Artralji ile Başvuran Bir Wegener Granülamatozu Olgusu

Granulomatosis with polyangitis (GPA/WG) (previously known as Wegener granulomatosis) is a multisystemsystemic necrotizing non-caeseating granulomatous vasculitis affecting small to medium sized arteries, capillaries andveins, with a predilection for the respiratory system and kidneys. The average incidence of this disease is 40-55. 90% of theWG patients have pulmonary involvement. Wegener Granulomatosis is a disease with high mortality when its diagnosisand treatment is delayed. Although WG may have symptoms such as hemoptysis and hematuria, it should be noted that itmay present with severe arthralgia and arthritis which may be in many connective tissue diseases and vasculitis. Malepatient, 52 years old. Analgesic treatment was applied when he came to the center due to arthralgia two months ago,however, there was no change in his complaints and intra-articular injection treatment was applied on left knee and bothshoulders. The symptoms did not regress and the patient lost 20 kg within the last two months. In urine analysis, 14-15erythrocyte and 10-15 leucocyte detected in every field; 1 positive detected. The patient was hospitalized in order to makefurther examination upon the determination of CRP: 61 mg/L and ESR: 82 mm/hr in the next polyclinic control after threedays. In the kidney biopsy report, “Pauci-immun glomerulonephritis” was primarily considered in the phenomenon. For thefirst three days 1 gr pulse and by the fourth day 1 mg/kg methylprednisolone and cyclophosphamide treatment was appliedWegener Granülomatozu özellikle üst solunum yolları, akciğer ve böbrekler olmak üzere, tüm organları tutabilen nekrotizan granülomatöz vaskülitik bir hastalıktır. Ortalama görülme yaşı 40-55 tir. Kadın ve erkek eşit etkilenir. Akciğer tutulumu Wegener granülomatozisli hastaların %90’ında mevcuttur. Wegener Granülomatozu, tanı ve tedavisi geciktiğinde, mortalitesi yüksek olan bir hastalıktır. WG’nin hemoptizi ve hematüri gibi semptomları olabileceği gibi; birçok konnektif doku hastalığı ve vaskülitte olabilen şiddetli artralji ve artritle de prezente olabilir. 52 yaşında erkek hasta. 2 ay önce başlayan eklemlerde ağrı şikayetiyle başvurduğu merkezde analjezik tedavisi uygulanmış ancak fayda görmemesi nedeniyle sol diz ve her iki omuzuna intraartiküler enjeksiyon tedavisi yapılmış. Şikayetleri gerilemeyen hastanın son 2 ayda 20kg kaybı olmuş. Tam idrar tahlilinde: her sahada 14-15 eritrosit ve 10-12 lökosit, protein; 1 pozitif saptandı. Hastanın 3 gün sonraki poliklinik kontrolünde CRP’si:61 mg/L, sedimantasyonu: 82 mm saptanması üzerine ileri tetkik amacıyla hospitalize edildi. Böbrek biyopsisi raporunda, ön planda “pauci-immun glomerulonefrit” düşünüldü. İlk 3 gün 1 gr pulse, 4. günden itibaren 1 mg/kg metilprednizolon tedavisi ve siklofosfamid tedavisi uygulandı

The mediating role of cognitive flexibility and critical thinking in the relationship between academic motivation and fear of negative evaluation

Studies showed that fear of negative evaluation of students may affect their academic motivation. However, which variables mediate between academic motivation and fear of negative evaluation is unclear. This study aims to explore the mediating role of cognitive flexibility and critical thinking in the relationship between academic motivation and fear of negative evaluation in adolescents. A correlational design was used to examine this relationship. A total of 2085 adolescents ages 13-14 (65% female) participated in this study. The data were collected via self-report screening tools, including a personal information form, Academic Motivation Scale, Fear of Negative Evaluation Scale, Cognitive Flexibility Scale, and Critical Thinking Scale. The findings revealed a moderate negative correlation between academic motivation and fear of negative evaluation (r = -.49), and cognitive flexibility and critical thinking also partially mediate. This model explains approximately 41% of the total variance. Despite some limitations, our study provides partial evidence of the mediating effect of cognitive flexibility and critical thinking between academic motivation and fear of negative evaluation. More research is needed to develop the model