Background: The objective of this study was to compare the effects of bisphosphonates and denosumab on sarcopenia-related parameters, contributing to a better understanding of osteosarcopenia management. Methods: This cross-sectional, comparative study assessed physical performance, muscle strength, muscle mass, and sarcopenia category in postmenopausal women aged 65 to 80 years with osteoporosis who were receiving either bisphosphonates or denosumab. Additional groups consisted of untreated osteoporotic patients and controls without osteoporosis (n = 50 per group). Muscle mass was assessed using bioelectrical impedance analysis, and the classification of sarcopenia was assessed according to the EWGSOP2 criteria. Results: Among the osteoporotic groups, the 4 m walking speed, 5-chair stand test, and timed up-and-go performance did not differ significantly, although denosumab-treated patients had numerically shorter completion times. Nondominant handgrip strength was the only grip parameter showing a significant between-group difference (p = 0.026), mainly due to higher values in denosumab-treated patients than in untreated osteoporotic patients; dominant and maximum handgrip strength were comparable. Skeletal muscle mass was higher in the denosumab group than in both the bisphosphonate-treated and untreated osteoporosis groups (p = 0.045), whereas ALM, ASM, and the ASMI did not differ significantly. No statistically significant between-group differences were observed in SARC-F scores or sarcopenia classifications. Controls had significantly higher odds of sarcopenia absence compared with untreated osteoporotic patients, and treatment duration was not correlated with sarcopenia-related parameters. Conclusions: These findings suggest a favorable but limited association between denosumab treatment and selected muscle-related parameters. Prospective longitudinal studies are needed to determine whether anti-osteoporotic therapies influence osteosarcopenia.

Background/Objectives: Quinolones are among the most frequently implicated antibiotics in immediate hypersensitivity reactions, yet diagnostic evaluation remains challenging and the real-world behaviour of patients after de-labeling has received little attention. We examined the diagnostic work-up, outcomes, and post-de-labeling drug-use behaviour of patients with suspected quinolone hypersensitivity. Methods: This single-centre ambispective study included 29 patients evaluated between January 2020 and April 2024. Clinical, demographic, skin test, and drug provocation test (DPT) data were extracted retrospectively. Patients in whom allergy had been excluded or a safe alternative identified were contacted by structured telephone interview between May and June 2025. Results: Anaphylaxis was the most common index reaction (42.9%), and ciprofloxacin was the most frequently implicated agent (57.1% of drug instances). Skin tests were positive in 84.2% of cases, but the positive predictive value in the DPT-tested subset was only 20.0%. Of the 12 reached patients, 11 had quinolone allergy excluded; among these, only 4 (36.4%) had reused the de-labeled quinolone, while 7 (63.6%) had avoided it, including 4 who declined it when clinically indicated. Conclusions: Quinolone skin tests show limited specificity, and successful de-labeling does not guarantee real-world drug use. Patient anxiety and counselling are central to effective management.

Hypertriglyceridemia (HTG) is the third most common cause of acute pancreatitis (AP). It is caused by disorders in lipoprotein metabolism due to primary or secondary causes. Metabolic syndrome is also an important factor contributing to the development of HTG. The primary treatment goal in severe HTG is to restore triglyceride levels within normal ranges which can be achieved with lipid lowering drugs mainly fenofibrates, fluid replacement, intravenous insulin infusion and/ or plasmapheresis treatments. Strict diet restricted from fat and simple sugars, exercise and weight control also contribute to HTG control in long term follow up. In this report, a case of severe AP triggered by HTG with other metabolic syndrome components like type 2 diabetes mellitus and obesity is presented.

Background and Objectives: Systemic mastocytosis (SM) is a clonal mast cell disorder characterized by abnormal mast cell accumulation and activation in multiple organs, leading to mediator-related symptoms, including anaphylaxis. Drug hypersensitivity reactions (DHRs) are a major clinical challenge in SM, but their frequency and characteristics remain undefined. This study aimed to evaluate the frequency of drug allergy, identify high-risk drug groups, investigate reaction characteristics, and examine the relationship between drug reactions, baseline serum tryptase levels, and SM subtypes in patients with SM. Materials and Methods: We retrospectively analyzed 34 patients diagnosed with SM between 2009 and 2024 at Ege University Faculty of Medicine. Clinical features, SM subtypes, baseline serum tryptase levels, and DHR characteristics were recorded. Reactions to antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol, anesthetics, radiocontrast media (RCM), and COVID-19 vaccines were graded using the Ring and Messmer anaphylaxis classification. Results: Among 34 patients, the mean age was 48.6 ± 13.3 years, 53% were male, and 10 (29.4%) had DHRs. The most common culprit drugs were NSAIDs (17.6%) and β-lactam antibiotics (14.7%). Anaphylaxis was the predominant reaction, frequently associated with hypotension. In 5 patients (14.7%), drug-induced anaphylaxis was the initial and only manifestation of SM. No hypersensitivity reactions occurred to quinolones, general anesthetics, or COVID-19 vaccines. Median baseline tryptase was 50.25 µg/L (min–max: 8.59–200.00) overall, and 41.85 µg/L (min–max: 19.00–200.00) among those with DHRs. Conclusions: Patients with SM are at increased risk of severe DHRs, particularly to NSAIDs and beta-lactam antibiotics. In some patients, drug allergy may be the first and only manifestation of SM. Measurement of baseline serum tryptase is essential in patients with drug-induced anaphylaxis. A comprehensive allergy assessment, including tolerance testing and individualized counseling, is crucial to ensure safe pharmacological management.

Background/Objectives: Systemic mastocytosis (SM) is a rare clonal mast cell disorder associated with mediator-related symptoms and a broad range of neurocognitive and sleep-related complaints. Fatigue, insomnia, and brain fog are frequently reported in clinical practice, but objective polysomnographic data in this patient population remain limited. As overweight and obesity are established contributors to sleep-disordered breathing, polysomnography (PSG) findings in patients with SM should be interpreted with caution when a control group is not available. This study aimed to characterize sleep architecture, sleep continuity, and sleep-disordered breathing in adult patients with SM who underwent PSG. Methods: This single-center observational study included nine adult patients diagnosed with SM from the Ege University Mastocytosis Database between January 2023 and January 2024. No control group was included. All patients underwent overnight laboratory PSG after discontinuation of antihistamine therapy for at least seven days. Demographic characteristics, SM subtype, baseline serum tryptase levels, Epworth Sleepiness Scale (ESS) scores, and brain fog-like cognitive complaints were recorded. PSG parameters included total sleep time, sleep efficiency, sleep onset latency, wake after sleep onset, rapid eye movement (REM) latency, sleep stage distribution, arousal burden, apnea–hypopnea index (AHI), oxygenation parameters, and periodic limb movements. Results: The study included four women and five men, with a median age of 50 years. Eight patients had a body mass index (BMI) ≥ 25 kg/m², indicating that the cohort was predominantly overweight or obese. The most common SM subtype was indolent SM. The median baseline serum tryptase level was 55.9 ng/mL, and the median ESS score was 9. Only two patients had excessive daytime sleepiness according to ESS > 10, whereas six patients reported brain fog-like complaints. Median sleep efficiency was 91.4%, total sleep time was 344 min, sleep onset latency was 9 min, and wake after sleep onset was 11 min. Median REM latency was 128.5 min. Sleep stage distribution showed median N1, N2, N3, and REM sleep proportions of 3%, 54%, 26%, and 16.7%, respectively. One patient had no observed REM sleep, and two patients had no measurable N3 sleep. The median number of arousals was 55. The median AHI was 8.2 events/hour. Although eight of nine patients met PSG criteria for obstructive sleep apnea (OSA), including five with mild and three with severe disease, this finding should be interpreted in the context of the high prevalence of overweight/obesity in the cohort. All patients with BMI ≥ 25 kg/m² had OSA, whereas the only normal-weight patient did not. Conclusions: In this single- center observational study, PSG demonstrated frequent sleep-disordered breathing, REM-related changes, and variable arousal burden in patients with SM; however, these findings cannot be separated from the predominance of overweight/obesity and the absence of a control group. Brain fog-like complaints were common, although excessive daytime sleepiness was present in only a minority of patients. Because most patients were overweight or obese and no control group was included, these findings cannot be attributed directly to SM. However, the results suggest that objective sleep assessment may be useful in selected patients with SM, particularly when fatigue, non-restorative sleep, or cognitive complaints are present. Larger controlled studies with BMI-matched groups are needed to clarify the relationship between SM, mast cell mediator activity, and sleep abnormalities.

Background/Objectives: We examined how allergy findings related to candidate-agent identification, subsequent real-world imaging and clinical outcomes. Methods: This single-centre retrospective cohort included 29 adults evaluated between January 2019 and May 2025 for contrast media hypersensitivity. Imaging and outcomes between allergy evaluation and a structured telephone interview in July 2026 were assessed retrospectively and verified in national electronic health records, without prospective follow-up. Primary outcomes were skin test positivity and new hypersensitivity reactions during subsequent contrast administration. Results: The culprit contrast agent was not documented by name in 18 patients (62.1%); median evaluation delay was 60 months. Skin tests were positive in 1/20 patients (5.0%); skin-test-negative candidate agents were identified in 19/20 (95.0%). New reactions occurred in 3/14 contrast recipients (21.4%), all with immediate Brown Grade III index reactions to iohexol. Subsequent reactions included one cardiac arrest after iohexol and two Grade II reactions after iodixanol. Of seven patients imaged without contrast, four had candidate agents but reported continuing patient and physician concerns. No Holm-adjusted comparison was significant. Conclusions: Skin testing identified a candidate agent in most tested patients, but candidate identification did not establish clinical tolerance or independent protection. A shared, individualised imaging plan should communicate agent selection, premedication decisions, test limitations and precautions to patients and radiologists while preserving access to necessary imaging.