The Possible Relation of Demodex and Facial Erythema in Connective Tissue Diseases

Background: We aimed to investigate the frequency of Demodex infestation and clinical implications in connective tissue disease patients with facial erythema. Methods: Patients diagnosed with a connective tissue disease and had facial erythema were consecutively enrolled in the study from 2019-2020. An age and gender matched control group was formed from healthy volunteers. Presence of Demodex was investigated by standardized skin surface biopsy. Number of Demodex mites over 5 per centimeter square was considered meaningful for infestation. Topical or systemic metronidazole treatment was given to the connective tissue disease patients with Demodex infestation. Facial erythema visual analog scale was questioned in patients at treatment onset and one month after. Results: A total of 31 connective tissue disease patients with facial erythema were enrolled. Control group included 31 healthy volunteers. Demographics and comorbidities were similar between groups. Demodex infestation was present in 58.1% of the disease group and in 25.8% of the control group (P=0.01). Pruritus was the most common symptom in patients with infestation. Median (IQR) facial erythema visual analog scale score was 6 (3) at treatment onset and was 2 (2.5) one month later (P<0.001). Conclusion: When evaluating facial cutaneous lesions, Demodex infestation should not be overlooked in a patient group like connective tissue diseases with dysfunctional immune system

Smoking May Be Related to Sacroiliitis in Enteropathic Arthritis Patients: Treasure Real-Life Preliminary Data

Annual European Congress of Rheumatology (EULAR) -- JUN 12-15, 2019 -- Madrid, SPAIN[No Abstract Available]European League Against Rheumatis

Koronavirüs Hastalığı-2019 Hastalarının Tırnak Dibi Kapilleroskopisi ile Değerlendirilmesi

Amaç: Mikrovaskülopati, Koronavirüs hastalığı-2019 (COVID-19) hastalığı komplikasyonlarında rol alan mekanizmalardan biridir. Tırnak dibi kapilleroskopisi (TDK) mikrovasküleriteyi değerlendirmede kullanılan non-invaziv bir yöntemdir. COVID-19 hastalarında endotel disfonksiyonu ve mikrovaskülopatinin saptanmasında yol gösterici olabilir. Gereç ve Yöntem: Şiddetli akut solunum yolu sendromu-CoV-2 testi pozitif çıkmış 54 hastaya TDK yapıldı ve hastalar kapiller yoğunluk, mimari ve morfoloji açısından değerlendirildi. Anormal ve normal kapilleroskopi bulguları olan hastalar COVID-19 klinik semptomları açısından karşılaştırıldı. Bulgular: Çalışmaya alınan hastaların %72’si erkek, yaş ortalaması ise 35,6±11,6 idi. Toplamda 22 hastada (%41) anormal kapilleroskopik değişikliklerden en az 1 tanesi vardı. Kapilleroskopik yaygın anormallikler ise sırasıyla, perikapiller ödem (%43), genişlemiş ve dilate kapil (%24), tortiyozite kapiller (%22) oldu. Hastaların %17’sinde hiperenflamatuvar yanıt görüldü ve 1 hastada yoğun bakım ihtiyacı oldu. Anormal kapilleroskopik değişliği olan hastalarda hiperenflamatuvar yanıt, antisitokin kullanımı ve tromboz sıklığı artmıştı. Sonuç: COVID-19 hastalarında anormal kapilleroskopik bulgular sıklıkla gözlenmiştir. Anormal kapilleroskopik bulguları olan hastalarda hiperenflamatuvar yanıt ve antisitokin ilaç kullanımı sıklığının artması hiperenflamasyon ile mikrovaskülopati arasında bir ilişki olabileceğini düşündürmektedir. TDK’nın, COVID-19 hastalığı klinik tutulumları ile ilişkisini değerlendirmek için daha fazla çalışmaya ihtiyaç vardır

Single-dose-dexketoprofen-induced acute kidney injury due to massive rhabdomyolysis

A 70-year-old male patient was admitted complaining of weakness and pain in his arms and lower limbs. His serum creatine kinase and serum creatinine were markedly elevated (36,248 IU/L and 2.8 mg/dL, respectively). He had taken dexketoprofen trometamol because of a common cold, which had developed the previous night. Acute kidney injury caused by dexketoprofen-induced rhabdomyolysis was diagnosed by ruling out other possible causes, such as dermato/polymyositis, myxedema, brucellosis, and hepatitis. Dexketoprofen administration was stopped. As diuresis did not restore spontaneously, the patient was treated with I.V. alkaline solutions and mannitol. Hemodialysis was performed because of anuria and severe metabolic acidosis. The patient's renal function later recovered. In conclusion, dexketoprofen may be a potential risk factor for acute kidney injury and rhabdomyolysis

Codeine-Induced Syndrome of Inappropriate Antidiuretic Hormone: Case Report

Background: The syndrome of inappropriate antidiuretic hormone was first described in 1957 by Schwartz, and is characterised by hyponatraemia, inappropriately increased urine osmolality and urine sodium, and decreased serum osmolality in a euvolemic patient without edema. A patient with the syndrome of inappropriate antidiuretic hormone should have normal cardiac, renal, adrenal, hepatic, and thyroid functions and should not take any diuretics. Case Report: We present a case of the syndrome of inappropriate antidiuretic hormone caused by codeine and associated with reduced urine volume, increased urine sodium, and decreased serum sodium concentration. Conclusion: The syndrome of inappropriate antidiuretic hormone is a disease that can lead to morbidity and even mortality. Clinicians should measure serum electrolytes intermittently in order to avoid missing the diagnosis of the syndrome of inappropriate antidiuretic hormone in patients using opioid. (Balkan Med J 2014;31:107-109)

Rare Occupational Cause of Nasal Septum Perforation: Nickel Exposure

Many etiologies are held accountable for nasal septum perforations. Topical nasal drug usage, previous surgeries, trauma, nose picking, squamous cell carcinoma, some rheumatological disorders such as granulomatosis with polyangiitis (Wegener granulomatosis), some infectious diseases such as syphilis and leprosy are among the causes of the perforations. Occupational heavy metal exposures by inhalation rarely may also cause nasal septum perforation. Here, we present a 29-year-old patient without any known diseases, who is a worker at a metallic coating and nickel-plating factory, referred for investigation of his nasal cartilage septum perforation from an otorhinolaryngology clinic. The patient questioning, physical examination and laboratory assessment about rheumatic and infectious diseases were negative. There was a metallic smell in the breath during the physical examination. The analysis showed serum nickel level at 31 mu g/l and urine nickel at 18 mu g/l (84.11 mu g/g creatinine). Other possible serum and urine heavy metal levels were within normal ranges. Nickel exposure is usually together with other heavy metals (chromium or cadmium), it is rarely alone. Nickel ingested by inhalation usually leads to respiratory problems such as reduced olfactory acuity, ulcers, septum perforation or tumors of the nasal sinuses. This case demonstrates the importance of occupational anamnesis and awareness of diagnosis

Abnormal Retinal Microvasculature Found In Active Rheumatoid Arthritis: A Different Perspective Of Microvascular Health

Background/aim: We aimed to assess the association between retinal vascular caliber (RVC) scores and disease activity in rheumatoid arthritis (RA) patients. Materials and methods: Forty-seven RA patients, 32 systemic lupus erythematosus (SLE) patients, and 45 healthy people were enrolled. RA and SLE patients were subdivided into groups according to C- reactive protein (CRP) levels. RA patients were also grouped according to Disease Activity Score-28 (DAS-28). Fundus photography was performed for all patients. RVC was summarized as the central retinal artery and vein equivalents (CRAE and CRVE). Results: Mean CRVE for RA patients was 213.3 +/- 17.8 mu m compared with 209.2 +/- 14.1 mu m for SLE and 217.5 +/- 26.2 mu m for the control group (P = 0.17). RVC scores did not differ between the CRP-high and CRP-low groups. As the RA disease activity increased, the widening of CRVE became more prominent and statistically significant. When the DAS-28 > 5.1 (CRVE, 220.4 (211.8-246.5) mu m) group and DAS-28 15 3.2 and DAS-28 <= 3.2 groups (P= 0.05). Conclusion: CRVE, which reflects systemic inflammation and possibly increased cardiovascular risk, was significantly increased in active RA patients. The association between retinal venular widening and disease activity, regardless of CRP, may be a sign that RA-related inflammation may have systemic vascular effects even with normal levels of CRP.WoSScopu

Treatment Regimen With Bevacizumab Decreases Mean Platelet Volume in Patients With Metastatic Colon Cancer

The risk of thromboemboli is increased in patients with cancer, and this is precipitated by the chemotherapeutic agents. Bevacizumab is an anti-vascular endothelial growth factor monoclonal antibody and has an importance in the treatment of metastatic colon cancer. The association between bevacizumab, which is demonstrated to increase the risk of thromboemboli, and mean platelet volume (MPV), which is a marker of thrombocyte function, has been investigated within study. A total of 74 patients with metastatic colon cancer were included in the study and the levels of platelets (PLTs), MPV, and platecrit (PCT) values were recorded in SPSS 16.0 program both at baseline and at the > third month. There were significant decreases in 3 parameters (PLT, MPV, and PCT) during the treatment period with bevacizumab (P = .009, P = .001, and P = .000, respectively). Unlike cases with thrombosis, there is a significant decrease in MPV in combination treatments with bevacizumab