A Case of Pantoprazole Anaphylaxis with Cross Reactivity to All Proton Pump Inhibitors: Finding a Safe Alternative.

BACKGROUND: Hypersensitivity reactions due to Proton pump inhibitors (PPIs ) are rare, and further anaphylaxis to a PPI with cross-reactivity to all commercially available PPIs is very rare. OBJECTIVE: To present a case of anaphylaxis to pantoprazole with cross-reactivity to all commercially available PPIs. METHODS: Skin prick tests (SPTs), intradermal tests (IDTs) and oral provocation tests (OPTs) were performed with available PPIs according to the method described in previous studies. RESULTS: All tested PPIs except lansoprazole were positive on skin tests either SPT or IDT. The patient was challenged with lansoprazole at increasing doses (7.5 mg, 15 mg, 30 mg capsule) every 60 minutes and she reacted with urticaria to 52.5 mg cumulative dose of lansoprazole. She could tolerate ranitidine and famotidine tablets via OPT. CONCLUSION: In our best knowledge, our case was the first case in this regard and that points the possibility of all cross-reactive pattern in patients with pantoprazole anaphylaxis and the importance of a thorough drug allergy work-up for finding safe alternatives. H2 receptor antagonists are used as safe alternatives in cases with PPI hypersensitivity.

Association between mean platelet volume and bone mineral density in postmenopausal women.

[Purpose] Osteoporosis is an inflammatory disease, and platelets play a critical role in bone remodeling. Mean platelet volume has been shown to be influenced by inflammation. Our aim was to evaluate the relationship between mean platelet volume and bone mineral density in postmenopausal women. [Subjects and Methods] The records of female patients who had been referred to a tertiary hospital for bone mineral density analysis were retrospectively reviewed. [Results] A total of 175 patients (mean age: 61.3 ± 9.0 years) were enrolled. Overall, 72% (126/175) of patients met the criteria for osteoporosis. Mean platelet volume was found to be inversely correlated with body mass index. There was a significant positive correlation between mean platelet volume and femoral neck bone mineral density in our normal weight osteoporotic group, whereas there was a significant negative correlation in our overweight-obese osteoporotic group. The negative correlation between mean platelet volume and femoral neck bone mineral density in the overweight-obese osteoporotic group persisted after adjustment for confounding factors. Multivariate analyses revealed that mean platelet volume was significantly associated with femoral neck bone mineral density in osteoporotic patients in both our normal weight and overweight-obese groups. [Conclusion] Regardless of mechanisms, mean platelet volume might be used as a biomarker for osteoporosis in clinical settings.

Unusual Chromosomal Rearrangement Resulted in Interstitial Monosomy 9p: Case Report.

We report on a 4.5-year-old boy with interstitial monosomy 9p in a unique and complex de novo rearrangement. The patient had been referred for craniofacial dysmorphism, delayed psychomotor development, and various congenital malformations. We combined cytogenetic studies and FISH analyses to delineate the deletion. The result of our cytogenetic studies was 46,XY,der(9)(p22pter). In order to confirm the deletion, we also performed FISH analysis, which showed that the 9p subtelomeric region was inserted into chromosome 13. Molecular karyotyping was performed to describe the exact genomic breakpoints of the rearrangement. In conclusion, this case is a complex insertion/deletion abnormality which has not been reported before.

Evaluation of the Relationship between Major Depressive Disorder and Bereavement Symptoms in Elderly Patients Who Present Either to Psychiatry or Family Medicine.

INTRODUCTION: We aimed to determine the level of bereavement and depression symptoms among elderly patients who experience the loss of a significant other and the relationship between depressive symptoms and bereavement symptoms. METHODS: The study sample consisted of elderly adults who lost a significant other at least 6 months prior to the submission time. Participants were recruited from patients who presented to either the psychiatry or family medicine outpatient unit of a Training and Research Hospital. Cognitive functions were assessed using Standardized Mini Mental Examinations for Educated and Uneducated People (SMME/SMME-U). Participants were excluded from the study if their SMME or SMME-U scores were lower than 23 points. To assess the severity of depressive and bereavement symptoms, the Geriatric Depression Scale (GDS) and Core Bereavement Items (CBI) scales were used, respectively. RESULTS: Overall, 33 out of 67 individuals (49.2%) who presented to the psychiatry unit and 7 out of the 43 individuals (16.3%) who presented to the family medicine unit were diagnosed with major depressive disorder (MDD). CBI scale score means were higher in the MDD groups than in the non-depressive groups (p=0.012 and p=0.001, respectively). CBI scores were significantly correlated to acute (p=0.047) and chronic stress (p=0.007) in the psychiatry group and to chronic stress in the family medicine group (p=0.001). CONCLUSION: Probing loss experiences and reactions to them can be important to understand depression, to evaluate its symptoms, and to help manage the relevant symptoms. Considering the significant contributions of bereavement to depressive symptom severity in elders, interventions specific to bereavement symptoms should not be ignored.

Knowledge of Primary Care Physicians About Breast-Cancer-Related Lymphedema: Turkish Perspective.

Breast-cancer-related lymphedema (BCRL) is a common complication of breast cancer treatment. Informing patients about BCRL can contribute to decrease their risk of developing the condition or prevent it from progressing further. In order to educate patients about BCRL effectively, clinical knowledge of clinicians must be adequate. In study, we aimed to reflect BCRL knowledge and attitude of Turkish primary care physicians (PCPs). This questionnaire-based study was conducted by face-to-face interview method. The participants included actively working PCPs from all parts of Turkey. The questionnaire elicited data on physicians' demographics, the BCRL knowledge, self-reported BCRL knowledge, referral patterns, and education. A total of 314 PCPs with a mean age of 36.9 % ± 8.1 years (mean ± standard deviation) were included in the study. Median BCRL knowledge score of all study group was 15 (11-18) [median (25-75 % range)]. PCPs who received education about BCRL during their medical faculty and/or residency periods had significantly higher knowledge scores (p = 0.005). Of PCPs, 94.9 % indicated to make a BCRL referral for a breast cancer patient. Among them, 55 % preferred to make a referral to a general surgeon, 28.2 % to an oncologist, and 16.8 % to a physical medicine and rehabilitation specialist. Assessment of factors related with BCRL should be part of routine evaluation of patients with breast cancer in primary care. Education of PCPs about BCRL is warranted in order to improve the BCRL care.

The association of vitamin D status with cardiometabolic risk factors, obesity and puberty in children.

UNLABELLED: Low serum 25-hydroxyvitamin D3 (25(OH)D) levels have been associated with insulin resistance and cardiovascular diseases. The influences of gender, puberty and adiposity on vitamin D status and the relationship between 25(OH)D and cardiometabolic risk factors in obese and non-obese children were studied. A retrospective analysis was carried out on 168 Turkish children during late winter. Age, gender, puberty, body mass index (BMI), 25(OH)D levels and cardiometabolic risk factors including lipid profiles, high-sensitivity C-reactive protein and insulin resistance index calculated by homeostasis model assessment (HOMA-IR) were evaluated. The median age of the study population was 11 (4-16) years, and 102 children (60.7 %) were prepubertal. Overall, 98.2 % of patients had 25(OH)D levels lower than 20 ng/mL (median 10.0 (4.0-21.3) ng/mL). The 25(OH)D levels did not correlate with BMI. However, an inverse correlation was seen between serum 25(OH)D and HOMA-IR (rho = -0.656, p = 0.006) and insulin (rho = -0.715, p = 0.002) in pubertal obese subjects. Female gender and puberty were all negatively associated with 25(OH)D. CONCLUSION: The association between vitamin D status and BMI is complex, and it does not seem to be altered by mild obesity. In addition, potential influence of puberty should be kept in mind while assessing the relationship between serum 25(OH)D and cardiometabolic risk factors.

Could mean platelet volume among complete blood count parameters be a surrogate marker of metabolic syndrome in pre-pubertal children?

Interest in childhood metabolic syndrome (MetS) has increased substantially due to the increasing prevalence of childhood obesity on a global scale. Early recognition of MetS is critical in order to delay the development of cardiovascular disease (CVD). In this study, we evaluated the relationship between complete blood count (CBC) parameters and MetS among pre-pubertal children which may provide evidence in support of using low cost, readily available clinical haematological parameters for the detection of MetS. A retrospective analysis was carried out on 330 (125 lean vs. 205 overweight) Turkish pre-pubertal children who attend to a paediatric outpatient clinic. Age, gender, puberty, body mass index, CBC parameters, cardiometabolic risk factors including lipid profiles, high sensitive serum reactive protein (hsCRP) and insulin resistance index calculated by homeostasis model assessment (HOMA-IR) were evaluated and compared among lean, overweight children and children with MetS. The mean age of the study population was 7.4 ± 1.9 years. In both gender, the mean values of mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH) and mean corpuscular haemoglobin concentration (MCHC) were significantly lower and red blood cell (RBC), platelet (PLT) counts were significantly higher in overweight children. Overall, 8.4% (n = 28) of patients met the criteria of MetS. Children with MetS had higher levels of PLT and lower levels of mean platelet volume (MPV). Of all the haematological parameters analysed, PLT was positively, whereas MPV was negatively correlated with MetS in girls. In addition, MPV was inversely correlated with fasting blood glucose, HOMA-IR, low density lipoprotein-cholesterol (LDL-C) and low density lipoprotein-cholesterol/high density lipoprotein-cholesterol (LDL-C/HDL-C) ratio in girls after adjusting for confounding factors. The risk analyses of MetS in terms of MPV quartiles showed that the adjusted OR (95% CI) for the lowest vs. the highest quartile was 7.71 (1.45-40.89) in girls. These data might suggest that MPV could be another feature of MetS in pre-pubertal girls and might be used as a surrogate marker for MetS in clinical settings.

Thyroid-stimulating hormone (TSH) level in nutritionally obese children and metabolic co-morbidity.

OBJECTIVE: In recent years, there has been increasing focus on thyroid function in pediatric obese patients. Our aims were to investigate whether there is an association between serum thyroid-stimulating hormone (TSH) within the normal range and body mass index (BMI), and to determine if TSH levels correlate with metabolic risk factors in children. METHODS: A retrospective cross-sectional analysis was carried out on 528 euthyroid, age- and sex-matched lean, overweight, or obese children. Anthropometric indices, blood pressure, fasting blood glucose, hepatic enzymes, lipid profiles, TSH, free triiodothyronine (fT3), and free thyroxine (fT4) were assessed from medical records and compared among groups. Subjects with known presence of diabetes, using medications altering blood pressure and glucose or lipid metabolism, with TSH levels >97.5 or <2.5 percentile, or with autoimmune thyroid disease were excluded. RESULTS: Hypertension, dyslipidemia, and elevated levels of hepatic enzymes were found to be more common in overweight and obese children (p<0.001), and those metabolic changes were significantly correlated with the increase in BMI (p<0.05). Serum concentrations of TSH and fT3 within the normal range were higher in overweight and obese children (p<0.01), and TSH was positively correlated with total cholesterol, triglycerides, and systolic blood pressure (p<0.05). CONCLUSION: Our findings suggest that obese children have higher serum TSH and fT3 levels even within the normal range, and that an increase in TSH is associated with dyslipidemia and higher systolic blood pressure. It remains to be seen whether TSH might serve as a potential marker of metabolic risk factors in obese pediatric patients.

A rare adverse effect of montelukast treatment: ecchymosis.

Montelukast is a leukotriene receptor antagonist that is effective in the treatment of allergic rhinitis and asthma. We report a rare case of a 31-year-old woman with a history of allergic rhinitis and moderate persistent asthma, who experienced severe bruising on her lower extremities after starting montelukast treatment. Clinicians should be aware of the possibility of unusual bruising during montelukast therapy, and in those patients montelukast should be discontinued.