Serum albumin and FT3/FT4 ratio as additional co-morbidity parameters to predict mortality as a new approach: The Haseki Scoring Index (updated Charlson Comorbidity Index).

BACKGROUND: Charlson Comorbidity Index (CCI) is the common and valid method to predict mortality by classifying comorbidities such as cardiovascular, metabolic, renal, hepatic, pulmonary diseases, and malignancy. Novel risk factors are not included in the Charlson Comorbidity Index, such as thyroid hormone index (FT3/FT4 ratio) and serum albumin levels. In the present study, we aimed to assess whether the thyroid hormone index and albumin are useful clinical parameters in short and long-term mortality. METHODS: In the retrospective cohort study with a 5 year follow up, the data of 1292 patients who were hospitalized between January 1st-June 30th of 2014 were examined. Three months mortality as short term and 5-year mortality as long term were evaluated. RESULTS: Three months and 5 years mortality rates for 1064 patients were analyzed. We showed that hypoalbuminemia and thyroid hormone index had statistically significant effects on short and long-term mortality. According to ROC analysis it was demonstrated that the scoring system including biochemical parameters such as thyroid hormone index and serum albumin level was more significant for 3-month mortality. In addition, both scoring systems are equal in demonstrating long-term mortality. CONCLUSION: Thyroid hormone index and albumin could improve the prognostic performance of the original Charlson Comorbidity Index in short term mortality. The combined score may offer improvements in comorbidity summarization over existing scores.

Prevalence and risk factors of osteopenia/osteoporosis in Turkish HIV/AIDS patients.

BACKGROUND: Recent studies showed a high frequency of low bone mineral density (BMD) in HIV-infected patients and no reports have been issued in Turkey. Our aim was to evaluate BMD and risk factors for osteopenia/osteoporosis in HIV-infected patients that attended an outpatient clinic in Istanbul, Turkey. METHOD: In order to determine the prevalence of BMD, 126 HIV-infected patients had been studied with dual energy X-ray absorptiometry (DEXA). The association between BMD and age, gender, body mass index (BMI), habits, 25(OH)vitamin D, HIV RNA, CD4 lymphocyte nadir, using and duration of highly active antiretroviral treatment (HAART) were investigated by using multivariate analysis. RESULTS: Median age was 40.1 years (range, 20-70); 84% were male; 35.7% patients had AIDS, 63.5% were treated with HAART. Osteopenia and osteoporosis were diagnosed in 53.9% and 23.8%, respectively. Mean plasma HIV RNA was 5.2 (SD 1.0) log10 copies/mL and CD4 lymphocyte nadir was 313.8 (SD 226.2)/mm(3). Factors associated with bone loss were high viral load (p=0.034), using (p=0.033) and duration of HAART (p=0.008). No correlation had been seen between sex and osteopenia/osteoporosis (p=0.794). However, males showed higher rates of osteoporosis than females (p=0.042). CONCLUSIONS: Our results show a very high prevalence of bone mass reduction in Turkish HIV-infected patients. This study supports the importance of both HIV and antiretroviral therapy in low BMD.

[Strongyloidosis caused Loeffler's syndrome in an immunosuppressed patient who uses cronic steroid]. / Kronik Steroid Kullanan Immunsuprese Hastada Strongyloidoza Bagli Loeffler Sendromu.

Strongyloides stercoralis is an intestinal nematode of humans that infects tens of millions of people worldwide. It is a rarely reported parasitic infestation in Turkey. Disseminated strongyloidiosis may develop in patients with immunodeficiencies. S. stercoralis hyperinfection is often accompanied by sepsis or meningitis with enteric organisms. Glucocorticoid treatment is one of the conditions most specifically associated with triggering hyperinfection, but cases have been reported in association with hematologic malignancy, malnutrition, and AIDS. Anthelminthic agents such as ivermectin have been used successfully in treating the hyperinfection syndrome. We report a case of Strongiloides stercoralis infection and Loeffler syndrome that developed in a patient who had systemic prednisolone. The patient in the pulmonary disease department clinic was examined because of right lung upper lobe mass image, and referred to us with complaints of abdominal pain, diarrhea and pruritus. Peripheral smear showed 43% eosinophilia. Parasitological examination of faeces showed larvae of Strongyloides stercoralis. Parasitosis and Loeffler's syndrome was considered in the patient. The patient's complaints declined significantly after treatment with albendazole.