The clinicopathological features and survival of Castleman disease: a multicenter Turkish study.

OBJECTIVE: In this study, we aimed to investigate the clinicopathological features and survival of CD, which is quite rare and has many unknowns. PATIENTS AND METHODS: This study was conducted by retrospectively evaluating patients diagnosed with CD in six different centers in Turkey. RESULTS: The median age of 33 patients included in the study was 49 and 51.5% (n = 17) of these patients were women. 18 (54.5%) patients were in the hyaline vascular subtype and most of the patients were UCD (n = 20, 60.6%). The most common involvement region was head and neck (n = 19, 57.5%). The UCD group was younger than the MCD group (p=0.027). Visceral lymph node involvement was higher in MCD than in UCD (p=0.001). Similarly, it was observed that there was more hepatomegaly (p=0.035) and splenomegaly (p=0.013) in the MCD group. During the median 19.5 months follow-up period, there were no patients who died. CONCLUSIONS: It was observed that UCD and MCD are different clinical entities. Promising survival times can be achieved with surgical and systemic treatments in both subtypes of this extremely rare disease. However, this result should be supported by well-designed prospective comprehensive studies.

Intraoperative and postoperative complications of gynecological laparoscopic interventions: incidence and risk factors.

PURPOSE: The aims of this study were to determine the incidence of intraoperative and postoperative complications of laparoscopic gynecological interventions and to identify risk factors for such complications. METHODS: All patients who underwent laparoscopic interventions from September 2013 to September 2017 at the Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital were identified retrospectively using a prospectively compiled clinical database. Binary logistic regression analysis was used to identify independent risk factors for intra- and postoperative complications. RESULTS: Data from 3351 patients were included in the final analysis. Overall, 188 (5.6%) intraoperative and 219 (6.5%) postoperative complications were detected. On multivariate analysis, age [odds ratio (OR), 1.03; 95% confidence interval (CI) 1.01-1.04], surgery duration (OR, 1.02; 95% CI 1.02-1.03), carbon dioxide use (OR, 0.99; 95% CI 0.99-1.00), and surgical indication (all p ≤ 0.01) were independent risk factors for intraoperative and duration of surgery (OR, 1.01; 95% CI 1.01-1.02; p ≤ 0.01), carbon dioxide use (OR, 0.99; 95% CI 0.99-1.00; p ≤ 0.01), hemoglobin drop (OR, 1.41; 95% CI 1.21-1.65; p ≤ 0.01), and ASA status (p = 0.04) for postoperative complications. CONCLUSION: In this large retrospective analysis with a generally low incidence of complications (5.6% intraoperative and 6.5% postoperative complications), a representative risk collective was identified: Patients aged > 38 years, surgery duration > 99 min, benign or malignant adnex findings were at higher risk for intraoperative and patients with surgery duration > 94 min, hemoglobin drop > 2 g/dl and ASA status III at higher risk for postoperative complications.

The Anthropometric Measurements and Percentile Curves of Children Aged 0-5 Years in Eastern Turkey

ABSTRACT Objective: To determine the growth reference value of children in our province and to compare these values with current values of the USA and other local values of our country. Methods: A total of 615 boys and 586 girls with different socioeconomic levels and ages of 0-5 years were included in the study. In all children, weight, height, head circumference, abdominal circumference, hip circumference, mid-arm circumference, and lower segment length were taken. All measurements were performed by the same paediatrician. The lambda-mu-sigma method was used for the preparation of percentile curves. Results: The body weight, head circumference and chest circumference measurements of boys were significantly higher than those in girls. Anthropometric measurements of children in high-income groups were higher than those in the low-income group. All of the anthropometric parameters except upper mid-arm circumference were higher in children fed with breast milk and formula milk than in children who only fed with breast milk. The relation between the mother's education level and anthropometric parameters was insignificant. Conclusion: Our results showed that the anthropometric measurements of our children were similar to those of west Turkey as well as those of the United States. On the other hand, our children's anthropometric measurements were higher than other local values. Relatively high values of height have been interpreted as a genetic feature.

RASopathic comedone-like or cystic lesions induced by vemurafenib: a model of skin lesions similar but not identical to those induced by dioxins MADISH.

BACKGROUND: Patients treated with vemurafenib for metastatic melanoma often develop skin lesions similar to those observed after exposure to dioxin-like compounds. We previously called these lesions MADISH (metabolizing acquired dioxin-induced skin hamartoma) when analysing a case of acute dioxin poisoning. OBJECTIVE: We performed a clinical trial aimed at comparing the skin lesions observed under vemurafenib treatment with MADISH in order to bring to light a possible crosstalk between vemurafenib and dioxin pathways. METHODS: In this case series study, we explored the histological aspect of skin lesions in 10 cases treated with vemurafenib for malignant melanoma. We also analysed the ability of vemurafenib and tyrosine kinase inhibitors to induce dioxin-AhR pathway. RESULTS: All patients had skin lesions diagnosed as 'non-inflammatory acneiform eruption' by dermatologists. These were predominantly facial with notable retroauricular involvement and clinically compatible with chloracne/MADISH when assessed by dioxin expert. Histological analysis showed mostly comedone-like lesions and dermal cysts containing epithelial wall with basal or lateral epithelial projections and lamellar keratinization and alterations of remaining sebaceous glands. The expression of CYP1A1, a gene highly induced following dioxin exposure, was not observed in these lesions. Vemurafenib and the tyrosine kinase inhibitors erlotinib and gefitinib did not induce CYP1A1 activity. DISCUSSION: Although the skin lesions under vemurafenib treatment were morphologically similar to MADISH, the absence of CYP1A1 expression in dermal cysts of patients and the absence of CYP1A1 activation by vemurafenib led us consider that these skin lesions were different from true MADISH and not mediated by a crosstalk of AhR signalling, but rather to a hyperactivation of PI3K-Akt pathway as a consequence of vemurafenib treatment. A strong expression of CYP1A1 in the epithelial wall of dermal cysts must be required, parallel to the morphology of the lesions, to make the diagnosis of MADISH, the hallmark of an exposure to dioxin-like/chloracnegen compounds.

Soluble fms-like tyrosine kinase-1 and placental growth factor kinetics during and after pregnancy in women with suspected or confirmed pre-eclampsia.

OBJECTIVES: To assess the evolution of the soluble fms-like tyrosine kinase-1 (sFlt-1) to placental growth factor (PlGF) ratio in women with suspected or confirmed pre-eclampsia (PE), and to investigate the changes in sFlt-1 and PlGF levels in pre-eclamptic women after delivery. METHODS: This was an exploratory study in which secondary analysis was performed on a prospective cohort study that enrolled women with a singleton pregnancy and suspected or confirmed PE from 18 weeks' gestation, carried out between December 2013 and April 2016 at the Department of Obstetrics of the Erasmus Medical Center in Rotterdam. sFlt-1 and PlGF were determined using Roche Diagnostics Elecsys assays in two groups of patients. In the first group, patients with suspected or confirmed PE had sFlt-1 and PlGF levels measured at least twice during their pregnancy. Changes in these biomarkers over the course of pregnancy were compared for patients in this group with a baseline sFlt-1/PlGF ratio of ≤ 38 and for those with a ratio > 38. In the second group, sFlt-1 and PlGF levels of women with PE or HELLP syndrome were measured before and after delivery. For this group, pre- and postpartum sFlt-1 and PlGF levels were compared and half-lives were calculated. RESULTS: Women with suspected or confirmed PE for whom sFlt-1 and PlGF levels were measured at least twice during pregnancy (n = 46) had a median gestational age at inclusion of 26 weeks (range, 18-40 weeks). In 27 of the 30 patients with sFlt-1/PlGF ratio ≤ 38 at baseline, thereby ruling out PE, the sFlt-1/PlGF ratio remained stable for up to 100 days. In the remaining three patients with a ratio ≤ 38 and in most of the 16 patients with a ratio > 38, the ratio increased further. For women diagnosed with PE or HELLP syndrome for whom sFlt-1 and PlGF levels were measured before and after delivery (n = 26), median gestational age at inclusion was 29 weeks (range, 16-37 weeks) and median time between antepartum measurement and delivery was 2 days (range, 1-17 days). In this group, after delivery, sFlt-1 dropped to < 1% of its pre-delivery value, with a half-life of 1.4 ± 0.3 days, while PlGF dropped to ∼30% of its pre-delivery value, with a half-life of 3.7 ± 4.3 days. CONCLUSIONS: Based on this small cohort, up to 10% of pregnant women admitted with suspected or confirmed PE presenting with a sFlt-1/PlGF ratio of ≤ 38 display a rise in sFlt-1/PlGF ratio in subsequent weeks, implying that repeat determination of the sFlt-1/PlGF ratio is required to exclude definitively a diagnosis of PE. Furthermore, the rapid and pronounced decline in sFlt-1 levels after delivery in patients with PE/HELLP syndrome suggests that sFlt-1, in contrast to PlGF, is almost entirely derived from the placenta. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Nivolumab for relapsed or refractory Hodgkin lymphoma: real-life experience.

BACKGROUND: Reed-Sternberg cells of classical Hodgkin's lymphoma (cHL) are characterized by genetic alterations at the 9p24.1 locus, leading to over-expression of programmed death-ligand 1 and 2. In a phase 1b study, nivolumab, a PD-1-blocking antibody, produced a high response in patients with relapsed or refractory cHL, with an acceptable safety profile. PATIENTS AND METHODS: We present a retrospective analysis of 82 patients (median age: 30 years; range: 18-75) with relapsed/refractory HL treated with nivolumab in a named patient program from 24 centers throughout Turkey. The median follow-up was 7 months, and the patients had a median of 5 (2-11) previous lines of therapy. Fifty-seven (70%) and 63 (77%) had been treated by stem-cell transplantation and brentuximab vedotin, respectively. RESULTS: Among 75 patients evaluated after 12 weeks of nivolumab treatment, the objective response rate was 64%, with 16 complete responses (CR; 22%); after 16 weeks, it was 60%, with 16 (26%) patients achieving CR. Twenty patients underwent subsequent transplantation. Among 11 patients receiving allogeneic stem-cell transplantation, 5 had CR at the time of transplantation and are currently alive with ongoing response. At the time of analysis, 41 patients remained on nivolumab treatment. Among the patients who discontinued nivolumab, the main reason was disease progression (n = 19). The safety profile was acceptable, with only four patients requiring cessation of nivolumab due to serious adverse events (autoimmune encephalitis, pulmonary adverse event, and two cases of graft-versus-host disease aggravation). The 6-month overall and progression-free survival rates were 91.2% (95% confidence interval: 0.83-0.96) and 77.3% (0.66-0.85), respectively. Ten patients died during the follow-up; one of these was judged to be treatment-related. CONCLUSIONS: Nivolumab represents a novel option for patients with cHL refractory to brentuximab vedotin, and may serve as a bridge to transplantation; however, it may be associated with increased toxicity.

Is Cytomegalovirus Surveillance Necessary for Patients With Low Reactivation Risk in an Autologous Hematopoietic Cell Transplantation Setting?

BACKGROUND: In an autologous hematopoietic cell transplantation (AHCT) setting, routine cytomegalovirus (CMV) surveillance is not indicated except in high-risk situations. On the other hand, some studies reported increased CMV reactivation in AHCT setting as a result of incorporation of novel agents into treatment algorithms, such as bortezomib and rituximab. We retrospectively analyzed CMV reactivation and infection rates in patients with no high-risk features, who were treated with AHCT. METHODS: During January 2010 to November 2015, all consecutive, CMV-seropositive patients were included. The viral copy numbers were measured twice a week from the start of the conditioning regimen until engraftment, once a week for the remaining time period until day 30 after AHCT and once weekly only for patients who had been diagnosed with CMV reactivation before and who developed primary/secondary engraftment failure during 31 to 60 days after AHCT. RESULTS: One hundred one (61.6%) men and 63 (38.4%) women were included in the study. The median age of study cohort was 51 years (range, 16-71 years). The indications for AHCT were Hodgkin lymphoma, non-Hodgkin lymphoma, and multiple myeloma in 44 (26.8%), 41 (25%), and 79 (48.2%) patients, respectively. CMV reactivation occurred in 60 (37%) patients, and 13 patients (8%) received pre-emptive ganciclovir treatment. CONCLUSIONS: On the basis of our results, it might be stated that CMV surveillance may be recommended during 40 days after AHCT in countries with a high CMV prevalence, even in patients without high-risk features regarding reactivation. Additionally, the risky conditions necessitating CMV screening after AHCT must be re-defined in the era of novel agents.

A novel and useful predictive indicator of prognosis in ST-segment elevation myocardial infarction, the prognostic nutritional index.

BACKGROUND AND AIM: The prognostic impact of poor nutritional status and cardiac cachexia in myocardial infarction is not clearly understood. Recent studies have implied a prognostic value of the prognostic nutritional index (PNI) in colorectal surgeries and postoperative septic complications. The present study aimed to evaluate the prognostic value of PNI in ST-segment elevation myocardial infarction (STEMI) patients. METHODS AND RESULTS: We evaluated the in-hospital and long-term (3 years) prognostic impact of PNI on 1823 patients with STEMI undergoing primary percutaneous coronary intervention. Patients with lower PNI had significantly higher in-hospital and long-term mortality and major adverse cardiac events. After adjustment for all confounders, the in-hospital mortality rates were 7.9 times higher at the lower PNI level (95% CI: 5.0-15.8) than those at the higher PNI level. The long-term mortality rates were also 6.4 times higher at the lower PNI level (95% CI: 4.4-12.4) than those at the higher PNI level. CONCLUSION: The present study demonstrated that the PNI, calculated based on the serum albumin level and lymphocyte count, is an independent prognostic factor for mortality in patients with STEMI.

Ewing's Sarcoma Localized in the Mandible: A Case Report.

Ewing's sarcoma is one of the most aggressive primary bone tumours. Ewing's sarcoma arising from the bones of the head and neck region is extremely rare; only 4-9% of all Ewing's sarcoma originate in this region. We report a case of Ewing's sarcoma localized in the mandible because of its unusual presentation.

Effect of Kidney Transplantation on Smoking Habits of Kidney Donors.

INTRODUCTION: Smoking increases the risk for cardiovascular disease in kidney donors, as is the case with normal individuals; it may also result in the development and progression of chronic renal failure. The present study aimed to investigate the effect of kidney transplant on smoking habits of kidney donors. METHOD: The study included 98 donors in total (54 female, 44 male). A questionnaire was administered to donors about smoking status. Smoking status was asked about before surgery and 12 months postoperatively, and the preoperative and postoperative values were compared. The Fagerstörm test for nicotine dependence was administered to individuals who were still smokers and those who had smoked but quit. RESULTS: The mean age of the participants was 48.27 ± 10.8 years. The preoperative smoking status was 47% (n = 46), whereas the postoperative rate decreased to 29% (n = 28). This reduction in smoking rate was significant (P = .001). There was no difference in Fagerström levels between donors who continued smoking and those who quit smoking after the surgery (P = .583). CONCLUSIONS: A person who becomes a kidney transplant donor has the chance to quit smoking, which is a cardiovascular risk factor. In addition to the psychosocial benefits of being a donor, it should be noted that it might also provide some medical benefits. However, some patients continue smoking after surgery. Smoking should be questioned in the postoperative follow-ups of donors and the support required for smoking cessation should be provided.

The effect of dietary supplements on healing of alloplastic bone grafted defects in rat tibia / Efecto de los suplementos dietarios sobre la cicatrización de defectos injertados con hueso aloplástico en la tibia de ratas

The aim of this investigation was to evaluate the potential effects of the systemically delivered combination of calcium, zinc and vit-d supplementation of the locally applied alloplastic bone graft. 28 male Wistar albino rats were used in this study. In each animal, bone defects (10 mm length ¥ 3 mm width ¥ 2 mm depth) were created in the tibias. The animals were divided into four groups. In Group 1 (Control Group) rats were fed with standard rat diet. In Group 2 (Calcium Group) rats received calcium carbonate (15 mg/kg body weight) suspended in saline. In Group 3 (Calcium/Zinc Group) rats received calcium carbonate (15 mg/kg body weight) and zinc sulfate (4 mg/kg body weight) suspended in saline. In Group 4 (Calcium/Vitamin D Group) rats received calcium carbonate (15 mg/kg body weight) and Vitamin D (500 IU/kg body weight) suspended in olive oil. Histopathological analysis of samples was performed to evaluate the process of osteoblastic activity, matrix formation, trabecular bone formation and myeloid tissue in bone defects. Total amounts of osteoblastic activity, matrix formation, trabecular bone formation and myeloid yissue in Ca Group (p= 0.002), Ca/Zinc Group (p= 0.002), and Ca/Vit.D Group (p= 0.001) were significantly higher than in Control Group. The total amounts of Ca/Vit.D Group were significantly different than Control Group and Ca Group. The results of the present study indicated that the oral calcium carbonate supplementation combination with zinc may have systemic effects on accelerating bone regeneration in alloplastic bone grafted tibial defects. Further human studies involving long-term follow up and different type of bone grafts should be conducted.

El objetivo de esta investigación fue evaluar los efectos potenciales de la combinación sistémica de calcio, zinc y vitamina D como suplemento de la aplicación local de un injerto óseo aloplástico. Fueron utilizadas 28 ratas Wistar albinas (machos). En cada animal, se crearon defectos óseos en las tibias (cuyas medidas fueron: 10 mm de longitud x 3 mm de ancho x 2 mm de profundidad). Los animales fueron divididos en cuatro grupos. En el Grupo 1 (control) las ratas fueron alimentadas con una dieta estándar. En el Grupo 2 (grupo de calcio) las ratas recibieron carbonato de calcio (15 mg/kg de peso corporal) suspendido en solución salina. En el Grupo 3 (grupo de calcio/zinc) las ratas recibieron carbonato de calcio (15 mg/kg de peso corporal) y sulfato de zinc (4 mg/kg de peso corporal) suspendido en solución salina. El Grupo 4 (calcio/vitamina D) recibió carbonato de calcio (15 mg/kg de peso corporal) y vitamina D (500 UI/kg de peso corporal) suspendidos en aceite de oliva. Se realizó un análisis histopatológico de las muestras para evaluar el proceso de actividad osteoblástica, formación de la matriz, hueso trabecular y tejido mieloide en defectos óseos. Las cantidades totales de actividad osteoblástica, formación de matriz, de hueso trabecular y tejido mieloide en los grupos Calcio (p= 0,002), Calcio/Zinc (p= 0,002), y Calcio/Vitamina D (p= 0,001) fueron significativamente mayores que en el grupo de control. Las cantidades totales de Calcio/Vitamina D Grupo fueron significativamente diferentes de los grupos Control y Calcio. Los resultados del presente estudio indican que lacombinación de suplementos de carbonato de calcio por vía oral con zinc puede tener efectos sistémicos sobre la aceleración de la regeneración ósea en defectos tibiales con injertos aloplásticos. Deben llevarse a cabo otros estudios en humanos, que involucren un largo plazo de seguimiento y también diferentes tipos de injertos óseos.

Molecular physiognomies and applications of adipose-derived stem cells.

Adipose-derived stromal/stem cells (ASC) are multipotent with abilities to differentiate into multiple lineages including connective tissue and neural cells. Despite unlimited opportunity and needs for human and veterinary regenerative medicine, applications of adipose-derived stromal/stem cells are at present very limited. Furthermore, the fundamental biological factors regulating stemness in ASC and their stable differentiation into other tissue cells are not fully understood. The objective of this review was to provide an update on the current knowledge of the nature and isolation, molecular and epigenetic determinants of the potency, and applications of adipose-derived stromal/stem cells, as well as challenges and future directions. The first quarter of the review focuses on the nature of ASC, namely their definition, origin, isolation and sorting methods and multilineage differentiation potential, often with a comparison to mesenchymal stem cells of bone marrow. Due to the indisputable role of epigenetic regulation on cell identities, epigenetic modifications (DNA methylation, chromatin remodeling and microRNAs) are described broadly in stem cells but with a focus on ASC. The final sections provide insights into the current and potential applications of ASC in human and veterinary regenerative medicine.

Serum adiponectin, leptin, and interleukin 6 levels as adipocytokines in children with febrile seizures: The role of adipose tissue in febrile seizures.

Proinflammatory and anti-inflammatory cytokines have an important role in the pathogenesis of febrile seizures (FS). Adipocytokines like interleukin 6 (IL-6), leptin, and adiponectin released from adipose tissue play a role in inflammation. This study aimed to assess the probable role of adipose tissue in children with FS. We measured serum IL-6, leptin, and adiponectin levels and evaluated clinical and laboratory findings in children with FS (n = 32) and compared the results with the values of children of the same age with febrile illness without seizures (febrile control, FC; n = 26) and healthy control group (HC; n = 29). The serum levels of white blood cells, C-reactive protein, IL-6, leptin, and adiponectin were found to be significantly higher, while serum hemoglobin (Hb) levels were found to be significantly lower in FS and FC groups than in the HC group (p < 0.001). When we compared the FS with the FC group, the serum Hb levels were significantly lower in the FS group than those in the FC group (p = 0.001). There was no significant difference between the FS and FC group with regard to the serum levels of these adipocytokines (p > 0.05). Our data showed that elevated levels of these adipocytokines as acute phase reactants in FS and FC groups did not contribute to the development of FS.

Does the STOP-Bang, an obstructive sleep apnea screening tool, predict difficult intubation?

OBJECTIVE: A close relationship between obstructive sleep apnea (OSA) and difficult intubation has been suggested. We hypothesized that the STOP-Bang questionnaire, a screening tool for obstructive sleep apnea (OSA), can predict difficult intubation. PATIENTS AND METHODS: In this prospective cohort study, 200 adult surgical patients undergoing surgery under general anesthesia were studied to evaluate the usefulness of the STOP-Bang questionnaire for predicting difficult intubation. STOP-Bang questionnaire results, Mallampati score and tonsil size, as well as demographic data, were recorded preoperatively. Cormack & Lehane grading and difficulty of intubation (Cormack & Lehane grade III or IV, need of an intubation aid, or need of three or more intubation attempts) were also evaluated. RESULTS: Eighty-three out of 200 patients had a high risk of OSA based on the STOP-Bang questionnaire. The occurrence of difficult intubation was higher in the patients at a high risk of OSA (i.e., a STOP-Bang score of ≥ 3) than in the patients at a low risk (13.3% vs. 2.6%) (p = 0.004). Higher age, greater weight, higher body mass index, greater neck circumference, male gender, presence of comorbidities, lower preoperative SpO2, longer extubation times, higher Mallampati score, higher Cormack & Lehane grading, tonsil size and difficult intubation were significantly correlated with a high risk of OSA (p < 0.001). Fourteen out of 200 patients had difficulty in intubation. A STOP-Bang score of ≥ 3 was seen more frequently in the difficult intubation patients (78.6% vs. 38.7%) (p = 0.009). Greater weight, greater neck circumference, greater Mallampati score, a STOP-Bang score ≥ 3 and male gender were significantly correlated with difficult intubation (p < 0.05). CONCLUSIONS: A STOP-Bang score of ≥ 3 was a predictor for difficult intubation.

Confirmed penicillin allergy among patients receiving benzathine penicillin prophylaxis for acute rheumatic fever.

BACKGROUND: Beta-lactam antibiotics are the most frequent drugs prescribed in children worldwide. Acute rheumatic fever (ARF) is the major cause of acquired heart disease among children and adolescents. Recurrences due to inadequate penicillin prophylaxis are responsible for chronic valvular lesions requiring surgery. The fear of a severe allergic reaction is the leading cause of discontinuing prophylaxis. OBJECTIVE: In this study, we aimed to reveal the frequency of adverse events and real allergic reactions to benzathine penicillin among children who are followed in our paediatric cardiology clinic with a diagnosis of ARF. MATERIALS METHODS: The children who were followed with a diagnosis of ARF between January 2005 and December 2011 were searched for a history of penicillin allergy. Patients with a positive history were evaluated in our paediatric allergy clinic. Skin tests and provocation tests were performed with parental consent. RESULTS: In total 535 children with a diagnosis of ARF were analysed for the study. Median follow up period was 24 months (12-36) [median (%25-75)]. Eleven of our 535 (11/17.641 injection) ARF patients were suspected to have allergic reactions after 17.641 penicillin injections but only one (0.18%) was diagnosed to have penicillin allergy after detailed evaluation. CONCLUSION: Our data suggest that the frequency of penicillin allergy is much lower than suspected among children on penicillin prophylaxis for ARF. Consequently, penicillin prophylaxis should not be given up without proper evaluation of drug allergy.

Surgical site infections and mortality in elderly patients.

OBJECTIVE: We present the characteristics and outcome of surgical site infections (SSI) in patients 65 years of age or more, and determine the factors influencing mortality. METHODS: We conducted a prospective observational cohort study, comparing patients who survived with those who died, to identify risk factors associated with mortality among elderly patients presenting with SSI. The diagnosis of SSI was made for each patient, according to the CDC's standardized criteria. RESULTS: Seventy-five patients presenting with SSI were included in the study. The mean age of patients was 75 ± 6 (65-92), 68% were male patients. The most frequently isolated pathogen was Acinetobacter baumannii (n = 24). The overall in-hospital mortality rate was 25.3%. The statistical analysis revealed that gastrointestinal surgery, organ/space infections, polymicrobial infections, and higher SOFA scores were significantly associated with hospital mortality (P = 0.005, P = 0.0001, P = 0.047, P = 0.0001). According to laboratory tests, higher white blood cell (WBC) and neutrophil count, higher total bilirubin level, and lower thrombocyte count and albumin levels were significantly associated with hospital mortality (P = 0.040, P = 0.014, P = 0.001, P = 0.019, P=0.002). Multivariate analyses revealed that serum albumin (P = 0.004, OR = 11.3, CI 95% 2.16-59.07), organ/space SSI (P = 0.0001, OR = 11.65, CI 95% 3.003-45.21), and SOFA score (P = 0.030, OR = 2.742, 1.100-6.84) were independent risk factors associated with mortality. CONCLUSIONS: Serum albumin levels, organ/space infections, and higher SOFA scores were independently significantly associated with hospital mortality in older patients with SSI. Serum albumin levels should be closely monitored, and if necessary, early surgery should be performed.

Vitamin D deficiency rickets in infants presenting with hypocalcaemic convulsions / Raquitismo por deficiencia de vitamina D en lactantes que presentan convulsiones por hipocalcemia

AIM: Hypocalcaemia evaluation of the clinical, biochemical and radiological features of 91 infants with rickets who presented as hypocalcaemic convulsions. SUBJECTS AND METHODS: Ninety-one hypocalcaemic infants who were brought to hospital with convulsion and diag-nosed with rickets related to vitamin D deficiency according to their clinical, biochemical and radio-logical features were retrospectively reviewed. RESULTS: Mean values of the laboratory data were as follows: calcium 5.55 ± 0.79 mg/dL, phosphorus 4.77 ± 1.66 mg/dL, alkaline phosphatase 1525.5 ± 925.4 U/L and parathormone 256.8 ± 158.3 pg/mL. Serum 25-OH vitamin D levels were below normal (< 20 ng/mL) in 37 infants. CONCLUSION: Vitamin D deficiency should be considered in infants presenting with hypocalcaemia. To avoid complications such as convulsions, clinicians should give vitamin D supplementation to such infants.

OBJETIVO: Evaluación hipocalcémica de los aspectos clínicos, bioquímicos y radiológicos de 91 lactantes con raquitismo, que presentaron convulsiones por hipocalcemia. PACIENTES Y MÉTODOS: Noventa y un lactantes hipocalcémicos llevados al hospital con convulsiones y a quienes se les diagnosticó raquitismo asociado a la deficiencia de vitamina D de acuerdo con sus características, bioquímicas y radiológicas, fueron revisados retrospectivamente. RESULTADOS: Los valores medios de los datos de laboratorio fueron los siguientes: calcio 5.55 ± 0.79 mg/dL, fósforo 4.77 ± 1.66 mg/dL, fosfatasa alcalina 1525.5 ± 925.4 U/L, y paratohormona 256.8± 158.3 pg/mL. Los niveles séricos de la vitamina 25 (OH) D estuvieron por debajo de lo normal en 37 lactantes (< 20 ng/mL). CONCLUSIÓN: La deficiencia de vitamina D debe considerarse en los infantes que se presentan con hipocalcemia. A fin de evitar complicaciones tales como convulsiones, se les debe dar suplementos de vitamina D.