Murat Hayran

PCR on disseminated tuberculosis in bone marrow and liver biopsy specimens : Correlation to histopathological and clinical diagnosis

Disseminated tuberculosis with negative pulmonary findings is a diagnostic problem. Histopathological studies of bone marrow (BM) and liver (LV) biopsies are the most reliable methods for diagnosis in such cases; however, their sensitivity is limited. In this retrospective study, 41 BM and 7 LV paraffin-embedded biopsy specimens from clinically (clinical response to antituberculous treatment after 6 months follow-up) and/or histopathologically diagnosed tuberculosis were analysed for the detection of Mycobacterium tuberculosis DNA by polymerase chain reaction (PCR). Two different primer sets, one based on the repeated IS6110 sequence of M. tuberculosis and the other based on the mtp40 gene region, were used for amplification. Histopathological and PCR studies were positive for M. tuberculosis in 12/41, and 30/41 in BM and 4/7, and 6/7 in LV biopsy specimens, respectively. As the control group, 17 BM biopsy specimens obtained from patients with a positive Mantoux skin test but no active tuberculosis were analysed. One BM biopsy out of 17 control cases was positive with PCR while none was consistent with TB histopathologically. In conclusion, PCR might be applicable and more reliable than histopathological studies for detection of tuberculosis in BM and LV biopsy specimens.

Correlation of in vitro fluconazole susceptibility with Clinical outcome for severely ill patients with oropharyngeal candidiasis

We investigated the correlation between in vitro susceptibility to fluconazole and clinical response in severely ill patients with oropharyngeal candidiasis treated with fluconazole. The study included 48 adult patients, of whom 23 were neutropenic (absolute neutrophil count, < 500/mm3). Forty-eight isolates (20 Candida albicans, 12 Candida krusei, 10 Candida kefyr, 3 Torulopsis glabrata, and 3 Candida tropicalis) were tested for susceptibility to fluconazole with use of the macrodilution method of the National Committee for Clinical Laboratory Standards. A strain was considered to be susceptible to fluconazole if the MIC was < or = 8 micrograms/mL and resistant if the value was > or = 64 micrograms/mL. All but one of the resistant strains were C. krusei isolates. Species of causative Candida, persistent neutropenia, and susceptibility to fluconazole were significant predictors of clinical response by univariate analysis. Logistic regression analysis indicated that the only significant factor was the species of Candida isolates, validating the recently recommended MIC breakpoint and the correlation between clinical outcome and in vitro antifungal susceptibility.

The effect of maintenance narrow-band ultraviolet B therapy on the duration of remission for psoriasis: a prospective randomized clinical trial

Background  Narrow‐band (311 nm) UVB is an effective treatment modality for moderate to severe psoriasis. The effect of maintenance narrow‐band UVB on the duration of remission is unknown.

Predicting Chronic Leukaemias from Assessment of Complete Peripheral Blood Counts

The chronic leukaemias include two distinct chronic neoplastic disease states, namely chronic myelogenous leukaemia (CML) and chronic lymphocytic leukaemia (CLL). The aim of this study was to assess the utility of leucocyte count, neutrophil percentage and absolute lymphocyte count from differential complete blood count analyses as indicators of the possible presence of CML and CLL. Blood counts from 102 patients with histopathologically confirmed CML and CLL were compared with counts for 858 cancer-free control subjects. Optimal cut-off values were identified by selecting values with the highest sensitivity–specificity combination for each blood count parameter for the two diseases. The results indicated that any individual with mature-appearing lymphocytes at a level > 6.65 × 109/l in the peripheral blood should be examined further for CLL, and that any individual with a leucocyte count > 18.0 × 109/l or a neutrophil proportion > 72.6% should be investigated for CML.

SEVERE HYPOGLYCEMIA IN A PATIENT WITH CHRONIC RENAL FAILURE DUE TO AMYLOIDOSIS

Arzu Topeli, Hacettepe Üniversitesi, Tip Fakültesi, İç, Hastahklari Ana Bilim Dali, TR-06100 Ankara (Turkey) Dear Sir, The cause of hypoglycemia in a patient with chronic renal failure (CRF) is a difficult clinical problem since it may be due to various causes, the first thought of is uremia itself. Here we describe a case with severe hypoglycemia in a patient with CRF. A 26-year old male patient with end-stage renal disease was admitted to our medical intensive care unit (MICU) because of upper gastrointestinal (GI) bleeding. He had systemic amyloidosis, diagnosed on rectal biopsy in 1984, secondary to seronegative rheumatoid arthritis since 1982. He had been on a regular hemodialysis program three times weekly since 1985. On admission his blood pressure was 180/100 mm Hg, pulse 104/min, body temperature 36.2°C and physical examination was unremarkable with the exception of a systolic murmur on the mesocardium. Laboratory examination revealed: hemoglobin 8.5 g/dl; blood urea nitrogen 74 mg/dl; creatinine 6.9 mg/dl; Na concentration 136 mgEq/dl; K concentration 4.2 mEq/dl; Ca 8.5 mg/dl on calcium supplement, and P 5.4 mg/dl. GI bleeding was successfully managed with medical therapy and 2 units of packed red blood cells were transfused. During his hospital stay, his plasma glucose levels were noted to be low, with fasting venous blood glucose concentrations of 40 and 45 mg/dl on two separate occasions, though he was asymptomatic. The patient denied any alcohol and drug abuse. Blood samples were taken for basal cortisol and adrenocorticotrophic hormone (ACTH). ACTH stimulation test was done with 250 mg synthetic ACTH (Synacthen; Ciba-Geigy, Basel, Switzerland) administered intramuscularly and plasma cortisol was measured 30 min later. Thyroid-stimulating hormone (TSH), insulin and C-peptide levels were measured after an overnight fast and fasting for 72 h with simultaneous glucose determinations. After stabilization of his GI bleeding, the patient was discharged on his own wish as he refused any other tests while the results of the tests were pending. Two days after discharge he was taken to the emergency room by a family member, in deep coma and unable to respond to even painful stimuli. Blood pressure was 130/ 75 mm