Amaç: Gelişmiş ülkelerde Diyabetes Mellitüs (DM) tanılı hastaların yıllık giderleri
değerlendirildiğinde giderlerin hastane yatışı ve tedaviler, komplikasyonların tedavisi,
antidiyabetik ilaçlar ve ...ajanlar, doktor ziyaret ücretleri, hemşirelik ve bakım hizmetleri ve acil
servis başvuruları için harcandığı görülmüştür. Bu çalışmada İç Hastalıkları kliniğine yatırılan
hastaların maliyet analizleri planlanlanmıştır.
Yöntem: Bu çalışmada 01.01.2011-30.09.2014 tarihleri arasında İç Hastalıkları kliniğine
yatırılan Tip 1 ve Tip 2 DM tanısı alan hastalar bilgisayar verilerinden taranmıştır. Hastaların
yaş, cinsiyet, yatış süreleri, yıllara göre yatış dağılımı, kaç kez yattıkları, sosyal güvenceleri,
toplam yatış maliyetleri ve birimlere göre yatış maliyetleri gruplandırılarak kaydedilmiştir.
Bulgular: Diyabet tanılı hastaların yıllık giderlerini araştıran birçok çalışma ile birlikte bu
çalışma değerlendirdiğimizde giderler içerisinde ilaç harcamalarının ve laboratuvar tetkiklerinin
yanı sıra komplikasyonların tanısı ve tedavisinin de önemli yer tuttuğunu tespit edilmiştir.
Çalışmada medikal tedavilerin, laboratuvar analizlerinin, yatak ücretlerinin yanında
hemodiyaliz giderlerinin ön planda olması beklenildiği gibi hasta grubunda renal
komplikasyonların sık görülmesiyle açıklanabilir. Bu çalışma, yurtdışındaki benzer çalışmalarla
karşılaştırıldığında hekim vizitlerinin maliyete katkısının oldukça düşük olduğunu saptanmıştır. Sonuç: Tüm elde edilen veriler göz önüne alındığında; giderek daha önemli bir sağlık problemi
olan Diyabetes Mellitüs tedavisinde daha başarılı olmak ve maliyeti düşürebilmek amacıyla
hastaların hastalık ve komplikasyonları hakkında detaylı bilgilendirilmesinin ve düzenli
aralıklarla doktor tarafından takip edilmesinin önemli olduğu kanaatine varılmıştır.
Inflammation, cytokine storm and lung damage associated with COVID-19 can cause the initiation of the thromboembolic process in patients. The 73-year-old male patient applied with sudden-onset ...shortness of breath to the emergency department of our hospital. Physical examination revealed an SpO2 of 80% in room air, respiratory rate of 27/min. As the chest CT scan was compatible with COVID-19, the patient was admitted to the hospital and empirical treatment for COVID-19 was started, comprising of favipravir and dexamethasone. The RT-PCR of SARS-CoV-2 test resulted positive one day later. Due to the D-dimer value that was higher than expected in COVID-19, arterial blood gas compatible with thromboembolism, and the accompanying high lactate level, a CT angiogram was ordered and was compatible with pulmonary embolism, showing partial embolic filling defects in the lobar branches in the inferior lobes, and the lingular branch of the left lung. A closer investigation of pulmonary embolism in high-risk patients during the pandemics, and prescribing anticoagulant therapy starting on especially the first day of symptoms are vital to prevent potential complications of possible thromboembolism.
In COVID-19 disease, the activation of the coagulation system is increasing. Here we presented a case of COVID-19 who developed a hematoma in the pectoral muscle possibly associated with ...anticoagulation therapy.
A 78-year-old male patient who had an indwelling urinary catheter because of benign hyperplasia of the prostate and who had been receiving hemodialysis twice a week due to endstage renal disease was ...admitted to our hospital complaining of three days of purple urine color (Figure 1). His medications included beta blocker, anti-aggregant, erythropoietin, piracetam and calcitriol therapies. A urine analysis was performed; the results were as follows: pH: 8.0, density: 1012, leukocyte esterase: (++), leukocyte: 11/HPF (high power field), erythrocyte: 4/HPF and nitrite: negative. The diagnosis of purple urine bag syndrome (PUBS) was made. Treatment with ceftriaxone 2 g/day intravenously (IV) was started immediately on an empirical basis, and the catheter was replaced. Extended- spectrum beta-lactamase-positive Escherichia coli was isolated in urine culture, and the antibiotherapy was changed to imipenem/cilastatin 250 mg IV twice daily. On the fifth day of treatment, the patient’s urine color returned to normal, and a urine sample was negative for leukocyte esterase.
Amaç: Son dönem çalışmaları C peptitin diyabetik nefropatide yararlı etkileri olduğunu öne sürmektedir. Bu çalışmada tip 2 diyabetes mellitus (T2DM) hastalarında gözlenen mikroalbuminüri ile serum C ...peptit düzeylerinin ilişkili olup olmadığını analiz etmeyi amaçladık.Gereç ve Yöntem: Bu amaçla 184 tip 2 diyabet hastası ve 46 sağlıklı kontrol çalışmaya alındı. Hastaların klinik özellikleri ve rutin biyokimyasal tetkiklerine ek olarak serum C peptit seviyeleri kaydedildi. Serum C peptit normal aralığı 1.1-4.4 olarak kabul edildi. Hastalardan 24 saatlik idrar toplanarak araştırıldı ve 30-300 mg aralığı mikroalbuminuri olarak kaydedildi. Değişkenler arasındaki ilişkiyi ortaya koymak amacıyla Pearson korelasyon analizi kullanıldı.Bulgular: Tip 2 diyabet hastaları sağlıklı control grubu ile karşılaştırıldığında C peptit düzeyleri arasında anlamlı farklılık saptanmadı. Pearson korelasyon analizinde C peptit düzeyleri, insulin ve mikroalbuminuri arasında pozitif korelasyon olduğu görüldü. Bununla birlikte C –peptit ve diğer değişkenler arasında anlamlı bir ilişki bulunmadı.Sonuç: Bu çalışmada serum C peptit düzeyleri ile mikroalbuminüri varlığının ilişkili olduğunu gösterdik. Bulgular C peptitin T2DM hastalarında renal komplikasyonları ile ilişkili olduğunu ortaya koymaktadır
Purpose: Latest studies suggest that C-peptide may have a beneficial biological role on diabetic nephropathy. The aim of this study is to analyze whether there is an association between serum C-peptide level and microalbuminuria in type 2 diabetes mellitus (T2DM).Materials and Methods: We enrolled 184 T2DM patents and 46 healthy subjects in this study. Clinical variables and routine biochemical tests along with serum C peptide levels measured after an overnight fasting. Serum C peptide levels between 1.1 and 4.4 accepted as normal. 24-hour-urine samples were investigated and values between 30-300mgwere recorded as microalbuminuria. Pearson correlation analysis were used to determine associations between continuous variables.Results: C peptide levels were not significantly difference in T2DM patients compared to healthy controls. Serum C peptide levels showed positive correlation with insülin and microalbminuria with the Pearson correlation analysis. However, there was no significant association between other variables and C peptide levels.Conclusion: A correlation was found between microalbuminuria and serum C-peptide in this present study. Findings suggest C-peptide is related with renal complications of T2DM patients.
Objectives: This study aims to report the incidence of inadvertent parathyroid gland removal during thyroidectomies, as documented by pathology
reports, and investigate its association with ...hypocalcemia.
Materials and Methods: The patients who underwent thyroidectomy at our department between 2009 and 2013 were retrospectively reviewed. The
patients who had standard total thyroidectomy were included in the study. Data on patient demographics, surgical reports, experience of surgeons,
anatomical localization of excised parathyroid glands (PG) and laboratory results were evaluated. Patients were divided into two groups according
to the presence or absence of an excised PG in the histopathology report (group P: presence of PG, and group T: absence of PG).
Results: A total of 343 patients were included to study. Of these, 26 patients were in group P, and 317 in group T. Post-operative hypocalcemia was
encountered in 37 patients. Hypocalcemia rates were similar between two groups (p=0.45). Surgical experience was found to decrease the rate of
Inadvertent parathyroidectomy (IP) (p=0.04), however, it wasn’t associated with post-operative hypocalcemia (p=0.72).
Conclusion: IP is an undesirable finding that can be encountered by surgeons. Our findings showed that IP was found to be associated with surgical
experience. However, these results were not associated with post-operative hypocalcemia.
Mycobacterium tuberculozis günümüzde özellikle gelişmekte olan
ülkelerde hala önemli bir halk sağlığı sorunudur. Tüberkülozun
başta akciğer olmak üzere her organı tutabilen bir hastalık olması
ve her ...organda farklı semptomlarla ortaya çıkması hastalığın tanısını
zorlaştırmaktadır. Olguların yaklaşık %1-3’ünü oluşturan tüberküloz
peritoniti sıra dışı prezentasyonları ile ayırıcı tanıda güçlüklere
yol açabilmektedir. Bu yazıda tanı koyma aşamasındaki zorlukları
vurgulamak adına iki tüberküloz peritoniti olgusu tartışılacaktır.
Objective: Breast cancer is the most common cancer in women. The incidence of bilateral breast cancer is 2%–11%. Synchronous bilateral breast cancer is uncommon (1%–2%). Bilateral breast cancer has ...worse prognosis than unilateral cancer. The aim of the retrospective study was to evaluate the incidence and demographic features of synchronous bilateral breast cancer patients in our hospital.Methods: We analyzed 266 breast cancer patients who were treated at our oncology department between January 2010 and December 2013. Five patients had synchronous bilateral breast cancer that was diagnosed at the same time.Results: We determined that five (1.87%) patients had synchronous bilateral breast cancer in this study. Of the five patients, one was a man and four were women. Median age was 53 years (40–64). Two patients were in premenopausal status. One patient revealed a positive family history of first-degree relatives. All of the patients had estrogen receptor positivity and invasive ductal carcinoma histopathology. Neoadjuvant chemotherapy was given to four patients. Only one metastatic patient had palliative chemotherapy. All patients had modified radical mastectomies and postoperative radiation therapy for bilateral breast cancer.Conclusion: Our clinical findings show a correlation with literature knowledge. Synchronous bilateral breast cancer is uncommon, and published data indicates worse prognosis. Hence, patients should be evaluated for the risk of contralateral breast cancer carefully at the same time of diagnosis.
INTRODUCTIONBK virus associated hemorrhagic cystitis(BKV-AHC) is a serious complication observed after allogeneic stem cell transplantation and the current therapeutic options are scarce with ...substantial renal side effects. Although the guidelines recommend intravenous cidofovir application with caution to nephrotoxicity, there are few studies which investigated intravesical administration and reported similar therapeutic results with less renal side effects. METHODSWe administered low dose, daily and consecutive (75 mg/day, for 5 days) intravesical cidofovir to 25 patients with BKV-AHC that developed after (ASCT). RESULTSThe response rate in our cohort was 92% and relapse was not encountered in 84% of the patient population during one year of follow-up. The median BK urine viral load significantly decreased from 260,000,000 IU/mL to 53,000,000 IU/mL after a week of treatment (p = 0.0001). Rise in serum creatinine was observed in 5 patients during treatment and post-treatment nephrotoxicity was seen in only 1 patient. CONCLUSIONSDaily low dose intravesical cidofovir might be an effective treatment option for BKV-AHC after ASCT with favorable less systemic side effects.
Introduction. In this study, we aimed to demonstrate the correlation of FGF-23 levels with bone-mineral metabolism, anemia, and the treatment in dialysis patients. Methods. Eighty-nine patients with ...similar age, gender, dialysis duration, and dialysis adequacy who were receiving hemodialysis replacement therapy for at least 6 months were included in the study. Serum iron, iron binding capacity, ferritin, hemoglobin (Hb), hematocrit (Htc), calcium (Ca), phosphorus (P), intact parathormone (iPTH), and FGF-23 levels were studied. In addition, active vitamin D and phosphate binders calcimimetic therapies that patients have received in the last 6 months were recorded. Results. It was determined that there was a positive correlation between serum FGF-23 values and PTH values (P<0,01) and Ca*P values (P<0,01). A positive correlation was found between serum FGF-23 values and Ca values at a rate of 24,6% (P<0,05) and between P values at a rate of 59,1% (P<0,01). A positive correlation was determined between serum FGF-23 values and hemoglobin (Hb) values (P<0,05) and hematocrit (Htc) values (P<0,05). In multivariate analysis, no significant correlation was found between serum FGF-23 levels and Hb and Htc. Conclusion. The effects of high serum FGF-23 levels on different parameters may be correlated with the development of refractory secondary hyperparathyroidism.
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