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Cardiopulmonary arrest is an occasional occurrence during pregnancy. As soon as maternal arrest is noticed in a woman in the second half of her pregnancy, medical teams should be called for perimortem cesarean (C/S). A 31–week-pregnant female patient was brought to our emergency department by the emergency medical service team with cardiopulmonary resuscitation (CPR) after a traffic accident. The patient, with no pulse or spontaneous breathing, was recognized as exitus. However, CPR was sustained to maintain fetal well-being. Before the arrival of the on-call gynecologist, we as emergency physicians initiated C/S both for fetal well-being and to avoid heighten-ing the risk of fetal mortality and morbidity. The Apgar scores were 0/3/4 and oxygen saturation values were 35/65/75% at 1/5/10 min, respectively. On the postnatal 11th day, the patient did not respond despite the advanced cardiac life support (ACLS) and thus was considered exitus.The ACLS team should be knowledgeable and well-equipped to perform C/S, to do aftercare, to watch for related risks in the infant. In our case, it took 40 min for the fetus to be removed from the mother’s womb, starting from the estimated time of exitus. © 2023, Turkish Association of Trauma and Emergency Surgery. All rights reserved.

A cardiac outpouching (CO) is a protrusion in a heart chamber’s internal anatomical lining. Most COs are clinically insignificant, but some are of vital importance, requiring immediate surgery. Cross-sectional imaging findings of COs, such as location, morphology, size, and accompanying wall motion abnormalities, play an esŞential role in determining the correct diagnosis and appropriate clinical management. Therefore, radiologists should be familiar with them. This article reviews the key cross-sectional imaging findings and differential diagnoses of COs. © 2023, Turkish Society of Radiology. All rights reserved.

Immune cell-type composition changes with age, potentially weakening the response to infectious diseases. Profiling epigenetics marks of immune cells can help us understand the relationship with disease severity. We therefore leveraged a targeted DNA methylation method to study the differences in a cohort of pneumonia patients (both COVID-19 positive and negative) and unaffected individuals from peripheral blood. This approach allowed us to predict the pneumonia diagnosis with high accuracy (AUC = 0.92), and the PCR positivity to the SARS-CoV-2 viral genome with moderate, albeit lower, accuracy (AUC = 0.77). We were also able to predict the severity of pneumonia (PORT score) with an R2 = 0.69. By estimating immune cellular frequency from DNA methylation data, patients under the age of 65 positive to the SARS-CoV-2 genome (as revealed by PCR) showed an increase in T cells, and specifically in CD8+ cells, compared to the negative control group. Conversely, we observed a decreased frequency of neutrophils in the positive compared to the negative group. No significant difference was found in patients over the age of 65. The results suggest that this DNA methylation-based approach can be used as a cost-effective and clinically useful biomarker platform for predicting pneumonias and their severity. © 2022 Informa UK Limited, trading as Taylor & Francis Group.

BACKGROUND: In our previous report on Turkish COVID-19 patients requiring intensive care, the 24 patients in a single ICU were elderly and mortality was high. We extended our analysis to include patients admitted to ten ICUs. OBJECTIVES: Report the demographics, clinical features, imaging findings, comorbidities, and outcomes in COVID-19 patients. DESIGN: Retrospective. SETTING: Intensive care unit. PATIENTS AND METHODS: The study includes patients with clinical and radiological confirmed or laboratory-confirmed COVID-19 infection who were admitted to ten ICUs between 15 March and 30 June 2020. MAIN OUTCOME MEASURES: Clinical outcomes, therapies, and death during hospitalization SAMPLE SIZE: 974, including 571 males (58%). RESULTS: The median age (range) was 72 (21–101) years for patients who died (n=632, 64.9%) and 70 (16–99) years for patients who lived (n=342, 35.2%) ( P P P =.013). Most (n=719, 73.8%) underwent invasive mechanical ventilation therapy. CONCLUSIONS: The majority of patients admitted to the ICU with a diagnosis of COVID-19 require respiratory support. LIMITATIONS: Although the Turkish Ministry of Health made recommendations for the treatment of COVID-19 patients, patient management may not have been identical in all ten units. CONFLICT OF INTEREST: None.

Background. Hereditary bone marrow failure syndromes are a category of biologically different syndromes that can cause cytopenia in at least one hematopoietic cell lineage. Case. We present a 29-week-old male infant who had a low Apgar Score, advanced delivery room resuscitation, widespread petechial rash, and ecchymoses at birth, without any dysmorphic features. Initial laboratory tests revealed bicytopenia (platelet count 7x10 3 /uL, hemoglobin of 3.9 g/dL, neutrophil 2.0x103 /uL) with findings of disseminated intravasculer coagulation (DIC). Imaging studies demonstrated accompanying left-sided congenital pulmonary airway malformation. On the second postnatal week pancytopenia occurred and the bone marrow findings were consistent with congenital amegakaryocytic thrombocytopenia. Further evaluations for differential diagnosis of pancitopenia were performed and the results of congenital viral infections, metabolic and immunologic tests were negative. While supportive treatments were in progress, haploidentical bone marrow transplantation (BMT) was performed from the father at 84th day due to unavailability of HLA-matched relative or nonrelative donor. Whole exome sequencing revealed a novel heterozygous frameshift variation (c.1242dupT [p. Thr538fs]) in exon 8 of the MECOM gene and validated by Sanger sequencing. No variation was detected in the parents genetic analysis. Conclusions. In this report, we present a patient with congenital bone marrow failure successfully treated with haploidentic BMT and describe a novel, de novo pathogenic variant in MECOM gene. © 2022, Turkish National Pediatric Society. All rights reserved.

Acute appendicitis is a rare gastrointestinal condition in neutropenic acute leukemia patients. Urgent surgery as appendectomy in these neutropenic patients is a procedure with risks of morbidity and mortality. We report a rare presentation of a neutropenic acute leukemia patient with acute appendicitis operated urgently without any complications. © 2021 Wolters Kluwer Medknow Publications. All rights reserved.

Aim: To determine the frequency of sinopulmonary infections, detect changes in the respiratory system, and measure functional capacity of the lungs in our patients with humoral immunodeficiency. Material and Methods: Fifty-six patients with humoral immunodeficiency were enrolled in this study. The clinical, laboratory, and radiologic data, and pulmonary function tests of the subjects were evaluated from their file records, retrospectively. Results: The distribution of our patients was as follows: 25 patients had common variable immune deficiency, three patients had X-linked agammaglobulinemia, five patients had hyper immunoglobulin M syndrome, 19 patients had deficiency of immunoglobulin G subset, and four patients had selective immunoglobulin A deficiency. The most common symptom of the patients was chronic cough (n=47, 83.9%). The most common pathologies on high-resolution computed tomography of the chest were atelectasis and bronchiectasis (27.7%). The most common pathology in pulmonary function tests was the presence of moderate obstructive patterns along with restrictive patterns (n=6,12.5%). The FEV 1, FVC, and FEF 25-75 values were significantly lower in patients with common variable immunodeficiency compared with the patients who had IgG subset deficiencies (p=0.001, p=0.01, p=0.01). Among the patients who were treated with intravenous immunoglobulin, the age at the diagnosis of immunodeficiency was higher in patients with bronchiectasis (14.2 +/- 8.4 years) compared with those without bronchiectasis (10.1 +/- 11.4 years) (p=0.04). Conclusion: Clinical findings are not sufficient to monitor the structural and functional changes in the respiratory system, and patients should be evaluated using high-resolution computed tomography of the chest and pulmonary function tests. Amaç: Humoral immün yetmezlik tanılı olgularımızda, sinopulmoner enfeksiyonların sıklığı ve bunların sonucunda solunum sisteminde meydana gelen değişikliklerin saptanması ve fonksiyonel akciğer kapasitelerinin ölçülmesi amaçlanmıştır. Gereç ve Yöntemler: Çalışmaya humoral immün yetmezlik tanılı 56 olgu alındı. Olguların dosya kayıtlarından klinik, laboratuvar, radyolojik görüntüleme bulguları ve solunum fonksiyon testi verileri geriye dönük olarak incelendi. Bulgular: Olguların tanılara göre dağılımı; yaygın değişken immün yetmezlik tanılı 25 olgu, X’e bağlı agamaglobulinemi tanılı üç olgu, Hiper immunoglobulin M sendromu tanılı beş olgu, İgG alt grup eksikliği tanılı 19 olgu ve selektif immunoglobulin A eksikliği tanılı dört olgu şeklindedir. Olguların 37’si (%66,1) erkek 19’u (%33,9) kadın, yaş ortalaması 14,1±10,6 yıldı. Olguların en sık yakınması kronik öksürük idi (n=47, %83,9). Akciğerlerin yüksek çözünürlüklü bilgisayarlı tomografilerinde en sık görülen patoloji atelektazi ve bronşiektaziydi (%27,7). Solunum fonksiyon testlerinde en sık görülen anormallik orta obstrüktif ve orta restriktif patern birlikteliğiydi (n=6,%12,5). Solunum fonksiyon testi bulguları ile radyolojik bulguların her zaman tutarlı olmadığı görüldü. İntravenöz immünglobulin alan olgular arasında yaygın değişken immün yetmezlik tanılı olgularda, immünglobulin G alt grup eksikliği olan olgulara göre solunum fonksiyon testlerinde; FEV 1, FVC ve FEF 25–75 değerlerinin anlamlı düşük olduğu saptandı (p=0,001, p=0,01, p=0,01). İntravenöz immünglobulin tedavisi alan olgularda; bronşiektazisi olanların immün yetmezlik tanı yaşı (14,2±8,4 yıl), olmayanlara (10,1±11,4 yıl) göre anlamlı olarak büyüktü (p=0,04). Çıkarımlar: Klinik bulgular solunum sistemindeki yapısal ve fonksiyonel değişiklikleri izlemek için yeterli değildir ve olgular gereğinde akciğer yüksek çözünürlüklü bilgisayarlı tomografi ve solunum fonksiyon testleri ile değerlendirilmelidir.

BACKGROUND: Supracondylar humerus fractures are the most common form of elbow fracture in children and adolescents. At present, treatment planning is based on the Gartland classification. Reduction and percutaneous pinning are done for Gartland type III fractures. In cases where closed reduction is unsuccessful, the procedure is converted to open reduction. However, there is no consensus on which patients are more likely to require conversion to open reduction. The aim of this study was to investigate the effect of fracture location on the rate of conversion to open reduction and clinical outcomes. METHODS: A total of 112 patients who underwent early surgery for Gartland type III supracondylar humerus fracture between August 2011 and August 2017 were evaluated. The patients’ age, sex, facture location, post-operative loss of reduction, and complications were noted. The fractures were classified according to fracture level relative to isthmus (high level) or at/below the isthmus (low level). Closed reduction was initially preferred. Open reduction with percutaneous pinning was performed, when necessary. Flynn’s criteria were used to evaluate elbow motion after treatment. RESULTS: Mean follow-up time was 39 months (16–62 months). The mean age of the patients was 6.4±2 years (1.4–12 years). Thirty-nine of the patients were female, 73 were male; 32 fractures were in the dominant arm, 80 were in the non-dominant arm. Ninety of the fractures were classified as high level (proximal) and 22 as low level (distal). Patients with low-level fractures were significantly younger (p0.05). CONCLUSION: The Gartland classification provides important guidance for the treatment of supracondylar humerus fractures, but may have limitations. Our results suggest that revising the classification by incorporating fracture location may be more beneficial for pre-operative planning. © 2022, Turkish Association of Trauma and Emergency Surgery. All rights reserved.

[No abstract available]

Background: Although several renal biopsy registry reports have been published worldwide, there are no data on primary glomerular disease trends in Turkey. Methods: Three thousand eight-hundred fifty-eight native kidney biopsy records were assessed in the Turkish Society of Nephrology Primary Glomerulopathy Working Group (TSN-GOLD) Registry. Secondary disease and transplant biopsies were not recorded in the registry. These records were divided into four periods, before 2009, 2009 to 2013, 2013–2017, and 2017–current. Results: A total of 3858 patients (43.6% female, 6.8% elderly) were examined. Nephrotic syndrome was the most common biopsy indication in all periods (58.6%, 53%, 44.1%, 51.6%, respectively). In the whole cohort, IgA nephropathy (IgAN) (25.7%) was the most common PGN with male predominance (62.7%), and IgAN frequency steadily increased through the periods (× 2 = 198, p < 0.001). MGN was the most common nephropathy in the elderly (> 65 years), and there was no trend in this age group. An increasing trend was seen in the frequency of overweight patients (× 2 = 37, p < 0.0001). Although the biopsy rate performed with interventional radiology gradually increased, the mean glomeruli count in the samples did not change over the periods. Conclusions: In Turkey, IgAN is the most common primary glomerulonephritis, and the frequency of this is increasing. © 2022, The Author(s), under exclusive licence to Springer Nature B.V.

Purpose: This study disseminates the diagnosis of COVID-19 emphasizing the importance of imaging tests in medical interpretation and identification of its complications, besides demonstrating the contribution to patient care. Methodology: The study was conducted based on a literature review, in addition to the acquired results of imaging tests from clinical patients at a Public Hospital of the State of Sergipe, Brazil, to point the scoring system in thorax radiography and compare to computed tomography (CT). Results: The imaging tests are not indicated for patients with mild symptoms and suspected COVID-19 infection, except for risk of disease progression, being indicated in the complementary diagnosis of COVID-19 positive patients. Studies show that thorax radiography is more used because it has low cost and easy access. However, its use has limitations due to the low sharpness of the images and impossibility of visualization of some lesions. Computed tomography, on the other hand, can be used as a pulmonary monitoring and evolution test in patients with COVID-19 worsening and/or persistent homeostatic changes. Nevertheless, this test is not indicated for acute cases without aggravating symptoms. Conclusion: The high degree of dissemination of SARS-CoV-2 and the collapse of health systems demonstrated the importance of the science in health. In addition, the importance of laboratory tests in the diagnosis of virus infection and imaging tests in the early diagnosis of SARS-CoV-2 pneumonia has been shown as efficient complementarity in the evolution and clinical interpretation of patients, highlighting the importance of radiography and CT exams. Objetivo: Este estudio disemina el diagnóstico de COVID-19 enfatizando la importancia de los exámenes de imagen en la interpretación y en la identificación de sus complicaciones, además de contribuir para el cuidado del paciente. Metodología: El estudio tuvo base en la literatura y en los resultados de exámenes de imagen de pacientes de un Hospital Público de Sergipe, Brasil, para señalar el sistema de puntuación en radiografía de tórax y comparar con la tomografía computarizada (TC). Resultados: Exámenes de imagen no están indicados para pacientes con síntomas leves y sospecha de infección por COVID-19, excepto con riesgo de progresión de la enfermedad. Por Consiguiente, se indican en el diagnóstico complementario de pacientes COVID-19 positivos. Estudios muestran que utilizan la radiografía de tórax por tener bajo costo y fácil acceso. Pero, su uso presenta limitaciones debido a la baja nitidez de las imágenes e imposibilidad de visualizar algunas lesiones. En contraste, puede utilizar la tomografía computarizada como monitoreo pulmonar y prueba de evolución en pacientes con empeoramiento del COVID-19 y/o alteraciones homeostáticas persistentes. Sin embargo, no está indicada para casos agudos sin síntomas agravantes. Conclusión: El alto grado de diseminación del SARS-CoV-2 y el colapso de los sistemas de salud demuestran la importancia de la ciencia en salud. Además, los exámenes de laboratorio en el diagnóstico de la infección vírica y las imágenes para el diagnóstico precoz de la neumonía por SARS-COV-2 demostró ser complemento eficaz en la evolución e interpretación clínica, destacando la importancia de radiografía y tomografía computarizada. Objetivo: Destacar o diagnóstico de COVID-19 enfatizando a importância dos exames de imagem na interpretação médica e na identificação de suas complicações, além de demonstrar a contribuição para o cuidado do paciente. Metodologia: Estudo baseado em uma revisão da literatura e exames de imagem de pacientes clínicos de um Hospital Público do Estado de Sergipe, Brasil, para apontar o sistema de pontuação em radiografia de tórax e comparar com a tomografia computadorizada (TC). Resultados: Os exames de imagem não são indicados para pacientes com sintomas leves e suspeita de infecção por COVID-19. Portando, eles sendo indicados no diagnóstico complementar de pacientes COVID-19 positivos. Estudos mostram que a radiografia de tórax é mais utilizada por ter baixo custo e fácil acesso. Porém, seu uso apresenta limitações devido à baixa nitidez das imagens e impossibilidade de visualização de algumas lesões. A tomografia computadorizada, por outro lado, pode ser utilizada como monitoramento pulmonar e teste de evolução em pacientes com piora do COVID-19 e / ou alterações homeostáticas persistentes. No entanto, este teste não é indicado para casos agudos sem sintomas agravantes. Conclusão: O alto grau de disseminação do SARS-CoV-2 e o colapso dos sistemas de saúde demonstram a importância da ciência em saúde. Além disso, a importância dos exames laboratoriais no diagnóstico da infecção viral e dos exames de imagem no diagnóstico precoce da pneumonia por SARS-CoV-2 tem se mostrado como uma complementaridade eficaz na evolução e interpretação clínica dos pacientes, destacando-se a importância dos exames de radiografia e tomografia computadorizada.

We report a preterm newborn diagnosed as having congenital cyto-megalovirus infection who developed lung cysts during her clinical follow-up. The lung cysts were shown in chest X-ray, and confirmed by thoracic computed tomography. A few weeks after starting ganciclovir therapy, we observed that the cystic lung changes of the patient were completely improved. No adverse effects of antiviral therapy were ob-served. Based on this presented patient, it should be kept in mind that congenital cytomegalovirus infection may cause lung cysts. © 2020 by Turkish Pediatric Association.

Background In clinical practice, identification of a case of severe asthma exacerbation prompts initiation of corticosteroids. However, not all that wheezes is asthma. Case presentation A 61-year-old man from the Peruvian Amazon presented with progressive dyspnea, abdominal pain, and cough for the past week. His medical history was remarkable for asthma since childhood; he was treated with beta-agonists, ipratropium, and orally administered corticosteroids. On evaluation, he was febrile and ill-appearing. His chest examination revealed diffuse wheezing and bilateral crackles. He was diagnosed as having community-acquired pneumonia and asthma exacerbation and was started on empiric antibiotics, nebulized beta-agonists, and orally administered corticosteroids. His clinical status continued deteriorating and he became critically ill despite broad-spectrum antibiotics and antifungals. Considering the epidemiological background of our patient, bronchoalveolar and fecal samples were obtained to investigate soil-transmitted helminths. Larvae of Strongyloides stercoralis were found in both specimens. Ivermectin was initiated and corticosteroids were discontinued. He experienced remarkable improvement of clinical condition over the next weeks. The literature on this topic was reviewed. Conclusion Cases of severe asthma exacerbation warrant careful evaluation before the initiation of corticosteroids, especially in patients at risk for parasitic infections. A high index of suspicion is critical. Alternative etiologies of respiratory decompensation should be considered in patients who fail to improve with broad-spectrum antibiotics and antifungals.

A two-month-old female kitten suffering from respiratory signs, lethargy, and anorexia for fifteen days was brought to Balikesir University Small Animal Internal Medicine Clinics of Veterinary Faculty. During pulmonary auscultation, stridors in the cranial pulmonary lobes were detected. Laterolateral and ventrodorsal radiographs were obtained. A live larva of Aelurostrongylus abstrusus was also detected in the patient's direct fecal smear. The patient had recovered after treated with suitable antibiotics and anthelmintics. The parasite is determined in young adults or older cats, and it can cause serious infection. It can cause serious radiological findings in the lungs in kittens besides clinical symptoms. In conclusion, a differential diagnosis list in kittens that have dyspnea and serious pulmonary radiological findings must involve A. abstrusus infection., Balıkesir Üniversitesi Veteriner Fakültesi Küçük Hayvan İç Hastalıkları Kliniği'ne Kliniği'ne 15 gündür solunum bulguları, uyuşukluk ve iştahsızlık şikayeti olan iki aylık dişi yavru kedi getirildi. Pulmoner oskültasyon sırasında, kraniyal pulmoner loblarda stridorlar tespit edildi. Hastanın laterolateral ve ventrodorsal radyografileri çekildi. Hastanın direkt dışkı yaymasında da canlı bir Aelurostrongylus abstrusus larvası tespit edildi. Hasta, uygun antibiyotik ve antelmintiklerle tedavi edildikten sonra iyileşti. Genç yetişkinlerde veya yaşlı kedilerde belirlenen parazit ciddi enfeksiyonlara neden olabilir. Ayrıca kedilerde klinik semptomların yanı sıra akciğerlerde ciddi radyolojik bulgulara neden olabilir. Sonuç olarak, nefes darlığı ve akciğerlerinde ciddi radyolojik bulguları olan yavru kedilerde ayırıcı tanı listesi A. abstrusus enfeksiyonunu içermelidir.

BackgroundCongenital heart disease (CHD) is a well-known co-occurring condition in Down syndrome (DS). We aimed to review the literature to evaluate the current evidence to address key questions.MethodsA series of key questions were formulated a priori to inform the search strategy and review process. These addressed the topics of prevalence, type of CHD, severity, and screening. Using the National Library of Medicine database, PubMed, detailed literature searches were performed. The quality of available evidence was then evaluated, the existing literature was summarized, and knowledge gaps were identified.ResultsFifty-six relevant original articles were identified which addressed at least one key question. Study details, including: research design, internal validity, external validity, and relevant results are presented. The total prevalence of CHD reported in DS ranged from 20 to 57.9%. In later decades, the prevalence remained constant at 40—55%. The types and classification of CHD varied considerably between studies. Some studies indicate a trend towards a milder phenotype, but this was not consistent. Over time, some studies observed an improved prognosis for CHD in DS. Studies investigating screening for CHD by physical examination, chest X-ray, and electrocardiogram report sensitivities of 71–95%.ConclusionTo further improve knowledge on CHD in DS, we suggest that future studies cover a wide range of nations and regions, with a longitudinal design, and account for potential confounding factors.

Maple Syrup Urine Disease is a very rare autosomal recessive inherited disease that results from the defect in the catalytic activity of the alpha ketoacid dehydrogenase enzyme complex. The deficiency in the catabolism of branched chain amino acids naturally results in the accumulation of these amino acids (leucine, isoleucine and valine) and toxic metabolic end products in human blood and urine. In this study, the importance in early diagnosis of cranial DWI imaging and MR spectroscopy and evaluation of treatment efficacy in a newborn who was referred to the emergency room with ketoacidotic coma was reported. © 2021, Medcom Limited. All rights reserved.

The immense spread of coronavirus disease 2019 (COVID-19) has left healthcare systems incapable to diagnose and test patients at the required rate. Given the effects of COVID-19 on pulmonary tissues, chest radiographic imaging has become a necessity for screening and monitoring the disease. Numerous studies have proposed Deep Learning approaches for the automatic diagnosis of COVID-19. Although these methods achieved outstanding performance in detection, they have used limited chest X-ray (CXR) repositories for evaluation, usually with a few hundred COVID-19 CXR images only. Thus, such data scarcity prevents reliable evaluation of Deep Learning models with the potential of overfitting. In addition, most studies showed no or limited capability in infection localization and severity grading of COVID-19 pneumonia. In this study, we address this urgent need by proposing a systematic and unified approach for lung segmentation and COVID-19 localization with infection quantification from CXR images. To accomplish this, we have constructed the largest benchmark dataset with 33,920 CXR images, including 11,956 COVID-19 samples, where the annotation of ground-truth lung segmentation masks is performed on CXRs by an elegant human-machine collaborative approach. An extensive set of experiments was performed using the state-of-the-art segmentation networks, U-Net, U-Net++, and Feature Pyramid Networks (FPN). The developed network, after an iterative process, reached a superior performance for lung region segmentation with Intersection over Union (IoU) of 96.11% and Dice Similarity Coefficient (DSC) of 97.99%. Furthermore, COVID-19 infections of various shapes and types were reliably localized with 83.05% IoU and 88.21% DSC. Finally, the proposed approach has achieved an outstanding COVID-19 detection performance with both sensitivity and specificity values above 99%. Scopus

OBJECTIVE: To evaluate the clinical features and outcomes of patients who were admitted with a diagnosis of coronavirus disease 2019 (COVID-19) but who were not confirmed with polymerase chain reaction (PCR) positivity. MATERIAL AND METHODS: This is a retrospective analysis of all patients admitted to two tertiary care centers between March 15 and May 15, 2020, with a diagnosis of COVID-19. From a common database prepared for COVID-19, we retrieved the relevant data and compared the clinical findings and outcomes of PCR-positive patients with those of PCR-negative cases who had been diagnosed on the basis of typical clinical and radiographic findings. RESULTS: A total of 349 patients were included in the analysis, of which 126 (36.1%) were PCR-negative. PCR-negative patients were younger (54.6 ± 20.8 vs. 60.8 ± 18.9 years, P = .009) but were similar to PCR-positive patients in terms of demographics, comorbidities, and presenting symptoms. They had higher lymphocyte counts (1519 ± 868 vs. 1331 ± 737/mm3, P = .02) and less frequently presented with bilateral radiographic findings (68.3% vs. 79.4%, P = .046) than PCR-positive patients. Besides, they had less severe disease and better clinical outcomes regarding admission to the intensive care unit (9.6% vs. 20.6%, P = .023), oxygen therapy (21.4% vs. 43.5%, P < .001), ventilatory support (3.2% vs. 11.2%, P = .03) and length of hospital stay (5.0 ± 5.0 vs. 9.7 ± 5.9 days, P < .001). CONCLUSION: This study confirms that about one-third of the COVID-19 patients are PCR-negative and diagnosed based on clinicaand radiographic findings. These patients have a more favorable clinical course, shorter hospital stays, and are less frequently admitteto the intensive care unit. © 2021 by Turkish Thoracic Society.

Background Heart failure (HF) is associated with changes in inflammatory and oxidative stress biomarkers. This study aimed to evaluate the changes of a panel of inflammatory and oxidative stress biomarkers in dogs with different stages of HF and its relation with the severity of the disease and echocardiographic changes. A total of 29 dogs with HF as a result of myxomatous mitral valve degeneration or dilated cardiomyopathy were included and classified as stage-A (healthy), B (asymptomatic dogs), C (symptomatic dogs) and D (dogs with end-stage HF) according to the ACVIM staging system. In these dogs an ecnhocardiographic examination was performed and cytokines, and inflammatory and oxidative stress markers were evaluated in serum. Results KC-like was significantly increased in dogs of stage-C (P P P P P Conclusion Our results showed that dogs with advanced HF show increases in positive acute-phase proteins and selected inflammatory cytokines such as KC-like, and decreases in antioxidant biomarkers, indicating that inflammation and oxidative stress act as collaborative partners in the pathogenesis of HF. Some of these biomarkers of inflammation and oxidative stress could have the potential to be biomarkers to monitor the severity of the disease and the effect of treatment.

The recommendation of conducting pulmonary function tests (PFTs) from different societies during and after the coronavirus disease (COVID-19) pandemic was rated by the experts of the Turkish Thoracic Society (TTS) and presented as the TTS experts consensus report. Information about the topic has been provided. Globally, as of mid-May 2020, there have been over 4.4 million confirmed cases of COVID-19. There are two main routes of transmission of COVID-19: respiratory droplets and contact transmission. PFTs are non-invasive tests that are commonly performed in routine assessment and follow-up of patients in the pulmonology units. However, PFTs may generate aerosols and require sharing common surfaces. With regard to the high prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the community, PFTs should not be performed routinely in confirmed or suspected patients with COVID-19 during the pandemic. Because of the risk of human-to-human transmission of COVID-19, PFTs should be restricted to a small patient population with selected indications. Triage for COVID-19 should be performed prior to testing. Only essential PFTs such as spirometry, diffusion capacity of the lungs for carbon monoxide (DLCO), arterial blood gas analysis, or pulse oximetry should be performed in the selected cases. Tests should be scheduled to allow sufficient time for donning and doffing of the technical personnel with the full personal protective equipment (PPE) (gown, a filtering respirator mask, goggles or full-face shield, and disposable gloves), ventilation of the room, and application of post-test cleaning and disinfection procedures of the equipment and the testing room.

The mortality rate for the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is increasing worldwide with each passing day. The risk factors for mortality include advanced age and comorbidities. It is still uncertain whether biological agents pose a risk for the progression of SARS-CoV-2. Although there are studies suggesting the use of biological agents in the literature, there are also studies suggesting the discontinuation of biological agents during SARS-CoV-2. In this study, we aimed to determine whether anti-tumor necrosis factor (anti-TNF-α agents) therapy, which is one of the biological agents commonly used in rheumatology clinics, has an effect on the clinical course of SARS-CoV-2 infection, and to review the literature. We searched the MEDLINE/PubMed and SCOPUS databases until the date of August 15, 2020, using the following keywords: SARS-CoV-2 and anti-TNF-α agents. We reviewed abstracts and retrieved the relevant articles. We reported the clinical manifestation and disease course of SARS-CoV-2 pneumonia in three patients with ankylosing spondylitis who were receiving anti-TNF-α agents. All patients in our case series had a mild course similar to the most cases reported in the literature. © 2020 Indian Journal of Rheumatology | Published by Wolters Kluwer - Medknow.

Background: The prevalence of vertebral fractures (VF) and their association with clinical risk factors and outcomes are poorly documented in chronic kidney disease (CKD) cohorts. The aim of the study was to evaluate the prevalence of VF in patients with non-dialysis dependent CKD (NDD-CKD), their value in predicting mortality and its correlation with parameters of bone mineral metabolism and vascular calci?cation. Materials and Methods: 612 NDD 3-5 stage CKD patients participating in the OSERCE-2 study, a prospective, multicenter, cohort study, were prospectively evaluated and categorized into two groups according to presence or absence of VF at enrollment. VF were assessed with lateral radiographs and Genant semi-quantitative method was applied. Three radiologists specialized in musculoskeletal radiology performed consensual reading of individual images obtained using a Raim DICOM Viewer and a Canon EOS 350 camera to measure with Java Image software in those who had traditional acetate X-ray. Factors related to VF were assessed by logistic regression analysis. Association between VF and death over a 3-year follow-up was assessed by Kaplan-Meier survival curves and Cox-proportional hazard models. Results: VF were detected in 110patients(18%). Serumphosphatelevels(OR0.719,95%CI0.532to0.972,p = 0.032),ankle-brachial index < 0.9 (OR 1.694, 95% CI 1.056-2.717, p = 0.029) and treatment with bisphosphonates (OR 5.636, 95% CI 1.876-16.930, p = 0.002) were independently related to the presence of VF. After a median follow-up of 35 months (IQR: 17-37 months), 62 patients (10%) died. The causes of death were cardiovascular (n = 21, 34%) and infectious (n = 11, 18%). In the crude analysis, fractured patients group had poorer survival (log-rank test, p = 0.02). After multivariate adjustment for age, MDRD, albumin, diabetes mellitus, comorbidity, Adragao Score > 3 and serum phosphate, the presence of VF (HR 1.983, 95% CI 1.009-3.898, p = 0.047) were an independent predictor of all-cause mortality. Conclusions: In our study 18% of patients with NDD-CKD have VF. Factors associated with VF were age, low serum phosphate levels and peripheral vascular disease. The presence of VF was an independent risk factor for mortality in stages 3-5 NDD-CKD patients. Clinical trials are needed to con?rm whether this relationship is causal and reversible with treatment for osteoporosis. © 2020 by the authors. Licensee MDPI, Basel, Switzerland.

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