A study of serological markers of hepatitis B and C viruses in Istanbul, Turkey

OBJECTIVE

This study was undertaken to investigate the prevalence of HBsAg, anti-HBs and anti-HCV positivity in Istanbul, Turkey.

SUBJECTS AND METHODS

The frequencies of HBsAg, anti-HBs and anti-HCV positivity were determined in 1,157 randomly selected patients attending the outpatient clinic of Istanbul University Hospital, Istanbul, Turkey, during the years 1998 and 2001. All patients underwent complete physical and various routine laboratory examinations.

RESULTS

Of the 1,157 patients, the prevalence of HBsAg, anti-HBs and anti-HCV was 6.6, 28.1 and 2.4%, respectively. It appeared that having dental and surgical procedures formed the risk factors for HBV infection. HBsAg positivity in the health care workers was not different from that of the other professions, but anti-HBs was significantly higher in this group.

CONCLUSIONS

Our findings indicate that HBV infection occurs more frequently than HCV in Istanbul, and this poses an important health problem in the community.

Results of cataract surgery in renal transplantation patients

PURPOSE

To evaluate the results of conventional extracapsular cataract extraction and phacoemulsification cataract surgery, in renal transplant patients.

METHODS

A total of 11 eyes of eight renal transplant recipients who underwent cataract surgery in Ankara between 1995 and January 2001 were evaluated. Each individual underwent routine ophthalmologic examination including visual acuity with Snellen chart testing, slit-lamp examination, intraocular pressure measurement, and fundus examination. Of these, seven patients had posterior subcapsular cataracts and four had nuclear cataracts. Conventional extracapsular cataract extraction (cECCE) was performed in four eyes with single-piece all-polymethylmethacrylate posterior chamber intraocular lens implantation. The other seven eyes were treated with small-incision phacoemulsification and implantation of a foldable hydrophilic acrylic lens.

RESULTS

We observed intraoperative posterior capsule rupture and vitreous loss in one patient, postoperative intraocular tension elevation in one patient, and sterile suture infiltration in one patient in our series. Average of the visual acuities 6 months after the operation was 20/30 (range, 20/60-20/20).

CONCLUSIONS

In this, the first published report to describe outcomes of cataract surgery in renal transplant patients, most complications were associated with high of steroids use and immunosuppressives, and were independent of the type of cataract surgery used, either ECCE or phacoemulsification surgery. The study suggests the need for additional care before, during, and after operation.

Determination of plasma fibronectin and serum C-reactive protein in patients with cerebrovascular events

The relationship between the levels of C-reactive protein (CRP) and fibronectin (FN) and atherosclerotic diseases such as coronary heart disease has already been studied, but their relationship with cerebrovascular events has not. The aim of this study was to determine the levels of plasma FN and serum CRP in cerebrovascular events, and their relationship with the outcome of the disease. CRP and FN levels were analysed in 133 patients with acute cerebrovascular disease, together with 66 healthy controls. Cerebrovascular event patients were divided into subgroups according to disease severity. FN and CRP levels in patients with cerebrovascular disease were found to be significantly elevated compared with the control group (p<0.001). CRP levels correlated with disease severity, in contrast to FN levels. We conclude that FN is not a clinically useful marker in patients with acute differentiative cerebrovascular events, in contrast to CRP which may be useful in such cases.

Nutrient removal of ammonia rich effluents in a sequencing batch reactor

The aim of this study was to develop an appropriate operating strategy for ammonia removal of young landfill leachate in a lab-scale sequencing batch reactor, SBR. SBR was operated at five different phases by changing the aerobic cycle time and external carbon source during the denitrification process. SBR provides the opportunity to arrange the operating periods according to variable conditions such as wastewater characterization in order to optimise the performance of the system. By monitoring the variations occurring in each period during a full cycle an appropriate operating strategy may be defined. The main problem faced during the experimentation period particularly was due to use of raw wastewater with high NH4-N content as an external carbon source, as it affected denitrification performance to a great extent. This trouble was overcome if calcium acetate was used as the external carbon source instead of the raw wastewater. In case of using a suitable aeration period and the convenient external carbon source, high ammonia removals were observed.

Spleen damage in endotoxaemic mice: the involvement of nitric oxide

The association between Escherichia coli endotoxin-induced organ damage and nitric oxide-related mechanisms was investigated in the spleen of male Swiss albino mice (20-40 g) by using (1) Pt/Ir electrochemical sensor connected to an amperometric detection system (NO-501, InterMedical Co., Japan), (2) nitrotyrosine immunohistochemistry, (3) conventional light microscopy and (4) immunoblotting techniques in parallel. 1 h before endotoxin injection, animals were pretreated with either nitric oxide synthase inhibitor, L-N(G)-nitroarginine methyl ester (L-NAME, 20 mg kg(-1), i.p.) or inducible nitric oxide synthase expression inhibitor, dexamethasone (5 mg kg(-1), i.p.) or the inhibitor of murine inducible nitric oxide synthase in vivo, 2-amino-5,6-dihydro-6-methyl-4H-1,3-thiazine (AMT, 1 mg kg(-1), i.p.). 5 h after endotoxin treatment, electrochemically detected concentration of nitric oxide was significantly elevated (nM, endotoxin: 716.6 +/- 178.2, n = 10 vs saline: 209.4 +/- 127.8, n = 9, P = 0.0312, unpaired Student's t-test) and remained so throughout the 30 min monitorization period. Neither dexamethasone nor AMT blocked the endotoxin-induced overproduction of nitric oxide indicating that the enhanced inducible nitric oxide synthase activity cannot be the only explanation. When dexamethasone and L-NAME combination was used to block both the constitutive and the inducible isoforms, nitric oxide production was virtually abolished, indicating a significant contribution from the constitutive isoform of nitric oxide synthase. The results of nitrotyrosine immunohistochemistry and the conventional light microscopy were also in agreement with the amperometric method while immunoblotting revealed the expression of both the endothelial and the inducible isoforms of nitric oxide synthase were induced endotoxaemic animals. Thus, conclude that endotoxin-induced splenic damage in endotoxaemia can be explained by enhanced production of nitric oxide due to the induction of both endothelial and inducible nitric oxide synthases while causal relationship and the roles of other deleterious mediators such as oxygen-derived free radicals are yet to be established.

Retinal vein occlusion and factor V Leiden and prothrombin 20210 G:A mutations

PURPOSE

The aim of this study was to establish whether the factor V Leiden mutation and the prothrombin 20210 G:A mutation were risk factors for retinal vein occlusion.

METHODS

Blood samples were obtained from 40 patients with retinal vein occlusion and from 50 healthy normal volunteers as controls. Polymerase chain reaction assays were done to detect factor V Leiden and prothrombin 20210 G:A mutations, and the two groups were compared.

RESULTS

Two (5%) of 40 patients with retinal vein occlusion and three (6%) of 50 controls were heterozygous for factor V Leiden (p=0.84). None of the individuals in either group had the prothrombin 20210 G:A mutation.

CONCLUSIONS

There was no significant association between retinal vein occlusion and the factor V Leiden mutation.

Diagnosis of HIV infection and laboratory monitoring of its therapy

BACKGROUND

Serological diagnosis of human immunodeficiency virus (HIV) infection became available in 1985, with the rapid increase in sensitivity and specificity of enzyme-linked immunosorbent assays (ELISAs) and the supplement tests. Molecular tests for detection of HIV in the diagnosis of HIV infection in special settings and monitoring of HIV-1 infection followed this.

OBJECTIVE AND DESIGN

In this review it is intended to give a brief overview of the diagnosis and monitoring of HIV infection.

RESULTS AND CONCLUSION

Serological methods and molecular methods for the detection and quantitation of HIV are discussed.

Limbal relaxing incisions in congenital astigmatism: 6 month follow-up

PURPOSE

To evaluate the effectiveness of limbal relaxing incisions (LRIs) for correcting naturally occurring astigmatism.

SETTING

Ankara Hospital, Ankara, Turkey.

METHODS

This prospective analysis of the results of the first LRIs in 22 eyes of 13 patients with congenital astigmatism was done using a modified Gills nomogram and was based on preoperative refractive astigmatism determined by manifest and cycloplegic refractions. There were no adjustments based on sex or age.

RESULTS

An absolute decrease of 0.91 diopter (D) (44%) in mean astigmatism was achieved after 6 months in 22 eyes. The mean uncorrected visual acuity (logMAR) increased from 0.42 to 0.26 from preoperatively to 6 months postoperatively. No patient lost best corrected visual acuity. Most regression occurred in eyes with more than 3.50 D of astigmatism and between the first and third postoperative months.

CONCLUSION

Limbal relaxing incisions are a practical, simple, and forgiving approach for the correction of lower degrees of astigmatism.

[The effectiveness of hemopoietic growth factors in sepsis]

In this experimental study, consist of 54 Sprague-Dawley rats, we tried to observe the effectiveness of haemopoietic growth factors such as G-CSF and GM-CSF in treatment of sepsis and see if they have any effects on phagocytic activity of macrophages when are administered after establishment of sepsis. In first phase of this study, twenty one rats were randomly divided into three groups of 7 animals each. Cecal ligation and perforation were carried out in each rat and sepsis made up. The Control group received 2 x 0.2 cc %5 dextrose injection subcutaneous (s.c.).. The G-CSF group received 2 x 1 g G-CSF with 0.2 cc %5 dextrose s.c. The GM-CSF received 1 x 2 g GM-CSF with 0.2 cc %5 dextrose s.c. Seventh day survival was considered as criterion in the three groups. In second phase of this study, thirty three rats were randomly divided into three groups of 11 animals each. The same procedures were carried out also in these groups. Leukocyte counts and peripheric spread were analyzed in postoperative 24th and 72th hours, alveolar and peritoneal macrophages were Investigated in postoperative 72nd hour. There was significantly neutrophilic leukocytosis in the G-CSF group according to the control group. Nevertheless, there was no change in the phagocytic activity of alveolar and peritoneal macrophages. GM-CSF brought about positive effect of phagocytic activity of macrophages without change of leucocyte count in the sepsis, but it caused neutrophilic, monocytosis and lymphocytopenia. The seventh day survival rates in control, G-CSF, GM-CSF groups were as; 42.8%, 71.4%, 28.5% respectively. As a result, we saw that G-CSF has no effect on the phagocytic activity of macrophages, while increases the survival by enhancing the count and probably the function of neutrophils. GM-CSF fails to increase survival while effects the phagocytic activities of macrophages positively and enhances the peripheral neutrophil and monosit counts without changing the total number of leukocytes.

Aqueous humor nitric oxide levels in patients with central retinal artery occlusion

BACKGROUND/PURPOSE

There is increasing evidence suggesting that nitric oxide (NO) is implicated in the pathogenic process of ischemic disease. The purpose of this study was to quantify the aqueous humor NO levels in patients with central retinal artery occlusion (CRAO) and in age-matched controls.

METHODS

Aqueous humor specimens were obtained from seven patients who had been diagnosed with CRAO; the sampling was done within 12 to 24 hours of diagnosis. All specimens were obtained by paracentesis, which was performed as a therapeutic intervention. Samples of aqueous humor were also collected from 15 age-matched healthy patients undergoing cataract surgery, to be used as controls. For each sample, we assayed the amount of nitrite, which is the stable metabolite of NO, using the spectrophotometric method based on the Griess reaction.

RESULTS

There were detectable levels of nitrite in the aqueous humor from five of seven patients with CRAO (mean level, 0.32 +/- 0.08 micromol/L). The levels in the control group were below the detection limit in all cases (<0.08 micromol/L). There was a statistically significant difference between the aqueous humor nitrite levels in the CRAO group and the controls (P = 0.0008).

CONCLUSIONS

Our study shows that patients with CRAO present with elevated levels of NO in the aqueous humor. These findings may provide insight into the role that NO plays in CRAO.

Intranasal budesonide spray as an adjunct to oral antibiotic therapy for acute sinusitis in children

We investigated the clinical value of intranasal budesonide in acute sinusitis in 52 children with acute maxillary sinusitis. We randomly divided them into two groups: group 1 received oral pseudoephedrine (2 x 30 mg) and cefaclor (40 mg/kg) for 10 days, and group 2 received intranasal budesonide (2 x 100 microg) and cefaclor (40 mg/kg) for 10 days. Symptoms of headache, cough, and nasal stuffiness and signs of nasal discharge were graded before and after treatment. The patients whose symptoms and signs completely normalized after treatment were considered to have recovered, and those with persisting symptoms and signs after treatment as having not recovered. The results of the two treatment groups were compared. The recovery rate of the children in group 2 were significantly higher than those in group 1 (P < 0.05). No adverse drug effects were determined during the study period. These findings suggest that topical steroids may be a useful adjunctive agent in the treatment of acute sinusitis of children without apparent side effects and can possibly hasten the resolution of symptoms.

Determination of serum B12 vitamin and folic acid levels in patient with stroke

The aim of this study is to evaluate whether any relationship between stroke and vitamin B12, folic acid concentration. We examined 50 patients with stroke (male: 26 and female: 24) aged between (mean +/- SD, year) 59 +/- 14 and 16 control subjects (male: 6 and female: 10) aged between (mean +/- SD, year) 53 +/- 11. Patients were classified into two groups as infarct and hemorrhagic by using Computerised Brain Tomography and Cranial Nuclear Magnetic Resonance Imaging techniques. The percentage of patients with infract was 47.5% in female and 52.5% in male while it was 40% in female and 60% in male with hemorrhagic. The vitamin B12 levels of patients with infarct, hemorrhagic and control group were found as mean +/- SEM, 355 +/- 47 pg/ml, 313 +/- 58 pg/ml, 1569 +/- 258 pg/ml and folic acid levels 13.4 +/- 2.6 ng/ml, 7.7 +/- 1.0 ng/ml, 14.8 +/- 4.0 ng/ml, respectively. The significant difference was found between subgroups of patients with stroke and control group in both folic acid and B12 vitamin levels (p < 0.001 and p < 0.0001, respectively). But, there was no significant difference between vitamin B12 and folic acid levels of patients with hemorrhagic and infarct. In order to well understand the effects of these vitamin in patients with stroke, more detailed follow up studies with long period are needed.

Effect of nitric oxide on proliferation of human retina pigment epithelial cells

PURPOSE

To investigate the effects of exogenous and endogenous nitric oxide (NO) on the proliferation of human retina pigment epithelial (RPE) cells.

METHODS

We stimulated cultured human RPE cells with 3-morphosydnonimine (SIN-1) to analyse the effect of exogenous NO. Incubation with a cytokine cocktail (interleukin 1-beta + interferon gamma + tumour necrosis factor alpha) plus lipopolysaccharide (LPS) induced cells to synthesise NO endogenously. The cultures were then incubated for 48 h, after which the cells were stained with crystal violet and absorbance at 550 nm was measured spectrophotometrically.

RESULTS

SIN-1 inhibited human RPE cell proliferation, while haemoglobin, an NO inhibitor, almost completely blocked the inhibitory effect. On the other hand, treatment with the cytokine cocktail plus LPS did not inhibit RPE cell proliferation.

CONCLUSION

These findings confirm that exogenous NO inhibits human RPE cell proliferation, while endogenous NO has no such blocking effect.

[Granulomatous peritonitis due to Ascaris lumbricoides]

Ascaris lumbricoides is one of the most common and most widespread helminthic infections of humans. Infection with ascaris appears to be asymptomatic in the vast majority of cases, but may produce serious pulmonary disease or obstruction of biliary or intestinal tract in a small proportion of infected people. We examined under the light of literature this case which caused the granulomatous peritonitis by ascaris, the adult worm, without any evidence of intestinal perforation.

Macular ischaemia in Behçet's disease

PURPOSE

To report macular ischaemia and visual loss in patients with panuveitis due to Behçet's disease.

METHODS

We describe macular ischaemia, a rare finding, in 3 eyes of 3 patients with panuveitis who were diagnosed and treated as having Behçet's disease. The patients underwent fundus fluorescein angiography (FFA) using a digital imaging system and were treated with topical and oral steroids and cyclosporine in 2 cases, and with added azathioprine in the third case.

RESULTS

The 3 eyes showed macular ischaemia associated with peripheral retinal vasculitis on FFA and control of inflammation was achieved in all cases. After an average of 2 years follow-up, visual acuity and macular ischaemia improved in 2 eyes, while no recovery was seen in the third.

CONCLUSION

The presence of macular ischaemia on FFA in Behçet's disease is a predictor of poor visual outcome. Macular ischaemia may show partial recovery with the treatment of the disease.

Elevated vitreous nitric oxide levels in patients with proliferative diabetic retinopathy

PURPOSE

The aim of this study was to determine nitric oxide levels in the vitreous of patients with proliferative diabetic retinopathy.

METHODS

Using the spectrophotometric method based on Griess reaction, we measured levels of nitrite, the stable product of nitric oxide, in the vitreous of 21 eyes of 21 patients who underwent vitrectomy for the treatment of proliferative diabetic retinopathy with tractional retinal detachment, prospectively. Three samples were excluded from the study because of blood contamination. The control group was made up of vitreous samples from 15 eyes of 15 normal cadavers and five eyes of five patients who were undergoing vitrectomy for macular hole surgery.

RESULTS

Nitrite levels were 0. 524 +/- 0.27 microM and 0.383 +/- 0.17 microM in the vitreous of patients with proliferative diabetic retinopathy of diabetes type I and type II, respectively. In 15 cadaver eyes and five vitreous samples from patients who underwent macular hole surgery, nitrite levels were below the detection limit (less than 0.08 microM). There was no significant difference between nitrite levels in patients with type I and type II diabetes (P =.56), whereas there was a significant difference between diabetes groups and controls (P <. 00001).

CONCLUSION

Vitreous nitric oxide levels are elevated in patients with proliferative diabetic retinopathy with tractional retinal detachment. Nitric oxide may play a role in the pathogenesis of proliferative diabetic retinopathy.

Retinal arterial macroaneurysm in a young patient with chronic renal failure

PURPOSE

To report the youngest case of retinal arterial macroaneurysm.

METHOD

Case Report.

RESULTS

Clinical examination and fundus fluoroscein angiography revealed retinal arterial macroaneurysm in a 23-year-old patient with chronic renal failure.

CONCLUSIONS

Acquired macroaneurysm may develop even in a very young patient, especially with chronic renal failure.

Prevention of selenite-induced opacification and biochemical changes in the rat pup lens through amiloride pretreatment

PURPOSE

To determine the effects of amiloride on selenite-induced cataracts, to identify this agent's role as an anti-oxidant, and to study related effects on ion levels in the rat lens.

METHODS

Wistar albino rat pups were assigned to one of three groups, one control and two experimental. The first experimental group (Group 1; n = 22) received a subcutaneous injection of sodium selenite (30 nmol/g body weight) on postpartum day 10. The second experimental group (Group 2; n = 21) received a subcutaneous injection of amiloride (1 nmol/g body weight) 15 minutes before the sodium selenite injection. The control group (n = 22) received no injection. The pups in each group were observed during three weeks after the injection date. At the end of this period, the stage of cataract development was identified by comparison with slit lamp photographs and then the pups were sacrificed and their lenses were removed intracapsularly using a posterior approach. Cation analysis was carried out and glutathione and malondialdehyde levels were measured for each group.

RESULTS

Cataract stage in Group 1 was significantly higher than Group 2. Mean cataract stages in Groups 1 and 2 were 3.8+/-0.12 and 1.6+/-0.25 respectively. None of the control animals developed cataracts. Amiloride-pretreated group contained significantly higher glutathione levels than Group 1. The level of malondialdehyde in Group 1 lenses was approximately twice that in the lenses of the Group 2 amiloride+selenite-treated animals. The Ca(2+) level was significantly higher in Group 1 lenses compared to the amiloride-pretreated rats, but there was no significant difference between Groups 1 and 2 with regard to Na(+) and K(+) levels.

CONCLUSION

Amiloride was very effective in preventing cataract formation in the selenite-induced cataract model. This protective effect of amiloride was accompanied by higher glutathione levels and lower malondialdehyde levels in the rat pups' lenses compared to levels in animals that received selenite alone. These results suggest an anti-oxidant role for this agent, in addition to its effects on lens ion homeostasis.

Occurrence of an aortic arch anomaly in two siblings born to a diabetic mother

A patient with interruption of aortic arch type A, born to a diabetic mother, is described. The patient, a male infant, was the fourth child of a 29-year-old mother, and had a sibling with coarctation of the aorta. The mother had been treated for insulin-dependent diabetes mellitus for the previous 10 years. The infant died on the 3rd day of life after symptoms of cardiogenic shock. To our knowledge, interruption of aortic arch type A has not been previously described in infants of diabetic mothers. The relevance of the case is discussed and the literature reviewed.

Optic disk neovascularization in a patient with cytomegalovirus retinitis associated with renal transplantation

PURPOSE

To report the development of optic nerve head neovascularization during the recovery phase of cytomegalovirus (CMV) retinitis in a renal allograft recipient.

CASE REPORT

A 46-year-old male renal allograft recipient developed CMV retinitis seven months after transplantation. At the time of the diagnosis, the patient was being immunosuppressed with prednisone, cyclosporine, and azathioprine, and was treated with repeated intravitreal and intravenous ganciclovir. Six weeks after the initiation of therapy, optic disk neovascularization developed. This was confirmed by fluorescein angiography, which showed no areas of retinal capillary nonperfusion. At this stage, active retinal lesions were partially resolved. Apart from intraocular inflammation, no other cause of neovascularization was detected. Over the following six months, optic disk neovascularization regressed spontaneously without causing vitreous hemorrhage or visual loss. There was no recurrence of CMV retinitis during follow-up.

CONCLUSION

Optic disk neovascularization may develop in the healing phase of CMV retinitis in renal transplant recipients.

Evaluation by exercise testing of children with mild and moderate valvular aortic stenosis

BACKGROUND

The aim of the present paper was to determine the factors related to sudden death in aortic stenosis.

METHODS

The factors related to sudden death were investigated in 40 asymptomatic children with mild and moderate aortic stenosis by treadmill testing.

RESULTS

The QT interval of aortic stenosis cases were significantly longer than those of healthy children with increasing heart rates during exercise.

CONCLUSIONS

A longer QT interval of aortic stenosis cases compared to normal children during exercise is the first sign of myocardial ischemia and leads to fatal ventricular arrhythmias and sudden death. For this reason we recommend that exercise testing should be performed frequently in aortic stenosis patients and that close follow up is necessary for patients with long QT segments that can be a marker for severe arrhythmias.