Influence of umbilical cord clamping time on cerebral oxygenation and early cardiac function in term infants

BACKGROUND

Delayed cord clamping is the standard of care for both term and preterm infants worldwide. The aim of this study was to evaluate the effect of 60-second or 180-second delayed cord clamping during labor on cerebral oxygenation and cardiac function.

METHODS

Healthy newborns were divided into two groups: a 60-second delay in cord clamping (60-s DCC) and a 180-second delay in cord clamping (180-s DCC) at birth. Pulse oximetry and cerebral near-infrared spectroscopy (cNIRS) probes were placed during postnatal care. A total of 84 healthy newborns were included in this study. Preductal oxygen saturation (SpO2), heart rate, and cNIRS values were recorded at 5 and 10 minutes after delivery. The cardiac function of the infants was assessed by echocardiography at 3-7 days postnatally.

RESULTS

There was no significant difference between the groups in SpO2 and cNIRS values at 5 and 10 min. While there was no significant difference in the number of neonates with targeted SpO2 at the 5th and 10th min and targeted cNIRS values at the 10th min, there was a significant difference in the number of neonates with target cNIRS values at the 5th min between groups (p <  0.001). Echocardiographic findings showed that pulmonary flow velocity was increased in the 180-s DCC group; the difference was statistically significant (p = 0.04).

CONCLUSION

Our results showed that the number of infants with normal cNIRS values regarding cerebral oxygenation was higher in the 180-s DCC group. The pulmonary flow velocity was significantly increased in the 180-s DCC group in terms of echocardiographic findings.

The epidemiologic trend of respiratory syncytial virus has returned strongly to its origin after the pandemic: Five-year data from a single center

OBJECTIVE

Only a few studies have investigated the frequency and severity of respiratory syncytial virus (RSV) infections after the end of the pandemic regulations. This study aims to investigate the frequency and severity of RSV infections before, during, and after the pandemic in Turkey.

MATERIALS AND METHODS

Patients under 18 years of age and those who tested positive for RSV between April 2018 and March 2023 were retrospectively reviewed. All patients were divided into three groups (pre-COVID-19, COVID-19, and post-COVID-19) according to admission date. Among inpatients, data were compared between the three groups to determine the impact of the pandemic on RSV epidemiology and clinical outcomes.

RESULTS

A total of 9567 patients were tested for RSV, of which 1073 (11.2%) were positive and included in the study. Hospitalization occurred in 447 (41.7%) patients. Inpatients were younger than outpatients (p < .000). Among the three inpatient pandemic groups, clinical outcomes were statistically significantly worse in the post-COVID-19 group than in the other two groups. SpO2 was lower (p < .000), inhaled salbutamol requirement was higher (p < .000), length of stay was longer (p = .031), and ICU admission was higher (p = .023).

CONCLUSION

Although the RSV trend changed within 2 years after the COVID-19 outbreak, it returned to its usual seasonality last year. After the repeal of all COVID-19 measures and the normal life began, the number of RSV-positive patients and RSV-related hospitalizations increased, and the clinical outcomes of RSV worsened. This may be a result of decreased herd immunity due to a change in society's attitude toward epidemic diseases.

Difficulties in Diagnosing Fabry Disease in Patients with Unexplained Left Ventricular Hypertrophy (LVH): Is the Novel GLA Gene Mutation a Pathogenic Mutation or Polymorphism?

Fabry disease (FD) is an X-linked, lysosomal glycosphingolipid storage disorder that occurs very rarely. Cardiac involvement may comprise of left ventricular hypertrophy (LVH), arrhythmias, conduction abnormalities, heart failure and valvular abnormalities. The goal of this study was to conduct gene analysis for FD in patients suffering from unexplained LVH. 120 patients over the age of 30 who were diagnosed by echocardiography with idiopathic LVH were included in the study. Patients with severe hypertension, intermediate valve disease such as moderate aortic stenosis, known FD, and a family history of autosomal dominant hypertrophic cardiomyopathy were excluded from the study. GLA gene mutations were studied by Sanger sequence analysis in all patients. Of the 120 total patients included in this study, 69 were female (58%) and 51 were male (42%). The mean age was 60.3 ± 15.7. GLA gene mutations were detected in three male patients. The detected mutations are as follows: NM_000169.2:IVS6-10G>A (c.1000-10G>A), NM_000169.2:c.937G>T (p.D313Y) (p.Asp313Tyr) and NM_000169.2:c.941A>T (p.K314M) (p.Lys314Met). Early diagnosis is of vital importance in FD, which can be treated with enzyme replacement. Genetic screening in patients diagnosed with idiopathic LVH by echocardiography is important in the early diagnosis and treatment of FD. Patients over 30 years of age with idiopathic LVH should be screened for FD. Various new polymorphisms can be detected in genetic screening. Identifying new polymorphisms is important for knowing the true mutations in FD.

Dynamic thiol-disulphide homeostasis as a biomarker for predicting the development of contrast medium-associated acute kidney injury in the endovascular treatment of peripheral arterial disease: should intravenous N-acetylcysteine be given before the procedure?

AIM

To determine the predictive ability of serum thiol-disulphide levels for contrast medium-associated acute kidney injury (CA-AKI) after endovascular treatment (EVT) of peripheral arterial disease (PAD) and evaluate the efficacy of intravenous N-acetylcysteine (NAC) in preventing CA-AKI.

MATERIAL AND METHODS

This double-blind, randomised controlled study included 85 consecutive adult patients who underwent EVT for PAD. Patients were divided into NAC negative (NAC-) and positive (NAC+) groups. While the NAC- group received only 500 ml saline, the NAC + group received 500 ml saline plus intravenous 600 mg NAC before the procedure. Intra- and intergroup patient characteristics, procedural details, preoperative thiol-disulphide levels, and ischaemia-modified albumin (IMA) levels were recorded.

RESULTS

There was a significant difference between NAC- and NAC + groups regarding native thiol, total thiol, disulphide/native thiol ratio (D/NT), and disulphide/total thiol ratio (D/TT). There was also a significant difference between the NAC- (33.3%) and NAC+ (13%) groups in CA-AKI development. Logistic regression analysis showed that the D/TT (OR 2.463) and D/NT (OR 2.121) were the most influential parameters for CA-AKI development. In the receiver operating characteristic (ROC) curve analysis, the sensitivity of native thiol to detect the development of CA-AKI was 89.1%. The negative predictive values of native thiol and total thiol were 95.6% and 94.1%, respectively.

CONCLUSION

The serum thiol-disulphide level can be used as a biomarker to detect CA-AKI development and reveal patients with a low risk for CA-AKI development before EVT of PAD. Furthermore, thiol-disulphide levels allow for the indirect quantitative monitoring of NAC. Preprocedural intravenous NAC administration significantly inhibits CA-AKI development.

Reactivation of Tuberculosis and COVID-19 in Pediatric Patients

Objective Mycobacterium tuberculosis is an immobile aerobic bacillus that causes tuberculosis (TB) disease. We aimed to evaluate the association between coronavirus disease 2019 (COVID-19), COVID-19-related drugs, TB reactivation, and TB incidence during the pandemic.

Methods Eight patients who were diagnosed as having TB in Meram Medical Faculty, Necmettin Erbakan University between March 1, 2020, and December 31, 2021, at the beginning of the pandemic, were enrolled in this study. The presence of COVID-19 infection was confirmed using COVID-19 antibody tests and the patients' COVID-19 history. We evaluated the demographic data, laboratory findings, imaging tests, and pathology results of all patients.

Results We checked all our patients with TB using COVID-19 antibodies (immunoglobulin [Ig]G + IgM) or polymerase chain reaction. Seven of the eight patients were female (87.5%). The median age was 16 years. Family screening of all patients was negative, and they had bacillus Calmette–Guérin vaccine scars. Two patients had chronic diseases. One was diagnosed as having primary ciliary dyskinesia in our department (patient no. 8) and the second was under follow-up by the rheumatology department with a diagnosis of juvenile idiopathic rheumatoid arthritis.

Conclusion There has been an increase in the incidence of TB in children, especially in adolescents, during the pandemic period. This may be due to the pathogenic structure of the COVID-19 virus with an unknown mechanism. In addition, lifestyle changes and changes in health care policies during the pandemic may have caused this. Further research should be performed on this topic.

Delta variant effect on the clinical course of adolescent COVID-19 patients

OBJECTIVE

The clinical course of new COVID-19 variants in adolescents is still unknown. The aim of this study is to evaluate the clinical characteristics of COVID-19 in adolescents and compare the differences between the original version and the delta variant.

MATERIALS AND METHODS

The medical records of patients aged 10-18 years treated for COVID-19 between April 1, 2020 and March 31, 2022 were retrospectively reviewed. Patients were divided into four groups (asymptomatic, mild, moderate, and severe) for COVID-19 severity and into two groups according to the diagnosis date (first-second year). The primary endpoint of the study was hospital admission.

RESULTS

The mean age of patients was 171.81 ± 29.5 months, and most of them were males (n: 435, 53.3%). While the patient number was 296 (43.52%) in the first year of pandemic, it raised to 520 (54.11%) in the second year (p < 0.01). The severity of COVID-19 was mild in 667 (81.7%) patients. In the comparison of patients according to the diagnosis date (first-second years); the parameters of anosmia, ageusia, weakness, muscle pain, vomiting, hospital admission, and length of stay in hospital were statistically different (p < 0.05). In the comparison of hospitalized patients between years, the necessity of oxygen support (p < 0.001), endotracheal intubation rates (p < 0.05), length of stay in the hospital (p < 0.001), and the severity of COVID-19 (p < 0.05) was significantly higher in the second year.

CONCLUSION

The clinical course for adolescents diagnosed with COVID-19 has linearly changed with the delta variant. Our results confirmed that the delta variant is more transmissible, requires more oxygen support, increases endotracheal intubation, and prolongs the length of stay in the hospital.

Investigation of the Antimicrobial Effect of Different Disinfectants on Alginate Measurement Materials

Objective The impression materials are contaminated with pathogenic microorganisms carried by saliva and blood in the mouth. The aim of this study is to evaluate the antimicrobial activity of 1 and 5.25% sodium hypochlorite (NaClO) and zeta 7 solution, a commercial disinfectant, on alginate and to compare it washing with distilled water.

Methods Samples obtained from alginate impressions taken from eight pediatric patients selected in accordance with the inclusion criteria with a size of 1 × 1 cm were subjected to five different disinfection protocols. After samples were vortexed in 3-mL physiological saline, 1-mL volume were inoculated onto brain heart infusion agar and cultured at 37°C for 72 hours to determine the number of colony-forming units/mL. Streptococcus mutans, Staphylococcus aureus, Escherichia coli, Candida albicans were used as control strains. The data obtained were statistically evaluated by using analysis of variance and post-hoc tests. The differences were considered statistically significant when p < 0.05.

Results All of the disinfectant solutions tested were effective in the disinfection of the impression materials examined. The control group with no treatment and the water and flushing group had a significantly higher bacterial load compared to the other disinfectant-treated groups in terms of bacterial load, and no significant difference has been observed between the disinfectant solutions (p < 0.05). Simple rinsing of the impressions in sterile water reduced the number of microorganisms but did not decontaminate the impressions.

Conclusion Washing with water alone is insufficient for measured disinfection. Although NaClO is an effective disinfectant even at low concentrations, microorganism growth was not observed at 5.25% concentration. It is appropriate to use NaClO at 1 and 5.25% concentrations for impression disinfection.

A meta-analysis of the association between Growth Hormone (GH) gene polymorphism and growth traits in cattle breeds

GH gene is one of the important genes that affect the productive and physiological traits in livestock. This study aimed to use a meta-analysis to determine the association of the GH gene with growth traits in cattle. Four different genetic models were used: dominant LL + LV versus VV, recessive LL versus LV + VV, complete over dominant LL+VV vs. LV and co-dominant LL vs. LV, LL vs. VV and LV vs. VV. The random-effect model was used in data analysis based on I2. Meta-analysis showed an effect of GH genotypes on the birth weight (BW) under the recessive (p<0.05) and complete over dominant (p<0.01) models. However, no association (p>0.05) was found under the dominant model. In terms of co-dominant model, the GH polymorphism showed a significant association with BW (SMD = 0.359, 95% CI = 0.119 to 0.599, p = 0.003) under LL vs. LV genotype combination patterns. No association was found between GH polymorphism and BW under LL vs. VV genotype combination. The results showed that the LL genotype had a significant effect on BW traits from LV and VV genotypes when comparing the models. The results showed an effect of the GH on ADG under four genetic models (p<0.05).

Outcomes of COVID-19 Infections in children: A single-center retrospective study

The COVID-19 pandemic is an important cause of morbidity and mortality, which has had a negative impact worldwide. Our aim was to describe clinical findings and outcomes of severe acute respiratory syndrome (SARS)-CoV-2 viral infection and COVID-19 cared for at a large pediatric tertiary care hospital during the first year of the pandemic. Patients aged 1 month to 18 years who were diagnosed as having COVID-19 between March 2020 and April 2021 were included. The files of patients diagnosed with COVID-19 were reviewed retrospectively. Results: Four hundred sixty seven children were included in the study. There were 34 (7.3%) patients under 1 year of age, 111 (23.8%) between 1 and 5 years, 98 (30.4%) between 5 and 10 years, 142 (30.4%) between 11 and 15 years, and 82 (17.6%) age over 15 years. Fever (88.2%), vomiting (32.4%), and diarrhea (29.4%) in patients aged under 1 year, sore throat (36.6%) in patients aged 11-15 years, and dysgeusia (11%), anosmia (14.6%), headache (18.3%), malaise (40.8%), myalgia (28%), and shortness of breath (17.1%) in those aged over 15 years were found to be significantly more common in comparison with the other age groups (p < 0.05). Thirty-five (7.5%) patients were asymptomatic, 365 (78.1%) had mild disease, 35 (7.5%) were moderate, 27 (5.8%) were severe, and five (1.07%) were critical. Leukocyte count, erythrocyte sedimentation rate, ferritin, and C-reactive protein values were significantly higher in hospitalized patients. Three patients died during the study period (0.64%). While SARS-CoV-2 infection may be asymptomatic and COVID-19 usually has a mild clinical course, some children have severe disease or mortality.

Serum Vitamins A, D, and Zinc Levels in Children with Coronavirus Disease 2019 and Multisystem Inflammatory Syndrome in Children

Objective Vitamin D, due to its immunomodulating effect, zinc, and vitamin A, which affect cellular and humoral immunity, are thought to affect the clinical severity of coronavirus disease 2019 (COVID-19) infection. The present study evaluates the association between vitamin A, D, and zinc deficiencies and disease severity in pediatric patients with COVID-19 infections.

Methods The levels of vitamin A, D, and zinc at the time of diagnosis of 123 pediatric patients who presented to our hospital and were diagnosed as having hospitalized, nonhospitalized COVID-19 infection group, and multisystem inflammatory syndrome in children (MIS-C) were evaluated. The correlations of the measured levels with the disease severity and the need for intensive care or hospitalization were analyzed.

Results Among the 123 patients, 21.1% (n = 26), 42.2% (n = 52), and 36.7% (n = 45) had a diagnosis of MIS-C, belonged to the hospitalized COVID-19 infection group, or belonged to the nonhospitalized COVID-19 infection group, respectively. Zinc levels were significantly lower in the MIS-C group than in the nonhospitalized group (p < 0.05). Vitamin A levels were found to be significantly lower in the MIS-C group than in the nonhospitalized group (p < 0.01) and significantly lower in the hospitalized group when compared with the nonhospitalized group (p < 0.001). Deficiencies in vitamin A, vitamin D, and zinc levels were found to be most common in the MIS-C group (42.3%) and in hospitalized COVID-19 group (15.3%). In the nonhospitalized COVID-19 group, it was found to be the lowest at 6.6%.

Conclusion Based on the results of the present study and a literature review, it can be said that vitamin A, D, and zinc deficiencies may associate with the severity of COVID-19, although more studies are required to clarify this subject further.

Seroprevalence of Toxoplasma gondii in Different Patient Groups in Our Hospital

OBJECTIVE

Toxoplasma gondii (T. gondii) is an obligate intracellular parasite. It is regarded as an important cause of morbidity and mortality in congenital contamination and immunosuppressive patients. This study aimed to determine the seropositivity of T. gondii in various ages and patient groups, as well as to reveal the current immune status, especially in risk groups.

METHODS

Results of T. gondii serology conducted between 2015 and 2019 in the medical microbiology laboratory in a university hospital were retrospectively analyzed. In the study, anti-T. gondii IgM, anti-T. gondii IgG antibodies, and anti-T. gondii IgG avidity test results were investigated by the enzyme-linked fluorescent assay method. Additionally, seropositivity rates among immunosuppressed patients and pregnant women, which are risk groups for toxoplasmosis, were revealed. In the identification of the immunosuppressed patients, groups with significant immunosuppression were retrospectively determined by examining their files.

RESULTS

The serology of T. gondii was investigated in serum samples of a total of 20.875 individuals, among which 6.220 (29.8%) are males and 14.655 (70.2%) are females. Anti-T. gondii IgM and IgG positivity rates were significantly higher in women than in men. When all years are evaluated, IgM positivity in 16.448 patients and IgG positivity in 4.427 patients were investigated. In the 5-year period, T. gondii IgM seropositivity and T. gondii IgG seropositivity was among all the patients was 2.4% and 24.1%, respectively. While the rate of T. gondii IgG seropositivity in women of childbearing age was 36.1%, it was 42.4% in pregnant women and 14.6% in immunosuppressed patients.

CONCLUSION

T. gondii serology follow-up of pregnant women and immunosuppressed patients in terms of reactivity of latent infection should be advised and toxoplasmosis should be considered in suspicious clinical cases.

Investigation of Children with Acute Gastroenteritis by Multiplex PCR Method in Central Part of Turkey

Objective Gastroenteritis is a disease that affects all age groups, especially children, and causes high mortality and morbidity in all countries. The most common agents of acute gastroenteritis are viral agents. As a result, millions of diarrhea attacks and hospital admissions occur worldwide every year due to viral gastroenteritis. This study uses the multiplex polymerase chain reaction (PCR) method to investigate the viruses that are the causative agents of viral gastroenteritis in the pediatric patient group in Konya, Turkey.

Methods Stool samples of 94 patients aged 0 to 18 years sent from Emergency clinics and Pediatric outpatient clinics, Meram Medical Faculty Hospital Pediatric clinics, Konya Necmettin Erbakan University to Medical Microbiology Laboratory with a diagnosis of gastroenteritis between February and December 2018 were included in the study. Stool samples were stored at –80°C until the time of the analysis. Deoxyribonucleic acid/ribonucleic acid isolation from stool samples was performed with EZ1 Virus Mini Kit v2.0 (Qiagen, Hilden, Germany) using an automatic extraction system (BioRobot EZ1 system, Qiagen). The presence of astrovirus, rotavirus, adenovirus, norovirus (GI, GII), and sapovirus agents was investigated by the multiplex PCR method (Fast Track Diagnostics, Luxembourg) viral gastroenteritis kit.

Results Viral gastroenteritis agents were detected in 56.3% of the patients. One viral agent was detected in 47 (50%) of these patients and at least two viral agents in 6 (6.3%) of them. Norovirus GII was detected in 20 (21.2%) of the children included in the study, adenovirus in 13 (13.8%), rotavirus in 11 (12.8%), astrovirus in 11 (11.7%), sapovirus in 4 (4.2%), and norovirus GI in 1 (1.06%). When the distribution of viral agents was examined by months, the most number of agents were observed (21; 35%) in May, followed by April and June (12; 20%). Considering the distribution of the prevalence of the agents by age, it was seen to be mainly between 0 and 12 months (42%).

Conclusion Considering that the most common viral agent in our region is norovirus GII, it will be useful to investigate the norovirus that is not routinely examined in children who are admitted to clinics with the complaint of gastroenteritis. It will be appropriate to examine routinely adenovirus, rotavirus, and norovirus in the laboratory, especially in children with diarrhea and vomiting in the winter and spring months.

SARS-CoV-2 Genome Analysis of Pediatric Patients in Konya Region, Turkey

Objective Genome sequencing is useful for following the change in mutation and variants in viral agent during pandemics. In this study, we performed next-generation sequencing of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) complete genomes on pediatric patients.

Methods Six pediatric patients aged 0 to 18 years who were positive for SARS-CoV-2 by reverse transcription polymerase chain reaction were included in this study. SARS-CoV-2 genome sequencing was performed using Oxford Nanopore Technologies MinION, following the ARTIC Network protocols. Sequencing data were obtained using the FASTQ program and quality assessment was evaluated. The sequence information of all samples was uploaded to the Global Initiative on Sharing All Influenza Data (GISAID) database. Genome, variant, clade, and phylogenetic tree analyses were performed with bioinformatic analysis.

Results Two of these six samples were at 20A, two were at 20B, and two were at 19A in the nextstrain clade. According to Pango lineages, B.1.36, B.1.218, B.1, and B.1.260 lineages were detected. A total of 84 mutations were observed in all samples. None of the variants were classified as variants of concern (VOC) nor variants of interest (VOI) according to the Pango database.

Conclusion This study is the first comprehensively sequence analysis registered in the GISAID database reported from the Konya region in Turkey. Similar studies will be informative to track changes in the virus genome, obtain epidemiological data, guide studies on diagnosis and treatment, and evaluate vaccine efficacy.

Profiles of multidrug-resistant organisms among patients with bacteremia in intensive care units: an international ID-IRI survey

Evaluating trends in antibiotic resistance is a requisite. The study aimed to analyze the profile of multidrug-resistant organisms (MDROs) among hospitalized patients with bacteremia in intensive care units (ICUs) in a large geographical area. This is a 1-month cross-sectional survey for blood-borne pathogens in 57 ICUs from 24 countries with different income levels: lower-middle-income (LMI), upper-middle-income (UMI), and high-income (HI) countries. Multidrug-resistant (MDR), extensively drug-resistant (XDR), or pan-drug-resistant isolates were searched. Logistic regression analysis determined resistance predictors among MDROs. Community-acquired infections were comparable to hospital-acquired infections particularly in LMI (94/202; 46.5% vs 108/202; 53.5%). Although MDR (65.1%; 502/771) and XDR (4.9%; 38/771) were common, no pan-drug-resistant isolate was recovered. In total, 32.1% of MDR were Klebsiella pneumoniae, and 55.3% of XDR were Acinetobacter baumannii. The highest MDR and XDR rates were in UMI and LMI, respectively, with no XDR revealed from HI. Predictors of MDR acquisition were male gender (OR, 12.11; 95% CI, 3.025-15.585) and the hospital-acquired origin of bacteremia (OR, 2.643; 95%CI, 1.462-3.894), and XDR acquisition was due to bacteremia in UMI (OR, 3.344; 95%CI, 1.189-5.626) and admission to medical-surgical ICUs (OR, 1.481; 95% CI, 1.076-2.037). We confirm the urgent need to expand stewardship activities to community settings especially in LMI, with more paid attention to the drugs with a higher potential for resistance. Empowering microbiology laboratories and reports to direct prescribing decisions should be prioritized. Supporting stewardship in ICUs, the mixed medical-surgical ones in particular, is warranted.

Experiences of cultural clashes at home and ethnic victimization in school: "I live between two cultures, and neither of them understands me"

The present study aims to examine the extent to which adolescents of immigrant background experience acculturative stress (i.e., cultural clashes with parents and ethnic victimization in school) in multiple contexts, and the reasons why such stress takes a toll on their psychological functioning and views of themselves. The analytic sample includes adolescents of immigrant background residing in Sweden (N = 423, M_age = 13.19, SD = 0.51). Cluster analysis revealed five distinct groups of adolescents, based on their reports of cultural clashes with parents and ethnic victimization in school: (1) low on both acculturative stressors, (2) average on both acculturative stressors, (3) high on cultural clashes only, (4) high on ethnic victimization only, and (5) high on both acculturative stressors. Mediation analysis showed that adolescents who experienced cultural clashes at home and who were also victimized by their peers in school reported higher levels of feeling in between cultures than adolescents in all the other clusters (except those high on cultural clashes only), and in turn reported higher levels of depressive symptoms and lower levels of self-esteem. The present study highlights the importance of understanding immigrant youth's experiences across multiple contexts simultaneously in order to develop a holistic perspective on their adjustment and integration processes.

Volumetric measurements of the subcortical structures of healthy adult brains in the Turkish population

BACKGROUND

The interest in the morphological development of brain structures during childhood and adolescence arises from discussions on subcortical anomalies and sexual dimorphism, from adolescent changes in cognitive functions supported by cortical and subcortical structures to a wide range of childhood neuropsychiatric diseases. This study aims to investigate the relationships subcortical structures regarding age/gender changes in the healthy adult human brain using web-based VolBrain.

MATERIALS AND METHODS

In this study, 303 normal healthy adults [male and female] were obtained using a 1.5 T unit with a 20-channel head coil.

RESULTS

The volumes of White Matter, Gray Matter, Total Brain, Cerebrospinal Fluid, and Total Intracranial Volume were significantly higher in males than those in females. Our analysis revealed a significantly larger accumbens volume for females. With age less than or equal to 50 years, older males were found to have higher total LV, putamen, thalamus, amygdala, cerebrum, White Matter and Gray Matter volumes than females. The age greater than the 50-years-old group resulted in a mean of total thalamus, Globus Pallidus and accumbens volumes higher in females than those in males. Right hemisphere volumes in younger and older age groups resulted in volumes except caudate in the older age group; the mean of caudate was significantly higher in females than those in males.

CONCLUSIONS

These conclusions might have important for the explanation of the effects of gender and age in cross-sectional structural MRI studies. Also, knowing the volume changes of the subcortical structures can provide convenience about the prevention, diagnosis, and treatment of various neuromental disorders.

Uncommon Presentation of COVID-19 in Pediatric Patients: Anosmia

Objective The novel coronavirus disease 2019 (COVID-19) infection was declared as a pandemic by the World Health Organization on March 11, 2020. Although the complaint of anosmia is well described in adult patients, there is limited knowledge in pediatric patients. We aim to evaluate the epidemiological characteristics and clinical findings of children with anosmia in COVID-19-positive pediatric patients.

Methods Patients diagnosed with COVID-19 infection at 1 month to 18 years of age, who admitted to Meram Faculty of Medicine of Necmettin Erbakan University between March and June 2020, were retrospectively reviewed, and the patients who had anosmia or developed anosmia during follow-up were then included in the study. The diagnosis was established by polymerase chain reaction (PCR).

Results A total of 71 patients were diagnosed with COVID-19 and 14 (19.7%) of them had anosmia. Mean patient age was 14.07 (range: 10–16) years. Six of our 14 (42.8%) patients had anosmia at the time of diagnosis and anosmia developed in the follow-up among eight patients. The mean duration of anosmia in our patients was 6.9 ± 3.8 days. Recovery time was 1 to 4 days in four patients (28.5%), 5 to 8 days in four patients (28.5%), and 9 to 14 days in six patients (42.8%).

Conclusion In this article, it was emphasized that anosmia can be the sole manifestation or concomitant with other symptoms in children with COVID-19 disease. Care and attention is important to identify COVID-19 patients at an early stage of the disease and limit the spread of the virus.

Clinical and demographic features of hidradenitis suppurativa: a multicentre study of 1221 patients with an analysis of risk factors associated with disease severity

BACKGROUND

Hidradenitis suppurativa (HS) is a chronic, relapsing and debilitating inflammatory disease associated with profound morbidity.

AIM

In this multicentre study, we investigated the demographic and clinical features of HS, and determined risk factors of disease severity.

METHODS

In total, 1221 patients diagnosed with HS from 29 centres were enrolled, and the medical records of each patient were reviewed.

RESULTS

The mean age of disease onset was 26.2 ± 10.4 years, and almost 70% (n = 849) of patients were current or former smokers. Mean disease duration was 8.9 ± 8.4 years with a delay in diagnosis of 5.8 ± 3.91 years. Just over a fifth (21%; n = 256) of patients had a family history of HS. The axillary, genital and neck regions were more frequently affected in men than in women, and the inframammary region was more frequently affected in women than in men (P < 0.05 for all). Acne (40.8%), pilonidal sinus (23.6%) and diabetes mellitus (12.6%) were the most prevalent associated diseases. Of the various therapies used, antibiotics (76.4%) were most common followed by retinoids (41.7%), surgical interventions (32.0%) and biologic agents (15.4%). Logistic regression analysis revealed that the most important determinants of disease severity were male sex (OR = 2.21) and involvement of the genitals (OR = 3.39) and inguinal region (OR = 2.25). More severe disease was associated with comorbidity, longer disease duration, longer diagnosis delay and a higher number of smoking pack-years.

CONCLUSIONS

Our nationwide cohort study found demographic and clinical variation in HS, which may help broaden the understanding of HS and factors associated with disease severity.

The effects of lockdown measures due to COVID-19 pandemic on burn cases

In this study, it was aimed to investigate the effects of lockdown measures implemented due to COVID‐19 on aetiology, sociodemographic characteristics, and clinical status of burn cases. This study was carried out retrospectively at the Burn Unit of Dicle University Medical Faculty Hospital. The burn cases during the COVID‐19 outbreak were compared with those of the previous 2 years. Statistical analyses were carried out using the IBM SPSS (Statistics Package for Social Sciences) Statistics 25. Descriptive statistics, independent samples t‐test, Kolmogorov‐Smirnov test, and Shapiro‐Wilk test were used for data evaluation. Results were evaluated at 95% confidence interval and P < .05 significance level. It was determined that burn cases were reduced by half during the COVID‐19 compared to the previous 2 years. Despite the increase in the number of third‐degree burns and surgeries, it was determined that the length of hospital stay decreased by an average of two thirds. Hot liquids have been identified as the most important cause of burns in all years. New studies should be conducted in order to examine the social dimension of COVID‐19 pandemic in burn cases and to prevent these cases completely. The short hospital stay preferred by clinicians after COVID‐19 and possible problems that may arise should be investigated.

Containment measures established during the COVID-19 outbreak and its impact on lipid profile and neutrophil to lymphocyte ratio

OBJECTIVE

Almost all countries announced social restrictions and distancing measures which could unintentionally lead to a decline in admissions to hospital for acute disorders other than signs of pneumonia. We aimed to evaluate lipid profile, neutrophil to lymphocyte ratio (NLR) and cardiovascular admissions to the coronary care unit (CCU) of a tertiary center in Turkey during the COVID-19 era and to compare these results with admissions in the same time interval of the previous year.

MATERIALS AND METHODS

We retrospectively analyzed CCU admissions due to new-onset atrial fibrillation, ST-elevation myocardial infarction, non-ST elevation acute coronary syndrome (NSTEACS) and acute heart failure during the COVID-19 outbreak and the same time interval of the past year. Laboratory measurements including lipid profile and NLR values were retrieved from the institutional digital database.

RESULTS

Compared to the same time interval of 2019 (March-April, 2019), the number of patients admitted to the CCU with acute cardiovascular disorders (atrial fibrillation, STEMI, NSTEACS and acute heart failure) were lower in the COVID-19 period. The levels of NLR, total cholesterol, and low-density lipoprotein (LDL) cholesterol were significantly higher and high-density lipoprotein (HDL) cholesterol was significantly lower in subjects admitted to the CCU during March-April 2020 compared to subjects admitted in March-April 2019.

CONCLUSIONS

Our findings show that subjects admitted to the CCU in the COVID-19 era have an unfavorable lipid profile and elevated NLR compared to those admitted in 2019. These patients appear to be at high risk for future cardiovascular events.

Comparative Evaluation of In-House and Commercial Real-Time PCR Methods for the Detection of the BK and JC Viruses in Clinical Samples

Aim  The two most common human polyomaviruses are the BK (BKV) and JC viruses (JCV). Diseases associated with polyomavirus usually occur in cases of severe cellular immunosuppression. BKV and JCV can cause many diseases, especially if they are reactivated in an immunosuppressed host. The aim of this study is to compare and evaluate the results of real-time polymerase chain reaction (PCR) methods targeting the small and large T gene regions of the viral genome, considering polymorphisms occurring in the viral genome of BKV and JCV.

Materials and Methods  Urinary specimens of 82 patients were taken from immunosuppressed patient and sent to molecular microbiology laboratory of Meram Medical Faculty. The small t gene was investigated using a commercial kit (LightMix, Roche) by real-time PCR method. Large T gene was investigated by using the optimized in-house real-time PCR method. Sequence analysis was accepted as the standard method.

Results  BKV positivity was detected in 9 samples and JCV positivity in 61 samples by real-time PCR method specific to small t gene region; BKV positivity in 21 samples and JCV positivity in 67 samples were determined by real-time PCR method specific to the large T gene region. Statistically, there was a significant difference for BKV, but not significant difference for JCV detection between the two methods.

Conclusion  Different polymorphisms in the target gene regions were responsible for the different outcomes obtained from this study. With this sensitivity and specificity, in-house PCR method which we used is a candidate for routine diagnosis.

Occurrence of and Factors Associated With the Presence of Aflatoxin M1 in Breast Milk of Mothers in Fethiye, Turkey

Aflatoxins comprise a group of mycotoxins that are found in the environment. Exposure to aflatoxins has been reported to cause serious health problems in humans. Since aflatoxin M₁ (AFM₁) is secreted in breast milk, the exposure of infants to this toxin is an important concern. The aim of this study was to determine the prevalence, levels of, and factors associated with the presence of AFM₁ in breast milk of mothers in Fethiye, Turkey. Breast milk samples were taken from 100 mothers who had given birth over the period of October-November 2017. The AFM₁ content of the samples was determined via enzyme-linked immunosorbent assay. The lowest limit for milk samples in the Ridascreen® AFM₁ commercial test kit is 5 ng/L. Because of this, AFM₁ levels below 5 ng/L in the breast milk samples were assessed as negative. Of the breast milk samples tested, 53 were positive. The average AFM₁ amount in the positive samples was 6.36 ng/L (ppt; range 5.10-8.31 ng/L). Mothers who were housewives, lived in damp, humid houses, or ate spices or dried fruits and vegetables had significantly greater prevalence of AFM₁ in their breast milk than those who were employed, did not report dampness or mold in the home, or did not eat spices or dried fruits and vegetables. AFM₁ in breast milk could be an important risk factor for infant health. Informing the public about food safety could reduce the amount of AFM₁ being transferred into breast milk via food channels.

Prevalence of sicca symptoms and Sjögren's syndrome in coeliac patients and healthy controls

Objective: There has been no previous study comparing the frequency of sicca symptoms and Sjögren's syndrome (SS) in coeliac patients (CPs) and healthy controls (HCs) using a tight screening method. The aim of this study was to compare the frequency of sicca symptoms and SS in HCs and CPs.Method: The study included 80 CPs and 100 HCs. This study was designed as a case-control study with four phases. The frequency of SS in CPs and HCs was defined according to the 2002 American-European Consensus Group (AECG) and 2012 American College of Rheumatology (ACR) classification criteria. The frequency of sicca symptoms and SS was compared between CPs and HCs.Results: Ocular and oral symptoms occurred in 22% and 26% of CPs, respectively, compared to 13% and 10% of HCs, respectively. Proportions with oral symptoms were statistically significantly different between CPs and HCs (p = 0.005), whereas there was no significant difference for ocular symptoms (p = 0.113). According to ACR and AECG criteria, the prevalence of SS was 3.8% and 5.0% in CPs and 3.0% and 2.0% in HCs, respectively.Conclusion: Although oral symptoms were more frequent in CPs than in HCs, the frequency of SS was not different between the groups. The increased frequency of oral symptoms may be related to reasons other than autoimmunity.

Investigation of Respiratory Tract Pathogen Human Parechoviruses in Konya, Turkey

Objective This study aims to better understand the epidemiological characteristics of parechoviruses and to determine the genotype distribution in Konya, Turkey.

Methods In this study, nasal and throat swab samples taken from 1,110 children who were diagnosed with respiratory tract infection (bronchitis, pneumonia, asthmatic bronchitis, and other respiratory diseases) and applied to various pediatric polyclinics of Meram Medical Faculty Hospital, Necmettin Erbakan University between September 2017 and March 2019 were evaluated. Human parechovirus (HPeV) RNA was investigated by multiplex polymerase chain reaction (PCR) in respiratory tract samples. Specific genotypes of the positive samples were identified by real-time PCR amplification of the VP1 region followed by sequence analysis.

Results Of the total of 1,110 samples, 4 were positive for HPeV. Of these, HPeV1 was the most predominant genotype (n = 3), followed by HPeV4 (n = 1). HPeV infections were detected throughout the year in Konya, Turkey.

Conclusion Although the number of positive samples for HPeV is low, these findings provide information about the genetic diversity and epidemiological of HPeV genotypes circulating in pediatric patients in Turkey. This is the first study to detect prevalence and genotyping of HPeV in respiratory tract infections in Turkey. HPeVs should be considered as causative agents especially in infants with sepsis, meningitis, or encephalitis, and routine testing panels for HPeV detection should be available in hospital laboratories. Further studies using molecular epidemiological methods will be beneficial for identifying genotypes of all HPeVs involved in the etiology and for better monitoring of these infections.

Risk Factors and Clinical Determinants in Bronchiolitis of Infancy

OBJECTIVES

The aims of this study was to demonstrate the viral pathogens, to evaluate the clinical prognosis, risk factors for recurrence, severity of acute viral bronchiolitis episodes among pediatric patients.

MATERIALS AND METHODS

Our study included 101 children aged between 2 months and 2 years diagnosed with clinical bronchiolitis between September 2011 and April 2012. The demographics and clinical, laboratory, and radiological results of the patients were recorded. Nasopharyngeal swab samples were collected and analyzed through polymerase chain reaction (PCR) method. The patients were followed up for at least one year for new episodes, existence of wheezing, frequency of pulmonary infections, and progression of asthma.

RESULTS

In half of the patients, determinants were indicated through the PCR method, with the most frequent being respiratory syncytial virus (44%). The frequency of bronchiolitis was higher in prematures (p<0.005). There was a relationship between crowded family structure and the existence of wheezing (p=0.003), increased recurrence (p=0.014), and need for inhaler treatment (p=0.014). The frequency was higher in patients living in urban cities (p<0.001), in houses with heating stoves (p=0.001), and in houses with smokers (p=0.001). Patients living in houses with heating stoves had more severe episodes (p=0.018). Recurrent wheezing and the need for regular inhaler usage were positively correlated with high API scores (p=0.008 and p=0.002, respectively).

CONCLUSION

Prematurity, exposure to smoking, living in a crowded house with heating stoves, and an urban life are the risk factors for frequent bronchiolitis. The API can be used to predict the recurrence of bronchiolitis.

Hepatitis C testing among adults born between 1945 and 1965 in Turkey: a multicentre study

OBJECTIVE

Hepatitis C virus (HCV) infection is a major public health problem and affects large populations all over the world. Serum anti-HCV level is a valuable marker to determine HCV infection. Anti-HCV testing has been recommended for high-risk population. The Center for Disease Control (CDC) and Prevention in the United States proposed a new high-risk population group - adults born between 1945-1965. Under this perspective, we designed a multicentre retrospective study to determine the seropositivity of anti-HCV among adults born between 1945 and 1965 and adults born after 1965 in Turkey. With the data collected, we aimed to determine whether there was a need for anti-HCV testing especially in people born between 1945 and 1965.

METHODS

We requested data from ten different medical centres in ten different provinces. Each medical centre collected the anti-HCV test results of adult patients for five-year period between 2009 and 2014 from hospital records.

RESULTS

A total of 974,449 anti-HCV test results were included in this study. When the seropositivity rates in the two groups of adults were compared, anti-HCV seropositivity rates were higher in nine medical centres out of ten. Anti-HCV seropositivity in adults born between 1945-1965 was significantly higher than in adults born after 1965 (p < 0.05).

CONCLUSIONS

We determined that the anti-HCV seropositivity rate is significantly higher in adults born between 1945-1965 compared to the younger adults as indicated in the literature. According to data from this study together with the WHO and CDC suggestions, we believe that it is appropriate to offer anti-HCV serology testing for people over 50 years of age since the anti- HCV seroprevalence in this age group is relatively high.

Laboratory Diagnosis of Pediatric Herpesvirus Infections of the Central Nervous System by a Multiplex Polymerase Chain Reaction Assay and Intrathecal Antibodies

Introduction Central nervous system (CNS) viral infections are a serious problem requiring accurate diagnosis and treatment. Human herpesviruses (HHVs) are an important cause of these infections. Recent research has focused on new diagnostic methods allowing accurate and rapid identification of viral infections because there are still diagnostic difficulties for these infections. This study was done to determine the etiologic role of human herpes viruses and to obtain information that will contribute to the diagnostic algorithm in suspected cases of viral encephalitis or aseptic meningitis.

Materials and Methods In our study, herpes simplex virus (HSV)-1, HSV-2, varicella zoster virus (VZV), cytomegalovirus (CMV), Epstein–Barr virus (EBV), and HHV-6 DNA was detected in the cerebrospinal fluid (CSF) by multiplex polymerase chain reaction (PCR) and virus-specific immunoglobulin G (IgG) antibodies in CSF and serum by EIA in pediatric encephalitis/meningitis cases.

Results HSV-1 and VZV were detected in 5 and 3.3% of aseptic meningitis cases, respectively, but no encephalitis cases. Other viruses were not identified as etiologic agents. The seroprevalences were determined as 72.4, 34.3, 81.9, 93.3, 88.6, and 80.9%, respectively for HSV-1, HSV-2, VZV, CMV, EBV, and HHV-6. The performance of specific IgG CSF/serum antibody index (AI) was not satisfactory.

Conclusion Our study indicates that the multiplex PCR method is the most suitable for the diagnosis of CNS infections caused by HHVs. However, due to the high cost of the PCR method, the positive results of the specific AI may be significant, but the negative results are unreliable, especially in limited health care facilities.

Investigation of Parvovirus B19 IgM and IgG Positivity Rates in Pediatric Hematology Patients

Human parvovirus B19 is a frequent etiologic agent causing erythema infectiosum in children. It has recently been suggested that parvovirus B19 may be latent after infection and cause reactive infections especially in immunosuppressed patients with hematological problems. In this study, we aimed to investigate the parvovirus B19 immunoglobulin M (IgM) and immunoglobulin G (IgG) seropositivity rates of patients evaluated in a pediatric hematology clinic. We retrospectively screened the laboratory results of parvovirus B19 IgM and IgG antibody assays of children less than 18 years, who consulted pediatric in-and-outpatient clinics between 2013 and 2016. Parvovirus B19 IgM and IgG antibodies were investigated in serum samples by using enzyme-linked immunosorbent assay method in the Medical Microbiology Laboratory. Parvovirus B19 IgM antibodies were detected in 109 of 602 patients attending pediatric hematology clinics (18.1%). Parvovirus B19 IgG antibody was detected in 244 of 952 patients attending pediatric hematology clinics (25.6%). Parvovirus B19 IgM and IgG positivity in samples from pediatric in-and-outpatient clinics other than pediatric hematology were 2.8% and 35.7%, respectively. Parvovirus IgM and IgG positivity in serum samples sent from the pediatric hematology clinic and outpatients was statistically significant compared with those sent from pediatric clinics other than pediatric hematology (p = 0.0001 and p = 0.0008, respectively). The higher detection rate of serum parvovirus B19 IgM positivity in patients under the follow-up of pediatric hematology clinics suggests that immune suppression-related viral reinfection or persistence may occur in these patients.

Might miRNAs Be Related to Mother-to-Child Transmission of HIV-1? A Short Review on Putative Viral miRNAs Encoded by HIV-1

MicroRNAs (miRNAs) are single-stranded small noncoding RNA molecules that are 22 to 25 nucleotides in length. They are implicated in the regulation of the immune response by modulating differentiation and proliferation of immune cells, production of cytokine types, and activation of the intracellular signaling pathways through posttranscriptional mechanisms. Although their actual functions are not yet fully understood, viral miRNAs are thought to help viruses to replicate and evade host immune response important in infectiousness. The determinants affecting the infectiousness of human immunodeficiency virus-1 (HIV-1) and progression to the disease state vary according to several host and viral factors. Interestingly, mother-to-child transmission rates are as low as 5 to 15%, even when the mother is not receiving antiretroviral therapy. Higher HIV-1 viral loads, and recent maternal infection, are associated with higher transmission rates. Also, cellular tropism is a well-known phenomenon in HIV-1 pathogenesis. Further, cellular and viral miRNAs seem to be involved in the pathogenesis and infectiousness of HIV-1. The aim of this review is to outline the history of the discovery of HIV-1-viral miRNAs and the evidence for their role in pathogenesis.

Value of multiplex PCR to determine the bacterial and viral aetiology of pneumonia in school-age children

BACKGROUND

Conventional methods for the aetiological diagnosis of community-acquired pneumonia (CAP) are often insufficient owing to low sensitivity and the long wait for the results of culture and particularly serology, and it often these methods establish a diagnosis in only half of cases.

AIM

To evaluate the most common bacterial and viral agents in CAP using a fast responsive PCR method and investigate the relationship between clinical/laboratory features and aetiology, thereby contributing to empirical antibiotic selection and reduction of treatment failure.

METHODS

In children aged 4-15 years consecutively admitted with a diagnosis of CAP, the 10 most commonly detected bacterial and 12 most commonly detected viral agents were investigated by induced sputum using bacterial culture and multiplex PCR methods. Clinical and laboratory features were compared between bacterial and viral pneumonia.

RESULTS

In 78 patients, at least one virus was detected in 38 (48.7%) and at least one bacterium in 32 (41%). In addition, both bacteria and viruses were detected in 16 (20.5%) patients. Overall, the agent detection rate was 69.2%. The most common viruses were respiratory syncytial virus and influenza and the most frequently detected bacteria were S. pneumoniae and H. influenzae. PCR was superior to culture for bacterial isolation (41% vs 13%, respectively). Fever, wheezing and radiological features were not helpful in differentiating between bacterial and viral CAP. White blood cell count, CRP and ESR values were significantly higher in the bacterial/mixed aetiology group than in the viral aetiology group.

CONCLUSION

In CAP, multiplex PCR is highly reliable, superior in detecting multiple pathogens and rapidly identifies aetiological agents. Clinical features are poor for differentiation between bacterial and viral infections. The use of PCR methods allow physicians to provide more appropriate antimicrobial therapy, resulting in a better response to treatment, and it may be possible for use as a routine service if costs can be reduced.

Prevalence of H. pylori in gastric biopsy specimen in the southeastern region of Turkey

Introduction: Helicobacter pylori is a Gram-negative, microaerophilic bacterium that colonizes human gastric mucosa. Gastric ulcer, duodenal ulcer, chronic atrophic gastritis, mucosa-associated lymphoid tissue lymphoma, and stomach adenocarcinoma are associated with H. pylori as the etiological agent. Cytotoxin-associated gene A (cagA), which is one of the most important virulence factors of H. pylori, encodes a 120–145 kDa protein. The prevalence of cagA genes shows differences in H. pylori infections based on geographical area, and cagA-positive H. pylori strains play an important role in pathogenesis of gastric carcinoma. Methodology: The aim of this study was to detect the prevalence of cagA and vacA genes in H. pylori isolates in adult patient groups in the southeastern region of Turkey. The presence of H. pylori was investigated in gastric biopsy specimens using the culture method, and polymerase chain reaction (PCR) analysis was performed to detect the presence of the cagA and vacA s1 genes. Results: H. pylori was detected in 65% (84/129) of patients who had gastrointestinal complaints. The number of vacA s1 and cagA genes of isolates were 44 (74.5%) and 31 (52.5%), respectively. Conclusions: H. pylori infection in southeastern region of Turkey with are comparable to those in developed countries. Patients with cagA- and vacA-positive H. pylori have a higher risk of severe inflammation and atrophy and should therefore be monitored for the development of gastric cancer.

Opportunities to enhance contribution of model forests in the sustainable forest resources management (example from Yalova Model Forest)

Model forests are nongovernmental organizations at local, regional and international level which are mainly focused on reconciling the conflicts between the stakeholders. This is an innovative approach to organization, which has been receiving more and more attraction from increasing number of countries, which gradually increased the number of model forests for the last 25 years. If these organizations reach desired levels of structure, medium, impacts and assets their contribution in sustainable forest resources management will increase ipso facto. The very first model forest of Turkey was created in Yalova Province in 2010. Yalova Province has certain fundamental problems including but not limited to; population growth and unplanned urbanization caused by industrialization, uncontrolled increase in demand for fire wood and non-wooden products of forestry resources, questionable resource management decisions adopted in the past and low-income levels of the people especially those in the rural areas. The main objective of present case study is to analyze Yalova Model Forest (YMF) so as to determine the possible problems that may occur during implementation of sustainable management for forestry resources through a planning approach with multiple stakeholders. As a result of research, it has been revealed that YMF has certain significant structural, environmental and impact-related problems. In order to ensure continuity of YMF's contribution to sustainable forestry resources management, these problems need to be addressed promptly.

Look-back study on recipients of Parvovirus B19 (B19V) DNA-positive blood components

BACKGROUND AND OBJECTIVES

To assess the relevance of Parvovirus B19 (B19V) DNA at low to intermediate concentrations in blood donors for the recipients of their blood components.

MATERIAL AND METHODS

We studied recipients of B19V DNA-positive blood components [red blood cell concentrates (RBCs), pooled platelet concentrates and fresh frozen plasma]. This included archived pretransfusion samples as well as follow-up samples investigated by ELISA or NAT and genome sequence analysis.

RESULTS

In 132 out of 424 recipients, we could detect no anti-B19V IgG before transfusion. In 67 out of 132 sero-negative recipients, a follow-up sample was available. Sixty-five of these received blood components from donors with <10(4) IU B19V DNA/ml plasma and had no evidence of transfusion-transmitted (TT)-B19V infection. Homology in genome sequences in donor and recipient provided evidence for a TT-B19V infection in two recipients. Both patients received RBC containing 3.4 × 10(6) and 1.8 × 10(4) IU B19V DNA/ml plasma, respectively. The anti-B19V IgG titres in the donors were 2 and 76 IU/ml plasma, respectively. The antibodies in the second donor were directed against capsid proteins and are thus considered as potential neutralizing antibodies.

CONCLUSIONS

TT-B19V infections through blood components with low (<10(4) IU/ml plasma) B19V DNA concentrations did not occur in our study. One of the TT-B19V infections occurred from RBC with intermediate B19V DNA concentration despite the presence of potential neutralizing antibodies in the donor, but its clinical significance was low.

Detection of the frequency of PER-1 type extended-spectrum β-lactamase-producing Acinetobacter baumannii clinical isolates in Turkey: a multicenter study

BACKGROUND/AIM

β-Lactamases are an important resistance mechanism in Acinetobacter baumannii. Pseudomonas extended-resistance (PER-1) type β-lactamase-producing strains have been reported from various geographic locations; however, PER-1 type β-lactamases from Turkish hospitals have not been investigated extensively. The aim of this study was to determine the prevalence of PER-1 type β-lactamases in A. baumannii isolates in various regions of Turkey.

MATERIALS AND METHODS

A total of 763 clinical A. baumannii isolates were collected from 9 university hospitals and 2 state hospitals between 2008 and 2011. Molecular amplification of the OXA-51 gene from the A. baumannii genome was performed in order to verify identification of the species. Real-time polymerase chain reaction was used to detect blaPER-1 genes.

RESULTS

PER-1 was detected in 24.6% of the isolates. The annual frequencies of the PER-1 enzyme were detected as 52.2%, 35.9%, and 8.3% in 2008, 2009, and 2010, respectively. PER-1 prevalence decreased gradually over time. The differences observed in PER-1 prevalence among the regions of Turkey were statistically significant (chi-square test; P < 0.001).

CONCLUSION

These data demonstrate that the frequency of detection of PER-1 type β-lactamases in A. baumannii species has decreased in Turkey. However, the increased carbapenem resistance, together with multidrug resistance, has created a worrisome situation regarding this pathogen.

Unusual case of frontal mucocele presenting with forehead ulcer

Paranasal mucoceles are benign slow-growing paranasal sinus lesions, which usually develop following the obstruction of the sinus ostiu. They most frequently occur in the frontal sinus. Frontal mucoceles are expansive lesions usually causing visual clinical signs and symptoms such as diminution of vision, visual field defects, diplopia, orbital swelling, retroorbital pain, displacement of eye globe, ptosis, and proptosis. When the frontal mucocele extends intracranially, it can manifest with meningitis, meningoencephalitis, intracranial abscess, seizures, or cerebrospinal fluid fistula. Very rarely it can cause forehead swelling. We report an 80-year-old woman presenting with a forehead skin ulcer and painless subcutaneous forehead induration. Histopathologic examination revealed mucin deposition and inflammation. Computerized tomography (CT) and magnetic resonance imaging (MRI) scans showed a mass originating from the frontal sinus with frontal bony defect and frontocutaneous fistula. Surgical excision of the mass confirmed the mucocele diagnosis. In this article, we present a case of frontocutaneous fistula and skin ulcer, which is an unexpected complication of frontal mucocele. We propose that in the case of a localized non-healing ulcerated forehead skin lesions, mucocele should be considered in the differential diagnosis.

The presence of Torque teno virus in chronic obstructive pulmonary disease

Torque Teno Virus (TTV) has been identified as transfusion-transmitted virus in humans, initially. Although TTV viremia is extremely common in the general population worldwide, there is no direct causal evidence linking TTV infection to specific clinical manifestations. Our hypothesis was that TTV might play a role in Chronic obstructive pulmonary disease (COPD) by inducing inflammatory mechanisms previously identified. The study was conducted on 57 COPD patients and 39 healthy control groups. COPD patient groups included: the patients (n:20) with exacerbation needed noninvasive ventilation, the patients (n:19) who received only medical treatment, and the invited patients (n:18) for outpatient control. Serum samples were collected from patients and voluntary blood donors. TTV DNA quantification was carried out with a real time PCR by the hybridization probe system and viral load was interpreted through the crossing point value. TTV DNA was detected in the majority of both patients and healthy control groups. The prevalence was 94.4% (17/18) in patients for outpatient control, 94.7% (18/19) in patients who received only medical treatment, 100% (20/20) in patients with exacerbation needed noninvasive ventilation and 84.6% (33/39) in healthy controls. This difference was not statistically significant. However, CP values was statistically different in all the patient groups from the control group. TTV DNA prevalence was higher in patients than healthy individuals. More interesting thing, viral load was highest in the patients with exacerbation needed noninvasive ventilation. As a result, TTV may be associated with COPD and the severity of it.