Journal of European Internal Medicine Professionals

Human Papillomavirus (HPV) Vaccines: A Comprehensive Review

Ezgi Eda Erden, Özlem Oyardi — Sun, 02 Feb 2025 00:00:00 +0300

Human papillomavirus (HPV) is a double-stranded DNA virus from the Papillomaviridae family that primarily infects basal epithelial cells. This virus is responsible for causing warts, papillomas, and various cancers in both men and women. To date, over 200 HPV types have been identified, which are classified into high-risk and low-risk categories. High-risk types, such as HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, and 82 are known to contribute significantly to cancer development. Among these, HPV 16 and 18 are the most common and are strongly associated with the onset of cancer. HPV remains a significant global public health issue, posing substantial social and economic burdens. Despite extensive research, there is currently no approved or proven drug for the effective treatment of HPV infections. However, vaccines play a critical role in the prevention of HPV-related diseases. The U.S. Food and Drug Administration (FDA) has approved three vaccines that provide protection against high-risk HPV types. These vaccines have led to a marked reduction in HPV incidence and associated complications. The World Health Organization (WHO) strongly recommends HPV vaccination as a preventive measure. Furthermore, ongoing research aims to develop next-generation vaccines to enhance protection against HPV. This study underscores the importance of HPV vaccines and highlights their role in mitigating the impact of this pervasive virus.

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

Bediz Kurt İnci — Sun, 02 Feb 2025 00:00:00 +0300

Letter to Editor

Hyponatremia in A Patient with Preeclampsia

Beyza Doğan, Süleyman Karaköse — Sun, 02 Feb 2025 00:00:00 +0300

It is not necessary for to letter to the editor.

A Rare Case of Sinonasal Invasive Mucormycosis Presenting Concurrently With A Fungus Ball

Başak Yalçıner, Onur Büyükkoç — Sun, 02 Feb 2025 00:00:00 +0300

Letter to Editor - No Abstract

A Rare Case of Left Ventricular Myocardial Metastasis of Patient Presenting with ST-Elevation Acute Coronary Syndrome

Sun, 02 Feb 2025 00:00:00 +0300

Lung cancer affected 2.2 million people and caused 1.8 million deaths in 2020. The most common type is non-small-cell lung cancer (NSCLC), with symptoms like cough, dyspnea, pain, and weight loss. Metastases often occur in the brain and the adrenal glands. Cardiac metastasis, detected in 25% to 30% of autopsy examinations of patients, generally involves the pericardium. Rarely, lung cancer metastasizes to the myocardium and can mimic acute coronary syndrome (ACS) or ST-elevation myocardial infarction (STEMI) without coronary artery blockage. Prognosis is generally poor in patients with cardiac metastasis, as patients showing ACS-like symptoms may die within days. These highlight the need for clinicians to be aware of this rare but severe complication of lung cancer. This case report presents a rare occurrence of myocardial metastasis from primary lung cancer, which is presented as ACS. PET-CT scans of the patient demonstrated lung lesions, lymphadenopathy, and multiple metastases. Biopsy specimens revealed poorly differentiated squamous cell carcinoma, with possible high-grade mucoepidermoid carcinoma. Physicians should recognize that lung cancer metastasis to the heart can mimic ACS or STEMI without coronary blockage. Recognizing that ACS-like symptoms and ECG changes in a cancer patient may be the result of myocardial metastasis prevents misdiagnosis and inappropriate treatments. Transthoracic echocardiography (TTE) should be considered as the initial imaging modality, followed by Cardiac MRI, CT, and PET-CT. As cardiac metastasis signals advanced cancer and poor prognosis, physicians should prioritize accurate diagnosis and can collaborate timely, with other specialists to initiate appropriate care such as radical surgical resection, radiotherapy and chemotherapy.

A Retrospective Comparison of Treatment Options in Secondary Hyperparathyroidism on Calcium Metabolism: A Single Center Study

Abidin Gündoğdu, Emre Çapar, Bülent Demirelli — Sun, 02 Feb 2025 00:00:00 +0300

Background: Many patients on hemodialysis (HD) receive treatment for secondary hyperparathyroidism (sHPT), but few studies have assessed the clinical outcomes for these patients when treated with cinacalcet or parathyroidectomy (PTx). This study aimed to compare the short-term outcomes of cinacalcet and PTx in HD patients with sHPT.

Methods: The study included retrospective data from 52 patients with ESRD who underwent HD and were diagnosed with sHPT between 2001 and 2013. Data regarding participant age, gender, serum calcium (mg/dL), phosphorus (mg/dL), and parathormone (PTH, pg/mL) levels before and six months after treatment initiation (after surgery for patients who underwent PTx) were obtained from patient files.

Results: The study involved 12 patients who underwent PTx, 18 patients treated with cinacalcet, and 22 who received calcitriol. PTx was the only treatment that significantly reduced post-treatment calcium. The mean calcium levels of patients treated with PTx were 7.67±0.95 mg/dL, showing a mean difference of 1.2 mg/dL (p=0.005, paired-samples t-test). Both PTx and cinacalcet significantly reduced phosphorus levels, when compared in mean changes, patients who underwent PTx had higher median reductions in phosphorus concentrations compared to patients treated with cinacalcet (p=0.03, Mann-Whitney U test). Post-treatment PTH levels significantly decreased in both the PTx and cinacalcet groups, however, only the patients who underwent PTx achieved PTH levels within the recommended range; post-treatment PTH levels in the cinacalcet group remained higher than recommended levels.

Conclusion: Both PTx and cinacalcet are beneficial in managing sHPT, however, PTx provides more significant improvements in mineral metabolism, while cinacalcet offers a less invasive alternative as a medical treatment.

Relation Between nt-ProBNP and Serum Sodium Based on Glomerular Filtration Rate

Muhammed Emir İnce, Semahat Karahisar Şirali, Mehmet Fatih Bulucu, Ahmet Çorakcı — Sun, 02 Feb 2025 00:00:00 +0300

Background: Electrolyte imbalance and volume overload are common in chronic kidney disease and heart failure. We aimed to evaluate the relationship between serum sodium and N terminal pro-brain natriuretic peptide (NT-proBnp) based on estimated glomerular filtration rates in heart failure (HF) patients with low ejection fraction.

Methods: A total of 389 patients aged 18-80 years who presented to our hospital with symptoms of heart failure were included in the study. Demographic, laboratory, and echocardiography findings were recorded. The study group consisted of patients with ejection fraction (EF) less than 55% and estimated glomerular filtration rate (eGFR) less than 90mL/min, and subgroups were formed according to eGFR, ejection fraction and NT-proBnp level.

Results: Of the total group, 54.5% were female, and the median age was 64 (IQR18) years. Age, NT-ProBnp, creatinine, BUN, and CRP were significantly (p<.05) higher in the study group compared to the control group. When subgroups were compared according to eGFR, age, creatinine, NT-proBnp, BUN, and CRP were significantly (p<.05) higher in the group with eGFR<45mL/min compared to the group with eGFR=45-89mL/min. In the group with NT-proBNP above 6000, it was seen that eGFR, EF, sodium, albumin, and hematocrit were effective at a rate of 38.4% in the multivariate logistic regression model.

Conclusion: In HF and low eGFR, NT-proBnp increases with volume increase. In light of the data that NT-proBnp, which is known to be released from stress-induced cardiomyocytes, is excreted and metabolized via the renal route, renal function should be taken into consideration in the interpretation of NT-proBnp elevated levels.

The Effects of Temporomandibular Joint Mobilization on Drooling Control, Swallowing Function and Quality of Life in Cerebral Palsy Patients; Double-Blind Study

Mehmet Sait Tangüner, Fadime Doymaz — Sun, 02 Feb 2025 00:00:00 +0300

Background: This study aimed to determine the effects of temporomandibular joint (TMJ) mobilization on saliva control, swallowing function, and quality of life in cerebral palsy (CP) patients with temporomandibular joint dysfunction (TMD).

Methods: A total of 20 patients who met the inclusion criteria and were between the ages of 1 and 18 years were included. They were then randomly divided into two groups. In the study group (n=10) patients were treated with TMJ mobilization in addition to control group treatments In the control group (n=10), patients were treated with physiotherapy, and a home program including passive joint movements was provided. The treatments were continued 2 sessions/week and 6 weeks. Patients were evaluated using the Pediatric Functional Independence Measurement (WeeFIM), the Drooling Frequency and Severity Scale (DFSS), and the Assessment of Swallowing Ability and Function (SAFE).

Results: The difference between the SAFE scale scores before and after treatment was statistically significant (p<0,05). There were negative correlations between WeeFIM, and DFSS scores; a positive correlation between drool frequency and severity scores; a negative correlation between drool severity and mandible lateral deviation values; and a negative correlation between drool frequency and mandible protrusion values.

Can the HALP Score Be Predictive in Different Clinical Stages of Diabetes?

Sun, 02 Feb 2025 00:00:00 +0300

Background: The Hemoglobin, Albumin, Lymphocyte, Platelet (HALP) score is a novel biomarker integrating routine laboratory parameters to assess a patient’s immune nutritional status. Integrating the HALP score into routine diabetes management could help stratify patients based on their risk of complications and guide treatment strategies accordingly. For example, a patient with a low HALP score presenting to a clinic might be flagged for immediate nutritional support and more frequent monitoring of inflammatory markers. In contrast, those with higher scores could follow standard care protocols. This study investigated the potential of the HALP score as a prognostic biomarker by evaluating its correlation with clinical and laboratory parameters between diabetic patients and healthy controls.

Method: A total of 133 participants, comprising 96 diabetic patients and 37 healthy individuals were included in the study. Participants were divided into four groups: control (n=37), prediabetes (n=37), diabetes (=30), and complicated diabetes (n=29). Comprehensive demographic, clinical, and laboratory data were collected, and the HALP score was calculated as hemoglobin × albumin × lymphocyte count/platelet count. The HALP score was calculated and its relationship with various parameters was analyzed using Spearman correlation and ROC analysis.

Results: The study found significant differences in HALP scores between the groups; the highest score was observed in the prediabetes group at 49 (18-101), while the lowest score was in the complicated diabetes group at 39 (13-101). There was no significant difference in HALP scores between genders. A weak negative correlation was found between age and HALP score. Significant correlations were identified between HALP scores and parameters such as albumin, hemoglobin, lymphocytes, BUN, CRP, and HbA1c. ROC analysis demonstrated high diagnostic accuracy of low HALP scores in identifying complicated diabetes, with AUC> 0.7 (p< 0.003). Among comorbidities, only the anemic group had a significantly lower HALP score of 28 compared to 50 in the non-anemic group (p= 0.026).

Conclusion: This study underscores the HALP score’s potential as a powerful prognostic biomarker for diabetes, offering a cost-effective and readily accessible tool for clinical stratification. Its significant correlations with disease severity, inflammatory markers, and nutritional parameters position it as an indispensable addition to the diagnostic arsenal for diabetes management. Future research, including longitudinal studies, is warranted to validate these findings and establish standardized clinical applications.

Frailty Status and Mortality Risk in Older Adults With Diabetes Mellitus

Neslihan Kayahan Satış, Mehmet İlkin Naharcı — Sun, 02 Feb 2025 00:00:00 +0300

Background: Frailty, characterized by decreased physiological reserves and an increased risk of adverse health outcomes, is prevalent among older adults with diabetes mellitus (DM). This study aimed to investigate how frailty status affects mortality in older individuals with diabetes.

Methods: Patients previously diagnosed with DM who presented to a tertiary referral center between March 2020 and March 2022 were selected and followed up for at least two years. The frailty assessment used the Fried frailty phenotype criteria, and patients were categorized as frail, pre-frail, or robust. Multivariate regression models were utilized to identify mortality risk factors.

Results: The study cohort comprised 424 patients with a median age of 75 years, of which 65.8% were female. Among the patients, 28.3% were classified as frail and 66.0% as pre-frail. During the observation period, the overall mortality rate was 6.8%, with a significantly higher mortality rate in frail patients (15%) compared to pre-frail patients (3.9%) (p<0.001). Multivariate analysis identified frailty as a significant predictor of increased mortality risk in the overall population (HR=2.84, 95% CI: 1.20–6.69, p=0.017) and in men (HR=7.35, 95% CI: 1.17–48.35, p=0.033), but not in women (HR=2.70, 95% CI: 0.99–7.30, p=0.051).

Conclusion: Frailty markedly elevates the risk of mortality in older adults with DM, with this effect being particularly pronounced in males. These findings emphasize the significance of early identification and management of frailty in enhancing survival outcomes in this population.

Determination of Antifungal Susceptibilities of Candida Species Isolated from Various Clinical Samples: An 8-Year Retrospective Study

Nihan Ünübol, Neval Yurttutan Uyar, Meltem Ayas — Sun, 02 Feb 2025 00:00:00 +0300

Background: The rate of fungal infection has increased due to advances in medical and surgical treatment. Recently, Candidiasis has become one of the major fungal infections among hospitalized patients. While various Candida species may cause the same clinical manifestations, they may also have different antifungal susceptibility patterns. The aim of this study was to determine the distribution and antifungal susceptibilities of Candida species isolated from various clinical specimens.

Methods: Various Candida species were isolated from different clinical samples sent to Acıbadem Labmed Medical Laboratory between 2015 and 2023. Antibiotic susceptibility studies of isolated Candida species were performed with Yeast one kit (Thermo Scientific™, USA) and the results were evaluated according to CLSI data.

Results: From 922 samples, most common species isolated was C. albicans (30.9%), followed by C. parapsilosis, C. glabrata, C. tropicalis and C. krusei. Candida species were sensitive to Fluconazole 76.2%, Itraconazole 64.1%, Voriconazole 93.1%, Anidulafungin 99.1%, Micafungin 99.1%, Caspofungin 98.9% and Flucytosine 92.6%. The antibiotic resistance rates of Candida species were Fluconazole 15.5%, Itraconazole 8.1%, Voriconazole 4.5%, Anidulafungin 0.7%, Micafungin 0.2%, Caspofungin 0.8% and Flucytosine 1.9%.

Conclusion: Speciation of Candida and antifungal susceptibility testing should be done routinely to prevent therapeutic failures.