The effect of mesenchymal stem cells administration on DNA repair gene expressions in critically ill COVID-19 patients: prospective controlled study.

When the studies are evaluated, immunomodulatory effect of MSCs, administration in critically ill patients, obstacle situations in use and side effects, pulmonary fibrosis prevention, which stem cells and their products, regeneration effect, administration route, and dosage are listed under the main heading like. The effect of MSC administration on DNA repair genes in COVID-19 infection is unknown. Our aim is to determine the effect of mesenchymal stem cells (MSCs) therapy applied in critically ill patients with coronavirus infection on DNA repair pathways and genes associated with those pathways. Patients (n = 30) divided into two equal groups. Group-1: Patients in a critically ill condition, Group-2: Patients in critically ill condition and transplanted MSCs. The mechanism was investigated in eleven genes of five different pathways; Base excision repair: PARP1, Nucleotide excision repair (NER): RAD23B and ERCC1, Homologous recombinational repair (HR): ATM, RAD51, RAD52 and WRN, Mismatch repair (MMR): MLH1, MSH2, and MSH6, Direct reversal repair pathway: MGMT. It was found that MSCs application had a significant effect on 6 genes located in 3 different DNA damage response pathways. These are NER pathway genes; RAD23 and ERCC1, HR pathway genes; ATM and RAD51, MMR pathway genes; MSH2 and MSH6 (p < 0.05). Two main points were shown. First, as a result of cellular damage in critical patients with COVID-19, DNA damage occurs and then DNA repair pathways and genes are activated in reaction to this situation. Second, administration of MSC to patients with COVID-19 infection plays a positive role by increasing the expression of DNA repair genes located in DNA damage pathways.

Real-life evaluation of incidence and clinical outcomes of COVID-19 among healthcare workers during pre-vaccination and post-vaccination periods: A cross-sectional impact study.

INTRODUCTION: We aimed to evaluate the prevalence and clinical outcomes of COVID-19 in healthcare workers (HCWs) in the pre-vaccination and post-vaccination periods. In addition, we determined factors associated with the development of COVID-19 after vaccination. METHODOLOGY: In this analytical cross-sectional epidemiological study, HCWs who were vaccinated between January 14, 2021, and March 21, 2021, were included. HCWs were followed up for 105 days after the 2 doses of CoronaVac. Pre-vaccination and post-vaccination periods were compared. RESULTS: A total of 1,000 HCWs were included, 576 patients (57.6%) were male, and the mean age was 33.2 ± 9.6 years. In the last 3 months during the pre-vaccination period, 187 patients had COVID-19, and the cumulative incidence of COVID-19 was 18.7%. Six of these patients were hospitalized. Severe disease was observed in three patients. In the first 3 months post-vaccination period, COVID-19 was detected in 50 patients, and the cumulative incidence of the disease was determined to be 6.1%. Hospitalization and severe disease were not detected. Age (p = 0.29), sex (OR = 1.5, p = 0.16), smoking (OR = 1.29, p = 0.43), and underlying diseases (OR = 1.6, p = 0.26) were not associated with post-vaccination COVID-19. A history of COVID-19 significantly reduced the likelihood of the development of post-vaccination COVID-19 in multivariate analysis (p = 0.002, OR = 0.16, 95% CI = 0.05-0.51). CONCLUSIONS: CoronaVac significantly reduces the risk of SARS-CoV-2 infection and alleviates the severity of COVID-19 in the early period. Additionally, HCWs who have been infected and vaccinated with CoronaVac are less likely to be reinfected with COVID-19.

Malnutrition risk frequency and independent risk factors associated with mortality in hospitalized elderly patients with COVID-19 in Turkey.

BACKGROUND AND OBJECTIVES: Malnutrition is common in elderly patients and is an important geriatric syndrome that increases mortality. We aim to examine the frequency of malnutrition and independent risk factors associated with mortality in hospitalized elderly patients with COVID-19. METHODS AND STUDY DESIGN: Patients aged 65 years and older with COVID-19, who were hospitalized between 15th March and 30th April 2020, were included. Demographic characteristics of the patients, their comorbid diseases, medications, malnutrition, and mortality status were recorded. Nutritional Risk Screening-2002 was used as a malnutrition risk screening tool. The factors affecting mortality were analyzed using multivariate Binary Logistic regression analysis. RESULTS: Of the 451 patients included in the study, the mean age was 74.8±7.46 and 51.2% of them were female. The mean number of comorbid diseases was 1.9±1.28. Malnutrition risk was 64.7%, polymorbidity rate was 57.6% and polypharmacy was 19.3%. Mortality rate was found 18.4%. The risk factors affecting mortality were presented as malnutrition risk (OR: 3.26, p=0.013), high number of comorbid diseases (OR: 1.48, p=0.006), and high neutrophil/lymphocyte ratio (OR: 1.18, p<0.001), C-reactive protein (OR: 1.01, p<0.001), and ferritin (OR: 1.01, p=0.041) in elderly patients with COVID-19. Malnutrition risk (3.3 times), multiple comorbid diseases (1.5 times), and high neutrophil/lymphocyte ratio (1.2 times) were independent risk factors that increased the mortality. CONCLUSIONS: The frequency of malnutrition risk and mortality in elderly patients with COVID-19 is high. The independent risk factors affecting mortality in these patients are the risk of malnutrition, multiple comorbid diseases, and a high neutrophil/lymphocyte ratio.

Respiratory viral infections in otherwise healthy humans with inherited IRF7 deficiency.

Autosomal recessive IRF7 deficiency was previously reported in three patients with single critical influenza or COVID-19 pneumonia episodes. The patients' fibroblasts and plasmacytoid dendritic cells produced no detectable type I and III IFNs, except IFN-ß. Having discovered four new patients, we describe the genetic, immunological, and clinical features of seven IRF7-deficient patients from six families and five ancestries. Five were homozygous and two were compound heterozygous for IRF7 variants. Patients typically had one episode of pulmonary viral disease. Age at onset was surprisingly broad, from 6 mo to 50 yr (mean age 29 yr). The respiratory viruses implicated included SARS-CoV-2, influenza virus, respiratory syncytial virus, and adenovirus. Serological analyses indicated previous infections with many common viruses. Cellular analyses revealed strong antiviral immunity and expanded populations of influenza- and SARS-CoV-2-specific memory CD4+ and CD8+ T cells. IRF7-deficient individuals are prone to viral infections of the respiratory tract but are otherwise healthy, potentially due to residual IFN-ß and compensatory adaptive immunity.

Changing characteristics of cancer patients during the COVID-19 pandemic.

INTRODUCTION: Cancer patients are more sensitive to infections, and, compared to other patients, may have more serious outcomes. Thus, cancer patients are a high-risk group in the COVID-19 pandemic. The aim of this study was to evaluate how cancer patients are affected by COVID-19 infection; the prevalence, and factors affecting mortality. METHODOLOGY: This single-centre, retrospective study included cancer patients under follow-up treatment at our hospital with a laboratory-confirmed diagnosis of COVID-19. Demographic and clinical data were obtained from electronic medical records. The effects of tumour subtype and patient demographic data on COVID-19 prevalence and mortality were analyzed using univariate and multivariate models. RESULTS: Evaluation was made of 217 cancer patients, comprising140 (64.5%) males and 77 (35.5%) females with a mean age of 62.05 ± 12.95 years. Mortality was seen in 84 (38.7%) patients. Disease grade, chemotherapy within the last 3 months and CT findings were determined to be related to mortality. In logistic regression analysis, the most important factors affecting survival were determined to be severe lung involvement (p < 0.001) and hematological malignancy. CONCLUSIONS: It is clear that cancer patients are at greater risk from COVID-19 infection than individuals without a malignant disease. The results showed that cancer patients with different tumour types had different levels of sensitivity to COVID-19. It is clear that with ongoing viral mutations, the duration of the pandemic is unknown. Therefore, the continuation of cancer screening and cancer treatments should not be interrupted.

Association between Acute Pancreatitis and COVID-19: Could Pancreatitis Be the Missing Piece of the Puzzle about Increased Mortality Rates?

BACKGROUND: The COVID-19 pandemic caused by SARS-CoV-2 commenced in Wuhan China in 2019 and soon spread worldwide. SARS-CoV-2 enters the cell by binding to the ACE II receptor and begins viral replication. The effects and clinical findings of SARS-CoV-2 on the liver, kidney, heart, gastrointestinal (GI) system and especially lungs have been widely discussed. However, the effects on the pancreas-another organ that also expresses ACE II-have not been studied. METHODS: This work prospectively evaluated data from 316 patients who were admitted with a diagnosis of COVID-19 pneumonia. The patients were categorized into three according to the severity of pneumonia (mild, severe, critical). Demographic data, rate of pancreatitis, biochemical parameters, and radiological images from each group were analyzed. The patients were divided into two groups and outcomes were compared: COVID-19 patients with acute pancreatitis (Group P) and without acute pancreatitis (Group C). RESULTS: The median age was 54 (18-87), and the median age for patients with acute pancreatitis was 55 (26-84). As an expected finding, we found a positive correlation between advanced age and mortality (p = 0.0003). 12.6% of the patients had acute pancreatitis. While pancreatitis was not seen in patients on mild status, the rate of pancreatitis was 32.5% in critical patients. Hospitalization and mortality rates were higher in patients with COVID-19 accompanied by acute pancreatitis (p = 0.0038 and p < 0.0001, respectively). C-Reactive Protein (CRP) and ferritin were significantly higher in those who had pancreatitis (p < 0.0001). D-Dimer and procalcitonin levels had only a small difference (p = 0.1127 and p = 0.3403, respectively). CONCLUSION: Acute pancreatitis alone is a clinical condition that can lead to mortality and may be one of the reasons for the exaggerated immune response developing in the progression of COVID-19. Our results point out that the presence of pancreatic damage triggered by SARS-CoV-2 can deteriorate the clinical condition of patients and the mortality rate may increase in these patients.

Fever of unknown origin: evaluation of 110 classical and HIV-associated cases in the last decade.

BACKGROUND: Fever is one of the critical symptoms of collagen vascular diseases, malignancies, and infectious diseases. Patients with a fever of unknown origin (FUO) were evaluated to determine the etiology. METHODS: In this study, 110 cases with FUO who were admitted to two hospitals with a total of 800 beds, in which 5000 daily outpatient patients were admitted between 2006 and 2016 have been evaluated retrospectively. Anamnesis and the findings were obtained from hospital records. Patients with a temperature higher than 38.3°C and lasting three weeks or longer without diagnosis despite one week of investigation in the hospital were included as FUO cases in this study. Nosocomial and neutropenic cases were excluded from the present study. RESULTS: Fifty-seven patients were male (52%), and the mean age was 40.2 ± 17.2. The distribution of the classic and HIV-associated cases was 85 (77.3%) and 18 (16.4%). Tuberculosis (TB) was the most frequent disease in both groups. The etiology was infectious in 68.2%, autoimmune in 14.5%, and neoplastic in 5.4%. There was no case of collagen vascular disease in the HIV-associated FUO group. CONCLUSION: As a result of our study, infectious diseases and TB were still the leading factors that caused FUO. TB has been notably found higher in the HIV-associated group than the classic group. FUO is usually either a rare cause or an unusual clinical presentation of a well-known infectious disease in Turkey. Therefore, it should be noted that various manifestations of extra-pulmonary tuberculosis may be considered a FUO case.

Relação entre os Sinais de Strain do Ventrículo Direito no Eletrocardiograma e Níveis de Biomarcadores Associados à Gravidade da Pneumonia por COVID-19 / Relationship between Right Ventricular Strain Signs in Electrocardiography and Levels of Biomarkers Associated with COVID-19 Pneumonia Severity

Resumo Fundamento A nova doença por coronavírus (COVID-19) pode levar a uma enfermidade grave e causar a morte. Sabe-se que a COVID-19 afeta o sistema cardiovascular. A detecção precoce da progressão para um estágio grave da doença que afeta o sistema cardiovascular pode desempenhar um papel crítico no tratamento da COVID-19. Objetivos Explorar a possível relação entre a pneumonia por COVID-19 e os achados de strain do ventrículo direito no eletrocardiograma (ECG). Métodos Foi realizado um estudo retrospectivo de 141 pacientes hospitalizados com COVID-19. A correlação de Spearman e as análises de regressão logística foram aplicadas para avaliar as relações entre as manifestações de strain ventricular direito na ECG e os níveis de biomarcadores e outros achados laboratoriais e de imagem do tórax. O nível de significância foi considerado estabelecido como p < 0,05. Resultados Os sinais de ECG de estresse ventricular direito foram significativamente mais frequentes e os níveis de fibrinogênio, PCR e ferritina foram significativamente mais elevados em pacientes com COVID-19 com níveis elevados de hs-cTnI, procalcitonina e dímero-D. A análise univariada mostrou que existem relações significativas entre a presença de pneumonia bilateral, a maioria dos sinais eletrocardiográficos de strain ventricular direito e lesão cardíaca e biomarcadores inflamatórios e trombóticos. A análise multivariada revelou que o supradesnivelamento do segmento ST em V1 e padrão S1Q3T3 são preditores independentes de lesão cardíaca ( odds ratio =0,23; IC95%, 0,06 a 0,90; p=0,035) e níveis elevados de procalcitonina ( odds ratio =0,19; IC 95%, 0,06 a 0,62; p=0,006), respectivamente. Conclusão Os achados do presente estudo sugerem que a dano cardíaco direito é prevalente na COVID-19. Além disso, nosso estudo demonstra o valor clínico do ECG na avaliação e monitoramento de pacientes com pneumonia por COVID-19.

Abstract Background The novel coronavirus disease (COVID-19) may lead to severe disease that can cause death. COVID-19 is known to affect the cardiovascular system. Early detection of the progression to the severe disease stage that affects the cardiovascular system may play a critical role in the treatment of COVID-19. Objectives To explore the possible relationship between the COVID-19 pneumonia and right ventricular strain findings on electrocardiography (ECG). Methods We conducted a retrospective study of 141 hospitalized patients with COVID-19. Spearman's correlation and logistic regression analyses were applied to assess relationships between ECG manifestations of right ventricular strain and levels of biomarkers and other laboratory and chest imaging findings. The significance level was considered as < 0.05. Results The ECG signs of right ventricular stress were significantly more frequent and the levels of fibrinogen, CRP, and ferritin were significantly higher in COVID-19 patients with elevated levels of hs-cTnI, procalcitonin and D-dimer. The univariate analysis showed there are significant relations between the presence of bilateral pneumonia, most of the ECG signs of right ventricular strain and cardiac injury and inflammatory and thrombotic biomarkers. The multivariate analysis revealed that ST-segment elevation in V1and the S1Q3T3pattern are independent predictors of cardiac damage (odds ratio=0.23; 95% CI, 0.06 to 0.90; p=0.035) and elevated procalcitonin levels (odds ratio=0.19; 95% CI, 0.06 to 0.62; p=0.006), respectively. Conclusion The findings of the present study suggest that right heart damage is prevalent in COVID-19. In addition, our study shows the clinical value of ECG in evaluating and monitoring the patients with COVID-19 pneumonia.

Comparison of systemic immune-inflammation index (SII), early warning score (ANDC) and prognostic nutritional index (PNI) in hospitalized patients with malignancy, and their influence on mortality from COVID-19.

INTRODUCTION: We evaluated several biological indicators based on inflammation and/or nutritional status, such as systemic immune-inflammation index (SII), early warning score (ANDC) and prognostic nutritional index (PNI) in hospitalized COVID-19 patients with and without malignancies for a prognostic significance. METHODOLOGY: This is a retrospective and observational study on 186 patients with SARS-CoV-2, who were diagnosed with COVID-19 by real-time PCR testing and hospitalized due to COVID-19 pneumonia. 75 patients had various malignancies, and the rest (111), having a similar age and comorbidity profile based on propensity score matching, had no malignancy. RESULTS: None of the measures as neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, monocyte to lymphocyte ratio, SII, PNI or ANDC was found to be significantly different between two groups. Odds ratio for the mortality, OR 2.39 (%95 CI 1.80-3.16) was found to be significantly higher for the malignancy group, even though the duration of hospitalization was statistically similar for both groups. PNI was found to be significantly lower for deceased patients compared with survivors in the malignancy group. Contrarily, ANDC was found to be significantly higher for deceased patients in the malignancy group. CONCLUSIONS: PNI and ANDC have independent predictive power on determining the in-hospital death in COVID-19 malignancy cases. It is suggested that ANDC seems to be a more sensitive score than SII in COVID-19 cases with malignancies.

The mortality rate of COVID-19 was high in cancer patients: a retrospective single-center study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has quickly turned into a global pandemic with close to 5 million cases and more than 320,000 deaths. Cancer patients constitute a group that is expected to be at risk and poor prognosis in COVID pandemic. We aimed to investigate how cancer patients are affected by COVID-19 infection, its clinical course and the factors affecting mortality. METHODS: In our single-center retrospective study, we included cancer patients with laboratory confirmed COVID-19 in our hospital. Demographic, clinical, treatment, and laboratory data were obtained from electronic medical records. Logistic regression methods were used to investigate risk factors associated with in-hospital death. RESULTS: In the hospital, 4489 patients were hospitalized with COVID infection and 77 were cancer patients. The mean age of cancer patients was 61.9 ± 10.9 and 44 of them were male (62%). While the mortality rate in non-cancer patients was 1.51% (n = 68), this rate was significantly higher in cancer patients, 23.9% (n = 17). The stage of the disease, receiving chemotherapy in the last 30 days also lymphopenia, elevated troponin I, D-dimer, CRP, and CT findings were associated with severe disease and mortality. Severe lung involvement (OR = 22.9, p = 0.01) and lymphopenia (OR = 0.99, p = 0.04) are the most important factors influencing survival in logistic regression. CONCLUSIONS: The disease is more severe in cancer patients and mortality is significantly higher than non-cancer patients. These data show that it may be beneficial to develop dynamic prevention, early diagnosis and treatment strategies for this vulnerable group of patients who are affected by the infection so much.

The diagnostic utility of the "Thwaites' system" and "lancet consensus scoring system" in tuberculous vs. non-tuberculous subacute and chronic meningitis: multicenter analysis of 395 adult patients.

BACKGROUND: Tuberculous meningitis (TBM) represents a diagnostic and management challenge to clinicians. The "Thwaites' system" and "Lancet consensus scoring system" are utilized to differentiate TBM from bacterial meningitis but their utility in subacute and chronic meningitis where TBM is an important consideration is unknown. METHODS: A multicenter retrospective study of adults with subacute and chronic meningitis, defined by symptoms greater than 5 days and less than 30 days for subacute meningitis (SAM) and greater than 30 days for chronic meningitis (CM). The "Thwaites' system" and "Lancet consensus scoring system" scores and the diagnostic accuracy by sensitivity, specificity, and area under the curve of receiver operating curve (AUC-ROC) were calculated. The "Thwaites' system" and "Lancet consensus scoring system" suggest a high probability of TBM with scores ≤4, and with scores of ≥12, respectively. RESULTS: A total of 395 patients were identified; 313 (79.2%) had subacute and 82 (20.8%) with chronic meningitis. Patients with chronic meningitis were more likely caused by tuberculosis and had higher rates of HIV infection (P < 0.001). A total of 162 patients with TBM and 233 patients with non-TBM had unknown (140, 60.1%), fungal (41, 17.6%), viral (29, 12.4%), miscellaneous (16, 6.7%), and bacterial (7, 3.0%) etiologies. TMB patients were older and presented with lower Glasgow coma scores, lower CSF glucose and higher CSF protein (P < 0.001). Both criteria were able to distinguish TBM from bacterial meningitis; only the Lancet score was able to differentiate TBM from fungal, viral, and unknown etiologies even though significant overlap occurred between the etiologies (P < .001). Both criteria showed poor diagnostic accuracy to distinguish TBM from non-TBM etiologies (AUC-ROC was <. 5), but Lancet consensus scoring system was fair in diagnosing TBM (AUC-ROC was .738), sensitivity of 50%, and specificity of 89.3%. CONCLUSION: Both criteria can be helpful in distinguishing TBM from bacterial meningitis, but only the Lancet consensus scoring system can help differentiate TBM from meningitis caused by fungal, viral and unknown etiologies even though significant overlap occurs and the overall diagnostic accuracy of both criteria were either poor or fair.

Taste and Smell Impairment in COVID-19: An AAO-HNS Anosmia Reporting Tool-Based Comparative Study.

OBJECTIVE: To identify the taste and smell impairment in coronavirus disease 2019 (COVID-19)-positive subjects and compare the findings with COVID-19-negative subjects using the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) Anosmia Reporting Tool. SETTING: Tertiary referral center/COVID-19 pandemic hospital. STUDY DESIGN: Comparative study. SUBJECTS AND METHODS: After power analysis, 128 subjects were divided into 2 groups according to real-time polymerase chain reaction (RT-PCR) COVID-19 testing results. Subjects were called via telephone, and the AAO-HNS Anosmia Reporting Tool was used to collect responses. RESULTS: The mean age of the study group was 38.63 ± 10.08 years. At the time of sampling, rhinorrhea was significantly high in the COVID-19-negative group, whereas those complaints described as "other" were significantly high in the COVID-19-positive group. There was a significant difference in the smell/taste impairment rates of the groups (n = 46% [71.9%] for the COVID-19-positive group vs n = 17 [26.6%] for the COVID-19-negative group, P = .001). For subjects with a smell impairment, anosmia rates did not differ between the groups. The rates of hyposmia and parosmia were significantly high in the COVID-19-positive group. For the subjects with taste impairment, ageusia rates did not differ between groups. The rate of hypogeusia and dysgeusia was significantly high in the COVID-19-positive group. Logistic regression analysis indicates that smell/taste impairment in COVID-19-positive subjects increases the odds ratio by 6.956 (95% CI, 3.16-15.29) times. CONCLUSION: COVID-19-positive subjects are strongly associated with smell/taste impairment.

[Detection of intestinal parasites with conventional and molecular methods in follow-up HIV/AIDS cases]. / Izlemdeki hiv /aids olgularindaki intestinal parazitlerin konvansiyonel ve moleküler yöntemler ile saptanmasi.

In people living with human immunodeficiency virus (HIV), several complaints related to the gastrointestinal system, mainly diarrhea can be determined. In our study, we aimed to detect the existence of intestinal parasites with conventional methods based on microscopy and with molecular methods based on multiplex-PCR among 90 anti-retroviral treatment (ART) naive or ART adherent HIV/AIDS cases. The existence of Giardia spp., Blastocystis spp., Entamoeba histolytica, Dientamoeba spp. and Cryptosporidium spp. were searched in stool samples and the relation with the existence of these parasites and demographic/clinical data of the cases were determined. The demographic and clinical data of the participants included in the study were as follows; the average age was 34.02 ± 9.7 years, average time of diagnosis was 2.4 ± 1.7 years. Gender distribution was as follows; 85.6% male and 14.4% female. HIV transmission was related with heterosexual intercourse in 60%, homosexual intercourse in 33.3%, blood/blood products contact in 1.1% and with unknown routes in 5.6% of the cases. Fifty percent of the patients were in pre-ART and 50% was in on-ART state. The average CD4+ T lymphocyte count was detected as 400 cells/mm3 and the median of viral load was 114.527 copies/ml. An overall prevalence of at least one intestinal parasitic infection was recorded as 36.7% and the prevalence of this infection due to Blastocystis spp. was 22.2%, followed by Dientamoeba spp. (13.3%), E.histolytica (4.4%), Cryptosporidium spp. (3.3%), Giardia spp. (2.2%) and multiple parasitic infections (7.7%). The type of sexual behaviours related with the detection of intestinal parasites were statistically significant especially in homosexual intercourse (p< 0.001). The increase in CD4+ T lymphocyte counts were reversely associated (p= 0.062) and the increase in the levels of viral load were positively associated (p< 0.001) with detection rate of intestinal parasite. The detection of parasites by molecular methods was statistically significant in pre-ART participants (p= 0.002) and participants with diarrhea (p= 0.019). In the present study, the increase in the frequency of intestinal parasitic infections has shown that essential interventions are required. In all HIV/AIDS cases, routine parasitic screening should be performed by more sensitive methods to manage early and specific treatment.

Cranial imaging findings in neurobrucellosis: results of Istanbul-3 study.

OBJECTIVE: Neuroimaging abnormalities in central nervous system (CNS) brucellosis are not well documented. The purpose of this study was to evaluate the prevalence of imaging abnormalities in neurobrucellosis and to identify factors associated with leptomeningeal and basal enhancement, which frequently results in unfavorable outcomes. METHODS: Istanbul-3 study evaluated 263 adult patients with CNS brucellosis from 26 referral centers and reviewed their 242 magnetic resonance imaging (MRI) and 226 computerized tomography (CT) scans of the brain. RESULTS: A normal CT or MRI scan was seen in 143 of 263 patients (54.3 %). Abnormal imaging findings were grouped into the following four categories: (a) inflammatory findings: leptomeningeal involvements (44), basal meningeal enhancements (30), cranial nerve involvements (14), spinal nerve roots enhancement (8), brain abscesses (7), granulomas (6), and arachnoiditis (4). (b) White-matter involvement: white-matter involvement (32) with or without demyelinating lesions (7). (c) Vascular involvement: vascular involvement (42) mostly with chronic cerebral ischemic changes (37). (d) Hydrocephalus/cerebral edema: hydrocephalus (20) and brain edema (40). On multivariate logistic regression analysis duration of symptoms since the onset (OR 1.007; 95 % CI 1-28, p = 0.01), polyneuropathy and radiculopathy (OR 5.4; 95 % CI 1.002-1.013, p = 0.044), cerebrospinal fluid (CSF)/serum glucose rate (OR 0.001; 95 % CI 000-0.067, p = 0.001), and CSF protein (OR 2.5; 95 % CI 2.3-2.7, p = 0.0001) were associated with diffuse inflammation. CONCLUSIONS: In this study, 45 % of neurobrucellosis patients had abnormal neuroimaging findings. The duration of symptoms, polyneuropathy and radiculopathy, high CSF protein level, and low CSF/serum glucose rate were associated with inflammatory findings on imaging analyses.

The evaluation of the clinical, laboratory and the radiological findings of the fifty-five cases diagnosed with tuberculous, Brucellar and pyogenic spondylodiscitis.

OBJECTIVE: In this study, the evaluation of the clinical, laboratory and radiological findings belonging to 55 cases that were hospitalized in our clinic to be followed-up and were diagnosed with tuberculous, brucellar and pyogenic spondylodiscitis (SD) was aimed. MATERIALS AND METHODS: The cases with SD were evaluated retrospectively. Hematological, serological, biochemical laboratory tests and imaging technics were used for diagnosis. RESULTS: Of 55 cases aged ranging between 25 to 79, 33 (59%) were female. The cases with tuberculous SD (TBSD), brucellar SD (BSD) and pyogenic SD (PSD) were found in 24 (43%), 12 (21%) and in 19 (34%) patients. Erytrocyte sedimentation rate, increased C-reactive protein, and leucocytosis were present in 51 (91%), 22 (39%) and 8 (14%) cases. The number of the cases with history of previous surgery or trauma was 14 (25%). Diagnosis of TBSD was established by acid fast bacilli positiveness and Löwenstein Jensen culture positiveness, in two and seven patients, respectively. While all 12 cases with BSD had positive standard tube aglutination test, only 3 (25%) had hemoculture positivity. In PSDs, diagnosis was confirmed with culture positivity in 9 of 19 cases.Of the cases in our study, 89% responded to medical treatment while three required surgery and three died (5.5% and 5.5%, respectively). CONCLUSION: SD may develop secondary to infections or following spinal surgical procedures and traumas. Also, the importance of endemicity should be kept in mind, beside the helpful diagnostic findings while treatment regulation.