Diagnostic approach of tuberculous lymphadenitis in a multicenter study.

INTRODUCTION: Tuberculous lymphadenitis (TBLN) is the most common infectious etiology of peripheral lymphadenopathy in adults, in Turkiye. This study aimed to identify the demographic, clinical, and laboratory variables that differentiate TBLN from non-tuberculous lymphadenitis (NTBLN), as well as the etiology of lymphadenopathy in adults. METHODOLOGY: Patients who were over 18 years old and were referred to the infectious disease outpatient clinics with complaints of swollen peripheral lymph nodes, and who underwent lymph node biopsy between 1 January 2010 and 1 March 2021, were included in this multicenter, nested case-control study. RESULTS: A total of 812 patients at 17 tertiary teaching and research hospitals in Turkiye were included in the study. TBLN was the most frequent diagnosis (53.69%). The proportion of patients diagnosed with TBLN was higher among females; and among those who had a higher erythrocyte sedimentation rate, positive purified protein derivative test, and positive interferon-gamma release test result (p < 0.05). However, TBLN was less frequent among patients with generalized lymphadenopathy, bilateral lymphadenopathy, axillary lymphadenopathy, inguinal lymphadenopathy, hepatomegaly, splenomegaly, leukocytosis, and moderately increased C reactive protein levels (p < 0.05). CONCLUSIONS: Identifying the variables that predict TBLN or discriminate TBLN from NTBLN will help clinicians establish optimal clinical strategies for the diagnosis of adult lymphadenopathy.

Monitoring of antibody levels in healthcare workers after inactivated coronavirus disease 19 vaccination

SUMMARY OBJECTIVE: Because of the coronavirus disease 19 pandemic, studies on vaccination are being conducted in our country as well as across the world. In this study, the antibody levels in healthcare workers vaccinated with two doses of inactivated vaccine and the factors affecting these levels were investigated. METHODS: Randomly selected volunteers from healthcare workers, who had been vaccinated with two doses of inactivated vaccine in January to February 2021, were included in the study. Blood samples were drawn twice, 1 month and 6 months after the second dose vaccine (CoronaVac:Sinovac Life Science Co, Ltd, Beijing, China). The antibody levels were determined by the chemiluminescence microparticle immunoassay method using kits for quantitative detection of immunoglobulin class G antibodies to severe acute respiratory syndrome coronavirus 2. RESULTS: The mean antibody levels of 129 volunteers were 1232.5 (min: 103 to max: 7151) AU/mL in the first month and 403.5 (min: 23 to max: 4963) AU/mL in the sixth month. According to the survey results, 91 (71%) volunteers had not been diagnosed with coronavirus disease 19 before vaccination. The antibody levels 1 month and 6 months after the second dose of vaccination were significantly higher in those who had been diagnosed with coronavirus disease 19 before vaccination than in those who had not. It was found that age, gender, fast food, or healthy nutrition had no effect on antibody levels. CONCLUSION: Vaccines are very important both to protect against coronavirus disease 19 and to experience only a mild form of the disease. Immunoglobulin class G levels formed after vaccination may be affected by many factors and may decrease over time.

Efficacy and Safety of Direct-Acting Antivirals in Elderly Patients with Chronic Hepatitis C: A Nationwide Real-Life, Observational, Multicenter Study from Turkey.

BACKGROUND: The number and proportion of elderly patients living with chronic hepatitis C are expected to increase in the coming years. We aimed to compare the real-world efficacy and safety of direct-acting antiviral treatment in elderly and younger Turkish adults infected with chronic hepatitis C. METHODS: In this multicenter prospective study, 2629 eligible chronic hepatitis C patients treated with direct-acting antivirals between April 2017 and December 2019 from 37 Turkish referral centers were divided into 2 age groups: elderly (≥65 years) and younger adults (<65 years) and their safety was compared between 2 groups in evaluable population. Then, by matching the 2 age groups for demographics and pretreatment risk factors for a non-sustained virological response, a total of 1516 patients (758 in each group) and 1244 patients (622 in each group) from the modified evaluable population and per-protocol population were included in the efficacy analysis and the efficacy was compared between age groups. RESULTS: The sustained virological response in the chronic hepatitis C patients was not affected by the age and the presence of cirrhosis both in the modified evaluable population and per-protocol population (P = .879, P = .508 for modified evaluable population and P = .058, P = .788 for per-protocol population, respectively). The results of the per-protocol analysis revealed that male gender, patients who had a prior history of hepatocellular carcinoma, patients infected with non-genotype 1 hepatitis C virus, and patients treated with sofosbuvir+ribavirin had a significantly lower sustained virological response 12 rates (P < .001, P = .047, P = .013, and P = .025, respectively). CONCLUSION: Direct-acting antivirals can be safely used to treat Turkish elderly chronic hepatitis C patients with similar favorable efficacy and safety as that in younger adults.

Evaluation of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and lymphocyte to monocyte ratio in patients with cellulitis

SUMMARY OBJECTIVE Cellulite infection is a non-necrotizing inflammation of the skin and subcutaneous tissue and is one of the most common reasons for admission to hospital. This retrospective study aimed to investigate the Neutrophil to Lymphocyte Ratio (NLR), Platelet to Lymphocyte Ratio (PLR), and Lymphocyte to Monocyte Ratio (LMR) in patients with cellulitis. METHODS In our study, we retrospectively analyzed 96 patients with cellulitis and 98 age- and sex-matched healthy controls. The study and control groups were compared regarding NLR, PLR, and LMR.0.001). When patients with cellulitis were divided into two groups, i.e., ≥65 years and <65 years, a statistically significant difference was noted in the NLR and LMR values (p < 0.05). In the ROC curve analysis, NLR had the highest discriminative power in distinguishing between cellulitis and healthy controls (AUC = 0.950, 95% CI: 0.920-0.979, p < 0.001; 91.6% sensitivity and 89.8% specificity). CONCLUSION NLR was significantly higher in differentiating cellulite and in patients older than 65 years. Larger, prospective studies are required to determine its usefulness in assessing differential diagnosis and prognosis in cellulitis patients.

RESUMO OBJETIVO A celulite infecciosa é uma inflamação não necrotizante da pele e do tecido subcutâneo e uma das causas mais comuns para internação. O objetivo deste estudo retrospectivo foi investigar as relações Neutrófilo/Linfócito (RNL), Plaqueta/Linfócito (RPL) e Linfócito/Monócito (RLM) em pacientes com celulite. MÉTODOS Nós analisamos, retrospectivamente, 96 pacientes com celulite e 98 controles saudáveis equivalentes em sexo e idade. Os grupos foram comparados quanto a RNL, RPL e RLM. RESULTADOS Os valores de RPL e RNL do grupo com celulite foram significativamente mais elevados do que os do grupo de controle (p < 0,001). Após dividir os pacientes com celulite em dois grupos, ≥65 anos e <65 anos, uma diferença estatisticamente significativa foi observada nos valores de RNL e RLM (p < 0,05). Na análise da curva ROC, a RNL apresentou o maior poder de discriminação para distinguir entre pacientes com celulite e controles saudáveis (AUC = 0,950, 95% CI: 0,920 - 0,979; p < 0,001; 91,6% de sensibilidade e 89,8% de especificidade). CONCLUSÃO O valor de RNL foi significativamente maior para a diferenciação de pacientes com celulite e pacientes com mais de 65 anos. Estudos prospectivos maiores são necessários para determinar a sua utilidade na avaliação de diagnósticos diferenciais e prognósticos em pacientes com celulite.

Elevated mean platelet volume to platelet ratio predicts advanced fibrosis in chronic hepatitis C.

OBJECTIVE: Chronic hepatitis C virus (HCV) infection is an important health problem that can cause liver cirrhosis and hepatocellular carcinoma. Recently, novel inflammatory markers from complete blood count have been used as a precursor of many clinical conditions. In this study, we investigated the role of hemogram parameters in predicting advanced liver fibrosis in chronic HCV patients. METHODS: Patients who underwent percutaneous liver biopsy due to chronic HCV infection between 01.01.2011 and 01.08.2019 were included in this study. Liver biopsies were evaluated according to Ishak method. Patients were classified into those with mild fibrosis (F ≤ 2) and advanced fibrosis (F ≥ 3). Hemogram parameters of these groups were compared and their efficacy in predicting severe fibrosis was investigated. RESULTS: Of the 81 chronic HCV patients, 38 cases were in the mild fibrosis group and 43 cases were in the severe fibrosis group. Mean platelet volume, mean platelet volume to lymphocyte ratio, mean platelet volume to platelet ratio, and red cell distribution width to platelet ratio of the severe fibrosis group were significantly higher than those of the mild fibrosis group (P < 0.05 for all). In the ROC curve analysis, mean platelet volume to platelet ratio showed the biggest area under the curve in the prediction of advanced fibrosis. CONCLUSION: Mean platelet volume to platelet ratio may be an easy and practical biomarker to gain a preliminary insight into advanced fibrosis in chronic HCV patients.

Trichosporon asahii fungemia in a patient with non-hematological malignancy.

Trichosporon fungemia is usually seen in neutropenic patients with underlying hematological malignancies. In this report we describe a fatal case of Trichosporon asahii fungemia in a non-neutropenic patient with a non-hematological malignancy. For 1 week the patient exhibited hematuria, weakness, easy fatigability and headaches. At admission she had anemia, renal failure and evidence of right hydronephrosis and bladder wall masses as detected by CT scan. She did not have a history of tobacco abuse, contact with urinary carcinogens or Schistosoma infestation; her clinical picture was suggestive of bladder cancer. After some investigations the patient underwent radical cystectomy and ileal conduit surgery because of transitional cell carcinoma in the urinary bladder. After an initial uneventful improvement postoperatively the patient deteriorated and died of septic shock despite all reanimation efforts and antibiotherapy including fluconazole. The blood culture obtained 4 days before the patient died revealed T. asahii, which was isolated on the day she died and found to be resistant to fluconazole and caspofungin. This report suggests that clinicians remain aware that T. asahii fungemia may develop in clinically deteriorated patients even if they do not have a hematological malignancy.