Purpose. To report clinical and in vivo confocal microscopy (IVCM) findings of two patients with ocular ochronosis secondary due to alkaptonuria. Materials and Methods. Complete ophthalmologic ...examinations, including IVCM (HRT II/Rostock Cornea Module, Heidelberg, Germany), anterior segment optical coherence tomography (AS-OCT) (Topcon 3D spectral-domain OCT 2000, Topcon Medical Systems, Paramus, NJ, USA), corneal topography (Pentacam, OCULUS Optikgeräte GmbH, Wetzlar, Germany), and anterior segment photography, were performed. Results. Biomicroscopic examination showed bilateral darkly pigmented lesions of the nasal and temporal conjunctiva and episclera in both patients. In vivo confocal microscopy of the lesions revealed prominent degenerative changes, including vacuoles and fragmentation of collagen fibers in the affected conjunctival lamina propria and episclera. Hyperreflective pigment granules in different shapes were demonstrated in the substantia propria beneath the basement membrane. AS-OCT of Case 1 demonstrated hyporeflective areas. Fundus examination was within normal limits in both patients, except tilted optic discs with peripapillary atrophy in one of the patients. Corneal topography, thickness, and macular OCT were normal bilaterally in both cases. Conclusion. The degenerative and anatomic changes due to ochronotic pigment deposition in alkaptonuria can be demonstrated in detail with IVCM and AS-OCT. Confocal microscopic analysis in ocular ochronosis may serve as a useful adjunct in diagnosis and monitoring of the disease progression.
Objective To compare tubal patency by using hysterosalpingography (HSG) in women with unruptured ectopic tubal pregnancy who were treated with either single-dose or multiple-dose methotrexate (MTX) ...regimen. Design A case series with a retrospective statistical analysis. Setting Maternity and teaching hospital in Turkey. Patient(s) Sixty-one patients treated with MTX therapy for unruptured tubal ectopic pregnancy. Intervention(s) Thirty-one patients received single-dose and 30 multiple-dose MTX treatment. The HSG was performed 4 to 6 months after treatment to assess tubal patency. Main Outcome Measure(s) Ipsilateral and contralateral tubal obstruction rates. Result(s) Free passage through the ipsilateral tube was observed in 17 of 30 cases (56.7%) after multiple-dose, and 26 of 31 cases (83.9%) after single-dose MTX therapy. Patency of the contralateral tube was higher after single-dose than multiple-dose MTX treatment, although the value was not statistically significant. Binary logistic regression analysis was used to evaluate the parameters of age, gravida, parity, initial titers of beta human chorionic gonadotropin, size of the adnexal mass, and MTX regimen and their correlation with the HSG results after the clinical treatment for unruptured ectopic pregnancy. Only the type of MTX regimen was found to be used as a predictor of ipsilateral tubal obstruction. Conclusion(s) In terms of ipsilateral tubal obstruction, multiple-dose MTX therapy appears to have a greater negative effect on tubal patency than single-dose therapy.
Objective
Neuroimaging abnormalities in central nervous system (CNS) brucellosis are not well documented. The purpose of this study was to evaluate the prevalence of imaging abnormalities in ...neurobrucellosis and to identify factors associated with leptomeningeal and basal enhancement, which frequently results in unfavorable outcomes.
Methods
Istanbul-3 study evaluated 263 adult patients with CNS brucellosis from 26 referral centers and reviewed their 242 magnetic resonance imaging (MRI) and 226 computerized tomography (CT) scans of the brain.
Results
A normal CT or MRI scan was seen in 143 of 263 patients (54.3 %). Abnormal imaging findings were grouped into the following four categories: (a) inflammatory findings: leptomeningeal involvements (44), basal meningeal enhancements (30), cranial nerve involvements (14), spinal nerve roots enhancement (8), brain abscesses (7), granulomas (6), and arachnoiditis (4). (b) White-matter involvement: white-matter involvement (32) with or without demyelinating lesions (7). (c) Vascular involvement: vascular involvement (42) mostly with chronic cerebral ischemic changes (37). (d) Hydrocephalus/cerebral edema: hydrocephalus (20) and brain edema (40). On multivariate logistic regression analysis duration of symptoms since the onset (OR 1.007; 95 % CI 1–28,
p
= 0.01), polyneuropathy and radiculopathy (OR 5.4; 95 % CI 1.002–1.013,
p
= 0.044), cerebrospinal fluid (CSF)/serum glucose rate (OR 0.001; 95 % CI 000–0.067,
p
= 0.001), and CSF protein (OR 2.5; 95 % CI 2.3–2.7,
p
= 0.0001) were associated with diffuse inflammation.
Conclusions
In this study, 45 % of neurobrucellosis patients had abnormal neuroimaging findings. The duration of symptoms, polyneuropathy and radiculopathy, high CSF protein level, and low CSF/serum glucose rate were associated with inflammatory findings on imaging analyses.
A novel Gram-stain positive, rod-shaped, non-motile and mycolic acid containing strain, FMN18ᵀ, isolated from soil, was characterised using a polyphasic approach. The organism showed a combination of ...morphological, biochemical, physiological and chemotaxonomic properties that were consistent with its classification in the genus Nocardia and it formed a phyletic line in the Nocardia 16S rRNA gene tree. The cell wall contained meso-diaminopimelic acid (type IV) and whole cell sugars were galactose, glucose, arabinose and ribose. The predominant menaquinone was MK-8(H₄ω₋cycₗₒ). The major phospholipids are diphosphatidylglycerol, phosphatidylglycerol, phosphatidylethanolamine, phosphatidylinositol and phosphatidylinositol mannosides. Major fatty acids are C₁₆:₀, 10-methyl C₁₈:₀ (TBSA), C₁₈:₁ cis9 and C₁₆:₁ trans9. These chemotaxonomic traits are in good agreement with those known for representatives of the genus Nocardia. The phylogenetic analysis based on the 16S rRNA gene sequence of strain FMN18ᵀ showed it to be closely related to Nocardia grenadensis GW5-5797ᵀ (99.2 %), Nocardia speluncae N2-11ᵀ (99.1 %), Nocardia jinanensis 04-5195ᵀ (99.0 %) and Nocardia rhamnosiphila 202GMOᵀ (98.3 %). The phylogenetic analysis based on the gyrB gene sequence of strain FMN18ᵀ showed it to be closely related to N. rhamnosiphila 202GMOᵀ (99.0 %), N. grenadensis DSM 45869ᵀ (96.6 %), N. jinanensis DSM 45048ᵀ (93.1 %), N. carnea IFM 0237ᵀ (89.7 %) and N. speluncae DSM 45078ᵀ (89.1 %). A combination of DNA–DNA hybridization results and phenotypic properties demonstrated that strain FMN18ᵀ was clearly distinguished from all closely related Nocardia species. It is proposed that the organism be classified as representing a novel species of the genus Nocardia, for which the name Nocardia zapadnayensis (type strain FMN18ᵀ = DSM 45872ᵀ = KCTC 29234ᵀ) is proposed.
For analyzing the changes in immunoglobulins, HSP70, ghrelin levels in blood samples were collected from volunteers vaccinated against swine flu before the vaccinations and on days 3, and 15, and 1 ...and 2 months after the vaccination in the presence or absence of fever associated with the it. The study included 11 subjects having developed a fever, and 13 subjects not having a fever, and 20 control subjects. Immunoglobulins were measured by nephelometry, and HSP70 and ghrelins by appropriate ELISA tests. The level of ghrelin was reduced, while the level of HSP70 was significantly increased in subjects who developed fevers. When temperatures were normalized, both levels were found similar to the control group. These results indicate that the increase in serum immunoglobulins levels associated with vaccinations, along with, elevations in HSP70 and reduced ghrelin levels associated with fever, may be the important parameters in the clinical evaluation and follow-up of treatments with vaccines.
Objective: The present study aims to evaluate vitamin D (Vit D) level in critically ill patients and to assess its level about morbidity and mortality. Materials and Methods: This study was conducted ...in an intensive care unit (ICU). Vit D level was measured on admission, third and seventh day. Results: Of the 62 patients, the median Vit D level at baseline and on the third and seventh days was 12.8 mcg/L, 8.35 mcg/L, and 9.30 mcg/L, respectively. Vitamin D level was low (<30 mcg/L) in 92% of patients at baseline and 97% on the third day. 23% of the studied patients developed a new site infection. No statistically difference in the Vit D level at baseline, or on the third or seventh day based on the presence of infection (p=0.556, p=0.404, p=0.439, respectively). The most commonly seen infections were ventilator-associated pneumonia (VAP) and catheter-related bloodstream infection (CRBSI). The growth of Acinetobacter baumannii was the most frequent. Vit D level (p>0.05) might not have a causal role in mortality (ICU, 30-day, and 6-month), and no correlation was found between them. Conclusion: The level of Vit D was low. Our study did not show any relationship between mortality rates and Vit D level, but VAP and CRBSI were observed. Keywords: Acinetobacter baumannii, critical illness, intensive care unit, mortality, new site infection, vitamin D
We investigated urinary bladder stone, surgical tools, and procedures in urologic sections of textbooks of Abul-Qasim Khalaf Ibn Abbas Alzahrawi (Albucasis) and Serefeddin Sabuncuoglu. In addition, ...we compared the relation of their textbooks with urologic surgery.
Al-Tasreef Liman Aajaz Aan Al-Taaleef (Al-Tasreef), a surgery textbook written by Alzahrawi (who lived in Endulus between 930 and 1013) and Cerrahiyyetu'l-Haniyye, written by Sabuncuoglu (who lived in Turkey between 1385 and 1470) were evaluated with regard to urinary bladder stone and surgical instruments.
The textbooks give information about urinary bladder stones. They include definitions of diseases, etiologies, and surgical techniques, and describe surgical tools. Cerrahiyyetu'l Haniyye is a colorful miniaturized textbook.
The urinary bladder stone section in Cerrahiyyetu'l Haniyye is the translation of Al-Tasreef with some additional information and illustrations. Surgical tools and procedures described by the two physicians have reached to our century. Tools and procedures invented by Alzahrawi come to the present day in similar or developed styles.
Introduction and hypothesis
The prolongation, protraction or complete cessation of labor is called failed labor. It is one of the leading indications for cesarean delivery. The goal of this study was ...to measure pelvic floor muscle strength and investigate its effect on labor in nulliparous pregnant women.
Methods
A total of 88 patients were included in the study. The study was conducted in nulliparous pregnant women with a low Bishop score (≤ 7). A low-dose intravenous oxytocin protocol was used for labor induction in all patients. Evaluation of pelvic floor muscle (PFM) strength was performed using a vaginal pressure measurement device just before labor induction. The duration of labor stages and the rate of failed labor were considered the main outcomes. The study group consisted of patients whose labor failed and who subsequently underwent cesarean delivery. The control group consisted of patients who delivered vaginally. The pelvic floor muscle strength and main outcome measures of the two groups were compared.
Results
No differences were found in age, weight, height, body mass index (BMI), and neonatal birth weight between the study and control groups. The mean resting and maximum squeeze pressures in the study group were 29.6 ± 9.8 and 56.4 ± 12.1 cm H
2
O respectively, significantly higher than in the control group. The best predictor of failed labor was a maximum squeeze pressure value of 59 cm H
2
0 (51.6% sensitivity and 87.7% specificity).
Conclusions
Pelvic floor muscle strength appears to play a role in predicting failed labor.
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