Search

A hydatid cyst is a parasitic disease that most commonly affects the liver and lungs: it rarely affects the heart: right ventricular involvement is even less common. A 33-year-old male patient with a cardiac cystic mass, detected during echocardiography, was evaluated. Early surgery was the best treatment option. A hydatid cyst is located in the right ventricular wall and detected during surgery. The cyst was drained and the defect in the right ventricle was quilted. Postoperative follow-ups occurred, and he was discharged with albendazole in good health.

Objective: We compared the air or saline insufflated endotracheal tube (ETT) cuff pressures and their effects on postoperative respiratory complications in gynecological laparoscopic surgeries in the Trendelenburg position (TP). Patients and Methods: This prospective study was carried out on a total of 60 patients, whose ages ranged from 18 to 65 years and who were classified by the American Society of Anesthesiologists (ASA) as I-III. They were scheduled for gynecological laparoscopic surgery in TP. Patients included in the study were randomly divided into two groups as the saline (Group S, n=30) and air (Group A, n=30) groups. ETT cuff pressures and peak airway pressures were recorded immediately after intubation and at 10-minute intervals during the intraoperative period. Results: The cuff pressure and maximum cuff pressure values in the saline group were significantly lower than in the air group in the 50-minute (p

Takayasu's arteritis (TAK) is a chronic vasculitis, affecting predominantly the aorta and/or its major branches. The aim of this study was to compare the differences between childhood and adult onset TAK.We retrospectively evaluated 179 TAK patients followed between August 2005 and July 2019. Demographic characteristics, laboratory features, disease activity, echocardiographic data at diagnosis and treatment regimens in the disease course were compared between the paediatric and adult onset patients.Twenty-five paediatric-onset (18 years of age at diagnosis) and 154 adult-onset patients (≥18 years of age at diagnosis) were enrolled. The mean age at diagnosis for children and adults were 13.6±4 and 35.6±13, respectively. Paediatric onset TAK patients had more intense inflammation at the time of diagnosis reflected in their clinical findings. Acute phase reactants were high in all paediatric patients and significantly higher in patients with paediatric-onset TAK (p=0.006 and p=0.005, respectively). Abdominal predominant disease was more common in the paediatric group, in contrast, focal disease and aortic arch predominant disease were more common in the adult group. Ascending aortic dilatation, left ventricular hypertrophy and moderate-severe aortic insufficiency were more frequent in echocardiography findings of paediatric onset TAK patients. In comorbidities, hypertension was more common in paediatric TAK patients during follow-up, whereas cerebrovascular disease was more common in adult patients.Our paediatric onset TAK patients presented with a more severe inflammation and more widespread vascular involvement. Multicentre studies from different geographic areas are needed to verify our observation and understand the underlying causes.

Objective To determine the outcome of thoracic epidural anaesthesia in open cholecystectomy procedures of comorbid advanced elderly patients. Study design Observational study. Place and duration of study Faculty of Medicine, Karadeniz Technical University Hospital, Trabzon, Turkey during 2014-2019. Methodology This study included 103 geriatric patients of over 65 years, who underwent open cholecystectomy under thoracic epidural anaesthesia during the study period. Patient files, anaesthesia registration forms, early postoperative follow-up, and discharge process were retrospective. Results The mean age of the patients included in the study was 79.42 ± 9.03 years, while the mean operation time was 68.02 ± 17.44 minutes. While only 7 (6.8%) patients had a chronic disease, the number of patients with two or three comorbid diseases was 67 (65%). The number of patients with 4 or more comorbidities was 29 (28.2%). The most common intraoperative complications were hypotension (n = 22, 21.4%) and bradycardia (n = 19, 18.4%). Intraoperative desaturation was observed in 7 (6.8%) patients; and oxygen and bronchodilator therapy was effective. The median discharge time was 6.5 (5.0-8.25) days; whereas, 5 (4.9%) patients died postoperatively. Conclusion In open cholecystectomy operations on comorbid advanced elderly patients, thoracic epidural anaesthesia can be preferred to general anaesthesia. Key Words: Geriatrics, Cholecystectomy, Anesthesia, Thoracic epidural, Comorbidity.

One-lung ventilation may cause negative changes in the oxygenation of cerebral tissue which results in post-operative cognitive dysfunction. We compared the potential effects of total intravenous anesthesia and inhalation general anesthesia techniques on cerebral tissue oxygenation.In this prospective double-blind trial, patients whose standard anesthesia induction was done were randomly divided into two groups as group total intravenous anesthesia using propofol (Group T, n = 30) and group inhalation general anesthesia using sevoflurane (Group I, n = 30) based on anesthesia maintenance. The intraoperative cerebral oxygen saturation and pre-post-operative mini-mental status test scores of the patients were monitored and recorded.Baseline characteristics were similar between the two groups. The decrease of cerebral oxygen saturation more than 20% in total intravenous anesthesia group was significantly higher than inhalation group (p0.05). In both groups, the mini-mental status test values at the post-operative 3Inhalation general anesthesia provided better cerebral tissue oxygenation in thoracic surgery with one-lung ventilation compared to total intravenous anesthesia. However, there was no significant correlation between the presence of desaturation and post-operative cognitive dysfunction.La ventilación unipulmonar puede provocar cambios negativos en la oxigenación del tejido cerebral que se traduce en una disfunción cognitiva postoperatoria. Comparamos los efectos potenciales de la anestesia total intravenosa y las técnicas de anestesia general por inhalación en relación con la oxigenación del tejido cerebral.En este ensayo prospectivo doble ciego, los pacientes en los que se realizó una inducción estándar de anestesia se dividieron aleatoriamente en dos grupos: grupo de anestesia intravenosa total con propofol (Grupo T, n = 30) y grupo de anestesia general por inhalación con sevoflurano (Grupo I, n = 30) basados en el mantenimiento de la anestesia. Se controlaron y registraron la saturación de oxígeno cerebral intraoperatoria y las valoraciones de la miniprueba de estado mental preoperatoria de los pacientes.Las características de base fueron similares entre los dos grupos. La disminución de la saturación de oxígeno cerebral de más del 20% en el grupo de anestesia intravenosa total fue significativamente mayor que en el grupo de inhalación (p0.05). En ambos grupos, los valores de la mini prueba del estado mental al cabo de la 3La anestesia general por inhalación facilitó una mejor oxigenación del tejido cerebral en la cirugía torácica con ventilación unipulmonar en comparación con la anestesia intravenosa total. Sin embargo, no hubo una correlación significativa entre la presencia de desaturación y la disfunción cognitiva posoperatoria.

Tissue hypoxia due to microvasculopathy is the main cause of digital ulcers (DUs) in systemic sclerosis (SSc). Reduced oxygen delivery (DO2) to the tissues may also contribute to the development of DU. This study was conducted to investigate the association between DO2 and DUs in patients with SSc.In all, 111 patients and 30 healthy controls were enrolled. DO2 was calculated by using the formula; DO2 = Cardiac output × arterial oxygen saturation (SpO2) × serum haemoglobin level × 1.39 × 10. Both right index finger SpO2 measurements (index-SpO2) and highest value of SpO2 (maximum SpO2) obtained among the fingers of the subjects were used for the calculations and DO2 results were adjusted both for weight and body surface area (BSA).Mean DO2 was lower in SSc patients as compared to controls in all 4 different calculations but the difference was only statistically significant when using index-SpO2 and adjusting for BSA (498 mL/min/mDO2 in SSc patients seems to be lower than healthy controls. However, DO2 is similar between the patients with and without DUs. Our results suggest that the contribution of DO2 is negligible to the development of DU and support the major role of microvasculopathy in SSc patients with DUs.

Inborn errors of immunity (IEIs) unveil regulatory pathways of human immunity. We describe a new IEI caused by mutations in the GTPase of the immune-associated protein 6 (GIMAP6) gene in patients with infections, lymphoproliferation, autoimmunity, and multiorgan vasculitis. Patients and Gimap6−/− mice show defects in autophagy, redox regulation, and polyunsaturated fatty acid (PUFA)–containing lipids. We find that GIMAP6 complexes with GABARAPL2 and GIMAP7 to regulate GTPase activity. Also, GIMAP6 is induced by IFN-γ and plays a critical role in antibacterial immunity. Finally, we observed that Gimap6−/− mice died prematurely from microangiopathic glomerulosclerosis most likely due to GIMAP6 deficiency in kidney endothelial cells.

Resume Objectifs L’arterite de Takayasu et la spondyloarthrite sont deux maladies inflammatoires distinctes qui touchent les memes classes d’âge. Le nombre croissant de publications decrivant des cas coincidents d’arterite de Takayasu et de spondyloarthrite a suscite des hypotheses quant a l’association de ces deux affections. L’objectif de cette etude est d’evaluer l’incidence des maladies du spectre des spondyloarthropathies chez les patients presentant une arterite de Takayasu. Methodes Les caracteristiques cliniques et demographiques detaillees de patients presentant une arterite de Takayasu ont ete enregistrees a la recherche de caracteristiques de spondyloarthropathie conformes aux recommandations de l’Assessment of SpondyloArthritis international Society (ASAS). Les patients ont ete interroges sur la presence de rachialgie inflammatoire, d’enthesite, d’uveite, de maladie inflammatoire chronique de l’intestin et d’arthrite peripherique, et les examens appropries de recherche de HLA-B27, radiographie standard et imagerie par resonance magnetique de l’articulation sacro-iliaque ont ete realises. Resultats Au total, 69 patients (65 femmes, 94,2 %) presentant une arterite de Takayasu ont ete recrutes. Une etude detaillee a determine que 14 (20,3 %) d’entre eux remplissaient les criteres de spondyloarthropathie de l’ASAS. La recherche de HLA-B27 s’est averee positive pour deux de ces patients (14,2 %). Les types 1 et 2 de l’arterite de Takayasu etaient plus frequents chez les patients presentant a la fois l’arterite et une spondyloarthropathie que chez ceux sans spondyloarthropathie. Les patients ayant besoin d’une biotherapie etaient plus nombreux dans le groupe presentant les deux affections que chez ceux ayant uniquement une arterite de Takayasu (64,3 % contre 29,1 %, p = 0,014), en raison du caractere refractaire de l’arterite. Conclusion Nos resultats suggerent l’existence d’une association entre arterite de Takayasu et spondyloarthropathie.

Inflammation and autoimmunity related ischaemic and nonischemic complications can occur in Behcet’s syndrome and can cause coronary vasculitis, myocarditis, aortic regurgitation and root dilatation...

Pulmonary arteriovenous malformations (PAVM) are abnormal connections between the pulmonary arterial system and the pulmonary veins. PAVMs, which are twice as common in women, are generally seen in 4-6 decades. It is thought that congenital origin, previous thoracic traumas and thoracic surgery, liver cirrhosis, mitral stenosis and infections are among the etiological reasons in PAVM.

Objectives: To investigate the optical coherence tomography angiography (OCTA) parameters of the optic nerve head and peripapillary retina and to assess macular and peripapillary retinal nerve fiber layer (RNFL) thickness by using spectral-domain optical coherence tomography (SD-OCT) in patients with limited scleroderma and to compare these results with those of healthy control subjects. Materials and Methods: 42 patients with a confirmed diagnosis of limited scleroderma and 32 age- and sex-matched healthy control subjects were included in the study. OCTA was performed for the radial peripapillary capillary plexus (RPCP) whole image, inside disc, and peripapillary vessel densities in all participants with XR Avanti AngioVue OCTA (Optovue, Fremont, California, USA). OCT images were obtained with Spectralis OCT with eye-tracking dual-beam technology (Heidelberg Engineering GmbH, Heidelberg, Germany), and peripapillary RNFL thickness was evaluated with circle program. The data from the right eyes of all participants were used for statistical analysis. Results: No significant difference was found between the radial RPCP whole image, inside disc, and peripapillary vessel density values or the RNFL parameters of the scleroderma patients when compared with the controls ( p > 0.05 for all). Conclusion: Decreased peripapillary vessel density on OCTA, which can be an early sign of glaucoma, could not be observed in scleroderma patients in this study. However, further long-term studies are still needed to identify glaucoma tendency in patients with scleroderma before clinically detectable glaucoma.

Objective: Pulmonary hypertension (PH) is a one of the major causes of death in patients with systemic sclerosis (SSc). In this study, we in- vestigated the impact of updated hemodynamic definition proposed by the 6th PH World Symposium (6th WSPH) on the frequency of PH and its subtypes in patients with SSc. Methods: Patients with SSc admitted between 2015 and 2019 and who underwent right heart catheterization (RHC) were included. The frequen- cy of PH and its subgroups based on the hemodynamic definitions of both 2015 European Society of Cardiology/European respiratory Society (ESC/ERS) PH guidelines and 6th WSPH was compared. Results: Of the 65 patients with SSc, 23 (35.4%) had normal mean pulmonary arterial pressure (mPAP), 20 (30.8%) had mildly elevated mPAP (21–24 mm Hg), and 22 (33.8%) had PH [pulmonary arterial hypertension (PAH) (n=16, 24.6%), group 2 PH (n=5, 7.7%), group 3 PH (n=1, 1.5%)] ac- cording to the 2015 ESC/ERS PH definition. Based on the updated criteria, 7 (10.8% of total cohort) additional patients were reclassified as having PH [PAH (n=3), group 2 PH (n=3), group 3 PH (n=1)]. Conclusion: The impact of the updated definition on the frequency of PH and PAH in our cohort was greater than previously reported, which may be caused by the difference in screening strategies for PAH.

Sağır, Özlem (Balikesir Author), Introduction More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. Methods and analysis EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. Ethics and dissemination EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369. ©

Objective: In the surgical treatment of tracheal stenosis, whether in long procedures such as tracheal resection-anastomosis or in short procedures such as rigid bronchoscopy and dilatation, performing a deep neuromuscular block to provide patient comfort and facilitate the surgery. In this study, neuromuscular block antagonism using sugammadex during the surgical treatment of tracheal stenosis was investigated. The aim of our study was to evaluate the antagonism of the neuromuscular block with sugammadex in cases of postintubation tracheal stenosis and posttracheostomy tracheal stenosis in terms of postoperative residual block, complications and its effect on postoperative respiratory pattern. Method: In order to evaluate the effectiveness of the anesthesia methods and neuromuscular block management procedures applied during the surgical treatment of tracheal stenosis, patient files, anesthesia record forms, early postoperative follow-up and discharge process were retrospectively reviewed. Since most of the 34 patients diagnosed with tracheal stenosis underwent more than one surgical procedure at different times, a total of 140 interventional procedures and anesthesia applications were examined. Patients who underwent tracheal stenosis surgery and used sugammadex for neuromuscular block antagonism were included in the study. Results: 34 patients were evaluated as postintubation- posttracheostomy tracheal stenosis. While rigid bronchoscopy (n = 78), balloon dilatation (n = 35) and stent (n = 5) were applied to the patients as short surgical procedures, 22 patients underwent tracheal resection-anastomosis surgery. After the use of sugammadex in short and long surgical procedures, the time to start spontaneous breathing was found to be similar. No complications related to sugammadex were identified. Conclusion: We argue that the use of sugammadex under the monitoring of anesthesia depth and muscle strength in tracheal stenosis surgery is an effective and reliable choice for neuromuscular block antagonism.

Background: Antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by arterial and/or venous thrombosis accompanied by persistently elevated levels of antiphospholipid antibodies. We aimed to evaluate pulmonary manifestations of APS. Method: We retrospectively reviewed the data of patients who were followed in the department of rheumatology with the diagnosis of APS between October 2010 and May 2017. Demographic data, clinical, radiological and laboratory findings were recorded. Results: The study included 67 patients (56 female/11 male) with a mean age of 39±13 years. Pulmonary manifestations such as parenchymal and/or vascular involvement were seen in 12 (17.9%) patients. There were no significant differences between patients with and without pulmonary manifestations in terms of age (p=0.46), comorbidities (p=0.48) and APS duration (p=0.661). Acute pulmonary thromboembolism (PE) was determined in 11 (16.4%), alveolar hemorrhage in 2 (3%) patients. Four patients with acute PE (36%) developed chronic thromboembolic pulmonary hypertension (CTEPH). One patient developed both CTEPH and diffuse alveolar hemorrhage after acute PE during follow up. Antiphosholipid antibody IgM was highly positive in patients with PE compared to patients without PE (p=0.005). Other antiphosholipid antibodies and lupus anticoagulant were not significantly different in patients with and without PE. None of the patients were deceased due to pulmonary manifestations of APS. Conclusion: PE was the most common pulmonary manifestation of APS. The development of CTEPH was high among APS patients. Patients with APS should be closely followed for the onset of PE and CTEPH.

The Turkish population is vaccinated with Bacille Calmette-Guérin (BCG), and the BCG vaccination decreases the specificity of the tuberculin skin test (TST). The purpose of this study was to investigate the incidence of active tuberculosis (TBC) among rheumatic patients who were screened only with the QuantiFERON®-TB Gold In-Tube (QFT-GIT) test for latent TBC prior to biological treatment.The Hacettepe University Biological Database (HUR-BIO) was used for latent TBC assessment. Consecutive patients were evaluated from July 2015 to October 2016 by a questionnaire that included the patients' demographic characteristics, treatment history, and symptoms of active TBC. A total of 664 patients were interviewed by physicians. TBC statuses of the 671 non-interviewed patients were checked from the Turkish National Tuberculosis Registry records. Mean TBC incidence per year was calculated for anti-tumor necrosis factor-alpha (TNF-α) agents.A total of 1335 (58.2% female) patients with the mean age of 44.2 ± 12.9 years were included. Of the patients, 836 (62.6%) had spondyloarthropathy, 432 (32.4%) had rheumatoid arthritis, and 67 (5%) had other rheumatologic diseases. The total biological drug exposure was 2292 patient-years (2043 patient-years for anti-TNF-α, 249 patient-years for non-TNF-α inhibitors). Positive and indeterminate QFT-GIT results were found in 258 (19.3%) and 23 (1.7%) patients, respectively. The median follow-up time after the onset of biological agent was 19.4 months (IQR = 29.5). Pulmonary TBC was found in 3 (0.2%) of the 1335 patients. The annual incidence of TBC was 147/100,000 patient-years for all TNF-α inhibitors (249/100,000 and 123/100,000 patient-years for QFT-GIT-positive and negative patients, respectively).TBC incidence increased by nearly seven times the Turkish national TBC incidence. The QFT-GIT Test appears acceptable to determine latent TBC before biological agent use. Consequently, the QFT-GIT Test can be appropriately used in BCG-vaccinated countries. Key Points • Our study contributes to filling the gap in the literature by reflecting real-life data about TBC frequency after QFT-GIT use in patients receiving biological agents. • The frequency of active TBC will remain within acceptable limits when only QFT-GIT is used in the screening of latent TBC prior to the use of biological agents in a population where the majority are vaccinated with BCG. • Using the QFT-GIT alone for latent TBC screening prior to biologic treatment in countries with high BCG vaccination rates reduces the number of patients needing isoniazid (INH) treatment.

Background Laser photocoagulation (LPC) is a surgical procedure used in the treatment of premature retinopathy that may cause retinal detachment and blindness if not diagnosed and treated early. The anesthesia method used in LPC varies from sedoanalgesia to general anesthesia and airway management varies from spontaneous ventilation to endotracheal intubation. In this study, we aimed to evaluate the effectiveness of sedoanalgesia applications and this anesthesia procedure concerning intraoperative and postoperative complications by avoiding intubation and mechanical ventilation in premature infants with a fragile population. Methods This retrospective study included 89 patients who underwent laser photocoagulation under anesthesia for premature retinopathy. Patients' demographic characteristics, preoperative risk factors, anesthesia technique, especially airway management, changes in ventilation status during surgery, intraoperative complications, postoperative complications, and intensive care follow-up, were recorded and analyzed statistically. Results Two of the 89 patients who underwent laser photocoagulation were excluded from this study because they were followed up intubated. The number of patients who received mask ventilation due to intraoperative complications was 12 (13.8%). The mean operation time was 36.2±10.1 minutes. In 86.2% (n=75) of the patients, the surgical procedure was completed with sedoanalgesia while maintaining spontaneous ventilation. Conclusion Sedoanalgesia application during the surgical intervention of patients with Retinopathy of Prematurity (ROP) requiring early diagnosis and emergency treatment will minimize intraoperative and postoperative complications. We believe that sedoanalgesia as an anesthetic method can be applied as an effective alternative method while preserving spontaneous ventilation.

Objective: To identify several clinical and/or laboratory parameters which can differentiate adult-onset Still's disease (AOSD) from other causes of fever of unknown origin (FUO) and create a clinician-friendly algorithm for this purpose. Methods: FUO patients hospitalized between March 2015 and September 2017 were recruited prospectively. AOSD patients diagnosed between 2001 and 2017 in our department were analyzed. Clinical and laboratory parameters were recorded for all patients. A multivariate analysis was performed to identify possible parameters related to the discrimination of AOSD from FUO. Results: We recruited 69 AOSD patients (51 females, 74%) and 87 patients (43 females, 49.4%) evaluated for FUO. Median ages were 45 (30-57) and 45 (30-62), respectively. Arthralgia, rash, sore throat, neutrophilia, serum ferritin level higher than 5 times of the upper limit, and elevated lactate dehydrogenase levels were associated with the likelihood of diagnosing AOSD; on the other hand, the number of daily fever peaks equal or greater than 3 was associated with the unlikelihood of diagnosing AOSD. After the clinical feasibility assessment of possible parameters derived from the multivariate analysis, in the setting of fever, two clinical (arthralgia, sore throat) and two laboratory (ferritin level, neutrophilia) parameters were selected to develop an algorithm for discrimination of AOSD and FUO. Conclusion: Presence of arthralgia, hyperferritinemia, sore throat, and neutrophilia suggests AOSD in patients presenting as FUO. This study proposes a clinician-friendly algorithm for the first time in current literature to discriminate AOSD from other causes of FUO.

OBJECTIVES Surgical stress and pain affect the respiratory condition of patients and can cause complications that affect morbidity and mortality in cardiac surgeries. The authors studied the effect of thoracic epidural analgesia (TEA) versus traditional intravenous analgesia on postoperative respiratory mechanics in cardiac surgery. DESIGN Retrospective, observational study. SETTING Single, university hospital. PARTICIPANTS Patients undergoing cardiac surgery. INTERVENTIONS Comparing the postoperative respiratory effects of TEA with bupivacaine or intravenous analgesia with tramadol or paracetamol or dexmedetomidine. MEASUREMENTS AND MAIN RESULTS A total of 1,369 patients were screened, and 1,280 patients were enrolled in the study. Postoperative sedation and analgesia level, extubation times, respiratory complications, lengths of intensive care and hospital stay, morbidity, and mortality were compared. Additional sedative and analgesic drug requirement in the TEA group (25.3% and 60.1% respectively) were significantly lower than the intravenous group (41.4% and 71.8%, respectively; p < 0.001 and p < 0.05, respectively). Extubation time in the TEA group also was significantly lower than the intravenous group (p < 0.01). Respiratory complication and hospital stay in the TEA group were lower than intravenous group (p < 0.05). CONCLUSIONS TEA provided better postoperative respiratory condition via better sedative analgesia in cardiac surgery.

Aim To determine the frequency and define the causes of pulmonary hypertension (PH) in patients with Takayasu arteritis (TA). Method Sixty-four TA patients were evaluated by transthoracic echocardiography (TTE). Having an estimated systolic pulmonary arterial pressure (sPAP) ≥40 mm Hg by echocardiography or if performed, mean PAP ≥25 mm Hg in right heart catheterization was defined as PH. Clinical, imaging and laboratory results of the TA patients were obtained from hospital files. Result In total, seven (10.9%) patients had PH. Four patients had PH due to left-sided heart disease (group 2 PH), three patients due to pulmonary arterial involvement (PAI; group 4 PH) and one patient due to atrial septal defect (group 1 PH). In one patient, combination of PAI, aortic insufficiency and pulmonary venous return anomaly was present and he was considered to have both group 2 and group 4 PH. PAI was more frequent (42.9% vs 15.7%) in patients with PH but the difference was not statistically significant. The percentage of patients treated with cyclophosphamide and/or biologics was higher in the group with PH as compared to the group without PH (P = 0.015). One patient with group 4 PH had been on pulmonary arterial hypertension (PAH)-specific agents for 8 years. Conclusion Pulmonary hypertension is not infrequent in TA patients and all the potential causes of PH should be carefully evaluated. Patients with severe or treatment-resistant disease are prone to have PH. PAH-specific agents may be effective in patients with group 4 PH.

The use of anti-tumor necrosis factor alpha (anti-TNF-α) agents has increased during the past decade in rheumatology practice. Opportunistic infections have been reported with anti-TNF-α agents in clinical trials and post-marketing usage. Aspergillus infection is a rare opportunistic infection that is associated with immunosuppression, and there are reported cases of pulmonary aspergillosis in various rheumatic diseases treated with anti-TNF-α agents. Here, we present the first case of pulmonary aspergillosis associated with infliximab treatment in a patient with Still’s disease.

Behçet's disease (BD) is a systemic autoimmune disorder. Cytochrome P450 enzymes (CYPs) are responsible for various drug metabolism reactions as well as those of endogenous substances which may be associated with autoimmune disease susceptibility. Recently, we reported that in patients with BD, CYP2C9 seems to be down-regulated due to inflammation. In the same Turkish patients with BD, we investigated whether also CYP2C19 activity is decreased. Lansoprazole (30 mg) was given as a probe drug to evaluate CYP2C19 activity in 59 patients with BD and 27 healthy control volunteers. An HPLC method was used to determine plasma lansoprazole and its metabolite, 5-hydroxy lansoprazole, concentrations. The genotyping for CYP2C19 *2, *3 and *17 polymorphisms was made using PCR-RFLP. The median lansoprazole/5-hydroxy lansoprazole metabolic ratio (MR) in patients with BD was 2.6-fold higher as compared to the healthy control group (p = 0.001, 22.6 (1.3-26) and 8.8 (0.5-140) as median and range, respectively). The CYP2C19*17*17 genotype frequency was found to be significantly less in the BD group as compared to the healthy controls (1.7% versus 14.8% in controls, p = 0.01). Additionally, colchicine treatment did not affect the CYP2C19 enzyme activity in six patients (p = 0.43). In conclusion, the patients with BD had lower CYP2C19 enzyme activity and lower frequency of the CYP2C19*17 allele as compared to those of the healthy controls. Further studies are warranted on the mechanisms underlying this relation. This study should also be applied to other autoimmune diseases similarly characterized by local or systemic inflammation.

Background:Obesity could be a risk factor for response to treatment and disease severity in psoriatic arthritis (PsA) because of potential pro-inflammatory effects of cytokines produced by adipose tissue (1).Objectives:This study aimed to assess association of demographic, clinical and disease activity indices with obesity in patients using biological disease-modifying antirheumatic drugs (bDMARD) treatment in HUR-BIO cohort.Methods:HUR-BIO (Hacettepe University Rheumatology Biologic Registry) is a prospective, single center database of biological treatments since 2005. Until January 2020, HUR-BIO PsA registry enrolled 469 patients. Demographic, clinical, laboratory, therapeutic data were collected from this database which including tender/swollen joint counts, Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP), Health Assessment Questionnaire (HAQ), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Disease Activity Score - 28 joint (DAS28), Disease Activity index for Psoriatic Arthritis - 28 joint score (DAPSA-28), Psoriatic Arthritis Impact of Disease 12-item questionnaire (PSAID-12). BMI≥30 was defined as obesity.Results:HUR-BIO PsA had 469 PsA patients and 441 patients with available BMI data were enrolled. Overall, 187/441 patients (42%) had obesity. The median follow-up period of obese and non-obese PsA patients was 7 (3-12) and 8 (4-12) years, respectively (p: 0.31). Obese patients were older at the age of PsA diagnosis (43 (33 - 53) vs 36 (28 – 45) years, pConclusion:Obesity was associated with higher disease activity and poorer effect of bDMARD treatment in patients with PsA. In obese PsA patients with high disease activity despite bDMARD therapy, intentional weight loss may be recommended as an adjunctive therapy.References:[1]Klingberg E, Bilberg A, Björkman S et al. Weight loss improves disease activity in patients with psoriatic arthritis and obesity: an interventional study.Arthritis research & therapy, 2019, 21.1: 17.Table.Baseline and last visit demographic, clinical and disease activity by BMI categoriesBMI > 30BMI < 30p-valueAge at PsA, years, median (Q1-Q3)43 (33-53.5)36 (28-45)0.000*Disease duration, years, median (Q1-Q3)7 (3-12)8 (4-12)0.31Gender (male/female, %)24/7636/640.008*Smoking Ever n, %102 (54.8)159 (62.8)0.091HLA B-27 (+) n, (%)7 (14)32 (35)0.006*Uveitis n, %4 (2.2)6 (2.4)0.571IBD n, %4 (2.1)6 (2.4)0.567PsA/Pso Family history n, %74 (39.6)84 (33.2)0.169Taking steroids before biological drugs n, %115 (61.5)156 (61.7)0.972BASDAI50% response n, %35 (31.8)61 (41)0.13Last HAQ score < 0.5 n, %91 (52.3)160 (68.1)0.001*Figure 1.Baseline and last visit disease activity by BMI categories p: 0.03* p: 0.01* p: 0.001* p: 0.002* *p < 0.05 BMI: Body mass index, DAS: Disease Activity Score, BASDAI: Bath Ankylosing Spondylitis Disease Activity Index, DAPSA: Disease Activity index for Psoriatic Arthritis, PSAID: Psoriatic Arthritis Impact of DiseaseFigure 2.Retention rate for biological DMARD by BMI categories Median of retention rate of first bDMARD: BMI > 30 kg/m2and < 30 kg/m254.2 and 79, respectively. Log rank p-value between BMI > 30 kg/m2and 2:0.03*Disclosure of Interests:Bayram Farisoğullari: None declared, Gözde Kübra Yardimci: None declared, Ertugrul Cagri Bolek: None declared, Emre Bilgin: None declared, Emine Duran: None declared, Gizem Ayan: None declared, Levent Kiliç: None declared, Omer Karadag: None declared, Ali Akdoğan: None declared, Şule Apraş Bilgen: None declared, Ali İhsan Ertenli: None declared, Sedat Kiraz: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB

Most patients with inflammatory arthritis are at their reproductive ages. Use of anti-tumour necrosis factor alpha (anti-TNF-α) agents, one of the important treatment options for inflammatory arthritis, can cause foetal morbidity and mortality. While most studies on the effects of anti-TNF-α agents on pregnancy outcomes are about maternal exposure, the number of studies on the risks related to paternal exposure is insufficient. This study aimed to assess pregnancy periods and outcomes of the partners of male ankylosing spondylitis (AS) patients receiving anti-TNF-α treatment during the preconception period. Totally, 163 male AS patients using anti-TNF-α agents were identified from the Hacettepe University Biological Registry. Of these patients, 45 (27.6%) who declared that their partners got pregnant after initiation on anti-TNF-α agents were included. Data regarding demographics and drug exposure and pregnancy and infant outcomes were evaluated. Of 45 pregnancies, 39 (86.7%) resulted in healthy live births, 3 (6.7%) resulted in spontaneous abortion, and 3 (6.7%) were terminated with curettage. Of 39 live births, 34 (87.2%) were term and 5 (12.8%) were preterm, 30 (76.9%) had normal birth weight, 6 (15.4%) had low birth weight, and 3 (7.7%) had fetal macrosomia. No congenital malformations related to paternal exposure were observed. This study is valuable as being one of the studies providing pregnancy outcomes of partners of male AS patients receiving anti-TNF-α agents with its relatively high number of patients. The results suggested that paternal exposure to anti-TNF-α agents during preconception period could be safe on pregnancy outcomes.

Background/aim: Tumour necrosis factor inhibitors and anti-interleukin-6 (anti-IL-6) therapies are increasingly being used in Takayasu’s arteritis (TA) patients who are unresponsive to corticosteroids ± conventional immunosuppressive agents. The aim of this study is to assess the efficacy and safety of anti-IL-6 (tocilizumab) therapy in refractory TA patients in real life. Materials and methods: Fifteen TA patients (86.7% were female) who received at least 3 cycles of tocilizumab therapy were retrospectively assessed by clinical, laboratory, and radiological evaluations before and after tocilizumab therapy. Results: The median (min–max) age of the patients at evaluation was 35 (20–58) years and the median disease duration from diagnosis was 24 (12–168) months. The median (min.–max.) duration of follow-up after tocilizumab was 15 (3–42) months. There was a significant decrease in erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and patient global visual analogue scale (VAS) scores of patients after tocilizumab therapy. The median (min.–max.) ESR was 26 (5–119) vs. 3 (2–49) mm/h, P = 0.02; CRP was 39.8 (2.4–149.0) vs. 7.9 (0–92.9) mg/L, P = 0.017; and patient global VAS was 50 (0–90) vs. 30 (0–60), P = 0.027, respectively. In 8 patients, ESR and CRP levels were in the normal range in the last control. Imaging modality results after tocilizumab were available for 9 patients; 8 patients were radiologically stable and regression was seen in 1 patient. Comparable imaging modality results before and after tocilizumab were available for 5 patients; 4 patients were radiologically stable and regression was seen in 1 patient. Radiological findings were consistent with laboratory responses. Glucocorticoid dosages decreased from a mean dosage of 16.2 (9.1) mg/day at baseline to 7.1 (3.8) mg/day (P = 0.001) at the last follow-up visit. There was no increase in the steroid dosage in any of the patients. All patients tolerated tocilizumab well. Conclusion: Based on retrospective real life data, anti-IL-6 (tocilizumab) appears to be an effective and tolerable treatment option in refractory TA patients.

Background/aim: Abnormal capillaroscopic findings have been reported in vasculitic syndromes such as Behçet's disease, Henoch-Schönlein purpura, and Wegener's granulomatosis. This study was conducted to define the capillaroscopic changes in patients with Takayasu arteritis (TA). Materials and methods: We studied 28 TA patients (27 females). The nail folds from the 2nd to 5th fingers on both hands were examined with video capillaroscopy for all. A patient was defined as having an abnormal capillaroscopic examination if more than 1 morphologic abnormality was present in at least 2 nail folds. Results: The median capillary density of TA patients was 9 (range: 9-11). There were no patients with capillary disorganization or avascular areas. Tortuous capillaries were detected in all patients. The other common morphological capillary abnormalities included enlarged/dilated capillaries (39.3%), branching capillaries (35.7%), and hemorrhages (32.1%). Only 1 patient had giant capillaries with early scleroderma-like pattern. Overall, there were 11 (39.3%) patients with abnormal capillaroscopic findings. There were more patients with abnormal capillaroscopic findings in the subgroup of TA patients whose upper extremity blood pressure could not be measured as compared to those whose blood pressure could be measured (66.7% vs. 26.3% patients; P = 0.04). Conclusion: Capillaroscopic abnormalities are frequently seen in TA patients. We consider that abnormal capillaroscopic findings in TA patients reflect the impaired blood flow due to narrowed or occluded arteries rather than the primary capillary involvement of the disease process.

Background: Takayasu Arteritis (TAK) is a rare idiopathic granulomatous large vessel vasculitis and it is a clinically heterogenous disease. Various classifications and subsets which based on distribution of arterial lesions were defined in the literature in order to exhibit and predict different disease courses. Objectives: We aimed to validate a new disease subsets developed by Goel et al in our TAK series (1). Methods: We retrospectively evaluated the medical records of 164 TAK patients followed at Department of Rheumatology and Department of Pediatric Rheumatology in Hacettepe University, Ankara, Turkey between August 2005 and October 2018. The pediatric-onset ( Results: There were forty-two (25.6%), sixty-three (38.4%) and fifty-nine (36%) patients in Cluster 1, 2 and 3, respectively. Demographic and clinical data was summarized in Table-1. Cluster 1 included approximately half of patients (45.8%) with pediatric-onset TAK (p= 0.048). Baseline acute phase reactants (Erithrocyte Sedimentation Rate:ESR and C-reactive protein:CRP) and age at disease diagnosis were slightly lower in Cluster 1, however none of them did not reach statistical significance (p= 0.94, p=0.99 and 0.56, respectively). In contrast, cerebrovascular accident rates were slightly higher in Cluster 2 (p=0.24). Although anti-TNF biological agents were more frequently used for treatment in Cluster 1 (p=0.004), cyclophosphamide and/or overall biological agents usage was similar in three groups (p=0.15). Conclusion: Decision tree which defined by Goel et al. was applied to our single center pediatric and adult TAK cohort. In contrast to original validation cohorts, there was no difference among three clusters of our cohort except pediatric-onset disease and anti-TNF usage. Dissimilarities among the cohorts in terms of new classification system may be caused either number of patients or ethnic/regional differences. Reference [1] Goel R, Gribbons KB, Maksimowicz-McKinnon K, Hoffman GS, Kumar S, Joseph G, et al., editors. Discovery and Validation of Novel Disease Subsets in 806 Patients with Takayasu’s Arteritis across Four International Cohorts. ARTHRITIS & RHEUMATOLOGY; 2018: WILEY 111 RIVER ST, HOBOKEN 07030-5774, NJ USA. Disclosure of Interests: Ertugrul Cagri Bolek: None declared, Selcan Demir: None declared, Alper Sari: None declared, Ummusen Kaya Akca: None declared, Levent Kilic: None declared, Ali Akdogan: None declared, Sedat Kiraz: None declared, Omer Karadag: None declared, Seza Ozen Consultant for: Seza Ozen is receiving consultancy fees from Novartis, Speakers bureau: Roche

Background: Although cardiovascular (CV) diseases are very common in inflammatory arthritis like psoriatic arthritis (PsA), long-term impact of medication on CV outcomes is lacking. Objectives: The aim of our study was to evaluate the long-term effects of anti-TNF-a drugs on subclinical atherosclerosis assessed by the flow-mediated dilatation (FMD) and carotid intima media thickness (IMT). Methods: A total of 30 patients with PsA according to classification of psoriatic arthritis (CASPAR) criteria1 and 28 healthy controls were enrolled in this cross-sectional study between June 2011-July 2012. 22 out of 30 PsA patients completed the study. Demographic data (sex, age), PsA and psoriasis duration, joint pattern (monoarthritis, oligoarthritis or polyarthritis) and other PsA involvements (nail, enthesis, dactilytis) were noted. Tender joint count, swollen joint count and disease activity score (DAS)-28 were used for joint activity assessment. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were used for acute phase reactants. Sex and age matched healthy controls were selected as the control group for this study. Flow mediated dilatation (FMD) from brachial artery and carotid intima media thickness (IMT) were measured by an experienced cardiologist both at initial and 5-year follow-up visits. Results: Psoriasis duration of PsA patients was 180±114 months. PsA disease duration was 108±33 months. The mean duration between two evaluations was 62±9 months. At first evaluation, 14 (63.6%) patients had peripheral joint, 1 (4.5%) patient had axial, and 7 (31.8%) patients had both peripheral and axial involvement among patients. Dactilytis in 6 (27.3%), enthesis in 7 (31.8%) and nail in 12 (54.5%) patients were other clinical involvements. FMD% was lower in PsA patients than healthy controls [9.3±3.9 vs 12.9±1.8, p Conclusion: Our results showed that there was a significant impact of anti-TNF-a drugs on progression of subclinical atherosclerosis at the vascular wall level, but no impact on the endothelial dysfunction. Further large-scale randomized studies are needed to confirm our findings. Disclosure of Interests: Abdulsamet Erden: None declared, Ugur Canpolat: None declared, Oguz Abdullah Uyaroglu: None declared, Cem Coteli: None declared, Levent Kilic: None declared, Ali Akdogan: None declared, Umut Kalyoncu Grant/research support from: MSD, Roche, UCB, Novartis and Pfizer, Consultant for: MSD, Abbvie, Roche, UCB, Novartis, Pfizer and Abdi Ibrahim, Speakers bureau: MSD, Abbvie, Roche, UCB, Novartis, Pfizer and Abdi Ibrahim, Omer Karadag: None declared, Ali Ihsan Ertenli: None declared, Sedat Kiraz: None declared, Kudret Aytemir: None declared, Sule Apras Bilgen: None declared

Background: Arterial aneurysmatic lesions are one of the unique features of Behcet’s disease (BD). However, it is difficult to determine which BD patients will develop an aneurysm. Objectives: In this study, we aimed to determine the differences between BD patients with and without an arterial aneurysm. Methods: Data of the 23 BD patients with an arterial aneurysm was published as an abstract in 2013 (1). We retrospectively reviewed the medical records of 441 patients with BD according to International Study Group (ISG) criteria between January 2013 and June 2018. Totally, we determined 45 BD patients with an arterial aneurysm. Six patients with isolated carotid and/or cranial arterial aneurysms who were followed by other clinics excluded from the analysis. Overall, 39 BD patients with an extracranial and extra carotidal aneurysm included in the study. Data regarding demographic features, clinical, laboratory and vascular imaging findings were collected. Results: A total of 39 BD patients (Male: 76.9%) with an arterial aneurysm were analyzed in this study. Mean age, mean age of diagnosis and a median follow-up of patients were 40.9±11.0 years, 29.7±7.7 and 71.8 (2-186) months, respectively. The mean age at the onset of the arterial aneurysm was 36.1±11.5 years. The median time lag between the onset of BD and detection of an aneurysm was 63.6 (0-482) months. The prevalence of male patients in BD with aneurysms, without aneurysms and only mucocutaneous were 76.9%, 52.3%, and 34.3%, respectively. Comparison of BD patients with and without an aneurysm shown in table 1. In multivariate analysis, having a venous thrombosis was the sole risk factor for the development of arterial aneurysm (OR 10.53, 95% CI 1.53-72.71) (Table). Distribution of aneurysms was shown in the figure. At the first diagnosis, a median number of the aneurysm was 1 (1-4), the median diameter of an aneurysm was 39 mm (10-80) and 16 (41%) patients had more than one aneurysm. Type of the firstly detected aneurysm was as follows; 38.5% saccular, 17.9% fusiform, 15.4% pseudoaneurysm and 2.6% dissecting aneurysms. Aneurysm type was not known in 25.6% of patients. The first diagnostic finding was an aneurysmal symptom in the 25% of BD patients. Conclusion: Aneurysm was the diagnostic symptom in 25% of BD patients with an aneurysms. The median time lag between the onset of BD and detection of an aneurysm was almost 5 years. In aneurysmal BD, there is male sex dominance and having venous thrombosis is the most important risk factor. Although pulmonary arteries have an important role in the BD course, the involvement of the aorta and iliac arteries can be seen frequently. References [1] Kalyoncu U, et al. Ann Rheum Dis 2013;72 (abs) Disclosure of Interests: Berkan Armagan: None declared, Ertugrul Cagri Bolek: None declared, Alper Sari: None declared, Gozde Kubra Yardimci: None declared, Bayram Farisogullari: None declared, Emre Bilgin: None declared, Fatma Gonca Eldem: None declared, Levent Kilic: None declared, Omer Karadag: None declared, Bora Peynircioglu: None declared, Barbaros Erhan Cil: None declared, Metin Demircin: None declared, Ali Akdogan: None declared, Sule Apras Bilgen: None declared, Ali Ihsan Ertenli: None declared, Sedat Kiraz: None declared, Umut Kalyoncu Grant/research support from: MSD, Roche, UCB, Novartis and Pfizer, Consultant for: MSD, Abbvie, Roche, UCB, Novartis, Pfizer and Abdi Ibrahim, Speakers bureau: MSD, Abbvie, Roche, UCB, Novartis, Pfizer and Abdi Ibrahim

Background Although the trend towards biopsychosocial approaches is increasing today, studies on psychosocial effects of exercise are limited in the literature. There is a need for framed exercise programs to assess the clinical effectiveness of biopsychosocial approaches. The reason why biopsychosocial programs are important may be due to multidimensional features of symptoms such as pain, fatigue. Objectives The purpose of this study is to investigate the effectiveness of the biopsychosocial exercise program on pain coping skill and fatigue in rheumatic patients. Methods Ninety-one patients with the rheumatic disease were included in this study. The patients were divided into two groups based on a prospective cohort (BETY group, n = 56; and control group, n = 35). BETY is a biopsychosocial exercise approach (1). It was performed in a period of one hour, 3 times a week for 12 weeks and included clinical pilates exercises, dance therapy-authentic movement and pain management information. The control group did not take any exercise treatment. The BETY-Biopsychosocial Questionnaire (BETY-BQ) was used to evaluate the pain coping skill and fatigue as well as assessing whole biopsychosocial status of individuals (2). The answers were given to the 5th question (I don’t know how to control my pain.) and the 11th question (I feel tired.) of the BETY-BQ were recorded as a 5-point Likert at ranging from ‘yes, always’ to ‘no, never. Also, the total score of BETY-BQ was recorded. Demographic data were given as mean ± standard deviation (X ± SD), and answers given to the questionnaire were expressed in frequency tables. Results The mean ages of BETY group and control group were 49.63 ± 11 and 39.74 ± 10 years and body mass indexes were 26.93 ± 3 kg/m2 and 26,54 ± 4 kg/m2, respectively. The frequency of answers to the 5th and 11th question and the total score of the BETY-BQ on the first assessment (pre-treatment) and the second assessment (post-treatment) were shown in Table 1. Conclusion It was concluded that BETY as a biopsychosocial exercise approach is effective in reducing fatigue and improving the pain coping skill as well as the biopsychosocial status of rheumatic patients. BETY should be kept in mind for further studies in terms of biopsychosocial aspects of pain coping, fatigue, etc. References [1] Kisacik, Pinar, et al. ”Investigating the effects of a multidimensional exercise program on symptoms and antiinflammatory status in female patients with ankylosing spondylitis.”Complementary therapies in clinical practice22 (2016): 38-43. [2] UNAL, Edibe, et al. “Romatizmali hastalar icin bir yasam kalitesi olceginin gelistirilmesi: madde havuzunun olusturulmasi.” Journal of Exercise Therapy and Rehabilitation 4.2 (2017): 67-75. Disclosure of Interests None declared