Aims Adult-onset Still's disease (AOSD) is a rare and non-familial auto-inflammatory disorder. Increased levels of IL-6 and other pro-inflammatory cytokines have been shown in AOSD. To evaluate the efficacy and safety profile of tocilizumab (TCZ), an IL-6 receptor antagonist monoclonal antibody, in AOSD. Methods Thirty-nine patients followed up with the diagnosis of AOSD between 2013 and 2019 were retrospectively evaluated and the 16 patients (10 Female/6 Male) treated with TCZ for refractory AOSD were included in the study group. Among the remaining 23 patients 16 had non-biological treatments and had no important complications at the presentation. TCZ was given to patients at a dose of 4-8 mg/kg every 4 weeks. Patients were evaluated after 3-6 months of TCZ treatment for side effects, inflammatory and clinical response and concomitant treatments. Results In TCZ (+) patients, the majority were female (62.5%), the mean age at disease onset was 38.5 +/- 17.9 (20-81) years, and the most common symptoms and signs were myalgia (81.3%), fever (81.3%) and skin eruptions (75%). There was no difference between TCZ (+) and TCZ (-) groups for age, sex and clinical presentations. There was a significant decrease in dose of prednisolone, sedimentation rate, leucocyte count, C-reactive protein and ferritin levels and improvement in all clinical complaints after TCZ treatment. There were no relapses during the treatment. Three patients are in remission and under follow-up without any treatment after cessation of TCZ (4 months-3 years). No exacerbation of disease yet seen in those patients. Conclusions TCZ is an effective and well-tolerated treatment option for treatment resistant AOSD and contributes to the glucocorticoid-sparing. Since TCZ is a new drug in the treatment of AOSD, further studies are needed to assess whether the complications reported during the treatment are because of TCZ or natural course of the disease or coincidental findings.

Background: The quality of life of individuals undergoing hemodialysis is related to many factors, including sleep disorders. Objective: To determine the prevalence of sleep disorders in individuals undergoing hemodialysis and to assess the effect of clinical and biochemical parameters on their sleep quality. Method: We conducted a cross-sectional descriptive survey in multiple hemodialysis centers. Individuals were interviewed using a questionnaire for obtaining general personal information, the Pittsburgh Sleep Quality Index (PSQI) for assessing sleep quality, and the Epworth Sleepiness Scale (ESS) for assessing excessive daytime sleepiness (EDS). Results: The study included 338 individuals with a median age of 55 years. Poor sleep quality (PSQ) and EDS were present in 41.4% and 6.5% of the individuals, respectively. The individuals’ PSQI scores were significantly proportional to their ESS scores. Concerns about the disease and its treatment (60.7%) and poor physical conditions (35.7%) were major reported reasons for PSQ. In a logistic regression analysis, female gender, household income, ESS score, chronic heart failure, and creatinine and parathormone levels were found to be independent predictors of PSQ; household income, PSQ presence, parathormone and potassium levels, and urea reduction ratio were found to be independent predictors of EDS. Conclusion: Sleep disorders are common in individuals undergoing hemodialysis and are related to gender, comorbid diseases, poor economic state, altered biochemical values, dialysis timing, and concerns about the disease and its treatment. Improving these individuals’ quality of life through adequate psychological and financial support and early diagnosis of sleep disorders should decrease their mortality and morbidity rates.

Nodular thyroid diseases are common in Turkey. Insulin resistance (IR) is considered as the most important component of metabolic syndrome (MetS), and it is thought to directly affect thyroid diseases, together with other components of MetS. The aim of this study was to evaluate potential factors associated with thyroid nodularity. This study was part of the prospective MELEN study. In total, randomly selected 2233 subjects were evaluated. A euthyroid subgroup of participants (n = 1432) was selected and 421 of them had MetS. Both goitres and multinodular goitres (MNGs) were significantly more common in the MetS (+) group (p < .001). Older age was the only factor that significantly affected the presence of a nodular goitre (NG) (p < .001). The presence of a MNG was associated with older age (p < .001), systolic blood pressure level (p < .008) and MetS (p < .001). There was no difference in the thyroid volume or presence of nodular thyroid diseases between the IR (+) and (−) groups. Both the thyroid volume and the presence of MNGs were significantly associated with MetS, independent of thyroid-stimulating hormone (TSH) and IR. We suggest that the individual components of MetS may influence thyroid nodularity to some degree and that together they exert a cumulative effect on the thyroid gland. As a result, in the absence of MetS, we further suggest that IR alone does not explain the increase in thyroid volume and thyroid nodule formation.

Background/Aims: This awareness study aimed to determine the ultrasound (US) examination rates in relation to US-confirmed metabolic dysfunction-associated fatty liver disease (MAFLD) diagnosis in internal medicine outpatients with type 2 diabetes (T2D) across Türkiye. Materials and Methods: A total of 6283 T2D patients were included in this multicenter retrospective cohort study conducted at 17 internal medicine clinics across Türkiye. The presence and indications for US performed within the last 3 years were recorded along with US-confirmed MAFLD rates, laboratory findings on the day of US, and referral rates. Fibrosis-4 (FIB-4) index was calculated to estimate the risk of advanced liver fibrosis (FIB-4 index ≥ 1.3). Results: Overall, 1731 (27.6%) of 6283 patients had US examination, which revealed MAFLD diagnosis in 69.9% of cases. In addition, 24.4% of patients with US-confirmed MAFLD were at risk of advanced fibrosis (FIB-4 index ≥ 1.3), and the referral rate was 15.5%. Conclusion: In conclusion, our findings emphasize an insufficient MAFLD awareness among clinicians and the likelihood of most of T2D patients to be at risk of living with an unknown status regarding their MAFLD and advanced fibrosis risk. Cite this article as: Şahintürk Y, Köker G, Koca N, et al. Metabolic dysfunction-associated fatty liver disease and fibrosis status in patients with type 2 diabetes treated at internal medicine clinics: Türkiye DAHUDER awareness of fatty liver disease (TR-DAFLD) study. Turk J Gastroenterol. 2024;35(8):643-650.

Metabolic syndrome (MetS) is a cluster of metabolic abnormalities that is linked with increased circulating markers of oxidative stress and low-grade inflammation. The link between inflammation and MetS is not yet fully understood. We aim to evaluate the relationship between the levels of pro and anti-inflammatory markers such as apolipoprotein A1 (Apo-A1), apolipoprotein B (Apo-B), interleukin (IL) 6, tumor necrosis factor alpha (TNF-α), fibrinogen and complement component 3 (C3) and adiponectin and MetS/MetS components. This study was a case-control study conducted in an outpatient internal medicine clinic of the Ondokuz Mayıs University Internal Medicine Department. A total of 108 subjects (59 female, 49 male) who were not under any dietary restrictions and older than 17 years were selected and divided into two groups (54 with MetS and 54 healthy controls). Increased levels of IL-6, C3 and Apo-B/Apo-A1 ratios and decreased levels of Apo-A1 and TNF-α (except in patients with hypertriglyceridemia) were detected in the MetS group. Apo-A1 and TNF-α exhibited decreased levels, and IL-6, fibrinogen, C3 and Apo-B levels and Apo-B/Apo-A1 ratios increased as higher numbers of MetS criteria were met in the total study group. We found that inflammatory marker levels were not affected by an increased number of MetS criteria met in the MetS group although these levels increased in the control group with higher numbers of MetS components. The presence of a high number of MetS components does not have an additive pro-inflammatory contribution for subjects already diagnosed with MetS.