Does decision tree analysis predict oral ulcer activity-related factors in patients with Behçet's syndrome?

OBJECTIVES: The study aimed to identify the interactions among treatment protocols and oral ulcer activity related factors in patients with Behçet's syndrome (BS) using the Classification and Regression Tree (CART) algorithm. METHODS: In this cross-sectional study, 979 patients with BS were included from16 centres in Turkey, Jordan, Brazil and the United Kingdom. In the CART algorithm, activities of oral ulcer (active vs. inactive), genital ulcer (active vs. inactive), cutaneous involvement (active vs. inactive), musculoskeletal involvement (active vs. inactive), gender (male vs. female), disease severity (mucocutaneous and musculoskeletal involvement vs. major organ involvement), smoking habits (current smoker vs. non-smoker), tooth brushing habits (irregular vs. regular), were input variables. The treatment protocols regarding immunosuppressive (IS) or non-IS medications were the target variable used to split from parent nodes to purer child nodes in the study. RESULTS: In mucocutaneous and musculoskeletal involvement (n=538), the ratio of IS use was higher in patients with irregular toothbrushing (ITB) habits (27.1%) than in patients with regular toothbrushing (RTB) habits (14.2%) in oral ulcer activity. In major organ involvement (n=441), male patients with ITB habits were more likely treated with IS medications compared to those with RTB habits (91.6% vs. 77.6%, respectively). CONCLUSIONS: Male BS patients on IS who have major organ involvement and oral ulcer activity with mucocutaneous and musculoskeletal involvement have irregular toothbrushing habits. Improved oral hygiene practices should be considered to be an integral part for implementing patient empowerment strategies for BS.

The Influence of Design Modifications and Microstructured Surface Topographies on Bleb Survival after Glaucoma Tube Shunt Implantation.

Lowering intraocular pressure (IOP) by placement of a glaucoma shunt is an effective treatment for glaucoma. However, fibrosis of the outflow site can hamper surgical outcome. In this study, the antifibrotic effect of adding an endplate (with or without microstructured surface topographies) to a microshunt made of poly(styrene-block-isobutylene-block-styrene) is investigated. New Zealand white rabbits are implanted with a control implant (without endplate) and modified implants. Afterward, bleb morphology and IOP is recorded for 30 days. After killing of the animals, eyes are collected for histology, Addition of an endplate extended bleb survival, Topography-990 has the longest recorded bleb-survival time. Histology reveals that the addition of an endplate increases the presence of myofibroblasts, macrophages, polymorphonuclear cells, and foreign body giant cells compared to the control. However, an increased capsule thickness and inflammatory response are observed in the groups with surface topographies, The addition of an endplate results in prolonged bleb survival, demonstrating that engineering of the shape of glaucoma implants could prolong bleb functionality. Future research should further elaborate the effect of surface topographies on long-term bleb survival, since an increased presence of pro-fibrotic cells and increased capsule thickness are observed compared to the control.

Cells Dynamically Adapt to Surface Geometry by Remodeling Their Focal Adhesions and Actin Cytoskeleton.

Cells probe their environment and adapt their shape accordingly via the organization of focal adhesions and the actin cytoskeleton. In an earlier publication, we described the relationship between cell shape and physiology, for example, shape-induced differentiation, metabolism, and proliferation in mesenchymal stem cells and tenocytes. In this study, we investigated how these cells organize their adhesive machinery over time when exposed to microfabricated surfaces of different topographies and adhesive island geometries. We further examined the reciprocal interaction between stress fiber and focal adhesion formation by pharmacological perturbations. Our results confirm the current literature that spatial organization of adhesive sites determines the ability to form focal adhesions and stress fibers. Therefore, cells on roughened surfaces have smaller focal adhesion and fewer stress fibers. Our results further highlight the importance of integrin-mediated adhesion in the adaptive properties of cells and provide clear links to the development of bioactive materials.

An easy to assemble PDMS/CNTs/PANI flexible supercapacitor with high energy-to-power density.

The fabrication of a flexible supercapacitor with state-of-the-art performance is described, based on a facile and low-cost fabrication method that encompasses aligned carbon nanotube arrays (ACNTA)-polyaniline/polydimethylsiloxane electrodes (ACNTA-PANI/PDMS). The ACNTA were partially embedded in PDMS to ensure excellent adhesion and integration whilst PANI was electrodeposited on its surface to improve energy storage properties. The supercapacitor structure and morphology were investigated by Raman spectroscopy and scanning electron microscopy (SEM), respectively. The energy storage properties of the electrodes were evaluated in two and three-electrode configurations. The maximum value of specific capacitance was 408 mF cm-2 (265 F g-1) at 1 mA cm-2, and a high energy density of 20 µW h cm-2 (25.5 W h kg-1) was achieved at a power density of 100 µW cm-2 (126.6 W kg-1) for a symmetric two-electrode device. The device showed a good capacitance retention of 76% after 5000 cycles and was able to maintain 80% of its electrochemical properties while being measured at different bending angles, demonstrating excellent mechanical agility performance under extreme conditions and some of the highest carbon-based energy storage properties.

The effect of thermo-mechanical fatigue on the retentive force and dimensional changes in polyetheretherketone clasps with different thickness and undercut.

PURPOSE: Esthetic expectations have increased the use of polyetheretherketone (PEEK) clasps as alternatives to Cr-Co in removable partial dentures (RPDs). The objective of this study was to evaluate the retentive force and dimensional change of clasps with different thickness and undercut made from PEEK by the thermo-mechanical fatigue. MATERIALS AND METHODS: PEEK clasps (N = 48) with thicknesses of 1 or 1.50 mm and 48 premolar monolithic zirconia crowns with undercuts of 0.25 mm or 0.50 mm were fabricated. Samples are divided into four groups (C1-C4) and were subjected to 7200 thermal aging cycles (at 5 - 55℃). The changes in the retentive force and dimensions of the clasps were measured by micro-stress testing and micro-CT devices from five measurement points (M1 - M5). One-way ANOVA, paired t-test, two-way repeated ANOVA, and post-hoc tests were used to analyze the data (P < .05). RESULTS: The retentive forces of C1, C2, C3, and C4 groups in initial and final test were found to be 4.389-3.388 N, 4.67 - 3.396 N, 5.161 - 4.096 N, 5.459 - 4.141 N, respectively. The effects of retentive force of all PEEK clasps groups were significant decreased. Thermo-mechanical cycles caused significant dimensional changes at points with M2, M4, and M5, and abraded the clasp corners and increased the distance between the ends of the clasp, resulting in reduced retentive forces (P * = .016, P * = .042, P < .001, respectively). CONCLUSION: Thermo-mechanical aging decreases the retentive forces in PEEK clasps. Increasing the thickness and undercut amount of clasps decreases the amount of dimensional change. The values measured after aging are within the clinically acceptable limits.

Tuberculosis despite latent infection screening and treatment in patients receiving TNF inhibitor therapy.

INTRODUCTION: Although latent tuberculosis infection (LTBI) treatment is given before anti-tumor necrosis factor (TNF) treatment, tuberculosis (TB) still develops in these patients and the risk factors are not well known. Besides, there is little data on the safety of isoniazid (INH) treatment in this group of patients. This study aimed to determine the risk factors for the development of tuberculosis and the safety of LTBI in such patients. METHODS: All patients (n=665) given anti-TNF in a single center were included in this study. Complete data were obtained from the records of 389 patients. RESULTS: Seven patients (1.1%) were diagnosed with TB. There was no significant difference in age, gender, smoking rate, comorbidities, leukocyte counts, hemoglobin, creatinine, AST, ALT, protein levels, and tuberculin reaction between patients with and without TB. Of 389 patients, 289 (76%) had received INH prophylaxis, including 43 tuberculin-negative patients. Thirty patients had anti-TNF use prior to INH prophylaxis. None of these patients had TB in the follow-up period. Seven patients who developed TB had completed LTBI treatment, including one patient who was tuberculin-negative. The time from the completion of INH treatment to the diagnosis of TB was 6-61 months. None had any history of contact with TB during this period. INH treatment was associated with hepatotoxicity in 49 patients (17%); all resolved without any need to stop INH. CONCLUSION: Patients on anti-TNF treatment had a high rate of TB despite INH prophylaxis, but no risk factor for TB development was identified. Mild hepatotoxicity frequently developed during LTBI treatment. Key Points • Tuberculosis still develops in patients treated with tumor necrosis factor (TNF)-inhibitors despite prior screening and treatment for latent tuberculosis infection (LTBI). • In this cohort, all patients in whom tuberculosis developed had been treated for LTBI and all but one were initially tuberculin-positive. No risk factors have been identified. • The current policy of treating tuberculin-positive patients with a 9-month INH regimen does not seem to be fully effective in preventing tuberculosis.

The effect of thermo-mechanical fatigue on the retentive force and dimensional changes in polyetheretherketone clasps with different thickness and undercut

PURPOSE@#Esthetic expectations have increased the use of polyetheretherketone (PEEK) clasps as alternatives to Cr-Co in removable partial dentures (RPDs). The objective of this study was to evaluate the retentive force and dimensional change of clasps with different thickness and undercut made from PEEK by the thermo-mechanical fatigue. @*MATERIALS AND METHODS@#PEEK clasps (N = 48) with thicknesses of 1 or 1.50 mm and 48 premolar monolithic zirconia crowns with undercuts of 0.25 mm or 0.50 mm were fabricated. Samples are divided into four groups (C1-C4) and were subjected to 7200 thermal aging cycles (at 5 - 55℃). The changes in the retentive force and dimensions of the clasps were measured by micro-stress testing and micro-CT devices from five measurement points (M1 - M5). One-way ANOVA, paired t-test, two-way repeated ANOVA, and post-hoc tests were used to analyze the data (P < .05). @*RESULTS@#The retentive forces of C1, C2, C3, and C4 groups in initial and final test were found to be 4.389-3.388 N, 4.67 - 3.396 N, 5.161 - 4.096 N, 5.459 - 4.141 N, respectively. The effects of retentive force of all PEEK clasps groups were significant decreased. Thermo-mechanical cycles caused significant dimensional changes at points with M2, M4, and M5, and abraded the clasp corners and increased the distance between the ends of the clasp, resulting in reduced retentive forces (P* = .016, P* = .042, P < .001, respectively). @*CONCLUSION@#Thermo-mechanical aging decreases the retentive forces in PEEK clasps. Increasing the thickness and undercut amount of clasps decreases the amount of dimensional change. The values measured after aging are within the clinically acceptable limits.

Colour-sensitive conjugated polymer inkjet-printed pixelated artificial retina model studied via a bio-hybrid photovoltaic device.

In recent years, organic electronic materials have been shown to be a promising tool, even transplanted in vivo, for transducing light stimuli to non-functioning retinas. Here we developed a bio-hybrid optoelectronic device consisting of patterned organic polymer semiconductors interfaced with an electrolyte solution in a closed sandwich architecture in order to study the photo-response of photosensitive semiconducting layers or patterns in an environment imitating biological extracellular fluids. We demonstrate an artificial retina model composed of on an array of 42,100 pixels made of three different conjugated polymers via inkjet printing with 110 pixels/mm2 packing density. Photo-sensing through three-colour pixelation allows to resolve incoming light spectrally and spatially. The compact colour sensitive optoelectronic device represents an easy-to-handle photosensitive platform for the study of the photo response of artificial retina systems.

Moderation analysis exploring associations between age and mucocutaneous activity in Behçet's syndrome: A multicenter study from Turkey.

The aim of the present study was to examine the effects of age on mucocutaneous activity by using moderation analysis in Behçet's syndrome (BS). In this cross-sectional study, 887 BS patients (female : male, 481:406; mean age, 38.4 ± 10.9 years) followed in 13 tertiary centers in Turkey were included. Mucocutaneous activity was evaluated by using the Mucocutaneous Index (MI) according to sex and disease course. Moderation analysis was performed to test the effect of age on mucocutaneous activity. A moderator variable is a third variable and affects the relationship between independent and outcome variables. Age was chosen as a potential moderator variable (interaction effect), MI score as the outcome variable and sex as an independent variable in the analysis. The moderation analysis tested the effects of age in three steps: whole BS patient group, patients without systemic involvement and those with systemic involvement. The moderation model was only significant in BS patients with systemic involvement (P = 0.0351), and a significant relationship was observed between female sex and MI score (P = 0.0156). In addition, the interaction plot showed that female patients had increased MI scores compared with male patients, especially in the 28-year-old age group (P = 0.0067). Moreover, major organ involvement was newly diagnosed in the majority of these young female BS patients. Our results suggest that the relationship between sex and mucocutaneous activity was moderated by age in the systemic involvement group. Also, increased mucocutaneous activity may be associated with new major organ involvement in young female BS patients with systemic involvement.

Low-Cost Catalyst Ink for Simple Patterning and Growth of High-Quality Single- and Double-Walled Carbon Nanotubes.

Research into carbon nanotubes (CNTs) has been a hot topic for almost 3 decades, and it is now that we are beginning to observe the impact of advanced applictions of this nanomaterial in areas such as electronics. Currently, in order to mass produce CNT devices, either large-scale synthesis, followed by numerous energy-intensive processing steps or photolithography processes, including several sputter-deposition steps, are required to pattern this material to fabricate functional devices. In the work reported here, through the utilization of a universal catalyst precursor (cyclopentadienyl iron dicarbonyl dimer) and the optimization of solution parameters, patterned high-quality vertically aligned arrays of single- and few-walled CNTs have been synthesized via various inexpensive, commercially scalable methods such as inkjet printing, stamp printing, spray painting, and even handwriting. The two-step process of precursor printing, followed immediately by CNT growth, results in CNTs with a Raman ID/IG ratio of 0.073, demonstrating very high-quality nanotubes. This process eliminates time-consuming and costly CNT post processing techniques or the deposition of numerous substrate barrier and catalyst layers to achieve device manufacturing. As a result, this method has the potential to provide a route for the large-scale synthesis of high-quality single- and few-walled CNTs that can be applied in industrial settings.

Water-Transferred, Inkjet-Printed Supercapacitors toward Conformal and Epidermal Energy Storage.

Rapid growth of the internet of things and health monitoring systems have stimulated the development of flexible, wearable, and conformal embedded electronics with the unprecedented need for energy storage systems fully adaptable to diverse form factors. Conventional fabrication methods, such as photolithography for electronics and electrode winding/stacking for energy storage systems, struggle as fabrication strategies to produce devices with three-dimensional, stretchable, and conformal form factors. In this study, we demonstrate the fabrication of supercapacitors on 3D objects through inkjet and water-transfer printing. The devices are initially printed on a water-soluble substrate, which is then placed on the surface of water. Once the substrate is dissolved, the level of water is lowered until the devices are transferred on to the submerged 3D object. As a proof of concept, planar supercapacitors constituted of a silver nanoparticle-based current collector, nickel(II) oxide (NiO) nanoparticle-based active electrodes, and ultraviolet-cured triacrylate polymer-based solid-state electrolyte were used as model materials. The conformal supercapacitors showed a maximum areal capacitance of 87.2 mF·cm-2 at a voltage window of 0-1.5 V. Moreover, the concept of water transfer was further explored with a particular focus on wearable applications by transferring the supercapacitors onto the skin of a human subject to realize epidermal energy storage. This new class of conformal electrochemical energy storage offers a new alternative approach toward monolithically integrated/object-tailored energy storage systems that are essential for complex-shaped devices for internet of things and flexible/on-skin electronic applications.

Predictive factors for work-day loss in Behçet's syndrome: A multi-center study.

OBJECTIVE: The aim of this multi-center study was to assess predictive factors for work-day loss as an indirect cost element in Behçet's syndrome (BS). METHODS: In this cross-sectional, multi-center study, 834 BS patients (F/M: 441/393, age mean: 38.4 ± 10.9 years) were included. Data were collected by a questionnaire regarding treatment protocols, disease duration, smoking pattern, frequency of medical visits during the previous year and self-reported work-day loss during the previous year. RESULTS: Work-day loss was observed in 16.2% of patients (M/F: 103/32). The percentages of being a smoker (81.8%), using immunosuppressive (IS) medications (82%), and having disease duration <5 years (74%) were higher in male patients with work-day loss (P < .05). The majority of males (90.9%) had more than four clinic visits during the previous year. Moreover, the mean work-day loss (30.8 ± 57.7 days) was higher in patients with vascular involvement (56.1 ± 85.9) than those without (26.4 ± 50.6 days) (P = .046). In addition, increased frequency of ocular involvement (25.9%) was also observed in patients with work-day loss compared to others (8.6%) (P = .059). CONCLUSION: Work-day loss was associated with both vascular and ocular involvement. Close associations were observed among male gender, early period of the disease, frequent medical visits, being a smoker and treatment with IS medications in patients with work-day loss.

Oral ulcer activity assessment with the composite index according to different treatment modalities in Behçet's syndrome: a multicentre study.

OBJECTIVES: The aim of this multicentre study was to understand patients' needs and to evaluate the oral ulcer activity with the Composite Index (CI), according to different treatment modalities in Behçet's syndrome (BS). METHODS: BS patients (n=834) from 12 centres participated in this cross-sectional study. Oral ulcer activity (active vs. inactive) and the CI (0: inactive vs. 1-10 points: active) were evaluated during the previous month. The effects of treatment protocols [non-immunosuppressive: non-IS vs. immunosuppressive: (ISs)], severity (mild vs. severe), disease duration (<5 years vs. ≥5 years) and smoking pattern (non-smoker vs. current smoker) were analysed for oral ulcer activity. RESULTS: Oral ulcer activity was observed in 65.1% of the group (n=543). In both genders, the activity was higher in mild disease course with non-IS treatment group compared to severe course with ISs (p<0.05). As a resistant group, patients with mild disease course whose mucocutaneous symptoms were unresponsive to non-IS medications were treated with ISs in a limited period and achieved the highest CI scores in females. Oral ulcer activity and poor CI score were associated with disease duration less than 5 years compared to others in male patients (p<0.05). CONCLUSIONS: Oral ulcer activity pattern is affected by both the combination of disease course, treatment protocols and disease duration. CI scores reflected the oral clinical activity and CI might be a candidate scale to evaluate the efficacy of treatments during the follow-up of oral ulcer activity in BS.

Green supplier evaluation with SWARA-TOPSIS integrated method to reduce ecological risk factors.

One of the most important agendas of the world is the topic of global warming. In order to protect the ecological balance, all organizations turning towards using natural resources more effectively and not harming the environment. Increasing social expectation, legal regulations, and diminishing natural resources necessitate the dissemination of these orientations in all areas. Enterprises' supply chain management applications are also affected by this situation, and the concept of green supply chain management which reflects the environmentalist perspective has emerged. One of the most important stages of this chain is to find suppliers who care about the environment. Choosing a green supplier is of great importance for both the business and the environment. In this study, 11 environmental criteria were defined for green supplier evaluation and SWARA-TOPSIS integrated method was used to determine the most suitable supplier. Furthermore, a case study for an international yachting company operating in Turkey was also presented in this study. Based on the results of the study, it was seen that supplier 2 was the most suitable among five prominent alternative suppliers, and "environmental management system", "senior management's support and commitment", and "green image" criteria were ranked as the top three criteria among the 11 determined criteria.

Highly Stretchable, Directionally Oriented Carbon Nanotube/PDMS Conductive Films with Enhanced Sensitivity as Wearable Strain Sensors.

Recent interest in the fields of human motion monitoring, electronic skin, and human-machine interface technology demands strain sensors with high stretchability/compressibility (ε > 50%), high sensitivity (or gauge factor (GF > 100)), and long-lasting electromechanical compliance. However, current metal- and semiconductor-based strain sensors have very low (ε < 5%) stretchability or low sensitivity (GF < 2), typically sacrificing the stretchability for high sensitivity. Composite elastomer sensors are a solution where the challenge is to improve the sensitivity to GF > 100. We propose a simple, low-cost fabrication of mechanically compliant, physically robust metallic carbon nanotube (CNT)-polydimethylsiloxane (PDMS) strain sensors. The process allows the alignment of CNTs within the PDMS elastomer, permitting directional sensing. Aligning CNTs horizontally (HA-CNTs) on the substrate before embedding in the PDMS reduces the number of CNT junctions and introduces scale-like features on the CNT film perpendicular to the tensile strain direction, resulting in improved sensitivity compared to vertically-aligned CNT-(VA-CNT)-PDMS strain sensors under tension. The CNT alignment and the scale-like features modulate the electron conduction pathway, affecting the electrical sensitivity. Resulting GF values are 594 at 15% and 65 at 50% strains for HA-CNT-PDMS and 326 at 25% and 52 at 50% strains for VA-CNT-PDMS sensors. Under compression, VA-CNT-PDMS sensors show more sensitivity to small-scale deformation than HA-CNT-PDMS sensors due to the CNT orientation and the continuous morphology of the film, demonstrating that the sensing ability can be improved by aligning the CNTs in certain directions. Furthermore, mechanical robustness and electromechanical durability are tested for over 6000 cycles up to 50% tensile and compressive strains, with good frequency responses with negligible hysteresis. Finally, both types of sensors are shown to detect small-scale human motions, successfully distinguishing various human motions with reaction and recovery times of as low as 130 ms and 0.5 s, respectively.

Do major histocompatibility complex tag single nucleotide polymorphisms accurately identify HLA-B27 in the Turkish population?

OBJECTIVE: To evaluate the performance of human leukocyte antigen (HLA)-B27 tag single nucleotide polymorphisms (SNPs) by polymerase chain reaction - restriction fragment length polymorphism (PCR-RFLP). METHODS: We genotyped three SNPs (rs116488202, rs13202464 and rs4349859). The primers were designed using Primer3 algorithm via primer-BLAST interface. PCR products were digested by using NlaIII, BmrI and TaqαI enzymes. Quality control was performed by DNA sequence analysis. RESULTS: In total, 207 patients with ankylosing spondylitis and 32 healthy controls were included in the study. The sensitivity and specificity of SNPs rs116488202 and rs4349859 in identifying HLA-B27 were identical and adequate at 0.946 and 1.000, respectively. On the other hand, the sensitivity and specificity for rs13202464 was 0.878 and 0.934, respectively. The presence of another SNP (rs141774149) in close proximity to rs116488202 complicated the analysis for RFLP and required that we sequence all the T allele carrying samples. CONCLUSION: The SNPs rs116488202 and rs4349859 may have a place in the identification of HLA-B27 in the Turkish population; however, methods other than PCR-RFLP should be considered.

Role and Clinical Significance of Plasma N-Terminal Brain Natriuretic Peptide Measurement in Children with Brain Edema.

OBJECTIVE: Brain natriuretic peptide (BNP) is a potent natriuretic and vasodilator factor. BNP plasma concentrations were found to be elevated in patients with brain edema. The purpose of the present study is to evaluate the relationship between plasma NT-proBNP concentration and the presence of brain edema in patients with intracranial pathology. MATERIALS AND METHODS: The plasma NT-proBNP levels of 50 patients and 25 healthy subjects were measured. The NT-proBNP levels of the patient group were measured during admission and after 7 days of treatment. RESULTS: NT-proBNP plasma concentrations were found to be significantly higher in the patient group with brain edema than in the control group (p < 0.005). There were no significant differences in the NT-proBNP plasma concentrations between patients with intracranial pathology without brain edema and the control group (p > 0.005). NT-proBNP plasma concentrations were found to be significantly higher in patients with brain edema as compared with patients without brain edema before treatment (p < 0.005). CONCLUSION: These results suggest that excessive secretion of plasma NT-proBNP is related to brain edema. Plasma NT-proBNP levels may serve as a marker to guide the early-diagnostic and therapeutic management in children with brain edema. Further studies are required to evaluate the role of BNP in brain edema pathophysiology.

Influence of Pterygium on Corneal Biomechanical Properties.

PURPOSE: To evaluate the influence of pterygium on corneal biomechanical properties as measured by the ocular response analyzer (ORA). METHODS: ORA measurements of 48 eyes with primary nasal pterygium were compared with those of healthy fellow eyes. The mean age of the patients was 46.6 ± 18.9 years. Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg), and corneal-compensated IOP (IOPcc) were obtained for each subject by using the ORA (Reichert Ophthalmic Instruments, Depew, NY). RESULTS: CH and CRF were significantly lower in the eyes with pterygium than in the healthy fellow eyes (p1 = 0.011, p2 = 0.014, respectively). On the other hand, there were no significant differences between the eyes with pterygium and healthy fellow eyes concerning IOPg and IOPcc (p1 = 0.948, p2 = 0.129, respectively). CONCLUSIONS: The present study showed that biomechanical properties measured by ORA were affected by pterygium. The eyes with primary nasal pterygium had lower CH and CRF than healthy fellow eyes. Therefore, the effect of pterygium should be taken into account in order to make correct diagnoses by ORA.

Clinical, radiological and laboratory findings in 185 children with tuberculous meningitis at a single centre and relationship with the stage of the disease.

BACKGROUND: A delay in the diagnosis and treatment of tuberculosis meningitis (TBM) may lead to increased mortality and morbidity. The aim of this study was to describe the clinical, radiological and laboratory findings of TBM on a cohort of 185 pediatric patients at a single centre over a 10 year period and to investigate relationship between the stage of the disease. METHODS: The hospital records of 185 TBM children that presented to the Pediatric Clinics of Dicle University Hospital were retrospectively evaluated. The age, gender, family history of tuberculosis, result of Mantoux skin test, status of BCG vaccination, stage of TBM at hospitalization, and clinical, laboratory and radiological features were recorded. Clinical staging of TBM was defined as follows: Stage I, no focal neurological findings and Glasgow Coma Scale (GCS) score 15; Stage II, GCS 15 presenting with focal neurological deficit or all the patients with GCS 10-14; Stage III, all the patients with GCS < 10. Relationships between results and stages of TBM were investigated. RESULTS: The mean age of the patients was 53.5 ± 44.9 months (4 months-18 years). 121 (65.4 %) of the patients were male and 64 (34.6 %) female. Family history of tuberculosis was defined in 62 (33.5 %) patients. Forty five (24.3 %) children had BCG vaccination scar. Mantoux skin test was interpreted as positive in 35 (18.9 %) patients. Sixty-eight (36.8 %) children were at stage I TBM, 57 (30.8 %) at stage II and 60 (32.4 %) were at stage III on admission. Mean duration of hospitalization was 23.9 ± 14.1 days. Totally, 90 patients (48.6 %) had abnormal chest X-ray findings (parenchymal infiltration in 46 (24.9 %), mediastinal lymphadenopathy in 36 (19.5 %), miliary opacities in 25 (13.5 %), pleural effusion in 2 (1.1 %), and atelectasis in 2 (1.1 %) patients). One hundred sixty seven (90.3 %) patients had hydrocephalus in cranial computerized tomography. There were 24 (13.0 %) patients with positive culture for Mycobacterium tuberculosis and 3 (1.6 %) patients with positive acid-fast bacilli in cerebrospinal fluid. Overall mortality rate was 24 (13.0 %). Among the findings; patients at Stage III had less frequent positive chest X-ray abnormality, miliary opacities and BCG vaccination scar when compared with patients at Stage I and II (p = 0,005; p = 0,007, p = 0.020, respectively). CONCLUSIONS: Children with TBM and positive chest X-ray findings at hospital admission were more frequently diagnosed at Stage I, and BCG vaccination might be protective from the Stage III of the disease.

Children with breakthrough varicella infection requiring hospitalization in Turkey (VARICOMP Study 2008-2013).

INTRODUCTION: Varicella in previously immunized individuals, known as "breakthrough varicella". While the majority of breakthrough cases are mild, some may be severe, requiring hospitalization in previously healthy children or children with an underlying condition. METHODS: This report, as a part of the prospective national pediatric varicella hospitalizations study (including 29 centers, represent 50% of pediatric population) in Turkey, is aimed to evaluate breakthrough varicella infection requiring hospitalization before the routine use of single-dose live varicella vaccine in national program from 2008 to 2013 (<10% of the pediatric age group received a single-dose vaccine). RESULTS: In the time period, 1939 children were hospitalized due to varicella infection in Turkey; 36 children (20 boys, 16 girls, mean age 68.0+37.6 months, all received single dose live varicella vaccine) with breakthrough varicella infection. Breakthrough varicella infection might be severe in previously healthy children (61.1%) and children with immune-compromising conditions (38.9%). The time elapsed between vaccination and hospitalization was approximately 5 years, and neurological complications, mainly encephalitis and meningitis, were the most common reason for hospitalization in previously healthy children. CONCLUSION: Pediatric breakthrough varicella requiring hospitalization have been seen in Turkey, is mainly observed in previously healthy children at 5 years after a single-dose varicella vaccine. The varicella vaccine has been implemented as part of the National Immunization Program in Turkey in 2013 (a single dose at age 12 months). Further surveillance in the same settings could evaluate the effectiveness of national immunization with single-dose varicella vaccine at 12 months of age and potential need for second dose of vaccine.