Erciyes Medical Journal - 2010; 32(1) - Current Issue

May Pyrrolized Protein Be a New Oxidative Stress Marker in Beh�et's Disease?

Seval Kaya, Kader K�se, Cevat Yaz�c�, Serap Uta�, Murat Borlu — 2010-03-01

Purpose: This study was planned to investigate whether pyrrolized-protein that occurred in oxidative conditions may be a marker for Beh�et's disease suggesting that oxidative stress might play a role in its pathogenesis, and also examine the effect of N-acetylcysteine (NAC), known as a potent antioxidant, on pyrrolized-protein levels. Material and Methods: This study was performed on 40 Beh�et's patients and 20 healthy volunteers. Treatment protocol for one-month was applied to Beh�et's patients randomly subdivided into two groups NAC (2x600mg NAC/day) and placebo (2x600mg placebo/day). Pyrrolized-protein was measured in sera obtained from patient groups at the beginning and at the end of the study, and from controls once. Results: When compared to controls, pyrrolized-protein, found to be higher in both patient groups before treatment, were not changed in Placebo group; but significantly decreased and also attained to control values in NAC group after one-month treatment. Conclusion: Our results may suggest that enhanced production of ROS in Beh�et's disease may lead to protein oxidation and pyrrolized-protein determination which may be used as an oxidative-stress "marker". In addition, the probability of NAC addition to the treatment protocols of several diseases related to oxidative stress, including Beh�et's disease, may lead to new study areas.

Hypernatremic Dehydration in Insufficient Breastfed Newborns

Erhan Berk, Dilara ��a�as�o�lu, Derya B�y�kkayhan, As�m G�ltekin, �mer Cevit — 2010-03-01

Purpose: Breast-feeding is the best and safest way to feed infants. However, inadequate breastfeeding may result in hypernatremic dehydration and serious neurological complications in neonates. The aim of the present paper was to define the incidence, complications, morbidity and mortality of hypernatremic dehydration due to inadequate breast-feeding in a neonatal intensive care unit. Material and Methods: Forthy six newborn who diagnosed as hypernatremic dehydration were investigated retrospectively between January 2004- December 2007. Results: The newborns in this study 65.0% were primiparity and 63% were spontaneous vaginal delivery. Hospitalization period was 1.4�0.3 days in spontaneous vaginal delivery. Average postnatal age of these patients was 7.18�3.2 days and average weight loss according to birthweight was 15.1%. The most common presenting symptom was fever (41.3%). Mean serum sodium level was 162.3�8.9 mEq/lt and these patients had 54.4%severe, 32.6% moderate and 13.0% mild dehydration according to physical and laboratory findings. Conclusion: Low level of maternal knowledge in lactation and failure of early postnatal follow up was associated with the neonatal hypernatremic dehydration. Increased efforts are required to establish successful breast-feeding and all breastfed infants should receive regular follow- up by health-care worker.

The Effect of Smoking on the Carriage of Potential Pathogens in Nasopharynx

G�lay Yetkin, Selma Ay, �zkan Yetkin, Ne�e Ta�tekin, Nilay G��l�er — 2010-03-01

Purpose: Smoking is associated with an increased risk of respiratory tract infections in adults and also with oral colonization by some potentially pathogenic microorganisms. Smoking or passive exposure is enhancing bacterial adherence of pathogenic bacteria to the epithelial cells of the oropharingeal mucous membrane. The aim of this study is to determine the effect of active smoking on colonization of potential aerobic pathogens and in the nasopharynx. We evaluated Haemophilus �nfluenza, Moraxella catarrhalis, Streptococcus pneumoniae, Streptococcus pyogenes, Neisseria meningitidis , Staphylococcus aureus and Candida albicans strains. Material and Methods: Study population; 77 healty hospital personel has been selected from several services. Cultures were obtained using sterile swabs. Specimens collected from the nasopharynx through the mouth. Smokers were classified three groups as: mild smokers (n: 29; 0-10 package/year), moderate (n: 16; 11-20 package/year) and heavy (n: 12; 25+ package/year). Cultures were evaluated with semiquantitative technics (roll plate) Results: We isolated Staphylococcus aureus from 3 specimens, Neisseria meningitidis 1, Acinetobacter lwoffi 1, E.coli 1, intense Candida albicans from 12 specimens, afew mold (Candida albicans ve Candida spp.) from 8 specimens, Haemophilus aphrophilus 1 and Group A � haemolytic streptococcus from 1 specimen. We have isolated pathogenic bacteria from 24 of 57 (%42) smokers and 4 of 20 (%20) nonsmokers (p<0.05). Conclusion: Distribution of pathojens in three groups described in smokers as follows; mild smokers (6 pathogen/29 person) (6 pathogen) (%20), moderate (8 pathogen/16 person) (8 pathogen) (%50), and heavy smokers (10 pathogen/12 person) (10 pathogen) (%83) (p<0.05). All growth rates within these groups have reisen up in comparison with nonsmokers.

In-vitro Activity of Carbapenem/Sulbactam Combination against Acinetobacter baumannii Strains

Fatma Mutlu Sar�g�zel, B�lent S�merkan, G�khan Metan — 2010-03-01

Purpose: Carbapenems and sulbactam are often the drug of choice for the treatment of infections due to multidrug-resistant Acinetobacter baumannii. The present study aimed to evaluate the in vitro synergistic activity between carbapenem and sulbactam against A. baumannii isolated from blood cultures of patients. Material and Method: The 100 A. baumannii strains isolated from blood culture specimens of patients hospitalized at Erciyes University Medical Faculty Gevher Nesibe Hospitals between February 2007 and March 2008, were included in this study. The in vitro synergistic activities of carbapenem-cefoperazone/ sulbactam combination on 100 A. baumannii strains were studied by E-test method. Results: With the combination of imipenem- cefoperazone/ sulbactam and meropenem- cefoperazone/ sulbactam on 43% and 49% of the strains respectively, synergistic activity was detected. No antagonism was detected with any combination. Conclusion: According to our in vitro study results, carbapenem-cefoperazone/ sulbactam combination can be an alternative for the treatment of infections caused by multidrug-resistant A. baumannii.

Cisplatin, Epirubicin and Uracil-Tegafur Combination in Metastatic Gastric Cancer: Retrospective Evaluation

�smail Hakk� Akbudak, Halit Karaca, Mustafa Dikilita�, Metin �zkan, �zlem Er — 2010-03-01

Purpose: Gastric cancers are one of the most common malignancies worldwide. Surgery, radiotherapy and chemotherapy are used in treatment alone or as combination. The aim of this study was to evaluate retrospectively the effectiveness of cisplatin, epirubicin, uracil- tegafur combination in gastric cancer. Material and Methods: A total of 20 patients were included who have histopatolagically proven gastric cancer with measurable metastasis by screening methods. Chemotherapy regimen consists of epirubicin 50mg/m² 1. day, cisplatin 60g/m² 1.day, uracil-tegafur 300mg/m² 2 weeks on, 1 weeks off in 3 weeks interval. Response rate, overall survival and toxicities were evaluated. Results: Twenty patients were included in the analysis ( 15 men, 5 women ,median age 55 years). Most common metastatic side was liver (%55). Totally 94 cycles chemotherapy were given which median cycles of five. Overall response rate was %25 and clinical benefit rate was %65. Overall survival and progression free survival was 8 months and 5 months respectively. Most common side effect were nausea and vomiting (%65), fatigue (%60) and anemia (%60). Conclusion: Epirubicin, cisplatin, uracil-tegafur combination has moderate effect in gastric cancer. Combination chemotherapy was well tolerated with acceptable side effect.

The Effectiveness and Safety of Ultrasound Guided Renal Biopsies

2010-03-01

Purpose: To evaluate the effectiveness and safety of US guided renal biopsies with 16G semi- automated biopsy needles. Material and Methods: Renal biopsies obtained with 16G semi-automated biopsy needle between the years 2005-2007 were included into the study. Free hand technique under US guidance was used. The biopsies were categorized as the ones obtained from a lesion and the ones obtained for parenchymal disease. The pathology results were noted and effectiveness was calculated. Major (need for blood transfusion, radiological intervention or surgical intervention, acute renal obstruction or failure, septicemia and death) and minor (pain and hematuria) complications were noted. Results: There were 32 patients in the lesion group and 73 patients in parenchymal disease group. In five patients the biopsy material was not suitable for a pathological diagnosis. In three patients biopsies were obtained from the necrotic part of the lesion and in two patients parenchymal biopsy was inadequately obtained from the medulla. All other biopsies were sufficient and appropriate for a pathological diagnosis. So the success rate was %95,1 for all biopsies, %90,62 for lesion biopsies, and %97,26 for parenchymal biopsies. Minor complications were seen in six patients. Conclusion: Renal biopsies with 16G semi-automated biopsy needles under US guidance are effective and safe.

The Prevalance of Atopy and Allergic Rhinitis in Asthma

Ay�e Bayram, Sema Oymak, �nci G�lmez, Ramazan Demir, Hakan B�y�ko�lan — 2010-03-01

Purpose: The aim of the present study was to determine the prevalence of atopy and allergic rhinitis by prick skin test with multi-test II applicator in patients with asthma. Material and Methods: In this study, 200 patients who were admitted to the Medical Faculty, Department of Pulmonary Disease and who was diagnosed asthma were evaluated prospectively. Pulmonary function test and twelve aeroallergens skin test were applied to patients. Total IgE levels and blood eosinophil counts were also measured. Atopic asthma was defined as the history of asthma with positive skin test. Results: Mean age of patients was 42.4�13.2 years old. 152 (76%) were women; 48 (24%) were men. 120 (60%) were skin test positive. Allergy to pollens (%69.2) was the most prevalent sensitization, followed by allergy to house dust mites, cockroach and molds (%56.7, %41.7, %7.5). Ninety-seven patients (48%) were allergic rhinitis. Conclusion: The results showed that asthma in 60% of the patients had an atopic background in Kayseri. Less than half of the asthmatic patients had associated rhinitis. The most frequent sensitization allergens that were determined by prick skin test with multi-test II applicator in patients with or without rhinitis were pollens in Kayseri. The frequency of house dust mite was second highest, of cockroach was third highest In patients with atopic asthma and allergic rhinitis, prevention should be provided against pollens and house dust mite to control the disease.

Determinants Contributing to the Newly Emergent Viruses

Yusuf �zbal — 2010-03-01

New viral diseases seem to be emerging globally with increasing frequency. Most of the emerging viruses are zoonotic, that is, communicated by animals to humans. Many different factors can contribute to the emergence of a new viral disease. These factors are: virological determinants, several genetic mechanisms that drive virus evolution such as mutation, recombination and reassortment; individual host determinants such as the host immune response, specific risk behaviors and physiological factors; host population determinants such as human demographics and behavior, international travel and community; environmental determinants such as ecological and zoonotic influences. These determinants need to be understood for prevention and control of emerging viral diseases. Developments in molecular and genetic epidemiology are helping us understand pathogen virulence, transmission patterns, and host susceptibility. Almost always there is a need for epidemiological field investigation to assess the risk to the human and/or animal populations.

Molecular Analysis in a Turkish Patient with Severe Form of Hurler Syndrome: Identification of a Novel c.826_828del3 Mutation

2010-03-01

Mucopolysaccharidosis type I (MPS I) is a lysosomal disease due to mutations in the gene encoding alpha-L-iduronidase (IDUA) leading to variable clinical phenotypes with progressive severe organomegaly, bone and neurological involvement in the most severe forms. A two-year-old Turkish patient born from consanguineous marriage had an enzymatic and urinary diagnostics suggested a MPS I phenotype. The genetic evaluation revealed c.826_828del3 mutation in the homozygous state, whereas her parents were heterozygous for this mutation. Because of the high frequency of consanguineous marriages in Turkey, identification of the novel mutations permits reliable genetic counseling of at-risk relatives and molecular prenatal diagnosis.

Coagulopaty due to Cefoperazone/Sulbactam in a Patient with Chronic Renal Failure : Case Report

2010-03-01

Continuous ambulatory peritoneal dialysis is one of renal replacement treatment in patients with end-stage kidney disease. Peritonitis is a serious problem in peritoneal dialysis patients that leads to hospitalisation and increased mortality. In treatment of peritoneal dialysis- associated peritonitis, broad spectrum antibiotics have been used according to potential dominant microorganism. With the extended spectrum and a remarkably safe, third generation cephalosporins are used frequently in clinics. Cefoperazone/sulbactam, which is one of the third generation cephalosporins, causes bleeding because of it induces hypoprothrombinemia. We report that in a patient with peritoneal dialysis, bleeding by inducing hypoprotrombinemia developing during cefoperazone/sulbactam therapy.

Anesthetic Management of a Patient with Myasthenia Gravis

F�sun Ye�eno�lu, Aliye Esmao�lu �oruh, Tar�k Art��, Adnan Bayram — 2010-03-01

Myasthenia Gravis is an autoimmune disorder in which the patients produce antibodies that attach the nicotinic acetylcholine receptors at the neuromuscular junction. The interactions between myorelaxants, anticholinesterases or the other drugs that are used in general anesthesia can cause postoperatif respiratuary failure. Regional anesthesia have been suggested for the lower abdominal and extremity operations. The purpose of this case report is to review to anesthetic management of a patient with myasthenia gravis.

Diagnostic Approach to a Case with Aortic Dissection

Meryem Aktoz, Okan Erdo�an, Ersan Tatl� — 2010-03-01

Without a clear diagnosis, patients with aortic dissection often die before presentation to the hospital. Keeping a high clinical index of suspicion is mandatory for the accurate and rapid diagnosis of aortic dissection. The choice of the diagnostic modality mainly depends on the availability of the diagnostic tools and the experience of the physicians at the given institution.

Duane's Retraction Syndrome Associated With Fuchs' Uveitis Syndrome in the Same Eye

Aras Saklamaz, Safiye Y�lmaz, Ahmet Maden — 2010-03-01

Duane retraction syndrome is an ocular motility disorder with a number of congenital systemic and eye abnormalities. Altough, numerous theories concerning the etiology and the pathogenesis of this syndrome are present, still the exact mechanism can not be explained. Fuchs uveitis syndrome is an inflammatory disease of the uvea, thought to be triggered by otoimmunity or some microbial agents. Here , we present a case with two syndromes in the one eye. These syndromes have no known causal association with each other, and although they occur often, their occurrence together is uncommon.

Genetic Approach to the Case with Amniotic Band Sequence

Asl� Suba��o�lu Uzak, Korhan Arslan, Munis D�ndar — 2010-03-01

Amniotic Band Sequence which can also be called as Early Amniotic Band Rupture Sequence; describes a variable group of anomalies by the cause of early rupture of the amnion membrane. A fortnightly dismorphic infant applied to our clinic with the symptoms of right complete lip cleft, complete palate cleft, hands with structural defects and left foot amputation. As a result of her examination, we thought that the reason of her structural defects was Early Amniotic Band Rupture Sequence and gave genetic counselling according to the literature to her family.

Sacral Parasite Conjoined Twin Mimicking Sacrococcygeal Teratoma: Multi-Detector CT Findings

Mecit Kantarc�, Hayri Ogul, Selim Doganay, Adnan Okur — 2010-03-01

Sacral parasite conjoined twins are rare form of conjoined twins. Differential diagnosis of the parasitic twin includes fetus in fetu (internal parasite) and teratoma. A 2900 g boy was born by normal vaginal delivery to a healthy young mother. At birth, the infant was found to have a large mass, attached to his sacrococcygeal region. Radiologic and histopathological examinations showed long and short bones within the sacral parasite. We present a rare case of parasitic conjoined twin attached to the sacrococcygeal region of the autosite who were evaluated by multidetector computed tomography including 3D volume rendering images.