Evaluation of intestinal parasites in patients with chronic spontaneous urticaria in a territory hospital in Turkey.

INTRODUCTION: Chronic spontaneous urticaria (CSU) which develops without a known stimulation is defined as the occurrence of spontaneous wheals, angioedema or both for longer than six weeks. Infections, autoimmunity, food intolerance and internal parasitic infections are supposed to be underlying causes of CSU. The aim of this study was to evaluate the intestinal parasites in children and adult patients diagnosed as CSU, to determine the frequency of parasites in chronic urticaria, and to compare these patients with healthy demographic control groups. METHODOLOGY: Seventy six children and 38 adult patients with CSU were examined in terms of parasitic infections. The patients whom parasites were detected received anti-parasitic therapy and the improvements in CSU symptoms were evaluated. Stool samples were examined with direct microscopic examination (native-lugol), stool concentration and trichrome staining methods. RESULTS: In pediatric patient group, 18.4% (n = 14) of the stool samples were positive for Blastocystis sp., 2.6% (n = 2), Dientamoeba fragilis and 1.3% (n = 1), Giardia duodenalis. In adult patient group, Blastocystis sp. was detected in 18.4% (n = 7) of the stool samples. Anti-parasitic therapy yielded substantial improvement in urticaria symptoms in 57.1% of pediatric and 60.0% of adult patients. CONCLUSIONS: Blastocystis sp. and D. fragilis may play a role in chronic urticaria which seriously disrupts the patient's quality of life. Parasitic infections should not be neglected in patients with cutaneous manifestations.

Comparison of non-invasive tests with invasive tests in the diagnosis of celiac disease.

BACKGROUND/AIMS: Today, invasive diagnostic tests are necessary for definite diagnosis of adult celiac disease (CD). However, in selected children patients, the need for invasive tests is ceased. In this study, we evaluated adult patients according to the ESPGHAN (European Pediatric Gastroenterology Hepatology and Nutrition Society) criteria. METHODS: Thirty-nine patients (aged 17-66) with symptoms of CD were included. Serum samples were tested for total IgA, tTG-IgA (antitissue transglutaminase), tTG-IgG, DGP-IgA (antideamidated gliadin peptide), DGP-IgG, and EMA (endomysial antibodies). HLA-DQ typing was studied with PCR-SSP (sequence-specific primers) method. Biopsy samples were evaluated according to Marsh scoring. RESULTS: In CD patients, 71.4% (15/21) of the patients were diagnosed without biopsy according to the EPSGHAN criteria but when ESPGHAN's IgA tTG threshold value for children was taken into consideration (>200 IU/mL), the sensitivity decreased to 81%. Celiac disease diagnosed and control groups were compared in terms of HLA tissue types. DQ2.5 homozygous or DQ2.5/DQ2.2 was significantly higher in CD group, and DQ2- or DQ8-negative HLA tissue type was significantly higher in control group. CONCLUSION: When serological tests, HLA typing, and clinical symptoms are all in favor of CD, biopsy may not be performed in selected adult CD patients.

Effect of fluoride on salivary immunoglobulins and sialic acid.

OBJECTIVE:: The aim of our study was to evaluate the effect of fluoride on salivary immunoglobulin and sialic acid levels in children with dental fluorosis and healthy teeth who live in places with high fluoride concentration in drinking water. METHOD:: Fifty-one (51) healthy children between 6 and 12 years old with no caries were randomly selected from primary schools enrolled in the dental-care program operated by the Department of Pediatric Dentistry. The children were divided into two groups: group I comprised 26 children with dental fluorosis [Thylstrup-Fejerskov Dental Fluorosis Index (TFI) = 4] who lived in Isparta (2.7-2.8 ppm), and group II consisted of 25 children without dental fluorosis who were born in low-fluoride areas and had lived in Isparta for only the previous two years. Stimulated and unstimulated saliva were collected and analyzed for fluoride, salivary immunoglobulins and sialic acid levels. RESULTS:: Sialic acid level was correlated negatively with age. Levels of secretory immunoglobulin A (sIgA) and secretory immunoglobulin G (sIgG) were higher in children with dental fluorosis compared with those in group II, although these differences were not significant. CONCLUSION:: Increased sIgA and sIgG levels may arrest the progression of caries in subjects with dental fluorosis. Given the risks of dental fluorosis, further studies of the effects of different fluoride levels in drinking water on salivary composition of children with mixed dentition are needed to confirm the results of our study and to provide data for comparison.

Effect of fluoride on salivary immunoglobulins and sialic acid

Summary Objective: The aim of our study was to evaluate the effect of fluoride on salivary immunoglobulin and sialic acid levels in children with dental fluorosis and healthy teeth who live in places with high fluoride concentration in drinking water. Method: Fifty-one (51) healthy children between 6 and 12 years old with no caries were randomly selected from primary schools enrolled in the dental-care program operated by the Department of Pediatric Dentistry. The children were divided into two groups: group I comprised 26 children with dental fluorosis [Thylstrup-Fejerskov Dental Fluorosis Index (TFI) = 4] who lived in Isparta (2.7-2.8 ppm), and group II consisted of 25 children without dental fluorosis who were born in low-fluoride areas and had lived in Isparta for only the previous two years. Stimulated and unstimulated saliva were collected and analyzed for fluoride, salivary immunoglobulins and sialic acid levels. Results: Sialic acid level was correlated negatively with age. Levels of secretory immunoglobulin A (sIgA) and secretory immunoglobulin G (sIgG) were higher in children with dental fluorosis compared with those in group II, although these differences were not significant. Conclusion: Increased sIgA and sIgG levels may arrest the progression of caries in subjects with dental fluorosis. Given the risks of dental fluorosis, further studies of the effects of different fluoride levels in drinking water on salivary composition of children with mixed dentition are needed to confirm the results of our study and to provide data for comparison.

Ureaplasma urealyticum: Presence among Sexually Transmitted Diseases.

The aim of this study was to detect the presence of Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Mycoplasma hominis, Trichomonas vaginalis, and Ureaplasma urealyticum in genital specimens of symptomatic patients. This study also examined the role of U. urealyticum in infections of the lower genital tract. Cervical and urethral samples from 96 patients (46 males, 50 females) were tested using the Seeplex(®) STD6 ACE kit. Consent forms were received and a questionnaire was applied. All statistical analyses were performed using the SPSS statistical software program (version 17.0). Among the samples tested, at least 1 pathogen was detected in 49% of the samples; specifically, the rate of detection of U. urealyticum, M. hominis, C. trachomatis, N. gonorrhoeae, M. genitalium, and T. vaginalis was 29.1%, 10.4%, 8.3%, 7.3%, 6.3%, and 4.2%, respectively. U. urealyticum was detected as the sole pathogen in samples from 10% of female patients and 28.3% of male patients (p = 0.035). U. urealyticum was present in 54.5% (18/33) of samples in which a single pathogen was detected and 71.4% (10/14) of samples in which multiple pathogens were detected. Among men, significant differences in discharge, dysuria, and pruritus were not noted among those with negative results (84.6%, 69.2%, and 38.5%, respectively), among those positive for only U. urealyticum (100%, 66.7%, and 26.7%, respectively), and those positive for N. gonorrhoeae, C. trachomatis, M. genitalium, and T. vaginalis (100%, 93.3%, and 26.7%, respectively). Detection of U. urealyticum, either alone or together with other pathogens, in a symptomatic group of patients is an important finding, particularly in men.

Evaluation of Risk Factors for Antibiotic Resistance in Patients with Nosocomial Infections Caused by Pseudomonas aeruginosa.

Background. Pseudomonas aeruginosa (P. aeruginosa) is resistant to various antibiotics and can cause serious nosocomial infections with high morbidity and mortality. In this clinical study, we investigated the risk factors in patients who were diagnosed with P. aeruginosa-related nosocomial infection. Methods. A retrospective case control study including patients with P. aeruginosa-related nosocomial infection. Patients who were resistant to any of the six antibiotics (imipenem, meropenem, piperacillin-tazobactam, ciprofloxacin, amikacin, and ceftazidime) constituted the study group. Results. One hundred and twenty isolates were isolated. Various risk factors were detected for each antibiotic in the univariate analysis. In the multivariate analysis, previous cefazolin use was found as an independent risk factor for the development of imipenem resistance (OR = 3.33; CI 95% [1.11-10.0]; p = 0.03), whereas previous cerebrovascular attack (OR = 3.57; CI 95% [1.31-9.76]; p = 0.01) and previous meropenem use (OR = 4.13; CI 95% [1.21-14.07]; p = 0.02) were independent factors for the development of meropenem resistance. For the development of resistance to ciprofloxacin, hospitalization in the neurology intensive care unit (OR = 4.24; CI 95% [1.5-11.98]; p = 0.006) and mechanical ventilator application (OR = 11.7; CI 95% [2.24-61.45]; p = 0.004) were independent risk factors. Conclusion. The meticulous application of contact measures can decrease the rate of nosocomial infections.

[Evaluation of common commercial systems for the identification of yeast isolates in microbiology laboratories: a multicenter study]. / Mikrobiyoloji laboratuvarlarinda maya türlerinin tanimlanmasinda sik kullanilan ticari sistemlerin degerlendirilmesi: Çok merkezli bir çalisma.

Accurate and rapid identification of yeast isolates have become important in recent years for not only antifungal susceptibility testing due to the species-specific clinical resistance breakpoints but also early initiation of appropriate antifungal therapy. In clinical microbiology laboratories species identification of yeasts is often performed with several commercial systems based on biochemical properties and rarely according to the physiological and morphological characteristics. The aim of this study was to compare the two common commercial systems, VITEK 2 YST ID Card (Vitek; bioMérieux, France) and API 20C AUX (API; bioMérieux, France) with conventional mycological methods. A total of 473 clinical yeast strains isolated from clinical specimens in different university and training/research hospitals and identified by Vitek system were included in the study. The isolates were re-identified with API and conventional methods including morphological identification in the Mycology Reference Laboratory of the Public Health Institute of Turkey. Candida dubliniensis MYA 583, Candida krusei ATCC 6258, Candida parapsilosis ATCC 22019, Candida albicans ATCC 10231 and Cryptococcus neoformans ATCC 32268 were used as quality control strains and those standard strains were studied consecutively 10 days with both of the methods. The results of identification by Vitek and API were compared with the results of conventional methods for those 473 yeast isolates [6 genus (Candida, Cryptococcus, Blastoshizomyces, Rhodotorula, Saccharomyces, Trichosporon), 17 species (5 common and 12 rarely isolated)]. The performances of the systems were better (Vitek: 95%; API: 96%) for the commonly detected species (C.albicans, C.parapsilosis, C.glabrata, C.tropicalis and C.krusei) than those for rarely detected species (Vitek: 78.4%; API: 71.6%) (p= 0.155). Misidentification or unidentification were mostly detected for C.parapsilosis (Vitek: 6/87; API: 7/87) and C.glabrata (Vitek: 9/104; API: 3/104) by both of the systems. For rarely detected yeast isolates, misidentification or unidentification were most frequently observed in species of C.pelliculosa (Vitek: 3/11; API: 6/11) and C.dubliniensis (API and Vitek: 2/5) isolates. Candida guilliermondii (API: 2/5) isolates had lower rate of identification with API compared to other species. Blastoschizomyces capitatus and Saccharomyces cerevisiae isolates could not be identified by both of the systems. As a result, the accurate diagnosis of Vitek and API systems were similar in terms of consistency (86.3%). Two systems performed well in correct identification of common clinical yeast species (at least 95%), while the identification of rare species was more challenging indicating that they require further morphological and physiological testing. The addition of morphological identification to commercial systems will be useful for accurate diagnosis and treatment of mixed infections.

Acupuncture versus solifenacin for treatment of overactive bladder and its correlation with urine nerve growth factor levels: a randomized, placebo-controlled clinical trial.

OBJECTIVE: To determine whether acupuncture is effective as an overactive bladder (OAB) treatment compared with solifenacin and placebo, and to investigate its relation with urine nerve growth factor (NGF) levels. PATIENTS AND METHODS: The study was conducted with methodological rigor based on the Consolidated Standards of Reporting Trials criteria. 90 female patients with OAB were included and randomly assigned to a solifenacin, acupuncture or placebo group. The medicated group received solifenacin 5 mg/day; the acupuncture and placebo groups were treated twice a week for 4 weeks. Symptom scores, quality of life scores, frequency of micturition and urine NGF levels were used to assess treatment efficiency. RESULTS: The study was completed with 82 patients (n = 30 in the solifenacin group, n = 28 in the acupuncture group and n = 24 in the placebo group). After treatment, comparison of the medical and acupuncture therapy groups with the placebo group showed significant differences between recovery concerning quality of life (p < 0.001 and p < 0.01, respectively) and symptom scores (p < 0.001 and p < 0.001, respectively). The decrease of NGF levels after treatment compared to before treatment was determined in each group (solifenacin, acupuncture, placebo group; p < 0.001, p < 0.001, p = 0.359, respectively). Sufficient symptomatic improvement was not achieved in 8 patients in the acupuncture group. Therefore, comparisons were assessed twice with and without including these patients, and NGF levels in the acupuncture group were higher than at first comparison in which all patients in the acupuncture group were included. CONCLUSIONS: In patients with OAB in whom anticholinergic treatment is contraindicated, acupuncture may be considered another treatment option.

Evaluation of serum sCD40L and homocysteine levels with subclinical atherosclerosis indicators in patients with psoriasis: a pilot study.

Psoriasis is a chronic inflammatory process associated with an increased risk of cardiovascular risk factors. sCD40L has been suggested to have a possible role in the pathogenesis, of psoriasis and is known to be associated with inflammation, atherogenesis and cardiovascular events. This study investigated cardiovascular risk factors (sCD40L and homocysteine) as well as subclinical atherosclerosis indicators in psoriatic patients and control subjects. The study included 56 consecutive patients with chronic plaque-type psoriasis and 53 age and gender matched healthy controls admitted to a university hospital. Serum sCD40L and homocysteine levels were measured by ELISA. Carotid artery intima-media thickness and brachial artery flow mediated dilatation (FMD) measurements were determined ultrasonographically. Subjects who had a history of cardiovascular diseases and cardiovascular risk factors and receiving any systemic treatment were excluded from the study. Plasma sCD40L levels were significantly higher in psoriasis patients compared with healthy controls (1.33±0.72 vs. 0.98±0.70 ng/ml P=0.012), whereas plasma homocysteine levels did not differ significantly between the two groups. FMD was significantly reduced in the psoriasis group compared to the controls (3.83±5.03 vs. 8.45±7.27% P=0.0001). Multiple linear regression analyses indicated a significant association between psoriasis, sCD40L, and FMD. Psoriatic patients had higher sCD40L levels than healthy controls, which may lead to an increase in cardiovascular diseases. sCD40L may be a more reliable and early predictive marker of cardiovascular events in psoriatic patients. New treatmentoptions that will be developed over sCD40L will benefit in prevention of psoriasis and its cardiovascular comorbidities.

Is gastroesophageal reflux contribute to the development chronic cough by triggering pulmonary fibrosis.

BACKGROUND/AIMS: Previous studies have shown that the prevalence of abnormal acid reflux in fibrotic lung disease patients is high, and in particular, patients with secondary pulmonary fibrosis show higher esophageal acid exposure than normal controls. There are also some findings that, in patients with pathological reflux, pulmonary fibrosis may develop. The aim of this study is to investigate if pulmonary fibrosis is involved in the pathogenesis of chronic cough due to Gastroesophageal Reflux. MATERIALS AND METHODS: A prospective study was performed in twenty-one patients with chronic cough due to gastroesophageal reflux who was diagnosed as reflux esophagitis by upper gastrointestinal endoscopy, histology, and in ten healthy controls without GER or any lung disease. All participitants underwent laryngoscopic examination and gastroesophageal scintigraphy with late lung imaging. Bronchoalveolar lavage fluid total and differential cell counts, T and B cell subsets, and the concentrations of IL- 1ß and TNF-α were measured. RESULTS: Reflux extending into the proximal esophagus was noted in 52.5%, and posterior laryngitis was present in 90.5% of the patients. No evidence of pulmonary aspiration was noted in the patients with reflux on scintigraphic examination. No significant difference was found between the GER and control groups in terms of cellular content, IL-1ß and TNF-α levels or mean T cell subsets and B cell counts in bronchoalveolar lavage fluid. Forced expiratory volume in one second, forced vital capacity FEV1/FVC, total lung capacity, and carbon monoxide diffusion capacity values were within normal limits in the gastroesophageal reflux group. CONCLUSION: Our findings do not support the hypothesis that gastroesophageal reflux leads to chronic cough by triggering alveolar epithelial injury and subsequent pulmonary fibrosis.

Antimicrobial Susceptibilities of Clinical Acinetobacter baumannii Isolates With Different Genotypes.

BACKGROUND: The treatment of Acinetobacter baumannii infections is difficult. Carbapenems, sulbactam, and colistin are the most effective antibiotics. OBJECTIVES: The aim of this study was to evaluate the susceptibilities of genotypically different A. baumannii isolates to sulbactam, amikacin, netilmicin, meropenem, tigecycline and colistin. PATIENTS AND METHODS: Isolates from various clinical samples of patients with hospital-acquired infections that were identified by the VITEK 2 Compact system in our hospital's microbiology laboratory between January 2010 and March 2012 were included in the study. To determine genetic relatedness of the isolates, the rep-PCR method was used. The broth microdilution method was used for amikacin, netilmicin, meropenem and colistin, while E-test was used for sulbactam and tigecycline. RESULTS: Among the 300 isolates, 30 were found to be genotypically different and were evaluated in terms of their antimicrobial susceptibilities. All isolates were susceptible to colistin. The susceptibility rates were 66.6%, 50%, 36.6%, 30%, and 10% for netilmicin, tigecycline, sulbactam, amikacin, and meropenem, respectively. For carbapenem resistant isolates, the susceptibility rates were 66.6%, 51.8%, 33.3%, and 25.9% for netilmicin, tigecycline, sulbactam, and amikacin, respectively. The sulbactam minimum inhibitory concentration (MIC) 50 and MIC 90 were 8 µg/mL and 12 µg/mL, respectively. CONCLUSIONS: In this study, it was concluded that determining the cut-off value for MIC breakpoints for sulbactam alone has a critical impact on the susceptibility results.

[The effect of kefir consumption on human immune system: a cytokine study]. / Kefir tüketiminin insan bagisiklik sistemi üzerine etkileri: Bir sitokin çalismasi

The systemic effects of bioactive peptides which are produced by the fermentation of milk via the microorganisms found in kefir have been the subject of interest in recent years. Bioactive peptides activate innate immunity by stimulating macrophages, increasing phagocytosis, augmenting NO and cytokine production and boosting the lumen levels of IgG and IgA+ B-lymphocytes. The aim of the present study was to determine the serum cytokine profiles of healthy volunteers after kefir consumption to evaluate helper T (TH) cell polarization and to bring out the effects on native and allergic immune responses. The study was designed as a prospective and self-controlled study. A total of 18 healthy volunteers (age range: 20-40 yrs, mean age: 35.5 ± 7.38 yrs) from a university hospital staff were recruited to the study, with the approval of ethical board and informed consent. The body mass indices of all participants were between normal range (20.10-25.70 kg/m2). After two weeks of a diet free from fermented products, the participants consumed 200 mL kefir daily, for six weeks. Kefir product was prepared by using kefir starter culture (Danisco Biolacta Sp - 05223B 10001, Poland) which contains Lactobacillus spp., Leuconostoc spp., Lactococcus lactis ssp. lactis and Streptococcus termophilus, an overnight incubation at 26°C, and consumed freshly. Fasting blood samples of subjects were collected just before kefir use (0th week), at the end of the 3rd and 6th weeks of kefir consumption, and three weeks after cessation of kefir usage (9th week). Serum TNF-a, IL-1, IL-5, IL-8 and TGF-ß levels were measured by using commercial ELISA kits (BioSource, Belgium and Invitrogen, USA). Hemoglobin, serum creatinine and ALT levels of all subjects were also determined for follow-up. All volunteers completed the study period without any problem and declared no complaint. Hemoglobin, creatinine and ALT levels did not change with kefir consumption. Serum IL-8 levels were decreased at 3rd and 6th weeks (p< 0.001) and were at low levels at 9th week (p= 0.005) when compared with baseline levels (0th week). Serum IL-5 levels were increased at 3rd week (0th-3rd weeks; p= 0.01) and decreased by a rebound effect at 9th week (6th-9th week p= 0.003). TNF-α levels were increased with kefir consumption (p= 0.046) but the increase was insignificant in paired comparisons and the level was borderline between 0th and 6th weeks (p= 0.013). IL-5 and TNF-α levels returned to their original levels (0th week) at 9th week. Levels of the other cytokines (IL-1 and TGF-ß) did not change significantly with kefir usage. These results indicated that kefir use increased polarization of the immune response towards TH1 type and decreased TH2 type response and accordingly allergic response. The decrease in IL-8 level due to kefir use, might control the inflammatory response by suppressing neutrophil chemotaxis and activation. On the other hand it was also concluded that increased IL-5 might stimulate secretory IgA at gastrointestinal mucosa leading to a more efficient immune response in the intestinal lumen.

Increased expression of CD11a and CD45 on leukocytes and decreased serum TNF-alpha levels in patients with isolated coronary artery ectasia.

BACKGROUND: Aneurysm and ectasia have similar pathological pathways. TH2-associated cytokines are stimulated by aneurismal tissue and correspondingly lack mediators associated with TH1 response. In this study, we measured serum TNF-alpha and IL-18 levels which are strong TH1 stimulating cytokines and also investigated the expression of CD11a, CD11b, CD18 adhesion molecules and CD45 on leukocytes in patients with coronary artery ectasia (CAE) and controls with normal coronary arteries (NCA). METHODS: A total of 51 isolated CAE patients free of atherosclerosis and 37 NCA controls were included in the study. Cell counts and cell surface adhesion molecules were detected by flow cytometry using fluorescence conjugated monoclonal antibodies. Serum TNF-alpha, IL-18 levels, and Chlamydophila pneumoniae IgG and IgM and Helicobacter pylori IgG levels were detected by ELISA methods. RESULTS: The mean fluorescence intensities of CD11a on granulocytes, monocytes and lymphocytes and CD45 on granulocytes and monocytes were significantly higher in CAE patients when compared with the NCA group (10.01 +/- 8.2 vs. 6.79 +/- 3.49, p = 0.04; 15.84 +/- 8.64 vs. 11.56 +/- 5.27, p = 0.016; 29.58 +/- 9.98 vs. 20.02 +/- 9.66, p < 0.001; 7.58 +/- 5.03 vs. 4.57 +/- 3.05, p = 0.003; 18.73 +/- 1238 vs. 10.74 +/- 738, p = 0.004; respectively) detected by flow cytometry. TNF-alpha levels were significantly lower in the patient group (18.76 +/- 7.07 vs. 24.29 +/- 8.46; p < 0.001) when compared with controls. The percentage of granulocytes was higher in the CAE group when compared with the NCA group (65.52 +/- 14.91 vs. 52.28 +/- 1537; p = 0.002). Contrarily, the percentage of monocytes was higher in the control group when compared with the CAE group (18.12 +/- 15.69 vs. 934 +/- 733 p = 0.008). Among the infection markers studied, only C. pneumoniae IgG levels were significantly higher in patients when compared with controls (81.62 +/- 48.53 RU/mL vs. 63.79 +/- 33.83 RU/mL; p = 0.045). In CAE patients, TNF-alpha levels significantly correlated with mean fluorescence intensity levels of CD45+ granulocyte (0.525, p < 0.001), monocyte (0.469, p = 0.001) and lymphocytes (0376, p = 0.013). CONCLUSIONS: The decreased levels of TNF-alpha may indicate predominance of TH2 and lack of TH1 type immunity in CAE patients, similar to patients with aortic aneurysms. Increased levels of cell surface adhesion molecules in CAE are an indicator of activation of leukocytes for adherence and transmigration through the vessels for the initiation of inflammation.

Comparison of five antimicrobial susceptibility tests in detecting high level aminoglycoside and vancomycin resistances in hospital acquired Enterococcus isolates.

BACKGROUND: Multiple antibiotic resistance is increasing in the genus Enterococcus. The aim of this research is to compare five different antibiotic susceptibility test methods used in enterococcal isolates. METHODS: Disc diffusion, agar dilution, Etest, and API Enteroc 5 tests were compared with the standard antimicrobial susceptibility test (SAST) (broth microdilution) in 100 Enterococcus strains isolated from various clinical specimens. RESULTS: The resistance rates of the isolates to antibiotics were as follows: 51% resistance to tetracycline, 38% to erythromycin, 28% to penicillin and ampicillin, 23% to high level gentamicin, 16% to high level streptomycin, 14% to chloramphenicol, 9% to ciprofloxacin, and 1% to nitrofurantoine, as determined by SAST. Except a moderate-susceptible vancomycin strain, all strains were found to be susceptible to vancomycin and teicoplanin. None of the strains examined had beta-lactamase enzyme activity. Of significance, one major error in detecting high level gentamicin and two serious errors in detecting high level streptomycin resistances were detected when API was compared with the SAST method. Major errors were also detected in penicillin, erythromycin, tetracycline, ciprofloxacin, and nitrofurantoin with the API method. CONCLUSIONS: Disc diffusion, agar dilution, SAST, and Etest methods were equally reliable for the detection of all antimicrobials studied and the disc diffusion method is considered easy to perform and inexpensive method. The API method is considered unreliable in detecting high level aminoglycoside resistance.

Microbiological evaluation of octenidine dihydrochloride mouth rinse after 5 days' use in orthodontic patients.

OBJECTIVE: To determine the absolute and relative antibacterial activity of octenidine dihydrochloride (OCT) against total and cariogenic bacteria in saliva samples of patients with fixed orthodontic appliances during 5 days of usage. MATERIALS AND METHODS: The study group consisted of 5 male and 13 female subjects who were selected from patients in the Clinic of Orthodontics. Each patient was given physiologic saline (PS), chlorhexidine gluconate (CHX), polyvinylpyrrolidone-iodine complex (PVP-I), and OCT every morning for 5 days, each separated by a 2-week interval. Total and cariogenic bacteria in saliva samples of orthodontically treated patients with fixed appliances were collected during 5 days of usage. Unstimulated saliva was collected as a baseline sample. Saliva samples were collected at 15 minutes, and on the second, third, and fifth day after rinsing the mouth with any of the solutions for 30 seconds, and bacterial counts were detected. RESULTS: OCT showed an ultimate reduction of total viable oral bacteria, Lactobacillus species, and Streptococcus mutans in vivo. OCT also had a significantly greater inhibitory effect than 0.2% CHX and 7.5% PVP-I, from the beginning of the study until the fifth day after the orthodontic appliances were bonded (P < .1). CONCLUSIONS: OCT compared favorably with respect to CHX and PVP-I complex in orthodontically treated patients with fixed appliances (P

The role of helper and regulatory T cells in the pathogenesis of vitiligo.

BACKGROUND: Alterations in cellular immunity, including CD4(+) T and CD8(+) T lymphocytes, have been proposed in the pathogenesis of vitiligo. There is also a proposed role for cytokines in the depigmentation observed in vitiligo. However, previous reports on the role of cytokines in the pathogenesis of vitiligo have been few in number. OBJECTIVE: The purpose of this investigation was to assess the role of the major cytokines produced by T-helper 1 and 2 cells as well as T-helper 17 and regulatory T cells in the pathogenesis of vitiligo. METHODS: Forty patients with vitiligo and 40 age- and sex-matched healthy control subjects were enrolled in the study. Serum interleukin (IL)-4, IL-6, IL-10, IL-17, interferon-gamma, tumor necrosis factor-beta, and transforming growth factor-beta levels were detected by enzyme-linked immunosorbent assay in both groups. The correlations of serum cytokine levels with age of onset, sex, duration of disease, type and activity of vitiligo, percentage of involved body area, Koebner positivity, family history, and the presence of associated autoimmune diseases were assessed. RESULTS: Serum transforming growth factor-beta levels were significantly decreased in the vitiligo group compared with the control group (P = .004). No difference was detected between the patient and control groups in mean levels of serum IL-6, IL-10, and tumor necrosis factor-beta. In the patients with vitiligo, serum IL-17 levels were positively correlated with the extent of body area involvement (rho = 0.329, P = .038). LIMITATIONS: Tissue cytokines compared with those in the peripheral blood were not measured. CONCLUSION: Although multiple factors have been implicated in the pathogenesis of vitiligo, reduced serum transforming growth factor-beta levels, as observed in patients in the current investigation, may contribute to enhanced cellular immunity. This may facilitate the occurrence of vitiligo by leading to diminished maturation of regulatory T cells, followed by impaired inhibition of inflammation.

Short-term relative antibacterial effect of octenidine dihydrochloride on the oral microflora in orthodontically treated patients.

OBJECTIVE: To evaluate the efficacy of common antiseptic mouth rinses and octenidine dihydrochloride (OCT). METHODS: The antibacterial activities of antiseptics against total and cariogenic bacteria (Streptococcus mutans and Lactobacillus species) in saliva were studied in vitro and in vivo. After unstimulated saliva was collected, one of the mouth rinse solutions was applied for 30seconds. Saliva samples were collected 15, 30, 60, and 120min later and evaluated for their bacterial count. RESULTS: OCT had a significantly greater inhibitory effect on the studied bacteria than 0.2% chlorhexidine gluconate (CHX) and 7.5% polyvinylpyrrolidone-iodine complex (PVP-I) from 15min to 120min following the application (p<0.01). The antiseptic efficacy of 0.2% CHX on total bacteria and Lactobacillus species was very similar to the efficacy observed with 7.5% PVP-I mouth solution from 15min up to 120min. Streptococcus mutans was completely inhibited by 0.15mg/ml PVP-I, 0.5mg/ml CHX, and 0.1mg/ml OCT concentrations, while Streptococcus salivarius was inhibited by 0.15mg/ml PVP-I, 2mg/ml CHX, and 0.8mg/ml OCT concentrations. Lactococcus lactis subspecies lactis was inhibited with 0.00313mg/ml OCT, 30mg/ml PVP-I, and 0.0063mg/ml CHX concentrations. CONCLUSIONS: OCT compared favorably with CHX and PVP-I in its antibacterial effects, both in vitro and in vivo (p<0.01).

The effect of Nomega-nitro-L-arginine methyl ester and L-arginine on lung injury induced by abdominal aortic occlusion-reperfusion.

PURPOSE: The aim of this study was to examine the effects of Nomega-nitro-L-arginine methyl ester (L-NAME) and L-arginine on lung injury after aortic ischemia-reperfusion (IR). METHODS: Twenty-four Wistar-Albino rats were randomized into four groups (n = 6) as follows: Control (sham laparotomy), Aortic IR (30 min ischemia and 120 min reperfusion), L-Arginine (intraperitoneal 100 mg kg(-1) live weight)+aortic IR, and L: -NAME (intraperitoneal 10 mg kg(-1) live weight)+aortic IR. In the lung specimens, the tissue levels of malondialdehyde (MDA), vascular endothelial growth factor (VEGF), and nitric oxide (NO) were measured and a histological examination was done. RESULTS: Aortic IR increased MDA, VEGF, and NO. L-Arginine further significantly increased MDA and NO, and decreased VEGF (P < 0.05 vs aortic IR). L-NAME significantly decreased MDA and NO (P < 0.05 vs L-arginine+aortic IR) and increased VEGF (P < 0.05 vs other groups). A histological examination showed the aortic IR to significantly increase (P < 0.05 vs control) while L-arginine also further increased (P > 0.05 vs aortic IR), whereas L-NAME caused a significant decrease in pulmonary leukocyte infiltration (P < 0.05 vs aortic IR). CONCLUSIONS: Our results indicate that L-arginine aggravates the lung injury induced by aortic IR, while L-NAME attenuates it.

Quantitative correlation of Helicobacter pylori stool antigen (HpSA) test with the severity of H. pylori-related gastritis.

The Helicobacter pylori (H. pylori) load in both stomach and stool and the resulting severity of gastritis are important criteria in validating the status of H. pylori infection. We aimed to assess the reliability of the H. pylori stool antigen (HpSA) test for the primary diagnosis of H. pylori infection by calculating the best cut-off value to obtain the highest sensitivity and specificity in dyspeptic patients. We also investigated the correlation of HpSA test with the severity of gastritis and H. pylori load. The H. pylori statuses of 95 patients were evaluated by the positivity of both rapid urease test and microscopic detection of H. pylori in biopsy specimens, 88 subjects of whom were H. pylori positive. The sensitivity and specificity of the HpSA test were 51.1% (45/88) and 100% (7/7), respectively, according to the manufacturer's recommended cut-off value of 0.16. However, with the best cut-off value of 0.048, calculated by receiver operator characteristics analysis, the sensitivity of the test increased to 92.0% (81/88) with the same specificity. High values of the HpSA test were correlated with high scores of corpus H. pylori load and the severity of antrum and corpus inflammation (p < 0.05). With the best cut-off value of the HpSA test, the primary diagnosis of H. pylori infection can be made with higher sensitivity and specificity. The HpSA test is a helpful tool that evaluates the severity of H. pylori infection and the degree of gastric inflammatory activity and gastric H. pylori load.

Finding the sources of septicemia at a neonatal intensive care unit: newborns and infants can be contaminated while being fed.

This study was conducted to determine whether the hospital devices and materials used for the examination and treatment of patients play a role in the outbreaks of infection in hospitals. Environmental sampling was performed to find the possible sources of septicemia at the neonatal intensive care unit (NICU). Environmental sampling results and blood culture records from the outbreak areas were compared to determine if they had any relationship with each other. Semisolid and solid samples were compared with liquid samples for positive cultures using a chi-square test. Statistical significance was accepted at P<0.05. The results showed that liquid sources were more frequent media for infectious agents (OR, 8.75; chi-square, 0.0278). The most common cultured microorganisms were coagulase negative Staphylococcus and Klebsiella pneumoniae, which were responsible for septicemias at NICU. There were strong relationships between environmental culture results and the agents responsible for the outbreak of septicemia at the NICU. The formula heater at the pediatrics clinic also revealed the same microorganisms with the blood cultures of 3 patients in the same clinic. Although there are matches between the environmental sampling and blood culture records in our study, there is a need for further studies. We conclude that moist areas and liquid environments must be regularly checked for pathogen microorganisms. Instead of using heated water to sterilize infant formula, dry air sterilization should be used. Liquid media like oxygen reservoir solution and antiseptic solutions must be checked for contamination and should be changed periodically.