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Background/Aim: Tuberculosis is a disease involving many systems, such as the lung, gastrointestinal system, genitourinary system, etc. Detecting this disease in its latency significantly reduces the morbidity and mortality associated with tuberculosis. One of the tests used in latent TB screening is the interferon gamma release test. In rheumatology practices, it is routinely used to screen for latent tuberculosis infections before treatment with biological agents and Janus kinase (JAK) inhibitors, and it can also be used to exclude tuberculosis infection in clinical practice. In our study, we aimed to evaluate the reasons for requesting interferon gamma release tests and the results of this test in patients who requested it. Methods: Patients admitted to internal medicine and rheumatology outpatient clinics were retrospectively screened within the retrospective cohort study. In total, 364 patients who requested interferon gamma release testing were included in the study. Nine patients with unclear test results were excluded. Laboratory results, demographic data, reasons for requesting the interferon gamma release test, and results were evaluated. Results: The interferon gamma release test was requested by 355 patients. Of these, 266 patients (74.9%) asked for latent tuberculosis screening before treatment with biological agents and JAK inhibitors. This was followed by patients with peripheral lymphadenopathy-lung nodules, patients with unexplained elevated acute phase reactants, and patients with constitutional symptoms, respectively. Ten out of 107 patients (9.3%) had an active tuberculosis infection, while six out of ten patients (60%) had pulmonary tuberculosis, and four (40%) had extrapulmonary tuberculosis. Conclusion: The most common reason for requesting the interferon gamma release test in internal medicine and rheumatology clinics was screening for latent tuberculosis before treatment with biologic agents and JAK inhibitors. In internal medicine, it has been observed that this test can also be requested by patients with constitutional symptoms, unexplained elevated acute phase reactants, and a preliminary diagnosis of tuberculosis in order to rule out or strengthen the preliminary diagnosis.

Aim: Patients can be protected against possible complications when antihypertensive drugs are regularly and properly used for the treatment of hypertension. The readability of package inserts increases treatment compliance. In the present study, the purpose was to determine the readability level of antihypertensive package inserts. Materials and Method: A total of 64 commonly used antihypertensive drugs were selected for this study. The readability scores of the package inserts for the selected drugs were calculated according to the Readability Scales developed by Atesman and Bezirci-Yılmaz. Results: The readability level for the selected package inserts were found to be suitable for an average of 11-12 years of education and high school education level according to the Atesman and Bezirci-Yılmaz Readability Scales, respectively. Conclusion: When it is considered that the average schooling year in Turkey is 6.5 years, the readability level of antihypertensive package inserts is highly above this level. It is recommended to simplify the package inserts to increase readability and drug compliance and prevent incorrect drug use.

Aim: Hemodialysis and peritoneal dialysis are renal replacement treatment options in patients with chronic renal failure. Mortality and morbidity rates are higher in hemodialysis and peritoneal dialysis patients when compared to the healthy population. Comorbidities of the patients play roles in the high mortality and morbidity rates. In the present study, the comorbidities of hemodialysis and peritoneal dialysis patients were evaluated; and the Charlson Comorbidity Index, whose reliability was proven in many studies before, was compared and discussed. Materials and Method: A total of 154 patients (78 hemodialysis and 76 peritoneal dialysis patients), who were followed up for end-stage renal disease, were included in the study. The Charlson Comorbidity Index scores of the patients were calculated. The Charlson Comorbidity Index score and parameters were compared between patient groups on hemodialysis and peritoneal dialysis. Results: The Charlson Comorbidity Index was found to be significantly higher in peritoneal dialysis patients than in hemodialysis patients (p=0.001). It was also found that the frequency of congestive heart failure, cerebrovascular accident, and connective tissue, which are the parameters of the Charlson Comorbidity Index, were significantly different between the groups (p

Objective: Deep vein thrombosis (DVT) of the lower extremities is the most common form of vascular involvement in Behcet disease (BD), frequently leading to post-thrombotic syndrome (PTS) as a disabling complication. We have described the clinical characteristics and predictors of PTS presence among patients with BD and lower extremity DVT. We also used venous Doppler ultrasound (US) examinations in our assessment. Methods: Patients with BD (n = 205; 166 men, 39 women; age 39 6 9.5 years) and a history of DVT were investigated. The Villalta scale was used to assess the presence and severity of PTS. Doppler US examinations were performed within 1 week of the clinical evaluation. The total number of vessels with reflux, thrombi, recanalization, and collateral vessels were calculated. Results: Of the 205 patients with BD, 62% had had PTS and 18% had had severe PTS. Patients with PTS had had greater reflux (P = .054) and thrombosis (P = .02) scores compared with patients without PTS. Treatment with anticoagulation (AC), immunosuppressive (IS) therapy, or AC combined with IS drugs did not affect the occurrence of PTS. However, patients treated with IS therapy, with or without AC drugs, had a decreased incidence of severe PTS compared with the AC-only group (P = .017). Patients treated with AC plus IS agents also had increased collateral scores compared with patients treated with only IS drugs. Interferon-a use seemed to provide better recanalization scores compared with azathioprine only (1.0 [range, 0-14] vs 2.5 [range, 0-10]; P = .010). Conclusions: Patients with BD and DVT have a high risk of developing severe PTS. IS treatment decreases the development of severe PTS. AC therapy might influence the course of PTS by increasing the collateral scores, and the use of interferon-a also increased recanalization scores. Routine assessment with Doppler US examinations could be helpful in the prediction of severe PTS. (J Vasc Surg Venous Lymphat Disord 2021;9:1451-9.)

Objective: Inflammation markers increase during Familial Mediterranean Fever (FMF) attacks and often return to normal within a few days. It is known that a subclinical inflammation continues in FMF patients in the inter-episode period, which increases the risk of developing amyloidosis. In recent years, several works have been conducted showing the relationship between platelet indices and inflammation, such as platelet count (PLT), platelet distribution width (PDW), mean platelet volume (MPV), plateletrite (PCT). In this study, we aimed to investigate the relationship between platelet indices and disease severity in FMF patients without attacks. Method: The records of all FMF patients followed by us were reviewed retrospectively. Patients with a hematological or oncological disease, patients with data deficiency for the study, and patients under 18 years of age were excluded. While the laboratory data were recorded, the condition of patients to be at least 3 months without attack was required. As the control group, the automation records of all healthcare professionals working in the internal medicine clinic of our hospital were examined. Our clinical staff, who did not have chronic diseases and regular drug use, were taken as a healthy control group. 173 patients and 20 control groups who met the conditions mentioned above were included in the study. Platelet indices were compared between patient and control groups. Results: It was determined that the value of MPV, one of the platelet indices, in the patient group was statistically significantly higher than the value in the healthy control group (p = 0.029). MPV was also found to correlate with disease severity (p

Background/aim: Familial Mediterranean Fever (FMF) is the prototype of hereditary autoinflammatory disorders and caused by mutations on the MEFV gene located on the short arm of chromosome 16. Although some MEFV variants are clearly associated with disease phenotype, there are numerous variants with unknown clinical association which are termed as variants of uncertain significance (VUS). Here, we present clinical correlations of VUS in a large cohort of adult FMF patients from three tertiary centers located in Central Anatolia. Materials and methods: All patients were recruited from FMF in Central Anatolia (FiCA) cohort. Demographic (sex, age at disease onset) and clinical features (disease characteristics, attack frequency, mean colchicine dose, colchicine nonresponsiveness, amyloidosis, and persistent inflammation) of patients with VUS were compared with those harboring pathogenic variants. Disease severity and damage were also evaluated using international severity score for FMF (ISSF) and autoinflammatory disease damage index (ADDI), respectively. Results: Among 971 participants included, MEFV gene analysis results were available for 814 patients. Twenty-six (3.2%) patients had single heterozygous VUS and 54 (6.6%) had pathogenic/VUS complex heterozygous variants. Patients with single heterozygous VUS had similar demographic/clinical features, ISSF and ADDI scores compared to those with single heterozygous pathogenic variant (p > 0.05 for all). No difference was observed in the demographic and clinical features of patients with single heterozygous pathogenic mutation and pathogenic/VUS complex heterozygous variant (p > 0.05 for all). ISSF and ADDI scores were lower in pathogenic/VUS complex heterozygous patients than those harboring single pathogenic mutation (p = 0.006 and 0.004, respectively). Conclusion: Our findings suggest that patients with single heterozygous VUS has mild FMF phenotype similar to those with single pathogenic mutation. Pathogenic/VUS complex heterozygosity does not lead to a more severe clinical phenotype than having a single pathogenic variant.

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.

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.

Amaç: Neonatal lupus eritematozus, anti-SS-A/Ro ve anti SS-B/La antikorlarının transplasental geçişiyle fetal dokulara bağlanması sonucu ortaya çıkan edinsel otoimmün bir hastalıktır. Kütanöz, kardiyak, hepatik, nörolojik, akciğer ve hematolojik bulgularla ortaya çıkabilir. Literatürdeki bilgi birikimi daha çok kütanöz ve kardiyak tutulumu ağırlıklıdır. Bu çalışmanın amacı, literatür taraması yaparak hepatik, nörolojik, akciğer ve hematolojik tutulumumların gözden geçirilmesidir. Gereç ve Yöntem: 1976 yılından Ağustos 2015 tarihini kapsayacak şekilde Pubmed Medline’da literatür taraması yapıldı. MeSH terimleri kullanılarak yayınlar belirlendi: (''konjenital kalp bloğu, neonatal lupus‘' (MeSH)), ‘'insanlar'', ''İngilizce'' ile kısıtlamaları yapılarak tarandı. Vakaların bilgilerinin hasta bazında raporlandığı makaleler son analize dahil edildi. Hematolojik, hepatik, nörolojik ve akciğer tutulumu olan NLE hastalarının demografik, klinik ve laboratuvar verileri kaydedildi. Bulgular: Toplam 755 NLE hastasının verileri kaydedildi. Bu hastaların 117 (%15,5)’sinde hematolojik, 78 (%10,3)’inde hepatik, 10 (%1,3)’unda akciğer (%1.3) ve 9 (%1,2)’unda nörolojik tutulum saptanmıştır. Sonuç: Neonatal lupus eritematozus’da hematolojik, hepatik, akciğer ve nörolojik tutulum, kardiyak ve cilt tutulumuna göre daha az görülmektedir. Buna ragmen, klinisyenler NLE yönetimi sürecinde görülebilen bu tutulumlar açısından uyanık olmalılardır.

Objective Persistent inflammation is an insidious and less studied feature of FMF. We investigated clinical determinants of persistent inflammation and its associations with individual damage items. Methods This is a cross-sectional analysis of 917 FMF patients, who fulfilled the Tel Hashomer criteria and had at least 6 months’ follow-up. Patients were stratified based on whether they had persistent inflammation. We used logistic regression analysis to investigate independent predictors of persistent inflammation and the associated individual damage items. Results One hundred and forty-two (15%) patients had persistent inflammation. Active FMF (54%) was the most prominent reason for the persistent inflammation. Spondylarthritis (16%), other inflammatory arthritis (8%) and IBD (2%) were other frequent reasons. Male gender, history of exertional leg pain, inflammatory comorbidities, M694V homozygosity, colchicine resistance, lower education levels and musculoskeletal attack dominance were found to be the independent predictors of persistent inflammation. Earlier disease onset led to a tendency towards persistent inflammation. Patients with persistent inflammation were more likely to suffer damage. There is an increased risk of developing proteinuria, amyloidosis and renal insufficiency. Conclusion We identified, for the first time, the predictors of persistent inflammation in adult FMF patients and related individual damage items of the Autoinflammatory Disease Damage Index. Persistent inflammation is insidious and one of the chief causes of damage; therefore, especially patients with these predictors should be followed up more closely. If detected, underlying inflammatory comorbidities should be assessed meticulously as early detection and proper treatment strategies may favourably impact the natural history of the disease.

Background/aim Colchicine is the mainstay of treatment in FMF. However, in daily practice it is not easy to maintain effective colchicine doses in a substantial number of patients due to its side effects. In this study, we aimed to investigate prevalence and risk factors for colchicine side effects that limit optimal drug dosing and cause permanent discontinuation. Materials and methods All patients were recruited from “FMF in Central Anatolia” (FiCA) cohort, 915 adults with a minimum follow- up time of 6 months during which they had obeyed all treatment instructions. Demographic and anthropometric data, FMF disease characteristics, disease severity, complications, and treatment features were recorded on a web-based registry. Prevalence of colchicine intolerance and characteristics of intolerant patients were analyzed. Results Effective colchicine doses cannot be maintained in 172 (18.7%) subjects. Main side effects that limit optimal dosing were as follows: diarrhea in 99 (10.8%), elevation in transaminases in 54 (5.9%), leukopenia in 10 (%1.1), renal impairment in 14 (1.3%), myopathy in five (0.5%), and allergic skin reaction in two. Colchicine had to be permanently ceased in 18 (2%) patients because of serious toxicity. Male sex and obesity were found to be associated with liver toxicity, and having a normal body weight was associated with diarrhea. Chronic inflammation and proteinuria were more common in colchicine-intolerant patients, and they had reported more frequent attacks compared to those tolerating optimal doses. Conclusion Colchicine intolerance is an important problem in daily clinical practice, mainly due to diarrhea and liver toxicity. Suboptimal colchicine dosing is associated with complications.

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.

OBJECTIVE To describe the associations between autoantibodies, clinical presentation, and outcomes among patients with systemic sclerosis (SSc) in order to develop a novel SSc classification scheme that would incorporate both antibodies and the cutaneous disease subset as criteria. METHODS Demographic and clinical characteristics, including cutaneous subset, time of disease and organ complication onset, and autoantibody specificities, were determined in a cohort of SSc subjects. Survival analysis was used to assess the effect of the autoantibodies on organ disease and death. RESULTS The study included 1,325 subjects. Among the antibody/skin disease subsets, anticentromere antibody-positive patients with limited cutaneous SSc (lcSSc) (n = 374) had the highest 20-year survival (65.3%), lowest incidence of clinically significant pulmonary fibrosis (PF) (8.5%) and scleroderma renal crisis (SRC) (0.3%), and lowest incidence of cardiac SSc (4.9%), whereas the frequency of pulmonary hypertension (PH) was similar to the mean value in the SSc cohort overall. The anti-Scl-70+ groups of patients with lcSSc (n = 138) and patients with diffuse cutaneous SSc (dcSSc) (n = 149) had the highest incidence of clinically significant PF (86.1% and 84%, respectively, at 15 years). Anti-Scl-70+ patients with dcSSc had the lowest survival (32.4%) and the second highest incidence of cardiac SSc (12.9%) at 20 years. In contrast, in anti-Scl-70+ patients with lcSSc, other complications were rare, and these patients demonstrated the lowest incidence of PH (6.9%) and second highest survival (61.8%) at 20 years. Anti-RNA polymerase antibody-positive SSc patients (n = 147) had the highest incidence of SRC (28.1%) at 20 years. The anti-U3 RNP+ SSc group (n = 56) had the highest incidence of PH (33.8%) and cardiac SSc (13.2%) at 20 years. Among lcSSc patients with other autoantibodies (n = 295), the risk of SRC and cardiac SSc was low at 20 years (2.7% and 2.4%, respectively), while the frequencies of other outcomes were similar to the mean values in the full SSc cohort. Patients with dcSSc who were positive for other autoantibodies (n = 166) had a poor prognosis, demonstrating the second lowest survival (33.6%) and frequent organ complications. CONCLUSION These findings highlight the importance of autoantibodies, cutaneous subset, and disease duration when assessing morbidity and mortality in patients with SSc. Our novel classification scheme may improve disease monitoring and benefit future clinical trial designs in SSc.

Objective: The aim of this multi-center study was to assess predictive factors for work-day loss as an indirect cost element in Behçet's syndrome (BS). Methods: In this cross-sectional, multi-center study, 834 BS patients (F/M: 441/393, age mean: 38.4 ± 10.9 years) were included. Data were collected by a questionnaire regarding treatment protocols, disease duration, smoking pattern, frequency of medical visits during the previous year and self-reported work-day loss during the previous year. Results: Work-day loss was observed in 16.2% of patients (M/F: 103/32). The percentages of being a smoker (81.8%), using immunosuppressive (IS) medications (82%), and having disease duration

AMAÇ: COVİD-19 hastalığı; güçlü bulaşıcılığa ve ağır patojeniteye sahip bir hastalıktır. COVİD-19 hastalığı için pek çok risk faktörü tanımlanmıştır. Sigara içiciliği bu risk faktörlerinden bir tanesidir. Bu çalışma COVİD-19 pandemisi boyunca enfekte hastalar ile yakın temas halinde olan sağlık çalışanlarının sigara içme alışkanlığının nasıl değiştiğini ve bu değişikliklere neden olan faktörlerin neler olduğunu ortaya koymak için yapılmıştır.GEREÇ VE YÖNTEM: Çalışma 3. basamak olarak hizmet veren bir pandemi hastanesinin sigara kullanan 242 sağlık personeline 15 - 30 Mart 2021 tarihleri arasında çevrimiçi bir anket uygulanarak gerçekleştirilmiştir. Anket yaş, cinsiyet, meslek gibi sorular ile başlamakta; COVİD-19 geçirip geçirmeme, COVİD-19 döneminde sigara içme alışkanlığının nasıl değiştiğine yönelik sorular ile devam etmekte ve Fagenstrom Nikotin Bağımlılık anketi ile sonlanmaktadır. İstatiksel analiz SPSS 26.0 paket programı ile yapılmış ve gruplar arasında kategorik değişken karşılaştırmasında ki-kare testi kullanılmıştır.BULGULAR: Katılımcıların 131’i erkek (%54.1), 111’i kadın (%45.9)dı. 90 kişi (%37.2) doktor,152 (%62.8) kişi yardımcı sağlık personeli idi. Katılımcılar içerisinden 58 kişi (%24) COVİD-19 geçirmişken, 184 kişi (%76) COVİD-19 geçirmemiş idi. COVİD-19 pandemisi seyri boyunca katılımcılar içerisinden 55 (%22.7) kişini sigarayı bıraktığı öğrenildi. Bu dönemde sigarayı bırakan 55 kişinin Fagerström nikotin bağımlılık testine göre 53 tanesinin çok az bağımlı-az bağımlı olduğu görülürken, 2 tanesinin yüksek ya da çok yüksek bağımlı olduğu görüldü.SONUÇ: COVİD-19 pandemisi sağlık çalışanlarının sigara içme alışkanlığı üzerinde istatiksel olarak anlamlı bir farklılık oluşturmamıştır. Sağlık çalışanlarının bu dönemde sigara içme alışkanlığında nikotin bağımlılıkları doğrudan bir rol oynamıştır., OBJECTIVE: COVID-19 disease; It is a highly contagious and highly pathogenic disease. Many risk factors have been identified for the COVID-19 disease. Smoking is one of these risk factors. This study was conducted to reveal how the smoking habits of healthcare workers who were in close contact with infected patients during the COVID-19 pandemic changed and what factors caused these changes.MATERIAL AND METHODS: The study was carried out by applying an online questionnaire to 242 smokers of a pandemic hospital serving as a third step between 15 - 30 March 2021. The survey starts with questions such as age, gender, occupation; Whether or not to have COVID-19 continues with questions about how smoking habits have changed during the COVID-19 period and ends with the Fagenstrom Nicotine Addiction questionnaire. Statistical analysis was done with SPSS 26.0 package program and chi-square test was used to compare categorical variables between groups.RESULTS: Of the participants, 131 (54.1%) were men and 111 (45.9%) were women. 90 people (37.2%) were doctors and 152 (62.8%) were assistant health personnel. Among the participants, 58 (24%) had COVID-19, while 184 (76%) had not had COVID-19. It was learned that 55 (22.7%) of the participants quit smoking during the course of the COVID-19 pandemic. According to the Fagerström nicotine addiction test of 55 people who quit smoking during this period, 53 of them were found to be very little addicted-low addicted, while 2 of them were highly or very highly addicted.CONCLUSIONS: The COVID-19 pandemic did not make a statistically significant difference on the smoking habits of health- care workers. Nicotine addictions played a direct role in the smoking habits of health workers in this period.

Background/Aim: COVID-19 is a serious disease, primarily affecting the respiratory system. The disease spreads from person to person and has become a global health problem of great concern worldwide. The aim of this study was to compare the clinical and laboratory characteristics and the mortality rates of suspected and confirmed COVID-19 cases admitted to the intensive care unit with severe pneumonia. Methods: A retrospective case-control study examination was made of 397 patients diagnosed with suspected or confirmed COVID-19 who were followed up in the intensive care unit (ICU) of Afyonkarahisar Health Sciences University Medical Faculty Hospital between 20 March 2020 and 31 December 2020. The cases were compared in respect of demographic, clinical and laboratory characteristics, prognosis, and mortality rates. Results: 397 patients comprised of 37 (9.3%) with suspected COVID-19 and 360 (90.7%) confirmed COVID-19. No difference was determined between the suspected and confirmed cases in respect of age, gender, and comorbidities (P

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.

Background: Gastroinestinal involvement in Behcet’s disease impacts morbidity and mortality. The diagnosis of gastrointestinal disease requires comprehensive evaluation with endoscopic and radiologic examinations which is costly and impractical. A biomarker is essential for non-invasive detection. Fecal S100A12 is an established biomarker in gastrointestinal inflammatory diseases and its serum levels are known to increase in Behcet’s Disease. In this study, we aimed to tests fecal S100A12 levels in Behcet’s patients, its relation with gastrointestinal symptoms to its potential as a biomarker in gastrointestinal involvement. Methods: We prospectively enrolled 48 cases of Behcet’s disease patients fulfilling International Study Group criteria from a university hospital. We excluded patients with other autoimmune conditions, active or recent infection, using NSAIDs and antibiotics. Control group was selected from volunteers who had applied to the rheumatology outpatient clinic. Patients with BD were categorized into 5 groups according to organ involvement. Also we evaluated and recorded disease activity with the BDCAF 2006. Fecal S100A12, fecal calprotectin and acute phase reactants were also collected. Results: Fecal calprotectin levels were six-fold higher in BD than controls (p

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.

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.

Background/aim: Peritonitis attacks of Familial Mediterranean Fever (FMF) usually requires emergency medical admissions and it's hard to distinguish a typical abdominal attack from surgical causes of acute abdomen. Therefore, history of abdominal surgery, particularly appendectomy, is very common in patients with FMF. However, history of appendectomy might also give some clues about the course of FMF in the adulthood. This study was to determine whether the history of appendectomy help to anticipate disease course of FMF in the adulthood. Materials and methods: All patients recruited from FMF in Central Anatolia (FiCA) cohort, comprising 971 adult subjects. All patients fulfilled the Tel Hashomer criteria. Demographic data, FMF disease characteristics, co-morbid conditions, past medical history, surgical history and disease complications were meticulously questioned and laboratory features and genotype data (if available) were recruited from patient files. Results: Appendectomy history was evident in 240 (24.7%) subjects. Disease onset was earlier and peritonitis is strikingly more prevalent (97.1% vs. 89.6%, p < 0.001) in appendectomized patients. These patients had reported almost two fold more frequent attacks in the last year compared to appendix intact patients (median 3.5 vs. 2 attacks, p = 0.001) without a difference in frequency of musculoskeletal and skin attacks. Severe disease was more common (10% vs. 5.9%, p = 0.038) due to involvement of more attack sites throughout the life and more frequent attacks. Appendectomy patients had used higher daily doses of colchicine to control disease (1.43 +/- 0.6 mg vs. 1.27 +/- 0.52 mg, p = 0.002) but colchicine resistance was also more common in these patients, 15% vs. 6.7% respectively, p < 0.001. Conclusion: Appendectomy history is common in FMF patients and associated with frequent serositis attacks in adulthood. These patients require higher colchicine doses with a lower rate of response and more need for Interleukin-1 antagonist therapies.

Background Systemic sclerosis (SSc) is typically manifests with SSc-specific antibodies (SSc-Abs): anti-topoisomerase I (ATA), anti-centromere (ACA), anti-RNA polymerase III (ARA), anti-U3RNP (u3RNP), anti-U1RNP (U1RNP), anti-PmScl (PmScl), anti-Ku (Ku) and anti-Th/T0 (Th/T0), each being characterised by distinct clinical features and prognosis. The presence of > 1 SSc-Abs is rare with minimum data about these patients’ clinical phenotype in SSc Methods The autoantibody profiles of 2,799 SSc patients from February 2001 to June 2017 were retrospectively reviewed. Patients with >1 SSc-Abs were identified. Clinical features were collected and compared to historical cohorts of SSc patients with single SSc-Ab positivity. Patients were excluded if treated prior to their immunology test with rituximab, iv immunoglobulins or stem cell transplantation. Statistical analysis was performed using Fisher exact test. Results 72 patients (2.6%) with >1 SSc-Ab were identified. Full clinical data were available for 63 patients. 60 patients (2.1%) had double Ab positivity and 3 patients had triple Ab positivity (0.1%). 13 Ab combinations were present. U1RNP and ATA was the most frequent combination (35%), these patients were significantly younger(51.38 years) than both U1RNP (58.64 years,p=0.050) and ATA (62.03 years,p=0.002) patients and more commonly of diffuse subset (dcSSc)(p = 0.001 and p = 0.041 respectively). Compared to ATA patients overlap features were more frequent (43% vs 15%, p = 0.004) including inflammatory arthritis (p = 0.025) and myositis (p = 0.013) (Table 1). U1RNP and ACA had a significantly higher prevalence of pulmonary arterial hypertension compared to U1RNP (p = 0.039) and ACA (p = 0.022) patients, and compared to ACA patients they were younger (57.88 vs 68.75,p=0.015) with a higher frequency of myositis (p = 0.001). U1RNP and ARA patients were more frequently dcSSc subtype compared to U1RNP patients (75% vs 21%, p = 0.040). U1RNP and PmScl patients had a higher prevalence of myositis compared to U1RNP patients (p = 0.006). ATA and ACA patients behaved similarly to ATA patients with a significantly higher prevalence of lung fibrosis (p = 0.006) and myositis (p = 0.041) compared to ACA. ACA and PmScl (7%) had higher prevalence of myositis compared to ACA patients (p = 0.04). Conclusion Coexistence of hallmark autoantibodies is exceedingly rare in SSc patients. When combined, both SSc-Abs have the potential to synergistically interact and modify the clinical phenotype. Disclosures C. Campochiaro None. K.E.N. Clark None. L. Host None. A. Sari None. C.P. Denton None. V.H. Ong None.

Background Iron deficiency (ID) is more prevalent in systemic sclerosis (SSc) patients with pulmonary hypertension (PH) than those without and associated with worse prognosis. Few data are available about the relationship between serum iron parameters and pulmonary haemodynamics. Methods Right heart catheterisation (RHC) reports of SSc patients were retrospectively reviewed. Subjects were included in the study if they had serum iron studies done within 12 months of RHC and were either diagnosed as 1) pulmonary arteral hypertension (PAH, group 1 PH), defined as mean pulmonary artery pressure (mPAP)≥25 mmHg at rest with pulmonary artery wedge pressure ≤15 mmHg; or 2) no PH. Patients with gastrointestinal disorders that may cause low iron levels and glomerular filtration rate below 60 ml/min/1.73m2 were excluded. We recorded serum iron concentration (µmol/L), total iron-binding capacity (TIBC, µmol/L), transferrin saturation (TS, %), ferritin (µg/L), red cell distribution width (RDW, %), as well as mPAP (mmHg) and pulmonary vascular resistance (PVR, dynes/sec/cm-5). Univariable assocıatıons were assessed using Mann-Whitney test and Spearman's correlation as appropriate. Multiple regression of log-transformed mPAP and PVR and Cox regression were used to compare iron and RDW association with haemodynamics and survival. Results We included 122 subjects in the analysis, 84% were female and mean age at RHC was 57 years. The majority (73%) had limited cutaneous SSc and 34% carried anti-centromere antibodies, followed by 18% with anti-Scl70 and 8% with anti-U3RNP.At RHC, 53/122 (43%) of the patients were diagnosed with PAH. Among them we observed substantially lower levels of serum iron (8.7 vs. 12.1 µmol/L, p < 0.001), TS (15.3% vs. 22.5%, p < 0.001), ferritin (68.1 vs. 112.5 µg/L, p = 0.07), significantly higher RDW (16.4% vs. 14.8%, p < 0.001) and no difference in TIBC (57.4 vs. 54.3 µmol/L, p = 0.163), compared to subjects in whom PH was excluded. mPAP showed moderately strong negative correlation with iron concentration (Spearman's rho=-0.35, p < 0.001) and TS (Spearman's rho=-0.39, p < 0.001) and positive correlation with RDW (Spearman's rho=0.46, p < 0.001).PVR was significantly inversely correlated with iron concentration (Spearman's rho=-0.30, p = 0.001), TS (Spearman's rho=-0.37, p < 0.001 and ferritin (Spearman's rho=-0.22, p = 0.016), while it showed positive correlation with TIBC (Spearman's rho=0.28, p = 0.003) and RDW (Spearman's rho=0.37, p < 0.001).Compared to serum iron indices, RDW is a better predictor of mPAP and PVR. In addition, iron levels did not demonstrate any association with survival, while risk of death was significantly higher for patients with higher RDW (HR = 1.18, p = 0.002) and the association remained after adjusting for presence of PH (HR = 1.16, p = 0.013). Conclusion To our knowledge, this is the first study to demonstrate a significant relationship between ID state and haemodynamic measures of SSc-PAH. Our data also support RDW, as an indicator for functional iron deficiency, may serve as a biomarker for severity of pulmonary vasculopathy in SSc. Disclosures A. Sari None. S.I. Nihtyanova None. B.E. Schreiber None. G. Coghlan None. C.P. Denton None. V.H. Ong None.

Defining predictors of damage would improve patient care. We applied damage indexes to patients with familial Mediterranean fever (FMF) and identified the predictors of damage.This is a cross-sectional analysis of 926 FMF patients, who fulfilled the Tel-Hashomer criteria and had at least six months of follow-up. Patients were stratified according to their damage status (damage vs. no damage) defined with autoinflammatory disease damage index (ADDI) and modified ADDI (excluding musculoskeletal pain). We used logistic regression analysis to investigate independent predictors of damage for both indexes.Mean disease duration was 21.6±11.9 years. 527 patients (57%) had damage according to ADDI. Median ADDI score was 1 (0-11). Most common FMF-related damages were observed in musculoskeletal, reproductive and kidney domains. Female gender, inflammatory comorbidity, colchicine resistance, colchicine nonadherence, musculoskeletal attack dominance, diagnostic delay, follow-up time, and smoking history remained independent predictors of damage according to ADDI score. The rate of patients with damage defined by modified ADDI was only to 23%. M694V/M694V homozygosity, female gender, musculoskeletal attack dominance, colchicine resistance, persistent inflammation, follow up time and family history of amyloidosis were found to be predictors of damage according to modified ADDI score.Our study is the first to apply comprehensive damage indexes to FMF patients and identified predictors of damage. Factors linked to a severe FMF phenotype, including M694V homozygosity and persistent inflammation, were associated with only modified ADDI. Our findings justify the concerns about musculoskeletal pain and might point to the need for re-evaluation of ADDI for FMF patients.

Introduction/objectives Familial Mediterranean fever (FMF) is characterized by recurrent attacks of fever, serositis, and arthritis, but some patients may experience long-term complications of disease such as infertility/subfertility. The published data about FMF-associated infertility is still limited. The aim of this study is to investigate the frequency and to determine potential factors for FMF-associated infertility/subfertility. Methods We enrolled 971 adult patients with FMF. We defined infertility as the failure to conceive after 12 months of regular, unprotected intercourse. All patients fulfilled Tel Hashomer criteria. Demographic data, FMF disease characteristics and genotype data (if available), disease complications, laboratory parameters, and treatment features were recorded. Results There were 582 subjects eligible for the present study (mean age 41.05 +/- 10.6 years, 65.8% female). MEFV mutations were available in 482 subjects, and 74.9% of subjects were harboring M694 V mutation (25.1% homozygous for M694 V). Infertility was present in 64 patients (14.6% of females and 4% of males). Multivariate analysis showed female sex [odds ratio (OR), 4.47; 95% confidence interval (CI95%) 1.75-11.42; p = 0.002], FMF disease onset < 20 years [OR, 2.99; (CI95% 1.04-8.61);p = 0.04], disease severity (ISSF) [OR, 4.81; (CI95% 2.28-10.17); p < 0.001], and colchicine nonresponse [OR, 2.80; (CI95% 1.17-6.74) p = 0.021] were the independent predictors of infertility. We also observed reversal of infertility in five patients who were treated with IL-1 beta antagonists. Conclusion Disease severity, FMF disease onset < 20 years, colchicine nonresponse, and female sex were found to be the independent predictors of infertility. The value of effective therapeutic interventions must be determined to treat infertility in these patients.center dot The prevalence of infertility increased in female patients with FMF.center dot Female sex, FMF disease onset < 20 years, disease severity, and colchicine nonresponse were risk factors for FMF-associated infertility.center dot With effective treatment of FMF, reversal of infertility was observed in five patients.

The aim of the present study was to examine the effects of age on mucocutaneous activity by using moderation analysis in Behçet’s syndrome (BS). In this cross-sectional study, 887 BS patients (female : male, 481:406; mean age, 38.4 ± 10.9 years) followed in 13 tertiary centers in Turkey were included. Mucocutaneous activity was evaluated by using the Mucocutaneous Index (MI) according to sex and disease course. Moderation analysis was performed to test the effect of age on mucocutaneous activity. A moderator variable is a third variable and affects the relationship between independent and outcome variables. Age was chosen as a potential moderator variable (interaction effect), MI score as the outcome variable and sex as an independent variable in the analysis. The moderation analysis tested the effects of age in three steps: whole BS patient group, patients without systemic involvement and those with systemic involvement. The moderation model was only significant in BS patients with systemic involvement (P = 0.0351), and a significant relationship was observed between female sex and MI score (P = 0.0156). In addition, the interaction plot showed that female patients had increased MI scores compared with male patients, especially in the 28-year-old age group (P = 0.0067). Moreover, major organ involvement was newly diagnosed in the majority of these young female BS patients. Our results suggest that the relationship between sex and mucocutaneous activity was moderated by age in the systemic involvement group. Also, increased mucocutaneous activity may be associated with new major organ involvement in young female BS patients with systemic involvement. © 2020 Japanese Dermatological Association

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 Free fascial flaps are widely used for the reconstruction of defects located on the distal extremities as they provide thin yet durable soft tissue coverage. The serratus anterior fascia flap stands out from other fascial flap alternatives as it has optimal anatomical properties that can provide ideal coverage in a wide range of reconstructive challenges. The purpose of this study was to present our experience with the serratus anterior fascia flap in a variety of complex soft tissue defects. Methods A retrospective review was conducted on patients who underwent reconstruction with the free serratus anterior fascia flap for complex soft tissue defects involving the distal extremities. Results Complex soft tissue defects of 13 patients were reconstructed using the free serratus fascia flap. No major postoperative complications such as flap loss, dehiscence, infection, or hematoma were encountered in any of the patients. All of the patients demonstrated durable and harmonious long-term flap coverage that facilitated movement without any signs of scar contractures and tendon adhesions at the site of reconstruction. Conclusions The serratus anterior fascia flap demonstrates versatility and stability for the closure of complex distal extremity defects. It creates thin yet durable coverage that facilitates underlying tendon gliding while providing harmony with the natural contours of these anatomic areas and has low donor site morbidity, making it a primary choice in the reconstruction complex soft tissue defects involving the hands and feet.

There is a need for better definition of polyarteritis nodosa (PAN) subphenotypes and the influence of ethnicity and geography. This study is aimed to study the demographic and clinical features of PAN cohorts from the UK and Turkey (TR) and to compare and contrast disease characteristics. A retrospective survey of databases from two vasculitis centres between 1990 and 2016 for PAN patients fulfilling the EMEA Vasculitis Classification algorithm. All paediatric-onset adult patients met the Ankara 2008 (EULAR/PReS endorsed) criteria for childhood PAN. Those with typical angiographic and/or histopathologic findings consistent with PAN were included. 93 (M/F: 51/42) patients (UK: 47, TR: 46) were included. Three were HBV-related, 20 (21.5%) had paediatric onset and 16 (16.5%), cutaneous PAN. TR patients had younger age of disease onset 44 (28.5-59.0) vs. 24.5 (11.8-40.5), p = 0.002. Twelve (26%) of TR patients had monogenic disease (Familial Mediterranean Fever association (n = 7), deficiency of adenosine deaminase 2, DADA2, (n = 5). No difference was found in phenotype between paediatric and adult onset patients except for frequency of cutaneous lesions (p = 0.002). During a median 67.5 (32-126) months follow-up, 13 patients died (12.7% in UK vs. 15.2% in Turkish cohorts). No difference was found between two cohorts in relation to relapse rate, death and vasculitis damage index. This study defined a diagnosis of PAN according to the EMEA algorithm. The TR group had a younger age of disease onset and more cases of monogenic disease; however, disease extent, relapse rate, damage index and death rates were similar between groups.

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.

Background: Relapsing polychondritis (RP) is a rare autoimmune disorder, and myelodysplastic syndrome (MDS) is accompanied by RP at variable rates. Herein, we report a case with RP and MDS who responded dramatically to 5-azacitidine for MDS. Case presentation: With conventional immunosuppressive treatment, our patient had several episodes of different side effects, including infections. With the diagnosis of MDS and initiation of azacitidine treatment, all the manifestations of RP disappeared, and remission was achieved for MDS. Although he had relapses of either RP or MDS after several years of azacitidine treatment, all relapses were controlled well with the initiation of azacitidine treatment every time. Conclusions: Azacitidine should be kept in mind as a treatment option for RP patients with MDS.

Oxaliplatin is a third-generation platinum anti-neoplastic agent, which is used in the treatment of colorectal, gastric, and biliary tract cancers with combination other chemotherapy drugs. In rare cases, thrombocytopenia may occur suddenly in approximately 24 hours due to immune-mediated reactions. This reaction is usually seen after long term usage of oxaliplatin-based chemotherapy. Here, we present our case of immune-mediated thrombocytopenia associated with oxaliplatin. A 56 years old man who had stage IV rectum cancer with liver metastasis, had palliative surgery due to bowel obstruction after initial diagnostic approach. After failure of first line treatment, mFOLFOX6 plus Cetuximab (Cetuximab: 500mg/m2 on day 1, Oxaliplatin: 85 mg/m2 day 1, Leucovorin (LV): 400 mg/m2 day 1, 5-FU 400 mg/m2 IV bolus on day 1 followed by 2400 mg/m2 on day 1 infused over 46 hours every two weeks) regimen was started. Before the 21st cycle of oxaliplatin plus cetuximab regimen, the patient had normal thrombocyte, haemoglobin and neutrophile count. Approximately 8 hours after the chemotherapy patient had been taken to the emergency service with petechia, vigorous gastrointestinal and nasal bleeding. The thrombocyte levels were 3000 at μl. The patient was given methylprednisolone for three days. The thrombocyte levels recover quickly in 24 hours. After this reaction, oxaliplatin stopped and the chemotherapy was changed to capesitabine plus cetuximab regimen. In conclusion, oxaliplatin induced immune-mediated thrombocytopenia is a rare side effect but a life threatening complication. A physician who uses oxaliplatin as a treatment option should keep in mind the possibility immune-mediated thrombocytopenia which may cause life-threatening bleeding. Especially the long term use of oxaliplatin (median >10 cycles) may alert the physician for immune-mediated adverse effects.