Makale Arama

 Celiac disease is the only life-long continuing food intolerance. This intolerance, caused by gluten, endamages the structure of small intestine and prevents the absorption of nutritional elements. Celiac disease is usually related with other auto-immune diseases. Rate of this disease in our country is increasing in time. It can be seen in people of different ages and different clinical findings. In our day, the most efficient way of treatment is removal of gluten from daily diet. Gluten-free diet that step in treatment phase, affects the living of individual in a period in which growth and development is most rapid. By applying the gluten-free diet strictly, the risk of complications like low bone mineral density and intestine malignite related with the disease, can be decreased. However, it is not always easy to apply and keep track of gluten-free diet by family or child. Moreover, gluten-free diet can cause excess of some nutritional elements (saturated fat), gaining high calorie, and poorness of some nutritional elements (fiber, folic acid, vitamin B ₁₂, iron, zinc, magnesium). Particularly, gluten-free products, when compared with their gluten-including equivalents, have less magnesium, fiber, and folic acid, as well as they are far more expensive. It is determined that a lot of patient considered "resistant" to diet treatment are also eating gluten-including food. Therefore, gluten-free diet should be planned and followed well, and family and child should be educated. This editted article is about, celiac disease, diet treatment for celiac disease, principles of the diet treatment, concordance to the diet, and the factors that effects this concordance.

Objective: The aim of our study is evaluate the association between serum vitB12 levels at time of diagnosis and clinical and laboratory signs in multiple myeloma patients.

Material and Methods: Patients were divided into two groups; those had low and normal levels of vitB12. Groups were analized by using independent simple T, Mann Whitney U and chi-square tests considering by distrubition characteristics of data.

Results: Two hundred-and-twelve patients' records were examined retrospectively. Forty-one (32%) patients had low vitB12 levels. In patients with low vit B12 levels, bone marrow plasma cell ratios were also significantly lower than those found normal vit B12 levels (median %30 vs %50, respectively) (p: 0,024). There was no statistically significant difference between the two groups in terms of age, lytic bone lesion numbers, and serum levels of total protein, lactate dehydrogenase, ß2-microglobulin, calcium, creatinin, albumin. However, 11 patients (%26,8) in low vitB12 group had anemia, while 44 (%50,5) patients in normal vitB12 group had. So, anemia was more often in vitamin B12 normal group patients (p: 0,019). No difference was found in terms of myeloma ISS and R-ISS stages in two patient groups.

Conclusions: Bone marrow median plasma cell ratio was also low in the group with low vit B12 levels. Our data could not show its clinical reflection. Further studies with larger groups are required to evaluate the response to treatment, survival and recurrence rate.

Aim: JAK2 V617F mutation is determined in 95% of polycythemia vera (PV) patients. However, this test is a high-cost and time-consuming examination. In this study, a rapid, inexpensive and easily available test that can be used in addition to JAK2 V617F mutation is planned to exclude secondary polycythemia (SP).

Patients and Methods: A total of 39 PV patients and 51 SP patients, who were diagnosed according to 2016 diagnostic criteria of World Health Organization, have been included in this study. Demographics, physical examination findings and laboratory results of patients have been determined. A statistical analysis was performed between these two groups.

Results: In PV group, serum vitamin B12 level, erythrocyte count, leukocyte count, neutrophil count, platelet count and lactate dehydrogenase levels were determined to be statistically significantly higher than SP group. Serum vitamin B12 level above 343 pg/mL has been determined as the threshold value for the differentiation of PV from SP.

Conclusion: High serum vitamin B12 level was determined to be associated with PV. However, there is a need for prospective studies performed with larger patient series supporting the data obtained in this study in order for serum vitamin B12 level to be used in the differential diagnosis of primary and secondary polycythemia.

\r\nAim: Diabetes is a serious health problem which has increased rapidly in recent years and causes numerous complications. Vitamin D levels may be a contributing factor to the glycemic control. The aim of the study was to evaluate the relationship between vitamin D levels and glycemic control in diabetic patients.

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\r\nMethods: 330 patients with Diabetes Mellitus type 2, who were admitted to our outpatient clinic between September 2015 and June 2016, were included in the study. Patients were stratified into three groups according to the vitamin D levels; ≤20 ng / mL, between 20-30 ng / mL and ≥30 ng / mL. These groups were compared in terms of patients' socio-demographic characteristics, blood parameters, diabetes-related characteristics, and diabetes treatment. Patients were categorized into two groups according to the HbA1c levels;  ≤7% and  ≥7%. The same parameters and vitamin D values were compared between two groups. All data were recorded into the SPSS version 21. Participants' demographic datas, percentage and frequency values, were tabulated. A p value  of <0.05 was the limit for statistical significance. 

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\r\nResults: A total of 330 patients (51.2% females, mean age 53,79±10,2 years) with diabetes were interviewed. When evaluated in terms of body mass index, 13.9% (n = 46) were classified as normal, 34.5% (n = 114) were overweight and 51.5% (n = 170) were obese. When patients were divided into groups according to vitamin D levels, 286 (86.7%) patients with a vitamin D level below 20 ng / mL and 44 patients (13.3%) with a level above 20 ng / mL were detected. When patients were compared according to vitamin D levels, there was a negative correlation (-r = 0.357, p <0.001, -r = 0.344, p <0.001, respectively) between vitamin D levels and patients' fasting blood glucose level (FBG) and postprandial glucose level (PBG). There was a negative correlation (-r = 0.433, p <0.001) between vitamin D levels and HbA1c levels. Negative correlation (-r = 0.131, p <0.05) was found between vitamin D and triglyceride levels.

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\r\nConclusion: Vitamin D levels were significantly lower in patients with HbA1c> 7% (n = 191) when compared to those with HbA1c <7 (n = 95) (p <0.001). Vitamin D levels may be important in glycemic control of diabetic patients.

Impression cytology (IC), using cellulose acetate filter papers is a simple, noninvasive technique that aids in the diagnosis of several disorders of the ocular surface.These disorders include ocular surface squamous neoplasia, dry eye syndrome, limbal stem-cell deficiency, specific viral infections, vitamin A deficiency, allergic disorders, conjunctival melanosis, and malignant melanoma. IC has been used increasingly to assist in diagnosis of ocular surface disease, improve our understanding of the pathophysiology of ocular surface disease, and provide biomarkers to be used as outcome measures in clinical trials.

Aim: We aimed to evaluate the relationship between magnetic resonance (MR) enterography and diffusion magnetic resonance imaging (MRI) investigations in inflammatory bowel disease (IBD) patients during active inflammation and remission phases. 

Patients and Methods: We included patients diagnosed with IBD between 01.12.2015-31.08.2016 at our hospital. 47 patients were included; 30 were male (63.8%) and 17 were female (36.2%). Thirty two (68.1%) of them had ulcerative colitis and 15 (31.9%) had Crohn’s disease. Standard institutional sequences for upper and lower abdomen scan included: sagittal and axial T2 TRUFI, axial and coronal fat suppressed T2 TRUFI and coronal and axial T1 VIBE following intravenous (at 60 seconds) contrast medium administration. First group of patients (n=10) had MRI investigations both at active and remission phases, whereas in the second group of patients (n=37) apparent diffusion coefficient (ADC) values, bowel wall thickness and contrast enhancement grades were compared between actively inflamed and non-inflamed bowel segments.

Results: A statistically significant difference was found regarding ADC values and bowel wall thickness measurements in the first group of patients when compared between active and remission phase MRI investigations (p=0.005). Bowel wall contrast enhancement degree did not differ between active and remission phases in the first group (p=0.059). In the second group, there was a statistically significant difference between active and normal bowel segments regarding ADC values, bowel wall thickness and contrast enhancement (p<0.001).

Conclusion: MR enterography and diffusion MRI may be beneficial to determine the degree of inflammation and response to treatment in IBD patients.

Sneddon syndrome(SS) is a rare, progressive vasculopathy with recurrent ischemic attacks. There is no specified treatment recommendation, various treatment methods such as anticoagulants, antiaggregants, and immunosuppressions are recommended. A 44-years-old woman who applied with a temporary numbness on her right side and speech disorder. In her neurological examination, there was central facial asymmetry on the right and mild dysarthria in his speech. In cranial diffusion MR, there was an acute ischemic change in the left lentiform nucleus and at the head of the caudate nucleus. In cranial MR, there were perivascular ischemic gliotic changes and diffuse cerebral cortical atrophy. The patient underwent a skin biopsy to have livedo reticularis-like lesions on both legs. Skin biopsy was compatible with vasculopathy. Due to the ischemic attack, periventricular ischemic changes, and livedoreticularis, the patient was accepted as SS. Since the antiphospholipid antibodies (APL) were negative, that she was followed up with dual antiplatelet therapy. There was no new attack within a year with dual therapy. Dual antiplatelet therapy may be used in SS patients with recurrent ischemic events and negative APL.                                                                                                                                           

\r\n Introduction: Multipl myeloma is a disease of unknown pathogenesis. Although there was a different

\r\n hypotheses on the subject, recently mutations in the pathway of apoptosis come to the fore. PUMA may play a role in apoptosis, bound or

\r\n unbound p53. The role is regulated by various signals of transcription factors. In this study; the expressions of p53 and PUMA in bone marrow hematopoetic cells of

\r\n have been worked and the relationship between myeloma pathogenesis with p53- PUMA was

\r\n searched.

\r\n Method: The expression of p53 and PUMA was evaluated using immunohistochemistry. The

\r\n procedure was carried out using specific antibodies against p53 and PUMA. Bone marrow

\r\n biopsies of MM patients at the time of diagnosis (n=31) were included in the study group.

\r\n Bone marrow biopsies from individuals who had normal hematopoiesis (n=12) were included

\r\n as control. After staining, strength was calculated of each positively staining

\r\n cells.

\r\n Findings: The percentage of cells showing PUMA expression was significantly higher in

\r\n bone marrows of MM patients as compared to normal bone marrow samples (p=0.000). We

\r\n found a correlation between the percentage of plasma cells with staining prevalence of

\r\n PUMA, but it was not statistically significant (p=0.385). There was no correlation between

\r\n the stage of the disease with PUMA expression.

\r\n Results: Our results showed that specially PUMA expression is significantly higher in bone

\r\n marrow cells of MM patients compared to healthy controls. Higher positivity of PUMA

\r\n suggested that, PUMA induced nongenotoxic reasons at the time of diagnosis. The lack of

\r\n p53 and PUMA positivite suggests that, apoptosis play a role in myeloma pathogenes

Objective: Familial hypercholesterolemia (FH) is an autosomal dominant inherited genetic disorder that causes a significant increase in low-density lipoprotein (LDL) cholesterol levels and leads to early coronary heart disease and cardiac mortality. Although this disease has a heterozygous (HeFH) and homozygous (HoFH) form, the incidence of HeFH is reported to be 1: 500, while HoFH is reported to be 1: 1 000 000. This disease is often caused by LDL receptor (most common), apolipoprotein B (Apo B), Proprotein Convertase Subtilisin/Kexin 9 (PCSK9), and LDL receptor adaptor protein (LDLRAP) gene mutations. Patients with FH do not respond well to lipid-lowering therapies such as a statin, and so lipoprotein apheresis is the treatment of choice.

Material and Methods: We compared the results of lipoprotein apheresis in a 20-year-old female patient diagnosed with HoFH with two different methods [double-filtration plasmapheresis (DFPP) and dextran sulfate column (DSC) methods]. 40 lipoprotein apheresis procedures including 20 sessions of DFPP and 20 sessions of DSC were evaluated.

Results: When the two methods were compared the changes in high-density lipoprotein, white blood cells, platelets, potassium, calcium, prothrombin time (INR) and activated partial thromboplastin time values were statistically significant.

Conclusions: In conclusion, our study suggests that it would be more appropriate to choose the apheresis method according to the clinical and laboratory findings of the patient since it shows that two different methods have different effects on serum electrolyte values, hemostasis criteria and leukocyte and platelet counts.

Aim: Atrial fibrillation is a common disorder and is an important cause of thromboembolic events. Recently, direct oral anticoagulant drugs (DOACs) are being used to reduce the frequency of thromboembolic events among these patients. DOACs have several advantages over oral vitamin K antagonists, such as fixed dosage and fewer side effects. However, since the drugs and their affects cannot be monitored directly, difficulties are encountered in assessing drug efficacy and side effects. For this purpose, platelet indices and their relationship with DOACs may be utilized for the prediction of thromboembolic and hemorrhagic events.

Patients and Methods: 301 patients with atrial fibrillation who were using DOACs were included in the study. Platelet indices such as platelet count, platelet distribution volume, plateletcrit, platelet-large cell ratio were evaluated at the first and sixth months. The effect of DOACs on these indices and relationships with bleeding events were investigated.

Results: All groups were similar in regard to baseline platelet indices, except for lower P-LCR value among recipients of rivaroxaban. When post-treatment results were compared, all groups were found to have similar values in all parameters. However, time-bound comparisons revealed that apixaban and dabigatran significantly reduced P-LCR value after 6 months of use.

Conclusion: This study showed that apixaban, rivoraxaban and dabigatran had no effect on platelet count, MPV, PDW, PCT values in whole blood count of patients with non-valvular AF. All characteristics of those with and without hemorrhagic events were also similar of patients with non-valvular AF.

Myotonic dystrophy is the most common muscular dystrophy of adulthood. Neurological manifestation of the disease is typical, however diagnosis could be challenge in patients presentig with predominant cardiac or systemic symptoms. 46 year old male was suffering from presyncope attacks for 16 years, and first examined by a cardiologist. Because of the recent complaints including walking difficulty, he was referred to neurology department. Following a detailed neurological examination and electrodiagnostic workup, he was finally diagnosed myotonic dystrophy type 1. The case highlights the necessitiy of neurological consultation in patients who present with conduction defects, arythmias or cardiomyopathies of unknown origin, accompanied by overt or subtle neurological symptoms. In such patients, neuromuscular disorders should be considered in the differential diagnosis; and in order to provide thorough diagnostic evaluation, multidisciplinary approach is essential.

\r\n Silent thyroiditis and Graves’ disease are autoimmune disorders which are common cause of thyrotoxicosis and should be given different treatments. Anamnesis and physical examination are not sufficient in the differential diagnosis of these two diseases, and advanced examinations such as thyroid scintigraphy, iodine reuptake study and thyroid stimulating receptor antibody could be needed. In this case, we present a patient diagnosed with a silent thyroiditis as a result of a thyrotoxicosis of a patient who was following up due to Graves' disease in remission and we aimed to emphasize the importance of differential diagnosis of these two diseases.