Effect of pulse methylprednisolone on prognosis in SARS-CoV-2 patients with severe pneumonia.

OBJECTIVE: This study aimed to evaluate the effect of pulse methylprednisolone treatment on prognosis in severe COVID-19 pneumonia. PATIENTS AND METHODS: This retrospective cohort study included 128 patients hospitalized in our clinic for severe COVID-19 between March 2020 and February 2021. Standard treatment (plaquenil, favipravir, low molecular weight heparin, and antibiotics when necessary) was given to the patients in accordance with the Turkish Ministry of Health guidelines. After steroid treatment was included in the guidelines, dexamethasone 6 mg/day was administered along with standard treatment. In patients whose clinical condition did not improve despite this treatment, 250 mg/day methylprednisolone (pulse steroid therapy) was administered intravenous (i.v.) for 3 days, followed by a 40 mg/day maintenance dose. The group receiving methylprednisolone 250 mg/day for 3 days and the group receiving standard treatment without steroids were compared in terms of symptoms, comorbidities, laboratory and radiological findings, length of hospitalization, prognosis, intensive care unit (ICU) admission, and intubation. RESULTS: Of the 128 patients included in the study, 85 (66.4%) were male, and the mean age was 61.7 ± 13.2 years (min: 25; max: 88). A total of 50 (39.1%) patients were transferred to the ICU, while the number of intubated patients was 37 (28.9%). Pulse methylprednisolone treatment was given to 98 (76.6%) patients, compared to the 30 (23.4%) patients who received only standard treatment. In total, 37 patients (28.9%) died. The presence of comorbid diseases (34.3% vs. 1.5%, p = 0.012), advanced age (67.7 vs. 59.3, p = 0.001), and not receiving steroid treatment (p = 0.046) significantly increased mortality. The mortality rate was 24.4% (24/98 patients) in the steroid therapy group and 43.3% (13/30 patients) in patients not receiving steroid therapy, and the difference was statistically significant (p = 0.046). Pulse steroid therapy also significantly decreased the rate of intubation (p = 0.014) and ICU admission (p = 0.007). In the logistic regression analysis that included comorbidity, advanced age, and pulse steroid therapy, advanced age (p = 0.022) and pulse steroid therapy (p = 0.048) were found to be effective independent variables of mortality. CONCLUSIONS: The results showed that pulse i.v. methylprednisolone significantly reduced mortality in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients with severe pneumonia requiring hospitalization, in addition to significantly reducing the need for intensive care and intubation. In SARS-CoV-2 patients with severe pneumonia, pulse i.v. methylprednisolone may be useful as a standard treatment in patients who do not respond to dexamethasone.

Aspirin 300 mg/day is effective for treating aspirin-exacerbated respiratory disease.

BACKGROUND: Aspirin desensitization (AD) treatment at doses of up to 1300 mg/day improves outcomes in aspirin-exacerbated respiratory disease (AERD). The aim of this study was to investigate the efficacy of aspirin 300 mg/day in the treatment of patients with AERD. METHODS: The study included 40 patients diagnosed in our clinic as AERD that were desensitized and treated with aspirin 300 mg/day between December 2005 and December 2012. Changes from the baseline status were analyzed at 1 year and at 3 years of follow-up. RESULTS: Of the 40 patients included, 24 (60%) were female and median (interquartile range [IQR]) age was 45 (40-51) years. Median (IQR) duration of AD was 31.5 (10.5-48.5) months. In total, 29 patients continued treatment for at least 1 year and 18 patients for at least 3 years. The annual rate of use of systemic corticosteroid regimens, episodes of sinusitis, and surgery was significantly lower both at 1 year (P = 0.002, P = 0.01, and P < 0.001, respectively) and at 3 years (P = 0.001, P = 0.03, and P = 0.002, respectively). Significant improvement was observed in the nasal congestion score (P = 0.01) and sense of smell score (P = 0.05) at 1 year and in the postnasal drainage score (P = 0.01) at 3 years. CONCLUSION: Daily treatment with aspirin 300 mg had beneficial effects in patients with AERD, especially for the control of upper airway disease.

Immediate-type hypersensitivity reactions to proton pump inhibitors: usefulness of skin tests in the diagnosis and assessment of cross-reactivity.

BACKGROUND: Data are limited about the value of skin tests in the diagnosis of proton pump inhibitor (PPI)-induced hypersensitivity reactions and the cross-reactivity between PPIs. We aimed to assess the role of skin testing in the diagnosis of PPI-related immediate hypersensitivity reactions and the cross-reactivity patterns among PPIs. METHODS: The study was designed in a prospective, national, multicentre nature. Sixty-five patients with a suggestive history of a PPI-induced immediate hypersensitivity reaction and 30 control subjects were included. Standardized skin prick and intradermal tests were carried out with a panel of PPIs. Single-blind, placebo-controlled oral provocation tests (OPTs) with the PPIs other than the culprit PPI that displayed negative results in skin tests (n = 61) and diagnostic OPTs with the suspected PPI (n = 12) were performed. RESULTS: The suspected PPIs were lansoprazole (n = 52), esomeprazole (n = 11), pantoprazole (n = 9), rabeprazole (n = 2), and omeprazole (n = 1). The sensitivity, specificity, and negative and positive predictive values of the skin tests with PPIs were 58.8%, 100%, 70.8%, and 100%, respectively. Fifteen of the 31 patients with a hypersensitivity reaction to lansoprazole had a positive OPT or skin test result with at least one of the alternative PPIs (8/52 pantoprazole, 6/52 omeprazole, 5/52 esomeprazole, 3/52 rabeprazole). CONCLUSION: Considering the high specificity, skin testing seems to be a useful method for the diagnosis of immediate-type hypersensitivity reactions to PPIs and for the evaluation of cross-reactivity among PPIs. However, OPT should be performed in case of negativity on skin tests.

The general characteristics of acute urticaria attacks and the factors predictive of progression to chronic urticaria.

BACKGROUND: The natural history of progression from acute urticaria (AU) to chronic urticaria (CU) remains poorly understood. This study aimed to investigate the potential triggers of AU attacks and factors associated with their duration, as well as the factors which may be predictive of progression to CU. METHODS: The study included 281 AU patients (AU group). Data were obtained from 207 AU patients retrospectively and from 74 AU patients prospectively. The CU group consisted of 953 patients, whose data were previously published. RESULTS: According to the medical history, the most common potential triggers of AU attacks were drugs (38.1%); infections (35.2%); stress (24.7%); and foods (17.8%). Attack duration was shorter in cases in which food (p=0.04) or infection (p=0.04) was the suspected trigger. Patients with a history of rhinitis (p=0.04) and food allergy (p=0.04), and positive skin prick test results for pollens (p=0.02) and dog (p=0.02) also had attacks of shorter duration. Patients with asthma had attacks of longer duration (p=0.01). Based on history and/or provocation test results, the prevalence of non-steroidal anti-inflammatory drug hypersensitivity (NSAIDH) was significantly higher in the CU group than the AU group (24.9% vs. 4.3%, respectively, (p<0.01)), as was antibiotic hypersensitivity (10.6% vs. 4.6%, respectively, (p<0.01)) and food allergy (18.3% vs. 3.9%, respectively, (p<0.01)). NSAIDH (OR: 7.97; 95%CI: 4.33-14.66; p<0.01) and food allergy (OR: 5.17; 95%CI: 2.71-9.85; p<0.01) were observed to be independent factors associated with CU. CONCLUSIONS: As NSAIDH and food allergy were associated with CU, their presence should be carefully evaluated in patients with AU in order to predict progression to CU.

Storage mite sensitisation is associated with early life village residence in Turkey.

BACKGROUND: Storage mites (SMs) occur in house-dust and the rate of sensitisation to them is high. We aimed to investigate if past and current living conditions are associated with the risk of SM sensitisation. METHODS: In total, 321 patients (70% females) aged 33.6 ± 11.9 years (range: 14-68 years) were studied at our allergy unit between September 2009 and December 2010. Patients with persistent or intermittent rhinitis and/or asthma were included in the study. Skin prick tests (SPTs) for SMs (Lepidoglyphus destructor, Tyrophagus putrescentiae, and Acarus siro) and other common aeroallergens were performed. Demographic data and characteristics of the patients' homes were assessed via a questionnaire. RESULTS: In all, 102 (31.8%) patients were sensitised to ≥ 1 SM, of whom 43.1% were also sensitised to Dermatophagoides pteronyssinus. Comparison between the SPT-negative group (n = 129) and the SM-positive only group (n = 33) showed that having lived in a village during the first years of life was associated with SM sensitisation. Current place of residence was not significantly associated with any of the study variables. CONCLUSIONS: Living conditions have been changing and SM sensitisation may be associated with a history of village residence. The high rate of SM sensitisation observed in the study population might indicate the necessity of including those mite species in SPT panels, but the clinical relevance of sensitisation remains unclear. The clinical importance of SM sensitisation in urban areas should be investigated further.

Effect of the COVID-19 pandemic on smoking habits in a tertiary hospital.

OBJECTIVE: The aim of this study was to identify changes in smoking behaviors along with the reasons thereof, 1 year after the pandemic started. Alterations in the smoking behavior of patients were investigated in the study. PATIENTS AND METHODS: Patients admitted to our Smoking Cessation Outpatient Clinic between March 1st, 2019, and March 1st, 2020, and registered in the Tobacco Addiction Treatment Monitoring System (TUBATIS) were evaluated. Patients were called in March 2021 by the same physician who conducted the smoking cessation outpatient clinic. RESULTS: When the first year of the pandemic was over, the smoking behavior of 64 (63.4%) patients did not change. Of the 37 patients who changed their smoking behavior, eight (21.6%) increased the amount of tobacco they consumed, twelve (32.5%) decreased the amount of tobacco they consumed, eight (21.6%) quit smoking, and nine (24.3%) relapsed smoking. When the reasons for the changes in smoking behavior were examined 1 year after the pandemic started, it was determined that the primary reason for patients who increased the amount of tobacco they consumed and started smoking again was stress, and the primary cause in those who reduced the number of cigarettes and quit smoking was health concerns due to the pandemic. CONCLUSIONS: This result can be a guide for estimating smoking trends in future crises or pandemics and for making necessary plans during the pandemic period to increase the rate of smoking cessation.

A case of Seckel syndrome with Tetralogy of Fallot.

Seckel syndrome, also known as Harper's Syndrome and Virchow-Seckel-Syndrome, was first described by Seckel in 1960, and is a rare (<1:10,000 live births) autosomal recessive trait. The syndrome (OMIM 210600) is a form of primordial dwarfism, characterized by severe intrauterine growth restriction, postnatal dwarfism, severe microcephaly with variable mental retardation, facial anomalies and skeletal abnormalities. Cardiac anomalies have been described in only five case. We report a male newborn with typical findings of Seckel sydrome associated with Tetrology of Fallot. This is the first case reported in concomitance with Tetralogy of Fallot, and might be a new finding of the syndrome. We would like to emphasize that clinicians should perform diagnostic interventions for congenital cardiac defects in Seckel Syndrome.

Retinal haemorrhage rates and resolution time of retinal haemorrhage in newborns after hypothermic treatment for hypoxic-ischemic encephalopathy.

PURPOSE: The aim of this study was to evaluate retinal hemorrhages (RHs) in newborns after therapeutic hypothermia performed for hypoxic-ischemic encephalopathy (HIE). METHODS: From 2014 January to October 2016, full-term newborns who were referred to us from the neonatal intensive care unit at our hospital for ophthalmological examination were evaluated retrospectively. Neonates diagnosed with HIE were examined with a RetCam Digital Retinal Camera (Massie Research Laboratories Inc., Pleasanton, CA) using a 130-degree or binocular indirect ophthalmoscope (Heine, Herrsching, Germany) imaging tool and were classified into three groups. Group 1 included patients without HIE, group 2 included patients with stage I HIE, and group 3 included patients with stage II or III HIE. The RH rates in cases of HIE were retrospectively reviewed. RESULTS: A total of 148 eyes of 74 patients were included in the study. RH was detected in 36 eyes (24.3%); there were two eyes (3.7%), 14 eyes (20.6%), and 20 eyes (76.9%), in groups 1, 2, and 3, respectively. In group 3, RH was mostly seen in a widespread form. RHs involving the macula were resorbed later than haemorrhages in other locations. CONCLUSION: RHs are frequent in neonates with HIE. RHs were seen significantly more frequently in stage II-III HIE. These haemorrhages may require treatment, especially when the macula is involved.

Can PET-CT predict diagnostic success in ultrasonography-guided transthoracic fine needle aspiration biopsies in lung cancers?

OBJECTIVE: To examine any correlations between tumor maximum standard uptake values (SUVmax) in positron emission tomography-computed tomography (PET-CT) and homogeneous/heterogeneous tumor FDG uptake in PET-CT, and the diagnostic success of the procedure in thoracic ultrasonography (US)-guided transthoracic fine needle aspiration biopsy (TFNAB). METHODS: The files of patients who underwent thoracic US-guided TFNAB between 2013 and 2018 were examined. Patients who underwent thoracic US-guided TFNAB and were diagnosed as having primary lung cancer were considered as the US-TFNAB diagnostic group. Patients whose disease was diagnosed as primary lung cancer using a different diagnostic method (e.g. CT-guided biopsies, fiberoptic bronchoscopy) due to a lack of diagnosis despite undergoing thoracic US-guided TFNAB were allocated to the US-TFNAB non-diagnostic group. The clinical and radiologic characteristics and PET-CT parameters of the two groups were compared. RESULTS: A total of 104 patients were included in the study; 79 (76%) patients whose disease was diagnosed using US-guided TFNAB, and 25 (24%) patients whose primary lung cancer could not be diagnosed with US-guided TFNAB. The mean SUVmax value of the US-TFNAB diagnostic group was 19.5 ±â€¯10.1, whereas it was 15.1 ±â€¯8.9 in the US-TFNAB non-diagnostic group (p = 0.016). Whether a lesion showed homogeneous or heterogeneous FDG uptake did not effect diagnostic success (p = 0.289). SUVmax value was the only effective independent factor in the diagnostic success of the procedure (p = 0.035). CONCLUSIONS: High SUVmax values in PET-CT in lung cancers may increase the diagnostic success of US guided-TFNAB procedures.

Anthropometric measurements of term neonates from a state hospital in Turkey.

To determine regional percentile values and compare them with currently used national and international curves, we determined the birth weight, height and head and chest circumference of 3688 term neonates born in a state hospital in the Anatolian part of Istanbul, Turkey. Mean birth weight, height and head and chest circumference were 3334 (SD 494) g, 48.3 (SD 2.2) cm, 34.4 (SD 1.3) cm and 32.8 (1.9) cm respectively. For both boys and girls, the current Turkish national percentile curves overestimate the birth weight, height and head circumference at the 10th percentile. For boys, the national curves and those from the USA underestimate birth weight of neonates above the 90th percentile.

Relationship of Interleukin-10 and Transforming Growth Factor-ß Levels With Short-Term Graft Function After Kidney Transplantation.

INTRODUCTION: We evaluated the relationship of interleukin-10 (IL-10) and transforming growth factor-ß (TGF-ß) levels with graft function in kidney transplantation patients receiving tacrolimus-based immunosuppression during the early post-transplantation period. MATERIAL AND METHODS: There were 112 patients who underwent kidney transplantation from live donors between May 2011 and May 2013. Eight patients had at least 1 of the exclusion criteria, and the remaining 104 patients were included in the study. The recipients underwent evaluation for biochemical markers, complete blood count, and creatinine and cytokine (IL-10, TGF-ß) levels during the pretransplantation and post-transplantation 6 months. RESULTS: The creatinine level was negatively correlated with IL-10 and positively correlated with TGF-ß levels in both the pretransplantation and early post-transplantation period. CONCLUSION: Low serum TGF-ß and high IL-10 levels at post-transplantation month 6 might have a positive effect on graft survival in living donor kidney recipients on tacrolimus-based immunosuppressive treatment.

Transient neonatal methemoglobinemia caused by maternal pudendal anesthesia in delivery with prilocaine: report of two cases.

This paper reports two cases of transient neonatal methemoglobinemia caused by maternal pudendal anesthesia with prilocaine. In the first case a two-hour-old, 3100 gram term-male infant was admitted to Neonatal Intensive Care Unit (NICU) because of central cyanosis. He was born from a 21-year-old mother with spontaneous vaginal delivery. Central cyanosis was noted without respiratory distress. Oxygen saturation was recorded as 72% with pulse oximetry in room air and with oxygen given by mask. Chest radiogram, echocardiography and laboratory findings were found to be normal except a methemoglobin level of 28%. No etiology was found, except for maternal prilocaine administration during labor. In the second case a six-hour-old 3300 gram, full-term male neonate born by spontaneous vaginal delivery was admitted to NICU for central cyanosis. The neonate was noted to have central cyanosis with respiratory distress. Oxygen saturation with pulse oximetry was 70% with mask oxygen therapy. Methemoglobin level was 42%. The neonate was treated with single dose intravenous ascorbic acid (300 mg/kg) to which he responded dramatically at 24 hours of life. No other etiology was detected except pudendal anesthesia during delivery with prilocaine. According to the authors, prilocaine administered before delivery to provide maternal local pudendal anesthesia may cause transient neonatal methemoglobinemia. All neonates born to mothers who receive potential oxidant drugs like prilocaine just before the time of delivery should be carefully monitored for methemoglobinemia.

The effect of low-dose heparin on maintaining peripherally inserted percutaneous central venous catheters in neonates.

OBJECTIVE: To evaluate the effect of low-dose heparin on duration of peripherally inserted percutaneous central venous catheter (PCVC) patency and catheter occlusion. STUDY DESIGN: Our research was a prospective, randomized, controlled, double-blind clinical study including 246 eligible neonates with PCVCs. It was conducted at the neonatal intensive care unit (NICU) of Diyarbakir Children's Hospital between 1 February 2007 and 31 October 2008. In the heparin group (n=118), the total parenteral nutrition (TPN) solutions contained heparin, which was infused at a rate of 0.5 IU kg⁻¹ h⁻¹ . The no-heparin group (n=121) received TPN fluids without heparin. RESULT: In the heparin group, the duration of catheter patency was longer than that of the no-heparin group reaching a statistically significant difference (12.4 ± 4.5 vs 9.7 ± 4.0, P<0.0001). In the heparin group, the proportion of patients completing the TPN therapy successfully was higher than in the no-heparin group (P=0.0001; relative risk (RR): 3.32 (95% confidence interval (CI): 1.92 to 5.73)) also demonstrating a statistically significant difference. The rate of catheter occlusion among infants in the heparin group was smaller (P=0.0001; RR: 3.44 (95% CI: 1.92 to 6.44)). There were no statistically significant differences between the two groups in the incidence of other catheter-related problems. The length of the occluded catheter outside the skin, TPN infusion rate and catheter duration time were found to be the factors associated with catheter occlusion. Heparin prevented catheter occlusion with a mechanism unrelated to these factors. CONCLUSION: In neonates with PCVCs, low-dose continuous infusion of heparin (0.5 IU kg ⁻¹h⁻¹ within TPN fluids is an effective measure in terms of reducing catheter occlusion, allowing successful completion of the therapy, without increasing adverse effects. Furthermore, this effect of heparin may occur independently via occlusion-related factors that we evaluated in the study.

A mutation in thyroid hormone receptor beta causing "resistance to thyroid hormone" in a neonate.

Resistance to thyroid hormone (RTH) is an inherited syndrome characterized by reduced tissue responsiveness to thyroid hormones. The main defects are due to mutations in thyroid hormone receptor beta (TRbeta). A male, term neonate was admitted because of indirect hyperbilirubinemia and polycythemia. Physical examination revealed ophtalmopathy. High serum T4 with unsupressed thyroid stimulating hormone (TSH) levels suggested RTH. In this presented case, A317T mutation was detected on exon 9 of the TRb-1 gene and precise diagnosis had been confirmed with genetic testing. In neonates and infants exhibiting hypo or hyperthyroidism features with increased circulating levels of thyroid hormones with a normal or increased serum TSH concentration should raise the suspicion of RTH.

Three blastocyst stage embryo transfer resulting in a quintuplet pregnancy.

High-order pregnancies are associated with high morbidity and mortality and the incidence is increased as a drastic complication of assisted reproductive technology. This case presents a high-order pregnancy achieved by transfer of three blastocyst stage embryos resulting in a quintuplet pregnancy including a monochorionic triplet. Following the selective termination of the monochorionic triplet, two healthy children were born. The mechanism of monochorionic development and its association with assisted reproductive technology are discussed.

Anthropometric measurements of term neonates from a state hospital in Turkey

To determine regional percentile values and compare them with currently used national and international curves, we determined the birth weight, height and head and chest circumference of 3688 term neonates born in a state hospital in the Anatolian part of Istanbul, Turkey. Mean birth weight, height and head and chest circumference were 3334 [SD 494] g, 48.3 [SD 2.2] cm, 34.4 [SD 1.3] cm and 32.8 [1.9] cm respectively. For both boys and girls, the current Turkish national percentile curves overestimate the birth weight, height and head circumference at the 10th percentile. For boys, the national curves and those from the USA underestimate birth weight of neonates above the 90th percentile