Amaç Lokal ileri rektum kanserlerinde neoadjuvan kemoradyoterapi(NAKRT) standart hale gelmiş olup patolojik tam yanıt (pCR) alınan hastalarda cerrahi yapılmadan izlem seçeneği tartışılmaktadır. Bu çalışmada NAKRT’ye yanıtı predikte edecek faktörleri araştırmayı amaçladık. Materyal ve metod 2011-2021 yılları arasındaki 18 yaş üstü rektum kanseri tanılı 184 hasta retrospektif olarak tarandı. Histopatolojik olarak rektum kanseri olduğu konfirme edilen ve lokal ileri evre olup neoadjuvan tedavi alan 79 hasta mevcuttu. 18 hasta çalışma dışı bıraklıdı, çalışmaya 61 hasta dahil edildi. TNM evrelemesi pelvik MRG (manyetik rezonans görüntüleme) ile yapıldı. Prediktif faktörleri belirlemek için SPSS’de lojistik regresyon modeli kullanıldı. Bulgular Çalışmaya 61 hasta dahil edildi. Median yaş 45 (44-89) idi. Hastaların 42(%68.9) si erkek idi. Klinik T evresi 34 (%55.7) hastada T3 ve 23 (%37.7) hastada T4 idi. Klinik N evresi 0, 1 ve 2 olan hastaların sayısı sırasıyla 5(%8.2), 28(%45.9) ve 28(%45.9) idi. Ortalama CEA(karsinoembriyojenik antijen) ve CA 19-9 değerleri sırasıyla 9.69 (std. Deviation:14.95) ve 12.32 (std. Deviation:12.61) idi. 49 (%80.3) hasta kapesitabin eşliğinde, 12 hasta 5-FU(5-Fluorourasil) eşliğinde RT(Radyoterapi) aldı. 40 (%65.6) hastaya LAR(Low anterior rezeksiyon) yapılmıştı. 57 (%93.4) hastanın patolojisi adenokarsinom idi. Patolojik yanıt durumuna bakıldığında 8 (%13.1) hastada tam yanıt ve 48 (%78.7) hastada kısmi yanıt varken 5 (%8.2) hasta tedaviye yanıtsız olarak görüldü. Sonuç Bazı çalışmalarda NAKRT ile tedavi yanıtını predikte edecek birtakım faktörler olduğu belirtilmiş olsa da henüz kılavuzlara yansımış ortak kabul edilmiş parametreler yoktur. Bizim çalışmamızda değerlendirilen parametreler arasında patolojik tam yanıtı predikte eden bağımsız bir faktör bulunamadı. ‘Neoadjuvan tedavi alan rektum kanseri hastalarında tedavi yanıtını predikte eden parametreler var mı?’ sorusuna cevap verecek daha çok sayıda ileri araştırmaya ihtiyaç duyulmaktadır.
In the present case, a 52-year-old female patient has no disease in her medical history. She was brought into the emergency department with muscle pain, nausea-vomiting, acute kidney injury (AKI), tumor lysis syndrome (TLS). Intensive hydration was performed. On the fourth day, venous blood gas, serum kidney function testing and electrolyte levels improved. Thrombocytosis was detected. Our patient with TLS-associated AKI was diagnosed with essential thrombocytosis. We have not previously observed such a case sample in the English literature in the extensive examination.
The incidence and prevalence of obesity are increasing rapidly throughout the world. Various methods have been developed to evaluate obesity. A body shape index (aBSI) is based on waist circumference adjusted for height and weight. High BSI values have been found to be associated with early mortality. It is known that obesity is associated with inflammation and cardiovascular diseases. In this study, we examined the relationship between aBSI, inflammatory markers such as C-reactive protein and interleukin-6 and cardiovascular disease in patients with stage 3-4 chronic kidney disease. Methods. One hundred twenty patients were enrolled in this cross-sectional observational study. The mean aBSI value was 0.0870. Patients were divided into 2 groups according to the mean value of aBSI as there is no currently defined cut-off value for BSI. Those with aBSI ≤ 0.087 were allocated to group I, and those with aBSI> 0.0870 to group II. Results. Patients in group II had more cardiovascular disease than in group I. In partial Spearman correlation analysis, the presence of cardiovascular disease was correlated with aBSI (r = 0.36, p = 0.0001). aBSI higher than 0.0986 predicted cardiovascular disease in our cohort: the area under the curve (CI 95%) for aBSI was 0.715 (0.602-0.829). Conclusions. The relationship between aBSI and inflammation could not be shown. But we found that high aBSI is associated with increased cardiovascular disease. Further studies are needed to recommend the routine clinical use of aBSI as a cardiovascular disease marker.
Objectives: This study aims to investigate the relationship between postprandial C-peptide-to-glucose ratio (PCGR), β-cell function and successful glycemic glycemic control in type 2 diabetes mellitus (DM) and determine the efficacy and feasibility of the PCGR index in the individualization of diabetes treatment. Materials and methods: This prospective study included a total of 49 patients (17 males, 32 females; mean age: 56±10 years; range, 32 to 75 years) under follow-up in Istanbul Medeniyet University Göztepe Training and Research Hospital Department of Internal Medicine with the diagnosis of type 2 DM between June and December 2016. Patients receiving insulin or insulin secretagogues were excluded. Data including age, sex, weight, height, waist circumference, hip circumference, date of DM diagnosis, serum hemoglobin A1c (HbA1c), and creatinine levels were recorded. All patients underwent a mixed meal test and their fasting blood glucose, C-peptide, postprandial glucose, and C-peptide levels were measured and recorded. Patients with a serum HbA1c level of 7% or lower were considered to have good glycemic control while patients with a serum HbA1c level of higher than 7% were considered to have uncontrolled diabetes. The relationship between C-peptide index (CPI), PCGR index, and parameters related to glycemia and β cell function was investigated. Results: Mean diabetes duration was 6.6±6 years and mean serum HbA1c level was 7.9±1.8%. There was a weak correlation between CPI and Homeostasis Model Assessment-β (HOMA-β), a moderate correlation between fasting C-peptide, delta C-peptide, and HOMA-β, and a strong correlation between fasting C-peptide, postprandial C-peptide, PCGR, and HOMA-β (p<0.05, p<0.05, p<0.001, respectively). There was a moderate negative correlation between postprandial C-peptide, delta C-peptide, fasting C-peptide-to-glucose ratio (FCGR), and serum HbA1c level (p<0.05). There was no correlation between fasting C-peptide and serum HbA1c level while there was a strong negative correlation between PCGR and serum HbA1c level (p<0.001). Comparison of the patient groups with and without glycemic control revealed that mean PCGR was significantly higher in the former group than the latter (p<0.001). Conclusion: We conclude that PCGR is significantly associated with glycemic control and variability. Our data suggest that PCGR is a useful index indicating β-cell function, and it can be used in the individualization of DM treatment.
Objectives: This study aimed to determine the efficacy and resistance of empirical antibiotics (EA) in patients admitted to the Internal Medicine Intensive Care Unit (ICU) due to community-acquired infections according to the infectious agents in the follow-up of patients and to determine its relationship on mortality. Patients and methods: A total of 162 patients (78 males, 84 females; mean age 74.7±13.5 years; range 22 to 98 years) with community-acquired infections, followed in Medeniyet University, Göztepe Training and Research Hospital Internal Medicine Intensive Care Unit between March 2015 and March 2017, were included in this study. The patients’ age, sex, comorbidities, diagnoses, EA, culture antibiogram, and mortality outcomes were all recorded retrospectively. Results: The most common (50%) comorbidity was hypertension. The common diagnosis on admission was pneumonia (46.2%). Acinetobacter Baumannii was the most isolated bacterium. The most frequently used group of EA was carbapenems (46.9%). Culture antibiogram results showed resistance to the EA in 42.6% of the patients. Empirical antibiotics were replaced with other antibiotics in 46.9% of the patients. When compared to the susceptible group, mortality was higher in the resistant group to the EA. Conclusion: In this study; antibiotic resistance was found to affect mortality in patients admitted to the Internal Medicine ICU for community-acquired infections.
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