First Report of a Case with Needle Track Sinus after Aspiration Biopsy of a Benign Thyroid Nodule Resulted in an Unexpected Postoperative Complication

Fine needle aspiration biopsy is the most feasible, safe, and accurate diagnostic tool for thyroid nodule diagnosis. The development of a sinus tract between thyroid gland and the skin through needle tract after fine needle aspiration biopsy is an extremely uncommon phenomenon. In this paper, a 71-year-old man presenting with a swelling and discharge on the anterior neck wall was reported. Similar complaints were present 15 to 20 days after fine needle aspiration biopsy of thyroid gland four years ago. Bilateral total thyroidectomy was performed considering a thyroid malignancy infiltrating the skin. Histopathologic examination confirmed a sinus tract between the thyroid gland and skin and thyroid nodule was benign in nature. It must be kept in mind that inflammatory reactions might also occur after fine needle aspiration biopsy of benign thyroid nodules. In patients with needle biopsy-related inflammation, surgery may be delayed until the inflammation subsides

CD4+CD25+CD127loFOXP3+ cell in food allergy: Does it predict anaphylaxis?

Background: Food allergy (FA), hence the incidence of food anaphylaxis, is a public health problem that has increased in recent years. There are still no biomarkers for patients with FA to predict severe allergic reactions such as anaphylaxis. Objective: There is limited information on whether regulatory T (Treg) cell levels are a biomarker that predicts clinical severity in cases presenting with FA, and which patients are at a greater risk for anaphylaxis. Methods: A total of 70 children were included in the study: 25 who had IgE-mediated cow’s milk protein allergy (CMPA) and presented with non-anaphylactic symptoms (FA/A−), 16 who had IgE-mediated CMPA and presented with anaphylaxis (FA/A+) (a total of 41 FA cases), and a control group consisting of 29 children without FA. The study was conducted by performing CD4+CD25+CD127loFOXP3+ cell flow cytometric analysis during resting at least 2 weeks after the elimination diet to FA subjects. Results: When the FA group was compared with healthy control subjects, CD4+CD25+CD127loFOXP3+ cell rates were found to be significantly lower in the FA group (p < 0.001). When the FA/A− and FA/A+ groups and the control group were compared in terms of CD4+CD25+CD127loFOXP3+ cell ratios, they were significantly lower in the FA/A− and FA/A+ groups compared to the control group (p < 0.001). Conclusions: Although there was no significant difference between the FA/A+ group and the FA/ A− group in terms of CD4+CD25+CD127loFOXP3+ cells, our study is important, as it is the first pediatric study we know to investigate whether CD4+CD25+CD127loFOXP3+cells in FA p redict anaphylaxis

Çocuklarda influenza A ve B enfeksiyonlarının klinik ve laboratuvar özelliklerinin karşılaştırılması

Aim: In this study, we aimed to compare the clinical and laboratory findings of Influenza A and Influenza B infections in children. Methods: The study included 1826 pediatric patients (aged <16 years) who were di¬agnosed with Influenza A (n=1400) and B (n=426) infections between 1 October 2019 and 30 April 2020. The patients were also divided into age groups: the age groups of 0–2 years, 3–9 years, and 10–16 years. The characteristic clinical and laboratory findings were compared. Results: Influenza A infection was significantly more common in patients aged <2 years and was significantly less common in patients aged 3–9 years. Body temperature was significantly higher in all age groups with Influenza A infection than in children with Influenza B infection. While leukocy¬tosis and lymphopenia were significantly more common in the Influenza A group, leukopenia and neutropenia were significantly more common in the Influenza B group. While acute otitis media was more common in Influenza A infection, myositis was more common in Influenza B infection. No significant difference was found between the Influenza A and B groups in terms of hospitalization rates. Of all patients, 98.3% were treated with oseltamivir. Conclusion: Our findings indicate that Influenza A and B infections are, in general, very similar in terms of symptoms. However, Influenza A infection is more common in very young children. It progresses with higher fever and is more frequently associated with pharyngeal hy¬peremia and acute otitis media, while leukopenia, neutropenia, conjunctivitis, nasal discharge, and myositis were found to be more common in Influenza B infection.Amaç: Bu çalışmada, çocuklarda İnfluenza A ve İnfluenza B enfeksiyonlarının klinik ve laboratuvar bulgularını karşılaştırmak amaçlanmıştır. Yöntem: Çalışma 1 Ekim 2019 ile 30 Nisan 2020 tarihleri arasında İnfluenza A (n=1400) ve B (n=426) enfeksiyonu tanısı almış 16 yaş altı 1826 çocuk hasta içerdi. Hastalar aynı zamanda yaş gruplarına ayrıldı: 0–2 (yıl) yaş grubu, 3–9 yaş grubu, ve 10–16 yaş grubu. Karakteristik klinik bulgu¬lar ve laboratuvar bulguları karşılaştırıldı. Bulgular: İnfluenza A enfeksiyonu <2 yaşındaki hastalarda anlamlı biçimde daha yaygın, 3–9 ya¬şındaki hastalarda anlamlı biçimde daha enderdi. Vücut sıcaklığı İnfluenza A enfeksiyonlu tüm yaş gruplarında İnfluenza B enfeksiyonlu çocuklara göre anlamlı biçimde daha yüksekti. İnfluenza A grubunda lökositoz ve lenfopeni anlamlı biçimde daha yaygınken, İnfluenza B grubunda lökopeni ve nötropeni anlamlı biçimde daha yaygındı. Akut orta kulak iltihabı İnfluenza A enfeksiyonunda daha yaygınken, miyozit İnfluenza B enfeksiyonunda daha yaygındı. Hastaneye yatış oranı açısından ise İnfluenza A ve B grupları arasında anlamlı fark bulunmadı. Tüm hastaların %98,3’ü oseltamivir ile tedavi edildi. Sonuç: Bulgularımız İnfluenza A ve B enfeksiyonlarının semptomlar açısından genel olarak çok benzer olduğuna işaret etmektedir. Bununla birlikte, İnfluenza A enfeksiyonu çok küçük çocuklarda daha yaygındır. Daha yüksek ateşle ilerler ve farengeal hiperemi ve akut orta kulak ilti¬habı daha sık görülür. Lökopeni, nötropeni, konjonktivit, burun akıntısı ve miyozitin ise İnfluenza B enfeksiyonunda daha yaygın olduğu tespit edilmiştir

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Fine needle aspiration biopsy is the most feasible, safe, and accurate diagnostic tool for thyroid nodule diagnosis. The development of a sinus tract between thyroid gland and the skin through needle tract after fine needle aspiration biopsy is an extremely uncommon phenomenon. In this paper, a 71-year-old man presenting with a swelling and discharge on the anterior neck wall was reported. Similar complaints were present 15 to 20 days after fine needle aspiration biopsy of thyroid gland four years ago. Bilateral total thyroidectomy was performed considering a thyroid malignancy infiltrating the skin. Histopathologic examination confirmed a sinus tract between the thyroid gland and skin and thyroid nodule was benign in nature. It must be kept in mind that inflammatory reactions might also occur after fine needle aspiration biopsy of benign thyroid nodules. In patients with needle biopsy-related inflammation, surgery may be delayed until the inflammation subsides

Can mean platelet volume be used as a biomarker for asthma?

Introduction : Platelets play important roles in airway inflammation and are activated in inflammatory lung diseases, including asthma. Aim :We evaluated the mean platelet volume (MPV), used as a marker of platelet activation, in asthmatic patients during asymptomatic periods and exacerbations compared to healthy controls to determine whether MPV can be used as an indicator of inflammation. Material and methods :Our patient group consisted of95 children with exacerbation of asthma who were admitted to our allergy clinic. The control group consisted of 100 healthy children matched for age, gender, and ethnicity. Mean platelet volume values of the patient group obtained during exacerbation of asthma were compared to those of the same group during the asymptomatic period and with the control group. We investigated factors that can affect the MPV values of asthma patients, including infection, atopy, immunotherapy treatment, and severity of asthma exacerbation. Results :The patient group consisted of 50 (52.6%) boys and 45 (47.4%) girls with a mean age of 125 ±38 months old. Mean MPV values in the exacerbation period, the healthy period, and in the control group were 8.1 ±0.8 fl, 8.1 ±1.06 fl, and 8.2 ±0.9 fl, respectively; there were no significant differences between groups (p > 0.05). The severity of asthma, severity of asthma exacerbation, immunotherapy, coinfection, eosinophil count, and IgE level also had no effect on MPV (p > 0.05). Conclusions : Although platelets play a rolein the pathophysiology of asthma, MPV measurement is insufficient to detect inflammation through platelet

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Characteristics of the patients followed with the diagnosis of common variable immunodeficiency and the complications

Introduction: In this study, we aimed to retrospectively evaluate the clinical and laboratory findings and complications of 28 common variable immunodeficiency (CVID) patients. Material and methods: The clinical features and laboratory data of 28 CVID patients were evaluated. Results: Nineteen patients were male. In 53.5% of the cases, complications included inflammatory bowel disease, cytopenia, bronchiectasis, granulomatous lymphocytic interstitial lung disease (ILD) and asthma. In their immunological evaluations, IgG, IgM, and IgA mean values were 474.8 ±214.1 mg/dl; 56.7 ±41.9 mg/dl; 35.3 ±58.2 mg/dl, respectively, and the vaccine response was positive in 64.2% of the cases. In all age groups, absolute lymphocyte counts, naive (CD19+IgD+27-), nonswitch (CD19+IgD-27+) memory B cells were numerically higher when compared to the data of healthy children; however, although switch memory (CD19+IgD+27+) B cells were proportionally low in the 4-8 and 12-18 age groups, they were low both numerically and proportionally in the 8-12 age group. No statistically significant difference was found between the cases with complications and without complications. But the cases with pulmonary complications were compared within the group, the CD8 ratio was high but the IgA level was low in patients with bronchiectasis and CD3 was numerically and proportionally low in the cases with ILD compared to others. According to the Paris classification, 11/27 (40.7%) of the cases, 3/27 (11.1%) of them and 13/27 (48.2%) of them were evaluated as MB0, MB1, and MB2, respectively. Conclusions: In genetic studies, TACI (trans-membrane activator and calcium-modulating cyclophilin ligand interactor – TNFRSF13B) mutation was found positive in 25% of the cases

Effects of the Hydrolysable Oak Tannins on the Quail Performance

In the present study effects of different levels of hydrolyzed oak tannin on Japanese quail, live body weight and live body weight gain, food intake, food conversion efficiency and mortality rate were investigated. Therefore, a total of 240 quails were weighed and divided into 4 treatment groups each with 3 replicates containing 20 birds and reared in flat for 42 days as experimental period. While one of the groups was fed control diet with no additives (0% tannin A), other groups were fed with the different percentages of tannin on their diets, which are 0.5% (B), 1.0% (C), 1.5% (D) respectively. It has been observed that Japanese quails that fed the oak tannin containing diet had slower growth rate and poorer feed conversion efficiency and high mortality rate than birds fed with a tannin-free diet

Inherited classical and alternative pathway complement deficiencies in children: A single center experience

Background: Primary complement deficiencies are rare diseases. Objective: To retrospectively evaluate the clinical and laboratory findings and complications of patients to increase awareness of pediatricians about complement deficiencies, which are rarely encountered. Methods: In this study, the clinical and immunological characteristics of 21 patients who consulted the Immunology Department of our hospital between 2003 and 2017 and were diagnosed with classical or alternative pathway complement deficiency were obtained from the file records. Results: Ten patients with C1 inhibitor deficiency, four patients with factor I deficiency, three patients with properdin deficiency, two patients with C8 deficiency, one patient with C1q deficiency, and one patient with C4B deficiency were assessed. The mean age of the patients at diagnosis was 11.4±4.7 years, the age of onset of symptoms was 7.9±3.9 years, and the follow-up period was 6.7±3.9 years. Fourteen cases had a similar medical history in the family. All patients with C1q, factor I, properdin, C8, and C4B deficiencies presented with an infection, and vasculitic rash was present in two patients with factor I deficiency. In addition, immune complex glomerulonephritis was present in one patient with factor I deficiency. Meningococcal, Haemophilus influenzae type B, and pneumococcal vaccines were administered and prophylactic antibiotic treatment was initiated in all patients except patients with C1 inhibitor deficiency. Conclusions: Early diagnosis of complement deficiencies can facilitate prevention of life-threatening complications such as severe bacterial infections by considering prophylactic antibiotics and vaccines. In patients with C1 inhibitor deficiency, achieving an acurate early diagnosis will assist in the management and timely treatment of life-threatening attacks such as upper airway obstruction and improve outcomes