Do the drug doses of conventional synthetic DMARDs used for the treatment of biologic/targeted-synthetic DMARDs naive rheumatoid arthritis patients affect QuantiFERON-TB Gold Plus test results?

We aimed to obtain the effects of immunosuppressive doses on the QuantiFERON-TB Gold Plus (QFT-Plus) test results in Rheumatoid Arthritis (RA) patients. Besides this, the impact of the TB2 tube in QFT-Plus test was also investigated. This study included RA patients registered to HURBIO and were screened via QFT-Plus test for latent tuberculosis between January 2018 and March 2021, before the initiation of treatment of biologic/targeted-synthetic disease modifying anti-rheumatismal drugs (b/ts-DMARDs). Patients using methotrexate ≥ 10 mg or leflunomide (any dose) or steroids (≥ 7.5 mg prednisolone) at the time of QFT-Plus test were classified as the "high dose" group and the rest of the patients constituted the "low dose" group. The study included 534 RA patients; 353 [66.1%] in the high-dose group and 181 [33.9%] in the low-dose group. While QFT-Plus test was positive in 10.5% (37/353) patients in the high-dose group, it was positive in 20.4% (37/181) patients in the low-dose group (p < 0.001). The percentage of QFT-Plus indeterminate results were similar (around 2%) in both groups. The contribution of the TB2 tube to QFT-Plus test positivity was 6.89%. During a median (inter-quartile range) follow-up period of 23 (7-38) months under treatment of b/ts-DMARDs, latent TB reactivation was not observed. Primer active tuberculosis disease developed in two patients. Positive test results of Interferon-Gamma Release Assays (IGRAs) could decrease as immunosuppressive treatment doses increase in patients with RA and addition of the TB2 tube could increase test sensitivity.

Correlation of Treponemal Chemiluminescent Microparticle Immunoassay Screening Test Signal Strength Values With Reactivity of Confirmatory Testing.

BACKGROUND: Automated chemiluminescent microparticle immunoassays (CMIAs) are the most common first step at high-volume laboratories for syphilis screening. If the initial screening test is reactive, 1 more treponemal test is required, resulting in increased cost. In this multicenter study, we aimed to determine the correlation between the CMIA signal-to-cutoff ratio (S/Co) and the confirmatory tests to reduce unnecessary confirmatory testing. METHODS: Eight hospitals from 5 provinces participated in this study. All laboratories used Architect Syphilis TP CMIA (Abbott Diagnostics, Abbott Park, IL) for initial screening. Treponema pallidum hemagglutination (TPHA), rapid plasma reagin (RPR), and fluorescent treponemal antibody absorption (FTA-ABS) were used as confirmatory tests according to the reverse or European Centre for Disease Prevention and Control algorithms. A receiver operating characteristic analysis was used to determine the optimal S/Co ratio to predict the confirmation results. RESULTS: We evaluated 129,346 serum samples screened by CMIA between January 2018 and December 2020. A total of 2468 samples were reactive; 2247 (91%) of them were confirmed to be positive and 221 (9%) were negative. Of the 2468 reactive specimens, 1747 (70.8%) had an S/Co ratio ≥10.4. When the S/Co ratios were ≥7.2 and ≥10.4, the specificity values were determined to be 95% and 100%, respectively. In a subgroup of 75 CMIA-positive patients, FTA-ABS was performed and 62 were positive. Among these FTA-ABS-positive patients, 24 had an S/Co ratio <10.4, and negative TPHA and RPR. CONCLUSIONS: We propose a potentially cost-effective reverse screening algorithm with a treponemal CMIA S/Co ratio ≥10.4, obviating the need for secondary treponemal testing in about 71% of the screening-reactive samples. This would substantially reduce the confirmatory testing volume and laboratory expenses. However, in high-risk group patients with CMIA positive results, S/Co ratio <10.4, and negative TPHA and RPR, FTA-ABS may be used for confirmation.

[SARS-CoV-2 Seroprevalence Among Healthcare Workers: Retrospective Analysis of the Data From A University Hospital in Turkey]. / Saglik Çalisanlarinda SARS-CoV-2 Seroprevalansi: Türkiye'deki Bir Üniversite Hastanesi Verilerinin Retrospektif Analizi.

COVID-19 infection caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) continues to affect people as a global threat, and the number of cases is increasing every day. Healthcare workers who face potential COVID-19 exposure are at high risk of SARS-CoV-2 transmission. Estimating the prevalence of infection among healthcare professionals, determining the related risk factors and applying effective infection control measures are essential for the continuity of the health system. The aim of this study was to investigate the seroprevalence of SARS-CoV-2 among healthcare workers in our hospital who have participated extensively in the monitoring of COVID-19 patients. In the study, the anti-SARS-CoV-2 IgG antibody test results of 774 healthcare workers between March 24, 2020, and September 10, 2020 were analyzed retrospectively. Age, sex, profession, and the status of being diagnosed with COVID-19 before the antibody test were determined for the healthcare workers in the study. When the anti-SARS-CoV-2 IgG antibody results were evaluated, it was determined that 57 healthcare workers were positive, 708 healthcare workers were negative, and 9 healthcare workers were borderline. The seroprevalence among the workers of our hospital was found to be 7.4%. The antibody positivity rate was 75.6% in individuals diagnosed with COVID-19 by SARS-CoV-2 PCR (polymerase chain reaction) and/or thoracic computed tomography and it was found to be 3.5% in individuals without the diagnosis. The semi-quantitative antibody index values of the healthcare workers who were seropositive and diagnosed with COVID-19 before the test (n= 31) and those who did not (n= 26) were statistically compared and a significant difference was found between the two groups (p<0.01). In our study, the highest seropositivity was observed among residents (12.3%) and among nurses (11.1%), respectively. When the seropositivity rates of the residents and the nurses were compared with other occupational groups, the differences were found to be statistically significant (p= 0.04, p= 0.04, respectively). In conclusion, the seroprevalence of SARS-CoV-2 was determined as 7.4% among healthcare workers in a tertiary hospital with high patient admissions during the COVID-19 pandemic. Considering that SARS-CoV-2 seroprevalence was announced as 0.81% in the press release made by the Ministry of Health of Turkey in July 2020, it is seen that the rate of seroprevalence among health care workers is significantly larger than the community. Determination of the seroprevalence in the general population and large-scale studies are needed for risk assessment in healthcare professionals.

Changes in pulmonary function in hyperbaric chamber inside attendants: a case-control study.

BACKGROUND: Inside attendants (IAs) [are] exposed to high pressure during hyperbaric oxygen (HBO2) therapy. The aim of this study was to evaluate the alterations of pulmonary functions in IAs over time. METHODS: IAs in our hyperbaric center constituted the IA group (n=11). A sex- and age-matched control group (n=15) was constituted from hospital staff who had not dived or been exposed to hyperbaric environments before. We measured the respiratory function of all subjects at two time points: 1) at the start of the study; and 2) 12 months after the first measurement. The following parameters were recorded: forced vital capacity (FVC), forced expiratory volume in one second (FEV1), rate of FEV1 to FVC (FEV1/FVC%), forced expiratory flow at 25% to 75% vital capacity (FEF25-75%), forced expiratory flow at 50% vital capacity (FEF50%), forced expiratory flow at 25% vital capacity (FEF25%). RESULTS: Both groups were similar in terms of age, sex, smoking and body mass index. We found that FEV1, FEV1/FVC%, FEF25-75% and FEF50% significantly reduced in both groups after 12 months (p⟨0.05). However, the rate of change in all parameters was similar in both groups (p⟩0.05). In the IA group, the total number of exposures within the 12 months was positively correlated with the rate of reduction in FEF25% (r=0.788, p=0.004). CONCLUSION: Working as an IA does not deteriorate pulmonary function in the short term. However, there is a need for long-term follow-up studies.

Neuropsychological Evaluation of Children and Adolescents With Acute Carbon Monoxide Poisoning.

OBJECTIVES: Carbon monoxide (CO) poisoning is a worldwide health problem. We have limited information regarding psychological adversities of CO poisoning in children and adolescents. The aim of this study was (1) to investigate the effects of severe CO poisoning on cognitive functions, mood, and behaviors in children and adolescents and (2) to identify factors related to occurrence of neuropsychological symptoms. METHODS: This study included pediatric patients, who were evaluated after CO poisoning at the Department of Child and Adolescent Psychiatry between January 2012 and April 2013. The patients were evaluated at 2 time points. The first evaluation was done when they were discharged from emergency department, and the second evaluation was done 1 month after CO poisoning. Turkish versions of internationally recognized tests were used to evaluate anxiety, depressive symptoms, attention, visual-spatial skills, memory, and behaviors of patients. RESULTS: Twenty-seven patients were analyzed. The mean age of the patients was 11.8 ± 2.7 years (range, 6-18 years). The mean carboxyhemoglobin level was 31.5% ± 7.8% (range, 19%-51%) dir. Delayed neurological sequel was observed in only 1 patient, who had headache and tinnitus. We found that carboxyhemoglobin level was not correlated with later neuropsychiatric test scores. However, we found a correlation between history of loss of consciousness and anxiety symptom level, hyperbaric oxygen (HBO) therapy session and behavioral problems, and time to HBO therapy and attention problems. CONCLUSIONS: We suggest that CO exposure duration, history of loss of consciousness, time to HBO therapy, and the number of HBO therapy session affect neuropsychological symptom levels and occurrence of attention and behavioral problems.

Hyperbaric oxygen treatment for unilateral testicular torsion in a child.

Torsion of the testis is a urological emergency most commonly occurring in adolescent boys. Hyperbaric oxygen treatment (HBOT) has been shown to alleviate reperfusion injury in experimental ischaemia of the testis. We report a 13-year-old boy who had prolonged right testicular ischaemia. Despite surgery, the colour of the testis remained poor. He underwent a post-operative course of 10 HBOT over 8 days, with restoration of blood flow on colour Doppler and reduction of oedema. At four-month followup, the testis appeared normal on ultrasonography. To the best of our knowledge, this is the first published case of torsion of the testis treated with HBOT.

An assessment of initial body size in loggerhead sea turtle (Caretta caretta) hatchlings in Turkey.

Eggs, hatchlings, and adult loggerhead turtles, and incubation durations of clutches, were measured on three Turkish beaches (Dalyan, Fethiye and Göksu Delta), and some physical features of nests were compared. These features were not statistically different among the beaches, except for nest depth and distance to the high water mark. There was a positive relationship between hatchling mass and egg size. The carapace length of hatchlings was correlated with both egg diameter and incubation duration. The duration of asynchronous emergence of hatchlings on Fethiye beach was slightly longer than on the other two beaches, and the size of hatchlings decreased as asynchronous emergence proceeded. Of the hatchlings that emerged first, those that died were significantly smaller in SCL and mass than those that lived. These results suggest that smaller hatchlings may not be vigorous enough to emerge earlier from nests, and that they may be less fit.

Sex ratio estimations of loggerhead sea turtle hatchlings by histological examination and nest temperatures at Fethiye beach, Turkey.

Hatchling sex ratios in the loggerhead turtle (Caretta caretta) were estimated by placing electronic temperature recorders in 21 nests at Fethiye beach during 2000-2002. Over the seasons, the mean temperature in the middle third of the incubation period ranged from 26.7 to 32.1 degrees C, and incubation periods ranged from 49 to 67 days. Based on the mean temperatures during the middle third of the incubation period, and on histologically sexed dead hatchlings, the sex ratios of hatchlings at Fethiye beach were roughly equal, i.e. 60-65% of the hatchlings were females. This contrasts with the highly female-skewed sex ratios in loggerhead turtles elsewhere; Fethiye has a relatively high proportion of male hatchlings. For endangered sea turtles, the knowledge of hatchling sex ratios at different beaches, coupled with appropriate conservation measures, can make an important contribution to their survival.