Introduction: Invasive fungal infection (IFI) is a major cause of morbidity and mortality in allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients. A previous history of IFI is not an absolute contraindication for allo-HSCT, particularly in the era of secondary antifungal prophylaxis (SAP). Prompt diagnosis and therapy are essential for HSCT outcome. Methodology: The charts of 58 allo-HSCT recipients [median age:29.5 (16-62); M/F:41/17] who had a previous history of IFI were retrospectively reviewed. Results: Possible IFI was demonstrated in 32 (55.2%), probable in 13 (22.4%) and proven in 13 patients (22.4%). All patients received SAP [liposomal amphoterisin B (n ꞊ 35), voriconazole (n ꞊ 17), caspofungin (n ꞊ 2), posaconazole (n ꞊ 1), combination therapy (n = 3)] which was started on the first day of the conditioning regimen. Treatment success was better in the voriconazole group when compared to the amphotericin B arm (100% vs 69.2%; p = 0.029). Development of breakthrough IFI was more frequent in patients on amphotericin B prophylaxis (42.4% vs 23.1%; p = 0.036). Clinical and radiological response were achieved in 13 of 18 patients (72.2%) who developed breakthrough infection. Overall survival of the study population was 13.5% at a median follow-up of 154 (7-3285) days. Fungal mortality was found to be 23%. Overall survival was better in the voriconazole arm, without statistical significance (90% vs 65.8%, p > 0.05). Conclusions: Secondary antifungal prophylaxis is considered to be an indispensible strategy in patients with pre-HSCT IFI history. Voriconazole seems to be a relatively better alternative despite an underlying necessity of larger prospective trials.

Background: Coeliac crisis is a life-threatening presentation of coeliac disease. Severe diarrhoea, weight loss, electrolyte imbalances and malnutrition are prominent features. Although mainly a disease of childhood, it can on the rare occasion be diagnosed in adults. Case presentation: A 25-year-old female with severe generalised oedema, lower extremity weakness, hypokalemia and profound hypoalbuminemia was referred with an initial diagnosis of nephrotic syndrome. Three months previously she had given birth to a healthy child following an uneventful pregnancy. She did not have proteinuria. She had a history of diarrhoea with gluten-containing food since childhood but lacked a formal diagnosis of coeliac disease. A duodenal biopsy confirmed the suspected diagnosis. Coeliac crisis was diagnosed with life-threatening multisystem involvement. Introduction of a gluten-free diet abolished all disease symptoms and ameliorated laboratory parameters at six months’ follow-up. Conclusion: Coeliac crisis is a rare, yet dangerous presentation of coeliac disease in adults. As this case suggests, it can present with generalised oedema and hypoalbuminemia mimicking nephrotic syndrome. Rapid diagnosis is the key to successful treatment.

Aim: Optic nerve sheath (ONS) contains subarachnoid space, pia mater layer, and optic nerve fiber layer. ONS diamater (ONSD) without subarachnoid space is known as internal ONSD (iONSD). There are too many astrocytes and vascular network in iONSD area. Astrocytes are known to swell with systemic infection, inflammation, pro-inflammatory cytokines, some metabolic disorders, and oxidative stress. Also, this vascular network can vary by many ICU pathologies. This study investigated the relationship between serial iONSD measured with USG and the prognosis of critically ill patients who had no intracranial pathologies. Material and method: The mean iONSD values for the right eye (RiONSD) and left eye (LiONSD) were measured. MiONSD (the mean of RiONSD and LiONSD) and DiONSD (the difference of final and admission MiONSD of ICU stay) were calculated. Results: 35 ICU patients without intracranial pathologies were included. There was a significant difference between survivors and non-survivors for DiONSD (-0.35 [(-0.85)-(-0.10)], 0.60 [(0.21)-(1.00)] mm respectively, p=0.0001). The multivariate analysis performed between DiONSD, SOFA, and APACHE II score (p=0.033, OR=10.66 %95 CI [1.21-93.92]) indicated that DiONSD was an independent risk factor for mortality. DiONSD values greater than + 0.25 mm was determined to be a predictor of mortality with 75% sensitivity and 95% specificity (LR=14.25, AUC=0.905, p=0.0001). There was a good corelation between DiONSD values and SOFA score, total fluid balance, sepsis, serum albumin level, and GCS level. Conclusion: iONSD measurement with USG can be used to determine the prognosis of ICU patients who have no intracranial acute or chronic pathologies.