Search

Background: Spondyloarthritis represents a group of diseases with common clinical, epidemiological, and genetic features, such as involvement of axial skeleton. To understand the etiopathogenesis of spondyloarthritis, we need to know its clinical, genetic, and environmental factors. Our country's data on axial spondyloarthritis is limited. In this study, we aimed to present the data of axial spondyloarthritis in Adıyaman in the Southeastern Anatolia region.Materials and Methods: The medical records of patients diagnosed with axial spondyloarthritis were retrospectively reviewed according to the Assessment of SpondyloArthritis international Society classification criteria in the rheumatology clinic of Adıyaman Training and Research Hospital. The Bath AS Disease Activity Index (BASDAI), erythrocyte sedimentation rate, and c-reactive protein data were collected during the follow-up period. Bath AS Functional Index (BASFI) was used to evaluate the functional status of the patients.Results: The study included a total of 308 patients, including 181 (58.8%) males and 127 (41.2%) females. The median (25-75 IQR) age was 36 (31-45) years. The median (25-75 IQR) time from the onset of symptoms to diagnosis (delay time in diagnosis) was 4 (3-5,5) years. HLA-B27 was found positive in 43.6% of 110 patients studied. There was a significantly higher percentage of male patients (66.7%, p = 0.025) and a higher BASFI score (p = 0.019) among the HLA-B27-positive patients, and the delay time in diagnosis was lower (p = 0.015). There were no significant differences in the clinical, laboratory, BASDAI, and BASFI parameters between patients receiving nonsteroidal anti-inflammatory drugs and tumor necrosis factor inhibitors (anti-tumor necrosis factor [anti-TNF]).Conclusion: Spondyloarthritis affects young adults more frequently. HLA-B27 status and male gender are important for prognosis. Anti-TNF therapy is a good option when there is no response to conventional treatment in spondyloarthritis. Disease activity is controlled and patients’ functional capacities are increased with anti-TNF treatment.Key words: Spondyloarthritis, anti-TNF, HLA-B27, Turkey, Amaç: Spondiloartritler ; aksiyel tutulumun ön planda olduğu, ortak klinik, epidemiyolojik ve genetik özellikleri bulunan bir grup hastalığı tanımlar. Spondiloartritlerde klinik, genetik ve çevresel faktörleri araştırmak etyopatogenezi anlamak açısından önemlidir. Aksiyel spondiloartritin ülkemiz verileri kısıtlıdır. Biz bu çalışmada aksiyel spondiloartritin Güneydoğu Anadolu bölgesinde yer alan Adıyaman ili verilerini sunmayı amaçladık. Materyal ve metod: Adıyaman Eğitim ve Araştırma Hastanesi romatoloji kliniğinde takipli ASAS aksiyel spondiloartrit sınıflama kriterlerine göre tanı konulmuş hastaların dosyaları retrospektif olarak tarandı. Hastalık takibinde Bath AS Hastalık Aktivite İndeksi (BASDAI), eritrosit sedimantasyon hızı (ESR) ve c-reaktif protein (CRP) kullanıldı. Hastaların fonksiyonel durum değerlendirmesinde Bath AS Fonksiyonel İndeksi (BASFI) kullanıldı.Bulgular: Çalışmaya toplam 308 hasta dahil edildi. Hastaların 181’i (%58,8) erkek, 127’si (%41,2) kadındı. Medyan (25-75 IQR) yaş 36 (31-45) idi. İlk semptomdan tanı almalarına kadar geçen süre (tanıda gecikme süresi) medyan (25-75 IQR) 4 (3-5,5) yıldı. 110 hastada çalışılan HLA-B27 %43,6 oranında pozitifti. HLA-B27 pozitif olan hastalarda istatiksel anlamlı olarak erkek oranı (%66,7, p=0,025) ve BASFI skoru daha yüksek (p=0,019), tanıda gecikme süresi ise daha düşüktü (p=0,015). Tümör nekrozis faktör inhibitörleri (Anti-TNF) ve Nonsteroid antiinflamatuar ilaç alan hasta grupları arasında klinik, laboratuvar, BASDAI ve BASFI parametrelerinde anlamlı farklılık yoktu.Sonuç: Spondiloartritler genç erişkinleri daha fazla etkiler. HLA-B27 ve erkek cinsiyet prognoz açısından önemlidir. Spondiloartritte konvansiyonel tedaviye yanıt olmadığında anti-TNF iyi bir seçenektir. Anti-TNF tedavi ile hastalık aktivitesi kontrol altına alınmakta ve hastaların fonksiyonel kapasiteleri artmaktadır.

BACKGROUND/AIMS: Drug-induced liver injury (DILI) is common worldwide and has a potentially fatal outcome. It accounts for more than half of the cases of acute liver failure in the United States. Herb-induced liver injury (HILI) is a less documented condition but a growing problem. We present here the clinical characteristics and outcome of patients with drug- and herb-induced liver injury from our center. MATERIALS AND METHODS: In this 4-year retrospective study, 82 patients in whom there was a causal or highly probable relationship between herbal medicine or drug use and liver disease are presented. RESULTS: The mean age of patients was 43.1±14.8 years; sexual distribution was 53 females and 29 males. The major cause of hepatotoxicity was drugs (87.8%), with herbal medicine accounting for 12.2%. The leading causative agents were nonsteroidal anti-inflammatory drugs (NSAIDs) (23.1%), followed by antibiotics (19.5%). The pattern of hepatotoxicity was hepatocellular in 35 patients (42.6%), mixed in 28 (34.1%), and cholestatic in 19 patients (23.1%). Teucrium polium (known popularly as felty germander), which is a traditionally used herbal medicine of the Labiatae family in our region, was the most common cause of herb-induced liver injury and responsible in 7 of 10 herbal hepatotoxic cases. Acute liver failure developed in 3 patients (two patients related with flurbiprofen and diclofenac and one patient due to an isoniazid-rifampicin combination). CONCLUSION: Antibiotics and NSAIDs were the most common etiologic agents for drug-induced liver injury. Surprisingly, herbs follow these groups of drugs and must be questioned more carefully. Language: en

Background Sarcopenia, obesity, and sarcopenic obesity are various features of the ageing process that can cause important health issues. The present study was undertaken to investigate the interrelationship between those body composition changes, including their clinical components and the quality-of-life variables. Methods A total of 423 individuals aged 65 years or older was included in this cross-sectional study. Sarcopenia was diagnosed according to The European Working Group on Sarcopenia in Older People criteria. Body composition parameters were measured with a bioelectrical impedance analyser, and Turkish population-based cut-off points were preferred for diagnosis of sarcopenia. Comprehensive geriatric assessment was performed on all patients. A logistic regression analysis was performed to identify important factors for sarcopenia and sarcopenic obesity. Results The prevalence of sarcopenic, obese and sarcopenic obese subjects was 14%, 35% and 11% respectively. The lowest mean gait speed and hand grip strength values were seen in the sarcopenic obese group (0.6 ± 0.3 m/s and 19.7 ± 9.8 kg respectively). Sarcopenic obese participants were associated with the highest rate for fall risk. The scores for domains of health-related quality of life were worse in both obesity and sarcopenic obesity when compared to others. Body mass index (BMI), number of drugs used, total body fat ratio and geriatric depression scale-short form scores were negatively correlated with all dimensions of SF-36 quality-of-life scale. Conclusions Sarcopenia, obesity and sarcopenic obesity are associated with many negative health outcomes, such as high fall risk and low health-related quality of life in geriatric population.

Amaç: Obezite yaşlı nüfus arasında giderek artan bir sıklıkta görülmektedir. Obezite, çok sayıda kronik hastalığın gelişmesine ve ilerlemesine katkıda bulunmasının yanı sıra, yaşam kalitesinde bozulmaya ve yeme bozukluklarının artmasına katkıda bulunmaktadır. Bu çalışmada yaşlı hastalarda obezitenin yaşam kalitesi ve yeme bozuklukları üzerine etkileri araştırıldı.Gereç ve Yöntemler: Bu kesitsel çalışmaya 65 yaş ve üstü toplam 281 birey dahil edilmiştir. Tüm hastalara kapsamlı geriatrik değerlendirme yapıldı. Sağlığa bağlı yaşam kalitesi Kısa Form (SF) - 36 kullanılarak ölçüldü. Yeme bozuklukları Yeme Tutum Testi (EAT) - 26 kullanılarak ölçüldü.Bulgular: Çalışmaya 125 obez ve 156 obez olmayan geriatrik hasta alındı. Obez ve obez olmayan geriatrik hastalarda yeme tutumu bozukluklarının görülme sıklığı sırasıyla% 17.8 ve% 8.6 idi (p

Increasing data suggests that chronic inflammation has an essential role on development of muscle dysfunction and progression of sarcopenia in aging population. The aim of the present study was to compare Neutrophil Lymphocyte Ratio (NLR) levels in sarcopenic and non-sarcopenic individuals and to present the correlation between NLR and other inflammatory markers.A total of 105 subjects with sarcopenia (male/female: 54/51, mean age 72.8 ± 7.3) and 314 subjects as non-sarcopenic (male/female: 125/189, mean age 71.44 ± 5.4) were enrolled in this cross-sectional study. Sarcopenia was diagnosed according to The European Working Group on Sarcopenia in Older People criteria. Comprehensive geriatric assessment was performed to participants. Complete blood count, biomarkers of inflammation (C-reactive protein (CRP), erythrocyte sedimentation rate (ESR)) of all patients were measured.NLR levels were found to be higher in the sarcopenic group (2.52 ± 1.30 vs 2.21 ± 0.93, p 0.013, respectively). Compared to non-sarcopenic participants white blood cell (WBC), ESR and CRP levels were also higher in sarcopenic group. There was a positive correlation between CRP, WBC, total body fat ratio and NLR (r: 0.433, p 0.001; r: 0.237, p: 0.022; r: 0.339, p 0.001, respectively). A strong negative correlation was identified between fat free mass and NLR levels in sarcopenic individuals (r: -0.755, p 0.001). The result of the logistic regression analysis depicted that NLR is an independent predictor for sarcopenia (OR = 1.31; 95% CI = 1.06-1.62, p: 0.013).Increased NLR levels may indicate that inflammation may have a significant role in development of sarcopenia in the elderly population.

Sarcopenia, obesity, and sarcopenic obesity are various features of the ageing process that can cause important health issues. The present study was undertaken to investigate the interrelationship between those body composition changes, including their clinical components and the quality-of-life variables.A total of 423 individuals aged 65 years or older was included in this cross-sectional study. Sarcopenia was diagnosed according to The European Working Group on Sarcopenia in Older People criteria. Body composition parameters were measured with a bioelectrical impedance analyser, and Turkish population-based cut-off points were preferred for diagnosis of sarcopenia. Comprehensive geriatric assessment was performed on all patients. A logistic regression analysis was performed to identify important factors for sarcopenia and sarcopenic obesity.The prevalence of sarcopenic, obese and sarcopenic obese subjects was 14%, 35% and 11% respectively. The lowest mean gait speed and hand grip strength values were seen in the sarcopenic obese group (0.6 ± 0.3 m/s and 19.7 ± 9.8 kg respectively). Sarcopenic obese participants were associated with the highest rate for fall risk. The scores for domains of health-related quality of life were worse in both obesity and sarcopenic obesity when compared to others. Body mass index (BMI), number of drugs used, total body fat ratio and geriatric depression scale-short form scores were negatively correlated with all dimensions of SF-36 quality-of-life scale.Sarcopenia, obesity and sarcopenic obesity are associated with many negative health outcomes, such as high fall risk and low health-related quality of life in geriatric population.

Background/aim: Frailty is a complex, multifactorial, and important geriatric syndrome characterized by decline in physiological reserves and functional deficiency in multiple systems. The aim of the current study is to investigate the prevalence of frailty and to determine the correlation between quality of life (QoL) and falling risk in geriatric hospitalized patients. Materials and methods: A total of 420 patients, aged 65 years and above, were enrolled in the study. All participants were hospitalized at a university hospital in the internal medicine clinics. The Cardiovascular Health Study (CHS) frailty scale, Health-Related Quality of Life Short Form (SF-36) scale, and Hendrich II Fall Risk Model were administered to the patients. Demographic data of patients, number of chronic diseases, and information on used medication were also collected.Results: The median age of patients was 71.9 $\pm$ 6.3 years and 49.5% of the patients were female. By applying the CHS frailty scale, the proportion of frail patients was determined to be 65.5%. There were statistically significant differences among quality of life mean scores of robust, prefrail, and frail patients (P < 0.001). Frail patients had the lowest scores in all SF-36 subgroups. Eighty-three (19.8%) patients were in the low-risk group while 337 (80.2%) were high-risk according to the Hendrich II Fall Risk Model. The rate of patients with high falling risk and poor QoL reached a maximum in the frail group (96%).Conclusion: Frailty is an important geriatric syndrome in elderly hospitalized patients. Poor QoL and high falling risk are issues commonly experienced with frailty.

Objective: Familial Mediterranean fever (FMF) is an autosomal recessive autoimmune disease, presenting with the attacks of fever and inflammation of serous membranes. One of the leading causes of death in autoimmune rheumatologic diseases is cardiovascular events. The purpose of this study is to evaluate the effects of FMF on the autonomic nerve and cardiovascular systems by measuring the indices of heart rate variability (HRV). Material and Methods: Thirty FMF patients and the same number of healthy volunteers were enrolled to the study. Standard deviation of all R-R intervals (SDNN), the square root of the sum of the square of the differences between successive R-R intervals (RMSSD), standard deviation of 5-minute mean values of R-R interval (SDANN), low frequency (LF), and high frequency (HF) were measured. Results: Time domain indices (SDNN, SDANN, and RMSSD) were: 124.67±40.79, 129.87±36.43 (p=0.605); 11.43±38.41, 11.23±38.98 (p=0.984); and 33.43±17.39, 38.17±12.8 (p=0.235) for FMF patients and controls, respectively, and similar in both groups. Frequency domain indices (HF, LF, and LF/HF) were: 290.41±290.25, 322.20±222.54 (p=0.639); 596.16±334.07, 805.80±471.00 (p=0.051); and 3.57±2.57, 3.05±1.40 (p=0.338) for FMF patients and controls, respectively, and similar in both groups. Conclusion: The HRV parameters were similar in both groups. However, studies including larger populations and using different methods are required to clarify if autonomic dysfunction exists in patients with FMF.

Vemurafenib is an inhibitor of the BRAF V600E mutation which is associated with tumor responses in patients with metastatic melanoma. Although it is generally well tolerated, common side effects of vemurafenib have been reported. Arthralgia is one of the more common adverse event associated with vemurafenib. We herein report a 49-year-old woman diagnosed with metastatic melanoma harboring the BRAF V600E mutation with severe polyarthritis associated with vemurafenib after 7 days of treatment. Sonographic examination of affected joints revealed synovitis and the patient's articular symptoms were improved by analgesic and anti-inflammatory treatment, including corticosteroids. During therapy with selective BRAF inhibitors, arthritis represents a new adverse event that can require dose reduction. In case of this adverse event, treatment with anti-inflammatory drugs, such as ibuprofen and prednisone, should be initiated early to keep patients on treatment and to avoid drug discontinuation and tumor progression.

Pulmonary arterial hypertension (PAH) is a progressive and fatal disorder that any valuable advance in the management of diseases has crucial importance. The present study aimed to compare the Endothelin1 (ET1) inhibitor bosentan which is regarded as standard therapy with different dose regimens of palosuran which is urotensin-II (UII) inhibitor and explore the discrepancy for mean pulmonary arterial pressure (mPAP), UII, ET1 levels, and pulmonary vascular pathology. Seventy rats were randomly divided into seven groups of ten animals each: group 1 (control group) received the vehicle subcutaneously, instead of monocrotaline (MCT) and vehicle; group 2 (MCT group) received subcutaneous MCT and vehicle; and group 3 (MCT + palosuran 30 mg) received subcutaneous MCT and palosuran. Other groups consist of group 4 (MCT + palosuran 100 mg), group 5 (MCT + bosentan 30 mg), group 6 (MCT + bosentan 100 mg), and group 7 (combination therapy). Serum ET1, UII, mPAP levels, and pulmonary arteriolar pathology of different diameter vessels of all groups have been measured and recorded. The ET1 and UII levels of untreated rats (group 2) were significantly higher than the other groups (p

OBJECTIVES: This study aims to evaluate the effect of blood glucose regulation on sarcopenia parameters in sarcopenic, obese, and poorly- regulated diabetic patients. PATIENTS AND METHODS: Between June 2013 and December 2013, a total of 147 patients (64 males, 83 females; mean age 70.3±6.3 years; range, 60 to 90 years) who were diagnosed with sarcopenia according to the European Working Group on Sarcopenia in Older People (EWGSOP) criteria were included in the study. All patients were obese with a body mass index (BMI) of >30 kg/m2 and their glycated hemoglobin (HbA1c) levels were above 8%. Sarcopenia parameters including the gait speed, muscle strength, muscle mass, and handgrip strength were assessed. After a six-month treatment period, the patients were divided into two groups according to their HbA1c levels as having 8%. Sarcopenia parameters were evaluated before and after receiving treatment. RESULTS: The mean disease duration was 16±6.2 years. Sixty patients were found to have a HbA1c level of

Rheumatoid arthritis (RA) is the most common chronic inflammatory disorder and is associated with progressive destruction of synovial joints and physical disability. Therapies with known benefits include disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, as well as more recent biologic agents, such as tumor necrosis factor inhibitors (anti-TNF therapy). This was a retrospective study, which included 205 RA and 112 early RA (ERA) patients from the Rheumatology Clinic at Gaziantep University School of Medicine Research Center as well as 104 healthy controls. The mean neutrophil to lymphocyte ratio (NLR) was found to be 3.15 ± 2.64 in the patient group and 2.03 ± 0.94 in the control group. The mean platelet to lymphocyte ratio (PLR) was 162.39 ± 107.76 in the patient group and 131.23 ± 48.09 in the control group. There was a significant difference in both the NLR and PLR between the patient and control groups (both p < 0.01). There was a significant difference in both the NLR and PLR between patients with active disease and remission (both p < 0.001) in RA, including anti-TNF therapy and DMARDs groups. There was a significant difference in NLR (p = 0.001) but not in PLR (p = 0.051) between active disease and remission in ERA. The results of the present study suggest that the NLR may be considered a useful marker of disease activity in RA and one that can aid the diagnosis of ERA. The PLR can be used in the assessment of disease activity in RA patients undergoing anti-TNF therapy but is not suitable for diagnosing ERA.

Pulmonary arterial hypertension (PAH) is a progressive and a life-threatening disease with its high morbidity and mortality ratios. On searching for new shining targets in pathogenesis, we noticed, in our previous studies, urotensin-II (UII) in systemic sclerosis with potent angiogenic and pro-fibrotic features. Owing to the mimicking properties of UII with endothelin-1 (ET1), we attempted to investigate the effect of palosuran in a PAH rat model. Thirty rats were randomly divided into three groups, with each group comprising 10 rats: group 1 (control group) received the vehicle subcutaneously, instead of monocrotaline (MCT) and vehicle; group 2 (MCT group) received subcutaneous MCT and vehicle; and group 3 (MCT + palosuran group) received subcutaneous MCT and palosuran. Serum UII, ET1, transforming growth factor-β1 (TGF-β1) levels, pulmonary arteriolar pathology of different diameter vessels, and cardiac indices were evaluated. The ET1, TGF-β1, and UII levels were significantly diminished in the treatment group, similar to the controls (p < 0.001). Right ventricular hypertrophy index and mean pulmonary arterial pressure scores were also significantly reduced in the treatment group (p = 0.001). Finally, in the 50–125-μm diameter arterioles, in contrast to Groups 3 and 1, there was a statistically significant thickness (p < 0.01) in the arteriolar walls of rats in Group 2. The treatment effect on arteries of more than 125-μm diameters was found to be valuable but not significant. Owing to its healing effect on hemodynamic, histological, and biochemical parameters of MCT-induced PAH, palosuran as an antagonist of UII might be an optional treatment alternative for PAH.

Idiopathic pulmonary fibrosis (IPF) is a chronic lung disease with unknown etiology and pathogenesis. With high mortality risks, most of the IPF cases emerged after a damage of alveolar epithelium, where this situation stimulates the over expression of matrix components. Inflammatory process observed as a reaction to emerged damage. Prolidase as an iminodipeptidase significantly increased during the development of fibrosis. The aim of this study is to measure prolidase activity as a marker of treatment and diagnosis in an experimental lung fibrosis animal model. Thirty male Wistar rats randomly divided into three experimental groups, with ten rats in each group. Group 1, control group; group 2, bleomycin (BLM)-induced lung fibrosis group, and group 3, BLM-induced lung fibrosis treated with palosuran (urotensin-II receptor antagonist). For histopathology, the middle lobes of right lungs were embedded in paraffin, followed by fixation in 10 % buffered formalin, and evaluation of IPF was performed using the Ashcroft scoring method. Prolidase activity was determined by a photometric method based on the measurement of proline levels produced by prolidase. The fibrosis scores and the prolidase activity were significantly enhanced by BLM stimulation. The BLM + palosuran treatment decreased prolidase activity in group 3. There was a positive correlation between prolidase activity and fibrosis scores. Palosuran seems to be effective in the treatment of lung fibrosis, and prolidase activity can be used for the diagnosis and/or for management of the treatment. However, further clinical and experimental studies with animals and/or patients are needed to verify these conclusions.

Amac : Kirilganlik, noromuskuler, metabolik ve immun sistemde ilerleyen yasla birlikte fizyolojik rezervlerin azalmasina bagli olarak meydana gelen gucsuzluk halidir. Kirilgan hastalar tum saglik calisanlari icin takip ve tedavide en karmasik ve en zorlayici sorunlara neden olan hasta grubunu olusturmaktadir. Bu calismanin amaci; uc farkli kirilganlik olcegi kullanilarak 65 yas ve ustundeki hastanede yatan geriatrik hastalarda kirilganlik prevalansinin arastirilmasidir. Gerec-Yontem : Bu calisma ic hastaliklari ve geriatri kliniklerinde yatan 65 yas ve ustundeki hastalarda yapilmistir. Calismaya 399 hasta dahil edilmistir. Hastalarda kirilganlik prevalansinin belirlenmesinde, Cardiovaskuler Health Study (CHS), Woman's Health and Aging Study (WHAS) ve Gerontopole kirilganlik olcekleri kullanilmistir. CHS ve WHAS olceklerinde bes kriterden ucu patolojik olanlar, Gerontopole olceginde ise alti kriterden biri patolojik olan hastalar kirilgan kabul edilmistir. Bulgular : Hastalarin ortalama yasi 71,9 ± 6,3 ve %50,6‘si erkekti. CHS olcegine gore, hastalarin %8,3’u saglam, %26,2’si prefrajil ve %65,5’i kirilgan, WHAS olcegine gore %9,3’u saglam, % 27,6’si prefrajil ve %63,1’i kirilgan iken Gerontopole olcegine gore ise hastalarin %8,8’ini saglam ve %91,2’sini kirilgan olarak bulduk. Sonuc : Yaptigimiz calismada farkli kirilganlik olceklerine gore hastanede yatan geriatrik hastalarda farkli kirilganlik olceklerine gore kirilganlik prevalansini %63.1 - %91.2 gibi yuksek degerlerde saptadik. Kirilganlik tedavi edilebilen, geri donuslu bir sendrom olup, erken fark edilmesi, dusme, kirik, bakimevine yatis ve artmis mortalite gibi istenmeyen sonuclarin onlenmesi icin buyuk onem tasidigindan dolayi kliniklerde yatan geriatrik hastalarda %90’lara varan oranlarda kirilgan hastalarla karsilasabilecegimizi saglik calisanlari olarak unutmamamiz gerekmektedir.

Pulmonary fibrosis is a chronic disease. Urotensin II (U-II) is a new peptide with angiogenic and profibrotic features. Therefore, we aim to evaluate the antagonism of U-II with palosuran in an animal model and plan to measure U-II, endothelin-1 (ET-1), and transforming growth factor-β1 (TGF-β1) and their association with lung fibrosis. Thirty Wistar male rats were used in the study and were divided into three groups: group 1, control; group 2, bleomycin-induced lung fibrosis group; and group 3, bleomycin-induced lung fibrosis with treatment palosuran group. U-II level (nanograms per milliliter) was 2.957 ± 0.159 in group1, 3.188 ± 0.122 in group 2, and 2.970 ± 0.165 in group 3 (p = 0.002). The ET-1 level (picograms per milliliter) was 4.486 ± 0.376 in group 1, 9.086 ± 1.850 in group 2, and 4.486 ± 0.376 in group 3 (p

Meningiomas are the most common benign brain tumors. Malignant meningioma is a rare subtype with a high recurrence rate and poor prognosis. Most meningiomas grow intracranially, whereas extracranial growth of meningiomas has been rarely reported. We herein report a rare case of a giant malignant meningioma with multiple recurrences. A 56-year old man presented with a forehead swelling. He had a history of repeated craniotomy for a frontal sinus invasion. The tumor recurred one year after the last surgery on the forehead and was classified as a giant meningioma at admission to our hospital. Neurosurgeons performed total resection of the giant meningioma and reconstructed the defect. However, six months after the surgery, the tumor recurred at the same site. The patient refused surgery and underwent cyber-knife treatment. An hydroxyurea treatment was initiated after radiotherapy, but the tumor progressed. Temozolomide and cisplatin treatment was started. A valuable clinical improvement was observed after the initiation of the first cycle. After completion of two cycles of systemic chemotherapy, the patient will be assessed clinically and radiologically.

Tinnitus is the perception of sound with no external stimulus and idiopathic subjective tinnitus is the most common type in adults. Mean platelet volume (MPV) alterations were shown in some inflammatory diseases and were evaluated as a clinically useful marker. Our aim was to investigate MPV alterations in idiopathic subjective tinnitus patients. A total of 101 patients and 54 age- and sex-matched healthy control subjects were enrolled in the study. Patients included in the study had complaints of tinnitus for at least 3 months. All patients underwent detailed otolaryngologic examination, blood sampling, pure tone audiometry, magnetic resonance imaging of ear, and vertebrobasilar artery Doppler ultrasonography to make the differential diagnosis of tinnitus. Blood sampling consisted of renal-liver-thyroid function tests, lipid profile, and complete blood count. All tests and examinations except the imaging modalities were also performed for the control group. There were no differences in age and sex distribution of groups. Mean platelet volume values were significantly increased in tinnitus patients when compared with controls (p = 0.001). We think that MPV can be qualified as a useful marker in tinnitus patients.

Objective: the mean platelet volume (MPV) is a good indicator of platelet activity; it is reported to increase in diseases associated with inflammatory processes and in vascular diseases. This study investigated the importance of mean platelet volume in patients with chronic venous insufficiency (CVI) and whether the MPV was likely to be a predictor of the CVI. Methods: 117 patients who were diagnosed as CVI by colored Doppler Ultrasound (CDU) method and 49 healthy volunteers (forming the control group) were en­rolled to this study, which was planned retrospectively. The patients’ blood count values taken within one month before and after the CDU evaluation were recorded by the hospital information system. The complete blood count, routine biochemical tests and thyroid function tests of the patients diagnosed with CVI were compared to the control group. Results: Significant differences were not detected be­tween the patients and the control group in terms of the levels of creatinine, aspartate aminotransferase, total cholesterol, LDL cholesterol, HDL cholesterol, triglycer­ides, erythrocyte, sedimentation speed, leukocyte, hae­moglobin and thrombocyte (p>0.05). The thyroid stimulat­ing hormone and the MPV levels were significantly lower in the control group (p

Rhupus is a rare syndrome characterized by overlap of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Previous reports mentioned that rhupus patients have prominent RA associated clinical manifestations and only mild organic damage related to SLE. Progressive or life-threatening manifestations are rare in rhupus patients. Our patient diagnosed as rhupus was a young women, presented with multi-organ involvement of systemic vasculitis. Rheumatologists should be aware of possibility that rhupus may be accompanied by progressive or life-threatening conditions such as vasculitis.

Transient osteoporosis of the hip is one of the causes of hip pain starts suddenly. It is a rare clinical condition characterized by dissapperance of hip pain after a while and osteoporosis view in the femoral head comes into the picture later on. The disease begins without any trauma. It manifests itsels with hip pain in middle aged men and third trimester pregnant women. The disease responds to treatment with resting and analgesics. In this article, a case of a third trimester pregnant woman who had admitted to the hospital with hip and leg pain and had been diagnosed as transient hip osteoporosis after some clinical and radiological examinations was presented. As a result, hip and leg pain sudden onset of the third trimester in pregnancy the differential diagnosis of transient osteoporosis of the hip should be kept in mind., Kalçanın geçici osteoporozu ani başlangıçlı kalça ağrısı nedenlerinden biridir. Kalça ağrısının bir süre sonra ortadan kalkması ve femur başında geç beliren osteoporoz görünümü ile karakterize olan ve nadir rastlanan bir klinik durumdur. Hastalık travma olmaksızın başlar. Genellikle orta yaş grubundaki erkeklerde ve üçüncü trimester gebelerde kalça ağrısıyla seyreder. İstirahat ve analjezik tedavisine yanıt verir. Bu makalede, kalça ve bacak ağrısı nedeniyle başvuran, klinik muayene ve radyolojik incelemeler sonucunda geçici kalça osteoporozu tanısı alan 3. trimesterdeki bir gebe olgu sunuldu. Sonuç olarak üçüncü trimester gebelerde ani başlangıçlı kalça ve bacak ağrısında geçici kalça osteoporozu ayırıcı tanıda akılda tutulmalıdır.

Brucellosis is a zoonotic infection caused by gram (-) Brucella species and involves multiple organ systems. It usually presents with fever and constitutional symptoms, but atypical presentations may also occur. Acute brucellosis presenting with pancytopenia and abdominal pain due to mesenteric lymphadenitis have been published as case reports. A 71-year-old woman admitted to our clinic with severe abdominal pain mimicking acute abdomen, fever, constipation and weight loss for last three weeks. In complete blood count, there was serious pancytopenia. Although Wright agglutination test was negative, Brucella species were isolated in blood culture. Combined treatment of rifampicin 600 mg/day and doxycycline 200 mg/day was started. There were mesenteric enlarged lymph nodes detected in the computerized tomography and the abdominal pain was thought to be related with this mesenteric lymphadenitis. The clinical and laboratory findings were dramatically improved with the treatment and it was continued for six weeks. In conclusion, although the presentation of acute brucellosis with mesenteric lymphadenitis and pancytopenia is rare, it must be considered in patients such in endemic areas., Brusellozis, gram (-) Brucella cinsi bakterilerin neden olduğu, birçok organ ve sistemi tutabilen zoonotik bir infeksiyondur. Brusellozis sıklıkla ateş ve konstitüsyonel semptomlarla ortaya çıkmakla birlikte atipik klinik bulgularla da prezente olabilir. Pansitopeni ve mezenterik lenfadenite bağlı karın ağrısıyla prezentasyon, vaka sunumlarıyla bildirilmiştir. Yetmiş bir yaşında bayan hasta 3 haftadır olan ve akut batını taklit eden karın ağrısı, ateş, kabızlık, kilo kaybı şikayetleri ile kliniğimize başvurdu. Tam kan sayımında belirgin pansitopeni vardı. Wright aglütinasyon testi negatif olmasına rağmen, kan kültüründe Brucella türleri üredi. Rifampisin 600 mg/gün ve doksisiklin 200 mg/gün kombine tedavisi başlandı. Yaygın karın ağrısı batın bilgisayarlı tomografisinde saptanan mezenterik lenfadenite bağlandı. Tedaviyle klinik ve laboratuvar bulguları dramatik olarak düzeldi, tedavi 6 haftaya tamamlandı. Sonuç olarak; brusellozisde mezenterik lenfadenit ve pansitopeni birlikteliği nadir karşılaşılan bir durum olmakla birlikte, özellikle brusellozisin endemik olduğu bölgelerde, benzer hastalarda göz önünde bulundurulmalıdır.

Objective. To evaluate total antioxidant capacity (TAC) and total oxidative stress (TOS) values in patients with myofascial pain syndrome (MPS).Method. The study comprised 38 patients diagnosed with MPS and 30 healthy volunteers. The age, body mass index (BMI) and pain scores (evaluation by visual analogue scales) of all the participants were recorded. The TAC, TOS and oxidative stress index (OSI) levels were compared between the MPS and control groups.Results. There was no significant difference between the MPS and control groups in respect of demographic characteristics. The TAC levels were determined to be significantly lower and TOS levels and OSI values, significantly higher in the MPS patients than in the control group.Conclusion. The results of this study determined that the oxidant/antioxidant balance was impaired in MPS patients and thus MPS can be considered to be related to an increase in oxidative stress.

Dear Editors, Tamoxifen is one of the treatment options for estrogen receptor (ER)-positive breast cancers, and it is considered to be a teratogenic agent. Animal models have shown that tamoxifen can cause genitourinary developmental defects [1]. Although there is 1 case report showing that tamoxifen can cause genital defects in humans [2], other case studies report delivery of healthy babies by women using tamoxifen [3, 4]. Here we report on 3 breast cancer patients who became pregnant while undergoing tamoxifen therapy. The first case, a 32-year-old woman, presented with a left breast lump in 2007; incisional biopsy revealed infiltrative ductal carcinoma. The disease was staged as cT4cN2M1. The patient had bone metastasis at the time of diagnosis. Immunohistochemical analysis showed this tumor to be ER-positive (100%(+)), progesterone receptor (PR) 100% (+), and HER2-negative. The patient received adjuvant tamoxifen following adjuvant chemotherapy including paclitaxel, carboplatin and doxorubicin and radiotherapy. The patient became pregnant in 2009 while on a 6-month tamoxifen therapy. She discontinued tamoxifen when she discovered she was pregnant, so tamoxifen therapy lasted only 1.5 months. The patient delivered a healthy baby in 2010. After birth, positron emission tomography-computed tomography revealed regression of bone metastases. The second case, a 23-year-old woman, underwent right modified radical mastectomy for infiltrating ductal carcinoma in 2009. The disease was staged as T2N0M0. Immunohistochemical analysis showed this tumor to be ER 5% (+), PR 50% (+), and HER2-positive (3+). The patient received adjuvant chemotherapy including paclitaxel, carboplatin, doxorubicin and trastuzumab. Adjuvant tamoxifen and leuprolide were also recommended. No radiotherapy was administered. The patient received tamoxifen for 26 months and discontinued treatment of her own accord. 1 month after that she became pregnant and took no further therapy. She delivered a healthy baby in October 2012, and is herself in good health at present. The third case, a 35-year-old woman, underwent breast-conserving surgery and sentinel lymph node dissection for infiltrating ductal carcinoma in 2011. The disease was staged as T1N0M0. Immunohistochemical analysis showed this tumor to be ER 90% (+), PR 10% (+), and HER2-positive (2+), confirmed by fluorescent in situ hybridization. She did not receive any adjuvant chemotherapy except tamoxifen following radiotherapy. The patient became pregnant while taking tamoxifen for 6 months in 2011. She discontinued tamoxifen when 4 weeks pregnant and had a voluntary medical abortion at 6 weeks gestation. She subsequently continued tamoxifen treatment. Tamoxifen is a non-steroidal anti-estrogen agent used in the treatment of ER-positive breast cancers. It is contraindicated during pregnancy due to teratogenic effects, and recommended non-hormonal contraceptive methods may cause patients to get pregnant while on tamoxifen therapy. Von Schoultz et al. [5] have suggested that women taking tamoxifen who wish to become pregnant should stop tamoxifen at least 2 months prior to conception because of the drug's long half-life. Although there is insufficient knowledge regarding the use of tamoxifen and pregnancy outcomes in humans, there are some case reports indicating healthy deliveries [3, 4]. In contrast, there is 1 case report of a baby with ambiguous genitalia suggestive of a tamoxifen effect on the fetus [2]. Another case report showed a baby with congenital cranio-facial defects, who was exposed to cocaine, marijuana, and a bone scan along with tamoxifen during fetal development. The effects of tamoxifen during pregnancy were described in the study by Braems et al. [6], based on records provided by AstraZeneca. The AstraZeneca Safety Database registered 11 babies with congenital malformations out of 44 live births, which is 1 infant with malformations for every 4 live births. In fact, the actual number of malformations was even higher, because there were 6 terminations and 2 stillbirths with fetal defects, compared with 17 terminations and 1 stillbirth without fetal defects, which is a total rate of nearly 1 in 3 births [6]. We herein report 3 breast cancer cases in which the patients became pregnant while taking tamoxifen therapy. In the first case, the patient had a healthy baby who is now 2 years old and has no abnormalities. The second patient had an uncomplicated pregnancy and a normal healthy baby. The patient in the last case had an elective abortion after a discussion with her physician regarding the possible side effects of the chemotherapy. To conclude, due to the lack of long-term data on outcome and studies showing teratogenicity, use of tamoxifen during pregnancy is contraindicated despite reports of healthy babies after tamoxifen exposure. Premenopausal breast cancer patients who are taking tamoxifen should practice meticulous use of contraception, and they must be informed about the possible teratogenic effects of tamoxifen as well as the lack of long-term data on this subject.

Natural killer (NK)/T-cell lymphomas represent a rare type of lymphoma derived from either activated NK cells or cytotoxic T cells. Most cases with T/NK cell lymphoma present with extranodal manifestations. Primary nodal disease is very rare. The upper respiratory tract is the most common site involved in extranodal disease. Symptoms include epistaxis and nasal obstruction. T/NK cell lymphomas show aggressive and invasive clinical progression, with a poor prognosis. Without treatment, survival is measured in months. We report a case of a 51-year-old male patient with pneumopericardium as a complication of intestinal T/NK cell lymphoma. To the best of our knowledge, this is the first report showing pneumopericardium as a fatal complication of T/NK cell lymphoma. Pneumopericardium should be considered in patients diagnosed with T/NK cell lymphoma presenting with chest pain.

Systemic sclerosis (SSc) is a disease characterized by skin and internal organ involvement. There is progressive accumulation of extracellular matrix components in the skin and involved organs. Tissue fibrosis is the prominent reason for mortality, and still, there is no satisfactory treatment. The aim of this study was to evaluate the effects of urotensin-II (U-II) antagonist palosuran in an animal model of scleroderma. We also planned to measure U-II, endothelin-1 (ET-1), and transforming growth factor-beta 1 (TGF-beta 1) levels, as well as the association of these levels with dermal thickness. Twenty-four male mice were included in this study and they were divided into three groups-group 1: control group, group 2: fibrosis group, and group 3: fibrosis + palosuran treatment group. Fibrosis + palosuran treatment in group 3 reduced ET-1, U-II, and TGF-beta 1 levels. In total, the diminished values were statistically significant in the ET-1 and TGF-beta 1 levels (p < 0.05). Dermal thickness was higher in the fibrosis group, when compared with the other groups. There was no significant relationship between dermal thickness and ET-1, U-II, or TGF-beta 1 levels (p > 0.05). It is believed that U-II is an important mediator in SSc, and its antagonism with palosuran could be a new treatment choice in SSc.

Systemic sclerosis (SSc) is a chronic fibrotic collagen tissue disease. Leptin's role in regulating immune and inflammatory response has become increasingly evident. Resistin has pro-inflammatory properties and also is associated with inflammatory markers in some rheumatologic diseases. The purpose of this study was to determine serum leptin, resistin and tumor necrosis factor alpha (TNF-α) in SSc patients and evaluate their association with other frequently used laboratory and clinic findings.Sixteen patients were compared with 30 healthy women of similar age and body mass index. Serum leptin, resistin and TNF-α levels were measured by enzyme-linked immunosorbent assay and results were assessed by Mann-Whitney U -test and Spearman's correlation test.Leptin levels were significantly increased in the SSc group compared to controls (7789.43 ± 1180.72 pg/mL, 1790.55 ± 333.68 pg/mL, P0.0001). TNF-α was significantly elevated in patients and it was also positively correlated with leptin (25.30 ± 2.16 pg/mL, 20.95 ± 0.30 pg/mL, P = 0.001), (P = 0.002, r = 0.523). There was no association between leptin, resistin, TNF-α levels and skin score, activity score and disease duration in the SSc patients (P0.05).Leptin, resistin and TNF-α levels were found to be higher in SSc in contrast to the control group. These adipokines may have differentiating roles in the pathogenesis of SSc. In order to verify these findings, further clinical studies are needed with larger patient groups.

We describe the diagnosis of a 77-year-old woman admitted to our outpatient department with a 3-month history of abdominal bloating and distension. Abdominal computed tomography revealed a large cystic lesion in the posterior segment of the right hepatic lobe, with a separated germinal layer and widespread ascites with dense internal echoes and septal appearance. The result of a serum Echinococcus indirect haemagglutination test was positive and findings were indicative of the spontaneous rupture of a hydatid cyst into the peritoneal cavity without trauma. Ascites is rarely seen in the course of hydatid disease, but can result from cyst rupture into the peritoneal cavity. This should be considered in the differential diagnosis of ascites, especially in areas such as Turkey, where hydatid disease in endemic.

To the Editor, Breast carcinoma that is diagnosed during pregnancy or within 1 year postpartum classified as pregnancyassociated breast cancer and it is the second most common malignancy associated with pregnancy accounting approximately 1 in 3,000 to 10,000 pregnancies.1 Breast cancer during pregnancy is a very important clinical antitiy for not only the patient but also for unborn child especially when regarding treatment modalities. In literature, knowledge about pregnancyassociated breast cancer is limited to rectospective studies and case reports. Here we are reporting clinicopathological charasteristics and treatment outcomes of pregnancy-associted breast cancer patients. We have looked rectospectively 2578 breast cancer patients who diagnosed in Hacettepe University Hospital between 2003 and 2012. Eight (0.3%) of those patients had pregnancy associated breast cancer. The mean age of patients was 36 (30-43). Seven patients had invasive ductal carsinoma and one patient had tubular carsinoma. 6 of 8 patients had T2/T3 stage. Totally 6 patients were grade III and 3 patients were having metastatic tumors when they were first diagnosed. 5 of 8 patients were both positive for estrogen and progesterone receptors. 2 patient were cerbB2 positive (Table 1). 6 of 8 patients were undergone modified radical mastectomy and all of 8 patients had chemotherapy.

Sjögren's syndrome (SS) is an autoimmune disease characterised by a chronic inflammatory response mainly localised to the lachrymal and salivary glands. Haematological abnormalities are common, although they rarely have clinical significance. Here, we report a patient with SS and thrombocytopenia caused by albendazole. Haematological abnormalities such as thrombocytopenia are seen in approximately 5-15% of SS patients; however, this disease is usually asymptomatic and can often be recovered to normal levels with corticosteroids. If it is not, we should keep in mind other reasons for the thrombocytopenia, such as drug use.

Systemic Sclerosis (SSc) is a chronic disease of unknown etiology which affects the vascular system and connective tissue. A wide series of studies showed an increased prevalence of cancer in patients with SSc than the normal population. Prostacyclin (PGI2) is an endogenously produced element that is basically synthesized by arachiodonic acid through prostacyclin synthesis in vascular system endothelial cells. Iloprost is a stable analogue of PGI2 which is used in the treatment of pulmonary arterial hypertension (PAH). In a limited number of animal models, the anti-metastatic activity of PGI2 is observed. Herein, we report iloprost treatment of a 60-year-old-woman with SSc, who lately developed PAH as a complication of her disease and lung adenocarcinoma as a co-incidence simultaneously. These two mortal complications were both treated successfully with inhaled iloprost until her death due to gastrointestinal complications of SSc.

Objective: To report pancytopenia caused by temozolomide, a second-generation alkylating agent. Clinical Presentation and Intervention: A 22-year-old patient presenting with seizures and confusion was seen in the emergency room. Cranial magnetic resonance imaging revealed a mass. After surgery, the patient was diagnosed with glioblastoma multiforme and was given temozolomide at 150 mg/m2 on days 1 through 5 every 4 weeks. During the last cycle of temozolomide, grade 3 thrombocytopenia persisted. Possible causes of pancytopenia including vitamin B12 deficiency were investigated. Conclusion: This case report shows that vitamin B12 deficiency can be a potential cause of pancytopenia and it should be kept in mind for patients receiving chemotherapy.

Background The alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT) have been previously investigated in patients with rheumatoid arthritis (RA); however their potential role on diseases activity has not been studied yet (1-2). Objectives Presented study aimed to investigate the correlation of ALP and GGT with disease activity (as assessed by DAS28) and acute phase reactants in patients with RA. Methods In total 81 newly diagnosed RA patients (male/female: 70/11), who fulfilled the 1987 American College of Rheumatology (ACR) classification criteria, as well as 32 healthy controls (male/female: 26/6) enrolled into study. Disease activity was assessed by DAS28. Demographic data, levels of ALP, GGT, and C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and DAS28 scores were obtained from the patient files when first diagnosed and compared with each other. Results Comparing RA patients with the control group, the ESR, and the levels of CRP, ALP and GGT were found higher in the RA group as compared to the control group. But only ESR and CRP levels were found statistical significance higher (p Conclusions In this study we found that levels of ALP and GGT were correlated with ESR and CRP levels although DAS28 disease activity criteria wasn9t found to be positively correlated with ALP and GGT levels. In RA patients levels of ALP and GGT may be used as disease activity indicators like ESR and CRP. However, more comprehensive studies are needed to make definite correlations between DAS 28, disease activity criteria, and levels of ALP and GGT. References Richardson C, Emery P. Laboratory markers of disease activity. J Rheumatol (suppl 44) 1996; 23: 23-30. Pepys MB. Rheumatoid arthritis: The role of acute phase proteins. Br J Rheumatol 32 1993; (suppl 3): 1-2. Disclosure of Interest None declared

Cetuximab, a monoclonal antibody to the extracellular domain of epidermal growth factor receptor (EGFR), is indicated for the treatment of metastatic colorectal cancers and head–neck cancers. Cetuximab is generally well tolerated but some side effects, such as skin rash, malaise, vomiting, diarrhea, hypomagnesemia, and hypersensitivity reactions, have been reported. Esophageal ulcer in patients receiving cetuximab treatment has not been described previously. We herein report a 59-year-old man diagnosed with metastatic rectal cancer with esophageal ulcers associated with cetuximab after five cycles of treatment. To the best of our knowledge, this is the first report that shows cetuximab may induce esophageal ulcers, which may be precursor lesions to a gastrointestinal tract perforation. (Published: 24 February 2014) Citation: Libyan J Med 2014, 9 : 23723 - http://dx.doi.org/10.3402/ljm.v9.23723