[A Marginal Case of Malaria: An Interesting Malaria Story of Cameroon Origin]

Malaria is a serious, contagious infection caused by single-celled parasites. About 200 species of Plasmodium have been described that can cause infection in vertebrates. Five different species of Plasmodium are known to cause infection in humans to date. Infection with more than one type of pathogen is called coinfection. This type of infections can be caused by different species of the same genus, as well as by different species. Malaria coinfections are mostly caused by the combination of Plasmodium vivax and Plasmodium falciparum. In this study, a case of malaria admitted to the hospital and diagnosed was presented. Thin smear blood preparations were prepared from the peripheral blood of a 54 year-old Republic of Türkiye citizen male patient who applied to the emergency department with fever and chills. The preparations were stained with Giemsa and examined under a microscope with a x 100 objective, and trophozoite and gametocyte forms belonging to Plasmodium genus were determined. As a result of probe-based quantitative real-time polymerase chain reaction (qRt-PCR) study with primers specific to Plasmodium vivax, Plasmodium malariae, Plasmodium falciparum, Plasmodium ovale and Plasmodium knowlesi for definitive species identification, co-infection of P.vivax, P.falciparum, P.ovale and P.knowlesi was detected in the patient. In addition, it was proved that our patient was infected with four different species by conventional PCR study in which five species were studied and then by DNA sequence analysis. On the fourth day of artemether-lumefantrine treatment, the patient's fever response was observed and the trophozoite forms disappeared from the third day in the daily peripheral smear follow-up. Since P.vivax and P.ovale species were also detected after species determination by molecular methods, primaquine 1 x 30 mg tablet was added to the existing drugs for the treatment of hypnozoite forms of the parasite. In recent years, there has been an increase in malaria imported cases, especially after visits to African countries. Such rare cases of malaria coinfection may be encountered during visits to geographies located at the intersection of endemic regions. According to the data of the World Health Organization, maximum attention should be paid to the prevention and prophylaxis protocols from vectors, especially in travels to countries with the highest mortality and morbidity. In co-infection cases similar to our patient, for tertian malaria and tertiary ovale malaria, hypnozoid therapy should not be overlooked. When the insecticide-resistant vectors and drug-resistant Plasmodium strains encountered in recent years are evaluated as a whole, there is a need to develop more effective strategies in the fight against malaria. In addition to microscopic examination, which is accepted as the gold standard, we believe that evaluating molecular studies together in diagnosis is extremely important for the treatment process when hypnozoite periods are considered.

[Domestic Malaria Cases in Kayseri Province]

Malaria continues to be a global public health problem considering the number of cases and death rate worldwide. There were no domestic cases reported from our country in the World Health Organization 2021 malaria report. All the 200-250 annual cases reported from our country have a history of travel to the endemic region. In this report, three malaria cases caused by Plasmodium falciparum and Plasmodium vivax in Kayseri province without a history of travel to the endemic region were presented. The first case was an 18-year-old male patient with no known chronic disease. He admitted to the hospital with the complaint of high fever reaching 40°C, which continued for two days, increased with chills and decreased with sweating. Physical examination revealed hepatosplenomegaly and laboratory results revealed thrombocytopenia. Species identification was made by real-time polymerase chain reaction (Rt-PCR) method in the patient with ring-shaped trophozoites in the peripheral smear. Artemether-lumefantrine and primaquine treatments were given to the patient with mixed parasitemia of P.falciparum and P.vivax. One and two days after the admission, the second and third cases also admitted with similar complaints. Mixed parasitemia was observed in all three patients who did not have a history of traveling abroad. After the antiparasitic treatment, the patients improved clinically and laboratory, and no recurrent parasitemia was observed. With the occurrence of these cases, efforts to combat vectors were initiated throughout the province. In conclusion, the presence of anopheles mosquitoes and imported cases still poses a risk for domestic malaria cases. In patients who do not have a history of traveling abroad, malaria should be considered in the clinical preliminary diagnosis and species identification should be made by methods such as Rt-PCR in order to give appropriate treatments.

Retrospective Determination of the Prevelense of Anti-Echinococcus granulosus Antibodies in Cystic Echinococcosis Pre-diagnosed Patients at Erciyes University Faculty of Medicine

OBJECTIVE

Cystic echinococcosis (CE) is a parasitic disease that has been known for years in helminth diseases and it is important as human and animal health problem in many parts of the world and in our country due to economic losses. In this study, it was aimed to retrospectively evaluate the distribution of anti-E. granulosus-IgG antibodies in patients with pre-diagnosis of CE that referred to parasitology laboratory between January 2013-December 2018.

METHODS

Commercial kit was used for indirect hemaglutination (IHA), indirect fluorescent antibody test (IFAT) and Western blot (WB) methods using sera from patient samples was applied according to the kit proposal. In addition, patient materials for CAM, CSF and blood for which polymerase chain reaction (PCR)/QPCR tests were requested were examined.

RESULTS

Sera of the patients who were tested with at least one of the IHA, IFAT and WB methods or a combination of these methods, and 443 cases out of 2.283 cases were found to be E. granulosus seropositive. It was determined that 369 (62.03%) of 443 positive patients were female and 330 (37.97%) were male patients. Among these patients, 87 patients whose IFAT and/or IHA tests were negative were found to have positive results with the WB method. IFAT or IHA test results of 13 patients with negative WB tests were found to be positive. Four patients were identified with both tests positive but WB test results negative. In addition, 36 of 72 patients who underwent PCR/QPCR tests were found to be positive.

CONCLUSION

As a result of a six-year retrospective screening, 22% of the cases were found to be positive, and it was concluded that the prevalence of CE is high and the use of a single test may be insufficient in the diagnosis of CE, therefore, test combinations will increase the sensitivity and reliability in reaching the correct diagnosis.

Noninvasive ventilation with nursing perspective: Impacts on patient tolerance, short-term adverse effects, and nursing workload

Background

The success of noninvasive ventilation (NIV) treatment is closely related to high levels of clinical support.

Aims

In this study, we sought to analyze patient mask compliance and minor side effects and to evaluate additional nursing workload needed for the NIV care.

Materials and Methods

The study was designed as a prospective and observational. The data were collected from an intensive care unit. Clinical and physiological data, patient tolerance and adverse effects, subjects' complaints about their experience, and additional nursing workload associated with NIV treatment were assessed.

Results

Statistically significant improvements were obtained in arterial blood gas analysis, respiratory rate, and heart rate during treatment. In the first 2 h, 65% of subjects had poor mask compliance, patients' comfort scores were poor, and incompliance was associated with discomfort. The ratio of skin problems was 15% in the first 24 h and reached 60% at 48 h. The pain rate due to mask ties was 80% and then increased to 90% at 48 h. There was a significant relationship between the problems detected by the nurses and problems described by the subjects. Additional nursing workload was found as 110 min for 0-6 h.

Conclusions

We observed that the mask compliance and comfort levels of the subjects were poor. Skin breakdowns increased depending on the duration of treatment. Treatment would require continuous nursing support in seven areas. NIV treatment generated a significant amount of workload for nurses. Additional nursing workforce planning is required for NIV units for successful NIV treatment.

Fabrication and characterization of large numerical aperture, high-resolution optical fiber bundles based on high-contrast pairs of soft glasses for fluorescence imaging

Fabrication and characterization of flexible optical fiber bundles (FBs) with in-house synthesized high-index and low-index thermally matched glasses are presented. The FBs composed of around 15000 single-core fibers with pixel sizes between 1.1 and 10 μm are fabricated using the stack-and-draw technique from sets of thermally matched zirconium-silicate ZR3, borosilicate SK222, sodium-silicate K209, and F2 glasses. With high refractive index contrast pair of glasses ZR3/SK222 and K209/F2, FBs with numerical apertures (NAs) of 0.53 and 0.59 are obtained, respectively. Among the studied glass materials, ZR3, SK222, and K209 are in-house synthesized, while F2 is commercially acquired. Seven different FBs with varying pixel sizes and bundle diameters are characterized. Brightfield imaging of a micro-ruler and a Convallaria majalis sample and fluorescence imaging of a dye-stained paper tissue and a cirrhotic mice liver tissue are demonstrated using these FBs, demonstrating their good potential for microendoscopic imaging. Brightfield and fluorescence imaging performance of the studied FBs are compared. For both sets of glass compositions, good imaging performance is observed for FBs, with core diameter and core-to-core distance values larger than 1.6 μm and 2.3 μm, respectively. FBs fabricated with K209/F2 glass pairs revealed better performance in fluorescence imaging due to their higher NA of 0.59.

The rapid effect of pulsed dye laser on demodex density of facial skin

BACKGROUND

Recently, treatment with acaricides, which is aimed at reducing excessive proliferation of demodex mites, has gained popularity due to its providing a significant improvement in the symptoms of diseases, such as rosacea, seborrhoeic dermatitis, and perioral dermatitis. The effect of IPL on demodex mites was reported in skin biopsy specimens in three patients; however, to the best of our knowledge, no study exists to date, which evaluates the effect of pulsed dye laser (PDL) on demodex density (Dd) in larger patient group. We aim here in to observe the Dd before and after PDL therapy with two different skin biopsy techniques.

MATERIAL AND METHODS

Thirty-one patients diagnosed with rosacea were included in the study who received PDL treatment. Dds which were measured by using both the SSSB (standardized skin surface biopsy) and CTM (cellophane tape method) techniques before and after 3 weeks of PDL therapy were evaluated.

RESULTS AND DISCUSSION

The Dd of patients before PDL treatment was 13.0 (interquartile range (IQR): 5.0-28.0) and after 3 weeks of PDL treatment it was 6.0 (IQR: 3.0-12.0) with SSSB. After PDL treatment, the Dd was significantly lower than pretreatment the Dd (p = 0.002). The present study shows that PDL significantly reduced Dd in facial skin with one session.

Case Report: Lupoid cutaneous leishmaniasis mimicking verruca plana

Cutaneous leishmaniasis (CL) is an infectious disease caused by various species of leishmania protozoan parasites. Lupoid CL is a rare form of CL that has a stunning similarity to other granulomatous cutaneous conditions of infectious or inflammatory origin. Verruca plana, also known as a "flat wart", is a benign proliferation of the skin resulting from infection with human papilloma virus (HPV). Herein, we presented a case of lupoid CL mimicking verruca plana on the face.

Prevalence of male pelvic dysfunction: results from the Turkish society of andrology male sexual health study group

The objective of this study was to determine the prevalence of male pelvic dysfunction (MPD) and its correlation in men ≥40 years of age in a population-based study. This study was designed as a non-interventional, observational, cross-sectional field survey. Participating males of ≥40 years were randomly selected from 19 provinces of Turkey. All participants were asked to complete a survey including data regarding demographics, socio-economic status, socio-cultural factors, medical and sexual history, current medications, comorbidities and three validated questionnaires assessing lower urinary tract symptoms (International Prostate Symptom Score), erectile dysfunction (International Index of Erectile Function) and ejaculatory behaviour (Male Sexual Health Questionnaire-4). MPD was defined by combining abnormal scores calculated from all three questionnaires. All data were analysed statistically and p < 0.05 was accepted as significant. A total of 2730 males of ≥40 years (mean, 54.2 ± 10.6 years) were enrolled in this study. The prevalence of MPD was calculated as 24.4% among all participants. The prevalence of MPD was lowest at age between 40 and 49 years (9.1%) and highest at ≥70 years (76.6%), exhibiting correlation with age. Each decade of increase in age was associated with a 3.4-fold increase in presence of MPD. At logistic regression analyses; age, diabetes, hypertension, dyslipidemia, cardiovascular disease, obesity and lower income were found to be independent predictors for increased prevalence of MPD. This study reports prevalence of MPD as 24.4% in males of ≥40 years. Furthermore, age was found to be the main independent predictor of having MPD.

[The molecular mechanisms of erythrocyte invasion of Plasmodium spp. as a model organism of apicomplexan protozoa]

Apicomplexan protozoa are a phylum of parazites that includes medically and agriculturally important pathogens. They are named for their cell apex which contains a number of organelles (rhoptri, micronemes, conoid, apical polar ring, dense granules and apicoplast), important for their invasion and development within host cells. Among important apicomplexan parasites that affect human health directly or indirectly are Plasmodium spp., Toxoplasma gondii, Cryptosporodium, Eimeria, Babesia, and Theileria. Apicomplexan parasites move and actively enter host cells by substrate-dependent gliding motility. In these parasites, gliding motility and host cell invasion are driven by an actomyosin-based system (Glydeosome). A gliding motor machinery is embeded between the plasma membrane and inner membrane complex (IMC), a unique double membrane layer. A unique actomyosin motor powers both host cell invasion and locomotion of apicomplexan invasive stage. The cytoplasmic motor, a transmembrane bridge, and surface ligants essential for cell invasion are conserved among the main apicomplexan pathogens. In this review, erythrocytet invasion of Plasmodial merozit, which is a model organism of apicomplexan parasites, has been reviewed in detail.

[The investigation of intestinal parasites in foreign high school students]

Intestinal parasites are important health problem especially in undeveloped or underdeveloped countries with low socio-economic status,. In this study, stool and cellophane tape samples were analyzed for intestinal parasites in 192 foreign students who were came from 28 different countries and attending a high school with the age of 15 to 21 (age mean: 17.92 ± 1.30) in Kayseri. At least one or more intestinal parasite species were found in 73 (38 %) of them. The distribution of parasites which were detected in stool samples as follow; Blastocystis hominis; 63 (32.8%); Giardia intestinalis, 13 (6.7 %); Endolimax nana, 8 (4.1%); Entamoeba coli, 7 (3.6%); Iodamoeba butschlii, 1 (0.52%). There was no any parasite in cellophane tape samples.

[Investigation of anti-Toxocara canis IgG antibodies in patients presenting at The Erciyes University Medical Faculty, Department of Parasitology.]

Human Toxocara canis infections are seen all over the world, especially in temperate and tropical climate regions. Dogs are known to be reservoir hosts in transmission of the disease. Because puppies are infected both transplacentally and by breast milk, they add huge amounts of eggs daily to the environment with their stools for months. It is known that the human is not a natural host of T. canis and larvae do not mature in the human body. However, after getting into the human they migrate through visceral tissues and act like a foreign body in the places where they come to rest. In this study, anti-T. canis IgG antibodies were investigated by ELISA in 61 (54.6%) males and 51 (45.5%) females making a total of 112 patients aged between 1 and 68 years (average:18.54+/-24.5) presenting at our laboratory from different services of our hospital. Anti T. canis IgG antibodies were found to be positive in 24 (21.4%) patients.

Peritonitis associated with Strongyloides stercoralis in a patient undergoing continuous ambulatory peritoneal dialysis

A 67-year-old male continuous ambulatory peritoneal dialysis (CAPD) patient presented with abdominal pain and pruritus. Strongyloides stercoralis larvae were seen on dialysate sediment and stool microscopic examination. Albendazole was given and improved the symptoms in 4 days. There was no episode of relapsing peritonitis after the therapy. This is the first report of S. stercoralis peritonitis in patients on CAPD. Strongyloides should be considered as a probable peritoneal pathogen in CAPD patients.

[The seroprevalence of Toxoplasma gondii among prisoners in the Kayseri closed prison]

Toxoplasmosis is a zoonosis caused by Toxoplasma gondii and can be found in humans, domestic animals and wild animals almost everywhere around the world. The aim of this study was to investigate the seroprevalence of toxoplasmosis among the 628 prisoners in the Kayseri Closed Prison. Anti-Toxoplasma gondii IgG and IgM antibodies were investigated in the serum specimens with the IFA method. Two hundred and thirty six (37.58%) prisoners were anti-T. gondii IgG seropositive and 11 (1.75%) were both IgG and IgM seropositive. There was no IgM seropositivity in IgG negative serum specimens.

[Three diarrheal cases caused by Cyclospora cayetanensis in Kayseri]

Cyclospora cayetanensis is a coccidian parasite that may be the agent of persistent and prolonged diarrhea. In this study, the etiologic agent of diarrhea in 18, 26 and 34 year-old immunocompetent female patients complaining of diarrhea was investigated. Cyclospora cayetanensis oocysts were observed in stool specimens taken from the patients and stained by the Kinyoun's acid-fast stain method. In this study, an attempt has been made to shown the importance of Cyclospora cayetanensis, which is a cause of prolonged diarrhea mainly in immunosuppressed patients and is generally presented in case reports in our country.

[Distribution of intestinal parasites in patients presenting at the parasitology laboratory of the medical school of Erciyes University between the years of 2005 and 2008]

In this study carried out from January 2005-June 2008, a total of 28,911 stool samples were examined using native-Lugol and flotation/sedimentation methods and 7,164 cellophane tape preparations were examined directly. Intestinal parasites were found in 6,975 (24.13%). Of the patients, 52.90% were female and 47.10%, male. Blastocystis hominis, 5,701 (19.72%); Entamoeba coli, 910 (3.15%); Giardia intestinalis, 568 (1.96%); Endolimax nana, 363 (1.26%); Entamoeba hartmann i, 357 (1.23%); Entamoeba histolytica/dispar, 253 (0.87%); Chilomastix mesnilii, 92 (0.32%); Enterobius vermicularis, 58 (0.20%); Iodamoeba butschlii; 40 (0.14%); Taenia sp., 35 (0.12%); Ascaris lumbricoides, 34 (0.12%); and Hymenolepis nana, 17 (0.06%) were found to be the most common parasites.

[Schistosoma haematobium infection in a Ghanaian patient residing for a period in Turkey]

Schistosoma haematobium is one of the important causes of haematuria in some parts of the world. We present a 16-year-old Ghanaian male who applied to our hospital with haematuria. Schistosoma haematobium eggs were found in his urine sediment. The epidemiological and clinical significance of S. haematobium has been discussed in detail because S. haematobium cases are rarely seen and are generally imported in Turkey.

[Evaluation of intestinal parasites in a period of four years in the coprology laboratory of a training hospital]

Parasitological examination of stool samples of 9867 individuals, submitted from both inpatient and outpatient departments to the Microbiology Department of an 800-bed Training Hospital between 1.1.2003 and 31.12.2006, revealed that 582 individuals (5.9%) were infected with intestinal parasites. Different diagnostic methods were employed in two different periods, and Blastocystis hominis, Giardia intestinalis and Entamoeba histolytica/dispar were found to be the most common parasites, respectively. Patients were predominantly male (67% (n=336) male vs. 33% (n=165) female) and aged between 15-25 years (36%). In addition, 14% (81/582) patients had multiple parasitoses. Despite being labor-intensive, parasitological examination of stool samples with necessary staining methods by experienced staff will surely help determine both the diagnosis and exact prevalence of intestinal parasitic infections in Turkey.

Cystic echinococcosis in Central Anatolia, Turkey

OBJECTIVE

Human cystic echinococcosis (CE) caused by infection with a larval stage of Echinococcus granulosus is a serious public health problem in Turkey. Echinococcosis is a zoonotic disease; dogs and livestock are important hosts in transmission. The aim of this study is to evaluate the rate of CE in Kayseri Rural Area, Central Anatolia, Turkey.

METHODS

At the present study, we planned to evaluate the rate of CE in Kayseri rural area in Central Anatolia between 2000 and 2002. We investigated 2,242 subjects using enzyme-linked immunosorbent assay (ELISA) and indirect fluorescence antibody (IFA), and we examined the seropositivity by using Western blotting (WB).

RESULTS

The seropositivity rate was 2.7% by ELISA and IFA. We retested seropositive serum samples and 200 seronegative sera by WB. Seropositive serum samples were studied using abdominal ultrasound and chest x-ray to confirmed the presence of hydatid cyst and we found 10 (0.5%) different localized cysts.

CONCLUSION

The results of our study indicate that Kayseri rural area has a high endemicity of human CE.

Anti-Toxoplasma gondii antibodies in patients with chronic heart failure

Chronic heart failure (CHF) involves interactions between the cardiovascular, neuroendocrine and immune systems. This study investigated the seropositivity rate for anti-Toxoplasma IgG and IgM antibodies by ELISA in patients with CHF. Ninety-seven patients with CHF and 50 healthy volunteers were selected for this investigation. The seropositivity rate for anti-Toxoplasma IgG antibodies among CHF patients (68%) was significantly higher than in healthy volunteers (36%). Thus, parasitological screening of this group of patients should be periodically performed to prevent the possible dissemination of toxoplasmosis.

Cutaneous lupoid leishmaniasis: a case report

Cutaneous leishmaniasis is a disease transmitted by the sandfly. During the course of the disease, all classical stages of the development of leishmaniasis from small erythematous papules to nodules to ulcerative lesions can be seen. We report a case of lupoid leishmaniasis (LL) treated with daily intramuscular injections of meglumine antimoniate for 20 days with marked improvement of clinical features.

[Investigation of intestinal parasites in residents of the Kayseri Karpuzsekisi basin]

In this study, we collected stool and cellophane tape samples from residents in four villages located in the Kayseri-Karpuzsekisi basin in order to investigate the distribution of intestinal parasites. A total of 240 samples collected from Hanyeri (40), Sariküklü (20), Dokuzpinar (80) and Karpuzsekisi (120) were investigated. The parasites detected were as follows: Blastocystis hominis, 82 (34.16%); Enterobius vermicularis, 37 (15.41%); Entamoeba coli 26, (10.83%); Entamoeba hartmanni, 10 (4.16%); Giardia intestinalis, 7 (2.91%); Endolimax nana, 5 (2.08%); Entamoeba histolytica/E. dispar, 4 (1.66%); and Taenia saginata, 1 (0.41%).

[Isospora belli infection in a patient with a renal transplant]

Isospora belli infection is frequent in immunosuppressed patients and can cause wasting diarrhea. We present the first isosporiosis case in a renal transplant recipient from Turkey. The 25-year old male patient who had had a renal transplantation due to renal failure and had received immunosuppressive therapy presented at the hospital complaining of weakness, nausea, vomiting and diarrhea that had lasted for 15 days. Isospora belli oocysts were detected in stool samples by direct microscopy, modified Ziehl-Neelsen staining methods and autofluorescence technique. Oocysts in the stool samples were also sporulated in 2.5% potassium dichromate and the sporulated oocysts were seen microscopically. The patient was treated with co-trimoxazole (trimethoprim 160 mg, sulphamethoxazole 800 mg) every 12 hours for seven days, with elimination of the symptoms at this time. After this, Isospora belli oocysts were no longer seen in stool samples.

Comparison of international index of erectile function with nocturnal penile tumescence and rigidity testing in evaluation of erectile dysfunction

We tried to compare the parameters of nocturnal penile tumescence and rigidity (NPTR) testing with erectile function (EF) domain score of International Index of Erectile Function (IIEF), which is used in diagnosis and determining the severity of erectile dysfunction (ED), and to assess the sufficiency of IIEF in the diagnosis of ED. A total of 90 men, mean age 46 years (24-75), presenting with ED to our clinic between January 2001 and March 2003 were included in the trial. All the men answered the standard IIEF (15 questions) forms and was divided into four groups as mild ED, moderate ED, severe ED and no ED according to the EF domain score that is obtained from 1st, 2nd, 3rd, 4th, 5th and 15th questions. Then NPTR testing with the RigiScan Plus monitoring device was performed for two consecutive nights on those men. The distribution of the six parameters of NPTR testing (number of erections, duration of erections, TAU base, RAU base, TAU tip, RAU tip) among the four groups and the correlation with IIEF-EF domain score were evaluated. Additionally, the distribution of the risk factors (diabetes mellitus, hypertension, atherosclerotic heart disease, dyslipidemia and smoking) was analyzed both among the four groups and in each group. According to IIEF-EF domain scores of 90 patients, 16 (18%) had severe ED, 21 (23%) moderate ED, 41 (46%) mild ED and 12 (13%) no ED. There was no statistically significant difference between the risk factors among the men in these groups (P > 0.05). When the IIEF-EF domain scores were compared with parameters of NPTR testing, no statistically significant difference was obtained among ED groups (mild, moderate, severe) (P > 0.05). However, we observed a statistically significant difference between three ED groups and no ED group (P < 0.05). If NPTR testing is considered as a gold standard test, sensitivity, specificity, positive predictive value and negative predictive value of IIEF-EF domain score in ED diagnosis are 100, 17.9, 29.4 and 100% respectively. In conclusion, we did not observe a clinical correlation between IIEF-EF domain scores and NPTR parameters in the whole population; however, we observed that if IIEF-EF domain scores were normal, NPTR parameters were also normal. In other words, we can say that if the initial IIEF-EF domain scores are normal, then we do not have to perform NPTR testing. This could be helpful to make a cost-effective diagnosis.

Nosocomial Oral Myiasis by Sarcophaga sp. in Turkey

We present a case of oral myiasis in a 15-year-old boy with tuberculosis meningitis. The diagnosis was based on the visual presence of wriggling larvae about 1 cm in size and on the microscopic features of the maggots, especially those relating to stigmatic structures. The larvae were identified as third-stage larvae of Sarcophaga sp.

Effect of penile size on nocturnal erections: evaluation with NPTR testing with men having micropenis

There has been conflicting opinions in the literature regarding sexual function in hypogonadal men with micropenis. In this study we aimed to evaluate erectile function in hypogonadal men with micropenis by nocturnal penile tumescence and rigidity testing (NPTR) and compared the results with young potent normal penile sized men. A total of 15 men (ages 17-30 y) defined having a micropenis with a stretched penile length of less than 9.3 cm were constituted the study group. Mean stretched penile length was 6.8+/-1.6 cm (range 3.6-7.8 cm). Karyotype analysis showed 46XY in all cases. Control group included 22 potent and normal penile sized men (23-29 y). All subjects completed three sessions of consecutive nights using the RigiScan Plus device. Comparison of the results of NPTR of control group with study group revealed that number and duration of erectile episodes (P < 0.001), duration of tip rigidity > 60% (P < 0.01), TAU tip and TAU base (P = 0.001), and RAU base (P = 0.01) were found to be significantly lower in men with micropenis. In conclusion, our study showed that men with micropenis are associated with decreased nocturnal erectile activity.

[Evaluation of the results of IgG avidity testing of Toxoplasma gondii in pregnant women.]

Toxoplasmosis is a parasitic disease caused by a protozoon, Toxoplasma gondii. Infection acquired during pregnancy may cause intrauterine damage and sequelae in the newborn. In this study, IgG-avidity values were investigated in 695 pregnant women who were anti-T. gondii IgG antibody positive and the results obtained were evaluated. It has been found that the IgG of 492 women (70.8%) had high avidity, of 33 (4.7%), low avidity and that of 170 (24.5%) was in an equivocal range. Our results indicated that the IgG-avidity test must be carried out in pregnant women positive for anti-T. gondii IgG even if they are IgM antibody negative.

[Distribution of intestinal parasites among patients who presented at the Department of Parasitology of the Erciyes University Medical School.]

In this study carried out from 2000-2004, a total of 34,883 stool samples were examined using native-Lugol and flotation/sedimentation methods and 9,879 cellophane tape preparations were examined directly. Intestinal parasites were found in 9,704 (27.8%) of the specimens. The parasites that were found and their prevalence is as follows: Blastocystis hominis, 6,723 (19.3%); Entamoeba coli, 1,007 (2.9%); Giardia intestinalis, 892 (2.6%); Entamoeba histolytica/E. dispar, 798 (2.3%); Endolimax nana, 486 (1.4%); Entamoeba hartmanni, 252 (0.7%); Enterobius vermicularis, 242 (0.7%); Iodamoeba bütschlii, 109 (0.3%); Taenia saginata, 92 (0.3%); Chilomastix mesnili, 67 (0.2%); Ascaris lumbricoides, 55 (0.2%); and Hymenolepis nana, 40 (0.1%).

Investigation of anti-Toxoplasma gondii antibodies in patients with neoplasia

This study aimed to determine the prevalence of anti-Toxoplasma gondii antibodies in patients with neoplasia. One hundred and eight patients with neoplasia and 108 healthy controls were studied for the presence of anti-T. gondii antibodies using a micro ELISA and peroxidase-labelled anti-human IgG (rabbit) and IgM (goat). Anti-T. gondii IgG antibodies were detected in 68 (63.0 %) patients and in 21 (19.4 %) of the controls, which was a statistically significant difference. In addition, anti- T. gondii IgM antibodies were detected in seven (6.5 %) patients and in one (0.9 %) control. A high percentage of positivity for Toxoplasma antibodies in patients with neoplasia was detected. Therefore, parasitological surveys of this patient group should be periodically performed.

Effect of aging on quality of nocturnal erections: evaluation with NPTR testing

Nocturnal penile tumescence and rigidity testing (NPTR) has traditionally been performed to distinguish psychogenic from organic impotence. However, considerable lack of uniformly accepted normative data for NPTR readings makes the reproducibility of the method questionable. In this study, we try to evaluate the impact of aging as independent criteria for quality of erectile episodes. A total of 455 patients (ages 20-71 y) whose initial complaints were erectile dysfunction underwent two nights NPTR measurement with Rigiscan device. After analyzing the data, 353 men out of 455 were regarded as having normal NPTR recordings. The number of normal erectile episodes (erectile episode of penile tip rigidity greater than 60% more than 10 min duration), RAU Tip, RAU Base, TAU Tip, TAU Base, Average event rigidity of Tip (%), Average event rigidity of Base (%) and Duration of erectile episodes > or =60% minute were re-evaluated with regard to five age groups (group I: <30 y; group II: 30-39 y; group III: 40-49 y; group IV: 50-59 y; group V: > or =60 y). The mean values of erectile episodes in the age groups were as follows: group I, 2.46; group II, 2.28; group III, 2.40; group IV, 1.58; group V, 1.27. When we analyzed the groups between themselves, we observed statistically significant difference after the age of 50 y. The mean erectile episodes in patients younger than 50 y were 2.37 (s.d.: 1.50), whereas 1.49 (s.d.: 1.15) in patients older than 50 y (P<0.001). We also observed statistically significant difference at all of the above-mentioned NPTR parameters with regard to age. The results of our study showed that aging negatively influence quality of nocturnal erections especially after 50 y and we suggest that age needs to be taken into account in the diagnostic interpretation of NPTR testing.

Behçet's disease presenting as deep venous thrombosis and priapism

Behçet's disease (BD) is a multi-system inflammatory disorder which may involve the vascular system. Currently, it is general practice to use the International Study Group (ISG) criteria for the diagnosis of BD. However, even though vascular involvement may be seen in one-fourth to one-half of BD patients, and occasionally is the presenting and only manifestation of BD, large vessel disease is not included among the ISG criteria. In this report we describe a patient who had deep venous thrombosis and priapism, but who does not fulfill ISG criteria for the diagnosis of BD.

Anti-Toxoplasma gondii antibodies in haemodialysis patients with chronic renal failure

This study aimed to determine the prevalence of anti- Toxoplasma gondii antibodies in haemodialysis patients with chronic renal failure (CRF).

METHODS

One hundred and seventy three haemodialysis patients, and 40 healthy controls, were studied for the prevalence of anti-Toxoplasma gondii antibodies by a micro enzyme-linked immunosorbent assay (ELISA). Anti-T. gondii IgG antibodies were detected in 97 (56.06%) haemodialysis patients and 8 (20%) controls with a statistical significance. In addition, anti-T. gondii IgM antibodies were detected in 1.73% of patients, but none of the controls. In conclusion, a high percentage of positivity for Toxoplasma antibodies in patients with CRF undergoing haemodialysis was noticed, thus parasitological surveys of CRF patients should be periodically performed to prevent the possible dissemination of toxoplasmosis through the dialysis procedure.

Effect of sildenafil on nocturnal erections of potent men

We try to evaluate the effect of sildenafil on nocturnal penile erections of potent men. We recruited 22 potent men (eight medical students and 14 urology residents) 23-29 years old into the study. A disorder-free medical and sexual history and normal erectile functions were the only inclusion criteria. All subjects completed three sessions of consecutive nights using the RigiScan Plus device. After a first night of adaptation, night 2 recordings were their baseline values whereas they received sildenafil 100 mg on night 3. We observed statistically significant improvement with regard to those NPT parameters at the nights with sildenafil: number of erectile episodes; duration of tip rigidity >60%, RAU tip, RAU base and TAU tip (P<0.005). Although the duration of erectile episodes (min) and TAU base were greater during the sildenafil night, these did not reach statistical significance. In conclusion, our study showed that sildenafil can improve nocturnal erectile quality not only in patients with erectile dysfunction as previously published but also in potent males.

Investigation of probable relationship between Toxoplasma gondii and cryptogenic epilepsy

PURPOSE

Cryptogenic epilepsy, defines a group of epilepsy syndromes for which an aetiology is unknown but an underlying brain disease is suspected. We selected patients in this subgroup of epilepsy and investigated the sero-positivity rate for anti-Toxoplasma IgG antibodies by Enzyme Linked Immunosorbent Assay (ELISA). We investigated the probable relationship between Toxoplasma gondii and cryptogenic epilepsy.

METHODS

We selected 50 patients with cryptogenic epilepsy, 50 patients with known cause epilepsy and 50 healthy volunteers and investigated the sero-positivity rate for anti-Toxoplasma IgG antibodies by ELISA.

RESULTS

The sero-positivity rate for anti-Toxoplasma IgG antibodies among cryptogenic epilepsy patients (52%) was found to be higher than healthy volunteers (18%) and known cause epilepsy patients (22%) with statistical significance, (X(2)=18.095, P<0.01).

CONCLUSION

There might be a causal relationship between chronic toxoplasmosis and the aetiology of cryptogenic epilepsy.

Cyclospora cayetanensis associated with diarrhea in a patient with idiopathic compensated hepatic cirrhosis

A 52 year-old male patient with idiopathic hepatic cirrhosis complaining of diarrhea and weakness was accepted to the gastroenterology clinic. In order to find out the causative etiologic agent of diarrhea, stool samples were examined by different methods and stained using modified Kinyoun's acid-fast stain. Following examination, approximately 9 microns diameter, acid-fast variable wrinkled spheres were seen and diagnosed as Cyclospora cayetanensis. Confirmation of the diagnosis was established by fluorescent microscope (380 to 420 nm excitation filter), which showed bright green to intense blue autofluorescent oocysts. It has been shown that, Cyclospora cayetanensis is a coccidian parasite mainly found in immunocompromised patients and that it may be the agent of prolonged diarrhea. Only three cyclosporiosis cases have been previously reported in our country; all three cases were AIDS patients. We report here a further case of Cyclospora cayetanensis infection in a patient with hepatic cirrhosis and we consider that this is the first case, which was reported in hepatic cirrhosis.

Effect of experimental hypercholesterolemia on cavernosal structures

OBJECTIVES

To determine the effect of experimental hypercholesterolemia on the ultrastructure of cavernosal smooth muscle cells, endothelial cells, elastic fibers, and collagen content, which are the key structures fundamental for erection.

METHODS

Forty-two New Zealand white rabbits were divided into a control group (group 1, n = 7, fed a standard diet), a hypercholesterolemia group (group 2, n = 20, fed a diet containing 1% cholesterol for 8 weeks), and a reversibility group (group 3, n = 15, fed a 1% cholesterol diet for 8 weeks, then switched to a standard diet for 4 weeks). Blood samples were obtained for lipid determination before and after the study. The cavernosal tissues were obtained at the end of 8 weeks for groups 1 and 2 and at the end of 12 weeks for group 3 and immunohistochemical examinations of these cells were performed.

RESULTS

Immunohistochemical analysis revealed that hypercholesterolemia produces marked and reversible decreases in the cavernosal content of smooth muscle cells, endothelial cells, and elastic fibers and increases the content of collagen 3 and 4.

CONCLUSIONS

Our findings suggest that hypercholesterolemia in this animal model affects the percentage of staining for smooth muscle actin, endothelial cells, elastin, and collagen 3 and 4. However, since this effect is temporary depending on the blood cholesterol levels, it might not alter the erectile function.

Effect of glycemia status on endocrinological parameters of impotent and infertile patients

OBJECTIVE

To identify the effects of glycemia status on hormone levels, we evaluated the effects of hypo and hyperglycemia on endocrinological parameters of patients with erectile dysfunction, infertility, varicocele and compared the results with control subjects.

MATERIALS AND METHODS

Twenty patients with erectile dysfunction, 20 infertile patients with oligo-azoospermia, 20 patients with normozoospermic left varicocele and 15 healthy control subjects constitute our study population. Plasma follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T) and prolactin (PRL) levels were measured both in patients in hypoglycemia and hyperglycemia status. Statistical analysis were done by Wilcoxon test.

RESULTS

All endocrinological parameters did not show any statistically significant difference between the hypoglycemia and hyperglycemia status. Also, no abnormalities in the endocrinological parameters were observed.

CONCLUSION

We showed that the glycemia status of the patient (either hypo or hyperglycemia) did not effect the results of endocrine profile. Also, endocrine evaluation is unnecessary in impotence and infertility.

Penile epithelioid sarcoma

Epithelioid sarcoma is a rare mesenchymal neoplasm. We had the opportunity to report a case of epithelioid sarcoma of the penis.

Significance of serum FSH levels and testicular morphology in infertile males

OBJECTIVES

To determine the relationship between plasma levels of FSH and testicular spermatogenic patterns.

METHODS

Testicular biopsies were obtained from 99 infertile men. Biopsies were performed either in order to distinguish the type of azoospermia (obstructive/non-obstructive) or because of severely subnormal semen variables. Serum FSH was measured by immunoassay (normal range is less than 7 mIU/ml).

RESULTS

Statistically significant difference was detected between patients with Sertoli cell only syndrome and normal spermatogenesis, hypospermatogenesis and maturation arrest (p<0.01, p<0.01, p<0.05, respectively). No statistically significant differences were found between normal spermatogenesis, hypospermatogenesis and maturation arrest.

CONCLUSION

Our study revealed that elevation of serum FSH correlates only with the appearance of Sertoli cell only syndrome. We think that azoospermic or severely oligoasthenoteratozoospermic patients with highly elevated plasma FSH levels (three times the normal) could be excluded from separate testicular biopsy, because these patients are not suitable for conventional treatments. If he is willing to undergo an IVF program the sperm will often be present, no matter what the testicular histology is to be used for assisted reproductive techniques, particularly ICSI.

Effect of microsurgical subinguinal varicocele ligation to treat pain

OBJECTIVES

The traditional treatment for a painful varicocele consists of conservative measures followed by varicocelectomy. We report our results with microsurgical subinguinal varicocele ligation to treat pain.

METHODS

From 1996 to 1999, a total of 119 men underwent subinguinal microsurgical varicocele ligation for painful varicocele. The diagnosis of varicocele was based on the findings of both physical examination and color Doppler ultrasound. Patients described pain with testicular discomfort as scrotal heaviness or a dull ache. While waiting for the operation (range 3 to 5 weeks), all the patients underwent a preoperative trial of conservative management for pain.

RESULTS

Of 119 men, 82 (69 %) were available for follow-up 3 months postoperatively. Of those 82 patients, 72 (88%) reported complete resolution of pain, 4 patients (5%) partial resolution, 5 patients (6%) no change, and 1 patient (1%) epididymal discomfort that resolved with conservative measures. Of the 9 patients with partial or no change, 2 patients had reflux recurrence as seen on color Doppler ultrasound.

CONCLUSIONS

Subinguinal microsurgical varicocele ligation is an effective treatment for painful varicocele when performed in selected patients.

The prognostic value of peripheral blood lymphocyte subsets in patients with bladder carcinoma treated using neoadjuvant M-VEC chemotherapy

OBJECTIVES

To assess the prognostic value of peripheral blood lymphocyte subsets in patients with bladder cancer who were treated with neoadjuvant chemotherapy.

PATIENTS, SUBJECTS AND METHODS

Thirty patients with a histological diagnosis of invasive bladder transitional cell carcinoma and 30 age-matched controls with no evidence of cancer and immunological disorders were evaluated. Peripheral blood samples were assessed in both groups using monoclonal antibodies. Patients with bladder cancer who achieved complete or partial responses and those who had progression of the disease after systemic chemotherapy with methotrexate, vinblastine, epirubicin and cisplatin were compared according to the pretreatment values of the peripheral blood lymphocyte subsets.

RESULTS

There were no significant differences in B lymphocyte levels between the groups. In patients with bladder cancer, the percentages of T lymphocytes (P<0.01), natural killer (NK) cells (P<0.05) and the CD4+/CD8+ ratio (P<0.05) were significantly lower than in the control group. In patients who responded to the chemotherapy regimen, the pretreatment values of T lymphocytes (P<0.001), the CD4+/CD8+ ratio (P<0.01) and NK cell levels (P<0.01) were significantly higher than in the patients who did not.

CONCLUSION

In patients with invasive bladder carcinoma, cell-mediated immunity may have a role in the resistance to this malignancy and in these patients the pretreatment levels of T lymphocyte subsets may be an indicator of the potential response to chemotherapy.

Spinal subarachnoid hemorrhage attributable to schwannoma of the cauda equina

BACKGROUND

Cauda equina syndrome occurring as a result of spontaneous spinal subarachnoid hemorrhage (SAH) from a spinal tumor is reported to be rare.

CASE DESCRIPTION

A 28-year-old woman presented at our clinic with a history of severe back pain for 10 days, progressive paraparesis, and urinary retention. Her physical examination revealed a mass located intradurally at the level of L1-2 and a massive SAH. An L1-L2, laminectomy and a hemilaminectomy from D9 to D12 were performed and the SAH was evacuated and the cord was decompressed.

CONCLUSION

At the first year follow-up, her restricted dorsal and plantar flexion continued. Post-gadolinium magnetic resonance imaging revealed no mass.

Transmurally absorbed intravesical chemotherapy with dimethylsulfoxide in an animal model

BACKGROUND

The purpose of the present study was to investigate the hypothesis that dimethylsulfoxide (DMSO) enhances the absorbtion of the intravesical chemotherapeutics.

METHODS

Fifty male Wistar rats received 1.5 mg N-methyl-N-nitrosourea (MNU) intravesically every other week (weeks 0, 2, 4, 6 and 8) for a total of five doses. After week 14, rats underwent intravesical installation of either epirubicin (1 mg) or epirubicin + DMSO (50%) every other week (weeks 14, 16, 18, 20 and 22). The absorbtion of epirubicin was estimated histologically by observing its fluorescence in the bladder.

RESULTS

We observed papiller and/or hyperplastic formations in rat bladders (10/50 rats) due to installation of MNU. Epirubicin fluorescence was observed in the entire bladder wall of normal or hyperplastic regions in rats that were given DMSO prior to epirubicin. However, epirubicin was observed only in normal-appearing mucosa or in superficial layers of hyperplastic regions.

CONCLUSIONS

The concomittant addition of DMSO with intravesical epirubicin enhances the absorbtion of epirubicin to the entire bladder wall. In this way, epirubicin cytotoxicity and antitumor activity can be potentiated. This can be useful for both the treatment of superficial bladder cancer (especially in local recurrence and progression) and invasive bladder cancer (especially in regional chemotherapy).

Analysis of the peripheral blood lymphocyte subsets in patients with bladder carcinoma

OBJECTIVES

To evaluate the immune system of patients with bladder transitional cell carcinoma (TCC) by using peripheral blood lymphocyte subsets and to further compare the relationship between these subsets with respect to tumor stage and grade (superficial versus invasive and low versus high grade).

METHODS

Thirty patients with superficial TCC of the bladder, 30 patients with invasive TCC of the bladder, and 30 age- and sex-matched control subjects without any malignancy or immunologic abnormality were included in this study. The peripheral blood lymphocyte subset analysis was performed in all patients before any treatment was performed.

RESULTS

All lymphocyte subset values of patients with invasive bladder cancer, except B cell value, were significantly lower (P < 0.01) than the values of the control group. There were no significant differences between the lymphocyte subset values of patients with superficial bladder cancer and those of control subjects. The comparison of the lymphocyte subset values of the patients with superficial versus invasive bladder carcinoma revealed that in patients with invasive bladder carcinoma, the numbers of T and natural killer (NK) cells were significantly lower (P < 0.05) than those of patients with superficial bladder carcinoma. Patients with high-grade tumors had significantly fewer (P < 0.05) T and NK cells than patients with low-grade tumors.

CONCLUSIONS

Our results indicate that analysis of mean NK and T cell values and the mean ratio of CD4+/CD8+ cells in peripheral blood might be a useful adjunct for the clinical evaluation of patients with bladder cancer.

Clinical experience with Dynaflex penile prostheses in 120 patients

OBJECTIVES

To present our experience with the Dynaflex (American Medical Systems) self-contained inflatable penile prosthesis and define specific complication and patient dissatisfaction rates.

METHODS

From May 1990 through January 1998, 120 men underwent implantation of a Dynaflex prosthesis. The follow-up period ranged from 2 to 80 months (mean 42).

RESULTS

Specific complication rates observed after penile prosthesis implantation were as follows: prosthetic infection, 4.16%; mechanical device failure, 7.5%; and patient dissatisfaction because of inability to work the pump, 16.66%. After intensive teaching, the patient dissatisfaction rate dropped to 0.83%. The overall complication rate was 14.15%.

CONCLUSIONS

With several types of penile prostheses available, Dynaflex can be regarded as an appropriate alternative with a relatively low mechanical failure rate. However, careful preoperative assessment and patient education in the use of the pump mechanism are essential to obtain a successful result.

Is deep dorsal vein arterialization an alternative surgical approach to treat venogenic impotence?

OBJECTIVE

Several surgical techniques have been applied for the treatment of cavernosal venous leakage, sufficient enough to create erectile dysfunction. In light of the variable success rates, we report our experience with deep dorsal penile vein arterialization for the management of severe cavernosal venous leakage.

PATIENTS AND METHODS

Twenty-four impotent patients with venous leakage were treated by the Virag-II type of end-to-end anastomosis of the inferior epigastric artery to the deep dorsal penile vein and ligation of the vein proximally. Diagnostic evaluation included color flow Doppler sonography before and after intracavernous 60 mg papaverine injection and dynamic cavernosometry/ cavernosography, which indicated veno-occlusive dysfunction in 28 patients. Revascularization was technically possible in 24 of the patients, although in 4 anastomosis could not be achieved due to the poor quality of the inferior epigastric artery.

RESULTS

Five patients had early occlusion in the immediate postoperative period and 4 had late occlusion within 8 months. Potency was improved initially in 9 (38%) of the 24 patients in whom successful anastomosis had been achieved, with longer term improvement in 6 (25%) of 24 who realized restoration of erectile potency as defined by clinical investigations. The mean follow-up was 24 months (range 3-36 months).

CONCLUSION

We believe that anastomosis of the inferior epigastric artery to the deep dorsal penile vein and ligation of the vein proximally in cases of venous leakage results in a low success rate due probably to a pancavernosal alteration in corporal tissue compliance.

Carcinosarcoma of the prostate. A case report and a possible evidence on the role of hormonal therapy

A case of prostatic carcinosarcoma is presented with histopathologic and immunohistochemical characteristics. A 70-year-old man presented with a history of anti-androgen (cyproterone acetate) therapy for prostatic adenocarcinoma. Diffuse and strong staining for progesterone receptor was observed in the carcinosarcoma specimen although it was completely negative in the previous adenocarcinoma specimen. It may be speculated that hormonal therapy might have facilitated the selection of a progesterone-dependent subclone of tumor cells with the ability of mesenchymal differentiation and that genetic instability due to p53 inactivation might have played a role in this process.