Clinical features and treatment outcomes of pulmonary actinomycosis.

OBJECTIVE: Pulmonary actinomycosis is a rare and chronic infectious disease that mimics malignancy and is frequently misdiagnosed. There are few reports that address the clinical characteristics of pulmonary actinomycosis. The objective of this research is to evaluate the clinical features, radiological findings, diagnostic approaches and treatment outcomes of pulmonary actinomycosis. PATIENTS AND METHODS: Thirty-seven patients with pulmonary actinomycosis histopathologically diagnosed from 2009 to 2021 were analyzed retrospectively. RESULTS: The mean age at presentation was 53.7 (±13.3) years. Frequent symptoms were cough and hemoptysis. The median diagnosis time from the first symptoms was 60 days (interquartile range 18-195). Pulmonary comorbidity was found in 59.5% of cases. The most common thorax computed tomography finding was mass or nodule. The low-attenuation center within the mass or consolidation was observed in 40% of the lesions. The median maximal standardized uptake value of lesions on positron emission tomography (PET) was 6.5 (interquartile range 2.7-10.3). In the majority of cases (97.3%), the diagnosis of pulmonary actinomycosis was not suspected at admission, and 56.8% of patients were misdiagnosed with lung cancer. The mean duration of antibiotic therapy was 9.4 days (range 3-22) with intravenous antibiotics and 64.7 days (range 5-270) with oral antibiotics. Four patients died due to concomitant comorbidities. Eight cases were lost to follow-up. All other cases were fully cured. CONCLUSIONS: Pulmonary actinomycosis mimics other diseases, often lung cancer. Clinicians should consider the diagnosis of actinomycosis when they detect a mass or consolidation, especially with a low-attenuation center. PET/CT appears not to be useful for differential diagnosis. A shorter course of antibiotic therapy than traditionally recommended appears to be sufficient.

Giant pericardial cyst with a growing feature.

Pericardial cysts are rare and benign lesions of the heart. They are usually asymptomatic and diagnosed incidentally on echocardiography or chest X-ray. In this report, we present an extremely rare case of a symptomatic giant pericardial cyst (11.6 cm × 10.6 cm × 8 cm) of a 55-year-old male patient who was admitted to our cardiology clinic. A thoracic computed tomography (CT) in 2013 revealed a giant pericardial cyst. However, at that time, the patient was asymptomatic and follow-up was recommended. Recent thoracic CT and magnetic resonance imaging demonstrated a significantly growing feature of this cyst with impending possible complications.

Investigation of Achievement Orientation of Nursing and Midwifery Students.

PURPOSE: This study was conducted to determine the achievement orientation of nursing and midwifery students and to examine some factors that may affect their achievement orientation. MATERIAL/METHODS: The descriptive sample of this research was created by 209 first-year students voluntarily attending and studying in the Department of Nursing and Midwifery at the Faculty of Health Sciences of a public university in Turkey. The data were collected with "Student Presentation Form" and "2x2 Achievement Orientation Scale". Mann Whitney-U test and Kruskal Wallis test were used with frequency, percentage, arithmetic mean and standard deviation in evaluating the data. RESULTS: The students were found to have 3.39±0.54 in the learning-approach orientation sub-dimension, 3.27±0.75 in the learning-avoidance orientation sub-dimension, 2.73±0.76 in the performance-approach orientation sub-dimension and 2.74±0.74 points in the performance-avoidance orientation sub-dimension. A significant difference was found between the students' gender, their reasons for choosing a career, and the factors that led them to succeed and the mean of the learning-approach orientation score. On the other hand, there was no statistically significant difference between the achievement orientation of the students and the variables such as age, high school type they graduated, and department preference order. CONCLUSIONS: According to the results of the study, it was seen that nursing and midwifery students have predominantly learning-approach orientation. Moreover, it was determined that female students, who selected their profession because of their interest and who expressed that the factor motivate themselves for the achievement is themselves, had higher learning orientation.

Nivolumab for relapsed or refractory Hodgkin lymphoma: real-life experience.

BACKGROUND: Reed-Sternberg cells of classical Hodgkin's lymphoma (cHL) are characterized by genetic alterations at the 9p24.1 locus, leading to over-expression of programmed death-ligand 1 and 2. In a phase 1b study, nivolumab, a PD-1-blocking antibody, produced a high response in patients with relapsed or refractory cHL, with an acceptable safety profile. PATIENTS AND METHODS: We present a retrospective analysis of 82 patients (median age: 30 years; range: 18-75) with relapsed/refractory HL treated with nivolumab in a named patient program from 24 centers throughout Turkey. The median follow-up was 7 months, and the patients had a median of 5 (2-11) previous lines of therapy. Fifty-seven (70%) and 63 (77%) had been treated by stem-cell transplantation and brentuximab vedotin, respectively. RESULTS: Among 75 patients evaluated after 12 weeks of nivolumab treatment, the objective response rate was 64%, with 16 complete responses (CR; 22%); after 16 weeks, it was 60%, with 16 (26%) patients achieving CR. Twenty patients underwent subsequent transplantation. Among 11 patients receiving allogeneic stem-cell transplantation, 5 had CR at the time of transplantation and are currently alive with ongoing response. At the time of analysis, 41 patients remained on nivolumab treatment. Among the patients who discontinued nivolumab, the main reason was disease progression (n = 19). The safety profile was acceptable, with only four patients requiring cessation of nivolumab due to serious adverse events (autoimmune encephalitis, pulmonary adverse event, and two cases of graft-versus-host disease aggravation). The 6-month overall and progression-free survival rates were 91.2% (95% confidence interval: 0.83-0.96) and 77.3% (0.66-0.85), respectively. Ten patients died during the follow-up; one of these was judged to be treatment-related. CONCLUSIONS: Nivolumab represents a novel option for patients with cHL refractory to brentuximab vedotin, and may serve as a bridge to transplantation; however, it may be associated with increased toxicity.

Research on Sleep Quality and the Factors Affecting the Sleep Quality of the Nursing Students.

PURPOSE: This research has been conducted in order to examine the quality of sleep and the factors affecting the sleep quality. MATERIAL/METHODS: The sample of this descriptive research is comprised of 223 volunteer students studying at Uludag University Faculty of Health Sciences Department of Nursing. Research datas have been collected through personal features survey and Pittsburg Sleep Quality Index(PSQI). RESULTS: The average result derived from the sample is 6.52±3.17. To briefly explain the average of the component scores: subjective sleep quality 1.29±0.76, sleep latency 1,55±0.94, sleep duration 0.78±0.99, habitual sleep activity 0.47±0.90, sleep disturbances 0.99±0.09, use of sleeping medication 0.12±0.48, daytime dysfunction 1.29±0.90. It has been observed that there is a meaningful discrepancies between average PSQI results and smoking habits of the students, total daily sleeping hours, efficient waking up times, average daily coffee consumption(p<0.05). According to the analyses there is no meaningful discrepancies between the age,gender, where the students live,snoozing during the morning classes, the existence of chronic diseases and daily average tea consumption.(p>0.05)Conclusions: According to the findings in the light of this research; nursing students have low sleep quality.