ÖZTikagrelor, akut koroner sendrom sonrasında kullanılan antiplatelet agregasyon inhibitörüdür. Statinler gibi karaciğerde sitokrom P450 enzim sistemi ile metabolize olmaktadır. Bu nedenle tikagrelor, atorvastatinin kan düzeyini artırarak statin ilişki rabdomiyolize neden olabilmektedir. Tikagrelorun son dönemde kullanımı giderek arttığından dolayı rabdomiyoliz yan etkisi de görülmektedir. Tikagrelor kullanan bir hastada, muhtemel atorvastatin düzeyinin artması sonucu gelişen şiddetli rabdomiyoliz olgusu sunacağız.ANAhtAR SÖZCÜkLER: Tikagrelor, Rabdomiyoliz, Atorvastatin ABStRACtTicagrelor is an antiplatelet aggregation inhibitor used after acute coronary syndrome. It is metabolized by the cytochrome P450 enzyme system in the liver, like the statins. Using these two agents together may result in rhabdomyolysis because of the rising serum atorvastatin level. Due to the increasing use of ticagrelor in the recent period, rhabdomyolysis has been seen as a side effect. We present a case of severe rhabdomyolysis possibly due to increased level of atorvastatin, in a patient using ticagrelor.kEY wORdS: Ticagrelor, Rhabdomyolysis, Atorvastatin GİRİŞTikagrelor akut koroner sendrom sonrasında kullanılan antiplatelet agregasyon inhibitörüdür. Trombosit agregasyonunda rol alan adenosin difosfatın bağlandığı trombosit reseptörü P2Y 12 reversible bağlanır. Klopidogrele göre üstünlüğünün gösterildiği çalışmalar mevcuttur (1-3). Bundan dolayı son dönemde kullanımı giderek artmaktadır.Tikagrelor ve atorvastatin sitokrom P450 (CYP) enzimi ile metabolize edilmektedir. Bu nedenle ilaç etkileşimleri olmakta ve tikagrelor, atorvastatin kan düzeyini yaklaşık olarak iki kat artırmaktadır (4,5). Yaşlı hastalarda bu ilaç etkileşimi ve yan etki insidansı artmaktadır (6). Statinlerin sık yan etkilerinden olan rabdomiyoliz, tikagrelor ile daha sık ve şiddetli şekilde görülebilmektedir.Biz tikagrelorun, muhtemel atorvastatin serum düzeyini artırmasına bağlı diyaliz gereksinimi olan ve nadir görülen şiddetli rabdomiyoliz olgusundan bahsedeceğiz. OLGUBir yıl önce ST elevasyonlu inferior miyokard infaktüsü geçiren 79 yaşında kadın hastaya, tikagrelor 90 mg günde iki kez, atorvastatin 40 mg, aspirin 100 mg, metoprolol 50 mg, ramipril 2,5 mg başlanmış. Tedaviden 11 ay sonra hasta bir ay düzenli diklofenak sodyum kullanımı sonrasında acil servise yaygın kas ağrıları ve kuvvetsizlik, bulantı, kusma, halsizlik, idrar miktarında azalma şikayeti ile başvurdu. Fizik muayenesinde şuur açık, takipneik, TA 125/78 mm Hg, nabzı dakika sayısı 65, tüm kaslarda 3/5 kas gücü kaybı saptandı. Tetkiklerinde kreatinin 8,1 mg/dl (bir ay önce kreatinin:1,1 mg/dl), Üre 272 mg/
Aim of the study: Obesity is a well-determined risk factor for acute pancreatitis. Increased visceral fat has been shown to increase the proinflammatory environment experienced by patients. In this study, we aimed to research the correlation between abdominal fat distribution parameters measured with computed tomography (CT) and severity of acute pancreatitis (AP). Material and methods:The study included patients monitored due to AP in the internal medicine clinic of GOP Education and Research Hospital from January 2015 to December 2018. The Acute Physiology and Chronic Health Evaluation (APACHE) score, the Imrie score and the Bedside Index of Severity in Acute Pancreatitis (BISAP) scores were calculated. Advanced image processing analysis software (INFINIT Xelis, v 1.0.6.3) was used to calculate individual abdominal fat distribution parameters from CT screening with division of abdominal tissues. Measurements were performed from -50 to -250 Hounsfield units (HU) between vertebrae L2-L3. Results: When mild and moderate AP groups were compared, there were statistically significant differences in duration of hospital stay and scoring (APACHE, Imrie and BISAP) (p < 0.001), while there were no significant differences in abdominal fat distribution parameters (p > 0.05). There was no significant correlation of visceral and subcutaneous fat volumes with development of systemic complications, while a significant correlation was identified for visceral to total fat tissue area ratio (VTR) with local complications (p < 0.001). Pearson correlation analysis found no correlations of mortality and pancreatitis severity with visceral (VFA) and subcutaneous fat area (SFA) (p > 0.05). Positive correlations were identified for VFA with Imrie, BISAP and APACHE scores (p < 0.01), and positive correlations were identified for visceral adipose tissue (VAT) with visceral to subcutaneous fat ratio (VSR) and APACHE scores (r = 0.256 and 0.252, respectively, p < 0.001). Positive correlations were identified for VTR and VSR ratios with BISAP scores (r = 0.266 and r = 0.277, respectively, p < 0.001). Conclusions: In patients with AP diagnosis and abdominal CT scans, increased VFA and VTR ratio were found to be associated with increased AP clinical scores with no significant correlation identified in terms of local/systemic complication development. Our study shows that VFA is linked to AP clinical scoring systems and should be included in AP predictive scoring systems.
BackgroundThe first symptoms of ankylosing spondylitis (AS) patients usually begin prior to 45 years, but can occur later in life.ObjectivesThe purpose of this study is to evaluate the efficacy and safety of anti-TNFα treatment in late-onset AS (LoAS) patients in comparison to those with adult onset AS (AoAS).MethodsWe studied AS patients in TURKBIO registry between the dates of January 2011 and November 2018. All the patients fulfilled the modified New York criteria for AS 1 and were classified into 2 groups based on their age at symptom onset: AoAS (age>16 but ≤45 years); and LoAS (age>45 years). In both groups, the following data were compared: (1) epidemiological variables (2) clinical manifestations, including signs and symptoms at diagnosis; (3) laboratory results (4) disease activity markers and follow-up parameters (BASDAI, ASDAS-CRP and HAQ); (5) previous and current treatments (6) adverse events.ResultsA total of 2551 AS patients (91,1% with AoAS and 8.9% with LoAS) were included in the study. LoAS group had more female patients, older age, shorter disease duration and diagnostic delay, higher initial ESR and less HLA-B27 positivity compared to the AoAS (Table 1). Peripheral arthritis (not statistically significant) and dactylitis was seen more common in the LoAS. The frequency of other involvements was similar between the groups (Table1). The frequency of using drugs was similar between each groups although the use of glucocorticoids and sulphasalazine was more common in the LoAS. Switching from the first anti-TNFα treatment to the second one was more common in the AoAS. However, there was found no significant difference between the two groups in 2 or more switch ratios (Table 1). At the latest visit after the anti-TNFα therapy, the mean improvement in BASDAI was significantly higher in the AoAS (Table 2). A total of 10 (4.4%) serious adverse events were reported in LoAS and 39 (1.7%) in AoAS patients in the follow-up (HR: 2.62; 95% CI: 1.32–5.18). Severe infections were the most commonly seen serious adverse events (1.3% in LoAS and 0.8% in AoAS), followed by allergic reactions (0.9% in LoAS and 0.3% in AoAS). Tuberculosis was observed in 2 patients (0.9%) in LoAS and 9 (0.4%) in AoAS, malignancy in 3 patients (1.3%) in LoAS and 6 (0.3%) in AoAS.ConclusionOur data showed that almost 8.9% of the patients with AS had late-onset of symptoms. The results suggested that LoAS patients might have different demographic, clinical features, disease activity parameters at baseline. The frequency of anti-TNFα use and response rate to the treatment was also similar in LoAS to those in AoAS patients. The LoAS patients seem to have more common severe adverse events compared to the AOAS patients possibly related to their older age.References[1] Van der Linden S, Valkenburg HA. Evaluation of diagnostic criteria for AS. Arthritis Rheum1984; 27: 361–368.Disclosure of InterestsSadettin Uslu: None declared, Gerçek Can: None declared, Ayse Cefle: None declared, Sema Yılmaz: None declared, Sinem Burcu Kocaer: None declared, ...
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