Can Polat Eyigün

Human orf complicated with erythema multiforme

References 1 Hynes LR, Shenefelt PD. Unilateral nevoid telangiectasia: occurrence in two patients with hepatitis C. J Am Acad Dermatol 1997; 36: 819–822. 2 Karakas M, Durdu M, Sonmezoglu S, et al. Unilateral nevoid telangiectasia. J Dermatol 2004; 31: 109–112. 3 Wilkin JK. Unilateral nevoid telangiectasia: three new cases and the role of estrogen. Arch Dermatol 1977; 113: 486–488. 4 Uhlin SR, McCarty KS Jr. Unilateral nevoid telangiectatic syndrome. The role of estrogen and progesterone receptors. Arch Dermatol 1983; 119: 226–228. 5 Kreft B, Marsch WC, Wohlrab J. Unilateral nevoid telangiectasia syndrome. Dermatology 2004; 209: 215–217. 6 Sadick NS, Urmacher C. Estrogen and progesterone receptors: their role in postsclerotherapy angiogenesis telangiectatic matting. Dermatol Surg 1999; 25: 539–543. 7 Sharma VK, Khandpur S. Unilateral nevoid telangiectasia – response to pulsed dye laser. Int J Dermatol 2006; 45: 960–964.

Brucellar epididymo-orchitis: a retrospective multicenter study of 28 cases and review of the literature.

OBJECTIVE To review retrospectively the clinical symptoms, laboratory findings and treatment outcomes of patients with Brucellar epididymo-orchitis. MATERIAL AND METHOD Retrospective data of 28 patients with Brucellar epididymo-orchitis who admitted to four medical centers between 2005 and 2013 were retrospectively reviewed. Positive blood culture, positive Rose Bengal test results or high agglutination titres of ≥ 1/160 with the positive clinical and ultrasonographic findings of orchitis were accepted as the main criteria for Brucellar epididymo-orchitis. RESULTS The mean patient age was 31 ± 16.9 years. Testicular involvement was on the left side in 16 patients and on the right side in 11 patients, one had bilateral disease. Testicular pain and swelling were the most common symptoms and elevation of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and leucocytosis were the most common laboratory findings. Initial treatment was orchidectomy in six patients due to malignancy suspicion. All but three patients were successfully treated with antibiotic combinations of rifampicin, doxycycline and streptomycin. Two of three treatment resistant patients underwent orchidectomy. CONCLUSION Brucellosis is a common cause of epididymo-orchitis in endemic regions. Early diagnosis and treatment is crucial in the management and thus it must be kept in mind in endemic and non-endemic regions.

The role of human leukocyte antigen tissue groups in hepatitis B virus vaccination in Turkey

BACKGROUND/PURPOSE Between 5% and 10% of the vaccinated population responds less well to standard vaccination schedules irrespective of hepatitis B virus (HBV) vaccination. This manuscript aims at describing possible correlation of different major histocompatibility complex (MHC) Class-I and MHC Class-II haplotype to anti-HBV humoral responsiveness following HBV vaccination. MATERIALS AND METHODS The study was conducted on 944 vaccinated hospital staff members and concentrated on the 38 nonresponders as defined by enzyme-linked immunosorbent assay (ELISA) results. In order to define significance of the different haplotypes from the nonresponders, their frequency was compared to the frequency of the same haplotype in 18 randomly selected responders. Human leukocyte antigen (HLA)-A and HLA-B antigens were typed among total mononuclear cells using a standard two-stage microlymphocytotoxicity test. The typing method of HLA Class-II is based on a technique that involves amplification of the second exon of different HLA Class-II genes by PCR. RESULTS Positive correlations were found between four HLA-DR (HLA-DRB1*04X, DRB1*0401X, DRB1*11/13, and DRB1*0401X0201) haplotypes and nonresponders but there was a negative correlation with one Class-I (HLA-B13). CONCLUSION This study suggested that certain HLA types are associated with nonresponsiveness to vaccination. The different HLA of ethnic groups should also be kept in mind when evaluating the response to hepatitis vaccination. The different HLA gene frequencies of ethnic groups should be examined in further large-scale population-based studies.

War and infection in the pre-antibiotic era: The Third Ottoman Army in 1915

Abstract Background: The aim of this study, which evaluated historical data, was to delineate the probable impacts of infectious diseases on human populations under extraordinary circumstances. The second goal was to disclose the mortality rates for infectious diseases in the absence of antibiotics. Methods: The Third Ottoman Army records at the Turkish General Staff Military History and Strategic Study Directorate were studied retrospectively for the period between March 1915 and February 1916. Results: For the Third Ottoman Army, the number of infection-related deaths over the single-year period was 23,601. Malaria, relapsing fever and dysentery were the most common infections. In that pre-antibiotic era, the highest mortality rates were seen for cholera (80%), pulmonary tuberculosis (58%) and typhoid fever (51%). However, typhus had the maximum share in soldier deaths (6053 soldiers). The rate of vector-borne infections peaked in the summer of 1915, while the frequency of respiratory tract infections was highest in the colder months. In contrast, gastrointestinal tract infections appeared to maintain a steady state throughout the year. Conclusions: If the wartime data for 1915 are accepted to provide a model for extraordinary circumstances in the 21st century, vector-borne, respiratory tract and gastrointestinal infections can be accepted as the challenging issues with significant mortality.

Freezing of Apheresis Platelet Concentrates in 6% Dimethyl Sulfoxide: The First Preliminary Study in Turkey.

Objective: Transfusion of platelet suspensions is an essential part of patient care for certain clinical indications. In this pioneering study in Turkey, we aimed to assess the in vitro hemostatic functions of platelets after cryopreservation. Materials and Methods: Seven units of platelet concentrates were obtained by apheresis. Each apheresis platelet concentrate (APC) was divided into 2 equal volumes and frozen with 6% dimethyl sulfoxide (DMSO). The 14 frozen units of APCs were kept at -80 °C for 1 day. APCs were thawed at 37 °C and diluted either with autologous plasma or 0.9% NaCl. The volume and residual numbers of leukocytes and platelets were tested in both before-freezing and post-thawing periods. Aggregation and thrombin generation tests were used to analyze the in vitro hemostatic functions of platelets. Flow-cytometric analysis was used to assess the presence of frozen treated platelets and their viability. Results: The residual number of leukocytes in both dilution groups was <1x106. The mean platelet recovery rate in the plasma-diluted group (88.1±9.5%) was higher than that in the 0.9% NaCl-diluted group (63±10%). These results were compatible with the European Directorate for the Quality of Medicines quality criteria. Expectedly, there was no aggregation response to platelet aggregation test. The mean thrombin generation potential of post-thaw APCs was higher in the plasma-diluted group (2411 nmol/L per minute) when compared to both the 0.9% NaCl-diluted group (1913 nmol/L per minute) and the before-freezing period (1681 nmol/L per minute). The flow-cytometric analysis results for the viability of APCs after cryopreservation were 94.9% and 96.6% in the plasma and 0.9% NaCl groups, respectively. Conclusion: Cryopreservation of platelets with 6% DMSO and storage at -80 °C increases their shelf life from 7 days to 2 years. Besides the increase in hemostatic functions of platelets, the cryopreservation process also does not affect their viability rates.

A strategical re-thinking on National Blood Donor Pool: Anti-HBc positivity related re-entry mechanisms.

BACKGROUND AND OBJECTIVES Screening of blood donations for antibodies against hepatitis B core antigen (anti-HBc) is used to prevent transfusion transmitted hepatitis B virus (HBV) infection. In this study, we studied the magnitude of blood donor gain by using a re-entry mechanism in our Blood Bank of Gulhane Military Academy of Medicine. MATERIALS AND METHODS Between January and May 2013, 5148 voluntary blood donors were screened by ELISA method for HBsAg, anti-HBc total and other screening markers, prospectively. Samples with repeated reactivity for the presence of anti-HBc were further tested with four supplemental assays. RESULTS We detected 515 (10%) anti-HBc positive and 4612 (90%) anti-HBc negative cases in 5127 HBsAg negative serum samples. A total of 461 (89.5%) blood units were reactive for at least one additional serologic parameter and 54 were (10.5%) negative. Isolated anti-HBc positivity rate was 1.3% (69/5127). In the isolated anti-HBc positive samples, 54 were also anti-HBe and HBeAg negative. HBV DNA was not detected in any of the samples. CONCLUSION Applying the EDQM criteria would decrease our blood donor loss from 10% to 5.4%. As alternative re-entry mechanisms have already been presented in the literature, institution of a new policy is needed to enhance the limited blood donor pool in our system.

A case of mucosal leishmaniasis: Mimicking intranasal tumor with perforation of septum

A 79-year-old male suffering from nasal congestion was referred to our hospital. Endoscopic examination revealed a hyperemic mass obstructing the left nasal passage. The lesions surface was smooth. The findings of imaging studies were consistent with a benign tumor despite the erosion and perforation of the septum. The lesion originated from the middle concha and was attached to it with a thin stalk. It was removed easily by endoscopic resection. Histopathology revealed significant infiltration of mononuclear inflammatory cells, mostly lymphocytes and histiocytes, into the edematous subepithelial connective tissue. High-power magnification showed numerous Leishmania amastigotes in the cytoplasm of the histiocytes. A polymerase chain reaction experiment for Leishmania also confirmed the morphological diagnosis. No relapse was observed in the 12 months after surgery and the patient was doing well.

Oropharyngeal tularemia cases admitted to a military hospital in Ankara, Turkey.

INTRODUCTION This study aimed to review the possible sources of infection of 16 oropharyngeal tularemia hospital cases, and to document their epidemiological and demographical characteristics, laboratory findings, treatment methods, and treatment results. METHODOLOGY Sixteen cases from a Turkish military hospital between January 2011 and December 2012 were retrospectively evaluated. The age, sex, occupation, place of residence, symptoms, duration of symptoms, laboratory results, treatment and duration, and treatment results were recorded. Tularemia was diagnosed through tularemia-specific tests once the other conditions that may have caused lymphadenopathy were excluded. RESULTS Twelve of the patients included in this study were males. The average age of the patients was 32.1 ± 17.2 years. Sore throat, fatigue, and fever were the most frequent symptoms. The mean duration of symptoms was 21.6 ± 6.9 days. All the patients had been treated for tonsillopharyngitis in primary healthcare institutions previously. However, despite the treatment, cervical lymphadenopathy had developed in these cases. Patients were given streptomycin, doxycycline, and ciprofloxacin monotherapy or in combination. Ten of the cases fully recovered, while five required surgical lymph node drainage. Spontaneous drainage occurred in the single remaining case. CONCLUSIONS Turkey is considered to be an endemic country with regards to tularemia. Prompt diagnosis and proper treatment of the disease is imperative in providing cure. Since it can be potentially confused with tuberculous lymphadenitis, differential diagnosis is vital. Patients presenting with a condition of tonsillopharyngitis in endemic areas must be carefully monitored.

Prevalence of HIV and syphilis among Turkish blood donors.

To the Editor: Screening of blood is now mandatory for many diseases and is undertaken routinely in blood banks. Many studies have been done on human immunodeficiency vir rus (HIV) and syphilis, separately, but knowledge about the interrelar tionship between these transfusion transmitted diseases is limited.1,2 This study was undertaken to assess the correlation between positivity for HIV infection and syphilis among blood donors of Eskisehir. Donors who applied to our blood center in a 10ryear period (1998r2007) were retrospectively evaluated. No pror fessional or honorary donation was included. Serum samples were screened for antirHIV by ELISA (microparr ticle enzyme immunoassay, Axym, Abbott Corp., IL, USA) and for syphilis by the Veneral Disease Research Laboratory (VDRL) test (nontreponemal test, immunotrep Omega Diagnostic, Scotland, UK). Samples were not screened for VDRL. Of the total of 19 630 individuals, 6850 (34%) were fer males and 12 780 (66%) were males. VDRL positivity was found in 33 donors (0.168%) and antirHIV was positive in 3 cases (0.015%) (Table 1). When the VDRL test was posir tive, a confirmatory treponemal test was done. AntirHIV positivity was also confirmed by the western blot test. For the statistical analyses, chir square and the Fisher exact test were used. The prevalence of VDRL reacr tivity varied from 0.03% to 0.3% in blood donors in different regions of Turkey.3 VDRL reactivty increased from 0.1% in first period to 0.3% in the second period (P=.001). This seems to be an alarming signal in the local blood banks for the probr able increase in syphilis and further diagnostic tests should be applied in these cases. According to the rer sults reported from other regions of Turkey, antirHIV positivity rates ranged between 0% and 0.66%.4 AntirHIV positivity was not found in the first period , but in the second period it was 0.03% (P=.105). Two donors with positive HIV serology (66.6%) were also positive for VDRL (P≤.001). The problem of safe blood has become an issue worldwide; there is no available method to reduce the infection risk from transfusion to zero. Thus, it appears to be essential to carefully select appropriate donors and to avoid unnecessary transfur sion. In conclusion, blood donors in our region show lower seropositivity rates, although there seems to be a regular increase in the rates of antir HIV and syphilis. Thus, taking into consideration the rising prevalence of these infections, a routine screenr ing of all the donated blood products for antirHIV and syphilis should be done, which will assist blood transr fusion services in improving transfur sion safety. Omer Coskun,a Cem Gul,a Hakan Erdem,a Orhan Bedir,b Can Polat Eyiguna

Profiles of biochemical parameters in central nervous system fluid during the therapeutic courses of adult Mycobacterium tuberculosis meningitis

Clinical features, cerebrospinal fluid (CSF) examination, and neuroimaging findings can yield a presumptive diagnosis of tuberculosis meningitis (TM). However, confirmed diagnosis depends on the culture of Mycobacterium tuberculosis from the CSF [1]. Generally, the decision to begin with tuberculostatic treatment cannot await the proof of the causative agent and the prognosis of the disease may be devastating even if treatment is started promptly [2]. Sometimes the clinicians are confused from the diagnostic burden whether to start therapy for TM or not. In some TM cases without microbiological confirmation, the clinical and laboratory parameters resolve very quickly after the initiation of antibiotics. There remains another controversy in this situation, i.e. whether the clinician will stop therapy or continue for 12 months. There is little knowledge on the changes of CSF biochemical parameters during antituberculosis therapy in TM patients. What happens to the biochemical profile in CSF in due course? To the authors’ knowledge there are no data in the literature on this issue. Our study, which was performed between 1 January 2000 and 31 December 2004, focuses on these CNF changes in biochemical profiles for TM patients receiving therapy. There is a chain of military hospitals over the country in Turkey. If a soldier is diagnosed as TM in 1 of the military hospitals, the patient is given antibiotics and sent home for 2 /3 months of rest following the hospitalization necessary for patient stabilization. The patient returns to hospital either in an emergency situation or following the end of the official rest period. Thus, all TM patients return to military hospitals every 2 to 3 months, but the patient does not necessarily apply to the hospital where the disease is diagnosed. Generally the patient applies to the military hospital nearest to where he lives, i.e. another institution may follow a TM case diagnosed in our hospital in the follow-up periods or we may follow a previously diagnosed case in another military hospital during the therapeutic course. In every periodical visit the patient was punctured once again either to delineate the status of infection or to present an official clue to provide the patient with an additional rest time. After the end of 12-month therapy, the surveillance of the patient is stopped. Therefore we have sparse data on TM patients which we may have encountered at any period during anti-tuberculosis therapy. All the cases were young males ranging from 20 to 28 y of age without immunosuppression. Dexamethasone was given to all patients in standard dosages