Use of lipid-lowering drugs in restricted health access settings: Results from the Trends in Drug Utilization During COVID-19 Pandemic in Turkey (PANDUTI-TR) study.

BACKGROUND: COVID-19 restrictions prompted changes in chronic disease management and lifestyle modifications, potentially altering cardiometabolic indicators and lipid-lowering pharmacotherapy patterns. We aimed to assess lipid-lowering drug (LLD) utilization trends during COVID-19 restrictions. METHODS: We obtained nationwide outpatient drug sales and prescribing data for 01.03.2018-31.12.2022 from IQVIA™ Turkey. We evaluated average monthly LLD consumption, their costs, and quarterly prescribing levels in three periods: "before restrictions" (BfR, 01.03.2018-31.03.2020), "during restrictions" (DuR, 01.04.2020-31.03.2022), and "after restrictions" (AfR, 01.04.2022-31.12.2022). Drug utilization was measured via "defined daily dose/1000 inhabitants/day" (DID) metric. RESULTS: LLD utilization increased from 25.4 ± 3.1 DID in BfR to 36.2 ± 6.8 DID in DuR (p < 0.001), and to 42.6 ± 5.3 DID in AfR (p < 0.001 vs. BfR). Statin consumption significantly rose from 22.0 ± 3.0 DID in BfR to 31.6 ± 6.3 DID in DuR (p < 0.001), and further to 37.6 ± 4.7 DID in AfR (p < 0.01 vs. DuR). High-intensity statin consumption elevated by 115.9% in AfR compared to baseline (p < 0.001). Prescribing of LLDs decreased from 12.5 ± 0.6 DID in BfR to 7.2 ± 1.2 DID in DuR (p < 0.001), later reached 13.6 ± 3.8 DID in AfR (p < 0.001 vs. DuR), with prescribing for ongoing users following similar trend. Expenditure on LLDs increased from €8.4 m ± 0.9 m in BfR to €11.4 m ± 2.0 m in DuR (p < 0.001) and to €12.8 m ± 1.9 m in AfR (p < 0.001 vs. BfR). CONCLUSIONS: This study revealed a surge in consumption of LLDs in Turkey following the onset of the COVID-19 pandemic. This rise might be related to practices facilitating drug access, in addition to potentially greater adherence, or the necessity for more intense pharmacotherapy due to elevated cardiovascular risk.

The effectiveness of a fall detection device in older nursing home residents: a pilot study.

BACKGROUND: Real-world research to evaluate the effect of device technology in preventing fall-related morbidity is limited. This pilot study aims to investigate the effectiveness of a non-wearable fall detection device in older nursing home residents. METHODS: The study was conducted in a nursing home with single-resident rooms. Fall detection devices were randomly set up in half of the rooms. Demographic data, comorbidities, lists of medications, and functional, nutritional, and frailty status were recorded. The residents were followed up for 3 months. The primary outcome was falls and the secondary outcome was all-cause mortality. RESULTS: A total of 26 participants were enrolled in the study. The study group consisted of 13 residents who had a fall detection device in their rooms. The remaining 13 residents on the same floor formed the control group. Participants had a mean age of 82 ± 10 years and 89% of the residents were female. The most prevalent comorbidity was dementia. Two residents from the control group and one resident from the study group experienced a fall event during follow-up. The fall events in the control group were identified retrospectively by the nursing home staff, whereas the fall in the study group received a prompt response from the staff who were notified by the alarm. One resident was transferred to the hospital and died due to a non-fall related reason. CONCLUSION: Device technology may provide an opportunity for timely intervention to prevent fall-related morbidity in institutionalized older adults.

Rome IV Criteria-Defined Irritable Bowel Syndrome in Atopic Patients and the Effect of Anxiety and Depression: A Case-Control Study.

BACKGROUND: Numerous studies report an increased prevalence of irritable bowel syndrome in patients with atopic diseases such as allergic rhinitis, allergic asthma, and chronic urticaria. Both disease groups have a higher incidence of psychological disorders. In this study, we aimed to examine the relationship of irritable bowel syndrome with the presence and severity of allergic diseases and accom- panying anxiety and depression. METHODS: One hundred sixty-two patients (56 with AR, 34 with AA, and 72 with CU) and 43 healthy volunteers were included in the study. Demographic and clinical data, along with disease duration and severity, was analyzed. Irritable bowel syndrome was diagnosed using Rome IV criteria. Hospital Anxiety and Depression Scale was used to evaluate anxiety and depression. All statistical analyses were performed using Statistic Program for Social Sciences 23.0. RESULTS: Irritable bowel syndrome prevalence in the control group was 9.3% and 56% in atopic patients (P < .0001). Hospital Anxiety and Depression Scale anxiety scores of 11 and above increased the odds of IBS approximately 14 times, and independently, the presence of allergic disease increased the odds 10 times. In the allergic patient subgroup, Hospital Anxiety and Depression Scale anxiety scores of 11 and above increased the risk of irritable bowel syndrome approximately 18 times. CONCLUSION: In this first study using Rome IV criteria to examine the relationship of irritable bowel syndrome, allergic diseases, and anxiety and depression, irritable bowel syndrome was more frequent in allergic patients, especially in patients with anxiety. Awareness of a disease cluster where these 3 disease groups intersect will guide clinicians from different disciplines involved in patients' treatment and follow-up.

A comparison of scientometric data and publication policies of ophthalmology journals.

Purpose: This retrospective database analysis study aims to present the scientometric data of journals publishing in the field of ophthalmology and to compare the scientometric data of ophthalmology journals according to the open access (OA) publishing policies. Methods: The scientometric data of 48 journals were obtained from Clarivate Analytics InCites and Scimago Journal & Country Rank websites. Journal impact factor (JIF), Eigenfactor score (ES), scientific journal ranking (SJR), and Hirsch index (HI) were included. The OA publishing policies were separated into full OA with publishing fees, full OA without fees, and hybrid OA. The fees were stated as US dollars (USD). Results: Four scientometric indexes had strong positive correlations; the highest correlation coefficients were observed between the SJR and JIF (R = 0.906) and the SJR and HI (R = 0.798). However, journals in the first quartile according to JIF were in the second and third quartiles according to the SJR and HI and in the fourth quartile in the ES. The OA articles published in hybrid journals received a median of 1.17-fold (0.15-2.71) more citations. Only HI was higher in hybrid OA; other scientometric indexes were similar with full OA journals. Full OA journals charged a median of 1525 USD lower than hybrid journals. Conclusion: Full OA model in ophthalmology journals does not have a positive effect on the scientometric indexes. In hybrid OA journals, choosing to publish OA may increase citations, but it would be more accurate to evaluate this on a journal basis.

Real-world diagnostic value of a nationwide standardized COVID-19 triage chart in Turkey.

BACKGROUND: Effective triage is critical during the coronavirus disease 2019 (COVID-19) pandemic. An appropriate triage plan is crucial to direct suspected COVID-19 cases to a designated area, in order to separate such patients from other patients and staff. OBJECTIVES: To report the diagnostic value of the "Possible Coronavirus Disease 2019 (COVID-19) Case Questioning Guide for Outpatients", a nationwide standard triage chart, and of the individual questions within the triage chart for detecting COVID-19 in patients admitted to our hospital. MATERIAL AND METHODS: A total of 39,681 outpatients admitted to our hospital between April 1 and April 30, 2021, underwent triage questioning. The triage chart consisted of 3 symptom questions and 4 contact and travel questions. Patients who responded "yes" to at least 1 question were referred to the pandemic area; others were considered low-risk and did not undergo routine COVID-19 polymerase chain reaction (PCR) test. RESULTS: Briefly, 3529 outpatients were referred to the pandemic area; among them, 1055 were PCR-positive. Among 36,152 low-risk patients, 94 were PCR-positive. The sensitivity of the triage chart was 91.82%, specificity was 93.58%, positive likelihood ratio was 14.30, and negative likelihood ratio was 0.09. Triage questions were in moderate agreement with PCR results (Cohen's Kappa: 0.429, p < 0.0001). The diagnostic value of the triage chart was mainly attributed to the questions regarding possible COVID-19 infection symptoms rather than contact history. However, the questions included in the triage chart had none to slight agreement with the PCR test results in the pandemic outpatients. CONCLUSIONS: The triage chart has high sensitivity and specificity for discriminating possible COVID-19 cases in all outpatients, but has unsatisfactory diagnostic value for predicting PCR positivity in pandemic outpatients. Therefore, the current triage chart should be used accordingly, i.e., to define possible COVID-19 cases rather than PCR-positive cases. Further studies regarding COVID-19 triage for possible and PCR-positive cases should also focus on the individual diagnostic value of less prevalent symptoms.

The Diagnostic Value of Fluoro-18 Fluorodeoxyglucose (F-18 FDG) PET/CT in Fever or Inflammation of Unknown Origin: A Retrospective Study at a Rheumatology Clinic.

Introduction Further diagnostic procedures are necessary for patients with fever of unknown origin (FUO) and unknown cause of inflammation (inflammation of unknown origin - IUO) for the identification of the definitive diagnosis. The aim of this study was to evaluate the contribution and roles of F-18 FDG PET/CT (fluoro-18 fluorodeoxyglucose-positron emission tomography/computed tomography) in the diagnostic process of patients with FUO/IUO. Methods The data of 58 patients who had F-18 FDG PET/CT scans for FUO/IUO were re-evaluated retrospectively. The relationships between definitive diagnosis and fluorodeoxyglucose uptake and SUVmax (maximum standardized uptake value) were examined. Results  Rheumatic disease was diagnosed in 26 patients (44.5%), malignancy in 20 patients (34.5%), and infectious diseases in six patients (10.3%). The most prevalent rheumatic disease in patients with FUO/IUO was systemic vasculitis (n:10, 17.2%), especially large vessel vasculitis. There were 37 patients (63.7%) with clinically significant true positive fluorodeoxyglucose uptake. True positive fluorodeoxyglucose uptake was significantly higher in patients diagnosed with malignancy (85%, 17/20 patients) compared to other diagnoses. Fluorodeoxyglucose uptake above physiological levels was determined in 15 of the 26 patients (57.6%) diagnosed with rheumatic diseases. Conclusion The results of this study showed that F-18 FDG PET/CT is a useful imaging modality in FUO/IUO patients, who present a challenging diagnostic process for clinicians. In addition to malignancies, the presence of chronic inflammatory diseases, especially early period systemic vasculitis, were diagnosed in these patients.

Distribution of transient receptor potential vanilloid-1 channels in gastrointestinal tract of patients with morbid obesity.

BACKGROUND: Transient receptor potential vanilloid-1 (TRPV1), a nonselective cation channel, is activated by capsaicin, a pungent ingredient of hot pepper. Previous studies have suggested a link between obesity and capsaicin-associated pathways, and activation of TRPV1 may provide an alternative approach for obesity treatment. However, data on the TRPV1 distribution in human gastric mucosa are limited, and the degree of TRPV1 distribution in the gastric and duodenal mucosal cells of obese people in comparison with normal-weight individuals is unknown. AIM: To clarify gastric and duodenal mucosal expression of TRPV1 in humans and compare TRPV1 expression in obese and healthy individuals. METHODS: Forty-six patients with a body mass index (BMI) of > 40 kg/m2 and 20 patients with a BMI between 18-25 kg/m2 were included. Simultaneous biopsies from the fundus, antrum, and duodenum tissues were obtained from subjects between the ages of 18 and 65 who underwent esophagogastroduodenoscopy. Age, sex, history of alcohol and cigarette consumption, and past medical history regarding chronic diseases and medications were accessed from patient charts and were analyzed accordingly. Evaluation with anti-TRPV1 antibody was performed separately according to cell types in the fundus, antrum, and duodenum tissues using an immunoreactivity score. Data were analyzed using SPSS 17.0. RESULTS: TRPV1 expression was higher in the stomach than in the duodenum and was predominantly found in parietal and chief cells of the fundus and mucous and foveolar cells of the antrum. Unlike foveolar cells in the antrum, TRPV1 was relatively low in foveolar cells in the fundus (4.92 ± 0.49 vs 0.48 ± 0.16, P < 0.01, Mann-Whitney U test). Additionally, the mucous cells in the duodenum also had low levels of TRPV1 compared to mucous cells in the antrum (1.33 ± 0.31 vs 2.95 ± 0.46, P < 0.01, Mann-Whitney U test). TRPV1 expression levels of different cell types in the fundus, antrum, and duodenum tissues of the morbidly obese group were similar to those of the control group. Staining with TRPV1 in fundus chief cells and antrum and duodenum mucous cells was higher in patients aged ≥ 45 years than in patients < 45 years (3.03 ± 0.42, 4.37 ± 0.76, 2.28 ± 0.55 vs 1.9 ± 0.46, 1.58 ± 0.44, 0.37 ± 0.18, P = 0.03, P < 0.01, P < 0.01, respectively, Mann-Whitney U test). The mean staining levels of TRPV1 in duodenal mucous cells in patients with diabetes and hypertension were higher than those in patients without diabetes and hypertension (diabetes: 2.11 ± 0.67 vs 1.02 ± 0.34, P = 0.04; hypertension: 2.42 ± 0.75 vs 1.02 ± 0.33, P < 0.01 Mann-Whitney U test). CONCLUSION: The expression of TRPV1 is unchanged in the gastroduodenal mucosa of morbidly obese patients demonstrating that drugs targeting TRPV1 may be effective in these patients.

Bacteria Causing Community-Acquired Urinary Tract Infections and Their Antibiotic Susceptibility Patterns in Outpatients Attending at a State Hospital in Turkey.

Introduction Clinicians should know the frequency and resistance patterns of bacteria that cause urinary tract infections (UTI) to provide patients with appropriate treatment and antibiotic management. However, the frequency of culture reproducing organisms and resistance patterns change in each community. Therefore, these data must be determined locally to make better treatment decisions. Herein, we aimed to determine the frequency of UTI-causing agents and current antimicrobial resistance profiles in outpatients attending our hospital. Methods This retrospective descriptive study included three hundred eight outpatients attending under the diagnosis of UTI between March and October 2020 who had a positive urine culture for bacterial growth. Age, sex, laboratory tests, urinalysis results, microorganisms grown in urine culture, and antibiograms were evaluated from the patients' medical records. Data were analyzed using SPSS version 23.0 (IBM Corp., Armonk, NY) for Windows. Results In urine culture results, Escherichia coli (E. coli) and Klebsiella species are the most commonly detected agents. The growth in 71 (23%) of the 308 cultures was extended-spectrum beta-lactamase (ESBL) positive. In the E. coli growths, the susceptibility rates to fosfomycin, gentamicin, nitrofurantoin, trimethoprim-sulfamethoxazole, and ampicillin were 95.2%, 90.3%, 95.3%, 76.8%, and 49.3%, respectively. The susceptibility of Klebsiella species to gentamicin was as high as 93.7%, similar to that of E. coli, whereas its susceptibility rates to fosfomycin, trimethoprim-sulfamethoxazole, and nitrofurantoin were lower than those of E. coli (76.1%, 48.4%, and 68.4%, respectively). Of the 71 ESBL-positive growths, 52 were E. coli (17.3% of all UTIs), and 14 were Klebsiella species (4.6% of all UTIs). Of the ESBL-positive strains, 88.7%, 81%, and 76.1% were susceptible to fosfomycin and nitrofurantoin, respectively, and 64.9% and 45.7% were sensitive to cefoxitin and trimethoprim-sulfamethoxazole. Conclusion UTIs are among the most common causes of hospital admission and infections for which empirical antibiotic administration is initiated. The increasing rates of ESBL positivity and resistance to antibiotics such as ampicillin, cephalosporins, trimethoprim-sulfamethoxazole, and quinolones, especially in E. coli and Klebsiella strains, which are the most common pathological agents of UTI in our region, have limited the use of these treatments. However, the high susceptibility of E. Coli growths to fosfomycin and nitrofurantoin and susceptibility of Klebsiella growths to gentamicin may make these antibiotics stand out as suitable options for the empirical treatment of UTI in our setting.

An analysis of scientometric data and publication policies of rheumatology journals.

OBJECTIVE: Scientometric indexes, based on citations, may be increased by open access (OA) publishing. We aimed to present the scientometric data of of rheumatology journals and analyze the scientometric data of rheumatology journals according to the OA publication policy. METHOD: Scientometric indexes and bibliometric data of 22 journals were obtained from Clarivate Analytics InCites, Scopus, and Scimago Journal & Country Rank websites. We included journal impact factor (JIF), CiteScore (CS), Hirsch index (HI), Source Normalized Impact per Paper (SNIP), Eigenfactor score (ES), and Scientific Journal Ranking (SJR). We separated the OA publishing policies into full OA and hybrid OA. The US dollar (USD) was used as the requested fee unit. RESULTS: All pairs of scientometric indexes had positive significant correlations. However, a journal in the first quartile of JIF was observed in the second quartile of CS, SNIP, and SJR, and the last quartile of ES and HI. Scientometric indexes of of full and hybrid OA journals were similar, apart from HI, which was higher in hybrid OA journals (p = 0.03, Mann-Whitney U test). However, full OA journal fees were less expensive by a median of 935 USD (p = 0.007, Mann-Whitney U test). CONCLUSION: We recommend that the JIF and HI pair or the ES paired with CS or SNIP be used together to evaluate rheumatology journals. We failed to show that the OA model positively affects the scientometric indexes of rheumatology journals; our results contradict the literature reporting that the OA publication model causes an increase in citations. Key Points •Clinicians should understand the scientometric indexes in rheumatology and if open access publishing affects citations (therefore, scientometric indexes). •The JIF and HI pair or the ES paired with CS or SNIP can be used to express different rankings since they are based on different databases and use different calculation methods. •We show that OA publication does not affect citations or scientometric indexes of rheumatology journals. •When choosing a rheumatology journal to publish OA, rheumatologists should consider individual OA citation patterns and APC charges together.

Changes in ghrelin, substance P and vasoactive intestinal peptide levels in the gastroduodenal mucosa of patients with morbid obesity.

AIMS: The aim of the study was to assess changes in levels of substance P (SP), vasoactive intestinal peptide (VIP) and ghrelin in the gastroduodenal mucosa of obese individuals, which has not been studied before. METHODS: Forty-six patients with a body mass index (BMI) of >40 kg/m2 and 20 patients with a BMI of 18-25 kg/m2 were included in the study. VIP and SP levels in the fundus, antrum and duodenal mucosa were measured in freshly frozen tissues using enzyme-linked immunosorbent assay (ELISA). Fasting levels of ghrelin in blood were also measured with ELISA. Tissue levels of ghrelin were assessed by immunohistochemical staining, and immunoreactivity scores were used for ghrelin evaluation in tissues. RESULTS: Antrum SP levels were higher in the obese group than in the control group. A significant number of obese patients had low VIP levels in the fundus and antrum. Intense ghrelin staining was observed in a limited number of cells in the mucosal area of the gastric fundus that was similar in the control and patient groups. In the antrum and duodenum, ghrelin staining was low in all the samples examined. CONCLUSION: Here, we found that SP levels are increased, while VIP levels are decreased in the antrum of morbidly obese individuals. Previous studies show that SP increases gastroduodenal motility, that VIP slows it down, and that the gastric emptying rate is higher in obese individuals, preventing negative feedback mechanisms upon food intake. Therefore, increases in SP and decreases in VIP levels in the antrum may contribute to obesity by accelerating gastric emptying.

Scientometric Data and Open Access Publication Policies of Clinical Allergy and Immunology Journals.

Introduction The scientific merit of a paper and its ability to reach broader audiences is essential for scientific impact. Thus, scientific merit measurements are made by scientometric indexes, and journals are increasingly using published papers as open access (OA). In this study, we present the scientometric data for journals published in clinical allergy and immunology and compare the scientometric data of journals in terms of their all-OA and hybrid-OA publication policies. Methods Data were obtained from Clarivate Analytics InCites, Scimago Journal & Country Rank, and journal websites. A total of 35 journals were evaluated for bibliometric data, journal impact factor (JIF), scientific journal ranking (SJR), Eigenfactor score (ES), and Hirsch index (h-index). US dollars (USD) were used for the requested article publishing charge (APC). Results The most common publication policy was hybrid-OA (n = 20). The median OA publishing APC was 3000 USD. Hybrid-OA journals charged a higher APC than all-OA journals (3570 USD vs. 675 USD, p = 0.0001). Very strong positive correlations were observed between SJR and JIF and between ES and h-index. All the journals in the h-index and ES first quartiles were hybrid-OA journals. Conclusion Based on these results, we recommend the use of SJR and ES together to evaluate journals in clinical allergy and immunology. Although there is a wide APC gap between all-OA and hybrid-OA journals, all journals within the first quartiles for h-index and ES were hybrid-OA. Our results conflict with the literature stating that the OA publication model's usage causes an increase in citation counts.

Clinical Characteristics and Follow-Up Results of Adrenal Incidentaloma.

It is recommended that adrenal incidentaloma patients should be monitored for radiological changes, increase in size and new functionality that may occur in the future, even if they are benign and nonfunctional at the initial evaluation. Our aim is to evaluate the key clinical characteristics of adrenal incidentaloma patients focusing on changes during follow-up and associated clinical outcomes. A total of 755 patients (median age: 56 years), with an adrenal incidentaloma > 1 cm and underwent functionality tests, were included in the study. Clinical characteristics, functionality status and follow-up durations were recorded. During the course of follow-up, any changes in size and development of new functionality, and clinical consequences thereof were evaluated. In 71.8% of patients, incidentalomas were non-functional. Most frequent functionality (15.8%, n=119) was subclinical hypercortisolemia (SH) [10.9% (n=82) possible autonomous cortisol secretion (PACS) and 4.9% (n=37) autonomous cortisol secretion (ACS)] of all incidentalomas. Frequencies of Cushing's syndrome (CS), pheochromacytoma and primary hyperaldosteronism were 4.9% (n=37), 3.8% (n=29) and 3.7% (n=28), respectively. Adrenocortical carcinoma frequency was 1.5% (n=11). Of 755 patients, 43% (n=325) were followed up regularly more than 6 months. Median follow-up duration was 24 months (6-120). A total of 17 (5.2%) patients, which had non-functional incidentalomas at baseline had developed new functionality during follow-up, of which 15 (4.6%) were SH [13 patients (4%) PACS and 2 patients (0.6%) ACS] and 2 (0.6%) were CS. During follow-up, 24% (n=78) of the patients had an increase in mass size between 5-9 mm, while 11.7% (n=38) of the patients had an increase of ≥10 mm. During follow-up, 4% (n=13) of the patients developed a new lesion with a diameter ≥10 mm on the opposite side. In patients with a follow-up duration of more than 2 years, frequencies of size increase and new lesion emerging at the opposite adrenal gland were higher. 14 patients (4.3% of the patients with regular follow-up) underwent surgery due to increase in size or development of new functionality during follow-up. Our study demonstrated that a necessity for surgery may arise due to increase in size and development of functionality during follow-up period in adrenal incidentaloma patients, and thus continuing patient follow-up, even with wider intervals, will be appropriate.

Publishing in Hematology Journals: A Scientometric and Economic Evaluation.

INTRODUCTION: Herein, we aimed to compare the scientometric data of hematology journals, and compare the publication models, especially the scientometric data of journals with all-open access (OA) and hybrid-OA publication models. METHODS: Data were obtained from Scimago Journal & Country Rank and Clarivate Analytics InCites websites. Fifty-four journals indexed in Science Citation Index (SCI) and SCI-Expanded were evaluated. Bibliometric data and impact factor (IF), scientific journal rank (SJR), eigenfactor score (ES), and Hirsch (h)-index of the journals were obtained. United States dollar (USD) was used as the requested article publishing charge (APC). Statistics Package for the Social Sciences (SPSS, IBM Corp., Armonk, NY) version 23.0 was used for data analysis. RESULTS: As a publication model, Hybrid-OA was the most common. One journal had subscription-only, and two journals had a free-OA model. Nine journals had a mandatory OA with the APC model and 42 journals used a hybrid model. The Median OA fee was 3400 USD. Hybrid-OA journals had a significantly higher median h-index (72 vs. 40, p=0.03) compared to all-OA journals. Other scientometric indexes were similar. When APCs were compared, all-OA journals were median 900 USD lower than hybrid-OA journals (2490 vs. 3400 USD, p=0.019). CONCLUSION: There is a widespread use of the OA publication model in hematology journals. Although hybrid OA journals have higher h-index, other scientometric indexes are similar. All-OA journals are more economically feasible considering a lower median APC. Further scientometric studies for journals in the field of hematology, randomized to follow citation per publication according to the OA model would better shed light on the data in this area.

Hypercalcemia associated with squamous cell carcinoma of renal pelvis: A case and review of the literature.

Renal pelvis squamous cell carcinoma (RSCC) is a rare tumor. It starts with nonspecific symptoms and it is usually at an advanced stage with a poor prognosis at the time of diagnosis. SCC-associated hypercalcemia is a well-known paraneoplastic syndrome; however RSCC-associated hypercalcemia is a rare condition. Our patient is a 57-year-old-male patient with no bone metastases. Based on the literature screening on PubMed Database for paraneoplastic malignant hypercalcemia-associated RSCC, we found a few cases.

Diagnostic value of the late-night salivary cortisol in the diagnosis of clinical and subclinical Cushing's syndrome: results of a single-center 7-year experience.

Late-night salivary cortisol (LNSaC) is an easy-to-use test reflecting the free cortisol level in the serum and does not require hospitalization. Controlled studies reported that LNSaC has a high sensitivity and specificity, but have not set a clearly defined cut-off value to be used in the diagnosis of Cushing's syndrome. In this study, we aimed to evaluate the diagnostic performance of LNSaC in patients with clinical Cushing's syndrome (CCS) and subclinical Cushing's syndrome (SCS). The data of 543 patients, whose LNSaC levels were assessed using electrochemiluminescence immunoassay method, were retrospectively evaluated. The study included a total of 324 patients: 58 patients with CCS, 53 patients with SCS, and 213 patients without Cushing's syndrome (NoCS). The cause of the Cushing's syndrome was hypophyseal in 26 patients (45%), adrenal in 24 patients (41%), and ectopic in 8 patients (14%) in the CCS group. Median LNSaC levels were 0.724 (0.107-33) µg/dL in CCS group, 0.398 (0.16-1.02) µg/dL in SCS group, and 0.18 (0.043-0.481) µg/dL in NoCS group (p=0.001). Accordingly, LNSaC had 89.6% sensitivity and 81.6% specificity at a cut-off value of 0.288 µg/dL in the diagnosis of CCS; and had 80.7% sensitivity and 85.1% specificity at a cut-off value of 0.273 µg/dL in the diagnosis of SCS. In the present study, a lower sensitivity and specificity than previously reported was found for LNSaC in the diagnosis of CCS. Moreover, the diagnostic performance of LNSaC in patients with SCS was close to its diagnostic performance in patients with CCS. Each center should determine its own cut-off value based on the method adopted for LNSaC measurement, and apply that cut-off value in the diagnosis of Cushing's syndrome.

Cystic lateral neck mass: Thyroid carcinoma metastasis to branchial cleft cyst.

Etiologies of lateral cervical masses are complex, most commonly these masses are branchial cleft cysts; however, metastatic thyroid carcinoma should be included in the differential. We report a case of lateral cystic neck mass in a 22-year-old female patient diagnosed as metastatic papillary thyroid carcinoma. The patient was diagnosed after she underwent surgery for branchial cleft cyst. The patient underwent thyroidectomy which revealed multifocal micropapillary thyroid carcinoma with capsular invasion and lymph node metastases. Radioactive iodine treatment was planned. Congenital malformations of the lateral neck may present themselves in the second and third decades of life. Ectopic thyroid tissue within a branchial cleft cyst may give rise to primary papillary carcinoma, as well as branchial cleft cyst may harbor metastases of primary thyroid papillary carcinoma. We classified our patient as a metastasis to the branchial cleft cyst rather than primary papillary carcinoma of the branchial cleft cyst.

Incidental Aluminum Phosphide Poisoning: Case Report and Current Management.

Aluminum phosphide (AlP) is a commonly used cheap rodenticide, insecticide, and fumigant. Most intoxications in the literature are suicidal ingestions, however, AlP may cause incidental inhalational toxicities as well. After ingestion or inhalation, nausea, vomiting, dyspnea and abdominal pain develops within minutes. Hallmark of toxicity is refractory hypotension, cardiac failure and severe metabolic acidosis developing within a matter of hours are the major cause of mortality. In Turkey, AlP tablets are widely accessible and are sold without any restrictions. However, there are few local case reports in the literature. Additionally, incidental AlP intoxications are rarely reported. Herein, we present a 25-year-old male patient incidentally poisoned with AlP. He was found unconscious in a grain storage unit protected by aluminum phosphide tablets. He had hypotension and tachycardia. Arterial blood gas analysis did not reveal metabolic acidosis. He was quickly intubated and admitted to Intensive Care Unit (ICU). Supportive care crystalloid solution, n-acetyl cysteine and norepinephrine infusion was administered. After 36 hours, he was extubated and discharged without any complications. There is no specific antidote or treatment for AlP toxicity. Literature is controversial regarding treatment approach. Inhalational toxicity may occur under extreme conditions, as presented in this case report. Preventive strategies should be considered to reduce incidents. Clinicians should also be aware that AlP is a widely available and highly toxic compound that has no specific antidote and toxicity needs to be urgently treated with best supportive care.

Bone metastases without primary tumor: A well-differentiated follicular thyroid carcinoma case.

Metastases to the bone are the most common malignant bone tumors. Prostate, breast, and lung carcinomas are the most common primaries of bone metastases. Bone metastases show poor prognosis in means of median survival; however, some patients with highly curable tumors such as thyroid carcinoma may benefit from treatment. We report and discuss a unique case of a 70-year-old female patient presenting with arm pain, diagnosed with metastatic well-differentiated follicular carcinoma without a primary tumor in the thyroid.