Levodopa-refractory hyperprolactinemia and pituitary findings in inherited disorders of biogenic amine metabolism

Elevated serum prolactin concentrations occur in inherited disorders of biogenic amine metabolism because dopamine deficiency leads to insufficient inhibition of prolactin secretion. This work from the International Working Group on Neurotransmitter Related Disorders (iNTD) presents the results of the first standardized study on levodopa-refractory hyperprolactinemia (LRHP; >1000 mU/L) and pituitary magnetic resonance imaging (MRI) abnormalities in patients with inherited disorders of biogenic amine metabolism. Twenty-six individuals had LRHP or abnormal pituitary findings on MRI. Tetrahydrobiopterin deficiencies were the most common diagnoses (n = 22). The median age at diagnosis of LRHP was 16 years (range: 2.5-30, 1st-3rd quartiles: 12.25-17 years). Twelve individuals (nine females) had symptoms attributed to hyperprolactinemia: menstruation-related abnormalities (n = 7), pubertal delay or arrest (n = 5), galactorrhea (n = 3), and decreased sexual functions (n = 2). MRI of the pituitary gland was obtained in 21 individuals; six had heterogeneity/hyperplasia of the gland, five had adenoma, and 10 had normal findings. Eleven individuals were treated with the dopamine agonist cabergoline, ameliorating the hyperprolactinemia-related symptoms in all those assessed. Routine monitoring of these symptoms together with prolactin concentrations, especially after the first decade of life, should be taken into consideration during follow-up evaluations. The potential of slow-release levodopa formulations and low-dose dopamine agonists as part of first-line therapy in the prevention and treatment of hyperprolactinemia should be investigated further in animal studies and human trials. This work adds hyperprolactinemia-related findings to the current knowledge of the phenotypic spectrum of inherited disorders of biogenic amine metabolism

Acil servise renal kolik ile başvuran hastaların değerlendirilmesi

Objective: This study aimed to assess some demographical and clinical aspects and laboratory findings of patients presenting with the complaint of renal colic to the emergency department. Material and Methods: The study included a total of 150 adult patients presenting to the emergency department of our University hospital with the complaint of renal colic between January 2009 and January 2010. The data were derived from the patient files of our hospital. Demographical data, time of admission, clinical findings together with laboratory and radiologic findings of patients were assessed. Mean values were calculated as mean value ± standard deviation. Results: Of the patients 91 (68,4 %) were male and the mean age was 38,9±16,5 years. Most of the patients were admitted in October (n= 22, 16,6 %). The most common complaint of the patients was flank pain. The erythrocytes was revealed in 72,2 % of the patients by the urinalysis. Calculus formation was determined in 71 (53,4 %) of the patients. The urinary system ultrasonography (USG) was applied to 39,1 % of the patients and localized renal calculus was detected in 52,0 % of those patients. It was identified that the most common region of localization was the ureter and detected in 29 of the patients (40,9 %). Conclusion: Ultrasonography is considerably a valuable method in identifying renal complications that might lead to dysfunctions in these patients. However, the absence of hematuria does not necessarily rule out the renal colic. We think that emergency physicians should rule out the urinary obstruction in such kind of patients.Amaç: Bu çalışmada acil servise renal kolik ile başvuran hastaların bazı demografik ve klinik özelliklerinin ve laboratuvar bulgularının değerlendirilmesi amaçlandı. Gereç ve Yöntem: Çalışmamız Ocak 2009-Ocak 2010 tarihleri arasında Üniversite hastanesi acil servisine renal kolik nedeniyle başvuran, erişkin, 150 hastayı kapsamaktadır. Veriler, hastanemizin hasta dosyalarından elde edilmiştir. Hastaların demografik özellikleri, başvuru zamanı, klinik bulguları, laboratuvar ve radyolojik verileri değerlendirildi. Ortalama değerler, ortalama ± standart sapma olarak verildi. Bulgular: Hastaların 91’i (% 68,4) erkekti ve yaş ortalamaları 38,9±16,5 yıl idi. En fazla hasta başvurusu ekim ayında oldu (n= 22, % 16,6). Hastaların en sık şikayeti yan ağrısı idi. Yapılan idrar analizinde hastaların % 72,2’ sinde eritrosit tespit edildi. Hastaların 71’inde (% 53,4) taşın lokalizasyonu belirlendi. Üriner sistem ultrasonografi (USG)’si uygulanan hastalarda (n=52, % 39,1) taşın görülme oranı % 52,0 idi. Tespit edilen en sık taş yerleşim yerinin 29 hasta (% 40,9) ile üreter olduğu belirlendi. Sonuç: USG, bu hastalarda böbreğin işlev kaybına sebep olabilecek komplikasyonları saptamak için oldukça değerli bir yöntemdir. Renal kolikli hastalarda mutlak hematüri olmayabilir. Acil hekimlerinin bu tür hastalarda üriner obstrüksiyonu dışlamaları gerektiğini düşünmekteyiz

Teriparatide Treatment in Patients with Severe Osteoporosis: Effects on Bone Mineral Density, Biochemical Parameters, Back Pain and Quality of Life

Objective: To evaluate effects of teriparatide therapy on bone mineral density (BMD), biochemical parameters, back pain, and quality of life in patients with severe osteoporosis, who had long-term bisphosphonate treatment. Materials and Methods: Fifteen patients with severe osteoporosis who did not respond to bisphosphonate therapy after an extended period of treatment were enrolled in the study. Teriparatide therapy (20 μq/day) was administered subcutaneously for 12 months as well as 800 IU/day of vitamin D3 and 1200 mg/day of calcium. Patients were evaluated before and after teriparatide therapy in terms of BMD, biochemical parameters, back pain and quality of life. Back pain was assessed by Visual Analog Scale (VAS), and quality of life was assessed by the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO). Results: The BMD, VAS scale of back pain and all subgroups of QUALEFFO except the social function sub-group showed statistically significant differences before and after treatment. Biochemical parameters did not show any significant difference. Conclusion: Teriparatide therapy may be a good alternative therapy in patients with severe osteoporosis in whom prolonged use of bisphosphonates was present. (Turkish Journal of Osteoporosis 2014;20: 51-5

Reasons for Overcrowding in the Emergency Department: Experiences and Suggestions of an Education and Research Hospital

SUMMARY: Objectives: In this study, we aimed to determine the causes of overcrowding in the Emergency Department (ED) and make recommendations to help reduce length of stay (LOS) of patients in the ED. Methods: We analyzed the medical data of patients admitted to our ER in a one-year period. Demographic characteristics, LOS, revisit frequency, and consultation status of the patients were determined. Results: A total of 163,951 patients were admitted to our ED between January 1, 2013, and December 31, 2013. In this period 1,210 patients revisited the ED within 24 hours. A total of 38,579 patients had their treatment in the observation room (OR) of the ED and mean LOS was found to be 164.1 minutes. Cardiology was the most frequently consulted specialty. Mean arrival time of the consultants in ED was 64 minutes. Conclusions: Similar to EDs in other parts of the world, prolonged length of stay in the ED, delayed laboratory and imaging tests, delay of consultants, and lack of sufficient inpatient beds are the most important causes of overcrowding in the ED. Some drastic measures must be taken to minimize errors and increase satisfaction ratio. ÖZET: Amaç: Bu çalışmada, acil serviste aşırı yoğunluğun nedenlerini belirlemeyi ve hastaların acil serviste kalış sürelerini azaltmaya yönelik önerilerimizi sunmayı hedefledik. Gereç ve Yöntem: Bir yıllık sürede acil servise başvuran hastaların tıbbi bilgileri incelendi. Hastaların demografik özellikleri, kalış süreleri, tekrar başvuru sayıları ve konsültasyon durumları belirlendi. Bulgular: 1 Ocak 2013 ile 31 Aralık 2013 tarihleri arasında toplam 163951 hasta acil servise başvurdu. Bu süre içinde, 1210 hasta 24 saat içerisinde tekrar acile başvurdu. Toplam 38579 hasta tedavisini acil servisin gözlem odasında aldı ve ortalama kalış süresi 164.1 dakikaydı. En fazla konsültasyon istenen bölüm kardiyoloji idi. Konsültanların acil servise varış süresi ortalama 64 dakikaydı. Sonuç: Dünyanın diğer bölgelerindeki acil servislere benzer şekilde, acilde aşırı yoğunluğun en önemli nedenleri acil serviste uzun kalış süresi, gecikmiş laboratuvar ve görüntüleme testleri, konsültanların gecikmesi ve yeterli hastane yatağı olmamasıdır. Hataları en aza indirmek ve memnuniyet oranını artırmak için, ilgili farklı birimlerle temas halinde, bazı sert önlemler alınmalıdır. Key words: Consultation, emergency department, overcrowding, Anahtar sözcükler: Konsültasyon, acil servis, aşırı yoğunlu

Impact of Rosuvastatin on Contrast-Induced Acute Kidney Injury in Patients at High Risk for Nephropathy Undergoing Elective Angiography

Although statins have been shown to prevent contrast-induced acute kidney injury in patients with acute coronary syndromes, the benefit of statins is not known for patients at high risk for nephropathy who undergo elective coronary angiography. Two hundred twenty consecutive statin-naive patients with chronic kidney disease (estimated glomerular filtration rate = 0.5 mg/dl or a relative increase of >= 25% measured 48 or 72 hours after the procedure. Contrast-induced acute kidney injury occurred in 15 patients (7.2%), 9 (8.5%) in the control group and 6 (5.8%) in the rosuvastatin group (p = 0.44). The incidences of adverse cardiovascular and renal events (death, dialysis, myocardial infarction, stroke, or persistent renal damage) were similar between the two groups at follow-up. In conclusion, rosuvastatin did not reduce the risk for contrast-induced acute kidney injury or other clinically relevant outcomes in at-risk patients who underwent coronary and peripheral vascular angiography. (C) 2015 Elsevier Inc. All rights reserved

How Dialysis Patients Cope with a Curfew? A Comparison of Psychological Status between Hemodialysis and Peritoneal Dialysis Patients During the COVID-19 Pandemic

Introduction: There are many differences between hemodialysis (HD) and peritoneal dialysis (PD) treatments, including their impact on the psychological status of the patients. In this study, our aim was to compare the psychological statuses of HD and PD patients during the social isolation period due to the COVID-19 pandemic. Methods: We conducted this cross-sectional study on adult HD and PD patients when the curfew measures were in effect. We used an electronic form composed of 3 sections to collect data. In the first section, we collected data on the demographics and clinical and laboratory parameters of the patients. The second and third sections consisted of the Hospital Anxiety and Depression Scale (HADS) and the Impact of Event Scale-Revised (IES-R) questionnaires, respectively. Results: The HD (n = 116) and PD (n = 130) groups were similar regarding age and sex, and they had similar HADS anxiety scores. HADS depression scores were higher in PD patients (p = 0.052). IES-R scores were significantly higher in PD patients in comparison to HD patients (p = 0.001). Frequencies of abnormal HADS-anxiety (p = 0.035) and severe psychological impact (p = 0.001) were significantly higher in PD patients. Discussion/Conclusion: During the social isolation period due to the COVID-19 pandemic, HD patients had better mood profiles than PD patients. A more stable daily routine, an uninterrupted face-to-face contact with health-care workers, and social support among patients in the in-center dialysis environment might be the cause of the favorable mood status. PD patients might need additional psychological support during those periods

Effects of SGLT2 inhibitors on patients with diabetic kidney disease: A preliminary study on the basis of podocyturia

Background The aim of this study was to investigate the effects of sodium glucose cotransporter 2 inhibitors (SGLT2i) on the glomerulus through the evaluation of podocyturia in patients with diabetic kidney disease (DKD). Methods The study population was composed of 40 male patients with type 2 diabetes mellitus; 22 of them received SGLT2i (SGLT2i group), and the others who did not were the control. The DKD-related parameters of patients were monitored before SGLT2i initiation, and then in the third and sixth month of the follow-up period. Patients' demographic, clinical, laboratory, and follow-up data were obtained from medical charts. Microalbuminuria was measured in 24-h urine. The number of podocytes in the urine was determined by immunocytochemical staining of two different markers, namely podocalyxin (podx) and synaptopodin (synpo). Concentrations of urine stromal cell-derived factor 1a and vascular endothelial growth factor cytokines were quantified with an enzyme-linked immunosorbent assay kit. Results At the end of the follow-up period, decreases in glycosylated hemoglobin, glucose, systolic and diastolic blood pressure, uric acid level, and microalbuminuria, and improvement in body mass index level and weight loss were significant for the SGLT2i group. On the other hand, there was no significant difference in terms of these parameters in the control group. The excretion of synaptopodin-positive (synpo(+)) and podocalyxin-positive (podx(+)) cells was significantly reduced at the end of the follow-up period for the SGLT2i group, while there was no significant change for the control. Conclusions At the end of the follow-up period, male patients receiving SGLT2i had better DKD-related parameters and podocyturia levels compared to baseline and the control group. Our data support the notion that SGLT2i might have structural benefits for glomerular health