Can chitotriosidase be a surrogate marker for invasive fungal disease?

BACKGROUND

Chitotriosidase (CHT) enzyme has been known to be secreted from the activated macrophages. We infer with these data that CHT activity is an indicator for the defence.

METHODS

In this study, we evaluated CHT levels in both neutropenic and non neutropenic patients. CHT enzyme activity was measured and compared to each other groups.

RESULTS

Chitotriosidase levels were found to be significantly higher in neutropenic patients with candidemia.

CONCLUSION

In the comparison between neutropenic and non neutropenic patients, there was a significant difference for CHT levels. The use of this enzyme as a surrogate marker for candidemias were evaluated in neutropenic and non neutropenic patients.

Effect of heparin on neuroprotection against spinal cord ischemia and reperfusion in rats

BACKGROUND

Paraplegia due to ischemia/reperfusion (I/R) injury of the spinal cord is a devastating and undesired complication of thoraco-abdominal aortic surgery. Unidentified clots cause a variety of thromboembolic events and deteriorate the severity of ischemia. We investigated the effect of the degree of anticoagulation on spinal cord I/R injury and whether heparin is protective against I/R injury beside its anticoagulant properties.

MATERIALS AND METHODS

Twenty-eight rats were randomly assigned to four groups (n=7 per group) as G1 (no aortic occlusion and heparin administration), G2 (45 min aortic occlusion; no heparin administration), G3 (45 min aortic occlusion; 400 IU/kg heparin to keep activated clotting time (ACT) level around 200 sec), and G4 (45 min aortic occlusion; 800 IU/kg heparin to keep ACT level around 600 sec). After neurologic evaluation at the 48th hour of reperfusion, lumbar spinal cords were removed for histopathologic evaluation and immunohistochemical staining for HSP70 (heat shock protein 70), interleukin-6 and myeloperoxidase (MPO).

RESULTS

The Motor Deficit Index (MDI) scores were lowest in G1 group (p < 0.05) and the MDI scores of G3 and G4 were significantly lower than G2 group (p < 0.05). The neuronal degeneration in G3 was significantly lower than the other groups, respectively (p = 0.03). Histopathological evaluation showed no significant intergroup differences in terms of the degree of edema and inflammatory response. There was no statistically significant difference found among the groups in terms of HSP70 staining, IL-6 staining or the degree of MPO staining.

CONCLUSIONS

Protection of spinal cord from I/R injury requires a multimodal management. We should not miss out the importance of adequate anticoagulation in thoraco-abdominal surgical procedures. Furthermore, the recently discovered anti-inflammatory property of glycosaminoglycans, including heparin, deserves to be investigated.

Bronchoscopy as an indicator of tracheobronchial fungal infection in non-neutropenic intensive-care unit patients

We aimed to establish that a bronchoscopic view can be as reliable as microbiology, and support an empirical tracheobronchial fungal infection (TBFI) treatment decision. We retrospectively studied 95 respiratory failure patients with suspected TBFI admitted to the intensive-care unit (ICU) in 2008 with sticky secretions, hyperaemic mucosa, and whitish plaques on bronchoscopic view. Patients not suspected of having TBFI were chosen as a control group (n = 151). Broncheoalveolar lavage (BAL) fluid was cultured, and biopsy samples were taken from the lesions. Biopsy samples positive for fungi were defined as 'proven', only BAL-positive (+ fungi) cases were 'probable TBFI', and BAL-negative (- fungi) cases were 'possible TBFI'. BAL (+ fungi) and BAL (- fungi) in the control group were defined as 'colonization' and 'no TBFI', respectively. The sensitivity, specificity and positive and negative predictive values of BAL (+ fungi) were 85.1% (63/74), 81.4% (140/172), 66.3% (63/95), and 92.7% (140/151), respectively. Biopsies were performed in 78 of 95 patients, and 28 were proven TBFI with fungal elements, and 100% were BAL (+ fungi). Probable TBFI was seen in 30 of 95 patients with BAL (+ fungi), and possible TBFI (BAL(- fungi)) in 25 of 95. Among the 95 patients, microbiology revealed fungi (90.5% Candida species; 9.5% Aspergillus) in 63 (66.3%). In the controls, the colonization and no TBFI rates were 11 of 151 and 140 of 151, respectively. Observing sticky secretions, hyperaemic mucosa and whitish plaques by bronchoscopy is faster than and may be as reliable as microbiology for diagnosing TBFI. These findings are relevant for empirical antifungal therapy in suspected TBFI patients in the ICU.

Resection and primary anastomosis with modified blow-hole colostomy or Hartmann's procedure. Which method should be performed for gangrenous sigmoid volvulus?

AIM

To evaluate the efficacy of Hartmann's procedure and RPA with modified blow-hole colostomy for gangrenous sigmoid volvulus.

METHODS

Sixty-one patients operated on between January 2004 to September 2010 were reviewed retrospectively. The demographic data of the patients,clinical features, type of surgical procedure performed, postoperative complications, mortality and duration of hospital stay (DHS) after surgery were reviewed.

RESULTS

The mean hospital stay, wound infection and mortality did not differ significantly between the groups. Superficial wound infection rate was higher in group A (32% vs15%). Development of leaks secondary to stoma closure was not observed in any patient. During hospitalisation period; the postoperative complications were wound infection in four patients, intraabdominal abscess in two, evisceration and wound dehiscence in two, arrhythmia in six, pneumonia in eight.Medical and surgical complication rates of the groups were not different (p>0.05). When compared, the durations of intensive care unit (ICU) stay were not statistically different (p>0.05), but mean duration of hospital stay (DHS) was longer in group A than group B (p less than 0.05).

CONCLUSION

Sigmoidectomy should be the basic principle in the management of sigmoid volvulus.RPA with modified blow - hole colostomy provides satisfactory results. It is easy to perform in patients with sigmoid volvulus. RPA with modified blow - hole colostomy can be performed safely in selected patients without increasing morbidity and DHS.

Serum leptin level mediates the association of body composition and serum C-reactive protein in HIV-infected persons on antiretroviral therapy

Higher body mass index (BMI) is associated with increased serum C-reactive protein (CRP) levels in HIV-infected individuals on antiretroviral therapy (ART), but the relationship of adipose tissue mass to systemic inflammation is not well described in this population. We hypothesized that serum adipokine levels (i.e., hormones produced by adipocytes) are a superior predictor of CRP compared to anthropometric or radiographic measures of body composition in patients on effective, stable ART. We evaluated the relationship of serum leptin, adiponectin, and resistin, BMI, and dual energy x-ray absorptiometry (DEXA) measurements with serum highly sensitive CRP (hsCRP) in a cross-sectional cohort of 106 predominantly virologically suppressed, HIV-infected adults on ART for ≥24 weeks using multivariable linear regression and formal criteria to assess statistical mediation. Median BMI, hsCRP, and leptin values were 25.2 kg/m(2), 3.0 mg/liter, and 3.8 ng/ml, respectively. BMI and DEXA limb fat, body fat, and trunk fat measurements were significantly associated with both serum leptin and hsCRP levels (all p≤0.02). Leptin was also associated with hsCRP (p<0.01). The regression coefficient for the effect of BMI or DEXA measurements on hsCRP was reduced, and the relationship was no longer statistically significant, after adjusting for leptin, indicating leptin functioned as a mediating variable within these relationships. Adiponectin and resistin levels did not demonstrate similar effects. Serum leptin was a superior predictor of hsCRP compared to BMI and DEXA body fat measurements, which may reflect alterations in body composition in treated HIV infection and the important contribution of adipose tissue to inflammation in this population.

Sex differences in urinary biomarkers of vascular and endothelial function in HIV-infected persons receiving antiretroviral therapy

BACKGROUND

Cardiovascular disease (CVD) risk can be underestimated in HIV-infected patients receiving antiretroviral therapy (ART). Novel CVD risk markers in this population are needed. We hypothesized that eicosanoid metabolite production is increased with metabolic complications of ART. Our objective was to determine relationships between urine eicosanoids and traditional CVD risk factors in a cohort of HIV-infected persons receiving ART.

METHODS

Cross-sectional analysis of 107 individuals from a prospective cohort study with urine eicosanoids (isoprostane [15-F(2t)-IsoP], prostaglandin-E metabolite [PGE-M], thromboxane metabolite [11dTxB(2)], prostacyclin metabolite [PGI-M]) determined by gas or liquid chromatography-mass spectrometry.

RESULTS

15-F(2t)-IsoP was higher (P=0.003), 11dTxB(2) tended to be higher (P=0.07) and PGE-M was lower (P=0.003) in females than in males. The overall median Framingham score was 4 (IQR 1-7). In multivariable analyses adjusting for age, CD4(+) T-cells, smoking status, non-steroidal anti-inflammatory drug use, aspirin use and body mass index (BMI), associations included: higher 15-F(2t)-IsoP with female sex (P=0.004) and current smoking (P=0.04), lower PGE-M with female sex (P=0.005) and higher BMI (P=0.03), higher 11dTxB(2) with increasing age (P=0.02) and current smoking (P=0.04), lower 11dTxB(2) with higher BMI (P=0.02), and higher PGI-M with current smoking (P=0.04).

CONCLUSIONS

In this pilot study of predominantly virologically suppressed HIV-infected individuals on ART, there were sex-specific differences in urinary eicosanoids, with females having more risk-associated parameters despite a low Framingham score. Eicosanoids might be useful CVD biomarkers in ART-treated, HIV-infected patients. Future studies should examine eicosanoids while assessing effects of specific ART regimens and targeted interventions on CVD outcomes.

Fournier's gangrene: series of twenty patients

BACKGROUND AND PURPOSE

Fournier's gangrene (FG) is a rare, rapidly progressive, fulminant form of necrotizing fasciitis of the genital, perianal and perineal regions. Our aim is to investigate the clinical signs, symptoms and factors which affect the clinical results of patients with FG in our clinic.

PATIENTS AND METHODS

20 patients having FG were admitted to our department during the past 6-year period. Age, gender, diabetes mellitus (DM), duration of symptoms, FG severity index score (FGSIS), colostomy, hospitalization time and number of debridements were investigated for their effects.

RESULTS

13 of our patients were male, 7 of them were female. The mean age was 52.2 years (range: 30-80 years). 85% of our patients had DM as a predisposing factor. The mean hospitalization time was 19.7 days (range: 6-45 days), and overall mortality was 20% (4 patients). Age and FGSIS have been found to be statistically significant factors among the parameters studied.

DISCUSSION

FG is still an important disease with high mortality rates in spite of the developments in intensive care units and new-generation antibiotics. In conclusion, we have found that the age and FGSIS of the patient are the most important effecting factors.

Cyclooxygenase-2 and Survivin in Superficial Urothelial Carcinoma of the Bladder and Correlation with Intratumoural Microvessel Density

This study was designed to investigate the protein levels of cyclooxyogenase-2 (COX-2) and survivin in superficial urothelial carcinoma (UC) and their correlation with microvessel density (MVD). High-grade UC was positive for both COX-2 and survivin protein, and the proportion of tumours positive for both proteins increased with increasing tumour grade. The presence of COX-2 protein was significantly correlated with the presence of survivin protein. Both COX-2 and survivin positivity were significantly correlated with MVD in all patients regardless of tumour grade, but there was no correlation between MVD and COX-2 and survivin positivity by individual tumour grade. Although there was no significant difference in the proportion of COX-2-positive tumours when patients were stratified by tumour stage, a significantly higher proportion of patients with pT1 stage tumours were survivin-positive compared with patients with pTa stage tumours. COX-2 and survivin positivity were significantly correlated in all patients regardless of tumour grade or stage. COX-2 and survivin were significantly correlated in patients with pTa, but there was no correlation in pT1 tumours. These findings demonstrate that together, COX-2, survivin and MVD may play an important role in UC.

Biofortification and localization of zinc in wheat grain

Zinc (Zn) deficiency associated with low dietary intake is a well-documented public health problem, resulting in serious health and socioeconomic problems. Field experiments were conducted with wheat to test the role of both soil and foliar application of ZnSO4 in Zn concentration of whole grain and grain fractions (e.g., bran, embryo and endosperm) in 3 locations. Foliar application of ZnSO4 was realized at different growth stages (e.g., stem elongation, boot, milk, dough stages) to study the effect of timing of foliar Zn application on grain Zn concentration. The rate of foliar Zn application at each growth stage was 4 kg of ZnSO4·7H2O ha(-1). Laser ablation (LA)-ICP-MS was used to follow the localization of Zn within grain. Soil Zn application at a rate of 50 kg of ZnSO4·7H2O ha(-1) was effective in increasing grain Zn concentration in the Zn-deficient location, but not in the locations without soil Zn deficiency. In all locations, foliar application of Zn significantly increased Zn concentration in whole grain and in each grain fraction, particularly in the case of high soil N fertilization. In Zn-deficient location, grain Zn concentration increased from 11 mg kg(-1) to 22 mg kg(-1) with foliar Zn application and to 27 mg kg(-1) with a combined application of ZnSO4 to soil and foliar. In locations without soil Zn deficiency, combination of high N application with two times foliar Zn application (e.g., at the booting and milk stages) increased grain Zn concentration, on average, from 28 mg kg(-1) to 58 mg kg(-1). Both ICP-OES and LA-ICP-MS data showed that the increase in Zn concentration of whole grain and grain fractions was pronounced when Zn was sprayed at the late growth stage (e.g., milk and dough). LA-ICP-MS data also indicated that Zn was transported into endosperm through the crease phloem. To our knowledge, this is the first study to show that the timing of foliar Zn application is of great importance in increasing grain Zn in wheat, especially in the endosperm part that is the predominant grain fraction consumed in many countries. Providing a large pool of Zn in vegetative tissues during the grain filling (e.g., via foliar Zn spray) is an important practice to increase grain Zn and contribute to human nutrition.

Clinical factors associated with plasma F2-isoprostane levels in HIV-infected adults

PURPOSE

Oxidant stress may be an effect of antiretroviral therapy (ART) or chronic HIV infection. Plasma F2-isoprostanes (F2-IsoP) reflect lipid peroxidation and oxidant stress and have been described in ART-associated toxicities. We explored factors associated with F2-IsoP in HIV-infected adults.

METHODS

HIV-infected adults enrolled in this cross-sectional study were (a) on ART including zidovudine or stavudine but not non-nucleoside reverse transcriptase inhibitors (NNRTI), (b) on ART including NNRTI, or (c) not on ART. Plasma F2-IsoP levels were quantified by GC/MS, and clinical and laboratory data were collected at enrollment.

RESULTS

Among 285 participants, 24% were female, 37% were African American, and 194 (68%) were on ART; 44 (23%) of whom were receiving efavirenz, 45 (23%) nevirapine, and 85 (44%) protease inhibitors. Median F2-IsoP was lower in those on NNRTI than those on ART without NNRTI (p = .02). In a multivariable model, factors independently associated with increased F2-IsoP were female sex (p = .002), higher BMI (p = .01), and heavy smoking (p = .004). There was a trend toward lower F2-IsoP among nevirapine users (p = .054).

CONCLUSIONS

Among HIV-infected adults, oxidant stress status differs by sex, BMI, smoking status, and perhaps specific ART. Prospective studies should better define relationships between oxidant stress and complications of HIV infection and its therapy.

Community-acquired acute bacterial meningitis in the elderly in Turkey

This investigation aimed both to delineate the current status of community-acquired acute bacterial meningitis and to produce data on the interrelationships between clinical, laboratory and therapeutic parameters in the elderly. This retrospective cohort study was conducted in 28 Turkish institutions in 159 culture-positive patients over the age of 50 years. Streptococcus pneumoniae was the most common pathogen (69.2%), followed by Listeria monocytogenes (8.8%). For this reason, antilisterial antibiotics such as ampicillin or benzylpenicillin should be added to the therapeutic regimen. Pathogen-specific mortality did not vary between S. pneumoniae and L. monocytogenes. The overall mortality was 2.5% at the third day, 12.6% at the seventh day, 20.1% at the 14th day and 21.4% at the 21st day. The risk factors for fatality were increasing age, the presence of stupor, sepsis and inappropriate antibiotic administration. Cerebrospinal fluid (CSF) leukocyte counts and CSF/blood glucose ratios were lower in patients who died. Fever did not differ between survivors and fatal cases. The mean duration of antibiotic therapy in survivors was 16.3 +/- 6.4 days. One-fifth of the patients had complications, and in 5.7% of the patients sequelae persisted at follow-up.