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OBJECTIVES: Treatment response may be variable across organ manifestations of Behçet syndrome (BS). We aimed to determine the frequency of de novo manifestations during adalimumab treatment. METHODS: We conducted a chart review of all BS patients who received adalimumab in our center between 2008 and 2023. Demographic data, reasons for initiating adalimumab, concurrent medications, previous treatments, and outcomes were recorded. We defined de novo manifestations as new BS manifestations that occurred for the first time during treatment with adalimumab. For patients with vascular involvement, a new vascular event at another vessel was also considered as a de novo manifestation. RESULTS: Among the 335 patients, a de novo manifestation developed in 14 (4%) patients. De novo manifestations were vascular involvement in 5 patients, arthritis in 3, anterior uveitis in 2, nervous system involvement in 2, gastrointestinal involvement in 1, and epididymitis in 1 patient. The primary reasons for adalimumab treatment were vascular involvement in 5 patients, uveitis in 4, arthritis in 3, mucocutaneous involvement in 1, and epididymitis in 1 patient. Upon the development of de novo manifestation, adalimumab was switched to another biologic in 4 patients, dose was intensified in 3, colchicine, conventional immunosuppressives, and/or glucocorticoids were added in 5, and topical eye drops were added in 2 patients, leading to remission of de novo manifestations in all patients. CONCLUSION: De novo manifestations were infrequent (4%) among BS patients treated with adalimumab. Of these, 57% were major organ involvement, mainly vascular involvement. None of the patients developed posterior uveitis.
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Most studies of sarcopenia in renal transplant recipients (RTRs) have been hampered by a lack of standardization in the definitions of sarcopenia. In this study, we aimed to investigate the prevalence of sarcopenia and the associated factors in RTRs using the recently proposed criteria of the European Working Group on Sarcopenia in Older People 2018 (EWGSOP2), which included a standardized definition of sarcopenia. We examined 93 consecutive adult RTRs, 46 chronic kidney disease patients, and 46 healthy controls. We assessed the muscle strength with a hand grip test using a dynamometer and with a chair stand test. We used bioimpedance analysis to estimate appendicular skeletal mass using the Sergi formula. Finally, we conducted a 2-minute walking test to assess endurance. Sarcopenia and probable sarcopenia were determined according to the revised criteria of the EWGSOP2. Probable sarcopenia was found in 29 RTR patients (31.2%), of them 14 (15.1%) were diagnosed with sarcopenia. Multivariate logistic regression analysis showed that presence of diabetes mellitus, increased uric acid level, and statin use were risk factors for probable sarcopenia. On the other hand, longer dialysis vintage was a risk factor for sarcopenia in RTRs. We found that probable sarcopenia and sarcopenia were highly prevalent in our relatively young RTRs. We recommend active screening for the presence of sarcopenia in RTRs, especially in the cadaveric ones. Furthermore, caution seems warranted regarding the myopathic side effects in RTRs who use statins.
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Transplante de Rim , Sarcopenia , Adulto , Humanos , Idoso , Sarcopenia/diagnóstico , Sarcopenia/epidemiologia , Força da Mão/fisiologia , Transplante de Rim/efeitos adversos , Diálise Renal , Força Muscular/fisiologia , PrevalênciaRESUMO
OBJECTIVE: Investigate the changes in the characteristics of presentation, in patients with acromegaly over a period of approximately half a century. METHODS: The medical records of patients diagnosed with acromegaly between 1980 and 2023 were retrospectively reviewed. The collected data were examined to assess any changes observed over the years and a comparison was made between the characteristics of patients diagnosed in the last decade and those diagnosed in previous years. RESULTS: A total of 570 patients were included in the study, 210 (37%) patients were diagnosed in the last decade. Patients diagnosed before 2014 had longer symptom duration before diagnosis, advanced age, larger pituitary adenomas, higher incidence of cavernous sinus invasion, and higher GH and IGF-1 levels than those diagnosed last decade (p < 0.05, for all). Furthermore, the patients diagnosed before 2014 had a lower rate of surgical remission (p < 0.001), and a higher prevalence of comorbidities such as diabetes, hypertension, colon polyps, and thyroid cancer at the time of diagnosis (p < 0.05, for all). CONCLUSION: There may be a trend for earlier detection of patients with acromegaly.
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Acromegalia , Adenoma , Neoplasias Hipofisárias , Humanos , Acromegalia/cirurgia , Estudos Retrospectivos , Adenoma/cirurgia , Comorbidade , Neoplasias Hipofisárias/cirurgia , Fator de Crescimento Insulin-Like IRESUMO
OBJECTIVES: Induction treatment in renal transplant is associated with better graft survival. However, intensified immunosuppression is known to cause unwanted side effects such as infection and malignancy. Furthermore, the effects of the routine use of immunosuppressants in low-risk kidney transplant recipients are still not clear. In this study, we assessed the first-year safety and efficacy of induction treatment. MATERIALS AND METHODS: We examined first living donor kidney transplant patients who were on tacrolimus based immunosuppression therapy. We formed 3 groups according to the induction status: antithymocyte globulin induction, basiliximab induction, and no induction. We collected outcome data on delayed graft function, graft loss, creatinine levels, estimated glomerular filtration rates, acute rejection episodes, hospitalization episodes, and infection episodes, including cytomegalovirus infection and bacterial infections. RESULTS: We examined a total of 126 patients (age 35 ± 12 years; 65% male). Of them, 25 received antithymocyte globulin, 52 received basiliximab, and 49 did notreceive any induction treatment. We did not observe any statistically significant difference among the 3 groups in terms of acute rejection episodes, delayed graft function, and first-year graft loss. The estimated glomerular filtration rates were similar among the groups. Overall bacterial infectious complications and cytomegalovirus infection showed similar prevalence among all groups. Hospitalization was less common in the induction-free group. CONCLUSIONS: In low-risk patients, induction-free regimens could be associated with a better safety profile without compromising graft survival. Therefore, induction treatment may be disregarded in first living donor transplant patients who receive tacrolimusbased triple immunosuppression treatment.
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Soro Antilinfocitário , Basiliximab , Imunossupressores , Transplante de Rim , Doadores Vivos , Tacrolimo , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Soro Antilinfocitário/efeitos adversos , Soro Antilinfocitário/uso terapêutico , Basiliximab/efeitos adversos , Basiliximab/uso terapêutico , Inibidores de Calcineurina/efeitos adversos , Inibidores de Calcineurina/administração & dosagem , Função Retardada do Enxerto/imunologia , Quimioterapia Combinada , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto/efeitos dos fármacos , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Transplante de Rim/efeitos adversos , Proteínas Recombinantes de Fusão/efeitos adversos , Proteínas Recombinantes de Fusão/uso terapêutico , Estudos Retrospectivos , Fatores de Risco , Tacrolimo/efeitos adversos , Tacrolimo/uso terapêutico , Fatores de Tempo , Resultado do TratamentoRESUMO
INTRODUCTION: The advent of tyrosine kinase inhibitors (TKIs) was revolutionary in the management of chronic myeloid leukemia (CML). Although TKIs were generally considered to be safe, they can be associated with renal injury. We evaluated the effect of TKIs on renal functions in a cohort of patients with long-term follow-up. MATERIAL AND METHODS: We retrospectively examined patients with chronic phase CML treated with TKIs. We analyzed the estimated glomerular filtration rate (eGFR) of patients from the initiation of TKI to the last follow-up. eGFR values of CML patients were compared to those of patients with stage 1 or 2 chronic kidney disease (CKD). RESULTS: A total of 195 patients with CML and 138 patients with CKD were examined. eGFR decline was 1.556 ml/min/1.73m2/year for patients with CML (P = .221). Patients receiving second-generation TKIs (2GTKI) were estimated to have 0.583 ml/min/1.73m2 higher eGFR value than that of the imatinib group, but it was not significant (P = .871). eGFR of patients who had used bosutinib had a downward trend. Duration of TKI therapy, age, and hypertension were found to be significant factors in eGFR decline for CML patients. Lower baseline GFR was associated with an increased risk of CKD development. CONCLUSION: Imatinib could result in a decline in eGFR which was clinically similar to early-stage CKD patients. We did not observe significant kidney function deterioration in patients receiving 2GTKIs including dasatinib and nilotinib. We recommend close renal function monitoring in patients receiving imatinib, especially for elderly patients with lower baseline eGFR and hypertension.
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Hipertensão , Leucemia Mielogênica Crônica BCR-ABL Positiva , Insuficiência Renal Crônica , Humanos , Idoso , Mesilato de Imatinib , Inibidores de Proteínas Quinases/efeitos adversos , Taxa de Filtração Glomerular , Estudos Retrospectivos , Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Dasatinibe/efeitos adversos , Insuficiência Renal Crônica/etiologiaRESUMO
Fabry disease (FD) is a rare, X-linked inherited lysosomal storage disorder, characterized by the accumulation of globotriaosylceramide (Gb3) due to the deficiency or absence of alpha-galactosidase A. Due to the accumulation of Gb3, cardiac, renal, neurological, and skin manifestations can be observed. Enzyme replacement therapy (ERT) with agalsidase alfa or agalsidase beta is the cornerstone in the management of FD. Both enzymes are clinically effective and widely used. In this study, we present a 19-year-old male patient with FD who had received ERT for almost two and half years without any complications. In January 2021, he was diagnosed with COVID-19 infection. Later, he developed an infusion reaction during his first ERT infusion following the resolution of COVID-19 infection. The patient experienced shortness of breath, shivering, and rash. Despite decreased infusion rate and premedication in repetitive infusion, his symptoms were not resolved. Subsequently, he developed an IgE antibody against agalsidase beta, and his skin prick test was positive. Since IgG positivity against agalsidase beta was also detected, agalsidase beta was replaced with agalsidase alfa. The patient did not experience any allergic reaction with agalsidase alfa. Moderate to severe allergic reactions during ERT infusion should be alarming for IgE development. Furthermore, COVID-19 should be considered a trigger for allergic reaction against ERT in patients with FD.
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COVID-19 , Doença de Fabry , Hipersensibilidade , Masculino , Humanos , Adulto Jovem , Adulto , alfa-Galactosidase/uso terapêutico , Doença de Fabry/complicações , Doença de Fabry/tratamento farmacológico , Resultado do Tratamento , COVID-19/complicações , Hipersensibilidade/tratamento farmacológico , Terapia de Reposição de Enzimas/efeitos adversos , Imunoglobulina E/uso terapêutico , Proteínas Recombinantes/efeitos adversosRESUMO
BACKGROUND: Matrix metalloproteinases (MMPs) play an important role in bone resorption and are regulated by tissue inhibitors of metalloproteinases (TIMPs). We investigated the use of MMP2/TIMP2 and MMP9/TIMP1 ratios as biomarkers of bone resorption in geriatric osteoporosis and evaluated the relationship between osteoporosis and geriatric syndromes. METHODS: This analytical cross-sectional study involved 87 patients (41 with osteoporosis) treated at the geriatric outpatient clinic of a university hospital. The demographic characteristics, comprehensive geriatric assessment scores, laboratory findings, and bone mineral density of the patients were recorded. Serum MMP9, TIMP1, MMP2, and TIMP2 levels were analyzed by enzyme-linked immunosorbent assay (ELISA). RESULTS: We enrolled 41 and 46 patients with and without osteoporosis, respectively. The groups showed no significant differences in MMP2/TIMP2 and MMP9/TIMP1 ratios (p=0.569 and p=0125, respectively). While the basic activities of daily life (BADL) scores in the osteoporosis group were higher than those in the group without osteoporosis, the instrumental activities of daily life (IADL) scores were significantly lower (p=0.001 and p=0.007, respectively). No significant differences were observed in Mini-Nutritional Assessment, Mini-Mental State Examination, and Geriatric Depression Scale scores (p=0.598, p=0.898, and p=0.287, respectively). CONCLUSION: This is the first study to examine the relationship between osteoporosis and several geriatric syndromes, as well as the relationship between osteoporosis and serum MMP, TIMP values, and MMP/TIMP ratios in geriatric patients. Our results showed that osteoporosis causes dependency in both BADLs and IADLs, and that the MMP2/TIMP2 and MMP9/TIMP1 ratios provided no additional benefit in demonstrating bone resorption in geriatric osteoporosis.
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Splenosis describe a clinical entity of autotransplantation after removal of the spleen secon-dary to a traumatic rupture or surgery. A 39-year-old female was referred to thoracic surgery department with complaints of severe chest pain. She had left thoracic and abdominal gun-shot injury that occurred 19 years earlier. Thorax computed tomograhy and thorax magnetic resonance imaging revealed pleural lesions. A video thoracoscopic biopsy disclosed splenosis in the patient. Splenic implants did not change in 6 years. The patient has mild thoracic pain. Thoracic splenosis can occur in patients who underwent abdominothoracic gunshot injury. The implants did not seem to change in long-term follow-up. Thoracic splenosis may occur, persist for years and it mimics pleural tumor after abdominal gun-shot injury and does not seem to necessitate any surgical intervention including diaphragmatic repair.
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Armas de Fogo , Neoplasias Pleurais , Esplenose , Ferimentos por Arma de Fogo , Adulto , Feminino , Seguimentos , Humanos , Esplenose/diagnóstico , Esplenose/etiologiaRESUMO
Mesangial immunoglobulin A (IgA) deposition is the hallmark of IgA nephropathy (IgAN). In some cases, crescentic involvement that might be associated with systemic leucocytoclastic vasculitis is documented. In such cases, the disease is called Henoch-Schönlein purpura (IgA vasculitis). Even more rarely, the coexistence of IgAN and anti-neutrophil cytoplasmic antibody (ANCA) seropositivity has been reported. IgAN might be complicated by acute kidney injury (AKI) due to different causes. Herein we present a patient with mesangial IgA deposition and ANCA seropositivity who developed AKI, haematuria and haemoptysis during the course of coronavirus disease 2019 (COVID-19) disease and was diagnosed with ANCA-associated vasculitis based on clinical, laboratory and radiological findings. The patient was treated successfully with immunosuppressive therapy. We also made a systematic review of the literature to reveal and present the cases with COVID-19 and ANCA-associated vasculitis.
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Platelets have significant role in modulating clot formation. Additionally, emerging data indicates that platelets have considerable roles in inflammation and immune response. Platelets gather at the damaged cite and adhere to white blood cells. Subsequently, they release cytokines and chemokines which are chemotactic for neutrophils and monocytes. Therefore, platelets are necessary for targeting lymphocytes, neutrophils and monocytes to inflammation site. Those interactions enhance inflammation. Moreover, platelets serve as an immune cell by engulfing microbes. Presence of platelets affect prognosis in some bacterial or viral infection and several other diseases.