Is bronchial provocation test positivity associated with blood eosinophil count and cut-off value?

OBJECTIVE: Asthma is characterized by airway hyperresponsiveness due to chronic inflammation in the airways. One of the main cells involved in airway inflammation is eosinophils. In the current study, a bronchial provocation test (BPT) was performed to demonstrate airway hyperresponsiveness. We investigated the relationship between BPT and blood eosinophil count and the cut-off value of blood eosinophil count. PATIENTS AND METHODS: In this study, we retrospectively evaluated the data of 246 patients who visited our immunology and allergy clinic, a tertiary reference center, with asthma symptoms between May 2017 and March 2020 and underwent BPT with methacholine for the diagnosis of asthma. The cases were grouped according to the level of BPT positivity and negativity. RESULTS: Of 246 patients, BPT was positive in 90 (36.6%) and negative in 156 (63.4%). The blood eosinophil measurement of the BPT-positive cases was found to be statistically significantly higher than that of the BPT-negative cases (135 vs. 119 cells/µl, respectively, p=0.029). When BPT is grouped according to positivity levels, there was no statistically significant difference in blood eosinophil measurements between subgroups (p=0.174). As a result of the evaluations, the cut-off point obtained for the blood eosinophil count was determined as ≥226 cells/µl. For the blood eosinophil count, for the cut-off value of ≥226 cells/µl, sensitivity was 30.0%, specificity 87.7%, positive predictive value 58.7%, and negative predictive value 68.3%. CONCLUSIONS: This study shows that BPT positivity is associated with blood eosinophil count. The cut-off value (≥226 cells/µl) determined for blood eosinophil count may be helpful when planning BPT and evaluating the diagnosis of asthma.

Views on Reading and Research Habits of Veterinary Medicine Students in Turkey.

Reading and research habits, together with individual and social development, some of the most important criteria of a qualified life in our age, are among the characteristics university students are expected to have. As in every profession, veterinary professional development is possible with individual development by continuous studying and researching professional topics starting in students' graduate years. This research provides perspectives from the veterinary students of six faculties in Turkey on reading and research interests. The researchers developed a 39-item questionnaire-type instrument, which was given to 1,359 students studying at Ankara, Aydin, Burdur, Samsun, Erzurum, and Bursa in Turkey; data were analyzed using statistical tests. The number of books veterinary students read in a year did not exceed five by 34% of respondents. Only 22.3% read more than 11 books. Students were most likely to read novels (26.1%) and least likely to read religious books (0.5%). We also found that more than half the students were willing to join the scientific research community (56.3%) and become research assistants (57.8%). The researchers found a positive increase in students' views on reading and research interests as grade level increased, in favor of female and urban-based participants. In conclusion, the authors recommend that students be encouraged to do research, given assignments for researching various scientific topics, and provided environments to gain lifelong learning skills. Individuals who prefer reading and research will likely contribute to their personal and professional development and to their country in general.

Long-Term Follow-up Results of Renal Transplantation in Pediatric Patients With Focal Segmental Glomerulosclerosis: A Single-Center Experience.

INTRODUCTION AND AIM: Focal segmental glomerulosclerosis (FSGS) is a common cause of end-stage renal disease in children. We analyzed the long-term outcome of pediatric patients with FSGS undergoing renal transplantation. The objective of the study is to report the experience of a single center and determine the incidence of recurrence, rejection, graft loss, and related risk factors. MATERIALS AND METHOD: This retrospective cohort study was performed between 1991 and 2018. Thirty patients with a pathologic diagnosis of primary FSGS were included in the study. The patients were diagnosed with FSGS according to histologic features in biopsies. RESULTS: Twenty-one of the donors were deceased (70%) and 9 were alive (30%). FSGS recurred in only 2 patients. Graft loss occurred in 6 patients (20%). The causes of graft loss were chronic rejection in 4 patients and acute rejection in 2. Our graft survival rate was 100% at 1 year, 91% at 5 years, 80% at 10 years, 70% at 15 years, and 42% at 20 years. Five- and 10-year graft survival rates were 83% and 83% in living donors and 94% and 79% in deceased donors, respectively. According to Kaplan-Meier analysis, there was no statistically significant difference in terms of graft survival between living and deceased donors. CONCLUSION: This study, with its contribution to literature in terms of long follow-up of FSGS patients from childhood to adulthood, is important. However, further studies are required.

Evaluation and therapy in four patients with Takayasu's arteritis.

Takayasu's arteritis (TA) is a large-vessel vasculitis primarily affecting the aorta and its branches. It ranks third among other types of childhood vasculitis, while it is the most common large vessel vasculitis observed in childhood. The diagnosis of TA should be made on the basis of clinical criteria and supported with laboratory findings, while confirming it with the imaging methods. Angioplasty, stent and bypass grafts may be necessary in the case of an irreversible arterial stenosis. Small-vessel involvement in TA and acute phase reactants should be taken into account for the diagnosis of an attack. In this report, treatment choices for four patients with the diagnosis of pediatric TA, their clinical and laboratory findings and their responses to treatment will be discussed.

Clinical everolimus experience in pediatric renal transplant patients.

OBJECTIVE: Everolimus is a potent immunosuppressive agent that has antiproliferative activities. This study sought to share our experience among renal transplanted children who required conversion from calcineurin inhibitors (CNIs) to the mammalian target of rapamycin inhibitor everolimus. PATIENTS AND METHODS: Exclusion criteria were multiple organ transplantations, loss of a previous graft due to immunologic reasons, receipt of an organ donated after cardiac death, donor age <5 years or >65 years, panel reactive antibodies >25%, platelets <75,000/mm(3), absolute neutrophil count of <1,500/mm(3), leucocytes <2,500/mm(3), hemoglobin <6 g/dL, severe liver disease, cold ischemia time >40 hours or anti-HLA panel-reactive antibodies >50%. RESULTS: Eighteen renal transplant patients (10 male, 8 female) underwent conversion to everolimus from CNI: 8 from cyclosporine (CsA) and 10 from tacrolimus. The mean age was 12.6 ± 0.9 years and the mean body mass index 21.8 ± 1.7 kg/m(2). The mean 2-hour postdose level of CsA before conversion was 671 ± 142 ng/mL; the patients on tacrolimus showed a mean trough concentration of 4.5 ng/mL. Six (33,3%) were taking mycophenolate mofetil and 12 (66.6%) enteric-coated mycophenolate sodium. No significant changes were observed in either hepatic functions, serum lipids, or hemograms. There was no mortality or graft loss. The mean level of serum creatinine was 1.3 ± 0.7 mg/dL before and 1.09 ± 0.6 mg/dL after conversion. Proteinuria observed in only 1 patient was well controlled with angiotensin-converting enzyme inhibitor therapy. All patients responded to statin therapy. One patient developed unilateral lower extremity edema and 1 a lymphocele. Although there were 3 cases (14%) of biopsy-confirmed acute rejection, there was no mortality or graft loss. CONCLUSIONS: Everolimus conversion has become an excellent choice, offering safety and efficacy with good outcomes.

Comparison of serum CA 19.9, CA 125 and CEA levels with severity of chronic obstructive pulmonary disease.

OBJECTIVE: To investigate serum levels of CA 19.9, CA 125 and carcinoembryonic antigen (CEA) in patients with different stages of chronic obstructive pulmonary disease (COPD). PATIENTS AND METHODS: Fifty-three consecutive patients (50 males, 3 females, mean age 67.6 +/- 10.1 years) with COPD were included in this study. Serum levels of CA 19.9, CA 25 and CEA were determined by the chemiluminescent immunometric method. Based on values obtained from pulmonary function tests, the patients were divided into 3 groups: moderate (21), severe (18) and very severe (14). Data were analyzed with a Kruskal-Wallis one-way analysis of variance test and Mann-Whitney U test. RESULTS: The mean serum levels of CA 125 and CA 19.9 were significantly higher in patients with very severe COPD (p = 0.013 and p = 0.017, respectively) than in patients with severe and moderate COPD (p < 0.05). Patients with cor pulmonale had significantly high mean serum levels of CEA, CA 19.9 and CA 125 (p < 0.05). Patients using a long-acting beta-agonist and theophylline showed significantly higher mean serum levels of CA 125 than patients who were not (p < 0.05). CONCLUSION: Data showed that the increased serum tumor markers in patients with COPD might be due to the severity of COPD, medication and cor pulmonale.

Prevalence and Risk Factors of Allergies in Turkey (PARFAIT): results of a multicentre cross-sectional study in adults.

The Prevalence and Risk Factors of Allergies in Turkey (PARFAIT) study was planned to evaluate the prevalence of and risk factors for asthma and allergic diseases in Turkey. The present analysis used data from 25,843 parents of primary school children, obtained from a cross-sectional questionnaire-based study. A total of 25,843 questionnaires from 14 centres were evaluated. In rural areas, the prevalences asthma, wheezing, allergic rhinitis and eczema in males were: 8.5% (95% confidence interval (CI) 7.9-9.1%), 13.5% (95% CI 12.8-14.2%), 17.5% (95% CI 16.7-18.2%) and 10.8% (95% CI 10.2-11.4%), respectively; and in females were: 11.2% (95% CI 10.9-11.8%), 14.7% (95% CI 14.3-15.1%), 21.2% (95% CI 20.4-22.0%) and 13.1% (95% CI 12.4-13.8%), respectively. In urban areas, the corresponding prevalences in males were: 6.2% (95% CI 5.8-6.6%), 10.8% (95% CI 10.3-11.3%), 11.7% (95% CI 11.4-12.0%) and 6.6% (95% CI 6.2-7.0%), respectively; and in females were: 7.5 % (95% CI 7.9-7.1%), 12.0% (95% CI 11.7-12.3%), 17.0% (95% CI 16.4-17.6%) and 7.3% (95% CI 6.9-7.7%), respectively. Having an atopic first-degree relative or any other atopic diseases had significant effects on the prevalence of allergic diseases. Housing conditions, such as living in a shanty-type house, visible moulds at home and use of wood or biomass as heating or cooking material were associated with one or more allergic diseases. Although genetic susceptibility is strongly associated, country- and population-based environmental factors may contribute to increased prevalence rates of allergic diseases.

Pregnancy-associated plasma protein-A: evaluation of a new biomarker in renal transplant patients.

OBJECTIVE: Trophoblasts produce high concentrations of pregnancy-associated plasma protein-A (PAPP-A) during pregnancy. PAPP-A has been described as a new inflammatory marker and an independent risk factor for posttransplant cardiovascular risk. This study evaluated the clinical significance of PAPP-A in renal transplant patients. METHODS: The study included 78 adult renal transplant patients (56 men and 22 women) and 37 control subjects (27 men and 10 women). We determined serum PAPP-A, urea, creatinine, uric acid, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglyceride, 24-hour proteinuria, and C-reactive protein (CRP) levels. RESULTS: The PAPP-A level was significantly higher among renal transplant patients [median (interquartile range), 10.5 (6.4 to 15.4) mU/L] than the control group [3.9 (3.1 to 5.2) mU/L; P<.001]. There were significant positive correlations between serum PAPP-A levels and urea (r=.547, P=.001), creatinine (r=.497, P=.001), uric acid (r=.452, P=.001), and CRP values (r=.387, P=.001). The drugs used for immunosuppression in transplant patients (cyclosporine, tacrolimus, and others) did not significantly affect serum PAPP-A levels (P>.05). CONCLUSION: We concluded that PAPP-A level was elevated in renal transplant patients and that high levels of PAPP-A might be a prognostic marker owing to their close association with high serum levels of urea, creatinine, uric acid, and CRP.