Propylthiouracil-induced lupus-like or vasculitis syndrome

A 27 year old female with Graves' disease presented with fever, exertional dyspnea and polyarthralgia. Erythema nodosum had occured three months earlier. The patient declared irregular use of propylthiouracil (PTU) for the last 8 months. Neutropenia and microscopic hematuria developed in the second week of admission. Chest X-ray showed inhomogenous pulmonary opacities, left pleural effusion and cardiomegaly. Computed tomography (CT) revealed multiple subpleural nodules, left pleural effusion, pericardial effusion, enlarged mediastinal and axillary lymph nodes. Bronchoalveolar lavage (BAL) cytology demonstrated hemosiderin laden macrophages. Histopathologic examination of the transbronchial biopsy specimen revealed a nonspecific inflammation. Serum was positive for ANA, P-ANCA, MPO-ANCA, PR3-ANCA and negative for anti-ds-DNA, C-ANCA, C3, C4 and anti-histone antibody. All symptoms resolved in two months after PTU withdrawal and starting steroid treatment. The same clinical manifestations recurred when the patient used PTU erronously one month after discharge. This is a case of PTU induced-autoimmune disease in whom the accurate distinction between drug-induced-lupus (DIL) and vasculitis was not possible due to the significant overlap of clinical and laboratory findings causing a significant diagnostic challenge for the chest physician

Rhabdomyolysis Secondary to Severe Hypokalemia: Case Report

Primary hyperaldosteronism is an endocrine disorder characterized by an increased aldosterone excretion from the adrenal glands, which causes hypertension, hypokalemia, and suppressed plasma renin activity. It can be difficult to diagnose until hypokalemic manifestations, such as rhabdomyolysis, occur, and also these subjects may be treated as essential hypertensive patients. Here, we report a 51 -year-old woman who presented with rhabdomyolysis caused by severe hypokalemia and was diagnosed with Conn's syndrome

Does plasma phoenixin level associate with cognition? Comparison between subjective memory complaint, mild cognitive impairment, and mild Alzheimer's disease

Background: Alteration in energy expenditure or metabolism is the most accused risk issue for the onset and for the course of neurodegenerative cognitive disorders. Neuropeptides are suggested to be related with learning and memory. Phoenixin (PNX) is the most recently reported neuropeptide and we aimed to compare the plasma level in people with subjective memory complaints, patients with mild cognitive impairment, and mild Alzheimer's disease (AD)

Prevalence of fecal incontinence and associated risk factors in elderly outpatients: a cross-sectional study

Data on the prevalence of fecal incontinence in elderly patients admitted to outpatient clinics in Turkey are scarce

The Attitudes of Patients toward the Presence of Students in Internal Medicine Inpatient and Outpatient Practice

Objective: The medicine educators increase the clinical skills and professional thinking ability of students by examining patients, showing their attitudes towards them, and attracting their response in the presence of medical students. In this study, we aimed to investigate the attitudes of patients who applied to internal medicine toward the presence of medical students and the possible factors that may influence such attitudes

Why is vaccination frequency low in elderly patients? Vaccination in elderly patients

Aim: The aim of the study is to investigate the frequency of vaccination in elderly outpatients, the reasons for not vaccinating despite vaccination recommendations and the related factors. Material and Method: The prospective study was done between June 2013-March 2015 and included patients who applied to the outpatient clinic for the first time, regularly attended to the controls and had at least 1 year of follow-up. Vaccination education was given to patients. At final assessment, the patients were interviewed by telephone. Vaccinations of all patients and why non-vaccinated patients were not vaccinated were questioned. All data were analyzed using appropriate statistical methods. Results: Of 267 patients enrolled in the study, mean age was 77 +/- 7.1 and mean follow-up period was 19.7 +/- 5.5 (month) were. At the end of follow-up, vaccination rates were: pneumococcal vaccine (PV) 21%, Influenza (IV) 35%, and tetanus-diphtheria (TdV) 8%. PV was found in a statistically significant relation between, IV (r=0.63, p<0.001), TdV (r=0.28, p<0.001), the inadequacy of information given by the physician and/or physician not telling to definitely do it (r=-0.43, p<0.001) and no previous vaccination recommendation (r=0.12, p=0.05). IV was found in a statistically significant relation between, PV (r=0.63, p<0.001), TdV (r=0.21, p<0.001), the inadequacy of information given by the physician and/or physician not telling to definitely do it (r=-0.46, p<0.001) and despite vaccination education missing to be vaccinated (r=0.20, p=0.01). Discussin: Vaccination frequency in elderly patients is lower than expected, although they are recommended to be vaccinated. The most common reason is the inadequacy of information given by the physician and/or physician not telling to definitely do it

Serum Endocan Level and the Severity of Coronary Artery Disease: A Pilot Study.

Endothelial-specific molecule 1 (endocan) is expressed in endothelial cells. We investigated the relationship between acute coronary syndrome (ACS) and serum endocan levels. We included 30 individuals as a control group and 53 patients diagnosed with ACS. The severity of coronary artery disease was assessed by a modified Gensini stenosis and SYNTAX scoring system. There was a significant difference in serum endocan levels between the control group and the ACS group (0.75 +/- 0.13 vs 0.86 +/- 0.25 ng/mL, P = .014). There was also a significant difference in serum endocan levels between diabetic patients with ACS and nondiabetic patients with ACS (1.02 +/- 0.33 vs 0.81 +/- 0.21 ng/mL, P = .016). There was no significant correlation between serum endocan level, Gensini, and SYNTAX score (r = .11, P = .53 and r = .16, P = .37). Endocan, a new biomarker of endothelial pathology, is significantly increased in patients with ACS