Search

Background: Haematopoietic stem cell transplantation is a curative treatment option for many haematological disorders. Infection following haematopoietic stem cell transplantation is one of the major causes of mortality. Aims: To investigate the outcomes of early cessation of empirical antibiotic treatment per protocol in febrile neutropenia patients who have undergone haematopoietic stem cell transplantation at our clinic. Study Design: Descriptive study. Methods: The present study retrospectively evaluated febrile neutropenia attacks in haematopoietic stem cell transplantation recipients during the period June 2014 - January 2015 at our haematopoietic stem cell transplantation clinic. Results: A total of 72 febrile neutropenia attacks were evaluated in 53 patients. In 46 febrile neutropenia attacks, microbiologic cultures revealed positive results. In culture-positive febrile neutropenia episodes a single bacterium was isolated in 32 cases and multiple strains were isolated in 14. In 15 patients, empirical antibiotic therapy was discontinued after 72 hours. These patients were clinically stable, without evident focus of infection and had negative culture results. Only 4 recurrent episodes were observed (27%) after cessation of antibiotherapy. No patient died as a result of recurrent infection. The 30-day and 100-day post-transplantation mortality rates of patients with febrile neutropenia episodes were 11.3% (6/53) and 3.8% (2/53), respectively. Infection-related 30-day and 100-day mortality rates were 7.5% (4/53) and 0% (0/53), respectively. Conclusion: The main message of our study is that early cessation of empirical antibiotherapy seems to be feasible in eligible patients without increasing febrile neutropenia mortality rates. [ABSTRACT FROM AUTHOR]

Introduction: The febrile convulsion (FC) occurs in neurologically normal children aged between six months and five years and it is defined as convulsions occurred during fever and in the absence of central nervous system (CNS) infection, electrolyte imbalance, diseases affecting directly CNS, and history of afebrile convulsion. The aims of this study were to determine the serum levels of selenium in patients with recurrent FC and to compare them with those of healthy children. Materials and Methods: The study included 61 pediatric patients diagnosed with recurrent FC. At the same session, 54 healthy children who admitted to our pediatric clinic for routine controls without history of fever and convulsion, are assigned as control group. The serum level of selenium was measured by atomic absorption spectrometric method (hydride technique). Results: Mean level of selenium was determined as 67.10±8.87 µg/L in patients and 81.99±13.13 µg/L in control group; the difference was statistically significant (p<0.05). Discussion: The lower serum levels of selenium in patients with recurrent FC may be the cause of triggering of convulsion or may contribute to its recurrence. Further studies are necessary to clarify this relationship. [ABSTRACT FROM AUTHOR]

Introduction: The febrile convulsion (FC) occurs in neurologically normal children aged between six months and five years and it is defined as convulsions occurred during fever and in the absence of central nervous system (CNS) infection, electrolyte imbalance, diseases affecting directly CNS, and history of afebrile convulsion. The aims of this study were to determine the serum levels of selenium in patients with recurrent FC and to compare them with those of healthy children. Materials and Methods: The study included 61 pediatric patients diagnosed with recurrent FC. At the same session, 54 healthy children who admitted to our pediatric clinic for routine controls without history of fever and convulsion, are assigned as control group. The serum level of selenium was measured by atomic absorption spectrometric method (hydride technique). Results: Mean level of selenium was determined as 67.10±8.87 µg/L in patients and 81.99±13.13 µg/L in control group; the difference was statistically significant (p<0.05). Discussion: The lower serum levels of selenium in patients with recurrent FC may be the cause of triggering of convulsion or may contribute to its recurrence. Further studies are necessary to clarify this relationship. [ABSTRACT FROM AUTHOR]

Giriş: Hastane kökenli üriner sistem enfeksiyonu (HKÜSE) en sık görülen hastane kökenli enfeksiyon olup, tüm hastane enfeksiyonlarının %40'ını oluşturmakta, ciddi morbidite ve mortaliteye neden olmaktadır. Bu çalışmada, hastanemiz yoğun bakım ünitelerinde (YBÜ) tespit edilen HKÜSE'lerde etken mikroorganizma dağılımı ve direnç profilini belirlemek amaçlandı. Gereç ve Yöntem: Ocak 2019-Aralık 2023 tarihleri arasında Mersin Üniversitesi Tıp Fakültesi Hastanesi erişkin YBÜ'lerinde hastane enfeksiyon kontrol komitesi tarafından tespit edilen 59 HKÜSE değerlendirildi. Hastaların demografik verileri, etken dağılımı ve direnç profiline hasta dosyası ve hastane bilgi sistemi aracılığıyla ulaşıldı. Bulgular: Değerlendirilen 59 hastanın 26'sı (%44,1) kadın, 33'ü (%55,9) erkekti. Yıl ve cinsiyete göre HKÜSE dağılımı Tablo 1'de gösterilmiştir. Hastaların 26'sı (%44,1) dahili YBÜ, 4'ü (%6,8) cerrahi YBÜ, 30'u (%49,1) anesteziyoloji ve reanimasyon YBÜ'deydi. Etken dağılımına baktığımızda; 18 (%30,5) Acinetobacter baumannii (A. baumannii), 12 (%20,3) Klebsiella pneumoniae (K. pneumoniae), 11 (%18,6) Escherichia coli (E. coli), 6 (%10,2) Enterococcus spp., 3 (%5,1) Pseudomonas aeruginosa (P. aeruginosa), 3 (%5,1) koagülaz-negatif stafilokok, %10.2 Enterobacter cloacae, birer tane de Burkholderia cepacia (%1,7), Candida parapsilosis (%1,7), Providencia (%1,7) ve Staphylococcus aureus (S. aureus) (%1,7) tespit edildi. Karbapenem direnci A. baumannii'nin 17'sinde (%94,4), K. pneumoniae'nin 5'inde (%41,7), P. aeruginosa'nın 1'inde (%33,3) tespit edildi. K. pneumoniae'nin 1'inde (%8,3), E. coli'nin 3'ünde (%27,3) ESBL pozitifliği vardı. E. coli'de karbapenem direnci tespit edilmedi. VRE saptanmadı. Koagülaz-negatif stafilokokların 2'sinde (%66,7) metisilin direnci varken, S. aureus'ta metisilin direnci tespit edilmedi. Sonuç: Literatürden farklı olarak merkezimizde HKÜSE'de en sık A. baumannii, ikinci sıklıkta K. pneumoniae görüldü. Bu sonucun, hastaların ağırlıklı olarak hastane kökenli diğer enfeksiyonlarda da A. baumannii'nin baskın olduğu anestezi YBÜ'den olmasının neden olabileceği düşünüldü. Karbapenem direnci iki mikroorganizmada yüksek çıktı. Her merkezin sağlık bakımı ilişkili enfeksiyonlarda etken dağılımı ve direnç profilini bilmesi, uygun olmayan antibiyotik kullanımını ve buna bağlı direnç gelişimini ve mortaliteyi önleyecektir. [ABSTRACT FROM AUTHOR]

Sydenham's chorea (SC) is common cause of acquired chorea in childhood. SC occurs mainly in children with untreated streptococcal infections. An effective list of therapeutic options has been used to treat this disorder: antiepileptic drugs (valproic acid, carbamazepine etc.), haloperidol, chlorpromazine, amphetamines, steroids, plasma exchange and intravenous immunoglobulins (IVIG). We report a 12-yearold girl with carditis and severely generalized chorea and successfully treated with IVIG. This case report shows that IVIG is an effective treatment for the chorea cases resistant to anticonvulsants, dopamine antagonists and steroids, although larger studies are needed to confirm this conclusion. [ABSTRACT FROM AUTHOR]

Objective: Platelet aggregation tests and the analysis of thromboxane A2 metabolites [serum thromboxane B2 (TXB2) and urine 11-dehydro TXB2] are used to evaluate the efficacy of aspirin. In myeloproliferative neoplasms (MPNs), the immature platelet fraction (IPF) rises due to enhanced platelet turnover, and this has been thought to reduce the efficacy of aspirin. This phenomenon is overcome by the recommendation of aspirin intake in divided doses. We aimed to evaluate aspirin efficacy in patients who were receiving aspirin treatment of 100 mg/day. Materials and Methods: Thirty-eight MPN patients and 30 control patients (non-MPN patients who received a single daily dose of aspirin at 100 mg for nonhematological conditions) were enrolled. IPF, serum TXB2, and urine 11-dehydro TXB2 levels were measured and aggregation tests with arachidonic acid and adenosine diphosphate were performed by light transmission aggregometry (LTA). Results: Mean IPF and TXB2 levels were higher in the MPN group (p=0.008 and p=0.003, respectively). IPF levels were lower in patients on cytoreductive therapy in the MPN group (p=0.001), but these values were similar between patients on hydroxyurea and the non-MPN group (p=0.72). TXB2 levels did not differ according to hydroxyurea treatment status but were higher in the MPN group compared to non-MPN patients (23.63 ng/mL and 19.78 ng/mL, respectively; p=0.04). TXB2 values were higher in patients with essential thrombocythemia and a history of thrombotic events (p=0.031). No difference was observed in LTA between the MPN and non-MPN patient groups (p=0.513). Conclusion: Higher levels of IPF and TXB2 in the MPN patient group indicated platelets that could not be inhibited by aspirin. It was observed that patients under cytoreductive therapy had lower IPF values, but the expected decrease in TXB2 levels was not observed. These findings suggest that a lack of response to aspirin may be due to additional intrinsic factors rather than increased platelet turnover. [ABSTRACT FROM AUTHOR]

Introduction: Pseudohypoparathyroidism (PIIPT) is characterized with end-organ resistance to parathormone (PTH) although normal hormone secretion. It is divided into two groups as Type 1 and Type 2. Furthermore, Type 1 PHPT is subdivided into 3 subgroups as 'a', 'b' and 'c'. Case: A 10-year- old male patient was admitted to our department with numbness and spasm in hands and we have detected hypocalcemia, hyperphosphatemia and increased parathormone levels. Cranial computed tomography revealed patchy calcific areas in phenotypically normal case. Conclusion: We primarily considered the case as having PIIPT Type l b or Type 2 and started active vitamine D and calcium replacement therapies which improved clinical and laboratory findings. [ABSTRACT FROM AUTHOR]

Giriş: Solunum yolu enfeksiyonları, basit üst solunum yolu enfeksiyonundan (ÜSYE) mortal seyreden alt solunum yolu enfeksiyonuna (ASYE) kadar değişik klinik tablolara neden olabilmektedir. Etkenlerin tespiti için büyük ölçüde laboratuvar testlerinden faydalanılmaktadır. Bu çalışmada, ÜSYE ve ASYE'ye neden olan etkenleri tespit etmede solunum yolu panelinin etkinliğinin değerlendirilmesi amaçlandı. Gereç ve Yöntem: Mayıs 2023-Şubat 2024 tarihleri arasında Mersin Üniversitesi Tıp Fakültesi Hastanesi, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Kliniği tarafından ÜSYE ve ASYE ön tanısıyla değerlendirilen 179 hastanın demografik özellikleri, ek hastalıkları ve nazofarengeal sürüntü örneklerinden çalışılan solunum yolu paneli-multipleks RT-PCR sonuçları hasta dosyası ve hastane bilgi sistemi aracılığıyla retrospektif olarak sorgulandı. Bulgular: Çalışmaya alınan 179 hastanın 78'i (%43,6) kadın, 101'i (%56,4) erkekti. Ortalama yaş 48,4±18,3 yıldı. ASYE olan hastaların %32,5'inde (14/43) etken tespit edilirken, ÜSYE olan hastaların %37,5'inde (51/136) etken tespit edildi ve istatistiksel açıdan anlamlı farklılık bulunmadı. Altmış beş yaş ve üstü olma ve cinsiyetin etken pozitiflik oranı ve türleri ile anlamlı ilişkisi yoktu. Altmış beş yaş ve üstü popülasyonda ASYE görülme oranı anlamlı şekilde daha fazlaydı (p=0,043). ÜSYE olan hastalarda viral etkenler, ASYE olan hastalarda bakteriyel etkenler anlamlı şekilde daha fazla tespit edildi (p=0,019). ASYE olan hastalarda sırasıyla Streptococcus pneumoniae (S. pneumoniae) %18,6 (8/43), SARS-CoV-2 %9,3 (4/43), H. influenzae %6,8 (3/43), influenza A %2,3 (1/43), parainfluenza 3 %2,3 (1/43) oranında pozitif bulundu. ÜSYE olan hastalarda ise sırasıyla S. pneumoniae %13,2 (18/136), SARS-CoV-2 %12,5 (17), influenza A %10,3 (14/136), RSV %2,2 (3/136), H. influenzae %2,2 (3/136), influenza A %1,5 (2/136), coronavirus OC43 %0,7, OC 44 %0,7 ve bocavirus %0,7 oranında tespit edildi. ASYE olan hastalarda eşlik eden hastalıklardan DM, KBH ve SVO anlamlı oranda daha yüksek bulundu (p<0,05). Sonuç: Solunum yolu enfeksiyonları, morbidite ve mortalitenin ilk dört nedeni arasında yer almaktadır ve bakteri, virüs, parazitler etken olabilmektedir. Solunum yolu patojenlerinin moleküler yöntemlerle tanımlanmasına yönelik erişkin ve çocuklarda yapılmış farklı çalışmalar mevcuttur. Çalışmamızda en sık görülen bakteriyel etken S. pneumoniae, viral etken ise SARS-CoV-2 olarak tespit edildi. Solunum yolu enfeksiyonlarına neden olan viral ve bakteriyel etkenlerin moleküler yöntemlerle hızlı ve duyarlı bir şekilde tespit edilmesi gereksiz antibiyotik kullanımının önüne geçilmesini ve ek hastalığı olan kişilerde gerekli görüldüğü takdirde hızlı bir şekilde antiviral tedavinin başlamasını sağlayacaktır. [ABSTRACT FROM AUTHOR]

Objective: High-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (AHCT) is a well-defined treatment modality for relapsed/refractory non-Hodgkin's lymphoma (NHL) and Hodgkin's lymphoma (HL). Although there are several options in terms of conditioning regimens before AHCT, no one treatment is accepted as a standard of care. This study aimed to compare different conditioning regimens for the treatment of NHL and HL. Materials and Methods: Medical records of 62 patients who had undergone AHCT following BEAM (BCNU, etoposide, cytarabine, and melphalan) and high-dose ICE (hICE; ifosfamide, carboplatin, and etoposide) conditioning regimens were analyzed retrospectively and compared in terms of efficacy and adverse effects. Results: The study included a total of 29 and 33 patients diagnosed with relapsed/refractory NHL and HL, respectively. Patients received BEAM (n=37) or hICE (n=25) regimens for conditioning. One-year overall survival was 73±6% in all patients. One-year overall survival was 71 ±8% and 74±9% in the BEAM and hICE groups, respectively (p=0.86). The incidences of nausea/vomiting (grade ≥2) (84% vs. 44.7%; p=0.04) and mucositis (grade ≥2) (13% vs. 3%; p=0.002) were higher in the hICE group compared to the BEAM group. In addition, we witnessed significantly more hepatotoxicity of grade ≥2 (40% vs. 2.7%; p<0.005) and nephrotoxicity of grade ≥2 (48% vs. 2.7%; p<0.005) among patients who received hICE. Significantly more patients (n=4; 25%) in the hICE group experienced veno-occlusive disease (VOD) compared to the BEAM arm, where no patients developed VOD(p=0.01). Conclusion: There was no difference in terms of overall survival between the BEAM and hICE groups. We observed significantly more adverse effects among patients treated with hICE. The BEAM regimen seems to be superior to hICE in terms of toxicity profile with comparable efficacy in patients with relapsed/refractory NHL and HL. [ABSTRACT FROM AUTHOR]

Background: Before the introduction of direct-acting antivirals in the treatment of chronic hepatitis C patients, the combination of peginterferon alpha and ribavirin was the standard therapy. Observational studies that investigated sustained virological response (SVR) rates by these drugs yielded different outcomes. Aims: The goal of the study was to demonstrate real life data concerning SVR rate achieved by peginterferon alpha plus ribavirin in patients who were treatment-naïve. Study Design: A multicenter, retrospective observational study. Methods: The study was conducted retrospectively on 1214 treatment naïve-patients, being treated with peginterferon alpha-2a or 2b plus ribavirin in respect of the current guidelines between 2005 and 2013. The patients' data were collected from 22 centers via a standard form, which has been prepared for this study. The data included demographic and clinical characteristics (gender, age, body weight, initial Hepatitis C virus RNA (HCV RNA) level, disease staging) as well as course of treatment (duration of treatment, outcomes, discontinuations and adverse events). Renal insufficiency, decompensated liver disease, history of transplantation, immunosuppressive therapy or autoimmune liver disease were exclusion criteria for the study. Treatment efficacy was assessed according to the patient's demographic characteristics, baseline viral load, genotype, and fibrosis scores. Results: The mean age of the patients was 50.74 (±0.64) years. Most of them were infected with genotype 1 (91.8%). SVR was achieved in 761 (62.7%) patients. SVR rate was 59.1% in genotype 1, 89.4% in genotype 2, 93.8% in genotype 3, and 33.3% in genotype 4 patients. Patients with lower viral load yielded higher SVR (65.8% vs. 58.4%, p=0.09). SVR rates according to histologic severity were found to be 69.3%, 66.3%, 59.9%, 47.3%, and 45.5% in patients with fibrosis stage 0, 1, 2, 3 and 4, respectively. The predictors of SVR were male gender, genotype 2/3, age less than 45 years, low fibrosis stage, low baseline viral load and presence of early virological response. SVR rates to each peginterferon were found to be similar in genotype 1/4 although SVR rates were found to be higher for peginterferon alpha-2b in patients with genotype 2/3. The number of patients who failed to complete treatment due to adverse effects was 33 (2.7%). The number of patients failed to complete treatment due to adverse effects was 33 (2.7%). Conclusion: Our findings showed that the rate of SVR to dual therapy was higher in treatment-naïve Turkish patients than that reported in randomized controlled trials. Also peginterferon alpha-2a and alpha-2b were found to be similar in terms of SVR in genotype 1 patients. [ABSTRACT FROM AUTHOR]

Introduction: In our study, it was aimed to evaluate clinical and routine laboratory findings and serum immunoglobulin and complement levels of pediatric patients with the diagnosis of Crimean-Congo Hemorrhagic Fever (CCHF). Materials and Methods: Medical records of 72 patients that diagnosed with CCHF proven by ELISA or polymerase chain reaction (PCR) in Sivas, Cumhuriyet University between 2011 and 2012 were reviewed retrospectively. The information about the epidemiological, clinical features and laboratory findings were recorded. Results: Seventy-two patients who participated in the study, (mean age11.95±3.95 years) came from Tokat, Sivas, Yozgat, Giresun and Erzincan. During the admission, patients mainly had fever (94.4%), vomiting (54.2%), fatigue (52.8%), anorexia (50%), headache (47.2%), upper respiratory tract infection findings (41.7%); rarely, petechiae-purpura, ecchymosis, epistaxis, diarrhea, melena, maculopapular rash, hematemesis, hematuria, hepatomegaly, splenomegaly, lymphadenopathy were seen. At admission, laboratory findings of the patients were as follows; thrombocytopenia, 80.6%; leucopenia,70.8%; neutropenia, 50%; high aspartate transaminase, 73.6%; high alanine transaminase, 26.4%; high lactate dehydrogenase 71.6%; high creatine kinase, 68.1%; prolonged protrombine time, 54.2%; prolonged partial thromboplastin time, 52.8%. In addition low IgG, low IgA, low C3, low C4 were found in 4, 3, 12 and 1 patient respectively. All patients received intravenous fluid therapy; some received blood products. Four patients received intravenous immunoglobulin, 69 patients were treated with ribavirin. Conclusions: Clinical findings of CCHF in children are similar to those in adults; in patients with low serum immunoglobulin outside the intravenous immunoglobulin (IVIG) treatment, other treatments are similar in all patients. In CCHF to investigate immunodeficiency status, further large-scale study is needed. [ABSTRACT FROM AUTHOR]