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Introduction: During the 2019 novel coronavirus (COVID-19) pandemic period, all cases admitted to the emergency services have been evaluated primarily for COVID-19, and therefore other infectious diseases, especially Crimean Congo Hemorrhagic Fever (CCHF), which are endemic in our region, can be overlooked. In this study, it was aimed to determine the diagnostic power of the Hitit Index, which we developed from a panel consisting of clinical and laboratory findings of the cases with and without CCHF in previous years, to distinguish CCHF cases from COVID-19 cases. Materials and Methods: The study groups consisted of the COVID-19 cases (n= 116) admitted to the emergency service and the CCHF patients (n= 110) who were followed up in the Infectious Diseases and Clinical Microbiology Clinic of the same hospital between 2015-2020. Results: Hitit Index was found to be statistically significantly higher in patients with CCHF. For Hitit Index, sensitivity and specificity were 88% and 99%, while negative predictive value (NPV) and positive predictive value (PPV) were 90% and 99%, respectively. Conclusion: The Hitit Index is an example of artificial intelligence that we can use to distinguish patients with CCHF from patients with COVID-19.

Idiopathic intracranial hypertension (IIH) is the increased pressure with normal cerebrospinal fluid (CSF) composition, not due to a secondary cause. However, the need for lumbar puncture, an invasive method in diagnosis, leads to research on noninvasive diagnostic methods. This study aims to examine the role of the size of the pituitary gland and the previously unevaluated pineal gland in radiological diagnosis in patients with IIH. The study retrospectively included 57 patients aged 18-80 years, who were followed up in our clinic with the diagnosis of IIH, and 52 control patients without central nervous system disease and cranial MR pathology. CSF pressure measurement values, CSF biochemistry, and cytology examinations were recorded as a result of lumbar puncture performed in the lateral decubitus position of all patients. In addition, the pineal gland and pituitary dimensions were measured by a neuroradiologist on cranial MR imaging of both groups.Pituitary gland height, anteroposterior (AP), and transverse dimensions were found to be significantly lower in the IIH patient group than in the control group (p0.05). There were a significant reduction in pineal gland AP and height measurements in the IIH patient group compared to the control group. Still, we found no significant difference between the two groups in transverse measurements (p0.05). Our findings suggest that measurement of pituitary and pineal gland sizes in neuroimaging may be a guide as a noninvasive method in diagnosing and treating IIH.

Scabies is an itchy cutaneous parasitosis caused by Sarcoptes scabiei. Leukocytoclastic vasculitis (LCV) is a common vasculitis in adults and is often idiopathic but may develop due to infection, autoimmune diseases, malignancy, or drugs. Few cases of scabies-related LCV have been reported in the literature. We present a case of LCV, which we thought to be related to scabies, in light of the literature review. A 62-year-old male patient presented with complaints of cough, sputum, fever, and itchy rash on his legs for one and a half months. Treatment targeting pneumonia was initiated. He was diagnosed as scabies with pruritic maculopapular and purpuric eruption. We learned that itchy skin lesions were present in the spouse, as well. Topical permethrin treatment was initiated on both the patient and the spouse. Skin biopsy of the vasculitic lesions was reported as leukocytoclastic vasculitis pathologically. Mass malignancy, autoimmune diseases, infectious causes were excluded. Vasculitic lesions regressed with topical treatment. Improvement of the vasculitic lesions with topical permethrin treatment, exclusion of other causes, and presence of similar complaints in the patients’ spouse have led us to the diagnosis of scabies and LCV secondary to scabies. LCV due to scabies, which is a rarely seen condition especially in itchy lesions, is a challenging diagnosis. A detailed anamnesis would facilitate diagnosing such cases.

Subskapular apse literatürde az sayıda olgu olması ve erken dönemde tanı konulup acil cerrahi müdahale gerektirmesi nedeniyle nadir ama ciddi klinik bir durumdur. Bu yazıda travma ya da cerrahi girişim olmaksızın metisiline dirençli Staphylococcus aureus septisemisine neden olan, erken dönemde tanısı konulan ve tedavi edilen spontan subskapular apse olgusu sunulmuştur Subscapular abscess is a rare but serious clinical condition due to the small number of cases in the literature requiring early diagnosis and urgent surgical intervention. We aimed to present a case of spontaneous subscapular abscess causing methicillin-resistant Staphylococcus aureus septicemia, which was diagnosed and treated early, without trauma or surgical intervention. WOS:000523303400015

The aim of the study was to evaluate the relationship among lower esophageal sphincter pressure (LESP),The retrospective study included patients with isolated hypertensive or hypotensive lower esophageal sphincter (LES) who underwent esophageal manometry in our gastroenterology motility laboratory and had normal manometry results. Demographic characteristics, complaints on admission, upper endoscopy findings, 24-h esophageal pH monitoring results, and presence of Hp in gastric biopsy were evaluated.A total of 1226 patients were included in the study, among whom women comprised 54% of all patients. Mean age was 45.4±13.4 years. Most common presenting complaint was pyrosis (85.4%). Pathological reflux was detected in 61.4% of the patients in 24-h esophageal pH monitoring. Reflux esophagitis was detected in 22.9% and LES laxity was present in 17.4% of the patients. In gastric biopsy, Hp was positive in 40% of the patients. The age of patients with hypertensive LES was significantly higher and female gender and body mass index (BMI) were associated with hypertensive LES. Pyrosis was significantly less prevalent in patients with hypertensive LESP. Esophagitis and LES laxity were significantly more prevalent in patients with hypotensive LES. No significant difference was found among the three groups with regard to reflux and Hp positivity. No significant difference was found between Hp-positive and Hp-negative groups with regard to reflux and reflux esophagitis.No clear relationship was found among LES disorders, GER, and Hp. Moreover, no significant difference was found among LES disorders with regard to GER, while the presence of hypotensive LESP, rather than Hp, was found to be an important factor in the development of reflux esophagitis.

Autonomic dysfunction in patients with RLS has been described in some domains; however, detailed studies on this subject are limited and report conflicting results. In this study, we aimed to evaluate autonomic functions electrophysiologically and clinically in patients with restless legs syndrome (RLS). Fifty-two adult patients with RLS and 40 healthy controls were enrolled in this prospective study. Electrophysiological tests of sympathetic skin response (SSR) and RR interval variability (RRIV) analysis were performed, and the SCOPA-AUT questionnaire was applied to evaluate autonomic functions. There was no significant difference in terms of SSR results between patients and controls (p > 0.05). However, there were significant differences between the patient and control groups in terms of RRIV analyses at rest, deep breathing, and valsalva, and also valsalva ratio (p = 0.037, p = 0.049, p = 0.017, p = 0.020). The mean SCOPA-AUT total score was higher in the RLS group compared with the control group (20.7 ± 10 vs 14.2 ± 8; p = 0.003). Significant differences were found regarding gastrointestinal, urinary, and cardiovascular domains (p = 0.01, p = 0.007, p = 0.049); on the other hand, pupillomotor, thermoregulatory, and sexual function did not significantly differ (p > 0.05). Autonomic functions should be questioned in detail as well as motor and sensory symptoms of RLS, and care should be taken especially on cardiac dysfunction.

Purpose Since many different rates have been reported in the literature and the studies conducted are mostly based on the patient anamnesis, it was aimed to analyze the olfactory dysfunction in Coronavirus Disease 2019 (COVID-19) quantitatively and to reveal its progress by time. Methods Patients who described new-onset olfactory dysfunction, who were treated in the COVID-19 departments of our hospital and whose PCR tests demonstrated SARS-CoV-2 presence were included in the study and they were investigated prospectively. Clinical information of all the patients was taken and the levels of olfactory function were detected using the Brief Smell Identification Test (BSIT). Scores equal to or below 8 are considered as olfactory dysfunction. Patients who were followed up for 3 months were reevaluated with the BSIT test at the end of the third month and the progression of the symptom was investigated. Results The mean BSIT test score of the 42 patients (23 female patients, 19 male patients, mean age: 41.2 +/- 14.6) was 5.2 +/- 2.2. There was severe olfactory dysfunction in 16.7% of the patients (0-2 points), moderate olfactory dysfunction in 31% (3-5 points), and mild olfactory dysfunction in 52.4% (6-8 points). After a follow-up for 3 months, full recovery was observed in 36 patients (85.7%) and the mean test score rose to 9.9 +/- 1.8. Although olfactory dysfunction persisted in 6 patients, an elevation in test scores was noted. Olfactory dysfunction was the first symptom in 17 patients (40%) and the other symptoms occurred after 2 days (1-6) on average. Conclusion We investigated olfactory dysfunction caused by COVID-19 using BSIT, and found a high rate of moderate-mild level symptoms with a high level of recovery in the 3-month follow-up. The finding revealing that olfactory dysfunction was the first symptom in 40% of the patients suggests the importance of inquiry on olfactory functions for the early diagnosis of the disease. WOS:000604082300006 2-s2.0-85098739871 PubMed: 33385250

Objectives: Myroides spp. is an environmental pathogen and causes disease in immunocompromised patients. In this study, we report an outbreak of urinary tract infections caused by M. odoratimimus in a university hospital in Turkey. Methods: A total of 25 M. odoratimimus strains isolated from the clinical samples of 20 patients in our intensive care units and clinics were included in the study. Phenotypic and genotypic identification of isolates was performed using conventional methods, VITEK®-2 automated identification system, Matrix Assisted Laser Desorption/Ionisation-Time of Flight Mass Spectrometry and 16S-RNA Microbial Diagnosis methods. In addition, Repetitive Extragenic Palindromic Elements (REP) PCR Assay method was applied for molecular epidemiological analysis. Results: All cases were diagnosed with nosocomial urinary tract infection, except for one case diagnosed with nosocomial bacteraemia. One of the M. odoratimimus isolates was sensitive to piperacillin/tazobactam (MIC: ≤4 µg/ml) and one isolate was moderately sensitive to cefepime (MIC: 16 µg/ml). Other M. odoratimimus isolates were resistant to the tested antibiotics of beta lactams, monobactams, carbapenems, aminoglycosides, fluoroquinolones and sulphonamides. When 10 isolates were evaluated with the REP PCR method, DNA finger print similarities were visually determined and there was a similar DNA pattern among them. Myroides source was not detected in environmental samples. Conclusion: Clinicians should consider that Myroides spp. isolates with multiple and broad-spectrum drug resistance may be a serious nosocomial pathogen like Pseudomonas aeruginosa or Acinetobacter baumannii. In order to choose the best treatment regimen, this atypical pathogen needs to be quickly identified and antibiotic susceptibility tests performed.

Objective:This study aimed to determine the prevalence of periodic leg movements (PLMs) in patients who underwent polysomnographic examinations and to compare the demographic and polysomnographic characteristics of patients with and without PLM.Materials and Methods:The demographic features and polysomnographic parameters of 491 patients were recorded. The patients were divided into two groups: PLMI ≤15 and >15. Patients with PLMI >15 and ≤15 and were defined as those with and without PLMI, respectively. All patients were grouped based on their sex and age.Results:Fifty-nine patients (12 men and 35 women) had PLMI >15. The age of the patients with PLM was significantly higher than that of those without PLM (p=0.05). When the groups were examined based on sex, in men, total sleep time (TST) in the non- PLM group and sleep time and sleep latency after sleep onset in the PLM group were significantly prolonged (p

Introduction Influenza subtypes vary by clinical, radiological, and prognostic courses and may go along with viral pneumonia. We aimed to identify clinical, radiological, and prognostic aspects of influenza epidemic during years 2016-2017. Materials and Methods Influenza cases reported to the Public Health Directorate in our city was assessed retrospectively. Clinical, radiological, and prognostic parameters were compared based on influenza subtypes. Result We analyzed samples from 197 cases with suspected influenza. Mean age of the subjects was 51.17 ± 26.74. We found influenza A/H1N1, influenza A/H3N2, and influenza B in 59 (30.0%), 29 (14.7%), and 3 (1.5%) cases, respectively. Comorbidity was present in 48 (24.4%) cases. Most common radiological finding was interstitial pattern. Seventy-one and 79 per cent of H1N1 and H3N2 cases were influenza pneumonia, respectively. The prevalence of overall mortality was 5.5% with a predominance in H1N1 over H3N2. Influenza vaccination had been performed in 6.8% and 3.4% of H1N1 and H3N2 cases, respectively. We detected no mortality in any vaccinated patient. We identified 6 pregnant women, 2 of which ended up with preterm birth, and another one with abortion. Conclusions Often manifested as lower respiratory tract infection, influenza may cause epidemics with increased mortality rate. Influenza should be suspected when interstitial pattern was seen on radiological images. H1N1 cases course worse. Since the prognosis is better in vaccinated patients, seasonal influenza vaccination among the community needs to be elevated. In addition, protective measures like vaccination should be taken in pregnancy to avoid preterm delivery or abortion.

[Abstract Not Available] WOS:000606993500017 2-s2.0-85096687342

Crimean-Congo hemorrhagic fever (CCHF) is a severe human infection caused by CCHF virus (CCHFV). Today, although the literature on CCHF pathogenesis is still limited, it is thought to be associated with immunosuppression in the early phase of infection followed by pro-inflammatory immune response that may lead to fatal outcomes. The aim of this study is to investigate the role of regulatory T-cells (T

Multiple sclerosis (MS) is a common chronic neurological disease that causes disability. MS can have various clinical manifestations, one of which is olfactory dysfunction. In clinical practice, olfactory disturbances are usually underdiagnosed. The aim of our study is to assess olfactory function and its relationship with MS disease duration, disability and cognition.We assessed 31 MS patients and 24 healthy controls matched in sex and age at our MS outpatient clinic of the Istanbul Education and Research Hospital Neurology Department. Each subject was interviewed to obtain demographic data. The Connecticut Chemosensory Clinical Research Center (CCCRC) olfactory test and Montreal Cognitive Assessment (MOCA) were applied to each participant.The CCCRC test scores of the MS patients were lower than those in the control group (p 0.05). Patients with a longer disease duration and more frequent attacks had lower CCCRC scores (p 0.05). The Expanded Disability Status Scale scores had no correlation with the CCCRC test scores. The MOCA score was positively correlated with all domains of the olfactory test scores.This study supports the presence of olfactory dysfunction in early stages of MS and the correlation of cognitive impairment with olfactory dysfunction, even in the early stages of the disease in young and less physically- disabled patients. The assessment of olfaction may be helpful as a surrogate method for tracking disease progression in patients over time.

The authors evaluated basic sleep architecture and non–rapid eye movement (NREM) sleep alterations in drug-naïve attention-deficit/hyperactivity disorder (ADHD) children without psychiatric or other comorbidities. This cross-sectional case-control study included 28 drug-naïve children with ADHD and 15 healthy controls. This subjective studies revealed that children with ADHD had a worse sleep quality and increased daytime sleepiness. Polysomnography data showed that the sleep macrostructure was not significantly different in children with ADHD. Sleep microstructure was altered in ADHD children by means of reduced total cyclic alternating pattern rate and duration of cyclic alternating pattern sequences. This reduction was associated with a selective decrease of A1 index during stage 2 NREM. SpO2 in total sleep was slightly decreased; however, the incidence of sleep disordered breathing showed no significant difference. The authors suggest that cyclic alternating pattern scoring would provide a further insight to obtain a better understanding of the sleep structure in children with ADHD.

yapar, derya/0000-0003-3566-9751; WOS: 000369701200020 PubMed: 26577431 Introduction: We aimed to determine clinical, laboratory and demographical characteristics of tularemia on admission to Emergency Department (ED). Material and Methods: Medical data of 317 patients admitted to ED and subsequently hospitalized with suspected tularemia between January 1, 2011, and May 31, 2015, were collected. Patients were divided into 2 groups according to microagglutination test results, as tularemia (+) and tularemia (-). Results: Of the 317 patients involved, 49 were found to be tularemia (+) and 268 were tularemia (-). Mean age of the tularemia (+) patients was found to be higher than that of tularemia (-) patients. When compared to tularemia (-) patients, a significant portion of patients in tularemia (+) patients were elderly, living in rural areas and had contact with rodents. When clinical and laboratory findings of the 2 groups were compared, any statistical significance could not be determined. Conclusion: Tularemia is a disease of elderly people living in rural areas. Contact with rodents also increases risk of tularemia in suspected patients. (C) 2015 Elsevier Inc. All rights reserved.

A 49-year-old man was admitted to the hospital with complaints of fatigue, epistaxis and a skin rash. The whole blood count revealed isolated thrombocytopenia (4,000/mL), and the patient was admitted to the hematology department with a diagnosis of immune thrombocytopenia. He did not respond to steroid treatment for 15 days, and a subfebrile fever developed during this period. A diagnosis of acute brucellosis was considered due to positive serological tests and a blood culture positive for Brucella spp. After starting doxycycline and rifampicin therapy, the patient's thrombocyte count increased to 15,000/mL on the third day, to 41,000/mL on the sixth day and was normal on the 21st day of treatment. A diagnosis of brucellosis must be considered in patients presenting with severe and isolated thrombocytopenia in countries where brucellosis is endemic.

Although brachial plexus injury occurring during multitrauma is frequent in adults, it is rarely observed in childhood. The most common cause of pediatric traumatic brachial palsy is motor vehicle accidents followed by pedestrian struck. Generally, phrenic nerve palsy accompanying brachial plexus trauma is observed in 10% to 20% of cases, but it is overlooked because unilateral injuries are frequently asymptomatic. Severe unilateral phrenic nerve palsy accompanying brachial plexus avulsion is very rare. Here, we present a pediatric case of unilateral phrenic nerve palsy associated with respiratory distress and brachial plexus avulsion due to multitrauma.