Evaluation of patients with fibrotic interstitial lung disease: Preliminary results from the Turk-UIP study

OBJECTIVE: Differential diagnosis of idiopathic pulmonary fibrosis (IPF) is important among fibrotic interstitial lung diseases (ILD). This study aimed to evaluate the rate of IPF in patients with fibrotic ILD and to determine the clinical-laboratory features of patients with and without IPF that would provide the differential diagnosis of IPF. MATERIAL AND METHODS: The study included the patients with the usual interstitial pneumonia (UIP) pattern or possible UIP pattern on thorax high-resolution computed tomography, and/or UIP pattern, probable UIP or possible UIP pattern at lung biopsy according to the 2011 ATS/ERSARS/ALAT guidelines. Demographics and clinical and radiological data of the patients were recorded. All data recorded by researchers was evaluated by radiology and the clinical decision board. RESULTS: A total of 336 patients (253 men, 83 women, age 65.8 +/- 9.0 years) were evaluated. Of the patients with sufficient data for diag-nosis (n=300), the diagnosis was IPF in 121 (40.3%), unclassified idiopathic interstitial pneumonia in 50 (16.7%), combined pulmonary fibrosis and emphysema (CPFE) in 40 (13.3%), and lung involvement of connective tissue disease (CTD) in 16 (5.3%). When 29 patients with definite IPF features were added to the patients with CPFE, the total number of IPF patients reached 150 (50%). Rate of male sex (p<0.001), smoking history (p<0.001), and the presence of clubbing (p=0.001) were significantly high in patients with IPE None of the women <50 years and none of the men <50 years of age without a smoking history were diagnosed with IPE Presence of at least 1 of the symptoms suggestive of CTD, erythrocyte sedimentation rate (ESR), and antinuclear antibody (FANA) positivity rates were significantly higher in the non-IPF group (p<0.001, p=0.029, p=0.009, respectively). CONCLUSION: The rate of IPF among patients with fibrotic ILD was 50%. In the differential diagnosis of IPF, sex, smoking habits, and the presence of clubbing are important. The presence of symptoms related to CTD, ESR elevation, and EANA positivity reduce the likelihood of IPF

Evaluation of 35 adult measles cases detected in a measles outbreak

Bu çalışmada, 2001 yılında Avrupa'da ve ülkemizde görülen kızamık epidemisinde kliniğimize başvuran erişkin kızamık olgularının demografik, epidemiyolojik ve klinik özelliklerinin prospektif olarak değerlendirilmesi amaçlanmıştır. Ocak-Haziran 2001 tarihleri arasında, yaşları 16-36 yıl (ortalama: 23.1 ±4.6 yıl) arasında değişen 10 erkek ve 25 kadın olmak üzere toplam 35 erişkin kızamık olgusu saptanmıştır. Kızamık tanısı tüm olgularda klinik bulgu ve belirtilere dayanılarak konulmuş, serolojik inceleme yapılabilen 11 olgunun tamamında kızamık IgM antikor pozitifliği belirlenmiştir. Olgularda en sık görülen semptomların, ateş (%91.4), öksürük (%94.3) ve konjunktivit (%77.1) olduğu izlenmiştir. Hastaların tamamında makülopapüler döküntü mevcut olup, %77.1'inde Koplik lekeleri, %57.1'inde lenfadenopati ve %5.7'sinde hepatomegali saptanmıştır. Laboratuvar incelemelerinde, hastaların %28.5'inde lökopeni ve %37.2'sinde karaciğer enzim yüksekliği belirlenmiştir. En sık karşılaşılan komplikasyon, hastaların %20'sinde ortaya çıkan pnömoni olmuştur. Olguların %2.9'unda otit ve %17.1 'inde ishal varlığı tespit edilmiş, gebeliği olan üç hastadan birinde spontan abortus gelişmiştir. Sonuç olarak, ülkemizde halen önemli bir halk sağlığı sorunu olan kızamığın, özellikle erişkin hastalarda yol açtığı komplikasyonlar ve neden olduğu iş gücü kaybı göz önüne alındığında, aşının iki doz uygulanmasının ve immünizasyonun hedef kitleye tam olarak yayılmasının kızamık eliminasyon programında başarı sağlayacağı düşünülmüştür.The aim of this study was to evaluate the clinical, epidemiological and demographical features of adult measles cases admitted to our hospital, during the measles epidemic which emerged in Europe and in our country in the year 2001. A total of 35 adult measles cases (10 male, 25 female) ages between 16-36 (mean age: 23.1 ±4.6) years were detected between January andJune 2001. The diagnosis was based on the clinical findings, however only 11 of the cases could be serologically confirmed with the presence of measles IgM antibody positivities. Fever (91.4%), cough (94.3%) and conjunctivitis (77.1%) were the most common symptoms. All of the patients had maculopapular rash, and the presence of Koplik spots, lymphadenopathy and hepatomegaly were observed in 77.1%, 57.1%, and 5.7% of patients, respectively. Leukopenia and elevated liver enzymes were detected in 28.5% and 37.2% of the patients, respectively. Pneumonia was the most common complication which was seen in 20% of the patients. Of the cases 2.9% exhibited otitis media and 17.1 % diarrhea. Spontaneous abortus occurred in one of the three pregnant women. In conclusion, measles is still an important public health problem in our country, and since it may lead to severe complications and economic and labor loss, an effective elimination programme should be obtained by the use of vaccine in two doses and effective strategies for the immunization of the target populations

A Case of Generalized Tetanus Discharged with Recovery

Tetanus is an acute-onset disease that results from exposure to the exotoxins produced by Clostridium tetani. It is characterized by tonic muscle spasms and has high morbidity and mortality. Respiratory failure is the most severe problem causing mortality in generalized tetanus. Mechanical ventilation is almost always mandatory for tetanus patients with respiratory failure and airway obstruction. Here, we report a 60-year-old man with generalized tetanus. He was admitted to the emergency department with jaw stiffness, dysphagia, breathlessness, and fever. His history revealed that he had suffered an injury to his left toe by a rusted nail seven days ago. He had received one dose of tetanus vaccine but no anti-tetanus immunoglobulin was given. He also did not know his prior vaccination history. He was diagnosed as tetanus and was followed up in the intensive care unit. He was treated with intravenous metronidazole and 60.000 IU equine tetanus antiserum. Midazolam was given for generalized muscle spasms. He was put on mechanical ventilation for 11 days and was discharged from the hospital 28 days after admission with recovery. In conclusion, although tetanus is now rare for our country, it should not be forgotten. Prior vaccination should be queried in patients who are admitted to hospitals with injury, and they should be accurately evaluated for vaccination and immunoglobulin

False positivity for marijuana in immunoassay analysis due to Efavirenz use. A case report

WOS: 000378754600011Cross-reaction is an important problem with immunoassays that may lead to interferences and potentially yield wrong results. This case study describes a false positive tetrahydrocannabinol (THC) screening with CEDIA immunoassay reagents after the use of efavirenz for anti-retroviral therapy. A 31-year-old HIV (+) probationer transsexual was admitted to Ege University Institute of Drug Abuse, Toxicology and Pharmaceutical Sciences Toxicology Laboratory due to marijuana abuse. He had been using 600 mg/day Efavirenz to overcome his disease. As the routine application in the laboratory, the urine specimens of the probationer were first screened for drugs of abuse using CEDIA reagents. The analysis results were all found to be positive. Subsequently, the urine specimens were also analyzed for their THC content with another urine screening immunoassay kit using DRI (Diagnostic Reagent Inc.) reagents. The results were found to be negative. In order to ensure a correct result, the confirmation of the analysis was performed with the gas chromatography-mass spectrometer for the urine samples and the results were found to be below the detection limit (LOD < 1.97 ng/mL), Additionally a hair sample belonging to probationer was obtained, analyzed with a fully validated method and the result was also found to be negative. Therefore, it was concluded that the result obtained with CEDIA reagents was false positive for THC which is, and was caused by Efavirenz use by the probationer. The results demonstrated that there is a strong need for the careful interpretation of the analysis results by an experienced forensic toxicologist to decrease the chances of obtaining wrong results

Local Steroid Treatment: An Effective Procedure for Idiopathic Granulomatous Mastitis, Including Complicated Cases

Purpose To evaluate the effectiveness of treatment with topical and intralesional steroids for idiopathic granulomatous mastitis (IGM) and to compare with surgical methods. Methods Data were retrospectively collected from records. Intralesional steroid injection and topical steroid administration, hereafter referred to as local steroid treatment (LST) were applied in Group 1. Surgery (local excision, wide excision, and mastectomy) was performed in Group 2. In Group 1, changes in lesion sizes were recorded and factors complicating treatment were identified. The Numeric Pain Rating Scale was used to determine subjective pain. LST and surgery were compared with regard to: pain before and after the treatment; complication rate; recurrence rate; and treatment cost. Results There were 38 and 48 patients in Group 1 and Group 2, respectively. In the LST group, 72 lesions were present and 70 of 72 (97%) responded completely to treatment. Pretreatment median maximum diameter was 23.50 (15.25–35.25) mm, which regressed to 16 (12–25) mm after the first session. While the pretreatment pain scores of Group 1 and Group 2 were similar (p = 0.756), there was a significant difference in the post-treatment pain scores (p < 0.001). No recurrence occurred in any patients in Group 1, while recurrence developed in 15 (31.2%) patients in Group 2 (p < 0.001). Conclusion LST is a treatment for IGM that is cheap, with high efficiency, negligible recurrence, and has good esthetic outcome. Our results suggest that LST should be the first-line treatment option for all IGM patients, including complicated cases

Oxidative stress in portal hypertension-induced rats with particular emphasis on nitric oxide and trace metals

AIM: To investigate the oxidative-stress-related changes in rats with portal hypertension with particular emphasis on nitric oxide (NO) and trace metals

Food-induced anaphylaxis in early childhood and factors associated with its severity.

Background: Several factors that increase the risk of severe food-induced anaphylaxis have been identified

Food-induced anaphylaxis in early childhood and factors associated with its severity

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