenmektedir. Bu çalışmada en sık izole edilen enterokok türleri olan Enterococcus faecalis ve Enterococ­cus faecium’un antibiyotik duyarlılıklarının değerlendirilmesi amaçlanmıştır.Gereç ve Yöntem: Çalışmamızda 2012 - 2016 yılları arasında Tıbbi Mikrobiyoloji Laboratuvarımıza gelen çeşitli klinik örneklerden izole edilen 727 enterokok suşu değerlendirmeye alınmıştır. Tür tanımlamaları ve antibiyotik duyarlılık testleri konvansiyonel metodlar ve VITEK®-2 (BioMérieux, Fransa) otomatize identifikasyon cihazı ile yapılmıştır.Bulgular: Bu çalışmada izole edilen 727 enterokok suşunun 450’si (%61,9) E. faecalis, 277’si (%38,1) E. faecium olarak tanımlanmıştır. Enterokok suşlarının izole edildiği hastaların cinsiyet dağılımı; 387 (%53,2) kadın, 340 (%46,8) erkektir. Klinik örneklerin dağılımı; 467 (%64.2) idrar, 110 (%15.1) kan, 77 (%10.6) gaita, 43 (%5.9) yara ve 30 %(4.1) diğer örneklerdir. Enterokok suşları en sık idrar örneklerinden izole edilmiştir. İzole edilen E. faecium ve E. faecalis suşlarının tamamı tigesikline duyarlı olarak saptanmıştır. Vankomisin direnç oranı E. faecium izolatlarında %29,9 (80/268), E. faecalis izolatlarında %8,6 (37/432) olarak belirlenmiştir.Sonuç: Enterokoklarda son zamanlarda giderek artan direnç oranları bu enfeksiyonlara karşı birçok antibiyotiğin kullanımını sınırlandırmaktadır. Her hastanenin kendi sürveyans programını oluşturarak enterokokların tür düzeyinde tanımlanması, antibiyogram duyarlılık testlerini yapılması ve tedavi protokollerinin bu direnç paternlerine göre uygulanmasının enterokok enfeksiyonlarının kontrol altına alınmasında etkili olacağı kanaatindeyiz.

Myroides spp. is an environmental pathogen and causes disease in immunocompromised patients. In this study, we report an outbreak of urinary tract infections (UTIs) caused by Myroides odoratimimus (M. odoratimimus) in a university hospital in Turkey. A total of 25 M. odoratimimus strains isolated from the clinical samples of 20 patients in our intensive care units and clinics were included in the study. Phenotypic and genotypic identification of isolates was performed using conventional methods, VITEK®-2 automated identification system, Matrix Assisted Laser Desorption/Ionization-Time of Flight Mass Spectrometry, and 16S-RNA Microbial Diagnosis methods. In addition, the repetitive extragenic palindromic (REP) elements polymerase chain reaction (PCR) assay method was applied for molecular epidemiological analysis. All cases were diagnosed with nosocomial UTI, except for one case diagnosed with nosocomial bacteremia. One of the M. odoratimimus isolates was sensitive to piperacillin/tazobactam (MIC: ≤4 µg/mL), and one isolate was moderately sensitive to cefepime (MIC: 16 µg/mL). Other all M. odoratimimus isolates were resistant to the tested antibiotics beta-lactams, monobactams, carbapenems, aminoglycosides, fluoroquinolones, and sulphonamides. When 10 isolates were evaluated with the REP PCR method, DNA fingerprint similarities were visually determined, and there was a similar DNA pattern among them. The source of Myroides infection could not be identified from the environmental samples. The increasing population of immunosuppressed patients suggests that M. odoratimimus and other opportunistic multi-drug resistant pathogens with resistance to broad-spectrum antibiotics may be encountered more frequently in critical units in future. In order to choose the optimal antibiotic regimen, awareness and an index of suspicion regarding this atypical pathogen are important for rapid identification and appropriate susceptibility testing. It has been observed that the pathogenicity of M. odoratimimus bacteria has increased recently, and it can not only cause UTIs but more serious manifestations such as sepsis with bacteremia, which can be life-threatening. Savci U, Eser B, Sungur M, Yildiz SS, Akdogan O, Caliskan S, et al. A New Emerging Threat in Critical Care: Myroides odoratimimus Outbreak in a Tertiary Hospital. Indian J Crit Care Med 2025;29(10):829–838.

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Metformin, tip 2 diabetes mellitus tedavisinde birinci basamak ajan olarak yaygın olarak kullanılan oral hipoglisemik bir ilaçtır. Son zamanlarda yapılan çalışmalarda, normal aralıkta hafif veya orta derecede böbrek yetmezliği olan hastaların metformin ilaç düzeyleri normal bulundu ve ayrıca laktat düzeyleri normal sınırlarda bulundu. Ancak, hastanın böbrek fonksiyonu, karaciğer yetmezliği veya akut enfeksiyonu kötüleşmesi durumunda klinik önemi artar. Bu durumlarda, ilaç seviyeleri, yaşamı tehdit eden laktik asidozu arttırabilir. Biz burada kardiyopulmoner arrest ile sonuçlanan bir metformin ilişkili laktik asidoz olgusunu sunuyoruz. 

Metformin is an oral hypoglycemic drug which is commonly used as a first-line agent in the treatment of type 2 diabetes mellitus. In recent studies, metformin drug levels of the patients with mild or moderate renal impairment were found in normal range and also lactate levels were found in normal range. But it’s clinical importance increases when the patient had worsening renal function, hepatic insufficiency or acute infection. In these situations, drug levels can increase lactic acidosis leading to life threatening. Here we present a case of metformin associated lactic acidosis resulted in cardiopulmonary arrest.