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Context: The Disablement in the Physically Active Scale (DPAS) was recently developed to evaluate the disability process and health-related quality of life. The aim of this study was to investigate the validity and reliability of the Turkish version of the DPAS in physically active individuals with musculoskeletal injury. Methods: The study sample comprised 64 physically active individuals with musculoskeletal injury aged 16–40 years. The DPAS was translated into Turkish according to the guidelines for cross-cultural adaptation. Short Form-36 was used concurrently to test the construct validity. The test–retest reliability of the Turkish version of the scale assessed by intraclass correlation coefficient and Cronbach α was calculated for internal consistency. Results: Confirmatory factor analysis carried out on the Turkish version of the DPAS was confirmed. Cronbach α was calculated to be .946. The intraclass correlation coefficients ranged between .593 and .924 (P P r = .906, P = .001), and the lowest correlation was between DPAS total score and quality of life (r = .637, P = .001). Conclusion: The Turkish version of the DPAS is a reliable, valid, and practical tool. The Turkish version of the DPAS can be used by health professionals to understand quality of life, the disability process, and activity limitations in Turkish-speaking physically active people after musculoskeletal injuries.

Aim: The aim of study was to investigate effects of nordic walking exercise (NWE) on physical fitness, physical activity, anxiety-depression level and quality of life in smokers. Material and Methods: 30 smoking individuals with a mean age of 31.45±12.75 years were assigned randomly into two groups: NWE (n=15) or control group (n=15). NWE group performed NWE three times a week for 6 weeks and gradually increasing to 45 min a day. No intervention was made in control group. The health-related physical fitness level was assessed with arm curl test (upper extremity endurance), chair sit and stand test (lower extremity endurance), two minutes step test (aerobic endurance), sit and reach and back scratch test (flexibility), eight foot up and go test (balance), 6-minute walk test (MWT) (cardiopulmonary endurance). Physical activity levels with International Physical Activity Questionnaire (IPAQ) short form, anxiety-depression level with Beck Depression Questionnaire, quality of life with Nottingham Health Profile (NHP) were evaluated. The differences in measurement parameters between two groups were evaluated by the Mann Whitney U Test since the data distribution was nonparametric. The distinction between categorical variables were determined by Chi-square test. Results: 6-MWT distance (p=0.005), two minutes step (p=0.022), IPAQ walking scores (p=0.028) statistically significant improvements were observed in NWE group. In control group, 6 MWT distance (p=0.025), two minutes step (p=0.032), sit and reach (p=0.043) scores decreased statistically significantly. 6 MWT distance (p=0.006), two minutes step (p=0.021), 8 foot up and go (p=0.005), IPAQ walking (p=0.045), moderate intensity activity (p=0.038), total scores (p=0.013), NHP emotional (p=0.045), total (p=0.045) scores significantly differed in favor of NWE group. Conclusion: It is thought that NWE may be effective and alternative exercise approache in increasing physical fitness, physical activity level and quality of life in smokers and guided to rehabilitation programme.

This study was planned to examine the effects of tele-yoga training on menstrual symptoms, quality of life, anxiety-depression level, body awareness, and self-esteem in healthy women.Thirty-two healthy premenopausal women between the ages of 18 and 45 were included in the study. The women were randomly divided into two groups as tele-yoga training (n: 16) and the control group (n: 16). The tele-yoga training was performed on the Zoom software for 6 weeks, 2 times a week and 45 min a day. No intervention was made in the control group. Menstrual pain and symptoms by Menstrual Symptom Scale (MSS), quality of life by Nottingham Health Profile (NHP), depression levels by Beck Depression Scale (BDS), anxiety levels by State and Trait Anxiety Scale (STAI), body awareness by Body Awareness Questionnaire (BAQ), and self-esteem by Rosenberg Self-Esteem Scale (RSES) were determined.In the tele-yoga training group, statistically significant improvements were observed in the MSS total (p = 0.001), negative effects (p = 0.003), menstrual pain symptoms (p = 0.003), coping methods (p = 0.001) sub-parameters, BDS score (p = 0.000), NHP sleep (p = 0.021), energy (p = 0.002), emotional (p = 0.000), and isolation (p = 0.039) sub-parameters. In the control group, there was statistically significant worsening in the NHP total score (p = 0.000). As regards the differences in values between the two groups, there were statistically difference in favor of the training group in sub-parameters of MSS, NHP sleep, energy, emotional, and isolation sub-parameters, and BDS and BAQ scores (p 0.05).It is thought that tele-yoga training may be a safe and effective method in reducing menstrual symptoms and depression, increasing quality of life, and body awareness.

The purpose of present study was investigating the effectivenes of Nordic walking exercise (NWE) on physical activity level, physical fitness level dyspnea, fatigue, functional status, depression and life quality after COVID-19 undergoing home isolation.Thirty subjects were randomly assigned in NWE (n=15) and control group (n=15). NWE group performed NWE 3 days a week for 6 weeks. The control group was not given any exercise. For physical fitness level, upper-lower extremity muscular endurance (arm curl test- chair sit and stand test) lower aerobic (two minutes step test) and cardiopulmonary endurance (six minute walk test), flexibility (back scratch and sit and reach test) balance (time up and go test) was assessed. The International Physical Activity Questionnaire Short Form (IPAQ-SF) was used to evaulate physical activity level. The anxiety-depression level was determined by Beck Depression Questionnaire. The dyspnea with Modified Medical Research Council (mMRC), functional status with Post-COVID-19 Functional Status Scale (PCFS), fatigue with Fatigue Severity Scale (FSS) and quality of life with Nottingham Health Profile (NHP) were determined. In NWE group, significant improvements were observed in upper-lower muscular extremity, lower aerobic, cardiopulmonary endurance, balance, mMRC, FSS, NHP energy, emotional reactions, sleep and total scores (p

Purpose This study aims to determine factors affecting kinesiophobia in patients with knee osteoarthritis (OA). Materials and Methods The fear of movement was measured using the Tampa Scale of Kinesiophobia in 60 patients with knee OA. Pain intensity was assessed with the Visual Analog Scale, quality of life with the Nottingham Health Profile (NHP), disability with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), anxiety and depression with the Hospital Anxiety and Depression Scale (HADS), balance with the Berg Balance Scale, mobility with the Timed Up and Go Test, and the physical activity status was measured with the International Physical Activity Questionnaire. Results Physical mobility and emotional reactions subscales of NHP, all WOMAC subscales and the HADS depression subscale were significantly related to kinesiophobia. Muscle strength, ROM, level of physical activity, balance, mobility and anxiety were not significantly related to kinesiophobia. Quality of life and disability explained 34.4% of the variation in the Tampa Scale of Kinesiophobia. Conclusions Kinesiophobia was associated with quality of life, disability and depression. It may be useful for clinicians to pay attention to the evaluation of psychosocial characteristics instead of physical performance parameters in order to increase treatment success in OA patients.

To compare the effectiveness of proprioceptive neuromuscular facilitation and myofascial release technique in patients with subacromial impingement syndrome on pain, range of motion, muscle strength, quality of life, functionality and disability.Thirty patients were randomly divided into two groups: proprioceptive neuromuscular facilitation group (After the treatment, shoulder pain, range of motion, muscle strength, functionality and disability were improved in two groups (The combined application of proprioceptive neuromuscular facilitation and myofascial release technique has a more acute and cumulative positive effect on pain, range of motion, muscle strength, functionality, disability and quality of life in patients with subacromial impingement syndrome.

BACKGROUND: Although the Pilates method has been reported to be effective in women with low back pain (LBP), the efficacy of Pilates exercises in pregnant women with LBP has not been evaluated widely. OBJECTIVE: The purpose of this study was to determine the effects of clinical Pilates exercises on lumbopelvic stabilization, pain, disability and quality of life in pregnant women with LBP. METHODS: Fourty pregnant women were randomized into either a Pilates exercise group (n= 20) or control group (n= 20). Subjects in the Pilates exercise group performed the exercises two times a week for eight weeks. Subjects in the control group followed regular prenatal care. Lumbopelvic stabilization was assessed with a pressure biofeedback unit, pain with the Visual Analog Scale, disability with the Oswestry Low Back Pain Questionnaire and quality of life with the Nottingham Health Profile (NHP). RESULTS: Pain and disability were significantly improved in the Pilates exercise group after intervention (p= 0.03, p< 0.001, respectively). There were also significant improvements in sleep, physical mobility sub-parameters of NHP and lumbopelvic stabilization after Pilates exercises (p= 0.048, p= 0.007, respectively). However, there were no statistically significant changes in all outcome measures in the control group (p> 0.05). CONCLUSIONS: Pilates exercises can be recommended as an effective and safe method for increasing lumbopelvic stabilization, reducing pain and disability, improving physical mobility and sleep problems in pregnant women with LBP.

We present a delayed diagnosis of sarcoidosis in an 11-year-old girl by demonstrating ultrasonographic imaging findings of granulomatous cervical and abdominal lymph node involvement. Pulmonary interstitial fibrosis in addition to multi-compartmental enlarged echogenic lymph nodes could be considered sarcoidosis. Punctate echogenic foci in the cervical lymph nodes should be considered in the differential diagnosis of sarcoidosis.

Chronic granulomatous disease (CGD) is a rare primary immunodeficiency disorder identified by recurrent pyogenic and fungal infections infections secondary to defective nicotinamide adenine dinucleotide phosphate oxidase enzyme. In the present study, we demonstrated a case with a history of multiple segmental lung resections because of invasive bronchopulmonary aspergillosis, multifocal hepatic and splenic granulomas, bilateral adnexal calcific foci presumed to be related with old granulomatous infection and finally gastric outlet obstruction secondary to the involvement of the stomach wall thickening with granulomatous tissue. This is an extremely severe case of CGD with multiorgan involvement within a 10-year period after the diagnosis. Gastric antral involvement may mimic inflammatory bowel diseases in such cases, and intestinal involvement can reliably be demonstrated via ultrasonography. Spontaneous resolution of the antral involvement was observed in the follow-up.

The aim of this study was to investigate the effects of inspiratory muscle training (IMT) on respiratory muscle strength, exercise capacity, dyspnea, fatigue, quality of life, and daily living activities of asthmatic patients.Thirty-eight asthmatic patients, between 18 and 65 years of age, were enrolled in the study and randomly divided into 2 groups; IMT (n = 20) or control (n = 18). Participants in the IMT group performed 30 breaths using a patient-specific threshold pressure device, twice daily for 6 wk at 50% maximal inspiratory pressure (MIP), in addition to "breathing training" during this period. Participants in the control group performed only the "breathing training" (sham or no threshold pressure device). Outcome measurements, performed before and after the intervention, included pulmonary function test, respiratory muscle strength, 6-min walk test, modified Medical Research Council dyspnea scale, St George's Respiratory Questionnaire, Fatigue Severity Scale, and London Chest Activity of Daily Living scale.Among the outcomes in the study, changes to key variables including MIP (P.01); MIP, percent predicted (P.01); maximal expiratory pressure (MEP), percent predicted (P.01); 6-min walk test walking distance (P = .001); modified Medical Research Council scale (P =.001); Fatigue Severity Scale (P = .03); St George's Respiratory Questionnaire symptoms (P = .03); London Chest Activity of Daily Living domestic (P = .03); and London Chest Activity of Daily Living leisure (P = .01) were significantly different in favor of IMT versus control.These findings suggest that IMT may be an effective modality to enhance respiratory muscle strength, exercise capacity, quality of life, daily living activities, reduced perception of dyspnea, and fatigue in asthmatic patients.

Aim Non-albicans Candida species and resistant microorganisms have been more commonly isolated in invasive candidiasis in recent years. The aim of this study was to evaluate the distrubution of Candida spp and antifungal resistance in our clinic. Material and methods Fifty-four Candida isolates and antifungal susceptibility results obtained from patients diagnosed as having invasive candidiasis between December 2012 and June 2016 were included. Clinical and laboratory data were retrospectively analyzed. E-test method was used in order to determine antifungal susceptibilities of Candida spp for amphotericin B, fluconazole, voriconazole, ketoconazole, itraconazole, anidulafungin, caspofungin, and flucytosine. Results The clinical diagnoses of the patients were candidemia (n=27, 50%), catheter-related blood stream infection (n=1, 1.8%), urinary tract infection (n=13, 24%), surgical site infection (n=4, 7.4%), intraabdominal infection (n=3, 5.5%), empyema (n=2, 3.7%), and pneumonia (n=4, 7.4%). The most common isolated agent was C. albicans (n=27, 50%) and the others were C. parapsilosis (n=13, 24%), C. tropicalis (n=6, 11.1%), C. glabrata (n=3, 5.6%), C. lusitaniae (n=2, 3.7%), and unspecified Candida spp. (n=3, 5.6%). Fluconazole resistance was 7.4% among all isolates. Resistance against itraconazole, ketoconazole, anidulafungin, voriconazole and caspofungin were 33.3%, 12.5%, 11.1%, 5%, and 2.5%, respectively. Isolates presented intermediate resistance against itraconazole (41.7%), voriconazole (5.6%), and amphotericin B (3.7%) to varying extents. All of the isolates were susceptible to flucytosine. Conclusions In our clinic, C. albicans and non-albicans Candida species were equally distributed and antifungal susceptibilities against major antifungal agents such as fluconazole, amphotericin B, and caspofungin were found considerably high.

WOS: 000414422500003 Objective: The aim of this study was to investigate the physical activity and physical fitness levels in patients with fibromyalgia syndrome (FMS) and to compare the data with those in healthy individuals. Methods: The study included 82 patients with FMS and 110 healthy individuals. In order to compare physical activity levels, all the subjects responded to the International Physical Activity Questionnaire, Long Form (IPAQ). The health-related physical fitness of the subjects was evaluated by body composition, muscle endurance, cardiorespiratory endurance, flexibility, and balance. Body mass index (BMI), sit-up test, 6-min walk test, sit and reach test, body lateral flexion, and Kinesthetic Ability Trainer 3000 (KAT 3000) were used to determine body composition, muscle endurance, cardiorespiratory endurance, flexibility, and balance, respectively. Results: Of the patients with FMS, 36.6% were inactive, 45.1% were insufficiently active, and 18.3% were active. Of the healthy individuals, 40.9% were active, 36.4% were insufficiently active, and 22.7% were inactive. Significant differences were found (p

Aim Clinical findings, mortality, and morbidity rates differ among influenza subspecies. Awareness of these differences will lead physicians to choose the proper diagnostic and therapeutic strategies and to foresee possible complications. The aim of this study was to evaluate the clinical differences of influenza subspecies among hospitalized children. Material and methods Hospitalized children with proven influenza infection by polymerase chain reaction on nasopharyngeal swab specimens in our clinic, between December 2013 and March 2016, were enrolled. These children were divided into 3 groups as Influenza A/H1N1 (n=42), Influenza A/H3N2 (n=23), and Influenza B (n=35). Results The median age of the children was 51.5 months (range, 3-204 months). The most common presenting symptoms were fever (n=83), cough (n=58), and difficulty in breathing (n=25). The most common non-respiratory findings were lymphadenopathy (n=18) and gastrointestinal system involvement (n=17). Sixty-two percent of the patients (n=62) had chronic diseases. H1N1 and H3N2 were significantly more common among patients with chronic neurologic disorders and renal failure, respectively. Leukopenia (n=32) and thrombocytopenia (n=22) were the most common pathologic laboratory findings. Neutropenia, elevated CRP levels, and antibiotic use were significantly more common among patients with H1N1 infection. Seven patients were transferred to the intensive care unit with diagnoses of acute respiratory distress syndrome (n=4), encephalitis (n=2), and bronchiolitis (n=1). Two patients with chronic diseases and H1N1 infection died secondary to acute respiratory distress syndrome. Conclusions Influenza A/H1N1 infection represented more severe clinical disease.

Background: Targeted intervention for subgroups is a promising approach for the management of patellofemoral pain. Hypothesis: Treatment designed according to subgroups will improve clinical outcomes in patients unresponsive to multimodal treatment. Study Design: Prospective crossover intervention. Level of Evidence: Level 3. Methods: Patients with patellofemoral pain (PFP; n = 61; mean age, 27 ± 9 years) were enrolled. Patients with PFP received standard multimodal treatment 3 times a week for 6 weeks. Patients not responding to multimodal treatment were then classified into 1 of 3 subgroups (strong, weak and tight, and weak and pronated foot) using 6 simple clinical tests. They were subsequently administered 6 further weeks of targeted intervention, designed according to subgroup characteristics. Visual analog scale (VAS), perception of recovery scale (PRS), 5-Level European Quality 5 Dimensions (EQ-5D-5L), and self-reported version of the Leeds Assessment of Neuropathic Symptoms and Signs scale (S-LANSS) were used to assess pain, knee function, and quality of life before and after the interventions. Results: In total, 34% (n = 21) of patients demonstrated recovery after multimodal treatment. However, over 70% (n = 29/40) of nonresponders demonstrated recovery after targeted treatment. The VAS, PRS, S-LANSS, and EQ-5D-5L scores improved significantly after targeted intervention compared with after multimodal treatment ( P < 0.001). The VAS score at rest was significantly lower in the “weak and pronated foot” and the “weak and tight” subgroups ( P = 0.011 and P = 0.008, respectively). Posttreatment pain intensity on activity was significantly lower in the “strong” subgroup ( P = 0.006). Conclusion: Targeted treatment designed according to subgroup characteristics improves clinical outcomes in patients unresponsive to multimodal treatment. Clinical Relevance: Targeted intervention could be easily implemented after 6 simple clinical assessment tests to subgroup patients into 1 of 3 subgroups (strong, weak and tight, and weak and pronated foot). Targeted interventions applied according to the characteristics of these subgroups have more beneficial treatment effects than a current multimodal treatment program.

To investigate the clinical impact of vancomycin-resistant enterococci (VRE) colonization in patients with hematologic malignancies and associated risk factors.Patients colonized and infected with VRE were identified from an institutional surveillance database between January 2010 and December 2013. A retrospective case-control study was performed to identify the risk factors associated with development of VRE infection in VRE-colonized patients.Fecal VRE colonization was documented in 72 of 229 children (31.4%). Seven VRE-colonized patients developed subsequent systemic VRE infection (9.7%). Types of VRE infections included bacteremia (n=5), urinary tract infection (n=1), and meningitis (n=1). Enterococcus faecium was isolated in all VRE infections. Multivariate analysis revealed severe neutropenia and previous bacteremia with another pathogen as independent risk factors for VRE infection development in colonized patients [odds ratio (OR): 35.4, confidence interval (CI): 1.7-72.3, p=0.02 and OR: 20.6, CI: 1.3-48.6, p=0.03, respectively]. No deaths attributable to VRE occurred.VRE colonization has important consequences in pediatric cancer patients.Amaç: Hematolojik malignitesi olan pediatrik hastalarda vankomisine dirençli enterokok (VDE) kolonizasyonunun klinik öneminin araştırılması ve eşlik eden risk faktörlerinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Ocak 2010-Aralık 2013 tarihleri arasında yapılan VDE sürveyans kayıtlarından faydalanılarak VRE ile kolonize ve/veya enfekte olmuş hastalar belirlenmiştir. VDE ile kolonize hastalarda VRE enfeksiyonu gelişimi ile ilişkili risk faktörlerini belirlemek amacıyla retrospektif olgu-kontrol çalışması yapılmıştır. Bulgular: Çalışma süresince yatırılan 229 hastanın 72’sinde (%31,4) rektal VRE kolonizasyonu saptanmıştır. VRE kolonize hastaların yedisinde (%9,7) kolonizasyon sonrası sistemik VRE enfeksiyonu gelişmiştir. Beş hastada bakteriyemi (n=5), bir hastada idrar yolu enfeksiyonu (n=1) ve bir hastada menenjit (n=1) gözlenmiştir. Tüm enfeksiyonlarda ilgili klinik örneklerde Enterococcus faecium üretilmiştir. Multivaryant analiz sonucunda, ciddi nötropeni ve başka bir patojene bağlı bakteriyemi öyküsü VDE kolonize hastalarda VDE enfeksiyonu gelişimi için risk faktörleri olarak bulunmuştur [odds ratio (OR): 35,4; güven aralığı (GA): 1,7-72,3; p=0,02 ve OR: 20,6; GA: 1,3-48,6; p=0,03; sırasıyla]. VDE enfeksiyonuna bağlı mortalite saptanmamıştır. Sonuç: Pediatrik kanser hastalarında VDE kolonizasyonunun önemli klinik sonuçları olduğu gözlenmiştir.

Cryptococcus neoformans is an important opportunistic pathogen that causes serious mortality and morbidity in AIDS patients. Although its incidence has decreased with proper antiretroviral treatment (ART), it is still a major concern in areas with low socioeconomic HIV endemic countries with poor sources of therapy. In our country, pediatric HIV infection and so, HIV-related opportunistic infections are very rare. In order to pay attention to this unusual collaboration; herein, we presented a pediatric case who was diagnosed with HIV and disseminated cryptococcus infection concomitantly. A 6.5-year-old previously healthy girl has admitted to our hospital with the complaints of prolonged fever, cough and hemoptysis. On her physical examination she had oral candidiasis, generalized lymphadenopathy and hepatosplenomegaly. Laboratory findings were as follows; white blood cell count: 3170 µL (neutrophil: 2720 µL, lymphocyte: 366 µL), hemoglobin level: 7.8 gr/dl, hematocrit: 25.5% platelets: 170.000 µL, CRP: 15.2 mg/L and serum IgG level: 1865 mg/dl. Her anti-HIV test yielde,d positive result and confirmed by Western blot assay, together with a high viral load (HIV-RNA: 3.442.000 copies/ml). She was started ART (lamivudine, zidovudine and lopinavir/ritonavir combination) with the diagnosis of stage 3 HIV infection (AIDS). Posteroanterior chest radiograph showed mediastinal extension and nodular parenchyma. Since the patient was suspected to have pulmonary tuberculosis based on the clinical and radiological findings, empirical antituberculosis therapy was started. Because of the insistance of fever, three different blood specimens, bone marrow and gastric aspirates were collected for culture, in which all of them yielded C.neoformans growth. She was then diagnosed as disseminated cryptococcosis and treated with liposomal amphotericin B and fluconazole successfully. Although pediatric HIV infection is usually diagnosed secondary to maternal disease, it can rarely be presented later in life with opportunistic infections. In the case of unusual infectious diseases, in addition to primary immune deficiency syndromes, HIV infection should also be kept in mind. Herein, we discussed a pediatric case with two rare infectious agents reported in our country and wanted to focus on secondary immune deficiency related with pediatric HIV infection.

The use of TNF-alpha inhibitor agents facilitates mycobacterial infections. Unlike in normal population, active tuberculosis in such patients may be asymptomatic. Here we present the case of an asymptomatic child who developed pulmonary tuberculosis during TNF-alpha inhibitor therapy. A 12-year-old child with a diagnosis of juvenile idiopathic arthritis and uveitis was referred to our clinic before initiation of adalimumab therapy. His tuberculin skin test was negative and chest X-ray was normal prior to therapy. On the third month of his therapy, his father was diagnosed with pulmonary tuberculosis, and he was initiated on isoniazid therapy. A month later, the patient’s tuberculin skin test was measured as 7 mm, and chest X-ray revealed paratracheal opacity. Computerized tomographic scan confirmed a necrotic mass lesion with a size of 40x27x24 mm which was compatible with tuberculosis. He was thus initiated on antituberculosis therapy. Patients undergoing anti TNF-alpha therapy should be followed up for tuberculosis before and during therapy.

Aim To determine the effect of a tele-rehabilitation (TR) program on glucose control, exercise capacity, physical fitness, muscle strength and psychosocial status in patients with type 2 diabetes mellitus (DM). Method Fifty type 2 DM participants were enrolled in the study and divided randomly into two groups; TR (n = 25, mean age: 52.82 ± 11.86) or control (n = 25, mean age: 53.04 ± 10.45) group. Participants in the TR group performed breathing and callisthenic exercises, three times a week, for 6 weeks, at home by internet based video conferences. Outcome measures including, HbA1c level, 6 min walk testing, physical fitness and muscle strength dynamometer measurement, Beck Depression Inventory were performed before and after the 6 weeks. Results HbA1c (p = 0.00), 6 min walking distance (p = 0.00), physical fitness subparameters; sit-up (p = 0.00), sit-and-reach (p = 0.04), back scratch (p = 0.00), lateral flexion right (p = 0.04), left (p = 0.00) and time up go tests (p = 0.00), muscles strength (p = 0.00); deltoideus-anterior, middle, quadriceps femoris and gluteus maximus, and depression levels (p = 0.00) changed significantly (p = 0.00) in TR groups. There were no significant improvements in control group (p > 0.05). Conclusion Our findings suggest that TR interventions found to be safe and effective, and may be an alternative treatment model for type 2 DM management. In addition to these health benefits, patients and rehabilitation team may save time, labor and treatment costs by using TR.

OBJECTIVE: To determine the diagnostic utility of a vascularity index via superb microvascular imaging in lymph nodes of children with malignant lymphoma and acute lymphadenitis compared to normal lymph nodes. METHODS: We performed a retrospective study for multiparametric lymph node (LN) evaluation. Malignant lymphoma diagnosed via histopathological examination and lymph nodes receiving an acute lymphadenitis diagnosis based on clinical and laboratory findings constituted the study subgroups. We calculated a shape index [SI (percent of shortest to longest diameter)] using grayscale ultrasonography and elasticity and velocity values via shear wave elastography (SWE) as well as a vascularity index (VI) using superb microvascular imaging (SMI) for comparison with normal lymph nodes. RESULTS: 45 lymph nodes diagnosed with malignant lymphoma, 72 lymph nodes diagnosed with acute lymphadenitis and 146 normal lymph nodes were evaluated. For differentiating lymphoma from normal lymph nodes, vascularity index cut-off values higher than 15% represented a diagnostic accuracy of 95%; cut-off elasticity values higher than 17 kPa exhibited a diagnostic accuracy of 99%. Optimal VI, elasticity, velocity and SI cut-off values in differentiating lymphoma from lymphadenitis were 15%, 17 kPa, 2.45 m sn(–1) (p < 0.001) and 65% (p < 0.002) with calculated diagnostic accuracies of 83, 87, 88 and 68%, respectively. CONCLUSION: Vascularity index values obtained via superb microvascular imaging and SWE would be reasonably useful in differentiating malignant lymphoma and acute lymphadenitis from normal LNs. SWE would be more efficient in distinguishing malignant lymph nodes from acute lymphadenitis compared with superb microvascular imaging. ADVANCES IN KNOWLEDGE: Vascularity index by superb microvascular imaging would be a novel Doppler parameter in differentiating both lymphoma from lymphadenitis and also lymphadenitis from normal lymph nodes.

Tuberculosis continues to be a major health problem worldwide. Multidrug resistant tuberculosis (MDR-TB) infection that occurs in childhood is caused by adult MDR-TB agents which are in circulation and resistant to primary drugs. In this case report a 17-month-old child with MDR-TB who was cured after a 24-month therapy regimen was presented. Physical examination of a 17-month-old girl admitted to the hospital with the cause of recurrent pneumonia revealed a rubbery lymphadenopathy less than 2 cm in the right upper cervical region. Crepitant rales were detected in the right basal on auscultation of the lung. Interferon gamma release assay (IGRA) and tuberculin skin (TST) tests were negative. Computed tomography (CT) scan of the chest showed mediastinal conglomerate pathologic lymphadenopathy and air bronchograms were detected near the lower lobe of the left lung. Treatment of isoniazid, rifampicin, pyrazinamide with the diagnosis of epituberculosis was started by taking a sample of gastric aspirate culture sample. In the sixth month of the treatment patient was admitted to our clinic with enlarged cervical rubbery lymphadenopathy. It was determined that microbiological test of gastric aspirate culture specimen was positive for M.tuberculosis complex resistant to isoniazid, rifampin, ethambutol, streptomycin, ethionamide and rifabutin. Control CT showed residual peribronchial infiltrations and hilar calcific lymph nodes. Hearing test, vision control and, thyroid function tests were performed and treatment of moxifloxacin, amikacin, para-amino salicylic acid, protionamide and pyrazinamide was started based on minor drug susceptibility results of M.tuberculosis isolate which was still growing in gastric aspirate culture. Gastric aspirate culture for M.tuberculosis was still positive after 3 months of treatment and the current treatment was continued. Amikacin was stopped after 6 months. Therapy regimen was stopped after 24-months. Over the course of a follow-up period of more than 3 years, the clinical and radiological resultsof the patient has improved significantly. The clinical presentation of TB in children is often nonspecific and differs from the patterns seen in adults. MDR-TB cases can be seen in this age group since tuberculosis in children is mainly caused by transmission of drug-resistant strains from adults. This situation is particularly problematic due to the long-term treatment and the lack of specific drug formulations for children.

To determine the incidence of vancomycin-resistant enterococcus (VRE) colonization in our neonatal intensive care unit (NICU) over five-year period, rate of progression to VRE infection and associated risk factors.A retrospective analysis of a prospective surveillance for VRE colonization and health care-associated infections was made. Contact precautions were taken against colonization, although the application varied over the years due to repairs in the unit.VRE rectal colonization was detected in 200/1671 neonates (12%) admitted to NICU. It showed great interannual variability from 1.9% to 30.3%. Sytemic VRE infection developed in 6/200 VRE-colonized patients (3%) within a median of 9 days (range: 3-58 days). The risk factors for VRE infection development identified in the univariate analysis were long hospital stay (≥30 days), necrotizing enterocolitis, surgical procedure, extraventricular drainage, receipt of amphotericin B and receipt of glycopeptides after detection of VRE colonization. Crude in-hospital mortality was higher in neonates who developed a systemic VRE infection (p 0.001).Maintaining physical conditions in the unit favorable for infection control and rational use of antibiotics are essential in the control of VRE colonization and resultant infections. Special attention should be directed to VRE-colonized babies carrying the risk factors.

OBJECTIVE Vitamin D has been suggested to be active as an immunomodulator in autoimmune diseases such as Hashimoto's thyroiditis (HT). The goal of the present study was to investigate the vitamin D status in HT patients. METHODS This prevalence case-control study was conducted on 90 patients with HT (of ages 12.32 ± 2.87 years) and 79 age-matched healthy controls (11.85 ± 2.28 years). Serum 25-hydroxyvitamin D3 [25(OH)D3] levels were measured in all 169 subjects. RESULTS The prevalence of vitamin D deficiency in HT patients (64 of 90; 71.1%) was significantly higher than that in the control group (41 of 79; 51.9%) (p=0.025). Mean serum 25(OH)D3 level in the HT group was significantly lower compared to the control group (16.67 ± 11.65 vs. 20.99 ± 9.86 ng/mL, p=0.001). HT was observed 2.28 times more frequently in individuals with 25(OH)D3 levels

Aim: Smoking and nicotine exposure increase insulin resistance and the risk of type 2 diabetes. Despite the pulmoner rehabilitation has many benefits, only a number of patients participate in programs. Telerehabilitation (TR) allows to the use of communication tehcnology to provide rehabilitation services in their home. Our study was conducted to evaluate the effect of TR on dyspnea and exercise capacity in patients with type 2 diabetes mellitus who smoked. Methods: Twenty smoker patients with type 2 diabetes mellitus randomized to either TR group (n:12, mean age 55.3±11.2 years, BMI:33.6±5.2 kg/m2 ) or a control group (n:8, mean age 50.2±13.8 years, BMI:26.0±2.3 kg/m2). Exercise capacity was assessed by Six Minute Walk Test (6MWT). Baseline dyspnea index (BDI) was used to determine dyspnea level. TR program include callisthenic and respiratory exercise at home by internet based video conferences, 3 days a week, for 6 weeks. Control group was just performed assessments before and after 6 weeks. Result: 6MWT distance (p:0.00), BDI functional impairment (p:0.00), magnitude of task (p:0.03) subparameters scores were improved in TR group. There were no significant differences in control group. Change in BDI functional impairment (p:0.02), magnitude of effort (p:0.02) and task (p:0.00) subparameters significantly differed between two groups. Conclusions: Our study shows that TR program may be effective on dyspnea and exercise capacity in type 2 diabetes mellitus patients who smoked. In addition to these health benefits, rehabilitation team may save time, labor and treatment costs by using TR.

Amaç: Çalışmanın amacı fibromyalji sendromlu (FMS) hastalarda fiziksel aktivite ve fiziksel uygunluk düzeyini belirlemek ve sağlıklı bireylerin verileri ile karşılaştırmaktır.Yöntemler: Çalışmaya 82 fibromyalji hastası ve 110 sağlıklı olgu dahil edildi. Fiziksel aktivite düzeyini karşılaştırmak için tüm olgular Uluslararası Fiziksel Aktivite Anketi’nin (UFAA) uzun formatını cevaplandırdılar. Olguların sağlıkla ilişkili fiziksel uygunluk düzeyini belirlemek için vücut kompozisyonu, kassal endurans, kardiorespiratuar endurans esneklik ve denge ölçümleri değerlendirildi. Vücut kitle indeksi, mekik testi, 6 dakika yürüme testi, otur-uzan test, gövde lateral fleksiyon, KAT 3000 testleri sırasıyla vücut kompozisyonu, kassal endurans, kardiorespiratuar endurans, esneklik ve dengeyi belirlemek için kullanıldı.Bulgular: FMS'li hastaların %36,6’sı aktif, %45,1'i minimal aktif, %18,3’ü aktifti. Sağlıklı olguların %40,9’u aktif, %36,4’ü minimal aktif, %22,7’si inaktifti. Gruplar arasında UFAA yürüme ve toplam skoru arasında istatistiksel olarak anlamlı fark bulundu (p, Objective: The aim of this study was to investigate the physical activity and physical fitness levels in patients with fibromyalgia syndrome (FMS) and to compare the data with those in healthy individuals.Methods: The study included 82 patients with FMS and 110 healthy individuals. In order to compare physical activity levels, all the subjects responded to the International Physical Activity Questionnaire, Long Form (IPAQ). The health-related physical fitness of the subjects was evaluated by body composition, muscle endurance, cardiorespiratory endurance, flexibility, and balance. Body mass index (BMI), sit-up test, 6-min walk test, sit and reach test, body lateral flexion, and Kinesthetic Ability Trainer 3000 (KAT 3000) were used to determine body composition, muscle endurance, cardiorespiratory endurance, flexibility, and balance, respectively.Results: Of the patients with FMS, 36.6% were inactive, 45.1% were insufficiently active, and 18.3% were active. Of the healthy individuals, 40.9% were active, 36.4% were insufficiently active, and 22.7% were inactive. Significant differences were found (p

Objectives: The aim of this study was to evaluate levels of physical activity in patients with rheumatoid arthritis, osteoarthritis and fibromyalgia and to compare the results with both healthy subjects and each other. Methods: A group of 50 rheumatoid arthritis patients, 95 osteoarthritis patients, 82 fibromyalgia patients and 110 healthy subjects were included in this study. Physical activity levels were assessed by the International Physical Activity Questionnaire (IPAQ). Results: There were significant differences in walking and total physical activity scores in IPAQ between the rheumatoid arthritis (RA), osteoarthritis (OA), fibromyalgia (FMS) patients and the control group (p Conclusion: As a result, when compared to healthy people, physical activity levels were significantly decreased in patients with rheumatoid arthritis, osteoarthritis, fibromyalgia. The decreases in the physical activity levels were clearer in patients with rheumatoid arthritis than in patients with osteoarthritis and fibromyalgia. Recommending regular physical activity should be integral to rheumatic disease management and walking offers a potentially accessible, inexpensive, and acceptable physical activity intervention.

Non-albicansFifty-four Candida isolates and antifungal susceptibility results obtained from patients diagnosed as having invasive candidiasis between December 2012 and June 2016 were included. Clinical and laboratory data were retrospectively analyzed. E-test method was used in order to determine antifungal susceptibilities ofThe clinical diagnoses of the patients were candidemia (n=27, 50%), catheter-related blood stream infection (n=1, 1.8%), urinary tract infection (n=13, 24%), surgical site infection (n=4, 7.4%), intraabdominal infection (n=3, 5.5%), empyema (n=2, 3.7%), and pneumonia (n=4, 7.4%). The most common isolated agent wasIn our clinic

To evaluate the neurological outcomes of children diagnosed with brain abscesses in the early post-treatment period.bMATERIAL and METHODS: This study was a retrospective analysis of pediatric brain abscess patients between January 2000 and December 2015, during a 16-years period. Patients were divided into two groups according to their outcome at the end of the treatment. The patients with "good outcome" were the ones without any neurological sequelae [Glasgow Outcome Scale (GOS) score 5]. "Unfavorable outcome" was defined as having any kind of neurological deficit (GOS score 1-4).A total number of 31 patients (22 male, 71%) with the median age at diagnosis of 84 months (range, 1-202 months) were enrolled in this study. The most common presenting symptom was fever being encountered in 71% of the patients (n=22), followed by focal neurological deficit (FND)(n=17, 54.8%), vomiting (n=14, 45.2%), headache (n=13, 41.9%), seizure (n=13, 41.9%), change in mental status (n=12, 38.7%) and visual disturbance (n=2, 6.5%). Twenty-four patients (77.4%) had predisposing factors. The most common pathogens were gram-positive cocci (n=9, 29%). Seventeen patients (54.8%) had unfavorable outcome; 2 patients (6.4%) died. All patients were treated with parenteral antibiotherapy with median duration of 73 days (range, 28-540 days). Surgical procedures were performed in 83.9% (n=26) of patients [isolated aspiration (n=19, 61.3%), only resection (n=5, 16.1%), aspiration and resection (n=2, 6.5%)].Glasgow coma scale score below 12 and the presence of FND on admission were found to be independent risk factors for unfavourable neurological outcome in children with brain abscesses.

This study evaluates the clinical/immunological features and outcomes of 91 patients with the diagnosis of transient hypogammaglobulinemia of infancy(THI). Mean age at diagnosis was 8.4±5.2 months. IgG levels normalized at 30.6±11.88 months. Sixty three patients (69.3%) resolved in their first 3 years of life and 28 patients (30.7%) thereafter. In the univariate analysis, presence of atopy, occurrence of recurrent infections (6/year) and hospitalization, initial low IgA and IgM levels were found to be associated with the late recovery. Patients with longer breastfeeding duration recovered earlier. Recovery time for Ig levels was found to be longer in patients who received IVIG (n=55, 60.4%). This study confirmed that delayed resolution in THI is not rare. Frequent infections, initial low IgA and/or IgM levels and presence of atopy were found as associated factors for the late recovery. Breastfeeding should be encouraged and IVIG should be used in well selected patients.

Acquired immune deficiency syndrome can be encountered with hypereosinophilia and hyperimmunoglobulin E (hyper-IgE) values, though these levels are rarely so high to be compared with hyperimmunoglobulin E syndrome. A 9-year-old boy presented with the complaint of fatigue, weakness, weight loss and generalized pruritic rash lasting for a year. He had frequent respiratory tract infections, wheezing episodes and urticarial skin lesions before that. On admission, he was cachectic and he had generalized lymphadenopathy, hepatosplenomegaly, oral moniliasis and pruritic rash all over his body. Laboratory evaluation revealed marked lymphopenia and hypergammaglobulinemia with extremely high IgE values (IgE: 59 300 kU/l). He was diagnosed with stage 4 human immunodeficiency virus (HIV) infection and started on antiretroviral treatment. In conclusion, HIV infection can be presented with increased IgE values.