[Show abstract][Hide abstract] ABSTRACT: Measles, mumps, rubella (MMR) vaccination is included in the routine vaccination program in our country. In the past, many children died or were permanently disabled due to measles and its complications. MMR has significantly decreased with routine and widespread use of MMR vaccination. Many adverse effects such as fever, parotitis, vasculitis, pancreatitis, uveitis, subacute sclerosing panencephalitis, 3rd and 6th nerve paralysis and anaphylaxis may develop following MMR vaccination. 'Claw hand defomity' developing after MMR vaccination has not been reported up to date. Claw hand is the motor dysfunction of the ulnar nerve. This paper presents patients who developed pain, fever and local discharge at the injection area and claw hand deformity after receiving MMR vaccination to the distal part of the deltoid muscle. Claw hand deformity did not improve despite medical and surgical treatment. Thus, we suggest that claw hand deformity may be due to an immunologic reaction. There are some misunderstandings about vaccination in our country. Vaccination rates may decrease if they are not clarified.
Preview · Article · Oct 2012 · Turkiye Klinikleri Journal of Medical Sciences
[Show abstract][Hide abstract] ABSTRACT: Background:
The aim of this study was to evaluate oxidative stress and to determine the activity of paraoxonase and arylesterase in patients with osteomyelitis compared to healthy controls.
In total, 30 patients diagnosed with osteomyelitis and 30 healthy volunteers were enrolled in the study. Paraoxonase and arylesterase activities were measured spectrophotometrically. Serum lipid hydroperoxide (LOOH) concentrations were measured by ferrous oxidation with xylenol orange (FOX) assay as markers of oxidative stress.
Serum paraoxonase and arylesterase activities were significantly lower in patients with osteomyelitis compared to control individuals (all p < 0.05). Serum LOOH concentrations were significantly higher in patients with osteomyelitis than those in controls (p < 0.05). Arylesterase activity was inversely correlated with triglyceride (r =- 0.49; p = 0.005) and cholesterol concentrations (r =- 0.41; p = 0.025).
In light of the findings obtained from the present study, it may be assumed that decreased activity of serum paraoxonase and increased concentrations of LOOH observed in osteomyelitis patients appear to be related to the increased oxidative stress and inflammatory conditions present in these patients, and may cause a much more severe status of the disease.
No preview · Article · Sep 2012 · Scandinavian journal of clinical and laboratory investigation
[Show abstract][Hide abstract] ABSTRACT: Brucellosis may involve multiple organs and progresses with complications. Brucella endocarditis, disseminated intravascular coagulopathy (DIC) and chronic renal insufficiency are rare complications of brucellosis. Capillary leak syndrome due to brucellosis is seen even more rarely and up to this date, only one case has been reported. Our case will probably be the second. In this article, a case of brucellosis associated with the development of DIC, infective endocarditis and capillary leak syndrome is presented. Although antimicrobial treatment with ceftriaxone, doxycycline and rifampicine in intensive care unit, the patient died. As the reporting of capillary leak syndrome due to brucellosis is very rare, this case is regarded as valuable to be presented and will serve to call attention to this issue (Ref. 15).
No preview · Article · Aug 2012 · Bratislavske lekarske listy
[Show abstract][Hide abstract] ABSTRACT: Neurobrucellosis (NB) is a rare, but important complication of brucellosis. The clinical features vary greatly and, in general, tend to be chronic. Many laboratory procedures are usually employed in the diagnosis of NB. Even though the culture method is the gold standard, growth rate is low and time consuming. Thus the rate of sequelae and mortality increase in case of a delay in treatment. Therefore it is necessary to perform serological tests in both serum and cerebrospinal fluid (CSF) in suspected patients. In this study we aim to evaluate clinical features, diagnosis, and treatment of patients with NB.
We enrolled 17 patients diagnosed with NB. Clinical features, cultures, serological tests, additional laboratory findings, and CSF analyses were recorded for all patients.
There were 14 female and 3 male patients. Ten patients presented with neuropsychiatric symptoms and signs (aphasia, diplopia, hemiparesis, facial paralysis, tremor, ataxia, depression, personality disorder, and hallucinations). Serum standard agglutination test (SAT) was negative in 4 (23.5%) patients and serum Coombs' test was negative in 2 (11.7%). CSF SAT was negative in 4 (23.5%) patients and CSF Coombs was negative in 3 (17.6%) patients. B. melitensis grew in the blood of 6 (35.2%) patients and in the CSF of 3 (17.6%). Treatment protocol for 11 patients consisted of ceftriaxone, rifampicin, and doxycyline for a period of four weeks, followed by rifampicin and doxycyline for an additional four weeks. The remaining patients were given different treatment combinations. One patient died, mild sequelae was present in another patient and the remaining patients recovered without any sequelae.
NB should be considered in the differential diagnosis of neurological and psychiatric cases that are encountered in endemic areas for brucellosis. In order to prevent overlooking this diagnosis, Coombs' test should be performed in both CSF and serum.
Preview · Article · Aug 2012 · Archives of Iranian medicine
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to evaluate the diagnostic value of serum mannose-binding lectin (MBL) and plasma soluble urokinase plasminogen activator receptor (SuPAR) levels in monitoring the treatment in patients with brucellosis, by comparing their levels before and after treatment with the values obtained from healthy control group. Thirty brucellosis patients (mean age: 25.8 ± 12.2 years; 15 were male) and 28 healthy controls (mean age: 29.3 ± 12.3 years; 15 were male) were included in the study. Patients were diagnosed with brucellosis according to the characteristic clinical findings and by brucella standard tube agglutination test (SAT) titer ≥ 1/160 and/or blood culture positivity. Serum MBL (Antibodyshop, Denmark) and plasma SuPAR (Virogates, Denmark) levels were investigated with commercial ELISA kits. In our study, no statistical significance was observed between the pre-treatment (13.8 ± 13.4 ng/ml) and post-treatment (12.4 ± 13.1 ng/ml) MBL levels of the patient group and MBL levels of the control group (16.5 ± 14.8 ng/ml) (p> 0.05). Moreover, the mean SuPAR levels measured in pre-treatment and post-treatment plasma samples of the brucellosis patients was 5.1 ± 1.9 ng/ml and 2.9 ± 1.3 ng/ml, respectively, while the mean SuPAR level was 1.8 ± 0.5 ng/ml in the control group. The difference between mean SuPAR levels of patients in pre- and post-treatment samples was found statistically significant (p< 0.001). In addition SuPAR levels were significantly higher in patients before and after treatment than the control group (p> 0.001). In conlusion, plasma SuPAR level would be a useful marker for the diagnosis and treatment follow up of the patients with brucellosis.
[Show abstract][Hide abstract] ABSTRACT: Hepatitis C infection represents a common healthcare issue worldwide. The present trial was designed to investigate the role of prolidase, an enzyme that is significantly involved in the biosynthesis of collagen, and of the oxidative stress that is considered to be involved in the pathogenesis of various diseases, in the chronic hepatitis C infection. The trial was performed to assess the serum prolidase enzyme level and the oxidative-antioxidative status and to determine the relation between the serum prolidase activity and the oxidative stress parameters.
A total of 95 individuals, including 55 patients with chronic hepatitis C infection (CHC) and 40 healthy adults, were enrolled in the trial. The values for prolidase, the total antioxidant status (TAS), the total oxidative stress (TOS), the oxidative stress index (OSI), sulfhydryl (SH), lipid peroxidation LOOH, catalase (CAT), and ceruloplasmin were measured and compared between the patient groups.
The prolidase, TOS, LOOH, CAT, and the OSI values were higher in the chronic hepatitis C group compared to the control group (P < 0.001). The TAS, SH, and ceruloplasmin levels were lower in the CHC group relative to the control group (P < 0.001).
We suppose that the values of prolidase and the oxidative stress are increased while the antioxidant levels are decreased in CHC. As a result, prolidase and the oxidative stress seem to be related with the progression of the disease.
No preview · Article · Jul 2012 · Journal of Clinical Laboratory Analysis
[Show abstract][Hide abstract] ABSTRACT: The hepatitis B virus is a significant pathogen that causes cirrhosis, and hepatocellular cancer as a result of the damage it causes to liver cells. Its infection affects more than 400 million people globally. Although there is an effective vaccine and treatment methods, almost 1, 000, 000 people die every year.
To investigate paraoxonase and arylesterase activities along with oxidative status parameters and serum lipid levels, and to find out if there is any increased susceptibility to atherogenesis.
Thirty-four subjects with chronic hepatitis B and 39 healthy subjects as control were enrolled in the study. Age, body mass index and gender, Serum Triglycerides (TG), High-density Lipoprotein (HDL) and Low-Density lipoprotein (LDL) levels, serum paraoxonase-1 and arylesterase activities were determined. Oxidative and antioxidative statuses were evaluated by measuring serum-free sulfhydryl groups, lipid hydroperoxide levels, total antioxidant capacity, total oxidant status, and oxidative stress index.
Serum TG and LDL levels were higher while serum HDL levels were lower in patients with chronic hepatitis B than in controls but the differences did not reach statistical significance. Serum paraoxonase-1 and arylesterase activities, plasma free sulfhydryl groups, and total antioxidant capacity were significantly lower in patients than in controls (p=0.018, p=0.005, p<0.001, p=0.037 respectively), while lipid hydroperoxide, total oxidant status, and oxidative stress index were significantly higher (for all p<0.001).
The diminution in the paraoxonase-1 and arylesterase activities could contribute to the accelerated development of atherosclerosis in patients with chronic hepatitis B.
Preview · Article · Jun 2012 · African health sciences
[Show abstract][Hide abstract] ABSTRACT: We aimed to examine cases of brucellosis that presented with severe thrombocytopenia and hemorrhagic diathesis.
A total of 10 brucellosis cases with severe thrombocytopenia were included in this case-series study. Patients' files were reviewed for their clinical and laboratory findings, as well as clinical outcomes and complications. Platelet counts of < 20000/mm³ were diagnosed as severe thrombocytopenia.
The lowest thrombocyte count was 3000/mm³ while the highest was 19000/mm³ (mean: 12000/mm³). Patients had the following symptoms: epistaxis (7 cases), petechia with epistaxis (4 cases), bleeding gums (3 cases), ecchymosis with epistaxis (2 cases), melena and renal failure (2 cases), and hematuria (1 case). Patients were given rifampicin and doxycycline along with supportive hematological therapy. All were treated successfully with no evidence of recurrence at follow-up visits.
Since brucellosis is endemic in developing countries, it must be considered in the differential diagnosis of cases that present with severe thrombocytopenia and hemorrhagic diathesis.
Preview · Article · May 2012 · Archives of Iranian medicine
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to evaluate oxidative stress in various clinical forms of hepatitis B infection and to investigate its role in the development of the chronic form of the disease.
Ninety-three patients with inactive hepatitis B surface antigen (HbsAg) carrier state (IHBCS), 65 patients with chronic hepatitis B infection (CHB), and 42 healthy adults were included in the study. The following values were measured and compared in patient groups: total antioxidant status (TAS), total oxidative stress (TOS), oxidative stress index (OSI), sulfhydryl (SH), lipid peroxidation (LOOH), catalase (CAT), and ceruloplasmin. In patients with chronic hepatitis B, these values were compared with HBV DNA and fibrosis levels.
ALT, TOS, LOOH, and OSI levels were higher in the CHB group compared to the other groups (P<0.001). Catalase levels increased in the CHB and IHBCS groups compared to the control group (P<0.001). Total aminooxidant and ceruloplasmin levels were found to be lowest in the CHB group and highest in the control group (P<0.001). Sulfhyrdyl was higher in the control group compared to the other groups (P<0.001). In the CHB group, there was no correlation between the HBV DNA and OSI (P>0.05).
These finding suggested that oxidative stress is associated with hepatitis B activity.
Preview · Article · Mar 2012 · Annals of Laboratory Medicine
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to the investigate the effect of brucellosis infection on paraoxonase-1 (PON1) activity and oxidative status in patients with brucellosis. Sixty patients with brucellosis (47 acute, 13 subacute) and the 67 healthy controls were used in the study. Serum PON1 and arylesterase activities, total antioxidant capacity (TAC), total oxidant status (TOS), oxidative stress index (OSI), total free sulfhydryl (-SH), and lipid hydroperoxide (LOOH) groups were determined. In addition, HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C), total cholesterol (TC) and triglyceride (TG) were measured. Serum PON1 and arylesterase activities, total -SH group levels and TAC were significantly lower in brucellosis patients than controls (P<0.001). TOS, OSI and LOOH levels were significantly higher in brucellosis patients than controls (P<0.001). There were no significant differences between of serum LDL-C, TG and TC levels of patients subjects compared to controls (P > 0.05). Patients with brucellosis are exposed to potent oxidative stress and they have decreased PON1 activity. These predisposal factors might play a role in the pathogenesis for atherosclerosis in patients with brucellosis.
Full-text · Article · Aug 2011 · African journal of microbiology research
[Show abstract][Hide abstract] ABSTRACT: F. hepatica infection is rare and mostly subclinical. Migration of juvenile forms of F. hepatica into the host's liver is accompanied by an inflammatory reaction followed by fibrosis and cirrhosis.
The aim of this study was to evaluate oxidative status by using a novel automated method in patients with Fasciola hepatica.
Twenty two patients with a diagnosis of F. hepatica and 26 healthy volunteers were enrolled in the study. Their Total antioxidant capacity status (TAC), total oxidant status (TOS) and catalase were measured in them and oxidative stress index (OSI) was calculated. These measurements were also taken for the control group and the values were compared.
Plasma levels of total TOS and OSI were significantly increased in patients as compared with healthy controls (P<0.001, P<0.001, P=0.001, P=0.008) respectively. In contrast, TAC level was significantly lower in patients as compared with controls (p<0.05). There was no significant difference between the catalase results of the two groups (p>0.05).
Total oxidative status and OSI were increased and total antioxidative status capacity was decreased in patients with F. hepatica infection. A high oxidative stress occurs during F. hepatica infection, which may cause severe damage in both the liver.
Preview · Article · Aug 2011 · African health sciences
[Show abstract][Hide abstract] ABSTRACT: The purpose is to determine the cut-off value of adenosine deaminase (ADA) activity in cerebrospinal fluid (CSF) of patients with tuberculous and non-tuberculous meningitis, and to assess its value in differential diagnosis.
This study was conducted in 91 patients with meningitis in two university hospitals in Turkey. 24 patients had tuberculous meningitis (TBM), 25 purulent meningitis (PM), 25 aseptic meningitis (AM) and 17 neurobrucellosis (BM). ADA activity of CSF was quantified by colorimetry.
In our study, mean ADA values in CSF were 28.34 ± 14.83 IU/L in TB cases, 8.71 ± 5.83 IU/L in BM, 6.18 ± 2.54 IU/L in PM and 3.43 ± 3.48 U/L in AM cases. If we accept for CSF ADA an activity cut-off value of 12.5 IU/L for differential diagnosis of TBM and BM, its sensitivity was 92% and specificity was 88%. If we accept 12.35 IU/L for differential diagnosis of TBM and PM, its sensitivity was 92% and specificity was 100%. If we accept 6.45 IU/L for differential diagnosis of TBM and AM, its sensitivity was 100% and specificity was 92%. Additionally, we examined the cases after dividing them into two groups, viz. TB and non-TB. If we accept an ADA activity cut-off level of 11 IU/L for differential diagnosis of TB and non-TB by applying ROC analysis, its sensitivity was 92% and specificity was 90%.
The sensitivity and specificity for CSF ADA activity are markedly high in differential diagnosis of TB from non-TB. Hence CSF ADA activity may be used as a simple, cost-effective and reliable test for early differential diagnosis of TB.
Full-text · Article · Jun 2011 · Schweizerische medizinische Wochenschrift
[Show abstract][Hide abstract] ABSTRACT: Food-borne botulism is an acute form of food poisoning that results from ingestion of the toxin produced by Clostridium botulinum. Intoxication classically presents as an acute, symmetrical paralysis. In this study, we report a case of botulism with unilateral paralysis that was confirmed by the mouse inoculation and neutralization method.
[Show abstract][Hide abstract] ABSTRACT: Objective: We aimed to retrospectively evaluate our cases followed up in department of Infectious Diseases, Medical Faculty of Yuzuncu Yil University with the diagnosis of bacterial meningitis between January 1995 and August 2008 in view of their clinical and laboratory findings. Material and Methods: Demographic features, history, physical examination and laboratory findings were achieved by screening the files. The diagnosis of bacterial meningitis in cases clinically consistent with suspected meningitis was done by microbiological, biochemical and serological tests performed on cerebrospinal fluid (CSF) samples, by radiological examinations of central nervous system (CNS) and the answers of the patients to antibacterial treatment. Results: Of 204 patients, 96 were females and 108 were males with an average age of 30.8 +/- 13.9 years. Thirty three percent of cases had acute bacterial meningitis (ABM), 44% had tuberculous meningitis (TM) and 23% brucella meningitis (BrM). Headache was the most frequent symptom in all cases with 80%, being 89.5% in ABM cases, 71% in TM cases and 74.5% in BrM cases. In CSF cultures of the patients with ABM, S. pneumonia was isolated in 13.4% of the cases, N.meningitides in 7.5% and S.aures in 3%. In patients with TM, acid-fast bacilli was seen in 20% of the cases. B. melitensis was grown from CSF in 10.6% of the patients with BrM and from blood in 17.2% of the patients. Mortality rate was 13.4% in ABM cases, 14.4% in TM cases and 2.1% in BrM cases. Conclusion: TM seems to be more frequent in our region when compared to other causes of bacterial meningitis and its high morbidity and mortality rates attract the attention. Clinical and laboratory findings of BrM are vaguer than other forms of bacterial meningitis.
Full-text · Article · Oct 2010 · Turkiye Klinikleri Journal of Medical Sciences
[Show abstract][Hide abstract] ABSTRACT: We presented four cases diagnosed with Herpes simplex virus encephalitis of those treated in our clinic in 2006 one of whom died, one recovered without any sequels. Two cases were left with advanced motor mental sequel. In this paper, clinical and laboratory findings along with diagnosis and treatment of Herpes simplex virus encephalitis were discussed.
[Show abstract][Hide abstract] ABSTRACT: Brucellosis is the most prevalent bacterial zoonosis worldwide. In this study, we aimed to compare our 1028 brucellosis cases with other big series in the literature in view of epidemiological, clinical, and laboratory findings and therapeutic features.
A total of 1028 brucellosis cases admitted to the Department of Infectious Diseases and Clinical Microbiology over a 10-year period were included in the study. A retrospective analysis was undertaken and patient files were reviewed for history, clinical and laboratory findings, and therapeutic features, as well as complications.
Of the 1028 patients, 539 (52.4%) were female and 489 (47.6%) were male. The mean age of patients was 33.7+/-16.34 years and 69.6% of cases were aged 13-44 years. Four hundred and thirty-five cases (42.3%) had a history of raising livestock and 55.2% of the cases were found to have no occupational risk for brucellosis. Six hundred and fifty-four of the cases (63.6%) had a history of raw milk and dairy products consumption. The most frequently seen symptoms were arthralgia (73.7%) and fever (72.2%), while the most common clinical findings were fever (28.8%) and hepatomegaly (20.6%). The most frequent laboratory finding was a high C-reactive protein level (58.4%). The standard tube agglutination (STA) test+Coombs STA test was positive in 1016 cases (98.8%). Focal involvement was present in 371 (36.1%) cases. The most frequent involvement was osteoarticular involvement with 260 cases (25.3%). The overall relapse rate for patients with brucellosis was 4.7%. The highest relapse rate, 8.5%, was observed in the group of patients with osteoarticular involvement. Regimens including doxycycline and streptomycin with or without rifampin appeared more effective than other regimens in osteoarticular involvement.
In humans, brucellosis may lead to serious morbidity, and it continues to be a major health problem in Turkey. There is no recommended treatment protocol for complicated brucellosis. Large multicenter studies are needed to determine the most appropriate treatment choices and durations in complicated brucellosis.
Full-text · Article · Nov 2009 · International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases
[Show abstract][Hide abstract] ABSTRACT: To examine our patients with brucellosis and renal involvement. Although brucellae have been recovered from the urine of patients with brucellosis, renal involvement is uncommon.
The data from 15 patients (8 males and 7 females, mean age 43 +/- 18.9 years, range 16 to 80), who had been admitted to our hospital with the diagnosis of brucellosis with renal involvement from 1998 to 2006, were retrospectively evaluated.
In almost all cases, urinalysis revealed hematuria and variable amounts of proteinuria; some of the patients had pyuria. Of the 15 patients, 14 had renal failure. The etiology of renal failure was prerenal azotemia in 1, acute tubular necrosis because of nonsteroidal anti-inflammatory drug use in 1, anuric tubulointerstitial nephritis due to rifampin use in 1, nephritis accompanied by brucellar endocarditis in 3, brucellar endocarditis and tubulointerstitial nephritis-associated vasculitis in 1, brucellar membranoproliferative glomerulonephritis in 1, and brucellar tubulointerstitial nephritis clinically in 6 patients. Hemodialysis was required in 5 patients. Chronic renal failure developed in 1 patient, 2 patients were lost to follow-up, and renal function completely recovered in 11 patients. Two patients underwent renal biopsy and membranoproliferative glomerulonephritis with intraglomerular infiltration of histiocytes was identified in 1 patient and chronic tubulointerstitial nephritis associated with vasculitis and immune complex nephritis features was identified in the other.
In areas endemic for brucellosis, this infection can be associated with hematuria, proteinuria, and renal failure. In addition, many diverse etiologies can play a role in the renal involvement associated with Brucella infection.