1
|
Can FI, Gültaç E, Yilmaz S, Kilinç RM, Kilinç CY. The Association between SLAP Lesions and Critical Shoulder Angle and Glenoid Depth. ACTA CHIRURGIAE ORTHOPAEDICAE ET TRAUMATOLOGIAE CECHOSLOVACA 2024; 91:57-61. [PMID: 38447566 DOI: 10.55095/achot2024/007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
PURPOSE OF THE STUDY The critical shoulder angle (CSA) is formed by the combination of glenoid inclination and acromial index and has been shown related to rotator cuff tears and glenohumeral osteoarthritis. SLAP lesions today have an important place among bicipitolabral pathologies that cause intensive shoulder pain. We aimed to investigate the relationship between CSA and glenoid depth and SLAP lesions. MATERIAL AND METHODS Between March 2017 and January 2022, 279 consecutive shoulder arthroscopy patients' MRI images were retrospectively examined. After the exclusion criteria, 191 patients were eligible. Patients with SLAP lesions (n=37) were assembled as the study group (Group 1), and patients with intact superior labrum (n=154) were named as the control group (Group 2). Critical shoulder angle (CSA) and glenoid depth measurements were performed using the preoperative MRI images. RESULTS A total of 191 patients, of whom 84 were male (44%) were included. The mean age was 49.9±14.96 (range 18-79). There was a statistically signifi cant difference between the SLAP group (Group 1) and the control group (Group 2) in terms of CSA (p=0.032). The mean CSA was 31.66°±3.51° in Group 1 and 33.57° ±5.01° in Group 2. The cut-off value for CSA in patients with SLAP lesions was calculated as 32.85° and the area under the curve was 0.61, therefore a satisfactory association was observed between the groups. The mean glenoid depth was 4.32 ±1.25 mm in Group 1, and 4.39 ±0.32 mm in Group 2. There was no statistically signifi cant difference between the groups in terms of glenoid depth (p=0.136) and also no association between the glenoid depth and SLAP lesions was observed (cut-off=4.45 mm, AUC=0.32). CONCLUSIONS Low CSA is associated with SLAP lesions, just as in glenohumeral osteoarthritis. Further prospective clinical studies are needed to enlighten the predisposing effect of CSA to SLAP lesions and the success of superior labral repairs. LEVEL OF EVIDENCE Retrospective comparative study, Level III.
Collapse
|
2
|
Baumkötter R, Yilmaz S, Zahn D, Schulz A, Prochaska JH, Hettich-Damm N, Schmidtmann I, Schuster AK, Lackner KJ, Münzel T, Beutel ME, Wild PS. Predictors for COVID-19 Vaccine Hesitancy in a Population-Based Cohort Study. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:886-887. [PMID: 38315654 PMCID: PMC10859747 DOI: 10.3238/arztebl.m2023.0253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/16/2023] [Accepted: 11/16/2023] [Indexed: 02/07/2024]
|
3
|
Demirhan O, Yüksel B, Yilmaz S, Cetinel N. Different Clinical Effects of Ectodermal Dysplasias in Four Generations. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:918-920. [PMID: 37276991 DOI: 10.1016/j.ad.2022.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 09/25/2022] [Accepted: 11/22/2022] [Indexed: 06/07/2023] Open
|
4
|
Demirhan O, Yüksel B, Yilmaz S, Cetinel N. Different Clinical Effects of Ectodermal Dysplasias in Four Generations. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:T918-T920. [PMID: 37716501 DOI: 10.1016/j.ad.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 09/25/2022] [Accepted: 11/22/2022] [Indexed: 09/18/2023] Open
|
5
|
Tocoglu AG, Dogan B, Tuzun S, Akcay EU, Altas AE, Ayhan LT, Yilmaz S, Genc AC, Gonullu E, Tamer A. The relationship between Salusin-α, Salusin-β, and Klotho levels with subclinical atherosclerosis in ankylosing spondylitis. EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES 2023; 27:9838-9845. [PMID: 37916350 DOI: 10.26355/eurrev_202310_34160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
OBJECTIVE Subclinical atherosclerosis (SA) is often observed in ankylosing spondylitis (AS) patients; Salusin-α (Sal-α), Salusin-β (Sal-β), and Klotho hormones are thought to be associated with atherosclerosis. This study aims to evaluate the relationship between Sal-α, Sal-β, and Klotho levels with SA in AS. PATIENTS AND METHODS The study included patients older than 18 years who applied between August 1, 2019, and September 1, 2019. Patients with AS were included in the AS group, and patients without a known disease were included in the healthy group. Epicardial adipose tissue thickness (EATT) and carotid intima-media thickness (CIMT) measurements were used to assess SA. RESULTS The study group included 38 (40.9%) patients diagnosed with AS, and the control group included 55 (59.1%) participants. CIMT and EATT levels were higher in the AS group than in the healthy group [0.37 (0.17) vs. 0.54±0.18, p<0.001; 0.44±0.11 vs. 0.54 (0.18), p=0.004, respectively]. There was no significant difference in Sal-α, Sal-β, and Klotho levels between the AS and healthy groups (p>0.05). Furthermore, there was no observed relationship between EATT or CIMT and Klotho, Sal-α, or Sal-β in either group (p>0.05). CONCLUSIONS Although SA level was higher in AS patients, there was no relationship between SA and Sal-α, Sal-β, and Klotho levels.
Collapse
|
6
|
Yilmaz S, Maspero M, Isakov R, Wong J, Foley N, Spivak A, Hull TL. Gracilis muscle interposition for recurrent rectovaginal fistula. Tech Coloproctol 2023; 27:945-946. [PMID: 37354333 DOI: 10.1007/s10151-023-02835-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/14/2023] [Indexed: 06/26/2023]
|
7
|
Taylan M, Dogru S, Sezgi C, Yilmaz S. Epidemiological trends and seasonal dynamics of tuberculosis in Southeastern Turkey. Niger J Clin Pract 2023; 26:928-933. [PMID: 37635576 DOI: 10.4103/njcp.njcp_629_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Background Tuberculosis (TB) is an important public health issue. Determining TB trend and seasonal variability provides useful information for designing treatment strategies and control programs. Aim The present study attempts to investigate the epidemiological trend and the seasonal variations. Materials and Methods TB data containing 2450 cases were collected over a period of seven years in the province of Diyarbakir in southeast Turkey. Trend function and seasonal variability were investigated by statistical curve fitting, surface fitting, and autoregressive time series analysis. Results The study revealed a gradually decreasing trend in the number of TB cases over a period of seven years. Total TB incidence had seasonal variations (P = 0.04); there was a greater number of TB cases between April and July, with a peak in June. There were significant monthly seasonal variations with June peaks among females (P < 0.001), in patients in the age groups of 0-15 (P < 0.001) and 36-45 years (P < 0.001), in new cases (P < 0.001) and in the patients with pulmonary TB (P = 0.01). The extra-pulmonary TB cases peak in May (P = 0.01). Pulmonary TB and TB patients in the 36-45 age group had summer peak, while the other groups peaked at spring. Conclusions Spring and summer peaks detected in total TB cases and in many subgroups indicate that multicenter and comprehensive clinical studies are needed to explain these variations.
Collapse
|
8
|
Gonultas F, Akbulut S, Sarici KB, Toprak S, Kilci B, Bilgic Y, Kose A, Yakupogullari Y, Garzali IU, Yilmaz S. Management of wet ascitic type of peritoneal tuberculosis: single center experience. EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES 2023; 27:980-987. [PMID: 36808343 DOI: 10.26355/eurrev_202302_31192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
OBJECTIVE We aimed to present our experience with the management of 17 patients with ascites who underwent diagnostic laparoscopy or laparotomy, and histologic confirmation of wet ascitic type of peritoneal tuberculosis (TB). PATIENTS AND METHODS Between January 2008 and March 2019, 17 patients whose ascites were investigated by a gastroenterologist and who were thought to have non-cirrhotic ascites were referred to our Surgery clinic for peritoneal biopsy. The clinical, biochemical, radiological, microbiological, and histopathological data of the patients who underwent diagnostic laparoscopy or laparotomy were analyzed retrospectively. Histopathological examination of peritoneal tissue samples in hematoxylin-eosin-stained preparations revealed necrotizing granulomatous inflammation with caseous necrosis and Langhans type giant cells. Ehrlich-Ziehl-Neelsen (EZN) staining was studied with the suspicion of TB. Acid-fast bacilli (AFB) were detected in EZN stained slide. Histopathological findings were also considered. RESULTS Seventeen patients aged 18 to 64 years were included in this study. The most common symptoms were ascites and abdominal distention, weight loss, night sweats, fever and diarrhea. Radiological examination revealed peritoneal thickening, ascites, omental cacking, and diffuse lymphadenopathy. Histopathologically, necrotizing granulomatous peritonitis consistent with peritoneal TB were detected. While direct laparoscopy was preferred in sixteen patients, laparotomy was preferred in the remaining one due to previous surgical procedures. However, seven were converted to open laparotomy. CONCLUSIONS Diagnosis of abdominal TB requires high index of suspicion, and the treatment should be prompt to reduce the morbidity and mortality associated with delay in treatment.
Collapse
|
9
|
Aloun A, Akbulut S, Garzali IU, Gonultas F, Baskiran A, Hargura AS, Colak C, Yilmaz S. Effect of ursodeoxycholic acid on liver regeneration capacity after living donor hepatectomy: a prospective, randomized, double-blind clinical trial. EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES 2023; 27:999-1006. [PMID: 36808345 DOI: 10.26355/eurrev_202302_31194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
OBJECTIVE Ursodeoxycholic acid (UDCA) has multiple hepatoprotective activities: it modifies the bile acid pool, decreases levels of endogenous, hydrophobic bile acids while increasing the proportion of nontoxic hydrophilic bile acids. It also has cytoprotective, antiapoptotic, and immunomodulatory properties. The aim of this study was to analyze the effect of postoperative administration of UDCA on liver regeneration capacity. PATIENTS AND METHODS This is a single-center, prospective, randomized, double-blind study that was carried out in our Liver transplant Institute. Sixty living liver donors (LLDs) who underwent right lobe living donor hepatectomy were divided into two groups using computer-generated random numbers: one group received oral UDCA 500 mg 12 hourly for 7 days (UDCA group; n=30) from the first postoperative day (POD) and the other did not receive UDCA (non-UDCA group; n=30). Both groups were compared in terms of the following parameters: clinical and demographic parameters, liver enzymes (ALT, AST, ALP, GGT, total bilirubin, direct Bilirubin), and INR. RESULTS The median ages in the UDCA and non-UDCA were 31 years (95% CI for median: 26-38) and 24 years (95% CI for median: 23-29), respectively. Liver function tests showed significant differences at various times within the first seven PODs. The INR was lower in UDCA group patients on POD3 and POD4. However, GGT was significantly lower on POD6 and POD7 for the UDCA group. Total bilirubin was also significantly lower on POD3 for the UDCA group patients, but ALP was lower all from POD1 to POD7. A significant difference was also observed in AST on POD3, POD5 and POD6. CONCLUSIONS Postoperative administration of oral UDCA significantly improves liver function tests and INR among LLDs.
Collapse
|
10
|
Akbulut S, Tamer M, Kucukakcali Z, Akyuz M, Saritas H, Bagci N, Ciftci F, Akbulut MS, Karabulut E, Yilmaz S. Factors affecting anxiety, depression, and stress among patients with hepatocellular carcinoma during COVID-19 pandemic. EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES 2023; 27:704-712. [PMID: 36734727 DOI: 10.26355/eurrev_202301_31073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Patients with chronic disease whose treatments are limited may experience depression, anxiety, and stress-related symptoms, as well as an increase in the levels of these conditions. This study aims to determine the factors affecting the depression, stress, and anxiety levels of hepatocellular carcinoma (HCC) patients due to the fear of COVID-19 exposure. PATIENTS AND METHODS 118 patients with advanced HCC treated with non-transplant treatment options or on the waiting list due to the lack of a donor were enrolled. To evaluate the stress, depression, and anxiety levels during the COVID-19 process, Depression Anxiety Stress Scales (DASS-21) and the Coronavirus Anxiety Scale (CAS) were administered to 118 patients through a face-to-face interview. Sociodemographic and clinical characteristics were recorded, and the primary endpoint measure was the total score of DASS. In addition, the multilayer perceptron (MLP) model was constructed to predict the scores of the DASS-21 total. RESULTS There were significant differences between DASS depression (p=0.010; p=0.030) DASS anxiety (p=0.010; p=0.010) and DASS total (p=0.046; p=0.023) scores in terms of gender and protective effect of the vaccine. Also, a significant difference between gender for the CAS scale was determined (p=0.044). The median score of the DASS total in the COVID-19 group was higher than in the non-COVID-19 group; however, the increase was not significant. MLP model revealed that chronic disease, gender, age, place of residence, smoking, type of vaccine, and COVID-19 exposure were the most important predictors for the DASS total. CONCLUSIONS Chronic disease, gender, and age were prominent factors in predicting the DASS-21 total score in HCC patients. Therefore, the crucial factors were clinically considered for managing depression, stress, and anxiety in HCC patients.
Collapse
|
11
|
Usta T, Gonenc M, Yilmaz S, Akyol GSC, Kale A, Oral E. Surgical Treatment of Catamenial Chest Pain: Excision of diaphragmatic endometriosis during robot-assisted laparoscopic surgery. Facts Views Vis Obgyn 2022; 14:339-341. [PMID: 36724427 PMCID: PMC10364330 DOI: 10.52054/fvvo.14.4.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background 10% of women of reproductive age are affected by endometriosis, and diaphragmatic endometriosis represents 1-1.5% of these cases. Diaphragmatic endometriotic lesions often require surgical treatment. Objective This video aims to demonstrate the appearance of diaphragmatic endometriosis and describe our experience with robot-assisted laparoscopic excision of full thickness diaphragmatic endometriosis. Materials and Methods The patient was a 37-year-old female with the complaint of cyclical right shoulder pain (for 1 year). She previously had caesarean section scar and umbilical endometriosis excision procedures. The magnetic resonance imaging (MRI) of the abdomen highlighted three endometriotic nodules, one of which was described as full thickness on the right hemi-diaphragm. The patient underwent a robot-assisted laparoscopic endometriosis surgery as a joint procedure between the gynaecology and general surgery teams. The falciform ligament was completely divided to obtain full views of the endometriotic lesions on the diaphragm. Superficial diaphragmatic lesions were first excised. The larger deep nodule, which was described on the MRI, was then excised with the full thickness of diaphragm. Pleural cavity was entered intentionally to achieve complete excision of the nodule. Laparoscopic assessment of the right lower pleural cavity through this opening did not show any endometriotic lesions. After the excision, the diaphragm was repaired with a barbed suture. Negative pressure suction of the pleural cavity was performed at the end of this repair instead of using a chest tube. Results The patient was discharged on the 3rd day with no complications encountered. Histopathological examination confirmed endometriosis. The patient was asymptomatic three months after surgery. Conclusion Robotic-assisted surgery is an easy and safe choice especially in such challenging dual compartment surgeries by providing a 3D view that abolishes sensory loss and increases depth perception, providing better manoeuvrability with tremor absence.
Collapse
|
12
|
Polat E, Gunay C, Eroksuz H, Yilmaz S, Kaya E, Karabulut B, Akdeniz Incili C. Histopathological, immunohistochemical and biochemical evaluation of electroacupuncture treatment of nervus radialis and nervus ulnaris injuries in rabbits. Pol J Vet Sci 2022; 25:511-524. [PMID: 36649113 DOI: 10.24425/pjvs.2022.142039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The aim of this study was to evaluate the efficacy of electroacupuncture in acute and chronic phases of radial and ulnar nerve injuries in histopathological, immunohistochemical and biochemical aspects. In the study, the rabbits were divided into four groups namely acute nerve injury (ANI) group, chronic nerve injury (CNI) group, positive control (PC) group and negative control (NC) group. In the ANI, CNI and PC groups, damage was created on the nervus radialis and nervus ulnaris by applying pressure for 60 seconds using a hemostatic forceps under anesthesia. No damage was created in the NC group. Fifteen sessions of electroacupuncture were applied to the rabbits in the ANI, CNI, and NC groups every other day using LI-4 (Large Intestine Meridian-4, He Gu), LI-10 (Large Intestine Meridian-10, Shou San Li), LR-3 (Liver Meridian-3, Tai Chong), and ST-36 (Stomach Meridian-36, Zusanli) electroacupuncture points. Electroacupuncture was not applied to the rabbits in the PC group. Decapitation was performed under general anesthesia at the end of electroacupuncture applications. After the euthanasia procedure, the samples obtained were evaluated for histopathological, immunohistochemical and biochemical parameters. In conclusion, degenerative foci in the treatment groups were found to be fewer than in the PC group whereas NGF and S-100 immunoreactivity were higher in the treatment groups than in the PC group. Whereas no statistically significant difference was observed between the treatment groups and the NC group in terms of oxidative stress factors, there was a statistically significant difference between the treatment groups and the PC group. In light of all these data, we have concluded that electroacupuncture is an effective treatment method for peripheral nerve injuries.
Collapse
|
13
|
Yilmaz S, Kaya E, Yonar H, Mendil AS. Doxorubicin-induced oxidative stress injury: The protective effect of kumiss on cardiotoxicity. J HELL VET MED SOC 2022. [DOI: 10.12681/jhvms.27822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Bu çalışmanın amacı, doksorubisinin (DOX) neden olduğu kardiyotoksisite üzerine kımızın etkisini araştırmaktı. Yirmi sekiz Wistar-Albino erkek sıçan 4 gruba ayrıldı: Birinci gruba (kontrol) herhangi bir müdahale yapılmadı. İkinci gruba 7 gün gavaj yoluyla 2 ml/kg/gün, üçüncü gruba intraperitoneal DOX, dördüncü gruba kımız+DOX 20 mg/kg tek doz verildi. DOX uygulamasından 7 gün önce Kumiss uygulamasına başlandı ve 7 gün devam edildi. 7 On thkımız uygulamasının ilk gününde intraperitoneal olarak DOX uygulandı. Malondialdehit (MDA), indirgenmiş glutatyon (GSH) seviyeleri ve katalaz (CAT), glutatyon peroksidaz (GSH-Px), süperoksit dismutaz (SOD), glukoz-6-fosfat dehidrojenaz (G6PD) ve glutatyon-S- gibi antioksidan enzimler Kalp ve kan dokularında kardiyotoksisite patogenezindeki etkinliklerini belirlemek için transferaz (GST) aktiviteleri belirlendi. DOX grubu kontrol grubu ile karşılaştırıldığında MDA (p<0,001, p<0,001) ve GSH (p<0,001, p=0,002) düzeylerinde artış ve CAT'de azalma (p=0,001, p<0,001) , GSH-Px (p<0.001, p<0.001), G6PD (p<0.001, p=0.001) ve GST (p=0.003) aktiviteleri bulundu ve SOD aktivitesinde istatistiksel olarak anlamlı fark bulunmadı. Histopatolojik olarak dejenerasyon, nekroz, DOX uygulanan grupta kanama ve ödem gözlendi. DOX ile tedavi edilen grup ile karşılaştırıldığında, DOX ile kımız verilen grupta MDA, GSH düzeyleri ve antioksidan enzim aktivitelerinin kontrol grubu değerlerine ulaştığı görüldü. Sonuç olarak, lipid peroksidasyon ürünlerindeki artış ve antioksidan enzimlerdeki azalmanın, güçlü bir kemoterapötik ilaç olan DOX ile indüklenen kardiyotoksisitenin patogenezinde rol oynayabileceği belirlendi ve kırmızının DOX kaynaklı oksidatif hasara karşı koruduğu gösterildi.
Collapse
|
14
|
Baumkötter R, Yilmaz S, Zahn D, Fenzl K, Prochaska JH, Rossmann H, Schmidtmann I, Schuster AK, Beutel ME, Lackner KJ, Münzel T, Wild PS. Protective behavior and SARS-CoV-2 infection risk in the population - Results from the Gutenberg COVID-19 study. BMC Public Health 2022; 22:1993. [PMID: 36316662 PMCID: PMC9623959 DOI: 10.1186/s12889-022-14310-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 09/26/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND During the SARS-CoV-2 pandemic, preventive measures like physical distancing, wearing face masks, and hand hygiene have been widely applied to mitigate viral transmission. Beyond increasing vaccination coverage, preventive measures remain urgently needed. The aim of the present project was to assess the effect of protective behavior on SARS-CoV-2 infection risk in the population. METHODS Data of the Gutenberg COVID-19 Study (GCS), a prospective cohort study with a representative population-based sample, were analyzed. SARS-CoV-2 infections were identified by sequential sampling of biomaterial, which was analyzed by RT-qPCR and two antibody immunoassays. Self-reported COVID-19 test results were additionally considered. Information on protective behavior including physical distancing, wearing face masks, and hand hygiene was collected via serial questionnaire-based assessments. To estimate adjusted prevalence ratios and hazard ratios, robust Poisson regression and Cox regression were applied. RESULTS In total, 10,250 participants were enrolled (median age 56.9 [43.3/68.6] years, 50.8% females). Adherence to preventive measures was moderate for physical distancing (48.3%), while the use of face masks (91.5%) and the frequency of handwashing (75.0%) were high. Physical distancing appeared to be a protective factor with respect to SARS-CoV-2 infection risk independent of sociodemographic characteristics and individual pandemic-related behavior (prevalence ratio [PR] = 0.77, 95% confidence interval [CI] 0.62-0.96). A protective association between wearing face masks and SARS-CoV-2 transmission was identified (PR = 0.73, 95% CI 0.55-0.96). However, the protective effect declined after controlling for potential confounding factors (PR = 0.96, 95% CI 0.68-1.36). For handwashing, this investigation did not find a beneficial impact. The adherence to protective behavior was not affected by previous SARS-CoV-2 infection or immunization against COVID-19. CONCLUSION The present study suggests primarily a preventive impact of physical distancing of 1.5 m, but also of wearing face masks on SARS-CoV-2 infections, supporting their widespread implementation. The proper fit and use of face masks are crucial for effectively mitigating the spread of SARS-CoV-2 in the population.
Collapse
|
15
|
Gunes O, Akbulut S, Atay A, Gonultas F, Tuncer A, Baskiran A, Yilmaz S. Vessel sealing system vs. conventional knot-tying for hilar dissection during living donor hepatectomy: a prospective, randomized, double-blinded study. EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES 2022; 26:6990-6994. [PMID: 36263546 DOI: 10.26355/eurrev_202210_29882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE LT has become the gold standard treatment for many liver diseases, especially chronic liver disease. A commonly seen problem, even in donors who do not develop any major complications after living donor hepatectomy (LDH), is the persistent drainage of lymphatic fluid from the hepatectomy site drain, which causes extensive hospitalization and consequent loss to the workforce. To our knowledge, no study has yet been published comparing LVSS and conventional knot-tying methods for hilar dissection, which is an important stage of the LDH procedure. We aimed to prospectively compare the outcomes of these two treatment methods. PATIENTS AND METHODS Donor candidates were divided into two groups: conventional suture tying (conventional knot tying group; n=34) and Ligasure vessel sealing system (LVSS; n=34). A simple randomization method of drawing lots was used to assign the patients to each group. The following parameters were analyzed for all patients: age, gender, BMI, duration of surgery, postoperative drainage amounts, drain removal times and complications, length of hospital stay, morbidity, and mortality. RESULTS There were no significant differences in terms of operative times, postoperative drainage levels, hospital stay or drain removal times. CONCLUSIONS In this study, the use of LVSS in LDH was found to be safe, although it did not offer any advantage over conventional methods. Nevertheless, it seems probable that the use of LVSS could reduce operative time and amounts of lymphatic drainage, especially in centers with minimal experience with LDH, such as new LDH centers.
Collapse
|
16
|
Kahraman AS, Kahraman B, Ozdemir ZM, Karaca L, Sahin N, Yilmaz S. Diffusion-weighted imaging of the liver in assessing chronic liver disease: effects of fat and iron deposition on ADC values. EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES 2022; 26:6620-6631. [PMID: 36196712 DOI: 10.26355/eurrev_202209_29762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE This study was designed to evaluate whether fat and iron affect the apparent diffusion coefficient (ADC) values of the liver parenchyma in the settings of fibrosis and inflammation. PATIENTS AND METHODS We evaluated the diffusion-weighted images (DWIs) of 58 patients with chronic liver disease and 48 control subjects. Liver specimens of patients were assessed for fibrosis, necroinflammation, iron, and steatosis. Liver ADCs, spleen ADCs, and normalized liver ADCs (defined as the ratio of the liver ADC to spleen ADC) values were analyzed after stratifying patients with either fibrosis stages or histology activity index (HAI) scores. The relationship between ADC values and histopathological findings was studied using multiple linear regression analysis. RESULTS The median liver and normalized liver ADC values were significantly lower in higher stages of fibrosis and HAI scores. Compared to the control group, patients with the highest stages of fibrosis and inflammation had significantly higher spleen ADCs. The effect of the fibrosis stage on liver ADC and normalized liver ADC values was significant in the setting of inflammation, whereas the degree of steatosis and iron grade did not affect these ADC values. CONCLUSIONS ADC values can distinguish both later stages of liver fibrosis and inflammation. There is no significant effect of fat and iron on ADC values. Therefore, DWI may be reliable in evaluating liver fibrosis and inflammation.
Collapse
|
17
|
Yilmaz S, Janelsins MC, Flannery M, Culakova E, Wells M, Lin PJ, Loh KP, Epstein R, Kamen C, Kleckner AS, Norton SA, Plumb S, Alberti S, Doyle K, Porto M, Weber M, Dukelow N, Magnuson A, Kehoe LA, Nightingale G, Jensen-Battaglia M, Mustian KM, Mohile SG. Protocol paper: Multi-site, cluster-randomized clinical trial for optimizing functional outcomes of older cancer survivors after chemotherapy. J Geriatr Oncol 2022; 13:892-903. [PMID: 35292232 PMCID: PMC9283231 DOI: 10.1016/j.jgo.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/01/2022] [Accepted: 03/04/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Cancer survivors over the age of 65 have unique needs due to the higher prevalence of functional and cognitive impairment, comorbidities, geriatric syndromes, and greater need for social support after chemotherapy. In this study, we will evaluate whether a Geriatric Evaluation and Management-Survivorship (GEMS) intervention improves functional outcomes important to older cancer survivors following chemotherapy. METHODS A cluster-randomized trial will be conducted in approximately 30 community oncology practices affiliated with the University of Rochester Cancer Center (URCC) National Cancer Institute Community Oncology Research Program (NCORP) Research Base. Participating sites will be randomized to the GEMS intervention, which includes Advanced Practice Practitioner (APP)-directed geriatric evaluation and management (GEM), and Survivorship Health Education (SHE) that is combined with Exercise for Cancer Patients (EXCAP©®), or usual care. Cancer survivors will be recruited from community oncology practices (of participating oncology physicians and APPs) after the enrolled clinicians have consented and completed a baseline survey. We will enroll 780 cancer survivors aged 65 years and older who have completed curative-intent chemotherapy for a solid tumor malignancy within four weeks of study enrollment. Cancer survivors will be asked to choose one caregiver to also participate for a total up to 780 caregivers. The primary aim is to compare the effectiveness of GEMS for improving patient-reported physical function at six months. The secondary aim is to compare effectiveness of GEMS for improving patient-reported cognitive function at six months. Tertiary aims include comparing the effectiveness of GEMS for improving: 1) Patient-reported physical function at twelve months; 2) objectively assessed physical function at six and twelve months; and 3) patient-reported cognitive function at twelve months and objectively assessed cognitive function at six and twelve months. Exploratory health care aims include: 1) Survivor satisfaction with care, 2) APP communication with primary care physicians (PCPs), 3) completion of referral appointments, and 4) hospitalizations at six and twelve months. Exploratory caregiver aims include: 1) Caregiver distress; 2) caregiver quality of life; 3) caregiver burden; and 4) satisfaction with patient care at six and twelve months. DISCUSSION If successful, GEMS would be an option for a standardized APP-led survivorship care intervention. TRIAL REGISTRATION ClinicalTrials.govNCT05006482, registered on August 9, 2021.
Collapse
|
18
|
Canbaş M, Colak S, Tekgoz E, Çinar M, Yilmaz S. AB0533 THE ASSESSMENT OF CLINICAL CHARACTERISTICS OF MALE SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundSystemic lupus erythematosus (SLE) is a multisystemic chronic autoimmune disease that is nine times more frequent among females. Due to a female dominancy, the data regarding male patients is limited.ObjectivesThis study aimed to evaluate the clinical characteristics of male patients with SLE.MethodsThis retrospective study included male SLE patients who followed up in a tertiary rheumatology outpatient clinic between October 2016 and December 2021. Those who met the Systemic Lupus International Collaborating Clinics (SLICC) criteria were included. The data of the patients and SLE Disease Activity Index-2000 (SLEDAI-2K) values were obtained from files.ResultsThere were 40 male SLE patients with a mean age of 42.7 ± 17.3 years. The median age of diagnosis was 30 years, and the median disease duration was 63.5 months (ranges between 5-444). The mean value of the SLICC score was 4.7 ± 0.8. The most frequent initial clinical manifestations were thrombocytopenia and photosensitivity, which were seen in 8 (9.6%) patients each (Table 1). Six (15%) patients had secondary antiphospholipid antibody syndrome. Thirty-five (87.5%) patients achieved remission, but 14 (35%) patients had at least one relapse in the follow-up period. The most frequent manifestation after relapse was nephritis in 9 (22.5%) patients that had no renal involvement at the time of diagnosis. The median SLEDAI score was 2 (ranges between 0-12). The most commonly preferred drug for the treatment was hydroxychloroquine and corticosteroids (92.5% for each). Nineteen (47.5%) patients received pulse steroids. Besides, the most frequently prescribed immunosuppressive drug was mycophenolate mofetil (37.5%). The rates of azathioprine, cyclophosphamide, methotrexate, cyclosporine A, rituximab, intravenous immunoglobulin, and leflunomide usage were 30%, 27.5%, 17.5%, 10%, 7.5%, 7.5%, 5%, respectively. Antinuclear antibody (ANA) was positive in 35 (87.5%) patients, and anti-dsDNA was positive in 9 (22.5%). The median level of anti-dsDNA titers was 40 IU/ml (ranges between 23-200). Other autoantibody positivity rates were; 12 (30%) for anti-Sm, 6 (15%) for anti-histon, 4 (10%) for anti-RNP and 4 (10%) for anti-nucleosome. Thirteen (32.5%) patients had low C3 levels, and 11 (27.5%) patients had low C4 levels. The hospitalisation rate was 55%, and no death was seen during follow-up.Table 1.Clinical characteristics of the patients (n=40)CharacteristicsPatients Clinical manifestations, n(%)InitialRelapseThrombocytopenia8 (20)None Photosensitivity8 (20)None Anemia7 (17.5)NoneMalar rash6 (15)2 (15) Nephritis6 (15)9 (22.5)Arthiritis/synovitis5 (12.5)6 (15)Subacute lesions4 (10)2 (5) Leukopenia/lymphopenia4 (10)NoneThrombosis3 (7.5)4 (10)Neurological involvement3 (7.5)NoneSerositis2 (5)2 (5)Pulmonery involvement2 (5)None Discoid lupus erythematosus1 (2.5)1 (2.5) Myositis1 (2.5)NoneConclusionSince SLE is more prevalent among females, it may occur in male patients with mild or life-threatening manifestations. In the current study, the seropositivity was less than in the literature, which may indicate male patients should be cautiously evaluated. Although renal involvement is not an initial manifestation, it may develop during the follow-up.Disclosure of InterestsNone declared
Collapse
|
19
|
Ozbey G, Cambay Z, Yilmaz S, Aytekin O, Zigo F, Ozçelik M, Otlu B. Identification of bacterial species in milk by MALDI-TOF and assessment of some oxidant-antioxidant parameters in blood and milk from cows with different health status of the udder. Pol J Vet Sci 2022; 25:269-277. [PMID: 35861970 DOI: 10.24425/pjvs.2022.141811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This study aimed to identify bacterial pathogens in milk samples from dairy cows with subclinical and clinical mastitis as well as to assess the concentrations of oxidant-antioxidant parameters [malondialdehyde (MDA), reduced glutathione (GSH), and total GSH levels] in both blood and milk samples. From a total of 200 dairy cows in 8 farms, 800 quarter milk samples obtained from each udder were tested in the laboratory for the presence of udder pathogens. Cultivated bacteria causing intramammary infection from milk samples were identified by Matrix-Assisted Laser Desorption/Ionization-Time of Flight (MALDI-TOF). In addition, from tested animals 60 cows were selected includıng 20 healthy cows that were CMT negative, 20 cows with subclinical mastitis (SM), and 20 cows with clinical mastitis (CM) for detection of MDA, GSH, and total GSH levels in blood and milk samples. Three hundred and eighty (47.5%; 380/800), 300 (37.5%; 300/800), and 120 (15%; 120/800) of milk samples, respectively were CMT positive or SM and CM, and those positives were cows from different farms. We observed that 87.4% (332/380), 25.3% (76/300), and 34.2% (41/120) of cows with CMT positive, CMT negative, and CM had bacterial growth. The most predominantly identified bacteria were Staphylococcus chromogenes (18.7%) obtained mainly from SM and Staphylococcus aureus (16.7%) as the most frequent cause of CM. According to our results, dairy cows with CM had the highest MDA levels, the lowest GSH, and total GSH levels in both blood and milk samples however, high MDA levels and low GSH levels in milk samples with SM were observed. Based on our results, lipid oxidant MDA and antioxidant GSH could be excellent biomarkers of cow's milk for developing inflammation of the mammary gland. In addition, there was no link between nutrition and MDA and GSH levels.
Collapse
|
20
|
Inanc N, Abacar K, Ozturk MA, Tufan A, Karadeniz H, Sari İ, Can G, Erez Y, Pehlivan Y, Dalkiliç E, Ocak T, Cefle A, Yazici A, Senel A, Akar S, Durak Ediboglu E, Koca SS, Piskin Sagir R, Yilmaz S, Gulcemal S, Soysal Gündüz Ö, Başibüyük CS, Alkan S, Cesur TY, Onen F. AB0420 UNINTENTIONAL MONOTHERAPY IN RHEUMATOID ARTHRITIS PATIENTS RECEIVING TOFACITINIB AND DRUG SURVIVAL RATE OF TOFACITINIB. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundCombination of MTX with a bDMARDs or tsDMARDs is considered the most effective treatment regimen currently available for patients with RA who have failed to respond to conventional DMARDs. However, approximately 30% of patients receive bDMARDs as monotherapy in daily clinical practice. Studies in the literature do not assess unintentional monotherapy in general. However, it is thought that some patients may switch to monotherapy unintentionally. In other words, some patients who are prescribed combination therapy switch to monotherapy without informing their physicians.ObjectivesTo determine the rate of unintentional monotherapy in rheumatoid arthritis (RA) patients receiving tofacitinib and to evaluate tofacitinib survival rate.MethodsThis national, multicentre, retrospective study included patients’ data from the TURKBIO Registry. Data on demographics, clinical characteristics, disease duration and activity, comorbidities, and treatment were analysed.ResultsData of 231 RA patients (84.8% female, median age, 56 years) were included; 153 were initially prescribed combination therapy and continued to their therapies; 31 were initially prescribed combination therapy but switched to monotherapy of their own will (unintentional monotherapy); 21 were initially prescribed monotherapy and switched to combination therapy; 26 were initially prescribed monotherapy and continued to their therapies. The combination and unintentional monotherapy groups did not differ regarding remission rate assessed by DAS28-CRP (60.5% and 70%, respectively, p=0.328). The rate of comorbidities at the time of data retrieval was significantly higher in the unintentional monotherapy group compared with the combination group (83.3% vs. 60.3%, p=0.031). Presence of comorbidities was a significant factor affecting switching to monotherapy (p=0.039, Odds ratio: 3.29, 95% CI: 1.06-10.18). Drug survival rates of the unintentional monotherapy and combination groups did not differ. The median drug survival duration of tofacitinib was 27+ months with a 1-year and 4-year drug survival rates of 89.6% and 60.2%, respectively, in the unintentional monotherapy group.ConclusionAlthough 13.4% of the study population started monotherapy unintentionally, drug survival rates of the unintentional monotherapy and combination groups were not different. Comorbidity was an important factor affecting transition from combination therapy to monotherapy.This study was sponsored by Pfizer.Figure 1.Disclosure of InterestsNevsun Inanc: None declared, Kerem Abacar: None declared, mehmet akif ozturk: None declared, Abdurrahman Tufan: None declared, Hazan Karadeniz: None declared, İsmail Sari: None declared, gercek can: None declared, Yesim Erez: None declared, yavuz Pehlivan: None declared, Ediz Dalkiliç: None declared, Tuğba Ocak: None declared, Ayse Cefle: None declared, Ayten Yazici Grant/research support from: Ayten Yazici has received project grant from Roche Pharmaceuticals, Turkey., Abdurrahman Senel: None declared, Servet Akar: None declared, Elif Durak Ediboglu: None declared, Süleyman Serdar Koca: None declared, Rabia Piskin Sagir: None declared, Sema Yilmaz: None declared, Semral Gulcemal: None declared, Özgül Soysal Gündüz: None declared, Canberk Sami Başibüyük Employee of: employee of Pfizer Pharmaceuticals, Istanbul, Turkey., Serdar Alkan Employee of: employee and shareholder of Pfizer Inc., Istanbul, Turkey., Teoman Yusuf Cesur Employee of: employee of Pfizer Pharmaceuticals, Istanbul, Turkey., Fatos Onen: None declared
Collapse
|
21
|
Dogan A, Tekgoz E, Colak S, Çinar M, Yilmaz S. POS1357 THE 10-YEAR OUTCOME OF PATIENTS WITH BEHCET’S SYNDROME: A SINGLE-CENTER EXPERIENCE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundBehcet’s syndrome (BS) is a vasculitis characterized by recurrent oral and genital ulcers, as well as ocular, cutaneous, vascular, gastrointestinal, musculoskeletal, and central nervous system manifestations.ObjectivesThe study aimed to evaluate the 10-year outcome of patients with BS.MethodsA cohort of 682 patients diagnosed with BS between January 2007 and December 2009 in the rheumatology outpatient clinic of Gulhane Training and Research Hospital were re-evaluated in November 2021. The data regarding the clinical course of 84 patients (84/682) were obtained from patients’ files and detailed telephone interviews.ResultsThe study included 84 patients (63 male, 21 female) with a mean age of 47.1±10.6 years. The mean disease duration was 17.6±5.7 years. At the time of the diagnosis, the mean age of the patients was 29.5±9.4 years. Oral ulcer (100%), papulopustular lesions (82.1%), genital ulcer (77.4%), and erythema nodosum (59.5%) were the most frequent manifestations at the time of diagnosis. Ocular (46.4%), musculoskeletal (35.7%), vascular (19%), gastrointestinal (3.6%), and neurological (1.2%) manifestations were seen in decreasing frequency. The most frequent ocular disease was posterior uveitis, whereas superficial thrombophlebitis and deep venous thrombosis were the most prevalent forms of vascular involvement. One patient had transverse myelitis as neurological involvement. Colchicine (88.1%) and corticosteroids (57.1%) were the most preferred drugs for the initial treatment. Fifty-one (60.7%) patients received at least one immunosuppressive agent. After 10-year, there was a statistically significant decrease in all manifestations of BS (Table 1). Nevertheless, 9 (10.7%) patients (8 male, 1 female) had new clinical findings. Five patients had (5.9%) mucocutaneous, 2 (2.4 %) arthritis and 2 (2.4%) vascular lesions as new clinical manifestations. The mean age of the patients with newly onset clinical findings was 48±8.9 years. There was no statistically significant difference between patients with and without new clinical findings with respect to age (p=0.79). The new onset mucocutaneous manifestations were genital ulcer and erythema nodosum. Besides, new onset vascular lesions were superficial and deep venous thrombosis of the lower extremities. The mean age of the patients who developed venous thrombosis at the time of the assessment was 37.0±7.07 years. Vascular involvement was detected more frequently in younger patients (p=0.03). However, ocular involvement is a frequent symptom after mucocutaneous involvement at the beginning, none of the patients had new eye involvement at the end of the follow-up. Colchicine, corticosteroid, and azathioprine were associated with the highest drug survival. Twenty-one (41.1%) patients of who were administered immunosuppressive agents as initial therapy were still using immunosuppressives 10 year later. The most frequently prescribed immunosuppressives were azathioprine and cyclosporine during the follow-up.Table 1.Clinical manifestations of Behcet’s syndromeInitialAfter 10 yearspNoYesOral ulceration, n (%)No000<0.001*Yes84 (100)42 (50)42 (50)Genital ulceration, n (%)No19 (22.7)16 (84.2)3 (15.8)<0.001**Yes65 (77.4)54 (83.1)11 (16.9)Erythema nodosum and Papulopustular lesions, n (%)No6 (7.1)4 (66.7)2 (33.3)<0.001**Yes78 (92.9)44 (56.4)34 (43.6)Arthritis, n (%)No54 (64.3)52 (96.3)2 (3.7)<0.001**Yes30 (35.7)21 (70)9 (30)Vascular involvement, n (%)No68 (81)66 (97.1)2 (2.9)0.013**Yes16 (19)12 (75)4 (25)Gastrointestinal involvement, n (%)No81 (96.4)81 (100)0<0.001*Yes3 (3.6)3 (100)0Ocular involvement, n (%)No45 (53.6)45 (100)0<0.001**Yes39 (46.4)29 (74.4)10 (25.6)Neurological involvement, n (%)No83 (98.8)83 (100)0<0.001*Yes1 (1.2)1 (100)0*McNemar-Bowker Test, **McNemar TestConclusionThe frequency of newly onset clinical manifestations decreases with age in BS, especially after age 40. Besides, especially male Behcet’s patients should be followed-up regularly for complications that may develop regardless of age.Disclosure of InterestsNone declared
Collapse
|
22
|
Demirci Yildirim T, Akleylek C, Cinakli H, Yildirim D, Hakbilen S, Coşkun BN, Okyar B, Ozdemir Isik O, Piskin Sagir R, Apaydin H, Gulle S, Erez Y, Yuce Inel T, Yilmaz N, Akar S, Tufan A, Yilmaz S, Pehlivan Y, Yildirim Cetin G, Cefle A, Koca SS, Erten S, Yazici A, Dalkiliç E, Can G, Sari İ, Birlik M, Onen F. AB1088 COVID-19 VACCINATION OF SPONDYLOARTHRITIS PATIENTS RECEIVING BIOLOGICAL THERAPY: REAL-LIFE DATA. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundConsidering the concerns regarding COVID-19 vaccine safety among patients with rheumatic diseases due to a lack of data, an urgent need for studies evaluating safety profiles of vaccines emerged.ObjectivesVaccination against the coronavirus disease-2019 (COVID-19) started in March 2021 in the group using biological therapy in our country. In this study, post-vaccine real-life data of patients with spondyloarthritis (SpA) followed up with biological therapy were analyzed.MethodsAdult patients diagnosed with SpA who were followed up under biological therapy and vaccinated by CoronaVac inactive SARS-CoV-2 orBNT162b2 messenger RNA (mRNA) COVID-19 (Pfizer-BioNTech) vaccine were included in our observational, multicenter, prospective study.ResultsA total of 287 patients (58.2% male; mean age: 47) were included in the study. 202 (%70,4) of patients were being followed up with the diagnosis of AS, 40 (%13,9) of them with PsA, 32 (%11,1) of them with nr-axSpA, 11 (%3,8) of them with enteropathic arthritis, and 2 (%0,7) of them with uSpA. The most common comorbidities were found to be HT (n:65; 22.6%) and DM (n:38; 13.2%). While 221 (77%) of the patients were receiving biological therapy alone, 27 (9.4%) patients were using methotrexate, 25 (8.7%) patients were using sulfasalazine, and 12 (4.2%) patients were using leflunomide. The median duration of biological therapy was 40 weeks (19-75 IQR). The most commonly used treatment was infliximab (26.8%), adalimumab (23.3%) was the second (Table 1).It was determined that 207 (72.1%) of the patients preferred inactivated virus vaccine, while 80 (27.9%) preferred mRNA vaccine. When the time between the biological treatment and the day of vaccination is examined, detected median time between biological treatment and the first dose of vaccination is 11.5 days (5-19 IQR), between the first dose of vaccination and biological treatment is 14 days (7-21 IQR), between treatment and the second dose of vaccine is 14 days (5-23.5 IQR), and between the second dose of vaccine and the next biological treatment is 12.5 days (7-15 IQR). While 25 (8.7%) of the patients had COVID-19 infection before vaccination, 7 (2.4%) patients were found to have COVID-19 after vaccination (p<0.001). While two of the patients who had COVID-19 infection in the pre-vaccination period required hospitalization, none of the patients who had COVID-19 in the post-vaccination period required hospitalization.The rate of patients who developed side effects after the first dose of the vaccine was 20.6%. The side effects seen, respectively, were detected as pain-redness at the injection site (16%), fatigue (11.8%), headache (8.4%), muscle-joint pain (7.3%) and fever (5.6%). The rate of patients reporting side effects after the second dose of the vaccine was 17.1%. The incidence of side effects after mRNA vaccine was found to be statistically significant compared to inactivated virus vaccine in terms of both doses (p=0.011, p<0.001). Major side effects such as myocarditis, anaphylaxis-angioedema, myocardial infarction, and thrombosis were not observed in any of the patients included in the study. There was no evidence of disease activation in the median follow-up of 209 days (145-280 IQR) after vaccination.ConclusionDuring the follow-up of the patients during the study, no major vaccine-related side effects, post-vaccine disease activation and the need for treatment change were not detected. In order to more accurately evaluate the efficacy of the vaccination program in the patient population using biologic agents, larger-scale studies including unvaccinated individuals are needed.References[1]Sattui SE, Liew JW, Kennedy K, et al. Early experience of COVID-19 vaccination in adults with systemic rheumatic diseases: results from the COVID-19 global rheumatology alliance vaccine survey. RMD Open. 2021;7(3):e001814.[2]Shenoy P, Ahmed S, Paul A, et al. Inactivated vaccines may not provide adequate protection in immunosuppressed patients with rheumatic diseases. Ann Rheum Dis. 2021. doi:10.1136/annrheumdi s-2021-221496Disclosure of InterestsNone declared
Collapse
|
23
|
Mercan R, Tezcan ME, Yağiz B, Ateş A, Küçükşahin O, Yasar Bilge NS, Kanitez NA, Gönüllü E, Yilmaz S, Ersözlü D, Solmaz D, Kaşifoğlu T, Coşkun BN, Koca SS, Bilgin E, Yazisiz V, Dalkiliç E, Yilmaz R, Kimyon G, Ayan G, Erden A, Bes C, Emmungil H, Pehlivan Y, Ertenli Aİ, Kiraz S, Kalyoncu U. AB0766 Biologic Drug Preferences of Turkish Rheumatologists in Spondiloartropathy Patients with Advanced Chronic Renal Disease. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundBiological therapies are the main treatment options for patients with active spondyloarthropathy (SpA) who do not respond to nonsteroidal anti-inflammatory drugs or conventional synthetic disease-modifying drugs. Kidney diseases are not a contraindication to biologic therapies. However, there are some safety concerns for these drugs for patients with advanced chronic kidney disease. De novo infection or recurrence of infections are the main challenges in patients with multiple comorbidities during biologic treatments. Neverthless, physicans should initiate these treatments in active and resistant diseases.ObjectivesHere, we evaluated which biologic therapies clinicians’ first option to initiate in SpA patients with advanced chronic kidney disease (CRD).MethodsTotal 140 patients of TREASURE database who fullfield axial and/or peripheral ASAS SpA criteria with glomerular filtration rate < 60 ml/dk (stage 3,4 or 5 CRD according to The National Kidney Foundation classification) were included to the study. Renal stages of the patients were evaluated when biologic therapy was initiated. Five anti-TNF (adalimumab, certolizumab, etanercept, golimumab, infliximab) and an interleukin-17A blocker (secukinumab) were on the market during the study. We evaluated physicans’ first choice for biologic therapy for patients with stage 3,4 and 5 CRD respectively.ResultsMore than two thirds of the patients had stage 3 CRD. Anti-TNF drugs were the first choice of biologic treatment in the patients with advanced CRD. Etanercept was started at most to the patients in general, in stage 3 and in stage 5 CRD groups. However, adalimumab was the first choise in stage 4 CRD. Both etanercept and adalimumab were the first drug of choise in three fourth of the stage 4 and stage 5 patients. All two patients on Il-17A blocker had stage 3 CRD (Table 1).Table 1.Drug of choise in the SpA patients with advanced chronic renal diseasesNTotal n (%)NStage 3 n (%)NStage 4 n (%)NStage 5 n (%)Adalimumab14044 (31.4)10830 (27.8)209 (45.0)125 (41.6)Etanersept52 (37.1)41 (38.0)5 (25.0)6 (50.0)Golimumab9 (6.0)7 (6.5)2 (10.0)0 (0)Infliksimab28 (20.0)23 (21.3)4 (20.0)1 (8.4)Secukinumab3 (2.1)3 (2.8)0 (0)0 (0)Sertolizumab4 (2.8)4 (3.7)0 (0)0 (0)ConclusionWe show that rheumatologists in the TREASURE group prefer to initiate anti-TNF drugs first in all advanced CRD stages. Etanercept was the first choice in these patients.References[1]Sieper J, et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis. 2009 Jun;68 Suppl 2:ii1-44. doi: 10.1136/ard.2008.104018. PMID: 19433414.[2]Antoni C, Braun J. Side effects of anti-TNF therapy: current knowledge. Clin Exp Rheumatol. 2002 Nov-Dec;20(6 Suppl 28):S152-7. PMID: 12463468.[3]Kalyoncu U, et al. Methodology of a new inflammatory arthritis registry: TReasure. Turk J Med Sci. 2018 Aug 16;48(4):856-861. doi: 10.3906/sag-1807-200. PMID: 30119164.Disclosure of InterestsNone declared
Collapse
|
24
|
Tecer D, Çinar M, Kaya MN, Bicakci F, Colak S, Tekgoz E, Yilmaz S. POS1195 CAN PRE-TREATMENT INFLAMMATORY BIOMARKER LEVELS GUIDE TO DETERMINE APPROPRIATE TIME OF TOCILIZUMAB THERAPY IN COVID-19. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundDue to the pleiotropic cytokine interleukin-6 (IL-6) plays a pivotal role in the pathogenesis of COVID- 19, tocilizumab, an inhibitor of the IL-6 receptors, was considered as an attractive therapeutic option. When the inflammation cascade is excessive and therapy is delayed, the efforts for suppression of inflammation does not necessarily reduce mortality in all cases. Besides, early using anti-cytokine therapy may lead to both increased cost and risks including iatrogenic immunosuppression (1). Defining of patients who will benefit from tocilizumab and determining optimal timing of tocilizumab will prevent drug-related side effects and increased costs due to unnecessary drug use.ObjectivesTo investigate the reliability of pre-treatment levels of prognostic nutritional index (PNI), C-reactive protein/albumin ratio (CAR), systemic immune-inflammatory index (SII), IL-6, lactate dehydrogenase (LDH) as a treatment response biomarker in hospitalized COVID-19 patients who administered tocilizumab.MethodsOne hundred thirty three COVID-19 patients received tocilizumab were included. The end-points of treatment effectiveness were evaluated with the rate of death and emerging need for mechanical ventilation at 28 days of hospitalization. To determine independent mortality risk factors, multivariate logistic regression analyzes were performed for statistically different variables among groups that were statistically different in univariate analysis. The capacity of IL-6, CAR, PNI, SII and LDH values in predicting of tocilizumab response in COVID-19 patients were analyzed using receiver operating characteristic (ROC) curve analysis.Results34 (25.56%) patients died after tocilizumab therapy. Patients who improved after tocilizumab were significantly younger and had significantly lower IL-6, LDH, SII, CAR and higher PNI than patients who died. In univariate analyses, mortality was significantly associated with age, IL-6, LDH, PNI, SII, CAR and CRP. In multivariate analysis, age (OR:1.070, 95%CI:1.019-1.124, p:0.007) and LDH (OR:1.006, 95CI%:1.003- 1.010, p<0.001) were found to be independent predictors of mortality after tocilizumab therapy. To identify of tocilizumab response in COVID-19 patients, IL6 had the highest area under curve (AUC) value (AUC:0.782, 95%CI:0694-0.870), followed by LDH (AUC:0.761, 95%CI:0.661-0.861), PNI (AUC:0.696, 95%CI:0.584-807), SII (AUC:0.671, 95%CI:0.551–0.790), CAR (AUC:0.682, 95%CI:0.578– 0.786) and CRP (AUC:0.643, 95%CI:0.535–0.751). Predictive performance of inflammatory biomarkers in the prediction of mortality after tocilizumab therapy was presented in Table 1.Table 1.Predictive performance of inflammatory biomarkers in the prediction of mortality after tocilizumab therapySensitivitySpecificityPLRNLRPPVNPVAccuracyDORIL-6 (pg/mL) >143.1264.71%84.85%4.270.4259.46%87.50%79.70%10.27LDH (U/L) >46073.53%71.72%2.600.3747.17%88.75 %72.18%7.04PNI<31.3555.88%79.80%2.770.5548.72%84.04%73.68%5.00SII>3895.9247.06%90.91%5.180.5864.00%83.33%79.70%8.89CAR>61.1561.76%67.68%1.910.5639.62%83.75%66.17%3.38CAR: C-reactive protein/albumin ratio; DOR: diagnostic odds ratio; IL-6: interleukin-6; LDH: lactate dehydrogenase; NLR: negative likelihood ratio; NPV: negative predictive value; PLR: positive likelihood ratio; PNI: prognostic nutritional index; PPV: positive predictive value; SII: systemic immune-inflammatory index.ConclusionAlthough the patients with significantly lower IL-6, LDH, SII, CAR and higher PNI levels improved after tocilizumab therapy, only serum LDH levels and age were found to be as independent predictors of mortality. To specify the optimal time interval and the patients who will benefit from tocilizumab, these biomarkers may be used.References[1]van Eijk LE, Binkhorst M, Bourgonje AR, et al. COVID-19: immunopathology, pathophysiological mechanisms, and treatment options. J Pathol. 2021;254(4):307-31AcknowledgementsI have no acknowledgments to declare.Disclosure of InterestsNone declared
Collapse
|
25
|
Akleylek C, Akar S, Cinakli H, Piskin Sagir R, Coşkun BN, Karakas A, Apaydin H, Kardaş RC, Ozdemir Isik O, Hakbilen S, Okyar B, Sosyal O, Koca SS, Pehlivan Y, Dalkiliç E, Can G, Sari İ, Birlik M, Onen F, Erten S, Ozturk MA, Yazici A, Cefle A, Yilmaz S, Yildirim Cetin G, Akkoc N, Yilmaz N. AB0762 Incidence Of Anterior Uveitis In Axial Spondyloarthritis During Secukinumab Treatment: TWO YEARS REAL LIFE EXPERIENCE FROM TURKBIO REGISTRY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundSecukinumab (SEC), a human anti-IL-17A monoclonal antibody, has similar treatment response rates to tumor necrosis factor (TNF) inhibitors in patients with axial spondyloarthritis (SpA). However, the efficacy of SEC on anterior uveitis (AU) is unclear.ObjectivesThis study aimed to evaluate the risk of new-onset or relapsing AU in axial SpA patients treated with SEC.MethodsIn this prospective cohort study, 130 axial SpA patients receiving SEC at the TURKBIO registry between 2019 and 2021 were evaluated. Demographic and clinical characteristics and data about the presence of AU pre or post-treatment were collected. The univariate and multivariate logistic regression analyses were performed to evaluate the predictors of AU development.ResultsThe mean age of the patients (F/M: 59/71) was 47.4±10.9 years. The median follow-up time was 540 days (IQR: 330-630). SEC was the first biological agent in 50 (38.4%) patients and 35 (26.9%) patients were using at least one concomitant conventional synthetic DMARD (Table 1). While continued SEC therapy was in 93 (71.5%) patients, treatment withdrawal was in 37 cases (in 26 due to ineffectiveness, two adverse events and nine other reasons). Overall, 15(11.5%) patients had a history of AU before the SEC. During follow-up, AU attacks were seen in the 6 cases (4 were new-onset and 2 were flare) and 5 of these patients have a history of inadequate response to TNF inhibitors. The frequency of AU was calculated as 3.42 per 100 patient-years during SEC treatment. The only significant predictor of AU development was the baseline high C-reactive protein (CRP) level on multivariate analysis (p=0.003, OR: 1.063 [95% CI 1.021-1.107]).Table 1.Demographics and clinical characteristics of the patientsTotal (n:191)Gender (F/M)59/71Age (years) (mean±SD)47.4±10.9Diagnosis; n (%) AS125 (96.2) nr-axSpA5 (3.8)BASDAI (mean±SD)47.2±20.48 Missing n (%)4 (3.07)ASDAS (mean±SD)3.32±0.92 Missing n (%)14 (10.7)C-reactive protein (mg/L) median (IQR)12.6 (4.67-22.62)Sedimentation (mm/h) median (IQR)22 (9-42)Concomitant csDMARDs n (%)35 (26.9)Secukinumab dose n (%) 150 mg120 (92.3) 300 mg10 (7.7)TNFi-naive patients n (%)50 (38.5)Number of previous bDMARDs n (%) 136 (27.7) 223 (17.7) ≥ 321 (16.1)History of previous TNFi n (%) Monoclonal TNFi64 Etanercept16AS; Ankylosing spondylitis, nr-axSpA; Non radiographic axial spondyloarthritis, BASDAI; Bath Ankylosing Spondylitis Disease Activity Index, ASDAS; Ankylosing Spondylitis Disease Activity Score, csDMARD; conventional synthetic disease modifying anti-rheumatic drug, TNFi; Tumor necrosis factor inhibitors, bDMARD; biological DMARD. Datas were expressed as number (%), mean±SD or median (IQR).ConclusionIn this real-life data from the TURKBIO registry, the incidence of AU in axial SpA patients treated with SEC was calculated as 3.42 per 100 patient-years. A high baseline CRP level was an independent factor for developing AU.Disclosure of InterestsNone declared
Collapse
|