New treatment strategies in the treatment of juvenile idiopathic arthritis

Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in childhood with an incidence of 10-19/100.000 children below the age of 16 years, and it is also one of the major causes of acquired disability and impairment of quality of life in childhood. Early and aggressive control of arthritis is essential to prevent long-term disability. Methotrexate (MTX) provides clinical benefits in JIA with an acceptable profile of toxic effects. Nevertheless, in many cases, inefficacy, especially in patients with polyarticular and systemic-onset form of JIA (SOJIA) or intolerance to MTX, has led investigators to try other therapeutic options. Biologic agents have been designed to target key cytokines implicated in JIA including tumor necrosis factor-α (TNF-α), Interleukin-1 (IL-1), IL-6 as well as signaling molecules involved in the regulation of T-cell and B-cell lympocyte responses. Up to now, the U.S. Food and Drug Administration (FDA) has approved three biologic agents for use in moderate to severe polyarticular JIA: etanercept, adalimumab and abatacept. In general, TNF-α inhibitors are more beneficial for children with polyarticular disease, and the biological agents that target IL-1 and IL-6 activity appear to be successful also in treating patients with SOJIA. The T-cell costimulation modulator, abatacept, was shown to be effective for the treatment of patients with moderate to severe polyarticular JIA. Autologous stem cell transplantation has also been used in patients with refractory JIA; however, the procedure carries the risk of treatment-related high morbidity and mortality. The purpose of this review is to summarise the recent advances in the treatment of JIA. © 2011 Turkish League Against Rheumatism. All rights reserved

Protracted Febrile Myalgia in a Child as the Presenting Sign of Familial Mediterranean Fever: Case Report and Review of the Literature

Protracted febrile myalgia (PFM) is a rare form of vasculitic disease which is an uncommon dramatic manifestation of familial Mediterranean fever (FMF), characterized by severe crippling myalgia and high fever. We describe a 14-year-old boy who presented with fever, abdominal pain and severe myalgia in all his muscles for 5 days. The diagnosis of PFM was considered based on the presence of fever, paralyzing myalgia with normal CPK, elevated CRP and ESR. Thus, we started prednisolone treatment and his symptoms disappeared and acute-phase reactants declined rapidly. Mutational analysis of the MEFV gene demonstrated homozygote M694V mutation. Thus, he was diagnosed as PFM and FMF. In this report, we present a child with PFM as the sole feature preceding the diagnosis of FMF, and draw attention to the PFM for the diagnosis of FMF even the patient does not fulfi ll the criteria for the clinical diagnosis. © Trakya University Faculty of Medicine

Multislice computed tomography findings of two cases with partial anomalous pulmonary venous return

Partial anomalous pulmonary venous return (PAPVR) is arare congenital disorder that involves drainage of one ormore pulmonary vein to the right atrium or systemic circulation.We report Multi Detector Computed TomographyAngiography (MDCTA) findings of two cases of PAPVRwith the dranaige of left superior pulmonary vein into leftbrachicephalic vein. MDCTA is a non-invasive, usefulmethod for detection of this situation. Multiplanar reformattedimages enables course of anomalous vein, connectionwith the systemic circulation, and accompanyingpulmonary and cardiac anomalies.Key words: Partial anomalous pulmonary venous return,Multi detector computed tomography, MDC

Evaluation of the Association between Paranasal Sinus Osteomas and Anatomic Variations Using Computed Tomography

Objective:The pathogenesis of paranasal sinus osteoma (PSO) has not been fully elucidated. It is thought that both embryological and developmental factors play a role in the etiology. The aim of the present study was to investigate the association of frequency and localization of PSOs detected on computed tomography (CT) examination with osteoma presence.Methods:In this retrospective study conducted in December 2017 through March 2020 in Gaziosmanpaşa University Faculty of Medicine, images of a total of 18,867 patients who underwent paranasal sinus, maxillofacial CT and brain CT angiography were reviewed for the presence of PSOs. Sizes of PSOs and accompanying mucosal pathologies were identified. Associations between PSOs and paranasal sinus variations were evaluated statistically compared to the control group (200 patients without PSO).Results:A total of 176 patients (0.92%) were found to have PSO. Average age of the patients with PSO was 59.9 years (range: 18–93). PSOs were unilateral in 152 patients while 24 patients had multiple osteomas. Female/male ratio was 1.1/1. PSOs were most commonly located in the frontal sinuses. Frequencies of vertical concha bullosa, secondary middle turbinate, twisted uncinate, supraorbital ethmoid cell, intersinus septal cell, ethmoidomaxillary cell, Haller’s cell, frontal sinus hypoplasia and sphenoid sinus hypoplasia were significantly higher in the patient group compared to the control group.Conclusion:Higher or lower incidence rates of some anatomic variations in the patients with PSO could be explained by the possible effects of genetic and/or environmental factor. Additional studies are needed to evaluate these possible associations

The relationship between insulin resistance, metabolic syndrome and nonalcoholic fatty liver disease in non-obese non-diabetic Turkish individuals: a pilot study

Background/Aims: Nonalcoholic fatty liver disease is related to obesity, metabolic syndrome, and insulin resistance. Nonalcoholic fatty liver disease and metabolic syndrome may also be encountered in non-obese, non-diabetic individuals, and there are no published data about the prevalence of these conditions in non-obese, non-diabetic Turkish subjects. We aimed to determine the difference between non-obese, non-diabetic nonalcoholic fatty liver disease patients and healthy controls in terms of insulin resistance and metabolic syndrome in Turkish subjects. Materials and Methods: Non-obese, non-diabetic individuals (n=219) were enrolled. The cohort was divided into two groups according to presence of steatosis in ultrasonography: nonalcoholic fatty liver disease group (n=143) and healthy control group (n=76). Insulin resistance and metabolic syndrome were analyzed and compared between the two groups. Results: The prevalences of metabolic syndrome (32.2% vs. 5.3%, respectively; p<0.001) and insulin resistance (46.2% vs. 9.2%, respectively; p<0.001) were significantly higher in the nonalcoholic fatty liver disease group. According to multiple logistic regression analysis, age (odds ratio 1.534; p=0.0032), insulin resistance (odds ratio 1.074; p<0.001), and serum ALT levels (odds ratio 1.102; p<0.001) were independently associated with nonalcoholic fatty liver disease. Conclusion: Insulin resistance and metabolic syndrome are not rare in non-obese, non-diabetic Turkish subjects with nonalcoholic fatty liver disease. Ultrasonographically detected fatty liver was independently associated with insulin resistance, irrespective of the presence of metabolic syndrome

MRI in the diagnosis of Mayer-Rokitansky-Kuster-Hauser syndrome

PURPOSEThe aim of this study was to establish the role of magnetic resonance imaging (MRI) in patients with Mayer-Rokitansky-Kuster-Hauser syndrome (MRKHS). MATERIALS AND METHODSSixteen female MRKHS patients (mean age, 19.4 years; range, 11–39 years) were studied using MRI. Two experienced radiologists evaluated all the images in consensus to assess the presence or absence of the ovaries, uterus, and vagina. Additional urogenital or vertebral pathologies were also noted. RESULTSOf the 16 patients, complete aplasia of uterus was seen in five patients (31.3%). Uterine hypoplasia or remnant uterus was detected in 11 patients (68.8%). Ovaries were clearly seen in 10 patients (62.5%), and in two of the 10 patients, no descent of ovaries was detected. In five patients, ovaries could not be detected on MRI. In one patient, agenesis of right ovary was seen, and the left ovary was in normal shape. Of the 16 cases, 11 (68.8%) had no other extragenital abnormalities. Additional abnormalities were detected in six patients (37.5%). Two of the six had renal agenesis, and one patient had horseshoe kidney; renal ectopy was detected in two patients, and one patient had urachal remnant. Vertebral abnormalities were detected in two patients; one had L5 posterior fusion defect, bilateral hemisacralization, and rotoscoliosis, and the other had coccygeal vertebral fusion. CONCLUSIONMRI is a useful and noninvasive imaging method in the diagnosis and evaluation of patients with MRKHS

Link between angiographic extent and severity of coronary artery disease and degree of sensorineural hearing loss

Aims. Atherosclerosis is a systemic disease that can affect the whole arterial tree. An important cause of neuronal degeneration is atherosclerosis, which may lead to sensorineural hearing loss. We aimed to investigate the relationship between the angiographic severity and extent of coronary artery disease, which is a surrogate of atherosclerotic burden, and the degree of sensorineural hearing loss.Patients and methods. Out of 381 consecutive patients who underwent coronary angiography for symptoms suggesting ischemic heart disease and who had ischemia detected by a noninvasive stress test, 265 patients [mean age, 61.5±13.0 years; median age (25th–75th percentile), 59 years (50.5–67)], including 146 male (55.1%) subjects met the eligibility criteria and were enrolled. Audiological measurements (hearing levels and discrimination scores) were performed before the coronary angiography. The Gensini score was calculated for each angiogram.Results. There was a statistically significant positive correlation between the degree of hearing loss at all frequencies analyzed (250, 500, 1,000, 2,000, 4,000 Hz) and the Gensini score (p<0.05 for all frequencies), which remained significant after adjustment according to age and other risk factors. A statistically significant negative correlation was observed between the Gensini score and the speech discrimination score (p<0.05).Conclusion. The findings of this study suggest that the angiographic severity and extent of coronary artery disease are significantly and independently correlated with the degree of hearing loss. Sensorineural hearing loss was more prominent in patients with higher Gensini scores. We propose that the findings of this study warrant further research and should be verified in large-scale studies

How An Emergency Can Effect Urological Emergencies: COVID-19

Objective:Coronavirus disease-2019 (COVID-19) has caused many changes in the health services since its inception. The change in the functioning of the emergency services and the decrease in admissions have also changed the form of consultations requested from the urology clinic. This study aims to reveal how the consultations requested from the urology clinic of a large hospital were affected during the COVID-19 period.Materials and Methods:In our study, one year before and after March 10, 2020, was divided into two groups as “pre-covid” and “covid era”. The gender, age, reason for consultation, result, date and time, hospitalization status of the patients were examined.Results:A total of 2018 consultations, 1242 in the pre-COVID period and 776 during the COVID period, were analyzed in the study. Although renal colic was the most common reason for consultation in both periods, its number and rate decreased significantly during the COVID period [384 (30.9%) vs. 165 (21.3%), p≤0.0001]. Proportionally, more patients were hospitalized during the COVID period [196 (15.8%) vs. 161 (20.7%), p=0.02]. In both periods, the most common reason for hospitalization was hematuria, but the difference was not statistically significant [26 (29.5%) vs. 20 (27.8%), p=0.261].Conclusion:COVID-19 has turned all health parameters upside down and has been one of the biggest factors affecting public health since the day it started. While the density and form of consultation requested from the urology clinic changed during the pandemic period, the hospitalization rates increased, so urology clinics should adapt accordingly for possible pandemic waves or epidemics in the future

Энергетическая дипломатия Китая - среднеазиатское и российское направление

В данной статье рассматривается феномен энергетической дипломатии Китая на современном этапе, его цели, свойства и основные направления. Также, в статье затрагивается актуальная тема российско-китайского энергетического сотрудничества (в частности подписание в 2014 году контракта на поставку российского трубопроводного газа в Китай) и его последствий для развития экономик обеих стран, перспективы обеспечения экономической безопасности Китая и Российской Федерации