Journal of European Internal Medicine Professionals

Targeted Treatment Strategies and Medication Management for Rheumatic Diseases During Pregnancy and Lactation: A Comprehensive Review

Mehmet Akif Baltaci — 2024-10-20

Pregnancy in women with immune-mediated rheumatic diseases poses significant challenges, including risks for both maternal and fetal adverse outcomes. This comprehensive review addresses the management of immune-mediated rheumatic diseases during pregnancy and lactation, focusing on medication strategies and treatment protocols to optimize pregnancy outcomes. The continuation or cessation of medications, including biologics and immunosuppressants, is a critical factor in managing disease activity while minimizing fetal risks. The review also explores the use of assisted reproductive technologies, fertility preservation methods for patients undergoing gonadotoxic treatments, and hormone replacement therapy. Additionally, the management of pregnancy in patients with conditions such as systemic lupus erythematosus, antiphospholipid syndrome, and Sjögren’s syndrome is discussed. Key recommendations from the American College of Rheumatology 2020 guidelines are provided, outlining best practices for medication use during pre-conception, pregnancy, and postpartum care. The review underscores the importance of individualized treatment plans and interdisciplinary collaboration to ensure favorable outcomes for both mother and child.

17q12 Deletion Syndrome with Convulsions and Family History of Increased Intracranial Pressure Syndrome

Mehmet Emin Demir — 2024-10-20

Not Available (Letter to Editor)

Humoral Response Decreases in Hemodialysis Patients 6 Months After The Third Dose of COVID-19 Vaccine

Demet Yavuz — 2024-10-20

Background: This study evaluated the antibody levels six months after the administration of the third dose of the COVID-19 vaccine in hemodialysis patients.

Methods: A total of 52 hemodialysis patients were enrolled in the study. Antibody levels were assessed using the Abbott SARS-CoV-2 immunoassay, designed to detect IgG antibodies targeting the receptor-binding domain of the S1 subunit of the SARS-CoV-2 spike protein.

Results: The incidence of COVID-19 infection within six months following the third vaccine dose was 29.6% (8 patients: 2 males, 25%; 6 females, 75%). Among patients who did not contract COVID-19 within this period, 9 were male (47.4%) and 10 were female (52.6%). There was no statistically significant association between gender and the incidence of COVID-19 within six months post-vaccination (p= 0.280). The median antibody level post-third dose was 7332.4 AU/mL (range: 10.5–40,000), which significantly decreased at the sixth month to 3238.4 AU/mL (range: 17–29,994.7) (p= 0.001). No significant difference between male and female patients was observed in the sixth-month antibody titers (p= 0.744). Furthermore, when analyzed by vaccine type, there was no statistically significant difference in the decline of SARS-CoV-2 IgG antibody levels between recipients of CoronaVac/Sinovac and BNT162b2 (Pfizer/BioNTech) [median (min-max) antibody levels: CoronaVac/Sinovac 2398.2 AU/mL (59.2–38,981.5); BNT162b2 (Pfizer/BioNTech) 11,325.7 AU/mL (17–40,000), (p= 0.181)] at the end of the sixth month.

Conclusion: Antibody titers in hemodialysis patients significantly decreased by the end of the sixth month following the third dose of the SARS-CoV-2 vaccine, independent of the vaccine type. This decline highlights the potential necessity for additional booster doses to enhance and maintain immune protection against SARS-CoV-2 in this vulnerable population.

Assessment of Individuals with Special Needs in Motor Development Presenting to the Pediatric Disability Health Board

Mahir Topaloğlu — 2024-10-20

Background: Developmental assessments are crucial for identifying moderate and severe special needs in children, ensuring their needs are recognized early and supported through Special Needs Reports for Children (SNRFC). This study aimed to evaluate the characteristics of pediatric patients with special needs in motor development who applied to the disability health board, focusing on their age, diagnoses, and the most common associated or accompanying disorders and the relationship between these terms.
Methods: A retrospective analysis was conducted on patients evaluated at the Pediatric Disability Health Board Polyclinic and the Physical Medicine and Rehabilitation Health Board Polyclinic.
Results: Among 1,507 patients admitted to the Pediatric Disability Health Board, 420 patients (6.57 ± 4.86 years) had varying levels of special needs related to motor development. Of these 420 patients, 147 patients (6.89 ± 4.74 years) were classified as having the most severe disability (HSCN), and 151 patients (5.19 ± 4.71 years) were categorized in the mildest disability group (HSN), with the remainder distributed across five intermediate levels in between. Cerebral palsy was the most frequent diagnosis in the HSCN. Other common diagnoses included epilepsy, specific motor developmental disorder, microcephaly, and hydrocephalus. Among the HSCN group, 60 individuals were also assessed as having severe disabilities in cognitive development. Trisomy 21 was the most common diagnosis, followed by specific motor developmental disorders and cerebral palsy in the HSN.
Discussion: The evaluation of individuals applying to the Pediatric Disability Health Board revealed that the largest group of patients in motor development had the HSN, followed by those with the HSCN. Cerebral palsy was the predominant diagnosis in the HSCN group, while trisomy 21 was most common in the HSN group. Additionally, patients with severe motor disabilities frequently had concurrent cognitive and nervous system impairments.
Conclusion: These findings provide valuable insights for physicians working in Pediatric and Physical Medicine and Rehabilitation Health Boards, facilitating more comprehensive evaluations of comorbid conditions and guiding the preparation of SNRFC for better patient management. Early recognition and documentation of special needs through these assessments are critical in ensuring children receive timely developmental and educational support. This process helps address immediate and long-term needs, improving outcomes for children with disabilities.

Clinical and Histopathological Predictors of Renal Survival in IgA Nephropathy Patients with Nephrotic Range Proteinuria: A Retrospective Survival Analysis

Feyza Bayrakdar Çağlayan — 2024-10-20

Background: IgA nephropathy (IgAN) presents with a wide spectrum of clinical features, most commonly hematuria accompanied by subnephrotic proteinuria. Nephrotic range proteinuria is rare, observed in approximately 6% of patients at diagnosis. Limited studies have examined the relationship between clinicopathological characteristics and renal prognosis in IgAN patients with nephrotic range proteinuria.

Methods: This retrospective, single-center case-control study included 114 patients diagnosed with IgAN via kidney biopsy at Şişli Hamidiye Etfal Training and Research Hospital from April 2004 to December 2016. Patients were divided into two groups: nephrotic (≥ 3.5 g/day) and subnephrotic (<3.5 g/day) proteinuria. Primary outcomes included a doubling of serum creatinine, while secondary outcomes measured the initiation of renal replacement therapy.

Results: Patients with nephrotic range proteinuria had significantly lower serum albumin levels (p=0.001), higher cholesterol levels (p=0.03), and increased fibrocellular crescent formation (p=0.01). Cox regression analysis identified baseline serum creatinine, uric acid, and albumin levels, along with histopathological findings such as glomerulosclerosis and crescent formation, as significant predictors of treatment response. The Kaplan-Meier analysis showed that patients with nephrotic range proteinuria had worse renal survival, with a significantly higher proportion reaching primary and secondary endpoints compared to the subnephrotic group.

Conclusion: Histopathological findings, particularly fibrocellular crescents, were more common in patients with nephrotic range proteinuria, and their presence was associated with poorer renal survival and lower treatment response rates. These patients require closer follow-up and may benefit from more aggressive therapeutic strategies.

Impact of Serum Albumin Levels on FDG Uptake in the Liver, Spleen, and Bone Marrow During Gastrointestinal Cancer Staging: A PET-CT Study

Erdal Çetinkaya — 2024-10-20

Abstract:

Background: Serum albumin is an essential biomarker in cancer patients, reflecting nutritional status and systemic inflammation. This study investigates the impact of serum albumin levels on FDG uptake in the liver, spleen, and bone marrow during the staging of gastrointestinal cancers using FDG PET-CT.

Methods: This retrospective study included 610 patients with various types of cancers. FDG PET-CT scans were used to measure FDG uptake in the liver, spleen, and bone marrow. Patients were grouped into hypoalbuminemia (< 3.5 g/dL) and normal albumin levels (≥ 3.5 g/dL). The study analyzed the correlation between serum albumin and SuVMax and SuVMean of the liver, spleen, and bone marrow.

Results: Patients with normal albumin levels exhibited significantly higher liver FDG uptake, with a mean Liver SuVMax of 3.73 ± 1.78 compared to 3.32 ± 0.75 in those with hypoalbuminemia (p < 0.0001). Similarly, Liver SuVMean was higher in the normal albumin group (2.17 ± 1.20) than in the hypoalbuminemia group (1.95 ± 0.48, p = 0.0009). No significant differences in FDG uptake were observed in the spleen and bone marrow between the two groups. The study found a weak positive correlation between albumin levels and liver FDG uptake, but no significant correlation with FDG uptake in the spleen and bone marrow.

Conclusion: Serum albumin levels are significantly associated with liver FDG uptake in patients with gastrointestinal cancers, suggesting that albumin may play a role in liver metabolism. However, albumin levels do not significantly impact FDG uptake in the spleen or bone marrow. These findings highlight the potential of albumin as a marker for liver metabolism in cancer patients but suggest that other factors influence the spleen and bone marrow.

Keywords: Albumin, FDG PET-CT, Gastrointestinal Cancers, Liver Metabolism, Hypoalbuminemia