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Gestational diabetes mellitus (GDM) is a condition that is very common during pregnancy and has negative consequences for both mother and fetus. Insulin resistance has been shown as an important cause in the pathogenesis of GDM and lowlevel inflammation is suggested to be one of the underlying causes of insulin resistance. We aimed to investigate whether the neutrophil-lymphocyte ratio (NLR), which is an indicator of systemic inflammation, is a predictor for GDM. A total of 228 pregnant women, including 128 GDM (patient group) and 100 healthy pregnant were included in the study. GDM was diagnosed with a 1-step approach between 24 and 28 weeks of pregnancy. We found a significant increase in NLR in the 1st and 3rd trimesters in the GDM group compared to healthy pregnant women, which supports that systemic inflammation starts in the early stages of pregnancy and continues throughout pregnancy. We also reported a positive correlation between NLR and fasting plasma glucose and body mass index in both trimesters. We showed that first trimester NLR independently predicted the development of GDM. Abbreviations: BMI = body mass index, CI = confidence interval, DM = diabetes mellitus, FPG = fasting plasma glucose, GDM = gestational diabetes mellitus, HDL = high-density lipoprotein, hsCRP = high-sensitivity C-reactive protein, LDL = lowdensity-lipoprotein, NLR = neutrophil-lymphocyte ratio, OR = odds ratio, PG = plasma glucose, PLR = platelet/lymphocyte rate, ROC = receiver operating characteristic, SPSS = Statistical Package for Social Sciences, T-C = total cholesterol, TG = triglyceride, Th = T helper.

Objective: This study aimed to investigate early and late postpartum glycemic abnormalities and related factors in women with a history of gestational diabetes mellitus (GDM). Material and Methods: This study included 152 women aged 18-40 years who were diagnosed with GDM either by one-or two-step oral glucose tolerance test (OGTT). Sociodemographic characteristics, body mass index (BMI), biochemical parameters, and OGTT results of the participants were recorded from files. In addition, BMI, fasting plasma glucose, lipid parameters, and glycosylated hemoglobin (HbA1c) levels were measured, and OGTT was performed between 4 and 12 weeks after postpartum and at the first year. Results: The mean age of the participants was 31.86±6.096 years, and their mean BMI was 26.23±3.67 kg/m 2 . In the early postpartum period (4-6 weeks) after 75 g OGTT, 70.4% of patients had normal glucose tolerance (NGT), 25% had prediabetes (preDM), and 4.6% had diabetes mellitus (DM). In the late postpartum period, 48.0% of patients had NGT, 45.4% had preDM, and 6.6% had DM. BMI and HbA1c levels were significantly higher in patients with both preDM and DM than women with NGT in both early and late periods (p<0.05). In addition, BMI before and 1 year after pregnancy and HbA1c level between 4 and 6 weeks after delivery were independent risk factors for the development of dysglycemia (OR: 1.004, p<0.001; OR: 2.848, p<0.001; and OR: 4.437, p=0.016, respectively). Conclusion: Women with GDM have a high risk of developing preDM and type 2 DM in the first year after delivery.

ÖZYeni direkt etkili antiviraller ile hepatit-C virüs (HCV) enfeksiyonunun etkin tedavisi mümkün olabilmektedir. Böbrek nakli sonrası ortaya çıkan veya nüks eden HCV enfeksiyonu tedavisi özenli bir yaklaşım gerektirir. Uygun tedavi seçimi yanında ilaç etkileşimleri de iyi bilinmelidir. Bu olgu sunumu ve literatür derlemesinde, HCV için tedavi başlandığı dönemde kalsinorin inhibitörü toksisitesi gelişen bir olguyu tanımlarken, böbrek nakli sonrası antiviral tedavide ilaç etkileşimlerine dikkat çekmeyi amaçladık. Kırk-sekiz yaşında böbrek nakilli erkek olgu genotip-1b nüks HCV enfeksiyonu için tedavi başlanması sonrasında ritonavir ile ilaç etkileşimine bağlı akut, şiddetli takrolimus toksisitesi nedeniyle takip edildi. Antiviral tedavi ve takrolimus kullanımı durduruldu. Klinik düzelme olduktan sonra hasta düşük doz siklosporin-A (CsA) eşliğinde antiviral tedavi alabildi ve sürdürülebilir viral yanıt elde edildi. Böbrek nakli alıcılarında uygun antiviral kombinasyonu seçerken HCV genotipi ve klinik özelliklerin yanı sıra immunosupressif ilaçlarla olası etkileşimlerin de dikkate alınması gerekeceği için, bu olgular hepatolog ve transplant nefroloğu tarafından yakın izlenmelidir. ANAHTAR SÖZCÜKLER: Böbrek nakli, Hepatit C virüs, İlaç etkileşimleri, Takrolimus, Ritonavir ABSTRACTNew direct acting antiviral agents are quite effective in treating hepatitis-C virus infection (HCV). Treating HCV that occurs or relapses after kidney transplantation necessitates a heedful approach for selecting the proper antiviral alternatives with respect to possible drug interactions. Here we want to lay emphasis on drug interactions in kidney transplant recipients along with a case that developed calcineurin inhibitor toxicity after initiation of anti-HCV treatment. A 48-year-old male was admitted after acute severe toxicity with tacrolimus due to a drug interaction with an antiviral regimen including ritonavir for relapsing genotype-1b HCV infection. Cessation of tacrolimus and antiviral therapy provided recovery. Sustained viral response was achieved with the same antiviral regimen with conversion to very low dose cyclosporine-A (CsA). Selection of a proper anti-HCV treatment combination for kidney transplant recipients requires consideration of the viral genotype, clinical features and possible drug interactions with immunosuppressives. These patients must therefore be followed by a hepatologist as well as a nephrologist.