The impact of the BIOFIRE® Blood Culture Identification 2 Panel on antimicrobial treatment of children with suspected systemic inflammatory response syndrome and sepsis

This study aimed to assess the therapeutic effects of implementing the BioFire® Blood Culture Identification 2 (BCID2) Panel (bioMérieux, Marcy l'Etoile, France) in the clinical practice of children with sepsis. This retrospective cross-sectional study included children from 15 days of age to 18 years old with sepsis and of whom the BCID2 Panel was studied from the positive blood culture. If the antimicrobial treatment was changed according to the results of BCID2 Panel, it was recorded and re-grouped as targeted antimicrobial therapy, de-escalation of the antimicrobial treatment and shifting to another antimicrobial drug if any antimicrobial resistance was detected. Seven-days and thirty-days mortality rate was recorded. Thirty-two patients with 36 septic episodes with positive BCID2 Panel results were included. The median age was 10 months 15 days (ranging from 15 days to 16.5 years). The mean difference between having positive results by the BCID2 Panel and conventional culture methods was 82.2 ± 45.4 h (ranging from 12.3 to 207 h). Effect of the BCID2 Panel on the antimicrobial treatment was detected in 69.4% of the episodes (n = 25). Glycopeptides were ceased at 6 patients, piperacillin/tazobactam was ceased at 6 patients, and cefotaxime was ceased at one patient and de-escalation was achieved in 13 episodes which formed the 36.1% of the initial antimicrobial treatment.   Conclusion: The BCID2 Panel had an important impact on the patients care and optimization according to the principles of antimicrobial stewardship. The BCID2 Panel may be one of the key items for rapid and accurate diagnosis in children with sepsis. Blood culture is still the mainstay for especially detection of antimicrobial drug resistance, while BCID2 tests had several advantages such as speed and diagnostic accuracy as good as blood culture. What is Known: • The BioFire® Blood Culture Identification 2 (BCID2) Panel (bioMérieux, Marcy l'Etoile, France) is a well-validated assay that allows for the simultaneous identification of 43 nucleic acid targets associated with bloodstream infections within about 1 h. What is New: • BCID2 Panel had a direct impact on the patient's treatment decision at the 69.4% of the sepsis episodes. • The clinicians received the microbiological results 82.2 h earlier with BCID2 panel compared to blood culture methods with antimicrobial resistance and de-escalation of the antimicrobial drugs was achieved at 13 episodes which formed the 36.1% of the initial treatment.

Evaluation of 601 children with multisystem inflammatory syndrome (Turk MISC study)

PURPOSE

Due to its link with the 2019 coronavirus, the multisystem inflammatory syndrome in children (MISC) has garnered considerable international interest. The aim of this study, in which MISC patients were evaluated multicenter, and the data of the third period of the Turk-MISC study group, to compare the clinical and laboratory characteristics and outcomes of MISC patients who did and did not require admission to an intensive care unit (ICU).

METHODS

This retrospective multicenter observational study was carried out between June 11, 2021, and January 01, 2022. The demographics, complaints, laboratory results, system involvements, and outcomes of the patients were documented.

RESULTS

A total of 601 patients were enrolled; 157 patients (26.1%) required hospitalization in the intensive care unit (ICU). Median age was 8 years (interquartile range (IQR) 4.5-11.3 years. The proportion of Kawasaki disease-like features in the ICU group was significantly higher than in the non-ICU group (56.1% vs. 43.2% p = 0.006). The ICU group had considerably lower counts of both lymphocytes and platelets (lymphocyte count 900 vs. 1280 cells × μL, platelet count 153 vs. 212 cells × 103/ μL, all for p< 0.001). C-reactive protein, procalcitonin, and ferritin levels were significantly higher in the ICU group (CRP 164 vs. 129 mg/L, procalcitonin 9.2 vs. 2.2 μg/L, ferritin 644 vs. 334 μg/L, all for p< 0.001). Being between ages 5-12 and older than 12 increased the likelihood of hospitalization in the ICU by four [95% confidence intervals (CI)1.971-8.627] and six times (95% CI 2.575-14.654), respectively, compared to being between the ages 0-5. A one-unit increase in log D-dimer (µg/L) and log troponin (ng/L) was also demonstrated to increase the need for intensive care by 1.8 (95% CI 1.079-3.233) and 1.4 times (95% CI 1.133-1.789), respectively.     Conclusion: By comparing this study to our other studies, we found that the median age of MISC patients has been rising. Patients requiring an ICU stay had considerably higher levels of procalcitonin, CRP, and ferritin but significantly lower levels of lymphocyte and thrombocyte. In particular, high levels of procalcitonin in the serum might serve as a valuable laboratory marker for anticipating the need for intensive care.

WHAT IS KNOWN

• Lymphopenia and thrombocytopenia were an independent predictor factors in patients with MISC who needed to stay in intensive care unit. • The possibility of the need to stay in the intensive care unit in patients with MISC who had Kawasaki disease-like findings was controversial compared with those who did not.

WHAT IS NEW

• A one-unit increase log D dimer and log troponin was demonstrated to require for intensive care unit by 1.8 and 1.4 times, respectively. • Serum procalcitonin levels had the best performance to predict stay in the intensive care unit stay.

Perianal abscess in children: an evaluation of microbiological etiology and the effectiveness of antibiotics

PURPOSE

We aimed to evaluate the demographic characteristics of children with perianal abscess, distribution of microbiological etiology, antibiotic susceptibility, and identify the effectiveness and coverage of antibiotics due to culture results.

METHODS

A retrospective study was designed to evaluate pediatric patients with perianal abscesses between January 2013 and December 2022.

RESULTS

A total of 197 episodes in 135 patients were evaluated. The median age of the patients was 10 months (22 days-17 years). The isolated microorganisms were Gram-positive bacteria in 56 (28.4%) patients and Gram-negative bacteria in 141 (71.6%) patients. The most common isolated species was Escherichia coli (n = 70, 35.5%), followed by Klebsiella spp. (n = 48, 24.4%), Staphylococcus aureus (n = 37, 18.9%), and Enterobacter spp. (n = 9, 4.5%). Forthy-two percent (n = 58) of isolates were positive for extended-spectrum beta-lactamase, 8% (n = 11) were carbapenem-resistant in Gram-negative bacteria, and 37.5% (n = 21) were methicillin-resistant, 7.1% (n = 4) were vancomycin-resistant in Gram-positive bacteria. According to bacterial culture results, ertapenem plus glycopeptide had the highest antimicrobial coverage rate (92.3%), followed by ertapenem plus clindamycin (89.8%), ertapenem (81.7%), third-generation cephalosporin plus glycopeptide (82.2%), third-generation cephalosporin plus clindamycin (69.5%).

CONCLUSION

Ertapenem can be a good choice in the empirical treatment of perianal abscesses in children due to its high coverage rate.

Multisystem inflammatory syndrome in children associated with COVID-19 in 101 cases from Turkey (Turk-MISC study)

AIM

Multisystem inflammatory syndrome in children (MIS-C) may cause shock and even death in children. The aim of this study is to describe the clinical features, laboratory characteristics and outcome of children diagnosed with MIS-C in 25 different hospitals in Turkey.

METHODS

The retrospective study was conducted between 8 April and 28 October 2020 in 25 different hospitals from 17 cities. Data were collected from patients' medical records using a standardised form. Clinical and laboratory characteristics and outcomes according to different age groups, gender and body mass index percentiles were compared using multivariate logistic regression analysis.

RESULTS

The study comprised 101 patients, median age 7 years (interquartile range (IQR) 4.6-9.3); 51 (50.5%) were boys. Reverse-transcriptase polymerase chain reaction (PCR) assay was positive in 21/100 (21%) patients; 62/83 (74.6%) patients had positive serology for SARS-CoV-2. The predominant complaints were fever (100%), fatigue (n = 90, 89.1%), and gastrointestinal symptoms (n = 81, 80.2%). Serum C-reactive protein (in 101 patients, median 165 mg/L; range 112-228), erythrocyte sedimentation rate (73/84, median 53 mm/s; IQR 30-84) and procalcitonin levels (86/89, median 5 μg/L; IQR 0.58-20.2) were elevated. Thirty-eight patients (37.6%) required admission to intensive care. Kawasaki disease (KD) was diagnosed in 70 (69.3%) patients, 40 of whom had classical KD. Most patients were treated with intravenous immunoglobulin (n = 92, 91%) and glucocorticoids (n = 59, 58.4%). Seven patients (6.9%) died.

CONCLUSION

The clinical spectrum of MIS-C is broad, but clinicians should consider MIS-C in the differential diagnosis when persistent fever, fatigue and gastrointestinal symptoms are prominent. Most patients diagnosed with MIS-C were previously healthy. Immunomodulatory treatment and supportive intensive care are important in the management of cases with MIS-C. Glucocorticoids and intravenous immunoglobulins are the most common immunomodulatory treatment options for MIS-C. Prompt diagnosis and prompt treatment are essential for optimal management.

COVID-19 associated multisystemic inflammatory syndrome in 614 children with and without overlap with Kawasaki disease-Turk MIS-C study group

Multisystemic inflammatory syndrome (MIS-C) diagnosis remains difficult because the clinical features overlap with Kawasaki disease (KD). The study aims to highlight the clinical and laboratory features and outcomes of patients with MISC whose clinical manifestations overlap with or without KD. This study is a retrospective analysis of a case series designed for patients aged 1 month to 18 years in 28 hospitals between November 1, 2020, and June 9, 2021. Patient demographics, complaints, laboratory results, echocardiographic results, system involvement, and outcomes were recorded. A total of 614 patients were enrolled; the median age was 7.4 years (interquartile range (IQR) 3.9-12 years). A total of 277 (45.1%) patients with MIS-C had manifestations that overlapped with KD, including 92 (33.3%) patients with complete KD and 185 (66.7%) with incomplete KD. Lymphocyte and platelet counts were significantly lower in patients with MISC, overlapped with KD (lymphocyte count 1080 vs. 1280 cells × μL, p = 0.028; platelet count 166 vs. 216 cells × 103/μL, p < 0.001). The median serum procalcitonin levels were statistically higher in patients overlapped with KD (3.18 vs. 1.68 µg/L, p = 0.001). Coronary artery dilatation was statistically significant in patients with overlap with KD (13.4% vs. 6.8%, p = 0.007), while myocarditis was significantly more common in patients without overlap with KD features (2.6% vs 7.4%, p = 0.009). The association between clinical and laboratory findings and overlap with KD was investigated. Age > 12 years reduced the risk of overlap with KD by 66% (p < 0.001, 95% CI 0.217-0.550), lethargy increased the risk of overlap with KD by 2.6-fold (p = 0.011, 95% CI 1.244-5.439), and each unit more albumin (g/dl) reduced the risk of overlap with KD by 60% (p < 0.001, 95% CI 0.298-0.559).

CONCLUSION

Almost half of the patients with MISC had clinical features that overlapped with KD; in particular, incomplete KD was present. The median age was lower in patients with KD-like features. Lymphocyte and platelet counts were lower, and ferritin and procalcitonin levels were significantly higher in patients with overlap with KD.

WHAT IS KNOWN

• In some cases of MIS-C, the clinical symptoms overlap with Kawasaki disease. • Compared to Kawasaki disease, lymphopenia was an independent predictor of MIS-C.

WHAT IS NEW

• Half of the patients had clinical features that overlapped with Kawasaki disease. • In patients whose clinical features overlapped with KD, procalcitonin levels were almost 15 times higher than normal. • Lethargy increased the risk of overlap with KD by 2.6-fold in MIS-C patients. • Transient bradycardia was noted in approximately 10% of our patients after initiation of treatment.

A rare cause of hydrops fetalis in two Gaucher disease type 2 patients with a novel mutation

Gaucher disease type 2 is the most progressive and the rarest form of Gaucher disease, defined as the acute neuronopathic type. We presented two GD2 patients who died before three months of age due to severe septicemia, respiratory and liver failure. One was homozygous for a novel GBA variant c.590 T > A (p.197 K), and the second homozygous for the known GBA mutation c.1505G > A (p.R502H). Ichthyosis, hydrops fetalis, apnea, myoclonic seizures, and hepatosplenomegaly occurred in both patients, but hypertrophic cardiomyopathy was observed only in the second and unilateral cataract in the first patient. Due to the disease's early and rapid neurological progression, we did not administer ERT to our patients. It is strongly believed that early diagnosis is essential, and prenatal diagnosis makes genetic counselling possible for future pregnancies.

Investigation of Epidemiological Characteristics of Patients over Age 65 with Covid-19 ın a City

Background

The population aged ≥65 is important because of the higher mortality rate and a riskier clinical course of COVID-19 in this patient group. This study aimed to examine the epidemiological characteristics, clinical conditions and factors affecting the clinical status of patients over 65 with COVID-19 in the Bingol province.

Methods

Study was conducted between March and December 2020 in the Bingol province using the data of 3,521 patients over age 65 who were positive for SARS-CoV-2 as per RT-PCR results. The study commenced after obtaining necessary institutional permissions and the ethics committee approval. In the study, independent variables were age, gender, presence of chronic diseases whereas dependent variables were mortality status, presence of pneumonia. Chi-square test and binominal logistic regression analysis were used for statistical analysis. In all evaluations, p < 0.05 was considered significant.

Results

The median age of the patients participating in the study was 72(65-102) and the case fatality rate was 2%. The mortality rates were significantly higher in patients aged between 75-84 and those aged >85 as well as patients who had a chronic disease, diabetes and ischemic heart disease compared to the other groups (p < 0.05). According to the regression analysis, mortality rate was 2.6-fold higher in males than in females and 24.3-fold higher in patients with pneumonia than in those without pneumonia (p < 0.05).

Conclusions

Among the patients in the study group, mortality rate was found to be higher in males, those in the advanced age group and those with pneumonia and chronic diseases. Therefore, if possible, patients with these characteristics should be followed more closely in a hospital setting during the pandemic.

Key messages

Mortality rates are higher in patients with COVID-19 who have a chronic disease, diabetes or ischemic heart disease.

Age, gender and presence of pneumonia are among the important factors in the course of COVID-19.

Determining How Nutritional Status is related to Anger Level and Anxiety Status in Persons

Background

Nutriments affect psychology and psychological state affects nutritional status of people. The present study is, therefore, intended to find out how nutritional status is related to levels of anger and anxiety in people receiving nutritional consultation.

Methods

This descriptive-type cross-sectional study includes a universe of 180 individuals aged over 18 who received nutrition counseling between August-December 2018. The approval of the ethics committee and of the relevant institution was obtained in order to conduct the study. The questionnaire form used to retrieve the data herein consists of socio-demographic characteristics, Trait Anger and Anger Expression Style Scale, Beck Anxiety Inventory, food consumption frequency, and food consumption record. Chi-Square test, Student t-test, and One-way ANOVA test were used for statistical analysis. The significance level was set as p &lt; 0.05.

Results

In the study group, those who consumed milk once a month had a subscale score of trait anger (22.83±3.13) that was significantly higher than that of those consumed it 3-5 times a week (18.74±3.93)(p = 0.025). Those who consumed fast food 1-2 times a week and 3-5 times a week had an anger expression score of 16.17±2.81 and 16.43±3.69, respectively; which were significantly higher than that of those consumed fast food once a month(14.07±2.42) and once every 15 days(14.12±3.05) (p = 0.028). The anger control subscale score of those who consume red meat daily is significantly lower than those who consume red meat 1-2 times a week and 3-5 times a week(p = 0.048). The body mass index and anxiety level did not have a significant difference (p &lt; 0.05).

Conclusions

In the study group, it was found that the trait anger score was low in the groups with less consumption of milk, the anger expression score was higher in the groups with increased fast food consumption, and the anger management score was lower in the group with more frequent red meat consumption.

Key messages

People who consume fast food more frequently have increased anger expression. The level of trait anger increases as the milk consumption diminishes.

Investigation of Epidemiological Characteristics of &lt; 18-Year-Old Patients with Covid-19 ın a City

Background

After the coronavirus disease 2019 (COVID-19) became a pandemic, the World Health Organization declared it to be a public health emergency. The population aged >of 18 years in Bingol province is 72766 and constitutes 25.8% of the entire population. This study aimed to examine the epidemiological characteristics of < 18-year-old patients with COVID-19 in Bingol Province.

Methods

In this study 1431 people aged <18 who tested positive on reverse transcription polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 in Bingol province between March and December 2020 were studied.The necessary institutional permission and ethics committee approval were obtained to conduct the study. The independent variables of the study were age, gender and place of residence, whereas the dependent variable was the development of pneumonia. Descriptive data were expressed as numbers and percentages, and Chi-Square test was used for statistical analysis. P < 0.05 was considered statistically significant.

Results

The median age of the study patients was 14 (0-17) years. Of the patients, 99.8% did not have any comorbidity and 96% presented with a good clinical condition. Of the patients, 91.1% were home-isolated and 6.9% developed pneumonia. Pneumonia developed at significantly higher rate in the age groups of 0-4 and 5-9 years compared with other age groups (p = 0.004). There was no significant difference in the development of pneumonia according to gender and comorbidity (p > 0.05).

Conclusions

The rate of pneumonia development was low in the study group. The clinical condition of most of the patients was good, and they isolated at home. Pneumonia developed at a higher rate in younger patients.

Key messages

COVID-19 has a milder prognosis in patients aged<18 years.

Among the patients aged <18 years, pneumonia develops at a higher rate in younger patients.

POS1359 REGIONAL DIFFERENCES IN DISEASE CHARACTERISTICS OF FAMILIAL MEDITERRANEAN FEVER IN TURKEY: PRELIMINARY REPORT

Background:

Familial Mediterranean fever (FMF) is a hereditary autoinflammatory disease accompanied by recurrent attacks of fever and serositis. It is prevalent among Mediterranean populations, mainly Turks, Armenians; Jews and Arabs. As genetic factors are variable in the population, environmental factors can also affect phenotypic characteristics.

Objectives:

This study aimed to determine the geographic differences in disease characteristics and burden in patients with FMF in Turkey.

Methods:

Patients diagnosed with FMF according to the Tel-Hashomer criteria were included in this multi-center study. Patients were included from the different regions of Turkey. Demographic features and clinic characteristics of the patients including disease duration, medications, comorbid conditions, attack characteristics, amyloidosis, acute phase reactants, FMF gene mutations, arthritis, sacroiliitis, and febrile myalgia were recorded. PRASS disease activity score, FMF-QoL, HAD, and HAQ were assessed. Patients from different parts of Turkey were divided into 3 groups the Central Anatolia, Western, and Eastern. Disease activity, characteristics and burden were also investigated among 3 distinct geographic regions.

Results:

A total of 281 patients with FMF (195 women, 86 men) were enrolled in this study. The mean age of the patients was 34.9 (SD:12.3) years. While the patients in the eastern areas of Turkey were diagnosed earlier age (p<0.001), the patients in the western area had a longer diagnostic delay time (p<0.001). Patients enrolled from western regions tended to have higher ESR and PRASS scores than those from eastern and central Anatolian regions, but attack numbers per 6 months were similar among the regions. The highest proportion of patients who were M694V/M694V homozygous patients were in western, and then eastern and central Anatolia (19.5%, 18%, and 5.4%). While fever and arthritis were more common in the eastern, pleuritis and sacroiliitis were more common in the central anatolia. Peritonitis and erysipelas like erythema rates were similar among the regions. The majority of patients were receiving colchicine treatment in all three regions. FMF-QoL scores were highest in the eastern and lowest in the western (p=0.006). Patients enrolled in the central Anatolia region experienced more functional disability than those from the western and eastern regions (p=0.009). Anxiety and depression scores were similar between groups (p=0.385 vs p=0.549).

Conclusion:

These findings suggest that patients with FMF have diversity concerning the age at diagnosis, diagnostic delay time, disease activity, quality of life, and functional disability among the 3 regions. In the genotypic analysis, the M694V mutation is the most common pathogenic mutation in all regions. Regional genetic and environmental varieties may explain the areal differences. These relationships can occur more clearly in larger patient populations.

References:

[1]Ureten K,et al. Demographic, clinical and mutational characteristics of Turkish familial Mediterranean fever patients: results of a single center in Central Anatolia. Rheumatol Int. 2010;30(7):911-915.

Table 1.

Clinical and demographic characteristics of patients by geographic region

Western, n=107Central, n=74Eastern,n=100pAge37.7 (12.5)36 (12.6)31.2 (10.9)<0.001Sex, female79 (73.8%)58 (78.4%)58 (%58)0.007Age at the symptom onset, year16.8 (11.3)20.4 (13.2)18.5 (11)0.229Age at the diagnosis, year29.6 (13.4)27.7 (13.3)22.1 (12.1)<0.001Diagnostic delay time, year12.3 (12.9)7.3 (10.5)3.6 (5.3)<0.001ESR, mm/hr26.8 (18.9)15.5 (12)13.1 (13.1)0.003PRASS41 (55.4%)0.577 Low50 (46.7%)28 (37.8%)51 (51%) Moderate48 (44.9%)45 (45%) High9 (8.4%)5 (6.8%)4 (4%)Fever83 (77.6%)60 (81.1%)96 (96%)0.001Peritonitis98 (91.6%)64 (86.55)92 (92%)0.412Pleuritis35 (32.7%)27 (36.5%)18 (18%)0.013Arthritis18 (16.8)16 (21.6)36 (36%)0.005Sacroiliitis8 (7.5%)14 (18.9%)1 (1%)0.000Erysipelas like erythema2 (1.9%)7 (9.5%)7 (7%)0.075

Data are presented as mean (SD), median (min-max), and n (%)

Disclosure of Interests:

None declared

POS1354 GENDER DIFFERENCES IN CLINICAL FEATURES AND BURDEN IN PATIENTS WITH FAMILIAL MEDITERRANEAN FEVER: PRELIMINARY REPORT

Background:

Familial Mediterranean fever (FMF) is the most common hereditary auto-inflammatory disease, which is more common in groups in the Mediterranean basin, characterized by recurrent attacks of febrile peritonitis, pleuritis and arthritis.

Objectives:

The aim of this study is to investigate the gender differences in clinical and demographic features in patients with familial Mediterranean fever (FMF).

Methods:

Patients with FMF diagnosed according to Tel-Hashomer criteria were included in this multi-center study. Data about age, sex, disease duration, symptom duration, age at diagnosis, comorbid diseases and medications were noted. All patients were screen with Hospital Anxiety and Depression Scale (HADS), Health Assessment Questionnaires (HAQ), Short Form 36 (SF-36). The severity of FMF was assessed by the PRASS scoring system.

Results:

Of the 286 patients, 199 (69,6%) were female with the mean age 36,2(SD:12.32) years and 87 (30,4%) were male with the mean age 32,9(SD:12,6) years (p=0,017). Age of diagnosis in male patients was lower than in females (p=0,008). The most common genetic mutation in both genders was M694V gene mutation. Homozygous M694V positivity was higher in males (31,79% vs 17,4%). More than 90% of patients were receiving colchicine,10 (3,5%) patients were receiving anakinra and 5(1,75%) patients were receiving canakinumab. Among the patients regularly taking colchicine, 86.2% were females and 86% were males (p=0,981). There were no differences between male and females in terms of clinical findings, frequency and duration of attacks, presence of colchicine resistance, and the presence of amyloidosis (p>0.05). ESR was detected higher in female group (p=0,011). Headache (p=0,001), migraine (p=0,031), and concomitant diseases (p=0,017) were also more common in females than males. Anxiety and depression scores were higher in females (p<0,05). The PRASS activity scores were similar between genders (p>0,05). All parameters of SF-36 were higher in male patients, while HAQ score was higher in females (p<0,05).

Conclusion:

Although clinical findings, disease severity and treatment compliance are similar in both genders, males are diagnosed with FMF earlier than females, but findings such as anxiety, depression, migraine, and headache are more common in female patients.

References:

[1]Doğan HO, Koca Y, Erden G, Karaaslan Y, Bozat H. Evaluating MEFV mutation frequency in Turkish familial Mediterranean fever suspected patients and gender correlation: a retrospective study. Mol Biol Rep. 2012 May;39(5):6193-6.

Table 1.

Demographic and clinical features between female and male FMF patients.

Female (n:199)Male (n:87)PDemographic features, mean (SD) Age36,2 (12.32)32,9 (12,6)0,017 BMI26,87(5,73)25,79(5,28)0,177 Educational level, years8,77(4,36)12,08(3,23)0,000 Age at diagnosis28 (13,31)23,7 (13,42)0,008 Age at onset of disease19,2 (12,6)17 (10,6)0,265Clinical features, n (%) Fever166 (83,4)77 (88,5)0,268 Abdominal pain180 (90,5)78 (89,7)0,835 Chest pain62 (31,2)20 (23)0,160 Erysipelas like erythema12 (6)4 (4)0,628 Arthritis46 (23,1)24 (24)0,419 Arthralgia102 (51,3)42 (48,3)0,643 Myalgia101 (50,8)47 (54)0,611MEVF mutations, n (%)  M694V/M694V24 (12.3)19 (22)0.047  M694V heterozygous38 (19,5)14 (16,3)0.523 M694V/any25 (12,8) 15 (17,4)0.307PRASS disease severity, n (%)0,813 Mild99(49,7)46(52,9) Moderate88(44,2)35(40,2) Severe12(6)6(6,9)ESR, mm/hour, mean (SD)23,77(16,27)18,25(18,41)0,011HAQ, mean (SD)0,49 (0,63)0,16 (0,43)0,000HAD, mean (SD)  Anxiety8,4 (4,4)6,7 (3,44)0,003  Depression7,1 (4,27)5,7 (3,81)0,006SF-36, mean (SD) Physical functioning63,56 (23,81)79,93 (19,32)0,000 Physical role limitation45,78 (40,95)61,41 (39,14)0,003 Emotional role limitation47,36 (42,04)66,20 (40,69)0,020 Energy/fatigue42,50 (20,64)53,64 (19,82)0,000 Emotional well-being51,61 (18,47)58,74 (18,30)0,003 Social functioning57,06 (23,09)70,52 (23,82)0,000 Pain51,66 (24,05)65,72 (24,51)0,000 General health39,53 (20,01)52,46 (23,83)0,000

Disclosure of Interests:

None declared

Epidemiological, Clinical, and Laboratory Features of Children With COVID-19 in Turkey

Objectives: The aim of this study is to identify the epidemiological, clinical, and laboratory features of coronavirus disease 2019 (COVID-19) in children. Methods: A retrospective study was conducted by pediatric infectious disease specialists from 32 different hospitals from all over Turkey by case record forms. Pediatric cases who were diagnosed as COVID-19 between March 16, 2020, and June 15, 2020 were included. Case characteristics including age, sex, dates of disease onset and diagnosis, family, and contact information were recorded. Clinical data, including the duration and severity of symptoms, were also collected. Laboratory parameters like biochemical tests and complete blood count, chest X-ray, and chest computed tomography (CT) were determined. Results: There were 1,156 confirmed pediatric COVID-19 cases. In total, male cases constituted 50.3% (n = 582) and females constituted 49.7% (n = 574). The median age of the confirmed cases was 10.75 years (4.5-14.6). Of the total cases, 90 were younger than 1 year of age (7.8%), 108 were 1-3 years of age (9.3%), 148 were 3-6 years of age (12.8%), 298 were 6-12 years of age (25.8%), 233 were 12-15 years of age (20.2%), and 268 cases were older than 15 years of age (23.2%). The most common symptom of the patients at the first visit was fever (50.4%) (n = 583) for a median of 2 days (IQR: 1-3 days). Fever was median at 38.4°C (38.0-38.7°C). The second most common symptom was cough (n = 543, 46.9%). The other common symptoms were sore throat (n = 143, 12.4%), myalgia (n = 141, 12.2%), dyspnea (n = 118, 10.2%), diarrhea (n = 112, 9.7%), stomachache (n = 71, 6.1%), and nasal discharge (n = 63, 5.4%). When patients were classified according to disease severity, 263 (22.7%) patients were asymptomatic, 668 (57.7%) patients had mild disease, 209 (18.1%) had moderate disease, and 16 (1.5%) cases had severe disease. One hundred and forty-nine (12.9%) cases had underlying diseases among the total cases; 56% of the patients who had severe disease had an underlying condition (p < 0.01). The need for hospitalization did not differ between patients who had an underlying condition and those who do not have (p = 0.38), but the need for intensive care was higher in patients who had an underlying condition (p < 0.01). Forty-seven (31.5%) of the cases having underlying conditions had asthma or lung disease (38 of them had asthma). Conclusions: To the best of our knowledge, this is one of the largest pediatric data about confirmed COVID-19 cases. Children from all ages appear to be susceptible to COVID-19, and there is a significant difference in symptomatology and laboratory findings by means of age distribution.

Investigating the Knowledge, Attitudes and Behaviours of Parents Regarding Vaccine Rejection

Background

With an escalating prevalence, vaccine rejection is one of the ten threats to global health as identified by the World Health Organization in 2019. Vaccine rejection and hesitancy can be defined as the hesitancy of individuals to get vaccinated against diseases that can be prevented by vaccination. This study aimed to investigate the knowledge, attitudes and behaviours of parents who use primary healthcare services.

Methods

Conducted between August and September 2019, this study adopted a descriptive cross-sectional design. The sample size of the study was calculated to be 378, considering a 95% confidence interval and 80% power. The survey form, the data collection tool of the study, included questions concerning sociodemographic characteristics of individuals and their knowledge, attitudes and behaviours regarding vaccination. The data were analysed on SPSS 22.0. Chi-square test was used in statistical analyses, and the significance level was set as p &lt; 0.05.

Results

In the study group, 15.5% of the parents stated that they were hesitant about vaccines in childhood, 81.3% stated that their source of information on vaccines was healthcare staff and 28% stated that it was the internet. The hesitancy level was significantly high among those who believed that vaccines led to autism and infertility and those who did not trust pharmaceutical companies (p &lt; 0.05). The hesitancy level regarding vaccines was significantly lower among those whose source of information was healthcare staff, whereas it was significantly higher among those whose source of information was the internet (p &lt; 0.05).

Conclusions

Parents' beliefs that vaccines led to autism and infertility increased their hesitancy levels. The inaccurate information on the internet and social media increased their hesitancy levels. Hesitancy levels were lower among the parents who received information from healthcare staff.

Key messages

Healthcare staff should organise public trainings on vaccines to reduce the hesitancy levels of parents. Anti-vaccination statements on the internet and social media influence individuals’ vaccination behaviours.

Knowledge and Behavior of Nurses on Childhood Vaccine Refusal in a Hospital of Eastern Turkey

Background

Among 10 global problems of 2019 determined by the World Health Organization, vaccine refusal was one of the problems mentioned. In this context, health services and health personnel whose main objectives are to keep individuals healthy and to prevent diseases have major responsibilities. This study aims to analyze knowledge and behavior of nurses working in Malatya Turgut Özal Hospital on childhood vaccine refusal.

Methods

This study, conducted between June-July 2019, is a descriptive cross-sectional study and its universe is composed of 850 nurses working in Turgut Özal hospital. Sample size was calculated to be 263 at a confidence interval of 95% and strength of 80%. In the questionnaire, sociodemographic questions on nurses and children as well as questions determining nurses' knowledge and behavior on childhood vaccine refusal were asked. Chi-square test and Fisher's Exact Test were used in statistical analyses. p &lt; 0.05 was determined to be significant.

Results

31.7% of nurses participating in the study stated that they had concerns on childhood vaccines. Two-thirds of nurses stated that their knowledge on vaccines were from their education, one-thirds of them knew that childhood vaccines were mandatory by law while three out of four stated they knew the vaccination schedule recommended by the Ministry of Health. The level of concern in those agreeing to the fact that vaccines caused autism and infertility, those stating that they did not trust vaccine-producing companies, and those stating that catching the disease was a better immunization method than vaccination was significantly higher than those not agreeing to these and those who were indecisive (p &lt; 0.05).

Conclusions

One-thirds of nurses was proven to have concerns on childhood vaccines and this rate is rather high. Nurses, being both health personnel and the communication channel for guiding parents, should be provided necessary trainings and practices in order to ease their concerns on vaccination.

Key messages

In-service trainings should be given importance in order to reduce nurses’ concern. Due to the fact that the information source for nurses on vaccination was their education, subjects that would eliminate their concerns should be highlighted.

Knowledge, Attitudes And Behaviors Of Faculty Members On Childhood Vaccine Refusal A University

Introduction

Vaccines stimulate the immune system and provides protection against a large number of diseases. Although there is a lot of scientific evidence that the benefits of vaccines are higher than their risks, concerns can occur in every segment of the community about the safety of vaccines.In this study, we aimed to examine the knowledge, attitudes and behaviors of the faculty members working at Inonu University regarding vaccine rejection.

Methods

This study is a descriptive cross-sectional study, conducted between July and August 2019. The universe of this study consists of 799 faculty members working at Inonu University. Sample size was calculated as 258 with 95% confidence interval and 80% power. The questionnaire used in the study consists of the questions including the sociodemographic characteristics of the faculty members and their knowledge, attitudes and behaviors about childhood vaccine rejection. Chi-square test was used for statistical analysis. p &lt; 0.05 was determined to be significant.

Results

99.1% of the faculty members had their children vaccinated during their childhood. 31.8% of faculty members stated that they were worried about childhood vaccines.As a source of information about vaccines, faculty members stated the scientific articles in highest rate (49.4%).It was found in comparison that parents who applied alternative medicine for their children were more worried about vaccines than those who did not, and those who did not read scientific publications about vaccines were more worried than to those who read (p &lt; 0.05).The levels of anxiety are significantly lower in those who do not think that vaccines cause autism and infertility, and those who trust vaccine producing companies (p &lt; 0.05).

Conclusions

Almost all of the faculty members have their children vaccinated, but their level of anxiety about vaccines is high. In our study, we observed that those who obtained their knowledge about vaccines from scientific articles were less anxious.

Key messages

Faculty members, who are among the most educated groups of the society, have a high level of anxiety about childhood vaccination. By keeping faculty members informed about the scientific publications about vaccines, their concerns about the vaccine can be eliminated.

The Knowledge and Behaviours of the Healthcare Staff Regarding Vaccine Rejection

Background

Vaccination is a cost-effective method to protect individuals from diseases and complications that might emerge due to diseases. The healthcare staff in primary healthcare services, as the primary body concerned with vaccines, are notably more likely to encounter families who reject vaccines in childhood. This study aimed to investigate the knowledge, attitudes and behaviours of the healthcare staff in primary healthcare services regarding vaccine rejection in childhood.

Methods

Conducted between July and August 2019, this study adopted a descriptive cross-sectional design. The population of the study comprised 392 healthcare staff working in primary healthcare services in Malatya City Centre. The sample size was calculated as 193, considering a 95% confidence interval and 80% power. The survey form used in the study included questions concerning sociodemographic characteristics of individuals, their views on vaccination and the views of parents regarding vaccine rejection according to the perspectives of the healthcare staff. Chi-square test was used in statistical analyses, and the significance level was set as p &lt; 0.05.

Results

In the study group, 25.4% of the healthcare staff stated that they were hesitant about vaccines in childhood. Also, 18.2% of the individuals indicated that they were hesitant about vaccines due to the chemicals in vaccines, 14.4% were hesitant due to the pharmaceutical industry and the relationships based on self-interest and 10.5% were hesitant due to the side effects. The hesitancy level was significantly higher among those whose source of information regarding vaccines in childhood was the internet (37.0%) compared with those whose source was not the internet (21.6%) (p = 0.004).

Conclusions

One-fourth of the healthcare staff, who are supposed to be the most informed group about vaccines, were hesitant about them. Moreover, the inaccurate information acquired from the internet and social media could be increasing the hesitancy level.

Key messages

Vaccination hesitancy is high among the healthcare staff in primary healthcare services. The source of information regarding vaccination influences the hesitancy levels of individuals.

FRI0483 SUBCLINICAL INFLAMMATION AND RELATED PARAMETERS IN PATIENTS WITH FAMILIAL MEDITERRANEAN FEVER

Background:

Familial Mediterranean Fever (FMF), which is more common in groups in the Mediterranean basin, is a monogenic autoinflammatory disease characterized by recurrent attacks of febrile peritonitis, pleuritis and arthritis.

Objectives:

In this study, we aimed to investigate the clinical, demographic and genotypic features that may be associated with subclinical inflammation in FMF and to determine the related parameters with subclinical inflammation.

Methods:

FMF patients according to the Tel-Hashomer criteria were included into the study. The demographic characteristics of the patients, duration of the disease, concomitant diseases, MEFV genotype mutation, colchicine use and resistance were collected. Acute-phase reactants such as white blood cell count, erythrocyte sedimentation rate, and C-reactive protein levels during the attacks and attack-free periods were noted. Subclinical inflammation was defined as the continuation of the acute phase response (CRP) between episodes. We divided study population into two groups as; patients with or without subclinical inflammation (Group 1 and Group 2, respectively) and these group were compared with the parameters described above. Patients with infectious disease (viral or bacterial) in the past two months were excluded from the study

Results:

Eigthy patients (72.5% female) with mean age 37.1 SD 11.2 years were recruited into the study. Twenty-three (28.7%) patients were determined with subclinical inflammation. Group 1 had significantly higher rate of concomitant rheumatic disease(i.e spondyloarthropathy), erythrocyte sedimentation rate and MEFV homozygous mutation compared with Group 2 (p<0.05, for each). Disease duration, months PRASS score, FMF quality of life, age at onset of symptoms, family history of FMF, response to colchicine, attack time, attack in the last 6, delay in diagnosis parameters were not significantly different between groups (p> 0.05).

Conclusion:

FMF patients whose elevated erythrocyte sedimentation rate and MEFV homozygous mutation should be closely monitored for subclinical inflammation even during attack-free periods. Concomitant disease should be detected in FMF patients with subclinical inflammation.

References:

[1]Shinawi M, Brik R, Kepten I, Berant M, Gersoni B. Familial Mediterranean fever: high gene frequency and heterogenous disease among Israeli-Moslem Arab population. J Rheumatol 2000;27:1492–5

[2]Bayram MT, Çankaya T, Bora E, Kavukçu S, Ülgenalp A, Soylu A, Türkmen M. Risk factors for subclinical inflammation in children with Familial Mediterranean fever. Rheumatol Int. 2015 Aug;35(8):1393-8.

Table 1:

Demographic and clinical features of the patients with familial Mediterranean fever

Without Subclinical inflamationn= (57)With Subclinical inflamationn= (23)P valueAge (years; mean SD)37,78 SD 13,2236,82 SD 10,490.987Female, gender, n (%)45(%78)13(%56)0.055Disease duration(month; mean SD)255,3 SD 195,1180,2 SD 121,10.191PRASS score(mean SD)6,08 SD 2,155,36 SD 1,590.147BMİ, kg/m226,12 SD 4,832,13 SD 28,480.629Current smoking status (%)17(%29)3(%13)0.067Age at onset of symptoms (month; mean SD)15,69 SD 9,4117,28 SD 10,340.54Family history of FMF(%)37(%64)18(%78)0.295Response to colchicine(%)6(%10)4(%17)0.462Attack time(day; mean SD)1,9 SD 1,12,26 SD 1,40,523Attack in the last 6 months (mean SD)2,79 SD 3,14,56 SD 5,50,184FMF quality of life(mean SD)31,5 SD 13,625.7 SD 16,40,130Delay in diagnosis(month; mean SD)12,29 SD 10,914,3 SD 14,90,840

Disclosure of Interests:

None declared

AB1024 EVALUATION OF CLINICAL FEATURES IN PATIENTS DIAGNOSED WITH JUVENILE AND ADULT-ONSET FAMILIAL MEDITERRANEAN FEVER

Background:

Familial Mediterranean Fever (FMF), which is more common in groups in the Mediterranean basin, is a monogenic auto inflammatory disease characterized by recurrent attacks of febrile peritonitis, pleuritis and arthritis.

Objectives:

The aim of this study is to investigate the clinical features of patients diagnosed with juvenile and adult-onset Familial Mediterranean Fever (FMF).

Methods:

Patients with FMF were included in the study consecutively without sample selection. Data about age, sex, disease duration (month), symptom duration, age at diagnosis, diagnosis delay time, comorbid diseases, and medications were noted. Patients with onset of symptoms ≤ 20 years old were classified as juvenile-onset, those > 20 years old were classified as adult-onset FMF. The frequency and characteristics of attacks and the presence of amyloidosis will be recorded.

Disease activity was assessed with the PRAS disease activity score. The Health Assessment Questionnaire (HAQ) and SF-36 were used to evaluate physical disability and quality of life, respectively.

The descriptive analysis was done for all parameters. Differences between categorical variables were assessed by Chi-square test and Fisher’s exact test. The Mann Whitney-U test was used to compare two sample means. P<0.05 accepted as significant. SPSS 20.0 (Statistical package for social sciences for Windows 20.0) program was used for the statistical analysis.

Results:

The mean age of 86 patients (63 female, 23 male) with FMF was 38.38 (SD: 12.13) years. The patients with the juvenile-onset FMF were 26.7% of the patients.

There were no differences between juvenile and adult-onset FMF groups in terms of gender, frequency of attacks, duration of attacks, acute phase values between attacks, colchicine dose, presence of colchicine resistance, and presence of amyloidosis (p>0.05). The latency to diagnosis was significantly higher in patients with adult-onset FMF (p<0.005).

The PRAS disease activity scores were significantly higher in the juvenile-onset FMF group (p=0.001). There were no significant differences between the two groups in terms of SF-36 and HAQ scores (p> 0.05).

Conclusion:

While there were no differences between juvenile and adult-onset FMF patients in terms of quality of life and functional disability, the PRAS disease activity scores were higher in patients with juvenile-onset FMF.

References:

[1]Shinawi M, Brik R, Kepten I, Berant M, Gersoni B. Familial Mediterranean fever: high gene frequency and heterogenous disease among Israeli-Moslem Arab population. J Rheumatol 2000;27:1492–5.

Disclosure of Interests:

None declared

Attitudes and behaviours of theology faculty students on organ donation An Eastern City Of Turkey

Background

Transplantation is the process by which a solid tissue or organ from a living donor or cadaver is transplanted to replace an organ that cannot function properly in the body. Religious beliefs of individuals affect their attitudes and behaviours regarding organ donation. The aim of the study is to determine the knowledge, attitudes, behaviours of Theology Faculty students about organ donation.

Methods

The study is cross-sectional study which carried out on students in Faculty of Theology.Total number of students was 800 at the time of study. Sample selection was not performed in this study,70% of the population was included. The first part of the questionnaires, which we created as data collection tools, comprised socio-demographic questions, whereas the second part comprised questions, prepared according to the literature that measures the knowledge, attitudes and behaviours on organ donation. Chi-square test was used for statistical analysis.

Results

0.7% Of the students participating in the study stated that they were organ donors, whereas 56.4% said that they considered organ donation as religiously appropriate behaviour, and 38.6% said that they have not become organ donors before because the subject of organ donation was not brought to their attention previously. A comparison of whether the students viewed organ donation as religiously appropriate behaviour with the students’ level of knowledge on organ donation revealed to be 65.8% among students with knowledge on organ donation and 49.5% among students who lacked knowledge on organ donation(p &lt; 0.05).

Conclusions

The ratio of organ donors among the participants was 0.7%. Students with knowledge on organ donation also said that they viewed organ donation as religiously appropriate behaviour. Through training activities, the aim should be to increase the level of knowledge and awareness on organ donation of future religious staff and to thereby increase the level of organ donation in the society.

Key messages

The ratio of organ donation among Theology Faculty students is low. The subject of organ donation should be added to the curriculum of Theology Faculty students.

Effects of dexmedetomidine and thymoquinone on erythrocyte deformability in lower limb ischemia reperfusion injury in streptozotocin-induced diabetic rats

OBJECTIVE

In this study we aimed to evaluate the effect of dexmedetomidine and thymoquinone on erythrocyte deformability in lower limb ischaemia-reperfusion (IR) injury in streptozotocin-induced diabetic rats.

MATERIAL AND METHODS

Thirty Wistar albino rats were equally divided into 5 groups (n = 6); randomized control group (Group C), diabetes control group (Group DC), DIR group (Group DIR), DIR group with thymoquinone 25 mg.kg‒1 intraperitoneally (Group DIRT) and Group DIR with dexmedetomidine 100 µg.kg‒1 intraperitoneally (Group DIRD). Erythrocyte packs were prepared from heparinized blood samples and deformability measurements were performed.

RESULTS

IR significantly increased the relative resistance, a marker of erythrocyte deformability when compared to control group (p < 0.05). There were significant differences among the groups in comparisons with ANOVA test (p < 0.0001). Comparisons of the groups DIRD and DIRT revealed similar results (p = 0.824). The values of Group DIR were significantly higher than those of the control, DC, DIRD and DIRT groups (p < 0.0001, p = 0.001, p = 0.004, p = 0.002, respectively). The values of the DC, DIR, DIRD and DIRT groups were significantly higher than those of the control group (p < 0.0001, all).

CONCLUSION

Erythrocyte deformability may cause more problems in microcirculation. Dexmedetomidine and thymoquinone may be useful in reducing the adverse effects of this type of injury (Fig. 1, Ref. 41).

Effect of different doses of pregabalin on skeletal muscle ischaemia-reperfusion injury in rats

AIM/INTRODUCTION

Analgesic, anti-inflammatory and anti-apoptotic effects of pregabalin have been shown previously. In this study, we investigated the protective effect of different doses of pregabalin on skeletal muscle IR injury in rats.

MATERIALS AND METHODS

24 rats were randomly divided into 4 groups (Control, Ischaemia-Reperfusion (IR), IR-Pregabalin 50 mg, IR-Pregabalin 200 mg). Following IR, serum Ischemia Modified Albumin (IMA) and tissue Paraoxonase (PON) were studied and gastrocnemius muscle tissue was removed for histopathologic examination.

RESULTS

Interstitial inflammation was higher in the IR group than in the control and Pregabalin 200 mg groups (p = 0.037, p = 0.037, respectively). Congestion was higher in the IR group than in the control, Pregabalin 50 and 200 mg groups (p = 0.001, p = 0.004, p = 0.004, respectively). PON was lower in the IR group than in the Control, Pregabalin 50 and 200 mg groups (p = 0.001, p = 0.007, p = 0.015, respectively). IMA was higher in the IR group than in the Control, Pregabalin 50 and 200 mg groups (p < 0.0001, all).

CONCLUSION

We think that administration of pregabalin, more prominent at 200 mg, can reverse the injury that occurs in the skeletal muscle of IR-induced rats. Pregabalin can be safely used for analgesia in cases of IR (Tab. 2, Fig. 9, Ref. 41).

Effects of intravenous ibuprofen and lornoxicam on erythrocyte deformability in rats undergoing hind limb ischemia reperfusion injury

BACKGROUND AND AIM

Acute hind limb ischemia reperfusion (I/R) injury is a common consequence of abdominal aorta cross‑clamping during aortic surgery. Erythrocyte deformability is affected by I/R process and may lead to increased tissue and organ injury. Lornoxicam and intravenous ibuprofen are becoming commonly used as non-steroidal anti-inflammatory drugs (NSAID) for postoperative analgesia. In this study, we aimed to investigate the effects of lornoxicam (2 mg/kg iv) and intravenous ibuprofen (30 mg/kg iv) on erythrocyte deformability in I/R model in rats.

MATERIALS AND METHODS

Four study groups, each containing 6 Wistar rats were created. Laparotomy was performed in all groups under general anesthesia with ketamine and xylazine. In all groups except sham group, ischemia and reperfusion were achieved by clamping and declamping the infrarenal abdominal aorta for 120 minutes. Rats in Group IR+L received intravenous infusion of lornoxicam (2 mg/kg) while rats in Group IR+I received intravenous infusion of ibubrofen (30 mg/kg) following 2 hours of ischemic period. At the end of reperfusion period, erythrocyte packs were prepared from heparinized blood samples. Erythrocyte suspensions with hematocrit at a concentration of 5% in a phosphate‑buffered saline (PBS) were used in order to perform deformability measurements. The value of p<0.05 was considered statistically significant.

RESULTS

Relative resistance has increased in ischemia reperfusion group when compared to control group (p < 0.0001). Lornoxicam or ibuprofen intravenous treatments did not change the erythrocyte deformability during ischemia reperfusion period in rats (p=0.851, p=0.690).

CONCLUSION

Intravenous ibuprofen or lornoxicam administrations during ischemia reperfusion period in rats have no negative effect on erythrocyte deformability. The findings of the study should be supported with more detailed and extensive clinical/experimental studies in the future (Fig. 1, Ref. 18).

The Effects of Calcium Channel Blockers are not Related to their Chemical Structure in the Collar Model of the Rabbit

Placing a silicone collar around the rabbit carotid artery induces intimal thickening, an early stage in atherosclerosis and restenosis. We investigated whether treatment with oral pranidipine, a new potent, long-lasting dihydropyridine calcium channel blocker (CCB), inhibited collar-induced intimal thickening in addition to the changes in vascular reactivity usually observed in this model. Pranidipine treatment did not inhibit collar-induced intimal thickening. Placing the collar around the carotid artery resulted in the characteristic changes in vascular reactivity, such as increased sensitivity to 5-hydroxytryptamine. Treatment with Nω-nitro-l-arginine (100 μM) and pranidipine, however, did not affect collar-induced changes in vascular reactivity. From results of this and previous studies, we conclude that pranidipine does not prevent collar-induced intimal thickening or collar-induced changes in vascular reactivity. Not all CCBs prevent collar-induced intimal thickening, suggesting that the effects of these agents are not related to their chemical structure and/or their calcium channel-blocking actions.

Impact of glucocorticoid receptor gene (NR3C1) polymorphisms in Turkish patients with metabolic syndrome

BACKGROUND

The metabolic syndrome (MetS) is characterized by a cluster of metabolic factors, including insulin resistance and type-2 diabetes, abdominal obesity, dyslipidemia, hypertension and microalbuminuria. Impaired glucocorticoid receptor (GR) activity also plays an important role in the etiology of MetS. The objective of our study is to evaluate the effects of GR gene polymorphisms (BclI, N363S, TthIII1 and ER22/23EK) in Turkish patients with MetS.

MATERIALS AND METHODS

Seventy subjects with MetS and 185 healthy controls were enrolled in the study. PCR-RFLP analysis was used for genotyping. Results for each polymorphism have been verified by allele-specific oligonucleotide analysis.

RESULTS

BclI GG genotype was significantly associated with an increased risk of MetS (p = 0.02). Also, only in women, the G allele carriers were significantly associated with higher C-peptide. T allele carriers of TthIII1 polymorphism were significantly associated with higher C-peptide, triglyceride, insulin and C-reactive protein (CRP, p value 0.048, 0.022, 0.005 and 0.022, respectively), and lower fasting blood glucose (FBG, p = 0.02). The combined carriers of BclI polymorphism G allele and TthIII1 polymorphism T allele were significantly associated with higher diastolic blood pressure in all patients, and lower FBG and postprandial blood glucose in only men. All the ER22/23EK polymorphisms coexisted with polymorphic variant of TthIII1 (p = 0.0058).

CONCLUSION

The presence of homozygote polymorphic variant of BclI might be good predictive markers for the disease susceptibility. The BclI and the TthIII1 polymorphism are associated with sex-specific clinical parameters. Our findings also suggest that the combination of BclI and TthIII1 polymorphisms may play a protective role in blood glucose.

Effect of alprostadil on erythrocyte deformability in ischemia reperfusion injury

BACKGROUND

Ischemia reperfusion injury (I/R) in lower extremity is a frequent and important clinical phenomenon. Protective effect of alprostadil on local and distant organ injury due to I/R has been well-documented but its effect on erythrocyte deformability needs further investigation. Our aim was to investigate the effect of alprostadil on erythrocyte deformability in infrarenal aorta of rats undergoing I/R.

MATERIALS AND METHODS

Our study was conducted with 18 Wistar albino rats. Rats were divided into 3 groups; randomized control group (group C; n=6), I/R group without alprostadil (group I/R; n=6) and I/R group with alprostadil 20 mcg.kg(-1), intraperitoneal (group I/R-A; n=6). Packs of erythrocytes were prepared from heparinized blood samples and deformability measurements were done.

RESULTS

Comparisons of the control and I/R-A groups revealed similar results (p=0.240). The values of the IR group were significantly higher than those of the control and IR-A groups (p=0.009, p=0.026, respectively).

CONCLUSION

In our study, we detected unfavourable effects of I/R on erythrocyte deformability, which may lead to disturbance in blood flow and hence tissue perfusion in infrarenal rat aorta. We also found that alprostadil had beneficial effects by reversing undesirable effects of I/R (Fig. 1, Ref. 22).

Effect of levosimendan on erythrocyte deformability during myocardial ischaemia-reperfusion injury

Diabetes mellitus (DM) is a chronic metabolic disorder accompanied by an increase in oxidative stress. Ischaemia-reperfusion (IR) injury is a cascade of events initiated by tissue ischaemia. The cellular damage produced by reperfusion leads to an active inflammatory response. Erythrocyte deformability and plasma viscosity are of crucial importance for the perfusion of tissues and organs. The aim of this study was to evaluate the effect of levosimendan on erythrocyte deformability during IR myocardial injury in diabetic rats.

METHODS

Twenty-four Wistar albino rats were included in the study after streptozocin (55 mg/kg) treatment for 4 weeks to observe the existence of diabetes. The animals were randomly assigned to one of four experimental groups. In Group C and DC (sham-control group), the coronary artery was not occluded or reperfused in the control rats. Myocardial IR was induced by ligation of the left anterior descending coronary artery for 30 min, followed by 2 h of reperfusion in the diabetes-IR (DIR) and diabetes-IR-levosimendan (DIRL) group. Deformability measurements were performed in erythrocyte suspensions containing Htc 5 % in a phosphate-buffered saline (PBS) buffer.

RESULTS

The deformability index was significantly increased in the diabetic rats. It was similar in Group DC and DIRL It was significantly increased in the DIR group compared to Group C, DIRL and DC. The relative resistance was increased in the IR models.

CONCLUSION

Erythrocyte deformability was decreased in rats with diabetes and IR injury. This injury might lead to further problems in microcirculation. Levosimendan may be useful in enhancing the adverse effects of this type of injury (Fig. 2, Ref. 41).

KEYWORDS

erythrocyte deformability, myocardial ischaemia reperfusion, experimental diabetes, levosimendan, rat.

Effect of dexmedetomidine on erythrocyte deformability during ischaemia-reperfusion injury of heart in diabetic rats

The aim of this study is to evaluate the effect of dexmedetomidine on erythrocyte deformability during IR heart injury in diabetic rats.

METHODS

Eighteen Wistar Albino rats were included in the study after streptozocin (55 mg/kg) treatment for four weeks. In the Group C and DC (sham-control group), the coronary artery was not occluded or reperfused in the control rats. In the Group DIR, a branch of the left coronary artery was occluded for 30 minutes followed by two hours of reperfusion to produce IR. In the Group DIRD, a branch of the left coronary artery was occluded for 30 minutes followed by two hours of reperfusion to produce IR, and dexmedetomidine was administrated via 100 µg/kg IP route 30 minutes before ligating the left coronary artery. Deformability measurements were performed in erythrocyte suspensions containing Htc 5 % in a PBS buffer.

RESULTS

The deformability index was significantly increased in diabetic rats; however, it was similar in the Group DC and DIRD. It was significantly increased in the Group DIR when compared to the Group C, DIRD and DC. The relative resistance was increased in IR models.

CONCLUSION

Erythrocyte deformability was decreased in rats having diabetes and IR injury. This injury might lead to further problems in microcirculation. It was shown that dexmedetomidine might be useful in enhancing the adverse effects of this type of injury (Fig. 1, Ref. 39).

The protective effects of dexmedetomidine on liver injury-induced myocardial ischemia reperfusion

PURPOSE

The aim of this study was to evaluate the effect of dexmedetomidine (100 µg/kg-ip) on liver injury-induced myocardial ischemia and reperfusion (IR) in rats.

MATERIALS AND METHODS

Twenty-four Wistar Albino rats were separated into four groups. There were four experimental groups (Group C (Control; n = 6), Group IR (ischemia-reperfusion, n = 6), Group D (Dexmedetomidine; n = 6) that underwent left thoracotomy and received ip dexmedetomidine without IR administered via 100 µg/kg ip route 30 minutes before ligating the left coronary artery, and Group IR-D (IR-Dexmedetomidine; n = 6). A small plastic snare was threaded through the ligature and placed in contact with the heart. To produce IR, a branch of the left coronary artery was occluded for 30 min followed by two hours of reperfusion. However, after the above procedure, the coronary artery was not occluded or reperfused in the control rats. At the end of the study, liver tissue was obtained for histochemical and immunohistochemical determination.Some part of tissue samples were stained with Masson-trichrome for the evaluation of ultrastructural changes and inducible nitric oxide synthase (iNOS) expression was evaluated in other part of samples for immunohistochemical examination.

RESULTS

Histopathological changes were detected in Group IR when compared with Group C. iNOS expression was found to be increased and stronger particularly in the vascular wall, perisinusoidal space and hepatocytes around vena centralis in this group compared to the control group. Perivascular oedema was detected to be decreased in Group IR-D compared to Group IR. It was also observed that the impairment in the radial arrangement of hepatocytes significantly recovered in Group IR-D. The immunoreactivity was found to be significantly decreased in the assessment of iNOS expression in the same group when compared with Group IR.

CONCLUSION

Administration of dexmedetomidine ameliorates liver injury induced by myocardial ischemia and reperfusion (Fig. 8, Ref. 33).

Comparison of results after fluoroquinolones and combination therapies in type IIIA chronic prostatitis

PURPOSE

We investigated retrospectively the clinical outcomes of the patients with type iii inflammatory chronic prostatitis, who were treated with fluoroquinolones with and without an α-blocker between 2009-2011.

MATERIAL AND METHODS

Diagnosis was established with medical history (symptoms presented longer than 3 months within previous 6 months), physical examination, Meares-Stamey test and the questionnaire of the NIH-CPSI. The responses to the treatment were assessed with uroflowmetry test and the questionnaire of NIH-CPSI at initial and after 4 weeks of the treatment. The patients with incomplete data and treatment and who treated with α-blockers and/or antibiotics in the period 4 weeks prior to the therapy started in our clinic and had any surgery of lower urinary tract previously were excluded. The patients were classified under 6 groups; group1=ciprofloxacin, group2=ofloxacin, group3=levofloxacin, group4=ciprofloxacin+tamsulosin, group5=ofloxacin+tamsulosin, group 6=levofloxacin+tamsulosin. Wilcoxon Signed Ranks and Kruskal Wallis test were used for comparison of results. Mann Whitney U test with Bonferroni correction made was used as posthoc (P<.05).

RESULTS

The median scores of NIH-CPSI decreased significantly in all groups (P<.05). Levofloxacin reduced the median total scores of NIH-CPSI more than ciprofloxacin and ofloxacin monotherapies. The combination therapies were better than antibiotic therapies alone and best result was obtained in levofloxacin+tamsulosin combination.

CONCLUSION

Tamsulosin+fluoroquinolone (especially tamsulosin+levofloxacin) combinations yielded better results in both NIH-CPSI scores and peak flow rates.

Brain diffusion-weighted imaging in diabetic patients with retinopathy

OBJECTIVE

Our aim was to detect whether there is any change in apparent diffusion coefficients (ADC) levels in different sites of the brain, particularly in areas associated with the vision, in diabetic patients with retinopathy by measuring diffusion-weighted imaging (DWI).

MATERIALS AND METHODS

Conventional magnetic resonance imaging (MRI) and DWI of the brain were obtained from 45 diabetic patients (15 patients with proliferative diabetic retinopathy (group 1), 15 patients with nonproliferative diabetic retinopathy (group 2), 15 diabetic patients without retinopathy (group 3) and from 15 age-matched healthy volunteers (group 4). ADC values of visual cortex, cingulate gyrus, orbitofrontal, dorsomedial and dorsolateral frontal, corona radiate, and thalamus were obtained.

RESULTS

The ADC values of visual cortex, cingulate gyrus and orbitofrontal cortex significantly increased in groups 1 and 2 compared to groups 3 and 4 (p < 0.001). The ADC values of visual cortex significantly increased in group 1 compared to group 2 (p < 0.001). The duration of disease and value of HbAlc positively correlated with ADC values of the visual and orbitofrontal cortexes, and cingulate gyrus.

CONCLUSIONS

We found an increase in ADC values supporting the neuronal loss in some regions, especially in visual center by DWI in the diabetic patients with retinopathy. This result supports the association between diabetic retinopathy and brain injury.

Immunohistochemical localization of transforming growth factor β1 and β2 in mouse testes during postnatal development

We examined age-related changes in the expression of transforming growth factor-β(1) (TGF-β(1)) and transforming growth factor-β(2) in mouse testes. The mice were assigned to three age groups: 35, 50, and 75 days old. Paraffin embedded testis sections were processed for the standard streptavidin biotin peroxidase complex immunohistochemistry method. TGF-β(1) expression increased in aging round spermatids over the time studied. There was no expression in 35-day-old Leydig cells, whereas strong expression of TGF-β(1) was observed in 50-day-old Leydig cells. Expression decreased in 75-day-old Leydig cells. TGF-β(2) expression was weak in 35- and 50-day-old mouse spermatids, but expression was greater in 75-day-old elongated spermatids. In Leydig cells, TGF-β(2) expression was strong in both 35- and 50-day-old mice, whereas the expression of TGF-β(2) was less in 75-day-old Leydig cells. Our results suggest that TGF-β(1) and TGF-β(2) may play significant roles in testicular functions and germ cell development in mice.

Knowledge, attitudes, and behaviors of officials of religion about organ donation in Kahramanmaras, an eastern Mediterranean city of Turkey

OBJECTIVE

To establish the knowledge, attitudes, and behaviors of the officials of religion, a group with potentially powerful influence on the society, in particular regarding organ donation.

METHODS

This study, performed in Kahramanmaras Province, Turkey, included 416 of 641 officials of religion (64.9%): 295 of 492 imams (59.9%) and 121 of 149 Koran course educators (81.2%).

RESULTS

The mean (SD) age of the study group was 37.2 (8.2) years. Only 1.4% had stated that carried organ donation cards. Of participants who had not donated organs asked whether they thought of donation, 14.1% answered yes, 17.1% answered no, and 68.8% were undecided. Of the study group, 88.2% considered organ donation appropriate according to their religion. The imams compared with Koran course educators, and men compared with women demonstrated higher rates of considering organ donation appropriate according to their religion (P < .05). Among participants who stated they had knowledge about organ donation, the 3 leading information sources were television, newspapers or journals, and in-service training by the Directorate of Religious Affairs. The 3 primary organs the study group stated they were aware of being transplanted were kidneys, liver, and heart.

CONCLUSION

Although 88.2% of religious officials in the present study stated that organ donation was appropriate according to their religion, only 1.4% agreed to donate organs. Officials of religion hold an important place in society, and should be well informed and educated about organ donation via in-service training courses, and encourage organ donation by members of society.

Cord entanglement in monochorionic monoamniotic twins

Monochorionic monoamniotic twin gestations have been associated with perinatal mortality rates as high as 28% to 47%. Umbilical cord entanglements and knots, twin-to-twin transfusion syndrome, congenital anomalies, prematurity and intertwin locking during labor are responsible for their high perinatal morbidity and mortality. We report here two cases of cord entanglements: One of them was associated with twin-to-twin transfusion syndrome with gross vascular anastomoses and a massive cord entanglement. The other one was associated with cesarean section due to dystocia of cord entanglement of the second fetus after vaginal birth of the first one. There is still no consensus in literature for the management and the mode of delivery of these rarely encountered cases (Fig. 3, Ref. 13).

Adolescent pregnancies and obstetric outcomes in southeast Turkey: data from two regional centers

PURPOSE OF INVESTIGATION

To evaluate adolescent pregnancy and obstetric outcomes.

METHODS

This retrospective cohort study was performed by analysis of patient files and birth records of pregnant women who delivered in two cities in Southeast Anatolia, Turkey. Pregnant women aged 19 years old and younger were included in the study group. Women between 20 and 35 years of age constituted the control group.

RESULTS

The incidence of adolescent pregnancy during the study period was 11%. Birth weight and hemoglobin level were significantly higher in the control group (p < 0.05). The majority of the women in the study group delivered vaginally (p < 0.05). The incidence of preterm labor, intrauterine growth retardation, and stillbirth was significantly higher in the study group (p < 0.05). Adolescent mothers were most likely to have low birth weight and very low birth weight babies (p < 0.05).

CONCLUSION

Adolescent pregnancies were associated with adverse pregnancy outcomes in our study population. Possible grounds for such increase warrant further evaluation and discussion.