SEPSİS VE TEDAVİ YAKLAŞIMLARI

Sepsis, dünya genelinde toplum sağlığını tehdit eden ve devletlerin ekonomik sistemleri üzerine önemli yükler bindiren oldukça ciddi bir hastalıktır. Önceden toplum kaynaklı bir hastalık olarak değerlendirilen sepsis, daha sonra önemli hastane kaynaklı hastalıklar içerisinde yerini almıştır

ANTİBİYOTİKLER VE KULLANIM MEKANİZMALARI

Antibiyotikler, genel olarak bakterilerin üremesini durduran veya onları öldüren kimyasal maddeler olarak bilinmektedirler. Antibiyotiklerle tedavi, 17. yüzyılda kininin sıtma, emetinin ise amebiyasis tedavisinde kullanılması ile başlamasıdır

Influence of Reduced Folate Carrier and Aminoimidazole Carboxamide Ribonucleotide Transformylase gene polymorphisms on the efficacy of methotrexate in juvenile idiopathic arthritis

PubMe

Different features of lung involvement in Niemann-Pick disease and Gaucher disease

SummaryBackgroundNiemann-Pick disease (NPD) and Gaucher disease (GD) are well-known lysosomal storage diseases. Respiratory system involvement is an important cause of morbidity and mortality in patients with NPD and GD.ObjectivesWe tried to assess the clinical, radiological, and histological features of GD and NPD patients with lung involvement.MethodsWe reviewed medical history, physical examination, radiological, and histological data of 10 NPD and 7 GD patients.ResultsThe most common respiratory symptoms were recurrent lung infection and dyspnea. Although lung examination results in 6 NPD patients were normal, they had lung involvement; 3 patients were diagnosed as NPD directly via lung biopsy during investigation of recurrent lung infection or interstitial lung disease. All GD patients but 1 had respiratory system symptoms at the time of diagnosis. Hepatopulmonary syndrome was present in 4 GD patients. A ground-glass pattern and atelectasis were 2 important high-resolution computed tomography features in the NPD and GD patients. Flexible bronchoscopy and bronchoalveolar lavage were used for emergency extraction of bronchial casts in 1 NPD patient.ConclusionsLung involvement in NPD and GD patients should be included in the differential diagnosis of interstitial lung disease. Besides interstitial appearance on HRCT, atelectasis related to bronchial cast and bronchiectasis are other radiological findings in these group of patients. Analysis of bronchoalveolar fluid and lung biopsy provide very important clues for diagnosis. Hepatopulmonary syndrome is an important vascular complication observed in GD patients

Henoch-Schönlein Purpura Hastalarının Böbrek ve Cilt Dokularında Yardımcı T Hücre Yanıtının Analizi

Henoch-Schönlein purpura (HSP) or IgA vasculitis is the most common childhood vasculitis in our country. The cardinal feature of the disease is a purpuric rash predominantly on lower extremities. Joint, gastrointestinal tract and renal involvement may also be observed. During the course of the disease, renal involvement may be observed in 30-60% of patients. In recent years, the role T cells in pathogenesis of HSP/IgA vasculitis has become a focus for research. In this study, the role of cytokines and transcription factors (FOXP3) of T helper cells in disease pathogenesis and their relations with clinical and histopathological parameters were investigated. Twentytwo patients diagnosed as HSP/IgA vasculitis with renal biopsy and non-tumoral renal tissues of nephrectomy materials of 20 patients diagnosed as Wilms tumor (control group) were included in the study. Immunohistochemical IFN-gamma, IL-4, IL-17 and FOXP3 expressions were investigated. Dispersion and intensity scores of immunohistochemical stainings were evaluated in the glomerular and tubulointerstitial areas. Renal biopsy specimens of HSP/IgA vasculitis patients had higher IFN-gamma, IL-4, IL-17 glomeruler and tubular scores when compared to the control group which was statistically significant. Interferon-gamma glomerule and tubule scores were positively correlated with protein/creatinine ratio of early morning urine specimen at the time of kidney biopsy. Interleukin-17 glomerule scores correlated negatively with serum albumin levels and positively with qualitative proteinuria at the time of kidney biopsy. Furthermore, IL-17 glomerular scores were positively correlated with the percentage of crescents. There was no difference of the amount of glomerular and tubuler FOXP3+ cells between HSP/IgA vasculitis and the control groups. Henoch-Schönlein purpura/IgA vasculitis group had more FOXP3+ cells on interstitial area when compared to the control group. There was no correlation of FOXP3 expression with any clinical parameter. Skin biopsies of patients with preliminary diagnosis of HSP and non-pathological skin biopsies of the control group were the second part of the study. In the specimens vii obtained from the area with a lesion, IFN-gamma, IL-4 and IL-17 expressions were statistically higher when compared to normal skin which was statistically significant. FOXP3 expressions were not statistically different. Our results showed that all T helper subtypes play role in pathogenesis of HSP/IgA vasculitis. Relations of Th17 cells with proteinuria and crescent indicates its role in renal prognosis of the patients. Better understanding of the role of these cells and processes may bring forward their potentials of being therapeutic targets.Henoch-Schönlein purpura (HSP) veya ĐgA vasküliti ülkemizde en sık görülen çocukluk çağı vaskülitidir. Hastalığın temel bulgusu; trombositopeninin eslik etmediği, genellikle alt ekstremitelerde olan, purpura veya petesi niteliğindeki döküntüdür. Bununla birlikte eklem tutulumu, gastrointestinal sistem tutulumu veya böbrek tutulumu görülebilir. Hastalığın seyri boyunca %30-60 hastada böbrek tutulumu görülür. Son senelerde HSP/IgA vaskülitinde yardımcı T hücrelerinin rolüne iliskin sorular gündeme gelmektedir. Bu çalısmada HSP/ĐgA vasküliti nefritinde ve hastaların deri biyopsilerinde T hücre alt gruplarının salgıladıkları sitokinlerin ve transkripsiyon faktörlerinin (FOXP3) klinik ve histopatolojik parametreler ile iliskisi ve hastalık patogenezindeki yerleri arastırılmıstır. Çalısmaya böbrek biyopsisi ile HSP/ĐgA vasküliti nefriti tanısı alan 22 hasta ve kontrol grubu olarak Wilms tümörü nedeni ile nefrektomi yapılan 20 hastanın tümör dısı böbrek dokuları dahil edildi. Bu dokulara ĐFN-gamma, ĐL-4, ĐL- 17 ve FOXP3 boyamaları yapıldı. Đmmünhistokimyasal boyaların yaygınlık ve siddet skorları kullanılarak glomerül ve tübül alanları ayrı ayrı değerlendirildi. HSP/ĐgA vasküliti nefriti hastalarının dokularında ĐFN-gamma, ĐL-4, ĐL-17 glomerül ve tübül boyanma skorları kontrol grubuna oranla istatistiksel olarak anlamlı düzeyde fazla bulundu. ĐFN-gamma glomerül ve tübül skoru ile biyopsi sırasındaki sabah ilk idrar protein/kreatinin oranı arasında iliski saptandı. Đnterlökin-17 glomerül skoru ile biyopsi sırasındaki serum albumin düzeyi arasında ters yönde, biyopsi sırasındaki kalitatif proteinüri miktarı arasında ise doğrusal bir iliski bulundu. Ayrıca ĐL-17 glomerül skoru ile kresent yüzdesi arasında iliski saptandı. HSP/ĐgA vasküliti nefriti ile kontrol grubu arasında μm2’ye düsen glomerüler ve tübüler FOXP3+ hücre sayısında anlamlı düzeye ulasan fark yoktu. Đnterstisyel bölgede μm2’ye düsen FOXP3+ hücre sayısı HSP/ĐgA vasküliti nefritinde kontrol grubuna göre fazlaydı. FOXP3 ekspresyonu ile klinik parametreler arasında iliski saptanamadı. Çalısmada HSP ön tanısı ile cilt biyopsisi yapılan hastalar ve çesitli nedenlerle cilt biyopsisi v yapılan ve patolojik bulgu saptanmayan kontrol hastaları karsılastırıldı. Đnterferongamma, ĐL-4 ve ĐL-17 ekspresyonunun lezyonlu alanda kontrol grubuna göre istatistiksel olarak anlamlı bir sekilde daha fazla olduğu bulundu. Lezyon alanında ve kontrol grubunda FOXP3 ekspresyonu farklı değildi. Sonuçlarımız HSP/ĐgA vasküliti patogenezinde tüm yardımcı T hücre alt tiplerinin aktif olarak görev aldığını göstermektedir. Proteinüri ve kresent ile olan iliskileri özellikle Th17 hücresinin böbrek hastalığının gidisinde etkin olduğunu düsündürmektedir. Bu süreçlerin ve bu sistemde yer alan hücrelerin daha iyi anlasılması ileride tedavide hedef olarak kullanılma potansiyellerini gündeme getirecektir

The Effect of Obstructive Sleep Apnea on Violent and Non-violent Behavior

Aim: Obstructive sleep apnea (OSA) characterized by repetitive collapse of the upper airway during sleep and thiscondition leading to oxygen desaturation, sympathetic activation, and recurrent arousals. Patients who experience sleepproblems consider themselves, less able to control impulsive, aggressive tendencies. The aim of this study was toinvestigate the effect of OSA and daytime sleepiness on violent and non-violent behaviors.Material and Methods: Hundred fifty individuals who were admitted to the Chest Disease Polyclinic for SleepDisorders of Duzce University, School of Medicine Hospital were included in the study. All patients underwentpolysomnography (PSG). All tests [Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), EpworthSleepiness Scale (ESS) and Nonviolent and Violent Offending Behavior Scale (NVOBS)] were applied to allparticipants by face to face interview.Results: In this study, no significant relationship was found between NVOBS and AHI in OSA patients. Patients withOSA; There was a significant relationship between total score of NVOBS and ESS (r=0.267 p=0.003). There was asignificant relationship between the ESS score and the BDI score (r=0.314 p <0.001) and BDI scale (r=0.319 p <0.001)scores.Conclusions: There was no significant relationship between violent and non-violent behaviors and AHI. However,there was a significant relationship between ESS and BDI, BAI and NVOBS. There may be commonneurophysiological activation mechanisms of sleep and violence action. Today, violent behavior and sleep problemsincrease and further research is needed to investigate the relationship between sleep problems and violent behavior.Amaç: Obstrüktif uyku apne (OUA) üst hava yollarının uyku sırasında daralması ile karakterizedir ve bu durum oksijen desaturasyonu, sempatik aktivasyon, tekrarlayan arousallara neden olur. Uyku problemi yaşayan insanlar kendilerini agresif eğilimleri olan ve dürtüselliklerini daha az kontrol edebilen kişiler olarak düşünürler. Bu çalışmanın amacı OUA ve gündüz uykululuk halinin, şiddet içeren ya da içermeyen davranışlar üzerine etkilerini araştırmaktır. Gereç ve Yöntemler: Düzce Üniversitesi Tıp Fakültesi Hastanesi Göğüs Hastalıkları Polikliniğine uyku bozuklukları nedeniyle başvuran 150 kişi çalışmaya dâhil edildi. Tüm hastalara polisomnografi (PSG) yapıldı. Tüm diğer testler [Beck depresyon ölçeği (BDÖ), Beck anksiyete ölçeği (BAÖ), Epworth uykululuk skalası (EUS) ve Şiddet içeren ve içermeyen suç davranışları ölçeği (ŞİSDÖ)] katılımcılarla yüz yüze görüşme ile yapıldı. Bulgular: Bu çalışmada OUA hastalarında ŞİSDÖ ile apne-hipopne indeksi (AHI) arasında anlamlı bir ilişki saptanmadı. OUA’li hastalarda toplam ŞİSDÖ skoru ile EUS arasında anlamlı bir ilişki bulundu (r=0,267 p=0,003). EUS ile BDÖ skoru (r=0,314 p <0,001) ve BAÖ skalası skoru (r=0,319 p <0,001) arasında anlamlı bir ilişki vardı. Sonuç: AHI ile şiddet içeren ve şiddet içermeyen davranışlar arasında bir ilişki yoktu. Bununla birlikte ESS ile BDÖ, BAÖ, ŞİSDÖ arasında anlamlı bir ilişki vardı. Uyku ve şiddet davranışlarının ortak nörofizyolojik bir mekanizması olabilir. Çalışmamız gündüz uykululuk halinin artmasıyla şiddet eğiliminin arttığını göstermiştir. Uyku problemleri ile şiddet davranışlarının arasındaki ilişkiyi araştırmak için ileri çalışmalara ihtiyaç vardı

Rituximab for Children With Difficult-to-Treat Nephrotic Syndrome

Background: Since the early 2000s rituximab (RTX) has been thought of as an alternative treatment for steroid-sensitive nephrotic syndrome (SSNS) and steroid-resistant nephrotic syndrome (SRNS)., Objective: This study aimed to determine the effects of RTX treatment on disease outcome and growth in pediatric SSNS and SRNS patients., Materials and Methods: The medical records of pediatric SSNS and SRNS patients that began RTX treatment at the mean age of 10.8 ± 5.1 years between 2009 and 2017 were retrospectively reviewed. Additionally, the effect of RTX on growth was evaluated based on patient height, weight, and BMI z scores., Results: The study included 41 children, of which 21 had SSNS and 20 had SRNS. Mean age at diagnosis of NS was 5.8 ± 4.7 years. Mean duration of post-RTX treatment follow-up was 2.3 ± 1.6 years. Among the SSNS patients, 6 and 11 patients were steroid free and calcineurin inhibitor free at the last follow-up visit, respectively. The 1-year cumulative steroid and calcineurin inhibitor doses both decreased after RTX treatment, as compared to before RTX (P = 0.001 and P = 0.015, respectively). The median height z-score at the time of RTX initiation was −1.2 and the median height z-score at the last follow-up visit was −0.6 (P = 0.044). The median BMI z-score decreased from 1.6 (IQR; 0.9–3.0) at the time RTX was initiated to 1.1 IQR; [(−0.7)−2.5] at the last follow-up visit (P = 0.007). At the last follow-up visit 4 SRNS patients had complete remission and 4 had partial remission. The 1-year cumulative steroid dosage in the SRNS patients decreased significantly after RTX, as compared to before RTX (P = 0.001). The median height z-score at the time of RTX initiation was −0.8 and the median height z-score at the last follow-up visit was −0.7 (P = 0.81). The median BMI z-score decreased from 0.3 at the time RTX was initiated to −0.1 at the last follow-up visit (P = 0.11)., Conclusion: RTX has a more positive effect on disease outcome and growth in SSNS patients than in those with SRNS.PubMedWoSScopu