Hakan Uslu

Is HMGB1 a new indirect marker for revealing fibrosis in chronic hepatitis and a new therapeutic target in treatment

In chronic hepatitis B virus (HBV) infection, inflammation-associated cytokines including proinflammatory cytokines are involved in the development and progression of liver fibrosis. The liver is a source of many cytokines that may influence liver function. High-mobility group box 1 (HMGB1) was identified as an inflammatory cytokine. HMGB1 is present in nuclei of all mammalian cells and is released both through active secretion from various cells and by passive release from necrotic cells. Here we explore the relationship between HMGB1 plasma levels and liver fibrosis. HMGB1 serum levels, HBV-DNA, and ALT values were significantly higher in patients with chronic HBV than in controls. In addition, HMGB1 serum levels were significantly higher in patients with low fibrosis (fibrosis score 1-2) compared to those with high fibrosis (fibrosis score 3-4). In the present study, we have shown that HMGB1 is a noninvasive, repeatable, and convenient marker for distinguishing advanced fibrosis from low fibrosis in chronic HBV patients. We believe that the inhibition of HMGB1 may reduce inflammation, apoptosis, and fibrosis, and may stop the progression of chronic liver disease. Furthermore, we are of the opinion that fibrotic progression in chronic liver patients may be prevented by the inhibition of HMGB1, and that this substance can be a new means of following chronic HBV treatment.

Conjunctival Flora in Patients With Type 1 or Type 2 Diabetes Mellitus

Patients with diabetes mellitus (DM) are prone to infection because glucose in the skin, urine, mucous membranes, and tears promotes growth of microorganisms. Conjunctival flora develops soon after birth, and some saprophytic conjunctival flora play a pathogenic role when immune function is compromised, which can lead to serious infection. DM is one condition that may compromise immune status. In lacrimal function tests of DM patients, a decrease in breakup time (BUT) of lacrimal film and a decrease in Schirmer’s test results were seen. In the present study, conjunctival flora in patients with DM was compared with that in controls with regard to type and duration of diabetes and results of lacrimal function tests. Seventeen patients with type 1 DM (n=34 eyes), 66 patients with type 2 DM (n=132 eyes), and 50 control subjects (n=100 eyes) were included. The control group consisted of age-matched patients with no ophthalmologic problems other than refractive error. Clycosylated hemoglobin values were measured with highpressure liquid chromatography with the Hi-AUTOA1c analyzer (Kyoto Daiichi Kagatu Co., Ltd., Kyoto, Japan). Type and duration of diabetes and demographic data were recorded, and routine ophthalmologic examinations were performed; the BUT of lacrimal film was determined, and the results of Schirmer’s test were assessed. Microbiologic sampling was performed twice for both eyes with sterile cotton swabs. One sample was incubated in 2 mL of brain-heart infusion broth agar; the other was incubated for the presence of fungi in Sabouraud dextrose agar. Colony morphology, hemolysis, and Cram’s stain, as well as catalase, oxidase, and coagulase tests were performed. No growth was observed in 12 of 1 7 patients (35.4%) with type 1 DM, 28 of 66 patients (21.2%) with type 2 DM, and 25 of 50 control subjects (50%).Staphylococcus epidermidis (11.79%) andStaphylococcus aureus (11.7%) were the most frequently isolated organisms in the type 1 DM group, and Sepidermidis (24.2%) and Saureus (21.2%) were the predominant organisms in the type 2 DM group. In control subjects, Sepidermidis (22%), Saureus (12%), andCorynebacterium spp (10%) were the most frequently isolated organisms, and the number of eyes with growth of Saureus was significantly higher in the type 2 DM group than in the other groups (P<.01). Patients with diabetes are more prone to postoperative endophthalmitis than are nondiabetics, and preoperative application of antiseptic or antimicrobial agents to the conjunctiva may not sterilize the area. Impaired integrity of the posterior capsule may also increase the risk of endophthalmitis. Postoperative endophthalmitis is usually associated with gram-positive organisms (75%–80%); gram-negative organisms (15%–29%) and fungi (3%–13%) account for a smaller number of cases. A high rate of resistance to penicillin, ampicillin, and tetracycline was observed in Saureus isolates, although resistance to vancomycin was absent, rendering this molecule the most effective therapeutic option. In this study, Sepidermidis and Saureus were the 2 most frequently isolated organisms in patients with DM. It is concluded that the conjunctival flora in diabetic subjects differs from that in nondiabetic subjects. This should be considered preoperatively and postoperatively, and prophylactic and postoperative treatment should be administered accordingly to diabetic patients.

PURIFICATION OF LACTOPEROXIDASE FROM CREEK-WATER BUFFALO MILK AND INVESTIGATION OF KINETIC AND ANTIBACTERIAL PROPERTIES

ABSTRACT Water buffalo lactoperoxidase (WBLP) was purified with Amberlite CG 50 H+ resin, CM Sephadex C-50 ion-exchange chromatography, and Sephadex G-100 gel filtration chromatography from skim milk. All purification steps of the WBLP were shown with SDS-PAGE and Rz (A412/A280) controlled the purification degree of the enzyme. Rz value for the purified WBLP was 0.8. To determine purification steps and kinetic properties, the activity of enzyme was measured by using 2,2-azino-bis-(3-ethylbenzthiazoline-6 sulfonic acid) diammonium salt (ABTS) as a choromogenic substrate at pH=6. Km, Vmax, optimum pH, and optimum temperature for the WBLP were found by means of graphics for ABTS as substrates. Optimum pH and optimum temperature of the WBLP were 6 and 60°C, respectively. Km value at optimum pH and optimum temperature for the WBLP was 0.82 mM. Vmax value at optimum pH and optimum temperature was 13.7 µmol/mL. min. Km value at optimum pH and 25°C for the WBLP was 0.77 mM. Vmax value at optimum pH and 25°C was 4.83 µmol/mL. min. The purified WBLP was found to have high antibacterial activity in a thiocynate-H2O2 medium for some pathogenic bacteria, such as Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginose, Shigella sonnei, Staphylococcus saphrophyticus, Staphylococcus epidermidis, and Shigella dysenteriae and compared with well known antibacterial substances such as tetracycline, penicillin, and netilmicine.

An evaluation of the hand and nasal flora of Turkish nursing students after clinical practice

AIM The purpose of this study was to evaluate and compare the hand and nasal flora of nursing students before and after the clinical practice. BACKGROUND Hospitals are places where infective agents abound. Healthcare workers, relatives of patients and students practising in the hospital medium are often exposed to these infective agents. Although the role of the hand and nasal flora of healthcare workers in the development of nosocomial infections has been emphasised by earlier studies, there are a limited number of studies which investigate the hand and nasal flora of nursing students. DESIGN Descriptive. METHODS This descriptive study involved 66 volunteer nursing students. Two samples of flora from both hands and nose of each student were obtained. The inoculated samples were then evaluated through routine bacteriological study methods. Chi-square and percentage calculations were used in comparisons. RESULTS None of the students had methicillin-resistant Staphylococcus aureus or methicillin-resistant coagulase-negative Staphylococcus colonisation in the hand samples before clinical practice, 6.1% of the students had methicillin-resistant Staphylococcus aureus and 4.5% had methicillin-resistant coagulase-negative Staphylococcus colonisation after the practice. Although the differences between the rates of contamination with pathogen micro-organisms in the hand and nasal flora of the student nurses before and after clinical practice were not significant, the rate of colonisation after clinical practice was higher. CONCLUSIONS In this study, the rate of colonisation after clinical practice was higher. These findings indicate that students might have been contaminated with bacteria during clinical practice. RELEVANCE TO CLINICAL PRACTICE The results of this study have practical importance in clinical practice. The role of the hand and nasal flora of nursing students in the development of nosocomial infections is significant. For this reason, some precautions, such as using gloves and handwashing with special solutions when needed, should be taken to prevent nosocomial infections and protect students against associated risks.

Relationships between intestinal parasitosis and handedness

The aim of the study was to investigate if there is a possible relation between intestinal parasitosis and handedness in patients with suspected intestinal parasitosis. Hand preference was assessed on the Edinburgh Handedness Inventory. Stool samples were examined microscopically for the presence of parasite. In the present study right-handers had many more helminth infections and left-handers had many more protozoon infections. Lower rate of helminth infections in the present study, and higher asthma incidences in the left-handed population in literature, may be associated with different immune machinery in left-handed people than in right-handed ones.

Mycological examination of the barbers’ tools about sources of fungal infections

The purpose of this study was to determine the colonisation of causative agents for fungal skin infections on the tools and surfaces of barbershops. A total of 357 samples from tools and surfaces of 32 barbershops in Erzurum, Turkey were collected and examined for fungal pathogens. From the combs, Trichophyton rubrum (1), non‐dermatophytic moulds (35) and Candida albicans (1); from the hairbrushes, T. rubrum (3), T. mentagrophytes (1), non‐dermatophytic moulds (21) and yeast (1); from the shaving brushes, non‐dermatophytic moulds (2) and C. albicans (2); from the headrest of barber chairs, T. rubrum (1), non‐dermatophytic moulds (19) were isolated. No fungi were isolated from towels. In conclusion, this study showed that shared tools and contacted surfaces in barbershops are important sources for fungal colonization and may play an important role in spreading mycotic infections among people.

Nonsurgically treated cervical brucellar epidural abscess causing spinal cord compression

Cervical spinal cord compression due to brucellar epidural abscess is extremely rare, with only 13 previously reported cases. We present another case of cervical spinal epidural abscess causing spinal cord compression. Diagnostic tools and treatment options are discussed.

Serotype distribution of Streptococcus pneumoniae in children with invasive diseases in Turkey: 2008–2014

Successful vaccination policies for protection from invasive pneumococcal diseases (IPD) dependent on determination of the exact serotype distribution in each country. We aimed to identify serotypes of pneumococcal strains causing IPD in children in Turkey and emphasize the change in the serotypes before and after vaccination with 7-valent pneumococcal conjugate vaccine (PCV-7) was included and PCV-13 was newly changed in Turkish National Immunization Program. Streptococcus pneumoniae strains were isolated at 22 different hospitals of Turkey, which provide healthcare services to approximately 65% of the Turkish population. Of the 335 diagnosed cases with S. pneumoniae over the whole period of 2008–2014, the most common vaccine serotypes were 19F (15.8%), 6B (5.9%), 14 (5.9%), and 3 (5.9%). During the first 5 y of age, which is the target population for vaccination, the potential serotype coverage ranged from 57.5 % to 36.8%, from 65.0% to 44.7%, and from 77.4% to 60.5% for PCV-7, PCV-10, and PCV-13 in 2008–2014, respectively. The ratio of non-vaccine serotypes was 27.2% in 2008–2010 whereas was 37.6% in 2011–2014 (p=0.045). S. penumoniae serotypes was less non-susceptible to penicillin as compared to our previous results (33.7 vs 16.5 %, p=0.001). The reduction of those serotype coverage in years may be attributed to increasing vaccinated children in Turkey and the increasing non-vaccine serotype may be explained by serotype replacement. Our ongoing IPD surveillance is a significant source of information for the decision-making processes on pneumococcal vaccination.

Alveolar echinococcosis of the brain in five patients.

Cerebral alveolar echinococcis is a biologically aggressive infestation that mimics a malignant neoplasm radiologically and macroscopically. This paper describes the clinical and radiological aspects of the disease, with new diagnostic studies, and discusses the surgical treatment of this infestation. The records of five patients with cerebral alveolar echinococcis treated at our center between 2000 and 2004 were reviewed. Three patients underwent radical surgical treatment and received antihelminthic therapy post-operatively, two of whom experienced asymptomatic recurrence. Two patients with multiple lesions were treated with antihelminthic therapy alone. The prognosis was poor for these patients. Radical surgery combined with antihelminthic therapy of sufficient duration are mandatory to prevent the progression of symptoms but the disease continues to be difficult to cure.

Comparison of Various Methods in the Diagnosis of Entamoeba histolytica in Stool and Serum Specimens.

OBJECTIVE Entamoeba histolytica is indistinguishable from Entamoeba dispar in direct microscopic examination. A definitive diagnosis of E. histolytica is important in terms of the treatment of the patient and to avoid unnecessary costs. This studys aim is to determine the prevalence of E. histolytica and to make a comparison of the different diagnostic tests in the patients specimens defined as E. histolytica/E. dispar infection. MATERIALS AND METHODS Faecal and serum specimens of 90 patients defined as E. histolytica/E. dispar with microscopy (wet mount examination with 0.85% saline and Lugols iodine) were examined. Stool samples were examined by trichrome staining for trophozoites and cysts and by immunoassay methods for specific adhesin antigens (Wampole (®) E. histolytica II antigen testing) and for specific serine-rich 30 kD membrane protein (Serazym(®) E. histolytica antigen testing). Anti-E. histolytica antibodies were investigated using a latex slide test and indirect hemagglutination methods in serum specimens. RESULTS Presence of E. histolytica was not confirmed in 31.1% cases with trichrome staining, 62.2% of the Wampole antigen test, 64.4%, of the Serazym antigen test, 73.3% of the indirect hemagglutination test and 75.6%. of the latex agglutination. Considering the common results from Wampole and Serazym antigen testing as a reference standard, the specificity/sensitivity is 100/53.85% for trichrome staining, 75.00/98.11% for the latex agglutination test and 78.57/96.77% for the indirect hemagglutination test. CONCLUSION It has been shown that investigation of E. histolytica in stools by direct wet-smear microscopy alone can cause significant false positive results. To obtain a reliable diagnosis for E. histolytica and to avoid unnecessary treatment for this parasite, at least one more specific assay, particularly an antigen testing and microscopy, is required.