Clinical impact of 99mTc-HDP SPECT/CT imaging as standard workup for foot and ankle osteoarthritis.

Objective: The primary aim of this study was to assess to what extent 99mTc-HDP Single photon emission computed tomography/computed tomography (SPECT/CT) will lead to change of diagnosis and treatment, in patients with suspected foot and ankle osteoarthritis (OA). Secondary aim was to assess the intraobserver variability. Methods: Retrospectively 107 patients, with suspected foot and/or ankle OA of which a SPECT/CT was made, were included for analysis. All the clinical and radiological data were randomized and blinded before being scored by one experienced orthopaedic surgeon. Firstly, based on the clinical data and conventional radiographs, a diagnosis and treatment plan was scored. Secondly, the observer accessed the SPECT/CT and could change the diagnosis and treatment plan. Additionally, the intraobserver reliability was determined by data of 18 patients that were added in twofold to the dataset, without awareness of the observer and by calculating the κ values. Results: The diagnosis changed in 53% (57/107) and treatment plans changed in 26% (28/107) of the patients. Intraobserver reliability for the conventional workup was k = 0.54 (moderate strength of agreement), compared to k = 0.66 (substantial strength of agreement) when SPECT/CT data were added. Conclusions: This study describes the influence of SPECT/CT on diagnosis and treatment plans in patients with suspected symptomatic OA. Also, it shows SPECT/CT leads to a higher intraobserver variability. We believe SPECT/CT has a promising role in the workup for foot and ankle OA. Advances in knowledge: In addition to what was found in complex foot and ankle cases, this study shows that in patients with non-complex foot and ankle problems, SPECT/CT has a substantial influence on the diagnosis (and subsequent treatment plan).

Efficiency of intravenous iron carboxymaltose in patients with iron-deficiency anemia due to heavy menstrual bleeding: a single-center experience.

OBJECTIVE: Heavy menstrual bleeding (HMB) is the most common cause of iron deficiency anemia (IDA) in premenopausal women. Clinical studies have shown that iron carboxymaltose (ICM) is an appropriate, effective, and well-tolerated treatment option for clinical situations associated with iron deficiency (ID). PATIENTS AND METHODS: This study took 78 out of 400 consecutive patients diagnosed with IDA due to HMB and intolerant or insufficient response of oral iron. All patients were administered the total calculated dose of ICM separately, based on the body weight and current hemoglobin (Hb) level. All the anemia parameters of the patients were compared before and after treatment. RESULTS: All anemia parameters, including median Hb, ferritin, and transferrin saturation, significantly increased four weeks after treatment. Pre- and post-treatment mean Hb levels were 8.9 (± 1.7) g/dL and 12.3 (± 1.2) g/dL, respectively. The mean ferritin level of the patients before treatment was 3.93 (± 2.7) ng/mL. After treatment, the mean ferritin level was 244 (± 185) ng/mL. The mean transferrin saturation levels before and after treatment were 5.7% (± 5.0) and 43.1% (± 20.9), respectively. Although no serious side effects were observed in all patients, headache was detected in 2 patients (2.6%), urticaria in 3 patients (3.8%), and flushing in 2 patients (2.6%). CONCLUSIONS: ICM is an effective and safe treatment option for patients with IDA due to HMB, in which oral iron therapy is insufficient or intolerant. In fact, without waiting for the failure or intolerance of oral iron therapy, moving ICM to the frontline could be cost-effective and more convenient to patients with HMB and health care providers.

The clinicopathological features and survival of Castleman disease: a multicenter Turkish study.

OBJECTIVE: In this study, we aimed to investigate the clinicopathological features and survival of CD, which is quite rare and has many unknowns. PATIENTS AND METHODS: This study was conducted by retrospectively evaluating patients diagnosed with CD in six different centers in Turkey. RESULTS: The median age of 33 patients included in the study was 49 and 51.5% (n = 17) of these patients were women. 18 (54.5%) patients were in the hyaline vascular subtype and most of the patients were UCD (n = 20, 60.6%). The most common involvement region was head and neck (n = 19, 57.5%). The UCD group was younger than the MCD group (p=0.027). Visceral lymph node involvement was higher in MCD than in UCD (p=0.001). Similarly, it was observed that there was more hepatomegaly (p=0.035) and splenomegaly (p=0.013) in the MCD group. During the median 19.5 months follow-up period, there were no patients who died. CONCLUSIONS: It was observed that UCD and MCD are different clinical entities. Promising survival times can be achieved with surgical and systemic treatments in both subtypes of this extremely rare disease. However, this result should be supported by well-designed prospective comprehensive studies.

Nivolumab as a bridge to allogeneic hematopoietic stem cell transplantation is associated with improved survival.

OBJECTIVE: The aim of the present study was to compare the effects of nivolumab bridge to allogeneic hematopoietic stem cell transplantation (allo-SCT) on progression-free survival (PFS) and overall survival (OS) and toxicity profile. PATIENTS AND METHODS: The study population consisted of relapsed/refractory cases of HL, who were treated with nivolumab for disease control and subsequently underwent allo-SCT at our institution. The control group consisted of HL patients who relapsed or refractory after multiple lines of therapy and underwent allo-SCT without nivolumab before transplantation as bridging therapy. RESULTS: The incidence of acute and chronic graft vs. host disease (GVHD) was similar in both groups. The 100-day mortality occurred in 1 patient (10%) in the nivolumab group and 4 patients (16.7%) in the control group (p = 0.54). During 30-month follow-up, PFS was achieved in 60% of patients in the nivolumab group and 45.8% in the control group (p = 0.69). OS during 30-month follow-up was 80% in the nivolumab group and 41.7% in the control group, OS was superior in patients in the nivolumab group than in the control group (p = 0.04). CONCLUSIONS: Allo-SCT after bridging therapy with nivolumab provides a survival advantage over patients who underwent allo-SCT without the bridging. Therapy with nivolumab in combination with post-transplant cyclophosphamide does not appear to increase GVHD.

Pregnancy outcomes in female cancer survivors after hematopoietic stem cell transplantation.

OBJECTIVE: This study was conducted to retrospectively investigate the pregnancy outcomes of patients who underwent stem cell transplantation (SCT). We also aimed at determining the reasons for avoiding pregnancy despite prolonged remission. PATIENTS AND METHODS: The study population consisted of patients who became pregnant after autologous or allogeneic SCT at Dr. Abdurrahman Yurtarslan Oncology Hospital between 2009 and 2020 for hematologic diseases. Data from 83 patients who had undergone allogeneic or autologous SCT were available for analysis. A total of 18 pregnancies occurred in 14 of these patients. To compare pregnancy outcomes, pregnant patients who received care at Etlik Zübeyde Hanim Maternity Hospital were selected as the control group. RESULTS: No pregnancy occurred in 69 of the patients whose data were analyzed. Of these 69 patients, 48 (69.6%) did not want to become pregnant. The most common reason for not wanting a pregnancy was due to the fact that the patient was not married [21 patients (30.4%)]. The pregnancy rate was higher in the HL group than in other hematologic malignancies [8 patients (57.1%)]. Twelve (85.7%) of the patients who became pregnant did so after autologous SCT and 2 (14.3%) after allogeneic SCT. The cumulative incidence of obstetric complications was higher in pregnancies after SCT than in the control group, and the prevalence of low birth weight was observed more frequently. CONCLUSIONS: Patients who became pregnant after SCT have a higher rate of pregnancy complications. However, these patients achieve similar live birth rates as the healthy population. Many patients have concerns about pregnancy and should be counseled appropriately.

Assessment of visceral and subcutaneous obesity to understand the efficiency of adipose tissue in acute pancreatitis.

BACKGROUND: Fat accumulation in the visceral and subcutaneous regions can trigger fat necrosis during acute pancreatitis (AP). AIMS: We investigated the role of visceral and subcutaneous fat in acute pancreatitis. In this study, we investigated the role of visceral and subcutaneous fat to understand the efficiency of adipose tissue in the AP. MATERIALS AND METHODS: Computed tomography of 68 patients and 68 healthy at the level of L4-5 intervertebral disc were analyzed for body adiposity composition using designated software. Body subcutaneous and visceral composition was measured by using the designated software of the CT. RESULTS: Visceral fat was higher in the control group (198 ± 146) than the group of the AP (155 ± 118) (P = 0.038), whereas the subcutaneous fat was found higher in the AP instead (292 ± 133 to 139 ± 102; P = 0,001). Visceral fat (B = 0,29; P = 0,0013), gender (male) (B = -0.3; P = 0.0122), age (B = 0.274; P = 0.0087), and complication (B = -0.229; P = 0.007) predicted the subcutaneous fat as the dependent variable. In the receiver operating characteristic (ROC), the area under curve was 0.562 (0.402-0.636; 95% CI, P = 0.038) for the visceral fat, while it was 0.906 (0.824-0.962; 95% CI, P < 0.0001) for the subcutaneous fat. Its cutoff was calculated as 183.7 for subcutaneous fat. CONCLUSION: Visceral fat analysis showed a contradiction according to subcutaneous fat that AP was strongly associated with subcutaneous one. The result supports that visceral and subcutaneous fat tissues should have different path of inflammation affecting the AP.

Is classical Hodgkin lymphoma a different disease in the elderly? A single-center retrospective cohort study.

OBJECTIVE: Although the clinical features and treatment results of Hodgkin lymphoma (HL) in young adults are well known, it is thought that the disease may have different characteristics in elderly patients with HL, which constitutes almost 25% of the group. In this study, our aim is to evaluate the clinicopathological features, treatment outcomes, and survival of elderly classical Hodgkin lymphoma (CHL) patients. PATIENTS AND METHODS: Patients aged 60 and over who were treated with a diagnosis of CHL were included in our retrospective cohort study. Patients under the age of 60, those with a diagnosis of nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) were excluded from the study. RESULTS: The median age of 51 patients in the study was 66 (60-76). Forty (78.4%) patients had at least one comorbid disease. The most common histological subtype was mixed cellular HL (n = 23, 45%) and 23 (45%) patients had B-symptoms. Thirty-two (62.8%) patients were in the advanced stage. The most preferred regimen in first-line treatment was doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) combination chemotherapy (n: 45; 88.2%). Forty-three (84.3%) patients were able to complete the initially planned treatment. Complete response was achieved in 34 (66.7%) patients. During the median follow-up period of 45.2 months, 23 (42.6%) patients had died. The 5-year OS was 57.4%. CONCLUSIONS: In conclusion, it was observed that the distribution of histological subtypes was different in elderly patients with CHL, B-symptoms were more common in elderly patients, and OS decreased with increasing age.

[Problematic attachment]. / Problematische gehechtheid.

Unsafe attachment relationships occur in more than one third of children living at home. In case of severely problematic attachment, it is important that physicians and paramedics recognise this, so that they can refer the child and its caregiver to specialist care. This is because interventions to improve attachment between children and their caregivers are possible. This will make it possible to limit the psychological consequences for the child, even at a later age.

Ocular adnexal lymphomas: An eye care service experience in Turkey.

AIM: This study aimed to evaluate the clinical and pathological features of ocular adnexal lymphoma (OAL) and the treatment results in an eye care service center in Turkey. MATERIALS AND METHODS: The data sets of the patients diagnosed with OAL acquired between January 2008 and January 2016 were collected and analyzed. RESULTS: Fifteen patients were included in our study. The mean age was 55.80 ± 17.85 years. The age range was 7-85 years. Most of the lesions originated from orbital tissue, and histopathological and immunohistochemistry examinations of the lesions were consistent with non-Hodgkin's lymphoma in 14 patients and Hodgkin's lymphoma in 1 patient. The most common subtype of OAL, accounting for 40% of cases, is extranodular marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) type. CONCLUSION: Most of our patients' histopathological and immunohistochemistry examinations are non-Hodgkin's type and also involve the orbits. Ocular adnexal lymphomatosis is not a rare disorder and could be treated if there is no systemic involvement at first diagnosis.

Is Cytomegalovirus Surveillance Necessary for Patients With Low Reactivation Risk in an Autologous Hematopoietic Cell Transplantation Setting?

BACKGROUND: In an autologous hematopoietic cell transplantation (AHCT) setting, routine cytomegalovirus (CMV) surveillance is not indicated except in high-risk situations. On the other hand, some studies reported increased CMV reactivation in AHCT setting as a result of incorporation of novel agents into treatment algorithms, such as bortezomib and rituximab. We retrospectively analyzed CMV reactivation and infection rates in patients with no high-risk features, who were treated with AHCT. METHODS: During January 2010 to November 2015, all consecutive, CMV-seropositive patients were included. The viral copy numbers were measured twice a week from the start of the conditioning regimen until engraftment, once a week for the remaining time period until day 30 after AHCT and once weekly only for patients who had been diagnosed with CMV reactivation before and who developed primary/secondary engraftment failure during 31 to 60 days after AHCT. RESULTS: One hundred one (61.6%) men and 63 (38.4%) women were included in the study. The median age of study cohort was 51 years (range, 16-71 years). The indications for AHCT were Hodgkin lymphoma, non-Hodgkin lymphoma, and multiple myeloma in 44 (26.8%), 41 (25%), and 79 (48.2%) patients, respectively. CMV reactivation occurred in 60 (37%) patients, and 13 patients (8%) received pre-emptive ganciclovir treatment. CONCLUSIONS: On the basis of our results, it might be stated that CMV surveillance may be recommended during 40 days after AHCT in countries with a high CMV prevalence, even in patients without high-risk features regarding reactivation. Additionally, the risky conditions necessitating CMV screening after AHCT must be re-defined in the era of novel agents.

Serum uric acid and inflammation in patients with immune thrombocytopenic purpura: preliminary results.

OBJECTIVE: The purpose of this study was to evaluate the uric acid (UA) and C-reactive protein (CRP) levels in patients with immune thrombocytopenic purpura (ITP). PATIENTS AND METHODS: Forty patients with newly diagnosed ITP and 40 healthy individuals were enrolled in the study. The patients were divided into two groups; group 1 (n = 40) consisted of patients with ITP, and group 2 (n = 40) consisted of healthy subjects. UA and CRP levels were measured in the blood samples from them. RESULTS: There were no statistical differences in gender, age and body mass index between two groups (p > 0.05 for all). Compared to group 2, group 1 had significantly higher UA levels (p = 0.002), whereas CRP levels were not significantly different (p > 0.05). In ITP patients, serum UA and CRP levels significantly correlated with low platelet count (r = -0.362, p = 0.022; r = -0.383, p = 0.015, respectively); and UA levels significantly correlated with CRP levels (r = 0.436, p = 0.005). CONCLUSIONS: The present study showed that UA levels increased in patients with ITP and negatively correlated with platelet counts. UA levels might be a mediator of inflammation via enhanced production of inflammatory cytokines; they might also be a potential mediator of low platelet count, and could play a pathophysiological role in the development of ITP.

Seroprevalence of IgG anti-Toxocara canis antibodies and anti-Fasciola sp. antibodies in patients with urticaria.

AIMS: Chronic urticaria (CU) is defined by recurrent episodes occurring at least twice a week for 6 weeks and generally characterized by the rapid appearance of wheals and/or angioedema and may be associated with parasitic infections. We aimed to investigate the seroprevalance of Toxocara canis and Fasciola species in patients with CU. MATERIALS AND METHODS: We included 55 patients (in age 16-55) with urticaria admitted in study. As a control group we recruited 30 healthy volunteers they had no history of urticaria, rhinitis, asthma, atopic eczema/dermatitis syndrome (AEDS), or other relevant diseases. IgG antibodies to Toxocara canis and Fasciola species were investigated by ELISA method. RESULTS: In a total of 55 patients (mean age: 31.85 ± 8.92), 8 patients (14.5%) were positive for IgG antibodies to Toxocara canis. Among seropositive patients (mean age: 38.62 ± 12.46) 6 patients were female. No patient was positive for Fasciola by ELISA. Six of Toxocara canis seropositive cases were frequently visited or lived in rural areas and had contact with pets. CONCLUSIONS: Patients with urticaria, should be tested for Toxocara canis and treated with anthelminthic drugs in endemics areas for toxocariasis.

Oxidative stress parameters and ceruloplasmin levels in patients with severe preeclampsia.

BACKGROUND: Oxidative stress is believed to have a role in the development of preeclampsia (PE). It is known that an increased ceruloplasmin (CP) level is also associated with PE. The aim of this study was to investigate the relationship between oxidative stress parameters and CP levels in patients with severe PE. PATIENTS AND METHODS: Sixty patients with severe PE and 60 healthy pregnant women were recruited to the study. All study subjects were divided into 2 groups; group 1(n=60) consisted of patients with severe PE, and group 2 (n=60) consisted of healthy pregnant subjects. Blood samples were obtained to measure CP, total antioxidant status and total oxidant status from all subjects. Oxidative stress index was calculated. RESULTS: Compared to group 2; group 1 had significantly higher CP, total oxidant status, oxidative stress index and lower total antioxidant status levels (p<0.001, p<0.001, p=0.001, p=0.008, respectively). Serum CP levels were significantly correlated with oxidative stress index levels (r=0.385, p=0.002). CONCLUSION: The present study demonstrated that both oxidative stress and CP levels increased in patients with PE, and increased CP levels seem to be a consequence of oxidative stress.

Familial Mediterranean fever without cardinal symptoms and role of genetic screening.

Familial Mediterranean fever is an autosomal recessive disorder characterized by paroxysmal episodes of fever and serosal inflammation. The classical presentation is fever and severe recurrent abdominal pain due to serositis that lasts for one to three days and the resolves spontaneously. Between the episodes patients are asymptomatic. Ninety-five percent of patients with familial mediterranean fever have painful episodes localized to the abdomen, which is usually the dominant manifestation of the disease. Herein, we present a case of 34-year-old man with incomplete abdominal pain episode of familial mediterranean fever limited to the epigastrum and had no cardinals symptoms of this disease. The diagnosis was made by genetic screening. Successful treatment response was achieved by colchicine.

An adult-onset still's disease with autoimmune thyroiditis.

Adult-onset Still's disease is a rare inflammatory disorder of unknown etiology and has same clinical characteristics of the systemic form of juvenile rheumatoid arthritis. A 17 years old white female had arthralgias of multiple joints including small joints of hands. She had fever, rash, hepatosplenomegaly, and CRP-122mg/dl, ESR-91mm in 1st hour. She had also TSH - 6.24µIU/mL, fT3 - 2.1pg/mL, fT4 - 1.36ng/dL and diagnosed as Adult-onset Still's disease with autoimmune thyroiditis. It is an inherited condition and is more common in women than in men.

The effect of day and night shifts on oxidative stress and anxiety symptoms of the nurses.

BACKGROUND: Oxidative stress is believed to have a role in the development of chronic diseases. It is also known that long-term night and shift work in nurses might be associated with many health-related problems like fatigue, sleep problems, anxiety and difficulties in maintaining regular lifestyles. AIM: In this study, we aimed to evaluate the changes of oxidative stress parameters and anxiety indexes of the nurses on day and night shifts. MATERIALS AND METHODS: One hundred and twenty nurses in ordinary service and intensive care unit (ICU) were enrolled to the study. Subjects were divided into 2 groups; group 1 (n = 60) consisted of nurses working in a day shift and group 2 (n = 60) as working in the night shift. Further, both groups were divided in to 2 groups again; group la and 2a (both n = 30) who working in the ICU, group 1b and 2b (both n = 30) in the ordinary service. Just before and the end of the shifts, blood samples were obtained to measure total antioxidant status (TAS) and total oxidant status (TOS). Oxidative stress index (OSI) was calculated. Anxiety index were determined at the end of the shift using State-Trait Anxiety Inventory index. RESULTS: Oxidative stress parameters were increased in all nurses at the end of the day and night shifts (p < 0.05). However, both in service and ICU nurses TAS, TOS, and OSI levels were not significantly different at the beginning and the end of the shifts (p > 0.05). Anxiety indexes of each ordinary service and ICU nurses were found to be similar (p > 0.05). CONCLUSIONS: Ordinary service and ICU nurses' oxidative stress parameters and anxiety indexes were not different and all nurses suffer the similar effects of the shifts both in day and night.

Intravascular lymphoma as an unusual cause of multifocal cerebral infarctions discovered on FDG-PET/CT.

Intravascular large B-cell lymphoma (IVLBCL) is a rare and aggressive variant of diffuse large B-cell lymphoma with frequent involvement of the central nervous system. Its atypical presentation often delays the diagnosis and due to its aggressive behaviour, the diagnosis is made post-mortem in half of the cases. We report a case of a 67-year-old male patient presenting with speech difficulties and balance disturbances in whom a magnetic resonance imaging (MRI) scan showed multiple lesions of the white matter, denoted as embolic infarctions. He was treated for a suspected endocarditis with antibiotics, but deteriorated neurologically with persistent fever. A consecutive FDG -PET /CT revealed an increased uptake in the adrenals, of which a biopsy showed IVLB CL. The patient was successfully treated with systemic R-CHOP with intrathecal methotrexate and achieved complete remission after six cycles of chemotherapy. The potential role of FDG-PET/CT is illustrated by this case leading to an exceptional diagnosis of IVLBCL.

Prevalência de sobrepeso e obesidade em crianças de seis a dez anos de escolas municipais de área urbana / Prevalence of overweight and obesity in six to ten year-old students from urban county schools

OBJETIVO: Identificar a prevalência de sobrepeso e obesidade e fatores associados em alunos de seis a dez anos das escolas públicas municipais da área urbana de Marialva, no Paraná. MÉTODOS: Estudo transversal que utilizou uma amostra aleatória estratificada de 356 alunos. Foram avaliadas as seguintes variáveis: índice de massa corpórea, sexo, faixa etária, número de irmãos, atividade física e atividades sedentárias. Utilizou-se estatística descritiva para apresentação da distribuição da amostra nas estratificações. O teste do qui-quadrado foi aplicado para verificar a diferença entre a distribuição da amostra para cada uma das categorias das variáveis. A associação entre as variáveis foi realizada por meio da análise univariada, com razão de prevalência como medida de associação. RESULTADOS: A prevalência de sobrepeso encontrada foi de 20 por cento e a de obesidade de 7 por cento. A maioria dos alunos (72 por cento) não praticava atividade física fora da escola e pouco mais da metade deles (53 por cento) gastava mais de quatro horas por dia em atividades sedentárias. O número de irmãos foi a única variável associada com o excesso de peso (RP=1,64; IC95 por cento=1,10-2,45) para aqueles que tinham apenas um irmão e (RP=1,70; IC95 por cento=1,02-2,84) para os que não tinham irmão, quando comparados àqueles que tinham dois ou mais irmãos. CONCLUSÕES: Observou-se elevada prevalência de sobrepeso e obesidade nessa amostra, reforçando a necessidade de mais estudos em crianças residentes em municípios de pequeno porte, assim como de pesquisas e ações que visem prevenir e/ou tratar a obesidade.

OBJECTIVE: To identify the prevalence of overweight and obesity and associated factors among six to ten-year-old students from public county schools in the urban area of Marialva in Paraná, Brazil. METHODS: Cross-sectional study that used a stratified random sample of 356 students. The following variables were evaluated: body mass index, gender, age, number of siblings, physical activity and sedentary activities. Descriptive statistics was used to verify the distribution of the sample in the strata. The chi-square test was used in order to verify the differences between the distribution of the sample for each category of variables. The association between variables was tested by univariate analysis. RESULTS: Prevalence of overweight was 20 percent and obesity, 7 percent. Most students (72 percent) did not practice physical activity outside school and about half of them (53 percent) spent more than four hours a day in sedentary activities. The number of siblings was the only variable associated with excessive weight for those who had only one sibling (PR=1.64; 95 percentCI=1.10-2.45) and for those who had no siblings (PR=1.70; 95 percentCI=1.02-2.84), compared to those who had two or more siblings. CONCLUSIONS: There was a high prevalence of overweight and obesity in this sample. Further studies are needed in order to investigate the prevalence of this disease in children living in small Brazilian municipalities, as well as for research and actions to prevent and/or treat obesity.

Methotrexate: can it be a choice for nasal polyposis in aspirin exacerbated respiratory disease?

Nasal polyposis (NP) is considered a subgroup of chronic rhinosinusitis and is commonly associated with asthma, bronchiectasis, and cystic fibrosis. A certain subgroup of nasal polyposis is known as Aspirin Exacerbated Respiratory Disease (AERD), previously called Samter's Triad or aspirin triad, comprising polyposis, asthma, and aspirin hypersensitivity and makes up almost 10% of cases of NP. Therapy of NP involves a combination of medical and surgical treatments. However, recurrences are common, particularly in patients with asthma and aspirin hypersensitivity. Both topical and systemic corticosteroids form the mainstay of conservative therapy for NP as well as a primary treatment and prevention for recurrences. They have been shown to improve nasal breathing, rhinitis symptoms, and reduce the size of NP, along with the rate of recurrence. There is great concern about the adverse effects of systemic steroids, especially when long-term usage is necessary to maintain improvement. So far, no knowledge exists about the effects of methotrexate (MTX) on NP of the patients with asthma. We report two patients whose NP dramatically reduced in size after a course of MTX therapy administered as an additional treatment for their steroid- dependent asthma.

Confirmed prevalence of food allergy and non-allergic food hypersensitivity in a Mediterranean population.

BACKGROUND: Until the present, no comprehensive studies evaluating the prevalence of food allergy and non-allergic food hypersensitivity (FA/NAFH) in adults have been done in Turkey or its surrounding countries. OBJECTIVE: This large population-based study was planned to identify the confirmed prevalence of adverse reactions to food in adults in Istanbul. METHODS: A total of 17 064 telephone numbers were randomly selected from both the European and Asian sides of Istanbul, and the 11 816 subjects who agreed to participate in the study were addressed with a questionnaire of eight items. Those who disclosed food-related complaints in this survey were called again and a similar questionnaire was repeated. The respondents who were suspected of having food allergy or food hypersensitivity were invited for a personal clinical investigation that included double-blind, placebo-controlled food challenge tests. RESULTS: The lifetime prevalence of self-reported FA/NAFH was found to be 9.5% [1118/11 816; 95% confidence interval (CI): 8.94-10.00%]. After the clinical investigations, the point prevalence of FA/NAFH, which also included the 'possible FA/NAFH group', was found to be as low as 0.3% (30/11 816; 95% CI: 0.17-0.36%), and the FA/NAFH rates assessed by double-blind, placebo-controlled food challenge tests were 0.1% (12/11 816; 95% CI: 0.05-0.18%) and 0.1% (11/11 816; 95% CI: 0.05-0.17%), respectively. The most significant factor influencing FA/NAFH was familial atopy (adjusted OR 4.3; 95% CI: 3.67-4.99), and the most related atopic disease was itching dermatitis/urticaria (adjusted OR: 3.9; 95% CI: 3.31-4.54). CONCLUSION: We may conclude that FA/NAFH in the Turkish population seems to be low when compared with Northern and Western European countries. This may be due to genetic, cultural or dietary factors, and further studies evaluating the reasons for this low prevalence of FA/NAFH in our population are needed.