Tertiary Care Center In Turkey Research Articles

Retrospective evaluation of 130 cases with kawasaki disease follow-up in a tertiary care center in Turkey between 1999 and 2019: a 20-year experience

ABSTRACT Objectives Kawasaki disease (KD), which is a medium vessel vasculitis, is common in Asian countries and is the most common cause of childhood-acquired heart diseases in developed countries. However, disease course and epidemiological data are limited in non-Asian developing countries like ours. We aimed to evaluate the clinical features and prognosis of patients with KD in our country and ethnicity, one of the referee centers of our country. Methods Patients with KD in our center for the last 20 years in the pre-COVID-19 pandemic era were included in the study. The clinical and laboratory findings, treatments, and follow-up findings were reviewed retrospectively in different age groups. Results Of the 130 patients, 82 (63%) were male. The median age at diagnosis was 2.97 years (2 months-11.5 years). Thirty-six (27.7%) patients were diagnosed with incomplete KD, and there was no significant laboratory difference between incomplete KD and complete KD patients. Thirty-three (25.3%) patients had coronary artery lesions (CAL), and it persisted in only 3 of 33 patients. One of 15 patients with IVIG resistance had CAL. The independent risk factors were days of illness at initial IVIG administration for CAL (p = 0.013, OR [95%CI] = 1.20 [1.04–1.38]) and low hemoglobin (p = 0.003, OR [95%CI] = 0.51 [0.33–0.79]) and low sodium for IVIG resistance (p = 0.012, OR [95%CI] = 0.81[0.69–0.95]). Conclusions The rate of CAL is approximately three times higher in our results than in the Japanese data in recent years. We showed that the time of IVIG administration is the most critical factor for preventing CAL. Wide-ranging studies are needed to decently predict the disease process according to the age and region of patients.

Clinical Characteristics of Children with Combined Pituitary Hormone Deficiency and the Effects of Growth Hormone Treatment.

We aimed to describe the clinical characteristics of patients with congenital combined pituitary hormone deficiency (CPHD) and evaluate the first-year growth responses of individuals with CPHD and isolated growth hormone deficiency (IGHD) in order to establish the influence of other hormone deficiencies on growth response. This retrospective study was conducted in four tertiary care centers in Turkey. The records of patients diagnosed with CPHD (n=39) and severe IGHD (n=50) were collected. Cases with acquired lesions or chronic diseases were not included in the study. Data are presented as median (interquartile range). Among 39 patients (13 females; 33%) with a diagnosis of CPHD, the majority of patients (64%) presented initially with combined deficits at baseline examination, whereas isolated deficiencies (36%) were less prevalent. Among all patients with GH deficiency, TSH, ACTH, FSH/LH, and ADH deficiencies were present in 94%, 74%, 44%, and 9% of patients, respectively. Patients with CPHD were diagnosed at a younger age (4.9 (8.4) vs. 11.6 (4.1), p<0.001, respectively) and had lower peak GH concentrations (0.4 (1.8) vs. 3.7 (2.9), p<0.001, respectively) than patients with IGHD. Patients with IGHD and CPHD had similar first-year growth responses (Δheight SD score of 0.55 (0.63) vs. 0.76 (0.71), respectively, p=0.45). We established the nature and timing of numerous hormonal deficits emerging over time. We also identified that the existence of CPHD did not hinder growth response.

Epidemiological and Clinical Profile of Newly Diagnosed HIV/AIDS Patients: A Retrospective Analysis of Changing Trends Over 16 Years

To evaluate the epidemiological profile and clinical findings of newly diagnosed HIV-infected patients in terms of changing trends over 16 years. A total of 748 patients (mean±SD age: 34±11.6 years, 88.9% were males) newly diagnosed with HIV/AIDS at a tertiary care hospital located in Istanbul province between 2002 and 2017 were included in this retrospective study. Data on sociodemographic characteristics, potential routes of transmission, the reason for HIV testing, time from diagnosis to treatment onset, and the HIV RNA values and CD4+ T cell count (at diagnosis and treatment onset) were recorded in each patient and compared between the diagnoses made within the 2002-2009 (n=141) vs. 2010-2017 (n=607) periods. When compared to HIV diagnoses within the 2002-2009 period, the diagnoses made within the 2010-2017 period were associated with a significantly higher percentage of males (78.7 vs. 91.3%, p<0.001), 18-29 years age group (23.6% vs. 35.5%, p=0.029), singles (34.0 vs. 49.6%, p=0.004), university graduates (9.9 vs. 23.4%, p<0.001) and students (0.7 vs. 8.2%), p<0.001) along with an increased likelihood of voluntary testing (6.4 vs. 15.2%, p=0.048) and a lower percentage of heterosexual individuals (63.8 vs. 47.0%, p<0.001). Sexual contact (88.0%) was the leading transmission route, and the presence of complaints (44.3%) was the leading reason for HIV testing. Overall, the time from diagnosis to treatment onset was a median 1 month (range, 1 to 97 months), and the median HIV RNA level at the time of diagnosis was 208065 copies/mL with no significant difference between study periods. The diagnoses within the 2010-2017 vs. 2002-2009 period were associated with significantly higher median(min-max) CD4+ T cell counts (378(0-2522) vs. 319(4-1270) cells/mm3, p<0.001) and a lower percentage of patients with CD4+ T cell count <200 cells/mm3 (22.1 vs. 39.0%, p=0.002) at the time of diagnosis. In conclusion, our findings on the epidemiological profile and clinical characteristics of newly diagnosed HIV patients over 16 years (2002-2017) in a tertiary care center in Turkey revealed a considerable increase in the number of new diagnoses, an improved earlier diagnosis and a change in epidemiologic profile over the years with increased likelihood of disease to be more commonly diagnosed among males, 18-29 years age group and MSM.

The pattern of chromosomal abnormalities in recurrent miscarriages: a single center retrospective study.

Chromosomal abnormalities are more common in first trimester recurrent miscarriages (RM). Chromosomal anomalies affect approximately 2%-8% of couples with RM. Evaluate the spectrum and the frequencies of chromosomal anomalies in RM. A retrospective hospital record-based descriptive study. A tertiary care center in Turkey. We studied couples with RM between October 2020 and January 2022. Relevant family and medical history, clinical examination and the results of karyotype were statistically analyzed. Prevalence and types of chromosomal aberrations in couples with RM. SAMPLE SİZE: 362 couples with a history of RM RESULTS: Among the 362 couples, 14 cases (3.86%) had chromosome abnormalities. Eight cases (57.14%) were structural anomalies and six cases (42.86%) were numerical chromosomal aberrations. We found five balanced translocations (67.5%) and three Robertsonian translocations (37.5%). The prevalence of polymorphic variants was 51/362 (14.1%). This study supports the conclusion that clinicians should understand the importance of chromosome analysis in these couples and direct them to karyotyping after two abortions in order to exclude the possibility of a genetic cause of RM. Single-center study and retrospective. None.

The child protection team in a tertiary care center in Turkey: There years experience

The child protection team in a tertiary care center in Turkey: There years experience

Prophylactic Central Nervous System Irradiation Is Not Indispensable in Adult Patients with Acute Lymphoblastic Leukemia: A Multicenter Retrospective Cohort Study

Objective:Studies comparing the efficacy and safety of prophylactic regimens for central nervous system (CNS) involvement in acute lymphoblastic leukemia (ALL) are scarce in adults. This multicenter retrospective study aimed to compare the efficacy of prophylactic regimens with and without CNS irradiation on the development of CNS relapse during follow-up.Materials and Methods:This was a multicenter comparative cohort study. A total of 203 patients were included from four tertiary care centers in Turkey. Patients were divided into two groups according to whether they received CNS irradiation or not. The groups were analyzed retrospectively regarding patient and disease characteristics, with the main focus being CNS relapse.Results:While 105 patients received chemotherapy-based prophylaxis, 98 patients received additional CNS irradiation. These groups were statistically comparable in terms of demographic characteristics and risk factors for CNS involvement. In the irradiation group, patients were younger and had more stem cell transplants. In a median of 23.8 (11.1-62.4) months, there was no difference between the two groups regarding CNS relapse-free survival (log-rank p=0.787).Conclusion:Craniospinal irradiation may not be indispensable for every adult patient with ALL, similarly to pediatric patients. It is crucial to avoid the long-term toxicities of radiation, especially in patients with long life expectancy. Craniospinal irradiation may be reserved for therapeutic use in cases of CNS relapse and prophylaxis for some high-risk patients.

COVID-19 Pandemic Experience in a Tertiary Care Center in Turkey: What have We Learned?

Coronavirus disease 2019 (COVID-19) has become a public health threat to people all over the world and it has stretched hospital resources since the beginning of the pandemic. Available reports to date showed that COVID-19 seems to be less common in children. However, the number of pediatric patients is increasing and a lower number of pediatric patients does not necessarily mean that children are less susceptible to the infection. On the other hand, it is shown that preparedness and response to the COVID-19 disease pandemic in the hospital caring for children are extremely variable. The main target during a pandemic is to maintain high quality and high-efficiency care, with emphasis on patient and provider safety. A documented pandemic plan, simulation training, appropriate use of personal protective equipment (PPE), and appropriate isolation areas in the hospital and also in the emergency department are essential components of pandemic response. Therefore, respiratory hygiene, proper patient placement/ isolation, handling and cleaning of patient care equipment, devices, and environment and procedure safety are all important for effective working flow and reliable working environment in the hospital. Early recognition and isolation of a patient with COVID-19 may help decrease exposure to the other patients and healthcare personnel. The use of a strict surveillance and management protocol during outbreaks of highly virulent viruses such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), through dedicated patient pathways, adoption of personal protective equipment for health care personnel, and use of nasopharyngeal screening of all admitted children and possibly all healthcare personnel should be recommended. Therefore, we developed a protocol addressing reception, risk management, and hospitalization of suspected SARS-CoV-2 cases at the pediatric emergency department, pediatric wards, and outpatient clinics aimed at containing intrahospital transmission of the infection. Our pandemic response planning was characterized by close collaboration among the head of our hospital, department of pediatrics, pediatric emergency department, pediatric infection control committee, and front-line staff as well as optimization of communication channels. In this article, we aimed to share our experiences of how to handle pediatric patients with COVID-19 in our university hospital from all aspects including prevention of possible transmissions during the first few months of the COVID-19 pandemic.

Benign nodules of the thyroid gland and 25-hydroxy-vitamin D levels in euthyroid patients.

BACKGROUND: The presence of nodules in the thyroid gland is common in iodine-deficient areas of the world. Recently, vitamin D levels were found to be lower than normal and sometimes deficient in malignant nodules of the thyroid.OBJECTIVE: Evaluate the relationship between the serum vitamin D levels and benign thyroid nodules in euthyroid patients.DESIGN: Cross-sectional.SETTING: Tertiary care center in Turkey.PATIENTS AND METHODS: Patients referred to the general surgery outpatient clinic and diagnosed with thyroid nodules were the study group. The control group consisted of healthy individuals without thyroid nodules. Age, BMI, thyroid ultrasonography, serum 25-hydroxyvitamin D, free T3, free T4, thyroid stimulating hormone, calcium, magnesium, phosphorous, total protein, albumin, glucose, creatinine levels and glomerular filtration rate (GFR) were compared between groups.MAIN OUTCOME MEASURE: Serum 25-hydroxy-vitamin D levels and size of the thyroid nodules.SAMPLE SIZE AND CHARACTERISTICS: Of 849 individuals, 453 were patients with thyroid nodules and 396 were healthy individuals.RESULTS: The mean serum vitamin D levels of patients with thyroid nodules were significantly lower than controls (P<.001). Serum vitamin D levels along with serum total protein levels and eGFR were independent variables associated with the presence of a thyroid nodule (P<.001, p=.005 and P=.017, respectively).CONCLUSION: These findings suggest vitamin D deficiency might be one of the pathophysiologic factors in development of thyroid nodules.LIMITATION: Single-center and possible information bias.CONFLICTS OF INTEREST: None.

A cross–sectional study of post–COVID syndrome at a tertiary care center in Turkey

Objective: To investigate long-term symptoms after acute COVID-19, the link between symptoms and respiratory function, radiological changes in the post-COVID period, and risk factors for post-COVID syndrome.Methods: In this cross-sectional study, 123 participants who were admitted within the first 3 months were categorized as group 1, and those who applied after 3 months were categorized as group 2. According to thoracic imaging and pulmonary function tests, patients were split into 3 groups as mild, moderate and severe.Results: At least one symptom was present in 91.9% and 61.8% in acute and post-COVID period, respectively. Pulmonary function tests were normal in 60 (70.6%) in the first three months, and 30 (78.9%) in 91-days to 1-year period after acute COVID-19 infection. After 3 months, 22.4% of chest X-rays and 7.9% of computerized tomography revealed progression. Patients who developed acute complications (OR 9.91, 95% Cl 1.93-50.87), had 2 or more symptoms at admission (OR 7.73, 95% CI 2.56-23.33), had 1% to 14% CT involvement (OR 3.05, 95% CI 1.06-8.79), or had 50% or more CT involvement (OR 14.68, 95% CI 1.24-172.55) had a higher risk of developing post-COVID syndrome.Conclusions: COVID-19 symptoms can last for long time. Severity of symptoms, acute complications, and the extent of radiological involvement may all contribute to elevated risk of post-COVID syndrome. As a result, patients with COVID-19 should be checked for long-term clinical difficulties on regular basis.

An outbreak investigation of Burkholderia cepacia infections related with contaminated chlorhexidine mouthwash solution in a tertiary care center in Turkey

BackgroundWe report a nosocomial outbreak caused by Burkholderia cepacia that occurred among six patients admitted in the medical and surgical intensive care unit between 04 March 2019 and 02 April 2019 in Istanbul, Turkey.MethodsThe outbreak investigation was launched on 11 March 2019 five days after the detection of B. cepacia in four different patients. We defined potential reservoirs and started environmental screening. We sampled the liquid solutions used in patient care activities. Pulse-field gel electrophoresis (PFGE) was performed to determine the genetic relatedness of environmental and patient samples.ResultsBurkholderia cepacia was isolated in tracheal aspiration cultures of six patients. Three out of six patients developed healthcare-associated pneumoniae due to B. cepacia. Environmental cultures in the ICUs revealed B. cepacia growth in 2% chlorhexidine-gluconate mouthwash solution that been used in the colonized patients as well as in samples obtained from the unused products. PFGE revealed the patient and a specific batch of chlorhexidine mouthwash solution samples had a 96% similarity.ConclusionContamination of medical solutions used in critical patient care could cause outbreaks and should be detected early by infection control teams.Graphic abstract

Therapeutic plasma exchange in neurological diseases: Eleven years experience at a tertiary care center in Turkey.

Therapeutic plasma exchange (TPE) is an apheresis procedure in which plasma is separated from the blood cellular components ex vivo, allocated, and replaced with another plasma or a plasma-replacing fluid. This study aimed to define the rate of complications and determine TPE distribution in various neurological diseases. Our study is a retrospective analysis of neurologic diseases requiring TPE between 2008 and 2019 that were selected using the medical records of neurology departments and apheresis units database. We performed 1459 TPE procedures on 207 patients between 2008 and 2019. TPE Procedure is most frequently applied in patients with Myasthenia-Gravis syndrome (34.7%). The complication ratio was 1.6% from a total of 1459 TPE procedures. The most commonly specified adverse event was allergic reactions 11 (5.3%), followed by hypotension 6 (2.9%). TPE was safe and tolerable, with manageable complications in experienced hands.

Maternal and Neonatal Outcomes of Syrian Adolescent Refugees and Local Adolescent Turkish Citizens: A Comparative Study at a Tertiary Care Maternity Hospital in Turkey

OBJECTIVE: In this study, we aim to compare the maternal and obstetric outcomes between local adolescent Turkish citizens and adolescent Syrian refugees admitted to a tertiary care center in Turkey. STUDY DESIGN: Between January 2014 and December 2019, a total of 57,049 births were performed in our hospital. The study included a total of 6,021 patients aged 19 years or younger pregnancy who gave birth at our hospital. Of this number, 5,164 (1,792 Syrian adolescent refugee cases and 3,372 local adolescent Turkish cases) were live singleton pregnancies. Our primary aim was to compare the maternal and obstetric outcomes between the two groups. RESULTS: In the pregnant refugee women, the maternal age was younger (p&lt;0.001). Hemoglobin and hematocrit levels are significantly lower in Syrian pregnant women (p&lt;0.001 and p&lt;0.001, respectively). Anemia was significantly higher in Syrian refugee pregnant women (p&lt;0.001). The double screening test and triple screening test were significantly lower in Syrian pregnant women (p&lt;0.001 and p&lt;0.001, respectively). Preterm birth rates and late preterm delivery prevalence (34-37 gestational weeks) were significantly higher in the adolescent Syrian immigrants' compared to the adolescent Turkish locals (p&lt;0.001 and p&lt;0.001, respectively). The average birth weight of the Syrian refugees was lower but the number of low birth weight babies was higher Turkish locals (p=0.010 and p=0.014, respectively). The preterm birth ratio and low birth weight ratio in Syrian adolescents has decreased over the years. CONCLUSION: Syrian adolescent refugees are particularly at risk of early pregnancy, high fertility rate, preterm birth, low birth weight, and anemia. Immigrant women should be provided with fertility, family planning, and training on behavior that protects reproductive health. Syrian pregnant women should be supported to receive services.

The effect of body mass index on the development of acute kidney injury and mortality in intensive care unit: is obesity paradox valid?

Background The conflicting results of studies on intensive care unit (ICU) mortality of obese patients and obese patients with acute kidney injury (AKI) reveal a paradox within a paradox. The aim of this study was to determine the effects of body mass index and obesity on AKI development and ICU mortality. Methods The 4,459 patients treated between January 2015 and December 2019 in the ICU at a Tertiary Care Center in Turkey were analyzed retrospectively. Results AKI developed more in obese patients with 69.8% (620). AKI development rates were similar in normal-weight (65.1%; 1172) and overweight patients (64.9%; 1149). The development of AKI in patients who presented with cerebrovascular diseases was higher in obese patients (81; 76.4%) than in normal-weight (158; 62.7%) and overweight (174; 60.8%) patients (p < 0.05). The risk of developing AKI was approximately 1.4 times (CI 95% = 1.177–1.662) higher in obese patients than in normal-weight patients. Dialysis was used more frequently in obese patients (24.3%, p < 0.001), who stayed longer in the ICU (p < 0.05). It was determined that the development of AKI in normal-weight and overweight patients increased mortality (p < 0.001) and that there was not a difference in mortality rates between obese patients with and without AKI. Conclusion The risk of AKI development was higher in obese patients but not in those who were in serious conditions. Another paradox was that the development of AKI was associated with a higher mortality rate in normal-weight and overweight patients, but not in obese patients. Cerebrovascular diseases as a cause of admission pose additional risks for AKI.

Etiology of Increased Referrals for Evaluation of Early Puberty in a Tertiary Care Center in Turkey: True Precocious Puberty, Obesity, or Parental Anxiety and Lack of Knowledge?

There has been a global increase in pediatric endocrinology referrals for the concerns of early puberty. The objective of this study was to determine the reasons behind this increase. A retrospective cross-sectional study was designed to analyze the clinical characteristics of patients seen for the concerns of early puberty in pediatric endocrinology clinic of a tertiary care center (Study A). Additionally, a prospective questionnaire study was designed to assess the knowledge and concerns of the mothers regarding the timing of puberty in girls (Study B). In study A, of the 305 girls, 42.9% were overweight/obese, 68.5% either had normal pubertal development for age or were prepubertal, 1 had non-classic congenital adrenal hyperplasia, and 2 had central precocious puberty. Of the 36 boys, 56% were overweight/obese, 64% either had normal pubertal development for age or were prepubertal, and 1 had non-classic congenital adrenal hyperplasia. In study B, 95% of the participants thought the girls have been developing earlier, over 10% considered the first sign of puberty to be normal after the age 14 years and 12.4% considered menarche to be normal after age 14 years. The common sources of anxiety for the participants regarding the earlier timing of puberty were psychosocial issues and short final height. In conclusion, many parents had wrong beliefs/information about the normal timing of puberty and were concerned about precocious puberty in girls. Education of parents about the normal timing of puberty may help avoiding unnecessary referrals, parental anxiety, and financial burden to the society.

The prevalence of metabolic-associated fatty liver disease in the Turkish population: A multicenter study.

Background and Aim:The objective of the present study was to investigate the prevalence of metabolic-associated fatty liver disease (MAFLD) in patients with dyspepsia.Materials and Methods:A total of 909 consecutive patients who presented with dyspepsia at 8 tertiary care centers in Turkey between March 2019 and December 2019 were included.Results:The median age was 47 years. Among them, 30.3% of the patients were obese, 18.8% had type 2 diabetes mellitus (T2DM), 35.1% had metabolic syndrome, 84.8% had dyslipidemia, and 23.9% had hypertension. The prevalence of MAFLD was 45.5%. Among the patients with MAFLD, the prevalence of obesity, T2DM, metabolic syndrome, dyslipidemia, and hypertension was 43.3%, 24.9%, 52.5%, 92.3%, and 31.9%, respectively. MAFLD was significantly associated with all of the metabolic comorbidities (p<0.001). The median Fibrosis-4 Index score of the MAFLD patients was 0.88 (range: 0.1–9.5). Of note, 53 patients with hepatic steatosis did not meet the MAFLD criteria.Conclusion:The results of the present study indicated that there was a significantly high prevalence of MAFLD observed in daily clinical practice in Turkey. Early diagnosis and prevention efforts should be implemented to reduce disease progression, and a region-based strategy is recommended.

Endobronchial valve vs coil for lung volume reduction in emphysema: results from a tertiary care centre in Turkey.

ABSTRACTBACKGROUND: Bronchoscopic lung volume reduction (BLVR) by either the endobronchial valve (EBV) or coil (EBC) procedure is recommended for severe emphysematous patients. BLVR applications generally help healthy lung areas ventilate more comfortably by reducing the hyperinflation and improving the contraction capacity of diaphragm.OBJECTIVES: Compare our experience with valve and coil BLVR devices.DESIGN: Retrospective.SETTING: Single tertiary care centre.PATIENTS AND METHODS: Demographic data, vital signs, pulmonary function tests (PFTs), the six-minute walking test (6MWT), vital signs, arterial blood gases and complications were recorded.MAIN OUTCOME MEASURES: Change in PFTs and completion of the 6MWT.SAMPLE SIZE: 60 Turkish men with a diagnosis of chronic pulmonary lung disease.RESULTS: Clinical and demographic characteristics were similar in patients who underwent EBV and EBC. Thirty (96.8%) EBV patients and 27 (93.1%) of the EBC patients were able to properly complete the PFT before the procedures, but all complied after the procedures. Significant improvement in PFTs were achieved after the procedure and there were no statistically significant differences in post-procedure performance. For the 6MWT, the completion rate improved from 15 (48.4%) to 19 (61.3%) patients in the EBV patients (P=.125) and from 19 (65.5%) to 21 (72.4%) patients in the EBC patients (P=.500). There was no significant difference in completion rates for the walking test for either group (median 32 meters in EBV patients and 37 meters in EBC patients; P=.652). Vital signs and arterial blood gases were similar in the two groups. The rates of complications were similar in both groups.CONCLUSION: Endobronchial valves and coils are safe and effective methods for BLVR for patients with severe emphysema.LIMITATIONS: Relatively small sample, retrospective design, single-centre retrospective study.CONFLICT OF INTEREST: None.

Infections in children with left ventricular assist device.

There are limited data about pediatric left ventricular assist device (VAD) infections in developing countries. This study aimed to investigate device postimplantation infectious complications and their pathogenic profile. Data were analyzed from patient charts involving 27 patients with dilated cardiomyopathy who underwent left VAD implantation at a leading tertiary care center in Turkey. The study included 17 boys and ten girls with a median age of 12.22years (range 17months to 18years). Nineteen patients were diagnosed with idiopathic, and three were diagnosed with familial dilated cardiomyopathy. Twenty-two out of 27 subjects (%81.48) developed 80 infection episodes in total. The most common type of left VAD-specific infection was the exit site of the driveline. Infected patients with left VAD had a significantly prolonged hospitalization compared with the patients without infection (P=.014). Infection-induced pediatric intensive care unit (ICU) admission was higher in patients with fungal infection(P=.023). Gram-positive staphylococci were the most commonly isolated bacterial pathogens, followed by Gram-negative bacteria. Five patients developed fungal infections. None of the fungal infection patients underwent transplantation(P=.035). Seven deaths occurred in our study group. All deaths were in the infected group. Mortality was associated with the presence of multidrug-resistant Gram-negative bacterial infections (P=.015), an increased number of infection episodes (P=.003), and hospitalization due to infection (P=.003). Ventricular assist device-related infections were frequent among our study patients. The predominantly isolated agents were Gram-positive bacterial pathogens. However, the emergence of relatively high rate of Gram-negative bacterial and fungal infections was associated with mortality before the transplantation. Establishing local programs for surveillance data, controlling for infection rates, and antibiotic stewardship are essential to reduce mortality of VAD patients in developing countries.

Long-term outcomes of therapeutic penetrating keratoplasty for microbial keratitis in a tertiary care center in Turkey

To present the long-term results of therapeutic keratoplasty for microbial keratitis in moderate to advanced phases. The medical records of 44 patients who underwent therapeutic keratoplasty for microbial keratitis at the ophthalmology clinic of a training and research hospital between June 2012 and March 2018 were reviewed in this retrospective study. Of the 65 patients that underwent TPKP, 44 eyes of 44 patients met the inclusion criteria and enrolled in this study. The most commonly found predisposing factor for keratitis was a history of trauma (n = 17, 38.6%), and most of them had occurred with a vegetative matter (n = 14, 31.8%). The most common clinically suspected cause was fungal (n = 17, 38.6%) followed by bacterial (n = 12, 27.3%). In 26 (59.1%) cases, the causative microorganism could not be proved with a microbial culture. The most common causative microorganism was Staphylococcus spp. (n = 4, 9.1%), followed by Fusarium solanii (n = 3, 6.8%). The mean follow-up time was 42 (range 12-54) months. At the last follow-up visit, anatomical success was achieved in 40 (90.9%) cases and the BCVA of more than half of the patients was over 1.0 (logMAR, n = 24, 54.5%). Most commonly seen complication was found to be secondary glaucoma (n = 19, 43.2%), followed by cataracts (n = 9, 34.6%) and graft rejection (n = 12, 27.3%). TPKP offers a definitive solution in the management of microbial keratitis with high rates of anatomical and functional success. However, secondary glaucoma is the most common complication after TPKP, which was seen in almost half of the patients.

Clinical and basic cardiovascular features of patients with COVID-19 admitted to a tertiary care center in Turkey

Aim: COVID-19 is a new zoonotic infectious disease that can cause acute respiratory failure, which first occurred in Wuhan, China in December 2019. The aim of study was to analyze cases with COVID-19 admitted to a tertiary care center in Turkey.Methods: We evaluated demographic characteristics, clinical symptoms or signs, comorbidities, laboratory results, chest computed tomography (CT) findings and outcomes including hospitalization, intensive care unit (ICU) admission and survival of 49 patients (20 females, 29 males) diagnosed with COVID-19 disease.Results: Twenty (40.9%) of the cases were female and 29 (59.1%) were male. The mean age of the patients was 56.20 (17.65) years. The most common symptom was cough (75.5%). Hypertension (26.5%) was the most prevalent comorbid disease. Troponin I result of 42 (85.7%) patients were negative (reference value &lt;0.1 ng/mL). Ten patients (18.4%) were admitted to the ICU and overall mortality rate was 4.1% (n=2). The important characteristics of two non-survivors were as follows: 1) A 67-year-old-man, high fever (38.50C), current smoker, diabetes mellitus (+), chronic obstructive pulmonary disease (COPD) (+), congestive heart failure (+), first admission to ICU, bilateral infiltration on chest CT, troponin I: 4.01 ng/L. 2) A 38-year-old-man, current smoker, COPD (+), first admission to ICU and high CRP (120.86 m/L).Conclusion: The clinical parameters that determine the prognosis of COVID-19 are currently acute respiratory tract exacerbation and accompanying cardiovascular diseases such as hypertension and coronary artery disease. Cardiac enzyme monitoring is important in patients with cardiovascular risk factors.

A 20-year audit of retinoblastoma treatment outcomes.

ObjectivesTo evaluate the long-term treatment outcomes in intraocular retinoblastoma (RB) including the associated factors for eventual treatment with external beam radiotherapy (EBRT) and enucleation as well as to analyse the risk factors for metastasis and death in extraocular RB.MethodsRetrospective analysis of 390 eyes from 256 (89.8%) intraocular RB and 29 (10.2%) extraocular RB cases diagnosed and treated between October 1998 and May 2018 at one of the largest tertiary care centers in Turkey.ResultsOf 351 intraocular RB eyes, 53.3% had group D/E disease at presentation. 75 (21.4%) of 351 eyes underwent primary enucleation. Of the remaining 276 eyes undergoing eye-conserving treatments, 201 (72.8%) were salvaged. Most of these eyes were treated using intravenous chemotherapy and/or focal treatments [transpupillary thermotherapy (TTT) and cryotherapy] initially. EBRT was eventually required in 48 (17.4%) eyes and secondary enucleation in 75 (27.2%) eyes. At mean follow-ups of 76.7 and 39.7 months for intraocular and extraocular RB cohorts, respectively, 180 (46.2%) eyes underwent primary/secondary enucleation and exenteration. Overall, 13 cases developed metastasis and 9 died. Two patients with trilateral RB also expired. Multivariable risk factors for enucleation were the presence of vitreous seeds (p < 0.001), absence of EBRT administration (p = 0.033), 5–9 TTT applications compared with no TTT (p = 0.031), and each 1 mm increase in tumour base diameter (p < 0.001). Univariate factors predictive of metastasis were the presence of extraocular RB detected by imaging methods (p < 0.001) and extrascleral/optic nerve cut end involvement at histopathological examination (p < 0.001).ConclusionsIn our series, 72.8% of the intraocular RB eyes undergoing eye-conserving treatments were saved. The globe salvage rate for all intraocular and extraocular RB eyes was 53.8% and the overall survival rate was 96.1%.