[Comparison of a new and rapid method, Brucella Coombs gel test with the other methods in the serological diagnosis of brucellosis]. / Brusellozun serolojik tanisinda yeni ve hizli bir yöntem olan Brucella Coombs jel testi ile diger yöntemlerin karsilastirilmasi.

Diagnosis of brucellosis basically depends on blood and/or bone marrow culture and demonstration of high titer specific antibody or seroconversion in serum. In routine serological diagnosis of the disease, after screening with Rose Bengal test, the positive samples are studied with standart tube agglutination (STA) test with serial dilutions. However false negative results can be seen in STA test due to the existence of blocking antibodies, this test should be verified with Coombs anti-Brucella (CAB) or immunocapture agglutination (ICA) tests. In recent years Brucella Coombs gel test (ODAK Brucella Coombs Gel Test, Toprak Medikal, Turkey) developed in our country, was available as a new and rapid agglutination based method. The test is performed in vials that contain Coombs antibodies within gel matrix and results are evaluated visually within two hours.The aim of this study was to compare the efficacy of Brucella Coombs gel test (BCGT) with STA, CAB and ICA methods in serological diagnosis of brucellosis. A total of 100 serum samples with suspected brucellosis sent to our laboratory between January 2012-August 2013 in which 31 high positive (≥ 1/160), 23 low positive (≤ 1/80) and 46 negative samples diagnosed with CAB test (Seromed, Turkey) were included in the study. All the samples were studied using titrations with STA (Seromed, Turkey), ICA (Vircell, Spain) and BCGT (Islab, Turkey) methods. With STA, CAB and BCGT tests ≥ 1/160, with ICA test ≥ 1/320 were accepted as positive titers. The correlation between the tests were evaluated with Cohen's kappa (κ) analysis. In our study, seven of the samples yielded positive results with STA, 30 with ICA, and 32 with BCGT. The number of the sera which yielded positive results with all three methods was 28. Two samples positive with CAB and BCGT resulted low titer/negative with ICA, one sample positive with ICA and BCGT resulted low titer/negative with CAB, and one low titer/negative sample with CAB and BCGT yielded positive with ICA test. STA test was not included in the statistical evaluation due to its very low positivity rate. According to the kappa analysis, almost perfect agreement was detected between the other methods (κ= 0.887 for CAB and ICA, κ= 0.977 for CAB and BCGT, κ= 0.907 for ICA and BCGT). In conclusion, BCGT method showed excellent correlation with both CAB and ICA tests; the application of the test was practical; resulted in a short time such as two hours and visually evaluation was determined to be practical compared to other methods. Although BCGT can be recommended for routine diagnostics, evaluation of specificity and sensitivity with comprehensive studies including a greater number of cases and control samples should be considered.

[The relation of serum interleukin-2 and C-reactive protein levels with clinical and radiological findings in patients with pulmonary tuberculosis]. / Akciger tüberkülozlu hastalarda serum interlökin-2 ve C-reaktif protein düzeylerinin klinik ve radyolojik bulgularla iliskisi.

Immunological events, not the bacilli, are responsible from the tissue damage of tuberculosis. Clarifying the immunological events may lead to the development of new approaches to treatment and defence against tuberculosis disease. In this study we aimed to determine the serum levels of interleukin-2 (IL-2) and C-reactive protein (CRP) in patients with tuberculosis and evaluate the relationship with clinical and radiological findings. The study included 60 patients (mean age: 37 +/- 12 years, all male) with newly diagnosed pulmonary tuberculosis and 23 healthy controls (mean age: 40 +/- 13 years, all male). Admission symptoms, clinical features, demographic data, laboratory investigations and radiological findings were all recorded into the study form. Serum samples which were obtained for determination of IL-2 and CRP levels were preserved at -80 degrees C. While serum IL-2 levels were similar in patients with tuberculosis and healthy controls, serum CRP levels were significantly higher in patients with tuberculosis (p< 0.001). There was a positive correlation between serum IL-2 level and the diameter of cavity (p= 0.012). CRP levels were significantly higher in patients who admitted with fever (p= 0.001) and weight loss (p= 0.024). Serum CRP levels were significantly higher in patients who had involvement of four or more zones (p= 0.029) and multiple cavitary disease (p= 0.001). There was a positive correlation between serum CRP level and the diameter of cavity (p= 0.004). In conclusion, apart from the diameter of cavity, serum IL-2 levels were not correlated with any clinical, laboratory or radiological parameter. Serum CRP levels were a good indicator of disease severity.

The role of serum inflammatory markers in acute appendicitis and their success in preventing negative laparotomy.

Improving the diagnosis of acute appendicitis in order to prevent unnecessary surgery is crucial. This study was intended to identify the role of serum inflammatory markers in patients with preliminary diagnosis of acute appendicitis with a retrospective design. Eighty-five patients with the preliminary diagnosis of acute appendicitis were recruited in this study within the period of November-December 2003. The average age was 31.8 years (ranged from 15 to 85). There were 62 males (72.9%) and 23 females (27.1%). In addition to performing routine tests, preoperative serum samples were obtained from the patients to measure C-reactive protein, interleukin-6, and interleukin-10. All the patients were operated on for a clinical suspicion of acute appendicitis. Depending on the macroscopic evidence during the operation and the histopathological examination of the specimen, the patients were separated into two groups: the ones who did not have acute appendicitis as the cause for acute abdomen (group I; n = 14) and the ones who had acute appendicitis (group II; n = 71). The ones who had acute appendicitis (group II) were further grouped as noncomplicated appendicitis (group IIA; n = 44) and complicated appendicitis (group IIB; n = 27). Being a male with elevated levels of leukocytes (white blood cells, WBC); C-reactive protein (CRP), interleukin-6 (IL-6); and interleukin-10 increased the probability of having acute appendicitis in patients with evidences of acute abdomen. The risk of complication of acute appendicitis significantly increased when patients had increased levels of C-reactive protein, increased erythrocyte sedimentation rate, and increased interleukin-6 levels, had symptoms for more than 24 h, and were female. Interleukin-10 levels within normal range might be helpful in eliminating the possibility of acute appendicitis. Thus, elevated levels of WBC, IL-6 and CRP might be helpful in confirming a potential diagnosis of acute appendicitis. In addition, normal levels of IL-10 might be of additional help to possibly rule out the diagnosis of acute appendicitis.

Measles, rubella, mumps, and varicella seroprevalence among health care workers in Turkey: is prevaccination screening cost-effective?

BACKGROUND: To investigate the immune status of health care workers (HCWs) against measles, rubella, mumps, and varicella zoster (MMRV) in Turkey and to define an appropriate vaccination program among HCWs. METHODS: Voluntary HCWs from a children's hospital and a general hospital were included in the study between March and May 2005. The specific IgG antibodies against MMRV viruses were screened by ELISA. RESULTS: Three hundred sixty-three HCWs participated in the study; 186 (51%) were physicians, 118 (33%) were nurses, 36 (10%) were housekeeping staff, and 23 (6%) were medical technicians. The proportion of HCWs who had antibodies against measles was 98.6%; rubella, 98.3%; mumps, 92.2%; and varicella, 98%. No association was found between the susceptibility to at least 1 of MMRV virus infections and gender, age, duration of work, profession, and department of work in analysis either among the whole study group, or each hospital. The positive predictive value for the history of varicella was 100%, whereas it was 92% for MMR. The cost of vaccination for varicella was significantly expensive without screening before vaccination. However, there was not much difference for MMR infections. CONCLUSION: A policy based on obtaining the history of varicella infection from the staff and then screening the ones with negative history and vaccination of only seronegative HCWs was found to be appropriate.

Brain-derived neurotrophic factor (BDNF) changes in the serum of depressed women.

Neuroplastic processes are thought to be involved in the pathophysiology of many psychiatric disorders, including major depression. It has been hypothesized that the brain-derived neurotrophic factor (BNDF), a key factor in neuroplasticity, is associated with depressive disorders. Our study evaluated the pre- and post-treatment levels of BDNF in a group of depressed patients and compared them with healthy controls. In order to exclude the effects of gender on neuroplasticity, our study group was restricted to women exclusively and consisted of 20 depressive patients and 20 healthy controls, with similar age and educational level distribution. Blood samples were collected before the treatment and on the sixth week of the treatment with 10 mg S-citalopram. The pre-treatment BDNF levels of the depressed patients were found to be lower than those of the healthy subjects. During the sixth week, the BDNF levels of depressive patients were significantly higher than the pre-treatment levels but similar to those of control subjects. These findings suggest that BDNF level may be an important factor in the etiopathogenesis of depression and may have a role in the action mechanism of antidepressant drugs.

IL-6 levels decrease with SSRI treatment in patients with major depression.

OBJECTIVE: Some evidence indicates that an immune response with an increased production of proinflammatory cytokines often accompanies major depression. The objective of this study was to examine the serum levels of IL-6 in patients with major depression and the changes occurring in IL-6 levels during treatment with selective serotonin reuptake inhibitors (SSRI). METHOD: Twenty-three patients with a DSM-IV diagnosis of major depressive disorder and 23 healthy matched controls were included in the study. The severity of depression was measured with the Hamilton rating scale for depression. Blood samples for IL-6 levels were obtained at baseline and at week 6 of treatment and IL-6 concentrations were evaluated using a solid phase sandwich enzyme immunoassay. All patients were treated with an SSRI. RESULTS: The IL-6 levels showed no statistically significant difference between the patients and the controls at baseline. However, IL-6 levels after treatment with SSRIs were significantly lower compared with the baseline IL-6 levels of both the patients and the controls. CONCLUSION: The results of this study suggest that proinflammatory cytokines show some changes during the course of treatment of major depression. These findings might also be considered as supporting the hypothesis of a modulatory role of antidepressants on the immune system.

Serum interleukin-8 as a serologic marker of activity in Behçet's disease.

BACKGROUND: Immune dysregulation has been shown to be one of the major aspects of the yet unknown pathogenesis of Behçet's disease. Interleukin-8 (IL-8), a major chemokine with pivotal effects concerning leukocytes and endothelial cells, has been found to be elevated in patients with Behçet's disease. AIM: To evaluate the significance of elevated levels of IL-8 with respect to the activity of Behçet's disease. METHODS: Sixty-seven consecutive patients with Behçet's disease (37 males, 30 females; 32.5 +/- 9.3 years) were enrolled in our study. The number of active clinical manifestations at the time of serum sampling was recorded. The degree of association between disease activity and IL-8, C-reactive protein, and erythrocyte sedimentation rate was assessed. RESULTS: Serum levels of IL-8 increased as the number of clinically involved organs increased (P < 0.05). C-reactive protein and the erythrocyte sedimentation rate showed no correlation with disease activity. CONCLUSIONS: Our study confirms that the IL-8 level is a more sensitive marker of disease activity than the erythrocyte sedimentation rate and C-reactive protein. It may be assumed that IL-8 plays an important role in the pathophysiology of Behçet's disease.

Correlation of middle meatus and ethmoid sinus microbiology in patients with chronic sinusitis.

Empirical antibiotics constitute the cornerstone of medical therapy for chronic sinusitis due to difficulties of obtaining cultures from the paranasal sinuses. Indirect isolation of the pathogenic microorganisms outside the paranasal sinuses with a non-invasive method may enable administration of specific antibiotics. In this prospective study, we obtained cultures from the middle meatus and ethmoid sinuses of 193 sides from 127 patients who had undergone FESS for chronic sinusitis with a method that minimizes the risk of nasal contamination. The same bacterial species were isolated from both the ethmoid sinus and middle meatus in 59.3% of the cultures. There was no bacterial growth in either site in 32.3% of the cultures. The overall correlation rate of middle meatus and ethmoid sinus cultures was estimated to be 91.6%. In conclusion, middle meatal cultures can be used for the isolation of pathogenic microorganisms indirectly, while administration of specific antibiotics can be possible according to the results of these cultures.