Evaluation of Intestinal Microbiota in Children With Sickle Cell Disease

BACKGROUND AND AIMS

Sickle cell disease (SCD) is a chronic hemolytic anemia that may be life-threatening due to multisystemic effects. Identification of the factors which affect the pathophysiology of the disease is important in reducing mortality and morbidity. This study aimed to determine gut microbial diversity in children and adolescents with SCA compared with healthy volunteers and to evaluate the clinical impact of microbiota.

MATERIALS AND METHODS

The study included 34 children and young adolescents with SCD and 41 healthy volunteer participants. The microbiome was assessed by 16S rRNA sequencing in stool samples. Laboratory parameters of all participants, such as complete blood count and C-reactive protein values and clinical characteristics of SCD patients, were determined and compared, as well as clinical conditions of the patients, such as vascular occlusive crisis and/or acute chest syndrome, frequency of transfusions, intake of penicillin, hydroxyurea, and chelation therapy were recorded.

RESULTS

White blood cell count, hemoglobin, immature granulocyte and C-reactive protein levels were significantly higher in the patient group ( P <0.05). Microbiota analysis revealed 3 different clusters among subjects; controls and 2 clusters in the SCD patients (patient G1 and G2 groups). Bacteroides spp. were more prevalent, while Dialester spp. and Prevotella spp. were less prevalent in SCD compared with controls ( t =2.142, P <0.05). Patient G2 (n=9) had a higher prevalence of Bacteroides and a lower prevalence of Prevotella than patient G1 (n=25).

CONCLUSION

In our study, there was a difference between SCD patients and the control group, while 2 different microbiota profiles were encountered in SCD patients. This difference between the microbiota of the patients was not found to affect the clinical picture (such as vascular occlusive crisis, acute chest syndrome).

Coronaviruses and SARS-COV-2

Coronaviruses (CoVs) cause a broad spectrum of diseases in domestic and wild animals, poultry, and rodents, ranging from mild to severe enteric, respiratory, and systemic disease, and also cause the common cold or pneumonia in humans. Seven coronavirus species are known to cause human infection, 4 of which, HCoV 229E, HCoV NL63, HCoV HKU1 and HCoV OC43, typically cause cold symptoms in immunocompetent individuals. The others namely SARS-CoV (severe acute respiratory syndrome coronavirus), MERS-CoV (Middle East respiratory syndrome coronavirus) were zoonotic in origin and cause severe respiratory illness and fatalities. On 31 December 2019, the existence of patients with pneumonia of an unknown aetiology was reported to WHO by the national authorities in China. This virus was officially identified by the coronavirus study group as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the present outbreak of a coronavirus-associated acute respiratory disease was labelled coronavirus disease 19 (COVID-19). COVID-19’s first cases were seen in Turkey on March 10, 2020 and was number 47,029 cases and 1006 deaths after 1 month. Infections with SARS-CoV-2 are now widespread, and as of 10 April 2020, 1,727,602 cases have been confirmed in more than 210 countries, with 105,728 deaths.

Cytomegalovirus and Epstein-Barr virus reactivation in the intensive care unit

AIM

The purpose of this work was to evaluate the reactivation of cytomegalovirus (CMV) and Epstein-Barr virus (EBV) in immunocompetent patients in the intensive care unit (ICU) and to identify risk factors associated with reactivation.

MATERIALS AND METHODS

In this observational prospective study, 60 adult immunocompetent patients who stayed at least 7 days in an ICU were evaluated. During hospitalization, the viral load was monitored at admission and on day 7 with polymerase chain reaction to detect viral reactivation and weekly thereafter on days 14, 21, and 28 if hospitalization continued.

RESULTS

The mean age of patients was 63.3 years (±23.4 years) and 34 (56.7 %) of them were male. Mean APACHE II scores for patients was 25 at admission. Of these patients, 28 were hospitalized in the internal ICU and 32 were hospitalized in the anesthesiology ICU. CMV/EBV reactivation was found in 17 individuals (12 for EBV, 3 for CMV, and 2 for both). The median high-sensitive C-reactive protein value in patients with CMV reactivation was significantly higher than in those patients without CMV reactivation (p = 0.037). EBV reactivation was statistically higher in patients with mechanical ventilation compared to patients without mechanical ventilation (p = 0.023). EBV reactivation in patients with fever was found to be statistically higher than in the patients without fever (p = 0.035).

CONCLUSION

There is a need for extended studies with a larger number of patients from specific groups to better understand the reactivation frequency and identify risk factors. EBV and CMV reactivation should be taken into consideration in critically ill patients with fever, without specific symptoms and unresponsive to the treatment.

The prevalence of tularemia in occupational groups that have contact with animals

BACKGROUND/AIM

The aim of the current study was to investigate the presence of antibodies against Francisella tularensis in individuals in different occupations that have contact with animals in the Kars region of northeastern Turkey.

MATERIALS AND METHODS

A total of 201 blood samples specifically including 103 farmers, 45 clinical veterinarians, 42 butchers, and 11 hunters were analyzed. The results of the study were reported in relation to some sociodemographic features (age, sex, occupation, and experience) of the volunteers. The presence of antibodies was determined by a microagglutination (MA) test. In addition, positive sera were confirmed using an ELISA kit.

RESULTS

Fifteen (7.46%) individuals, including fourteen farmers and one clinical veterinarian, were found to be positive for F. tularensis by both MA and ELISA with a titer range of 1/10 to 1/160. The highest seroprevalence rate was observed in farmers (13.59%), followed by clinical veterinarians (2.22%). The occurrence of tularemia was found to increase with age.

CONCLUSION

Though the main route of tularemia outbreaks is water-borne in Turkey, it was determined that people whose occupations bring them into contact with animals are at risk. Similar studies are recommended in order to further clarify the epidemiology of the disease in the northeast of Turkey.

[Tularemia is spreading from north to south side of Turkey: a small outbreak in Kahramanmaras, Turkey]

Tularemia is a zoonotic disease caused by Francisella tularensis. Sporadic tularemia cases have been increasingly reported particularly from provinces located at northwest and central regions of Turkey especially during last two decades, as well as waterborne outbreaks reported from almost all regions. Transmission most often occurs through consumption of contaminated water and food, thus, oropharyngeal form is the most common clinical presentation in our country. The aim of this study was to present a small outbreak experience in Afsin, country of Kahramanmaras province located at southern part of Turkey. A total of 10 patients (5 male, 5 female; age range 2-68 years; mean age 25 years) who were admitted to Afsin State Hospital with the complaints of swollen neck between 21 October 2013-22 January 2014, were evaluated considering their clinical findings and treatment outcomes. Following the diagnosis of the first tularemia case coming from Nadir village, a field investigation was performed. All villagers were informed about the disease and water samples from the possible sources of outbreak were collected by provincial health authorities. Lymph node aspirate and serum samples were sent for culture and serologic investigation and the environmental water samples were sent for molecular analysis to the National Tularemia Reference Laboratory at Public Health Institution of Turkey. Six out of 10 patients' sera were found positive in terms of F.tularensis antibodies between the titers of 1/320-1/1280 by microagglutination test (MAT) and diagnosis of oropharyngeal tularemia was based on the clinical and serological findings. One of the patients also presented with oculoglandular form accompanying oropharyngeal form. Cultures from aspirate samples that could be obtained from only two patients yielded negative results. Three out of six patients' lymph nodes were drained surgically and one was drained by ultrasound-guided needle. In one case lymph node suppuration occured spontaneously during examination. Three of the patients were treated with streptomycin, two with ciprofloxacin and one with doxycycline. Although no polymerase chain reaction positivities in terms of F.tularensis were detected in the water samples, the outbreak was thought to be waterborne since the hygienic conditions of the water sources were inadequate and the chlorination procedures were inappropriate. In conclusion, the detection of the first case of tularemia and the following small outbreak in Kahramanmaras region, emphasized that the disease has had a spreading trend from the endemic northern Anatolia to nonendemic southern provinces of Turkey.

Gram-Negative Bacterial Resistance to Cephalosporins in Community-Acquired Infections in Turkey

Cephalosporins are widely used and trustworthy antibiotics in daily medical practice. Although antibacterial resistance has been reported in hospital wards, there are less data for community-acquired infections. In this study we investigated the cephalosporin susceptibility profiles of community-acquired Gram-negative bacteria isolates in Sivas Kizilay Medical Center (Turkey) between March 2002 and March 2003. In our study, 949 Escherichia coli, 165 Proteus spp., 97 Enterobacter spp., 24 Klebsiella spp and 84 Pseudomonas aeruginosa strains were evaluated. Cefepime seemed to be the most effective antibiotic against our community-acquired Gram-negative isolates. Resistance to this drug was 19.3% for P. aeruginosa and around 0-10.6% for enteric bacteria. Enteric pathogen resistance ranged between 44.3-100% for cefazolin, 25-51.9% for cefuroxime, 4.8-25.3% for ceftriaxone, 5.4-14.5% for ceftazidime. Resistance in enteric pathogens to gentamicin ranged between 5.8-15.4%, to amikacin between 3.8-6.25%, to ciprofloxacin between 6.7-20%. 8.1% of P. aeruginosa were resistant to ciprofloxacin. With these profiles the aminoglycosides and ciprofloxacin resemble highly effective cephalosporins like cefepime. On the contrary, first- and second-generation cephalosporins, trimethoprim-sulfamethoxazole, ampicillin and ampicillin-sulbactam are no longer used in probable Gram-negative bacterial infections in our region. Since treatment based on cephalosporins was less efficacious than expected in community-acquired infections, urgent measures are needed to limit antibacterial resistance outside of hospitals.

Francisella tularensis bacteremia: report of two cases and review of the literature

Isolation of Francisella tularensis in blood culture is exceedingly rare and has been reported infrequently in Europe; a literature review showed 28 documented cases. Herein we report the first cases of bacteremic F.tularensis pneumonia in immunocompetent individuals in Turkey.

In vitro susceptibility of isolates of Francisella tularensis from Turkey

BACKGROUND

Tularemia is an infection caused by Francisella tularensis, which has a wide distribution in the northern hemisphere and diverse clinical manifestations. For decades, the drug of choice for the treatment of tularemia has been streptomycin, with tetracycline and chloramphenicol being used as alternatives. The purpose of the present study was to determine the in vitro antimicrobial susceptibility of a large panel of geographically diverse F. tularensis isolates from Turkey against traditional and newer antimicrobial agents.

METHODS

The antibiotic susceptibilities of 250 F. tularensis strains were examined using the Epsilometer test for 9 antimicrobial agents. Each isolate was identified by conventional and molecular techniques.

RESULTS

All the strains were confirmed biochemically and using a combination of species- and subspecies-specific polymerase chain reaction (PCR) assays to be F. tularensis subsp. holarctica. One isolate was assigned to F. tularensis subsp. holarctica biovar japonica based on erythromycin susceptibility, an ability to ferment glycerol, and the nucleotide sequence of the region of difference 1 (RD1). All strains were susceptible to aminoglycosides (streptomycin and gentamicin), tetracyclines (tetracycline and doxycycline), chloramphenicol, 2 fluoroquinolones (ciprofloxacin and levofloxacin), and rifampicin. In addition, all isolates except 1 had a minimal inhibitory concentration (MIC) for erythromycin of > 256 μg/ml.

CONCLUSIONS

Since the fluoroquinolones showed the lowest MIC values and have advantages such as excellent bioavailability and activity, availability of oral formulations, and lower toxicities, they represent candidate therapeutic options in the first-line treatment of tularemia. To the best of our knowledge, this is the first report of the presence of F. tularensis subsp. holarctica biovar japonica outside Japan.

Tularemia during pregnancy: report of four cases

Tularemia during pregnancy is exceedingly rare and has been reported infrequently in Europe. A review of the literature identified only 3 documented cases. Herein we report 4 tularemia cases occurring early in the second and third trimesters, which were successfully managed without any adverse pregnancy outcomes.

Asymptomatic Brucella bacteraemia and isolation of Brucella melitensis biovar 3 from human breast milk

Brucellosis is a zoonotic disease and virtually all infections derived from exposure to animals or ingestion of unpasteurized dairy products. Brucellosis among family members has been reported. However, screening household members of an index case of acute brucellosis is not a routine procedure. A 10-y-old boy was diagnosed with acute brucellosis. Unpasteurized goat cheese commonly consumed within the family was thought to be the possible source of the bacteria. The family (parents, sister and brother) was screened with physical examination, serum tube agglutination test, blood cultures and routine laboratory tests. Three additional cases (parents and sister) of serological and culture proven brucellosis were detected. Two of them (mother and sister) were asymptomatic and had no clinical findings. Brucella melitensis biovar 3 was isolated from breast milk culture and from all blood cultures of 4 brucellosis cases. In conclusion, brucellosis, even with bacteraemia, can be completely asymptomatic. Consumption of raw milk products by household members is a common risk factor for brucellosis outbreak among family members. Thus, screening household members of an index case of brucellosis can expose new brucellosis cases.

[Investigation of Leishmania infantum seropositivity in HIV/AIDS patients]

In recent years an increase in the rate of detection of HIV and Leishmania co-infections has been reported from many countries especially countries in Southern Europe. Visceral leishmaniasis (VL) is sporadically detected in some parts of Turkey. Although the natural transmission is via sandfly bites, VL may be transmitted by needle sharing of intravenous drug addicts or by blood transfusion in HIV/AIDS patients. The aim of this study was to investigate the presence of specific antibodies against Leishmania infantum, which is the causative agent of VL, in the sera of HIV/AIDS patients. A total of 79 HIV/AIDS patients (61 male, 18 female; mean age: 30 +/- 2 years) with confirmed diagnosis by HIV Reference Laboratory of Refik Saydam Hygiene Center between the years of 2004-2006, were included in the study. L. infantum antibodies were searched by fast agglutination screening test (FAST), direct agglutination test (DAT), indirect immunofluorescent antibody test (IFAT) and rK39 dipstick assay. Only one serum sample (1.2%) was found to be seropositive by all of the serological tests (> 1/100 by FAST, 1/3200 by DAT, 1/256 by IFAT, and specific bands for L. infantum by rK39 dipstick test), while the remaining samples were negative with all of the methods. The seropositive serum was from a 49 years-old heterosexual male, living on the Mediterranean cost and has had acquired the HIV infection by sexual contact. He has no history of intravenous drug use but he had experienced blood transfusion. Since the seropositive serum sample was collected 2-3 weeks after the transfusion, the transmission of L. infantum was thought to be during blood transfusion, however it could also be acquired via a previous sandfly bite. In conclusion although the rate of L. infantum seropositivity was low in HIV/AIDS patients in our study, the possibility of HIV/Leishmania co-infections should be considered.

Investigation of Toxoplasma gondii antibodies in sport horses bred in Ankara province

The aim of this study was to determine the seroprevalence of Toxoplasma gondii in horses bred for sportive purposes in the province of Ankara. Sera collected from a total of 100 clinically healthy horses were tested for the presence of anti-Toxoplasma gondii antibodies using the Sabin-Feldman dye test and a seropositivity of 28% was found. The distribution of seropositivity among dilutions showed that 23 samples were positive at a dilution of 1:16 (82.1%), and 5 samples, positive at 1:64 (17.8%).

[Investigation of the seropositivity of Toxoplasma gondii (Nicolle and Manceaux, 1908) in layer hens by the Sabin-Feldman Dye Test in the region of Konya]

This study was carried out on layer hens in the region of Konya between December 2004 and March 2005. During this period, blood samples were collected from a total of 287 layer hens and the sera were separated by centrifugation at 4000 rpm for 10 minutes. All the sera were investigated with the Sabin-Feldman Dye Test for Toxoplasma gondii specific antibodies. The rate of seropositivity for Toxoplasma gondii was found to be 0.34%.

[The investigation of the seroprevalence of cystic echinococcosis in veterinary surgeons]

In Turkey where agriculture is a major industry, cystic echinococcosis is a serious public health problem which also has a significant impact on the country's economy. In this case, echinococcosis seroprevalence among veterinary surgeons was tested using the enzyme linked immunosorbent assay (ELISA) and indirect hemagglutination (IHA) methods and the samples tested positive were subjected to a further verification test using the western blot (WB) method. While sera from 2 out of 93 veterinary surgeons (2.15%) were found to be positive for Echinococcus-IgG antibody using the ELISA method, the optic density values of the two sera were found to be very close to the limits. All of the sera were found to be seronegative for Echinococcus-IgG antibody using the IHA method. Further verification using the WB method was used for confirmation of the 2 (2.15%) sera positive with ELISA, one of the sera tested positive for IgG and the other was at the limit.

[Short communication: investigation of Toxoplasma gondii antibodies in blood donors by Sabin-Feldman Dye Test]

In this study, a serological survey of Toxoplasma gondii infection in healthy blood donors admitted to Blood Center of Ministry of Health, Ankara Training and Research Hospital was carried out. Sera from 390 male and 24 female (ages between 18-59 years) were evaluated by using Sabin Feldman Dye Test (SFDT). Of 414 donors 176 (42.5%) were found positive for T. gondii antibodies. Among the seropositive cases, 106 (25.6%) had 1/16, 40 (9.7%) had 1/64, 28 (6.8%) had 1/256, and two (0.5%) had 1/1024 SFDT titers. The seropositivity rates for females and males were found as 62.5% and 41.3%, respectively, and there was no statistically significant difference (p=0.053). A statistically significant increase was detected in the seropositivity rates with age, 39% being under the age of 40 (18-39 years), 54% over the age of 40 (p<0.01). In conclusion, although it is not necessary to screen the blood donors routinely for T. gondii antibodies, if the transfusion of cellular blood components is planned for immunosuppresive recipients, then those bloods should be tested for T. gondii antibodies.

Zoonotic infections among veterinarians in Turkey: Crimean-Congo hemorrhagic fever and beyond

OBJECTIVES

We aimed to determine the seroprevalence of Crimean-Congo hemorrhagic fever (CCHF) virus, Brucella spp, and Coxiella burnetii among veterinarians in a highly endemic and a non-endemic region for these infections in Turkey.

METHODS

The antibody levels against these three infections were surveyed. Eighty-three veterinarians were included from two distinct geographic regions.

RESULTS

CCHF IgG positivity (3% vs. 0%) and Brucella agglutination titer of > or =1/160 (33% vs. 5%) were more common in the endemic region, whereas the rates of Coxiella burnetii antibodies were similar (7% and 8%). A history of tick bite was significantly more common in the endemic region (35% vs. 12%, p=0.011). A multivariate analysis was performed among the veterinarians living in the endemic area, and percutaneous injuries were found to be associated with Brucella infection (OR 1.8, CI 1.09-3, p=0.022).

CONCLUSIONS

Veterinarians should protect themselves against tick bites, and should use masks to prevent transmission by inhalation of zoonotic infections in endemic countries.

Pulmonary protective effects of hyberbaric oxygen and N-acetylcysteine treatment in necrotizing pancreatitis

The purpose of this study is to analyze the protective effect of combining N-acetylcysteine (NAC) and hyberbaric oxygen (HBO) treatment in the lung tissue during acute pancreatitis. Sixty Sprague-Dawley male rats were randomly divided into five groups; Group I; Control group (n=12), Group II; pancreatitis group (n=12), Group III; pancreatitis + NAC treatment group (n=12), Group IV; pancreatitis + HBO treatment group (n=12), Group V; pancreatitis + HBO + NAC treatment group (n=12). HBO was applied postoperatively for 5 days, twice a day at 2.5 fold absolute atmospheric pressure for 90 min. Lung tissue was obtained for measuring malondialdehyde (MDA), superoxide dismutase (Cu/Zn-SOD) and glutathione peroxidase (GSH-Px) levels along with histopathological tissue examinations. This study showed that all three treated groups (HBO alone, NAC alone and combined HBO+NAC treatment) had pulmonary protective effects during acute necrotizing pancreatitis.

Identification ofBrucella species isolated from proven brucellosis patients in Izmir, Turkey

In many parts of the world, brucellosis has significantly decreased, but it is still a problem in some regions of Turkey. Totally, 11 Brucella strains isolated from the blood cultures of patients with presumptive diagnosis of brucellosis were identified to species and biovar level. For species identification, (i) CO2 requirements of isolates; (ii) detection of urease activation; (iii) detection of H2S production; (iv) dye sensitivities (thionine and basic fuchsin); (v) susceptibility to Brucella phage and (vi) agglutination with monospecific antisera (A and M) were performed. Ten out of 11 isolates were identified as B. melitensis biovar 3 and one out of 11 were identified as B. melitensis biovar 1. The sensitivity of isolates to antibiotics was determined by the E-test. All isolates were found to be sensitive to doxycycline, rifampin, ciprofloxacin and cephtriaxone. Only one out of 11 isolates was found to be semi-sensitive to trimethoprim/sulfamethoxazole (cotrimoxazole).

Seroepidemiology of leptospirosis, toxoplasmosis, and leishmaniosis among dogs in Ankara, Turkey

Seroprevalence of five different Leptospira interrogans serovars, Toxoplasma gondii and Leishmania infantum in stray dogs in Ankara was investigated. A total of 116 dog sera collected from apparently healthy stray dogs were tested for L. interrogans serovars by microscopic agglutination test (MAT), for T. gondii antibodies by Sabin-Feldman dye test (SFDT), and for L. infantum antibodies by indirect fluorescence antibody test (IFAT). Of the 116 dogs, 51 (43.96%) were seropositive for leptospirosis, 72 (62.06%) for T. gondii and 3 (2.58%) for L. infantum. No statistically significant difference was observed between male and female dogs in the seroprevalences of toxoplasmosis and leptospirosis (P>0.05), but statistically significant difference was observed among different age groups in the seroprevalences of toxoplasmosis and leptospirosis (P<0.05). Although the seroprevalence of L. infantum was low, asymptomatic animals should be considered as a reservoir for the spread of the disease.

Characteristics of B. melitensis versus B. abortus bacteraemias

OBJECTIVE

To determine the epidemiological and the clinical characteristics of bacteremic brucellosis.

METHODS

A prospective study, performed in the First Infectious Diseases Clinic of Ankara Numune Education and Research Hospital. All the patients had positive culture result for Brucella spp.

RESULTS

Fifty-four acute bacteremic brucellosis cases were included. The majority of patients (76%) were from rural Anatolia. Brucella melitensis serotypes were more common than Brucella abortus (83% versus 17%). Fever and arthralgia were the most common symptoms. The number of patients with back pain and arthralgia was higher in B. abortus infected group (p = 0.014 and p = 0.009).

CONCLUSIONS

B. melitensis is the most common subtype of Brucella infection in Turkey. The infections with B. abortus spp. are not less severe than the infections with B. melitensis.

Venlafaxine extended release for the treatment of patients with premature ejaculation: a pilot, single-blind, placebo-controlled, fixed-dose crossover study on short-term administration of an antidepressant drug

In this study, we aimed at evaluating the efficacy and safety of venlafaxine extended release 75 mg, a serotonin and noradrenaline reuptake inhibitor, in the treatment of patients with premature ejaculation. Thirty-one patients with intravaginal ejaculation latency of less than 2 min received venlafaxine XR (75 mg/day) or placebo during a 2-week period for each agent with a washout period of 1 week between agents. Efficacy was assessed for each agent with changes in ejaculation latency measured with a stopwatch and sexual satisfaction scores of patients and partners. Side-effects, pre- and post-treatment levels of biochemical and spermiogram parameters, follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin and total testosterone were recorded for each agent. Statistical analysis was performed on 21 patients. After 2 weeks of treatment with placebo and venlafaxine, ejaculation latency time was significantly increased from 60.1 +/- 39.1 to 126.9 +/- 98.3 sec and to 178.1 +/- 122.8 sec, respectively (p < 0.0001 for each one). However, the difference between the two agents was insignificant (p = 0.144). Venlafaxine and placebo increased sexual satisfaction scores of both patients and partners similarly, no statistically significant difference was found between them in this respect. The incidence of side-effects with venlafaxine was indifferent than that of placebo (p > 0.1) except nausea (p = 0.035). Both agents did not change the blood and spermiogram parameters significantly, except FSH increases. Short-term use of venlafaxine XR 75 mg has only a placebo effect on ejaculation latency and sexual satisfaction scores, therefore, is not appropriate for the patients with premature ejaculation. Further dose-time studies are required to draw final conclusions on the inefficacy of this drug in premature ejaculation.

Detection of Toxoplasmosis gondii seropositivity in sheep in Yalova by Sabin Feldman Dye Test and Latex Agglutination Test

Sera collected from 63 sheep older than one year of age in two regions of Yalova were tested for anti- Toxoplasma gondii antibodies using the Sabin-Feldman Dye Test (SFDT) and Latex Agglutination Test (LAT). Of the 63 samples tested, 42 (66.66%) and 41 (65.08 %) were determined to be seropositive by SFDT and by LAT, respectively. Of the positive sheep serum samples, 23 were positive at a dilution of 1/16; 13, at a dilution of 1/64; and 6, at a dilution of 1/256. SFDT was accepted as a reference test. The sensitivity and specificity of LAT were 78.57% and 61.90 %, respectively. The correlation between these two tests was determined to be 73.01%.

Evaluation of flow hemodynamics by color-Doppler following two different brachial arterial repair techniques

OBJECTIVES

We compared the clinical and hemodynamic results following surgical repair of traumatic brachial artery injury using two different techniques micro- and macrovascular repair.

MATERIALS AND METHODS

This was a retrospective study of 27 patients who had sustained penetrating, clean cut injuries of the brachial artery. Macrovascular techniques and a saphenous vein graft was used in 13 patients, while 14 patients were treated by primary microsurgical technique. Postoperatively, patients were followed for a mean of 26 months. All patients had color Doppler examination of the brachial artery, digital artery pressures and transcutaneous oxygen saturation determined.

RESULTS

Clinical results based on distal pulses, Allens test and digital pressures were similar in the two groups. Color Doppler showed 8/13 anastomotic stenoses in macrovascular vein grafted repairs and 2/14 in microvascular repairs (p<0.05). The ratio of flow velocity proximal compared distal to the injury was significantly decreased in patients who had macrovascular repairs.

CONCLUSION

Using ratio between proximal and distal site of anastomosis maximal peak systolic velocity as a objective color Doppler parameter, we were able to demonstrate differences in the hemodynamic status following macrovascular repair with vein grafts and microvascular primary repair. The results emphasize the importance of using a standard repair technique for similar injuries rather than the preference of the surgeon.

[A seroprevalence study of Coxiella burnetii in Antalya, Diyarbakir and Samsun provinces]

The aim of this study was to demonstrate the presence of Q fever infection in three selected provinces, located in South Anatolia, Southeast Anatolia and Black Sea regions of Turkey. Specimens of 339 healthy subjects (114 from Antalya, 116 from Diyarbakir, and 109 from Samsun) were randomly selected from serum samples that are stored in National Serum Bank, Refik Saydam National Hygiene Center, and tested for the presence of IgG antibodies against Coxiella burnetii phase II antigen by using indirect immunofluorescent antibody (IFA) test with a commercial kit (Vircell, SL Granada, Spain). IgG antibodies were accepted positive in case of > or = 1:64 titers, and negative in case of < 1:64 titer, according to the test guidelines. IgG seropositivity rates were found 13.2% (n: 15), 6% (n: 7) and 1.8% (n: 2), in Antalya, Diyarbakir and Samsun provinces, respectively, with an overall rate of 7.1% (n: 24). By logistic regression analysis on the positive IgG antibodies, no significant differences were shown in terms of age, gender and residence in all the three selected provinces, but seropositivity rate was significantly higher in Antalya (OR=8.21, %95 GA=1.82-36.96). The study results showed that Q fever exists in Turkey, and it is necessary to take control measures against this disease.

[Anti-Leptospira antibodies in slaughterhouse workers in Ankara]

Leptospirosis is one of the zoonotic infections which is widely seen especially in tropical regions, and the primary transmission is by direct contact of water, contaminated by the secretions of animals. The aim of this study was to investigate the seroprevalence of leptospirosis in the slaughterhouse workers, who have very close contact with the animals, as a risk factor. The serum samples collected from 102 personnel (3 female, 99 male, age range: 19-66 years) who work in the different slaughterhouses in Ankara province, have been screened by means of anti-leptospira antibodies with a reference method, microscopic agglutination test (MAT). In this method, a total of 40 strains were used as antigens, including L. interrogans serotype gripptyphosa Moskva V, L. icterohaemorrhagiae Wijnberg, L. sejroe Hardjoprajitno, L. pomona Pomona, L. canicola Canicola, L. australis Jez-Bratislava and L. biflexa serotype semeranga patoc I. The evaluation was made by dark field microscopy, and the presence of agglutination in > or = 1/100 titers, were accepted as positive. As a result, in only 2 (1.96%) of the sera, anti-leptospira antibodies against L. australis Jez-Bratislava antigen were found positive, and it was detected that, these subjects were the personnel who worked in the same slaughterhouse for a mean period of 15 years. In conclusion, as 100 workers were found seronegative, the seroprevalence of leptospirosis is very low in our province.

Large cavernous hemangioma of the kidney presenting as a solid renal mass

We report a case of large renal hemangioma that completely filled the collecting system in a 43-year-old man. Most of the renal hemangiomas are small in size and this situation is extremely rare. The diagnosis and treatment of the case is discussed.

Hepatitis agents with enteric transmission--an epidemiological analysis

BACKGROUND

Viral hepatitis is characterized by special clinical, biochemical and serological findings. This study was planned to determine the seroprevalence, epidemiological characteristics and clinical and biochemical findings of hepatitis A virus (HAV) and hepatitis E virus (HEV) infections during an outbreak of jaundice.

MATERIALS AND METHODS

340 children aged 5-16 years were included. Clinical findings and alanine aminotransferase (ALT) levels were documented. Anti-HAV IgG and IgM in addition to anti-HEV IgG and IgM were determined by microELISA.

RESULTS

Clinical findings, high levels of ALT, anti-HAV IgM and IgG, anti-HEV IgM and IgG were present in 6%, 23%, 17%, 100%, 7% and 9% of cases, respectively. The relationship between ALT levels and anti-HAV or anti-HEV IgM seropositivity was significant (p </= 0.0001).

CONCLUSION

HAV and HEV infection were both caused by a contaminated water supply.

Detection of LOH of the RB1 gene in bladder cancers by PCR-RFLP

OBJECTIVES

Retinoblastoma (RB1) gene involves in retinoblastoma, osteosarcoma, bladder, prostate, lung, breast carcinomas, and soft tissue sarcomas. Loss of heterozygosity (LOH) is the most common mutation of the gene.

METHODS

Xba I polymorphism in intron 17 of the gene was used to detect LOH in 20 bladder cancer patients. A cystitis and an osteosarcoma were used as control. LOH was investigated in three different kinds of samples (blood, paraffin-embedded tissue and fresh tissue) belonging to the same patients, and 20 blood samples, 20 paraffin-embedded tissue samples and 16 fresh tissue samples were obtained from 20 cancer patients.

RESULTS

None of the 20 blood samples showed LOH. Eleven out of 20 paraffin-embedded bladder tissues were amplified, 3 of them homozygous and all 8 informative paraffin-embedded tissues showed LOH. Five out of 16 fresh tumor tissues obtained were amplified, in 1 the fresh tissue was normal, 1 fresh tissue showed LOH and 3 were not digested by Xba I.

CONCLUSION

The results of the study have suggested that detection of LOH of the RB1 gene by PCR-RFLP can be a good adjunctive test for evaluation of the bladder cancer.

Influence of antioxidants on the blood-brain barrier permeability during epileptic seizures

Pentylenetetrazol-induced seizures in rats lead to the breakdown of the blood-brain barrier. We compared the disruption of the blood-brain barrier during epileptic seizure in untreated rats and in rats treated with vitamin E or selenium. The rats were supplemented with nontoxic doses of sodium selenite (4 pp) in drinking water for 3 months, or vitamin E (70 mg/kg) was given intraperitoneally for 30 min before the pentylenetetrazole injection. Evans-blue was used as a blood-brain barrier tracer and was given intravenously at a dose of 4 ml/kg of a 2% solution. The rats were divided into four experimental groups. Group I: control (n = 24); Group II: pentylenetetrazole-induced seizure (n = 12); Group III: vitamin E injected + seizure (n = 12); Group IV: Selenium supplemented + seizure (n = 12). The rats subjected to epileptic seizures showed Evans-blue albumin extravasations especially in the thalamic nuclei, brainstem, occipital, and frontal cortex. Mean values for Evans-blue dye were found to be 0.28 +/- 0.04 mg % brain tissue in control rats and 1.6 +/- 0.2 mg % brain tissue after epileptic seizures (P < 0.01). The magnitude of distribution of the blood-brain barrier during epileptic seizures was significantly less in rats treated with vitamin E or selenium. The mean value for Evans-blue dye was found to be 1.2 +/- 0.1 mg % brain tissue in selenium supplemented rats and 1.2 +/- 0.1 mg % brain tissue in vitamin E injected rats after epileptic seizures. This difference between treated and untreated animals was found to be significant (P < 0.05). The findings of the present study suggest that free radicals contribute to disruption of the blood-brain barrier during pentylenetetrazol-induced seizures.

Pigmented villonodular synovitis of the knee presenting as a popliteal cyst

Pigmented villonodular synovitis is a locally aggressive tumor of the synovium of joints and tendon sheaths. It is commonly seen in the synovial lining of the flexor tendons of the hand and in the synovium of the knee and less commonly in other joints. A case of pigmented villonodular synovitis of the knee in a 60-year-old man, with an intra-articular origin extending extra-articularly, is presented. The interesting point is that the initial diagnosis was a Baker cyst.

Do renal failure and hemodialysis have any effect on the elimination of free and total prostate-specific antigen?

OBJECTIVES

The aim of this study was first to determine the serum levels of free prostate-specific antigen (f-PSA), total prostate-specific antigen (t-PSA) and f-PSA/t-PSA ratios in patients with renal failure, and secondary, to investigate whether a significant difference between serum f-PSA and t-PSA levels consists in patients with end-stage renal disease before and after hemodialysis.

METHODS

Serum concentrations of f-PSA and t-PSA were measured in 36 men with end-stage renal disease before and after hemodialysis and in 95 healthy controls. A chemiluminescent enzyme assay was used to determine the levels of f-PSA and t-PSA.

RESULTS

The mean concentrations of serum t-PSA were 1.36+/-0.43 ng/ml in patients on hemodialysis and 1.08+/-0.60 ng/ml in controls. There was no significant difference in f-PSA and t-PSA levels between patients with renal failure and controls. F-PSA and t-PSA levels in patients with renal failure also showed no statistical differences before and after hemodialysis.

CONCLUSIONS

The limited kidney reserve in patients with end-stage renal disease is sufficient to maintain the levels of t-PSA and f-PSA within normal ranges and hemodialysis does not alter the serum levels of different PSA forms.

Successful bone marrow transplantation in a case of Griscelli disease which presented in accelerated phase with neurological involvement

Griscelli disease (GD) is a rare disorder characterized by pigment dilution, immunodeficiency and occurrence of accelerated phase consisting of hemophagocytosis, pancytopenia and neurological manifestations. Allogeneic BMT in the early period is an important modality of treatment for GD. We carried out an alloBMT from an HLA-identical sibling donor on a 4-year-old girl who presented in accelerated phase with neurological manifestations including convulsions, strabismus, severe dysarthria, ataxia and clonus. She was treated with etoposide, methylprednisolone and intrathecal methotrexate for 8 weeks and underwent alloBMT after receiving a conditioning regimen including ATG (rabbit, 10 mg/kg x 5 days), Bu/Cy. 8 x 108/kg nucleated bone marrow cells were given. Engraftment occurred early and the post-BMT period was uneventful. Currently, she is at 18 months post BMT with sustained engraftment and with a normal neurological examination except for minimal clonus. Long-term follow-up will determine the prognosis regarding the neurological findings.

Alopecia universalis in a patient with common variable immunodeficiency

A 12-year-old boy with common variable immunodeficiency (CVI) who developed severe alopecia is presented. His sister also had alopecia and recurrent infections and died of lung infection at the age of 7 years. The loss of hair in both children was total; the pathology of a scalp skin biopsy specimen was typical for alopecia areata. The boy was subjected to clinical and immunologic evaluation and the results were compatible with common variable immunodeficiency.

Serum prolactin in neonatal seizures

BACKGROUND

Prolactin is the most specific neurohormone that is elevated after seizures. This study was undertaken to determine the clinical usefulness of plasma prolactin as a diagnostic aid in differential diagnosis of neonatal convulsions.

METHODS

Forty-five patients followed for seizures were included in the study. Postictal serum prolactin levels were obtained 30 min after the onset of the seizures. A second sample obtained 24 h later was used to measure an unstimulated serum prolactin level.

RESULTS

The most common cause of seizure was hypoxic ischemic encephalopathy (HIE) followed by sepsis. In patients with HIE, postictal serum prolactin levels were significantly higher than the unstimulated levels (P < 0.0002). Additionally, postictal prolactin levels were significantly higher than the unstimulated levels in clonic (P < 0.02) and tonic convulsions (P < 0.001).

CONCLUSIONS

We conclude that the postictal serum prolactin level may be a marker in the differentiation of seizures as well as providing important information about their etiology. Further studies are needed to assess the normal range of serum prolactin levels in unstressed newborns.

Serum free and total prostate-specific antigen levels in patients with liver disease

OBJECTIVES

To determine the effect of liver diseases on serum free prostate-specific antigen (fPSA) levels, total prostate-specific antigen (tPSA) levels, and fPSA/tPSA ratios.

METHODS

Serum concentrations of tPSA and fPSA were measured in 18 men with histologically confirmed liver cirrhosis, 20 men with histologically proved chronic hepatitis, and 20 healthy men. All patients underwent a standard urologic evaluation, including history, physical examination, urine analysis, serum fPSA and tPSA determinations, and liver function tests (serum bilirubin, serum glutamic oxaloacetic transaminase, and serum glutamic pyruvic transaminase).

RESULTS

Patients with liver cirrhosis had slightly lower fPSA levels than did control subjects or patients with chronic hepatitis, but these differences did not reach statistical significance. tPSA levels also were not significantly different among the three groups.

CONCLUSIONS

In the presence of liver disease, despite the limited liver reserve, tPSA and fPSA are specific and reliable markers in the clinical management of prostatic diseases in this population. This result should be taken into account when serum concentrations of fPSA, tPSA, and the fPSA/tPSA ratio are evaluated in patients with liver disease.

Ratio of free to total prostate-specific antigen in patients with prostatic intraepithelial neoplasia

OBJECTIVE

There are many reports about the effects of prostatic intraepithelial neoplasia (PIN) on serum prostate-specific antigen (PSA) level. The aim of this study was to determine the relationship between PIN and serum free PSA/total PSA (fPSA/tPSA) ratios.

METHODS

We evaluated 46 patients with PIN, 15 patients with benign prostatic hyperplasia (BPH), and 16 patients with localized prostatic carcinoma (CaP) for the amount of fPSA and tPSA with the chemiluminescent enzyme assay.

RESULTS

fPSA values from BPH to high-grade PIN (PIN2 and PIN3) was increased, and then a decrease was observed from high-grade PIN to CaP. fPSA was significantly different between BPH and low-grade PIN and high-grade PIN. There was no significant difference observed between BPH and CaP. tPSA values increased from BPH to CaP. tPSA was significantly different between BPH and high-grade PIN and CaP. fPSA/tPSA ratios decreased from BPH to CaP. This ratio was significantly different between CaP and BPH and low-grade PIN. There was no significant difference between CaP and high-grade PIN.

CONCLUSIONS

Our results confirm that fPSA/tPSA ratio is better at discriminating between patients with CaP and those with BPH, but not between patients with CaP and those with high-grade PIN. Due to similarities between CaP and high-grade PIN, we think that decreased fPSA/tPSA ratio obtained at the time of intial diagnosis of PIN without concurrent carcinoma could be used as predictive factors to distinguish patients in whom carcinoma will be found on subsequent biopsies from those with PIN not associated with cancer on repeat biopsy.

Systemic candidiasis with acute Epstein-Barr virus infection

Systemic Candida infections are usually encountered as opportunistic infections in a setting of immunologic depression. Sepsis or arthritis due to Candida is not expected in healthy people. Epstein-Barr virus may infect B cells, but does not cause immunosuppression of any clinical significance. As far as we know, invasive non-albicans Candida infection complicating Epstein-Barr virus infection has not been reported in previously healthy children. In this report, two previously healthy children, one with sepsis due to Candida species and the other sepsis and arthritis due to Candida parapsilosis are described. Both patients were male and were aged 2 and 9 y. The diagnosis was confirmed by culture. Both children also had coincidental acute Epstein-Barr virus infection, confirmed by Epstein-Barr virus viral capside antigen-IgM. They were both cured with fluconazole given for 21 days and 48 days, respectively.

Stone disintegration: effect of shock wave projection and electrode age on this parameter in a standard stone model

Despite the real effectiveness and successful results of shock wave application, the effect of some varying parameters, namely number of shock wave (SW) electrical discharge value (kV), projection of the shock waves and electrode age are still to be evaluated. By using a standard stone model, we evaluated the real effect of the projection of shock waves and electrode age on the degree of stone disintegration. Our results indicated no significant relationship between the kV value and the degree of stone disintegration. However, as the number of SW increased, the rate of disintegration became evident. On the other hand, application of the same number of SW from two different angles revealed more effective disintegration rate on standard stone model. Thus SW number, age of the electrode and the projection of shock waves seemed to be important in the disintegration of the stones.

Effects of extracorporeal shock wave lithotripsy on stone forming risk factors

It has been reported in some definite studies that ESWL causes transient deterioration in renal haemodynamics and function. Again certain parameters in blood and urine have been used in order to assess this functional deterioration and different results are reported. In our present study we aimed to describe the adverse effects of shock waves on the excretion of urinary metabolites such as electrolytes, oxalate and citrate. Evaluation of our results in 30 patients revealed that although exposure to shock waves during ESWL for symptomatic renal calculi causes a slight increase in the urinary level of metabolites, all of these changes remained in normal range and no statistically significant changes in the urinary level of the aforementioned parameters could be demonstrated.

Effect of total and ionized calcium levels of seminal fluid on sperm motility

Total and ionized calcium (Ca2+) levels of seminal fluid were assessed in 75 semen samples obtained from infertile patients and fertile patients referred to our clinic with different complaints. Patients who showed only motility disorders on sperm analysis were include into the study program. Forty-five patients showing hypomotility (motility < 60%) and 30 patients with normal motility (motility > or = 60%) on sperm analysis were evaluated comparatively. No significant difference was observed in the seminal fluid concentration of total calcium, regardless of spermatozoa motility immediately after ejaculation. However, the seminal fluid of men with hypomotility exhibited a significantly lower Ca2+ concentration (p < 0.05) when compared with that of men with normal motility. A significant difference was observed in the seminal fluid Ca2+/total calcium rate (p < 0.05) when compared with that of men with normal motility. Further, spermatozoa from men with hypomotility exhibited both a significantly lower progression rate and sperm count. Our study suggests a direct relationship between Ca2+ and sperm motility.

Long-term follow-up of renal morphology and function in children after lithotripsy

Between October 1990 and May 1991, extracorporeal shock wave lithotripsy (ESWL) was performed on 35 children. All the treatments were done with the Dornier MPL 9000 Lithotriptor under sedation. Following treatment all the children were controlled regularly every 6 months, and the long-term follow-up results concerning the renal functional and morphological alterations together with changes in blood pressure values and the rate of stone recurrence were analyzed. Renal functional evaluations using a radiosiotope renogram revealed a transient decrease in renal function in the early follow-up period (0-3 months), which returned to normal limits after this period. Sonographic evaluation of the renal dimensions and morphology did not show any gross pathology in the early and long-term evaluation. Again determination of renal parenchymal thickness together with renal growth showed no statistically significant alteration in the late control of the children. Finally, careful monitoring of blood pressure and the recurrence rate of stone disease revealed no statistically significant changes in these aspects. ESWL seems to be the preferred treatment modality in children due to its safe and effective therapy results. Especially the long-term evaluation of our children proved the safety of this procedure.

Evaluation of cellular immunity following bacillus Calmette-Guérin therapy in patients with superficial bladder cancer

Despite its marked effectiveness in the prevention of tumor recurrences, a great deal of information on the mode of action of Bacillus Calmette-Guérin (BCG) as an antitumor therapy modality is still lacking. In this prospective study, by performing lymphocyte subset analysis and quantitative assessment of delayed hypersensitivity skin reactions before transurethral resection of the detected tumor and 3-6 months after intravesical BCG administration in 23 patients with superficial bladder carcinoma, we tried to demonstrate the immunostimulatory effect of BCG therapy. We had 4 recurrences at 6 months' follow-up. Evaluation of lymphocyte subset analysis readings in our group revealed a statistically significant difference (p < 0.05) in CD4+/CD8+ ratio between baseline values and that obtained following BCG administration at 3 and 6 months. However, there was no statistically significant increase of this value in 4 patients who had tumor recurrences. Evaluation of delayed hypersensitivity skin test score results revealed a statistically significant increase in the whole group at 3 months of follow-up (p < 0.05) but the same evaluation at 6 months of follow-up showed no statistically significant difference with respect to this evaluation. Again, no statistically significant difference was found in 4 patients who had tumor recurrences. These results support the idea that BCG-associated antitumor activity is an immune-mediated reaction and the assessment of T-lymphocyte subsets together with quantitative evaluation of delayed hypersensitivity skin reactions would give us a definite idea about the immunotherapeutic effects of BCG in such patients.

Adenosine: a new agent in the diagnosis of impotence

The haemodynamic effects of different dosages of adenosine were studied using colour flow Doppler sonography (CFDS) in 33 men, whose penile vascular bed responded well to papaverine. In six cases, we injected 25, 50, 100, 250 micrograms dosages of adenosine intracavernously at 15 min intervals and no erection occurred. However, 500 and 1000 micrograms doses of adenosine increased the arterial blood velocities for a few seconds in five cases. Later on, in eight cases, we infused 80 and 120 micrograms/kg/min adenosine for 3 min and only with 120 micrograms/kg/min dosage, did we observe clinical response and significant changes in CFDS parameters. Finally, 120 micrograms/kg/min adenosine dosage was infused for 10 min in 14 men and eight showed full erection while six had only tumescence. As adenosine was rapidly metabolized by adenosine deaminase, the erection lasted for only 5 to 13 min. No prolonged erection and no other side-effect was observed. In addition no fibrosis and curvature was detected 6 months after the injections. We found that, in men, 10 min infusion of 120 micrograms/kg/min adenosine increased the arterial flow and to some extent venous resistance, resulting in full erection or tumescence. Therefore, adenosine may be used as an agent for the diagnosis of vasculogenic impotence, but further studies for determining the standard dosage of adenosine are needed.

Color flow Doppler sonography in the diagnosis of vesicoureteric reflux

We describe an alternative technique using color flow Doppler sonography (CFDS) for detection of vesicoureteric reflux (VUR). Twenty-one children, ages 2-16 years, were investigated for VUR using voiding cystourethrography (VCU) and CFDS. Forty-two ureterovesical junctions were studied and a total of 27 were found to be refluxing at VCU. Five of these 21 patients were operated for VUR and they were also reevaluated 3 and 6 months after the operation. With good diuresis ureteric jets could easily be detected with CFDS and if there was a reflux of urine into the ureter this could also be displayed. Afterwards, the patient was asked to urinate and if reflux into the ureter was detected, particular attention was paid to the detection of ureteral and pelvicalyceal dilatation by conventional gray-scale sonography. Taking VCU as the gold standard, CFDS revealed reflux in all cases except 1. There were 3 patients who had only one-sided reflux at VCU and bilateral reflux at CFDS examination (false-positive: 20%). Correlation of CFDS and VCU was 90, 100 and 75% in low grade, grade III and grade IV reflux, respectively. The results of CFDS correlated well with the results of VCU during the follow-up of 5 patients who had antireflux operations. As a conclusion, CFDS could be used as an adjunct to standard ultrasonography for detection of VUR.

371 bladder calculi in a benign prostatic hyperplasia patient

We describe a patient with 371 bladder calculi secondary to benign prostatic hyperplasia. To our knowledge this patient had one of the highest numbers of the bladder calculi reported.

The place of acupuncture in the management of psychogenic impotence

Successful sexual functioning is a complex process involving psychological and social responses as well as neurological, biochemical and vascular processes. Today it is believed that more than 50% of the sexual dysfunction cases have an organic etiology. Reflecting the controversy over the management of psychogenic impotence, there are several different methods which are currently in clinical use. In this prospective study we aimed to evaluate the curative effects of acupuncture therapy in men with purely psychogenic impotence. Of the 29 patients treated with this procedure 20 patients demonstrated successful erections following a varying number of acupuncture sessions. In the light of our findings we may conclude that acupuncture may be an effective alternative in the management of purely psychogenic impotence.