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Objectives: To evaluate the clinical features of pediatric non-infectious uveitis (NIU) patients treated with adalimumab (ADA) and the efficacy of ADA in patients unresponsive to conventional immunosuppressive therapy. Materials and Methods: The records of 91 NIU patients aged ≤16 years who received ADA therapy were evaluated retrospectively. The patients’ demographic and clinical characteristics and treatment approaches were recorded. The efficacy of ADA in patients treated for at least 1 year after failure of conventional immunosuppressive treatment was evaluated by comparing the best corrected visual acuity (BCVA), severity of intraocular inflammation, uveitis flare-ups, topical and systemic corticosteroid (CS) use, and central macular thickness (CMT) values before and after ADA treatment. Results: The study included 103 eyes of 53 patients, of whom 29 (54.7%) were female. The mean age at presentation was 8.2±3.4 (range: 3-16) years. The mean follow-up period was 41.6±28.2 (range: 18-120) months. Twenty-six patients (49.0%) had anterior uveitis, 22 (41.5%) had intermediate uveitis, and 5 (9.4%) had panuveitis. The mean duration of ADA treatment was 23.0±13.7 (range: 12-60) months. Uveitis flare-ups developed in only 13 patients (24.5%) while on ADA treatment. When pre- and post-treatment periods were compared, the mean number of uveitis flare-ups, intraocular inflammation severity, mean dose of topical and systemic CS, and mean CMT values were significantly lower in the post-treatment period (p

Objectives: Behçet uveitis (BU) is a potentially blinding disorder. The main determinant of visual prognosis is early and appropriate treatment that provides rapid suppression of inflammatory attacks, control of subclinical inflammation, and prevention of new attacks. Our study aimed to determine the Turkish uveitis specialists’ approach regarding the treatment choices and management of special situations such as pregnancy, vaccination, and surgical planning in BU patients, and to increase information sharing and raise awareness of issues where knowledge is lacking. Materials and Methods: A web-based survey including 16 questions about the treatment approach in ocular involvement of Behçet’s disease was sent via e-mail to uveitis specialists in Türkiye. Based on the answers of 49 ophthalmologists who responded to the survey, we evaluated the approaches of uveitis specialists in our country to initiating treatment, selecting therapeutic agents, monitoring, switching and stopping treatment, and special situations such as surgical planning, vaccination, and pregnancy in BU patients. Results: Uveitis specialists in our country mostly act in accordance with the guidelines in the decision to start treatment, selection of therapeutic agents, and monitoring the safety of treatment in BU. However, there is a lack of information about the therapeutic approach in pregnancy and vaccination practices. It was also observed that there is no consensus on the precautions to be taken before cataract surgery. Conclusion: Our study has shown that there is a need for more detailed and widespread information sharing on treatment in preparation for ocular surgery, safety monitoring, drug use during pregnancy, and vaccination in BU patients.

Objectives:To report the ocular findings, laboratory results, and management of patients with tubulointerstitial nephritis and uveitis syndrome (TINU), whose numbers increased during the 2019 coronavirus disease (COVID-19) pandemic.Materials and Methods:Demographic characteristics, ophthalmic examination findings, laboratory results including polymerase chain reaction (PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), serum SARS-CoV-2 immunoglobulin G (IgG) antibody, and treatment of patients diagnosed with TINU between March 2020 and March 2022 were evaluated retrospectively.Results:The study included 19 eyes of 10 patients (6 female/4 male). The mean age was 13.5±2.4 years (range: 8-16 years). The mean follow-up duration was 13.5±6.1 months (range: 6-24 months). All patients presented with anterior uveitis. Anterior uveitis was bilateral in 9 patients (90%) and unilateral in 1 patient (10%). Posterior segment findings were normal in 8 patients (80%), and bilateral optic disc edema was observed in only 2 patients (20%). None of the patients had a previous SARS-CoV-2 infection and/or vaccination history. The SARS-CoV-2 PCR test was negative in all patients at presentation. The SARS-CoV-2 IgG antibody test was reactive in 7 patients (70%). Recurrent uveitis developed in 8 patients (80%) during follow-up. Systemic immunomodulatory therapy was required for the control of ocular inflammation in 7 patients (70%) with severe uveitis flare-ups.Conclusion:TINU is a multisystemic autoimmune disease, especially in response to environmental triggering factors such as viral infections. Although TINU is a rare disease, the number of cases increased during the COVID-19 pandemic. SARS-CoV-2 antibodies were detected at a significant rate of 70% in these patients, who did not have a history of SARS-CoV-2 infection and vaccination. Previous asymptomatic SARS-CoV-2 infection in children may be a triggering factor in the development of TINU.

Aim: Disease-related immune dysfunction and/or treatment with immunosuppressive drugs may affect the course of coronavirus disease-2019 (COVID-19) infection in rheumatic patients. The aim of this study was to evaluate the course of COVID-19 infection and predictors of COVID-19 pneumonia in patients with rheumatological disease using biological or targeted therapies. Methods: This cross-sectional study was conducted between April 2022 and July 12, 2022. Demographic and clinical parameters and COVID-19-related data in patients with and without COVID-19 pneumonia were recorded and compared. Logistic regression analyses were performed to identify the predictors of COVID-19-related pneumonia. Results: A total of 110 patients (67 with spondyloarthritis, 25 with rheumatoid arthritis, 8 with familial Mediterranean fever, 5 with Takayasu arteritis, 3 with granulomatosis with polyangiitis, and 2 with Behçet’s disease) were included in the study. The mean age of 110 rheumatic patients was 47.27±12.77 years. Their mean body mass index (BMI) was 29.59±5.59 kg/m2, and 67.3% of them were female. Twenty-one (19.1%) patients had a history of COVID-19 pneumonia. The rates of hypertension (HT), diabetes mellitus, comorbidity status, comorbidity groups, cough, dyspnea, non-healing complaints, and COVID-19 treatment in addition to BMI, the total number of comorbidities, and the number of vaccines after COVID-19 infection were statistically different in the groups with and without pneumonia (for all, p

Objective:Our objective was to evaluate the association of benign prostatic hyperplasia (BPH) with each component of metabolic syndrome (MS), and determine which component plays the major risk for developing BPH.Materials and Methods:This cross-sectional observational study was performed on 203 male patients aged over 50, who came to the internal medicine outpatient clinics just for a check-up with/without any known disease. Forty-three of them were healthy control patients and the rest had only 1 criterion of MS. They were searched for the presence of BPH.Results:BPH prevalence ranged between 45.5-65.6% in the subgroups, there was no statistically significant difference in the presence of BPH between these groups. There was a slight positive correlation between glucose level and prostate volume. Triglyceride levels were positively correlated with Qmax and negatively correlated with the grade of hypertrophy. There was also a slight positive correlation between systolic blood pressure and prostate volumes, grade of hypertrophy, and IPSS scores.Conclusion:BPH prevalence was not different between MS components. We concluded that none of the MS components increase the occurrence of BPH by itself but when those metabolic disorders come together and form a syndrome, the prevalence of BPH increases.

Objectives:To evaluate the demographic characteristics, clinical findings, and treatment approach of patients with sympathetic ophthalmia (SO).Materials and Methods:The records of 14 patients with SO between 2000 and 2020 were retrospectively reviewed. The patients’ Snellen best corrected visual acuity (BCVA), detailed ophthalmological examination, optical coherence tomography (OCT), enhanced depth imaging-OCT (EDI-OCT), fundus fluorescein angiography findings, and treatment approaches were recorded.Results:The study included the 14 sympathizing eyes of 14 patients with SO (7 female, 7 male). The mean age was 48.5±15.4 years (range: 28-75), and the mean follow-up duration was 55.1±48.7 months (range: 6-204). Ten patients (71%) had a history of ocular trauma and 4 (29%) had a history of ocular surgery. The time to symptom onset in the sympathizing eye after trauma or ocular surgery ranged from 15 days to 60 years. The most common posterior segment findings were optic disc edema (36%) and exudative retinal detachment (36%). In the acute period, the mean choroidal thickness value on EDI-OCT was 716.5±63.6 μm (range: 635-772) and decreased to 296±81.6 μm (range: 240-415) after treatment. Treatment with high-dose systemic corticosteroid was given to 8 patients (57%), azathioprine (AZA) to 7 (50%), AZA and cyclosporine-A combination to 7 (50%), and tumor necrosis factor-alpha inhibitors to 3 patients (21%). Recurrence was observed in 4 patients (29%) during follow-up. At last follow-up, BCVA values were better than 20/50 in 11 (79%) of the sympathizing eyes. Remission was achieved in 13 patients (93%), but 1 patient (7%) lost her vision due to acute retinal necrosis.Conclusion:SO is a bilateral inflammatory disease that presents with granulomatous panuveitis after ocular trauma or surgery. Favorable functional and anatomical results can be obtained with early diagnosis and initiation of appropriate treatment.

Introduction:The aim of this study is to determinate the frequency and characteristics of pressure ulcers in critically ill children hospitalized in the pediatric intensive care units (4 centers) in Adana. In addition, it is to identify the risk factors that cause pressure ulcers and to discuss the data in the light of the literature.Methods:For this multi-center, prospective point prevalence study, pediatric intensive care units were visited and demographic data, hospitalization diagnoses, treatment and equipment applied, presence and location of pressure ulcers were recorded.Results:Pressure ulcer was detected in 22.4% (17/76) of the patients. There was no difference between patients with and without pressure ulcer in terms of age, gender, body weight, height, hemoglobin and albumin level, nutritional status, feeding route, repositioning and pressure assessment scale. The mortality score of the patients with pressure ulcer was found to be statistically significantly higher than that of those without pressure ulcer, and the Glasgow Coma score was found to be statistically significantly lower. Inotrope therapy, mechanical ventilation therapy, intubation tube and the presence of edema are the risk factors for pressure ulcer.Conclusion:Despite the precautions taken, pressure ulcers continue to be an important problem for critically ill patients. It is possible to reduce the frequency of pressure ulcers by using valid scales to identify patients at risk for pressure ulcers within the first 8 hours after hospitalization and by customizing preventive care activities according to the patient’s condition.

Objective:General anesthesia management in coronary artery bypass graft surgery (CABGC) should preserve myocardial function, prevent ischemic damage, and maintain stable hemodynamics. There is not a universally accepted technique for anesthetic management during CABGC. Drugs or drug combinations and maintenance of infusions are decided based on the pathophysiological condition of the patient and the individual preference and experience of the anesthesiologist (1). Although there are many studies about an anesthesia induction in CABGC, studies about anesthetic maintenance are very limited. In this study, we compared the hemodynamic effects of three different methods that were used in anesthetic maintenance in CABGC.Method:The retrospective records of 108 patients in ASA II-III group who underwent elective CABGC were divided into 3 groups according to their anesthetic maintenance methods. Group I was maintained with 1-3% sevoflurane and fentanyl 4 mcg/kg/hour infusion, group II with propofol 1.5-4 mg/kg/hour and fentanyl 4 mcg/kg/hour infusion, and group III with propofol 1.5-4 mg/kg/hour and remifentanil infusion of 0.03 mg/kg/hour. Systolic blood pressure, diastolic blood pressure, mean arterial pressure (MAP) and heart rate (HR) were measured and recorded after induction (T0), after sternotomy (T1), after pericardiotomy (T2), 5 minutes after cardiopulmonary bypass (CPB) (T3), after thorax closure (T4), at the end of the operation (T5). The vasodilator requirements in the time period before CBP and the inotropic agent requirements after CPB were noted.Results:Data of 108 patients (88 men/20 women) were analyzed. Demographic characteristics of the patients were similar in all the groups. Statistical analysis was made among the groups depending on coronary artery bypass graft number, cross-clamp time, total fluid administration, total blood transfusion, total urine volume, inotropic agent requirement after CPB, postoperative central venous pressure, and pre- and postoperative lactate levels; however, there was no statistical difference. There was not change more than 20-25% in MAP and HR in group I than the others.Conclusion:Better hemodynamic results were achived with sevoflurane and fentanyl in the anesthetic maintenance of CABGC.

Aim: Lower respiratory tract infections are an important reason for mortality and morbidity in children with congenital heart disease. This study aimed to evaluate 50 children who had congenital heart disease and were hospitalized with lower respiratory tract infection in the Ege University Faculty of Medicine Pediatrics Hospital. Materials and Methods: Fifty pediatric patients were taken into the study. Their clinical symptoms, acute phase reactants, chest X-rays, bacterial culture of transtracheal aspirate, respiratory virus panel (with multiplex polimerase chain reaction) from nasopharyngeal swab were examined. The groups were evaluated in terms of age, gender, enviromental smoke exposure, living with school-aged siblings, Respiratory Syncytial virus (RSV) prophylaxis, hospitalization time, causative pathogen, additional risk factors. Results: Of the 50 cases, 12 (24%) were cyanotic, 38 (76%) were acyanotic. There were 26 boys and 24 girls. The most common diagnosis in the acyanotic group was hemodynamically significant VSD (isolated or with other diagnoses) with 20 cases. The average age of the cyanotic group was 23.88±28.81, and the acyanotic group was 12.25±15.45 months old. Hospitalizations most frequently occured in winter. The most frequent viral agent was RSV, which was not seen in the cyanotic group. All of the RSV infected patients were under 12 months old. In 16.7% of cyanotic and 52.6% of acyanotic patients there were extra risk factors such as immune deficiency, Down syndrome, prematurity, Di George syndrome, cerebral palsy, postoperative early period. Three cases lost their lives due to severe respiratory failure. There was no statistically significant difference between the two groups when compared for demografic variables, risk factors, causative pathogens, hospitalization times. Conclusion: Lower respiratory tract infections and especifically RSV pneumonia are important causes of mortality and morbidity in patients diagnosed with congenital heart disease. To prevent risk factors, more studies must be done.

Kawasaki disease is a vasculitis of infant and childhood period. Diagnosis of Kawasaki disease is based on clinical criteria including cervical lymphadenopathy. Here we reported a 3.5-year-old boy presenting with Kawasaki disease mimicking bacterial lymphadenitis and fever. If a child presents with lymphadenopathy only which is unresponsive to antibiotics, Kawasaki disease should be considered.

Introduction: Febrile neutropenia, developing in hematological cancer patients, is a common complication requiring hospitalization and resulting in death. It is assumed that it is caused by infection until its reason is clarified. Hence, it requires a multidisciplinary approach and treatment as a medical emergency. For these patient groups, most of whom are at high risk, death caused by infection is attempted to be minimized by continuously updating treatment approaches. This study aimed to determine clinical characteristics, risk factors, distribution and frequency variance of isolated pathogens and impact in mortality of hematological cancer patients with febrile neutropenia prospectively. Materials and Methods: In this study, 161 febrile neutropenia episodes of 99 patients with hematological cancer monitored between January 2012 and January 2013 in the Department of Hematology in the Hospital of our Medical Faculty were evaluated. Age, gender, underlying disease, chemotherapy regimens, hematologic and radiologic findings, antibacterial and fungal therapeutic regimens were recorded. Routine microbiological blood and urine cultures were performed. When necessitated, cultures from other sterile body sites were taken. Results: Mean age of the patients in the study group was 50.7 ± 15.9. Mean duration of hospitalization was 29.7 ± 14.9 days. Meanduration of neutropenia was 14.6 ± 5.7 days. In 21% of the evaluated episodes, microbiologically defined infection was found, where clinically defined infection was determined in 40% and fever of unknown origin was determined in 39%. A total of 47 isolates were isolated in total. When distribution of all isolated microorganisms, in all cultures was evaluated, 40% were grampositives, 47% were gram-negatives and 13% were fungi. The most frequently observed microorganisms were coagulase negative staphylococci with 31% and Escherichia coli with 22%. In blood cultures, 58% were gram-positives, 32% were gramnegatives and 10% were fungi. The most frequent febrile neutropenia treatment used in our center was carbapenem monotherapy. Mortality rate was 25.4%. Neutropenia duration and stage were the most important factors increasing mortality risk. Conclusion: Febrile neutropenia is a complication which may result in mortality in patients with hematological cancer. In order to define treatment models, each center is supposed to determine its center’s microorganism spectrum and antibiotic resistance profiles periodically.

Summary Osteogenesis imperfecta is a disease that involves mesodermal tissues and characterized by decreased bone mass and increased bone fragility. Bone fractures developed due to ligamentous laxity, low energy trauma and joint deformities and contractures due to dislocations may be seen during the disease process. For that reason, it could be confused especially with rheumatoid arthritis. In this article we presented a case with osteogenesis imperfecta that misdiagnosed as rheumatoid arthritis because of joint deformities and common joint pain. (From the World of Osteoporosis 2010;16:35-7)

Leprosy is a chronical infectious disease caused by Mycobacterium Leprae involving peripheral nerve, skin, reticuloendothelial system, eyes, testicles and other internal organs. Low bone mineral density in male patients with leprosy due to inactivity, neuropathy, musculosceletal pathology, testicular atrophy and hypogonadism is possible. In this report, we present a male case with hypogonadism and testicular atrophy caused by leprosy and aim to discuss its effects on androgen and bone mineral density (From the World of Osteoporosis 2010;16:22-4)