Purpose. - To compare retrospective data on microbial keratitis (MK) from two different climatic regions in Turkey over 11 years. Study design. - Retrospective cohort. Methods. - This retrospective cohort study included patients diagnosed with presumed MK at two referral centers. Center A was located in the subtropical region of Turkey, whereas Center B was located in a continental temperate climate zone. Clinical and laboratory data were also recorded. The results were evaluated for seasonal variations. Results. - This study included data from 665 patients with presumed MK (351 and 314 patients from centers A and B, respectively). The most common predisposing factors were ocular trauma in Center A, prior ocular surgery, and systemic disease in Center B. Severe keratitis was related to prior ocular surgery, presence of systemic disease, and fungal infection at presentation. The culture positivity rate was higher in spring and lower in summer at both centers. Gram-positive bacteria were the most commonly isolated bacteria in both centers in all seasons. The fungal and mixed keratitis ratios were higher in Center A than in Center B. In Center A, filamentous fungi were common pathogens that were found year-round, and peaks were observed in July and October. Conclusion. - The results of this study show that climatic and seasonal factors may affect the microbial profile of keratitis. Fungal keratitis appears to be a climatic disease. Understanding the regional profile of MK can aid clinicians in their disease management. (c) 2023 Elsevier Masson SAS. All rights reserved.

Background: COVID-19 and lysosomal storage disorders (LSDs) share a common immunological pathway as they cause the release of cytokines in a similar pattern. We aimed to evaluate the immunity status and reveal the course of COVID-19 in patients with LSDs. Results: The median age of 110 patients with LSDs was 129 months (range: 21-655), and all but one patient with mucopolysaccharidosis (MPS) type III were regularly receiving enzyme replacement therapy (ERT). In 53.6% (n = 56) of the patients (23 patients with Gaucher disease [10 type III, 13 type I], 26 patients with MPS [8 type VI, 11 type IVA, 1 type III, 3 type II, and 3 type I], and 7 patients with Pompe disease), an abnormality in at least one of the autoimmunity or immunodeficiency parameters was reported. Furthermore, 12 (57%) of 21 Gaucher cases (7 type III, 5 type I), 18 (40.9%) of 44 MPS cases (9 type IVA, 5 type VI, 1 type I, 2 type II, and 1 type III), and six (66%) of nine Pompe cases were reported to involve abnormalities in at least one of the parameters related to immunodeficiency. Immunoglobulin (Ig) M and IgA levels were reported to be lower, and there were abnormalities in the lymphocyte counts and subgroups in the MPS group. ANA was reported to be positive in one patient with Gaucher type III, anti-DNA in two patients with Gaucher type I and one patient with MPS type VI, antithyroglobulin in two patients with Gaucher type I, anti-TPO in one patient with Gaucher type I, TRAB in one patient with Gaucher type I, antiphospholipid IgM in three patients with Gaucher type III and one patient with Gaucher type I, anticardiolipin IgM in one patient with Gaucher type I, one patient with Gaucher type III, and one patient with MPS type II. However, no clinical presentation was consistent with the laboratory results except for one patient with Gaucher type I disease with Hashimoto thyroiditis. Two of the four patients who survived the COVID-19 infection with mild symptoms had a diagnosis of Gaucher type I, and no abnormality was detected in their laboratory tests. The other two patients had a diagnosis of MPS types VI and II. Immune dysfunction was detected in the patient with a diagnosis of MPS type II. Four of our patients were discharged without any sequelae.Conclusion: Problems with immunity did not cause any noticeable clinical results. Being well protected by reducing social contact might have played a role. However, we believe that it should be borne in mind that cardiac and pulmonary involvement, as well as immune dysfunction in LSDs, may cause an increased need for intensive care because of secondary bacterial infections. (c) 2022 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.

Objective: The aim of this study was to evaluate the clinical and prognostic importance of programmed death-1 (PD-1) and/ or programmed death-ligand 1 (PD-L1) in uterine carcinosarcoma (UCS). Study Design: Formalin fixed, paraffin-embedded tissue samples from 59 cases with UCS were analyzed. PD-1 and PD-Ll expressions in tumor tissue and microenvironment were detected by immunohistochemistry. Clinical and pathological characteristics including age, stage, initial symptom, surgical approach, myometrial invasion, lymphovascular space invasion (LVSI), lymph node invasion, adjuvant therapy, and survival were evaluated. The Kaplan-Meier and Cox proportional hazards models were used to compare the outcomes and prognostic factors. Results: PD-1 expression in tumor tissue and microenvironment was detected in 15 (25 %) and 18 (30 %) cases, respectively. PD-Ll expression in tumor tissue and microenvironment was detected in 15 (25 %) and 12 cases (20 %), respectively. PD-Li expression in tumor was associated with longer survival and median survival was 38 and 15 months in cases with and without PD-L1 expressions, respectively (p = 0.019). Lymphovascular space invasion (LVSI) (p = 0.014), myometrial invasion (p = 0.008) and PD-Ll expression were found to be prognostic for UCS's. PD-Li expression was found to be an independent good prognostic factor with Cox regression analysis (OR 3.9; 95 % CI: 1.4-11.0) for overall survival. Conclusion: PD-1 and/or PD-Ll expression are important due to their expressions in one fourth of the cases with UCS and PD-1/PD-L1 blockade may be a new avenue in UCS. (C) 2019 Elsevier B.V. All rights reserved.

Introduction/Background In this study we aimed to compare the long-term oncological outcomes of laparotomy (LT) and laparoscopic (LS) surgeries in endometrial cancer under the light of 2016 ESMO-ESGO-ESTRO risk classification system, focusing on the high intermediate and high-risk categories. Methodology Using multicentric database, overall (OS) and disease-free survivals (DFS) of 2745 endometrial cancer cases were compared according the surgery route, laparotomy vs laparoscopy. A sub-analysis was performed considering the 2016 ESMO-ESGO-ESTRO risk classification for endometrial cancer. Thus, high intermediate and high-risk patients were grouped and a comparison was made between the groups. Results Among the enrolled patients 1743 (63.5%) were operated by laparotomy and 1002 (36.5%) were operated with laparoscopy. The total number of high intermediate and high-risk endometrial cancer cases was 734 (45%) patients in the LT group and 307 (30.7%) patients in the LS group. OS and DFS were not statistically different when compared between LS and LT groups in terms of low, intermediate, high intermediate and high-risk endometrial cancer. Conclusion Regardless of the endometrial cancer risk category, long-term oncologic outcomes of LS were found to be comparable to those treated classically with LT. Our results are encouraging for primarily considering laparoscopic surgery for high intermediate and high-risk endometrial cancer cases in order to minimize surgical morbidity, as adjuvant therapies will mostly be offered to this population. It should be strongly emphasized that this suggestion is limited to gynecological oncology centers with high laparoscopical experience. Disclosure Nothing to disclose.

Introduction/Background Ovarian malignant germ cell tumors (OMGCT’s) are derived from primitive germ cells of the embryonic gonad and they are heterogenous tumors. OMGCT should be investigated separately from other tumors for its association to long-term survival, different pathways and biological characteristics. This study was performed to evaluate the clinical and pathological characteristics of patients who were followed up for OMGCT in the last twenty-five years in our clinic. We also aimed to investigate prognostic parameters and the effect of findings on survival rates. Methodology One hundred and fifteen patients with OMGCT, treated and followed-up between April 1992 and November 2017 were included to this study. Clinical characteristics, operative information, pathologic findings, treatment and follow-up data of the patients were gathered from medical records. The parameters on survival was investigated. Survival analysis were performed using Kaplan - Meier test. Overall survival (OS) and Disease Free Survival (DFS)’s statistically significance was evaluated with Log-Rank test. Reproductive outcomes were analyzed. Results The average age of patients were 27.5±14.3. Mean follow-up time was 71 months. Approximately 61 (53%) of patients was Stage 1. Complete staging surgery (CSS) was performed 60 patients. Fertility-sparing surgery (FSS) was performed 55 patients. Nineteen (34.5%) of the FSS patients had pregnancy and 15 of them had live births. Poor prognostic factors were suboptimal cytoreduction, advanced stage disease, poor differentiation, metastasis, mixed germ cell histological type, co-morbidity of patients. Factors affecting disease-free survival (DFS) in multivariate analyzes are advanced stage, mixed germ cell histology, and suboptimal cytoreduction. The 5-year survival rate of the 115 patients was 74%. Conclusion Both DFS and OS period of mixed germ cell ovarian tumors were shown to be significantly lower than other histologic types. The high pregnancy rates after fertility surgery are hopeful for patients. Disclosure Nothing to disclose.

Methods and patients: Fluorescence in situ hybridization (FISH) was performed 3 micron sections of formalin-fixed, paraffin-embedded tissue. IRF4/DUSP22 (Cytotest, USA) break-apart FISH probe kit was used for rearrangement detection. Slides were analyzed using standard fluorescence microscopy techniques. 100 cell nuclei without overlapping were counted on each slide. The cutoff value for IRF4/DUSP22 was accepted %15. Eighty four cases with indolent lymphoma were evaluated for DUSP22 expression. The signal could not be detceted in 8 cases and of the total 76 cases with indolent lymphoma were evaluated for DUSP22 expression. Female/male ratio was 31/45. Fifteen cases had stage I disease, 8 had stage II, 18 had stage III and 26 had stage IV disease. Thirty nine had follicular lymphoma (FL), 30 had marginal zone lymphoma (MZL) and 7 had chronic lymphocytic leukemia (CLL). Among FL, 5 had grade I, 10 cases had grade II, 24 had grade III disease: 13 had grade IIIA-11 had grade IIIB. Among MZL 4 had nodal and 26 had extranodal MZL. Complete response was achieved in 42 cases and partial response in 11 cases; 8 cases did not respond to treatment. During this analysis 43 cases was living without disease, 12 cases was living with disease and 21 cases died. Results: DUSP22 expression was detected in 17 cases (22.3%). Expression was detected 4 of 31 women and 13 of 45 men. DUSP22 expression was detected 10 of 39 cases with FL, 6 of 30 cases with MZL and 1 of 7 cases with CLL. Among grade I cases. The mean OS was found to be longer in cases without DUSP22 compared to cases with DUSP22 expression (126 vs 58 months p:0.036) (Figure 1). However no significant differences were found between the cases with and without DUSP22 expression according to mean of event-free survival (EFS) (58 vs 82 months p:0.717). The OS was found to be longer in DUSP22 (-) females than males (157 vs 104 months p: 0.018). In univariate analysis, OS was found to be longer in cases with early stage disease (p:0.0001) and in females (p:0.009). Sex (OR:3.5, %95CI:1.0-12.1, p:0.046), stage (OR:8.0, %95CI:1.736.7, p:0.008) and DUSP22 expression (OR:3.4, %95CI:1.2-9.3, p:0.018) were found to be independent prognostic factors according to Cox regression analysis. Conclusions: Little is known about the functional roles of DUPS22 and the underlying mechanisms. The silencing of DUSP22 in peripheral T cell lymphomas especially in ALK (-) anaplastic large cell lymphoma suggest that this gene is a candidate tumor suppressor gene and its inactivation may contribute to the pathogenesis of peripheral T cell lymphoma subtypes. Some studies showed that of the 20-30% of ALK(-) anaplastic large cell lymphomas have chromosomal rearrangements of DUSP22. DUSP22 rearranged cases with ALK (-) subtype have favorable outcomes similar to ALK (+) anaplastic large cell lymphoma. There is no sufficient data about the clinical and/or prognostic significance of DUSP22 rearrengement in other lymphomas. We found poor outcome in cases with DUSP22 expression. How can we define this controversy? It is known that DUSP22 regulates MAPK signal transduction but the effect of DUSP22 on MAPKs is controversial. Since there have been several conflicting reports regarding its substrate specificity. One report showed that DUSP22 dephosphorylates ERK2 in vitro, while other studies showed that DUSP22 enhances JNK activation but not p38 and ERK2. Therefore, further studies are required to clarify the physiological role of DUSP22. We found poor overall survival in cases with DUSP22 expression and we need further studies about the prognostic significance of DUSP22 expression in indolent lymphomas. Keywords: non-Hodgkin lymphoma (NHL); prognostic indices.

OBJECTIVE:The aim of the present study was to compare the long-term outcomes of the laparotomy (LT) and laparoscopic surgery and to evaluate the results according to low, intermediate, and high-risk groups of endometrial cancer (EC).METHODS:We identified 801 patients with EC and these patients were classified as group 1, who underwent LT (n=515); and group 2, who underwent laparoscopy (LS) (n=286). Patient's demographics, clinical characteristics such as stage, grade, histopathologic type, lymphovascular space invasion, myometrial invasion, lymph node involvement, and risk groups, peri- and post-operative outcomes, and survival outcomes were compared between the groups according to risk classification. Survival outcomes were assessed using Kaplan-Meier method.RESULTS:The demographic characteristics of both groups were similar except age. Shorter hospital stay and fewer complications were observed in group 2. The overall survival (OS) were similar in the low, low-intermediate, high-intermediate and high-risk groups (p=0.269, 0.476, 0.078, and 0.085; respectively) for LS compared to LT. The covariate analysis revealed that the death and recurrence risks were approximately twice higher in the LT group than in the LS group (odds ratio [OR]=1.9; 95% confidence interval [CI]=1.2-3.1 for OS; OR=2.0; 95% CI=1.2-3.3 for disease-free survival).CONCLUSION:The results of our study support the well-known positive aspects of LS as well as safe and effective use in cases of intermediate and high-risk EC.

Background: Hodgkin Lymphoma (HL) is one of the curable malignant diseases. International prognostic score7 (IPS-7) was a valuable scoring system predicting FFP and OS in cases with HL. A simpler prognostic score: IPS-3 has been proposed 2 years ago and in this scoring system age and stage were found to be significant for FFP and age, stage and hemoglobin were found to be significant for OS. Here we evaluated IPS-3 new system in cases with HL. Methods: 364 patients with HL treated by ABVD have been included in this study. Two thirds of the patients had nodular sclerosing type HL, 76 had mixed cellularity type. Median follow up was 71 months. Results: Seven clinical parameters on the basis of the IPS-7 determined to be associated with adverse clinical outcome were evaluated. The prognostic ability of seven IPS factors was evaluated for both FFP and OS. A new 3-factor prognostic score (IPS-3 new) was constructed utilizing factors that were significant in multivariate Cox models: age>45 years, stage IV disease and lymphocytopenia were found to be independent factors. Thus IPS-3-new was constructed utilizing these 3 factors that were significant in multivariate Cox models. Lymphocytopenia was used instead of hemoglobin <10.5g/dl that has been recommended for IPS-3 score. The prognostic performance of IPS-7, IPS-3 and IPS-3-new was evaluated. Patients classified into 3 risk groups low, intermediate, and high risk. Specifically, for cases that were re-classified to different risk group by IPS-3-new, the observed FFP and OS estimates were compared to survival rates predicted by IPS-7 and IPS-3 respectively. An alternative prognostic index, the IPS-3-new, was constructed using age, stage, and lymphocytopenia (FFP: p = 0.0001 and OS: p < 0.0001). Conclusions: The IPS-3 new covering lymphocytopenia instead of anemia besides age and stage factors on risk prediction for FFS and OS may provide a more accurate and reliable framework for risk assessment for the patients with HL.IPS-3 new is important due to the predictive property of lymphocytopenia in HL in immunotherapy era. Legal entity responsible for the study: Semra Paydas et al Funding: None Disclosure: All authors have declared no conflicts of interest.

Purpose:This study was conducted to identify normal reference values of basal cerebral artery blood flow velocities in healthy children and adolescents and determine influence of age and sex on normal values. Materials and Methods:A total of 129 healthy children were evaluated within the childhood and adolescence period by color transcranial sonography. Blood flow velocities and Doppler indices were determined in the anterior cerebral, middle cerebral, posterior cerebral, vertebral arteries, and basilar arteries. Measurements were correlated with the age and sex of the children. Results:Normal values of blood flow velocities for cerebral arteries according to age and sex were obtained and presented in tables. Side differences are also indicated and values are given in relation to age and sex. The flow velocities rapidly increase in children (from 3 up to 11 y) and gradually decrease with increased age. The resistance indices decrease in children and increase in older people. Conclusion:The changing intracranial hemodynamics during childhood and adolescence require age-dependent reference values to distinguish physiological and pathologic flow velocities in the basal cerebral arteries. The tables according to age and sex will definitely be helpful in managing cerebral hemodynamics in children.

PURPOSE:We investigated the relationship between the distribution of the IL-1RN, TNF-β and IL-4 polymorphism and the clinical features of bladder cancer.MATERIALS AND METHODS:A total of 100 patients with bladder carcinoma and 102 healthy control subjects were enrolled in the study. The IL-1RN, IL-4 and TNF-β gene polymorphisms were identified by PCR restriction fragment length polymorphism-based analysis. Allelic frequencies were compared between patient and the controls. Tumor stage, histopathological grade, tumor size/number and smoking condition were evaluated with IL-1RN, IL-4 and TNF-β gene polymorphisms.RESULTS:Allele distribution frequencies of IL-1RN and IL-4 gene polymorphisms were significantly different between patients and control groups. However, allele distribution of TNF-β gene was not statistically significant. There was no difference in allele distribution of the three genes in both groups regarding stage, tumor size, number of tumors and smoking condition. Although allele distribution of IL-4 gene showed significant difference considering histopathological grades in both smoking and total patients group, allele distribution of IL-1RN and TNF-β was not different.CONCLUSION:The present research suggests that the IL-1RN and IL-4 gene polymorphisms are potential genetic markers of susceptibility to bladder cancer. In the future, clinical improvements on diagnosis, treatment and prognosis of bladder carcinoma are expected owing to development of more sensitive and specific tests for genetic polymorphisms of cytokines that are effective on inflammation.

Objective: The aim of this study was to investigate the frequency of familial history of collagen tissue disease and antinuclear antibody (ANA) positivity in cases with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) related to childhood Obsessive Compulsive Disorder. Method: To determine psychiatric diagnoses, Schedule for Affective Disorders and Schizophrenia for School-Age Children--Present and Lifetime Turkish Version (KSADS-PL) was administered to the patients followed up with the diagnosis OCD. Serum levels of Anti Streptolysin O (ASO), C Reactive Protein (CRP) and Anti nuclear Antibody (ANA) were screened. Results: There were 91 OCD patients. Among these, 52 patients (57.1%) were diagnosed with PANDAS, 19 (20.9%) were diagnosed with non-PANDAS and 20 (22%) were diagnosed with PANDAS-variant. History of familial CTD was found in 34 (37.4%) of the cases. Among these,18 (52.9%) were first degree relatives while 16 (47.1%) were second degree relatives. The most commonly reported CTD was Rheumatoid Arthritis as present in 7 patients (20.5%). When each subgroup was compared, ANA positivity was most common in the PANDAS group, present in 15 patients (28.8%) indicating a statistical significance at p=.90. Discussion: This study is important for being one of the limited number of studies that searched for an association between familial CTD and PANDAS. There is a need for genetic studies to explore the association between PANDAS OCD and familial collagen tissue disease.

Objective: To evaluate the impact of gestational age on clinical laboratory findings and maternal-perinatal outcomes in patients with HELLP syndrome. Method: A retrospective review of 74 patients with HELLP syndrome between January 2007 and October 2010 was performed. Data were stratified into two groups by gestational age at the onset of disease: group 1 (< 34 weeks) and group 2 (>= 34 weeks). Clinical signs and symptoms, laboratory findings, and maternal and perinatal outcomes were evaluated. Results: No differences were observed between the two groups in the clinical and laboratory characteristics according to onset of HELLP syndrome except for gravidity, parity, and delivery interval. Maternal complications did not differ between the groups. The perinatal mortality rate was 22.9% in total and it was 43.2% in group I. Conclusions: The time of onset of the HELLP syndrome mainly affects neonatal outcomes. To assess the effect on maternal morbidity more studies are needed.

BACKGROUND:Recent studies have reported that Nramp1 polymorphisms might have an important role in the development of tuberculosis in various populations. In this study, we aimed to determine Nramp1 polymorphisms in our patients with tuberculosis population.METHODS:We enrolled 127 patients with active tuberculosis and 116 healthy adults with similar age and gender. Peripheral blood samples were taken for determining the Nramp1 polymorphisms. By using Polymerase Chain Reaction (PCR) - Restriction Fragment Length Polymorphisms (RFLP) technique, we evaluated the polymorphisms of Nramp1 at the regions of D543N and INT4.RESULTS:We found that the Nramp1 polymorphisms at the region of D543N (OR: 0.44, 95%CI: 0.09-2.06 for GA allele) were not a risk factor for tuberculosis. Furthermore, we could not able to detect Nramp1 polymorphism at the regions of INT4 (OR: 0.97, 95%CI: 0.55-1.72 for GC allele and OR: 0.90, 95%CI: 0.21-3.77 for CC allele).CONCLUSION:The findings of the present study do not support the hypothesis that Nramp1 at the regions of D543 and INT4 might play a role in influencing the growth of bacilli and progression of cavitary tuberculosis rather than susceptibility to M. tuberculosis infection. Future studies are needed to elucidate the role of Nramp1 variants in the pathogenesis of tuberculosis (Tab. 3, Ref. 29).