Akut Lösemi Hastalarında İnvaziv Fungal Enfeksiyonlar

In this study, we aimed to determine the distribution of invasive fungal infections (IFI), risk factors and agent spectrum, to evaluate them according to the EORTC/MSG criteria, to investigate the efficiency of bronchoalveolar lavage (BAL) as a diagnostic method and to perform survival analysis in adult acute leukemia patients. The incidence of IFI was found to be 33.1% in 502 patients who were followed up in an inpatient ward or intensive care unit between 2003 and 2020. While there was no difference in the risk of developing IFI according to the type of acute leukemia, the incidence was shown as 33% in patients with AML or ALL. Lung involvement was found to be the most (93.4%), however it affected neither survival time nor death risk. The most common clinical symptom in patients with IFI was fever (79.5%), the most common thoracic CT finding was macronodules (77.7%) and the most common agent was Aspergillus. According to the definition criteria established by EORTC/MSG to avoid delays in diagnosis, 32 (19.3%) patients were defined as proven IFI, 35 (21.1%) patients as probable IFI, and 99 (59.6%) patients as possible IFI. When only proven and probable IFI were evaluated, the incidence of IFI was determined as 13.3%. All patients included in the study had the host factor required by EORTC/MSG, due to their haematological malignancies, when additional clinical and mycological criteria were required for the diagnosis of proven or possible IFI. Aspergillus galactomannan (GM) antigen test has been found positive in serum in 39 (23.5%) patients and in BAL fluid in 6 (3.6%) patients. Fungal elements have been demonstrated or pathogens been produced in 13 (7.8%) sputum cultures and 4 (2.4%) BAL fluid cultures. BAL was applied to a total of 26 patients with IFI, and contributed to proven or probable IFI diagnosis in 10 patients. Hereunder, BAL efficiency was determined as 38.4% in our study. The risk of developing IFI was increased 3.5 times in 136 (81.9%) patients with neutropenia (95% confidence interval (CI): 2.248, 5.531), 2.5 times in 64 (38.6%) patients who were followed up in the intensive care unit (95% CI: 1.669, 3.801) and 1.8 times (95% CI: 1.195, 2.997) in 42 (25.3%) patients who underwent mechanical ventilator (MV). Although the main pathogen isolated from proven IFI cases was Aspergillus (14, 43.8%), Candida (9, 28.1%), Mucor (8, 25.0%) and PCP (1, 3.1%) were also detected. Our study was not aimed to detect antifungal efficacy or safety, however it was observed that almost all patients were given antifungal prophylaxis, and adapted to empirical, preemptive or targeted antifungal therapy according to the follow-up. Voriconazole (24.1%) was used the most as an antifungal agent. The mean survival time of patients with IFI was determined as 5 (1.9-8) months. While the mean survival time of patients without intensive care follow-up was 13 months, it was 1 month in patients with intensive care follow-up, and also a 2.49-fold increase in death risk was found. Similarly, while the mean survival time of patients who did not receive MV was 62 months, it was 4.4 months in patients who were administered MV, and also a 3.82-fold increase in death risk was found. The mean survival time of Mucor infection (1 month) was found to be statistically significantly lower than other pathogens. There was no significant difference in IFI diagnosis or survival time between patients who were applied BAL or not. As of the termination date of the study, IFI-related deaths were detected in 116 (69.9%) of 166 patients with IFI. According to the results, IFI is an important cause of morbidity and mortality in acute leukemia patients. Lung involvement is seen the most and lung samples such as sputum or BAL fluid can contribute to the diagnosis. Also neutropenia, intensive care follow-up and MV administration are associated with an increased risk in the development of IFI and of death, and mold agents are gradually increasing in patients with haematological malignancies, considering the previous studies. Finally, as a center that provides diagnosis and treatment of patients with haematological malignancies, we recommend in the IFI approach in patients with acute leukemia, to be aware of IFI in patients receiving intensive chemotherapy and/or recipients of haematopoietic stem cell transplantation, and to evaluate with microbiological, serological and radiological tests during the clinical follow-up, and if necessary, to apply invasive diagnostic methods such as bronchoscopy or tissue biopsy.Bu çalışmada erişkin akut lösemi hastalarında invaziv fungal enfeksiyonların (İFE) dağılımının, risk faktörlerinin ve etken spektrumunun belirlenmesi, EORTC/MSG kriterlerine göre değerlendirilmesi, tanı yöntemi olarak bronkoalveolar lavaj (BAL)’ın etkinliğinin araştırılması ve sağkalım analizlerinin yapılması amaçlandı. 2003-2020 yıllarında yataklı servis veya yoğun bakım ünitesinde yatışı yapılarak takip edilen 502 hastada İFE insidansı %33,1 olarak saptandı. Akut lösemi türüne göre İFE gelişme riskinde farklılık saptanmazken, AML ve ALL hastalarında insidans %33 olarak gösterildi. En sık akciğer tutulumu (%93,4) belirlenirken akciğer tutulumunun sağkalım veya ölüm riski üzerine etkisi olmadığı görüldü. İFE saptanan hastalarda klinik olarak en sık semptom ateş (%79,5) olurken en sık görülen Toraks BT bulgusu makronodüller (%77,7) ve en sık etken Aspergillus olarak saptandı. Tanıdaki gecikmelerin önüne geçilebilmesi için EORTC/MSG tarafından oluşturulan tanı kriterlerine göre 32 (%19,3) hasta kanıtlanmış İFE, 35 (%21,1) hasta olası İFE, 99 (%59,6) hasta mümkün İFE olarak tanımlandı. Sadece kanıtlanmış ve olası İFE değerlendirildiğinde ise İFE insidansı %13,3 olarak belirlendi. Hastaların tümü hematolojik maligniteleri nedeniyle EORTC/MSG’nin İFE için gerektirdiği konak faktörüne sahipken kanıtlanmış veya olası İFE tanısı için ek olarak klinik ve mikolojik kriterlere ihtiyaç vardı. Aspergillus GM antijen testi 39 (%23,5) hastada serumda ve 6 (%3,6) hastada BAL sıvısında pozitif saptanmıştı. 13 (%7,8) balgam kültürü ve 4 (%2,4) BAL sıvısı kültüründe ise fungal elemanlar gösterilmiş veya patojen üretilmişti. İFE saptanan toplam 26 hastaya BAL uygulanmış, 10 hastada kanıtlanmış veya olası İFE olarak tanıya katkı sağlanmıştı. Buna göre çalışmamızda BAL etkinliği %38,4 olarak belirlendi. İFE gelişme riskinin nötropeni saptanan 136 (%81,9) hastada 3,5 kat arttığı (%95 güven aralığı (GA): 2,248, 5,531), yoğun bakım izlemi olan 64 (%38,6) hastada 2,5 kat arttığı (%95 GA: 1.669, 3.801) ve mekanik ventilator (MV) uygulanan 42 (%25,3) hastada 1,8 kat arttığı (%95 GA: 1.195, 2.997) gösterildi. Kanıtlanmış İFE olgularından izole edilen ana patojen Aspergillus (14, %43,8) olmakla birlikte Candida (9, %28,1), Mucor (8, %25,0) ve PCP (1, %3,1) patojenleri de saptandı. Çalışmamız antifungal etkinlik veya güvenilirliğini göstermeyi hedefleyen bir çalışma olmamakla birlikte çalışmaya dahil edilen neredeyse tüm hastalara antifungal profilaksi verilmiş olduğu, hastaların izlemlerine göre ampirik, preemptif veya hedefe yönelik antifungal tedavi uygulandığı görüldü. Antifungal ajan olarak en sık Vorikonazol (%24,1) kullanıldığı tespit edildi. İFE saptanan hastaların ortalama sağkalım süresi 5 (1,9-8) ay olarak belirlendi. Yoğunbakım izlemi olmayan hastaların ortalama sağkalım süresi 13 ay iken yoğun bakım izlemi olanlarda 1 ay olarak saptandı ve ölüm riskinde 2,49 kat artış belirlendi. MV uygulanmayan hastalarda ortanca sağkalım süresi 62 ay iken MV uygulananlarda 4,4 ay olarak tespit edildi ve ölüm riskinde 3,82 kat artış saptandı. Mucor’un sağkalım ortancası (1 ay) diğer patojenlere göre istatistiksel anlamlı olarak daha düşük bulundu. BAL yapılan ve yapılmayan hastalarda İFE tanısında veya sağkalımda anlamlı fark saptanmadı. Çalışmanın sonlandırıldığı tarih itibariyle İFE saptanan 166 hastanın 116 (%69,9)’sında İFE ilişkili ölüm tespit edildi. Bu sonuçlara göre, akut lösemi hastalarında İFE’nin önemli bir morbidite ve mortalite nedeni olduğu, en sık akciğer tutulumunun görüldüğü, balgam ve BAL sıvısı gibi akciğer örneklerinin tanıya katkı sağladığı, nötropeni, yoğun bakım izlemi ve MV uygulanmasının İFE gelişiminde risk faktörü olduğu ve ölüm riskini arttırdığı ve daha önceki çalışmalar da dikkate alınarak hematolojik maligniteli hastalarda küf etkenlerinin giderek artmakta olduğu söylenebilir. Hematolojik maligniteli hastaların tanı ve tedavilerini sağlayan bir merkez olarak akut lösemi hastalarında İFE yaklaşımında, yoğun kemoterapi alan ve/veya hematopoietik kök hücre nakil alıcısı olan hastalarda İFE’nin akılda tutulmasını, hastaların klinik izlemleri sırasında aynı zamanda mikrobiyolojik, serolojik ve radyolojik yöntemlerle de takip edilmelerini, gereği halinde bronkoskopi veya doku biyopsisi gibi invaziv tanı yöntemleri ile değerlendirilmelerini öneririz

Prognostic significance of positive lymph node ratio in patients with pN3 gastric cancer who underwent curative gastrectomy

...Japanese Society of Medical OncologyEuropean Society for Medical Oncolog

Prognostic significance of metastatic lymph node ratio in patients with pN3 gastric cancer who underwent curative gastrectom

WOS: 000464383800005PubMed ID: 30870846Background: Lymph node involvement is an important prognostic factor in patients with gastric cancer. The aim of this study was to determine the prognostic significance of metastatic lymph node ratio (MLNR) and compare it to the number of lymph node metastasis in pN3 gastric cancer. Methods: We retrospectively analyzed 207 patients with pN3 gastric cancer who had undergone radical gastrectomy. Prognostic factors and MLNR were evaluated by univariate and multivariate analysis. Results: An MLNR of 0.75 was found to be the best cut-off value to determine the prognosis of patients with pN3 gastric cancer (p = 0.001). The MLNR was significantly higher in patients with large-sized and undifferentiated tumors, vascular, lymphatic and perineural invasion, and total gastrectomy. In multivariate analysis, MLNR (p = 0.041), tumor differentiation (p = 0.046), and vascular invasion (p = 0.012) were found to be independent prognos-tic factors for disease-free survival, while both MLNR (p 0.75 compared to the MLNR <0.75 group (p <0.05). However, recurrence patterns were similar between pN3a and pN3b. Conclusion: Our results showed that MLNR was a useful indicator to determine the prognosis and recurrence patterns of patients with radically resected gastric cancer. Moreover, MLNR is a beneficial and reliable technique for evaluating lymph node metastasis

A multicenter study on epidemiological and clinical characteristics of 125 newborns born to women infected with COVID-19 by Turkish Neonatal Society

Palalioglu, Rabia Merve/0000-0003-2717-7925WOS: 000558113600001PubMed: 32776309Limited data are available on pregnant women with COVID-19 and their neonates. We aimed to evaluate the epidemiological and clinical characteristics of newborns born to women infected with COVID-19. A multicenter cohort study was conducted among newborns born to mothers with COVID-19 in 34 neonatal intensive care units (NICUs) in Turkey. Pregnant women (n = 125) who had a positive RT-PCR test and their newborns were enrolled. Cesarean section, prematurity, and low-birthweight infant rates were 71.2%, 26.4%, and 12.8%, respectively. Eight of 125 mothers (6.4%) were admitted to an intensive care unit for mechanical ventilation, among whom six died (4.8%). Majority of the newborns (86.4%) were followed in isolation rooms in the NICU. Four of 120 newborns (3.3%) had a positive RT-PCR test result. Although samples taken on the first day were negative, one neonate became positive on the second day and the other two on the fifth day. Sample from deep tracheal aspirate was positive on the first day in an intubated case. Conclusion: COVID-19 in pregnant women has important impacts on perinatal and neonatal outcomes. Maternal mortality, higher rates of preterm birth and cesarean section, suspected risk of vertical transmission, and low rate of breastfeeding show that family support should be a part of the care in the NICU. Trial registration:identifier: NCT04401540 What is Known: center dot the common property of previous reports was the conclusions on maternal outcomes, rather than neonatal outcomes. center dot Published data showed similar outcomes between COVID-19 pregnant women and others. What is New: center dot Higher maternal mortality, higher rates of preterm birth and cesarean section, suspected risk of vertical transmission especially in a case with deep tracheal aspiration during the intubation, and the possible role of maternal disease severity on the outcomes are remarkable findings of this study. center dot in contrast to recommendation for breastfeeding, parents' preference to formula and expressed breast milk due to anxiety and lack of information shows that family support should be a part of the care in the NICU. Trial registration: ClinicalTrials.gov identifier: NCT0440154

ERS international virtual congress 2021: Highlights from the Turkish thoracic society early career members

This review aimed to highlight some important points derived from the presentations of the European Respiratory Society 2021 Virtual International Congress by a committee formed by the Early Career Task Group of the Turkish Thoracic Society. We summarized a wide range of topics including current developments of respiratory diseases and provided an overview of important and striking topics of the congress. Our primary motivation was to give some up-to-date information and new developments discussed during congress especially for the pulmonologists who did not have a chance to follow the congress. This review also committed an opportunity to get an overview of the newest data in the diverse fields of respiratory medicine such as post-coronavirus disease 2019, some new interventional and technologic developments related to respiratory health, and new treatment strategies

Turkish Thoracic Society early career members task force group's virtual congress notes: European Respiratory Society International Congress 2020

In this article, Early Career Task Force Group members of the Turkish Thoracic Society summarize the European Respiratory Society 2020 virtual congress. Current developments in the field of respiratory diseases were compiled with the addition of sessions specific to coronavirus disease 2019 this year. Almost all of the congress sessions were examined, and the important and striking results of the congress were highlighted. Congress sessions were attended by expert researchers, and the prominent messages of each session were highlighted in short summaries. They were then grouped under relevant titles and ranked in order of meaning and relation. It was finalized by a team of researchersTurkish Thoracic Society (TTS

Re-examining the characteristics of pediatric multiple sclerosis in the era of antibody-associated demyelinating syndromes.

Background: The discovery of anti-myelin oligodendrocyte glycoprotein (MOG)-IgG and anti-aquaporin 4 (AQP4)-IgG and the observation on certain patients previously diagnosed with multiple sclerosis (MS) actually have an antibody-mediated disease mandated re-evaluation of pediatric MS series. Aim: To describe the characteristics of recent pediatric MS cases by age groups and compare with the cohort established before 2015. Method: Data of pediatric MS patients diagnosed between 2015 and 2021 were collected from 44 pediatric neurology centers across Turkiye. Clinical and paraclinical features were compared between patients with dis-ease onset before 12 years (earlier onset) and >= 12 years (later onset) as well as between our current (2015-2021) and previous (< 2015) cohorts. Results: A total of 634 children (456 girls) were enrolled, 89 (14%) were of earlier onset. The earlier-onset group had lower female/male ratio, more frequent initial diagnosis of acute disseminated encephalomyelitis (ADEM), more frequent brainstem symptoms, longer interval between the first two attacks, less frequent spinal cord involvement on magnetic resonance imaging (MRI), and lower prevalence of cerebrospinal fluid (CSF)-restricted oligoclonal bands (OCBs). The earlier-onset group was less likely to respond to initial disease-modifying treatments. Compared to our previous cohort, the current series had fewer patients with onset < 12 years, initial presentation with ADEM-like features, brainstem or cerebellar symptoms, seizures, and spinal lesions on MRI. The female/male ratio, the frequency of sensorial symptoms, and CSF-restricted OCBs were higher than reported in our previous cohort. Conclusion: Pediatric MS starting before 12 years was less common than reported previously, likely due to exclusion of patients with antibody-mediated diseases. The results underline the importance of antibody testing and indicate pediatric MS may be a more homogeneous disorder and more similar to adult-onset MS than previously thought