Mediha Gonenc Ortakoylu

Differentiating sarcoidosis from tuberculosis in patients with mediastinal and/or hilar granulomatous lymphadenopathy remains challenging due to overlappin

Homozygosity for rare loss-of-function IL23R variants abolishes IL-23–dependent IFN-γ production by lymphocytes, including NK and innate-like T cells, thereby underlying clinical disease due to weakly virulent mycobacterial species. We report selective enrichment in homozygosity for four hypomorphic IL23R variants in our cohort of patients with tuberculosis. Three of these IL23R alleles are rare (G300V, G149R, and L372F), with a minor allele frequency (MAF) under 1%, but the fourth (R381Q) is surprisingly common, with an MAF as high as 10.2% in certain populations. The other 15 missense alleles found in the homozygous state in public databases are isomorphic. The four hypomorphic IL-23R variants identified dimerize with IL-12Rβ1 and bind IL-23. However, their function is impaired by low levels of cell surface expression (R381Q, G300V) and/or as a consequence of conformational changes altering agonist efficacy. IFN-γ production in response to IL-23 is impaired in innate-like T cells and NK cells. These data suggest that recessive partial IL-23R deficiency, whether due to rare or common variants, confers a predisposition to tuberculosis while preserving immunity to less virulent mycobacteria.

Background and Aim: Emerging evidence suggests a link between vitamin D deficiency and increased susceptibility to TB. Vitamin D regulates calcium, phosphorus, and bone metabolism and plays a pivotal role in immune responses. This study investigates the relationship between 25(OH)D3 levels and the clinical course, radiological findings, and treatment outcomes in TB patients. Materials and Methods: This prospective study was conducted over ten months at a tertiary care hospital, involving 70 newly diagnosed TB patients (aged 18-69 years) and 20 healthy controls. TB diagnosis was confirmed through clinical, radiological, and microbiological findings, including acid-resistant bacteria (ARB) smear and M. tuberculosis culture positivity. All participants underwent physical examinations, routine blood tests, and serum 25(OH)D3 level measurements. Serum 25(OH)D3 levels were categorized as deficient (

Aims: To investigate the diagnostic value of purivate kinase isoenzyme-M2 (M2-PK) levels and their relationship with tumor histological type in patients diagnosed with lung cancer. Methods: In this prospective study, 98 cases diagnosed with lung cancer (Study group) and 90 cases with lung cancer excluded (Control group) were included. The study group consisted of people over the age of 18 who had been diagnosed with lung cancer and had not received any treatment for the tumor. The control group consisted of 45 people who had been diagnosed with any lung disease but did not have lung cancer, and 45 of them were completely healthy people. Those with benign lung disease apart from lung cancer were named as control group-1 and healthy control group was named as control-group-2. Plasma samples with 5 cc of EDTA were taken from all subjects and these samples were quickly frozen at – 80 degrees and stored in this way until laboratory analysis could be performed. Commercial kit based on the sandwich ELISA principle (ScheBo Biotech Ag, Tumor M2-PK ELISA kit, Germany) was used to determine plasma M2-PK levels. The M2-PK values of the samples were calculated on the basis of the standard graph. Results: M2-PK levels were measured and compared in the lung cancer group, control group-1 with non-lung cancer lung disease and healthy control group-2. M2-PK levels were found to be significantly higher in the lung cancer group than in the control group-1 (p<0.0001) and control-group-2 (p<0.0001). When M2-PK levels were compared in all three groups, they were statistically significant in the lung cancer group (p<0.001). In our study, the diagnostic cut off value was found to be 8.9 IU/ml using ROC curve. At this cut-off value, plasma m2-pk level was calculated as 100% sensitivity and 97.8% specificity in showing lung cancer. When compared, there was no statistically significant difference between histopathological diagnoses, stage of the disease and M2-PK levels in the lung cancer group. Conclusion: As a result of this study, it has been shown that tumor M2-PK can be used in the differentiation of lung cancers from other benign lung lesions and as a marker in patients with suspected lung cancer.

Background and Objectives: There is a lack of information regarding the effective duration of treatment necessary to prevent the development of acquired resistance when fluoroquinolones (FQ), and/or pyrazinamide (Z) resistance has occurred in patients with polydrug-resistant tuberculosis and isoniazid resistance. The management of these kinds of patients should be carried out in experienced centers according to drug susceptibility test results, clinical status of the patient and the extensity of the disease. Materials and Methods: We evaluated treatment regimens, treatment outcomes, and drug adverse effects in seven patients with polydrug-resistant tuberculosis, including those with Z and/or FQ resistance in a retrospective analysis Results: Regarding the patients with polydrug-resistant tuberculosis in addition to isoniazid (H) resistance, three had Z, two had FQ, and the remaining two had both Z and FQ resistance. In the intensive phase of the treatment, the patients were given at least four drugs according to drug susceptibility tests, and at least three drugs in the continuation phase. The duration of treatment was 9–12 months. Two of the patients were foreign nationals, and could not be followed up with due to returning to their home countries. Regarding the remaining five patients, three of them were terminated as they completed treatment, and two as cured. No recurrence was observed in the first year of the treatment. The most common, and serious drug side effect was seen for amikacin. Conclusions: In patients with polydrug-resistant TB, if Z and/or FQ resistance is detected in addition to H resistance, the treatment of these patients should be conducted on a case-by-case basis, taking into account the patient’s resistance pattern, clinical condition, and disease prognosis. Close monitoring of the side effects will increase the success rate of the treatment.

Background/aim: Considering its early bactericidal activity, isoniazid (H) is an important first-line agent in tuberculosis (TB) treatment. The aim of this study was to evaluate the treatment regimens and results of H-resistant pulmonary TB patients. Materials and methods: We retrospectively evaluated treatment regimens and results of 188 H-resistant pulmonary TB patients who were treated in our center between January 2015 and December 2017. Treatment regimens applied were noted and treatment outcomes were recorded. The long-term results were evaluated. Results: Totally 174 (92.6%) of 188 patients with H-resistant pulmonary TB achieved treatment success. Ninety-seven patients (51.6%) were cured and 77 patients (41.0%) completed treatment. Five patients (2.7%) had treatment failure. Four patients (2.1%) having treatment success relapsed during one-year follow-up. Eighteen patients (9.6%) had unfavorable outcomes, including treatment failure in five (2.7%), death in nine (4.8%), and relapse in four patients (2.1%). The treatment success rate was found to be statistically higher in group 1 (9-month regimen 2HREZ/7HRE) compared with those in group 2 (9HREZ) (97.4% vs. 85.9%; p = 0.010). Group 3 (HREZFQ) and group 1 had statistically significant favorable outcomes, compared to group 2 (group 2 vs. group 3, p = 0.048; group 1 vs. group 2, p = 0.022). Interestingly, no relapse and acquired rifampicin resistance in patients occurred who received an FQ-containing regimen. Conclusion: Our study results show higher treatment success and positive results with the treatment regimen containing FQ and that treatment with HREZ for nine months is associated with a lower treatment success rate.

It is important to identify cases of latent tuberculosis infection (LTBI) who are at risk for tuberculosis (TB) reactivation. We aimed to evaluate the performance of interferon (IFN)-gamma-inducible protein 10 (IP-10) as a marker to detect LTBI in patients with inflammatory rheumatic diseases (IRD). This study comprised 76 consecutive subjects with IRD. Patients with a history of TB or having active TB were excluded. In all patients, IP-10 level was measured and tuberculin skin test (TST) and QuantiFERON-TB Gold In-Tube test (QFT-GIT) were performed. Seventy patients with complete test results were analyzed. Twenty-one (30%) QFT-GIT-positive patients were defined as having LTBI. IP-10 yielded 2197 pg/mL cut-off point. At this cut-off point, IP-10 showed 89% specificity with a sensitivity of 91% (AUC: 0.950, 95% CI 0.906–0.994). TST, QFT-GIT, and IP-10 were positive in 77.1%, 30%, and 44.3% of the patients, respectively. Concordance among the results of TST, QFT-GIT, and IP-10 tests was evaluated. Agreement was poor between IP-10 and TST (58.6%, κ = 0.19), whereas it was good between QFT-GIT and IP-10 (84.3%, κ = 0.65). The results of the present study demonstrated that sensitivity and specificity of released IP-10 were as high as those of QFT-GIT in indicating LTBI in IRD patient group.

Coronavirus,pandemic,rifampicin,SARS-CoV-2,treatment