Search

Hypertension is a common and important public health problem in Turkey and worldwide. Recommendations on the diagnosis and treatment of hypertension have been presented in many nationally and internationally agreed European and American guidelines. However, there are differences among these guidelines, and some of the recommendations are not consistent with clinical practice in our country. Consensus report preparation, with the participation of relevant associations, was considered necessary to merge recommendations by evaluating hypertension guidelines from the perspective of Turkey and to create a joint approach in the diagnosis and treatment of hypertension in adults. For this purpose, it was aimed to prepare a practical text in Turkey in which all physicians dealing with hypertensive patients, from family practitioners in primary care to specialists in tertiary care, could come to agreement on common concepts, and which would be used as a basic reference guideline. Considering health care practices and sociocultural structure in Turkey, this report aimed to enhance awareness on hypertension, provide a common basis for different definitions and values as well as therapeutic options in various guidelines, and establish a practical reference guide to improve clinical practices in Turkey. This report is not a document describing hypertension in every aspect, but a reference, including basic recommendations with outlines. Care was taken to ensure that recommendations were evidence-based and valid for a majority of patients in clinical practice. However, it should be kept in mind that an approach assessment should be made on an individual basis for each patient.

Otolog hematopoetik kök hücre nakli (OHKHN) relaps/refrakter Hodgkin lenfoma (HL) için kurtarma tedavisi sonrasında uygulanılan standart bir tedavidir. Çalışma ile merkezimizdeki relaps/refrakter HL tanılı OHKHN uygulanılan hastaların hastalıksız (DFS) ve genel sağkalım (OS) saptamasını ve risk faktörlerinin sağkalım üzerindeki etkisini incelenmeyi amaçladık. Merkezimizde Ocak 2009–Mart 2020 tarihleri arasında takipli OHKHN uygulanılan 314 hastanın 35 (%11)’i HL tanılıydı. Çalışmaya relaps/refrakter HL tanılı 18 yaşından büyük OHKHN uygulanılan 35 hasta dahil edildi. Hastaların %46’sı kadındı. Medyan tanı yaşı 29 (14-62) ve nakil yaşı 33 (22-62)’idi. Primer kemoterapi sonrasında hastaların %66’sında remisyon sağlanırken %34’ü refrakter kaldı. Relaps/refrakter HL’ye uygulanılan kurtarma tedavisi sonucunda %6 parsiyel yanıt, %26 tam yanıt, %68 refrakter kabul edildi. OHKHN sonrası hastaların %49’unda remisyon sağlanırken, %51’inde relaps gelişti. OHKHN sonrasında relaps olan hastaların tedavi yanıtında %39’u remisyon, %17’si refrakter, %44’ü hayatını kaybetti. Hayatını kaybeden hastaların %88'i lenfoma kaynaklı, %12’si lenfoma harici nedenden kaybedildi. OHKHN sonrası hastaların ortalama OS 99(±8,9) ay; DFS 60(±10,7) aydı. OHKHN sonrası relaps süresi 12 ay altında (p=0,033) ve relaps anındaki sedimentasyon düzeyinin normal olması (p=0,021) DFS için anlamlı; relaps anında LDH düzeyinin normal olması (p=0,022) OS için anlamlı olduğu saptandı. Çok değişkenli analizde OS üzerinde etkili prognostik risk faktörü saptanmadı. Diğer taraftan DFS üzerinde; hemoglobin düzeyinde bir birimlik artışın relaps riskini 1,67 kat arttırdığı, nötrofil engraftmanında bir birimlik artışın relaps riskini %30 ve relaps süresi 12 ay üzerinde olmasının relaps riskini %85 düzeyinde azalttığı saptandı. Çalışmamızda hastaların birkaç risk faktörünün OHKHN sağkalımı ve süresi üzerinde etkili olduğunu saptadık. Ancak daha anlamlı sonuçlar için çalışmaların örneklem grubunun genişletilmesi ve takip süresinin uzatılması gerekmektedir. Autologous hematopoietic stem cell transplantation (AHSCT) is a standard treatment applied after rescue treatment for relapse/refractory Hodgkin's lymphoma (HL). In our study, we aimed to determine the disease-free (DFS) and overall survival (OS) of patients diagnosed relapse/refractory HL who applied AHSCT in our center and to examine the effect of risk factors on survival. Thirty-five (11%) of 314 patients who underwent AHSCT between January 2009 and March 2020 and followed up in our center were defined HL. 46% of the patients were female. The median age of diagnosis was 29(14-62), and the transplantation age was 33(22-62). After primary chemotherapy; 66% of patients remained in remission, 34% refractory. The rescue treatment’s result applied to relapse/refractory HL, 68% refractory. 26% complete and 6% partial response. After AHSCT, the patients accomplished remission of 49% and developed relapsed 51%. The result of the treatment applied to patients who relapsed after AHSCT was accomplished remission in 39%, considered refractory at 17%, and died at 44%. The patients who died after AHSCT died 88% from lymphoma and died 12% from causes other. After AHSCT, the mean OS of patients was 99(±8.9); the mean DFS was 60(±10.7) months The time-to-relapse being less than 12 months (p=0.033) and normal sedimentation at relapse (p=0.021) were found to be substantial on DFS, and normal LDH at relapse (p=0.022) was found to be substantial on OS. In multivariate analysis, no prognostic risk factor was detected affecting OS. On the other hand, that was found that the increase in hemoglobin at diagnosis on PFS increased the risk of relapse 1.67 times; increase in one-unit neutrophil engraftment decreased the risk of relapse by 30%, and the time-to-relapse being over 12 months decreased the risk of relapse by 85%. In our study, we could validate several risk factors affecting survival and duration of patients who underwent AHSCT. However, that ıs necessary to expand the sample group of the studies and extend the follow-up period for more meaningful results.

Kronik miyeloid lösemi (KML), kemik iliğindeki hematopoietik kök hücrelerin monoklonal çoğalmasıyla karakterize myeloproliferatif bir hastalıktır. Gebelikte KML oldukça nadir görülür, tahmin edilen yıllık insidansı 100.000 gebelikte 1’dir. KML gebelikte görülen lösemilerin %10’undan azını oluşturur. Gebelikte löseminin tedavi ve bakım süreci, anne ve bebek sağlığı açısından son derece önemlidir. Lösemili gebe olguların hemşirelik bakımının önemine dikkat çekmek ve daha etkin bir hemşirelik bakımına ilişkin farkındalık oluşturmak amacı ile 27 yaşında, 5 aylık gebe, KML tanılı olgu ele alındı. KML tedavisi altında sağlıklı canlı doğum yaptırıldı. Gebelik ve pospartum hemşirelik bakımı gerçekleştirildi., Chronic myeloid leukemia (CML) is a myeloproliferative disease characterized by monoclonal proliferation of hematopoietic stem cells in the bone marrow. CML is extremely rare in pregnancy, with an estimated annual incidence of 1 in 100,000 pregnancies. CML is less than 10% of leukemias seen in pregnancy. The treatment and care process of leukemia during pregnancy is extremely important in terms of maternal and infant health. The aim of this study was to evaluate the importance of nursing care of pregnant women with leukemia and to develop awareness of more effective nursing care. Healthy live birth was performed under CML treatment. Pregnancy and pospartum nursing care were performed.

Sekmek S., Renal Transplantasyon Yapılan Hastalarda Diyare Yan Etkisi Sebebiyle Mikofenolattan Azatioprine Geçilmesinin Etkinlik Ve Güvenliği. Hacettepe Üniversitesi İç Hastalıkları Uzmanlık Tezi, Ankara, 2020. Mikofenolat, renal transplantasyon sonrasında sık kullanılan bir immunsupresif ilaçtır. Mikofenolat tedavisinin klinik pratikte en sık karşılaşılan yan etkilerinden birisi ishaldir. Mikofenolat tedavisi altında ilaca bağlı ishal gelişen hastalarda, azatioprin tedavisine geçilmesi alternatif yollardan birisidir. Çalışmamızda ishal sebebiyle mikofenolat tedavisi kesilerek azatioprin tedavisi başlanan hastaların, tedavi değişikliği sonrasında ishal şikayetinde ne oranda düzelme olduğunun ve bu tedavi değişikliğinin rejeksiyon gelişimi ve greft ve hasta sağ kalımına etkisinin araştırılması planlanmıştır. Çalışmaya 59'u azatioprine geçilen gruptan, 118'i kontrol grubundan olmak üzere toplam 177 hasta katılmıştır. Çalışmaya katılan hastalardan, azatioprine geçilen gruptaki bazal glomerüler filtrasyon hızının, kontrol grubuna göre daha düşük olduğu (p < 0,0001); bazal kreatinin (p = 0,001) ve bazal proteinüri (p = 0,004) değerlerinin kontrol grubuna göre daha yüksek olduğu saptanmıştır. İshal sebebiyle azatioprine geçilen hastaların %89,8'inde ishal şikayetinin düzeldiği gözlenmiştir. Azatioprine geçilmesine rağmen ishal şikayeti düzelmeyen hastalar incelendiğinde, hastaların %83,3'ünün amiloidoz tanılı hastalar olduğu görülmüştür. Çalışmamızın sonucunda, azatioprin kullanan hastalarda, mikofenolat kullanan hastalara göre daha çok greft kaybı olduğu gözlenmiştir (p = 0,004). Özellikle glomerüler filtrasyon hızı 30 ml/dk'nın altında olan hastalarda, ishal sebebiyle mikofenolattan azatioprine geçiş yapıldığında, greft kaybı riskinin arttığı gözlenmiştir. Uygun hastalarda, ishal sebebiyle mikofenolat tedavisinin kesilip azatioprin tedavisine başlanmasının, ishal şikayetinin düzelmesinde etkili bir yaklaşım olduğu saptanmıştır. Sekmek S, Efficacy and Safety of Switching from Mycophenolate to Azathioprine in Renal Transplant Patients Due to Diarrhea Side Effect. Thesis in Internal Medicine, Ankara, 2020. Mycophenolate is a commonly used immunosuppressive drug after renal transplantation. Diarrhea is one of the most common side effects of mycophenolate treatment in clinical practice. In patients with drug-induced diarrhea under mycophenolate treatment, one of the options is to switch from mycophenolate to azathioprine. In this study, we aimed to investigate the effect of switch from mycophenolate to azathioprine on amelioration of diarrhea complaints and the risks on rejection and graft and patient survival. A total of 177 patients, 59 of whom were switched to azathioprine and 118 of which were control group, participated in this study. Basal glomerular filtration rate was lower in the patients who were switched to azathioprine than the control group (p

WOS: 000411827200025, PubMed ID: 28961828, Background: Reed-Sternberg cells of classical Hodgkin's lymphoma (cHL) are characterized by genetic alterations at the 9p24.1 locus, leading to over-expression of programmed death-ligand 1 and 2. In a phase 1b study, nivolumab, a PD-1-blocking antibody, produced a high response in patients with relapsed or refractory cHL, with an acceptable safety profile. Patients and methods: We present a retrospective analysis of 82 patients (median age: 30 years; range: 18-75) with relapsed/refractory HL treated with nivolumab in a named patient program from 24 centers throughout Turkey. The median follow-up was 7 months, and the patients had a median of 5 (2-11) previous lines of therapy. Fifty-seven (70%) and 63 (77%) had been treated by stem-cell transplantation and brentuximab vedotin, respectively. Results: Among 75 patients evaluated after 12 weeks of nivolumab treatment, the objective response rate was 64%, with 16 complete responses (CR; 22%); after 16 weeks, it was 60%, with 16 (26%) patients achieving CR. Twenty patients underwent subsequent transplantation. Among 11 patients receiving allogeneic stem-cell transplantation, 5 had CR at the time of transplantation and are currently alive with ongoing response. At the time of analysis, 41 patients remained on nivolumab treatment. Among the patients who discontinued nivolumab, the main reason was disease progression (n = 19). The safety profile was acceptable, with only four patients requiring cessation of nivolumab due to serious adverse events (autoimmune encephalitis, pulmonary adverse event, and two cases of graft-versus-host disease aggravation). The 6-month overall and progression-free survival rates were 91.2% (95% confidence interval: 0.83-0.96) and 77.3% (0.66-0.85), respectively. Ten patients died during the follow-up; one of these was judged to be treatment-related. Conclusions: Nivolumab represents a novel option for patients with cHL refractory to brentuximab vedotin, and may serve as a bridge to transplantation; however, it may be associated with increased toxicity.

Amaç: Bu çalışma Tıbbi Onkoloji Kliniği'nde yatan kanserli hastaların yaşadıkları semptomların sıklığı, şiddeti ve etkileyen faktörlerin incelenmesi amacıyla yapılmıştır.Yöntem: Tanımlayıcı nitelikteki araştırma, Ocak 2019-Mart 2019 tarihleri arasında Akdeniz Üniversitesi Hastanesi Tıbbi Onkoloji Kliniği'nde yürütülmüştür. Çalışmaya dahil edilme kriterlerini karşılayan 91 hasta araştırma kapsamına alınmıştır. Verilerin toplanmasında; Hasta Tanıtım Formu, ECOG performans skalası, Braden skalası, İtaki düşme riski ölçeği ve MD Anderson Semptom Envanteri kullanılmıştır. Verilerin değerlendirilmesinde ortalama, yüzdelik, Ki-kare, Mann Withney U, Kruskal Wallis ve Korelasyon analizi kullanılmıştırtır. Tüm veriler SPSS paket programının 22.0 sürümü kullanılarak analiz edilecektir ve p

Amaç: Kemoterapi alan hastalarda febril nötropeni mortalite riski yüksek bir onkolojik acildir. Bu tez projesinde solid kanserli hastalarda kemoterapi sonrası febril nötropeni riskini hesaplamada kullanılan nomogramı retrospektif olarak analiz edebilmek, daha önce sınırlı tanıda geliştirilen nomogramın tüm solid organ kanserlerinde kullanılabilirliğini ölçmek ve nomogram kullanımın günlük klinik pratiğine uygun hale getirebilmek amaçlanmıştır.Yöntem: 2014-2016 yılları arasında kanser tanısı almış ve kemoterapi uygulanmış hastalar retrospektif olarak çalışmaya dahil edilmiştir. Hasta verileri dosya taraması ile elde edilmiştir. Her hastanın nomogram ile febril nötropeni riski tayin edilmiştir. Tüm tanı ve tedavi seçim gözetmeksizin değerlendirmeye alınmıştır. Kullanılan kemoterapi özellikleri ve her tedavi kürü ayrı olarak değerlendirmeye alınmıştır. Tek değişkende anlamlı olduğu belirlenen faktörler, lojistik regresyon testine dahil edilmiştir.Bulgular: Çalışmaya 895 hasta dahil edilmiştir. Bu hastaların %50,8 (455),'i erkek %49,2 (440)' si kadındır. Hastaların yaş ortalaması 56,66±11,21, min-max 22-86, medyanı ise 57,5'tir. Bu hastaların 1032 siklus değerlendirmeye alınmıştır. Febril Nötropeni risk analizlerine göre en yüksek rölatif risk hastanın kaç basamak kemoterapi aldığı değişkeninde bulunmuştur. OR: 1,696 (%95 CI=1,263-2,276) ve veriler istatistiksel olarakta anlamlıdır (p=0,000). Buna ek olarak, doz azaltımı, LDH değeri ve GCSF kullanımı parametreleri febril nötropeniye etki eden diğer bağımsız prediktif faktörler olarak bulunmuştur (p=0,000).Sonuç: Bu nomogram onkoloji hastalarında febril nötropeni risk oranını hesaplamak ve febril nötropeniye bağlı mortalite ve morbitite oranını azaltmak için yardımcı bir araç olarak kullanılabilir.Anahtar Kelimeler: Febril nötropeni, nomogram, kemoterapi Objective: Febrile neutropenia is an oncological emergency with is high risk mortality in patient receiving chemotherapy. The purpose of this project, to analysis the nomogram which use to calculate febrile neutropenia risk, to measure all solid cancers with using nomogram which is previously limited developed, and use nomogram is intended to adapt to daily clinical practice.Method: Patients enrolled retrospectively the study, who had cancer diagnosis and chemotherapy regimen administered at between 2014-2016 years. Patient data were obtained with scan of file. Risk of each patient was determined by nomogram. All diagnosis and treatment evaluated without selection. Properties of used chemotherapy and each of treatment cure were evaluated by separately. Determined factors that meaningful in one variant was included logistic regression test.Results: 895 patients were included in study. The patient was %50,8 (455) male , %49,2 (440) female. The median age was 56,66±11,21, min-max 22-86, median was 57,5. 1032 cycles of these patients were evaluated the study. According to analysed risk for febrile neutropenia, the highest relative risk found of how many steps the patients received chemotherapy. OR: 1,696 (%95 CI=1,263-2,276) and the data were statistically significant (p=0,000). In addition, parameters that dose reduction, LDH value and using GCSF were found independent predictive factors on febrile neutropenia (p=0,000).Conclusion: This nomogram can be use with a tool to calculate the risk ratio of febrile neutropenia and to reduce to mortality and morbidity rate depending on febrile neutropenia in oncology patients.Key Words: Febrile neutropenia, nomogram, chemotherapy 60

Bu çalışmada, vasküler Behçet Hastalığı (BH) tanısı ile izlediğimiz hastaların klinik, demografik verilerinin değerlendirilmesi, relaps sıklığı ve kullanılan tedavilerle olan ilişkisinin irdelenmesi amaçlanmıştır. BH tanılı 512 hastanın dosyası geriye dönük incelenerek 68 vasküler tutulumlu Behçet hastası tespit edildi. Demografik özellikler, birinci vasküler olay ve varsa nüksü, tedavi protokolleri kaydedildi. Vasküler tutulum sıklığı %13,28’idi. Hastaların %85’i erkekti. En sık alt ekstremitelerde venöz tutulum görüldü (%77,9). İlk vasküler relaps, hastaların %29,4’inde, ikinci vasküler relaps ise %8,8’inde gelişti. Vasküler tutulumlu Behçet hastalarında vasküler tutulumun tespit edilmesini takiben hastaların %73,5’i sistemik immünsüpresif (İS) tedavi, %45,5’i antikoagülan tedavi almıştı. İS tedavi almayan grupta relaps riski anlamlı olarak yüksek bulundu. (p=0.001) Antikoagülan tedavi alan grupta relaps oranı daha fazla olmakla birlikte istatistiksel olarak anlamlı bir fark saptanmadı (p=0.61). Vasküler tutulum sıklıkla erkeklerde görülmektedir. Tedavide İS'ler ve antikoagülanlar kullanılmaktadır. İmmünsupresif tedavi kullanımı vasküler relaps riskini azaltabilir, ancak antikoagülan tedavinin ek faydası gösterilememiştir. Bu konuda daha fazla sayıda hasta ile yapılacak çok merkezli çalışmalara ihtiyaç vardır. In this study, we aimed to evaluate the clinical and demographic data of the patients followed up with the dia gnosis of Vascular Behçet's Disease (BD), and to examine the frequency of relapse and its relationship with the treatments used. The data of 512 patients diagnosed with BD were reviewed retrospectively, and 68 BD with vascular involvement were detected. Demographic characteristics, first vascular event, and recurrence, if any, and treatment protocols were recorded. The frequency of vascular involvement was 13.28%. 85% of the patients were man. Venous involvement was most common in the lower extremities. (77.9%) The first vascular relapse occurred in 29.4% of the patients, and the second vascular relapse occurred in 8.8%. After the first vascular event, 73.5% of the patients received systemic immunosuppressive therapy and 45.5% received anticoagulant therapy. The risk of relapse was found to be significantly higher in the group that did not receive immunosuppressive therapy. (p=0.001) Although the relapse rate was higher in the group receiving anticoagulant treatment, no statistic ally significant difference was found. (p=0.61) Vascular involvement often occurs in male patients. Immunosuppressive therapies an d anticoagu- lants are used in the treatment. The use of immunosuppressive therapy can reduce the risk of vascular relapse. No additional benefit of anticoagulant therapy was observed. Multicenter studies with larger numbers of patients are needed for a better understanding in this issue.

Bu çalışmada; Diyarbakır yöresindeki koyunlarda Kazeöz Lenfadenitis’in (KLA) etiyolojik ajanı olan Corynebacterium. pseudotuberculosis (C. pseudotuberculosis)’in bakteriyolojik kültür, PCR ve ELISA teknikleri kullanılarak tanısının ortaya konulması, izolasyon bulguları ile testlerin özgüllük ve duyarlılıklarının belirlenmesi ve böylece hastalığın rutin teşhisinde kullanılabilirliklerinin ortaya konulması amaçlanmıştır. Çalışmanın materyalini Diyarbakır’ın farklı bölgelerinde olmak üzere 11 ayrı sürüden toplamda 2650 adet Akkaraman koyun oluşturdu. Sağlık taramasından geçirilen koyunların içinden 90 adet KLA semptomları gösteren ve yüzeysel lenf yumrularından bir veya birkaç tanesi birden apseleşmiş hasta koyunlar tespit edilerek çalışmaya dahil edildi. Kan örnekleri ve apse içeriğinden swap örnekleri alındı. Etkenin tanısı için, swap örneklerinden bakteriyolojik kültür ve PCR analizleri, kan örneklerinden ise ELISA analizleri yapıldı. Diyarbakır yöresindeki koyunlarda PCR analizlerine göre 26 (%28.9) pozitif, 64 (%71.1) negatif, ELISA analizinde 17 (%18.9) pozitif, 73 (%81.1) negatif ve bakteriyolojik kültürde 12 (%13.3)’sinde C. pseudotuberculosis, 16’sından Staphylococcus aureus (S. aureus), 8’inde Streptococ spp. ve 6’sında Escherichia coli (E. coli) kolonileri izole edilirken 48 (%53.3) kültürde hiç üreme olmadığı görüldü. PCR, ELISA ve bakteriyolojik kültür sonuçları karşılaştırıldığında PCR’ın daha belirleyici bir tanı testi olduğu görüldü (p

PubMedID: 25231929 Current treatment modalities can cure up to 70–80 % of patients with classical Hodgkin lymphoma. Approximately, 20–30 % of patients require further treatment options. Brentuximab vedotin has been approved for the treatment of relapsed and refractory Hodgkin lymphoma. In the present study, we report the experience with brentuximab vedotin as single agent in 58 patients with relapsed or refractory Hodgkin lymphoma. The objective response rate was 63.5 % with 13 complete responders (26.5 %) among 49 patients evaluated at the early phase of treatment (2–5 cycles). Upon treatment prolongation (?6 cycles), 37 patients achieved a final objective response rate of 32.4 % with 21.6 % of complete and 10.8 % of partial response. Overall survival at 12 months was 70.6 %, and progression-free survival at 12 months was 32.8 %. Median overall survival could not be reached and median progression-free survival was 7 months. While the median duration of response was 9 months in the whole cohort, it was 11.5 months in the complete responders. Complete response rates in patients treated with >3 chemotherapy regimens before brentuximab vedotin were significantly lower (p = 0.016). Fourteen patients were subsequently transplanted. In conclusion, brentuximab vedotin provided a bridge to transplantation in approximately one quarter of the patients. The declining response rates during the course of treatment suggest that transplantation should be implemented early during brentuximab vedotin treatment. © 2014, The Author(s).

İnsülin enjeksiyonlarında amaç sızıntı veya rahatsızlık olmadan subkutan alana ilacın güvenilir bir şekilde verilmesidir. Bu amaca ulaşmak için uygun iğne boyunun seçilmesi büyük önem taşır. İğne uzunluğuna ilişkin karar fiziksel, farmakolojik ve psikolojik olanlarda dahil olmak üzere çok sayıda faktöre dayalı olarak hasta ve sağlık profesyoneli tarafından birlikte verilir. Bu çalışma uygun iğne boyutunu belirlemek amacıyla diyabetli yetişkinlerde deri kalınlığı ve subkutan yağ dokusu ölçümü yapılarak, iğne boylarının metabolik kontrole, enjeksiyonla ilgili yan etkilere ve hasta memnuniyeti üzerine etkisini belirlemek amacıyla planlanmıştır. Çalışmaya Akdeniz Üniversitesi Hastanesi Endokrinoloji ve Metabolizma Polikliniği'nde takip edilen ve insülin kullanan 45 tip 1 ve tip 2 diyabetli hasta dahil edildi. Hastaların deri kalınlığı ve subkutan yağ dokusu ölçümü üç farklı enjeksiyon alanında ultrason eşliğinde yapılmıştır. Hastalar üç hafta boyunca 4 mm iğne ucu ile abdomene, sonraki üç hafta boyunca 4mm iğne ucu ile uyluğa ve daha sonraki üç hafta boyunca 4 mm iğne ucu ile kola enjeksiyon yapmıştır. Ardından üç hafta boyunca 8 mm iğne ucu ile abdomene, sonraki üç hafta boyunca 8 mm iğne ucu ile uyluğa ve daha sonraki üç hafta boyunca 8 mm iğne ucu ile kola enjeksiyon yapılmıştır. Her üç haftanın sonunda glisemik kontrol için ortalama glikoz düzeyleri ve fruktozamin değerlendirilmiştir. 9. ve 18. haftanın sonunda hastaların ağrı düzeyi vizüel analog skala (VAS) ile değerlendirilmiştir. Hastaların insülin enjeksiyonu ile ilgili komplikasyonlarına yönelik bilgiler (kanama, morarma, lipodistrofi ve sızıntı) günlük veri toplama formuna kaydedilmiş ve her 3 haftanın sonunda değerlendirilmiştir. Glisemik kontrol açısından iğneler karşılaştırıldığında 4 mm iğne ile 8 mm iğne arasında fark saptanmamıştır. Hastalar kısa iğneleri tercih etmekle beraber, kısa iğnelerle daha az kanama, morarma ve ağrı bildirirken uzun iğnelerde daha az sızıntı bildirmiştir. Yapılan ultrason ölçümlerinde yaş ve cinsiyetin deri kalınlığına etkisinin olmadığı, BKİ arttıkça deri kalınlığınında arttığı fakat enjeksiyon yapılan bölgelerde deri kalınlığının 1,05 mm ve 3,03 mm arasında değişkenlik gösterdiği saptanmıştır. Ortalama deri kalınlığı kolda 1,66 mm, abdomende 1,9 mm ve uylukta 1,84 mm bulunmuştur. Deri kalınlığı en fazla abdomende 3,03 mm bulunmuştur. Deri kalınlıklarına göre 4 mm iğne ile subkutan bölgeye tüm vücut bölgelerinde rahatça ulaşılabileceği gösterilmektedir Bu sonuçlar kısa iğne uçlarının da diyabetlilerde güvenle kullanılabileceğini desteklemektedir.Anahtar Kelimeler : Deri Kalınlığı, İğne Uzunluğu, Glisemik Kontrol The purpose of insulin injection is to give medicine safely without any discomfort to the subcutaneous area. It is important to choose the right needle length to meet this goal. Patient and health staff decide needle length according to many factor such as physical, pharmacological and psychological. This study planned to reveal the impacts of needle length on metabolic situation, side effects of needle and patient satisfaction. At the same time skin thickness and subcutaneous fat tissue was measured for the efficiacy. Total 45 type 1 and type 2 patients who using insulin and followed in `Akdeniz University Hospital, Endocrinology and Metabolism Division` take part in this study. To measure patients' skin thickness and subcutaneous fat tissue, three different injection area were evaluated. Patients used injection into the abdomen with 4 mm needles during first three weeks. Then, they used injection into the thigh with 4 mm needles during next three weeks . Finally, they used injection into the arm with 4 mm needles during final three weeks After that patient used injection into abdomen with 8 mm needle during first three weeks. Then, they used injection into the thigh with 8 mm needles during next three weeks. Finally, they used injection into the arm with 8 mm needles during final three weeks. To verify glycaemia, average glucose level and fructosamine were evaluated after every three weeks. At the 9 th and 18 th weeks, patients pain level is evaluated by visual analog scale (VAS). Patients complications about insulin injection site (like bleeding, ecchymosis, lipodystrophy and dribble) were collected in daily data collecting form and this data was evaluated after every three weeks.When needles are compared in terms of glycaemia, no difference is determined between 4mm needles and 8mm needles. Patients prefered short needles, also, they reported less bleeding, ecchymosis and pain with short needles. It is determined that skin thickness is independent from age and sex, the skin thickness increased with BMI. There is no change in skin thickness in injected area. In this study, the thickest skin is in the abdomen with 3mm. This result supports that diabetic patients can use short needle safely as well. Key Words: Skin Thickness, Needles Length, Glycemic Control 64

Langerhans hücreli histiyositoz (LHH) erişkinde nadir rastlanılan multi-sistemik (MS) ve heterojen bir hastalıktır. Erişkin hastaya yaklaşım ve tedaviyle ilgili veri oldukça azdır. Bu çalışmada Mart 2000 ile Mart 2022 tarihleri arasında merkezimize sevk edilen LHH’li 16 erişkin hastayı retrospektif olarak inceledik. Hastaların %68,7’si erkek ve ortanca yaş 30,5 yıl idi. Tanıda hastaların %50’sinde tek bölgede, %50’sinde MS tutulum vardı. Riskli organ tutulumu 3 hastada (%18,75) mevcuttu. En çok tutulan alanlar kemik ve akciğer (%43.75), sonrasında ise santral sinir sistemi (SSS) (%31,25) idi. Sistemik tedavi endikasyonu olan 8 hastanın tamamına birinci sırada vinorelbin ve steroid tedavisi verildi. Diğer hastalara cerrahi eksizyon veya radyoterapi uygulandı. Tedaviye tam yanıt oranı %37.5, kısmi yanıt oranı %37.5 idi. Hastaların 3’ü (%18,75) nüks etti. Tek bölge tutulumu olan hastaların hepsi hayatta ve nüks gelişmedi. On bir hasta ise halen hayattadır. Median genel sağkalıma (OS) ulaşılamadı, 3 yıllık OS %79.8 idi. Otuz yaş üzerindeki hastaların sağkalımı daha düşük bulundu. Ancak bu fark istatistiksel olarak anlamlı değildi (p=0.2). MS hastalığı olanların median OS verileri daha kötüydü (48 aya karşı ulaşılamadı, p=0.02). Tanı yaşının 30’un üzerinde olması ve SSS tutulumu bulunması daha düşük OS ile ilişkiliydi ancak bu istatistiksel olarak anlamlı değildi. Dalak ve karaciğer tutulumu olan hastalarda hızlı hastalık progresyonu ya da tedaviye refrakterlik izlendi. Özellikle kötü prognostik özellikleri olan hastalara birinci basamakta vinblastin/steroid bazlı tedaviler yetersiz kalabilir. Erişkin LHH’da klinik ve prognostik özelliklerinin daha iyi belirlenebilmesi, uygun tedavi stratejilerinin geliştirilmesi için çok merkezli, prospektif çalışmalara ihtiyaç vardır., Langerhans cell histiocytosis (LCH) is a rare, multisystemic, and heterogeneous disease seen in adults. There is very little data on how to approach and the treatment of the adult patient. In this study, we retrospectively analyzed 16 adult patients with LCH who were referred to our center between March 2000 and March 2022. 68.7% of the patients were male, and the median age was 30.5 years. At the time of diagnosis, 50% of the patients had a single site, and 50% had multisystemic (MS). Risk organ involvement was present in 3 patients (18.75%). The most involved areas were bone and lung (43.75%), followed by the central nervous system (CNS) (31.25%). All eight patients with indications for systemic treatment were given vinorelbine and steroid treatment in the first line. Other patients underwent surgical excision or radiotherapy. The response rate to treatment was 37.5%, and the partial response rate was 37.5%. 3 (18.75%) of the patients relapsed. All patients with single-site involvement survived and did not relapse. Eleven patients are alive. Median overall survival (OS) was not achieved; 3-year OS was 79.8%. Survival of patients over 30 years of age was found to be lower. However, this difference was not statistically significant (p=0.2). Those with MS had worse median OS data (48 months vs. unavailable, p=0.02). Age at diagnosis over 30 and CNS involvement was associated with lower OS, but this was not statistically significant. Rapid disease progression or refractoriness to treatment was observed in patients with spleen and liver involvement. Especially in patients with poor prognostic features, vinblastine/steroid-based treatments may be insufficient in primary care. Multicenter, prospective studies are needed better to determine the clinical and prognostic features of adult LCH and to develop appropriate treatment strategies.

Kronik Myeloid Lösemide (KML), etyolojisinde sorumlu tirozin kinaz aktivitesi gösteren bcr-abl füzyon geninin keşfinden sonra, bu aktiviteyi inhibe eden ilaçların keşfiyle, daha uzun sağkalım sürelerine ulaşılabilmiştir. Bu ilaçlarla tedaviye zamanla direnç gelişmesi, ikinci ve üçüncü kuşak ajanların geliştirilmesinin önünü açmıştır. Bu çalışmamızda, merkezimizde ikinci kuşak tirozin kinaz inhibitörü (TKİ) – bosutinib - tedavisi alan hastaların, klinik, laboratuvar, moleküler yanıt, yan etki profili ve mortalite üzerindeki etkilerini değerlendirmeyi amaçladık. KML nedeniyle bosutinib tedavisi başlanan 17 hasta çalışmaya dahil edildi. Hastaların tedaviye kaçıncı sırada başlandığı, klinik, laboratuvar ve moleküler yanıt durumları retrospektif olarak elektronik hasta kayıtlarından tarandı. Elde edilen veriler hastaların ilaç başlanma sırasına göre karşılaştırıldı. İkinci (n=2), üçüncü (n=7) ve dördüncü (n=8) sırada bosutinib başlanan hastaların yaş, cinsiyet, komorbidite sayısı, bosutinib tedavi süresi açısından anlamlı bir fark gözlenmezken KML tanı yaşları arasında anlamlı bir farklılık mevcuttu. Moleküler yanıt ve yan etki profili açısından değerlendirildiğinde, ilacın başlanma sırası ile anlamlı bir farklılık yoktu. Hastaların genel sağkalımı 43,38 ± 4,98 ay (%95 GA: 33,62 – 53,16 ay) olarak gözlemlendi. Bosutinib tedavisinin her yaş grubunda, ilacın her başlanma sırasında kullanımının, stabil moleküler yanıt sağlaması açısından güvenli olduğu gözlemlendi. Yan etki profili açısından kullanımını sınırlayacak bir profile sahip olmaması nedeniyle KML tedavisinde tercih edilebilir bir molekül olarak düşünülmelidir. After the discovery of the bcr-abl fusion gene, which shows the tyrosine kinase activity responsible for its etiology in Chronic Myeloid Leukemia (CML), longer survival times have been achieved with the discovery of drugs that inhibit this activity. The development of resistance to treatment with these drugs over time paved the way for the development of second and third generation agents. In this study, we aimed to evaluate the effects of patients receiving second generation tyrosine kinase inhibitor (TKI) - bosutinib - treatment on clinical, laboratory, molecular response, side effect profile and mortality in our center. Seventeen patients who were started on bosutinib therapy for CML were included in the study. The order in which the treatment was initiated, the clinical, laboratory and molecular response status of the patients were retrospectively scanned from electronic patient records. The data obtained were compared according to the order of initiation of the drugs of the patients. While no significant difference was observed among the second-line (n=2), third-line (n=7) and fourth-line (n=8) bosutinib treated patients in terms of age, gender, number of comorbidities, and duration of bosutinib treatment, there was a significant difference between the ages of CML diagnosis. There was no significant difference with the order of initiation of the drug and molecular response and side effect profile. The overall survival of the patients was 43.38 ± 4.98 months (95% CI: 33.62 – 53.16 months) Conclusion: It was observed that the use of bosutinib treatment was safe in all age groups at each initiation order and provide a stable molecular response. Since it does not have a side-effect profile that would limit its use, it should be considered as a preferred molecule in CML treatment.

Relaps veya refrakter akut lösemide klofarabin bazlı kurtarma tedavilerinin genel yanıt oranları %17-48 arasında değişmektedir. Çalışmamızda relaps veya refrakter akut lösemi tanılı hastalarda klofarabin bazlı kurtarma tedavisi sonrası yanıt oranları, enfeksiyon ile ilişkili komplikasyonları ve yan etkileri değerlendirildi. Ocak 2015 ile Aralık 2020 tarihleri arasında kliniğimizde klofarabin bazlı kurtarma tedavisi alan 12 hasta retrospektif olarak değerlendirildi. Hastaların %58 (n=7)’i erkek olup ortalama yaş 36,6±16,4 olarak saptandı. Hastaların %75 (n=9)’i akut lenfoblastik lösemi, %25 (n=3)’i akut myeloid lösemi tanısı ile takip edilmekteydi. Klofarabin öncesi almış oldukları kemoterapi rejim sayısı medyan 3 idi. Hastaların %66 (n=8)’sı son aldığı tedaviye refrakter, %33 (n=4)’ü erken nüks ile başvurdu. Hastalar klofarabin 22,5 mg/m2 + sitozin arabinozid 1000 mg/m2 dozunda intravenöz 1-5. gün olacak şekilde tedavi aldılar. Tedavi esnasında tüm hastalar febril nötropeni ile komplike oldu, hastaların %58 (n=7)’inde sepsis gelişti. Ciddi (grade 3-4) non- hematolojik yan etkiler arasında hepatotoksisite %33, diyare %25, bulantı-kusma %16, mukozit %16 civarındaydı. Klofarabine bağlı nörotoksisite izlenmedi. Hastaların birinde tam yanıt (%8) elde edildi. Hastaların %33 (n=4)’ü tedaviye yanıtsızdı. İlk 30 gün içindeki mortalite oranı %50 (n=6) idi. Mortal seyreden hastaların bir tanesinde erken ölüm (

Myelodisplastik Sendromlar, sitopeni veya sitopeniler, bir veya birden fazla majör myeloid hücre serisinde displazinin olduğu inefektif hematopoezle karakterize akut myeloid lösemi riskinin arttığı bir grup hematopoetik kök hücre hastalığıdır. MDS hematopoetik kök hücrelerin olgunlaşma aşamasında ortaya çıkan proliferasyonundaki çeşitli bozukluktan kaynaklanan kemik iliği hastalığıdır. Hücrelerde morfolojik anormaliteler, displastik değişiklikler vardır. MDS'in sebebi tam olarak bilinmemektedir. MDS genellikle yaşlı bireylerde meydana gelir. İmmünolojik, genetik, çevresel faktörlerin ve bazı alkilleyici ajanların hastalığa neden olduğu düşünülmektedir.Regülatör T hücreler, otoimmün hastalıkları önleyen hücrelerdir. Treg'ler immün cevapta rol oynayan diğer hücrelerin fonksiyonlarını inhibe ederek immün cevabı kontrol edebilirler. Foxp3, Treg'lerin gelişimlerini ve fonksiyonlarını düzenleyen bir transkripsiyon faktörüdür. Foxp3, doğal Treg hücreleri için özel bir aktivasyon belirtecidir. CD4+CD25+ Treg hücreler otoimmün hastalıklarda önemli role sahiptirler.MDS immün sistemin otoimmün bozuklukları etkilediği, bazı alt gruplarında immünsupresif tedaviden fayda sağlandığı bilinen bir hastalıktır. Bu çalışmada bizim amacımız (otoimmün bozukluğun eşlik edebildiği `pre malign` kabul edilen bir grup hastalığı oluşturan) MDS'de kemik iliği ve periferik kan Treg hücrelerin etkilenip etkilenmediğini MDS alt gruplarına göre ayırırak göstermektir. Ayrıca hastalarda ve sağlıklı konrol grubunda baskılayıcı CD3, yardımcı CD4 ve sitotoksik CD8 gruplarını araştırdık. MDS hastaları ile sağlıklı kontrollerin perifer Treg hücre yüzdeleri karşılaştırıldığında MDS hastalarında daha yüksek bulunmuştur fakat istatistiksel analiz sonucunda anlamlı bir fark bulunmamıştır. MDS hastalarını risk grubuna göre 2'ye ayırarak sağlıklı kontrollerle karşılaştırdığımızda perifer Treg hücre yüzdelerinin 2.grupta 1.gruba göre daha yüksek olduğu, sağlıklı kontrollerde ise 1. ve 2. gruptan daha düşük olduğu bulunmuş ancak istatistiksel analiz sonucunda anlamlı bir fark olmadığı tespit edilmiştir. MDS 1.grup ve 2.gruptaki hastaların kemik iliği Treg hücre yüzdeleri karşılaştırıldığında 2.grupta daha yüksek olduğu bulunmuş fakat istatistiksel analiz sonucunda anlamlı bir fark olmadığı tespit edilmiştir. MDS 1.grup ve 2.gruptaki hastalar ile sağlıklı kontrollerin perifer CD3+, CD4+ ve CD8+ T hücre yüzdeleri karşılaştırıldığında istatistiksel olarak anlamlı bir fark bulunmamıştır. MDS 1.grup ve 2.gruptaki hastaların kemik iliği CD3+, CD4+ ve CD8+ T hücre yüzdeleri karşılaştırıldığında da istatistiksel olarak anlamlı bir fark bulunmamıştır.Anahtar kelimeler: Myelodisplastik Sendrom, Treg, FoxP3 The Myelodisplastic Syndromes are a group of clonal haematopoietic stem cell diseases characterized by cytopenia or cytopenias, dysplasia in one or more of the major myeloid cell lines, ineffective haematopoiesis, and an increasing risk of development of acute myeloid leukaemia. The Myelodisplastic Syndromes are a bone marrow disease resulting from the defects in proliferation during development and maturation of stem cells. Cells contain morphologic abnormalities, dysplastic features. The cause of MDS is not known accurately. MDS occur principally in older adults. It is accepted that immunologic, genetical, and environmental factors and some alkilizing agents may cause the disease.Regulatory T cells are the cells that block resist autoimmune diseases. Tregs can control the immune response by inhibiting the functions of other cells involved in immunologic functions. FoxP3, which is a transcription factor, regulates the development and functions of Tregs. FoxP3, is an activation marker of natural Tregs. CD4+CD25+ Treg cells have an important role in autoimmune diseases.MDS is known as a disease effecting immune system, auto immune defects and can be recuperated by immune suppressive treatment in some subgroups of disease. In this study, our aim is to show by dividing MDS into subgroups whether the bone marrow tregs and periferic treg cells in MDS, a group of diseases accepted `pre malign? and seen with autoimmune defects, are affected or not. Moreover, suppressor CD3, helper CD4, and cytotoxic CD8 subgroubs in patients and control groups were searched. When percentages of perifer Treg cells of MDS patients and healthy controllers were compared, it was found to be higher in the former but there wasn?t a significant difference in the outcomes of the statistical analysis. When we compared MDS patients to healthy controllers by dividing into two in terms of risk groups, percentages of perifer Treg cells is higher in the second group than that in the first group whereas in healthy groups it is lower than that in the first and second grou ps; however, it was discovered that there wasn?t a significant difference in the outcomes of the statistical analysis. When percentages of bone marrow Treg cells in the first and second group of MDS patients were compared, it was found to be higher in the second group but it was found out that there wasn?t a significant difference in the outcomes of the statistical analysis. When percentages of perifer CD3+, CD4+ and CD8+ T cells of MDS patients of first and second groups and healthy group were compared, it was discovered that there wasn?t a significant difference in the outcomes of the statistical analysis. When percentages of bone marrow CD3+, CD4+ and CD8+ T cells between MDS patients of first and second groups were compared, it was found out that there wasn?t a significant difference in the outcomes of the statistical analysis, either.Keywords: Myelodisplastic Syndrome, Tregs, Foxp3 52

Tip 1 Diyabet tedavisinde tıbbi beslenme tedavisinin önemi büyüktür.. Bu anlamda kullanılan başlıca tıbbi beslenme tedavileri kalorilik diyet programı ve karbonhidrat sayma yöntemi olmak üzere ikiye ayrılmaktadır. Bu çalışmada da, kullanılan bu iki beslenme tedavi şeklinin kan şekerleri ve kilo üzerine etkisinin karşılaştırılması amaçlanmıştır. Yoğun insülin tedavisi alan, diyabet süresi en az 1 yıl olan Tip 1 Diyabetli hastalar arasından kontrollere düzenli gelebilecek ilk 29 hasta çalışmaya alındı. Çalışmaya alınan hastaların 15'üne karbonhidrat sayımı yöntemi uygulanırken geri kalan 14 hastaya kalorilik diyet programı düzenlendi. Hastalar 6 ay süre ile takip edildi. Her ay fruktozamin, kilo ve bel çevresi değerleri , 3 ayda bir ise HbA1c değerleri kaydedildi. Karbonhidrat sayımı uygulanan grubun HbA1c ve fruktozamin değerlerinde anlamlı bir azalma sağlanmıştır (p=0.004, p=0.002). Kalorilik diyet uygulayan grubun kan parametrelerinde anlamlı bir değişme olmazken kilo ve BKI değerleri anlamlı olarak yükselmiştir (p=0.02, p=0.006). Ancak iki yöntem birbiri ile karşılaştırıldığında aralarında anlamlı bir fark saptanmamıştır. Bu çalışma karbonhidrat sayımı yönteminin doğru uygulandığında kilo alımı olmadan HbA1c değerlerini kalorilik diyet sistemine göre daha iyi düzelttiğini göstermiştir.Anahtar Kelimeler: Tip 1 Diyabetes Mellitus, karbonhidrat sayımı, kalorilik diyet programı, metabolik kontrol, vücut ağırlığı In Type 1 diabetics treatment medical feeding treatment is of great importance. In this respect there are two methods; the fist method is caloric diet programme and the second one is carbohydrate counting. In this study it is aimed to compare the effects of these two treatment methods on the blood glucose and weight. Amongst the patients who have been receiving intensive insulin treatment and having diabetics with type 1Diabetes Mellitus for one year only those twenty-seven patients who would come for check up regularly were chosen for the study. Carbohydrate counting method was implemented on the 14 patients and the calory dieting programme was implemented on the other 13 patients. These patients were followed for 6 months. Their fruktozamin and, weight and waist circumference values were recorded every month and their HbA1c values were recorded every three months. As a result; there has been meaningful decrease in the values of fruktozamin and HbA1c of the patients who had carbohydrate counting treatment (p=0.004, p=0.002). But in the group who had dieting treatment, while there has been no meaningful change in the blood parameters, the values of weight and BKI has increased meaningfully (p=0.02, p=0.006). However, when these two treatment methods were compared no meaningful difference was observed. This study showed that when carbohydrate counting is implemented correctly, it can correct HbA1c values without gaining weight to calory dieting programme.Key words: Type 1 Diabetes Mellitus, carbohydrate counting, caloric dietprogramme, metabolic control, weight 52

Tip 2 diabetes mellitus' da beslenme ve öğün planlaması ile ilgili prensipler başarılı bir diyabet tedavisinin en önemli komponentidir. Bu amaçla sıklıkla kullanılan tıbbi beslenme tedavileri kalorilik diyet tedavisi ve son yıllar da popülerliliği artan karbonhidrat sayımı yöntemidir. Bu çalışma kalori hesabına dayanan tıbbi beslenme tedavisi ile karbonhidrat sayımı yöntemini karşılaştırarak her iki diyetin beden kitle indeksi (BKI), kan şekeri regülasyonu ve kan yağları üzerine olan etkilerini ortaya koymak amacıyla planlanmıştır. Çalışmaya 20-70 yaş arası, HbA1c değeri %6-8, diyabet süresi 1-10 yıl olan ve oral antidiyabetiklerden sülfanilüre ve/veya metformin kullanan 15 Tip 2 diabetes mellitus'lu hasta (3 erkek, 12 kadın) alındı. Çalışmaya katılan hastalar 6 ay süreyle takip edildi. Çalışmanın birinci aşamasında 3 ay süreyle kalori hesabına dayanan tıbbi beslenme tedavisi, ikinci aşamada da karbonhidrat sayımı yöntemi kullanılmıştır. Kilo ölçümü her kontrolde, açlık kan şekeri ve tokluk kan şekerleri her ay sonunda; HbA1c, total kolesterol, LDL Kolesterol, HDL Kolesterol ve trigliserit ölçümleri ise her diyetin başlangıcında ve 3. ay sonunda alınmıştır. Tıbbi beslenme tedavisinde diyet öncesi ve sonrası parametrik ölçümlere bakıldığında; kilo, BKI, açlık kan şekeri, tokluk kan şekeri ve HbA1c' de (p0,05) istatistiksel olarak anlamlı olmayan bir azalma ve LDL kolesterolde de başlangıca göre bir artış saptanmıştır (p>0,05). Karbonhidrat sayımı yönteminde ise kilo, BKI ve HbA1c' de (p0,05) istatistiksel olarak anlamlı olmayan bir azalma ve HDL kolesterolde de bir artış saptanmıştır (p>0,05). İki diyetin birbirine üstünlüğüne bakıldığında ise açlık kan şekeri, tokluk kan şekeri ve HbA1c' deki azalmanın kalori hesabına dayanan tıbbi beslenme tedavisinde daha fazla olduğu ve istatistiksel olarak da bu üstünlüğün anlamlı olduğu görülmüştür (p0,05). LDL cholesterol levels was increased compared to the baseline. With carbohydrate counting method, body weight, BMI, HbA1c levels (p0,05). When diet strategies are compared the decrease in HbA1c level, fasting and postprandial blood glucose with medical nutrition therapy is different from carbohydrate counting method is also meaningful statistically (p

Trombositopenili Köpeklerde Ehrlichia canis ve Babesia canis Enfeksiyonlarının PrevalansıBu çalışmada trombositopenili köpeklerde E. canis ve B. canis enfeksiyonlarının prevalansı, trombositopeninin derecesi ile bu iki hastalığın prevalansı arasındaki ilişkinin belirlenmesi ve buna bağlı olarak trombositopeninin E. canis ve B. canis enfeksiyonlarının tanısındaki rolünün ortaya çıkarılması amaçlandı..farklı ırk ve cinsiyetteki toplam 224 köpekten kan örnekleri toplandı. Kan örnekleri trombosit sayılarına göre (Trombosit sayısı 201.000 /µl'den yüksek olanlar, 101.000?200.000 /µl arasında olanlar ve 100.000 /µl'den küçük olanlar olmak üzere) 3 gruba ayrıldı. Kan örneklerine E. canis için İFAT serolojik tanı yöntemi ve B. canis için PCR moleküler tanı yöntemi uygulandı. Köpeklerden elde edilen sonuçlar SPSS paket programında x2 testi kullanılarak istatiksel açıdan değerlendirildi.Toplam 224 hayvanın 81 tanesi (%36,2) E. canis yönünden pozitif, 4 tanesi (%1,8) B. canis yönünden pozitif bulundu. Trombositopenik 143 köpeğin 69 tanesi (%48,3) E. canis yönünde pozitifken nontrombositopenik 81 köpeğin 12 tanesi (%14,8) pozitif olarak bulundu. Trombositopeninin derecesinin artması ile E. canis görülme sıklığı arasında istatistiksel önem bulunurken trombositopeninin derecesi ile B. canis enfeksiyonu arasındaki istatistiksel bir önem bulunamadı.Sonuç olarak, bu çalışmada trombositopeninin derecesinin artması ile E. canis enfeksiyonunun görülme sıklığının arttığı ve trombosit sayısının E. canis enfeksiyon için spesifik bir test olamayacağı, ileri diagnostik testlere geçiş amacıyla bir tarama testi olarak kullanılabileceği ortaya kondu.Anahtar kelimeler: Ehrlichia canis, Babesia canis, köpek, trombositopeni, Prevalence of Ehrlichia canis and Babesia canis Infections in Thrombocytopenic DogsIn the present study the aim was to investigate the prevalance of Ehrlichia canis and Babesia canis infections in thrombocytopenic dogs, and to determine the relation among those aforementioned diseases, and diagnostic role of thrombocytopenia in the latter infections.Blood samples were collected from 224 dog of different ages and of both sexes. Samples were seperated to three groups according to their thrombocyte counts (thrombocyte counts higher than 201.000µ/L; thrombocyte counts between 101.000?200.000µ/L, thrombocyte counts below 101.000). In blood samples, E. canis was determined using IFAT and B. canis was detected using a molecular diagnostic method, PCR. Data gathered from the dogs were examined using SPSS software program using Chi-Square testEighty one (36,2%) of 224 dogs were positive to E. canis and 4 (1,8%) were B. canis positive. Sixty nine of 143 trombocytopenic dogs (48,3%) and 12 of 81 non-trombocytopenic dogs (14,8%) were E. canis positive, respectively. A statistically significant difference was found among the degree of thrombocytopenia and E. canis prevalance, however there was insignificant importance between the severity of thrombocytopenia and B canis infection.In conclusion, it was suggested that as the degree of thrombocytopenia elevates the incidence of E. canis infection increases and thrombocyte counts could not be evaluated specifically for E canis infection, therefore could be used for sureveillance test for experiencing forward diagnostic applications. Increase in the degree of thrombocytopenia causes increase the conincide of E. canis infection and determination of the thrombocyte numbers could not be a specific test for the possible diagnosis of E canis infection but could be refered a transision for these tests.Key words: Ehrlichia canis, Babesia canis, dog, thrombocytopenia 72

Takayasu arteritis is a rare inflammatory disease of large arteries. We performed a genetic study in Takayasu arteritis comprising 6,670 individuals (1,226 affected individuals) from five different populations. We discovered HLA risk factors and four non-HLA susceptibility loci in VPS8, SVEP1, CFL2, and chr13q21 and reinforced IL12B, PTK2B, and chr21q22 as robust susceptibility loci shared across ancestries. Functional analysis proposed plausible underlying disease mechanisms and pinpointed ETS2 as a potential causal gene for chr21q22 association. We also identified >60 candidate loci with suggestive association (p < 5 x 10(-s)) and devised a genetic risk score for Takayasu arteritis. Takayasu arteritis was compared to hundreds of other traits, revealing the closest genetic relatedness to inflammatory bowel disease. Epigenetic patterns within risk loci suggest roles for monocytes and B cells in Takayasu arteritis. This work enhances understanding of the genetic basis and pathophysiology of Takayasu arteritis and provides clues for potential new therapeutic targets., National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of HealthUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Institute of Arthritis & Musculoskeletal & Skin Diseases (NIAMS) [R01 AR070148]; National Institute of Arthritis and Musculoskeletal and Skin DiseasesUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Institute of Arthritis & Musculoskeletal & Skin Diseases (NIAMS) [U54 AR057319, U01 AR51874 04]; National Center for Research ResourcesUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Center for Research Resources (NCRR) [U54 RR019497]; Office of Rare Diseases Research of the National Center for Advancing Translational Sciences; Imperial College, National Institute for Health Research, Biomedical Research Centre; Wellcome TrustWellcome TrustEuropean Commission [WT107881]; Medical Research CouncilUK Research & Innovation (UKRI)Medical Research Council UK (MRC)European Commission [MC_UU_00002/4], This work was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health grant R01 AR070148 to A.H.S. The Vasculitis Clinical Research Consortium has received support from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (U54 AR057319 and U01 AR51874 04), the National Center for Research Resources (U54 RR019497), and the Office of Rare Diseases Research of the National Center for Advancing Translational Sciences. J.C.M., A.P.K., and R.M.M. acknowledge support from the Imperial College, National Institute for Health Research, Biomedical Research Centre. C.W. and G.R. acknowledge support from The Wellcome Trust (WT107881) and the Medical Research Council (MC_UU_00002/4). This work was supported by the use of study data downloaded from the dbGaP website, under dbGaP: phs000272.v1.p1, phs000431.v2.p1, phs000583.v1.p1, and phs000444.v1.p1.

Hepatitis delta virus (HDV) infection causes the most severe form of viral hepatitis. PEG-interferon alpha-2a (PEG-IFN alpha-2a) is the only effective treatment but its long-term clinical impact is unclear. the aim of this study was to investigate the long-term outcome after 48 weeks of pegylated interferon alpha-2a therapy. We performed a retrospective follow-up study of the Hep-Net-International-Delta-Hepatitis-Intervention-Study 1 (HIDIT-I trial). Patients had received 48 weeks of treatment with either PEG-IFN alpha-2a plus adefovir dipivoxil (ADV) (Group I), PEG-IFN alpha-2a alone (Group II) or adefovir dipivoxil alone (Group III). Liver-related complications were defined as liver-related death, liver transplantation, liver cancer and hepatic decompensation defined as development of Child-Pugh scores B or C or an increase in Model for End-stage Liver Disease (MELD) scores of five or more points in relation to baseline values. Patients were considered for further analysis when they were retreated with PEG-IFN alpha-2a. Follow-up data (at least 1 visit beyond post-treatment week 24) were available for 60 patients [Group I, (n = 19), Group II (n = 20), Group III (n = 21)]. Mean time of follow-up was 8.9 (1.6 - 13.4) years. 19 patients were retreated with IFN-based therapy: 42% (n = 8) in PEG-IFN alpha-2a arms and 58% (n = 11) in the adefovir only arm. Clinical complications on long-term follow-up occurred in 17 patients and were associated with nonresponse to therapy and baseline cirrhosis. the annual event-free survival rate in patients with cirrhosis vs noncirrhotic patients at year 5 and 10 was 70% vs 91% and 35% vs 76%. Long-term follow-up of a large randomized clinical trial suggests that off-treatment HDV RNA response to PEG-IFN alpha-2a treatment leads to improved clinical long-term outcome., German Centre for Infection Research (DZIF), partner site Hannover-Braunschweig; German Liver Foundation; EASL registry grant, This study was funded by the German Centre for Infection Research (DZIF), partner site Hannover-Braunschweig with a grand to the HepNet Study-House, the German Liver Foundation and an EASL registry grant.

Objectives: Transplantation affects the patient's psychological state and daily life activities. Although there are various studies regarding the quality of life of patients, there are limited studies on the daily life activities and learning needs of patients after renal transplant. Here, we investigated the daily life activities and learning needs of patients after renal transplant. Materials and Methods: This descriptive and cross-sectional study was conducted on 120 renal transplant recipients. Data were collected using the "Patient Information Form," the "Nottingham Extended Activities of Daily Living Scale," and the "The Patient Learning Needs Scale." Data were evaluated with t test, analysis of variance, and Pearson correlation analyses. Results: In our patient group, the mean general health score was 6.8 +/- 2.34, and the fatigue score was 4.53 +/- 2.88. Although 66.7% of our patients reported that they had information about the drugs that they used, 58.3% could not answer questions regarding the most important adverse effects of their drugs. We found that 20% of the patients had a respiratory problem, 34.2% had sexual problems, and 26.7% had sleep problems. The average Nottingham Extended Activities of Daily Living Scale levels were lower in patients with only primary school education, patients who did not work, and patients with other illnesses. Learning needs of patients were as follows in order: quality of life, feelings related to the conditions, treatment, and complications. Conclusions: Our study patients reported that their overall daily life activities and quality of life, given the holistic approach to treatment and care, were good. However, when we examined each activity separately, our findings showed that patients lacked information regarding how to cope with stress, emotions, and the effects of renal transplant on their life.

Makale, WOS:000941436500004, Objective: This study was aimed to compare serum galectin-3 (Gal-3) levels in gestational diabetes mellitus (GDM) and healthy pregnant women and to evaluate the relationship between insulin resistance parameters and serum Gal-3 levels. Materials and Methods: Fifty-nine pregnant women who were screened for GDM with oral glucose tolerance tests (OGTT) at the 24th-28th gestational weeks were included in the study. According to the results of OGTT, 34 pregnant women were included in the GDM group and 25 pregnant women were included in the control group. Results: Serum Gal-3 value was found to be similar in the GDM and control group (P < 0.471). However, there was a significant positive association between Gal-3 and fasting insulin (r = 0.509, P < 0.001) and homeostasis model assessment of insulin resistance (HOMA-IR) (r = 0.479, P < 0.001) in the whole pregnancies, and between Gal-3 levels and fasting insulin (r = 0.608, P < 0.001), HOMA-IR (r = 0.609, P < 0.001), and OGTT 60 min glucose (r = 0.444, P = 0.016) in the GDM patients. Conclusions: There was no difference in the last trimester serum Gal-3 levels between GDM and healthy pregnant women. However, a significant positive correlation was determined between Gal-3 and fasting insulin, HOMA-IR, and OGTT 60 min glucose values in the GDM group, and fasting insulin and HOMA-IR values in whole pregnancies. The results of our study support previous data reporting the relationship between Gal-3 and GDM through insulin resistance., Scientific Research Projects (BAP) Coordination Unit of Selcuk University

Objective: The aim of this multi-center study was to assess predictive factors for work-day loss as an indirect cost element in Behçet's syndrome (BS). Methods: In this cross-sectional, multi-center study, 834 BS patients (F/M: 441/393, age mean: 38.4 ± 10.9 years) were included. Data were collected by a questionnaire regarding treatment protocols, disease duration, smoking pattern, frequency of medical visits during the previous year and self-reported work-day loss during the previous year. Results: Work-day loss was observed in 16.2% of patients (M/F: 103/32). The percentages of being a smoker (81.8%), using immunosuppressive (IS) medications (82%), and having disease duration

Objective.Deficiency of adenosine deaminase 2 (DADA2) is an autosomal recessive autoinflammatory disorder associated with ADA2 mutations. We aimed to investigate the characteristics and ADA2 enzyme activities of patients with DADA2 compared to non-DADA2 patients.Methods.This is a descriptive study of 24 patients with DADA2 who were admitted to the Adult and Pediatric Rheumatology, Pediatric Haematology, and Pediatric Immunology Departments of Hacettepe University. All ADA2 exons were screened by Sanger sequencing. Serum ADA2 enzyme activity was measured by modified spectrophotometric method.Results.Twenty-four patients with DADA2 were included: 14 with polyarteritis nodosa (PAN)-like phenotype (Group 1); 9 with Diamond-Blackfan anemia (DBA)-like features, and 1 with immunodeficiency (Group 2). Fourteen PAN-like DADA2 patients did not have the typical thrombocytosis seen in classic PAN. Inflammatory attacks were evident only in Group 1 patients. Serum ADA2 activity was low in all patients with DADA2 except one, who was tested after hematopoietic stem cell transplantation. There was no significant difference in ADA2 activities between PAN-like and DBA-like patients. In DADA2 patients with one ADA2 mutation, serum ADA2 activities were as low as those of patients with homozygote DADA2. ADA2 activities were normal in non-DADA2 patients. ADA2 mutations were affecting the dimerization domain in Group 1 patients and the catalytic domain in Group 2 patients.Conclusion.We suggest assessing ADA2 activity along with genetic analysis because there are patients with one ADA2 mutation and absent enzyme activity. Our data suggest a possible genotype–phenotype correlation in which dimerization domain mutations are associated with PAN-like phenotype, and catalytic domain mutations are associated with hematological manifestations.

Aim. Papillary thyroid carcinoma (PTC) and medullary thyroid carcinoma (MTC) are two different types of thyroid carcinoma with significant different clinical and histological findings. Their coexistence in the same patient is a very rare event which demands different clinical approach. Case Report. We report a case with concurrent MTC and PTC in the same thyroid having characteristics of a collision tumour. A 35-year-old patient has admitted to endocrinology outpatient department with complaint of pain in the neck. Physical examination revealed 2 cm nodule on the thyroid right lobe. Serum thyroid hormone levels were within normal range. Ultrasonography revealed a 23x15 mm hypoechoic nodule with micro calcifications and cystic areas on the right lobe. Preoperative serum calcitonin was 2 pg/ml (0-11.5). PTK 1.7 cm and MTK 1.8 cm in the same thyroid with healthy tissue in between them were detected on pathological examination. RET gene mutation was negative. She has been followed up to now without any evidence of disease. Conclusion. This is a collision tumour since lesions with features of MTC and PTC were detected in two different locations and separated by normal thyroid tissue. Germline point mutation of the RET gene had a potential role in the development of both MTC and PTC. On the other side, familial concurrent MTC and PTC without RET gene mutation was also published. Both RET and BRAF genes had a role in the development of the medullary and papillary collision tumours. We do not know the presence of BRAF gene mutation in this case report yet.

Objective: To identify several clinical and/or laboratory parameters which can differentiate adult-onset Still's disease (AOSD) from other causes of fever of unknown origin (FUO) and create a clinician-friendly algorithm for this purpose. Methods: FUO patients hospitalized between March 2015 and September 2017 were recruited prospectively. AOSD patients diagnosed between 2001 and 2017 in our department were analyzed. Clinical and laboratory parameters were recorded for all patients. A multivariate analysis was performed to identify possible parameters related to the discrimination of AOSD from FUO. Results: We recruited 69 AOSD patients (51 females, 74%) and 87 patients (43 females, 49.4%) evaluated for FUO. Median ages were 45 (30-57) and 45 (30-62), respectively. Arthralgia, rash, sore throat, neutrophilia, serum ferritin level higher than 5 times of the upper limit, and elevated lactate dehydrogenase levels were associated with the likelihood of diagnosing AOSD; on the other hand, the number of daily fever peaks equal or greater than 3 was associated with the unlikelihood of diagnosing AOSD. After the clinical feasibility assessment of possible parameters derived from the multivariate analysis, in the setting of fever, two clinical (arthralgia, sore throat) and two laboratory (ferritin level, neutrophilia) parameters were selected to develop an algorithm for discrimination of AOSD and FUO. Conclusion: Presence of arthralgia, hyperferritinemia, sore throat, and neutrophilia suggests AOSD in patients presenting as FUO. This study proposes a clinician-friendly algorithm for the first time in current literature to discriminate AOSD from other causes of FUO.

Objective Patients with Cushing’s syndrome (CS) have increased mortality. The aim of this study was to evaluate the causes and time of death in a large cohort of patients with CS and to establish factors associated with increased mortality. Methods In this cohort study, we analyzed 1564 patients included in the European Registry on CS (ERCUSYN); 1045 (67%) had pituitary-dependent CS, 385 (25%) adrenal-dependent CS, 89 (5%) had an ectopic source and 45 (3%) other causes. The median (IQR) overall follow-up time in ERCUSYN was 2.7 (1.2–5.5) years. Results Forty-nine patients had died at the time of the analysis; 23 (47%) with pituitary-dependent CS, 6 (12%) with adrenal-dependent CS, 18 (37%) with ectopic CS and two (4%) with CS due to other causes. Of 42 patients whose cause of death was known, 15 (36%) died due to progression of the underlying disease, 13 (31%) due to infections, 7 (17%) due to cardiovascular or cerebrovascular disease and 2 due to pulmonary embolism. The commonest cause of death in patients with pituitary-dependent CS and adrenal-dependent CS were infectious diseases (n = 8) and progression of the underlying tumor (n = 10) in patients with ectopic CS. Patients who had died were older and more often males, and had more frequently muscle weakness, diabetes mellitus and ectopic CS, compared to survivors. Of 49 deceased patients, 22 (45%) died within 90 days from start of treatment and 5 (10%) before any treatment was given. The commonest cause of deaths in these 27 patients were infections (n = 10; 37%). In a regression analysis, age, ectopic CS and active disease were independently associated with overall death before and within 90 days from the start of treatment. Conclusion Mortality rate was highest in patients with ectopic CS. Infectious diseases were the commonest cause of death soon after diagnosis, emphasizing the need for careful clinical vigilance at that time, especially in patients presenting with concomitant diabetes mellitus.

Objective: This study investigated the prevalence of frailty in older patients with hematologic cancer and assessed the association between older patients’ characteristics and frailty. Methods: This descriptive study enrolled 90 older patients undergoing treatment for hematological malignancies at an oncology hospital. Frailty was assessed with the Edmonton Frailty Scale as not frail (0–4), apparently vulnerable (5–6), mildly frail (7–8), moderately frail (9–10), and severely frail (11–17). The association of frailty and older patient characteristics and diagnosis was assessed by logistic regression. Results: The prevalence of frailty (mild, moderately, and severely) was 42.2%, and “apparently vulnerable” frailty was 60%. The mean scale score was 5.59 ± 3.13. Frailty was more prevalent in patients who were ≥75 years of age, had ≥4 children, were diagnosed with leukemia, and were diagnosed for ≥2 years. Gender, diagnosis, and employment were factors associated with the presence of frailty. Female gender and lack of employment were factors associated with a high risk of frailty. A diagnosis of multiple myeloma was associated with a low risk of frailty. Conclusions: The prevalence of frailty was high in older patients. Female and unemployed patients were at high risk for frailty. Frailty characteristics of older patients with hematologic cancer highlighted the need for comprehensive geriatric assessment and frailty screening, provided prevalence and characteristics of frailty in this group of patients during treatment, and highlighted the need for holistic care approach.

Acute lymphoblastic leukemia (ALL) is a neoplastic disease characterized by clonal malignant proliferation of the lymphoid blast cells. The aim of this study is to compare chemotherapy, pediatric regimen BFM-95 protocol with adult ALL protocols in our patient cohort. We retrospectively collected data of patients aged 17 and older who were registered to database of our Hematology Department as acute lymphocytic leukemia between the years 2003-2016. Demographic data,chemotherapy protocols,side effects due to chemotherapy,disease free survivals (DFS) and overall survivals(OS) of remaining 101 patients were compared. The mean age of the patients was 33.6 +/- 14.5 ages.80% of patients were B-ALL,15% were T-ALL, 5% were in Ph+ ALL phenotype.Coagulopathy was seen more in patients receiving BFM-95 (p= 0.002). There was no significant difference among the protocols except for the coagulopathy. The complete remission rate (CR) was 100% in the BFM-95 protocol group, 70% in the Hyper-CVAD group and 60% in the CALGB receiving group. Three-year OS rate was 89% in patients receiving BFM-95, 41% in patients receiving Hyper-CVAD and 53% in CALGB group (p= 0.022).Since patients receiving BFM-95 are under 40 years of age, in order to be able to evaluate the BFM-95 protocol more clearly, OS is examined separately in patients under 40 years of age and it was found that OS was again significantly high in BFM-95 group (p= 0.014). The BFM-95 protocol has been shown to be well tolerated and to improve survival in adult patients when careful in terms of L-asparaginase and steroid-dependent side effects.

Trombositler kan pıhtılaşmasında rol oynayan küçük kan hücreleridir ve inflamasyonda temel bir rol aldığı bilinmektedir. Ortalama trombosit hacmi (MPV), trombositlerin ortalama büyüklüğünü gösteren kantitatif bir ölçümdür. Trombosit fonksiyonunun ve aktivasyonunun bir göstergesidir. Kordon kanı önemli bir kök hücre kaynağıdır. Hematopoetik kök hücre (HSC), mezenkimal kök hücre (MSC) ve kordon kanı kök hücresi olmak üzere bünyesinde üç farklı tipte kök hücre barındırır. İnsan mezenkimal kök hücreleri kullanılarak yapılan hücresel tedaviler, çoklu terapötik etkilerine dayanılarak çeşitli hastalıkların tedavisi için kapsamlı bir şekilde araştırılmıştır. Kordon kanı bankacılığında ürünleri saklamadan önce hematopoetik potensi ve transplantasyon etkinliğini tahmin etmek için güvenilir ve kolay testlere ihtiyaç vardır. Ortalama trombosit hacminin total çekirdekli hücre (TNC) ve CD34 + hücre sayıları ile ilişkili olduğu bildirilmiştir. Bununla birlikte ortalama trombosit hacmi ile kordon kanı mezenkimal kök hücresi arasında ilişki bulunup bulunmadığı bilinmemektedir. Bu çalışmada kordon kanındaki mezenkimal kök hücre oranı ile ortalama trombosit hacmi arasındaki ilişki değerlendirildi.

Background/aim Takayasu’s arteritis (TA) is a rare, large-vessel vasculitis of unknown etiology, affecting aortic arch, and its main branches. Noninvasive imaging methods are frequently used in diagnosis and follow-up in Takayasu’s arteritis. Studies investigating optimal timing of follow up imaging are rare. This study is aimed to investigate the radiologic changes in vascular involvements of Takayasu’s arteritis patients one year after diagnosis. Materials and methods Database of our Vasculitis Center was analyzed retrospectively and 97 patients were included into the study. Demographic, clinical, radiological, and therapeutic findings of patients were recorded. Patients with follow-up imaging after approximately one year of diagnosis were recruited into further analysis. Radiological changes and the effect of different immunosuppressive agents on vascular involvements were investigated. Results Mean age and disease duration of patients were 43.0 and 9.0 years. The most commonly used imaging methods/modalities for the diagnosis of TA were computer tomography-angiography (CT-Ang) (58.8%), magnetic resonance-angiography (MR-Ang) (29.9%), and doppler ultrasonography (11.3%). Subclavian and common carotid arteries were the most frequently involved vessels. Fifty-three patients underwent follow-up imaging after one year of diagnosis and, in 64% of patients, same imaging method had been used. MR- Ang (62.3%) and CT-Ang (35.9%) were the most preferred follow-up imaging studies. Sixty-eight percent of patients had stable vascular involvement, 28% had progression, and 4% had regression. No difference was found in radiological changes regarding patients with usage of different immunosuppressive agents (P = 0.634). There was no association between the change in serum acute phase reactants and radiological disease activity. Conclusion The most commonly used imaging modality for the diagnosis of TA was CT-Ang, whereas MR-Ang was the most preferred for follow-up. Almost 30% of TA patients in our Vasculitis Center had progression at around one year concordant with previous literature. A follow-up imaging at around one year of treatment seems feasible in management of TA.

Background/aim: Tumour necrosis factor inhibitors and anti-interleukin-6 (anti-IL-6) therapies are increasingly being used in Takayasu’s arteritis (TA) patients who are unresponsive to corticosteroids ± conventional immunosuppressive agents. The aim of this study is to assess the efficacy and safety of anti-IL-6 (tocilizumab) therapy in refractory TA patients in real life. Materials and methods: Fifteen TA patients (86.7% were female) who received at least 3 cycles of tocilizumab therapy were retrospectively assessed by clinical, laboratory, and radiological evaluations before and after tocilizumab therapy. Results: The median (min–max) age of the patients at evaluation was 35 (20–58) years and the median disease duration from diagnosis was 24 (12–168) months. The median (min.–max.) duration of follow-up after tocilizumab was 15 (3–42) months. There was a significant decrease in erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and patient global visual analogue scale (VAS) scores of patients after tocilizumab therapy. The median (min.–max.) ESR was 26 (5–119) vs. 3 (2–49) mm/h, P = 0.02; CRP was 39.8 (2.4–149.0) vs. 7.9 (0–92.9) mg/L, P = 0.017; and patient global VAS was 50 (0–90) vs. 30 (0–60), P = 0.027, respectively. In 8 patients, ESR and CRP levels were in the normal range in the last control. Imaging modality results after tocilizumab were available for 9 patients; 8 patients were radiologically stable and regression was seen in 1 patient. Comparable imaging modality results before and after tocilizumab were available for 5 patients; 4 patients were radiologically stable and regression was seen in 1 patient. Radiological findings were consistent with laboratory responses. Glucocorticoid dosages decreased from a mean dosage of 16.2 (9.1) mg/day at baseline to 7.1 (3.8) mg/day (P = 0.001) at the last follow-up visit. There was no increase in the steroid dosage in any of the patients. All patients tolerated tocilizumab well. Conclusion: Based on retrospective real life data, anti-IL-6 (tocilizumab) appears to be an effective and tolerable treatment option in refractory TA patients.

D vitamini, obezite, kas iskelet sistemi, kronik hastalıklar, böbrek hastalıkları, kanserler (kolon, prostat, meme vb.), kardiyovasküler hastalıklar, metabolik sendrom, otoimmün hastalıklar (multipl skleroz, romatoid artrit vb.) ile ilişkili olduğu bilinmektedir. Son yıllarda yapılan çalışmalarda, D vitaminin cinsellik üzerine de etkisi olduğu belirtilmektedir. D vitamini her iki cinste de cinsel yaşamın yanı sıra üreme fonksiyonunu da etkilemektedir. D vitamini eksikliğinin cinsel yaşamı primer olarak etkilediği gibi, neden olduğu hastalıklar nedeniyle sekonder olarak da etkileyebileceği düşünülmektedir. Bu derleme, D vitaminin cinsellik üzerine etkisinin gözden geçirilmesi amacıyla yapılmıştır. Vitamin D is known to be related with obesity, musculoskeletal, chronic diseases, kidney diseases, cancers (colon, prostate, breast, etc.), cardiovascular diseases, metabolic syndrome, autoimmune diseases (multiple sclerosis, rheumatoid arthritis, etc.). Recent studies indicate that vitamin D also has an effect on sexuality. Vitamin D affects sexual life as well as reproductive function in both sexes. As of vitamin D deficiency affects sexual life as the primary cause is thought to affect as secondary diseases that are due. This review was conducted to review the effect of vitamin D on sexuality.

Amaç: Uzun dönemdeki surviye ve allograft fonksiyonuna etkili olan faktörler her merkezde farklılıklar gösterebilmektedir. Bu nedenle ünitemizden takipli renal allograft biyopsi yapılmış olan hastaların biyopsi sonuçları ve greft sağ kalımları arasındaki ilişkilerin değerlendirilmesi amaçlanmıştır. Yöntemler: 70 hastaya yapılan 94 adet biyopsi retrospektif olarak incelemiştir. Ultrason rehberliğinde tek kullanımlık 16G otomatik iğne ile 2 kore biyopsi alınmıştır. Her biyopsi ışık mikroskopisi ve immunfloresan boyama ile incelenmiştir. Hastalar akut selüler rejeksiyon (ASR), kalsinörin inhibitörü(KNI) toksisitesi, intersitisyel fibrozis tübüler atrofi (IFTA), akut tubüler hasar(ATH) ve greft kaybı gelişenler olarak gruplara ayrılarak alt analizleri yapılmıştır. Bulgular: Toplamda 34(%36,2) biyopsi ile en sık tespit edilen patolojiyi akut selüler rejeksiyon oluşturmaktadır. IFTA, ATH, nüks/de novo glomerülonefrit biyopsi sayıları sırasıyla 21(%22,3), 20(%21,3), 15(%16) olarak bulunmuştur. Akut rejeksiyon öyküsü olanlarda greft sürvisinin daha kısa olduğu tespit edilmiştir (p

Paratüberküloz, Mycobacterium avium subsp. paratuberculosis’in neden olduğu, başlıca sığırları etkileyen kronik seyirli, bulaşıcı ve ölümcül bir hastalıktır. Hastalık uzun dönem bir subklinik evreye sahiptir. Bu evrede etken hasta hayvanlar tarafından sağlıklı hayvanlara bulaştırılabilir. Hastalık süt sığırı işletmelerinde ciddi ekonomik kayıplara yol açar. Yanı sıra, paratüberküloz olası zoonotik karakterde bir hastalık olup, insanlarda gözlenen Crohn’s hastalığının temelinde rol oynayabileceği bildirilmektedir. Türkiye de bu hastalığın varlığı uzun yıllardır bilinmektedir. Sunulan çalışmada ülkemiz süt sığırı yetiştiriciliği açısından önem arz eden Kırklareli yöresinde subklinik paratüberküloz prevalansının belirlenmesi hedeflendi. Antikor tespiti serum örneklerinde ELISA yöntemiyle yapıldı. Çalışma materyalini optimal süt verimine ve canlı ağırlığa sahip, klinik olarak sağlıklı, yaşları 3-4 arasında değişen, 400 multiparoz Holştayn süt sığırı oluşturdu. Çalışma kapsamında, Kırklareli merkez dahil olmak üzere, sekiz farklı ilçede toplam 23 işletmeden randomize örnekleme gerçekleştirildi. Araştırma sonucunda, Kırklareli yöresi süt sığırlarında subklinik paratüberkülozun seroprevalansı %1.5 pozitif, %1.5 şüpheli ve %97 negatif olarak tespit edildi. Paratuberculosis is a contagious, chronic and deadly disease affecting the primary cattle produced by Mycobacterium avium subsp. Paratuberculosis. It has a long-term subclinical phase. In this period, the disease can be transmitted to healthy animals by the patients. It raises important economical losses in dairy cattle farms. It is also reported that paratuberculosis is zoonotic and plays a key role in Crohn's disease observed in humans.The condition of the disease in Turkey has been known for many years. Purpose of this study was to define the prevalence of subclinical paratuberculosis in Kırklareli region which is important in terms of milk cattle breeding. Antibody detection was done by ELISA in serum samples. The research animal material consisted of 400 multiparous Holstein dairy cattle with optimal milk yield and live weight, clinically healthy, aged 3-4 years. Within the scope of the study, a total of 23 farms were randomly sampled in eight different districts, including the Kırklareli center. As a result of the present study, the seroprevalence of subclinical paratuberculosis was 1.5% positive, 1.5% suspected and 97% negative in Kırklareli region in dairy cattle.

Purpose: Tamoxifen remains an important hormonal therapy for ER-positive breast cancer; however, development of resistance is a major obstacle in clinics. Here, we aimed to identify novel mechanisms of tamoxifen resistance and provide actionable drug targets overcoming resistance. Experimental Design: Whole-transcriptome sequencing, downstream pathway analysis, and drug repositioning approaches were used to identify novel modulators [here: phosphodiesterase 4D (PDE4D)] of tamoxifen resistance. Clinical data involving tamoxifen-treated patients with ER-positive breast cancer were used to assess the impact of PDE4D in tamoxifen resistance. Tamoxifen sensitization role of PDE4D was tested in vitro and in vivo. Cytobiology, biochemistry, and functional genomics tools were used to elucidate the mechanisms of PDE4D-mediated tamoxifen resistance. Results: PDE4D, which hydrolyzes cyclic AMP (cAMP), was significantly overexpressed in both MCF-7 and T47D tamoxifen-resistant (TamR) cells. Higher PDE4D expression predicted worse survival in tamoxifen-treated patients with breast cancer (n = 469, P = 0.0036 for DMFS; n = 561, P = 0.0229 for RFS) and remained an independent prognostic factor for RFS in multivariate analysis (n = 132, P = 0.049). Inhibition of PDE4D by either siRNAs or pharmacologic inhibitors (dipyridamole and Gebr-7b) restored tamoxifen sensitivity. Sensitization to tamoxifen is achieved via cAMP-mediated induction of unfolded protein response/ER stress pathway leading to activation of p38/JNK signaling and apoptosis. Remarkably, acetylsalicylic acid (aspirin) was predicted to be a tamoxifen sensitizer using a drug repositioning approach and was shown to reverse resistance by targeting PDE4D/cAMP/ER stress axis. Finally, combining PDE4D inhibitors and tamoxifen suppressed tumor growth better than individual groups in vivo. Conclusions: PDE4D plays a pivotal role in acquired tamoxifen resistance via blocking cAMP/ER stress/p38-JNK signaling and apoptosis. Clin Cancer Res; 24(8); 1987–2001. ©2018 AACR.

Tyrosine kinase inhibitors (TKIs) have a good efficacy profile in treatment of cancers but also have a potential risk for drug interactions and adverse effects. The aim of this study was to identify and evaluate drug-drug interactions and adverse effects related to TKIs in patients by the involvement of a clinical pharmacist within an outpatient setting. This study was conducted at an outpatient clinic of the University Oncology Hospital between October 2015 and April 2016. The patients on TKIs treatment were included and monitored during 3 months by a clinical pharmacist. The severity and a clinical significance of drug interactions were assessed by using different information resources. An occurrence of adverse effects in patients was evaluated in the first and the second visits. Fifty-five patients were included in the study. A total of 92 drug interactions were identified, of those 54 (58.69%) were assessed as a clinically significant. Among clinically significant drug interactions, a pharmacist recommended treatment modifications for 18 drug interactions, all were accepted by doctors and necessary modifications were implemented. Adverse effects (n = 32) were identified in 55 patients during the 3 months where a pharmacist made 32 recommendations, of which 29 (91%) were accepted by doctors. Statistically significant decrease was found in the number of occurred gastrointestinal disorders (p = 0.001) and fatigue (p = 0.021) between the first and the second visits. Close monitoring of patients by clinical pharmacists whom are integrated into the outpatient settings may further contribute to the health outcomes in collaboration with a multidisciplinary team in oncology.

WOS: 000429393100017, PubMed ID: 29503112, Background: We evaluated the immunogenicity and safety of 1 and 2 doses of quadrivalent meningococcal serogroup A, C, W and Y tetanus toxoid-conjugate vaccine (MenACWY-IT) given alone or co administered with 13-valent pneumococcal conjugate vaccine (PCV13) in toddlers. Methods: In this phase III, open-label, controlled, multicentre study (NCT01939158), healthy toddlers aged 12-14 months were randomised into 4 groups to receive 1 dose of MenACWY-TT at month (M) 0 (ACWY_1), 2 doses of MenACWY-TT at MO and M2 (ACWY_2), MenACWY-TT and PCV13 at MO (Co-ad), or PCV13 at MO and MenACWY-TT at M2 (PCV13/ACWY). Immune responses were assessed 1 month post-each vaccination. Solicited and unsolicited symptoms were recorded for 4 and 31 days post-each vaccination, respectively; serious adverse events (SAEs) and new onset of chronic illnesses (NOCIs) up to M9 from first vaccination. Results: 802 toddlers were vaccinated. Post-dose 1 of MenACWY-TT, >= 92.8% of toddlers had rSBA titres >= 1:8, and >= 62.5% had hSBA titres >= 1:4 for each meningococcal serogroup. Post-dose 2 of MenACWY-TT, rSBA titres >= 1:8 were observed in >= 98.0% and hSBA titres >= 1:4 in >= 95.3% of toddlers. Percentages of toddlers with hSBA titres >= 1:4 were higher after 2 doses versus 1 dose of MenACWY-TT for MenW (97.1% versus 62.5-68.9%) and MenY (95.3% versus 64.3-67.6%). Non-inferiority of immune responses to co-administered MenACWY-TT and PCV13 over their separate administration was demonstrated. AEs incidence was comparable among groups. SAEs were reported for 4.9%, 5.1%, 5.5% and 7.5%, and NOCIs for 2.0%, 3.0%, 0.5% and 3.5% of toddlers in the ACWY_1, ACWY_2, Co-ad and PCV13/ACWY groups, respectively; 4 SAEs reported in 3 toddlers were vaccine-related. Two fatal vaccine-unrelated SAEs were reported. Conclusion: MenACWY-TT was immunogenic when administered as a single dose at 12-14 months of age. A second dose in toddlers increased hSBA responses against MenW and MenY. MenACWY-TT and PCV13 can be co-administered without impairing the immunogenicity or safety profile of either vaccine. (C) 2018 GlaxoSmithKline Biologicals SA. Published by Elsevier Ltd., GlaxoSmithKline Biologicals SAGlaxoSmithKline, GlaxoSmithKline Biologicals SA was the funding source and was involved in all stages of the study conduct and analysis as well as the development of the manuscript and its approval for submission. GlaxoSmithKline Biologicals SA also took in charge all costs associated to the development and publishing of the present manuscript.

Introduction: Femoral fracture is associated with high geriatric mortality. Frailty is the increased vulnerability to stressors resulting from aging-associated decreases in physiological reserve. We aimed to predict 30-365-day postoperative mortality and morbidity rates using modified frailty index and perioperative characteristics in geriatric femoral fractures. Materials and Method: Using a prospective observational design, data were collected from patients >65 years undergoing femoral fracture surgery from 13 different hospitals in 2016 and 2017. Post-discharge follow-up periods were 30, 90, 180, and 365 days. Age, sex, modified frailty index and anaesthesia types used during surgery were recorded. Renal markers, troponin I and haemoglobin levels were examined preoperatively and postoperatively at 24 and 72 hours. Results: We included 392 patients in this study. The age of the patients were between 65 and 101 (mean, 79 +/- 11.9). Median modified frailty index was 5 (interquartile range, 2-7). Increase in modified frailty index increased mortality rate. Mortality rate at postoperative 30 days was 9.8%, while overall study mortality rate was 23%. Spinal anaesthesia was administered in 205 patients (52.3%, most frequent), followed by general in 110 (28.1%), peripheral nerve blocks in 21 (5.4) and spinal-epidural in 43 (11%). Anaesthesia type affected both intensive care unit (p

Although outbreaks of Neisseria meningitidis serogroup X occured in a couple of African countries, a limited number of serogroup X meningococcal cases were reported in America and Europe as well as Turkey. Additionally, serogroup X is still not represented in current conjugated meningococcal vaccines. Here, we describe the first pediatric case with meningitis caused by Neisseria meningitidis serogroup X ST-5799 (ST-22 complex) that formed a distinct lineage.

Acanthamoeba is a free-living amoeba which can be isolated from environment and among others well known as an opportunist protozoan parasite causing infections in humans and animals. Eyes are extremely important for the wild birds and losing sight ability due to Acanthamoeba can be dangerous. The studies on Acanthamoeba infection in wild birds is very few in world and Turkey therefore we aimed to screen deceased wild birds found in Izmir and Manisa provinces located in western Turkey using PCR and non-nutrition agar (NNA) plate method. Cornea samples were obtained from 18 deceased wild birds. During the external examination, signs of keratitis were observed in two Eurasian sparrowhawks (Accipiter nisus). All of the corneal samples were analyzed by two PCR methods and NNA plate. According to results, the Acanthamoeba positivity in corneal samples was 16.6% and 5.5% by PCR and plate method, respectively. According to sequencing data, two of isolates belonged to genotype T5 and one was genotype T4. In conclusion, Acanthamoeba infection was detected in wild bird cornea samples with/without keratitis for the first time in the world. The result of this study also show that Acanthamoeba can be a cause of keratitis in wild birds of Turkey and thus these predator birds can be a target of other wild animals due to loss of sight ability. In terms of public health, these results show the importance of wild birds as a source of Acanthamoeba infection in nature. Ege Üniversitesi - 2014-TIP-073

AMAÇ: Hemodiyaliz hastalarında kronik bir metabolik asidoz eğilimi söz konusudur. Yüksek olgu sayılı çalışmalarda diyaliz öncesi serum bikarbonat konsantrasyonu ile mortalite arasında ilişki saptanmıştır. Çalışmamızda 32 ve 36 mmol/L bikarbonat içerikli diyaliz solüsyonu kullanımının asidoz kontrolüne etkisi araştırıldı.GErEÇ ve YÖnTEMLEr: Bir merkezde haftada üç kez hemodiyalize giren 91 (43E,48K) hastaya ilk altı ay 32 mmol/L diyalizat, ikinci altı ayda aynı hastalara 36 mmol/L bikarbonat diyalizat kullanılmaya başlandı ve diyaliz öncesi ve sonrası plazma bikarbonat düzeyleri karşılaştırıldı. BULGULAr: İlk altı ayda ortalama bikarbonat düzeyi 20,552,55 mmol/L olup sadece 30 hastada bikarbonat düzeyi 22 mmol/L ve üzerindeydi. İkinci altı aylık dönemde ise ortalama bikarbonat düzeyi 23,593,3 mmol/L olup hedef düzeylerdeydi. Ancak 19 hastada diyaliz sonu ortalama bikarbonat düzeyi 30 mmol/L'nin üzerinde bulundu. Prediyaliz asidozu olan hastaların ortalama interdiyalitik kilo artışı 2,80,5 kg olup, asidozu olmayan gruptan daha yüksekti (p0,05). Prediyaliz üre, Kt/V, albumin, potasyum ve CRP düzeyleri bakımından iki periyot arasında anlamlı farklılık yoktu. SOnUÇ: 36 mmol/L bikarbonat içeren diyaliz solüsyonu kullanımı ile asidoz kontrolü daha iyi yapılmakta ancak hastaların yaklaşık yüzde yirmisinde diyaliz sonunda ciddi metabolik alkaloz gelişmektedir. Bu durum aritmiyi tetikleyebilir. Bu nedenle aritmisi olan veya metabolik alkaloza eğilimi olan hastalarda yüksek bikarbonatlı solüsyon kullanımında bikarbonat içeriğinin ayarlanmasının gerektiğini düşünmekteyiz., OBJECTIVE: In hemodialysis patients; there is a continuing tendency to metabolic acidosis. In studies, the relationship between serum bicarbonate concentration and dialysis mortality has been determined. In our study, the effect of 32 and 36 mmol/L bicarbonate-containing dialysis solution on acidosis control was investigated. MATErıAL and METHODS: In a hemodialysis clinic, a 32 mmol/L bicarbonate-containing dialysate was used in the first six months and a 36 mmol/L bicarbonate-containing dialysate was used in the second six months. The study was performed on 91 (43M/48F) patients. Plasma bicarbonate levels before and after dialysis were compared. rESULTS: In the first period, only 30 patients' bicarbonate levels were 22 mmol/L or more. In the second period, the mean bicarbonate level was 23.59±3.3 mmol/L. However, the level of bicarbonate after dialysis was above 30 mmol/L in 19 patients. In patients with predialysis acidosis, the interdialytic mean weight gain was higher than in the group without acidosis (p>0.05). There were no significant differences between the two periods in terms of predialysis urea, Kt/V, albumin, potassium and CRP levels.CONClUSION: Acidosis control is better with the use of a dialysis solution containing 36 mmol/L bicarbonate. But at the end of dialysis, severe metabolic alkalosis developed on approximately twenty percent of patients. This situation can trigger arrhythmia. We therefore think that it is necessary to adjust the machine bicarbonate in the use of high bicarbonate solution in patients with arrhythmia or alkalosis tendency.

The objective of this study was to use the Tandem Mass Tag (TMT) isobaric label-based proteomic approach, in order to identify new potential biomarkers for the treatment monitoring of canine leishmaniosis that could not be identified by the use of gel-based techniques. For this purpose serum samples were obtained from 5 clinically diseased dogs before and one month after the treatment of canine leishmaniosis. The non-depleted serum samples were subjected to reduction, alkylation and trypsin digestion, and the resulting peptides were labeled using 6-plex TMT reagents. To obtain information about protein identities and relative quantification, liquid chromatography-MS analysis of multiplexed TMT-labeled peptides was employed. This gel-free, label-based quantitative proteomic approach enabled identification of 117 canine proteins. Among these, 23 showed significant difference (p < 0.05) in expression (two downregulated and 21 upregulated ranging from 1.25 to 2.5 fold change). Comparison of gel-free TMT-based quantification and a gel-based approach previously applied to the same samples resulted in the identification of some common markers (Apo-A1, vitamin D binding protein and RBP4). However, 20 additional differentially represented proteins were highlighted by the gel-free approach, 13 of which have not been previously reported in canine leishmaniosis. In conclusion, the TMT-based proteomic approach allowed identification of new serum proteins that significantly change in concentration after canine leishmaniosis treatment. These proteins are involved in various physiopathological processes such as inflammatory, coagulation or defense mechanisms, and could potentially be suitable biomarkers for treatment monitoring of this parasitic disease. Fundacion Seneca - 19894/GERM/15 ERA Chair initiative (VetMedZg) - 621394 Robles Chillida foundation European Commission European Commission Joint Research Centre

Background. There is little information about the efficacy of active alternative drugs to carbapenems except beta-lactam/beta-lactamase inhibitors for the treatment of bloodstream infections (BSIs) due to extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E). The objective of this study was to assess the outcomes of patients with BSI due to ESBL-E who received empiric therapy with such drugs (other active drugs [OADs]) or carbapenems. Methods. A multinational retrospective cohort study of patients with BSI due to ESBL-E who received empiric treatment with OADs or carbapenems was performed. Cox regression including a propensity score for receiving OADs was performed to analyze 30-day all-cause mortality as main outcome. Clinical failure and length of stay were also analyzed. Results. Overall, 335 patients were included; 249 received empiric carbapenems and 86 OADs. The most frequent OADs were aminoglycosides (43 patients) and fluoroquinolones (20 patients). Empiric therapy with OADs was not associated with mortality (hazard ratio [HR], 0.75; 95% confidence interval [CI],.38-1.48) in the Cox regression analysis. Propensity score-matched pairs, subgroups, and sensitivity analyses did not show different trends; specifically, the adjusted HR for aminoglycosides was 1.05 (95% CI,.51-2.16). OADs were neither associated with 14-day clinical failure (adjusted odds ratio, 0.62; 95% CI,.29-1.36) nor length of hospital stay. Conclusions. We were unable to show that empiric treatment with OAD was associated with a worse outcome compared with carbapenems. This information allows more options to be considered for empiric therapy, at least for some patients, depending on local susceptibility patterns of ESBL-E.

Objective:Despite national guidelines recommending early concurrent palliative care for individuals newly diagnosed with metastatic cancer, few community cancer centers, especially those in underserved rural areas do so. We are implementing an early concurrent palliative care model, ENABLE (Educate, Nurture, Advise, Before Life Ends) in four, rural-serving community cancer centers. Our objective was to develop a “toolkit” to assist community cancer centers that wish to integrate early palliative care for patients with newly diagnosed advanced cancer and their family caregivers.Method:Guided by the RE-AIM (Reach, Effectiveness–Adoption, Implementation, Maintenance) framework, we undertook an instrument-development process based on the literature, expert and site stakeholder review and feedback, and pilot testing during site visits.Results:We developed four instruments to measure ENABLE implementation: (1) the ENABLE RE-AIM Self-Assessment Tool to assess reach, adoption, implementation, and maintenance; (2) the ENABLE General Organizational Index to assess institutional implementation; (3) an Implementation Costs Tool; and (4) an Oncology Clinicians' Perceptions of Early Concurrent Oncology Palliative Care survey.Significance of results:We developed four measures to determine early palliative care implementation. These measures have been pilot-tested, and will be integrated into a comprehensive “toolkit” to assist community cancer centers to measure implementation outcomes. We describe the lessons learned and recommend strategies for promoting long-term program sustainability.

The knowledge about the viral etiologies causing respiratory disease in adults is limited. Viral respiratory diseases may lead deterioration in certain patient populations. The aim of this study was to determine the viral etiologies of influenza-like illness among patients requiring hospitalization and to document the risk factors for mortality. This prospective study was performed in one of the 7 centers in Turkey in the context of influenza surveillance by the Global Influenza Hospital Surveillance Network. A 35-bed Adult Emergency Service and 10-bed Acute Care Unit were screened for consequent recruitment of eligible patients daily, on weekdays only. ICD-10 codes in the electronic health records and direct patient encounters were used to screen for the following eligibility diagnoses: acute respiratory tract infection, asthma, heart failure, pneumonia, influenza, chronic obstructive lung disease, dyspnea/respiratory abnormality, respiratory symptoms, cough and fever. A total of 334 patients who were admitted with the eligible ICD-10 codes within the 24th and 48th hours were screened during the study period and of those eligible ones, 106 consented and were swabbed. Nasal or nasopharyngeal swabs were collected using Virocult (Medical Wire & Equipment, UK) and sent to the central laboratory in 1-3 days. Swabs were collected and specimens were introduced to real-time polymerase chain reaction based multiplex kits, as well as, ABI 7500 platform with CDC primers and probes. A total of 106 patients were swabbed. Hospital mortality was 12.2%. More than one fourth of the patients needed a sort of mechanical ventilation support and at least one organ failure developed in one third of the patients. One or more viral pathogens were detected in 56 (52.8%) of the swabbed patients, with influenza H3N2 being the most prevalent one. Having a lower body mass index (OR, 0.845, p= 0.034) was associated with mortality. Chronic lung diseases were shown to confer a survival advantage (OR, 0.127, p= 0.009). Community acquired viral respiratory infections might lead to significant compromise in adult patients. Prevention of malnutrition might result in better outcomes in patients who need acute admission. The survival advantage of those with chronic lung diseases warrants further investigation.

WOS: 000408336600027, PubMed: 29156867, Background/aim: The aim of this study was to evaluate the reliability and validity of the Turkish version of the Vulnerability to Abuse Screening Scale (VASS). Materials and methods: This was a methodological study. The sample included 140 elderly individuals. Data were collected by using a questionnaire form, the VASS, and the Geriatric Depression Scale (GDS). The Cronbach alpha value was calculated and test-retest reliability was tested for the reliability analyses. Results: The Cronbach alpha value calculated for the VASS (12 items) was 0.819. There was no difference between test and retest mean scores of the VASS. A statistically significantly positive and strong relationship was found between the test and retest scores of the individuals. A statistically significantly positive and moderate relationship was found between the VASS and GDS scores. Factor analysis revealed that a total of four factors accounted for 63.66% of the total variance with an eigenvalue of >1. These results show that the Turkish version of the VASS is a valid and reliable scale. Conclusion: This study showed that the adoption of the translated VASS in Turkey is reliable and valid to evaluate the risk of abuse in adults over the age of 65.

This paper represents an international collaboration of paediatric endocrine and other societies (listed in the Appendix) under the International Consortium of Paediatric Endocrinology (ICPE) aiming to improve worldwide care of adolescent girls with polycystic ovary syndrome (PCOS)1. The manuscript examines pathophysiology and guidelines for the diagnosis and management of PCOS during adolescence. The complex pathophysiology of PCOS involves the interaction of genetic and epigenetic changes, primary ovarian abnormalities, neuroendocrine alterations, and endocrine and metabolic modifiers such as anti-Müllerian hormone, hyperinsulinemia, insulin resistance, adiposity, and adiponectin levels. Appropriate diagnosis of adolescent PCOS should include adequate and careful evaluation of symptoms, such as hirsutism, severe acne, and menstrual irregularities 2 years beyond menarche, and elevated androgen levels. Polycystic ovarian morphology on ultrasound without hyperandrogenism or menstrual irregularities should not be used to diagnose adolescent PCOS. Hyperinsulinemia, insulin resistance, and obesity may be present in adolescents with PCOS, but are not considered to be diagnostic criteria. Treatment of adolescent PCOS should include lifestyle intervention, local therapies, and medications. Insulin sensitizers like metformin and oral contraceptive pills provide short-term benefits on PCOS symptoms. There are limited data on anti-androgens and combined therapies showing additive/synergistic actions for adolescents. Reproductive aspects and transition should be taken into account when managing adolescents.

Objective: The aim of this study was to compare the efficacy and safety of 2-week levofloxacin-containing triple therapy, levofloxacin-containing bismuth quadruple therapy, and standard bismuth-containing quadruple therapy as a first-line regimen for the eradication of Helicobacter pylori.Methods: A total of 329 patients with H. pylori infection were randomly divided into 3 groups to receive one of the following regimens: (a) levofloxacin-containing bismuth quadruple therapy, RBAL (rabeprazole 20 mg, b.i.d., bismuth subsalicylate 562 mg, b.i.d., amoxicillin 1 g, b.i.d, levofloxacin 500 mg, once daily), (b) standard bismuth quadruple therapy, RBMT (rabeprazole 20 mg, b.i.d, subsalicylate 562 mg, b.i.d., metronidazole 500 mg, t.i.d, tetracycline 500 mg, q.i.d), or (c) levofloxacin-containing triple therapy, RAL (rabeprazole 20 mg, b.i.d., amoxicillin 1 g, b.i.d, levofloxacin 500 mg, once daily). The primary outcome was the eradication rate in the intention-to-treat (ITT) and per protocol (PP) analysis. Results: The eradication rates of the above 3 groups using ITT analysis were RBAL 83.8%, RBMT 88.3%, and RAL 74.8% compared with 91.2, 92.5, and 79.2%, respectively, using PP analysis. The eradication rate using RBMT was significantly higher than that of RAL (p = 0.029 in ITT analysis and p = 0.017 in PP analysis). Several side effects occurred in 156 patients (54.1%) in the RBAL group, 215 (52.3%) in the RBMT group, and 56 (26.2%) in the RAL group (p > 0.05, RBAL vs. RBMT; p < 0.001, RBMT vs. RAL; p < 0.001, RBAL vs. RAL). Conclusion: All bismuth-containing quadruple therapies had acceptable eradication rates, but levofloxacin-containing triple therapy was not as good as quadruple therapies. Hence, quadruple therapies should be considered the preferred first-line therapy for H. pylori infections.