Selçuk Kaya | Karadeniz Technical University (original) (raw)

Papers by Selçuk Kaya

European Journal of Clinical Microbiology & Infectious Diseases, Feb 20, 2015

The aim of this study was to determine the independent risk factors, morbidity, and mortality of ... more The aim of this study was to determine the independent risk factors, morbidity, and mortality of central nervous system (CNS) infections caused by Listeria monocytogenes. We retrospectively evaluated 100 episodes of neuroinvasive listeriosis in a multinational study in 21 tertiary care hospitals of Turkey, France, and Italy from 1990 to 2014. The mean age of the patients was 57 years (range, 19-92 years), and 64% were males. The all-cause immunosuppression rate was 54 % (54/100). Forty-nine (49 %) patients were referred to a hospital because of the classical triad of symptoms (fever, nuchal rigidity, and altered level of consciousness). Rhombencephalitis was detected radiologically in 9 (9 %) cases. Twenty-seven (64 %) of the patients who had cranial magnetic resonance imaging (MRI) performed had findings of meningeal and parenchymal involvement. The mean delay in the initiation of specific treatment was 6.8±7 days. Empiric treatment was appropriate in 52 (52 %) patients. The mortality rate was 25 %, while neurologic sequelae occurred in 13 % of the patients. In the multivariate analysis, delay in treatment [odds ratio (OR), 1.07 [95 % confidence interval (CI), 1.01-1.16]] and seizures (OR, 3.41 [95 % CI, 1.05-11.09]) were significantly associated with mortality. Independent risk factors for neurologic sequelae were delay in treatment (OR, 1.07 [95 % CI, 1.006-1.367]) and presence of bacteremia (OR, 45.2 [95 % CI, 2.73-748.1]). Delay in the initiation of treatment of neuroinvasive listeriosis was a poor risk factor for unfavorable outcomes. Bacteremia was one of the independent risk factors for morbidity, while the presence of seizures predicted worse prognosis. Moreover, the addition of aminoglycosides to ampicillin monotherapy did not improve patients' prognosis.

Türkiye parazitoloji dergisi, Sep 1, 2011

Myiasis ürogenital parazitoz nedenlerinden biridir. Bu çalışmada, idrarından kurtçuk düşürme şika... more Myiasis ürogenital parazitoz nedenlerinden biridir. Bu çalışmada, idrarından kurtçuk düşürme şikayetiyle polikliniğimize müracaat eden 29 yaşındaki bir erkek hasta sunulmuştur. Hastanın idrarından alınan larvalar parazitolojik yönden incelenmiş ve hastada "Psychoda albipennis" larvalarının neden olduğu ürogenital myiasis tanısı konulmuştur. Hastada başka bir patolojik bulgu görülmemiş ve tedavisiz takipte şikayetleri spontan olarak birkaç günde düzelmiştir. Ürogenital myiasis insanlarda nadir görülse de üriner parazitozu olan hastalarda düşünülmesi gerekmektedir. Bu hastalarda tedavi verilmeksizin komplikasyonsuz düzelme mümkün olabilmektedir.

Journal of Infection Prevention, Dec 10, 2014

Aims: To evaluate the effectiveness of the International Nosocomial Infection Control Consortium ... more Aims: To evaluate the effectiveness of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Hand Hygiene Approach in Turkey and analyse predictors of poor hand hygiene compliance. Design: An observational, prospective, interventional, before-and-after study was conducted from August 2003 to August 2011 in 12 intensive care units (ICU) of 12 hospitals in 11 cities. The study was divided into a baseline and a follow-up period and included random 30-minute observations for hand hygiene compliance in ICU. The hand hygiene approach included administrative support, supplies availability, education and training, reminders in the workplace, process surveillance, and performance feedback. Results: We observed 21,145 opportunities for hand hygiene. Overall hand hygiene compliance increased from 28.8% to 91% (95% CI 87.6-93.0, p 0.0001). Multivariate and univariate analyses showed that several variables were significantly associated with poor hand hygiene compliance: males vs. females (39% vs. 48%; 95% CI 0.79-0.84, p 0.0001), ancillary staff vs. physicians (35% vs. 46%, 95% CI 0.73-0.78, p 0.0001), and adult vs. pediatric ICUs (42% vs. 74%, 95% CI 0.54-0.60, p 0.0001). Conclusions: Adherence to hand hygiene was significantly increased with the INICC Hand Hygiene Approach. Specific programmes should be directed to improve hand hygiene in variables found to be predictors of poor hand hygiene compliance.

Infection, Oct 26, 2019

Purpose To develop a practical scoring system to assist clinicians in differentiating leptospiros... more Purpose To develop a practical scoring system to assist clinicians in differentiating leptospirosis and hantavirus infections, whose epidemiological, clinical, and laboratory characteristics are literally like identical twins. Methods The study population consisted of 162 patients admitted to hospital with a confirmed diagnosis of leptospirosis (LG group, n = 92) and hantavirus infections (HG, group = 70) between January 2000 and January 2019. The two groups were compared in terms of demographic, clinical and laboratory features. Sensitivity, specificity, and positive and negative predictive values were determined from ROC analysis for findings of significance in the diagnosis of leptospirosis, and a scoring system for diagnosis was developed ("MICE" score). During the development of this scoring system, we were careful to employ parameters that would not affect one another statistically, to reflect the involvement of very different systems (such as the hematological, hepatic, renal, and musculoskeletal systems) due to the multisystemic effect of the disease in the organism, and to ensure that the system should be simple to apply and understand. Accordingly, five parameters, serum WBC, creatinine, creatine kinase, total bilirubin, and C-reactive protein, were employed in the "MICE" scoring system. Results Three cutoff values were determined using ROC analysis for the five parameters included in the MICE system. Accordingly, scores of 0, 1, or 2 were given based on the values WBC (/μL

Journal of Microbiology and Infectious Diseases, Apr 30, 2015

Objectives: To determine the clinical and laboratory predictors of fatality among patients with H... more Objectives: To determine the clinical and laboratory predictors of fatality among patients with Hantavirus infection. Materials and methods: A retrospective study was conducted on the patients with Hantavirus infection between April 2009 and October 2011 at the Black Sea and the Mediterranean regions in Turkey. Demographic, clinical and laboratory findings of fatal cases and non-fatal cases at the admission were compared. Results: Twenty-two patients with confirmed Hantavirus infection were evaluated. Five patients died (22.7%). The cause of death was massive bleeding. The rate of hemorrhage was significantly higher in the fatal cases than non-fatal cases (p<0.001). Massive gastrointestinal hemorrhage was seen in four of these patients, cerebral hemorrhage in two and both gastrointestinal and pulmonary hemorrhage in one. Disseminated intravascular coagulation (DIC) was present in four of the fatal cases and a remarkable cause of the bleeding (p=0.02). White blood cell count (WBC) (p=0.002), creatine phosphokinase (CPK) (p=0.011), blood-urea-nitrogen (BUN) (p=0.014), C reactive protein (CRP) (p=0.005) and D-dimer levels (p=0.001), prothrombin time (PT) (p=0.023), activated partial thromboplastin time (aPTT) (p=0.001) and international normalized ratio (INR) (p=0.021) were significantly higher, and platelet counts (p=0.038) significantly lower in the fatal cases. Optimum diagnostic cutoff points for specific laboratory parameters which may be predictive of fatality were; WBC=16,000 µL-1, PLT=30000 µL-1, PT=19.7 s, aPTT=36 s, INR=1.2, D-dimer=9.3 µg/mL, CPK=600 U/L, BUN=47 mg/dL and CRP=13.4 mg/dL. Conclusions: Physicians should be aware of the high fatality risk for patients with Hantavirus infection with hemorrhage, elevated WBC, CPK, BUN, CRP, PT, aPTT, INR and D-dimer and reduced platelet counts.

Journal of Medical Microbiology, Dec 1, 2013

Infective endocarditis is a very rare clinical form caused by Erysipelothrix rhusiopathiae. It is... more Infective endocarditis is a very rare clinical form caused by Erysipelothrix rhusiopathiae. It is rarely seen in immunocompetent individuals. Even after surgery it may entail mortality rates as high as 30-40 %. This report describes a case of native valve endocarditis caused by E. rhusiopathiae and cured with crystallized penicillin G and surgery.

Journal of Clinical Virology, Feb 1, 2012

Background: Crimean Congo Hemorrhagic Fever (CCHF) is a potentially fatal tick-borne viral diseas... more Background: Crimean Congo Hemorrhagic Fever (CCHF) is a potentially fatal tick-borne viral disease, the course of which may accompanied by various clinical findings. Objectives: We describe a picture of non-suppurative parotitis developing in association with CCHF virus. Study design: A 48-year-old patient presenting to our hospital with lethargy, hemorrhage and pain and swelling below the left ear was diagnosed with CCHF through IgM antibody and polymerase chain reaction positivity in serum investigated for CCHF virus. A picture of non-suppurative parotitis developed on the 3rd day of admission. Results: Other causes of parotitis were excluded with the help of serological tests, and the case was regarded as one of CCHF-associated parotitis. The patient was put on adjuvant therapy, an improvement in clinical findings was observed and he was discharged in a healthy condition on the 8th day. Conclusions: Ours is the first case in the literature of parotitis seen during CCHF. CCHF should be considered in differential diagnosis in addition to other frequently encountered viral agents in patients from endemic regions presenting with a picture of non-suppurative parotitis.

Journal of Medical Virology, Sep 19, 2012

The aim of this study was to investigate the predictive factors which contribute to diagnosis of ... more The aim of this study was to investigate the predictive factors which contribute to diagnosis of hantavirus infection. One hundred patients from rural areas hospitalized with a preliminary diagnosis of hantavirus infection from different hospitals in Turkey were investigated. Hantavirus infection was confirmed in 20 patients (Group 1) using immunofluorescence and immunoblot assays at the Refik Saydam National Public Health Agency. Hantaviruses were not detected in the serum of the remaining 80 patients, other infectious and non-infectious diseases being diagnosed in this group (Group 2). Patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; demographic characteristics and clinical and laboratory data on admission were examined and compared between the two groups. Fever, proteinuria, hematuria, lethargy-weakness, and nausea-vomiting were the most frequent symptoms and findings in Group 1, seen in almost all patients. Proteinuria, hematuria, muscle pain, diarrhea/abdominal pain, hypotension, shock, and sweating were observed at significantly higher levels in Group 1 compared to Group 2. Serum urea, creatinine, uric acid, lactate dehydrogenase (LDH), aspartate transaminase (AST), alkaline phosphatase (ALP), and C-reactive protein (CRP) were significantly higher, but serum platelet counts were lower in Group 1 patients. Area beneath the receiver operating characteristics (ROC) curve analysis was used to calculate the discriminative ability of various laboratory values to identify patients with hantavirus infection. This analysis revealed that, serum CRP had a 100% negative predictive value, whilst, platelet, and creatinine had 75% and 70% positive predictive values for the diagnosis of hantavirus infection. In summary, laboratory markers used in clinical practice are of great importance predicting hantavirus infections.

Infection, Oct 29, 2011

This study was intended to investigate the clinical significance and molecular epidemiology of Ac... more This study was intended to investigate the clinical significance and molecular epidemiology of Acinetobacter baumannii complex (ABC) isolated from cerebrospinal fluid (CSF) in neurosurgical intensive care unit (NSICU) patients, particularly comparing isolates from healthcare workers&amp;#39; (HCW) hands. We retrospectively reviewed the medical records of 30 patients with CSF cultures positive for ABC seen at our NSICU from the date it first opened, January 2007, to September 2010. Pulsed-field gel electrophoresis (PFGE) typing was performed on 68 strains isolated from 32 patients&amp;#39; CSF and 36 HCWs&amp;#39; hands. ABC isolates were considered to be clinically significant in 21 (70.0%) patients but insignificant in the other nine (30.0%) patients. The prolonged (&amp;gt;7 days) use of cephalosporins was more common in patients with clinically significant ABC isolates (p = 0.049). Multiple drug resistance (MDR) was observed in 12 (57.1%) clinically significant isolates. Empirical antimicrobial therapies were not appropriate for nine of these 21 patients (42.8%). Mortality was significantly higher in the clinically significant group than in the clinically insignificant group (18/21 vs. 3/9; p = 0.008). Fifty-three isolates (77.9%) were grouped into 15 clusters, three of which contained possibly related isolates from patients&amp;#39; CSF and staff members&amp;#39; hands. The fact that ABC isolates grown from CSF cultures do not always exhibit infection and have high multiple antibiotic resistance, including to carbapenems, should be borne in mind when planning treatment for these patients. In addition, HCWs&amp;#39; hands may play a significant role in transmission to patients, and compliance with infection control procedures, especially hand washing, must be enhanced in order to avoid ABC infections.

International Journal of Infectious Diseases, Nov 1, 2013

Infections are one of the main causes of mortality in febrile neutropenic patients with hematolog... more Infections are one of the main causes of mortality in febrile neutropenic patients with hematologic malignancies. 1,2 Since clinical symptoms and findings in infections seen in neutropenic hosts are indistinct and nonspecific and may sometimes be identified late, the early and accurate diagnosis of infections in these patients is still problematic. 1,2 Due to their low sensitivity, many classic diagnostic techniques, such as culture, are not practicable. 2,3 Delays in diagnosis may lead to delays in treatment, and this inevitably leads to an increase in mortality levels in this patient group. 2,3 Soluble urokinase plasminogen activation receptor (suPAR) is a novel biomarker that exhibits an increase in levels during bacterial and viral infections, particularly in the acute period; this could therefore be used in the diagnosis and monitoring of many infectious diseases. 4-7 On the basis of the characteristics of suPAR, our study aimed to investigate its contribution to early diagnosis

Health and Quality of Life Outcomes, Nov 3, 2016

Background: The aim of this study was to assess health-related quality of life (HRQOL) among chro... more Background: The aim of this study was to assess health-related quality of life (HRQOL) among chronic hepatitis B (CHB) patients in Turkey and to study related factors. Methods: This multicenter study was carried out between January 01 and April 15, 2015 in Turkey in 57 centers. Adults were enrolled and studied in three groups. Group 1: Inactive HBsAg carriers, Group 2: CHB patients receiving antiviral therapy, Group 3: CHB patients who were neither receiving antiviral therapy nor were inactive HBsAg carriers. Study data was collected by face-to-face interviews using a standardized questionnaire, Short Form-36 (SF-36) and Hepatitis B Quality of Life (HBQOL). Values equivalent to p < 0.05 in analyses were accepted as statistically significant. Results: Four thousand two hundred fifty-seven patients with CHB were included in the study. Two thousand five hundred fifty-nine (60.1 %) of the patients were males. Groups 1, 2 and 3, consisted of 1529 (35.9 %), 1721 (40.4 %) and 1007 (23.7 %) patients, respectively. The highest value of HRQOL was found in inactive HBsAg carriers. We found that total HBQOL score increased when antiviral treatment was used. However, HRQOL of CHB patients varied according to their socio-demographic properties. Regarding total HBQOL score, a higher significant level of HRQOL was determined in inactive HBV patients when matched controls with the associated factors were provided. Conclusions: The HRQOL score of CHB patients was higher than expected and it can be worsen when the disease becomes active. Use of an antiviral therapy can contribute to increasing HRQOL of patients.

The Eurasian Journal of Medicine, Mar 10, 2016

The purpose of this study was to evaluate compliance with guidelines in surgical prophylaxis (SP)... more The purpose of this study was to evaluate compliance with guidelines in surgical prophylaxis (SP) procedures in Turkey. A point prevalence study involving 4 university, 5 education and research and 7 public hospitals was performed assessing compliance with guidelines for antibiotic use in SP. Compliance was based on the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Clinical Practice Guidelines for Antimicrobial Surgery (CPGAS) 2013&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; guideline. Sixteen centers were included in the study, with 166 operations performed at these being evaluated. Parenteral antibiotic for SP was applied in 161 (96.9%) of these. Type of antibiotic was inappropriate in 66 (40.9%) cases and duration of use in 47 (29.1%). The main antibiotics used inappropriately in SP were ceftriaxone, glycopeptides and aminoglycosides. No significant difference was observed between secondary and tertiary hospitals in terms of inappropriate selection. Duration of prophylaxis was also incompatible with guideline recommendations in approximately half of surgical procedures performed in both secondary and tertiary hospitals, however statistical significance was observed between institutions in favor of tertiary hospitals. Antibiotics are to a considerable extent used in a manner incompatible with guidelines even in tertiary hospitals in Turkey. It must not be forgotten that several pre-, intra- and postoperative factors can be involved in the development of surgical site infections (SSI), and antibiotics are not the only option available for preventing these. A significant improvement can be achieved in prophylaxis with close observation, educational activities, collaboration with the surgical team and increasing compliance with guidelines. All health institutions must establish and apply their own SP consensus accompanied by the guidelines in order to achieve success in SP.

European Journal of Clinical Microbiology & Infectious Diseases

Fever of unknown origin (FUO) is a serious challenge for physicians. The aim of the present study... more Fever of unknown origin (FUO) is a serious challenge for physicians. The aim of the present study was to consider epidemiology and dynamics of FUO in countries with different economic development. The data of FUO patients hospitalized/ followed between 1st July 2016 and 1st July 2021 were collected retrospectively and submitted from referral centers in 21 countries through ID-IRI clinical research platform. The countries were categorized into developing (low-income (LI) and lower middle-income (LMI) economies) and developed countries (upper middle-income (UMI) and high-income (HI) economies). This research included 788 patients. FUO diagnoses were as follows: infections (51.6%; n = 407), neoplasms (11.4%, n = 90), collagen vascular disorders (9.3%, n = 73), undiagnosed (20.1%, n = 158), miscellaneous diseases (7.7%, n = 60). The most common infections were tuberculosis (n = 45, 5.7%), brucellosis (n = 39, 4.9%), rickettsiosis (n = 23, 2.9%), HIV infection (n = 20, 2.5%), and typhoid fever (n = 13, 1.6%). Cardiovascular infections (n = 56, 7.1%) were the most common infectious syndromes. Only collagen vascular disorders were reported significantly more from developed countries (RR = 2.00, 95% CI: 1.19-3.38). FUO had similar characteristics in LI/LMI and UMI/HI countries including the portion of undiagnosed cases (OR, 95% CI; 0.87 (0.65-1.15)), death attributed to FUO (RR = 0.87, 95% CI: 0.65-1.15, p-value = 0.3355), and the mean duration until diagnosis (p = 0.9663). Various aspects of FUO cannot be determined by the economic development solely. Other development indices can be considered in future analyses. Physicians in different countries should be equally prepared for FUO patients.

Türkiye Tıp Dergisi Dahili Tıp Bilimleri, 2001

European Journal of Clinical Microbiology & Infectious Diseases, 2019

Brucellosis in pregnant women is reported to be associated with obstetric complications (OCs), an... more Brucellosis in pregnant women is reported to be associated with obstetric complications (OCs), and adequate data for human brucellosis during pregnancy are largely lacking. We performed this multicenter retrospective cross-sectional study to evaluate the epidemiology, clinical course, treatment responses, and outcomes of brucellosis among pregnant women. The study period comprised a 14-year period from January 2002 to December 2015. All consecutive pregnant women diagnosed with brucellosis in 23 participating hospitals were included. Epidemiological, clinical, laboratory, therapeutic, and outcome data along with the assessment data of the neonate were collected using a standardized questionnaire. Data of 242 patients were analyzed. The OC rate was 14.0% (34/242) in the cohort. Of the 242 women, 219 (90.5%) delivered at term, 3 (1.2%) had preterm delivery, 15 (6.2%) aborted, and 5 (2.1%) had intrauterine fetal demise. Seventeen (7.0%) of the newborns were considered as low birth weight. Spontaneous abortion (6.1%) was the commonest complication. There were no maternal or neonatal deaths and pertinent sequelae or complications were not detected in the newborns. Splenomegaly (p = 0.019), nausea and/or vomiting (p < 0.001), vaginal bleeding (p < 0.001), anemia (blood hemoglobin < 11 g/dL; p < 0.001), high level of serum aspartate aminotransferase (> 41 IU/L; p = 0.025), oligohydramnios on ultrasonography (p = 0.0002), history of taking medication other than Brucella treatment during pregnancy (p = 0.027), and Brucella bacteremia (p = 0.029) were the significant factors associated with OCs. We recommend that pregnant women with OC or with fever should be investigated for brucellosis if they live in or have traveled to an endemic area.

European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, Jan 27, 2018

Neurosyphilis (NS) has different clinical manifestations and can appear during any stage of syphi... more Neurosyphilis (NS) has different clinical manifestations and can appear during any stage of syphilis. We aimed to identify the factors affecting poor outcome in NS patients. Patients with positive cerebrospinal fluid Venereal Disease Research Laboratory test, and positive serological serum treponemal or nontreponemal tests were classified as definite NS. The data of 141 patients with definite NS were submitted from 22 referral centers. Asymptomatic NS, syphilitic meningitis, meningovascular syphilis, tabes dorsalis, general paresis, and taboparesis were detected in 22 (15.6%), 67 (47.5%), 13 (9.2%), 10 (7%), 13 (9.2%), and 16 patients (11.3%), respectively. The number of HIV-positive patients was 43 (30.4%). The most common symptoms were headache (n = 55, 39%), fatigue (n = 52, 36.8%), and altered consciousness (50, 35.4%). Tabetic symptoms were detected in 28 (19.8%), paretic symptoms in 32 (22.6%), and vascular symptoms in 39 patients (27.6%). Eye involvement was detected in 19 of...

Oman Medical Journal, 2016

olistin is an old polypeptide antibiotic that fell out of use but has since reappeared because of... more olistin is an old polypeptide antibiotic that fell out of use but has since reappeared because of the increase in multidrug-resistant gram-negative bacteria. Originally, the nephro-and neurotoxic effects of colistin led to concerns regarding its clinical use. 1-3 We investigated the incidence of and risk factors for nephrotoxicity in patients using intravenous (IV) colistin.

Health and Quality of Life Outcomes, 2016

The Eurasian Journal of Medicine, 2017

Objective: The aim of this study was to examine clinico-epidemiological properties of HIV/AIDS pa... more Objective: The aim of this study was to examine clinico-epidemiological properties of HIV/AIDS patients. Materials and Methods: For this purpose, 115 HIV/AIDS patients monitored in our clinic between January 1, 1998, and December 31, 2013, were retrospectively evaluated. Results: For the 115 patients with a diagnosis of HIV/AIDS that we monitored, the mean age at the time of presentation was 34.5±13.21 (10-79) years. Eighty-nine (76.5%) patients were male and 27 (23.5%), female. In this study, HIV/AIDS was the most prevalent in the young male population with a low educational and sociocultural level. The most common mode of transmission in our patients was heterosexual relations: approximately 1 patient in 3 had a history of traveling to countries with a high prevalence of HIV/AIDS, namely, Russia and Ukraine. The examination of diagnosis with respect to years showed an increase in new cases since 2008. Only 21 (18.3%) of our patients were diagnosed through clinical symptoms, while 91 (81.7%) during routine scanning. At first presentation, 68% of our patients were stage A; 4.7%, stage B; and 27.3%, stage C. The mean length of the monitoring of our patients was 2.74 years (2-180 months). Thirteen (11.3%) patients died due to opportunistic infections and malignities. The most common opportunistic infection was tuberculosis (16.5%), followed by syphilis and HBV. Malignity, most commonly intracranial tumor, was seen in 8.6% patients. Conclusion: The disease was generally seen in the young male population with a low sociocultural level, and it was most frequently transmitted by heterosexual sexual contact. This clearly shows the importance of sufficient, accurate information, and education on the subject of the disease and its prevention. The fact that many of our patients were diagnosed in the late stage due to stigma and that diagnosis was largely made through scanning tests confirms the importance of these tests in early diagnosis.

Clinical Microbiology and Infection, 2016

There have been many studies pertaining to the management of herpetic meningoencephalitis (HME), ... more There have been many studies pertaining to the management of herpetic meningoencephalitis (HME), but the majority of them have focussed on virologically unconfirmed cases or included only small sample sizes. We have conducted a multicentre study aimed at providing