Journal of European Internal Medicine Professionals

Assessment of Oxidative Stress in Hashimoto’s Thyroiditis Patients: Effects of Levothyroxine Sodium Treatment

Burçak Cavnar Helvacı, Özant Helvacı, Gamze Dam, Salim Neşelioğlu, Özcan Erel — Wed, 06 Aug 2025 00:00:00 +0300

Background: Hashimoto’s thyroiditis (HT) is a prevalent autoimmune disease characterized by chronic inflammation of the thyroid gland, leading to hypothyroidism. Oxidative stress has been implicated in the pathogenesis of HT, influencing disease progression and therapeutic outcomes. Understanding the dynamics of thiol/disulfide balance, a marker of oxidative stress, in HT patients receiving levothyroxine treatment is crucial for elucidating its role in disease management. Our study has the largest cohort on this topic.
Methods: This study enrolled 357 euthyroid HT patients, divided into groups based on levothyroxine treatment status. Thiol/disulfide homeostasis was assessed using the Erel method. Clinical parameters, including thyroid function tests and antibody levels, were measured. Statistical analyses were performed to compare oxidative stress markers between groups.
Results: Patients on levothyroxine therapy showed lower native and total thiol levels than untreated patients, indicating potential antioxidant depletion. Higher disulfide/native thiol and disulfide/total thiol ratios in the treated group suggest elevated oxidative stress. There were no correlations between thyroid antibodies (TPO-Ab, TG-Ab) and thiol/disulfide levels.
Conclusion: This study highlights alterations in thiol/disulfide balance among euthyroid HT patients, with implications for oxidative stress management in clinical practice. Levothyroxine treatment appears to be associated with oxidative stress markers, suggesting associations that warrant further investigation.

Empirical Treatment Approach for Itchy Ear Syndrome: Topical Steroids or Antifungals?

Wed, 06 Aug 2025 00:00:00 +0300

Background: “Itchy ear syndrome”, defined as ear itching after exclusion of related pathologies with a thorough physical examination, is common in otolaryngology practice. Despite the fact that it is frequent, high quality evidence regarding its etiology and treatment is lacking. We aimed to investigate whether empirical antifungal therapy is effective in this situation in comparison with corticosteroid therapy and the effectiveness of topical mometasone furoate lotion.
Methods: This retrospective observational study included 57 patients who applied with recurrent ear pruritus, were treated with mometasone or ciclopirox olamine, and who did not have any pathological findings on examination. The patients were retrospectively scanned through the hospital database, called, and asked to fill out a modified form of the 5D itching questionnaire to assess the degree of itching before and after treatment. The results were compared statistically.
Results: Of the 57 patients included, 25 (43.8%) were male and 32 (56.1%) were female. The mean age of the two groups was similar (p=0.915). Twenty-eight (49.1%) patients were treated with ciclopirox olamine, and 29 (50.9%) patients with mometasone. When the scores before and after treatment were compared, the decrease in scores was significant (p<0.001). There was no significant difference between the two cohorts regarding pre-treatment and post-treatment scores (p=0,26 and p=0.22, respectively).
Conclusion: Our findings indicate that topical antifungal treatment with ciclopirox olamine and topical steroid treatment with lotion form mometasone furoate are both effective in the treatment of itchy ear syndrome.

Investigation of Factors Affecting the Formation of Secondary Non-Traumatic Fractures Due to Mineral Bone Disorder in Hemodialysis Patients: A Single-Center Experience

Özdem Kavraz Tomar, Haldun Öner, Tülin Akagün , Muhammed Aydın — Wed, 06 Aug 2025 00:00:00 +0300

Background: In our study, we aimed to determine whether demographic data and biochemical parameters of patients undergoing hemodialysis influence the prediction of secondary non-traumatic fractures due to mineral bone disorder caused by chronic kidney disease.

Methods: This cross-sectional study was conducted by retrospectively scanning the records of patients aged 18 years and older who had undergone hemodialysis for at least six months at our hospital’s hemodialysis unit between 2017 and 2022. A total of 272 patients meeting the inclusion criteria were examined through hospital records.

Results: Of the 272 patients included in the study, 57.7% were males, and the median age was 65 years. Non-traumatic fractures were detected in 32 (11.8%) patients. Non-traumatic fractures were significantly more common in female patients compared to males (18.3% vs. 7%; p=0.008). Eight patients had undergone parathyroidectomy, and among them, non-traumatic fractures were significantly more frequent compared to those who had not undergone the procedure (50% vs. 10.6%; p=0.008). Patients using steroids had significantly more non-traumatic fractures compared to non-users (26.9% vs. 10.2%; p=0.021). The duration of dialysis was significantly longer in patients with non-traumatic fractures compared to those without (60.5 months [7 - 324] vs. 39.5 months [7 - 330]; p=0.017). The risk of non-traumatic fractures was found to be 3.66 times higher in women, 4.17 times higher in steroid users, and increased by 0.7% with each additional month of dialysis.

Conclusion: This study investigated factors influencing non-traumatic fractures associated with mineral bone disorder in hemodialysis patients. Female gender, steroid use, parathyroidectomy, and dialysis duration were found to increase the risk of fractures. No significant association was found between fractures and other laboratory parameters or medications used by patients to regulate bone mineral metabolism.

Renal and Hemodynamic Effects of Sodium-Glucose Cotransporter 2 Inhibitors in Patients with Type 2 Diabetes and Chronic Kidney Disease Receiving Varying Doses of Renin-Angiotensin System Blockade

Bülent Demirelli — Wed, 06 Aug 2025 00:00:00 +0300

Background: Chronic kidney disease (CKD) in the context of type 2 diabetes mellitus (T2DM) remains a significant global health challenge. Sodium-glucose co-transporter-2 inhibitors (SGLT2i) have emerged as a renoprotective therapy, often co-administered with renin–angiotensin system inhibitors (RASi). However, the clinical impact of background RASi intensity on SGLT2i-associated renal and hemodynamic outcomes remains unclear.
Methods: This retrospective study included 67 patients with T2DM and CKD initiated on SGLT2i therapy and followed for 12 months. Patients were stratified into three groups based on background RASi use: no RASi, moderate-dose RASi, and full-dose RASi. Clinical, biochemical, and hemodynamic parameters—including blood pressure, eGFR, proteinuria, and glycemic/metabolic markers—were evaluated at baseline, 3 months, and 12 months. Adverse events including acute kidney injury (AKI) and urinary tract infections (UTIs) were recorded.
Results: All groups exhibited significant reductions in systolic blood pressure (SBP), with the greatest decline observed in the full-dose RASi group (–13 mmHg at 12 months). A transient significant dip in eGFR was noted at month 3 in the full-dose group, with partial recovery by month 12. Proteinuria decreased significantly in both the moderate-dose and full-dose RASi groups, with the greatest absolute reduction in the moderate-dose group. Glycemic control improved across all groups, with the non-RASi group showing the most pronounced decline in fasting glucose and HbA1c. No significant differences in AKI or UTI incidence were observed among groups.
Conclusion: SGLT2i therapy is safe and effective across all RASi backgrounds. However, co-administration with RASi—particularly at full doses—appears to enhance antihypertensive, renal function, and antiproteinuric outcomes. These findings underscore the potential synergistic role of full-dose RAS blockade in optimizing the renoprotective benefits of SGLT2i in diabetic CKD.

Seasonal, Geographic, and Socioeconomic Patterns of Public Interest in Frailty Syndrome: Insights From Google Trends

Mert Zure — Wed, 06 Aug 2025 00:00:00 +0300

Background: Frailty syndrome is a complex geriatric condition characterized by reduced physiological reserves and increased vulnerability to stressors. While its clinical implications are well established, knowledge on public awareness remains limited. As online search behavior increasingly reflects public interest, tools like Google Trends offer real-time insights into population-level awareness of frailty and its influencing factors.
Methods: This observational study analyzed global Google Trends data for the search topic “frailty syndrome” from January 2004 to May 2025. Relative search volume (RSV) was examined across temporal, seasonal, geographic, and socioeconomic dimensions. Seasonal trends were evaluated using time-series decomposition and winter-to-summer amplitude ratios. Geographic patterns were assessed by mapping RSV and classifying countries by World Bank income levels. Pearson correlation was used to assess associations between RSV and socioeconomic indicators including GDP per capita and internet penetration.
Results: Global RSV increased from a baseline mean of 8.2 (±3.1) in 2004–2009 to a peak of 78.5 (±15.2) in 2020, followed by sustained elevated interest through 2025 (mean: 45.3 ±12.1). Seasonal analysis showed consistent winter peaks, with amplitude ratios exceeding 1.3. Japan had the highest RSV (100), followed by the United Kingdom (55), Singapore (52), and Ireland (44). All top countries were high-income. RSV was significantly correlated with GDP per capita (r = 0.62, p < 0.01) and internet penetration (r = 0.58, p < 0.01).
Conclusion: Search interest varied by season and socioeconomic context. Higher wintertime interest may reflect seasonal vulnerability in older adults, while increased search activity in high-income countries suggests better digital access and health literacy. Low visibility in lower-income regions highlights a digital and educational gap. Google Trends provides meaningful insight into frailty awareness. Understanding seasonal and socioeconomic patterns can guide targeted public health campaigns to promote early detection and prevention in aging populations.

A Rare Relapse: Recurrence of Nephrotic Syndrome in an NPHS1 Mutation Post-Kidney Transplant

Mehmet Sezen, Abdülmecit Yıldız — Wed, 06 Aug 2025 00:00:00 +0300

Letter to Editor - No Abstract

Piperacillin-Tazobactam Induced Fanconi Syndrome

Ferah Taran, Ercan Turkmen — Wed, 06 Aug 2025 00:00:00 +0300

Letter to Editor -No Abstract

Gout: Evaluation and Management

Can Hüzmeli — Wed, 06 Aug 2025 00:00:00 +0300

Uric acid is a byproduct of purine nucleotide metabolism, primarily synthesized in the liver and less frequently in other tissues. Hyperuricemia, characterized by elevated uric acid levels, can lead to gout and nephrolithiasis. It is also associated with conditions such as hypertension, metabolic syndrome, cardiovascular disease, and chronic kidney disease. Gout is an inflammatory disease marked by the deposition of monosodium urate (MSU) crystals in joints and tissues. It commonly affects the metatarsophalangeal joint, followed by other lower extremity joints, making it the most prevalent inflammatory arthritis. The pathophysiology of gout involves pro-inflammatory cytokines, lipid mediators, and the complement system, which contribute to the initiation and exacerbation of gout flares. Diagnosis relies on clinical evaluation, the identification of MSU crystals, and radiological imaging. Treatment encompasses acute gout flare management, prophylaxis, dietary modifications, and urate-lowering therapies. Common therapeutic agents include nonsteroidal anti-inflammatory drugs, colchicine, glucocorticoids, adrenocorticotropic hormone, and anti-IL-1β biological agents.