Journal of European Internal Medicine Professionals

Comment on “Gout: Evaluation and Management”

İlyas Öztürk — Wed, 25 Mar 2026 00:00:00 +0300

To the Editor,

In the review titled “Gout: Evaluation and Management” presented by Huzmeli (1), the topic is summarized in a comprehensive, clear, and fluent manner. As Huzmeli also highlighted, among urate-lowering treatment (ULT) agents used in the management of hyperuricemia and gout, allopurinol has long served as the first-line treatment. However, in recent years, strong evidence has demonstrated that febuxostat is more effective, particularly in achieving target serum uric acid levels. Furthermore, the renal elimination of allopurinol poses certain limitations in patients with chronic kidney disease (CKD), while the frequency of adverse effects remains a clinical concern. These factors collectively increase the relevance of febuxostat in CKD patients.

Randomized controlled trials such as FACT (2) and APEX (3) have shown that febuxostat achieves target serum uric acid levels at a higher rate than allopurinol in patients both with normal renal function and with CKD. Due to the need for dose reduction of allopurinol in CKD as a result of renal elimination, the use of effective doses may be limited, which can compromise treatment efficacy. In contrast, febuxostat is primarily metabolized hepatically, allowing its administration at therapeutic doses without the need for dose adjustment in patients with impaired renal function. This characteristic is of particular importance in preventing inflammation, crystal deposition, and renal disease progression associated with uric acid accumulation.

On the other hand, although the CARES trial (4) raised concerns regarding a possible association between febuxostat and cardiovascular mortality, the more recent FAST study (5) did not confirm these findings and demonstrated that febuxostat does not increase cardiovascular risk. Therefore, treatment decisions should be individualized based on cardiovascular risk assessment.

In conclusion, current literature indicates that febuxostat provides more effective serum uric acid control than allopurinol, particularly in patients with CKD. When used in appropriate patients with appropriate cardiovascular monitoring, febuxostat should be considered an important therapeutic option in nephrology practice.

Familial Nephrocalcinosis Associated With Heterozygous SLC34A1 and TRPV5 Variants Presenting With Elevated 1,25-Dihydroxyvitamin D

Emre Çankaya, Faysal Gök, Vedat Gencer — Wed, 25 Mar 2026 00:00:00 +0300

Nephrocalcinosis is frequently associated with inherited disturbances of calcium-phosphate metabolism and renal tubular transport. Variants affecting renal phosphate reabsorption or distal tubular calcium handling may result in hypercalciuria, nephrolithiasis, and progressive renal calcification. The SLC34A1 gene encodes the sodium-phosphate cotransporter NaPi-IIa in the proximal tubule, and loss-of-function variants can cause renal phosphate wasting with inappropriate activation of 1α-hydroxylase, leading to elevated 1,25-dihydroxyvitamin D. The TRPV5 gene encodes a calcium-selective channel in the distal nephron and is essential for transcellular calcium reabsorption. We report a familial nephrocalcinosis phenotype in a 30-year-old woman and her 2-year-old daughter. The mother presented with bilateral flank pain, dysuria, palpitations, and fatigue. Laboratory evaluation demonstrated suppressed parathyroid hormone (PTH 9.6 pg/mL), serum calcium at the upper limit of normal (9.7 mg/dL), normal phosphate (3.1 mg/dL), chronically low 25-hydroxyvitamin D (24 ng/mL), and elevated 1,25-dihydroxyvitamin D, suggesting PTH-independent calcitriol excess. Nephrocalcinosis had previously been detected in the child. Targeted next-generation sequencing revealed a heterozygous splice-region variant in SLC34A1 (NM_003052.5:c.644+5G>C) and a heterozygous missense variant in TRPV5 (NM_019841.7:c.1849G>A; p.Gly617Arg) in both individuals. This case is presented as a hypothesis-generating report. Although both variants are classified as variants of uncertain significance, the shared genotype and characteristic biochemical profile suggest a potential disturbance of renal phosphate and calcium handling that may contribute to familial nephrocalcinosis and PTH-independent elevation of active vitamin D. However, definitive causal inferences cannot be established without additional evidence including segregation analysis in extended family members, functional studies, and comprehensive biochemical characterization.

Dysphagia and Refractory Gastroesophageal Reflux Due to Antral Web: A Case Report

Derya Bakır, Elif Haskan, Fatih Karaahmet, Rabia Kipel, Muhammet Fatih Karakaya — Wed, 25 Mar 2026 00:00:00 +0300

Gastric antral web is a rare congenital or acquired condition that may remain undiagnosed until adulthood and typically presents with nonspecific upper gastrointestinal symptoms. In adults, it may mimic functional dyspepsia, gastroesophageal reflux disease, or cardiac conditions, leading to diagnostic delay. Impaired antral peristalsis and delayed gastric emptying increase intragastric pressure and contribute to dysphagia and refractory reflux symptoms. Endoscopic evaluation plays a key role in diagnosis, while management ranges from medical therapy to endoscopic interventions such as balloon dilation, needle-knife incision, and surgery in selected cases. In this case, the patient was treated with proton pump inhibitors and showed clinical improvement. This case highlights the need to consider antral web in the differential diagnosis of patients with dysphagia and refractory gastroesophageal reflux symptoms.

The Impact of Diabetes Mellitus on the Clinical Course and Early Outcomes in Guillain–Barré Syndrome: Single Center Experience

Wed, 25 Mar 2026 00:00:00 +0300

Background: This research was designed to evaluate whether comorbid diabetes mellitus (DM) influences the clinical presentation, severity of illness, and short-term functional recovery in individuals suffering from Guillain–Barré syndrome (GBS).
Methods: We performed a retrospective cohort study of 77 adult patients with GBS managed at a tertiary care neurological center from January 2020 through December 2025. Participants were categorized into two distinct groups: those with pre-existing type 2 diabetes mellitus (T2DM) (GBS+DM) and those without (GBS–DM). The comparison focused on demographic data, electrophysiological variants, Medical Research Council (MRC) sum scores, Modified Erasmus GBS Outcome Scores (mEGOS), and discharge functional capacity measured by the Hughes disability scale.
Results: In the total sample, 14 patients (18.2%) had diabetes mellitus. The GBS+DM group tended to be older; however, this difference was not statistically significant (p = 0.142). The mean mEGOS score was slightly higher in the diabetic cohort (3.8 ± 2.4) than in the non-diabetic group (3.4 ± 2.7), but the difference was not statistically significant (p = 0.364). No significant differences were observed regarding electrophysiological subtypes or early functional recovery between the cohorts. Nevertheless, a consistent numerical trend toward greater disability and less favorable prognostic markers was noted in the DM group.
Conclusion: Although not statistically significant, our data suggest that the presence of DM might be associated with a more severe clinical course and slower early recovery in GBS patients. Further validation through large-scale, prospective, multicenter trials is essential to definitively characterize the impact of DM on GBS outcomes.

Short-Term Changes in Glycemic Parameters Following Proton Pump Inhibitor Therapy in Patients With Type 2 Diabetes Mellitus: A Retrospective Cohort Study

Muhammed Fatih Karakaya, Mina Gülfem Temiztürk, Canan Akkuş — Wed, 25 Mar 2026 00:00:00 +0300

Background: Emerging evidence suggests that proton pump inhibitors (PPIs) may influence glucose metabolism through mechanisms such as gastrin-mediated stimulation of pancreatic β-cell activity and alterations in gut microbiota composition. However, clinical studies evaluating the metabolic effects of PPIs in patients with type 2 diabetes mellitus (T2DM) have yielded inconsistent findings. The present study aimed to evaluate short-term changes in glycemic parameters after initiation of PPI therapy in patients with T2DM and to explore clinical characteristics associated with reductions in fasting glucose.
Methods: This retrospective observational study included 66 adults with T2DM who were newly prescribed a PPI in a gastroenterology outpatient setting. Clinical and laboratory data were obtained from electronic medical records and verified through the national prescription monitoring system. Fasting glucose, postmeal glucose, glycated hemoglobin (HbA1c), and body mass index (BMI) were recorded at baseline and during a three-month follow-up period. Changes in glycemic parameters were analyzed using paired statistical tests, and logistic regression was used to identify factors associated with reductions in fasting glucose.
Results: The mean age of participants was 57.93 ± 10.90 years, and the mean BMI was 29.31 ± 2.98 kg/m². During the three-month follow-up period, mean fasting glucose decreased significantly from 132.12 ± 19.61 mg/dL to 122.13 ± 23.52 mg/dL (p < 0.001). Postmeal glucose and HbA1c levels showed numerical reductions but did not reach statistical significance. A decrease in fasting glucose was observed in 47 of 66 participants (71.2%). Patients who experienced fasting glucose reduction were significantly older, had lower BMI, and had a shorter duration of diabetes compared with those without reduction. Multivariate analysis demonstrated that older age, lower BMI, and shorter diabetes duration were independently associated with fasting glucose reduction.
Conclusions: PPI therapy was associated with a modest reduction in fasting glucose during short-term follow-up, whereas HbA1c and postmeal glucose levels did not change significantly. The observed association appeared to vary according to patient characteristics, particularly BMI and duration of diabetes. These findings suggest that metabolic responses to PPI therapy may differ across clinical subgroups of patients with T2DM and warrant further investigation in larger prospective studies.

Early Lactate Clearance as an Independent Predictor of In-Hospital Mortality: A Retrospective Cohort Study

Kübra Bektaş, Aymer Coşar, Gökçen Terzi — Wed, 25 Mar 2026 00:00:00 +0300

Background: Serum lactate is widely used as a biomarker of tissue hypoperfusion in critically ill patients. While elevated baseline lactate levels are associated with adverse outcomes, dynamic changes in lactate concentration (particularly early lactate clearance) may provide superior prognostic information. Data regarding the predictive value of early lactate clearance in secondary-care medical intensive care units (ICUs) remains limited. We aim to evaluate the association between early (0–6-hour) lactate clearance and in-hospital mortality in adult patients admitted to a secondary-care medical ICU.

Methods: This retrospective cohort study included 114 adult patients admitted to a general medical ICU between 2018 and 2019. Patients with serum lactate measured within the first hour of ICU admission and repeated at approximately 6 hours were eligible. Lactate clearance was calculated as: [(Lactate₀ – Lactate₁) / Lactate₀] × 100. The primary outcome was in-hospital mortality. Secondary outcomes included ICU length of stay, mechanical ventilation requirement, and acute kidney injury (AKI). Multivariable logistic regression analysis was performed to assess the independent association between lactate clearance and mortality, adjusting for baseline lactate, SOFA score, age, and vasopressor use.

Results: The cohort consisted of 59 males (51.8%) and 55 females (48.2%), with a median age of 65 years (interquartile range [IQR], 52–78 years; range, 18–94 years). Mean baseline lactate was 3.82 ± 2.14 mmol/L, and mean lactate clearance was 18.7 ± 21.3%. Patients with low lactate clearance (<10%) had significantly higher mortality compared with those achieving ≥20% clearance (64.3% vs. 15.9%, p<0.001). In multivariable analysis, lactate clearance remained independently associated with reduced mortality (OR 0.78 per 10% increase; 95% CI 0.67–0.91; p=0.002). The model demonstrated good discrimination (AUC 0.87). Lower lactate clearance was also associated with longer ICU stays, increased mechanical ventilation requirements, and a higher incidence of AKI, though the observational nature of this study precludes establishing causality.

Conclusions: Early lactate clearance is a strong and independent predictor of in-hospital mortality in a secondary-care medical ICU population. Dynamic lactate assessment within the first 6 hours may improve early risk stratification and guide resuscitation strategies in critically ill patients.