The effect of systemic sclerosis and its subtypes on ocular anterior and posterior segment parameters.

PURPOSE: To evaluate anterior and posterior segment parameters in the eyes of patients with systemic sclerosis (SSc) and examine the effect of disease and disease subtypes on these parameters. METHODS: This cross-sectional study included 54 eyes of 27 SSc patients and 54 eyes of 27 age- and sex-matched healthy controls. In addition to a complete ophthalmologic examination, all patients were examined using a Scheimpflug camera, specular microscopy, and spectral domain optical coherence tomography. RESULTS: The mean age of the patients was 52.5 ± 11.4 years and 19 patients were female. Anterior chamber volume, central corneal thickness, and central macular thickness (CMT) were significantly lower in the eyes of SSc patients compared to healthy controls (p = 0.01, p = 0.03, and p = 0.006, respectively). When evaluated according to SSc subtype, CMT was lower in diffuse SSc patients (p = 0.001), while mean retinal nerve fiber layer (RNFL) and inferior quadrant RNFL values were lower in limited SSc (p = 0.003 and p = 0.005, respectively). CONCLUSION: In the eyes of patients with SSc, some ocular parameters may show decreases compared to healthy individuals, presumably secondary to disease-related vasculopathy and fibrosis. CMT and RNFL parameters may be affected differently according to disease subtype.

Investigation of factors affecting physical activity level in patients with primary Sjögren's syndrome.

OBJECTIVES: This study aimed to determine physical activity levels and understand the factors influencing an active lifestyle among patients with primary Sjögren's syndrome (pSS). METHODS: Ninety-seven patients participated in this multicentric study. Physical activity levels were assessed using the International Physical Activity Questionnaire-Short Form (IPAQ-SF). The Inflammatory Arthritis Facilitators and Barriers (IFAB) questionnaire was used to evaluate perceived barriers and facilitators to physical activity. RESULTS: Forty-six patients were physically inactive and the rest of them were moderately active. Commonly identified barriers included a lack of motivation, fatigue, and pain. Conversely, knowledge of the health and mood benefits for physical activity emerged as a key motivator. Patients with better scores on facilitators and lower scores on barriers exhibited higher physical activity levels (p < 0.05). Notably, a high level of perceived facilitators of physical activity (odds ratio [OR]: 1.02; 95% confidence interval [CI], 1.00 ­ 1.05) and reduced pain (OR: 0.81; 95% CI: 0.69 ­ 0.95) were linked to an active lifestyle. CONCLUSIONS: This study emphasizes the role of motivation and awareness of the benefits of physical activity for health and mood in driving physical activity for patients with primary Sjögren's syndrome. Tailored physical activity programs that address psychological aspects and disease-related pain, and fatigue should be designed to counter sedentary lifestyles in pSS patients.

Performance of myotonometer in the assessment of skin involvement in systemic sclerosis.

OBJECTIVES: A clinically practical tool to assess skin biomechanical properties rapidly and accurately is still lacking. Our aim was to examine the intra- and inter-observer reproducibility of a myotonometer for objective skin property assessment in systemic sclerosis (SSc), comparing it with the modified Rodnan skin score (mRSS), and distinguishing patients from healthy controls. METHOD: Thirty-four patients (21 limited and 13 diffuse SSc), and 31 age and gender-matched healthy controls were enrolled. Skin tone and stiffness were measured at four different anatomical sites (the forearm, hand, leg, and foot) using a myotonometer. The correlation between the mRSS and skin properties was assessed. Also, hand functionality was evaluated for possible correlations between the variables. The differences in skin properties between dcSSc and lcSSc patients, and healthy controls were assessed using variance analysis. RESULTS: Intra- and inter-examiner reproducibility were excellent (ICC = 0.70 to 0.98) for tone and stiffness except for non-dominant hand tone, which showed good reliability (ICC = 0.64 to 0.74). Stiffness and tone values of the hands, forearms, and feet significantly correlated with mRSS total score (r = 0.40 to 0.71, p < 0.05). Additionally, tone and stiffness of the hands and forearms moderately correlated with hand function (p < 0.05). Tone and stiffness values increased in patients with dcSSc compared to healthy controls, or patients with lcSSc, at the hands, forearms, and legs (p < 0.05). CONCLUSIONS: Our findings emphasize the potential utility of the myotonometer for assessing skin properties and differentiating SSc patients from controls, demonstrating its promise as a valuable clinical evaluation tool in this context. Key Points •The myotonometer displayed excellent intra- and inter-examiner reproducibility for assessing skin properties. •Skin tone and stiffness parameters well correlated with the mRSS scores. •The myotonometer can distinguish patients with diffuse cutaneous SSc from healthy controls.

Treatment Adherence Effect on the Visual Acuity of Behçet's Uveitis Patients.

PURPOSE: This study aimed to explore the relationship between treatment adherence, visual acuity, quality of life (QoL), depression, and anxiety levels in individuals with Behçet's uveitis (BU). METHODS: A total of 55 BU patients and 55 healthy controls completed sociodemographic questionnaires, the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), World Health Organization Quality of Life Questionnaire-BREF version (WHOQOL-BREF), Self-reported Questionnaire About Treatment Compliance, and the Morisky Medication Adherence Scale (MMAS). The scores obtained from these scales were analyzed to assess the relationship between treatment adherence, visual acuity, QoL, depression, and anxiety levels. RESULTS: The results revealed that 36 (65.4%) of the 55 BU patients exhibited depressive symptoms, while 45 (81.8%) of them experienced symptoms of anxiety. Patients with BU demonstrated significantly higher BAI and BDI scores compared to the healthy control group (p < 0.001). Furthermore, the patient group reported lower mean scores across multiple domains of the WHOQOL-BREF questionnaire, including general health, psychological health, social relationships, and environment (p < 0.05). Moreover, a significant association was observed between low treatment adherence and lower values of best-corrected visual acuity (BCVA) (p < 0.05), as well as a higher frequency of uveitis attacks (p = 0.005). CONCLUSION: Poor treatment adherence in BU patients has a negative effect on final visual acuity outcomes. Moreover, BU patients experience lower QoL and higher rates of depression and anxiety compared to the healthy control group. These findings highlight the importance of addressing treatment adherence and psychological well-being in the management of BU.

Low relapse rate in patients with giant cell arteritis in a multi-centre retrospective Turkish Registry.

OBJECTIVES: Glucocorticoids (GC) are widely accepted as the standard first-line treatment for giant cell arteritis (GCA). However, relapse rates are reported up to 80% on GC-only protocol arms in controlled trials of tocilizumab and abatacept in 12-24 months. Herein, we aimed to assess the real-life relapse rates retrospectively in patients with GCA from Turkey. METHODS: We assembled a retrospective cohort of patients with GCA diagnosed according to ACR 1990 criteria from tertiary rheumatology centres in Turkey. All clinical data were abstracted from medical records. Relapse was defined as any new manifestation or increased acutephase response leading to the change of the GC dose or use of a new therapeutic agent by the treating physician. RESULTS: The study included 330 (F/M: 196/134) patients with GCA. The mean age at disease onset was 68.9±9 years. The most frequent symptom was headache. Polymyalgia rheumatica was also present in 81 (24.5%) patients. Elevation of acute phase reactants (ESR>50 mm/h or CRP>5 mg/l) was absent in 25 (7.6%) patients at diagnosis. Temporal artery biopsy was available in 241 (73%) patients, and 180 of them had positive histopathological findings for GCA. For remission induction, GC pulses (250-1000 methylprednisolone mg/3-7 days) were given to 69 (20.9%) patients, with further 0.5-1 mg/kg/day prednisolone continued in the whole group. Immunosuppressives as GC-sparing agents were used in 252 (76.4%) patients. During a follow-up of a median 26.5 (6-190) months, relapses occurred in 49 (18.8%) patients. No confounding factor was observed in relapse rates. GC treatment could be stopped in only 62 (23.8%) patients. Additionally, GC-related side effects developed in 64 (24.6%) patients, and 141 (66.2%) had at least one Vasculitis Damage Index (VDI) damage item present during follow-up. CONCLUSIONS: In this first multi-centre series of GCA from Turkey, we observed that only one-fifth of patients had relapses during a mean follow-up of 26 months, with 76.4% given a GC-sparing IS agent at diagnosis. At the end of follow-up, GC-related side effects developed in one-fourth of patients. Our results suggest that patients with GCA had a low relapse rate in real-life experience of a multi-centre retrospective Turkish registry, however with a significant presence of GC-associated side effects during follow-up.

Computed Tomography-Guided Tru-Cut Biopsy in the Diagnosis of Lung Lesions; Our Clinical Experience.

INTRODUCTION: CT-guided tru-cut biopsy, which is less invasive and cost-effective, is an important diagnostic tool with high accuracy in lesions located peripherally in the lung. In this article, CT-guided tru-cut biopsy experiences of thoracic surgeons are shared. MATERIALS AND METHODS: CT-guided tru-cut biopsy was performed on 200 patients with suspected lung lesions in the thoracic surgery clinic. Diagnostic rates of biopsies, complications, factors affecting the development of complications, and complication management were examined. RESULTS: The diagnostic rate of the biopsies was 88%. Pneumothorax developed in 19.5% and hemothorax in 1% after the procedure. There was a significant relationship between mass dimensions and total complication rates (p=0.017). The relationship between the distance among the pleura and the mass and the development of complications was significant (p<0.001). The relationship between the number of biopsies and the development of pneumothorax was significant (p=0.011). The relationship between the size of the mass and the development of pneumothorax was significant (p=0.011). In univariate binary logistic regression analysis, a significant correlation was found between the size of the mass and the development of total complications (odds ratio (OR)=0.356 (95% CI: (0.146-0.868), (p=0.023)). DISCUSSION: In the diagnosis of lung lesions, CT-guided tru-cut biopsy is an effective diagnostic tool with high diagnostic power, with its less invasiveness, and lower cost. The increase in the lung parenchyma distance passed with the biopsy needle increased the likelihood of complications most significantly. The size of the mass and the number of biopsies also had significant effects on the development of complications.

Anti-mutated citrulline vimentin antibodies may be higher in Ankylosing spondylitis, but may not have a role in diagnosing disease and may not be associated with disease severity.

OBJECTIVE: Ankylosing spondylitis (AS) is a rheumatologic disease with severe morbidity and mortality. Many studies in the literature showing that serum antibodies against anti-mutated citrullinated vimentin (anti-MCV ab) can be elevated in rheumatoid arthritis (RA) patients. However, there is little data in the literature about the levels of anti-MCV antibodies in AS patients. We designed the study to evaluate the role of anti-MCV antibody in the diagnosis of AS and to investigate whether it is associated with disease activity parameters. METHODS: There were three separate groups in our study. The number of participants in these groups is 60 patients in the AS group, 60 patients in the RA group, and 50 healthy participants in the control group. The anti-MCV ab levels of the participants were measured by enzyme-like immune assay method. We compared anti-MCV levels between groups. We then evaluated its role in the diagnosis of AS and evaluated its relationship with disease activity parameters. RESULTS: The anti-MCV antibody levels of both AS (p=0.006) and RA (p>0.001) patients were found to be significantly higher than controls. Anti-MCV antibody was higher than predefined threshold level (20 IU/mL) in 4 of 60 (6.7%) AS patients. Anti-MCV levels are similar in patients with or without a -acceptable symptom state (PASS). There is also no appropriate anti-MCV cutoff level with respect to PASS and a highly sensitive and specific level for diagnosis of AS. CONCLUSION: Although AS patients has higher anti-MCV levels than controls, it may have a limited ability to AS diagnosis and to predict severity of the disease.

Importance of hematological markers in familial Mediterranean fever in terms of disease severity and amyloidosis.

There are limited follow-up parameters for familial Mediterranean fever (FMF) related to disease severity and amyloidosis. Some hematological markers are emerging to assess inflammation. In this study, we hypothesized that some hematological parameters could be used to determine disease severity and amyloidosis in FMF. We included 274 adult FMF patients, and evaluated the relationship between neutrophil lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR) and platelet-lymphocyte ratio (PLR), platelet counts and leukocyte counts, mean erythrocyte haemoglobin concentration (MCHC) and mean erythrocyte haemoglobin (MCH) with disease severity and amyloidosis. First, we classified patients according to disease severity and presence of amyloidosis. We then compared the parameters within the groups. In addition, we determined predictive cut-off values with ROC analysis. Finally, we correlated the change in ISSF scores with the change in hematological parameters of 52 patients with follow-up hematological indices after six months. The patients with severe-moderate group had higher CRP levels (p < 0.001), white blood cell (p = 0.002) and neutrophil counts (p = 0.004) and, conversely, lower MCHC levels (p = 0.001) than patients with mild disease severity. FMF patients with amyloidosis had higher neutrophil (p = 0.04) and monocyte count (p = 0.02), increased NLR (p = 0.01) and lower MLR (p = 0.02) levels than those without. In addition, MCHC levels were also lower in the severe-moderate group in the follow-up analyses after sixth months (p = 0.03). MCHC, neutrophil and monocyte counts, NLR, MLR may be associated with poor prognosis in FMF patients. These parameters can be used in conjunction with acute phase reactant and clinical features to assess disease status.

Quantitative analysis of lung parenchymal involvement in Behçet's disease by the novel automatic program.

OBJECTIVES: We aimed to quantitatively analyze lung parenchymal changes in Behçet's patients and to detect early parenchymal quantitative changes that occur in the absence of positive visual radiological findings. METHODS: In our study, a total of 31 patients with Behçet's disease, 17 with positive radiological findings and 14 patients without positive radiological findings, and a control group of 33 individuals were evaluated. The automatic program determined lung volumes, lung densities, and opacity volume percentages by evaluating the contrast-enhanced lung computed tomography scans. RESULTS: The total lung volume was 3632.98 ± 1100.53 mL in the Behçet's disease patient group and 4925.70 ± 1098.88 mL in the control group, and there was a significant decrease in the total lung volume in Behçet's disease patients (P < 0.0001). The mean lung density was -723.73 ± 65.16 in the Behçet's disease patient group and -767.35 ± 41.17 in the control group, and there was a significant increase in the mean density in the Behçet's patients (P = 0.0023). A significantly higher correlation was observed between lung density and lung volume in Behçet's patients (P < 0.0001, r = -0.795). The lung volume of Behçet's disease patients with negative radiological findings was significantly lower than that of the control group (P = 0.0342). CONCLUSIONS: Lung volumetric changes in Behçet's disease patients are the quantitative data most affected by the disease. In addition, lung volume decreases in Behçet's patients who do not have visual parenchymal involvement.

Apical fibrosis was the most common incidental pulmonary finding in a familial Mediterranean fever cohort.

INTRODUCTION: Familial Mediterranean fever (FMF) is one of the common autoinflammatory diseases with multisystemic manifestation. Pleuritis is the only known pulmonary involvement of FMF; however, as far as we know, thoracic involvements in pleural, parenchymal, bronchial, and vascular structures have not been evaluated yet. METHOD: We included 243 consecutive FMF patients who applied to our clinic within the last 5 years and were requested to have a thorax CT for any reason and 122 trauma patients without any comorbidity. An experienced radiologist evaluated the thorax CT images blindly according to the relevant guidelines. We then presented the common incidental pulmonary and mediastinal findings on the thorax CT. Additionally, we compared patients with and without lung involvement according to demographic and disease-related parameters. RESULTS: In our study, 167 of 243 patients (68.7%) had at least one of the pulmonary findings on their thorax CT. The most common pulmonary findings were apical fibrosis in 96 (39.5%) patients, parenchymal fibrotic changes in 48 (19.8%) patients, and a solitary parenchymal nodule smaller than 4 mm in 33 (13.6%) patients. All demographic, genetic, and disease-related characteristics, including the frequency of spondyloarthropathy, were similar in patients with and without pulmonary findings. CONCLUSIONS: We showed that the most common incidental pulmonary finding in our FMF cohort was apical fibrosis on thoracic CT. Our data did not show causality between FMF and apical fibrosis; therefore, more studies are needed to evaluate the frequency and clinical significance of apical fibrosis in FMF. Key Points • More than two-thirds of familial Mediterranean fever (FMF) patients in our study group who underwent a thoracic scan for any reason had pulmonary and mediastinal findings on thorax computed tomography (CT). • In our FMF cohort, the most common incidental pulmonary finding on their thorax CT was apical fibrosis. • All demographic and disease-related characteristics, including the frequency of spondyloarthritis, were similar between patients with and without pulmonary and mediastinal findings.

A Case Report of Conjunctival Extranodal Marginal Zone Lymphoma Treated with Intralesional Rituximab Injection Therapy.

PURPOSE: To describe the safety and efficacy of intralesional rituximab (anti-CD 20 monoclonal antibody) therapy in a patient with conjunctival extranodal marginal zone lymphoma. METHODS: A single case report from a tertiary referral center. RESULTS: A 43 years old female patient with low-grade conjunctival extranodal marginal zone lymphoma who was completely and safely treated with intralesional rituximab therapy was presented. After four injections per week, intralesional rituximab injections were given monthly, and the treatment was completed in 6 months. Near-total regression was achieved at the end of the tenth cycle. No recurrence was observed during the 20-month follow-up period. CONCLUSION: The intralesional rituximab is a cost-effective and well-tolerated treatment for low-grade conjunctival lymphoma. The intralesional rituximab therapy may be prefer in the patients with low grade conjunctival lymphoma instead of radiotherapy. There will be needed further researches in this area.

Quality of life, disease activity and preferences for administration routes in rheumatoid arthritis: a multicentre, prospective, observational study.

Objective: We aimed to evaluate quality of life (QoL), disease activity, compliance to treatment, patient and physician preferences for route of administration (RoA), status of health and pain in RA patients starting advanced treatments or needing a switch, and the factors associated with patient preferences. Methods: A multicentre, prospective, observational and 1-year follow-up study was conducted, between 2015 and 2020, in adult RA patients using advanced treatments for the first time or needing a switch in their current treatments. All the data collected were entered into electronic case report forms. DAS in 28 joints with ESR [DAS28-4(ESR)], EuroQol 5-Dimensional Questionnaire (EQ-5D), HAQ Disability Index (HAQ-DI), Compliance Questionnaire for Rheumatology (CQR-19), Work Productivity and Activity Impairment Instrument (WPAI) and Patient Global Assessment-Visual Analogue Scale (PGA-VAS) questionnaires were used for longitudinal assessments. Results: Four hundred and fifty-nine patients were enrolled. Three hundred and eight patients (67.1%) attended the final study visit at 12 months and were included for comparative analyses. Irrespective of RoA, the disease activity and QoL improved significantly at 12 months, whereas compliance worsened. At baseline and 12 months, EQ-5D and DAS28-4(ESR) scores were significantly correlated (P < 0.001). The WPAI scores changed significantly in favour of better outcomes over 12 months after initiation of advanced treatment or switching (P < 0.001). A higher proportion of patients preferred an oral RoA, in comparison to physicians (53.6% vs 31.4%; P < 0.001). Patient and physician RoA preferences were independent of gender, age, disease duration, advanced treatment type and the EQ-5D-3L, DAS28-4(ESR), HAQ-DI, PGA-VAS and CQR-19 scores at baseline. Conclusion: The oral route was more frequently preferred by patients compared with physicians, although patients' preference rates showed a slight increase towards the end of the treatment, which might be an important factor for RA outcomes. Better control of disease activity and QoL were achieved at 12 months, regardless of RoA.

Metabolic syndrome may be more frequent in treatment-naive sarcoidosis patients.

INTRODUCTION: Sarcoidosis is a chronic granulomatous multisystem inflammatory disease. An association between sarcoidosis and subclinical atherosclerosis has recently been demonstrated. However, there are limited publications on metabolic syndrome (MetS) and its metabolic changes in sarcoidosis. In this study, we evaluated our hypothesis that the frequency of MetS may also be increased in treatment-naive, newly diagnosed sarcoidosis patients. METHODS: We included 133 newly diagnosed sarcoidosis patients, 133 age- and sex-matched controls, and 51 untreated rheumatoid arthritis (RA) patients as diseased controls. We then compared the frequency of MetS and MetS-related items in the three groups. The criteria defined for metabolic syndrome in the National Cholesterol Education Program (NCEP) Adult Treatment Panel III report (ATP III) were used to diagnose MetS. RESULTS: MetS was more common in sarcoidosis than controls (odds ratio, OR: 5.3; 95% confidence interval, CI 95%: 2.4-11.5; p < 0.001) and was similar to RA. In addition, triglyceride and glucose levels, diastolic blood pressure measurements, and waist circumference of female sarcoidosis patients were significantly higher than in controls. CONCLUSION: We show that MetS is a frequent feature of sarcoidosis even before treatment is started. Therefore, clinicians should be aware of MetS both during treatment and during the course of the disease to reduce the risk of cardiovascular events.

Familial mediterranean fever patients may have unmet needs for the treatments of exertional leg pain and enthesitis.

INTRODUCTION: Exertional leg pain (ELP) and enthesitis are musculoskeletal findings in familial Mediterranean fever (FMF). They are not accepted as principal treatment targets. In this study, we assessed the effectiveness of treatments on ELP and enthesitis. MATERIAL AND METHODS: We have included 218 FMF patients to the study. We retrospectively compared the FMF attacks' frequency, duration and intensity (FMF attack VAS score) and levels of ELP VAS and enthesitis VAS scores between pre-treatment stage and while patients were on treatment at the last visit. RESULTS: Forty-nine (22.5%) and 52 (23.9%) of the patients had enthesitis and ELP respectively. All patients were on colchicine treatment. Serositis attacks respond the treatments significantly. Moreover, both ELP VAS scores (p=0.002) and enthesis VAS scores (p=0.17) were improved with treatment. But only improvement in ELP VAS scores was significant. CONCLUSION: FMF treatments had favourable effect on ELP and enthesitis in FMF patients. However, the response rates would be inadequate. Therefore, there would be unmet need for treatment of both conditions.

Familial mediterranean fever patients may have unmet needs for the treatments of exertional leg pain and enthesitis / Los pacientes con fiebre mediterránea familiar podrían tener necesidades no satisfechas de tratamiento del dolor en piernas con el esfuerzo y entesitis

Introduction: Exertional leg pain (ELP) and enthesitis are musculoskeletal findings in familial Mediterranean fever (FMF). They are not accepted as principal treatment targets. In this study, we assessed the effectiveness of treatments on ELP and enthesitis. Material and methods: We have included 218 FMF patients to the study. We retrospectively compared the FMF attacks’ frequency, duration and intensity (FMF attack VAS score) and levels of ELP VAS and enthesitis VAS scores between pre-treatment stage and while patients were on treatment at the last visit. Results: Forty-nine (22.5%) and 52 (23.9%) of the patients had enthesitis and ELP respectively. All patients were on colchicine treatment. Serositis attacks respond the treatments significantly. Moreover, both ELP VAS scores (p=0.002) and enthesis VAS scores (p=0.17) were improved with treatment. But only improvement in ELP VAS scores was significant. Conclusion: FMF treatments had favourable effect on ELP and enthesitis in FMF patients. However, the response rates would be inadequate. Therefore, there would be unmet need for treatment of both conditions.(AU)

Introducción: El dolor en piernas con el esfuerzo (ELP) y la entesitis son hallazgos musculoesqueléticos en la fiebre mediterránea familiar (FMF), no aceptados como dianas de tratamiento principales. En este estudio evaluamos la efectividad de los tratamientos para ELP y entesitis. Material y métodos: Incluimos en el estudio a 218 pacientes con FMF. Comparamos retrospectivamente la frecuencia de los ataques de FMF, su duración e intensidad (escala analógica visual [VAS] del ataque de FMF) y los niveles VAS para ELP y las puntuaciones VAS para entesitis entre la etapa previa al tratamiento y la etapa en que los pacientes estaban siendo tratados en la última visita. Resultados: Cuarenta y nueve (22,5%) y 52 (23,9%) pacientes tuvieron entesitis y ELP, respectivamente. Todos los pacientes recibieron colchicina. Los ataques de serositis respondieron significativamente a los tratamientos. Además, tanto las puntuaciones VAS para ELP (p=0,002) como para entesis (p=0,17) mejoraron con el tratamiento, pero únicamente fueron significativas las puntuaciones VAS para ELP. Conclusión: Los tratamientos para FMF tuvieron un efecto favorable para ELP y entesitis en los pacientes con FMF. Sin embargo, las tasas de respuesta serían inadecuadas. Por tanto, existiría una necesidad no satisfecha de tratamiento de ambas situaciones.(AU)

Accuracy of Metabolic Imaging-guided Transthoracic Biopsy in Lung Cancer.

OBJECTIVE: To compare the detection of transthoracic tru-cut biopsy performed on metabolically active areas in positron emission tomography (PET) for the diagnosis of lung cancer, compared to only CT scan-guided biopsy. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Thoracic Surgery, Kayseri City Training and Research Hospital, Turkey, between December 2020 to June 2021. METHODOLOGY: Patients of suspected lung cancer with pre-transthoracic biopsy chest computerised tomography and without positron emission tomography were included in Group A; while, patients with both and positron emission tomography chest computerised tomography were included in Group B. Based on the CT findings of the patients in Group A, a biopsy was obtained from the most appropriate place. The patients in Group B were evaluated by a nuclear medicine specialist and the place with the highest maximum standardised uptake value before the biopsy was marked and the area to be biopsied was determined. RESULTS: The malignancy detection rate was significantly higher in Group B (48/50 patients, 96%) than in Group A (36/50 patients, 72%, p=0.001). Two lesions in the Group B (4 %) and 14 lesions in the Group A (28 %) were found to give benign results (p=0.001). Biopsy was repeated in one patient of Group B, and in five patients of Group A due to an initial negative diagnosis. The sensitivity of PET/CT in predicting malignant tumor was 96%, with the positive predictive value (PPV) of 98.0%; while the sensitivity of CT was 74.5%, with PPV of 82%. CONCLUSION: Transthoracic biopsies taken by considering metabolically active areas of the mass in positron emission tomography-guided can both increase diagnosis rate and reduce the complication rate by preventing repeated biopsies. Key Words: Transthoracic biopsy, PET/CT, Metabolic active lesion, Malignant tumor.

Assessment of proarrhythmic ventricular electrophysiological remodeling in patients with rheumatoid arthritis.

INTRODUCTION: Rheumatoid arthritis (RA) is related to cardiovascular disease and results in increased mortality rates. Ischemia, autonomic nervous system dysfunction, impaired cardiac ionic currents, and genetic predisposition may be the underlying mechanisms. Proarrhythmic ventricular electrophysiological remodeling detected on the basis of Tp­e interval, Tp-e/QT, and Tp-e/QTc ratios plays a key role in the prognosis. Our aim was to assess proarrhythmic ventricular electrophysiological remodeling in patients with RA, a well-known chronic inflammatory disorder. MATERIALS AND METHODS: A total of 163 patients with RA and 47 patients as a control group were included in this retrospective study. Proarrhythmic ventricular electrophysiological remodeling markers were evaluated in both groups along with baseline demographic and clinical variables. Patients using medication or with chronic disorders that can affect ventricular repolarization markers were excluded. RESULTS: The patients with RA had prolonged Tp­e interval (66 ms [44-80]; 80 ms [78-96], p < 0.001) and increased Tp-e/QT ratio (0.18 [0.12-0.22]; 0.22 [0.20-0.24], p < 0.001) and Tp-e/QTc ratio (0.16 [0.11-0.19]; 0.20 [0.17-0.22], p < 0.001) compared to the control group. CONCLUSION: The Tp­e interval and Tp-e/QT ratio, which may help to clarify the pathophysiological mechanisms of ventricular arrhythmias, were increased in patients with RA.

The role of telomerase in the etiology of primary spontaneous pneumothorax.

BACKGROUND: This study aims to investigate the role of telomerase activity in the risk of primary spontaneous pneumothorax, which is most frequently encountered in the practice of thoracic surgery. METHODS: A total of 61 patients (56 males, 5 females; median age: 29.4 years; range, 17 to 43 years) who underwent treatment for primary spontaneous pneumothorax and 19 age- and sex-matched healthy controls (10 males, 9 females; median age: 29.1 years; range, 23 to 43 years) were included in this prospective study between January 2018 - August 2018. Telomerase activity was evaluated with enzyme-linked immunosorbent assay. The correlation between telomerase activity and clinical and demographic parameters was examined. RESULTS: The mean serum telomerase level was 3.4±0.6 ng/mL in the primary spontaneous pneumothorax group and 1.9±0.5 ng/mL in the control group, indicating significantly higher levels in the patient group (p<0.001). There was no significant association between the telomerase levels and presence of blebs and/or bullae on thoracic computed tomography, extent of pneumothorax, laterality (right, left, or bilateral), and pack years of cigarette smoking. CONCLUSION: Telomerase levels of patients with primary spontaneous pneumothorax are significantly higher than healthy individuals. Future genetic studies may ultimately clarify a potential relationship between primary spontaneous pneumothorax and short telomere syndrome.

Association of Alpha 1-antitrypsin Deficiency and Genetic Predisposition in Primary Spontaneous Pneumothorax.

OBJECTIVE: To determine the association of alpha-1 antitrypsin deficiency (AATD) in patients diagnosed with primary spontaneous pneumothorax (PSP), the presence of the SERPINA 1 gene, and the phenotype in patients with low enzyme values. STUDY DESIGN: Cross-sectional descriptive study. PLACE AND DURATION OF STUDY: Kayseri City Training and Research Hospital, Turkey, from October 2019 to October 2020. METHODOLOGY: A total of 42 patients with PSP and 42 healthy volunteers were included in the study. The antitrypsin (AAT) level of all participants was measured by the ELISA method. Presence of SERPINA 1 gene was determined in all the participants and its phenotype variants. RESULTS: In this study, AAT level was statistically and significantly lower in the patient group than the control group (p = 0.018). The presence of the SERPINA 1 gene was studied in 13 (31%) patients with AATD and 7 (16.7%) healthy volunteers. Six patients had PI M1V variant (37.5%), five patients had PI M1A variant (31.3%), four patients had PI M4 variant (25%), and one patient had an indeterminate variant (6.2%). Four healthy volunteers had PI M1V variant (66.7%), and two healthy volunteers had PI M4 variant (33.3%). CONCLUSION: AAT level was found to be lower in the patient group compared to the control group. In addition, the effect of SERPINA 1 gene on PSP development was found to be benign. AATD is an effective factor in the development of PSP. Key Words: Primary spontaneous pneumothorax, Alpha 1 antitrypsin deficiency, Genotype variants, SERPINA 1 gene.