Crohn’s disease (CD) is a chronic inflammatory bowel disease that affects any part of the gastrointestinal tract, most commonly terminal ileum and proximal colon; and Celiac Disease (CeD) is immuno-mediated systemic disease caused by gluten and similar prolamins in genetically susceptible individuals. Concomitant occurrence of CD and CeD is rare and there are limited literature data regarding the association of CeD to CD. Although, recent findings propose shared mechanisms, genetics and functional pathways. Herein, we report a case that has co-occurrence of CD and CeD and rewiew the literature of the association between these two diseases.
Fecal carriage is one of the most important reasons for extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) causing infections. We aimed to demonstrate epidemiological features for subtype of ESBL-PE-encoding TEM, SHV and CTX-M as well as for qnrA, qnrB, qnrC, qnrS, aac-(6)-Ib genes through polymerase chain reaction (PCR) in patients undergoing transrectal needle prostate biopsy (TRNBP). Between October 2008 and February 2010, we collected 400 fecal swabs from patients prior to TRNBP in four separate centers. After detecting ESBL- PE isolates in the material, we further analyzed TEM, SHV and CTX-M enzymes, as well as three types of qnr genes of qnrA, qnrB, qnrC and aac-(6)-Ib by PCR. We detected 80 ESBL-PE isolates in 400 fecal samples. Of the 80 isolates; blaSHV, blaTEM and blaCTX-M were observed in 12, 46 and 79 isolates, respectively. All three genes were present in eight isolates. Resistance to Quinolone was identified in 67 (83.7%) isolates, resistance to aminoglycoside in 52 (65%) isolates, and resistance to both antibiotics in 46 (57.5%) isolates. Subsequently, we determined qnrB, qnrS and aac-(6)-Ib genes in 7 (8.8%), 11 (14%) and 60 (76%) isolates, respectively. qnrA and qnrC were not detected in any of the isolates. CTX-M-producing ESBL-PE is the most common pathogen responsible for fecal carriage in the community. Plasmid mediated quinolone resistance genes (qnr, aac-(6)-Ib) are the reason behind the dissemination of ESBLs.
Acinetobacter baumannii has emerged as one of the most important nosocomial pathogens and multi-drug resistant (MDR) isolates are of great concern worldwide. The aim of the present study was to investigate the in vitro synergistic activity of colistin in combination with other antibiotics against MDR A. baumannii blood stream isolates. A total of 54 non-duplicate, MDR A. baumannii isolates from blood culture specimens obtained between June 2011 and July 2012 were included in the study. In vitro synergistic activity of colistin in combination with imipenem, tigecycline or cefoperazone-sulbactam against study isolates was investigated by Etest superimposing method and the fractional inhibitory concentration (FIC) index was calculated for each antibiotic combination. The most frequent synergistic effect of colistin was found in combination with tigecycline in only 7 isolates (13.0%). All three antibiotics were found to have synergistic effect with colistin in four isolates (7.4%). Of isolates, 46 (85.2%) showed additive effect of colistin in combination with cefoperazone-sulbactam or tigecycline, 45 (83.3%) with imipenem. We found synergistic activity of colistin with other study antibiotics in only a small number of isolates. Although Etest method is a practical method to investigate the synergistic activity, in case of choosing empirical treatment, colistin in combination with another antibiotic may be preferred.
Sporotrichosis is a cutaneous or systemic fungal infection caused by Sporothrix schenckii. The infection is characterized by nodular, pustular, or ulcerative lesions. Infection usually occurs after traumatic implantation of the fungus into the skin. We report a case presenting first cellulitis and later on as a non-healing ulcer which was diagnosed by punch biopsy as sporotrichosis and managed successfully with itraconazole. A 56-year-old woman admitted to our department with complaint acute onset of swelling of the right lower-extremity with erythema and warmth. The patient was diagnosed initially as celulitis and started on ampicillin-sulbactam. Diagnosis of sporotrichosis was made with histological examination skin biopsy and the patient was started on itraconazole. One month after commencement of antifungal treatment, the ulcer began to dry up and at 3 months the lesions had healed. This case shows that if a wound do not respond to antibiotics in cases with ulcer, some rare etiological agents should be considered.
Leptospirosis is a globally widespread zoonotic infection caused by leptospira-type spirochetes. In humans the infection generally occurs by way of direct or indirect contact with infected animal urine. The main clinical symptoms are fever, septicemia, headache, fatigue and myalgia. The disease usually begins with a high fever. The largest risk factor for leptospirosis is occupational and it includes farmers, ranchers, military personnel and, sewer workers. There is also a risk through recreational exposure such as freshwater swimming and kayaking. This report describes a case of leptospirosis following a course with hyper-pyrexia, for the first time in the medical literature.
The aim of this study was to investigate the effects of hyperbaric oxygen (HBO) therapy on acetaminophen (APAP) induced renal and liver injudr and the role of heme oxygenase-1 (HO-1) activation. Wistar-Albino rats were randomly assigned into four groups. Control group received no treatment. APAP (3gr/kg) was administered by gastric lavage in APAP group. Animals in the APAP+HBO and APAP+zinc protoporphyrin (ZnPP)+HBO groups received HBO therapy (90 min at 2.5 atm), starting 1 hour after APAP administration, for 2 consecutive days.HO-1 activity was inhibited by ZnPP. APAP+ZnPP+HBO group received intraperitoneal 50 µmol\kg ZnPP injection 30 minutes after APAP treatment and HBO therapy for 2 days. Serum and tissue samples were taken at 48 hours after APAP treatment. Renal and liver functions were evaluated by serum levels of urea, creatinine and transaminases. Lipid peroxidation and tissue levels of antioxidant enzymes were measure by ELISA. Tissue injury was evaluated by light microscopy.HO-1 level was determined by immunohistochemistry. HO-1 mRNA level was investigated by polymerase chain reaction (PCR). Serum transaminase levels significantly increased after APAP treatment (p
Estrogen replacement reduces the frequency of type 2 diabetes (T2D), an effect which involves the suppression of hepatic glucose production. The objective of this study was to identify the hepatic mechanisms involved in the beneficial effects of 17β-estradiol (E2) on insulin sensitivity in mice exposed to long term (10 months) high fat diet (HFD) feeding. E2 treatment in HFD mice led to significant improvements in glycemic control. In the livers from these animals, Western blotting studies showed that E2 treatment led to significant increases in the activation state of the AMP-activated protein kinase (AMPK), in association with reduction of the nuclear receptor Nr2c2/TR4 both mRNA and protein levels, and suppression of downstream lipogenic gene expression. These effects were in parallel with up-regulation of hormone sensitive lipase (lipe) expression by E2. Increased fasting glucose levels following HFD feeding were associated with increases in the expression levels of the gluconeogenic genes, g6pt1 and pyruvate carboxylase, whilst E2 treatment significantly reduced their expression levels. The insulin signaling pathway was studied in the liver after acute insulin intervention. The phosphorylation states of AKT2 and FOXO1 were both decreased in HFD mice, and E2 treatment reversed these changes. In conclusion, E2 treatment reduced body weight and improved glycemic control in association with activation of hepatic AMPK, reduced expression of its downstream target Nr2c2/TR4, and consequent decreases in lipogenic gene expression. Together with increased triglyceride mobilization, these changes paralleled improved hepatic insulin signaling and reduced gluconeogenic gene expression.
This paper describes primary subcutaneous infection caused by Nocardia abscessus in a 60-year-old male patient with the history of non-Hodgkin’s lymphoma and chronic lymphocytic leukemia. The patient was presented with pain and swelling in his left thigh for 45 days. Soft tissue ultrasonography showed a heterogeneous and hypoechoic mass consistent with an abscess. Gram-positive and branched filamentous bacilli, along with neutrophils, were identified in Gram-stained smears of the pus. The pus culture was pos itive for Gram-positive bacilli, which identified as N. abscessus. Initially, the patient was treated with trimethoprim-sulfamethoxazole (TMP-SMX). Due to insufficient clinical re -sponse, ceftriaxone was added for 2 weeks. Then, the patient was prescribed a 3-month course of TMP-SMX. It is important to start appropriate and effective treatment as soon as possible in patients with immunosuppression.
Sepsis, which develops as a result of inflammatory response against infection, is a signicant cause of mortality, especially in patients in intensive care unit. Early diagnosis and effective treatment of bacterial infections is life-saving. The aim of this study was investigate the differences in C-reactive protein (CRP), procalcitonin (PCT), white blood cell count (WBC) and mean platelet volume (MPV) levels in bloodstream infections caused by Gram- negative (GN), Gram-positive (GP) or fungal agents. We retrospectively evaluatd the patients with bloodstream infections hospitalized between 01.01.2014 and 01.01.2016. Identification of microorganisms was performed in Microbiology Laboratory. Blood cultures were performed by using BACTEC 9120 (Becton Dickinson, USA) automatized blood culture system. CRP, PCT, WBC and MPV levels, which were investigated simultaneously with blood culture, of patients in whose blood culture growth occured were investigated. Mean PCT, CRP, WBC and MPV values were compared in patients with different infection agents. A total of 74 patients were investigated. There were 35 (47%) patients with Gram-negative, 26 (35%) patients with Candida and 13 (18%) patients with Gram-positive microorganisms. The most common GN microorganism agents were was Acinetobacter, Candida albicans was the most common fungal agent and coagulase-negative staphylococci (CoNS) was the most common GP agent. The highest PCT values were in patients with Klebsiella, Escherichia coli and Acinetobacter infections, respectively. CRP and PCT values were higher in GN bacteremias compared to GP and fungal infections. We think that CRP and PCT levels may be beneficial for differentiation of GN bacteraemia, GP bacteraemia and fungal infections aand may be considered as a factor which may guide empirical antimicrobial treatments.
Diabetes is a metabolic disorder characterized by chronic hyperglycemia and impaired cytokine levels leading to inflammation. Interlukin-10 (IL-10) is an anti-inflammatory cytokine which acts as macrophage deactivator affecting the synthesis of TNF-a, IL-1, IL-6, IL-8 and GM-CSF. Single-nucleotide polymorphisms (SNPs) viz. -592A/C, -819T/C and -1082A/G in IL-10 promoter are associated with IL-10 production. Low IL-10 levels in T2DM cases may be regulated by such gene variants. The present study was undertaken to evaluate the association of two genetic polymorphisms viz. IL-10 -819T/C and -1082A/G with T2DM in a North Indian population. Blood samples from 402 subjects (201 each of controls and T2DM cases) were collected after ethical approval and individual written consent. All subjects were genotyped by polymerase chain reaction-restriction length polymorphism (PCR-RFLP) using specific primers and restriction enzymes. Genotypic, allelic, carriage rate frequencies were calculated and haplotypic analysis performed by SPSS (version 21.0) and SHEsis (online version). All biochemical parameters except WHR and TG showed significant association with T2DM (P<0.005). In the study population ‘TC’ genotype of -819T/C and ‘GG’ genotype of -1082A/G showed significant association with T2DM (P< 0.0001, OR=2.195; P<0.038, OR=1.946 respectively) while allelic frequencies did not show association. Individuals with genotypic combinations viz. CT/AG (+/-) and CT/GG (+/-, +/+) showed 2-4 times higher risk of developing T2DM while haplotype analysis did not show any association. All genotypes of IL-10 polymorphism showed significant association with biochemical parameters viz. BPS, BPD, F, PP and TC (P<0.007). The IL-10 gene polymorphisms therefore play important roles in determining diabetes susceptibility.
Ebola virus disease (EVD), formerly known as Ebola hemorrhagic fever, is a re-emerging zoonotic disease that has caused periodic outbreaks since the first reported outbreak in 1976. In 2014, in West Africa, the largest outbreak of Ebola virus in history emerged, affecting close to 30,000 people; more than 10,000 of these individuals died. This virus, which causes fatal hemorrhagic fever in humans and non-human primates, has the highest mortality rate (25-90%) among the viral hemorrhagic fever diseases. Ebola virus is transmitted through the blood and body fluids of infected animals and humans, as well as through contaminated materials. The virus is often spread in the hospital setting, and it is classified as a biosafety level 4 agent. Accordingly, diagnostic procedures and infected patient care should be performed at the highest safety levels. The potential therapies and vaccines against EVD have continued developing or been used in emergency situations during last outbreak. Some of these include the chimpanzee adenovirus type-3 and recombinant vesicular stomatitis virus-Ebola vaccines and new treatment modalities, such as passive immunization, brincidofovir, and ZMapp. Although these trials have shown different levels of success, there are no standardized treatments or vaccines that have been approved for humans. Such prevention is the only way to reduce human infection and the spread of outbreaks and is primarily based on personal protection measures and raising awareness of the risk factors.
Background: Small nerve fibre damage has been shown to precede large fibre damage and represents the early stage for diabetic neuropathy (DPN).Aims: To assess small nerve fibre deficit in patients with mild to severe DPN using quantitative sensory testing (QST) and to correlate QST findings with other neuropathy assessment measures in patients with DPN.Materials and Methods: Seventy-nine diabetic patients (49 with and 30 without diabetic neuropathy) and 35 healthy volunteers underwent neuropathy assessment. The evaluation comprised neuropathy symptoms profile, modified neuropathy disability score (NDS), quantitative sensory testing (QST) in form of cold and warm thresholds, vibration pressure threshold (VPT), nerve conduction studies (NCS), deep breathing heart rate variability (DB-HRV), and Neuropad staining scores. Patients were also stratified by their NDS scores into mild, moderate and severe DPN. Measures of QST were compared among various grades of DPN severity and correlated with other clinical and neurophysiological tests.Results: Patients with DPN demonstrated higher vibration perception (P<0.001) and warm (P<0.001) thresholds and lower cold threshold (P<0.001) and these QST abnormalities related directly to the grade of DPN severity. Measures of QST also correlated with those of nerve conduction studies (r range 0.54-0.68) and autonomic function assessment(r range 0.33-0.48).Conclusion: Quantitative sensory testing can identify small nerve fibres impairment which could represent the early stage of diabetic neuropathy and hence the optimal period for intervention.
Since it was first defined, human immunodeficiency virus / acquired immunodeficiency syndrome (HIV / AIDS) has become one of the most studied infectious disease. Syphilis is a sexually transmitted chronic infection, which can affect all systems and organs with different clinical stages, and Treponema pallidum, a member of the spirochete family, is the agent. Syphilis has led to numerous epidemics throughout the world, which started in the 1990s and still ongoing with the increase of HIV-infected patients. Despite the decline in the United States and Europe, it has increased since 2000. It is noteworthy that syphilis shows high rates of co-infection with HIV and HIV infection may alter the clinical signs of syphilis. Since these two infections can be frequently seen together, all HIV-infected patients should be tested for syphilis. In this report, a case with HIV co-infection with secondary syphilitic skin lesions is presented.
Endometrial cancer is the most commonly encountered malignancy of female genital system. Surgery is the main treatment approach in endometrial cancer. The frequency of surgical site infections (SSI) has recently increased. Prediction of risk factors which may cause SSI and taking due precautions may provide a decrease in frequency of these infections. The aim of this study was to determine the risk factors for SSI after surgery for endometrial cancer. The medical records of patients who were operated due to endometrial cancer in Kanuni Sultan Suleyman Education and Research Hospital between January 1, 2015, and July 31, 2015, were retrospectively reviewed. The patients were divided into two groups; those that developed SSI following the operation and those that did not develop SSI. SSI was diagnosed based on Center for Disease Control and Prevention criteria. Ages, comorbid diseases, body mass index, American Society of Anesthesiologists (ASA) scores, smoking, durations of operation, the presence of drainage, blood transfusion, pre-operative hemoglobin level, and pre-operative glucose level of patients were recorded. A P < 0.05 was considered to be statistically significant. Of the 103 patients included, 12 patients (11.65%) developed SSI. We found a relationship between SSI development and high body mass index; the presence of diabetes mellitus, presence of transfusion, and high pre-operative glucose level. No relationship among age, hypertension, smoking, ASA score, presence of drainage, duration of operation, pre-operative hemoglobin level, and development of SSI has been determined. In conclusion, although there are patient-related and non-modifiable risk factors, we are in thought of that prediction of modifiable risk factors, such as blood glucose level, may reduce the frequency of SSI after endometrial cancer surgery.
Brucellosis is an important zoonotic disease that remains a world-wide public health problem. Pulmonary involvement in the course of brucellosis is an extremely rare condition reported about 1-5% of the cases. Here, we present a case with pulmonary brucellosis, and hypogonadotropic (secondary) hypogonadism referred our tertiary medical center for further evaluation about eunuchoidism and delayed puberty when he was applied to the primary care center with the complaint of only non-product ı ve cough. Clinicians should be considered to the possibility of brucellosis being the cause of respiratory symptoms, even in the absence of other frequent symptoms of brucellosis particularly osteoarticular problems.
In this case, we present a follicular non-Hodgkin lenfoma patient whose liver enzymes increased after withdrawal of chemotherapy and afterward hepatitis B virus (HBV) reactivation was occurred despite HBV surface antigen was negative before immunosuppressive therapy.
Background and Purpose: A mean percentage of 5% was reported for neurological involvement in researches related to Behcet's disease. The neurological involvement may be characterized by headache, neuropsychiatric symptoms, brain stem involvement, cerebral venous thrombosis or peripheral nervous system involvement. Sometimes neurological involvement may be seen without any neurological sign or symptom. In our study, we aimed to evaluate the cognitive, psychiatric and neurophysiological responses in Behcet's disease without neurological sign and symptom. Methods: The study was performed on patients with Behcet's disease without neurological signs and symptoms and healthy volunteers that would make the control group. The patients were assessed with Mini Mental State Examination, Hamilton Rating Scale for Depression, nerve conduction study and visually evoked potential. Results: A total of 27 male patients (age: 24.88±5.45 years) were enrolled in the study. Neurological examinations of all the patients were normal. Mean Mini Mental State Examination score of the patients was 29.62±0.79 (2 patients had loss of focus, 2 patients had disturbance in the copying function) and 2 patients had mild depression in Hamilton Rating Scale for Depression. In the nerve conduction study, 2 patients had right sensory-motor carpal tunnel syndrome, 1 patient had right sensory-motor carpal tunnel syndrome - bilateral ulnar nerve entrapment. In the visually evoked potential examination, 8 patients had prolonged P100 latency, decreased amplitude and disturbance of wave morphology. Conclusion: Visually evoked potential examination may be used as a conductive method to detect the subclinical neurological pathologies in Behcet's disease. The possible silent neurological involvement should be evaluated with further neuro-screening methods.
Objective: Immunosenescence is an important aspect in elderly cancer patients. In aging, T cell dysfunction and increasing CD4+CD25+ Regulatory T (Treg) cells have been reported. However, the status of these cells has not been uncovered so far in elderly cancer patients. In this study, we aimed to investigate Treg cells, CD8+CD28- suppressor cells, and other lymphocyte subpopulations in elderly cancer patients. Materials and Methods: Seventy-five cancer patients were included in the study. Data were obtained from our previous three studies about Treg, suppressive cells and other lymphocyte populations of breast, gastric and lung cancer patients. Total CD4+CD25+ Treg cells, CD8+CD28- suppressor cells, CD8+ memory cells, CD8+ naive cells, Natural Killer (NK) cells, CD8+ and CD4+ T cells had been investigated by flow cytometry. The parameters were compared between in patients over and under the age of seventy. Results: Eighteen patients were older than 70 years of age and fifty-seven patients were not. The percentage of CD4+CD25high cells in CD4+ T cells were higher in elderly cancer patients than control patients (smaller than 70 years old) (13.01%±6.59% vs. 8.43%±5.01%; p:0.02). CD8+CD28- suppressor cells in lymphocytes were similar in both groups (18.12%±7.73% vs 18.03%±8.33%; p:0.97). NK cells were elevated in elderly patients. CD8+ memory cells, CD8+ naive cells, CD8+ T cells, and CD4+ T cells were not different between groups. Conclusion: Our data suggest that CD4+CD25+ Treg cells are increased in elderly cancer patients, but not CD8+CD28- suppressor cells. This may be a cause of age-related immunosuppression in cancer patients.
