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BACKGROUND:The aim of this study was to determine if the use of tranexamic acid (TXA) during intramedullary reaming treatment for tibial diaphyseal fractures was safe, reduced blood loss, or affected cost effectiveness. METHODS:A total of 70 patients with a tibia diaphysis fracture were randomized into 2 groups and prospectively followed for data on blood loss, thrombosis, and fracture healing. Preoperative TXA was administered intravenously to Group A, and Group B served as the control group. RESULTS:While there was no significant difference between the preoperative and postoperative 1-hour hemoglobin (Hb) and hematocrit (Hct) levels of the patients, there was a statistically significant difference in the comparison of the postoperative 24-hour and 48-hour Hb and Hct levels. There was no need for an allogenic blood transfusion to any patient in Group A; however, 2 patients in Group B each received 1 unit of erythrocyte suspension because their Hct values dropped below 27%. There was no deep vein thrombosis or embolism observed in any of the patients. CONCLUSION:The application of intravenous TXA during the preoperative period in the treatment of tibial fractures with intramedullary nailing reduced the bleeding seen in the postoperative period. It did not lead to intravascular thrombosis in the postoperative period, and had no adverse effect on bone healing.

Objectives To determine the seroconversion (SC) rate after CoronaVac and BNT162b2 vaccines in adults with inflammatory rheumatic disease (IRD). Methods Patients who were followed up with IRD and who received two doses of either CoronaVac or BNT162b2 vaccines were included in this prospective observational single-center study. Subjects with two doses of CoronaVac or BNT162b2 without known IRD were included in the healthy controls. The blood samples were taken at a minimum of two and a maximum of 12 weeks after the second dose of vaccine. Results A total of 81 patients with IRD (61 CoronaVac, 20 BNT162b2) and 100 healthy controls (70 CoronaVac, 30 BNT162b2) were included. The SC rate was slightly lower among patients with IRD versus controls (84 vs 97%, p = 0.002). The SC rate was 100% in all participants who received BNT162b2 both in the patient and control group. The IgG antibody level after CoronaVac in the patient group was significantly lower than both the BNT162b2 ( p = 0.031) and the healthy group ( p < 0.001). Among patients with IRD, those on rituximab (RTX) (12/81,14.8%) had significantly less SC rate (5/12, 41.7%). The median neutralizing antibody titers were significantly higher in patients with BNT162b2 compared with CoronaVac (1.97 vs. 16.34, p < 0.001). Conclusions This study showed that all patients with BNT162b2 vaccine developed immunogenicity in patients with IRD, while there was a decreased antibody response with CoronaVac vaccine compared to that of BNT162b2. In particular, RTX significantly reduces the SC rate.

Objective The aim of the study was to detect the frequency and course of coronavirus disease 2019 (Covid‐19) infection among our rheumatology outpatients and to investigate how patient follow‐up differed during Covid‐19 pandemic in a tertiary University Hospital in the capital of Turkey. Patients and method Patients with inflammatory rheumatic diseases (IRDs) registered in our rheumatology clinic were assessed during their routine outpatient follow‐up control or contacted via phone between July and December 2020. Patients' demographics, diagnosis, medication, comorbidities, frequency of going outside during the pandemic, work status, whether patients could attend their routine follow‐up, treatment changes, access to drugs during the pandemic, and the incidence of Covid‐19 infection were collected. Results A total of 320 patients with IRD were analysed; 114 (35.6%) patients were treated with conventional synthetic disease‐modifying antirheumatic drugs (csDMARDs) (methotrexate/leflunomide/sulfasalazine), 93 (29.1%) patients with biologic DMARDs (bDMARDs), 113 (35.3%) patients with glucocorticoids, and 103 (32.2%) patients with hydroxychloroquine (HCQ). A total of 15.9% of patients on HCQ experienced problems in medication supply. Only 87 (27.2%) patients presented for their routine follow‐up appointment, and 38 (11.9%) of the patients changed their treatment without professional health advice. While 53 (57%) patients on biological agents continued their treatment, 31 patients (33.3%) interrupted the treatment with doctor's recommendation and 9 patients (9.6%) on their initiative, and 23 of these 31 patients had to restart treatment because of disease activation. The nasopharyngeal swab collected from 30 patients with a suspected Covid‐19 contact but without any symptoms was negative. In total, there were 33 patients diagnosed with Covid‐19; none of whom had severe respiratory complications or death. Conclusions Many patients with rheumatic diseases are left without disease monitoring during the pandemic. There was no increased risk of severe Covid‐19 infection among patients with IRD.

SummaryObjective: To examine the relationship between serum 25-hydroxyvitamin D [25(OH)D] level and disease activity in male patients with ankylosing spondylitis (AS). Materials and Methods:The study enrolled 51 male AS patients being followed at our hospital. Patient demographics as well as serum levels of 25(OH)D vitamin, C-reactive protein (CRP), calcium, phosphorus, alkaline phosphatase and parathormone, and erythrocyte sedimentation rate (ESR) at 1 hour were recorded. Patients were divided into two groups based on their serum 25(OH)D vitamin levels; one group consisted of 21 patients with 25(OH)D vitamin levels less than 20 ng/mL and the other group comprised 30 patients with 25(OH)D levels greater than 20 ng/mL. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores were evaluated in order to determine the disease activity. Results: BASDAI scores were statistically significantly higher in the group with serum 25(OH)D vitamin levels less than 20 ng/mL compared to the group with 25(OH)D levels above 20 ng/mL (p<0.05). There was no statistically significant difference between groups in terms of ESR, serum levels of CRP, parathormone, calcium, phosphorus and alkaline phosphatase. Conclusion: In the present study, an inverse relationship has been found between serum vitamin D levels and disease activity in male AS patients and it was concluded that serum vitamin D levels should also be taken into account while developing a treatment plan.