Antiviral treatments can impact serum lipids as well as kidney function. We conducted a retrospective observational study with a 48-month follow-up period, involving liver transplant recipients receiving either entecavir or tenofovir alafenamide, to assess the effects of these antiviral medications on serum lipids and renal function. The study was conducted with 47 patients. Research data were retrospectively collected. Serum creatinine and lipid levels were measured at least once per year for each patient. The Friedman test was applied to compare estimated glomerular filtration rate (eGFR) and serum lipids. . During the 48-month observation period, a mean decrease in eGFR of 10 mL/min/1.73 m² was observed in the tenofovir alafenamide treatment group (p < 0.001), while a decrease of 8 mL/min/1.73 m² occurred in the entecavir group (p < 0.001). However, there was no statistically significant difference in the eGFR decrease between the two groups (p = 0.990). Although entecavir showed more favorable effects on total cholesterol compared to tenofovir alafenamide at the 12th and 24th months (p = 0.025 and p = 0.023, respectively), neither treatment demonstrated a lipid-lowering effect by the end of the 48-month observation period. We found no significant difference in renal safety between tenofovir alafenamide and entecavir; however, the relatively small sample size and retrospective design limit the power to detect subtle differences. Entecavir was associated with a more favorable lipid profile compared to tenofovir alafenamide during the first two years of treatment, with modest reductions in total cholesterol observed at 12 and 24 months. Overall, both entecavir and tenofovir alafenamide have similar impacts on serum lipids and renal function, making them safe and effective treatment options for liver transplant recipients.

Infective endocarditis (IE) is a life-threatening disease, with its mortality rate varying depending on the infectious agent. Streptococci are among the most common causes of infective endocarditis. However, Streptococcus vestibularis has rarely been associated with human infections, typically affecting patients with underlying conditions such as immunosuppressive diseases, valve replacement, rheumatic heart disease, and hemodialysis. We present the case of a 26-year-old man who presented with fever, unanticipated weight loss, and fatigue. Although no typical risk factors for infective endocarditis were identified at admission, transesophageal echocardiography revealed a bicuspid aortic valve with calcification, paravalvular aortic abscess formation, and vegetations on the anterior leaflet of the mitral valve. Blood cultures grew S. vestibularis , which was initially sensitive to benzylpenicillin but developed emergent resistance on the third day of the antibiotic treatment. Subsequently, ceftriaxone therapy was initiated, and blood cultures became sterile on day 10. The patient eventually underwent aortic valve replacement. We report the first known case of native aortic and mitral valve endocarditis caused by S. vestibularis , accompanied by a paravalvular abscess around the native aortic valve, in a patient who had no typical risk factors for infective endocarditis, except for a bicuspid aortic valve.

Eosinophilic gastroenteritis (EG) is an inflammatory bowel condition characterised by eosinophilic infiltration of the stomach and small bowel. Smoking and certain foods can trigger EG. A man in his 40s presented to the emergency department with acute abdominal pain. He had rebound tenderness and guarding on his initial abdominal examination. A subsequent CT scan showed jejunal wall thickening and ascites He had similar attacks of abdominal pain and was misdiagnosed with familial Mediterranean fever and Crohn’s disease. Paracentesis revealed eosinophilic ascites. No mucosal abnormality was detected on gastroduodenoscopy and colonoscopy. A double-balloon enteroscopy revealed mucosal inflammation in the jejunum and a biopsy was taken. In this biopsy, eosinophilic jejunitis was detected. He was given corticosteroids and montelukast and his condition was resolved promptly. After discharge, he had attacks of EG until he quit smoking. After quitting smoking, he had an attack once in the last 2 years after consuming eggplant.

Small-bowel angioectasia is commonly diagnosed and managed using double-balloon enteroscopy; however, rebleeding rates can vary significantly. This study aimed to identify and evaluate the clinical predictors of rebleeding in patients with small-bowel angioectasia. This retrospective study focused on adult patients who underwent endoscopic management for small bowel vascular lesions (SBVLs). A total of 67 patients were included in the study, all of whom were retrospectively analyzed. The SBVLs were classified using the Yano et al. classification system. Among these, 62 patients with angioectasia who received endoscopic treatment were specifically analyzed. To further investigate the clinical outcomes, the angioectasia group that required endoscopic treatment was divided into two subgroups based on the number of double-balloon enteroscopy (DBE) procedures performed. Univariate and multivariate binary logistic regression analyses were used to establish which predictor variables were significantly related to the recurrence. A total of 67 patients (mean age 68.1 ± 8.9 years; 44 males) with SBVL, angioectasia was diagnosed in 62 (92.5%) patients, dieulafoy lesion in 1 (1.5%) patient, and arteriovenous malformation in 4 (6%) patients. Similarly, the prevalence of chronic renal failure and diabetes mellitus were significantly higher in the multiple DBE endotherapy group compared to the single DBE endotherapy group (p < 0.001; p = 0.032, respectively). In multivariate logistic regression analysis, anticoagulant use (OR = 9.648, 95% CI: 1.729–53.817, p = 0.010), chronic renal failure (OR = 15.683, 95% CI: 2.727–90.203, p = 0.002), localization of duodenum (OR = 13.509, 95% CI: 1.598–114.168, p = 0.017), and localization of the ileum (OR = 17.100, 95% CI: 1.477–197.905, p = 0.023) were all independently associated with a higher risk of angioectasia recurrence. The findings of this study demonstrates a high success rate of endoscopic treatment, with a rebleeding rate of 27%, highlighting the significance of this approach. Chronic renal failure, use of anticoagulant, and lesion localization in the duodenum or ileum were identified as independent risk factors for rebleeding, underscoring the need for careful patient monitoring and targeted intervention in these cases.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most globally prevalent chronic liver disorder. Thus, this study aimed to evaluate the association of serum endocan and endoglin levels with fibrosis severity in patients with MASLD. In the study, between December 2023 and November 2024, 58 MASLD patients and 30 healthy controls were enrolled; sample size was based on a power analysis. Vibration-controlled transient elastography, reporting controlled attenuation parameter, and liver stiffness in kilopascals was used to quantify hepatic steatosis and fibrosis, and serum endocan and endoglin levels were measured. Comparisons were made between the MASLD and control groups, and within the MASLD group between patients with advanced-stage fibrosis versus those with lower-stage fibrosis. Discriminative ability of the biomarkers was evaluated by receiver operating characteristic (ROC) analysis. Independent associations between serum biomarkers and kilopascals values in the patient group were assessed by regression analysis. Serum endocan and endoglin were significantly elevated in the MASLD group compared with controls. In the MASLD group, patients with advanced fibrosis exhibited higher endocan and endoglin levels than those with lower-stage fibrosis. In ROC analysis for discriminating advanced fibrosis, endoglin demonstrated strong discriminative ability and endocan exhibited good accuracy for fibrosis assessment. Multivariate regression analysis revealed that log-transformed kilopascals values were independently associated with serum endocan and endoglin. Endoglin and endocan are promising, accessible noninvasive biomarkers that may support fibrosis triage and referral decisions in general internal medicine for MASLD. Prospective validation is warranted.

Cold agglutinin syndrome is a form of acquired hemolytic anemia that typically arises from underlying conditions, such as infections, autoimmune disorders or lymphoid malignancies. The majority of patients remain asymptomatic and are diagnosed with anemia through routine complete blood count (CBC) testing. The present study describes the case of a male patient in his 50s who sought a second opinion at the authors' clinic due to newly detected anemia. A peripheral blood smear revealed red blood cell (RBC) agglutination, and testing confirmed the presence of cold agglutinin antibodies. Thoracoabdominal computed tomography identified a mass in the right kidney, leading to a partial nephrectomy. A pathological examination of the mass confirmed a diagnosis of renal cell carcinoma. At that time, no secondary cause for the cold agglutinin syndrome was identified. At 2 years following his initial admission, the patient presented with bilaterally enlarging masses in the groin. A biopsy was performed, which revealed low‑grade B‑cell lymphoma. Following R‑CHOP treatment, the RBC agglutination was resolved, and the CBC returned to normal ranges. On the whole, the present study demonstrates that cold agglutinin syndrome may serve as an early indicator of lymphoma.