Çocukluk çağında periferik lenfadenopatiler: tek merkezli çalışma

Purpose: Lymphadenopathy is defined as an abnormality in the size and/or character of lymph node. In this study we aimed to describe the clinical and laboratory findings of benign and malignant causes of peripheral lymphadenopathy in childhood. Material and Methods: Two hundred and twenty four patients who were admitted to the clinic with peripheral LAP were evaluated. Age, gender, laboratory and radiologic findings, final diagnoses, and duration, localization, size, consistency, spread, and accompanying local and systemic symptoms of LAP were determined. Benign and malignant causes of peripheral lymphadenopathy were compared. Results: One hundred twenty-six patients (56.0%) were male and 98 patients (44.0%) were female. After the first evaluation the patients were divided into two groups. The first group included 186 patients with benign causes and the second group included 38 patients with malignant causes. One hundred and sixty four of 224 patients (73.2 %) had localized peripheral lymphadenopathy. The most frequent cause of localized lymphadenopathy in the benign group was acute lymphadenitis (34.8%). The most common cause of localized lymphadenopathy in the malignant group was Hodgkin's lymphoma (4.3%). Sixty of 224 (26.8%) patients had generalized peripheral lymphadenopathy. The most significant cause of generalized lymphadenopathy in the benign lymphadenopathy group was Epstein-Barr virus (10.0%), whereas Hodgkin's lymphoma (23.3%) was the most common cause in malign lymphadenopathy group. Localized and generalized lymph node enlargement was most frequently found in cervical region. The most frequent site of involvement among benign and malignant cases was the cervical area. The results revealed that findings such as chronic course, generalized LAP, supraclavicular, cervical and inguinal location, organomegaly, hilier LAP, abdominal LAP, and abnormal laboratory findings (thrombocytopenia and blasts on the peripheral blood smear) were associated with malignant diseases. Conclusion: Infections are the most common cause of peripheral LAP. The risk of malignany increases with the age of child and the duration of LAP. Older children with chronic LAP, generalized LAP associated with organomegaly, abnormal laboratory findings should be considered as malignant LAP.Amaç: Lenfadenopati, lenf nodunun boyut ve/veya karakterindeki anormallik olarak tanımlanır. Bu çalışmada amacımız çocukluk çağında selim ve malign nedenlere bağlı periferik lenfadenopatilerin klinik ve laboratuvar bulgularını belirlemek. Materyal ve Metod: Çalışmaya periferik lenfadenopati nedeni ile hastanemize başvuran 224 hasta alındı. Hastaların; yaşı, cinsiyeti, laboratuvar ve radyolojik bulguları, tanıları, lenfadenopatinin; süresi, lokalizasyonu, boyutu, kıvamı, yayılımı, eşlik eden lokal ve sistemik semptomları kaydedildi. Malign ve selim hastalıklara bağlı lenfadenopatilerin klinik ve laboratuvar özellikleri karşılaştırıldı. Bulgular: İki yüz yirmi dört hastanın 126’sı (%56.0) erkek, 98’i (%44.0) kız idi. Hastalar 2 gruba ayrıldı. Birinci grupta selim nedenlere bağlı lenfadenopatisi olan 186 hasta, ikinci grupta ise malign nedenlere bağlı lenfadenopatisi olan 38 hasta mevcuttu. Yüz altmış hastada(%73.2) localize lenfadenopati vardı. Selim hasta grubunda lokalize lenfadenopatinin en sık nedeni akut lenfadenitler (%34.8) iken, malign hasta grubunda en sık nedenin Hodgkin lenfoma (%4.3) olduğu tespit edildi. İki yüz yirmi dört hastanın 60’ında (%26.8) jeneralize lenfadenopati vardı. Jeneralize lenfadenopatinin selim hasta grubunda başlıca nedeni Epstein–Barr virus enfeksiyonu (%10.0) iken, malign hasta grubunda Hodgkin lenfoma (%23.3) olduğu tespit edildi. Servikal bölge lokalize ve jeneralize lenfadenopatilerde en sık tutulan bölgedir. Malign ve selim nedenlere bağlı lenfadenopailer en sık servikal bölgede görüldü. Elde ettiğimiz sonuçlara göre kronik seyirli, jeneralize lenfadenopati, supraklavikular, servikal ve inguinal yerleşimli lenfadenopati, organomegali, abdomanial lenfadenopati, hilier lenfadenopati ve anormal laboratuvar bulgularının (trombositopeni, periferik yaymada blast ) varlığında öncelikle malign nedenler düşünülmelidir. Sonuç: Enfeksiyonlar çocukluk çağında periferik lenfadenopatinin en sık nedenidir. Malignite riski yaş ve lenfadenopatinin süresi ile artmaktadır. İleri yaş, kronik lenfadenopati, jeneralize lenfadenopati, eşlik eden organomegali, anormal laboratuvar bulguların varlığında öncelikle malignite düşünülmelidir

Relationship Between Atheroma Regression and Change in Lumen Size After Infusion of Apolipoprotein A-I Milano

ObjectivesThe aim of this study was to determine the relationship between atheroma regression and arterial wall remodeling.BackgroundInfusion of reconstituted high-density lipoprotein (rHDL) containing recombinant apolipoprotein A-I Milano (AIM) has been reported to promote rapid regression of coronary atherosclerosis. The current study analyzed intravascular ultrasound (IVUS) to define the changes that take place in the arterial wall that accompanied atheroma regression in this study.MethodsForty-seven patients, ages 30 to 75 years, after an acute coronary syndrome were randomized to receive five weekly infusions of placebo or rHDL containing either low- or high-dose AIM. External elastic membrane (EEM) and lumen volumes were compared between coronary IVUS studies at baseline and follow-up.ResultsIn comparison with baseline, infusion of rHDL was associated with a 4.6% reduction in EEM volume. Lumen volume did not change. In 10-mm arterial subsegments with the greatest plaque burden at baseline, atheroma volume regressed by 10.9% with a similar reduction in EEM volume but with no change in lumen size. In contrast, EEM and atheroma volume did not change in the 10-mm segments containing the least plaque burden. The reduction in EEM in the most diseased segments was only apparent in subjects who underwent plaque regression. Reduction in EEM volume correlated with the decreased atheroma volume (r = 0.62), but there was no correlation between change in lumen size and change in plaque volume.ConclusionsRemodeling of the arterial wall is a focal and heterogeneous process. After infusion of rHDL containing AIM, regression of coronary atherosclerosis is accompanied by reverse remodeling of the EEM, resulting in no change in luminal dimensions

Pseudomonas aeruginosa Bloodstream Infections in Patients with Cancer: Differences between Patients with Hematological Malignancies and Solid Tumors

Objectives: To assess the clinical features and outcomes of Pseudomonas aeruginosa bloodstream infection (PA BSI) in neutropenic patients with hematological malignancies (HM) and with solid tumors (ST), and identify the risk factors for 30-day mortality. Methods: We performed a large multicenter, retrospective cohort study including onco-hematological neutropenic patients with PA BSI conducted across 34 centers in 12 countries (January 2006-May 2018). Episodes occurring in hematologic patients were compared to those developing in patients with ST. Risk factors associated with 30-day mortality were investigated in both groups. Results: Of 1217 episodes of PA BSI, 917 occurred in patients with HM and 300 in patients with ST. Hematological patients had more commonly profound neutropenia (0.1 x 10(9) cells/mm) (67% vs. 44.6%; p < 0.001), and a high risk Multinational Association for Supportive Care in Cancer (MASCC) index score (32.2% vs. 26.7%; p = 0.05). Catheter-infection (10.7% vs. 4.7%; p = 0.001), mucositis (2.4% vs. 0.7%; p = 0.042), and perianal infection (3.6% vs. 0.3%; p = 0.001) predominated as BSI sources in the hematological patients, whereas pneumonia (22.9% vs. 33.7%; p < 0.001) and other abdominal sites (2.8% vs. 6.3%; p = 0.006) were more common in patients with ST. Hematological patients had more frequent BSI due to multidrug-resistant P. aeruginosa (MDRPA) (23.2% vs. 7.7%; p < 0.001), and were more likely to receive inadequate initial antibiotic therapy (IEAT) (20.1% vs. 12%; p < 0.001). Patients with ST presented more frequently with septic shock (45.8% vs. 30%; p < 0.001), and presented worse outcomes, with increased 7-day (38% vs. 24.2%; p < 0.001) and 30-day (49% vs. 37.3%; p < 0.001) case-fatality rates. Risk factors for 30-day mortality in hematologic patients were high risk MASCC index score, IEAT, pneumonia, infection due to MDRPA, and septic shock. Risk factors for 30-day mortality in patients with ST were high risk MASCC index score, IEAT, persistent BSI, and septic shock. Therapy with granulocyte colony-stimulating factor was associated with survival in both groups. Conclusions: The clinical features and outcomes of PA BSI in neutropenic cancer patients showed some differences depending on the underlying malignancy. Considering these differences and the risk factors for mortality may be useful to optimize their therapeutic management. Among the risk factors associated with overall mortality, IEAT and the administration of granulocyte colony-stimulating factor were the only modifiable variables

Pseudomonas aeruginosa Bloodstream Infections Presenting with Septic Shock in Neutropenic Cancer Patients: Impact of Empirical Antibiotic Therapy

This large, multicenter, retrospective cohort study including onco-hematological neutropenic patients with Pseudomonas aeruginosa bloodstream infection (PABSI) found that among 1213 episodes, 411 (33%) presented with septic shock. The presence of solid tumors (33.3% vs. 20.2%, p < 0.001), a high-risk Multinational Association for Supportive Care in Cancer (MASCC) index score (92.6% vs. 57.4%; p < 0.001), pneumonia (38% vs. 19.2% p < 0.001), and infection due to multidrug-resistant P. aeruginosa (MDRPA) (33.8% vs. 21.1%, p < 0.001) were statistically significantly higher in patients with septic shock compared to those without. Patients with septic shock were more likely to receive inadequate empirical antibiotic therapy (IEAT) (21.7% vs. 16.2%, p = 0.020) and to present poorer outcomes, including a need for ICU admission (74% vs. 10.5%; p < 0.001), mechanical ventilation (49.1% vs. 5.6%; p < 0.001), and higher 7-day and 30-day case fatality rates (58.2% vs. 12%, p < 0.001, and 74% vs. 23.1%, p < 0.001, respectively). Risk factors for 30-day case fatality rate in patients with septic shock were orotracheal intubation, IEAT, infection due to MDRPA, and persistent PABSI. Therapy with granulocyte colony-stimulating factor and BSI from the urinary tract were associated with improved survival. Carbapenems were the most frequent IEAT in patients with septic shock, and the use of empirical combination therapy showed a tendency towards improved survival. Our findings emphasize the need for tailored management strategies in this high-risk population

Assessment of the requisites of microbiology based infectious disease training under the pressure of consultation needs

<p>Abstract</p> <p>Background</p> <p>Training of infectious disease (ID) specialists is structured on classical clinical microbiology training in Turkey and ID specialists work as clinical microbiologists at the same time. Hence, this study aimed to determine the clinical skills and knowledge required by clinical microbiologists.</p> <p>Methods</p> <p>A cross-sectional study was carried out between June 1, 2010 and September 15, 2010 in 32 ID departments in Turkey. Only patients hospitalized and followed up in the ID departments between January-June 2010 who required consultation with other disciplines were included.</p> <p>Results</p> <p>A total of 605 patients undergoing 1343 consultations were included, with pulmonology, neurology, cardiology, gastroenterology, nephrology, dermatology, haematology, and endocrinology being the most frequent consultation specialties. The consultation patterns were quite similar and were not affected by either the nature of infections or the critical clinical status of ID patients.</p> <p>Conclusions</p> <p>The results of our study show that certain internal medicine subdisciplines such as pulmonology, neurology and dermatology appear to be the principal clinical requisites in the training of ID specialists, rather than internal medicine as a whole.</p

Guideline adherence and survival of patients with candidaemia in Europe: results from the ECMM Candida III multinational European observational cohort study

© 2022 Elsevier Ltd. All rights reserved.[Background] The European Confederation of Medical Mycology (ECMM) collected data on epidemiology, risk factors, treatment, and outcomes of patients with culture-proven candidaemia across Europe to assess how adherence to guideline recommendations is associated with outcomes.[Methods] In this observational cohort study, 64 participating hospitals located in 20 European countries, with the number of eligible hospitals per country determined by population size, included the first ten consecutive adults with culture-proven candidaemia after July 1, 2018, and entered data into the ECMM Candida Registry (FungiScope CandiReg). We assessed ECMM Quality of Clinical Candidaemia Management (EQUAL Candida) scores reflecting adherence to recommendations of the European Society of Clinical Microbiology and Infectious Diseases and the Infectious Diseases Society of America guidelines.[Findings] 632 patients with candidaemia were included from 64 institutions. Overall 90-day mortality was 43% (265/617), and increasing age, intensive care unit admission, point increases in the Charlson comorbidity index score, and Candida tropicalis as causative pathogen were independent baseline predictors of mortality in Cox regression analysis. EQUAL Candida score remained an independent predictor of mortality in the multivariable Cox regression analyses after adjusting for the baseline predictors, even after restricting the analysis to patients who survived for more than 7 days after diagnosis (adjusted hazard ratio 1·08 [95% CI 1·04–1·11; p<0·0001] in patients with a central venous catheter and 1·09 [1·05–1·13; p<0·0001] in those without one, per one score point decrease). Median duration of hospital stay was 15 days (IQR 4–30) after diagnosis of candidaemia and was extended specifically for completion of parenteral therapy in 100 (16%) of 621 patients. Initial echinocandin treatment was associated with lower overall mortality and longer duration of hospital stay among survivors than treatment with other antifungals.[Interpretation] Although overall mortality in patients with candidaemia was high, our study indicates that adherence to clinical guideline recommendations, reflected by higher EQUAL Candida scores, might increase survival. New antifungals, with similar activity as current echinocandins but with longer half-lives or oral bioavailability, are needed to reduce duration of hospital stay.Scynexis.Peer reviewe

The possible effect of calcitriol on NDRG2 (N-Myc downstream regulated gene-2) and NIS (sodium-iodide symporter) gene expressions in undifferantiated human anaplastic thyroid cancer cell line

Giriş: Anaplastik tiroid kanseri en agresif neoplazilerden biridir. Sodyum-iyod simporter ve TSH-reseptöründeki ekspresyon kayıpları, tiroidektomi ya da radyoaktif iyodür tedavisi gibi konvensiyonel tedavilerin sonuçsuz kalmasına neden olmaktadır. Ameliyat, radyoterapi ve agresif kemoterapi ajanlarının birlikte kullanıldığı multimodel tedavilere rağmen, sağ kalım oldukça düşüktür. Bu nedenle anaplastik tiroid kanserinin tedavisinde tümör büyümesini inhibe edici ve diferansiyasyonu tetikleyici, kemoterapötikler ile kullanımında düşük sitotoksisite gösteren ajanların geliştirilmesi önemlidir. Amaç: Bu çalışmanın amacı Nthy-ori-3-1 hücreleri ile 8505C hücrelerinde N-Myc Dowstream Regulated Gene-2 (NDRG2) ve Sodyum-İyot Simporter (NIS) gen ekspresyonlarındaki olası farkın karşılaştırılması ve 1,25-dihidroksivitamin D3'ün (kalsitriol) farklı sürelerde inübasyonunun 8505C hücrelerinde hücre canlılığı ile NDRG2 ve NIS gen ekspresyonları üzerindeki meydana getirebileceği olası değişimlerin incelenmesidir. Materyal ve Yöntemler: Çalışma, Nthy-ori-3-1 normal insan tiroid folliküler epitelyal hücreleri ile 8505C indiferansiye insan anaplastik tiroid kanseri hücreleri üzerinde gerçekleştirildi. Her iki hücre hattındaki başlangıç NDRG2 ve NIS gen ekspresyon düzeyleri Real-Time Polimerase Chain Reaction (RT-PCR) ile incelendi. Kalsitriolün 8505C hücre hattında, hücre canlılığı üzerindeki etkisi WST-1 testi ile değerlendirildi. Kalsitriolün 8505C hücrelerinde NDRG2 ve NIS gen ekspresyonları üzerinde meydana getirdiği olası değişimler de RT-PCR ile değerlendirildi. Bulgular: Nthy-ori-3-1 hücrelerinde NDRG2 ve NIS gen ekspresyonları, 8505C hücrelerine göre anlamlı ölçüde yüksek bulundu. WST-1 bulgularına göre 8505C hücrelerinin 60 nM kalsitriol ile 24,48 ve 72 saat inkübasyonları sonucu, kalsitriolün hücre canlılığı üzerinde sırasıyla %62, %63 ve %56 düzeyinde azalma meydana getirdiği gözlendi. 60 nM kalsitriol ile 24 ve 48 saat inkübe edilen 8505C hücreleri ile kalsitriol uygulanmayan kontrol grubu arasında NDRG2 ve NIS gen ekspresyonları bakımından anlamlı bir fark bulunmadı. Sonuç: Nthy-ori-3-1 hücrelerinde NDRG2 ve NIS gen ekspresyonları 8505C hücrelerine göre anlamlı ölçüde yüksek bulundu. Ancak kalsitriolün 8505C hücrelerinde NDRG2 ve NIS gen ekspresyonları üzerinde anlamlı bir fark yaratmadığı saptandı. Background: Anaplastic thyroid cancer is one of the most agressive neoplasm. The loss of expressions in sodium-iodide symporter and TSH-receptor leads to failed conventional therapies such as thyroidectomy and radioactive iodide treatment. Despite surgery, radiotherapy and chemotherapy agents used in combination with aggressive multimodal therapies, the survival rate is extremely low. Thus, it is important to develop tumor growth inhibiting and differantiation inducing agents which can be used with chemotherapeutics that have low cytotoxicity. Aim: The aim of this study is to compare the possible difference of N-myc Downstream Regulated Gene-2 (NDRG2) and Sodium-Iodide Symporter (NIS) gene expressions in Nthy-ori-3-1 and 8505C cells and to investigate the possible effects of 1,25- dihydroxyvitamin D3 (calcitriol) on cell viability as well as NDRG2 and NIS gen expressions in 8505C cells with different incubatoin time. Material and Methods: This study was carried out on Nthy-ori-3-1, normal human thyroid follicular epithelial cells and 8505C, undifferentiated human anaplastic thyroid carcinoma cell line. The basal expression levels of NDRG2 and NIS on both cell lines were investigated with RT-PCR. The effect of calcitriol on cell viability was evaluated with WST-1 test. The changes in NDRG2 and NIS gene expressions in calcitriol treated 8505C cells were also investigated with Real-Time Polimerase Chain Reaction. Results: NDRG2 and NIS gene expressions were found significantly higher in Nthy-ori-3-1 cells compared with 8505C cells. According to WST-1 test results, the incubation of 8505C cells with 60 µM calcitriol by 24 - 48 and 72 hours resulted in 62% - 63% and 56% decrease in cell viability, respectively. No significant differences were found in NDRG2 and NIS gene expressions between control group without calcitriol and 8505C cells which were incubated with 60 µM calcitriol by 24 and 48 hours. Conclusions: NDRG2 and NIS gene expressions were found significantly higher in Nthy-ori-3-1 cells compared to 8505C cells. However, it was shown that calcitriol didn?t lead to any differences on NDRG2 and NIS gene expressions in 8505C cells

Peripheral Lymphadenopathy in Childhood: Single Center Study

Purpose: Lymphadenopathy is defined as an abnormality in the size and/or character of lymph node. In this study we aimed to describe the clinical and laboratory findings of benign and malignant causes of peripheral lymphadenopathy in childhood. Material and Methods: Two hundred and twenty four patients who were admitted to the clinic with peripheral LAP were evaluated. Age, gender, laboratory and radiologic findings, final diagnoses, and duration, localization, size, consistency, spread, and accompanying local and systemic symptoms of LAP were determined. Benign and malignant causes of peripheral lymphadenopathy were compared. Results: One hundred twenty-six patients (56.0%) were male and 98 patients (44.0%) were female. After the first evaluation the patients were divided into two groups. The first group included 186 patients with benign causes and the second group included 38 patients with malignant causes. One hundred and sixty four of 224 patients (73.2 %) had localized peripheral lymphadenopathy. The most frequent cause of localized lymphadenopathy in the benign group was acute lymphadenitis (34.8%). The most common cause of localized lymphadenopathy in the malignant group was Hodgkin's lymphoma (4.3%). Sixty of 224 (26.8%) patients had generalized peripheral lymphadenopathy. The most significant cause of generalized lymphadenopathy in the benign lymphadenopathy group was Epstein-Barr virus (10.0%), whereas Hodgkin's lymphoma (23.3%) was the most common cause in malign lymphadenopathy group. Localized and generalized lymph node enlargement was most frequently found in cervical region. The most frequent site of involvement among benign and malignant cases was the cervical area. The results revealed that findings such as chronic course, generalized LAP, supraclavicular, cervical and inguinal location, organomegaly, hilier LAP, abdominal LAP, and abnormal laboratory findings (thrombocytopenia and blasts on the peripheral blood smear) were associated with malignant diseases. Conclusion: Infections are the most common cause of peripheral LAP. The risk of malignany increases with the age of child and the duration of LAP. Older children with chronic LAP, generalized LAP associated with organomegaly, abnormal laboratory findings should be considered as malignant LAP

Evaluación de la progresión y la regresión de la aterosclerosis coronaria mediante ecografía intravascular: ¿Un nuevo cambio de paradigma?

La ecografía intravascular (EIV) se ha convertido en una importante modalidad de imagen para la evaluación de la pared arterial y de su respuesta a la acumulación de la placa aterosclerótica. La posibilidad de visualizar las arterias coronarias de manera seriada hace que la EIV ofrezca una oportunidad única para estudiar el efecto de las diferentes estrategias antiateroscleróticas en la placa. Por eso, los estudios que han utilizado la EIV de forma seriada como criterio principal de valoración han demostrado que las estrategias terapéuticas que modifican los valores de las lipoproteínas de baja densidad (LDL) y alta densidad (HDL) y de la presión arterial en los pacientes con enfermedad coronaria establecida tienen un profundo impacto en la progresión de la placa aterosclerótica. Todo ello anuncia un cambio de paradigma en el que se considera la regresión de la placa como objetivo potencial para el desarrollo de estrategias preventivas