Management of patients with connective tissue disease-associated interstitial lung diseases during the COVID-19 pandemic

The novel coronavirus disease (COVID-19) is similar to connective tissue disease-associated interstitial lung diseases (CTD-ILD) in many aspects. However, patients with CTD-ILD have required particular attention during the pandemic since they are at high risk due to -immunosuppressive treatments. Thus, prompt decisions for diagnosis and treatment initiation have become more important than earlier for these patients during the pandemic. Radiological perspectives have become inevitable for the differential diagnosis of this group -during the pandemic, particularly to obtain rapid and accurate results that allow the physicians to start treatment immediately. However, in addition to radiological images, a definitive diagnosis also requires access to extensive information regarding patient history, including characteristics of comorbidities, and clinical and serological findings. Consequently, the differential diagnosis of COVID-19 and CTD-ILD can yield accurate treatment regimens that differ greatly between the 2 diseases, and also prevent the spread of the outbreak with COVID-19 patients treated under isolation

Adrenal Glands of Chinchilla lanigera - Study of Anatomical Features with Computed Tomography and Magnetic Resonance Imaging

   Background: Since chinchilla (Chinchilla lanigera) is frequently used as a laboratory animal, satisfactory data about the imaging anatomical appearance of its adrenal glands, such as their anatomical location and closeness with other abdomi­nal soft tissue and vessels, are important. The aim of this study to determine anatomical features of the chinchilla adrenal gland’s using computed tomography and magnetic resonance imaging. Materials, Methods & Results: We used 12 chinchillas (6 males and 6 females), aged 18 months. The animals were in supine recumbency when contrast-enhanced computed tomography (CT) was performed. Transverse, sagittal and dorsal images of the adrenal glands were obtained with iodinated contrast medium, and 3D reconstruction of the obtained images was applied. The craniocaudal (CrCc - length), dorsoventral (DV - height) and lateromedial (LM - width) diameters were measured using an electronic calliper. Magnetic resonance imaging was performed, and coronal T1-weighted images were obtained. The transverse CT anatomical image at the level of the 3rd lumbar vertebra demonstrated the location of the both adrenal glands in accordance with the grey-white scale’s variation. The right adrenal gland was hypo-attenuated and elliptic compared to the right kidney and in close contact to it and to the caudal vena cava. The left adrenal gland was oval and at a distance to the abdominal aorta. The dorsal MRI anatomical study of the chinchilla’s abdominal organs at a distance of 10 mm from the spine and in a T1-weighted sequence showed that both adrenal glands were retroperitoneal organs. Discussion: Post-contrasted CT defined the topography of both glands. The right adrenal gland has an oval shape and is cranially situated to the left gland, whose shape is cylindrical and elongated. The LM diameter of the right gland is higher than that measured in the left gland. Both DV and CrCc diameters of the right gland are lower compared to those of the left gland. The right adrenal gland is in close contact to the caudal vena cava, the right kidney and the liver, and the left adrenal gland is in a distance to the abdominal aorta. The right adrenal gland was close to the caudal vena cava and the right kidney and medially to the left kidney. The successful comparative analysis of the images in 3D reconstruction and post-contrast CT in 2D allowed us to conclude that 3D reconstruction is suitable to obtain detailed information in a sum­mary form regarding the closeness of the glands and their shape, mainly because the results are in a real time and highly comprehensive. Our data are in in agreement with previous findings about the advantages of 3D reconstruction. The research algorithm applied was based on the dorsal visualization of the glands in T1-weighted sequence, achieving a comprehensive and high-quality MRI imaging of the examined organs in chinchillas. Both adrenal glands were retroperitoneal organs and with low signal. The dorsal MRI anatomical study of the chinchilla’s abdominal organs at a distance of 10 mm from the spine and in a T1-weighted sequence showed the whole profile of the right and left glands and the cranial position of the right gland to the left one, the close contact between the right gland and the kidney and the distance between the left gland and the left kidney. The MRI results are detailed and comprehensive for interpretation. In conclusion, the results of the present study are comprehensive, detailed and with high resolution. We present data for the anatomical relationships of the studied organs, their shape and macrometric parameters, concluding that the above mentioned modalities are very important tools for studying the chinchilla’s adrenal glands to create a morphological base, which is necessary to inves­tigate specific diseases. Keywords: adrenal glands, chinchilla, CT, imaging anatomy, MRI, 3D reconstructio

Evaluation of immunization status in patients with cerebral palsy: a multicenter CP-VACC study

Children with chronic neurological diseases, including cerebral palsy (CP), are especially susceptible to vaccine-preventable infections and face an increased risk of severe respiratory infections and decompensation of their disease. This study aims to examine age-appropriate immunization status and related factors in the CP population of our country. This cross-sectional prospective multicentered survey study included 18 pediatric neurology clinics around Turkey, wherein outpatient children with CP were included in the study. Data on patient and CP characteristics, concomitant disorders, vaccination status included in the National Immunization Program (NIP), administration, and influenza vaccine recommendation were collected at a single visit. A total of 1194 patients were enrolled. Regarding immunization records, the most frequently administrated and schedule completed vaccines were BCG (90.8%), hepatitis B (88.9%), and oral poliovirus vaccine (88.5%). MMR was administered to 77.3%, and DTaP-IPV-HiB was administered to 60.5% of patients. For the pneumococcal vaccines, 54.1% of children received PCV in the scope of the NIP, and 15.2% of children were not fully vaccinated for their age. The influenza vaccine was administered only to 3.4% of the patients at any time and was never recommended to 1122 parents (93.9%). In the patients with severe (grades 4 and 5) motor dysfunction, the frequency of incomplete/none vaccination of hepatitis B, BCG, DTaP-IPV-HiB, OPV, and MMR was statistically more common than mild to moderate (grades 1-3) motor dysfunction (p = 0.003, p < 0.001, p < 0.001, p < 0.00, and p < 0.001, respectively). Physicians' influenza vaccine recommendation was higher in the severe motor dysfunction group, and the difference was statistically significant (p = 0.029). Conclusion: Children with CP had lower immunization rates and incomplete immunization programs. Clinicians must ensure children with CP receive the same preventative health measures as healthy children, including vaccines

Real-World Outcomes of Anti-VEGF Treatment for Neovascular Age-Related Macular Degeneration in Turkey: A Multicenter Retrospective Study, Bosphorus Retina Study Group Report No: 1

Objectives: To evaluate the real-world outcomes of intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment in neovascular age-related macular degeneration (nAMD) patients. Materials and Methods: Multicenter, retrospective, interventional, non-comparative study. The records of nAMD patients treated with an anti-VEGF agent on a pro re nata treatment regimen basis between January 2013 and December 2015 were reviewed. The patients who completed a follow-up period of 12 months were included. Primary outcome measures of this study were the visit and injection numbers during the first year. Results: Eight hundred eighty eyes of 783 patients met the inclusion criteria for the study. Mean number of visits at month 12 was 6.9±2.5 (range: 1-15). Mean number of injections at month 12 was 4.1±1.9 (range: 1-11). Mean visual acuity at baseline and months 3, 6, and 12 was 0.90±0.63 LogMAR (range: 0.0-3.0), 0.79±0.57 LogMAR (range: 0.0-3.0), 0.76±0.57 LogMAR (range: 0.0-3.0), and 0.79±0.59 LogMAR (range: 0.0-3.0), respectively. Mean central retinal thickness at baseline and months 6 and 12 was 395±153 μm (range: 91-1582), 330±115 μm (range: 99-975), and 332±114 μm (range: 106-1191), respectively. Conclusion: The numbers of visits and injections were much lower than ideal and were insufficient with the pro re nata treatment regimen