The aim of this study is to evaluate the density of retinal vascular structures and their relationship with disease duration and activity in patients with axial spondylarthritis (axSpA) using optical ...coherence tomography angiography (OCT-A). In this case–control study, 56 eyes of 29 axSpA patients and 61 eyes of 31 healthy controls (HCs) were evaluated using OCT-A. The capillary plexus density (CPD) of vessels in the parafovea and perifovea regions was evaluated from the superficial capillary plexus (SCP) and deep capillary plexus (DPC) flow areas. The CPD of vessels in the fundus was evaluated from the radial peripapillary capillary (RPC) flow area. Foveal avascular zone (FAZ) size was measured. In axSpA patients and HCs, the mean CPD (%) in the whole retina was 50.75 ± 2.59 and 52.43 ± 2.10 (
p
< 0.001) in SCP, 54.00 ± 5.83 and 58.37 ± 4.36 (
p
< 0.001) in DCP, and 50.13 ± 2.32 and 50.13 ± 2.26 (
p
= 0.984) in RPC flow areas, respectively, and the mean FAZ (mm) was 0.275 ± 0.10 and 0.294 ± 0.07 (
p
= 0.281), respectively. A significant negative correlation was detected between the CPD and disease duration in the parafovea (
ρ
: − 0.306,
p
= 0.022), parafovea superior-hemi (
ρ
= − 0299,
p
= 0.025), parafovea inferior-hemi (
ρ
= − 0.270,
p
= 0.044), parafovea temporal (
ρ
= − 0.349,
p
= 0.008) and parafovea nasal regions (
ρ
= − 0.356,
p
= 0.007) in the DCP flow area. CPD was found to be lower in the macula, while similar in the fundus region in axSpA patients compared to HCs. The decrease in CPD was correlated with disease duration, but not with disease activity in axSpA. Small vessel structures may be affected in axSpA. OCT-A may be used to detect subclinical vasculitis in axSpA patients.
Background and objectiveAccurate identification of parathyroid adenoma (PA) is essential for minimally invasive treatment of primary hyperparathyroidism (PHPT). The aim of this study is to evaluate ...the results of parathyroid hormone (PTH) assay in aspirates of suspicious neck lesions and to clarify its reliability in determining whether the lesion is of parathyroid origin.MethodsA total of 134 lesions (104 imaging-suspected PA and 30 concomitant thyroid nodules as a control group) of 101 patients were retrospectively analyzed. Patients with positive, negative, or never scintigraphy were included in our study. Ultrasound (US) was performed again and US-guided tissue fine needle aspiration with PTH washout (PTH-WO) was performed from suspicious lesions. A PTH-WO level higher than the patient's serum PTH levels is proposed for a positive test, and a PTH-WO level lower than the upper limit of the laboratory PTH level is proposed for a negative test. A definitive diagnosis was made postoperatively histopathologically.ResultsPTH-WO levels (median (IQR)) were significantly higher in the positive group (n = 93, 5000 (1600) ng/L) compared to the negative group (n = 11, 17 (13.1) ng/L) and thyroid nodule aspirate group (n = 30, 14 (4.3) ng/L) (p < 0.001). Among 93 PTH-WO-positive lesions, 42 lesions (45.1%) were not identified by parathyroid scintigraphy (PS), 20 (21.5%) lesions were suspiciously PS, and 33 lesions (35.4%) were negative or suspicious by first US findings. Of the 93 patients localized with PTH-WO, two were cystic PAs ablated by aspiration. The final pathology result of 91 operated patients proved PA. The sensitivity, specificity, negative predictive value, and positive predictive value of the PTH-WO were observed as 1.00, 0.82, 0.09, and 0.91, respectively.ConclusionComprehensive repeated US and PTH-WO from the lesion increase the accurate localization of PAs. PTH-WO is a highly reliable method for differentiating parathyroid lesions from other cervical lesions.
The number of cases of coronavirus disease-2019 (COVID-19) globally is over 225 million, and disease-related deaths are over 4 million. The type, prevalence, and antibody susceptibility of the virus ...variants of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) and the vaccination rate and coverage are considered critical factors in the progress of COVID-19. We aimed to compare the clinical and laboratory parameters of the patients hospitalized due to COVID-19 in pre-vaccination and post-vaccination periods. We conducted this retrospective cross-sectional study in a tertiary clinic in Turkey. The files of the patients over the age of 18, whose real-time polymerase chain reaction (RT-PCR) tests were positive and who were hospitalized before (November-December 2020, Group 1) and after (March-April 2021, Group 2) COVID-19 vaccination were scanned. Patients’ demographical data, clinical severity, laboratory parameters, thorax computed tomography involvement, and mortalities were recorded. The obtained data were compared among the groups. 601 patients (344 male, 57% and 257 female, 43%) were included in the study. It was observed that the patients in the Group 2 were younger (60.71 ± 14.06 vs. 66.95 ± 14.57, p < 0.001), and a significant decrease in mortality 83 (28.6%) vs.139 (44.6%), p = 0.001 were observed in Group 2. The number of patients who needed ventilatory support and the rate of pulmonary involvement was lesser in Group 2, but the difference was non-significant. C-reactive protein, D-dimer, procalcitonin levels were significantly lower in Group 2 patients. Our study shows that the age and mortality of hospitalized COVID-19 patients decreased significantly after vaccination. An increase in the number of booster doses in individuals with advanced age (age > 75) and comorbidity (especially malignancy) may contribute to the control of the disease and immunity in this population.
To measure the retinal capillary density quantitatively with optical coherence tomography angiography (OCTA) in patients with rheumatoid arthritis (RA) and healthy controls (HCs), and to evaluate the ...relationship between OCTA findings and RA disease activity.
In this cross-sectional study, 106 eyes of RA patients and 71 eyes of HCs were evaluated. RA patients were divided into inactive (DAS28 < 3.2) and active (DAS28 ≥ 3.2) subgroups. Retinal capillary plexus density (CPD) was obtained from the superficial capillary plexus (SCP), deep capillary plexus (DCP), and radial peripapillary capillary (RPC).
In RA patients and HCs, the CPD (%) was 50.99 ± 3.30 and 52.08 ± 2.36 (
= .013) in the SCP, 55.65 ± 5.73 and 57.53 ± 4.60 (
= .019) in the DCP, and 49.98 ± 2.25 and 49.93 ± 2.25 (
= .947) in the RPC blood supply regions, respectively. In inactive and active RA patients, the CPD (%) was 51.01 ± 2.92 and 50.97 ± 3.73 (
= .947) in the SCP, 55.02 ± 5.70 and 56.40 ± 5.74 in the DCP (
= .229), and 50.34 ± 2.23 and 49.55 ± 2.22 (
= .079) in the RPC blood supply regions, respectively. DAS28 was negatively correlated with CPD in RPC blood supply region (Rho = -0.272,
= .006).
In RA, retinal CPD in the macula is lower than HCs. Although retinal CPD is not generally different in active and inactive RA patients, capillaries in the optic disc may be affected by disease activity.
HIV infection can manifest itself in many different clinical situations. In a pandemic such as COVID, when fever is of diagnostic importance and manifests itself with different clinical pictures, it ...is very difficult to distinguish the true cause of high fever. In this case report, we shared the process of diagnosing HIV infection in a patient with type 1 diabetes who presented with fever and neurological symptoms under pandemic conditions.
Heart failure is a disease that may present with various presentations depending on different etiological factors. External pressure on the heart is one of the rare causes that can cause heart ...failure. Here, we presented a 73-year-old female patient with inoperable endometrial cancer who developed heart failure due to hiatal hernia compression.
Objective: Kidney transplantation is one of the most important treatments in end-stage renal disease (ESRD). We aimed to share our experiences in 60 (57 deceased donors, 3 living donors) kidney ...transplantation cases performed in our center between July 2017 and August 2020. Material and methods: The demographic data of 60 patients with kidney transplantation performed in our kidney transplant center were evaluated in terms of causes and duration of renal failure human leucocyte antigen (HLA) tissue compatibility, immunosuppressive protocol used, antimicrobial agents, rejection status, graft loss, patient loss, postoperative surgical complications. Results: 57 of our kidney transplants were made from deceased donors and 3 from living donors. The mean age of the patients was 44.66 (23-68) years. Kidney transplantation was performed in 8 patients (13.33%) in the preemptive period. The mean number of mismatches in kidney transplants was 3.95 (2-5) and the mean duration of renal replacement therapy (RRT) was 54.73 (0-270) months. While the mean follow-up period after transplantation was 18.86 (2-37) months, it was observed that the mean cold ischemia time was 742.8 (60-1080) minutes. Serum creatinine levels of 56 patients with functional grafts at the end of the first month 1.39 (0.5-4.9) mg/dL, 54 patients at the end of the sixth month, creatinine levels 1.29 (0.56-5.9) mg/dL, The creatinine levels of the 52 patients as of October 2020 were 1.37 (0.75-5.16) mg/dL. As surgical complications, hematoma developed in 5 patients (8.33%) and lymphocele in 3 patients (5%). Early graft loss developed in one patient with renal artery embolism and two patients with renal vein thrombosis, while chronic rejection developed in two patients. We performed a deceased kidney transplant again 14 months later in a patient who developed graft loss in the early period due to renal vein thrombosis. The kidney inserted later is functional in the 10th postoperative month. One of our patients died due to rhino-orbital mucor mycosis in the postoperative 2nd month, and one patient due to the development of sepsis due to infection in the hip prosthesis in the postoperative 6th month, while another patient died due to myocardial infarction in the postoperative 2nd month. Conclusion: As a result, our kidney transplant center is in development. Our results obtained from 60 kidney transplants, almost all of which were performed from deceased donors, seem to be compatible with the literature. More detailed results can be obtained with the long-term follow-up results and the increase in the number of living donor transplants.
The correct diagnosis of acute aortic syndrome complicated by neurologic symptoms is essential. Performing thrombolytic therapy for acute-stage cerebral infarction would probably be the reason for ...fatal outcomes. We herein report the case of a 63-year-old man who presented with left hemiparesis and paraparesis. An acute myocardial infarction was excluded by electrocardiography and blood tests. Head computed tomography (CT) showed no remarkable findings. Although there was no chest pain, it was found in CT-angiography that he has an intramural hematoma in the ascending aorta and a severe dissection in the descending aorta. Aortic dissection may mimic acute stroke, in order to make the right decision about the treatment of acute aortic syndrome with neurologic complications, the benefits and risks should therefore be considered in individual patients.
Objectives
Low fetuin-A levels in hemodialysis patients can be associated with development of vascular and valvular calcifications. The mechanisms underlying vascular and valvular calcifications are ...multifactorial. There are a few studies showing the relationship between low fetuin-A levels and valvular calcification after kidney transplantation. We aimed to evaluate the association between serum fetuin-A levels and valvular calcification in kidney transplant recipients.
Methods
The cardiac valvular calcification was assessed by echocardiography in 56 recipients. Patients were divided into two groups as those with (
n
= 11) and without (
n
= 45) aortic and/or mitral valve calcification. The extent of valvular calcification was visually assessed according to the standard visual score method: moderately (multiple larger spots) and heavily calcified (extensive thickening and calcification) of all cusps. Serum fetuin-A levels were measured.
Results
The demographic features of both groups were comparable. There was no significant difference between regular physical exercise (63.6% vs. 55.6%), obesity (18.2% vs. 17.8%), abdominal obesity (54.5% vs. 46.7%), smoking (0% vs. 13.3%), hypertension (63.6% vs. 68.9%), left ventricular hypertrophy (45.5% vs. 33.3%) and diabetes mellitus (9.1% vs. 20%) ratios in groups with or without valvular calcification, respectively (
p
> 0.05). Fetuin-A levels of both groups did not differ. Fetuin-A levels positively correlated with serum creatinine (
r
0.326,
p
= 0.014), and negatively correlated with estimated glomerular filtration rate (
r
− 0.297,
p
= 0.026).
Conclusions
We could not find a relationship between serum fetuin-A levels and valvular calcification in kidney recipients. In this population, further studies are needed to assess the role of serum fetuin-A in valvular calcification.
Sarcoidosis is a chronic multisystemic inflammatory disease of unknown etiology, often associated with pulmonary involvement and characterized histopathologically by non-caseating granulomatous ...lesions. In this report, we aimed to present a 32-year-old patient who was hospitalized with a pre-diagnosis of cellulite, diagnosed with sarcoidosis based on skin lesions, and whose symptoms completely regressed with sarcoidosis treatment.
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