Diabetic ketoacidosis as the presenting manifestation of pancreatic adenocarcinoma with cystic features

AbstractThe common presenting symptoms of pancreatic cancer are abdominal pain, weight loss, and jaundice. Pancreatic adenocarcinoma presenting with diabetic ketoacidosis is a very rare emergent clinical condition. However, pancreatic ductal cystadenocarcinoma presenting with diabetic ketoacidosis was not reported. We describe a 60-year-old man with pancreatic cystadenocarcinoma presenting with diabetic ketoacidosis as the initial manifestation. It must be kept in mind that in diabetic ketoacidosis cases, the precipitating factor may be pancreatic ductal cystadenocarcinoma

Effects of Glucose Control on Hematological Indices in Patients with Diabetes Mellitus

Aim: We aimed to investigate the effects of diabetes treatment modalities on haematological parameters and leukocyte formula in patients with type 2 diabetes mellitus.Materials and Methods: The study included 102 patients with type 2 diabetes, out of which 51 receiving insulin treatment and 51 receiving oral antidiabetics (OAD). Hemogram data of insulin and OAD treated groups were compared.Results HbA1c levels were 11.12 ± 2.09 mg/dl in insulin group and 7.94 ± 2.1 mg/dl in OAD group p=0.001. Platelet counts were 27866.67 ± 77693 109/L before treatment and 258941.18 ± 69068.2 109/L in OAD group at six months, p: 0.015 whereas; 293011.76 ± 73711.21 109/L before treatment and 289492.86 ± 82631.49 109/L in insulin group at six months p: 0.821. Monocyte counts were 0.47 ± 0.12 109/L before the treatment and 0.57 ± 0.12 109/L in mix insulin therapy subgroup at six months, p:0.004; monocyte percentage was % 6.11 ± 1.74 before the treatment and %7.51 ± 2.57 in mix insulin subgroup at six months p:0.039;  Basophiles counts were 0.1 ±  0.02 109/L before treatment and 0.09 ± 0.04 109/L in intensive insulin therapy subgroup at six months, p: 0.005; Lymphocyte and basophils counts were significantly decreased at six months insulin treatment as compared to the pretreatment values.Conclusion: This study showed that, glucose control effects; blood indices HbA1C, basophiles, eosinophils, platelets and lymphocytes counts

Association between neutrophil-to-lymphocyte ratio and nutritional status in geriatric patients

Background Neutrophil-to-lymphocyte ratio (NLR) and presence of malnutrition have been found to be associated with mortality and morbidity in various clinical conditions. We investigated the association between NLR and nutritional status in geriatric patients. Methods This cross-sectional study included 95 geriatric (age >= 65 years) patients from general internal medicine outpatient clinic of a university hospital. Nutritional status of the patients was evaluated using Mini Nutritional Assessment (MNA), Geriatric Nutritional Risk Index, albumin, total cholesterol, body mass index, mid-arm circumference, and calf circumference. NLR was calculated from the complete blood count results. Results A total of 59 patients were female, and the mean age was 73 +/- 9.8 years. According to the MNA, 51.6% of patients had a normal nutritional status, and 48.4% were malnourished or at risk of malnutrition. The mean NLR of patients with malnourished or at risk of malnutrition was significantly higher than that of patients with normal nutritional status (P = 0.004). There was a negative correlation between NLRs and the MNA scores (r = -0.276, P = 0.007). Optimal NLR cutoff point for patients with malnourished or at risk of malnutrition was 1.81 with 71.7% sensitivity and 63.3% specificity [95% confidence interval (CI): 0.562-0.780, P = 0.004]. Logistic regression analysis revealed that elevated NLR was an independent factor in prediction of malnutrition or risk of malnutrition in geriatric patients. Conclusion These results demonstrated that NLR was associated with the nutritional status of geriatric patients. NLR may be a useful nutritional marker for evaluating the nutritional status of geriatric outpatients

A Very Rare Presentation of Multiple Myeloma: Unilateral Raccoon Eye

Multiple myeloma (MM), the second most common hematological malignancy, is caused by the accumulation of monoclonal plasma cells in bone marrow. It accounts for 10–15% of deaths from hematological malignancies and approximately 2% of deaths from cancer. The median age at presentation is 70 years old. The diagnosis is incidental in 30% of cases. MM is often discovered through routine blood screening with a large gap between the total protein and the albumin levels.Two thirds of patients complain of bone pain, especially lower back pain. MM could be diagnosed after a pathologic fracture occurs in one third of patients. Presentation with symptoms related to hyperviscosity, hypercalcemia and bleeding tendency could also be observed. A rare presentation of MM is peri-orbital ecchymotic lesion (raccoon eye). Here, we report a 64 years old, male patient presented with unilateral raccoon eye and high erythrocyte sedimentation rate (ESR) to internal medicine outpatient. The patient was referred to hematology outpatient and was diagnosed with multiple myeloma

The efficacy of adefovir dipivoxil in chronic hepatitis B patients with lamivudine resistant

Kronik hepatit B (KHB) virus infeksiyonu dünyada tahmin edilen prevalansıyla 400 milyondan fazla kişide görülmektedir. KHB’si ve viral replikasyon bulguları olan hastalar ciddi karaciğer hastalığı yönünden yüksek risk altındadırlar. Lamivudin tedavisinin KHB’li hastalarda virolojik, biyokimyasal ve histolojik olarak etkili olduğu gösterilmiştir. Uzun dönem lamivudin tedavisiyle ilgili önemli bir sorun hepatit B virusu (HBV) polimerazında mutasyonlara bağlı viral direnç gelişimidir. Lamivudine dirençli HBV gelişmesi, lamivudine klinik ve virolojik cevabı azaltır. Bu nedenle lamivudine dirençli hastalarda alternatif veya ek tedaviler gereklidir. Adefovir dipivoksil lamivudine dirençli KHB’de etkili olduğu gösterilmiş bir nükleotid analogudur. Bu nedenle lamivudine dirençli KHB’li hastalarda genellikle adefovire geçilmesi önerilmektedir. Bu çalışmanın amacı bizim toplumumuzdaki lamivudine dirençli KHB’li hastalarda adefovir dipivoksilin etkinliğini değerlendirmekti. Çalışmaya lamivudine dirençli KHB’si olan 47 hasta alındı. Tüm hastalara en az 6 ay süreyle (aralık, 6–24 ay) 10mg/gün adefovir dipivoksil verildi. Başlangıçta ve tedavi boyunca her 3 ayda bir serum HBV-DNA, aspartat aminotransferaz (AST), alanin aminotarnsferaz (ALT) değerleri ölçüldü. Adefovir dipivoksil ile tedavinin 3, 6, 12, 18 ve 24. aylarındaki ortalama HBV-DNA, AST, ALT seviyelerinde başlangıçtaki ortalama değerlere göre anlamlı değişiklik saptandı (p<0,001). Adefovir dipivoksil alan hastalarda serum HBV-DNA, AST, ALT seviyeleri anlamlı olarak azaldı. Çalışmada adefovir dipivoksil, tedavi süresince genel olarak iyi tolere edildi. Bu çalışmada, daha önceki çalışmalara benzer şekilde adefovir dipivoksil lamivudine dirençli KHB’li hastalarda anlamlı antiviral ve biyokimyasal etki gösterdi. Lamivudine dirençli KHB’li hastalarda adefovir dipivoksilin uzun dönem etkinlik ve güvenirliğinin değerlendirilmesi için başka çalışmalar gerekmektedir.Chronic hepatitis B (CHB) virus infection is common, with an estimated global prevalence of more than 400 million people. Patients with CHB and evidence of ongoing viral replication have a high risk of serious liver disease. Lamivudine has been shown to achieve virological, biochemical, and histological responses in patients with CHB. A major problem with prolonged lamivudine therapy is the increasing rate of viral resistance due to mutations within the hepatitis B virus (HBV) polymerase. Emergence of lamivudine resistant HBV has been associated with a diminished clinical and virologic response to lamivudine. Thus, there is a clear need for alternative or additional therapies against lamivudine resistant HBV. Adefovir dipivoxil is a nucleotide analog that has been shown to have activity against lamivudine resistant HBV. Therefore, a switch to adefovir is usually recommended for patients with lamivudine resistant CHB. The aim of this study was to evaluate the efficacy of adefovir dipivoxil against lamivudine resistant chronic hepatitis B in our patients. 47 patients with lamivudine resistant CHB were enrolled in the study. All patients received adefovir dipivoxil 10 mg once daily for at least 6 months (range, months 6–24). Serum HBV-DNA, aspartate aminotransferase (AST), alanine aminotransferase (ALT) levels were measured at baseline and every 3 months during the treatment period. There were significant change in mean HBV-DNA, AST, ALT levels following 3,6,12,18,24 months of treatment with adefovir dipivoksil from baseline (p<0,001). Serum HBV-DNA, AST, ALT levels significantly decreased in patients receiving adefovir dipivoxil. Adefovir dipivoxil was generally well tolerated during treatment period in the study. In this study, as previous studies adefovir dipivoxil showed significant antiviral and biochemical activity in CHB patients with lamivudine resistance. Further studies are needed to examine long term efficacy and safety of adefovir dipivoxil in patients with lamivudine resistant CHB

Stadyum Yer Seçimi Kararlarına Taraftar Tepkileri

Kentlerdeki büyük alan kullanımı gerektiren havalimanı, spor tesisleri, toplukonut projeleri gibi kararların yer seçiminde planlamanın ön göremediği sorunlaryaşanmaktadır. Özellikle çok paydaşlı olan projelerde çeşitli grupların çıkarlarıdoğrultusunda tepkiler verdiği görülmektedir. Stadyumlar yer seçim kararlarınatepkiler gösteren taraftar grupları da bunun öne çıkan örneklerindendir. Kimizaman yeni bir stadyumun yapılmasında kimi zaman da var olan stadyumun yerdeğiştirmesinde taraftar gruplarının protestoları gündeme gelmektedir. Bu çalışma,Türkiye’deki futbol kulüplerinin stadyum kararlarına verdiği tepkiler üzerindenörnekler inceleyerek kentteki kararlarda kullanıcı görüşlerini tartışmayıamaçlamaktadır. Araştırmada planlamada katılım ve stadyumların yer seçimikriterleri hakkında literatür taraması ve taraftar tepkilerini ortaya koymak içinmedya araştırması yöntemleri kullanılmıştır. Sonuç olarak, bu tür makro ölçeklikararlarda plancıların kamu yararı ve yatırımcıların rant için taraf olduğu yer seçimisüreçlerinde kullanıcılar erişim, konfor ve anı değeri konularını dile getirmektedir.Bu çalışmanın çeşitli aktör görüşlerinin dikkate alınması konusundaki vurgusu ileplanlama sürecindeki çatışmalarla ilgili literatüre ve taraftarların öncelikleriniortaya çıkarması ile de stadyum yer seçimindeki karar vericilere katkı ve bilgisağlaması hedeflenmektedir.</p