Performance of the Enzyme Linked Fluorescent Assay in Diagnosis of HIV Infection; Comparative Evaluation with other Methods.

BACKGROUND: Our study aimed to investigate the role of the enzyme linked fluorescent assay (ELFA) method in the diagnosis of Human Immunodeficiency Virus (HIV) infection by comparing it with enzyme-linked immunosorbent assay (ELISA) and chemiluminescent microplate immunoassay (CMIA) methods and its role in the HIV diagnostic algorithm and to update the recommended algorithm for HIV testing. METHODS: We evaluated 101 HIV-reactive and 101 HIV-negative specimens. All samples were studied with the methods of anti HIV1/2 test micro-ELISA, ELFA, and CMIA. At the same time, HIV RNA PCR and western blot (WB)/rapid immunochromatographic test (RICT) were also studied with the same samples. RESULTS: All HIV RNA and WB positive samples (n = 101) were positive with micro-ELISA, CMIA and ELFA. Twenty-five negative samples of HIV RNA and WB were positive with micro-ELISA and CMIA, while just 6 samples were positive with ELFA. When all samples were evaluated together, the false positivity rate of the ELFA method was found to be 5.9%, and the false positivity rates of the micro-ELISA and CMIA methods were determined to be 31.7% and 30.7%, respectively. CONCLUSIONS: It was determined that there is a high level of agreement between the ELFA method and confirmation tests. It was thought that it might take place in the preconfirmation stage. As can be seen from the results obtained, the false positive rate by ELFA method was found to be about five times lower than that of micro-ELISA and CMIA methods. Considering that antigen (p24) and antibody positivity can be given separately with this aspect, it can be considered that there is a confirmation place in HIV diagnosis algorithm.

Human milk mycobiota composition: relationship with gestational age, delivery mode, and birth weight.

Intestinal and human milk microbiota studies during infancy have shown variations according to geographical location, delivery mode, gestational age, and mother-related factors during pregnancy. In this study, we performed metagenomic mycobiota analyses of 44 transient and mature human milk among five different groups: mothers of normal spontaneous delivery-term (NS-T), caesarean delivery-term (CS-T), premature (PT), small for gestational age (SGA), and large for gestational age (LGA) infants. Fungi were detected in 80 out of the 88 samples. Regarding the number of observed fungal species, the NS-T group was more homogeneous (less variable) comparing the other groups (P<0.05). In the transient human milk samples, the most abundant species were Saccharomyces cerevisiae (33.3%) and Aspergillus glaucus (27.4%). While A. glaucus (33.7%) was second most abundant species in mature milk, S. cerevisiae disappeared (P<0.01) and Penicillium rubens became the most abundant species (35.5%) (P<0.05). Among the NS-T group, the most abundant species was Malassezia globosa in both transient and mature milk. In contrast, S. cerevisiae was the most abundant species in transient human milk (45.0%) in the CS-T group, but it disappeared in mature milk (P<0.01). In transient milk, M. globosa was only represented 6.0-9.0% of taxa in the PT, SGA, and LGA groups (P<0.05). In transient and mature milk in the PT, SGA and LGA groups, the most abundant species were A. glaucus and P. rubens. In mature milk samples, P. rubens is more abundant in CS-T group, PT group and LGA group, than the NS-T groups (P<0.05 for all). Although fungi constitute only a very small part of the human milk microbiome, we observed some changes that the human milk mycobiota composition varies in caesarean delivery, premature, SGA and LGA groups, comparing the normal spontaneous delivery, as well as differences between transient and mature human milk.

Assessment of novel biomarkers: sTREM-1, pentraxin-3 and pro-adrenomedullin in the early diagnosis of neonatal early onset sepsis.

BACKGROUND: Early onset bacterial sepsis in neonates (EOS) is recognized as an important health condition. Early diagnosis is crucial. However, blood culture results are released in 48-72 hours. Many biomarkers have been investigated but none have been accepted as the gold standard. This study aimed to investigate the diagnostic value of the molecules: soluble form of triggering receptor expressed on myeloid cells-1 (sTREM-1), pentraxin-3 (PTX-3) and pro adrenomedullin (pro-ADM) in EOS and compare with currently used biomarkers. METHODS: In this multicenter prospective study, patients were enrolled from different NICUs around the Turkey. Patient data were collected via web-based registry system from attending centers. Neonates, hospitalized with a suspicion of EOS were enrolled. Blood culture and routine blood tests were collected and a serum sample was obtained and kept in - 80°C for studying the molecules. According to laboratory results, patients were divided into three groups as; proven sepsis, clinical sepsis and control group. Groups were compared in terms of demographic, clinical and laboratory findings. The primary outcome of the study was to assess any difference between groups in terms of the diagnostic value of the markers aforementioned. RESULTS: A total of 130 patients were enrolled; proven sepsis (n = 36), clinical sepsis (n = 53) and control (n = 41) groups. Groups were similar in terms of demographic findings; mean WBC (P = 0.445), procalcitonin (PCT) (P = 0.083) and IL-6 (P = 0.814) levels. Mean C-reactive protein (CRP) level was significantly higher in clinical sepsis and proven sepsis groups compared to control group (P < 0.001). Mean PTX-3 (P = 0.547), pro-ADM (P = 0.766) and sTREM-1 (P = 0.838) levels were similar between groups. CONCLUSION: These promising molecules failed to help in early diagnosis of EOS. Their relation to correlation with disease progression may make more sense as they seem to be expressed in higher amounts with the progression of the disease in previous studies. CRP was the most frequently used biomarker for detecting the sepsis in our study population.

Human milk antibiotic residue levels and their relationship with delivery mode, maternal antibiotic use and maternal dietary habits.

OBJECTIVE: It is important to identify undesirable toxins and metabolites present in human milk that may be passed on to nursing infants. Such residues may derive from the antibiotics that are widely used to treat infectious diseases in both humans and food-producing animals. To the best of our knowledge, there are no reports in the literature on human milk antibiotic residue levels. PATIENT AND METHODS: As a part of the Human Milk Artificial Pollutants (HUMAP) study, we aimed to evaluate human milk antibiotic residues among mothers with 7 to 90-day-old babies. Pregnant women who had received antibiotic treatment during pregnancy were excluded. The use of antibiotic prophylaxis with cefazoline sodium during labor was noted among the study subjects. Human milk antibiotic residues were evaluated with the InfiniPlex for Milk Array (Randox Laboratories, London, United Kingdom), a semi-automated system with a multi-array biochip designed to detect antibiotic residues and toxins. RESULTS: The HUMAP study included 83 mothers, ranging in age from 17 to 41 years (mean 29.7 ± 6.2 years). Of these, 59% received cefazoline sodium shortly after birth, while 41% did not receive any antibiotics during the pregnancy, delivery or lactational periods. Testing revealed that 71/83 (85.5%) human milk samples were positive for beta-lactams and 12 (14.5%) samples were positive for quinolones. There was no difference in maternal age, gestational week, delivery type, sampling time, maternal dietary habits between the mothers with quinolones or beta-lactam residues in their milk and those without (p > 0.05 for both). Beta-lactam and quinolone residues were detected in 85.7% and 23.5%, respectively, of the human milk samples of mothers who did not receive antibiotics at birth and/or during the first seven days after birth. CONCLUSIONS: We found that the majority of human milk samples included beta-lactams or quinolones, even though the mothers did not receive these antibiotics during pregnancy and lactation. Antibiotic residues in human milk may affect early maintenance of the intestinal microbiota. Previous studies have shown that antimicrobials in food might increase the risks of allergies and could lead to the development of antibiotic-resistant bacterial strains. Effective policies on food safety and appropriate antibiotic use during pregnancy and lactation are needed.

Increased asymmetric dimethylarginine levels in severe transient tachypnea of the newborn.

OBJECTIVE: Nitric oxide (NO) is synthesized by NO synthase (NOS), and asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of NOS. We aimed to investigate l-arginine and ADMA levels in transient tachypnea of the newborn (TTN) and their relationship with systolic pulmonary artery pressure (PAP) and disease severity. STUDY DESIGN: Infants born at ⩾35 weeks gestational age with clinical signs and chest X-ray findings consistent with TTN were enrolled; controls were recruited at the same time. l-arginine and ADMA levels were measured at 12 to 24 h (first samples) and at 48 to 72 h (second samples). Systolic PAP was evaluated on the second day. Patients were divided according to the duration of tachypnea and designated as group A (duration ⩽72 h) and group B (duration >72 h). RESULTS: In the first samples, the ADMA levels were significantly higher in patients with TTN compared with controls (P<0.001). In the second samples, the ADMA levels were significantly higher in group B compared with that in group A (P=0.019). In group A patients, the second ADMA levels were significantly lower compared with that in the first samples (P<0.001), whereas the second ADMA levels remained unchanged compared with the first samples in group B. Systolic PAP values were significantly higher in group B compared with that in group A patients (P=0.033). CONCLUSION: Increased ADMA concentration may reduce NO synthesis, leading to increased PAP and thus longer duration of tachypnea.

The impact of physical and psychological comorbid conditions on the quality of life of patients with acute myocardial infarction: a multi-center, cross-sectional observational study from Turkey.

OBJECTIVE: Acute myocardial infarction (MI) has significant and detrimental effects on the lifestyles of the patients. It has been shown that quality of life (QoL) in patients with MI is impaired in every aspect. This study aims to evaluate the impact of depression and physical comorbidity on QoL in Turkish patients with acute first MI. METHOD: This multi-center cross-sectional study was carried out in 15 centers with 998 patients hospitalized for acute first MI. For detection of depression, Beck Depression Inventory (BDI) was used. For evaluation of QoL, World Health Organization Quality of Life Questionnaire (WHOQOL) was applied. RESULTS: The mean age of the patients was 57.5 +/- 10.1 years and 79.2 % (n = 792) of the patients were men. Patients with comorbid depression (BDI > or = 10) and comorbid medical conditions, and female patients had significantly lower scores in every domain of WHOQOL. In the regression analysis model, female gender, low education, comorbid medical conditions, especially comorbid hypertension, and BDI score were found to have a significant effect on the domains of WHOQOL. CONCLUSIONS: Female patients are more prone to impairment in quality of life after myocardial infarction. Both comorbid medical conditions and depression have a significant impact on the impairment of QoL in Turkish patients with acute MI. In order to improve the subjective wellbeing of post MI patients, both psychiatric and physical comorbidities must be detected and managed even in the short-term.

Neuropsychological testing of cognitive impairment in euthymic bipolar disorder: an individual patient data meta-analysis.

OBJECTIVE: An association between bipolar disorder and cognitive impairment has repeatedly been described, even for euthymic patients. Findings are inconsistent both across primary studies and previous meta-analyses. This study reanalysed 31 primary data sets as a single large sample (N = 2876) to provide a more definitive view. METHOD: Individual patient and control data were obtained from original authors for 11 measures from four common neuropsychological tests: California or Rey Verbal Learning Task (VLT), Trail Making Test (TMT), Digit Span and/or Wisconsin Card Sorting Task. RESULTS: Impairments were found for all 11 test-measures in the bipolar group after controlling for age, IQ and gender (Ps ≤ 0.001, E.S. = 0.26-0.63). Residual mood symptoms confound this result but cannot account for the effect sizes found. Impairments also seem unrelated to drug treatment. Some test-measures were weakly correlated with illness severity measures suggesting that some impairments may track illness progression. CONCLUSION: This reanalysis supports VLT, Digit Span and TMT as robust measures of cognitive impairments in bipolar disorder patients. The heterogeneity of some test results explains previous differences in meta-analyses. Better controlling for confounds suggests deficits may be smaller than previously reported but should be tracked longitudinally across illness progression and treatment.

Total antioxidant capacity and total oxidant status in perinatal asphyxia in relation to neurological outcome.

This study aimed to investigate the global oxidant/antioxidant status of infants with perinatal asphyxia and its relation to neurological outcomes. A prospective controlled study including term infants with perinatal asphyxia was conducted. Blood samples were obtained from patients and controls at 6-24 h and on the 3rd day of life for TAC and TOS measurement and OSI values were calculated. Neurodevelopment was evaluated at 12 months of age in survivors using Bayley scales of infant development II (BSID II). 17 term infants with perinatal asphyxia and 17 healthy controls were enrolled. On the first day of life TAC, TOS and OSI were significantly higher in patients with perinatal asphyxia (p<0.001). Total antioxidant capacity decreased significantly on day 3 compared to first day of life in the patient group (p=0.04). Infants with seizures and abnormal amplitude-integrated electroencephalography recordings had higher TOS and OSI levels in the 1st day. There was no correlation between TAC, TOS and OSI levels and BSID II scores. In conclusion oxidant/antioxidant balance is disturbed in favour of oxidants in perinatal asphyxia. Degree of oxidative stress is related to severity of neurological involvement in the first days of life.

Adjusted poor weight gain for birth weight and gestational age as a predictor of severe ROP in VLBW infants.

AIM: To analyze relative weight gain by 2-week intervals up to 6 weeks after birth in order to predict the development of retinopathy of prematurity (ROP) requiring treatment among very low birth weight (BW) infants. METHODS: A prospective study including infants with BW ≤1500 g born in a single tertiary intensive care unit over 1-year period was conducted. Body weight measurements were recorded weekly and relative weight gains (g/kg/day) were calculated. The main outcome was development of ROP requiring treatment. RESULTS: Mean BW and gestational age (GA) of the whole cohort were 1165±223 g and 29.3±2.3 weeks, respectively. Relative weight gain at 2 weeks and 4 weeks postnatal age were significantly lower in infants with severe ROP (P=0.041 and P=0.017, respectively). Relative weight gain at 6 weeks was not different between groups. Infants with severe ROP gained 6.7±4 g/kg/day in the first 4 weeks of life, compared with 9.3±4.5 g/kg/day for those with mild or no ROP. After adjusted for BW and GA in logistic regression poor relative weight gain in the first 4 weeks was found to be related to severe ROP (P=0.015). When all the other risk factors significant for severe ROP were included in the logistic regression poor weight gain did not arise as an independent risk factor. CONCLUSION: Poor postnatal weight gain in the first 4 weeks of life is the end result of several comorbidities rather than being an independent risk factor. Poor weight gain can be an additional predictor of severe ROP in very low BW infants.

Effect of whey pH at drainage on physicochemical, biochemical, microbiological, and sensory properties of Mozzarella cheese made from buffalo milk during refrigerated storage.

The objective of this research was to determine the effect of drainage pH on physicochemical, biochemical, microbiological and sensory properties of Mozzarella cheese made from buffalo milk during refrigerated storage. Four vats of cheese were made at 4 different whey drainage pH (6.2, 5.9, 5.6, and 5.2). Lower drainage pH caused higher pH 4.4-soluble N and pH 4.4-soluble N:total N. Interaction of drainage pH at d 1 and 30 of storage on all soluble nitrogen fractions was significant. Degradation of caseins in samples made at a drainage pH of 6.2 was lower than that of other cheese samples. The decreasing whey drainage pH significantly increased counts of thermophilic and mesophilic lactobacilli of the samples during refrigerated storage. No coliforms or Escherichia coli were detected in the cheeses. The average sensory property scores of all cheese samples were very close, and, as expected, storage time had a negative effect on all sensory scores.

The factors that have a role in variability for temperature.

Our objective was to determine the factors that affect (i) the rectal-axillary temperature measurement difference (RATD) for digital and mercury-in-glass thermometers and (ii) the difference between mercury-in-glass and digital thermometer readings taken by the rectal and axillary routes. Children (between the ages of 2 and 48 months) who were admitted to Hacettepe University Children Hospital and Corum Children's Hospital in 2 months period were included in this study. Two measurements were taken from each patient within 2 days at two different occasions including day/night and sleep/awake by the same physician. A total of 135 patients were enrolled. RATD was 0.61 + 0.54 degrees C in the mercury-in-glass thermometer, and 0.81 +/- 0.57 degrees C in the digital thermometer. The mean differences between digital and mercury-in-glass thermometers were 0.16 degrees C for rectal routes and -0.02 degrees C for axillary routes. Children at older age with hypoalbuminemia and children exposed to higher ambient temperatures had lower values of RATD than others. Temperature recordings from different sites might change with ambient temperature and individual characteristics of children.

Toriello-Carey syndrome in a Turkish newborn.

Toriello-Carey syndrome in a Turkish newborn: Toriello-Carey syndrome is characterized by agenesis of the corpus callosum, telecanthus, short palpebral fissures, small nose with anteverted nares, retrognathia, abnormal ears, laryngeal and cardiac anomalies, brachydactyly, and hypotonia. We describe the findings in a Turkish newborn, presumed to be another example of the Toriello-Carey syndrome, which extends the phenotype of the syndrome.

Depression and anxiety in hypothyroidism.

The aim of the study was to determine the prevalence and severity of depression and anxiety in patients with hypothyroidism and to compare this with euthyroid patients. Thirty patients with hypothyroidism and 30 euthyroid controls attending the Endocrinology outpatient department of Celal Bayar University, Medical Faculty were included in the study. The hormonal screening was done by immunoassay and haemagglutination methods. Then, for psychiatric assessment, Hospital Anxiety and Depression Scale (HAD), Hamilton Depression Rating Scale (HAM-D), and Hamilton Anxiety Rating Scale (HAM-A) were used. There was no difference between the two groups in terms of demographic features. Total scores obtained from the scales used in the study did not differ significantly (p > 0.05). The frequency of items of both HAM-D and HAM-A did not show any differences in the two groups. By Wilks' Lambda discriminant analysis, depressive mood (HAM-D#1) was found to be the discriminating feature between the hypothyroid group and the euthyroid group. Therefore, depression and anxiety were not outstanding features in hypothyrodism. However, depression was more significant in the hypothyroid than euthyroid group.

Aprotinin reduces ischemia-reperfusion injury in the retina of guinea pigs.

PURPOSE: The aim of this study was investigate the role of aprotinin on retinal lipid peroxidation and histopathological changes during ischemia/reperfusion (I/R) of guinea pigs. METHODS: Three groups of seven pigmented guinea pigs each were formed: a control (group 1), ischemia/saline (group 2) and ischemia/aprotinin (group 3). One eye of each animal was selected for histopathological evaluation and the other for biochemical assay. Bilateral pressure-induced retinal ischemia was instigated for 90 min and was followed by 24 hours of reperfusion. Animals in the ischemia/aprotinin and ischemia/saline groups received either 20,000 KIU/kg of aprotinin or saline, repeated four times at 6-hour intervals, with the first dose administered 5 min prior to the ischemic insult. The animals were killed at 24 hours of reperfusion. Retinal malondialdehyde (MDA) levels and the thickness of the inner plexiform layers were measured. RESULTS: The level of MDA in group 1 was significantly (p<0.001) lower than the other groups. The mean MDA level in group 2 was significantly (p<0.01) higher than in group 3. The inner plexiform layer in group 1 was significantly (p<0.001) thinner than in the other groups. The mean thickness of the inner plexiform layer in group 2 was significantly (p<0.01) higher than in group 3. CONCLUSIONS: These data indicate that intraperitoneally administrated aprotinin has a protective effect against I/R injury in the retina of guinea pig as evidenced by reduced retinal MDA level and retinal thickness.

Depression and anxiety in hypothyroidism

The aim of the study was to determine the prevalence and severity of depression and anxiety in patients with hypothyroidism and to compare this with euthyroid patients. Thirty patients with hypothyroidism and 30 euthyroid controls attending the Endocrinology outpatient department of Celal Bayar University, Medical Faculty were included in the study. The hormonal screening was done by immunoassay and haemagglutination methods. Then, for psychiatric assessment, Hospital Anxiety and Depression Scale (HAD), Hamilton Depression Rating Scale (HAM-D), and Hamilton Anxiety Rating Scale (HAM-A) were used. There was no difference between the two groups in terms of demographic features. Total scores obtained from the scales used in the study did not differ significantly (p > 0.05). The frequency of items of both HAM-D and HAM-A did not show any differences in the two groups. By Wilks' Lambda discriminant analysis, depressive mood (HAM-D#1) was found to be the discriminating feature between the hypothyroid group and the euthyroid group. Therefore, depression and anxiety were not outstanding features in hypothyrodism. However, depression was more significant in the hypothyroid than euthyroid group

Relationship of sexuality with psychological and hormonal features in the menopausal period.

Women may experience some mental and sexual problems between the ages of 40 years and 60 years due to serious changes in the hormonal system. The aim of this study was to examine the relationships between the changes in sex hormones, sexual behaviours, depression and anxiety levels of women who were in either the premenopausal, perimenopausal or postmenopausal period. The subjects of this cross-sectional study consisted of 324 women who attended the Gynaecology and Obstetrics Out-Patient Ward of Celal Bayar University Hospital. Of this group, 37.0% (n = 124) were postmenopausal, 27.2% (n = 84) perimenopausal and 35.8% (n = 116) premenopausal. Beck Depression Inventory (BDI), State and Trait Anxiety Inventories (STAI-I and II) and a questionnaire on sexual behaviour which was prepared for this study by the authors, were applied to all of the attendees and serum sex hormone levels were analyzed. Beck Depression Anxiety, STAI-I and STAI-II scores and sexual behaviours did not show any statistically significant difference among these three groups. The frequency of sexual intercourse was lower in women with high BDI scores. The rate of painful intercourse was higher in women with high STAI-I scores. The frequency of sexual intercourse, sexual desire and orgasm decreased and painful intercourse increased in women with high STAI-II scores. The frequency of sexual intercourse decreased significantly as the age or follicle stimulating hormone level of women increased. These findings have revealed that the menopausal state did not affect the sexual behaviour, and psychological state of women between the ages of 40 and 60 years, but the increase in anxiety and depression scores affected the sexual life in a negative manner.

Relationship of sexuality with psychological and hormonal features in the menopausal period

Women may experience some mental and sexual problems between the ages of 40 years and 60 years due to serious changes in the hormonal system. The aim of this study was to examine the relationships between the changes in sex hormones, sexual behaviours, depression and anxiety levels of women who were in either the premenopausal, perimenopausal or postmenopausal period. The subjects of this cross-sectional study consisted of 324 women who attended the Gynaecology and Obstetrics Out-Patient Ward of Celal Bayar University Hospital. Of this group, 37.0 (n = 124) were postmenopausal, 27.2 (n = 84) perimenopausal and 35.8 (n = 116) premenopausal. Beck Depression Inventory (BDI), State and Trait Anxiety Inventories (STAI-I and II) and a questionnaire on sexual behaviour which was prepared for this study by the authors, were applied to all of the attendees and serum sex hormone levels were analyzed. Beck Depression Anxiety, STAI-I and STAI-II scores and sexual behaviours did not show any statistically significant difference among these three groups. The frequency of sexual intercourse was lower in women with high BDI scores. The rate of painful intercourse was higher in women with high STAI-I scores. The frequency of sexual intercourse, sexual desire and orgasm decreased and painful intercourse increased in women with high STAI-II scores. The frequency of sexual intercourse decreased significantly as the age or follicle stimulating hormone level of women increased. These findings have revealed that the menopausal state did not affect the sexual behaviour, and psychological state of women between the ages of 40 and 60 years, but the increase in anxiety and depression scores affected the sexual life in a negative manner

Psychiatric morbidity and depressive symptomatology in patients with permanent pacemakers.

Implantation of a permanent pacemaker requires a psychological effort on the patient's part for adaptation in the acute term, and chronically, it restricts activities of the patient and may cause some psychiatric disturbances. To investigate psychiatric morbidity and depressive symptomatology of the patients with permanent pacemakers, 84 pacemaker patients were diagnosed using the DSM-III-R criteria and depressive symptoms were determined by modified Hamilton Depression Rating Scale (mHDRS). Sixteen (19.1%) patients had been given a psychiatric diagnosis. The most frequent diagnoses were adjustment disorder (5.9%) and major depressive episode (4.7%). Nine patients (10.7%) were diagnosed as having clinical depression (mHDRS > or = 17). The mean score of mHDRS was 7.57 +/- 7.46, and the severity of depression was significantly higher in females. The most frequent symptoms are difficulties in work and activities (53.6%), psychic anxiety (48.8%), loss of energy (42.9%), and hypochondriasis and insomnia (39.3%). Depressed mood, psychic anxiety, loss of energy, loss of interest, insomnia, and hypochondriasis were significantly more frequent in females. Uneducated patients had a more significant loss of energy than educated patients. Depressed mood, psychic anxiety, and somatic concerns and symptoms were more frequent in patients with permanent pacemakers than in the general population. These symptoms, resembling mixed anxiety-depression disorder, were related to fears of having a permanent pacemaker, since our series were composed of uneducated patients who did not have enough knowledge about the device.