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Results in Journal Turkish Journal of Internal Medicine: 90

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Sefa Erdi Ömür, Çağrı Zorlu
Turkish Journal of Internal Medicine, Volume 3, pp 127-130; doi:10.46310/tjim.873267

Abstract:
Cardiac amyloidosis (CA); It can be referred to as a progressive cardiomyopathy that occurs as a result of the accumulation of endogenous proteins in the form of amyloid fibrils, whose folding is disrupted in the kidney, liver, gastrointestinal system, soft tissue and heart. The course of the disease depends on the involvement of the organs and treatment options depending on the source of the protein. Immunoglobulin light chain (AL) amyloidosis and transtretin (TTR) amyloidosis are the most common CA types. While AL amyloidosis is more common in the heart and kidney, TTR amyloidosis is more common in the heart. Although CA is not considered a common disease, TTR amyloidosis is observed in approximately 15% of patients with heart failure with preserved ejection fraction and severe aortic stenosis. CA diagnosis; It can be placed by echocardiography (ECHO), magnetic resonance or nuclear scintigraphy methods. At the same time, genetic analysis, biopsy and histopathological tests are also useful for early diagnosis. After the diagnosis, antiplasma treatment or stopping the produced protein constitute the main lines of the treatment.
Gökhan Öztürk
Turkish Journal of Internal Medicine, Volume 3, pp 113-116; doi:10.46310/tjim.876357

Abstract:
The hydatid cysts disease is a parasitic cystic infection of the liver, lungs, and other organs, caused by Echinococcus granulosus. It is mostly seen in the sheep and cattle farms, which have poor health conditions. It is endemic in the eastern and southwestern regions of Türkiye. The big cysts that are seen in the lungs are called a huge pulmonary cyst. And it is a particular clinic situation. The symptoms of the disease are cough, chest pain, dyspnoea, hemoptysis, or allergic reactions. The hemoptysis could be seen when these cysts rupture. The use of anthelmintic drugs to treat the pulmonary hydatid cysts could cause cyst rupture. The surgery must be the first choice of treatment. In our case, we discussed the two huge pulmonary hydatid cysts in the upper left lobe of the lung which were treated with thoracotomy.
Tuba Erürker Öztürk
Turkish Journal of Internal Medicine, Volume 3, pp 110-112; doi:10.46310/tjim.876345

Abstract:
Echinococcus granulosis commonly involve the liver and are mostly seen in Turkey . One of the early complication following the surgery for liver hydatid cyst is biliary leakage (B.L.) which’s incidence is %4.5-26. Endoscopic sphincterotomy (E.S.) and biliary stenting are usually successful in treating B.L. In this case, I’m presenting endoscopic treatment for the B.L. after the liver hydatid cyst operation.
Mehmet Sezen, Abdülmecit Yildiz, Kamil Dilek, Mustafa Güllülü, Mahmut Yavuz, Ayşegül ORUÇ, Mehmet Fethullah Aydin, Alparslan Ersoy
Turkish Journal of Internal Medicine, Volume 3, pp 107-109; doi:10.46310/tjim.876204

Abstract:
Sjogren's syndrome (SjS) is a chronic, slow-progressing, autoimmune and lymphoproliferative disease. The main symptoms of the syndrome are xerostomia and keratoconjuctivitis sicca as a result of chronic inflammatory infiltration of the salivary and lacrimal glands. Focal Segmental Glomerulosclerosis complicating primary Sjögren's syndrome is extremely rare. We report on a 39-year-old woman with 5 years history of sjogren syndrome who was found to have nephrotic syndrome. Histopathological findings in kidney biopsy compatible with focal segmental glomerulosclerosis. Steroid therapy was initiated (oral prednisolone at a dose of 15 mg/day) and Cyclosporine 2 * 100mg/d. FSGS, which is associated with sjögren's syndrome, was considered suitable for the presentation because of its rare occurrence
Murat Çalapkulu, Muhammed Erkam Sencar, Ilknur Öztürk Ünsal, Hakan Düğer, Mustafa Özbek, Erman Çakal
Turkish Journal of Internal Medicine, Volume 3, pp 123-126; doi:10.46310/tjim.877025

Abstract:
Ganglioneuroma (GN) is a rarely seen benign tumor originating from neural crest cells and consisting of ganglion and Schwann cells. Adrenal GNs occur most frequently in the fourth and fifth decades of life. They have an equal frequency in male and female patients and are usually found incidentally during imaging. It is not related to hormonal activity and is clinically asymptomatic. We aimed to present a 49-year-old female patient whose magnetic resonance image performed for abdominal pain was found a biochemically normal mass in the right adrenal gland and then was pathologically diagnosed as GN after right adrenalectomy.
Şeyda Günay, Osman Akın SERDAR, Dilek Yeşilbursa, Sümeyye Güllülü, Naile Bolca Topal
Turkish Journal of Internal Medicine, Volume 3, pp 117-119; doi:10.46310/tjim.868729

Abstract:
Introduction: Peripartum cardiomyopathy is a rare disease that is difficult to diagnose and treat. Clinical findings are similar with heart failure. New treatments are needed in addition to the treatment of heart failure. Case Report: A 32-year-old woman presented with symptoms of heart failure 4 days after first delivery. Chest X-ray showed cardiomegaly. Serum BNP level was high. Transthoracic echocardiography (TTE) indicated dilated left atrium and left ventricle, severe mitral regurgitation and ventricular dysfunction. The global longitudinal strain was – 9.1%. Cardiac magnetic resonance imaging (MRI) revealed mid-myocardial staining detected in late phase images. Concomitant bromocriptine (2,5 mg po twice a day for 15 days and then 2,5 mg po once a day for 15 days) was used with standard heart failure therapy. At 6 months, TTE and cardiac MRI revealed normal biventricular function and size. Global longitudinal strain was –14%. Conclusion: Patients with peripartum cardiomyopathy may benefit from bromocriptine.
Ezel Elgun, , Bedrettin Orhan, Fahir Özkalemkaş,
Turkish Journal of Internal Medicine, Volume 3, pp 131-133; doi:10.46310/tjim.876139

Abstract:
Hairy cell leukemia (HCL) is a rare chronic lymphoproliferative disease. LSV is characterized by inflammation of small vessels. Its association is rare in the literature and HCL can be seen in LSV etiology, although the relationship between the 2 diseases is far from clear. Here, we aimed to present a case with constitutional symptoms, palpable purpuric lesions on the body and diagnosed as HCL from bone marrow biopsy.
Mehmet Sezen, Abdülmecit Yildiz, Mahmut Yavuz, Kamil Dilek, Mustafa Güllülü, Ayşegül ORUÇ, Mehmet Fethullah Aydin, Alparslan Ersoy
Turkish Journal of Internal Medicine, Volume 3, pp 120-122; doi:10.46310/tjim.877028

Abstract:
Autoimmune hemolytic anemia (AIHA) is a rare disease with a rate of 1-3 in 100,000 in adults. AIHA are defined as primary (idiopathic) or secondary depending on the presence or absence of accompanying disease. Secondary causes include drugs, immunodeficiencies, infections, other autoimmune diseases, or malignancies. Here, we report an 42-year-old female presented to us with diarrhea, nausea-vomiting, fever, chills and jaundice for two days. Hematological investigations revealed hemolytic anemia. Direct Coombs test was positive. The patient was diagnosed acute tubuler necrosis with autoimmune hemolytic anemia. Methylprednisolone 40 mg/day was started considering autoimmune hemolytic anemia. She was on hemodialysis at regular intervals. After 4 weeks, the patient was symptomatically improved with remission of acute tubuler necrosis and hemolytic anemia. In our case, the association of AIHA due to acute gastroenteritis and acute tubular insufficiency was considered suitable for the presentation because of its rare occurrence.
Orkide Kutlu, Hakan Selçuk, Özlem Buluz, Ayça Zeynep Kutlu
Turkish Journal of Internal Medicine, Volume 3, pp 60-61; doi:10.46310/tjim.875949

Abstract:
Dolichoectasis is a dilative arteriopathy that can be seen in intracranial vertebral and basilar arteries in people with hypertension and advanced age. Although most cases are asymptomatic, cerebral ischemia, bleeding or compression may occur. The diagnosis of VBD was made by catheter angiography before; while MR angiography is the most sensitive imaging method today. In addition, differential diagnosis of aneurysm/other vascular problems, demyelinating diseases and space-occupying lesions can be made with MR imaging. Here, we aimed to report VBD because it is a rare condition in a hypertensive patient presenting with impaired balance.
Neslihan Hazel Saydam, Ibrahim Ethem Pinar, Tuba Ersal, Cumali Yalçin, Bedrettin Orhan, Ömer Candar, , Fahir Özkalemkaş
Turkish Journal of Internal Medicine, Volume 3, pp 71-72; doi:10.46310/tjim.876554

Abstract:
Blastic Plasmacytoid Dendritic Cell Neoplasia (BPDCN) is a rare hematological malignancy whose pathogenesis has not yet been elucidated. Skin, bone marrow, and lymph node involvement can be observed, and it is generally seen in men and old adults. Immunohistochemistry (IHC) features of skin and bone marrow biopsy are essential for diagnosis. There are no standardized treatment options for this malignancy, and the prognosis is particularly poor. Although there are no standardized treatment options for this malignancy, multiple agent chemotherapies such as Hyper-CVAD and CHOP can be used. Bone marrow transplantation may be an option for patients with life expectancy. More case reports are required to understand and manage this extremely rare malignancy. We report the case we encountered in our clinic and selected CVP as the treatment approach.
Kübra Vurat Acar, Ibrahim Ethem Pinar, Tuba Ersal, Cumali Yalçin, Bedrettin Orhan, Ömer Candar, , Fahir Özkalemkaş
Turkish Journal of Internal Medicine, Volume 3, pp 73-74; doi:10.46310/tjim.876799

Abstract:
Diffuse Large B-Cell Lymphoma is characterized by the infiltration of small vessels by lymphoid cells. These cells are not seen in the systemic circulation. Depending on the involvement location, it may present with different clinics such as central nervous system and skin involvement. Therefore, diagnosis may delay. Diagnosis is based on pathology. Herein we present a rare patient who initially presented with cellulitis and was ultimately diagnosed with Intravascular Large B Cell Lymphoma. With this case, we aim that lymphoma infiltration should be considered in skin lesions that are difficult to diagnose.
Gül Ada, Rıdvan Ali, Fahir Özkalemkaş, , Tuba Ersal, Ibrahim Ethem Pinar, Bedrettin Orhan, Cumali Yalçin
Turkish Journal of Internal Medicine, Volume 3, pp 77-78; doi:10.46310/tjim.876945

Abstract:
Cranial imaging is vital in patients with complaints of sudden speech disorder, deterioration in performance status, urinary and fecal incontinence, and numbness in hands and feet. It provides an investigation of etiology and clarification of diagnosis. Hematological malignancies sometimes present with these symptoms and imaging may be the first method for diagnosis. In this case, we will present a patient diagnosed with primary central nervous system lymphoma, who was found to be HIV-positive during follow-up, and who progressed early and died despite treatment.
Büşra Gürbüz, Ensar Aydemir, Coşkun ATEŞ, Yasemin Aydoğan Ünsal, Özen Öz Gül, Soner Cander, Erdinç Ertürk, Canan Ersoy
Turkish Journal of Internal Medicine, Volume 3, pp 98-100; doi:10.46310/tjim.885771

Abstract:
Osteoporosis is a skeletal disease characterized by low bone mass associated with decreased bone strength and increased risk of fractures. Low bone mass in premenopausal women is less common than in postmenopausal women, and bone loss in premenopausal women is usually due to secondary causes such as estrogen deficiency, glucocorticoid exposure, malabsorption, thyroid disorders, and hyperparathyroidism. In women with premenopausal osteoporosis, treatment should be planned according to the underlying secondary causes. In this case report, the importance of investigating the secondary causes leading to premenopausal osteoporosis and its treatment are discussed.
Müge Şahin, Ensar Aydemir, Coşkun ATEŞ, Yasemin Aydoğan Ünsal, Özen Öz Gül, Soner Cander, Erdinç Ertürk, Canan Ersoy
Turkish Journal of Internal Medicine, Volume 3, pp 104-106; doi:10.46310/tjim.885781

Abstract:
Cushing’s disease (CD) constitutes most common cases of adrenocorticotropic hormone (ACTH) dependent Cushing’s syndrome (CS). CD more often occurs in women. Recent studies indicate increasing prevalence of CD amongst the obese people. Therefore, the possibility of underlying CD should be ruled out in obese people. Inferior petrosal sinus sampling (IPSS) is an important diagnostic method for diagnosing and localizing CD cases who can’t be diagnosed by standard imaging methods. IPSS can increase the success of the surgeon's treatment with information about the location of the adenoma. Here, we present a case of a 36-year-old female patient admitted to the hospital for bariatric surgery who was diagnosed having CD localized by IPSS.
Ali Erol, Nizameddin Koca, Ozlem Arican Ozluk
Turkish Journal of Internal Medicine, Volume 3, pp 49-51; doi:10.46310/tjim.873597

Abstract:
Heart failure is a disease that may present with various presentations depending on different etiological factors. External pressure on the heart is one of the rare causes that can cause heart failure. Here, we presented a 73-year-old female patient with inoperable endometrial cancer who developed heart failure due to hiatal hernia compression.
Orkun Sakar, Cemre Uçaryilmaz, Ahmet Bilgehan Şahin, Türkkan Evrensel, Cengiz Gebitekin
Turkish Journal of Internal Medicine, Volume 3, pp 62-64; doi:10.46310/tjim.875951

Abstract:
Osteosarcoma is a common primary malignant bone tumor in young adults presenting with back and chest pain complaints. Here, we presented a rare case of osteosarcoma.
Ece Ünal Çetin, Adil Uğur Çetin
Turkish Journal of Internal Medicine, Volume 3, pp 65-66; doi:10.46310/tjim.876058

Abstract:
Membranous nephropathy is a common form of glomerulonephritis that typically presents with nephrotic syndrome between the 3rd and 5th decades and one-third of patients experience spontaneous remission. Here, a patient with primary membranous nephropathy is presented.
Yağnur UZUN, Ayşe Eda FİDAN, Ceylin Aybüke Dağistan, Öznur Bal, Efnan Algin, Kemal Karaman
Turkish Journal of Internal Medicine, Volume 3, pp 67-68; doi:10.46310/tjim.876386

Abstract:
Teratomas are types of germ cell tumor which can arise from gonads or extragonadal tissues and can show malignant transformation. . In this article,We presented a patient with enteric adenocarcinoma on the basis of teratoma with a mediastinal mass invading the sternum .
Satı Burcu ÇETİN, Ibrahim Ethem Pinar, Tuba Ersal, Cumali Yalçin, Bedrettin Orhan, Ömer Candar, , Fahir Özkalemkaş
Turkish Journal of Internal Medicine, Volume 3, pp 75-76; doi:10.46310/tjim.876918

Abstract:
Rhabdomyosarcoma caused bone marrow metastasis cases are among the rarest cases reported in the literature. Similar to the cases reported in the literature, the clinical presentation of our patient mimicked acute leukemia, and the leukoerythroblastosis in the peripheral smear test and the cytopenia in the hemogram raised suspicion of hematological malignancy initially.1,2 The diagnosis made by immunohistochemical staining in biopsy. The primary tumor field could not be detected in the radiological imaging, and it was determined by rhinoscopy evaluation performed upon patient's anosmia and epistaxis complaints. Here, we reported a case in which we were diagnosed with acute leukemia at admission but later diagnosed as a primary malignancy that metastasized.
Melis Ardiç, Mert Türk, Nizameddin Koca
Turkish Journal of Internal Medicine, Volume 3, pp 82-84; doi:10.46310/tjim.877015

Abstract:
HIV infection can manifest itself in many different clinical situations. In a pandemic such as COVID, when fever is of diagnostic importance and manifests itself with different clinical pictures, it is very difficult to distinguish the true cause of high fever. In this case report, we shared the process of diagnosing HIV infection in a patient with type 1 diabetes who presented with fever and neurological symptoms under pandemic conditions.
Özlem Buluz, Ayça Zeynep Kutlu, Seçil Gunher Arica
Turkish Journal of Internal Medicine, Volume 3, pp 90-91; doi:10.46310/tjim.878062

Abstract:
Subacute granulomatous thyroiditis (DeQuervain's disease) is a self-limiting inflammatory disease which is often diagnosed in the ”temporary thyrotoxicosis period" during the initial phases of the desease. Liver enzyme abnormalities can be seen in the course of thyrotoxicosis. The definition of "thyrotoxic hepatitis" is used to describe the elevation of liver enzymes after excluding other causes. In this case report, a female patient who developed thyrotoxic hepatitis in the course of her subacute thyroiditis, is reported to remind the importance of evaluating liver functions in the follow-up of subacute thyroiditis.
Ensar Aydemir, Satı Burcu ÇETİN, Yasemin Aydoğan Ünsal, Coşkun ATEŞ, Soner Cander, Özen Öz Gül, Erdinç Ertürk, Canan Ersoy
Turkish Journal of Internal Medicine, Volume 3, pp 94-95; doi:10.46310/tjim.882279

Abstract:
Severe hypertriglyceridemia is defined as serum triglyceride levels of 1000 mg/dL and more. Acute pancreatitis and fetal losses can be observed in association with severely high triglyceride levels during pregnancy. Here we report the management of a 28-year-old pregnant woman with very severe HTG with the data in the literature.
Merve Nur Akyol, Ensar Aydemir, Yasemin Aydoğan Ünsal, Coşkun ATEŞ, Soner Cander, Özen Öz Gül, Erdinç Ertürk, Canan Ersoy
Turkish Journal of Internal Medicine, Volume 3, pp 96-97; doi:10.46310/tjim.884844

Abstract:
Panhypopituitarism occurs as a result of the insufficiency of all hormones produced in the anterior pituitary gland. Pituitary Stalk Interruption Syndrome (PSIS) is a rare congenital syndrome leading to hypopituitarism. The anterior pituitary hormones should be evaluated in patients with the signs and symptoms of hormone insufficiency and magnetic resonance imaging of the pituitary should be performed for the etiology. Although PSIS is a rare cause of hypopituitarism, it must be treated with the replacement of the insufficient hormones. In this case report, we evaluated a PSIS case presented with panhypopituitarism
Müge Karacakayalilar, Selman Candan, Mehmet Çiçek, Abdülmecit Yildiz, Münevver Irem Kök
Turkish Journal of Internal Medicine, Volume 3, pp 44-45; doi:10.46310/tjim.866999

Abstract:
Autosomal Dominant Polycystic Kidney Disease (ADPKD) is the most common inherited kidney disease. Kidney stones develop in 20-30% of patients with ADPKD.Hydronephrosis, which is the most valuable radiological finding in the diagnosis of stone-related postrenal insufficiency, may be difficult to differentiate from common cysts in ADPKD patients. When kidney dysfunction develops in ADPKD patients, Glomerular Filtration Rate (GFR) loss reaches an average of 4.4 to 5.9 mL / min per year. Faster deterioration in these patients requires investigation for prerenal factors such as dehydration that triggers acute kidney damage or stone-related postrenal factors. In ADPKD, stone-related postrenal obstruction should be considered in rapid GFR losses despite negative ultrasound report for hydronephrosis as there is frequent occurrence of kidney stones and the difficulty in detecting hydronephrosis with ultrasonography (US) in these patients. Here, we present a case with ADPKD whose renal functions rapidly deteriorated while under chronic follow-up and renal function markers returned to the basal levels with the treatment of the underlying cause.
Seda Karaaslan, Ensar Aydemir, Coşkun ATEŞ, Yasemin Aydoğan Ünsal, Canan Ersoy, Özen Öz Gül, Soner Cander, Erdinç Ertürk
Turkish Journal of Internal Medicine, Volume 3, pp 101-103; doi:10.46310/tjim.885774

Abstract:
Hypertriglyceridemia (HTG) is the third most common cause of acute pancreatitis (AP). It is caused by disorders in lipoprotein metabolism due to primary or secondary causes. Metabolic syndrome is also an important factor contributing to the development of HTG. The primary treatment goal in severe HTG is to restore triglyceride levels within normal ranges which can be achieved with lipid lowering drugs mainly fenofibrates, fluid replacement, intravenous insulin infusion and/ or plasmapheresis treatments. Strict diet restricted from fat and simple sugars, exercise and weight control also contribute to HTG control in long term follow up. In this report, a case of severe AP triggered by HTG with other metabolic syndrome components like type 2 diabetes mellitus and obesity is presented.
Esra Demir Demir, Ozgul Mustu Koryurek, Onur Tanrikulu
Turkish Journal of Internal Medicine, Volume 3, pp 57-59; doi:10.46310/tjim.875858

Abstract:
Urticaria, also known colloquially as hives, is a vascular reaction characterized by itchy, edematous plaques and papules, which develops by immunological or non-immunological mechanisms after the exposure to a triggering stimulant. Painless and itchy lesions that blanch upon pressure and fade spontaneously within 48 hours are the characteristic feature of the condition. In the case of urticarial vasculitis, on the other hand, the plaques, which last for at least 24 hours and present with burning, pain, and itching, leave a pigmentation behind when fading, and exhibit the histopathological characteristics of leukoclastic vasculitis. Urticarial vasculitis, which constitutes 5-20% of all chronic urticaria cases, is more common in the fourth decade of life and women.
Ece Ünal Çetin, Adil Uğur Çetin
Turkish Journal of Internal Medicine, Volume 3, pp 55-56; doi:10.46310/tjim.875351

Abstract:
Multiple myeloma is a malignant disease that can result in organ damage due to abnormal plasma cell growth and immunoglobulin or light chain overproduction in the bone marrow. It is the second most common hematologic cancer after lymphomas. Approximately half of the patients have kidney failure. Bone involvement is one of the most common organ damage in myeloma. Bone involvement is a feature that has diagnostic and prognostic value, shows tumor burden, organ damage, and affects the patient's quality of life. With the recent advances in Multiple Myeloma treatment, the survival of patients has increased dramatically. Although new agents contribute positively to total survival and disease-free life span, they cannot prevent disease recurrence. Therefore, it should be considered in patients with back pain, anemia, and kidney failure, and treatment delay should be avoided.
Elif Tuğba TUNCEL, Mesut Aydin, Erhan Ergin
Turkish Journal of Internal Medicine, Volume 3, pp 52-54; doi:10.46310/tjim.874433

Abstract:
Gastric polyps; They are pedunculated or sessile lesions that project towards the lumen arising from the gastric epithelium or submucosa. It is mostly asymptomatic and is detected incidentally during endoscopy. In our clinic, gastric polypoid lesions detected in many different shapes and sizes on endoscopy were pathologically diagnosed as fundic gland polyps. We aimed to present this case, which is rare compared to the cases in the literature, because it is interesting.
Mehmet Sezen, Muhammed Mesut Aytekin, Kamil Dilek, Abdülmecit Yildiz, Mustafa Güllülü, Mahmut Yavuz, Ayşegül ORUÇ, Mehmet Fethullah Aydin, Alparslan Ersoy
Turkish Journal of Internal Medicine, Volume 3, pp 69-70; doi:10.46310/tjim.876429

Abstract:
Light chain myeloma nephropathy is the most common form of renal involvement in plasma cell dyscrasias. It usually causes tubulointerstitial renal damage. About one in five people with multiple myeloma produce only light chains. We report a case of lambda light chain deposition disease in a 61-year-old female who presented with acute renal failure . She is currently in partial remission following treatment with bortezomib, cyclophosphamide, and steroids.We present a case with rare kappa light chain myeloma with light chain deposition in renal tubules.
, Damla Gürleyik, Nur Ramoğlu, Yasemin Gündoğdu, Iftihar Köksal
Turkish Journal of Internal Medicine, Volume 3, pp 79-81; doi:10.46310/tjim.876970

Abstract:
In COVID-19 disease, the activation of the coagulation system is increasing. Here we presented a case of COVID-19 who developed a hematoma in the pectoral muscle possibly associated with anticoagulation therapy.
Murat Çalapkulu, Muhammed Erkam Sencar, Ilknur Öztürk Ünsal, Hayri Bostan, Erman Çakal
Turkish Journal of Internal Medicine, Volume 3, pp 85-86; doi:10.46310/tjim.877156

Abstract:
Diabetic ketoacidosis (DKA) is a leading cause of mortality and morbidity in type 2 diabetic patients. Sodium-glucose co-transporter (SGLT-2) inhibitors are a new antidiabetic treatment class that increases the renal excretion of glucose. The Food and Drug Administration issued a warning in May 2015 notifying that patients using this class of anti-diabetic drugs may develop DKA. Risk factors for DKA development among patients who take SGLT-2 inhibitors include carbohydrate intake/starvation or acute illness. In the current report, we aimed to present a case of euglycemic DKA using dapagliflozin treatment.
Ensar Aydemir, Canan Ersoy, Özen Öz Gül, Soner Cander, Yasemin Aydoğan Ünsal, Coşkun ATEŞ, Erdinç Ertürk
Turkish Journal of Internal Medicine, Volume 3, pp 92-93; doi:10.46310/tjim.882244

Abstract:
Postsurgical chronic hypoparathyroidism is most commonly seen in adults. Synthetic recombinant human parathyroid hormone (rhPTH) 1-34 can be used to stabilize serum calcium levels in patients with resistant hypocalcemia in rare conditions. Here we report a 52-year-old woman with postsurgical uncontrolled hypocalcemia despite the usual therapy. Once-daily treatment with PTH 1-34 maintained serum calcium within the normal range and reduced the dose of previous medical therapies.
Tuğba İLHAN, Ayten Başak KARAAKIN DİNAR, Nizameddin Koca, Koray Ayar
Turkish Journal of Internal Medicine, Volume 3, pp 87-89; doi:10.46310/tjim.877255

Abstract:
Sarcoidosis is a chronic multisystemic inflammatory disease of unknown etiology, often associated with pulmonary involvement and characterized histopathologically by non-caseating granulomatous lesions. In this report, we aimed to present a 32-year-old patient who was hospitalized with a pre-diagnosis of cellulite, diagnosed with sarcoidosis based on skin lesions, and whose symptoms completely regressed with sarcoidosis treatment.
Ersin Elgin, Mehmet Fethullah Aydin, Abdülmecit Yildiz, Ayşegül ORUÇ, Suat Akgür, Mehmet Sezen, Mehmet Çağatay Çiçek, Kadir Ömür Günseren, Ibrahim Ethem Arslan, Sahriye Keskin, et al.
Turkish Journal of Internal Medicine, Volume 3, pp 34-35; doi:10.46310/tjim.876858

Abstract:
Evaluation of Death Patients on the Cadaveric Kidney Waiting List of Bursa Uludağ University Medical Faculty According to Years by Gender, Age, Blood Type, Dialysis Type In Turkey, there is 22953 end-stage kidney disease patient in national deceased kidney waiting list (1). According to the 2019 Registry Report of the Turkish Society of Nephrology, the number of patients receiving dialysis is 64633. The number of patients receiving hemodialysis (HD) and peritoneal dialysis (PD) are 61341 and 3292, respectively (2). However, patients registered on the national kidney waiting list consist of preemptive, PD, and HD patients. Due to the increase in the average life expectancy of the elderly population in our country, chronic kidney disease and comorbid diseases are increasing day by day. In this study, the characteristics of the patients who died on the deceased kidney waiting list of our kidney transplant center were evaluated retrospectively. Our center's patient data were obtained from Transplantation Dialysis Monitoring System records. Turkey’s general patient data were obtained from the Turkish Statistical Institute and the 2019 Registry Report of Turkish Society of Nephrology. In our center, the number of patients who died on the kidney waiting list from deceased donors was 350 (HD: 273, PD: 73, preemptive: 4). The number of female patients was 134 (38.2%) and the number of male patients was 216 (61.4%). The age distribution of the patients 0-9: 5%, 1.4, 10-19: 5 1.4%, 20-29: 14 4%, 30-39: 36 10.2%, 40-49: 62 17%, 7, 50-59: 100 28.5%, 60-69: 96 27.4%, 70-79: 31 8.8%, and 80-89: 1 0.2%. The distribution of blood groups of patients was consistent with the data in Turkey. [A Rh (+): 41.4%, A Rh (-): 3.7%, 0 Rh (+): 29.1%, 0 Rh (-): 6%, B Rh (+): 10.6%, B Rh (-): 0.6%, AB Rh (+): 7.1% and AB Rh (-): 1.4%]. The distribution of our patients by gender and kidney replacement therapies was in line with the 2019 Registry Report of Turkish Society of Nephrology. The number of patients who died by years is shown in figure 1. In our study, deaths between the age range of 50-59 and 60-69 registered in our center and died constitute 56% of the total deaths. Patients with chronic kidney failure have a high risk of death between the ages of 50 and 69. In one study, the course of Covid-19 disease caused by the SARS-CoV-2 virus is terrifying in elderly, co-morbid diseases, and male patients (3). Also, COVID-19 is severe and fatal in chronic kidney disease. With the COVID-19 disease being a pandemic in the world in 2020, according to the data of the current World Health Organization (WHO) dated 07.02.2021, 105,394,301 cases were detected in the world 2,302,302 deaths occurred (4). When we look at the distribution of cases by years, the death rate in 2020 is the highest. Although this suggests that this situation is related to the COVID-19 disease, the relationship with COVID-19 could not be determined since the causes of the deaths of these cases could not be reached from the death notification system of Ministry of Health. Due to the high mortality rates in the range of 50 to 69 years of age of patients in kidney transplant waiting lists, especially for patients with advanced age with chronic kidney disease "Turkey Kidney Diseases Prevention and Control Program" (5) to be controlled although work on the policy for new infectious diseases needs to be improved.
Nihal Lermi, Yavuz Pehlivan
Turkish Journal of Internal Medicine, Volume 3, pp 38-39; doi:10.46310/tjim.876957

Abstract:
Introduction: Spondylarthritis (SpA) comprises multiple divergent forms of inflammatory arthritis. ENA ranks in SpA group. It is aimed to present the features of 33 ENA cases which have been being monitored in our clinic, in this study. Method: Demographical and clinical features, presentation forms, of the 33 ENA cases who sought medical service in our polyclinic and diagnosed with ENA and treated with biological agents, have been recorded. It has been interrogated before biological agents treatment whether conventional DMARD’s (Disease-modifying antirheumatic drugs) were used. Results: Sixteen of the patients ( 48.4%) have been females, whereas 17 of them ( 51.6%) have been males. Eleven of the patients ( 33.3%) have been diagnosed with Crohn’s disease, whereas 22 of them (66.7%) with ulcerative colitis. Eighteen patients ( 54.5%) have presented with joint complaints and 13 of them ( 39.4%) with bowel complaints. The inquiry of the pre-treatments before the biological agents presented that 23 of them ( 69.7%) used nonsteroid anti-inflammatory drug (NSAID’s). Seventeen of the patients ( 51.5%) have used NSAID’s after IBD diagnosis whereas 4 patients ( 12.1%) had IBD inflammation symptoms as bleeding and diearrhea due to NSAID’s use after IBD diagnosis. Conclusion: Since there is a close link between SpA and ENA, patients should also be monitored in the aspect of bowel symptoms during the SpA course. It is needed to take into account the activation of intestinal symptoms as well, while deciding on the treatment of the patients with enteropathic arthritis.
Zeynep Yilmaz Bozkurt, Hüseyin Ediz Dalkiliç
Turkish Journal of Internal Medicine, Volume 3, pp 36-37; doi:10.46310/tjim.876917

Abstract:
May The Neutrophyl Lymphocıde Ratıo Be A New Marker For Uveıt Development In Ankylosıng Spondilitis? Introduction Neutrophil-lymphocyte ratio (NLR) is a marker that has been researched in recent years to be used as a marker of inflammation. The aim of our study is to evaluate the NLR in Ankylosing Spondylitis (AS) patients with uveitis, which is an extraarticular involvement, while having uveitis and to compare it with the NLR at first admission. Methods: Ninety patients with uveitis and diagnosed with AS according to the modified New York Criteria were included in the study. The files of the patients were analyzed retrospectively. NLR was calculated arithmetically using neutrophil and lymphocyte values in complete blood count. Results: There was no significant difference between the genders in terms of age, duration of diagnosis, and body mass index (p = 0.104, p = 0.073, p = 0.557, respectively). No significant difference was found between genders in terms of NLR values at first admission and at the time of uveitis (p = 0.016). The aim of our study was that there was a significant difference between the NLR values (1.660 ± 0.67 and 2.623 ± 1.293, respectively) in both genders at first admission and at the time of uveitis (p <0.001). The aim of our study was that there was a significant difference between the NLR values (1.660 ± 0.67 and 2.623 ± 1.293, respectively) in both genders at first application and at the time of uveitis (p <0.001). Conclusion: As a result, we found that NLR increased when having uveitis compared to the time of first admission. NLR may be a new marker for evaluating increased inflammation and disease activity in AS patients. Keywords: Ankylosing spondylitis, disease activity, neutrophil lymphocyte ratio, uveitis
Celaleddin Demircan, Ulviyya Hasanzade
Turkish Journal of Internal Medicine, Volume 3, pp 46-48; doi:10.46310/tjim.879724

Abstract:
In this study, we aimed to investigate the rates of polypharmacy and potentially inappropriate drug (PID) use in elderly patients who admitted to General Internal Medicine Outpatient Clinic. In this prospective cross-sectional study, the frequency of chronic diseases, the number of drugs used and polypharmacy rates of elderly patients were determined. Then, PIDs rates were investigated according to the 2015 Beers criteria. 304 (58,9% female, 41,1% male) patients were included in the study. 95,8% had at least one concomitant chronic disease, the mean number of drugs used by the patients per day was 4,9 ± 3,3 and the rate of polypharmacy was 52,9%. A total of 124 PIDs were determined in 104 (34,2%) patients, and this rate was higher in patients with polypharmacy (p < 0,05). The most common PIDs; the use of drugs that should be avoided in the elderly (Table 2-related PIDs; 28,3%), and the most common of these was the inappropriate use of proton pump inhibitors (PPIs).
Ibrahim Ethem Pinar, Fahir Özkalemkaş, , Tuba Ersal, Cumali Yalçin, Bedrettin Orhan, Ömer Candar
Turkish Journal of Internal Medicine, Volume 3, pp 42-43; doi:10.46310/tjim.877068

Abstract:
The management of acute myeloid leukemia (AML) gradually turns into an individualized approach with the application of targeted therapies. Venetoclax is a BCL-2 inhibitor that is synergistic with azacitidine. In this case series, 14 patients diagnosed with relapsed / refractory AML and 1 MDS RAEB-1 were followed up with venetoclax + azacitidine in the Hematology Department Bursa Uludag University Faculty of Medicine were evaluated. The best responses obtained with venetoclax + azacitidine were complete remission (CR) in one patient, complete remission with incomplete hematologic recovery (CRi) in one patient, morphological leukemia-free state (MLFS) in 4 patients, and partial response (PR) in one patient. The median time to first response with treatment was one month (0.5-5). The time to enter early remission is critical. For this reason, deaths due to infection should be prevented. Although the toxicities of this combination therapy can be managed, close follow-up of the patients is mandatory. In conclusion, this combination therapy is promising as it is relatively well-tolerated, improves the quality of life, and prolongs survival.
Ömer Candar, Fahir Özkalemkaş, , Tuba Ersal, Ibrahim Ethem Pinar, Cumali Yalçin, Bedrettin Orhan
Turkish Journal of Internal Medicine, Volume 3, pp 40-41; doi:10.46310/tjim.877049

Abstract:
Nodular lymphocyte predominant Hodgkin lymphoma is an infrequent disease. It is associated with a favorable prognosis. The most important problems with the management of the disease are relapses, transformation to non-Hodgkin lymphoma, and treatment-related toxicities. In early stages of disease, watchful waiting, surgery, radiotherapy, and single-agent rituximab are the treatment options. Chemo-immunotherapy may be preferred in early disease with high tumor and symptom burden. In advanced disease, chemo-immunotherapy with or without radiotherapy is used. Good responses can be achieved in relapsed disease. The risk of transformation is high. It is reasonable to obtain re-biopsies at relapses. Transformed disease and the primary disease have been shown to be clonally-related in most cases. Prognosis of transformed disease which is treated with salvage chemo-immunotherapy followed by autologous stem cell transplantation is similar to that of de novo diffuse large B-cell lymphoma. All of the data regarding the treatment come from retrospective data.
Belkis Nihan Coskun Coşkun, Oğuzhan Sıtkı Dizdar, Şeniz Korkmaz, Engin Ulukaya, Türkkan Evrensel
Turkish Journal of Internal Medicine; doi:10.46310/tjim.875437

Abstract:
Introduction: We aimed to investigate the predictive effect of serum M30 and M65 antigens on long-term prognosis in patients with advanced stage lung cancer before and after the first dose of chemotherapy. Methods: Fourty eight patients with advanced stage lung cancer were included in the study. Demographic data and histopathological characteristics of the patients were recorded. Serum levels of M30 and M65 were studied in 48 patients before chemotherapy, and in 43 patients both before and 48 hours after chemotherapy. Long-term survival was evaluated using Kaplan-Meier curves. The effect of high or low M30, M65 levels and M30/M65 ratio on long-term survival was investigated. Results: The mean age of the patients at the time of diagnosis was 57.52 ± 9.38 years. Fourty six of the 48 patients were men. While M30 value before chemotherapy was 163.23 ± 112.30 U/l; It was measured as 249.74 ± 266.67 U/l 48 hours after chemotherapy (p<0.001). While M65 value before chemotherapy was 415.97 ± 214.63 U/l; It was 656.65 ± 394.15 U/l hours after chemotherapy (p<0.001). Median survival time was calculated as 17 (2-142) months. It was found that the long-term survival of the group with a low M30/M65 ratio before chemotherapy was statistically significantly longer. It was observed that the M30/M65 ratio, or M30 or M65 alone, measured 48 hours after chemotherapy had no predictive value for long-term survival. Conclusion: The M30/M65 ratio before chemotherapy may be a prognostic factor for long-term survival in patients with advanced lung cancer.
Mehmet Baysal, , Serap Baysal
Turkish Journal of Internal Medicine; doi:10.46310/tjim.873515

Abstract:
Introduction With the introduction of FLT3 inhibitors in recent years, the presence of FLT3 mutation in newly diagnosed acute myeloid leukemia (AML) patients has become more important. it was observed that the addition of Midostaurin to remission induction and consolidation chemotherapy, brought a 22% reduction in mortality risk in patients with FLT3 mutation. In the light of the above information, we aimed to share our experience regarding the use of Midostaurin in our newly diagnosed AML patients. Methods The data of 20 patients who were diagnosed with AML between April 2020 and November 2020 in the Hematology Department of Bursa City Hospital and who were eligible for standard remission induction therapy were evaluated retrospectively. Standard remission induction chemotherapy consisting of a combination of cytosine arabinoside (ARA-C) and an anthracycline was applied to patients. Consolidation treatment with high dose ARA-C was given to patients in remission; Midosaturin 100 mg was added to High-dose ARA-C between days 8 and 21 in patients with FLT3 mutation. Results: Twenty patients included in the study, 14 were men and 6 were women. There were six patients with the FLT3 mutation. Five patients with FLT3 mutation were male and one was female. The mean age of the patients is 53.8; the mean age of the patients with FLT 3 mutation was 49.8 years. Two patients with FLT 3 mutation died due to sepsis during remission induction treatment; In Four patients, complete response was obtained with remission induction therapy. Four patients had been given midostaurin with high dose ARA-C and referred for bone marrow transplantation. Conclusion The use of FLT3 inhibitors in combination with chemotherapeutic agents in the treatment of AML patients with FLT3 mutation is considered as a standard. However, it takes a certain amount of time for the FLT3 mutation to result. For this reason, Midostaurin treatment could be added not during remission induction but consolidation. Although our study included a limited number of patients it shows the importance of Midostaurin treatment in newly diagnosed AML patients with FLT3 mutation as real-world data.
Ensar Aydemir, Özen Öz Gül, Yasemin Aydoğan Ünsal, Coşkun ATEŞ, Soner Cander, Canan Ersoy, Erdinç Ertürk
Turkish Journal of Internal Medicine; doi:10.46310/tjim.882858

Abstract:
Papillary thyroid carcinoma (PTC) and Medullary thyroid carcinoma (MTC) are extremely rare and constitute less than 0.5% of all thyroid malignancies. In this study, the prevelance and characteristics of 8 patients with simultaneous PTC and MTC diagnoses were evaluated.
Ayten Dinar, Koray Ayar
Turkish Journal of Internal Medicine; doi:10.46310/tjim.876499

Abstract:
The aim of this study is to investigate the differences between males and females in clinical findings, hereditary characteristics, treatment responses and pathogen Mediterranean fever (MEFV) gene phenotype frequencies in FMF patients. The data of 105 patients (70 females, 35 males) whose charts were available for all research data were evaluated. While evaluating the clinical findings; The age of attack onset, attack character, dominant attack location, presence of recurrent fever, appendectomy history and family history were evaluated. the response to colchicine treatment was questioned. The phenotype frequencies of the pathogen variations in the MEFV gene were determined. The frequency of individuals with typical attack character was 71.4% in women and 82.9% in men. The frequency of the predominant attack localization with peritoneum was 90% in women and 88.6% in men. The proportion of those with colchicine response was 92.8% and 85.7% in women and men, respectively. The phenotype frequencies of pathogen MEFV gene mutations were 62.7% and 88.6% for M694V (p=0.006), 22.4% and 14.3% (p=0.328) for V726A, 20.9% for M680I in women and men, respectively, and 22.9% (p = 0.819) and 14.9% and 14.3% (p=0.931) for E148Q. Clinical findings and treatment responses are not different in individuals with FMF disease. The frequency of the M694Vmutation, which has high penetration and is associated with important complications such as amyloidosis, is higher in men. There is a need for studies to evaluate FMF activity according to gender distribution.
Umut Karabulut, Dilay Karabulut
Turkish Journal of Internal Medicine; doi:10.46310/tjim.875857

Abstract:
Background: This study aims to reveal whether the Lymphocyte-C-reactive protein ratio (LCR), a systemic inflammatory marker, predicts disease progression in COVID-19 patients with myocardial injury. Methods: A total of 172 patients,18 years and older, hospitalized due to COVID 19 between April 2020 and May 2020 in our hospital were included retrospectively. Hg, leukocyte, lymphocyte, neutrophil, thrombocyte, AST, ALT, creatinine, LDH, albumin, ferritin, triglyceride, procalcitonin, C-reactive protein, fibrinogen, D-dimer, troponin, LCR values of the patients were recorded. LRC ratios were amplified as x100. Patients were divided into two groups as with and without myocardial injury. IBM SPSS Statistics 21.0 program was used for statistical analysis. Statistically, p 0.05). Hypertension (HT), chronic renal failure (CRF) were more common in the group with myocardial injury (p <0.01, p <0.01). Procalcitonin and creatine levels were significantly higher in the group with myocardial injury (p = 0.002, p <0.001). When we analyzed the correlation analysis of parameters associated with myocardial injury with troponin, it showed a good correlation with CRF (r = 484, p <0.001), moderate with procalcitonin (r = 274, p <0.001, and weak correlation with age and HT (r = 484, p <0.001) = 180, p = 018) (r = 159, p = 037),respectively. DM and D-dimer did not correlate (r = 055, p = 472) (r = 072 p = 345).In the multivariate regression analysis, only CRF (Odds ratio (OD): 11.062 (95% confidence interval (CI): 1.866-65.580)) and reference procalcitonin levels (OR: 1.183, 95% CI: 1.014-1.379) predicted myocardial injury. Conclusion: Our study found that LRC did not predict disease progression in Covid-19 patients with myocardial injury.
Yasemin Aydoğan Ünsal, Özen Öz Gül, Soner Cander, Canan Ersoy, Ensar Aydemir, Coşkun ATEŞ, Oktay Ünsal, Erdinç Ertürk
Turkish Journal of Internal Medicine; doi:10.46310/tjim.876517

Abstract:
IIntroduction The aim of this study was to evaluate the clinicodemographic factors and features of tumors in patients with malignant pheochromocytoma. Methods: We retrospectively evaluated the data of 5 cases admitted to our department between 2013 and 2020 and diagnosed with malignant pheochromocytoma. Results: The patients included three females with mean age of 45 years at presentation. Three cases were diagnosed with pheochromocytoma after hypertensive attack and two cases were diagnosed after detection of adrenal mass. The average diameter of the adrenal mass of the cases was 58 mm. Extesion to periadrenal adipose tissue was detected in two patients, vascular invasion in one patient, and capsule invasion in 1 patient in the surgery-resected specimen. Intraabdominal lymph node metastasis was found in 1 patient and metastatic focus was seen in the liver in 1 patient at the time of the diagnosis. During follow-up, perirenal region metastasis was detected in 1 patient. Bone metastasis was seen in 3 patients, lymph node metastasis in 2 patients and lung metastasis in 1 patient. Transperitoneal surrenalectomy was performed in all cases. Lutetium-177, radiotherapy and surgery were the preferred adjuvant therapies. Three patients died because of progression of the disease or acute complications and the other 2 patients are still under follow-up in our clinic. Conclusion: Malignant pheochromocytoma is rare and definitive criteria for malignancy is not established. Prognosis is poor and there is no curative treatment. Resection of malignant pheochromocytoma with intent to cure, which may improve symptoms and possibly survival is important.
Hacer Hicran Mutlu, Hasan Hüseyin
Turkish Journal of Internal Medicine; doi:10.46310/tjim.875717

Abstract:
Aim: Although the term 'addiction' was previously used only to describe excessive alcohol and substance abuse, it has recently been realized that some behaviors have a neurobiological basis similar to alcohol and substance addiction. Food addiction is one of these behaviors. In many studies, it has been suggested that especially obese and overeating people have food addiction (1,2). The aim of our study was to compare the food addiction prevalence among obese and non-obese persons who applied to obesity and family medicine outpatient clinics. Material-method: The patients who applied to the Family Medicine outpatient clinic and obesity outpatient clinic between 15.01.2019-30.06.2019 were included in the study. The age, gender, weight, height, and smoking status of the patients were questioned. Yale Food Addiction Scale which was developed by Ashley N. Gearhardt (1) et al and adapted to the Turkish language by Bayraktar (2) et al was conducted on the individuals who volunteer to participate in the study. Results: 195 patients without obesity and 403 patients with obesity were included in the study. The mean age and body mass index, the distribution of gender, and smoking status of the individuals are shown in Table 1. The food addiction prevalence in the obese group was 33,7% and 14% in the non-obese group. The prevalence of food addiction was significantly higher in obese individuals (p<0,001) (OR 3,13, 95 % Cl 2,09-4,68).
Ersin Elgin, Mehmet Fethullah Aydin, Abdülmecit Yildiz, Ayşegül ORUÇ, Suat Akgür, Mehmet Sezen, Mehmet Çağatay Çiçek, Kadir Ömür Günseren, Ibrahim Ethem Arslan, Sahriye Keskin, et al.
Turkish Journal of Internal Medicine; doi:10.46310/tjim.876465

Abstract:
In Turkey, there is 22953 end-stage kidney disease patient in national deceased kidney waiting list (1). According to the 2019 Registry Report of the Turkish Society of Nephrology, the number of patients receiving hemodialysis (HD) and peritoneal dialysis (PD) treatment is 64633 (2). However, patients registered on the national kidney waiting list consist of preemptive, PD, and HD patients. Due to the increase in the average life expectancy of the elderly population in our country, chronic kidney disease and comorbid diseases are increasing day by day. In this study, the patients’ characteristics on the deceased kidney waiting list from our kidney transplant center were evaluated retrospectively. Our center's patient data were obtained from Transplantation Dialysis Monitoring System records. Turkey’s general patient data were obtained from the Turkish Statistical Institute and the 2019 Registry Report of the Turkish Society of Nephrology. In our center, the number of patients on the deceased donor kidney waiting list was 420 (HD: 301, PD: 24, preemptive 95). The number of female patients was 162 (38.6%), and the number of male patients was 258 (61.4%). The age distribution of the patients 0-9: 1.1%, 10-19: 3%, 20-29: 4.4%, 30-39: 11.6%, 40-49: 20%, 50-59: 24.4%, 60-69: 26.8%, 70-79: 7.8% and 80-89: 0.2%. The blood group distribution of patients was consistent with Turkey's general data. [0 Rh (+): 26.7%, 0 Rh (-): 3.1%, A Rh (+) 43.3%, A Rh (-) 5.7%, B Rh (+) 11%, B Rh (-) 1.7%, AB Rh (+) 8.1% and AB Rh (-) 0.5%]. The number of male patients was higher than female patients in other age groups except the 40-49 and 80-89 age range (Figure 1). Our patients' distribution by gender and kidney replacement therapies was in line with the 2019 Registry Report of the Turkish Society of Nephrology. An increase in comorbid diseases and kidney failure in advanced age also increases health expenditures. The Republic of Turkey Ministry of Health aims to increase the awareness of kidney disease and the rate of early diagnosis with the "Turkey Kidney Diseases Prevention and Control Program" (3). In our center, the highest number of patients on the deceased kidney waiting list was observed in the age range of 60-69, 50-59, and 40-49, respectively. Physical quality of life worsens as the dialysis period prolongs and the patient ages. Therefore, elderly HD patients need more social and mental support (4). The donor's age is 60 years and above is one of the extended donor criteria (EDC). Using kidneys with advanced age and EDC criteria in candidates of similar age may increase patient and graft survival and physical quality of life. For this reason, policies should be developed to ensure the transplantation of EDC grafts to patients who will benefit most.
Aslı Kurtar MANSIROĞLU
Turkish Journal of Internal Medicine; doi:10.46310/tjim.866344

Abstract:
Pulmonary Hypertension is defined as the mean pulmonary artery pressure measured by right heart catheterization greater than 25mmHg at rest. Symptoms and signs include shortness of breath, lightheadedness, syncope, tiredness, chest pain, swelling of the legs, poor appetite, chest pain, right-sided abdominal pain, palpitations, cyanosis and rarely non-productive cough, exercise-induced nausea, and vomiting. A diagnosis of Pulmonary Hypertension requires clinical suspicion based on symptoms and physical examination. In our daily practice, it is necessary to raise awareness for this patient group, whose diagnosis is delayed, and the specialist referral centers should be determined and the referral chain should be operated. We herein present 3-year Follow-up Results of Abant Izzet Baysal University Training and Research Hospital Patients with Pulmonary Hypertension.
Ender Eren Özçelik, Alparslan Ersoy
Turkish Journal of Internal Medicine; doi:10.46310/tjim.872047

Abstract:
Infection is the most common reason for admission to the emergency department in the early period after transplantation. Urinary tract infections (UTIs) in adult kidney transplant patients are common. Their incidence is significantly higher than in the general population.1 The majority of sepsis cases in this period are composed of UTIs.2 While mild UTIs generally do not affect graft function, acute pyelonephritis observed in the post-transplant period causes a decrease in graft function and an increase in mortality.3 In the literature, a small amount of data has been published regarding the incidence, epidemiological features, and risk factors of UTIs in kidney transplant recipients. In this retrospective study, we evaluated the data of 550 patients who underwent kidney transplantation between January 2006 and May 2019 at our center and analyzed UTIs' characteristics. Among 550 recipients, 633 episodes were detected in 200 patients (36.4%). Recurrent infection was encountered in 74 (37%) of 200 patients. We determined 1 episode in 63 (31.5%), 2 episodes in 39 (19.5%), 3 episodes in 31 (15.5%), 4 episodes in 14 (7%), 5 episodes in 10 (5%), 6 episodes in 8 (4%), and 7 or more episodes in 35 (17.5%). While 48.3% (n=306) of 633 episodes were asymptomatic bacteriuria, 51.6% (n=327) was symptomatic. The risk factors for UTI were female gender, the advanced age of transplant and advanced donor age, long-term dialysis period before transplant, prolonged urinary catheterization and hospitalization time after transplant, cytomegalovirus infection, vesicoureteral reflux, and neurogenic bladder history. At the survival analysis, a transplant from living donor, female gender, use of tacrolimus, mycophenolate mofetil and corticosteroid combination as maintenance immunosuppressive therapy, preemptive transplant compared to patients receiving peritoneal dialysis was found to be associated with longer survival; advanced age of transplant, obesity, delayed graft function, acute rejection, diabetes mellitus and a history of cytomegalovirus infection was also associated with a shorter life span. Escherichia coli (64.9%) and Klebsiella pneumonia (51.6%) were the most common causative microorganisms, and ESBL (Expanded Spectrum Beta-Lactamase) was positive in 19.9% and 67.5% of them, respectively. Similarly, female gender, the advanced age of transplant, prolonged catheterization time, history of vesicoureteral reflux, neurogenic bladder, acute rejection, and deceased donor were dependent risk factors for developing of UTI in transplant recipients in other studies,4-6 but not body mass index, history of diabetes mellitus, dialysis type and duration, primary kidney disease, donor type, delayed graft function, and history of acute rejection in another study.7 UTI frequency in the female gender increases due to anatomical differences such as the shorter urethra compared to men and its relative proximity to the perianal region and vulva, as in the general population. Age-related changes in the urinary tract and existing additional diseases are important factors that predispose to bacterial colonization. Prolonged urinary catheterization and hospitalization durations facilitate pathogen entry into sterile body parts in the post-operative period. Immunosuppression, frequent hospitalizations, and surgical interventions increase the risk of nosocomial infections in dialysis patients. A history of vesicoureteral reflux facilitating bacterial invasion and a neurogenic bladder causing urinary stasis poses a UTI risk. Hospitalizations for septicemia are most commonly associated with UTI.8 In our cohort, antibiotics in the carbapenem group, started in more than half of the episodes. There is an increase in trimethoprim/sulfamethoxazole, ciprofloxacin and ceftazidime resistance in Klebsiella species.9 Although the microorganism spectrum in the studies is similar all world, ESBL positivity is noticeably higher than the average in UTI episodes is an observation in parallel with the increasing antibiotic resistance both in our country and in the world in recent years. This observation was considered as a cautionary finding for the review of antibiotic selection preferences in our clinic. Finally, UTIs being a threat to graft and patient survival in the post-transplant period should be treated effectively by carefully evaluating risk factors.
Ece Ünal Çetin, Yavuz Beyazit
Turkish Journal of Internal Medicine; doi:10.46310/tjim.875560

Abstract:
The signalling pathway of Janus kinase (JAK)/signal transducer and activator of transcription 3 (STAT3) is suggested to be involved in various pathophysiological processes, including immune function, cell growth, differentiation, hematopoiesis and more importantly oncogenesis of distinct tumoral conditions. Interleukin (IL) 6 is a proinflammatory cytokine produced by antigen-presenting cells and non-hematopoietic cells in response to external stimuli and considered to be a key player in the development of the microenvironment of malignancy by promoting tumor growth and metastasis by acting as a bridge between chronic inflammation and cancerous tissue. Recent studies suggest that aberrant interleukin IL6/JAK/STAT3 signaling pathway exists in both IBD and inflammation-related gastrointestinal cancers. In the present meta-analysis we aimed to analyze the relationship between IL-6/JAK/STAT3 and IBD associated colorectal carcinogenesis and the effect of the inhibition of this system on disease follow-up and management.In light of the small number of studies able to be included in the meta-analysis evidence strongly proposed that JAK/STAT3 signaling, especially via the IL-6/STAT3 axis is involved in the transition of inflammatory lesions to tumoral diseases and leading to ulcerative colitis associated colorectal cancer. For this reason, based on the evidence presented in this meta-analysis it is reasonable to suggest that targeting components of the IL-6/JAK/STAT3 signalling pathway can inhibit tumour cell growth and relieve immunosuppression in the UC associated colonic tumoral microenvironment.
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