Analysis of candidemia cases in a city hospital during the COVID-19 pandemic.

OBJECTIVE: The frequency and mortality of candidemia remain important. Non-albicans Candida species such as C. auris are increasing. PATIENTS AND METHODS: A retrospective review of adult patients diagnosed with bloodstream infection due to Candida species in the 17 months between July 1, 2020, and December 1, 2021, was performed. Yeast colonies grown in culture were identified by matrix-assisted laser desorption/ionization time-of-flight. Antifungal susceptibility tests of Candida strains were performed with Sensititre YeastOne (TREK Diagnostic Systems Inc., Westlake, Ohio) kits, and minimum inhibitory concentration values were evaluated according to the Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility Testing (EUCAST) clinical breakpoints. RESULTS: In total, 217 patients (mean age 64.9±15.7 years) were included. C. albicans was the most common fungus (detected in 82 patients; 37.8%), followed by C. parapsilosis (17.1%), C. glabrata (15.2%), C. tropicalis (15.2%), and C. auris (9%). Candidemia developed in 175 (81.4%) of the cases during their intensive care unit stay. Fluconazole (41.0%) and caspofungin (36.4%) were the two most frequently used antifungal agents in antifungal therapy. There were 114 (52.3%) deaths in the study group. Mortality rates were found to be lower in patients infected with C. parapsilosis or C. auris. Age and previous COVID-19 infection were other important risk factors. When the 217 Candida spp. were examined, resistance and intermediate susceptibility results were higher when EUCAST criteria were used. While the two methods were found to be fully compatible only for fluconazole, a partial agreement was also observed for voriconazole. CONCLUSIONS: As our study observed, the COVID-19 pandemic brought increasing numbers of immunosuppressed patients, widespread use of antibacterials, and central venous catheters, increasing the frequency and mortality of candidemia cases. All health institutions should be prepared for the diagnosis and treatment of candidemia. In addition, C. auris, the frequency of which has increased in recent years, is a new factor that should be considered in candidemia cases.

Comparison of safety and efficiency between sequential simultaneous bilateral and staged bilateral total knee arthroplasty at a high-volume center: a retrospective cohort study.

The treatment strategy remains controversial for bilateral end-stage osteoarthritis, particularly with regard to patient safety. The aim of this study was to compare the safety and clinical results of sequential simultaneous bilateral total knee arthroplasty (ssBTKA) and staged bilateral total knee arthroplasty (staBTKA). Patients who underwent either simultaneous (n=168) or staged (n=63) bilateral total knee arthroplasty in a single center between February 2017 and April 2021 were identified retrospectively. Data related to age, gender, body mass index, ASA score, comorbidities, operative time, transfusion rate, length of stay, knee range of motion (ROM), Knee Society Score (KSS), complications, and mortality rates were evaluated. Mean follow-up duration was 39.0±14.7 months. Preoperative characteristics were similar among cohorts. Transfused units were significantly higher in the ssBTKA group (p<0.001). Operative time and length of stay were significantly higher in the staBTKA group (respectively, p<0.001 and p=0.004). Complication rates (except superficial infection rate which was significantly higher in the staBTKA group), revision rates, mortality rates and functional outcomes were statistically similar between the groups (p>0.05). Presence of preoperative coronary artery disease comorbidity was significantly associated with increased postoperative myocardial infarction risk (p=0.001). ssBTKA provided similar functional results, shorter cumulative hospital stay and shorter operative time without increasing complications and mortality rates compared to staBTKA procedure. For patients with pre-existing coronary artery disease, a more cautious approach should be preferred to decrease complications.

The effect of impacted third molars on second molar external root resorption, a cross-sectional cone beam computed tomography study.

BACKGROUND: Third molars have the highest prevalence of impaction in teeth and can cause pathological damage on the adjacent second molars. This study aims to evaluate the effects of factors related to impacted third molars on external root resorption (ERR) in adjacent second molars using cone-beam computed tomography (CBCT). MATERIAL AND METHODS: In CBCTs, the effect of impacted third molars on the root surface of adjacent second molars was investigated. Inclusion criteria for subjects were being older than 16 and younger than 55, presence of at least one impacted third molar and adjacent second molar. Exclusion criteria were pathology, a follicle gap greater than 5 mm, crowned second molar, severe decay, an artifact on a radiologic image, and previous surgery on the second or third molars. The investigations were made based on age range, gender, tooth inclination, Pell-Gregory classification, retention type, contact area, root formation, pericoronal width, and tooth absence on the same quadrant for potential risk factors. The collected data were statistically analyzed with R software. The Chi-Square test was used to find out any significant difference. Logistic regression analyses were done for potential risk factors for ERR. RESULTS: A total of 437 impacted third molars and adjacent second molars were investigated using CBCT. Of these, 381 met the inclusion criteria. Mesioangular and horizontal inclination, Pell-Gregory Class B-C, contact area, and retention type were found the statistically potential risk factors for ERR. CONCLUSIONS: The impacted third molar with horizontal or mesioangular position, and osseous retention, with Pell and Gregory Class B and C, are more likely to cause external root resorption in adjacent second molars.

Pre-seasonal immunotherapy is effective in both monosensitized and polysensitized patients with allergic rhinitis.

Summary: Background. The effectiveness of pre-seasonal allergoid immunotherapy in polysensitized patients are not well-known. The aim of the present study was to compare the clinical efficacy and immunological changes of pre-seasonal allergoid immunotherapy in mono and polysensitized patients with grass pollen allergy. Methods. Fourty six patients with seasonal allergic rhinitis undergoing pre-seasonal grass pollen immunotherapy and 28 cases followed by conventional drug treatment were included. These groups were divided into monosensitized and polysensitized ones. All patients were followed between March-September with symptom-medication scores, and visual analogue scale (VAS). The quality of life was assessed using the Mini-RQLQ questionnaire. Phleum pratense (Phl p) specific IgE and IgG4 (UNI-CAP 100, Phadia) measurements were performed before and after 7 weeks of immunotherapy. Results. In the immunotherapy group, 15th weekly symptom-medication scores and VAS scores between May and August were found to be significantly lower than those in the control group (p < 0.05). Phl p specific IgE and IgG4 levels were significantly higher after immunotherapy compared to those before immunotherapy (p = 0.001). Furthermore, Phl p specific IgG4 levels after immunotherapy were also significantly higher than in the control group (p = 0.001). Improvements in activities-practical problems and non-nose/eye symptoms quality of life scores were significantly different between two groups (p < 0.05). There was no difference in terms of clinical and immunological parameters in mono- and polysensitized patients (p > 0.05). Conclusions. This study indicates that clinical improvement with pre-seasonal grass pollen immunotherapy is accompanied by important increase in specific IgG4 blocking antibodies. Furthermore, a single-allergen immunotherapy can lead to similar clinical efficacy and immunological changes in polysensitized as well as monosensitized patients with grass pollen allergy.

Overview of asthma patients followed up in a tertiary clinic.

Summary: Background. Asthma is a disease that combines different biological mechanisms, inflammatory pathways, and phenotypic features. Our aim was to investigate the demographic and disease characteristics of patients with asthma and to reveal the distribution with different phenotypes according to endotype groups. Methods. Patients were identified as eosinophilic if the absolute eosinophil count was measured at least once ≥ 300/µL during the oral corticosteroid free period or ≥ 150/µL under oral corticosteroids. Patients sensitive to at least one inhalant allergen with skin prick test and/ or spIgE measurement were defined as allergic. They were categorized into four main endotypes. Results. Data of 405 asthma patients with a median age of 50.9 years were analyzed. The prominent clinical and phenotypic characteristics of the study group were being obese (43.2%) or overweight (32%), severe asthma (49.6%), adult-onset (56.1%) or late-onset asthma (35.3%). The distribution of the four main endotypes according to eosinophilic and/or allergic status, is as follows: 22.7% allergic-eosinophilic (AE), 27.9% nonallergic-eosinophilic (NAE), 22.9% allergic-noneosinophilic (ANE), 26.4% nonallergic-noneosinophilic (NANE). While most severe asthma patients were in the AE and NAE groups, those with early-onset asthma were in AE and ANE, and those with late-onset asthma were in the NAE and NANE groups. The proportion of uncontrolled patients was higher in the NAE group. Among the severe asthma patients, the rate of uncontrolled disease was higher in those with NANE asthma. Conclusions. Different phenotypes were more closely related to some endotypes. This may allow the clinicians to identify patients and predict appropriate treatment modalities and response for individualized care.

The effects of laparoscopic Roux-en-Y gastric bypass and one-anastomosis gastric bypass on glycemic control and remission of type 2 diabetes mellitus: study protocol for a multi-center randomized controlled trial (the DIABAR-trial).

BACKGROUND: Metabolic surgery induces rapid remission of type 2 diabetes mellitus (T2DM). There is a paucity of high level evidence comparing the efficacy of the laparoscopic Roux-en-Y gastric bypass (RYGB) and the laparoscopic one-anastomosis gastric bypass (OAGB) in glycemic control. Also, the mechanisms that drive the conversion of T2DM in severe obese subjects to euglycemia are poorly understood. METHODS: The DIABAR-trial is an open, multi-center, randomized controlled clinical trial with 10 years follow-up which will be performed in 220 severely obese patients, diagnosed with T2DM and treated with glucose-lowering agents. Patients will be randomized in a 1:1 ratio to undergo RYGB or OAGB. The primary outcome is glycemic control at 12 months follow-up. Secondary outcome measures are diverse and include weight loss, surgical complications, psychologic status and quality of life, dietary behavior, gastrointestinal symptoms, repetitive bloodwork to identify changes over time, glucose tolerance and insulin sensitivity as measured by mixed meal tests, remission of T2DM, presence of non-alcoholic fatty liver disease/non-alcoholic steatohepatitis in liver biopsy, oral and fecal microbiome, cardiovascular performance, composition of bile acids, and the tendency to develop gallstones. DISCUSSION: The DIABAR-trial is one of the few randomized controlled trials primarily aimed to evaluate the glycemic response after the RYGB and OAGB in severe obese patients diagnosed with T2DM. Secondary aims of the trial are to contribute to a deeper understanding of the mechanisms that drive the remission of T2DM in severe obese patients by identification of microbial, immunological, and metabolic markers for metabolic response and to compare complications and side effects of RYGB and OAGB. TRIAL REGISTRATION: ClinicalTrials.gov NCT03330756 ; date first registered: October 13, 2017.

Adipose Tissue, Bile Acids, and Gut Microbiome Species Associated With Gallstones After Bariatric Surgery.

Several risk factors are associated with gallstone disease after bariatric surgery, but the underlying pathophysiological mechanisms of gallstone formation are unclear. We hypothesize that gallstone formation after bariatric surgery is induced by different pathways compared with gallstone formation in the general population, since postoperative formation occurs rapidly in patients who did not develop gallstones in preceding years. To identify both pathophysiological and potentially protective mechanisms against postoperative gallstone formation, we compared the preoperative fasting metabolome, fecal microbiome, and liver and adipose tissue transcriptome obtained before or during bariatric surgery of obese patients with and without postoperative gallstones. In total, 88 patients were selected from the BARIA longitudinal cohort study. Within this group, 32 patients had postoperative gallstones within 2 years. Gut microbiota metagenomic analyses showed group differences in abundance of 41 bacterial species, particularly abundance of Lactobacillaceae and Enterobacteriaceae in patients without gallstones. Subcutaneous adipose tissue transcriptomic analyses revealed four genes that were suppressed in gallstone patients compared with patients without gallstones. These baseline gene expression and gut microbiota composition differences might relate to protective mechanisms against gallstone formation after bariatric surgery. Moreover, baseline fasting blood samples of patients with postoperative gallstones showed increased levels of several bile acids. Overall, we revealed different genes and bacteria associated with gallstones than those previously reported in the general population, supporting the hypothesis that gallstone formation after bariatric surgery follows a different trajectory. Further research is necessary to confirm the involvement of the bile acids, adipose tissue activity, and microbial species observed here.

Can dose reduction be made in patients with allergic bronchopulmonary aspergillosis receiving high-dose omalizumab treatment?

Summary: Objective. To reduce the omalizumab dose in patients with allergic bronchopulmonary aspergillosis (ABPA) who were on long-term omalizumab treatment. Methods. Once asthma was controlled, two approaches were used to reduce total monthly omalizumab dose, 1) both extending dose intervals from 2 to 4 weeks and decrease omalizumab dose, 2) to reduce omalizumab dose while keeping dose intervals stable. Results. Thirteen patients with ABPA (8F/5M, mean age 53.4 ± 13.0 years) were included. Pre-omalizumab, mean blood eosinophil count was 723.1 ± 547.1 cells/mcL, mean numbers of attacks and hospitalizations were 2.5 ± 1.5 and 1.3 ± 0.8, respectively. Median total monthly omalizumab dose was 750 (min 300, max 900) mg. First and 2nd approach to reduce omalizumab dose was used in nine and four patients with a median time of reduction 32 (min 13, max 47) months. The 2nd dose reduction was made in four patients at median of 23.5 months. Pre-omalizumab, mean oral corticosteroid (OCS, as methylprednisolone) dose was 12.2 ± 10.4 mg daily, it decreased to 0.69 ± 0.95 mg (p = 0.001) in the 1st year of omalizumab and could be stopped in 11 patients. Attacks and hospitalizations decreased to 0.31 ± 0.86 (p less than 0.001) and 0 (p = 0.003), respectively, in the 1st year of omalizumab. Total omalizumab dose was reduced by median 40% (min 20, max 60) in 1st intervention and 50% (min 20, max 67) after 2nd intervention. After omalizumab reduction, asthma control did not deteriorate and there was no need to increase the omalizumab or OCS-dose. Conclusions. Decreasing the total omalizumab dose does not cause clinical deterioration in ABPA after the disease is controlled.

Indoleamine-2,3-dioxygenase-related anti-inflammatory effects of 3-aminobenzamide and infliximab in experimental colitis

SUMMARY OBJECTIVE: This study aimed to investigate the presence of indoleamine-2,3-dioxygenase and bacterial translocation after the administration of 3-aminobenzamide and infliximab in the TNBS model of rat colitis. METHODS: The study group was divided into five categories as follows: group 1: (control), group 2: colitis+saline, group 3: colitis+3-aminobenzamide, group 4: colitis+infliximab, and group 5: colitis+3-aminobenzamide+infliximab. Intestinal mesenteric cultures were incubated on specific agar media plates under aerobic and anaerobic conditions, bacterial translocation was evaluated and assessed as colony-forming units per gram of tissue. Colonic tissue samples were evaluated by Western blotting method to detect the presence of indoleamine-2,3-dioxygenase. RESULTS: The results obtained were as follows: group 1: normal gut flora; group 2: eight of nine samples had bacterial translocation, of which six of them had positive indoleamine-2,3-dioxygenase protein; group 3: five of nine samples had bacterial translocation, of which seven of them had positive indoleamine-2,3-dioxygenase; group 4: three of nine samples had bacterial translocation, of which seven of them had positive indoleamine-2,3-dioxygenase; and group 5: only one sample had exact indoleamine-2,3-dioxygenase protein. CONCLUSION: Altered expression of indoleamine-2,3-dioxygenase results in a lower bacterial translocation via infliximab compared with 3-aminobenzamide treatment. Combined treatments emphasized different approaches for the new molecules related to indoleamine-2,3-dioxygenase.

Patients with rheumatic diseases are ready to use social media in clinical practice; what about rheumatologists? A cross-sectional survey.

Social media can be an innovative communication method between patients and physicians that help to overcome time limitation in outpatient clinics. In this study, we investigated how patients with rheumatic diseases (RD) and physicians use and are willing to use social media platforms to communicate with each other. We used a face-to-face survey that provides information on current social media habits and communication methods of rheumatology patients and physicians. We studied 399 (135 M/262 F) patients with RD with a median age of 45 (IQR: 34) years. We also studied 55 (30 M/25F) rheumatologists with a median age of 37 (IQR:34-44) years. Among patients with RD, 288 (72%) used at least one social media site within the previous month. Facebook was the most preferred social media platform, whereas Twitter and Instagram were favored by males and higher educated patients. While 17% of the patients with RD could communicate with their physicians outside of the hospital, 94% expressed that they would like to. Most patients (74%) defined social media as a reliable source for health-related information, yet 90% declared that they would like to obtain information about their disease using face-to-face communication. Forty-two (83%) rheumatologists were using social media and reported that they already communicate or would like to communicate with their patients outside of the hospital. Internet-based mobile applications and social media platforms are promising communication and educational tools for rheumatology patients.

Psychometric validation of the desire thinking questionnaire in a Turkish adolescent sample: Associations with internet gaming disorder.

BACKGROUND: Desire thinking is a conscious and voluntary cognitive process that consists of perseverative focus on information, memories, and prefiguration of images related to a desired target. The Desire Thinking Questionnaire (DTQ) is acknowledged as a reliable and valid tool to measure desire thinking in both adults and adolescents. The aim of the present study was to examine the psychometric properties of the DTQ in Turkish adolescent sample. METHODS: A convenience sample of 200 adolescents completed the Turkish version of the DTQ (DTQ-T) and an Exploratory Factor Analysis (EFA) was performed. Subsequently, a convenience sample of 701 adolescents completed the DTQ-T and a battery of questionnaires assessing personality traits, affect, boredom, impulsivity, and Internet Gaming Disorder (IGD). A Confirmatory Factor Analysis (CFA) was performed on the DTQ-T and validity was determined by examining correlations with other measures. RESULTS: A 9-item two-factor structure was observed in the EFA. An 8-item two-factor structure was established in the CFA. Results demonstrated that the DTQ-T yields adequate levels of reliability and concurrent validity. Additionally, an examination of incremental validity showed that DTQ-T significantly predicted IGD when controlling for personality traits, affect, boredom, and impulsivity. CONCLUSIONS: The 8-item DTQ-T was found to be a reliable and valid measure of desire thinking among Turkish adolescents. Desire thinking may be a feasible target for mental health workers to alleviate the symptoms of IGD.

A systems biology approach to understand gut microbiota and host metabolism in morbid obesity: design of the BARIA Longitudinal Cohort Study.

INTRODUCTION: Prevalence of obesity and associated diseases, including type 2 diabetes mellitus, dyslipidaemia and non-alcoholic fatty liver disease (NAFLD), are increasing. Underlying mechanisms, especially in humans, are unclear. Bariatric surgery provides the unique opportunity to obtain biopsies and portal vein blood-samples. METHODS: The BARIA Study aims to assess how microbiota and their metabolites affect transcription in key tissues and clinical outcome in obese subjects and how baseline anthropometric and metabolic characteristics determine weight loss and glucose homeostasis after bariatric surgery. We phenotype patients undergoing bariatric surgery (predominantly laparoscopic Roux-en-Y gastric bypass), before weight loss, with biometrics, dietary and psychological questionnaires, mixed meal test (MMT) and collect fecal-samples and intra-operative biopsies from liver, adipose tissues and jejunum. We aim to include 1500 patients. A subset (approximately 25%) will undergo intra-operative portal vein blood-sampling. Fecal-samples are analyzed with shotgun metagenomics and targeted metabolomics, fasted and postprandial plasma-samples are subjected to metabolomics, and RNA is extracted from the tissues for RNAseq-analyses. Data will be integrated using state-of-the-art neuronal networks and metabolic modeling. Patient follow-up will be ten years. RESULTS: Preoperative MMT of 170 patients were analysed and clear differences were observed in glucose homeostasis between individuals. Repeated MMT in 10 patients showed satisfactory intra-individual reproducibility, with differences in plasma glucose, insulin and triglycerides within 20% of the mean difference. CONCLUSION: The BARIA study can add more understanding in how gut-microbiota affect metabolism, especially with regard to obesity, glucose metabolism and NAFLD. Identification of key factors may provide diagnostic and therapeutic leads to control the obesity-associated disease epidemic.

Seroprevalence and associated risk factors of Toxoplasma gondii in sheep in Erzurum province, Eastern Anatolia region, Turkey.

BACKGROUND: Toxoplasmosis causes economic losses due to abortion, neonatal death and reproductive diseases in infected sheep. Erzurum is one of the most important cities in Turkey where sheep farming is done. Aims: The aim of this study was to evaluate seroprevalence of Toxoplasma gondii and related risk factors in sheep brought to the slaughterhouse in Erzurum province of Eastern Anatolia region, Turkey. METHODS: Nine-hundred and sixty sheep brought to slaughterhouse from Erzurum center and districts were used in this study. The data on age, breed, abortion history of sheep and whether or not they had contact with cats were recorded. The presence of T. gondii antibodies was determined by enzyme-linked immunosorbent assay (ELISA) kit in blood samples taken from sheep just before slaughter. RESULTS: According to the study results, 44 (4.58%) of 960 sheep were found to be seropositive. Seroprevalence was found to be highest in the ≥2<3 age group with 5.29% (P>0.05), and it was more common in Akkaraman breed compared to Morkaraman breed (P<0.01). It was determined that 43 (97.73%) of the 44 seropositive sheep had contact with cats (P<0.01) and 12 of them (27.27%) had abort history. CONCLUSION: The study results identify the presence of T. gondii in the sheep from Erzurum province of Eastern Anatolia region, Turkey.

Distinct differences in gut microbial composition and functional potential from lean to morbidly obese subjects.

INTRODUCTION: The gut microbiome may contribute to the development of obesity. So far, the extent of microbiome variation in people with obesity has not been determined in large cohorts and for a wide range of body mass index (BMI). Here, we aimed to investigate whether the faecal microbial metagenome can explain the variance in several clinical phenotypes associated with morbid obesity. METHODS: Caucasian subjects were recruited at our hospital. Blood pressure and anthropometric measurements were taken. Dietary intake was determined using questionnaires. Shotgun metagenomic sequencing was performed on faecal samples from 177 subjects. RESULTS: Subjects without obesity (n = 82, BMI 24.7 ± 2.9 kg m-2 ) and subjects with obesity (n = 95, BMI 38.6 ± 5.1 kg m-2 ) could be clearly distinguished based on microbial composition and microbial metabolic pathways. A total number of 52 bacterial species differed significantly in people with and without obesity. Independent of dietary intake, we found that microbial pathways involved in biosynthesis of amino acids were enriched in subjects with obesity, whereas pathways involved in the degradation of amino acids were depleted. Machine learning models showed that more than half of the variance in body fat composition followed by BMI could be explained by the gut microbiome, composition and microbial metabolic pathways, compared with 6% of variation explained in triglycerides and 9% in HDL. CONCLUSION: Based on the faecal microbiota composition, we were able to separate subjects with and without obesity. In addition, we found strong associations between gut microbial amino acid metabolism and specific microbial species in relation to clinical features of obesity.

Molecular characterisation and phylogenetic analysis of Marek's disease virus in Turkish layer chickens.

1. There is no current data about the genotypes of Marek's disease virus (MDV) in Turkish poultry flocks; hence, this study was performed to analyse CVI988/Rispens, turkey herpesvirus (HVT) vaccine viruses and MDV field viruses as well as to perform phylogenetic analysis of MDV in Turkish layer chickens. 2. In 2017 and 2018, a total of 602 spleen samples from 49 layer flocks were collected from the Marmara, West Black Sea and Aegean regions. DNA was extracted from the spleen samples and the samples were analysed by real-time PCR probe assay to detect CVI988/Rispens and HVT vaccine viruses and MDV field strains. Samples found positive for MDV by real-time PCR were subjected to PCR using the Meq gene primers for phylogenetic analysis. 3. Amongst 49 flocks, virulent MDV was detected in nine flocks. CVI988/Rispens and HVT vaccine strains were detected in 47 flocks and HVT in all 49 flocks. Splenomegaly, hepatomegaly and tumours in the oviduct were observed in chickens of affected flocks. Virulent MDV was detected in 120 out of 602 spleen samples. Sequencing and phylogenetic analyses showed that MDVs detected in this study were closely related to MDV strains from Italy, Poland, Saudi Arabia, Iraq, India and China but showed diversity with MDV strains from Egypt and Hungary. Multiple sequence analysis of the Meq protein revealed several point mutations in deduced amino acid sequences. Interestingly, CVI988/Rispens vaccine virus from China (AF493555) showed mutations at position 66 (G66R) and 71 (S66A) along with two other vaccine strains from China (GU354326.1) and Russia (EU032468.1), in comparison with the other vaccine strain CVI988/Rispens (DQ534538). The molecular analyses of the Meq gene suggested that Turkish field strains of MDV are in the class of virulent or very virulent pathotypes. 4. The results have shown that MDV still affects poultry health, and the phylogenetic and amino acid variation data obtained will help in vaccination and control strategies.

Ruptured cystic teratoma associated with mucinous cystadenoma in a pregnant woman.

Mature cystic teratoma is the most common ovarian neoplasm. However, mucinous cystadenoma with teratoma has been very rarely reported in literature. This case report, which is very rare, describes a clinical entity not previously reported in literature. A 34-year-old pregnant woman presented in the 23rd gestational week with severe right lower quadrant pain. She was diagnosed with acute abdomen and was then treated surgically. During the surgical intervention, a spontaneously ruptured mass was detected in the right ovary. This was reported histopathologically as a mature cystic teratoma in collision with mucinous cystadenoma. To the best of our knowledge, this case report is the first to have identified a ruptured mature cystic teratoma in collision with mucinous cystadenoma in a pregnant woman.

Phylogeny and evolution of infectious bursal disease virus circulating in Turkish broiler flocks.

The emergence of new infectious bursal disease virus (IBDV) variants can threaten poultry health and production all over the world causing significant economic losses. Therefore, this study was performed to determine IBDV molecular epidemilogy, VP2 gene variation, and corresponding pathological lesions in IBDV infected chickens in Turkey. For this, 1855 bursa of Fabricius samples were collected from 371 vaccinated broiler flocks. Atrophia and haemorrhages were seen in the bursa Fabricius of very virulent IBDV (vvIBDV) infected chickens. Partial VP2 gene was sequenced and phylogenetic, recombination, and evolutionary analyses were performed. 1548 (83.5%) out of 1855 of bursa of Fabricius samples were IBDV positive and 1525 of those could be sequenced. The recombination analysis did not detect occurrence of any recombination event among the Turkish strains. Among 1525 sequenced samples, 1380 of them were found to be classical strains. Among 1380 classical strains, 1317 were similar to IBDV 2512, 11 to Faragher 52/70, 40 to 228 E, and 12 to Lukert strain. Out of 1525 reverse transcriptase ploymerase chain reaction positive samples, 144 of them were found to be similar to vvIBDV-VP2 gene reported to GenBank previously. The phylogenetic tree performed on a broad sequence dataset demonstrated grouping of vvIBDV Turkish strains in three different clusters, including sequences collected also from Iraq and Kuwait (Cluster 1), Indian (Cluster 2), and a distinct Turkish-only cluster (Cluster 3). The evolutionary rate estimation on branches/clades including Turkish strain mirrored the expected one for RNA viruses and no significant differences were found among different considered branches. In conclusion, results of this study indicate that vvIBDV strains similar to those circulating in various countries in the Middle East are present and undergoing evolution in chickens from Turkish broiler flocks. This point needs to be taken into account in planning adequate control strategies.

Local anesthetics allergy: who should be tested?

Summary: Objective. To document the test results of patients referred to our clinic for testing with local anesthetics (LAs) in real life conditions and provide data related to the necessity of these tests. Methods. All consecutive subjects who were referred to be evaluated for LA allergy during a two-year follow up were included in the analysis. All subjects underwent skin prick / intradermal tests followed by a subcutaneous provocation test with the LAs tested. Results. A total of 228 subjects were included. The main referral reason was the presence of a history of drug hypersensitivity reaction (DHR) to drugs other than LAs (n = 128; 56%), whereas a history of LA allergy constituted the second most common referral reason (n = 64, 28.1%). In the majority of cases (n = 39; 60.9%), the culprit LA was not known by the patients. Asthma was the third most common referral reason, presented in 49 cases (21.5%). Ten cases had positivity to the tested LA in skin testing / challenges. Nine out of 10 patients had a history of DHR to drugs other than LA, whereas 5 of them had also a history of DHR to LA. Six of the 10 patients had a history of multiple DHR. None of the asthma patients without any DHR history were positive in the LA tests. Eight out of 10 cases who underwent skin testing / challenge with an alternative LA, tolerated the alternative LA. Conclusion. The most common referral reason for testing with LA was a history of DHR to drugs other than LAs, whereas asthma was the third most common referral reason. Patients with a history of multiple DHR may be considered for testing with LAs. Asthmatics and those with other allergic diseases without a history of drug / LA allergy do not need to be tested with LA.

Rhino-Orbita-Maxillary Mucormycosis After Liver Transplantation: A Case Report.

Mucormycosis is a rare lethal complication of organ transplantation that progresses rapidly, and the prognosis is dismal if diagnosed late. We present a surviving liver transplant recipient in whom severe rhino-orbita-maxillary mucormycosis developed 1 month after liver transplantation. Prompt diagnosis with tissue biopsy, local control of the underlying condition with aggressive surgical debridement, and appropriate administration of systemic antifungal therapies are essential to improve prognosis and survival.