Garip Şahin

Recombinant factor VIIa treatment for life‐threatening haemoptysis

Abstract:  Diffuse alveolar haemorrhage is a severe clinical disorder that may be life‐threatening. The early diagnosis of diffuse alveolar haemorrhage and prompt intervention is crucial. Recombinant factor VIIa has been used extensively for the treatment of haemophilia A and B patients. More recently, recombinant factor VIIa has been used successfully for the treatment of bleeding in patients without pre‐existing coagulopathy. We describe the successful use of recombinant factor VIIa in a patient with diffuse alveolar haemorrhage secondary to pulmonary–renal syndrome.

Effects of Lipoprotein-Associated Phospholipase A2 on Arginase/Nitric Oxide Pathway in Hemodialysis Patients

Lipoprotein-associated phospholipase A2 (Lp-PLA2) and arginase are recently described inflammatory biomarkers associated with cardiovascular disease. In this study, we aimed to investigate the possible effects of serum Lp-PLA2 mass levels on arginase/nitric oxide (NO) pathway as a cardiovascular risk marker in hemodialysis (HD) patients. Forty-three HD patients and 15 healthy subjects were included in this study. Lipid profile, high sensitivity C-reactive protein (hs-CRP), albumin, creatinine, body mass index (BMI), Lp-PLA2 and total nitrite levels, and arginase activity were determined in serum samples from patients and control subjects. Lp-PLA2 levels were found to be positively correlated with arginase, triglycerides, total cholesterol, low-density lipoprotein-cholesterol, and age and negatively correlated with high-density lipoprotein-cholesterol and total nitrite levels, while there was no correlation with BMI and hs-CRP, albumin, and creatinine levels in HD patients. We conclude that elevated Lp-PLA2 mass levels may contribute to impaired arginase/NO pathway in HD patients and that increased the arginase activity and Lp-PLA2 mass levels with decreased total nitrite levels seem to be useful biochemical markers in terms of reflecting endothelial dysfunction and associated cardiovascular risks in HD patients.

Autoimmune hypothyroidism and lupus-like syndrome

The frequency of thyroid disorders, particularly Hashimoto’s thyroiditis, may be increased in patients with connective tissue diseases. Both hypothyroidism and connective tissue diseases often cause muscle and joint aches, pains and stiffness. Skin, renal and cardiovascular involvement seen in the course of autoimmune hypothyroidism (AIH) may simulate connective tissue diseases such as systemic lupus erythematosus (SLE). We herein report a case of AIH who presented with massive proteinuria, haematuria, pleural fluid and arthritis simulating SLE.

Minimal Change Disease and Toxic Hepatitis Due to Ecstasy

Minimal change disease (NIL (Nothing In Light microscope) disease) is the most common cause of nephrotic syndrome in childhood; and one of the most common causes of nephrotic syndrome in adults. Characteristic findings are: diffuse foot process effacement in electrone microscopy, no complement or immunoglobulin deposits on immunofluorescence microscopy , severe functional defect in glomerular permselectivity. Most cases of MCD are idiopathic or primary. Secondary MCD is associated with the following: drugs, tumors, allergy, infections and other glomerular diseases. Ecstasy (3,4methylenedioxymethamphetamine, MDMA) is a synthetic psychoactive compound with C11H15NO2 formula. Malign hypertension, tachycardia, hyperthermia, acute kidney failure, hyponatremia, rhabdomyolisis, neurologic symptoms like agitation, anxiety, hepatotoxicity can be seen due to ecstasy abuse. In our case, we wanted to mention that MCD cases can come with atypical clinical findings and we should keep ecstasy abuse in mind as secondary reason at these types of cases.