Persistent fever during treatment of a pregnant woman with acute pyelonephritis

Acute pyelonephritis is a serious infection in pregnancy. It is presented with fever, shaking chills and flank pain. Intravenous hydration and antimicrobial therapy are sufficient in the treatment unless pyelonephritis is complicated. In case of fever persisting for more than 48 h despite appropriate antimicrobial treatment, a possible complication such as urinary tract obstruction, abscess or phlegmon should be considered. Here, we present an 18-year-old pregnant woman with acute pyelonephritis whose persistent fever returned to normal after double-J ureteral stent was placed even if she had no finding of such a complication.

Use of entecavir in hepatitis B virus reactivation of a patient with non-Hodgkin's lymphoma

We read with interest the case report by Liu et al and the correspondence by Tuna et al regarding this case. Liu et al described hepatitis B virus(HBV) reactivation in a patient with non-Hodgkin's lymphomaafter withdrawal of lamivudine prophylaxis. When HBV reactivation was observed three months after lamivudine withdrawal, entecavir 0.5 mg daily was started. HBV DNA level was moderately elevated(104 copies/m L) at that time. So, we could not understand why a potent antiviral like entecavir was required for this case. In addition to this, entecavir must be used at a dose of 1 mg in patients with prior prophylactic treatment with lamivudine. As stated by Tuna et al duration of lamivudine prophylaxis in this case might be insufficient and HBV reactivation might have occured for this reason. So, we suppose that resolution of HBV reactivation might also be achieved with lamivudine instead of entecavir in this case.

Animal bites and tetanus prophylaxis

Dear Editor,In a recent article,Babazadehet al.investigated the cost of postexposure rabies prophylaxis which is a signifant issue on the epidemiology of acute animal bites(1)However,I have some comments regarding to this article.Animal bites are often dirty wounds.So,every patient suffered from an animal bite should be evaluated for the necessity of tetanus prophylaxis,which is also an important subpart of postexposure rabies prophylaxis[2].So,the cost of tetanus prophylaxis also increases the economic burden.Information on how many patients received tetanus prophylaxis and the financial burden of this will bring a more comprehensive view.

Chest radiography findings and hematological values: Early findings on COVID-19 patients from Turkey

Objective:To investigate the chest radiography findings,hematological values and the risk factors of the mortality of coronavirus disease 2019(COVID-19).Methods:Patients who were diagnosed with COVID-19 in a secondary-level state hospital in Turkey from March to April 2020 were included in the study.COVID-19 diagnosis was confirmed by reverse transcriptase-polymerase chain reaction.Initial routine blood tests and chest radiography findings were examined.The relationship between chest radiography findings and hematological values and risk factors of the mortality of COVID-19 were assessed.Results:In total,94 patients with confirmed COVID-19 diagnosis were included in the study.Among them,33 patients did not have lung involvement(RALE score of 0),and 42 had moderate lung involvement(RALE score of 1 to 4),and 19 had severe lung involvement(RALE score of 5 to 8).Patients with higher RALE scores were significantly elder(P=0.000)and had significantly lower lymphocyte count(P=0.032).Patients in need of intensive care had a lower mean number of platelets compared to patients who did not require intensive care(P=0.007).The receiver operating characteristic analysis revealed that RALE score(P=0.005),age(P=0.002),duration of symptoms(P=0.006),neutrophil-lymphocyte ratio(P=0.007),and lymphocyte percentage(P=0.012)were significantly associated with the risk of mortality.Conclusions:Patients with severe lung involvement have lower lymphocyte values and ratios.Age,RALE score,duration of symptoms,neutrophils/lymphocytes ratio,lymphocytes percentage are risk factors of mortality of COVID-19.