Tubulointerstitial Nephritis and Uveitis Syndrome During the COVID-19 Pandemic: A Case Series.

Objectives: To report the ocular findings, laboratory results, and management of patients with tubulointerstitial nephritis and uveitis syndrome (TINU), whose numbers increased during the 2019 coronavirus disease (COVID-19) pandemic. Materials and Methods: Demographic characteristics, ophthalmic examination findings, laboratory results including polymerase chain reaction (PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), serum SARS-CoV-2 immunoglobulin G (IgG) antibody, and treatment of patients diagnosed with TINU between March 2020 and March 2022 were evaluated retrospectively. Results: The study included 19 eyes of 10 patients (6 female/4 male). The mean age was 13.5±2.4 years (range: 8-16 years). The mean follow-up duration was 13.5±6.1 months (range: 6-24 months). All patients presented with anterior uveitis. Anterior uveitis was bilateral in 9 patients (90%) and unilateral in 1 patient (10%). Posterior segment findings were normal in 8 patients (80%), and bilateral optic disc edema was observed in only 2 patients (20%). None of the patients had a previous SARS-CoV-2 infection and/or vaccination history. The SARS-CoV-2 PCR test was negative in all patients at presentation. The SARS-CoV-2 IgG antibody test was reactive in 7 patients (70%). Recurrent uveitis developed in 8 patients (80%) during follow-up. Systemic immunomodulatory therapy was required for the control of ocular inflammation in 7 patients (70%) with severe uveitis flare-ups. Conclusion: TINU is a multisystemic autoimmune disease, especially in response to environmental triggering factors such as viral infections. Although TINU is a rare disease, the number of cases increased during the COVID-19 pandemic. SARS-CoV-2 antibodies were detected at a significant rate of 70% in these patients, who did not have a history of SARS-CoV-2 infection and vaccination. Previous asymptomatic SARS-CoV-2 infection in children may be a triggering factor in the development of TINU.

Investigation of the relationship between nurses' perception of toxic leadership and their organizational trust levels and turnover intentions.

AIM: This study aimed to investigate the relationship between nurses' perception of toxic leadership and their organizational trust levels and turnover intentions. DESIGN: This cross-sectional study was conducted using an online survey of 168 nurses working in public and university hospitals. METHODS: Data were collected between April and November 2022 with the Toxic Leadership Scale, Organizational Trust Scale and Turnover Intention Scale. Descriptive statistics, correlations, and regression analyses were used to analyse these data. RESULTS: It was determined that almost half of the nurses (46.4%) were exposed to negative behaviours from their managers within the last year. Nurses' perception of toxic leadership, organizational trust level and turnover intention were moderate. It was found that nurses' perceptions of toxic leadership had a negative effect on organizational trust level (R2 = .691; ß = -0.832; p < .05) and a positive significant effect on turnover intention (R2 = .267; ß = 0.521; p < .05). CONCLUSIONS: This study revealed that toxic leadership behaviours in health organizations should be struggled with to increase nurses' organizational trust and reduce their turnover. In this context, an organizational culture in which toxic behaviours are not tolerated should be established in health organizations. IMPACT: What problem did the study address? In the literature, mostly positive leadership behaviours of nurse managers are emphasized and little is known about their negative behaviours such as toxic leadership. What were the main findings? It was determined that nurses who perceived more toxic behaviour from their managers had less trust in their organizations and higher turnover intention. On whom will the research have an impact? To provide a positive working environment and reduce turnover, it is necessary to create an organizational culture in which the toxic behaviours of nurse managers are not tolerated. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Adaptation of the Workflow Integration Survey to Turkey: A Validity and Reliability Study.

Background and Purpose: Electronic health record systems (EHRSs) are widely used to record patients' data and should be compatible with nurses' workflow. The purpose of this study was to adapt the Workflow Integration Survey (WIS) to the Turkish language and examine the reliability and validity measures of the Turkish version of the scale. Methods: In this methodological study, data were collected between December 2019 and February 2020 from 120 nurses. This study included the following phases: translation and evaluation of the content validity; explanatory and confirmatory factor analyses (CFAs) and reliability analysis. The intraclass correlation coefficient (ICC) was used for the test-retest reliability with 30 nurses. Results: The results of CFA revealed a two factors' structure, and these two factors explained 50.57% of the total variance. This was confirmed (χ2/df = 1.673, goodness-of-fit index [GFI] = 0.948, incremental fit index [IFI] = 0.923, comparative fit index [CFI] = 0.918, root mean square error of approximation [RMSEA] = 0.075, and standardized root mean square residual [SRMR] = 0.0604) using structural equation modeling. The total Cronbach's alpha value was found to be .702, .636, and .649 for the subscales. The intraclass correlation coefficient (ICC) was calculated for test-retest reliability and was found to be 0.871. Conclusions: The validity and reliability of the WIS have been found to be sufficient. It is recommended that the validity and reliability studies on the WIS be conducted in different hospitals with a larger number of participants. Furthermore, the use of the scale in cross-cultural studies to evaluate the compatibility of EHRSs with nurses' workflow in different cultures is also suggested.

Ocular side effects of Trametinib and Dabrafenib: a case report.

A 53-year-old man who has stage 4 non-small cell lung carcinoma and treated with Dabrafenib-Trametinib combination chemotherapy; presented with decreased bilateral visual acuity. We checked out slit lamp examination, fundoscopy, optical coherence tomography and fundus fluorescein angiography. In slit lamp biomicroscopy; bilateral posterior synechiae, granulomatous keratic precipitates and + 4 cells in the anterior chamber were detected. Cystoid macular edema and subretinal fluid accumulation were revealed in optical coherence tomography. Dabrafenib and Trametinib treatments were discontinued and systemic methylprednisolone, topical corticosteroid and topical cyclopentolate were started. His best corrected visual acuity was increased from counting fingers from 2 m to 0,9 bilaterally and cystoid macular edema and serous retinal detachment were completely regressed as a result of systemic and topical corticosteroid treatment.

Survey of hygiene, behaviours, and awareness regarding contact lens wear with conventional and novel questions.

Clinical relevance: Contact lens (CL) compliance studies are beneficial to identify potential risks, take necessary measures, and issue warnings on time.Background: Understanding CL compliance is crucial to ensure that individuals maintain healthy and appropriate CL wear. The present study aims to assess knowledge and awareness about soft CLs; the degree of non-compliance among soft CL wearers; and the associations of these with demographic features.Methods: A comprehensive questionnaire composed of 44 questions was used to assess the demographic characteristics, hygiene care, habits, knowledge, opinions, awareness and experiences of 109 soft CL wearers. The survey was conducted between September 2019 and March 2020.Results: The mean non-compliance rates were: 35.4% and 11.2% for hand-washing and hand-drying; 77.8% for rubbing/rinsing of the CLs; and 37.0%, 50.5%, and 31.6% for swimming, showering, and overnight sleeping with the CLs in, respectively. Women were more compliant in manual cleaning and rinsing of the CL storage cases with lens solution (p = 0.037). Swimming behaviour with inserted CLs was significantly high among CL users with over 5 years of experience (p = 0.03). Additionally, 85% of the wearers generally found the soft CLs comfortable, and 69.8% found the cost of the soft CLs reasonable. Over 90% of the wearers spent between 0 to 5 min per day to insert and remove the soft CLs.Conclusion: Women presented with more frequent CL use, and were significantly more compliant in terms of cleaning the CL storage cases. Regardless of gender, the non-compliance of swimming with inserted CLs was significantly high among CL wearers with over five years of experience. A majority of the results of the investigated non-compliances did not depend on gender, income level, age-group, duration of CL use, and education level.

The frequency and causes of abnormal head position based on an ophthalmology clinic's findings: is it overlooked?

PURPOSE: To determine the frequency of abnormal head position (AHP) and identify the underlying causes in patients who presented to an ophthalmology clinic due to any ophthalmologic complaint. METHODS: The medical records of patients who presented with any ophthalmologic symptoms during a 6-month period were prospectively evaluated. In all, 2,710 patients (1,492 female and 1,218 male) aged 6 months-91 years were included in the study. Each patient underwent complete ophthalmologic evaluation. RESULTS: Among the 2,710 patients, 30 (1.1%) (7 female and 23 male) with a mean age of 14.62 ± 17.45 years (range 6 months-60 years) had AHP. In total, 24 (80%) of the patients with AHP were aged ≤16 years. The initial complaint in the patients with AHP was ocular misalignment in 18 (60%) patients, AHP in 4 (13.3%), abnormal ocular movements in 4 (13.3%), double vision in 3 (10%), and droopy eyelid in 1 (3.3%). Comitant strabismus, nystagmus, and Duane syndrome were the most common causes of AHP. Other diagnoses included fourth nerve palsy, sixth nerve palsy, Brown syndrome, congenital muscular torticollis, ptosis, and blowout orbital fracture. CONCLUSIONS: The leading underlying causes of AHP in patients who presented to an ophthalmology clinic were ocular and treatable. Of note, in only a minority of these patients AHP was the initial presenting complaint. Clinicians must be aware that observation of any head position that is not normal should prompt additional investigation, as the underlying pathology can cause treatable morbidity or in rare instances mortality, such as in cases of acute cranial nerve palsy.

Adult orbital xanthogranulomas: clinical features and management.

PURPOSE: Adult-onset asthma with periocular xanthogranuloma and adult-onset xanthogranuloma are 2 rare subtypes of non-Langerhans cell histiocytic disorder and much remains unknown regarding optimal treatment. The authors describe their experience in the management of these 2 disease subtypes. METHODS: This is a retrospective case series with histopathologically proven orbital xanthogranuloma over a period of 12 years. Clinical, imaging, and histopathologic features; associated systemic conditions; treatment modality; and outcome during follow-up of 6 adult patients who had adult-onset asthma with periocular xanthogranuloma and adult-onset xanthogranuloma were reviewed. RESULTS: The age range was 29-75 years (median 56 years). The duration of symptoms and signs varied from 10 months to 9 years. All patients had bilateral and asymmetric involvement. Palpebral swelling with yellow discoloration and upper eyelid ptosis were the most common signs. Adult-onset asthma was present in 2 patients. Imaging studies demonstrated ill-defined infiltrative lesions involving the preseptal area, lacrimal glands, extraocular muscles, retrobulbar fat, and optic nerves. The median follow-up was 50 months. Complete regression of all clinical signs was obtained at 8 months, whereas imaging findings disappeared at 18 months with treatment. No recurrence was observed. CONCLUSIONS: Treatment consisting of debulking as much affected soft tissue as possible followed by a 3-day course of intravenous pulse methylprednisolone administration and then by oral prednisone for at least 6 months may provide adequate regression of the granulomas without recurrence and satisfactory cosmesis in patients with adult orbital xanthogranuloma with and without asthma.