Suda Tekin Koruk

Management of Brucella endocarditis: results of the Gulhane study

Brucella endocarditis (BE) is a rare but life-threatening complication of human brucellosis. The aim of this study was to investigate the course of BE along with the therapeutic interrelations. A total of 53 patients with BE hospitalised in 19 health institutions between 2006 and 2011 were included in the Gulhane study. Diagnosis of brucellosis was established by either isolation of Brucella sp. or the presence of antibodies, and the definition of endocarditis was made according to Dukes criteria. There were four treatment groups: ceftriaxone combined with oral antibiotics (Group 1); aminoglycosides combined with oral antibiotics (Group 2); oral antibiotic combinations (Group 3); and aminoglycoside plus ceftriaxone combined with an oral antibiotic (Group 4). Involvement rates of the aortic, mitral and tricuspid valves were 49.1%, 43.4% and 5.7%, respectively. Thirty-two patients (60.4%) had an underlying cardiac valvular problem, including previous prosthetic valve replacement (n=18). Medical treatment was provided to 32 patients (60.4%), whilst concordant medical and surgical approaches were provided to 21 patients (39.6%). Mortality in Group 1 was 15% (3/20), whilst in Group 2 it was 5.3% (1/19). In Group 3, 25.0% (3/12) of the cases died, whereas none of the cases in Group 4 died. In conclusion, mortality increased 47-fold with pericardial effusion and 25-fold due to congestive heart failure that developed after BE. Although mortality was lower in the aminoglycoside-containing arm (Groups 2 and 4), statistical analysis could not be performed owing to the small number of patients.

Prolidase and oxidative stress in chronic hepatitis C.

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.

Decreasing oxidative stress in response to treatment in patients with brucellosis: could it be used to monitor treatment?

OBJECTIVESnThe aims of this study were to evaluate oxidant and antioxidant status in patients with acute brucellosis before and after therapy, and to determine whether this index could be used to monitor the treatment of brucellosis.nnnMETHODSnThirty patients with a diagnosis of acute brucellosis and 37 healthy volunteers were enrolled in the study. Total antioxidant status (TAS) and total oxidant status (TOS) were measured in patients before and after therapy, and an oxidative stress index (OSI) was calculated. These measurements were also taken for the healthy control group and the values were compared.nnnRESULTSnPlasma levels of TOS and OSI were significantly higher in patients with brucellosis before therapy as compared to the treated group (t: 11.19, p<0.000 and t: 9.91, p<0.000, respectively). After treatment, TOS and OSI levels were lower, whereas in contrast, TAS levels were significantly higher (t: -4.17, p<0.000). TOS and OSI levels were found to be significantly higher in the patients before treatment than in the control group (t: 15.01, p<0.000 and t: 15.00, p<0.000, respectively). TAS levels in patients before treatment were lower than in the controls and the difference was significant (t: -8.03, p<0.000). TOS and OSI levels were significantly higher in the treated group than in the control group (t: 4.58, p<0.000 and t: 9.91, p<0.000, respectively). TAS levels in the treated group were lower than in the control group and the difference was significant (t: -3.02, p<0.004).nnnCONCLUSIONnReduced TAS capacity and elevated TOS levels may lead to considerable oxidative stress in brucellosis. Increased oxidative stress may cause severe oxidative damage in the body, and even though this damage ameliorates considerably with 6weeks of treatment, normal healthy levels are not attained. In addition, it appears possible that these oxidant and antioxidant parameters could be used to monitor treatment.

The activity of paraoxonase and arylesterase in patients with osteomyelitis

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. Method. 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. Results. 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). Conclusion. 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.

Where Do We Stand in the Control of Rabies? Knowledge and Practices Among Physicians in a Health District in Turkey

OBJECTIVEnThe aim of this study was to determine the level of knowledge of rabies transmission and control among physicians practicing in healthcare centers in Sanliurfa, Turkey where 2 cases of human rabies were reported in the past 12 months. Implementation issues regarding the current guidelines will also be discussed.nnnMETHODSnA cross-sectional study was conducted among 84 physicians practicing in healthcare centers in Sanliurfa, located in the Southeastern Anatolian region of Turkey.nnnRESULTSnAmong physicians, average duration of medical practice was 8.5 ± 6.7 years. The correct incubation period of rabies cases was known by 57.1% of the physicians. While 88.1% of physicians were aware of possible exposure routes, only 44.0% of them had the information that mucosal contact may also lead to transmission. While 96.4% of the physicians correctly indicated that cats and dogs can transmit the disease, the fact that foxes also have a role in transmission was known by only 48.8%. Post-exposure prophylaxis was correctly indicated by 65.5% of participants, but only 17.9% had correct information about pre-exposure prophylaxis.nnnCONCLUSIONnAn important approach in rabies control is to increase community awareness, particularly among healthcare providers. It was found that basic management issues and insufficient awareness still exist despite the presence of legal regulations. To control rabies, the issue must be dealt with locally, through both economic and social means, by supporting rabies control efforts of local health and agricultural directorate managers and by encouraging collaboration with academics.

Serum paraoxonase and arylesterase activities in various forms of hepatitis B virus infection

The aim of this study was to determine and evaluate the activity of paraoxonase and arylesterase enzymes in various clinical forms of hepatitis B infection and to investigate the correlation between these parameters and chronic disease course/fibrosis. Overall, 40 patients diagnosed as hepatitis B carriers (CIHBV), 40 chronic active hepatitis B (CAHBV) patients, and 40 healthy adults (control group) between 18 and 65 years of age were enrolled the study. Serum paraoxonase and arylesterase activities were measured spectrophotometrically. Their activities were significantly lower in patients with CAHBV compared with CIHBV patients or with control group patients (P<0.001). There was a negative correlation between alanine aminotransferase levels and theactivity of paraoxonase and arylesterase (r=−0.38, P=0.001 and r=−0.28, P=0.002, respectively). A statistically significant negative correlation was found between arylesterase activity in the sera of CAHBV patients and HBV DNA levels (ρ=−0.33, P=0.03). On the contrary, no correlation was found between paraoxonase levels and HBV DNA levels (P>0.05). The histology activity index of CAHBV patients did not correlate with paraoxonase and arylesterase activities (P>0.05). In light of these findings, it may be assumed that during the progression of an inactive hepatitis B carrier to being actively infected, reduced paraoxonase and arylesterase activities may be observed. J. Clin. Lab. Anal. 25:311–316, 2011.

Evaluation of hepatitis B virus transmission and antiviral therapy among hepatitis B surface antigen-positive pregnant women

The aim of the present study was to assess the potential risk of hepatitis B virus (HBV) vertical transmission among Turkish parturient women and to evaluate the efficacy and safety of antiviral agents.

Increased liver mast cells in patients with chronic hepatitis C

BACKGROUND AND AIMnThe aim of the study was to investigate the mast cell (MC) concentration in the liver tissue of patients diagnosed with chronic hepatitis C and to determine whether there was a correlation with clinical and pathological characteristics of patients.nnnMATERIALS AND METHODSnThe study was conducted on liver biopsy samples from 60 patients with chronic hepatitis C. Clinical and laboratory data were obtained from follow-up records. Stained liver biopsies were examined. Immunohistochemical staining was performed by using an anti-c-kit antibody. Patients were divided into four groups (minimal, mild, moderate, and severe) based on the intensity of inflammation and their hepatic activity index scores and into two groups (no-mild, moderate-severe) according to fibrosis grade.nnnRESULTSnAmong patients enrolled, 60.0% (n=36) were men with a mean age of 48.3 ± 12.7 (range 18-64) years. The mean number of mast cells per portal area in the liver was 0.87 ± 0.86 (0-4.0). No correlation was found between alanine aminotransferase (ALT) and hepatitis C virus (HCV). Ribonucleic acid ( RNA ) levels and the degree of inflammation of cases with number of mast cells and liver steatosis (P>0.05). As the degree of fibrosis increased in the liver so did the number of mast cells in portal areas (P=0.001). On the other hand, no correlation was found between the degree of fibrosis and the number of MCs in the sinusoids and steatosis (P<0.05). The increase in the number of MCs in the portal areas correlated with an increase in liver steatosis (t: 0.02, P=0.04).nnnCONCLUSIONnIn light of these findings, it appears possible that MC accumulation in chronic HCV patients may be used as an indicator of fibrosis and possibly be considered in the follow-up of these patients.

Assessment of Growth and Development in Children With Hepatitis B Positivity

Background Chronic infections and liver diseases may influence the growth and development of children by leading to malnutrition. In this study, demographic characteristics, anthropometric measurements and laboratory findings for children with hepatitis B positivity were analyzed. Methods A total of 43 cases were admitted to our clinic between January 2012 and February 2013 and detected to have HBsAg positivity. Results Malnutrition was detected in 11 cases (25.6%) and obesity in three cases (6.9%). Aspartate aminotransferase (AST) levels were significantly higher in malnourished patients compared to those without malnutrition. The weight to height was significantly higher in patients with positive HBeAg compared to children with negative HBeAg. We found that the weight standard deviation scores (SDS) ratios dropped as alanine aminotransferase (ALT) and AST levels increased and height SDS ratios decreased. In addition, body mass index (BMI) decreased as AST and alpha feto protein (AFP) values increased. While a significant relationship was not detected between insulin-like growth factor binding protein-3 (IGFBP-3) and insulin-like growth factor-1 (IGF-1) and ALT, a significantly negative correlation was detected between IGFBP-3 and IGF-1 and AST. We found a malnutrition rate of 25.6% in children with HBsAg positivity. We also found that weight and height SDS rates decreased as ALT and AST levels increased. In addition, we detected that BMI decreased as AST and AFP values increased. Conclusion We consider that hepatic inflammation is the factor that affects growth. Monitoring of growth and development during follow-up of children who are detected to have HBsAg positivity would be beneficial to determine the mechanism and causes of growth retardation.