The preoperative predictive factors for pathological T3a upstaging and positive surgical margin of clinical T1 renal cell carcinoma

OBJECTIVES

The objective of this study is predict positive surgical margin (PSM) and pathological T3a (pT3a) upstaging in patients with clinical T1 (cT1) renal cell carcinoma (RCC).

MATERIALS AND METHODS

159 patients who underwent radical nephrectomy (RN) or partial nephrectomy (PN) for RCC. Patients' demographic, laboratory, radiological and pathological data that could predict PSM and pT3a upstaging pre-operatively were evaluated. The categorical and continuous variables were compared between the patient groups with or without PSM and/or pT3a upstaging using Pearson's chi-square test, and independent samples t-test or the Mann-Whitney U test, respectively.

RESULTS

PT3a upstaging was detected in 32 (20.1%) patients, and PSM was detected in 28 (17.6%) patients. PT3a upstaging was detected in 27 and 5 patients who underwent open surgery and laparoscopic surgery, respectively (P < .001). In addition, pT3a upstaging was detected in 6 and 26 patients who underwent RN and PN, respectively (P < .001). Peritumoral fatty tissue thickness was 11.97 and 15.38 in the pT1 and pT3a patient groups, respectively (P = .022). In patients with pT3a upstaging, tumor size was larger, and renal nephrometry score and systemic immune-inflammation index (SII) were higher (P < .001, P < .001, and P = .022, respectively). It was determined that De Ritis ratio (DRR) and albumin-to-alkaline phosphatase (ALP) ratio (AAPR) parameters had significant prognostic values in predicting PSM (P = .024, and P = .001, respectively). ROC analysis indicated that tumor size predicted pT3a upstaging with 100% sensitivity and 98.6% specificity when its cut-off value was taken as 6.85 mm (AUC: 1.000, P < .001). In addition, logistic regression analysis revealed AAPR and DRR as significant predictors of PSM (P < .001, and P = .009, repsectively).

CONCLUSION

The findings of this study indicated that the surgical technique of choice and the type of operation, tumor size, RNS value, peritumoral fatty tissue thickness, HU values of peritumoral and tumor side fatty tissues, and DRR and SII values can predict pT3a upstaging of patients with cT1 RCC, and that AAPR and DRR values can predict PSM.

Safety and efficacy of nivolumab therapy in patients with metastatic renal cell carcinoma and impaired kidney function

INTRODUCTION

Patients with renal insufficiency, usually defined as those with creatinine clearance < 40 mL/min, were excluded from pivotal clinical trials, especially in studies involving nivolumab therapy in patients with renal cell carcinoma (RCC). The aim of the study is to evaluate the efficacy and safety of nivolumab in patients with metastatic RCC (mRCC) stratified according to creatinine clearance.

MATERIAL AND METHODS

Data from mRCC patients treated with nivolumab were retrospectively analyzed. Patients were classified into two categories according to their estimated glomerular filtration rate (eGFR); the first category (C1) included patients with eGFR < 40 mL/min/1.73 m2 and the second category (C2) included those with eGFR ≥ 40 mL/min/1.73 m2.

RESULTS

Of the 95 patients enrolled, 1. group included 26 patients (27.4%) and 2. group included 69 patients (72.6%). None of the pts in category 1 were on hemodialysis. Overall incidence of adverse events was not statistically different between the two groups (P = .469). The overall response rate ORR was 50% in the first group and 42.0% in the second group (P = .486). Median overall survival (OS) was longer with 23.3 months in the 2. group versus 11 months in the 1. group (P = .415).

CONCLUSION

Renal insufficiency is a common problem in patients with advanced renal cancer since they often undergo nephrectomy and their renal function may also worsen while receiving tyrosine kinase inhibitor therapy. We found that there is no significant difference in the safety and efficacy of nivolumab treatment between two groups. Nivolumab appears to be a safe and effective agent in patients with renal impairment.

Evaluation of sarcopenia and phase angle in elderly patients with Parkinson's Disease

PURPOSE

To investigate sarcopenia and related factors and to determine the disease-specific phase angle (PhA) cut-off score in detecting sarcopenia in elderly patients with Parkinson's Disease (PD).

METHODS

This cross-sectional study was conducted with 89 participants. The Mini-Nutritional Assessment (MNA), the Eating Attitude Test-10 (EAT-10), the Physical Activity Scale for The Elderly (PASE) questionnaire and the Hoehn-Yahr scale have been used. Additionally, anthropometric measurements were performed. The diagnosis of sarcopenia was based on the new consensus published by the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). PhA has been performed by Bioelectrical Impedance Analysis (BIA) with Tanita MC 780®.

RESULTS

The mean age was of the participants 68.9 ± 6.4 years, and 57.3% were male. The prevalence of sarcopenia was 12.3%. PhA, malnutrition, age, disease severity, low calf circumference (CC), low body mass index (BMI), the difference between the pre-diagnosis and current weight loss, dopaminergic treatment, and low PASE score were associated with sarcopenia. The cut-off value of the PhA in terms of the ability to identify sarcopenia was <4.5o with a sensitivity of 53.3% and a specificity of 93.2% (p = 0.001). When we grouped the PhA of the patients according to this cut-off score, it was seen that 14.6% of them were sarcopenic. Age, disease severity, PASE score and hand grip strength were significantly related to both sarcopenia and PhA.

CONCLUSION

It is important to be aware of sarcopenia and related factors at an early stage in Parkinson's patients. Because of disease-related symptoms, it may be more appropriate to use a disease-specific PhA cut-off score in the definition of sarcopenia.

Erector spinae plane block prior to extracorporeal shock wave lithotripsy decreases fluoroscopy time and promise a comfortable procedure for renal stones: A prospective randomized study

INTRODUCTION AND OBJECTIVES

To compare the efficacy of erector spinae plane block (ESPB) and intramuscular (i.m.) diclofenac sodium in regard to pain management and impact on stone-free status in patients undergoing SWL.

PATIENTS AND MATERIALS

The study included patients who underwent SWL for kidney stones in our institution. The patients were randomly assigned to the ESPB (Group 1: n = 31) and i.m. 75 mg diclofenac sodium (Group 2: n = 30) groups. The demographic data of the patients, fluoroscopy time during SWL, number of need of targeting, total shocks given, voltage, stone free rates (SFR), analgesy method, number of SWL sessions, VAS score, stone location, maximum stone size, stone volume and Hounsfield unit (HU) were also recorded.

RESULTS

A total of 61 patients were included the study. There was no statistically significant difference between the two groups according to stone size, volume and density, SWL duration, total shocks given, voltage, BMI, stone-free status and stone location. Fluoroscopy time and number of need for stone targeting were significantly lower in group 1 than group 2 (p = 0.002, p = 0.021, respectively). The VAS score was significantly lower for group 1 compared to group 2 (p < 0.001).

CONCLUSIONS

We observed that the VAS score was lower in the ESPB group compared to i.m. diclofenac sodium group and although it was not statistically significant, we achieved a higher rate of stone-free status in the first session in ESPB group. Most importantly, the patients in the ESPB group were exposed to less fluoroscopy and radiation.

Assessment of sensitivity to the anesthesia in a diabetic rat model

OBJECTIVE

Diabetes mellitus and glucose regulation are important in deciding on surgical intervention in pre-surgical assessments. In our study, we aimed to investigate the correlations between the induction time of anesthesia, glucose level, and weight in a diabetic rat model.

MATERIALS AND METHODS

Weight-matched adult male Wistar rats were grouped as control (n=8) and diabetic (n=8). In the latter group, diabetes was induced with a single intraperitoneal injection of 50 mg/kg streptozotosin. 72 hours after the injection, animals possessing a blood glucose concentration above 300 mg/kg were considered diabetic. The weights and blood glucose levels were observed for 7 days. In the end, 80 mg/kg ketamine and 12 mg/kg xylazine were administered to both groups, and the induction time of anesthesia was recorded. The success of anesthesia was confirmed with toe pinching by using a clamp. The Student's t- and Pearson's correlation tests were used for statistical analyses.

RESULTS

The induction time of anesthesia was significantly reduced in the diabetic group compared to the controls (p<0.01). Diabetic animals weighed less than the control group (p<0.01). The correlation analysis in the diabetic group showed that the weight and blood glucose level of animals did not influence the induction time of anesthesia (respectively, p=0.80, r: 0.150; p=0.68, r: -0.300). A negative correlation between blood glucose concentration and weight was found in diabetics (p<0.05, r: -0.828).

CONCLUSIONS

The dosage of anesthetic agents is important in the effectiveness of anesthesia, and surgical complications. Since our results indicate the susceptibility of diabetics to anesthesia, we suggest that the dose of anesthetics should be finely adjusted considering the presence of diabetes.

Subacute THYROiditis Related to SARS-CoV-2 VAccine and Covid-19 (THYROVAC Study): A Multicenter Nationwide Study

CONTEXT

The aims of the study are to compare characteristics of subacute thyroiditis (SAT) related to different etiologies, and to identify predictors of recurrence of SAT and incident hypothyroidism.

METHODS

This nationwide, multicenter, retrospective cohort study included 53 endocrinology centers in Turkey. The study participants were divided into either COVID-19-related SAT (Cov-SAT), SARS-CoV-2 vaccine-related SAT (Vac-SAT), or control SAT (Cont-SAT) groups.

RESULTS

Of the 811 patients, 258 (31.8%) were included in the Vac-SAT group, 98 (12.1%) in the Cov-SAT group, and 455 (56.1%) in the Cont-SAT group. No difference was found between the groups with regard to laboratory and imaging findings. SAT etiology was not an independent predictor of recurrence or hypothyroidism. In the entire cohort, steroid therapy requirement and younger age were statistically significant predictors for SAT recurrence. C-reactive protein measured during SAT onset, female sex, absence of antithyroid peroxidase (TPO) positivity, and absence of steroid therapy were statistically significant predictors of incident (early) hypothyroidism, irrespective of SAT etiology. On the other hand, probable predictors of established hypothyroidism differed from that of incident hypothyroidism.

CONCLUSION

Since there is no difference in terms of follow-up parameters and outcomes, COVID-19- and SARS-CoV-2 vaccine-related SAT can be treated and followed up like classic SATs. Recurrence was determined by younger age and steroid therapy requirement. Steroid therapy independently predicts incident hypothyroidism that may sometimes be transient in overall SAT and is also associated with a lower risk of established hypothyroidism.

Can anterolateral thigh flap be a rescuer in lower extremity injuries?

OBJECTIVE

The lower extremity contains a variety of functional structures therefore re-establishing soft tissue coverage in large-scale injuries is a challenging procedure. Microsurgery has made progress in reducing donor morbidity and achieving a functional and aesthetic appearance in recent years. This study aimed to apply anterolateral thigh (ALT) flap to tissue defects in the lower extremity and to discuss the results.

PATIENTS AND METHODS

Twenty-three patients who were admitted to our hospital with lower extremity trauma and underwent ALT flap surgery due to soft tissue defect between November 2020 and March 2022 were included in the study. Patients' demographic data, the applied surgical procedure, the development of postoperative complications, and postoperative functional results were evaluated.

RESULTS

Twenty-three patients were included in this research. The mean age of the patients was 36.56±14.67 (10-61). Of these patients, 3 were female (13%), and 20 were male (87%). The most common etiology was traffic accident (n=8, 34%), followed by gunshot injuries (n=5, 21%), electrical burn (n=4, 17%), open fractures (n=2, 7%), infection (n=2, 7%), diabetic foot (n=1, 4%), skin tumor (n=1, 4%). Flaps were raised from the contralateral extremity in twelve patients (52%) and on the ipsilateral extremity in eleven patients (48%). The average time from first trauma to free flap surgery was 10.7±5 days (4-22). The average postoperative hospitalization was 13.6 days (9-23 days). The average follow-up time of patients was 8 months (3-13 months). The donor site is closed with primary saturation in 19 patients (82%) and closed with split-thickness skin grafting in 4 patients (18%). Our overall success rate was 96%. We had only one total flap failure out of twenty-three patients (4%).

CONCLUSIONS

ALT-free flap is an excellent choice for reconstructing lower extremity complex defects. For experienced surgeons, the ALT flap can be used successfully in the treatment of soft tissue defects of variable size in the lower extremity.

Rapid and efficient ambient temperature X-ray crystal structure determination at Turkish Light Source

High-resolution biomacromolecular structure determination is essential to better understand protein function and dynamics. Serial crystallography is an emerging structural biology technique which has fundamental limitations due to either sample volume requirements or immediate access to the competitive X-ray beamtime. Obtaining a high volume of well-diffracting, sufficient-size crystals while mitigating radiation damage remains a critical bottleneck of serial crystallography. As an alternative, we introduce the plate-reader module adapted for using a 72-well Terasaki plate for biomacromolecule structure determination at a convenience of a home X-ray source. We also present the first ambient temperature lysozyme structure determined at the Turkish light source (Turkish DeLight). The complete dataset was collected in 18.5 min with resolution extending to 2.39 Å and 100% completeness. Combined with our previous cryogenic structure (PDB ID: 7Y6A), the ambient temperature structure provides invaluable information about the structural dynamics of the lysozyme. Turkish DeLight provides robust and rapid ambient temperature biomacromolecular structure determination with limited radiation damage.

Diagnostic performance of FDG PET/MRI for cervical lymph node metastasis in patients with clinically N0 head and neck cancer

OBJECTIVE

Treatment management in cases of head and neck squamous cell cancer (HNSCC) that are clinically negative for lymph node metastases (cN0) is still an important topic of discussion. There is increasing interest in sensitive imaging modalities that can detect the risk of occult metastases at levels below 20%. This study aimed to examine the efficacy of integrated positron emission tomography (PET)/magnetic resonance imaging (MRI) in determining neck nodal metastasis status in cN0 patients with HNSCC.

PATIENTS AND METHODS

In this retrospective study, 44 patients who underwent neck dissection with the diagnosis of HNSCC between January 2018 and August 2020 were analyzed. Clinical examinations, including ultrasonography, were performed to identify cervical metastases in HNSCC patients with preoperative cN0. A nuclear medicine specialist visually evaluated the MRI, PET, and PET/MRI results.

RESULTS

Histopathologically, 86.4% of patients were classified as N0. According to the histopathological results, MRI showed 50% sensitivity, 89.5% specificity, 91.8% negative predictive value (NPV), 42.8% positive predictive value (PPV) and 84% accuracy, while PET showed 83.3% sensitivity, 68.4% specificity, 96.2% NPV, 29.4% PPV and 70.4% accuracy. PET/MRI was more successful in distinguishing pathological N0 and N+ patients (83.3% sensitivity, 92.1% specificity, 97.2% NPV, 62.5% PPV and 90.9% accuracy).

CONCLUSIONS

PET/MRI is more sensitive and has a higher NPV compared to MRI alone, while its sensitivity was found to be comparable to that of PET. In addition, with its ability to detect pathological N0 patients, PET/MRI may significantly decrease the number of unnecessary neck dissections.

A label-free dual immunosensor for the simultaneous electrochemical determination of CA125 and HE4 biomarkers for the early diagnosis of ovarian cancer

The blood levels of cancer antigen 125 (CA125) and human epididymal secretory protein 4 (HE4) are measured in the diagnosis and progression monitoring of ovarian cancer (OC), and the Risk of Ovarian Malignancy Algorithm (ROMA) score% values are calculated for cancer risk assessment. For the first time, disposable dual screen-printed carbon electrodes modified with reduced graphene oxide, polythionine, and gold nanoparticles were used to fabricate label-free electrochemical dual CA125-HE4 immunosensors for the sensitive, fast, and practical simultaneous determination of CA125 and HE4. DPV and SWV methods were used to simultaneously determine antigens in two different linear ranges (1-100 pg mL^-1 and 1-50 ng mL^-1). High sensitivity, low LOD, and LOQ were obtained for two linear ranges with a correlation coefficient above 0.99. The application stability of the dual CA125-HE4 immunosensors was determined as 60 days, and the storage stability was determined as 16 weeks. The dual immunosensors exhibited high selectivity in eight different antigen mixtures. The reusability of the dual immunosensors has been tested up to 9 cycles. ROMA score% values for pre-menopausal and post-menopausal status were calculated using the concentration of CA125 and HE4 in the blood serum and assessing OC risk. The disposable dual immunosensors can be used in point-of-care tests for rapid and practical simultaneous determination of CA125 and HE4 with high selectivity, sensitivity, and repeatability.

Ubiquitin C-terminal hydrolase 1 is increased in migraine attack

OBJECTIVE

This study aimed to determine the serum level of Ubiquitin C-terminal hydrolase 1 enzyme during a migraine attack and after its treatment.

METHODS

Blood samples of 43 patients and 30 healthy controls who presented to the emergency department with migraine attacks were analysed. Study sample was classified into three groups: Group 1 (patients presenting with migraine attack), Group 2 (4thhour after dexketoprofen treatment) and Group 3 (healthy control). Demographic data of patients, visual analogue scale and Ubiquitin C-terminal hydrolase 1 levels were analysed.

RESULTS

Median (IQR) Ubiquitin C-terminal hydrolase 1 levels were 13.70 (10.75-18.92) in Group 1, 9.45 (6.95-11.56) in Group 2 and 6.04 (3.88-8.72) ng/mL in Group 3; the Kruskal-Wallis test result showed a significant difference between the groups (P<0.001). Following the Kruskal-Wallis test, the post-hoc Dunn test was performed for binary comparison between the groups, which revealed significant differences between all groups (Group 1-Group 2, Group 1-Group 3 and Group 2-Group 3 with P=0.001, P<0.001 and P=0.008, respectively). Moreover, a significant positive correlation was found between VAS score and UCHL1 levels before treatment (r=0.884, P<0.001).

CONCLUSION

UCHL1 levels of patients with migraine increase during acute attack and they can be used to assess the severity of attack and response to treatment.

Comparison of the results of percutaneous and open screw fixation in the treatment of scaphoid nonunion fractures

OBJECTIVE

Our study aims to compare the clinical results of percutaneous screw fixation and non-vascularized bone grafting with open screw fixation in patients who did not achieve union due to failure in diagnosis and treatment after a scaphoid fracture.

PATIENTS AND METHODS

Forty-three patients with scaphoid nonunion fractures corresponding to the first three Slade and Dodds classification were divided into two groups. Non-vascularized bone grafting with open reduction and internal fixation (ORIF) was applied to 24 patients in the first group, and 19 patients in the second group were treated with a closed reduction and internal fixation (CRIF) (percutaneous screw fixation). The patients were followed up for preoperative and postoperative functional scores and time to union.

RESULTS

Our study found that the scaphoid was most commonly fractured in the waist of the scaphoid. In our study, we found that distal scaphoid fractures had the highest union rate (100%), followed by the waist fractures (93.2%) and the weakest union (50%) in the proximal pole fractures. We observed that the fastest union had occurred in the fractures of the waist. We also observed that the union was completed earlier in patients who operated with ORIF than those with CRIF. We found union in 87.5% of patients who underwent ORIF, in 84.2% of patients who underwent CRIF. CRIF operation duration was shorter than expected from ORIF operation duration.

CONCLUSIONS

We found that similar union rates could be achieved in the patient groups who underwent percutaneous and open screw fixation by selecting the appropriate patient in scaphoid nonunion fractures. Union was faster and functional results were more satisfactory in the ORIF group. The operation time was shorter in the CRIF group.

Acetabular dysplasia: a comparison of periacetabular osteotomy results of patients older and younger than 35 years

OBJECTIVE

Patient age has been reported to be an important determinant of treatment success in developmental dysplasia of the hip (DDH). This study aimed to determine the efficacy of periacetabular osteotomy (PAO) in DDH patients aged ≥ 35 years and to compare patient-reported and radiological outcomes with a control cohort of younger patients.

PATIENTS AND METHODS

This retrospective analysis included 43 patients (23 aged < 35 years; 20 aged ≥ 35 years) who underwent unilateral Bernese PAO for symptomatic DDH, between May 2001 and August 2015. Patients with a history of ipsilateral pelvic osteotomy or other pelvic pathologies were excluded. To evaluate the morphology of the dysplastic hip joints, 11 conventional radiographic measures were taken. Preoperative and postoperative Harris Hip Scores, postoperative visual analogue scale scores, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and hip range of motion measurements were used for clinical evaluation.

RESULTS

Of the 43 patients, 31 (72.1%) were women and 14 (27.9%) were men. The average age was 32 (range: 19-45) years. Regarding sex, surgery site, mean body mass index and mean follow-up time, there were no significant differences between the groups. Both groups showed significant differences in radiographic parameters before and after the PAO. There were no significant differences in preoperative or postoperative clinical outcomes between the groups, except for the WOMAC score.

CONCLUSIONS

PAO can be performed safely to treat acetabular dysplasia in patients aged ≥ 35 years, before the onset of femoroacetabular osteoarthritis, with satisfactory clinical and functional outcomes.

Alpha-lipoic acid could be a promising treatment in steroid-induced osteonecrosis

OBJECTIVE

Glucocorticoid-induced osteonecrosis is a serious debilitating health problem. In the present study, we investigated the effects of alpha-lipoic acid on glucocorticoid-induced osteonecrosis in rats.

MATERIALS AND METHODS

A total of 40 male Wistar albino rats were equally assigned to 4 groups as control, methylprednisolone acetate (MPA), alpha-lipoic acid (ALA), and methylprednisolone acetate with alpha-lipoic acid (MPA+ALA). The animals in MPA group subcutaneously received 15 mg/kg/week for 2 weeks, whereas 100 mg/kg/day alpha-lipoic acid was intraperitoneal administered for 4 weeks to ALA group. The MPA+ALA group was subjected to both treatments in same doses. Osteonecrosis was confirmed and graded histologically. The serum concentrations of glucose, total cholesterol, low- and high-density lipoprotein, triglyceride, as well as the total oxidant and antioxidant status, oxidative stress index, prothrombin time and activated partial thromboplastin time were evaluated. Also, lipid peroxidation and DNA damage were immunohistochemically assessed in the bone.

RESULTS

Osteonecrotic lesions were narrower in the MPA+ALA group than in the MPA group (p<0.05). As compared to the controls, the biochemical parameters in MPA and MPA+ALA groups were significantly increased (p<0.001). The oxidative stress index was significantly higher in the groups with MPA than the controls (p=0.002), but the animals treated with ALA alongside MPA displayed lesser scores than the ones injected with solely MPA (p=0.03). The administration of MPA elevated lipid peroxidation and DNA damage, which were successfully alleviated by ALA.

CONCLUSIONS

Alpha-lipoic acid may be suggested to be a protective supplement in glucocorticoid-induced osteonecrosis in rats. The antioxidant capacity of alpha-lipoic acid may involve its beneficial effects.

Factors affecting recurrence in subacute granulomatous thyroiditis

Objective

This study aimed to evaluate the factors affecting recurrence in subacute granulomatous thyroiditis (SAT).

Methods

A total of 137 patients with SAT were enrolled in the study; 98 (71.5%) were women and 39 (28.5%) were men. The patients received either steroid or nonsteroidal anti-inflammatory drug (NSAID) for eight weeks. Erythrocyte sedimentation rate (ESR), C-reactive protein, serum thyroid-stimulating hormone (TSH), free triiodothyronine, free thyroxine (FT4), anti-thyroid peroxidase antibodies and thyroglobulin antibodies, neutrophil, lymphocyte, platelet, neutrophil to lymphocyte ratio, and platelet to lymphocyte ratio levels were evaluated. In addition, recurrence rates were compared between patients who received NSAID treatment and those who received steroid therapy.

Results

Treatment modality and pretreatment TSH, FT4, and ESR were significantly different between patients with and without recurrence (p = 0.011, 0.001, 0.004, and 0.026, respectively). Compared with patients without recurrence, those with recurrence had higher pretreatment TSH levels, but lower FT4 and ESR levels. On logistic regression analysis, treatment modality was found to be an independent risk factor for recurrence. The risk of recurrence was higher in those taking steroids than in those taking NSAIDs (p = 0.015). The optimal TSH cutoff value for recurrence was 0.045 µIU/mL, with a sensitivity of 83.3% and specificity of 76% (AUC 0.794, 95% CI 0.639-0.949).

Conclusion

The risk of SAT recurrence was higher with steroid therapy than with NSAIDs. Patients who had mild thyrotoxicosis had relatively high recurrence rate and may need a relatively longer duration of treatment.

The role of coronary CT angiography and person"s lifestyle habits in assessment of risk for primer protection from cardiovascular diseases

Funding Acknowledgements

Type of funding sources: None.

Introduction

Prevention of  atherosclerotic coronary artery disease (CAD), is primarily based on risk assesment. SCORE risk model is the most widely used risk assesment tool which is a comprehensive model of classical risk factors for CAD . However this model does not include several important risk factors such as socioeconomic level, education status, social support , sedantary life style,  systemic inflammation and etc.. SCORE model also does not have any component about imaging findings. Actually high Agatston score, which measures coronary artery calcium (CAC) in cardiac computed tomography angiography (CCTA) is  an important risk estimator for CAD.

Aim

The aim of this study is to investigate the importance of CCTA findings together with  sociocultural and lifestyle characteristics of individuals  on top of SCORE risk assesment

Methods

565 patients who applied to the Izmir Medical Park Hospital cardiology outpatient clinic between 15.01.2019-20.01.2020 and underwent CCTA were screened. Patients with known CAD were excluded,497 people were included in the study.Cardiovascular risk factors, socioeconomic and lifestyle characteristics of the person were learned and SCORE risk calculated. Agatston  CAC score (CACS), presence of hepatosteatosis, paracardial adipose tissue thickness (PATT) measured in CCTA.Data of individuals were analyzed in terms of presence of Agatston CACS. Parameters that were significant in univariate analysis were included in multivariate analysis. Independent predictors of atherosclerosis were investigated.

Results

 Patients  were divided into 2 groups according to CAC score: group 1  with an CCS = 0 and  group 2 as CCS &gt; 0 . Among several lifestyle and sociocultural characteristics assesed, only having an active working life was found to be significantly associated with CCS = 0 (table 1) However in multivariate analysis, significance was lost for active working ; the only significant predictors of CCS = 0  were SCORE value of &lt;5 and PATT &lt; 5mm. (table 2) The PATT value was a more powerful predictor of atherosclerosis compared to the all other well known metabolic parameters such as BMI, blood glucose and lipid levels

Conclusion

 Although SCORE risk model does not include components about  lifestyle characteristics of individuals and imaging findings , it was the most powerful estimator of presence of atherosclerosis. No single lifestyle characteristics was able to predict CAD independently. However the PATT which is a marker of visseral obesity with inflamatory roles on heart and coronary arteries, was found to be an independent predictor of atherosclerosis on top of SCORE risk. So we think that The measurement of PATT can be useful to predict an individual"s  risk of atherosclerosis. We can use it in our routine  practice to make the risk assessment  of people more effective. Abstract Figure. Independent Predictors of Being Agatston  Abstract Figure. Independent Predictors of Being Agatsto2

Identifying Clinical Characteristics of Hypoparathyroidism in Turkey: HIPOPARATURK-NET Study

Hypoparathyroidism is an orphan disease with ill-defined epidemiology that is subject to geographic variability. We conducted this study to assess the demographics, etiologic distribution, treatment patterns and complication frequency of patients with chronic hypoparathyroidism in Turkey. This is a retrospective, cross-sectional database study, with collaboration of 30 endocrinology centers located in 20 cities across seven geographical regions of Turkey. A total of 830 adults (mean age 49.6 ± 13.5 years; female 81.2%) with hypoparathyroidism (mean duration 9.7 ± 9.0 years) were included in the final analysis. Hypoparathyroidism was predominantly surgery-induced (n = 686, 82.6%). The insulting surgeries was carried out mostly due to benign causes in postsurgical group (SG) (n = 504, 73.5%) while patients in nonsurgical group (NSG) was most frequently classified as idiopathic (n = 103, 71.5%). The treatment was highly dependent on calcium salts (n = 771, 92.9%), calcitriol (n = 786, 94.7%) and to a lower extent cholecalciferol use (n = 635, 76.5%) while the rate of parathyroid hormone (n = 2, 0.2%) use was low. Serum calcium levels were most frequently kept in the normal range (sCa 8.5-10.5 mg/dL, n = 383, 46.1%) which might be higher than desired for this patient group. NSG had a lower mean plasma PTH concentration (6.42 ± 5.53 vs. 9.09 ± 7.08 ng/l, p < 0.0001), higher daily intake of elementary calcium (2038 ± 1214 vs. 1846 ± 1355 mg/day, p = 0.0193) and calcitriol (0.78 ± 0.39 vs. 0.69 ± 0.38 mcg/day, p = 0.0057), a higher rate of chronic renal disease (9.7% vs. 3.6%, p = 0.0017), epilepsy (6.3% vs. 1.6%, p = 0.0009), intracranial calcifications (11.8% vs. 7.3%, p < 0.0001) and cataracts (22.2% vs. 13.7%, p = 0.0096) compared to SG. In conclusion, postsurgical hypoparathyroidism is the dominant etiology of hypoparathyroidism in Turkey while the nonsurgical patients have a higher disease burden with greater need for medications and increased risk of complications than the postsurgical patients.

Examining the relationship between anhedonia symptoms and trait positive appraisal style in adolescents: A longitudinal survey study

INTRODUCTION

Anhedonia, defined as a loss of interest and pleasure in previously enjoyable activities, is a core symptom of depression that predicts a poor treatment response in adolescents. We know little about the cognitive vulnerability factors that contribute to the development of anhedonia in youth. This cross-sectional and longitudinal survey study investigated the link between anhedonia symptoms and cognitive appraisal of positive affect.

METHODS

Baseline data were collected from 392 secondary school students in the UK (aged 13-16, 54 % Female), 170 of whom went on to complete the three-month follow-up assessment (a 43 % response rate). Participants rated their anhedonia symptoms and appraisal styles which were measured in terms of use of amplifying appraisals, dampening appraisals, and fear of positive emotion.

RESULTS

At baseline, greater anhedonia was significantly associated with increased levels of dampening and reduced levels of amplifying but was not significantly related to fear of positive emotion. Prospectively, greater baseline levels of amplifying uniquely predicted lower anhedonia severity at three-month follow-up, and vice-versa. There was no evidence for reciprocal prospective associations between anhedonia and, appraisal styles of dampening and fear of positive emotion.

CONCLUSION

These results indicate that cognitive appraisal of positive affect is associated with concurrent and to some extent can predict future symptoms of anhedonia in youth.

POS1372 EVALUATION OF E148Q AND CONCOMITANT AA AMYLOIDOSIS SECONDARY TO FAMILIAL MEDITERRANEAN FEVER AFTER ADJUSTED CLINICAL-DEMOGRAPHIC CHARACTERISTICS

Background:

Amyloid A (AA) amyloidosis, previously known as secondary or reactive amyloidosis, is a long-recognized severe complication of some chronic inflammatory diseases. The pathogenesis and risk factors for amyloidosis in Familial Mediterranean Fever (FMF) remain partially understood (1). The development of AA amyloidosis is dependent on ethnicity and country of residence (2). In the pre-colchicine era, renal AA-amyloidosis was largely reported patients of Turkish (67%) and Sephardic Jewish ancestry (26.5%) (2,3). Currently it’s well known that the MEFV M694V variant associated with high risk of amyloidosis however, mutations on exon 2, specifically E148Q variant remained controversial.

Objectives:

To evaluate the E148Q mutation variant and concomitant AA Amyloidosis secondary to FMF after adjusted clinical-demographic characteristics.

Methods:

Patients were recruited from the renal unit at Epigenetic Health Center outpatient clinic in Turkey between September 2003 and February 2020. Patients who had biopsy confirmed FMF related AA amyloidosis were included the study. Tel-Hashomer criteria were applied in the diagnosis of FMF. The clinical characteristics of FMF patients and medication history were recorded by the physician at the time of registry entry. All patients had detailed baseline assessment of clinical features, renal functions, genetic testing, histopathological diagnosis of amyloidosis, and treatment received. We performed multiple comparisons according to the age of diagnosis, demographic features, disease phenotype, allele frequency, type of mutation and mortality. Statistical analysis was performed with Statistical Package of Social Science (SPSS) for Windows, version 15.0 (SPSS Inc, Chicago, IL).

Results:

Our registry consists of 195 patients with a diagnosis of AA amyloidosis. Complete information on 169 patients (lost to follow up, n=26) were included. The median age was 36 (19-49) years; male/female ratio was 1.6 (104/65). The median follow-up duration was 15.0 years (4-17 years). There were 101 patients diagnosed with FMF <18 years of age and 68 patients diagnosed ≥18 years of age. All participants developed renal amyloidosis before the age of 32 years. Family history of FMF was documented in 56 patients (33.1%) and family history of amyloidosis was present in 41 patients (24.3%). The three most common clinical symptoms were fever (84,6%), abdominal pain (71.6%) and arthritis (66.9%). During the follow-up, 5 patients started dialysis treatment and 9 patients had kidney transplantation. The most common allele frequency across patients was M694V (60.6%), E148Q (21.4%) and M680I (10.3%). The most frequent mutations were M694V/M694V (63.3%), M694V/E148Q (20.8%) and E148Q/E148Q (15.8%). During the follow up period, 15 patients (10 male, 5 female) died. In those that died, the mutations in 14 had M694V/M694Vand one demonstrated E148Q/E148Q.

Conclusion:

Patients with FMF related AA amyloidosis have an increased risk for mortality. This study confirmed the association between M694V and FMF-associated AA amyloidosis, which has been reported in many studies. Close clinical follow-up and further evaluation of patients with the E148Q mutation is warranted specifically if residing in FMF endemic areas. The possible relationship between E148Q and AA amyloidosis need to be confirmed in other cohorts.

References:

[1]Erer B, Demirkaya E, Ozen S, Kallinich T. What is the best acute phase reactant for familial Mediterranean fever follow-up and its role in the prediction of complications? A systematic review. Rheumatology international. 2016;36(4):483-7.

[2]Touitou I, Sarkisian T, Medlej-Hashim M, Tunca M, Livneh A, Cattan D, et al. Country as the primary risk factor for renal amyloidosis in familial Mediterranean fever. Arthritis and rheumatism. 2007;56(5):1706-12.

[3]Pras M, Bronshpigel N, Zemer D, Gafni J. Variable incidence of amyloidosis in familial Mediterranean fever among different ethnic groups. Johns Hopkins Med J. 1982;150(1):22-6.

Disclosure of Interests:

None declared

POS1352 ANTIINFLAMMATORY, ANTIOXIDANT AND ANTI-ATHEROSCLEROTIC EFFECTS OF A COMBINATION OF NATURAL SUPPLEMENTS ON PATIENTS WITH FMF RELATED AA AMYLOIDOSIS: A NON-RANDOMIZED 24 WEEKS OPEN LABEL INTERVENTIONAL STUDY

Background:

Few studies have focused on Familial Mediterranean Fever (FMF)-related AA amyloidosis and cardiovascular disease event risk. Systemic inflammation stimulates the development and progression of atherosclerosis which is accelerated by vascular endothelial inflammation and enhanced oxidative stress. Excessive reactive oxygen species (ROS) generation has been reported in FMF, which correlated with attack severity. ROS may also be involved in amyloid formation, and in the pathogenesis of progressive renal injury.

Objectives:

In this non-randomized, 24 weeks open label interventional study, we aimed to evaluate the effect of a combination of natural products on parameters related to inflammation, endothelial dysfunction and oxidative stress in a cohort of FMF patients with AA amyloidosis.

Methods:

Morinda citrifolia (anti-atherosclerotic liquid- AAL), omega-3 (anti-inflammatory capsules- AIC) and extract with Alaskan blueberry (anti-oxidant liquid- AOL) were given to patients with FMF related AA amyloidosis. We included patients with biopsy proven AA amyloidosis, older than 18 years who have normal estimated glomerular filtration rate (eGFR) and proteinuria [>3500mg/day]. Flow-mediated dilatation (FMD), asymmetric dimethylarginine (ADMA), hs-CRP, serum PTX3, Carotis intima media thickness (CIMT), malondialdehyde (MDA), Cu/Zn-superoxide dismutase (Cu/Zn-SOD), glutathione peroxidase (GSH-Px) levels were studied in baseline and after 24 weeks.

Results:

67 FMF-related amyloidosis [52 male (77.6%); median recruitment age 36 years (range 21-66)] were enrolled. M694V mutation was the most common mutation found (74%), with 50.7% of the patients in homozygosity. All patients were treated with colchicine, and most of them (83.6%) has been on colchicine treatment at the time of enrollment. Serum ADMA, MDA, PTX3, hsCRP, cholesterol, and proteinuria were significantly decreased compared to baseline, while CuZn-SOD, GSH-Px and FMD levels were significantly increased following AAL, AIC and AOL therapies (Table 1). The change of the inflammatory markers PTX3, and hsCRP were negatively correlated with the change in FMD and positively correlated with the change of proteinuria, ADMA, MDA, cholesterol and CIMT.

Conclusion:

24 weeks of AAL, AIC and AOL combined supplementation was significantly associated with reduction in serum inflammatory markers (PTX3 and hsCRP), improved endothelial functions (FMD, ADMA), and oxidative state (MDA). Our findings highlight the link among the three pathogenetic mechanisms including inflammation, endothelial function and oxidative status in progression of atherosclerosis and renal injury in patients with FMF related AA amyloidosis. Efficient control of these three mechanisms can have long term benefits from the cardiovascular and renal perspective of the patients with AA amyloidosis.

References:

[1]Romano M et al. Sci Rep, 2020

[2]Yilmaz M et al. Sci Rep, 2020

Table 1.

Comparison of clinical and laboratory characteristics at the baseline and after 24 weeks of AAL, AIC and AOL supplementation

BaselineMean (SD)24th weekMean (SD)DeltaMean (SD)pTotal Cholesterol (mg/dl)221.2 (60.3)155.8 (35.4**)-65.3 (55.5)<0.001eGFR (ml/min/ 1.73 m2)110.2 (12.8)104.1 (11.2**)-6.1 (11.9)<0.001Malondialdehyde (MDA) (nmol/ml)4.2 (1.8)1.8 (0.5**)-2.2 (1.8)<0.001CuZn-SOD (U/ml)431.5 (154.7)538.1 (146.4**)159.7 (211.8)<0.001GSH-Px (U/ml)47.8 (13.2)74.1 (20.3**)26.3 (21.1)<0.001ADMA (µmol/l)4.5 (2.6)1.3 (0.6**)-3.2 (2.5)<0.001FMD (%)5.0 (0.7)6.4 (0.8**)1.3 (0.9)<0.001CIMT (mm)0.9 (0.2)0.7 (0.1)-0.2 (0.2)<0.001Proteinuria (mg/24h)6855.3 (3116.9)4079.9 (2359.6)-2775.3 (2874.5)<0.001hs-CRP (mg/l)25.5 (4.4-48.0)3.0 (1.0-9.1)*-20.8 (11.2)<0.001PTX3 (ng/ml)13.4 (2.3-67.0)2.3 (0.4-14.5)*-17.5(17.5)<0.001

Disclosure of Interests:

None declared

Evaluation of Retinal Neurodegeneration and Choroidal Thickness in Patients with Inactive Graves' Ophthalmopathy

PURPOSE

The study was conducted for the assessment of the retinal nerve fiber layer, ganglion cell layer, and subfoveal choroidal thickness changes in patients with inactive Graves' ophthalmopathy (GO) using swept-source optical coherence tomography (SS-OCT) before the development of active GO findings.

MATERIALS AND METHODS

The cross-sectional designed study consisted of patients with inactive Graves' ophthalmopathy (study group) and healthy subjects (control group). The thicknesses of the retinal ganglion cell layer, retinal nerve fiber layer, and subfoveal choroid (SFCT) were measured using SS-OCT with deep range imaging technology to compare these parameters between the study and control groups.

RESULT

Patients with inactive Graves' ophthalmopathy had higher values of intraocular pressure but similar best-corrected visual acuity (p = 0.001, p = 0.232, respectively). The retinal nerve fiber layer was thinner only in the superior zone of the study group (p = 0.039), whereas similar values were noted in the temporal, nasal, and inferior areas as well as the average thickness. We did not observe any statistically significant difference in any sector of the ganglion cell layer between the study and control groups. A thicker mean subfoveal choroidal thickness value was measured in patients with inactive Graves' ophthalmopathy than in healthy subjects (p = 0.013) in correlation with a clinical activity score (p = 0.046).

CONCLUSION

SS-OCT showed minimal retinal neurodegenerative alteration and significant choroidal thickening in inactive GO. Thus, SS-OCT might be a beneficial technique to detect retinal neurodegenerative and choroidal changes earlier in the stage of inactive GO before the development of active GO signs, which may affect the time and type of treatment modalities to prevent further ocular or systemic complications. Additionally, SFCT may be a good indicator for assessment of the severity of Graves' disease.

Association between minimum inhibitory concentration, beta-lactamase genes and mortality for patients treated with piperacillin/tazobactam or meropenem from the MERINO study

INTRODUCTION

This study aims to assess the association of piperacillin/tazobactam and meropenem minimum inhibitory concentration (MIC) and beta-lactam resistance genes with mortality in the MERINO trial.

METHODS

Blood culture isolates from enrolled patients were tested by broth microdilution and whole genome sequencing at a central laboratory. Multivariate logistic regression was performed to account for confounders. Absolute risk increase for 30-day mortality between treatment groups was calculated for the primary analysis (PA) and the microbiologic assessable (MA) populations.

RESULTS

320 isolates from 379 enrolled patients were available with susceptibility to piperacillin/tazobactam 94% and meropenem 100%. The piperacillin/tazobactam non-susceptible breakpoint (MIC > 16 mg/L) best predicted 30-day mortality after accounting for confounders (odds ratio 14.9, 95% CI 2.8 - 87.2). The absolute risk increase for 30-day mortality for patients treated with piperacillin/tazobactam compared with meropenem was 9% (95% CI 3% - 15%) and 8% (95% CI 2% - 15%) for the original PA population and the post-hoc MA populations, which reduced to 5% (95% CI -1% - 10%) after excluding strains with piperacillin/tazobactam MIC values > 16 mg/L. Isolates co-harboring ESBL and OXA-1 genes were associated with elevated piperacillin/tazobactam MICs and the highest risk increase in 30-mortality of 14% (95% CI 2% - 28%).

CONCLUSION

After excluding non-susceptible strains, the 30-day mortality difference was from the MERINO trial was less pronounced for piperacillin/tazobactam. Poor reliability in susceptibility testing performance for piperacillin/tazobactam and the high prevalence of OXA co-harboring ESBLs suggests meropenem remains the preferred choice for definitive treatment of ceftriaxone non-susceptible E. coli and Klebsiella.

Non-Compartment and compartmental pharmacokinetics, efficacy, and safety of Kedrion FIX concentrate

BACKGROUND

An open-label phase II, multicenter clinical trial was conducted at 11  Haemophilia Centres in  Italy, Romania, and Turkey, to evaluate the pharmacokinetics (PK), efficacy, and safety of high purity, plasma-derived, double virus inactivated and double nano-filtered factor IX (pd-FIX) concentrate (Kedrion FIX), EudraCT Number: 2005-006186-14.

MATERIAL AND METHODS

16 previously treated patients (PTPs) with severe or moderately severe haemophilia B were enrolled in the study. At enrolment, 14 underwent the first PK assessment (PK I), and the second PK (PK II) assessment was performed after six months of treatment (5 on-demand and nine prophylaxis) at the end of the study. PK parameters were evaluated by Non-Compartmental Analysis (NCA), One-Compartment model (OCM), and Two-Compartment Model (TCM). Efficacy of Kedrion FIX in all 16 patients was evaluated by the number of bleeding events, and clinical response following the infusions. Periodic FIX inhibitor assays and thrombogenicity tests were scheduled throughout the study to assess the safety of the drug.

RESULTS

As compared to the published data on PK of pdFIX, Kedrion FIX displayed a longer half-life (22.37-55.73 hrs), reduced clearance, and regular volume of distribution at PK I by both NCA and OCM. The comparison of outcomes of PK II with those of PK I by OCM,  also showed significant changes, particularly in patients on prophylaxis, who showed some improved parameters of PK. Due to two outlier values at the end of the trial, the NCA parameters of PK I were not compared to those of PK II. Breakthrough bleeds were successfully treated with 1 or 2 infusions. No significant adverse events were observed during the study.

DISCUSSION

During the six-month clinical study period, the use of Kedrion FIX resulted in a safe and effective pd-FIX concentrate with excellent PK characteristics.

FRI0547 THE EFFECT OF CORRECTED INFLAMMATION, OXIDATIVE STRESS AND ENDOTHELIAL DYSFUNCTION ON FMD LEVELS IN PATIENTS WITH SELECTED CHRONIC DISEASES: A QUASI-EXPERIMENTAL STUDY

Background:

While the pathophysiology of chronic disorders varies there are three basic mechanisms - inflammation, oxidative stress and endothelial dysfunction – that are common in many chronic diseases. These mechanisms, which have a dynamic structure, are key to homeostasis. However, the failure of these mechanisms to work synchronously can lead to morbidity complicating the course of many chronic diseases.

Objectives:

To evaluate the effect of anti-atherosclerotic liquid (AAL), anti-inflammatory capsules (AIC) and anti-oxidant liquid (AOL) supplementation on the flow-mediated dilatation (FMD), inflammatory, oxidative stress and endothelial dysfunction markers in patients with selected chronic diseases

Methods:

We analyzed data of 178 patients from cohorts with selected chronic diseases (Rheumatoid arthritis, familial Mediterranean fever, DM type-2, Hypertension, Multiple sclerosis, Chronic obstructive pulmonary disease, Alzheimer disease and Cancer) in this quasi-experimental study. Endothelial dysfunction was determined by FMD and serum asymmetric dimethylarginine (ADMA) levels. Serum ADMA, high sensitive C-reactive protein (hs-CRP), serum PTX3, malondialdehyde (MDA), Cu/Zn-superoxide dismutase (Cu/Zn-SOD), glutathione peroxidase (GSH-Px) levels and FMD were studied in baseline and after 12 weeks of Morinda citrifolia (AAL, 3 ml once per day), omega-3 (AIC, 3 capsules once per day) and extract with Alaskan blueberry and 21 different red purple fruit vegetables (AOL, 30 ml once per day). Stepwise multivariate regression analysis evaluated the association of FMD with clinical and serologic parameters.

Results:

Serum ADMA, MDA, PTX3, hsCRP and albumin levels, and proteinuria were significantly decreased and CuZn-SOD, GSH-Px and FMD levels were significantly increased following AAL, AIC and AOL therapies. FMD was negatively correlated with serum ADMA, MDA, PTX3, hsCRP levels, SBP and DBP and positively correlated to CuZn-SOD and eGFR levels both at baseline and after the 12-weeks treatment period. Multivariate regression analysis revealed that ADMA and PTX3 levels were independently related to FMD both before and after AAL, AIC and AOL therapies (Table 1, Figure 1).

Conclusion:

Our study shows that serum ADMA, MDA, PTX3 levels are associated with endothelial dysfunction in patients with selected chronic diseases. Short-term AAL, AIC and AOL therapies significantly improves FMD and normalizes ADMA, PTX3, hsCRP and MDA. This may have implications for adjunctive therapy in a number of chronic disorders.

References:

[1] Yilmaz MI, Saglam M, Caglar K, Cakir E, Sonmez A, Ozgurtas T et al. The determinants of endothelial dysfunction in CKD: oxidative stress and asymmetric dimethylarginine. Am J Kidney Dis. 2006;47(1):42-50. doi:10.1053/j.ajkd.2005.09.029.

Disclosure of Interests:

None declared

SAT0541 THE SEVERITY OF FMF MAY BE ASSOCIATED WITH CO-MORBIDITIES

Background:

Familial Mediterranean fever (FMF) is an auto inflammatory disease with recurrent attacks of serositis. Frequent attacks and disease related sequels may be associated with co-morbidities in FMF patients.

Objectives:

One of the tools for evaluating the FMF severity is the international severity scoring system for FMF (ISSF)1. This score includes disease related sequels, acute phase measurements, attack features and exertional leg pain. Therefore, more severe disease may be link with subclinical inflammation, amyloidosis and frequent, prolonged and widespread attacks. All these components may augment the frequency of non-disease related co-morbidities.

Methods:

We enrolled 158 FMF patients who fulfilled modifiedTel-HashomerDiagnosisCriteria2. The patients dichotomized based upon disease severity (mild disease or severe disease). Patients with ISSF scores lower or equal to 2 were accepted to have mild disease. Then, we compared frequency of non-disease related co-morbidities between the groups. These co-morbidities arehypertension, hypothyroidism, hyperthyroidism cardiovascular diseases, coronary artery diseases, cerebrovascular diseases, chronic renal disease (non-FMF related), chronic obstructive pulmonary diseases, and diabetes mellitus. This study was approved by the Local Research Ethics Committee and carried out in compliance with the Helsinki Declaration. All the patients gave written informed consent. P-value lower than 0.05 was considered as statistically significant.

Results:

Demographic features, disease duration, smoking history and body mass index (BMI) were similar between the groups. Frequency of co-morbidity in severe disease group was statistically higher than mild disease group (p=0.02). Most frequent co-morbidity was hypertension in both groups.

Table.

Features of mild and severe FMF groups

Mild (n=135)Severe (n=23)pGender (M/F)47/8811/120.23Age36.4±11.336.5±14.30.68Smoking (%)38 (28.1)5 (21.7)0.52BMI (kg/m2)24.3±9.224.0±8.90.34Disease duration (year)7.7±11.38.6±14.30.09Amyloidosis (%)2 (1.4)3 (13.0)0.02Exon 10 homozygote (%)35 (25.9)9 (39.1)0.19Colchicine dosage (mg/day)1.2±0.41.4±0.50.02ISSF scores0.7 ±0.73.4±0.5<0.001Co-morbidity (%)25 (18.5)9 (39.1)0.02

Conclusion:

In our FMF patient cohort, we found that severity of the disease may be associated with higher frequency of co-morbidities. Therefore, clinicians should be aware of the high possibility of co-morbidities in patients with more severe FMF and addressed these co-morbidities timely and properly.

References:

[1]Demirkaya E, et al. Development and initial validation of international severity scoring system for familial Mediterranean fever (ISSF). Ann Rheum Dis 2016;75:1051-6.

[2]Berkun Y, et al. Diagnostic criteria of familial Mediterranean fever. Autoimmun Rev 2014;13:388-90.

Acknowledgments:

None

Disclosure of Interests:

None declared

FRI0501 CARDIOVASCULAR DISEASE RISK ASSESSMENT IN PATIENTS WITH FAMILIAL MEDITERRANEAN FEVER RELATED AMYLOIDOSIS

Background:

FMF is an autosomal recessive disorder. Systemic inflammation in autoinflammatory disorders cause secondary systemic AA amyloidosis, which has been suggested as an important contributing factor to the excess cardiovascular disease (CVD) risk in patients with FMF.

Objectives:

Our aim was to investigate the CVD-related clinical outcomes in patients with FMF-related amyloidosis and to define risk factors for CVD events (CVDEs).

Methods:

A cross-sectional evaluation with prospective follow-up of consecutive patients with FMF-related amyloidosis or other non-diabetic primary glomerulonephropathy (PGN) was performed. Patients were followed for CVDEs. Flow-mediated dilatation (FMD), FGF-23 levels, serum lipid levels, hsCRP, BMI and homeostasis model assessment (HOMA) were assessed. A Cox regression analysis was performed to evaluate the probability of CVDEs associated with each risk factor.

Results:

There were 107 patients in FMF-related amyloidosis group and 126 patients with PGN group. Forty-seven CVDEs were registered during the 4.2-years follow up; all 28 patients in the FMF-related amyloidosis versus 14/19 patients with PGN group who developed CVDEs before 40 years of age (P=0.002) (Figure 1). CVD mortality was 2.8 times higher (95% CI 1.02-7.76, p=0.03) in patients with FMF-related amyloidosis (n=12) than PGN (n=5). Mortality due to CVD was higher in patients less than 40 years old with amyloidosis than PGN (12/107 and 3/126 respectively, RR=4.71, 95% CI 1.36-16.25, p=0.006). Patients with CVDEs had higher levels of proteinuria, hsCRP and FGF23, and lower FMD compared to patients without CVDEs. Across both groups, FGF23 and FMD levels were independently associated with the risk of CVDEs (Table 1).

Table 1.

Multivariate analysis of factors associated with the risk of suffering a cardiovascular event

BHR95.0% CI for Exp(B)pVariablesLowerUpperAll GroupsFGF23.0331.0341.0171.051<.001FMD-.946.388.262.575<.001PrimaryFGF23.0501.0511.0191.084.002glomerulopathyFMD-.651.522.300.908.021AmyloidosisFGF23.0341.0351.0121.058.003FMD-1.531.216.109.430<.001hsCRP-.040.961.9151.009.108

FMD, Flow-mediated dilatation; hsCRP, high sensitivity C reactive protein; CI, Confidence interval

Figure 1.

Comparison of cardiovascular disease survival between patients with FMF-related amyloidosis or primary glomerulopathy.

Conclusion:

Patients with FMF-related amyloidosis are at increased risk of CVDEs with early mortality age. These patients should be closely monitored and if inflammation is poorly controlled with colchicine, biological agents must be added to treatment even if they develop amyloidosis. We also found that hsCRP, FGF 23 and FMD levels were the strongest predictors of CVD risk in patients with FMF. These biomarkers can stratify risk of early CVD in patients with FMF-related amyloidosis.

References:

[1] Yilmaz, M.I., et al.,Endothelial function in patients with familial Mediterranean fever-related amyloidosis and association with cardiovascular events.Rheumatology (Oxford), 2014.53(11): p. 2002-8.

Disclosure of Interests:

None declared

Self Reported Dysphagia is not Associated with Sarcopenia Defined by the Revised EWGSOP2 Criteria and Regional Thresholds at the Hospital Among Ambulatory Older Patients

Introduction:

Dysphagia and sarcopenia are geriatric syndromes, and they are shown to be related. There is no study on dysphagia and sarcopenia with the revised European Working Group on Sarcopenia in Older People (EWGSOP)2 criteria.

Aim:

We aimed to evaluate dysphagia and sarcopenia with the revised criteria implementing regional thresholds for skeletal muscle mass (SMM) in hospitalized older patients.

Methods:

Ambulatory patients ≥60 years of age from the Internal Medicine Department of our hospital were taken into the study. Grip strength, SMM via bioelectrical impedance analysis, nutritional status, dysphagia screening with Eating Assessment Tool-10, prior hospitalizations and diet were evaluated. Sarcopenia was defined by EWGSOP2 criteria using regional SMM thresholds adjusted to body mass index (BMI) (SMMI (BMI)).

Results:

Out of 112, 61 patients were enrolled. Sarcopenia, nutritional risk, and dysphagia were shown in 36.1%, 88.5%, and 14.8% of the patients. The risk of dysphagia was not associated with sarcopenia (p=0.263). Hospitalizations (≥1) in one year with pneumonia, modified diet, malnutrition, and low SMMI (BMI) were more common in patients with dysphagia risk than in the patients without (p=0.001, p<0.01, p=0.011, p=0.008, respectively). The median age and BMI were higher where SMMI (BMI) was lower in the group with dysphagia risk than in the group without (p=0.016, p=0.034, p=0.032), respectively.

Conclusion:

We found that self-reported dysphagia was not associated with sarcopenia defined by the EWGSOP2 criteria in ambulatory hospitalized patients over 60 years of age. Further studies using revised criteria, different adjustments and thresholds are needed to reveal possible differences.

Assessment of atrial fibrillation and ventricular arrhythmia risk in patients with asthma by P wave/corrected QT interval dispersion

OBJECTIVE

Although the relationship between obesity-asthma, obesity-atrial fibrillation (AF) and obesity-sudden cardiac death is clearly known, the risk of AF and ventricular arrhythmia has not been clearly determined in asthmatic patients. The aim of this study was to investigate whether AF, ventricular arrhythmia, and sudden cardiac death risk were increased in asthmatic patients using P wave dispersion (PWD) and corrected QT interval dispersion (CQTD).

PATIENTS AND METHODS

The study was designed as a cross-sectional study. A total of 164 participants (88 patients with asthma and 76 healthy volunteers) were enrolled into the study. PWD and CQTD were measured and recorded in both groups. The statistical difference between the two groups was examined.

RESULTS

PWD was higher in the asthma patients than in control subjects (31.53 ± 3.18 vs. 30.33 ± 3.53, p = 0.023). However, there was no statistically difference between the groups in terms of CQTD measurement (43.9 ± 1.84 vs. 43.63 ± 2.06, p = 0.385). In comparison between control group and asthma subgroups (mild, moderate and severe), there was a statistically significant difference among these four groups in terms of PWD (p = 0.017). Subgroup analyses showed that this difference was mainly due to patients with severe asthma.

CONCLUSIONS

PWD value was elevated in asthmatic compared to the control group. The CQTD was not statistically significant between the groups. These results indicate that the risk of developing AF in asthmatic patients might be higher than in the normal population. Ventricular arrhythmia and sudden cardiac death risk may not be high in asthmatic patients.

The relationship between anogenital distance and lifelong premature ejaculation

BACKGROUND

Many diseases have been associated with anogenital distance, as an indicator of intrauterine androgen exposure.

OBJECTIVES

The aim of this study was to investigate the association between lifelong premature ejaculation and anogenital distance.

MATERIALS AND METHODS

The study included 140 participants: 70 with lifelong premature ejaculation (group 1) and 70 without any ejaculatory complaints (group 2). Premature Ejaculation Diagnostic Tool and stopwatch intravaginal ejaculatory latency time were recorded from all participants in order to evaluate ejaculatory function. Two variants of anogenital distance were measured: anogenital distance (from anus to the posterior base of the scrotum) from anus to the posterior base of the scrotum and anogenital distance (from anus to the cephalad insertion of the penis) to the cephalad insertion of the penis. We compared differences between groups and correlations between anogenital distance variants and patients' characteristics.

RESULTS

The groups were similar in terms of age, BMI, and total testosterone levels. The mean anogenital distance (from anus to the posterior base of the scrotum) scores were 59.45 ± 10.76 vs. 55.02 ± 10.13 (p = 0.01), and anogenital distance (from anus to the cephalad insertion of the penis) scores were 128.37 ± 22.2 vs. 126.78 ± 16.21 (p = 0.63) in groups 1 and 2, respectively. Significant correlation was observed between anogenital distance (from anus to the posterior base of the scrotum) and Premature Ejaculation Diagnostic Tool scores (r = 0.199, p = 0.019) and intravaginal ejaculatory latency time (r = -0.185, p = 0.028). There were no statistically significant differences between anogenital distance (from anus to the posterior base of the scrotum) scores and total testosterone levels and between anogenital distance (from anus to the cephalad insertion of the penis) and Premature Ejaculation Diagnostic Tool scores or intravaginal ejaculatory latency time.

CONCLUSIONS

These results suggest that longer anogenital distance is associated with higher possibility of lifelong premature ejaculation. However, further studies are needed to confirm our results.

Controlled release of doxorubicin from polyethylene glycol functionalized melanin nanoparticles for breast cancer therapy: Part I. Production and drug release performance of the melanin nanoparticles

In this study, polyethylene glycol (PEG) conjugated melanin nanoparticles (MNPs) were prepared (PEG-MNPs). A model chemotherapy drug, doxorubicin (DOX), was loaded into the PEG-MNPs with varied concentrations (0.125, 0.250, 0.500 mg/mL). TEM images showed that, DOX-PEG-MNPs are spherical-shaped and 15 ± 2.2 nm in diameter. FTIR spectroscopy analysis demonstrated that MNPs were successfully modified with PEG. The UV-Vis spectroscopy results showed that the drug loading capacity of MNPs was 0.7 mg/ml of DOX in 2 mg/ml of PEG-MNPs. The time course data showed that, the release behavior of DOX from MNPs was primarily diffusion controlled. In vitro cytotoxicity assays demonstrated that MNP and PEG-MNP did not show any toxic effect on mouse fibroblast cells while DOX-PEG-MNP was able to inhibit the proliferation of human breast cancer cells. The results confirm that the application area of MNPs in controlled and prolonged drug release could be extended to the different types of cancer therapeutics.

Utilization of glial fibrillary acidic protein and galectin-3 in the diagnosis of cerebral infarction patients with normal cranial tomography

OBJECTIVE

It was aimed to determine whether levels of glial fibrillary acidic protein (GFAP) and Galectin-3 contribute to the diagnosis of cerebral infarction in clinically suspected ischemic stroke patients with normal computerized cranial tomography (CCT) in the emergency department.

MATERIALS AND METHODS

In this study, patients above the age of 18 years who presented to emergency department of Firat University between December 2011-November 2012 and were diagnosed with cerebral infarction were included. Exclusion criteria were as follows: symptom onset exceeding 24 hours, trauma, pregnancy, acute myocardial infarction, acute pulmonary embolism, chronic renal insufficiency and steroid therapy.

RESULTS

A total of 90 participants, forty patients with ischemic infarction who were diagnosed by CCT and clinical findings (Normal CCT in 17 patients and CCT with an area of infarction in 23 patients) and fifty healthy controls, were included in this study. Compared with the control group, levels of Galectin-3 and GFAP were found to be significantly increased in patients with ischemic infarction (P <0.001 and P = 0.01, respectively). It was found that levels of Galectin-3 and GFAP were significantly increased in ischemic stroke patients with normal CCT compared to the control group (P = 0.04 and P = 0.025, respectively). In ROC curve analysis, we detected %70.59 sensitivity and 70% specificity (AUC = 0.684, P = 0.0213, 95% CI: 0,558-0.792) with a cutoff value of 33.24 ng/ml for GFAP and 76.47% sensitivity and 68% specificity (AUC = 0.734, P = 0.0048, 95% CI: 0.611-0.834) with a cutoff value of 0.84 ng/ml for Galectin-3. No correlation was found between National Institutes of Health Stroke Scale (NIHSS) scores and Galectin-3 and GFAP (r = 0.251, P = 0.118 and r = 0.164, P = 0.311, respectively).

CONCLUSION

The levels of Galectin-3 and GFAP were increased in acute ischemic stroke patients.

Comparison of effectiveness of the home exercise program and the home exercise program taught by physiotherapist in knee osteoarthritis

BACKGROUND

Home-based exercise therapy is effective in reducing pain and improving function in adults with osteoarthritis of the knee.

OBJECTIVE

To investigate and compare the effectiveness of the home exercise program and the home exercise program taught by a physiotherapist in knee osteoarthritis.

METHODS

The study was conducted with 80 patients with knee osteoarthritis. The patients were randomized into two groups. The first group was given the home exercise brochure by the orthopedist, while the second group did home exercises under the guidance of the physiotherapist. The goniometer for the range of motion (ROM) of the knee, Myometer for evaluation of the quadriceps and hamstring muscles strength, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Short Form Health Survey (SF-36) were used for evaluation.

RESULTS

Statistically significant improvements were found in the post-treatment ROM, VAS, quadriceps and hamstring muscles strength, WOMAC and SF-36 values in both groups (p< 0.05). When the change values were compared, the evaluation results of group II were better than group I statistically (p< 0.05).

CONCLUSIONS

This study proved that home exercises taught by a physiotherapist were more useful for patients with knee osteoarthritis. When the home exercise program is implemented, a new role is created for a physiotherapist.