Adalet Aypak

Objective: Extrapulmonary tuberculosis (EPTB) accounts for a growing proportion of the global TB burden, with rising incidence in many countries, including Türkiye. This study aimed to describe the demographic, clinical, diagnostic, and therapeutic characteristics of adult patients diagnosed with EPTB in a tertiary care setting. Methods: This retrospective cohort included adults (≥18 years) diagnosed with EPTB between June 2010 and March 2022 at two tertiary hospitals in Ankara. Descriptive and comparative statistical analyses were performed. Results: A total of 93 patients were included (51.6% male; median age: 55 years). The most affected sites were spine/joints (32.3%), lymph nodes (26.9%), and the central nervous system (16.1%). Histopathological confirmation was achieved in 60.2%, culture positivity in 30.1%, and PCR positivity in 31.2%. AFB staining was positive in 25.8%, and drug susceptibility testing was performed in 27.9%, revealing resistance in two patients. Standard four-drug anti-TB therapy was initiated in 95.7% of cases, with a median duration of 6 months (range: 1–13). Surgery was required in 22.6% of patients. Nine patients (9.7%) died during follow-up. Immunosuppression was significantly more common among non-survivors (44.4% vs. 11.9%, p = 0.027), who also had shorter durations of therapy (p < 0.001). Conclusion: EPTB in adults can present with severe forms, particularly spinal and CNS involvement. Histopathology remains a key diagnostic tool. Mortality was associated with immunosuppression and insufficient treatment duration, highlighting the need for early diagnosis and individualized management strategies.

Background/Objectives: Several studies investigated the risk factors for severe COVID-19-related outcomes. Early identification and proper treatment of COVID-19 patients who may develop severe pneumonia are crucial. The aim of this study was to detect the importance of the laboratory parameters for risk prediction of severe pneumonia in COVID-19 patients. Methods: This retrospective cohort study included COVID-19 patients’ laboratory parameters at admission. Biochemical, hematological, coagulation, and inflammatory parameters values were compared between the non-severe and severe groups. Results: A total of 534 COVID-19 patients were screened, and 472 of them were included in this study. The mean age of patients was 64 (±3.1) years; 242 (51.3%) were men. A total of 204 (43.2%) patients were diagnosed as severe cases. The independent predictors of severe illness were C-reactive peptide, Eosinophil, neutrophil–lymphocyte ratio, interleukin-6, and lactate dehydrogenase. These parameters were named as CENIL scores from 0 to 5 points. The findings of this study indicate that these biomarkers identified tend to increase progressively with disease severity in severe COVID-19 patients. Additionally, the CENIL risk score identified a specific cut-off value of 3, highlighting it as a critical threshold for identifying patients at high risk of severe COVID-19 progression. Conclusions: In this study, we identified biomarkers—including CRP, eosinophil count, NLR, IL-6, and LDH—named as CENIL risk score that can help predict the likelihood of severe disease at diagnosis. Clinicians may be more vigilant regarding the development of severe disease in patients with high CENIL risk scores, guided by clinical and radiological findings.

Amaç: Üçüncü basamak bir merkezde takip edilen 14 HIV (insan immün yetmezlik virüsü) pozitif gebe kadının perinatal sonuçlarını değerlendirmek. Yöntemler: : Bu, Ankara Bilkent Şehir Hastanesi perinatoloji kliniğinde yürütülen retrospektif bir kohort çalışması olup çalışmaya 2020-2023 yılları arasında HIV pozitif tanısıyla takip edilen tüm gebeler dahil edildi Gebelerin demografik özellikleri, tanı zamanı, prenatal ve intrapartum dönemde aldıkları antiretroviral tedavi, bebeklere aldıkları antiretroviral tedavi ve süreleri, vertikal bulaşma oranları değerlendirildi. Bulgular: Çalışmaya toplam 14 HIV pozitif gebe dahil edildi. Olguların 2'si (%14,28) birinci trimesterde, bir olgu (%7,14) ikinci trimesterde, 10 olgu (%71,42) üçüncü trimesterde ve bir olgu (%7,14) postpartum 10. günde idi. Hastalardan dokuzunun (%64,3) düzenli hastane takipleri ve düzenli tetkik ve tedavileri vardı. 5'i (%35,7) düzenli kontrollere gelmemiş ve düzenli tedavi görmemişti. Ortalama CD4+ sayısı 611±243 hücre/mm3, CD8+ sayısı ise 852±366 hücre/mm3 idi. Ortalama CD4/CD8 oranı 0,94±0,74 idi. Bir hastada annenin HIV plazma RNA kopya numarasına bakılmadı, 5 hastada sonuç negatif, 8 hastada ise pozitif çıktı. Medyan HIV RNA'sı 471 (aralık 0-106559) kopya/mL idi. Bebekler farklı zamanlarda doğdukları için 0-18 ay ve 18-40 ay olmak üzere 2 gruba ayrıldılar. Bebeklerin tamamı çocuk doktoru ve enfeksiyon hastalıkları uzmanı tarafından düzenli olarak takip edildi. Tüm bebeklere lamivudin/zidovudin ve raltegravir ile standart tedavi verildi. 18 ay sonra yapılan kontrollerde bebeklerin hiçbirinde HIV pozitifliğine rastlanmadı. Sonuç: Sonuç olarak, annede HIV enfeksiyonu multidisipliner bir ekip tarafından uygun şekilde yönetildiğinde olumlu sonuçlarla ilişkili olduğu gözlenmiştir.

It is known that the use of inhaled corticosteroids increases the incidence of pneumonia in patients followed up with the diagnosis of chronic asthma and chronic obstructive pulmonary disease (COPD). This study aimed to investigate the contribution of inhaled steroid use to pneumonia severity and mortality in cases with COVID-19 pneumonia. The study is a retrospective, observational study. Among the cases admitted to the pandemic clinic, patients diagnosed with COVID-19 pneumonia were included. The plan was to compare cases who received and did not receive inhaled corticosteroids in terms of pneumonia severity and mortality. In order to define risk factors for mortality, univariate and multivariable negative binomial regression analyses were performed. In our study, it was observed that n= 540 (75%) cases did not receive inhaled corticosteroids (group 1), and 180 (25%) cases used inhaled corti costeroids (group 2). Group 1 and group 2 cases were compared in terms of pneumonia severity with no significant difference between the two groups (p= 0.11). Then, risk factors affecting mortality in all cases were examined with univariate analyses. Increasing age, applying mechanical ventilation, having severe pneumonia, having interstitial lung disease, and applying prone position were found to be statistically significant factors in mortality (p < 0.05). In conclusion, in our study, it was observed that the use of inhaled corticosteroids did not increase the severity of pneumonia and mortality. It was thought that the treatment they received could be continued when the patients treated with inhaled corticosteroids due to asthma and COPD had COVID-19 pneumonia.

Solid organ transplantation,tuberculosis,latent tuberculosis infection,interferon-gamma release test,tuberculin skin test

Human immunodeficiency virus (HIV)/acquired immundeficiency syndrome (AIDS) is a critical global public health problem that significantly affects both life expectancy and the overall quality of life of in dividuals in all age groups. The landscape of HIV infection has changed significantly in recent years due to the introduction of effective combination antiretroviral therapies (ART). A key component of first -line ART regimens for HIV treatment is abacavir, a nucleoside HIV reverse transcriptase inhibitor. Although ab acavir is effective in suppressing viral replication and managing disease, its clinical utility is overshadowed by the potential for life -threatening hypersensitivity reactions in HLA-B*57:01-positive patients. In our country, local data obtained from various centers regarding the prevalence of HLA-B*57:01 in HIV -1 -infected patients are available. In this study, it was aimed to determine the prevalence of the HLA-B*57:01 genotype in HIV -infected patients who were followed up and treated in many regions of our country. This retrospective study consists of the data of the patients aged 18 years and over diagnosed with HIV -1 infection between 01.01.2019 and 31.07.2022. Age, gender, place of birth, mode of transmission of the disease, death status, CD4+ T cell count and HIV RNA levels at the first clinical presentation, HLA-B*57:01 positivity, and the method used, clinical stage of the disease, virological response time with the treatment they received were recorded from the patient files. Data were collected from 16 centers and each center used different methods to detect HLA-B*57:01. These methods were sequence -specific oligonucleotide probe hybridization (SSOP), DNA sequence -based typing (SBT), single -specific primer-polymerase chain reaction (SSP-PCR), allele -specific PCR (AS-PCR) and quantitative PCR (Q-PCR). A total of 608 HIV -infected individuals, 523 males (86%) and 85 females (14%), were included in the study. The mean age of the patients was 36.9 +/- 11.9 (18-73) years. The prevalence of HLA-B*57:01 allele was found to be 3.6% (22 patients). The number of CD4+ T lymphocytes in HLA-B*57:01 allele -positive patients was > 500/ mm(3) in 10 patients (45.5%), while the number of CD4+ T lymphocytes in HLA-B*57:01 negative pa- tients was > 500/mm(3) in 216 patients (36.9%) (p> 0.05). Viral load at the time of diagnosis was found to be lower in patients with positive HLA-B*57:01 allele but it was not statistically significant (p> 0.05). Although different treatment algorithms were used in the centers following the patients, it was observed that the duration of virological response was shorter in HLA-B*57:01 positive patients (p= 0.006). Although the presence of the HLA-B*57:01 allele has a negative impact due to its association with hypersensitivity, it is likely to continue to attract interest due to its association with slower progression of HIV infection and reduced risk of developing AIDS. In addition, although the answer to the question of whether it is cost-effective to screen patients for HLA-B*57:01 before starting an abacavir-containing ART regimen for the treatment of HIV infection is being sought, it seems that HIV treatment guidelines will continue to recommend screening to identify patients at risk in this regard.

We address the lack of research regarding aerodynamic events behind respiratory distress at COVID-19. The use of chest CT enables quantification of pneumonia extent; however, there is a paucity of data regarding the impact of airflow changes. We reviewed 31 COVID-19 patients who were admitted in March 2020 with varying severity of pulmonary disease. Lung volumes were segmented and measured on CT images and patient-specific models of the lungs were created. Incompressible, laminar, and three-dimensional Navier-Stokes equations were used for the fluid dynamics (CFD) analyses of ten patients (five mild, five pneumonia). Of 31 patients, 17 were female, 18 had pneumonia, and 2 were deceased. Effective lung volume decreased in the general group, but the involvement of the right lung was prominent in dyspnea patients. CFD analyses revealed that the mass flow distribution was significantly distorted in pneumonia cases with diminished flow rate towards the right lung. In addition, the distribution of flow parameters showed mild group had less airway resistance with higher velocity (1.228 m/s vs 1.572 m/s) and higher static pressure values at airway branches (1.5112 Pa vs 1.3024 Pa). Therefore, we conclude that airway resistance and mass flow rate distribution are as important as the radiological involvement degree in defining the disease severity. Graphical Abstract

We evaluated neutralizing antibodies against the Omicron variant and Anti-Spike IgG response in solid organ (SOT) or hematopoietic stem cell (HSTC) recipients after a third dose of BNT162b2 (BNT) or CoronaVac (CV) following two doses of CV. In total, 95 participants underwent SOT (n = 62; 44 liver, 18 kidney) or HSCT (n = 27; 5 allogeneic, 22 autologous) were included from five centers in Turkey. The median time between third doses and serum sampling was 154 days (range between 15 to 381). The vaccine-induced antibody responses of both neutralizing antibodies and Anti-Spike IgGs were assessed by plaque neutralizing assay and immunoassay, respectively. Neutralizing antibody and Anti-Spike IgG levels were significantly higher in transplant patients receiving BNT compared to those receiving CV (Geometric mean (GMT):26.76 vs. 10.89; p = 0.03 and 2116 Au/mL vs. 172.1 Au/mL; p < 0.001). Solid organ transplantation recipients, particularly liver transplant recipients, showed lower antibody levels than HSCT recipients. Thus, among HSCT recipients, the GMT after BNT was 91.29 and it was 15.81 in the SOT group (p < 0.001). In SOT, antibody levels after BNT in kidney transplantation recipients were significantly higher than those in liver transplantation recipients (GMT: 48.32 vs. 11.72) (p < 0.001). Moreover, the neutralizing antibody levels after CV were very low (GMT: 10.81) in kidney transplantation recipients and below the detection limit (<10) in liver transplant recipients. This study highlights the superiority of BNT responses against Omicron as a third dose among transplant recipients after two doses of CV. The lack of neutralizing antibodies against Omicron after CV in liver transplant recipients should be taken into consideration, particularly in countries where inactivated vaccines are available in addition to mRNA vaccines.

Aim: The aim of the study is to classify patients infected with Covid-19 in our population according to the radiological consensus defined by Radiology Society of North America (RSNA) and American College of Radiology (ACR) and to show the relationship of the patients with clinical-laboratory findings. Material and Methods: 127 cases (74 males, 53 females; age range 19-92 years) who applied to Ankara City Hospital with symptoms such as fever, cough and respiratory distress and whose laboratory findings were compatible with Covid-19 were included in our study. The thorax computed tomography (CT) findings of the cases were classified according to the RSNA criteria and their relationship with clinical-laboratory data was statistically evaluated. Results: 47.2% of them had fever, 62.2% cough, 22 dyspnea, 4.7% diarrhea and 28.3% fatigue-malaise symptoms. When the thorax CT findings were evaluated, 55% of the patients had a typical appearance, 21% intermediate appearance, 11% atypical appearance and 13% negative appearance. Conclusion: It is obvious that thoracic CT examination has many advantages in evaluating Covid-19 pneumonia. However, it was concluded that more observations should be made in order to classify the findings better and to reveal their relationship with clinical-laboratory findings.