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The time to acquisition of tolerance to unheated milk and regular egg after achievement of tolerance to baked goods is not known.To determine the time to acquisition of unheated-milk-regular-egg tolerance, after the tolerance of the baked forms, in children younger than 2 years.An initial oral food challenge with baked milk (BM) and baked egg (BE) was performed on patients who were reactive to unheated milk-regular egg, respectively. Patients who were BM-BE tolerant were offered unheated-milk-regular-egg challenges, and patients who were BM-BE reactive were offered BM-BE challenges at an average of 3-month intervals. Food-induced atopic dermatitis was included.Thirty-six children with unheated-milk allergy (median age, 7.3 months [interquartile range (IQR), 6.0-13.5]) and 65 with regular-egg allergy (median age, 7 months [IQR, 5.8-11.0]) were included. Seven of 13 children who were BM tolerant acquired unheated-milk tolerance after a median 4.0 months (IQR, 2.0-7.0). Twelve of 23 children who were BM reactive acquired unheated-milk tolerance after a median 5.0 months (IQR, 3.0-8.0) after BM tolerance. Twenty-one of 29 children who were BE tolerant acquired regular-egg tolerance after a median 3.0 months (IQR, 1.0-6.0). Sixteen of 36 children who were BE reactive acquired regular-egg tolerance after a median 4.0 months (IQR, 2.0-6.8) after BE tolerance.Different tolerance rates were determined for baked products at different time points in the first 2 years of life. Unheated-milk-regular-egg allergy resolved in up to 65.5% and 75.5% of cases, respectively, in an average 4 to 5 months after acquisition of BM-BE tolerance. Baked-milk-baked-egg tolerance may be regarded as a precursor of tolerance.

Real-world studies showed varying levels of effectiveness of CoronaVac vaccine against COVID-19 disease. This study aimed to assess the association between the vaccination with CoronaVac and the COVID-19 infections among the health care workers in a university hospital and to determine the vaccine effectiveness against COVID-19 in a period when alpha variant was dominant.This retrospective cohort study was conducted in a university hospital in Istanbul, Turkey employs 4067 health care workers. The follow-up period was defined as starting 14 days after receiving the second dose for fully vaccinated group. Health care workers were censored when have a positive PCR test result or at the end of the study. Unvaccinated health care workers were censored if they receive any COVID-19 vaccine doses. The incidence rate ratio and Cox regression were used to estimate the unadjusted and adjusted effectiveness of the vaccine.Seventy-one percent of the health care workers were fully vaccinated whereas 29% percent did not receive any doses. The incidence rate of SARS-CoV-2 infection was 133.7 vs 70.7 per 100.000 person-days in the unvaccinated and fully vaccinated groups, respectively. The unadjusted effectiveness against COVID-19 infection was 47% (95% CI 31-59%) whereas adjusted effectiveness was 39% (95% CI 20-64%).This real life study conducted in health care workers demonstrated that the effectiveness of two doses of the CoronaVac vaccine (39%) was lower than that determined in clinical trials. Due to reduce in protection over time or against variants, booster doses may be needed.

Background We aimed to determine whether the histopathological grading of dysplastic nevi is an objective endeavour, considering interobserver variability, according to 2018 World Health Organization (WHO) Criteria. Methods In total, 179 cases of dysplastic nevi, with high and moderate degree of atypia, diagnosed and graded according to the previous criteria were reviewed by three pathologists. Then the observers graded the dysplastic nevi as low or high according to 2018 WHO criteria. Results Grading of dysplastic nevi was in complete agreement in 99 of 179 cases across three observers with a fair level of overall interobserver agreement (multirater Kfree: 0.40). The observers showed moderate to good agreement for most of the architectural features, except for criteria regarding focal continuous basal proliferation of melanocytes, density of non- nested junctional melanocytes and presence of dyscohesive nests of intraepidermal melanocytes. Whereas fair agreement was achieved for the cytological criteria. Conclusions The 2018 WHO criteria for dysplastic nevus will ensure a common approach to diagnosis and grading of dysplastic nevi. However, histopathological criteria, such as cytological features and focal continuous basal proliferation of melanocytes, should be improved, so as to ensure a more accurate surgical approach and risk assessment. This article is protected by copyright. All rights reserved.

Background: Several factors that increase the risk of severe food-induced anaphylaxis have been identified. Objective: We aimed to determine the demographic, etiologic, and clinical features of food-induced anaphylaxis in early childhood and also any other factors associated with severe anaphylaxis. Methods: We carried out a medical chart review of anaphylaxis cases from 16 pediatric allergy and immunology centers in Turkey. Results: The data of 227 patients with 266 food-induced anaphylaxis episodes were included in the study. The median (interquartile range) age of the first anaphylaxis episode was 9 months (6‐18 months); 160 of these patients were boys (70.5%). The anaphylaxis episodes were mild in 75 cases (28.2%), moderate in 154 cases (57.9%), and severe in 37 cases (13.9%). The most frequent food allergens involved were cow's milk (47.4%), nuts (16.7%), and hen's egg (15.8%). Epinephrine was administered in only 98 (36.8%) of these anaphylaxis episodes. A logistic regression analysis revealed two statistically significant factors that were independently associated with severe anaphylaxis: the presence of angioedema and hoarseness during the anaphylactic episode. Urticaria was observed less frequently in patients who developed hypotension. In addition, confusion and syncope were associated with 25.9- and 44.6-fold increases, respectively, in the risk of concomitant hypotension. Conclusion: Cow's milk, nuts, and hen's egg caused the majority of mild and moderate-to-severe anaphylaxis episodes. The presence of angioedema and hoarseness in any patient who presents with a history of food-induced anaphylaxis should alert clinicians that the reaction may be severe. In addition, the presence of confusion, syncope, or stridor probably indicates concomitant hypotension.

This study aimed to evaluate the necessity of cord arterial blood gas analysis in cases without fetal distress and normal Apgar score.The cord arterial blood gas analysis and the 1- and 5-minute Apgar scores data of 1438 cases were evaluated. Newborns with fetal distress, neonates requiring cardiopulmonary resuscitation in the delivery room, congenital anomalies, severe and moderate acidemia (pH ≤7.1 at cord arterial blood gas analysis), and pre- and post-term newborns are excluded. Following cord arterial blood gas analysis, threshold values were accepted as abnormal pH7.2, base excess ≥ -6 mmol/L, lactate ≥ 5 mmol/L, bicarbonate18 mmol/L, and partial pressure of carbon dioxide ≥ 50 mmHg. We evaluated the correlation between cord arterial blood gas analysis and 1- and 5-minute Apgar scores.There was a significant correlation between both 1- and 5-minute Apgar scores and cord arterial blood gas analysis values such as pH, lactate, and partial pressure of carbon dioxide (P.001). In addition, a significant correlation was found between the 5-minute Apgar score of7 and some cord arterial blood gas analysis abnormal threshold values (pH, bicarbonate, base excess) (P.001). We found that some patients with mild acidemia had 1- and 5-minute Apgar scores of ≥7 in 1.9% and 2% of cases, respectively.The 5-minute Apgar score of 7 or higher may not be sufficient to verify the wellbeing of a newborn. Relying only on the Apgar scores may create the risk of missing some newborns with mild metabolic acidosis. The necessity of routine cord arterial blood gas analysis should be considered in prospective studies even if there are no signs of fetal distress and Apgar score ≥7.

Background Umbilical artery cord blood gas (UACG) values and Apgar scores (AS) are the two parameters that provide the fastest information about the well-being of a baby after birth. We hypothesized that AS may not be sufficient for a complete and correct evaluation of the newborns and UACG should be used routinely for all births even without any signs of fetal distress. Material-methods In this retrospective study, the data of 1781 babies born between January 2018 and December 2019 at Cerrahpasa Faculty of Medicine were analyzed. Newborn with fetal distress, congenital anomalies, severe and moderate acidemia (pH ≤7.1 at UACG), and pre and postterm newborns are excluded. The UACG and the 1 and 5-minute AS data of 1438 cases were evaluated. Mild acidemia was accepted as a pH between 7.1 and 7.2. Following UACG threshold values were accepted as abnormal pH

BackgroundHypothyroxinemia is defined by low levels of thyroxine (T4) despite low or normal levels of thyroid-stimulating hormone (TSH). This study aimed to evaluate the factors associated with transient hypothyroxinemia of prematurity (THOP) in newborns admitted to the neonatal intensive care unit (NICU).MethodThis is a single center, retrospective, case-control study. Premature newborns, between 24 and 34 weeks of gestation, hospitalised between January 2014–December 2019 in Istanbul University-Cerrahpasa Faculty of Medicine NICU were analyzed through their medical records. Thyroid function tests were routinely performed between the 10th and 20th days of postnatal life and were evaluated according to the gestational age references. Thirty six possible associated factors (prenatal and postnatal parameters, medical treatments, clinical diagnoses and applications in NICU) were searched in the patient group with THOP (n = 71) and the control group with euthyroid prematures (n = 73). The factors for THOP were identified by univariate analysis, followed by multivariate analysis.ResultsMean gestational ages of the study and the control groups were 29.7 ± 2.48 and 30.5 ± 2.30 weeks, respectively (p = 0.606). The birth weight, small for gestational age (SGA), intraventricular hemorrhage (IVH), congenital heart disease (CHD) were found to be the possible associated factors for THOP in the univariate analysis and CHD (p = 0.007, odds ratio [OR]:4.9, 95% confidence interval [CI]: 1.5–15.8), BW (p = 0.004, OR:0.999, 95% CI: 0.9–1.0) and SGA (p = 0.010, OR:4.6, 95% CI: 1.4–14.7) were found to be factors associated with THOP determined by univariate logistic regression analysis.ConclusıonsAlthough some treatment practices might have had direct effects on pituitary–thyroid axis, related with the severity of the newborn clinical conditions, non of them was found to be a associated factor for THOP. However, CHD and SGA may be considered as associated factors with THOP detected in preterm infants.

AIMS To evaluate the validity and reliability of the Turkish version of the Symptoms of Lower Urinary Tract Dysfunction Research Network Symptom Index-29 (LURN SI-29). METHODS Patients with lower urinary tract symptoms (LUTS) were included in a single-center study between January and April 2021. Patients' demographics, such as age, sex, and level of education, were recorded. The Turkish version of the LURN SI-29 and the International Prostate Symptom Score (IPSS) were administered to all patients, and the Urogenital Distress Inventory (UDI-6) was additionally administered to female patients. Construct validity was evaluated by confirmatory factor analysis. Concurrent validity was evaluated with correlations to similar measures. Internal consistency (Cronbach's alpha) and split-half reliability analyses were used to establish the scale's reliability. RESULTS A total of 295 participants, 35.3% females and 64.7% males, were included in the final analysis. The mean age was 56.4 ± 11.7 years. The median total LURN SI-29 scores were 38.0 (26-50) and 26.0 (18-43) for female and male patients, respectively. The LURN SI-29 scale showed a high correlation with IPSS and UDI-6 scales (r = .758, p

Background: Hypothyroxinemia is defined by low levels of thyroxine (T4) despite low or normal levels of thyroid-stimulating hormone (TSH). This study aimed to evaluate the risk factors associated with transient hypothyroxinemia (THOP) in premature newborn.Method: This is a single center, retrospective, case-control study. Premature newborns, between 24-34 weeks of gestation, hospitalised between January 2014-December 2019 in our Newborn Intensive Care Unit (NICU) were analyzed through their medical records. Thyroid function tests were routinely performed between the 10th and 20th days of postnatal life and were evaluated according to the gestational age references. Thirty six risk factors (prenatal and postnatal parameters, medical treatments, clinical diagnoses and applications in NICU) were searched in the patient group with THOP (n=71) and the control group with euthyroid prematures (n=73). The risk factors for THOP were identified by univariate analysis, followed by multivariate analysis. Results: Mean gestational ages of the study and the control groups were 29.7 ± 2.48 and 30.5 ± 2.30 weeks, respectively (p = 0.606). The birth weight, small for gestational age (SGA), intraventricular hemorrhage (IVH), congenital heart disease (CHD) were found to be the risk factors for THOP in the univariate analysis and CHD (p=0.033, odds ratio [OR]:3.7, 95% confidence interval [CI]: 1.1-12.3), BW (p=0.012, OR:0.998, 95% CI: 0.9-1.01) and SGA (p=0.006, OR:5.3, 95% CI: 1.6-17.71) were found to be an independent risk factor for THOP as a result of the multivariate analysis.Conclusıons: Although some treatment practices might have had direct effects on pituitary–thyroid axis, associated with the severity of the newborn clinical conditions, non of them was found to be a risk factor for THOP. However, preterm babies with CHD and SGA could have more risk for THOP.

Background Some aspects of diagnostic elimination/challenge diets in food protein-induced allergic proctocolitis (FPIAP) are still poorly defined. Objective This study investigated the symptom spectrum, time required for resolution of each symptom, triggering foods, and risk factors for multiple food allergies (MFA) in FPIAP. Methods Infants referred with visible blood in stool were enrolled after etiologies other than FPIAP had been excluded. Laboratory evaluation, clinical features and elimination/challenge steps were performed prospectively during diagnostic management. Results Ninety-one out of 102 infants (53 boys) were diagnosed with FPIAP. Eleven children did not bleed during challenges. Visible blood in stool began before two months of age in 63.6% of the infants not diagnosed with FPIAP, compared to 18.9% of the patients with FPIAP (p=0.003). Offending foods were identified as cow’s milk (94.5%), egg (37.4%), beef (10.9%), wheat (5.5%), and nuts (3.3%). MFA was determined in 42.9% of patients. Multivariate logistic regression analysis identified atopic dermatitis (AD) (OR 2.98, 95% CI 1.18-7.55, p=0.021) and an eosinophil count ≥300 cells/μL (OR 2.72, 95% CI 1.09-6.80, p=0.032) as independent risk factors for MFA. Blood and mucus in stool disappeared in a median three days (IQR: 1-14.5 days) and 30 days (IQR: 8-75 days), respectively. Conclusions A tendency to transient bleeding occurs in infants who present with bloody stool before two months of age. A two-week duration of elimination for blood in stool is sufficient to reach a judgment of suspected foods for FPIAP. Mucus in stool is the last symptom to disappear. Concurrent AD suggests a high probability of MFA in FPIAP.

Background: This national cross-sectional survey aimed to assess the iodine status in pregnant women and their offspring, and also to demonstrate regional differences by measuring urinary iodine concentration (UIC). For each woman and her newborn a questionnaire was prepared with basic facts as age, parity number or birth weight and additional information regarding thyroid diseases, use of iodized salt in the household, extra iodine supplementation during pregnancy, education level and wage income. Methods: The target population represented 1444 pregnant women who gave birth between January 1 st, 2018 and 2019, and their offspring. Iodine deficiency for pregnant women and their offspring were defined as urine iodine level

BackgroundOne-fifth of COVID-19 patients are seriously and critically ill cases and have a worse prognosis than non-severe cases. Although there is no specific treatment available for COVID-19, early recognition and supportive treatment may reduce the mortality. The aim of this study is to develop a functional nomogram that can be used by clinicians to estimate the risk of in-hospital mortality in patients hospitalized and treated for COVID-19 disease, and to compare the accuracy of model predictions with previous nomograms.MethodsThis retrospective study enrolled 709 patients who were over 18 years old and received inpatient treatment for COVID-19 disease. Multivariable Logistic Regression analysis was performed to assess the possible predictors of a fatal outcome. A nomogram was developed with the possible predictors and total point were calculated.ResultsOf the 709 patients treated for COVID-19, 75 (11%) died and 634 survived. The elder age, certain comorbidities (cancer, heart failure, chronic renal failure), dyspnea, lower levels of oxygen saturation and hematocrit, higher levels of C-reactive protein, aspartate aminotransferase and ferritin were independent risk factors for mortality. The prediction ability of total points was excellent (Area Under Curve = 0.922).ConclusionsThe nomogram developed in this study can be used by clinicians as a practical and effective tool in mortality risk estimation. So that with early diagnosis and intervention mortality in COVID-19 patients may be reduced.

Background: Urticaria can be the only sign of a food allergy or can be seen together with other signs and symptoms of a food allergy. Objective: To determine the demographic, etiologic, and clinical features of food-induced acute urticaria in childhood. Methods: Patients suspected of food-induced acute urticaria were included in this prospective cross-sectional multicenter study. Results: Two hundred twenty-nine urticaria cases were included in this study. Seventeen patients who did not meet the inclusion criteria of the study were excluded. Of the 212 included cases, 179 (84.4%) were diagnosed with definitive food-induced acute urticaria. The most common foods causing acute urticaria were cow’s milk, hen’s eggs, and nuts in 56.4, 35.2, and 19% of cases, respectively. The positive predictive value of a history of milk-induced acute urticaria together with a milk-specific IgE >5 kU/L for cow’s milk-induced acute urticaria was 92% (95% CI: 81–96%). A history of cow’s milk-induced and/or hen’s egg-induced acute urticaria was consistent with a definitive diagnosis of food-induced urticaria (Chen’s kappa: 0.664 and 0.627 for milk and eggs, respectively). Urticaria activity scores were higher in patients with food-induced acute urticaria (p = 0.002). Conclusion: Cow’s milk, hen’s eggs, and nuts were the most common allergens in the etiology of childhood food-induced acute urticaria. Although the urticaria activity score provides guidance for diagnosis, an oral food challenge is often essential for the definitive diagnosis of a patient with a history of food-induced acute urticaria.

Sayili, Ugurcan/0000-0002-5925-2128; Acar, Hazal Cansu/0000-0001-9244-3818; Kara, Beril/0000-0001-5296-0001; CAN, GUNAY/0000-0001-5815-6700; Kucukali, Huseyin/0000-0003-1669-3107 WOS:000502057400045 PubMed ID: 31703402 Heat waves are one of the most common direct impacts of anthropogenic climate change and excess mortality their most apparent impact. While Turkey has experienced an increase in heat wave episodes between 1971 and 2016, no epidemiological studies have examined their potential impacts on public health so far. In this study excess mortality in Istanbul attributable to extreme heat wave episodes between 2013 and 2017 is presented. Total excess deaths were calculated using mortality rates across different categories, including age, sex, and cause of death. The analysis shows that three extreme heat waves in the summer months of 2015, 2016, and 2017, which covered 14 days in total, significantly increased the mortality rate and caused 419 excess deaths in 23 days of exposure. As climate simulations show that Turkey is one of the most vulnerable countries in the Europe region to the increased intensity of heat waves until the end of the 21st century, further studies about increased mortality and morbidity risks due to heat waves in Istanbul and other cities, as well as intervention studies, are necessary. Scientific Research Projects Coordination Unit of Istanbul University-Cerrahpasa [BYP-2018-31650] This work was supported by the Scientific Research Projects Coordination Unit of Istanbul University-Cerrahpasa. Project number: BYP-2018-31650.