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Objectives: Oxidative stress plays a significant role in the pathogenesis of chronic diabetic complications. Hyperglycemia induced oxidative stress is prominent for the development of diabetic polyneuropathy (PNP). Thiol disulfide homeostasis plays a vital role in antioxidant defense. In this study, we aimed to investigate thiol-disulfide homeostasis, total antioxidant capacity (TAC), and advanced oxidant protein products (AOPP) in patients with PNP. Methods: Eighty patients with T2DM and 19 healthy controls were included in the study. PNP was assessed by using the Michigan Neuropathy Screening Instrument and Electroneuromyography. TAC, AOPP, and total thiols, native thiols and disulfide levels of thiol-disulfide homeostasis parameters were studied with serum samples. The results were compared in patients with/without PNP and control group. Results: Serum HbA1c (9.5 ± 2.0% vs 8.0 ± 1.8%; p = 0.019) and triglyceride levels (204.4 ± 77.0 vs 151.7 ± 58.5 mg/dL, p = 0.014) were significantly higher and serum total thiol levels (540.4 ± 9.9 vs 566.7 ± 2.6 μmol/L, p = 0.038) were significantly lower in patients with PNP. Serum TAC, AOPP, native thiol, and disulfide levels were comparable among patients with/ without PNP. Serum CRP, AOPP, total thiol, and native thiol levels were found to be higher in patients with type 2 DM (p = 0.001, p = 0.002, p = 0.02 and p = 0.03; respectively) compared to the control group. No correlation was observed between serum thiol-disulfide homeostasis parameters and serum glucose and HbA1c levels. Conclusions: Our study reveals that oxidative stress markers such as serum TAC, AOPP, and disulfide levels are closely related to the existence of diabetes. No significant difference was noted among patients with and without diabetic PNP.

The number of cases of coronavirus disease-2019 (COVID-19) globally is over 225 million, and disease-related deaths are over 4 million. The type, prevalence, and antibody susceptibility of the virus variants of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) and the vaccination rate and coverage are considered critical factors in the progress of COVID-19. We aimed to compare the clinical and laboratory parameters of the patients hospitalized due to COVID-19 in pre-vaccination and post-vaccination periods. We conducted this retrospective cross-sectional study in a tertiary clinic in Turkey. The files of the patients over the age of 18, whose real-time polymerase chain reaction (RT-PCR) tests were positive and who were hospitalized before (November-December 2020, Group 1) and after (March-April 2021, Group 2) COVID-19 vaccination were scanned. Patients' demographical data, clinical severity, laboratory parameters, thorax computed tomography involvement, and mortalities were recorded. The obtained data were compared among the groups. 601 patients (344 male, 57% and 257 female, 43%) were included in the study. It was observed that the patients in the Group 2 were younger (60.71 ± 14.06 vs. 66.95 ± 14.57, p0.001), and a significant decrease in mortality [83 (28.6%) vs.139 (44.6%), p = 0.001] were observed in Group 2. The number of patients who needed ventilatory support and the rate of pulmonary involvement was lesser in Group 2, but the difference was non-significant. C-reactive protein, D-dimer, procalcitonin levels were significantly lower in Group 2 patients. Our study shows that the age and mortality of hospitalized COVID-19 patients decreased significantly after vaccination. An increase in the number of booster doses in individuals with advanced age (age75) and comorbidity (especially malignancy) may contribute to the control of the disease and immunity in this population.

Background/aim In this study, we aimed to evaluate the initial hematological findings analyzed on admission in confirmed COVID-19 patients who were transferred to the intensive care unit (ICU), to predict possible hematological indices. Materials and methods Initial neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR), red cell distribution width to platelet ratio (RPR), mean platelet volume to platelet ratio, and lymphocyte multiplied by platelet count (LYM × PLT), of 695 patients with laboratory-confirmed COVID-19 were investigated and comparisons were made between the mild/moderate and severe groups. Results The proportion of COVID-19 cases admitted to the ICU was 3.9%. The median age of patients admitted to the ICU was significantly higher than those who were not; [68.5 (interquartile range (IQR); 21.5] years vs. 41.0 (IQR; 15.7) years; P < 0.001. Severe cases had higher NLR (6.6 vs. 2.4; P < 0.001), and MLR (0.40 vs. 0.28; P = 0.004) and lower PLR (180.0 vs. 129.0; P < 0.001) compared to that of mild or moderate patients. Among all of the parameters, the ROC curve of NLR gave us the best ability to distinguish serious patients at an early stage (AUC = 0. 819, 95% confidence interval 0.729–0.910; P < 0.001). Conclusion These data showed that age, initial NLR, PLR, and LYM × PLT were associated with the severity of COVID-19 disease and patients’ need for the ICU. Therefore, initial hemogram parameters may be essential to predict the prognosis of COVID-19 patients.

Aim:: To present an insulinoma case with post-prandial hypoglycemic symptoms associated with glucose inducible endogenous hyperinsulinemia. Case:: A 52-year-old female patient was evaluated for hypoglycemic symptoms especially those occuring within 3 hours after consuming sugary foods. These symptoms were persistent for a year and a half. She was diagnosed with reactive (post-prandial) syndrome and followed a recommended diet and was given acarbose but there was no improvement. The results suggested post-prandial endogenous hyperinsulinemia related hypoglycemia. Multiphasic computerized tomography revealed an 11x15x12 mm size mass lesion, anteriorly in the head and uncinate process of the pancreas and then the patients were treated surgically with pancreatic enucleation and cured. Conclusion:: Distinguishing post-prandial syndrome by careful history and clinical evaluation in patients with postprandial symptoms is of great importance in terms of cost-effectivity. However, it should not be forgotten that although organic pathologies are mostly presented with fasting hypoglycemia, they may also cause post-prandial symptoms. Severity and progression of the symptoms that point to neuroglycopenia is important, and in this condition the most convenient clinical approach to the patient should be performed with careful and appropriate assessment steps.

It is thought that the loss of conduction that causes clinical findings in multiple sclerosis (MS) attack may be the result of loss and damage of myelin, as well as the substances that activate autoimmune cascades affect axonal conductivity. Only some of the inflammatory processes that occur are manifesting and are reflected as an attack. The effects of these changes can also be seen in the serum of the patients during the attack period, when the inflammatory changes are intense. In this study, we aimed to compare the laboratory findings of MS patients during the attack and non-attack periods. The data of 61 patients between 18-65 years of age, who had liver function tests, lipid parameters, vitamin D levels, thyroid function tests, ferritin, folate and vitamin B12 levels studied both during and after the attack, were analyzed retrospectively. The attack period and non-attack data of the patients whose age, gender, height, weight, duration of diagnosis and EDSS (expanded-disability status scale) scores were recorded were compared. There was no significant difference in lipid parameters, ferritin, folate, vitamin B12 levels and liver function tests measured in the attack period and in the non-attack period, while the patients had significantly lower vitamin D levels and high thyroid function tests. VitD, Thyroid function tests and changes in cholesterol levels, which are easily accessible laboratory tests, are thought to give an idea about disease activity and attack status. More specific studies with the greater number of samples are needed to evaluate the possible effects of thyroid hormone on remyelination., Multipl skleroz (MS) atağında klinik bulguların ortaya çıkmasına neden olan ileti kayıplarının; myelin kaybı ve hasarlanması sonucu olabileceği gibi, otoimmünkaskadları aktive eden maddelerin aksonal iletkenliği etkilemesiyle de ortaya çıkabileceği düşünülmektedir. Ortaya çıkan inflamatuar süreçlerin yalnızca bir kısmı bulgu vermekte ve atak olarak kliniğe yansımaktadır. İnflamatuar değişikliklerin yoğun görüldüğü atak döneminde hastaların serumlarında da bu değişikliklerin yansımaları görülebilmektedir. Bu çalışmada, MS hastalarının atak döneminde ve atak dışı dönemdeki laboratuvar bulgularını karşılaştırmayı amaçladık. Hem atak döneminde hem de atak dışı dönemde karaciğer fonksiyon testleri, lipit parametreleri, D vitamini düzeyleri, tiroid fonksiyon testleri, ferritin, folat ve vitamin B12 düzeyleri kayıtlı olan, 18-65 yaş aralığında, 61 hastanın verileri retrospektif olarak incelendi. Yaş, cinsiyet, boy, kilo, tanı süresi ve hastalık şiddetini gösteren EDSS (expanded disability status scale) skorları kayıt edilen hastaların atak dönemi ve atak dışındaki verileri karşılaştırıldı. Hastaların atak döne-minde ve atak dışı dönemde ölçülen lipid parametreleri, ferritin, folat, vitamin B12 düzeyi ve karaciğer fonksiyon testlerinde anlamlı farklılık saptanmazken hastaların atak döneminde Vitamin D düzeylerinin anlamlı olarak daha düşük, tiroid fonksiyonlarının da yüksek olduğu gözlendi. Hastaların takip sürecinde, kolay ulaşılabilir laboratuvar tetkikleri olan vitamin D, tiroid fonksiyon testleri ve kolesterol seviyelerinde-ki değişikliklerin hastalık aktivitesi ve atak durumu ile ilgili fikir verebileceği düşünülmektedir. Tiroid hormonunun remiyelinizasyon üzerine olası etkilerini değerlendirecek örneklem sayısının daha fazla olduğu daha spesifik çalışmalara ihtiyaç vardır.

The aim of this study is to evaluate the density of retinal vascular structures and their relationship with disease duration and activity in patients with axial spondylarthritis (axSpA) using optical coherence tomography angiography (OCT-A). In this case–control study, 56 eyes of 29 axSpA patients and 61 eyes of 31 healthy controls (HCs) were evaluated using OCT-A. The capillary plexus density (CPD) of vessels in the parafovea and perifovea regions was evaluated from the superficial capillary plexus (SCP) and deep capillary plexus (DPC) flow areas. The CPD of vessels in the fundus was evaluated from the radial peripapillary capillary (RPC) flow area. Foveal avascular zone (FAZ) size was measured. In axSpA patients and HCs, the mean CPD (%) in the whole retina was 50.75 ± 2.59 and 52.43 ± 2.10 (p

Introduction: In the general population, the rate of older people seeking healthcare would increase. Understanding underlying factors that determine positive and negative attitudes towards the elderly is essential to give better healthcare.Methods: One-hundred and sixty-nine physicians participated in the study. Participants answered an online questionnaire consists of sociodemographic information, and the University of California at the Los Angeles Geriatrics Attitude (UCLA-GA) scale to evaluate the attitudes towards the geriatric population.Results: The attitude towards the elderly by internist, neurologist, and psychiatrist was comparable. Relationship with positive attitude and specialties, gender, age, marital status, duration of specialty expertise, and having geriatrics education and monthly followed-up elderly patients was not significant. The positive attitude was significantly related to having an elderly relative.Conclusions: In our study, although neurologists received more geriatric education, and mostly seen inpatient and outpatient patients, their attitudes towards geriatric patients were similar to psychiatry and internal medicine specialists. In addition, we observed that positive attitudes in elderly patients were significantly associated with having a relative over 65 years old. Education curriculum should include programs increasing the exposure to healthy older people may increase positive attitude rates. The organization of working programs should be carried out considering the necessity of a long time to evaluate the elderly.

Chronic diseases concomitantly decrease quality of life and lifespan expectancy. Novel medications, including Sodium-glucose-co-transporter-2 inhibitors (SGLT-2i), affect both diabetes, heart failure, and diabetic kidney disease. These multisystemic effects give patients with mono systemic and multisystemic diseases new treatment options. Recent studies have shown that SGLT2i may benefit heart failure patients without diabetes. In this case report, we presented a 65-years old patient who was admitted to the emergency room with shortness of breath. Bilateral pleural effusion was observed in the chest X-ray. After etiological studies, empagliflozin was initiated for pleural effusion, which is thought to be related to heart failure. The patient’s symptoms declined on the fourth day of the treatment, and the control lung X-ray revealed that the effusions declined.

Objectives: Colistimethate sodium (colistin) is the member of polymyxins, the cyclic structured cationic polypeptide antibiotics. The purpose of our study is to determine the patients’ nephrotoxicity rates and risk factors related to nephrotoxicity development that are under colistin treatment in the tertiary intensive care unit (ICU). Methods: One-hundred colistin received patients files were reviewed retrospectively, who were in tertiary ICU in Bursa Yüksek Ihtisas Training and Research Hospital. Fifteen patients with the history of renal failurewere excluded from the study. The data before the first colistin treatment was taken into consideration for the patients received repetitive colistin treatment. RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease) classification was used for the evaluation of nephrotoxicity. Results: The patients mean age was 67.81 ± 16.56 years (range: 21-94) and 52.9% were male. Nephrotoxicity was determined in 35 (41.2%) patients. According to the RIFLE classification the nephrotoxicity rates were determined for risk, injury and deficiency were 24.7%, 10.6% and 5.9%, respectively. Nephrotoxicity was detectedin 9 (25.7%) out of 35 patients on the first day of the colistin treatment. Mortality rate was observed as 82.9% in patients with nephrotoxicity. Conclusions: Colistin treatment is preferable for the treatment of multi drug resistant infections in intensive care unit. The patients,under certain circumstances, i.e., malignancy, using additional nephrotoxic agent and elder age must be closely monitored for the possible nephrotoxicity development.

Objectives: Kidney transplantation recipients (KTRs) have higher cardiovascular complications risk compared to the general population. Cardiovascular risk factors (CVRF, Traditional and non-traditional) are widely studied to understand the causes of increased cardiovascular disease (CVD) risk in KTRs. Fetuin-A prevents from vascular calcification (VC) by inhibiting production and collapsing of apatite crystals to the vascular wall. The relationship between fetuin-A levels and CVRF in KTRs was investigated in this study. Methods: Sixty-two KTRs with no prior CVD history participated. Anthropometrical, laboratory (fetuin-A, inflammation markers, antioxidants, lipid peroxidation products) and cardiological (echocardiographic, pulse wave velocity) measurements were performed. Participants were divided into two groups according to normal (≥ 0.5 g/L, n = 32, NFA) and low (< 0.5 g/L, n = 30, LFA) fetuin-A levels according to manufacturer’s reference range, and the results were compared. Results: No significant difference was observed in demographic features, body mass index, systolic and diastolic blood pressures, left ventricle mass index, waist and hip circumferences, left ventricle hypertrophy and waist-hip ratios between the two groups (p > 0.05). The ratios of drug usage such as immunosuppressives, anti-hypertensives and statin were comparable between two groups. Parathormone levels were significantly higher in the NFA group (p = 0.015) and glomerular filtration rate was calculated significantly higher in LFA group (p = 007). The comparison of other CVRF reveals no significant difference (p > 0.05). Conclusions: Although many CVRF improved in KTRs, subclinical inflammation markers were still higher than the healthy population. Identification and early recognition of CVRF in high-risk individuals may contribute to the reduction of cardiovascular mortality. In our study, we observed no significant relationship between fetuin-A levels and CVRFs. We evaluated the relationship between serum fetuin-A levels on cardiovascular risk factors by its role in pathophysiology.

Increasing numbers of the papers indicate that SARS-CoV-2 also causes neurological symptoms; the underlying mechanism has not been elucidated yet. Hypothetic mechanisms to explain the CNS involvement of SARS-CoV-2 include the neurotropic mechanisms and the cytokine storm developing during the disease process. A middle age female patient applied to the emergency department with complaints of eye pain, a double, foggy, and blurred vision and a severe throbbing headache. The outward gaze was found to be limited in her right eye. Nasopharyngeal swab for SARS-CoV-2 RNA was positive, radiological findings were supported the COVID pneumonia and diffuse sinonasal inflammation. Cranial imaging showed thickening and contrast involvement in the cavernous sinus in the postcontrast series. While shortness of breath improved, and the headache was completely resolved on the 10th day of treatment the right eye outward gaze restriction was continued. The control MRI reveals a significant reduction in cavernous thickening and contrast enhancement and complete resolution in dural thickening. In our case of COVID, cranial nerve involvement and pansinusitis developed without cytokine storm findings suggests that the virus has spread to the cavernous sinuses and dura by regional neighborhood. Neurological symptoms may appear as the first symptom of COVID.

BACKGROUND Increased cardiovascular risk, represented by endothelial inflammation, probably starts with the very first course of type-2 diabetes (T2DM). Almost 85.2% of all T2DM patients are overweight or obese. Thrombosis accounts 80% of all deaths in patients with diabetes. The thrombotic-fibrinolytic equilibrium shifts in favor of thrombosis by plasminogen activator inhibitor-1 (PAI-1). PAI-1 secretion is induced primarily by CRP. PAI-1 overexpression predisposes unstable plaque development. The contribution of obesity and diabetes to this process is not clearly understood. In this study, we aimed to investigate comparison of inflammatory markers, PAI-1 levels and arterial stiffness according to BMI and impaired glucose metabolism in patient with newly diagnosed T2DM. METHODS Newly diagnosed 60 T2DM patients were enrolled. Demographics and measurements were noted. Liver (AST, ALT), kidney (urea, creatinine, albumin/creatinine ratio), metabolic (fasting blood glucose, post-prandial blood glucose, insulin, c-peptide, HbA1c, total cholesterol, low-density lipoprotein [LDL], high-density lipoprotein [HDL], triglyceride) parameters, inflammatory markers [hsCRP, fibrinogen]), PAI-1 levels and pulse wave velocity was measured from all participants. The results were compared. RESULTS Inflammatory markers and PAI-1 levels were significantly elevated in obese group compared to overweight participants. The correlation analysis showed that waist and hip circumferences, high-sensitive CRP, fibrinogen and PAI-1 levels were positively correlated with BMI but not with HbA1c levels. CONCLUSIONS The results of our study showed that lipid levels, glycemic and blood pressure values of the obese and overweight patients were similar. BMI affects inflammatory markers and PAI-1 levels independent of glucose regulation and insulin resistance in newly diagnosed T2DM. According to the current study BMI is found to be more prominent in terms of inflammatory markers and PAI-1 levels compared to insulin resistance and impaired glucose metabolism in newly diagnosed T2DM.

HIV infection can manifest itself in many different clinical situations. In a pandemic such as COVID, when fever is of diagnostic importance and manifests itself with different clinical pictures, it is very difficult to distinguish the true cause of high fever. In this case report, we shared the process of diagnosing HIV infection in a patient with type 1 diabetes who presented with fever and neurological symptoms under pandemic conditions.

Objectives: Glutathione S-transferase (GST) polymorphism may play a role in the etiology of type 1 diabetes, as GST is involved to detoxification of reactive oxygen radicals and synthesis of proinflammatory mediators. Genetic polymorphisms in the renin-angiotensin aldosterone system, including angiotensin converting enzyme (ACE) gene insertion-deletion (I/D) polymorphism, can affect the progression of diabetes and diabetic complications. In our study we aimed to investigate the GST and ACE gene I/D polymorphism in type 1 diabetic patients for comparison with population and relationships with diabetic complications. Methods: A total of 116 type 1 diabetic patients were included to study. ACE polymorphism analyzed in the 71 subjects and GST polymorphism analyzed in the 62 subjects as control groups. Polymorphism of DNA samples was studied by PCR technique. Results compared with control groups and studied according the diabetic complications. Results: ACE gene DD genotype and D allele ratio in the patient group were significantly higher than control group. GST T1 and GST M1 ratios were similar between patient and control groups. ACE genotype group distributions and GST M1/T1 genotype ratios were not different in terms of obesity, glycemic control, duration of diabetes and hypoglycemia frequency and not changed according to diabetic complications. Conclusions: DD genotype and D allele ratio in diabetic patient group were found to be significantly higher and so a significant relationship was observed between and ACE I/D gene polymorphism and type 1 diabetes. On the other hand, it was observed that ACE I/D and GST gene polymorphism did not have any significant effect on diabetic microvascular complications.

Objective: Kidney transplantation is one of the most important treatments in end-stage renal disease (ESRD). We aimed to share our experiences in 60 (57 deceased donors, 3 living donors) kidney transplantation cases performed in our center between July 2017 and August 2020. Material and methods: The demographic data of 60 patients with kidney transplantation performed in our kidney transplant center were evaluated in terms of causes and duration of renal failure human leucocyte antigen (HLA) tissue compatibility, immunosuppressive protocol used, antimicrobial agents, rejection status, graft loss, patient loss, postoperative surgical complications. Results: 57 of our kidney transplants were made from deceased donors and 3 from living donors. The mean age of the patients was 44.66 (23-68) years. Kidney transplantation was performed in 8 patients (13.33%) in the preemptive period. The mean number of mismatches in kidney transplants was 3.95 (2-5) and the mean duration of renal replacement therapy (RRT) was 54.73 (0-270) months. While the mean follow-up period after transplantation was 18.86 (2-37) months, it was observed that the mean cold ischemia time was 742.8 (60-1080) minutes. Serum creatinine levels of 56 patients with functional grafts at the end of the first month 1.39 (0.5-4.9) mg/dL, 54 patients at the end of the sixth month, creatinine levels 1.29 (0.56-5.9) mg/dL, The creatinine levels of the 52 patients as of October 2020 were 1.37 (0.75-5.16) mg/dL. As surgical complications, hematoma developed in 5 patients (8.33%) and lymphocele in 3 patients (5%). Early graft loss developed in one patient with renal artery embolism and two patients with renal vein thrombosis, while chronic rejection developed in two patients. We performed a deceased kidney transplant again 14 months later in a patient who developed graft loss in the early period due to renal vein thrombosis. The kidney inserted later is functional in the 10th postoperative month. One of our patients died due to rhino-orbital mucor mycosis in the postoperative 2nd month, and one patient due to the development of sepsis due to infection in the hip prosthesis in the postoperative 6th month, while another patient died due to myocardial infarction in the postoperative 2nd month. Conclusion: As a result, our kidney transplant center is in development. Our results obtained from 60 kidney transplants, almost all of which were performed from deceased donors, seem to be compatible with the literature. More detailed results can be obtained with the long-term follow-up results and the increase in the number of living donor transplants.

To measure the retinal capillary density quantitatively with optical coherence tomography angiography (OCTA) in patients with rheumatoid arthritis (RA) and healthy controls (HCs), and to evaluate the relationship between OCTA findings and RA disease activity.In this cross-sectional study, 106 eyes of RA patients and 71 eyes of HCs were evaluated. RA patients were divided into inactive (DAS28 3.2) and active (DAS28 ≥ 3.2) subgroups. Retinal capillary plexus density (CPD) was obtained from the superficial capillary plexus (SCP), deep capillary plexus (DCP), and radial peripapillary capillary (RPC).In RA patients and HCs, the CPD (%) was 50.99 ± 3.30 and 52.08 ± 2.36 (In RA, retinal CPD in the macula is lower than HCs. Although retinal CPD is not generally different in active and inactive RA patients, capillaries in the optic disc may be affected by disease activity.

Aim: To investigate the association of food addiction (FA) with the psychosocial functioning and metabolic parameters in obese patients seeking weight-loss treatment. Methods: Two hundred twenty-fo...

Introduction: Obesity is one of the most important community health threatening problem, because of its high prevalence and associated comorbidities. Each of these comorbidities have various risks for health. There are very few studies investigating the awareness of people about obesity associated comorbiditiesMethods: Five-hundred adult patients, admitted to Endocrinology & Internal Medicine outpatient clinics, whose body mass index was>18.5 kg/m2 and completed a questionnaire concerning obesity associated comorbidities were included in this study. Each correct answer was scored as 1 point. Each participant’s total score and mean total score (MTS) was calculated. The scores among normal weight, overweight and obese groups were compared. Besides the questionnaire, age, gender, education level was asked and waist and hip circumference, height and weight were measured by the researchers.Results: Mean education score was the lowest in the obese group, altough MTS was the highest. Awareness of obesity associated stroke, breast cancer and osteoarthritis were significantly higher in the obese group when compared to the other groups, but there was no difference between men and women. Awareness of obesity associated menstrual irregularity and infertility was higher in women, hypertension and prostate cancer was higher in men. Conclusions: Although the education level was lowest in the obese group, the awareness of obesity-associated comorbidities was highest.

Background:The negative impact of COVID-19 in patients with ANCA associated vasculitis (AAV) and patients on rituximab (RTX) treatment have been reported (1). Risk factors for severe course of COVID-19 and increased mortality in these patients are unclear.Objectives:To evaluate the course of COVID-19 in our AAV cohort and identifying risk factors for mortality.Methods:Patients with AAV who were classified according to CHCC and whose scheduled last visit were after December 2019 were screened and evaluated for COVID-19 either by phone call or in the clinic. Records of patients with a history of hospital admission due to COVID-19 were evaluated. Cumulative clinical findings and treatment history were noted. Hypogammaglobulinemia (hIgG) was defined as IgG level below 700 mg/dl. All inpatients with a diagnosis of COVID-19 were screened for hIgG and IVIG was administered if necessary.Results:Eighty-nine patients (47.2% female, mean age 56 + 12.5 (28-81)) were included into the study. The diagnosis was GPA in 56 (62.9%) and MPA in 33 (37.1%) patients. Mean follow up time was 91 + 53.4 (26-272) months. Anti-PR3 and anti-MPO were positive in 46 (51.7%) and 32 (35.9%) patients, respectively. Lower respiratory tract (LRT) involvement was present in 72 (80.9%) and 10 patients had a history of diffuse alveolar haemorrhage (DAH). Sixty-one patients (68.2%) had a history of rapidly progressive glomerulonephritis (RPGN) and 21 (23.6%) had peripheral nervous system (PNS) involvement.Fifteen (16.9%) patients had COVID-19; 14 of them were PCR positive, one patient had symptoms and thorax CT findings compatible with COVID-19. Pulmonary infiltrates were observed in 13 patients (86.7%); 9 (60%) had severe pneumonia. Twelve patients (85.7%) were hospitalized, 6 patients (42.9%) needed ICU admission and 5 patients (35.7%) died. Tocilizumab and anakinra for hyperinflammation during COVID-19 were used in 1 (6.7%) and 4 (26.7%) patients, respectively.Four out of five deceased patients (3 on RTX treatment, 1 with renal transplant) were in remission at the time of COVID-19. COVID-19 was detected in a patient with disease flare and DAH, during treatment with high dose steroids and plasmapheresis. hIgG was detected in all deceased patients from COVID-19 during hospital admission (mean IgG: 495±113.2 mg/dL).Symptomatic COVID-19 was more frequent in patients with a history of DAH, RPGN and hIgG. hIgG during the follow-up was significantly associated with COVID-19 in multivariable analysis (p=0.01, OR=20,6 %95 CI (2-210). Comparison of patients who died of COVID-19 and survived showed that female sex, PNS involvement and hIgG during the clinical course and hospital admission were risk factors for increased mortality (Table 1). Age, smoking, treatments, history of flares or serious infections, remission status and chronic renal insufficiency did not differ between groups.Conclusion:The frequency and mortality from COVID-19 is found to be high in our AAV cohort compared to previous reports (1). Patients with serious lung or renal involvement are prone to symptomatic COVID-19. Previously reported severe outcomes on RTX therapy might be related to consequent hIgG. High dose IVIG treatment may not be sufficient in improving survival in AAV patients with severe COVID-19 and hIgG.References:[1]Severity of COVID-19 and survival in patients with rheumatic and inflammatory diseases: data from the French RMD COVID-19 cohort of 694 patients. 2020:annrheumdis-2020-218310.Table 1.Comparison of risk factors for CI and mortality in patients with AAVCOVID-19 (n=15)Non-infected (n=74)pORDeath (n=5)Survive (n=10)p2OR2Age53.4±11.956.6±12.6NS51.2±12.654.6±12.1NSSex (female)635NS420.03614 (0.9-207)LRT Involvement1458NS59NSDAH460.0384.1 (1-16.9)13NSRPGN15460.0048.5 (1-68.4)57NSPNS involvement318NS300.0059 (1.4 - 57)RTX treatment1033NS37NShIgG in outpatient visits670.026.3 (1.8-23.3)420.0216(1.5-234)hIgG during hospitalization due to CI----540.0252.5 (1.2-5.4)Flares≥1725NS43NSChronic Renal Insufficiency722NS43NSDisclosure of Interests:None declared

Background:Retinol binding protein 4 (RBP4) is a plasma retinol transporter that transports retinol from liver to periphery. RBP4 has been studied as a biomarker in metabolic and neoplastic conditions, however its association with inflammation is not clear. Serum amyloid A (SAA), another retinol binding protein, has been known as a sensitive biomarker of inflammation in familial Mediterranean fever (FMF) and other autoinflammatory disorders. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and SAA are commonly used as acute phase reactants, but they are not successful in differentiating non-infectious inflammatory conditions from infections.Objectives:We aimed to evaluate the potential of serum RBP4 as a biomarker of acute phase response and to determine its performance in differentiation of inflammation of patients with FMF and AA amyloidosis from infections.Methods:A total of 169 participants in 5 groups, consisting of FMF (n = 60), FMF with AA amyloidosis (n = 58), non-FMF AA amyloidosis (n = 23), infections (n = 10, 3 pneumonia, 3 sepsis, 1 pyelonephritis, 1 fungal infection, 1 cellulitis, 1 disseminated zoster), and healthy controls (HC) (n = 18), were included and evaluated cross sectionally. Hemogram and serum CRP, ESR, SAA, ferritin, creatinine, AST, ALT, albumin levels were recorded from the patient charts. FMF and FMF + amyloidosis patients were evaluated during attack-free period. Serum RBP4 levels were investigated by ELISA (Elabscience, USA). Mean values and relative changes compared to healthy controls were evaluated for SAA, CRP, RBP4 levels in all groups.Results:Serum RBP4 level was found to be higher in FMF group compared to the patients with infection (p = 0.002) and HC (p Table 1.Demographic features and laboratory findings of the participantsVariablesFMF(n=60)FMF- Amyloidosis(n=58)Non-FMF-AA Amyloidosis(n=23)Infection(n=10)Healthy control(n=18)Female/Male46/1433/258/153/78/10Age (SD)*38±13(18-74)43±11(21-69)53±1365±1533±9Creatinine (mg/dL)*0,8±0,21,7±1,72,0±1,61,7±1,00,7±0,2Albumin(mg/dL)*4,7±0,44,3±0,63,3±0,93,0±0,94,8±0,2Ferritin (ng/mL)*70±94245±315139±168554±3883±72RBP4 (ng/mL)*772±183671±214666±256512±204524±117RBP4 (median)770(434-1142)653(227-1259)645(331-1214)487(226-876)498(566-738)CRP (mg/L)*16±47,112,8±32,825,7±36,469±36,81,2±1,2SAA (mg/dL)*10,3±31,45,0±13,97,1±14,140,2±18,50,3±0,1ESR*15±1319±1641±2945±427±5Relative RBP4 increase1,47±0,351,28±0,411,27±0,490,98±0,39Relative CRP increase13,4±39,210,6±27,321,4±30,357,7±30,6Relative SAA increase34,5±104,816,0±45,723,7±47,1133,9±61,7*mean, RBP4 (Retinol Binding Protein 4), C-Reactive Protein (CRP), Erythrocyte Sedimentation Rate (ESR), Serum Amyloid A (SAA).Conclusion:This preliminary study showed that RBP4 levels may be increased about 1.5 times in FMF and to lesser extent in AA amyloidosis patients despite no significant change during acute phase response of different infections. Patients with infections show strong CRP and SAA response, and the differential response of RBP4 in FMF patients warrants further analysis in larger group of patients with different clinical characteristics.Disclosure of Interests:None declared

Background:COVID-19 runs a variable course resulting in acute respiratory distress syndrome and death in a subset of patients. The entry of SARS-CoV-2 into the cell stimulates innate immunity including NLRP3 inflammasome and lead to development of adaptive immunity later. Hyperinflammatory response with the release of proinflammatory cytokines including IL-1β and IL-6 results in cytokine storm in some patients with a worse outcome. Colchicine acts on NLRP3 inflammasome and inhibits and IL-1 mediated inflammatory attacks in gout and familial Mediterranean fever (FMF) patients. Patients with inadequate response to colchicine may benefit from anti-IL-1 biologic agents such as anakinra and canakinumab. Recently, favourable effects of anakinra have been observed in COVID-19 patients with findings of cytokine storm.Objectives:We aimed to evaluate the impact of COVID-19 among refractory FMF patients followed-up in tertiary referral with the treatment of biologic agents and also document the course of COVID-19 in these patients.Methods:We searched out database of FMF patients to identify those using biologic agents (anti-IL-1, anti-IL-6 or anti-TNF) for colchicine-refractory FMF. We interviewed the patients using a standard questionnaire by phone call for symptomatic COVID-19 and evaluated those patients who described findings of COVID-19 further by their hospital records or inviting them to the hospital for additional investigations.Results:We identified 183 patients and contacted 106 of them by phone in May-October 2020. A history of symptomatic COVID-19 was documented in 7 FMF patients who were on a biologic agent. Six were on anti-IL-1 and one was on anti-TNF, and one of the patients was not taking his biologic agents for 1 year. All of 7 patients had a favourable outcome. All but 1 patient followed at home and none of them developed findings of cytokine storm, thromboembolism and secondary bacterial infection. Hospitalized patient did not require intensive care unit (ICU) support or mechanical ventilation, and he was not given additional anti-inflammatory medications.Conclusion:This series of refractory FMF patients with potentially higher inflammatory characteristics showed COVID-19 did not result in a worse outcome in those patients during the first phase of the pandemic, and none developed findings of cytokine storm. Observations in these patients supports further that biologic agents blocking IL-1 and possibly TNF may contribute to the uneventful course of COVID-19 by preventing the development of hyperinflammatory response. Data collection from a larger group of patients, especially those with amyloidosis, will clarify the protective effects of colchicine and contribution of anti-IL-1 treatments on the favourable disease course during the second phase of the pandemic.Patient 1Patient 2Patient 3Patient 4Patient 5Patient 6Patient 7Age (years)45483953323731MEFV variantsUnknownM694V/M680IUnknownM694V/ M694VM694V/ M694VM694V/ M694VM694V/ M694VAmyloidosisNoNoNoNoNoNoNoBiologic agentsAnakinra100 mg/dayNot takenfor 1 yearAdalimu-mabCanakinumab150 mg/monthAnakinra100 mg/dayCanakinumab150 mg/monthAnakinra100 mg/dayPrednisone (mg/day)5NoNoNoNoNoNoColchicine(mg/day)21,51,51,51,52,02,0RT-PCR positivityYesYesYesYesYesYesYesChest CT signsYesYesNot doneNot doneNot doneNot doneNot doneHospitalisationNoNoNoYesNoNoNoAntiviral therapyOseltamivirOseltamivirNoFavipravirFavipravirFavipravirFavipravirHCQ useYesYesYesYesNoNoNoNew FMF attackduring COVID-19NoNoNoNoNoNoNoDisclosure of Interests:None declared

Background:COVID-19 runs a severe disease associated with acute respiratory distress syndrome in a subset of patients, and a hyperinflammatory response developing in the second week contributes to the worse outcome. Inflammatory features are mostly compatible with macrophage activation syndrome (MAS) observed in other viral infections despite resulting in milder changes. Early detection and treatment of MAS may be associated with a better outcome. However, available criteria for MAS associated with other causes have not been helpful.Objectives:To identify distinct features of MAS associated with COVID-19 using a large database enabling to assess of dynamic changes.Methods:PCR-confirmed hospitalized COVID-19 patients followed between March and September 2020 constituted the discovery set. Patients considered to have findings of MAS by experienced physicians and given anakinra or tocilizumab were classified as the MAS group and the remaining patients as the non-MAS group. The MAS group was then re-grouped as the cases with exact-MAS and borderline-MAS cases by the study group. Clinical and laboratory data including the Ct values of the PCR test were obtained from the database, and dynamic changes were evaluated especially for the first 14 days of the hospitalization. The second set of 162 patients followed between September-December 2020 were used as the replication group to test the preliminary criteria. In the second set, hospitalization rules were changed, and all patients required oxygen support and received dexamethasone 6mg/day or equivalent glucocorticoids. Daily changes were calculated for the laboratory items in MAS, borderline, and non-MAS groups to see the days differentiating the groups, and ROC curves and lower and upper limits (10-90%) of the selected parameters were calculated to determine the cutoff values.Results:A total of 769 PCR-confirmed hospitalized patients were analysed, and 77 of them were classified as MAS and 83 as borderline MAS patients. There was no statistically significant difference in the baseline viral loads of MAS patients compared to the non-MAS group according to the Ct values. Daily dynamic changes in the MAS group differed from the non-MAS group especially around the 6th day of hospitalization, and more than a twofold increase in ferritin and a 1.5-fold increase in D-dimer levels compared to the baseline values help to define the MAS group. Twelve items selected for the criteria are given in Table 1 below. The total score of 45 provided 79.6% sensitivity for the MAS (including borderline cases) and 81.3% specificity around days 5 and 6 in the discovery set, and a score of 60 increased the specificity to 94.9% despite a decrease in sensitivity to 40.8%. The same set provided a similar sensitivity (80.3%) in the replication, but a lower specificity (47.4-66% on days 6 to 9) due to a group of control patients with findings of MAS possibly masked by glucocorticoids.Table 1.Preliminary Criteria for Macrophage Activation Syndrome Associated with Coronavirus Disease-191.Fever (>37.0 °C)2.Ferritin concentration > 550 ng/mL3.More than 2 times increase of ferritin concentration within 7 days of disease onset4.Neutrophil count > 6000 cell/mm35.Lymphopenia < 1000 cell/mm36.Neutrophil/lymphocyte ratio > 67.D-dimer concentration > 1000 ng/ml8.More than 50% increase of D-dimer concentration within 7 days of disease onset9.CRP concetration > 50 mg/L10.LDH concentration > 300 U/L11.ALT or AST concentration > 50 U/L12.Procalcitonin concentration < 1.21 point for each positive item assessed on Days 5-7Score calculation: Total points / 12 x 100Possible MAS ≥45 and Definite MAS ≥60Conclusion:This study defined a set of preliminary criteria using the most relevant items of MAS according to the dynamic changes in the parameters in a group of COVID-19 patients. A score of 45 would be helpful to define a possible MAS group with reasonable sensitivity and specificity to start necessary treatments as early as possible.Disclosure of Interests:None declared.

Background:Systemic AA amyloidosis is a serious and life-threatening complication of chronic inflammatory diseases such as rheumatoid arthritis, spondyloarthritis (SpA), and periodic fever syndromes. While most common cause of AA amyloidosis is Familial Mediterranean Fever; Ankylosing Spondylitis (AS) is another frequent cause of AA amyloidosis in Turkey.Objectives:We aimed to evaluate the response of secukinumab (SEC) treatment in three patients with AS and AA amyloidosis (AS-AA) in our tertiary referral centre.Methods:We retrospectively evaluated three AA amyloidosis patients who fulfilled Modified New York Criteria for diagnosis of AS in our AA amyloidosis cohort with 163 patients. Diagnosis of AA amyloidosis was confirmed by Congo red stain and by monoclonal AA-specific antibodies.Results:Patient 1: 61-year-old male patient with inflammatory back pain (IBP) and peripheral arthritis for 14 years was evaluated in our clinic. After methotrexate (MTX) failure, he used adalimumab (ADA), etanercept (ETA) and certolizumab (CZP). Nephrotic range proteinuria was detected when he was on CZP, and rectum biopsy documented AA amyloidosis 3 years ago. After the diagnosis, CZP treatment was switched to infliximab (IFX). IFX was ineffective in controlling inflammatory findings. SEC was started 15 months ago and he responded partially. The dose of SEC was increased to 300 mg monthly, which resulted in a sustained improvement in clinical and laboratory findings.Patient 2: 69-year-old woman was admitted to our clinic with peripheral arthritis in addition to the history of IBP for 19 years in 2005. MTX, NSAID and prednisolone were started. Because of inefficacy to conventional treatments and development of nephrotic range proteinuria, ETA was added to treatment. The patient responded to ETA and was followed-up for 13 years without symptoms of AS and proteinuria. ETA was switched to IFX due to secondary inefficacy two years ago. On the third month of IFX treatment, she developed demyelinating polyneuropathy. IFX treatment was switched to SEC and she is still being followed-up on SEC without any findings of AS and proteinuria.Patient 3: 49-year-old woman who was on sulphasalasine for 24 years for treatment of ulcerative colitis (UC) was evaluated for recent onset IBP and peripheral arthritis in 2007. After failure of MTX, she started to receive IFX. She did not respond to first IFX and then ADA and CZP, and she developed nephrotic range proteinuria when she was on anti-TNF. Her serum creatinine increased progressively, and haemodialysis (H/D) was started six months later. Due to ongoing IBP and elevated acute phase response with CZP treatment, SEC was started. Significant improvement was observed in both clinical and laboratory findings with no worsening of UC.Table 1.Clinical characteristics, laboratory findings and treatment responses of patientsPatient 1Patient 2Patient 3Age (year)616949SexMaleFemaleFemaleAge of AS onset (year)473525Age of amyloidosis diagnosis (year)575046Amyloidosis duration (months)4216830 Family historyNoAS and amyloidosis in siblingsNoHLA-B 27 statusPositivePositiveNot available MEFV statusNegativeNegativeM694V heterozygousOrgan involvement of amyloidosisGIS and kidneyKidney, liver, heart, bone marrowGIS, kidneySecukinumab duration (months)151824 CRP (mg/L) Before271523 After2.44.52.8Creatinine (mg/dl) Before0.51.6H/D After0.51.3H/DProteinuria (g/day) Before4.25.5H/DAfter2.40.9H/DAlbumin (g/dL)Before2.72.53.1After3.14.34.2ASDASBefore4.11.64.6After1.81.11.7GIS: Gastrointestinal System, ASDAS: Ankylosing Spondylitis Disease Activity ScoreConclusion:AA amyloidosis is a rare complication of SpA, and SEC treatment was found to be safe and effective in our three patients with AS-AA. Although anti-TNF agents have previously used successfully in treatment of AS-AA, SEC may be a new option especially in patients who are resistant or intolerant to anti-TNFs.Disclosure of Interests:None declared

Background:Familial Mediterranean fever (FMF) is a hereditary autoinflammatory disorder caused by the MEFV gene variants. Although association between FMF and spondyloarthritis (SpA) has previously been reported, clinical and laboratory features of patients with FMF and SpA have not been defined in detail.Objectives:We aimed to evaluate clinical and laboratory characteristics, disease outcome and biologic responses of patients with FMF+SpA compared to patients with only SpA who were followed-up in our tertiary referral center.Methods:Database of FMF Clinic was screened for FMF patients with coexistent SpA and 113 patients were identified fulfilling Tel Hashomer and ASAS criteria for FMF and SpA, respectively. A group of patients with SpA without FMF matched for age, gender and disease duration were selected as the control group.Results:Thirteen patients were excluded because of missing data, and 100 patients (F/M: 52/48) were included into the analysis. Mean follow-up time was 93.6 ± 77 (range[r]: 3-324) months and mean patient age was 43.3 ± 12 (r: 20-87) years. Mean age of onset for FMF was 12.5 ± 8 (r: 1-36) and for SpA was 25 ± 11 (r: 7-72) years. SpA findings was classified as axial in 35.4%, axial and peripheral in 47.9% and only peripheral in 16.7% in FMF+SpA group. Half (49%) of the patients had hip involvement (70% bilaterally), and 21.5% of them needed total hip joint replacement (TJR), which were significantly more frequent compared to control group. Two exon 10 MEFV variants were found in 69.4%, and most (69.8%) had homozygous M694V. Hip involvement was more frequent in patients with two exon 10 variants (p=0.036; OR=4.4) compared to those with one variant; and TJR was more frequent in those with homozygous M694V compared to other exon 10 variants (p=0.001; OR=10). Radiographic sacroiliitis was less frequent in patients with homozygous M694V (p=0.019; OR=5.48). HLA-B27 positivity was not associated with hip or axial involvement in patients with FMF+SpA.Biologics were used in 60 patients (anti-TNF in 43, secukinumab in 1, and tocilizumab in 2). Anti-IL-1 drugs were used in 23 patients for refractory FMF. In 9 patients, anti-TNF and anti-IL-1 drugs were tried for refractory joint involvement: 5 switched to anti-TNFs from anti-IL-1, 4 patients switched to anti-IL-1 from anti-TNFs. Biologic DMARD requirement was more frequent in patients with two exon 10 variants (p=0.006; OR=7.4), especially in those with homozygous M694V (p=0.006; OR=7.6). Although anti-IL-1 usage did not differ among MEFV variants, anti-TNF was used more frequently in patients with homozygous M694V (p=0.007; OR=7.2). FMF+SpA patients had higher serum CRP and developed amyloidosis more frequently than those patients with SpA.Table 1.Comparison of clinical and laboratory findings between the patients with FMF+SpA and SpA controlFMF + SpA (n=100)SpA (n=217)P valueAge (years)*43.3 ± 1243.4 ± 110.6Sex (n, %) Male48104 (47.9)0.99 Female52113 (52.1)Duration of SpA (monnths)*181.6 ± 108180.2 ± 1120.8Age onset of SpA (years)*25.1±1128.4±80.008Peripheral arthritis (n, %)35/80 (43.8)79/212 (37.3)0.3HLA-B27 positivity (n, %)6/21 (28.6)105/139 (75.5)CRP (mg/dL)*26.7 ± 25**18.96±290.001ESR (mm/hour)*39.7 ± 2739.4 ± 280.8Hip involvement (n, %)47/96 (49)23/118 (19.5)TJR (n, %)20/93 (21.5)8/205 (3.9)Fulfilling mNY criteria (n, %)52/81 (64.2)164/199 (82.4)0.001 (OR=10.8)Biologic DMARD (n, %)6068/214 (31.8)Anti-TNF (n, %)4668/214 (31.8)0.015 (OR=5.96)Amyloidosis (n, %)165/205 (2.4)* mean±standard deviation, **during the attack-free periodConclusion:In this group of FMF+SpA patients, hip involvement and need for TJR were more frequent and associated with penetrant MEFV variants rather than HLA-B27 positivity. These patients had higher inflammatory response and risk of developing amyloidosis, and they needed biologics more frequently compared to SpA group. More severe disease course in FMF+SpA patients requires further attention and analysis in larger cohorts.Disclosure of Interests:None declared

Background:AA amyloidosis has been associated with uncontrolled chronic inflammatory diseases such as rheumatoid arthritis (RA), ankylosing spondylitis (AS), inflammatory bowel disease (IBD) and hereditary periodic fever syndromes, and the most common cause is familial Mediterranean fever (FMF) in Turkey.Objectives:We herein aimed to evaluate clinical and laboratory characteristics and treatment responses of patients with AA amyloidosis retrospectively in a tertiary referral center.Methods:Study group was consisting of patients with biopsy proven AA amyloidosis, and their data were recorded from their charts. Treatment responses were categorized as follows:complete responsewas defined as no increase in serum creatinine and a proteinuria below 1gr/day;partial responseas 50% decrease in proteinuria; andstable disease as no significant change in serum creatinine and proteinuria. Progressive disease was defined as increase in serum creatinine and/or proteinuria under treatment.Results:173 patients were identified, and 10 patients with no biopsy result and/or missing data were excluded. A total of 163 patients (79 females, 84 males) were included in the study. Median age of patients was 45.4, and median age at diagnosis of amyloidosis was 33.5. Most common cause of amyloidosis was FMF (78.5%), followed by idiopathic cases (7.9%) and patients with AS (4.9%). A quarter (26%) of amyloidosis patients had a family history for AA amyloidosis, and 59% of patients with FMF had a family history of FMF. Amyloidosis was confirmed by renal biopsy in 76.1%, by gastrointestinal (GIS) biopsy in 11.7%, and by other biopsies in the remaining. Renal involvement was documented in 160 (98.2%) patients, while GIS involvement in 20.9%, heart in 13.5%, thyroid in 3.7% and bone marrow in 3.1%. In FMF patients, most common MEFV mutation was M694V (77.7%); and 66.7% of the patients had homozygous, 14.6% had compound heterozygous, and 18.7% heterozygous exon 10 variants. Mean age at diagnosis of amyloidosis was earlier in homozygotes (29.1) and compound heterozygotes (32.3) compared to heterozygotes (43.9) (p = 0.001). There was no difference in treatment responses, organ involvement, progression to end stage renal disease (ESRD) and mortality between monoallelic and biallelic exon 10 mutations (p = 0.42). While 44.3% (n = 70) of patients had chronic renal disease (CRD) at time of diagnosis, ESRD developed in 45.3% (n = 73) of patients. During follow-up, 55 patients underwent renal transplantation and recurrence of renal amyloidosis occurred in 24% of them. Mean creatinine and proteinuria levels at time of diagnosis were higher in patients with ESRD than those without ESRD (p Figure 1: Survival graphic of AA amyloidosis patients who developed ESRD according to their baseline GFR statusConclusion:Increased rate of ESRD and progression of amyloidosis findings in patients who presented with GFRDisclosure of Interests:None declared

WOS: 000486224300009, PubMed: 31250147, Objectives Low fetuin-A levels in hemodialysis patients can be associated with development of vascular and valvular calcifications. The mechanisms underlying vascular and valvular calcifications are multifactorial. There are a few studies showing the relationship between low fetuin-A levels and valvular calcification after kidney transplantation. We aimed to evaluate the association between serum fetuin-A levels and valvular calcification in kidney transplant recipients. Methods The cardiac valvular calcification was assessed by echocardiography in 56 recipients. Patients were divided into two groups as those with (n = 11) and without (n = 45) aortic and/or mitral valve calcification. The extent of valvular calcification was visually assessed according to the standard visual score method: moderately (multiple larger spots) and heavily calcified (extensive thickening and calcification) of all cusps. Serum fetuin-A levels were measured. Results The demographic features of both groups were comparable. There was no significant difference between regular physical exercise (63.6% vs. 55.6%), obesity (18.2% vs. 17.8%), abdominal obesity (54.5% vs. 46.7%), smoking (0% vs. 13.3%), hypertension (63.6% vs. 68.9%), left ventricular hypertrophy (45.5% vs. 33.3%) and diabetes mellitus (9.1% vs. 20%) ratios in groups with or without valvular calcification, respectively (p > 0.05). Fetuin-A levels of both groups did not differ. Fetuin-A levels positively correlated with serum creatinine (r 0.326, p = 0.014), and negatively correlated with estimated glomerular filtration rate (r - 0.297, p = 0.026). Conclusions We could not find a relationship between serum fetuin-A levels and valvular calcification in kidney recipients. In this population, further studies are needed to assess the role of serum fetuin-A in valvular calcification.

Giriş: Obezite, yüksekprevalansı ve eşlik eden komorbiditeleri nedeniyle toplum sağlığını tehdit edenen önemli sorunlardan biridir. Bu komorbiditelerin her birinin sağlık içinçeşitli riskleri vardır. Obezite ile ilişkili komorbiditeler hakkında insanlarınfarkındalığını araştıran çok az çalışma vardır.Yöntem: Bu çalışmaya,Endokrinoloji ve Dahiliye polikliniklerine başvuran, vücut kitle indeksi>18,5kg/m2 olan ve obezite ile ilişkili komorbiditelere ilişkinbir anket doldurmayı kabul eden beş yüz yetişkin hasta dahil edildi. Her doğrucevap 1 puan olarak puanlandı. Her bir katılımcının toplam puanı ve ortalamatoplam puanı hesaplandı. Skorlar normal kilolu, kilolu ve obez gruplardakarşılaştırıldı. Anketin yanı sıra yaş, cinsiyet, eğitim düzeyi ve bel çevresi,kalça çevresi, boy ve kiloları ölçüldü.Bulgular: Toplam puanı enyüksek olmasına rağmen obez grupta ortalama eğitim skoru en düşüktü. Obeziteile ilişkili inme, meme kanseri ve osteoartritis farkındalığı obez grupta diğergruplara göre anlamlı olarak yüksek bulundu, ancak kadın ve erkek arasında farkyoktu. Obeziteye bağlı menstrüel düzensizlik ve infertilite farkındalığıkadınlarda daha yüksek iken obezite ilişkili hipertansiyon ve prostat kanserifarkındalığı erkeklerde daha yüksekti.Sonuç: Eğitim düzeyiobez grupta en düşük olmasına rağmen obezite ile ilişkili komorbiditelerinfarkındalığı en yüksek düzeydedir., Introduction: Obesity is one of the most important community healththreatening problem, because of its high prevalence and associatedcomorbidities. Each of these comorbidities have various risks for health. Thereare very few studies investigating the awareness of people about obesityassociated comorbiditiesMethods: Five-hundred adult patients, admitted to Endocrinology& Internal Medicine outpatient clinics, whose body mass index was>18.5kg/m2 and completed a questionnaire concerning obesity associatedcomorbidities were included in this study. Each correct answer was scored as 1point. Each participant’s total score and mean total score (MTS) wascalculated. The scores among normal weight, overweightand obese groups were compared. Besides the questionnaire, age, gender,education level was asked and waist and hip circumference, height and weightwere measured by the researchers.Results: Mean education scorewas the lowest in the obese group, altough MTS was the highest. Awareness of obesity associated stroke, breast cancerand osteoarthritis were significantly higher in the obese group when comparedto the other groups, but there was no difference between men and women. Awarenessof obesity associated menstrual irregularity and infertility was higher inwomen, hypertension and prostate cancer was higher in men.Conclusions: Although the education level was lowest in the obesegroup, the awareness of obesity-associated comorbidities was highest.