Fluoroquinolone group antibiotics are frequently used in various infections such as urinary system, respiratory system, skin, and soft tissue infections owing to their broad spectrum and good antibacterial activity. Various tendon pathologies, especially tendinopathy, have been reported in literature most commonly in the Achilles tendon, but gastrocnemius tendon rupture has never been documented. A 58-year-old Caucasian white female patient had knee and calf pain that started 10 days after levofloxacin treatment. Various differential diagnoses were excluded, and finally a knee magnetic resonance image scan was performed owing to the patient’s history of diabetes and levofloxacin use 10 days prior. A significant effusion was detected in the lateral gastrocnemius muscle, and millimetric hypointense free tendon fragments were seen within the effusion. Therefore, gastrocnemius tendon rupture was diagnosed, and bed rest, extremity elevation, 900 mg acetaminophen, and cold application therapy were provided. During follow-up, the patient’s extremity pain subsided, and walking function improved. By presenting this case, we aim to remind clinicians to keep in mind the rare tendon rupture possibilities other than Achilles tendon during fluoroquinolone group antibiotic therapy.

OBJECTIVE: The rate of cardiovascular disease is increasing in developed countries progressively with estimates predicting 22 million by 2030. Based on these cardiovascular events lies atherosclerosis, a condition intricately linked to chronic inflammatory processes. Among fundamental clinical biomarkers, C-reactive protein (CRP) stands out as a backbone of inflammatory activity. Notably, the excessive production of CRP, often linked with obesity, plays a pivotal role in the dysregulation of triglyceride apo B-100 fractional catabolism, thus emerging as a significant cardiovascular risk factor. Apart from atherosclerotic processes, the interplay between high CRP levels and impaired fasting glucose (IFG) is also gaining recognition as a messenger of disrupted glucose metabolism, potentially ushering in the onset of a prediabetic state. METHODS: Our retrospective analysis scrutinized the biochemical data - namely low-density lipoprotein cholesterol (LDL-C), triglycerides, fasting blood sugar, and CRP levels-of 3500 patients from an internal medicine outpatient clinic seen from August 2006 to May 2007. Our objective was to dissect the correlations among these parameters. Exclusion criteria were omitting individuals with acute or chronic inflammation, known inflammatory diseases, diagnosed diabetes, coronary artery disease, lipid metabolism disorders, those on lipid-lowering agents, and anyone outside the age bracket of 18-65 years. This study was conducted in strict adherence to the ethical principles outlined in the Declaration of Helsinki. RESULTS: As a result of our study, the ratio of CRP levels above 0.8 was significantly higher in patients with IFG according to the World Health Organization criteria (6.1-6.9 mmol/L or 109-124 mg/dL) than in individuals with normal fasting glucose (70-108 mg/dL). (19.7%, 17.2%, respectively) (p<0.001). In addition, the ratio of CRP levels above 0.8 was also higher in patients with triglyceride levels between 151 and 199 mg/dL) and over 500 mg/dL. (23.2%, 24.1%, respectively) (p0.05). CONCLUSION: This retrospective study suggests the imperative for a proactive approach in the clinical evaluation of patients exhibiting elevated CRP, especially in the context of preemptive management of prediabetes. In light of these findings, we think that elevated CRP may be a warning sign for prediabetic status and may be useful in early diagnosis.

Background. Among the chronic diseases, chronic kidney failure is one of diseases that have the most difficulty in coping with oxidative stress due to the deterioration of the antioxidant system balance in the body. Beyond being a vitamin, 1α,25‐dihydroxycholecalciferol (vitamin D3) is a molecule that positively or negatively affects many enzymes which are in protein structures. Thioredoxin (TRX), which has an important role in the antioxidant system, is one of these proteins. By conducting this study, we wanted to emphasize the role of vitamin D3 in reducing the oxidative stress load on patients undergoing peritoneal dialysis (PD) via serum TRX level measurement. Methods. In this study, we evaluated the medical treatments of 69 PD patients who were followed up routinely. The patients were divided into 2 groups according to whether they used vitamin D3 or not. 49 of our patients were using vitamin D3. While requesting routine laboratory tests, we reserved a separate serum sample to measure serum TRX levels by double‐antibody sandwich enzyme‐linked immunosorbent assay for all patients. Results. Only one parameter has a significant statistical relationship with serum TRX level and the treatment protocol. The serum TRX level was significantly higher (211,62 U/l ± 314,46) in the group receiving vitamin D3 compared to the group which is not using Vitamin D3 (101,63 U/l ± 215,03) (p < 0,006). Conclusion. This study highlights the importance of appropriate dose of vitamin D3 replacement especially in PD patients who are under intense oxidative stress compared to healthy individuals.

“SIAD” (syndrome of inappropriate antidiuresis) is frequently encountered in clinical practice, often necessitating the exclusion of various differential diagnoses and involving expensive treatments. In cases of SIAD concomitant with vitamin D deficiency, treatment with vitamin D supplementation may not only correct hyponatremia but also improve accompanying clinical findings, offering a cost‐effective alternative for clinicians. A 52‐year‐old Caucasian Turkish white male presented to the emergency department with symptoms of nausea, weakness, and altered consciousness. The patient was euvolemic. Laboratory results showed severe hyponatremia with low serum osmolality and high urine osmolality. Serum ADH levels were elevated. Extensive workup excluded other causes of SIAD. No significant pathology was detected, except for vitamin D deficiency. Following high‐dose vitamin D supplementation, the patient's sodium levels normalized without requiring further vasopressin receptor antagonist treatment. Long‐term follow‐up revealed that sodium levels remained within normal limits. Vitamin D deficiency is not traditionally considered among the common causes of SIAD. It may contribute to dysregulation of ADH. However, correcting this deficiency may resolve hyponatremia, making it a potentially overlooked, yet reversible, contributor. In patients with unexplained hyponatremia, vitamin D levels should be evaluated and corrected before initiating costlier treatment options.

Background/Objectives: Hypertension is a recognized risk factor for renal cell carcinoma; however, the impact of antihypertensive therapy AHT on clinical outcomes in patients with established RCC remains insufficiently understood. This study aimed to evaluate the association between antihypertensive therapy use and clinical outcomes, particularly overall survival, in patients diagnosed with renal cell carcinoma. Methods: This retrospective cohort study included 100 patients with renal cell carcinoma treated at a single center. Antihypertensive medications were evaluated according to both the presence of therapy and the number of agents used. Overall survival was defined as the time from renal cell carcinoma diagnosis to death from any cause or last follow-up. Survival outcomes were analyzed using Kaplan–Meier methods and Cox proportional hazards regression. Results: Hypertension was present in 66% of patients, all of whom were receiving antihypertensive therapy. Kaplan–Meier analysis demonstrated significantly longer overall survival among AHT users compared with non-users (log-rank p = 0.0007), with median overall survival 17.1 months in the non-AHT group and 112.2 months in the AHT group. After propensity score adjustment, antihypertensive therapy remained associated with improved survival (HR 0.35, 95% CI 0.13–0.94, p = 0.036). Antihypertensive therapy was not associated with tumor size, stage, or metastasis at diagnosis. Conclusions: Antihypertensive therapy use at diagnosis was associated with improved overall survival in patients with renal cell carcinoma. This association was not observed for tumor size, stage at diagnosis, or metastasis status, although nodal involvement was less frequent among patients receiving antihypertensive therapy. Because antihypertensive therapy exposure overlapped with hypertension status and baseline differences existed between groups, the observed survival advantage should be interpreted cautiously and considered hypothesis-generating rather than evidence of a causal relationship.

52-year-old female patient who presented with painless hematuria, was admitted to the urology outpatient clinic. After the initial ultrasound examination, she underwent cystoscopy. Urine cytology and pathology were benign. So, she referred to the nephrology clinic. Her renal functions were normal, and she had no proteinuria. Urinary sediment revealed 10-15 isomorphic erythrocytes. Diagnosis of glomerulonephritis was excluded. According to her medical history and records it was learned that she had undergone Whipple operation three years ago. Considering surgery history, doppler ultrasound was planned because of the possibility of renal vein compression. Renal vein doppler ultrasound revealed that the left renal vein diameter was 9.5 mm before the superior mesenteric artery, and it was 1.8 mm after the artery. Nutcracker syndrome of the renal vein was diagnosed. Since the kidney functions were normal and the patient was normotensive, follow-up was planned at 6- month intervals. Nutcracker syndrome is a rare syndrome that occurs when the renal vein is compressed in various anatomical regions, most commonly between the aorta and the superior mesenteric artery. It be produced by pancreatic neoplasms, para-aortic lymphadenopathy, retroperitoneal tumors, or strangulating fibrolymphatic tissue between the superior mesenteric artery and the aorta. However, there is no case reported in the literature because of previous Whipple surgery. By documenting this case, we aimed to remind that taking a good anamnesis and making relevant imaging methods, may attribute to diagnosis rare cases and save time for clinicians especially in cases with a grave result such as nephrectomy unless they diagnosed.