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Although a period longer than 10 months has passed since the detection of the first cases in and more than 40 million people have been diagnosed with COVID-19 worldwide, there is still no well-accepted and proven treatment choice for the novel coronavirus disease. This study aimed to retrospectively investigate cases in whom treatment had started due to detected as positive during screening and also having shown signs including fever, cough, shortness of breath, excessive malaise, fatigue or loss of smell-taste, without any findings of pneumonia between March 11, 2020, when the first cases were detected in Turkey, and the beginning of May, 2020. A total of 19.276 SARS-CoV-2 PCR positive outpatients, within the first 48 hours of detection and had no findings in lung auscultation or radiology, were detected from the data of Health Information System. 9559 patients were males (49.6%) and 9717 were females (50.4%). An underlying disease considered in the risk group for COVID-19 was found in 1789 of the patients (8.8%). An underlying disease was present in 9.4% using hydroxychloroquine and in 9% not using hydroxychloroquine. 43 deaths (0.2%) were detected among all cases. Mortality in cases using and not using hydroxychloroquine was respectively 5 (in 12.293 cases) and 38 (in 6.983 cases). It was confirmed that pneumonia developed in 2.080 of the patients (10.8%). This number was found as 1286 (10.5%) in cases using HQ and as 794 (11.4%) in cases not using HQ. In conclusion, since this study confirmed that hydroxychloroquine used in outpatients presenting in the early period without any symptoms of pneumonia can ensure survival and prevent pneumonia development particularly in young adults, we may speculate that the early use of hydroxychloroquine in mildly symptomatic patients results in a cost-effective and potent treatment.

Background Alport syndrome (AS) is an inherited glomerular disease caused by mutations in COL4A3, COL4A4, or COL4A5. Associations between clinical manifestations and genotype are not yet well defined. Our study aimed to define clinical and genetic characteristics, establish genotype-phenotype correlations, and determine prognosis of AS in children. Methods A total of 87 children with AS from 10 pediatric nephrology centers, whom had genetic analyses performed at the Hacettepe University Nephrogenetics Laboratory between February 2017 and February 2019, were included. Data regarding demographics, family history, clinical and laboratory characteristics, histopathological and genetic test results, treatments, and yearly follow-up results were retrospectively analyzed. Results Of 87 patients, 16% presented with nephrotic syndrome. In patients with nephrotic syndrome, kidney biopsy findings showed focal segmental glomerulosclerosis (FSGS) in 79%, and COL4A3 mutations were the leading genetic abnormality (50%). Twenty-four percent of all patients progressed to chronic kidney disease (CKD). The rate of progression to CKD and the decline in the glomerular filtration rate of the patients with COL4A3 mutation were higher than other mutation groups (p < 0.001 and p = 0.04, respectively). In kidney survival analysis, nephrotic syndrome presentation, histopathology of FSGS, COL4A3 mutations, and autosomal recessive inheritance were found as independent risk factors for earlier progression to CKD. Cyclosporin A treatment did not improve kidney survival. Conclusions We emphasize that genetic testing is important for patients suspected as having AS. Furthermore, COL4A mutations should be considered in patients with FSGS and steroid-resistant nephrotic syndrome. This approach will shed light on the prognosis of patients and help with definitive diagnosis, preventing unnecessary and potentially harmful medications. C1 [Ozdemir, Gulsah; Gulhan, Bora; Duzova, Ali; Ozaltin, Fatih; Topaloglu, Rezan] Hacettepe Univ, Fac Med, Div Pediat Nephrol, TR-06230 Ankara, Turkey. [Atayar, Emine; Ozaltin, Fatih] Hacettepe Univ, Fac Med, Div Pediat Nephrol, Nephrogenet Lab, Ankara, Turkey. [Saygili, Seha] Istanbul Univ Cerrahpasa, Fac Med, Div Pediat Nephrol, Istanbul, Turkey. [Soylemezoglu, Oguz] Gazi Univ, Fac Med, Div Pediat Nephrol, Ankara, Turkey. [Ozcakar, Zeynep Birsin] Ankara Univ, Fac Med, Div Pediat Nephrol, Ankara, Turkey. [Eroglu, Fehime Kara] Dr Sami Ulus Matern & Childrens Hlth Hosp, Div Pediat Nephrol, Ankara, Turkey. [Candan, Cengiz] Istanbul Medeniyet Univ, Goztepe Training & Res Hosp, Div Pediat Nephrol, Istanbul, Turkey. [Demir, Belde Kasap] Tepecik Training & Res Hosp, Div Pediat Nephrol, Izmir, Turkey. [Soylu, Alper] Dokuz Eylul Univ, Fac Med, Div Pediat Nephrol, Izmir, Turkey. [Yuksel, Selcuk] Pamukkale Univ, Fac Med, Div Pediat Nephrol, Denizli, Turkey. [Alpay, Harika] Marmara Univ, Fac Med, Div Pediat Nephrol, Istanbul, Turkey. [Agbas, Ayse] Haseki Training & Res Hosp, Div Pediat Nephrol, Istanbul, Turkey. [Hayran, Mutlu] Hacettepe Univ, Fac Med, Dept Prevent Oncol, Ankara, Turkey.

Background and objectives Infantile nephropathic cystinosis is a severe disease that occurs due to mutations in the cystinosis gene, and it is characterized by progressive dysfunction of multiple organs; >100 cystinosis gene mutations have been identified in multiple populations. Our study aimed to identify the clinical characteristics and spectrum of cystinosis gene mutations in Turkish pediatric patients with cystinosis. Design, setting, participants, & measurements We identified the clinical characteristics and spectrum of cystinosis gene mutations in Turkish patients with cystinosis in a multicenter registry that was established for data collection. The data were extracted from this registry and analyzed. Results In total, 136 patients (75 men and 61 women) were enrolled in the study. The most common clinical findings were growth retardation, polyuria, and loss of appetite. None of the patients had the 57-kb deletion, but seven novel mutations were identified. The most common mutations identified were c.681G>A (p.G1u227G1u; 31%), c.1015G>A (p.Gly339Arg; 22%), and c.18_21 del (p.Thr7Phefs*7; 14%). These mutations were associated with earlier age of disease onset than the other mutations. To understand the effects of these allelic variants on clinical progression, the mutations were categorized into two major groups (missense versus deletion/duplication/splice site). Although patients with missense mutations had a better eGFR at the last follow-up visit, the difference was not significant. Patients in whom treatment began at age A (p.G1u227G1u), c.1015G>A (p.Gly339Arg), and c.18_21 del (p.Thr7Phefs*7). Patients with less severe cystinosis gene mutations tend to have better kidney outcome.

Background: Adult-onset Still's disease (AOSD) is a rare condition, and treatment choices are frequently dependent on expert opinions. The objectives of the present study were to assess treatment modalities, disease course, and the factors influencing the outcome of patients with AOSD. Methods: A multicenter study was used to reach sufficient patient numbers. The diagnosis of AOSD was based on the Yamaguchi criteria. The data collected included patient age, gender, age at the time of diagnosis, delay time for the diagnosis, typical AOSD rash, arthralgia, arthritis, myalgia, sore throat, lymphadenopathy, hepatomegaly, splenomegaly, pleuritic, pericarditis, and other rare findings. The laboratory findings of the patients were also recorded. The drugs initiated after the establishment of a diagnosis and the induction of remission with the first treatment was recorded. Disease patterns and related factors were also investigated. A multivariate analysis was performed to assess the factors related to remission. Results: The initial data of 356 patients (210 females; 59%) from 19 centers were evaluated. The median age at onset was 32 (16-88) years, and the median follow-up time was 22 months (0-180). Fever (95.8%), arthralgia (94.9%), typical AOSD rash (66.9%), arthritis (64.6%), sore throat (63.5%), and myalgia (52.8%) were the most frequent clinical features. It was found that 254 of the 306 patients (83.0%) displayed remission with the initial treatment, including corticosteroids plus methotrexate with or without other disease-modifying antirheumatic drugs. The multivariate analysis revealed that the male sex, delayed diagnosis of more than 6 months, failure to achieve remission with initial treatment, and arthritis involving wrist/elbow joints were related to the chronic disease course. Conclusion: Induction of remission with initial treatment was achieved in the majority of AOSD patients. Failure to achieve remission with initial treatment as well as a delayed diagnosis implicated a chronic disease course in AOSD. (C) 2016 Elsevier Ltd. All rights reserved.

A repetitive sequence of Mycobacterium tuberculosis DNA was amplified by polymerase chain reaction (PCR), from sputum samples, for the diagnosis of pulmonary tuberculosis. The method of heating the sample in a boiling water bath to break down the bacterial cell wall and to release the DNA was compared with that of enzymatic lysis of bacteria and then phenol-chloroform extraction of DNA. Heating the sample was the better method with a sensitivity of approximately 10 microorganisms. A total of 78 sputum specimens prepared by heating were examined by PCR, and the results were compared with the results of acid-fast stained smears, cultures, and clinical data. M. tuberculosis was detected by PCR in all smear- and culture-positive and smear-negative, culture-positive cases. Additionally, PCR was capable of detecting four of nine cases which were smear and culture negative but clinically suspected of tuberculosis. DNA amplification by PCR is a sensitive and specific method for the diagnosis of tuberculosis, and with this simplified DNA isolation procedure it can be used in routine clinical practice.

WOS: 000269862100389 …

The purpose was to construct a decision model that incorporated patient preferences over differing health state prospects and to analyze the decision context of early stage breast cancer patients in relation to two main surgical treatment options.

There have been studies concerning the protection of the facial nerve during plastic surgery intended for the parotid gland. The close relationship between the parotid duct and the buccal and zygomatic branches of the facial nerve is studied here. The dissections were performed on 10 fixed cadavers at the Anatomy Dissection Laboratory of Ankara University in 2004. The reference points used for surgery of this region were taken into consideration as the landmarks for morphometric measurements. In 7 of the cases the zygomatic branch was double and in 3 it was single. In 4 of the 7 cases with a double zygomatic branch both superior and inferior branches crossed the parotid duct. In the remaining 3 cases the superior branches of the zygomatic nerve coursed through the zygomatic major and minor muscles. In 9 of all the cases the zygomatic branch of the facial nerve crossed the duct anteriorly and in one it did so posteriorly (case 10). The buccal branch was single in 4 of the cases and double in 6. Among these one of the most precise measurements was the distance between the lateral canthus and the intersection point of the zygomatic branch and the duct with a coefficient of variation of 9.9%. With the use of this reliable measurement the intersection point of the zygomatic branch and the duct may be estimated to be within 5.16+/-1.01 centimetres of the lateral canthus. Facial nerve paralysis is the most important complication of superficial face surgery and the anatomy of this region must thus be taken into detailed consideration by surgeons.

A tumor model in the rat was used to study peritoneal tumor growth and abdominal wall metastases after carbon dioxide (CO2) pneumoperitoneum, gasless laparoscopy, and laparotomy.The role of laparoscopic resection of cancer is under debate. Insufflation of the peritoneal cavity with CO2 is believed to be a causative factor in the development of abdominal wall metastases after laparoscopic resection of malignant tumors.In the solid tumor model, a lump of 350-mg CC-531 tumor cells was placed intraperitoneally in rats having CO2 pneumoperitoneum (n = 8), gasless laparoscopy (n = 8), or conventional laparotomy (n = 8). After 20 minutes, the solid tumor was removed through a laparoscopic port or through the laparotomy. In the cell seeding model, 5 x 10(5) CC-531 cells were injected intraperitoneally before CO2 pneumoperitoneum (n = 12), gasless laparoscopy (n = 12), or laparotomy (n = 12). All operative procedures lasted 20 minutes. After 6 weeks, in the solid tumor model and after 4 weeks in the cell seeding model, tumor growth was scored semiquantitatively. All results were analyzed using the analysis of variance.In the solid tumor model, peritoneal tumor growth in the laparotomy group was greater than in the CO2 pneumoperitoneum group (p0.01). Peritoneal tumor growth in the CO2 group was greater than in the gasless group (p0.01). The size of abdominal wall metastases was greater at the port site of extraction of the tumor than at the other port sites (p0.001). In the cell seeding model, peritoneal tumor growth was greater after laparotomy in comparison to CO2 pneumoperitoneum (p0.02). Peritoneal tumor growth in the CO2 group was greater than in the gasless group (p0.01). The port site metastases in the CO2 group were greater than in the gasless group (p0.01).The following conclusions can be made: 1) that direct contact between solid tumor and the port site enhances local tumor growth, 2) that laparoscopy is associated with less intraperitoneal tumor growth than laparotomy, and 3) that insufflation of CO2 promotes tumor growth at the peritoneum and is associated with greater abdominal wall metastases than gasless laparoscopy.