Pulmonary tuberculosis incidence in Turkish prisons: importance of screening and case finding strategies.

INTRODUCTION: The purpose of this study was to evaluate the burden of pulmonary tuberculosis in 10 prisons mostly located in the Marmara Region of Turkey, and to compare them with the country incidence. PATIENTS AND METHODS: All the inmates in ten prisons mostly located in the four cities in the Marmara Region of Turkey were enrolled in this study. Tuberculosis screening was done between January 2006-January 2007. Radiological screening for tuberculosis was performed by the mobile X-ray system and it was followed by bacteriological analysis of sputum for tuberculosis suspects. Four physicians evaluated the X-rays independently. RESULTS: Four thousand six hundred and fifteen prisoners were detected by radiological screening. Three hundred and one (7%) of them were female and 4314 (93%) were male, age range was between 14-72 years. Age ranges of female and male prisoners were 16-59 and 14-72 respectively. 398/4615 (8.6%) were young adults inmates with an age range of 14-18. Radiological abnormalities consistent with tuberculosis were found in 130 chest X-rays and followed by sputum bacteriology. Smear and culture positive pulmonary tuberculosis diagnosed in five out of 130, were all male with mean age 33 ± 10 years. Tuberculosis prevalence in the prisons was found to be 108/100.000 which was four times higher than the overall incidence of tuberculosis in Turkey in the year which the present study was conducted. CONCLUSION: Prisoners are one of the most important risk groups with high burden of tuberculosis in Turkey. This result highlights the need for adequate case- finding strategies in prisons.

Preliminary Report of the Academic CAR-T (ISIKOK-19) Cell Clinical Trial in Turkey: Characterization of Product and Outcomes of Clinical Application

Objective: Chimeric antigen receptor T (CAR-T) cell therapies have already made an impact on the treatment of B-cell malignancies. Although CAR-T cell therapies are promising, there are concerns about commercial products regarding their affordability and sustainability. In this preliminary study, the results of the first production and clinical data of an academic CAR-T cell (ISIKOK-19) trial in Turkey are presented. Materials and Methods: A pilot clinical trial (NCT04206943) designed to assess the safety and feasibility of ISIKOK-19 T-cell therapy for patients with relapsed and refractory CD19+ tumors was conducted and participating patients received ISIKOK-19 infusions between October 2019 and July 2021. The production data of the first 8 patients and the clinical outcome of 7 patients who received ISIKOK-19 cell infusions are presented in this study. Results: Nine patients were enrolled in the trial [5 with acute lymphoblastic leukemia (ALL) and 4 with non-Hodgkin lymphoma (NHL)], but only 7 patients could receive treatment. Two of the 3 participating ALL patients and 3 of the 4 NHL patients had complete/partial response (overall response rate: 72%). Four patients (57%) had CAR-T-related toxicities (cytokine release syndrome, CAR-T-related encephalopathy syndrome, and pancytopenia). Two patients were unresponsive and had progressive disease following CAR-T therapy. Two patients with partial response had progressive disease during follow-up. Conclusion: Production efficacy and fulfillment of the criteria of quality control were satisfactory for academic production. Response rates and toxicity profiles were also acceptable for this heavily pretreated/refractory patient group. ISIKOK-19 cells appear to be a safe, economical, and efficient treatment option for CD19+ tumors. However, the findings of this study need to be supported by the currently ongoing ISIKOK-19 clinical trial.

[The investigation of frequency of cystic echinococcosis in the autopsies committed in the Speciality Department of Istanbul Forensic Medicine Institute]. / Istanbul Adli Tip Kurumu Morg Ihtisas Dairesi'nde Yapilan Otopsilerde Kistik Ekinokokkozis Görülme Sikliginin Arastirilmasi.

Cystic echinococcosis, which is caused by a parasite called Echinococcus granulosus, is a disease frequently find in the liver and in the lungs. In many countries, it is an important public-health problem. This study was done to find out the prevalence of Cystic echinococcosis in forensic autopsies performed for sudden death cases. This investigation was realized between July 2003-January 2004 at Istanbul Forensic Medicine Institution. During this six month period, total of 1687 autopsies were performed. Of those, 56 autopsy cases had macroscopic unknown cysts. The sera obtained from these 56 autopsy cases were examined by IgG Enzyme-linked Immunosorbent assay (ELISA) and IgG Indirect Hemaglutination (IHA) methods. In the end of the serologic evaluation, of 56 cases with macroscopic unknown etiology cysts, 34 cases (60.7%) were serologically positive for cystic echinococcosis, of those 8 were females (14.2%) and 26 were males (46.4%). This study shows that cyst echinococcosis may be find frequently in postmortem cases. The fact that the people who perform autopsies must work carefully and in hygienic conditions is another important lesson obtained from the study.

[A review of malpractice claims concerning orthopedic applications submitted to the Council of Forensic Medicine]. / Adli Tip Kurumu'ndan görüs sorulan ve ortopedi uzmanlik alanina giren tibbi uygulama hatalarinin gözden geçirilmesi.

OBJECTIVES: The aim of this study was to review malpractice claims concerning orthopedic applications that were sent to the Council of Forensic Medicine by public prosecutors and law courts. METHODS: A retrospective review was conducted on 174 malpractice claim files related with orthopedic applications, which had been examined and concluded by the Third Specialized Board of the Council of Forensic Medicine between January 2004 and December 2007. RESULTS: Of 174 files, 129 files were concerned with trauma and 45 files were concerned with orthopedic causes. The types of institutions involved were 82 state hospitals, 56 private hospitals, 17 training and research hospitals, 18 university hospitals, and one military hospital. Orthopedic surgeons were found liable for failure in 61 cases (51 trauma, 10 orthopedic cases). Those who were considered blameworthy were working for 26 private hospitals, 24 state hospitals, seven training and research hospitals, and two university hospitals with the following titles: professor (n=2), chief of clinic (n=1), associate professor (n=2), specialist (n=54), resident (n=3), and nurse (n=1). CONCLUSION: In order to minimize malpractice claims, physicians should steadily improve professional knowledge and skills, give special attention to documenting all information about the patients and applications, and establish a good and intimate physician-patient relationship.