A prospective, multi-center study: factors related to the management of diabetic foot infections

The Turkish Association of Clinical Microbiology and Infectious Diseases, Diabetic Foot Infections Working Group conducted a prospective study to determine the factors affecting the outcomes of diabetic foot infections. A total of 96 patients were enrolled in the study. Microbiological assessment was performed in 86 patients. A total of 115 causative bacteria were isolated from 71 patients. The most frequently isolated bacterial species was Pseudomonas aeruginosa (n = 21, 18.3%). Among cases with bacterial growth, 37 patients (43%) were infected with 38 (33%) antibiotic-resistant bacteria. The mean (±SD) antibiotics cost was 2,220.42 (±994.59) USD in cases infected with resistant bacteria, while it was 1,206.60 (±1,160.6) USD in patients infected with susceptible bacteria (p < 0.001). According to the logistic regression analysis, the risk factors related to the growth of resistant bacteria were previous amputation (p = 0.018, OR = 7.229) and antibiotics administration within the last 30 days (p = 0.032, OR = 3.796); that related to the development of osteomyelitis was wound size >4.5 cm(2) (p = 0.041, OR = 2.8); and that related to the failure of the treatment was the growth of resistant bacteria (p = 0.016, OR = 5.333). Diabetic foot osteomyelitis is usually a chronic infection and requires surgical therapy. Amputation is the accepted form of treatment for osteomyelitis. Limited limb-saving surgery and prolonged antibiotic therapy directed toward the definitive causative bacteria are most appropriate. This may decrease limb loss through amputations. As a result the infections caused by resistant bacteria may lead to a high cost of antibiotherapy, prolonged hospitalization duration, and failure of the treatment.

Predictive value of Doppler ultrasound in childhood pneumonia

This study aimed to determine the predictive value of intercostal and pulmonary artery Doppler flow patterns in the outcome of childhood pneumonia. Pneumonia was classified according to type of pleural effusion and the ultrasound features of consolidations. Doppler flow patterns of intercostal and pulmonary arteries were analysed and correlated with pneumonia type and hospital stay. Of 83 pneumonia cases, 55 were uncomplicated and 28 were complicated. Pleural effusion was present in 54 cases, with 29 non-septated and 25 septated cases. Patients with uncomplicated pneumonia did not have abnormal Doppler flow patterns, compared with 64% (18 of 28) of patients with complicated pneumonia. Doppler ultrasound patterns in childhood pneumonia were correlated with pneumonia type and may be predictive of pneumonia outcome.

Radiographic manifestations of the temporomandibular joint in a case of Proteus syndrome

Proteus syndrome is a rare disorder with progressive asymmetrical and disproportionate overgrowth of various tissues of the body. The syndrome is characterized by a wide range of malformations, including craniofacial deformities. Extraoral examination revealed several of the classical craniofacial features of Proteus syndrome: pronounced hemifacial hypertrophy, macrodactyly and hyperostosis. Intraoral examination revealed a high arched palate and gingival hyperplasia. Other findings were unilateral enlargement of the tongue, alveolar growth and dilaceration of the roots of the teeth. There were severe degenerative changes and deformities in the left temporomandibular joint but the oversized condyle was asymptomatic; there was no pain, limitation and deviation at mouth opening. Treatment was not necessary owing to the asymptomatic situation but periodic follow-up with clinical and radiographic examination was considered. The aim of this article is to describe the radiographic manifestations of an asymptomatic condyle malformation and other craniofacial, oral and dental findings in a 33-year-old female patient with known Proteus syndrome.

The effect of enalapril on renal resistive index, urine electrolyte levels and TGF-β1 levels of kidney tissues in rats with unilateral partial ureteropelvic junction obstruction

BACKGROUND

This study aimed to investigate renal arterial resistive index measurements and urine electrolytes before and after enalapril therapy in a rat model of unilateral ureteropelvic obstruction. The transforming growth factor (TGF)-β1 response of the renal tissue was also investigated.

MATERIALS AND METHODS

30 Wistar albino rats were randomly allocated into 5 groups (n=6). Group C rats served as controls. Group S rats had only laparotomy. Group E rats were only treated with enalapril. Rats in group UP and group UPE underwent laparotomy to create a left unilateral moderate partial obstruction. 2 weeks after establishing partial ureteropelvic junction obstruction, group UPE rats were treated with enalapril. Urine was collected over 24 h in all groups. Intrarenal arterial resistive index measurements were performed before and 2 weeks after surgery and after enalapril treatment in group UPE, and before and after enalapril treatment in group E. Rats were sacrificed by intracardiac puncture and left kidneys were harvested to evaluate levels of mRNA TGF-β1.

RESULTS

There was no significant difference in ARI values in group E. In group UPE, the difference between ARI values before and after surgery was statistically significant; the difference between ARI values after surgery and after enalapril treatment was also statistically significant. There was no statistically significant intra-group difference in urine electrolyte levels for UP group or UPE group. There was no difference in renal mRNA TGF-β1 levels.

CONCLUSION

Enalapril maintained renal blood flow by decreasing the arterial resistive index and maintained renal tubular function by protecting urine concentration and dilution ability in a rat model with unilateral ureteropelvic junction obstruction.

[Aspergillus colonization of an echinococcal cyst cavity: case report]

Although lungs are common sites for the occurrence of saprophytic or invasive mycosis as well as hydatid cyst, aspergilloma within a hydatid cyst is a rare occurrence. A 36-year-old immunocompetent male presented with hemoptysis episodes of about 1 year duration. Chest X-ray revealed a smooth countered mass lesion located in the upper part of lower lobe of left lung. Surgical enucleation of the cyst wall was performed. Microscopic examination showed that the laminated membranes of hydatid cyst were invaded by septated fungal hyphea oriented with acute angles consistent with aspergillus. Herein, we report such a unique coexistence of hydatid cyst and aspergilloma, and emphasize possible complications depending on the immunostatus of the patient, if the aspergillus colonization is unnoticed in resected cystectomy material.

Determination of rhodamine B in soft drink, waste water and lipstick samples after solid phase extraction

A new solid phase extraction method is described for sensitive and selective determination of trace levels of rhodamine B in soft drink, food and industrial waste water samples. The method is based on the adsorption of rhodamine B on the Sepabeads SP 70 resin and its elution with 5 mL of acetonitrile in a mini chromatographic column. Rhodamine B was determined by using UV visible spectrophotometry at 556 nm. The effects of different parameters such as pH, amount of rhodamine B, flow rates of sample and eluent solutions, resin amount, and sample volume were investigated. The influences of some alkali, alkali earth and transition metals on the recoveries of rhodamine B were investigated. The preconcentration factor was found 40. The detection limit based on three times the standard deviation of the reagent blank for rhodamine B was 3.14 μg L⁻¹. The relative standard deviations of the procedure were found as 5% in 1×10⁻⁵ mol L⁻¹ rhodamine B. The presented procedure was successfully applied to real samples including soft drink, food and industrial waste water and lipstick samples.

Reversible protease-activated receptor 1 downregulation mediated by Ankaferd blood stopper inducible with lipopolysaccharides inside the human umbilical vein endothelial cells

Ankaferd Blood Stopper (ABS) is a novel topical hemostatic agent with pleiotropic actions indicated in clinical hemorrhages. Protease-activated receptor 1 (PAR-1) is located in the crossroads of hemostasis, inflammation, infection, apoptosis and tumorigenesis. ABS-induced formation of the protein network with vital erythroid aggregation covers the entire physiological hemostatic process. The aim of this study is to assess the effects of ABS on PAR-1 in the Human Umbilical Vein Endothelial Cells (HUVEC) model, in relation to the "ipopolysaccharides (LPS)-challenge" to endothelium. For this purpose, ABS 10 μL and 100 μL, had been applied to HUVEC within the time periods of 5 minutes (min), 25 min, 50 min, 6 hours (h) and 24 h. The cells have lifted from the plastic surface and adhered to each other during theABSapplication to the HUVECs. After 24 hours the cells returned to normal baseline level. We observed dose-dependent reversible PAR-1 down-regulation mediated by ABS inside the human umbilical vein endothelial cells. ABS-induced sustained PAR-1 down-regulation in the presence of LPS. Those findings indicated that ABS hemostatic agent may act as a topical biological response modifier by acting on PAR-1 at the vascular endothelial and cellular level.

Relations between human leukocyte antigens and autoimmune hepatitis in Turkish children

BACKGROUND/AIMS

We aimed to identify the genetic factors associated with increased tendency toward autoimmune hepatitis, a chronic and progressive inflammatory condition.

METHODS

A total of 32 children diagnosed with autoimmune hepatitis were included in the present study, and 160 healthy adult blood donors served as controls. In both groups, HLA phenotypes were examined (HLA-A, B, C, DR, DQ) and compared. In addition, the association between the type of autoimmune hepatitis and HLA status was explored.

RESULTS

Compared to controls, patients with autoimmune hepatitis had increased frequencies of the following class 1 HLA antigens: A24.9 (28% vs. 9%, p=0.007), A26 (25% vs. 3%, p<0.001), A32 (34% vs. 4%, p<0.001), B38 (9% vs. 0.6%, p=0.015), and B51 (16% vs. 0%, p<0.001). Among class II HLA antigens, DRB1*04 (22% vs. 0%, p<0.001), DRB1*07 (9% vs. 0%, p=0.004), DRB1*11 (12% vs. 0%, p=0.001), DRB1*15 (25% vs. 0%, p<0.001), DRB1*14 (31% vs. 0%, p<0.001), and DR11.5 (9% vs. 0%, p=0.004) were more frequent in patients compared to controls. Type 1 autoimmune hepatitis was associated with high frequencies of A24.9, A26, A32, and DRB1*15, whereas type 2 autoimmune hepatitis was associated with high frequencies of A26, B51, B38, and DRB1*11. On the other hand, frequencies of A32 and DRB1*04 were high among patients with unclassified autoimmune hepatitis.

CONCLUSIONS

There seem to be associations between certain HLA antigens and susceptibility to autoimmune hepatitis, but variations among different geographical locations suggest a role for environmental factors.

Acidogenic fermentation of municipal solid waste and its application to bio-electricity production via microbial fuel cells (MfCs)

Acidogenic fermentation of organic municipal solid waste (MSW) and the bio-electricity production potential from its volatile fatty acid (VFA)-rich leachate using an air-cathode microbial fuel cell (MFC) was investigated in this study. The acidogenic fermentation of 2 kg of MSW has been carried out in a 6 L anaerobic leach-bed reactor (LBR) under mesophilic conditions (30 degrees C). Total production of 92 g VFA expressed as chemical oxygen demand (COD) in 3 L leachate mainly containing acetic, propionic, butyric, and valeric acids has been achieved with manual leachate recirculation and without pH control in 74 days of incubation. Leachate collected on day 32 was used as a feed to an air-cathode MFC after being diluted and supplemented with NaCl or NaHCO3. The maximum power density in the diluted leachate was only 5.9 W/m3, but reached up to 8.6 W/m3 upon the addition of 7 mmol/L NaCl. Increase in coulombic efficiency from 6 to 22% was also observed as a result of NaCl supplementation. On the other hand, NaHCO3 addition did not improve the power output.

The relationship between human leukocyte antigens (HLA) and renal cell carcinoma

Etiologies of Renal Cell Carcinoma (RCC) are not clear despite of the fact that many risk factors have been suggested. Especially in high stages RCC can affect the immune system in various ways. Human Leukocyte Antigens (HLA) may play a complementary role in the activation between the tumor and immunity. Our aim was to determine the existence of the relationship between HLA system and RCC. By using the standard microlymphocytotoxic method of Terasaki in our study, the HLA A, B, DR and DQ antigen types of 20 patients with RCC Stage T1 and T2 were compared with the control group consisting of healthy 30 people. In our RCC patient group, HLA-A23(9) and DQ7(3) antigens were significantly higher than the control group statistically (p=0.005, p=0.0028; respectively). HLA-A10, DQ1, DR10 and B44 antigens were significantly higher in the control group than the patient group (p=0.011; for all).The findings made us suggest that the people, carrying the antigens which were detected in the patient group, were at high risk for RCC and the people, carrying the protective antigens that were detected in the control group were at less risk for RCC. There may be a dramatic regression for the patients who underwent immunotherapy and HLA expression, which is known to play role in tumor biology, may direct the effects of immunotherapeutic agents. Immunologic description and destruction is avoided in case of change or disappearance of HLA expression by cancer cells. Further investigations which will be performed in our population in the future will be more illuminating to confirm those results. We have concluded that, HLA profiles may be evaluated for detection the people at risk of RCC, the prognosis of the patients and their treatments.

Sorbent extraction of 4-(2-thiazolylazo) resorcinol (TAR)-metal chelates on Diaion SP-850 adsorption resin in order to preconcentration/separation

A sensitive and simple separation-enrichment technique for the determination of trace amounts of some metal ions was described. By the passage of aqueous samples including Fe(III), Cu(II), Ni(II) and Co(II) ions-4-(2-thiazolylazo) resorcinol (TAR) chelates through Diaion SP-850 column, metal chelates adsorb quantitatively and almost all matrix elements were passed through the column to drain. Quantitative recoveries for analyte ions were obtained at pH 6 at 3 ml/min flow rate of sample solution in 0.5 g Diaion SP-850 filled glass column. The investigations were also carried out on the interferences from other concomitant ions in the sorption process. After optimization, a preconcentration factor of 60 and a recovery values as % higher than 95 were achieved. The detection limit (N=10, 3 sigma) for Fe(III), Cu(II), Ni(II) and Co(II) were found as 3.6, 1.1, 2.8 and 2.3 microg l(-1), respectively. The applications to the determination of iron, copper, nickel and cobalt in real samples and the validation of the analytical methodology employing NIST SRM 1549 milk powder, NIST RM 8433 Corn Bran and BCR 144R Sewage sludge of domestic origin as certified reference materials were performed.

Peritoneal seeding and subsequent progression of mantle cell lymphoma after splenectomy for debulking

BACKGROUND

Peritoneal seeding after abdominal surgery is a well known route of metastasis in intra-abdominal solid tumours. Direct mechanical contamination, local peritoneal trauma and subsequent inflammation, postoperative immunosuppression, and laparoscopic surgery are the proposed predisposing factors for this type of metastasis. These factors probably result in enhanced adhesion or growth of tumour cells. However, this route of metastasis has not yet been reported for lymphomas. Here, we report the first case of peritoneal seeding of lymphoma cells after an abdominal surgery.

CASE DESCRIPTION

A 47-year-old man with mantle cell lymphoma had ascites because of infiltration of the liver. He underwent debulking splenectomy. The postoperative ascites cytology and control abdominal computed tomography imaging both confirmed peritoneal involvement and lymphoma progression. Demonstration of negative peritoneal involvement before surgery and close timing of peritoneal involvement after splenectomy suggested to us that the debulking surgery was the main cause of peritoneal seeding of lymphoma cells in our case.

CONCLUSIONS

Factors similar to those in solid tumour seeding may also be valid for lymphomas. Peritoneal seeding and consequent disease progression may be a potential complication of abdominal surgery in lymphoma with extensive intra-abdominal involvement.

Endothelial nitric oxide synthase (eNOS) gene polymorphism in early term chronic allograft nephropathy

Chronic allograft nephropathy (CAN) is a complex phenomenon caused by underlying kidney disease with superimposed enviromental and genetic factors. CAN development begins with progressive renal microvascular injury. Endothelial cells play key roles in the regulation of vascular tone, permeability, and remodeling. A reduction in basal nitric oxide (NO) release as a result of genetic variation in endothelial NO synthase (eNOS) function may predispose to hypertension, thrombosis, vasospasm, and atherosclerosis, all contributing to the development of CAN. We analyzed the G894T mutation at exon 7 of the eNOS gene in relationship to CAN among 81 children with renal transplantations. The 20 patients who developed CAN underwent renal biopsies for histological confirmation. Proteinuria and hypertension were observed in CAN. We selected 173 healthy reference subjects. The G894T polymorphism of the eNOS gene was determined by PCR-restriction fragment-length polymorphism analysis. The group included 33 male and 48 female subjects who received 32 living-related grafts and 49 from deceased donors (DD) donors. Donor age (y) was 32.7 +/- 13.7 and the HLA A,B,DR mismatch number of the cadaveric cases was 3.5 +/- 0.79. The distribution of the genotypes were ENOS GG/GT/TT 48%, 33%, 19%, respectively. G-alleles frequency was 64.8%; T-allele frequency was 35.2%. ENOS G894T gene polymorphism did not seem to influence long-term renal allograft outcome. Recipient ENOS G894T gene polymorphism did not alter the risk of chronic allograft failure. Even if NO synthesis and bioactivity are influenced by this polymorphism, many vasoactive factors may have roles to suppress the advantageous effects of NO.

Analysis of uterine rupture cases in Agri: a five-year experience

INTRODUCTION

We attempted to establish the frequency of uterine rupture and to address etiological factors, complications, management and maternal and perinatal outcome of complete versus incomplete rupture, with the aim of proposing preventive measures.

METHODS

The clinical records of uterine rupture cases managed at the Obstetrics and Gynecology Department of Agri Maternity and Children's Hospital in Turkey from June 2004 to June 2009 were analyzed retrospectively.

RESULTS

There were 44 cases of ruptured uterus. Among 24,554 deliveries the total incidence of uterine rupture was 1/558 or 17%. The most common site for the location of rupture was the fundal region (36.36%) followed by the lower segment, isthmic and mixewd types, respectively.

DISCUSSION

Prevention must necessarily include regular antenatal care and meticulous screening of high-risk patients. Improved organization and access to maternal care, decentralization of obstetric services into peripheral care units in villages to prevent home deliveries and good supervision during labor can reduce the incidence of this preventable obstetric catastrophe.