Prospective randomized non-blinded clinical trial on the use of dapsone plus antihistamine vs. antihistamine in patients with chronic idiopathic urticaria

BACKGROUND

Treatment of chronic idiopathic urticaria (CIU) is difficult.

OBJECTIVE

The purpose of this study was to evaluate the efficacy and safety of dapsone in CIU.

METHODS

The response to dapsone was evaluated in 65 CIU patients with a randomized, two armed study: 3-month dapsone + desloratadin and 3-month desloratadin. All were followed for up to 3 months and 3 months after; all took desloratadine 10 mg daily throughout the study. The primary measure of efficacy was a daily urticaria activity score (UAS) of weal numbers and itch (maximum score, 42 per week).

RESULTS

Sixty-five patients completed the randomized 3-month trial medication. Mean reduction in UAS from baseline at 3 months was 7 [95% confidence interval (95% CI), 6.92-7.08] for active group and 5.77 (95% CI, 5.47-6.08) for control subjects (P < 0.001). The reduction in visual analogue score (VAS) at 3 months for active group (mean, 2.58; 95% CI, 2.33-2.83) and control subjects (mean, 2.55; 95% CI, 2.38-2.73) was also significant (P < 0.001). The reduction of UAS and VAS at 3 months compared between active group and control subjects showed no significant difference. Mean reduction in UAS from the end of the study at 3 months after was 1.16 and -4.8 for active and control subjects, respectively. These results were compared with each other, and it was statistically significant (P <or= 0.05).

LIMITATIONS

No placebo was used. The study was not blinded. Lack of blinding may have led to bias. The follow-up period was short.

CONCLUSION

This study shows that dapsone leads to a persistent decrease in VAS and UAS and is associated with complete remission in some patients.

Widespread deregulation of microRNA expression in human prostate cancer

MicroRNAs (miRNAs) are small regulatory RNAs that can regulate gene expression by binding to mRNA sequences and repressing target-gene expression post-transcriptionally, either by inhibiting translation or promoting RNA degradation. We have analysed expression of 328 known and 152 novel human miRNAs in 10 benign peripheral zone tissues and 16 prostate cancer tissues using microarrays and found widespread, but not universal, downregulation of miRNAs in clinically localized prostate cancer relative to benign peripheral zone tissue. These findings have been verified by real-time RT-PCR assays on select miRNAs, including miR-125b, miR-145 and let-7c. The downregulated miRNAs include several with proven target mRNAs whose proteins have been previously shown to be increased in prostate cancer by immunohistochemistry, including RAS, E2F3, BCL-2 and MCL-1. Using a bioinformatics approach, we have identified additional potential mRNA targets of one of the miRNAs, (miR-125b) that are upregulated in prostate cancer and confirmed increased expression of one of these targets, EIF4EBP1, in prostate cancer tissues. Our findings indicate that changes in miRNA expression may have an important role in the biology of human prostate cancer.

Nasal carriage of Staphylococcus aureus in 4-6 age groups in healthy children in Afyonkarahisar, Turkey

AIM

Staphylococcus aureus is a common cause of disease, particularly for colonized persons. Although methicillin-resistant S. aureus (MRSA) infection has frequently reported, population-based S. aureus and MRSA colonisation estimates are lacking. Our objective in this report is to present the prevalance of S. aureus carriage among 4-6 age groups healthy children in our region.

METHODS

Nasal samples for S. aureus culture were obtained from healthy children. Sociodemographic features and the data related with risk factors were obtained from the parents of the children. Nasal swabs were inoculated on to a variety of bacteriological culture media, which were then incubated at 35 +/- 1 degrees C for 16-18 h. Antimicrobial susceptibility testing of the isolates was determined according to Clinical and Laboratory Standard Institute (CLSI, 2005) guidelines.

RESULTS

In this study 1134 children between 4 and 6 years old age were evaluated; 607 (53.5%) of the subjects were boys and 527 (46.5%) were girls. S. aureus was isolated in 322 (28.4%) subjects and MRSA was isolated in 3 (0.3%) subjects of them. All of the MRSA isolates were found in healthcare workers' children.

CONCLUSIONS

This first assessment of this study is that nearly one third of the 4-6 age group healthy children population present nasal carriage of S. aureus in Turkey. However, it also shows that the rate of MRSA carriage remains low. In addition, it is considered that MRSA colonization may be a risk factor for healthcare workers' children.

En coup de sabre accompanied by pachydermoperiostosis: a case report

Scleroderma en coup de sabre, a variant of localized scleroderma is a disorder characterized by fibrosis of connective tissue. We report a 21-year-old female with scleroderma en coup de sabre accompanied by pachydermoperiostosis. She was born to consanguineous parents and her older sister also had pachydermoperiostosis characterized by clubbing of the digits, enlargement of distal parts of the extremities. The two disorders were diagnosed by clinical examination, histological and x-ray findings. In contrast to scleroderma, pachydermoperiostosis is a hypertrophic process characterized by periosteal proliferation of the tubuler bones and hypertrophic skin changes. We discuss this interesting coexistence and review the literature.

Sublingual immunotherapy to house dust mite in pediatric patients with allergic rhinitis and asthma: a retrospective analysis of clinical course over a 3-year follow-up period

BACKGROUND AND OBJECTIVE

Specific allergen immunotherapy is believed to be the only treatment able to change the natural history of allergic airway diseases. Sublingual immunotherapy (SLIT) is especially preferred because of its easy application and safety. The aim of this study was to describe the effect of SLIT in pediatric patients who have allergic airway disease.

METHODS

Children with asthma and rhinitis who were allergic to house dust mite were evaluated. The effect on clinical course of 3 years of SLIT with 50% Dermatophagoides pteronyssinus and 50% Dermatophagoides farinae in a standardized extract was assessed retrospectively.

RESULTS

The records of 39 patients (23 boys, 16 girls) were studied. The mean (+/- SD) age for starting SLIT was 8.8 +/- 2.3 years. The mean number of acute asthma attacks at the onset of the disease was 8.18 +/- 3.05. The mean number of attacks after 3 years of SLIT was 0.44 +/- 0.79. There was a statistically significant difference in the number of acute asthma attacks before and after therapy (P < .001). Complete clinical remission of asthma was recorded in 37 (95%) patients. Similarly, complete clinical remission of allergic rhinitis was recorded in 32 (82%) patients.

CONCLUSION

This retrospective study shows that SLIT is effective in children who have allergic airway disease which cannot be controlled effectively with allergen avoidance measures only.

Interrelation between some butterflies and plant associations (Turkey)

The butterfly fauna in Ordu province (N-Turkey) was determined in this study. Their relations with the phytosociological associations found in the zone were evaluated and the Lepidoptera taxa in these units were presented. The numbers of determined taxa in each plant association are Castanea-Carpinus-Corylus (23), Fagus orientalis, Carpinus betulus and Picea orientalis Mixed Forest Zone (23), Subalpine Zone (Rhododendron luteum-Vaccinium myrtillus) (25), Lower Alpine Zone (Festuca lazistanica ssp. giresunica) (20), Mid-alpine Zone (Festuca lazistanica ssp. giresunica) (13). Fifteen taxa are new for Ordu province.

Pathergy reaction in different body areas in Behçet's disease

Behçet's disease (BD) is a chronic inflammatory multisystemic disorder characterized mainly by vasculitis. Although the pathergy reaction (PR) has been accepted as one of the major criteria in this disease, there is a lack of a standardized method to measure PR. The aim of this study was to evaluate results of PR in different body areas and the effect on the positive rate of PR of application of numerous needle pricks. The pathergy test was performed using simultaneous 16 needle pricks with 20G disposable needles on different body areas of 56 patients with BD, 49 patients with recurrent aphthous stomatitis (RAS) and 17 healthy subjects. No positive PR was found in healthy controls, but was observed in nine patients with RAS (18.3%). It was detected in 48 of 56 patients with BD, a positive rate of 85.7%. The site most frequently positive for PR was the forearm, while the least frequent was the abdomen. Multiple needle pricks could play an important role in increasing the positive rate of PR in BD, and it may be important in the investigation of aetiological factors in RAS.

Effects of magnesium sulfate on spinal cord tissue lactate and malondialdehyde levels after spinal cord trauma

OBJECTIVE

In the present study, the effects of magnesium sulfate (MgSO4) on tissue lactate and malondialdehyde (MDA) levels after spinal cord trauma (SCT) in rabbits were studied.

SUBJECTS

Thirty New Zeland rabbits. Interventions. The rabbits were divided equally into three groups: group I was the sham- operated group, group II suffered from SCT but received no treatment, group III was given a dose of 100 mg/kg of magnesium sulfate intravenously at 5th minute after SCT. MEASUREMENTS. The lactate and MDA levels were measured in contused spinal cord tissue at 60 minutes after SCT. There was a significant increase of lactate and MDA levels in group II (p < 0.05) when compared with groups I and III, and a significant increase in the level of MDA in group III compared with group I, and also a significant decrease compared with group II, which was the trauma group without treatment (p < 0.05).

CONCLUSION

The findings of this study showed that magnesium sulfate can attenuate the increase of tissue MDA and supply a normalization of lactate levels following SCT which may be related to the neuroprotective effects of (MgSO4).

Genetic imbalances in endometrial hyperplasia and endometrioid carcinoma detected by comparative genomic hybridization

OBJECTIVE

To evaluate the sequential genomic copy alterations related to the development of precursor lesions and endometrioid-type endometrial carcinomas, and its association with cellular atypia.

STUDY DESIGN

Paraffin-embedded tissue specimens from 32 cases of endometrial hyperplasia, 15 of endometrial carcinoma, and 20 of normal endometrial tissue were retrospectively evaluated by the comparative genomic hybridization (CGH) technique. The average number of copy alterations (ANCA) index was used to define the incidence of genomic imbalances in each tissue group. Identified sequential genetic abnormalities were compared with the final histopathological diagnosis and the cellular atypia.

RESULTS

Detectable and consistent chromosomal imbalances were found in 13 hyperplasia and 9 carcinoma specimens. There was a significant correlation between ANCA value and degree of cellular atypia and tumor grade. While 1p36-pter, 20q deletions, and 4q overrepresentation were the most prevalent imbalances detected in both complex hyperplasia and complex atypical hyperplasia, 17q22-qter deletion and amplification of 2p34 were only seen in hyperplasia with atypical cells. Overrepresentations of chromosomes 8q, 1q, and 3q are the most frequent aberrations in endometrial carcinomas, but were absent from all the precursor lesions except one. Underrepresentations of chromosomes 1p36-pter and 10q are the other commonly seen aberrations in carcinomas, the latter being more frequent in moderately differentiated than in poorly differentiated lesions.

CONCLUSIONS

Different patterns of chromosomal aberrations are seen in precursor lesions than in endometrial carcinomas, except for the loss of 1p36-pter. The presence of 1p deletion in both endometrial hyperplasia and cancer specimens suggests that this is an early event in the development of carcinoma. These results support a stepwise mode of tumorigenesis with accumulation of a series of genomic copy alterations in endometrial carcinogenesis.

Skin test hypersensitivity for childhood asthma in Istanbul during a period of 16 years

BACKGROUND

For diagnosis of allergic disorders, besides history and physical examination, many in vivo and in vitro laboratory tests are used. Skin prick test (SPT) is an easily performed and valuable test in children. Our aim was to evaluate the SPT results of asthmatic children according to age and gender, in Istanbul and its neighborhood, followed for a period of 16 years.

MATERIAL AND METHODS

Consecutive 5080 asthmatic children, aged 1 to 18 years, admitted to Pediatric Allergy Policlinics of Istanbul University Cerrahpasa Medicine Faculty from 1987 to 2003, were screened retrospectively for 10 frequently exposed allergens.

RESULTS

3086 cases (61 %) had SPT reactivity for one and/or for multiple allergens; the SPT reactivity percentages of the exposed allergens was 50 % (2554 cases) for house dust mites DP, 49 % (2462 cases) for house dust mites DF, 15 % (784 cases) for cat dander, 10 % (525 cases) for dog dander, 4 % (228 cases) for lamb wool, 10 % (504 cases) for wheat, 3 % (162 cases) for egg white, 6 % (345 cases) for hazelnut pollen, 6 % (318 cases) for Candida Albicans, 6 % (326 cases) for Aspergillus Fumigatus.

CONCLUSION

While house dust mites were determined as the predominant allergen for each age groups in this study, allergy against cat dander was the third important allergen in sequence, as cat is a domestic pet which is frequently kept at home in Turkey.

Articaine versus lidocaine plus bupivacaine for peribulbar anaesthesia in cataract surgery

BACKGROUND

We compared the efficacy and safety of articaine 2% with a mixture of lidocaine 2% and bupivacaine 0.5% without hyaluronidase for peribulbar anaesthesia in cataract surgery.

METHOD

In this double-blind randomized clinical study, 58 cataract patients were allocated to receive either articaine 2% with epinephrine 1:200 000 or a mixture of equal parts of lidocaine 2% with epinephrine 1.25:100 000 and bupivacaine 0.5%. Ocular and eyelid movement scores, the number of supplementary injections, total volume of solution used and pain and complications during injection and surgery were used as clinical end-points.

RESULTS

Articaine produced greater akinesia after 5 min (P=0.03). Eighteen patients (60%) in the articaine group and 26 (93%) in the lidocaine/bupivacaine group required a second injection (P=0.003). A third injection was needed by two patients (7%) in the articaine group and 12 (43%) in the lidocaine/bupivacaine group (P=0.001). The total mean volume of local anaesthetic required to achieve akinesia was mean 9.4 (SD 1.7) ml in the articaine group and 11.28 (1.86) ml in the lidocaine/bupivacaine group (P<0.001). Median pain score was lower in the articaine group than in lidocaine/bupivacaine group during injection (P=0.004) and surgery (P=0.014). There was no difference between the groups for the incidence of complications.

CONCLUSION

Articaine 2% without hyaluronidase is more advantageous than a mixture of lidocaine 2% and bupivacaine 0.5% without hyaluronidase for peribulbar anaesthesia in cataract surgery.

Effects of fibrovascular traction and pooling of tears on corneal topographic changes induced by pterygium

AIM

To investigate the effects of fibrovascular traction and the pooling of tears at the pterygium apex on the corneal topographic changes induced by pterygium.

METHODS

A total of 16 eyes of 14 cases with primary pterygium were included in the study. A computerized corneal topography system was used for corneal topography examinations. Baseline keratographs were taken two times at straight gaze. A repeat corneoscope photograph was immediately obtained in temporal gaze. Then the tears at the pterygium apex were dried with a cellulose sponge, and a new corneoscope photograph was immediately obtained without allowing one to blink. Corneal topographic maps (numeric maps) were divided into 301 fields in 24 meridians. One colour was allocated to each field, representing its mean refractive power for all groups. In all eyes, keratometric astigmatism at the 3 mm central cornea and total mean corneal refractive power were found. Data were compared using paired-samples two-tailed t-tests.

RESULTS

Keratometric astigmatism at the 3 mm central cornea was significantly reduced at the temporal gaze (3.10+/-2.34 D, t=3.40, P=0.027) and dried eyes (2.12+/-1.01 D, t=4.74, P=0.001) according to the first baseline measurement (4.31+/-1.91 D) of the total mean corneal refractive power was found to be 43.45+/-1.28 D (39.29-45.87) at the first baseline measurement. There was no change at the temporal gaze (43.54+/-1.06 D, P>0.05). However, the total corneal refractive power was significantly higher in dried eyes (44.26+/-0.93 D, t=34.92, P<0.001). The steepest region of corneal topography was a superior quadrant, and the flattest area was a nasal quadrant at the baseline. At the temporal gaze, the cornea was significantly flatter in the superior and inferior sides of the pterygium meridian. After dried pooling of tears, topographic abnormalities returned, and the cornea became more uniform and symmetric.

CONCLUSION

We conclude that the pooling of tears at the pterygium apex plays an important role, but fibrovascular traction has no effect on the corneal topographical changes induced by pterygium.

Spontaneous bilateral femoral neck fractures in a young adult with chronic renal failure

Pathologic femoral neck fracture due to renal osteodystrophy is rare. We report the case of a young adult patient with chronic renal failure who presented with bilateral spontaneous femoral neck fractures due to renal osteodystrophy. The pathophysiology of renal osteodystrophy and the treatment of hip fractures in patients with renal failure is discussed.

Risk factors for ocular surface disorders in patients with diabetes mellitus

OBJECTIVE

To evaluate risk factors for ocular surface disorders and tear dysfunction in patients with type 2 diabetes.

STUDY DESIGN AND METHODS

This prospective case controlled study included 41 patients with type 2 diabetes and 20 healthy subjects as the control group. All subjects underwent routine ophthalmic examination, tear film break-up time (BUT) test, Schirmer test, fluorescein dye test, rose bengal staining test, and a questionnaire for subjective complaints. The relationship of metabolic control of diabetes mellitus, duration of diabetes, severity of diabetic retinopathy, and argon laser photocoagulation (ALP) to tear dysfunction was evaluated.

RESULTS

Tear film BUT and Schirmer test values were significantly lower in diabetic patients compared with control subjects (P < 0.001). In the diabetic group, significantly more subjects had abnormal fluorescein and rose bengal staining than in the control group (P < 0.001). Abnormal tear function tests were associated with poorer metabolic glucose control, panretinal ALP, and proliferative diabetic retinopathy (P < 0.05), but not with duration of diabetes (P > 0.05).

CONCLUSIONS

The results of the study indicate that poor metabolic control, panretinal ALP, and proliferative diabetic retinopathy are high risk factors for ocular surface disorders in type 2 diabetes. These patients should be followed more carefully, and should be referred to an ophthalmologist when required.

Behcet's disease with a large and free right atrial thrombus

We present a case of a 27-year-old male patient with Behcet's disease who presented with dyspnoea and haemoptysis in whom further investigation revealed a large and free right atrial thrombus and pulmonary thromboembolism. Considering the absence of haemodynamic compromise and the risk of recurrence after surgical treatment for cardiac thrombus, we preferred medical management which consisted of immunosuppression and anticoagulation. On a follow-up period of 12 months we observed complete dissolution of the thrombus and dramatic improvement of clinical status.

One-stage treatment of open tibial fracture in a child using a distally based sural artery flap: a case report

Open fractures in children have a high level of morbidity and require early treatment. This case describes the successful treatment of a child who sustained an open tibial fracture with soft tissue loss. The fracture was stabilized with a monolateral external fixator devised in our clinic, and the soft tissue loss was covered with a distally based sural artery flap. The flap is simple, can be done quickly, and a surgeon does not need microsurgical or specialty training to perform the operation. This combined use of external fixation and distally based sural artery flap is a straightforward technique in distal tibial open fractures of children with soft tissue loss.

Direct stenting in angiographically apparent thrombus-containing lesions

The data regarding the potential benefits of direct stenting in the setting of angiographically apparent thrombus-containing lesions are scarce. The aim of this study was to evaluate the impact of direct stenting on the angiographic results in the setting of thrombus. We reviewed our institutional interventional database and identified 30 patients who had undergone stenting in the setting of angiographically apparent thrombus-containing lesions (33% unstable angina pectoris, 67% acute myocardial infarction). The majority of patients had a baseline TIMI 2 and 3 flow (80%). Of the 6 patients (20%) who had TIMI 0-1 flow at baseline, four of them achieved a TIMI 2 flow immediately after crossing the lesion with a 0.014 guidewire. Although the remaining 2 patients had TIMI 1 flow, as distal opacification beyond the stenosis was obtained we successfully implanted the stents directly. All stents were successfully implanted without any crossing failure or stent loss. There was no "no re-flow", with a final TIMI 3 flow rate in 93%. In 1 patient with TIMI 2 flow after stenting, TIMI 3 flow was obtained after intracoronary verapamil. In 2 patients (7%, TIMI 2 flow), a final TIMI 3 flow could not be achieved despite intracoronary nitroglycerin and verapamil. There was no stent loss and imprecise stent placement. There were no in-hospital deaths, repeat interventions or coronary artery bypass graft surgeries. However, two patients had undergone mitral valve replacement due to severe mitral regurgitation. Eight patients with recurrent ischemia had control angiography; stents were found to be patent in all 8 patients. Two patients experienced recurrent myocardial infarction (6.6%). Direct stenting strategy in thrombus-containing lesions seems to be a safe and feasible approach in avoiding no re-flow. We believe that benefits observed with direct stenting in this study should be compared to conventional stenting in the same setting with a randomized study.

Stenting of the septal perforator coronary artery

This report describes the first application of intracoronary stenting to the septal perforator coronary artery in a patient with a totally occluded left anterior descending coronary artery (LAD) and a patent venous graft to the distal LAD. The procedure was successful and resulted in almost complete relief of class III angina. Therefore, diseased large septal perforators may cause angina and be treated effectively by intracoronary stenting in selected cases.