Sule Colakoglu

Eleven cases of mucormycosis with atypical clinical manifestations in diabetic patients.

OBJECTIVEnWe retrospectively investigated 11 cases of mucormycosis with atypical clinical features accompanied by diabetes mellitus and discussed clinical features, results of laboratory investigations and radiological examinations and treatment outcomes of each case.nnnMETHODSnEleven cases of mucormycosis presenting to our clinic between January 2002 and October 2006 were retrospectively investigated.nnnRESULTSnWe will present a total of 11 cases of mucormycosis, including 2 cases of mucormycosis with orbital apex syndrome as an initial sign, 2 cases of mucormycosis involving the carotid artery and cavernous sinus with the resultant fatal stroke, 1 case of disseminated mucormycosis with atypical clinical manifestations. Mucormycosis was accompanied by type II diabetes mellitus in five cases, chronic renal failure and type II diabetes mellitus in four cases and type II diabetes mellitus and chronic myelocytic leukemia in two cases. None of them had diabetic ketoacidosis. Only one patient recovered but with sequels: blindness, complete ophthalmoplegia of the right eye. Ten patients died of mucormycosis.nnnCONCLUSIONnIn fact, mucormycosis is a fungal infection which may involve all organs and systems. Mucormycosis must be considered in patients presenting with orbital or preorbital sellulitis, even in the absence of ketoacidosis as in our cases.

Three Cases of Serious Infection Caused by Aerococcus urinae: A Patient with Spontaneous Bacterial Peritonitis and Two Patients with Bacteremia

Aerococcus urinae (A. urinae) is an unusual urinary tract pathogen [1–3], which is also reported in case of endocarditis [1, 3–5], septicemia [6–9], balanitis and phlegmon [1], lymphadenitis [10], and spondylodiscitis [11] in elderly patients with local or systemic predisposing conditions such as neutropenia and prostatic diseases. A. urinae is a grampositive, catalase-negative, microaerophilic, alpha-hemolytic coccus, growing predominately in tetrads and clusters. A. urinae is usually susceptible to b-lactam antibiotics and resistant to sulfonamides and aminoglycosides. Susceptibility to trimethoprim and cotrimoxazole is variable [9]. This paper presents three case reports of the serious A. urinae infections, two associated with bacteremia and to our knowledge the first case recorded of spontaneous bacterial peritonitis (SBP).

Clinical outcomes of manual bowel decompression (milking) in the mechanical small bowel obstruction: a prospective randomized clinical trial

BACKGROUNDnThe aim of this prospective randomized study was to investigate the effects of manual bowel decompression in patients who were operated on for mechanical small bowel obstruction.nnnMETHODSnBetween March 2008 and February 2010, 40 consecutive patients with mechanical small bowel obstruction were randomized into 2 clinically comparable groups. The intestinal content of the dilated small bowel was caressed to the stomach (by milking) and aspirated via a nasogastric tube in the milking group (group M, n = 20) and left uncaressed in the control Group (group C, n = 20). Patients characteristics and general operative outcomes were compared and analyzed.nnnRESULTSnThe resumption of a regular diet and postoperative hospital stay (P = .68) were not significantly different in groups M and group C. Similarly, there were no differences between the 2 groups regarding respiratory complications (P = .34), bacterial translocation (P = 1), or wound infection (P = 1).nnnCONCLUSIONSnThe findings suggest that routine milking is unnecessary in mechanical small bowel obstruction.

The African variant of BKV in a Turkish renal transplant patient

In renal transplant recipients, BK polyomavirus (BKV) is linked to nephropathy. BK virus genotypes have a strong geographic component. This paper presents the African variant of BKV in a Turkish renal transplant patient, which is a rare cause of infection in the Northern Hemisphere and, to our knowledge, the first case from Turkey.

Two drugs with paradoxical effects on liver regeneration through antiangiogenesis and antifibrosis: Losartan and Spironolactone: A pharmacologic dilemma on hepatocyte proliferation

BACKGROUNDnThere is a strong relationship between liver regeneration and angiogenesis and fibrosis. It is known that Spironolactone, an aldosterone antagonist, acting on rennin-aldosterone axis, and Losartan, an angiotensin II type I antagonist, have both antifibrotic and antiangiogenic effects. Theoretically, the end result of these mechanisms with contradictory influences on liver regeneration is not known well. In this study, we aimed to reveal the effects on liver regeneration of administration of Spironolactone and Losartan, having contradicting effects on regeneration through antiangiogenesis and antifibrosis.nnnMATERIALS AND METHODSnA total of 72 Wistar albino rats were divided into control, Spironolactone, and Losartan groups and subdivided to conduct examinations on days 1, 3, 5, and 7. The specimens were treated with proliferating cell nuclear antigen to evaluate the characteristics ofxa0liver regeneration; with phosphorylated Smad2 (phospho-Smad2), serum transforming growth factor beta (TGF-B) 1, and tissue TGF-B1 to evaluate the termination of regeneration andxa0with vascular endothelial growth factor receptor 2, Flk-1/KDR, to evaluate angiogenesis.nnnRESULTSnThe proliferating cell nuclear antigen-labeling index was found to be significantly higher in Spironolactone and Losartan groups than in the control group on days 1, 3, and 5 (P = 0.031, 0.0023, and 0.032, respectively). Vascular endothelial growth factor receptor 2, Flk-1/KDR, expression was significantly lower in Spironolactone and Losartan groups than in the control group on days 3, 5, and 7 (P = 0.032, 0.0024, and 0.007, respectively). Phospho-Smad2 was significantly lower on days 1, 3, and 5 in Spironolactone and Losartan groups than in the control group (P = 0.011, 0.0020, and 0.05, respectively). Tissue TGF-B1 levels were significantly lower in Spironolactone and Losartan groups than in the control group only on day 3 (P = 0039). Serum TGF-B1 levels in Losartan groups were significantly different from those of control and Spironolactone groups only on day 1 (P < 0.05).nnnCONCLUSIONSnLiver regeneration, expected to decrease on day 3, was prolonged and increased even on day 5 despite antiangiogenic effects of Losartan and Spironolactone, which in fact inhibit fibrosis through phospho-Smad2 and increase regeneration. In addition, serum and tissue TGF-B1 levels are not sensitive enough to show active TGF-B1 for the evaluation of regeneration.

Molecular methods for detection of invasive fungal infections and mycobacteria and their clinical significance in hematopoietic stem cell transplantation.

Infection remains an important source of morbidity and mortality in patients who undergo hematopoietic stem cell transplantation (HSCT). In the immune reconstitution period after transplantation, HSCT recipients are most likely to have bacterial or fungal infections. Invasive fungal infections (IFIs) and mycobacterial infections (MBIs) are among the complications of HSCT, with high morbidity and mortality rates. Early diagnosis of both is crucial in order to manipulate the disease and to avoid fulminant outcomes. This chapter reviews the current knowledge on the molecular diagnosis of IFIs and MBIs in HSCT recipients, describing two different polymerase chain reaction (PCR)-based methods, one commercial (qPCR, Roche) and one in-house IS6110-based protocol.