A new scoring system to predict mortality in community-acquired pneumonia: CURB (S)-65.

OBJECTIVE: The first decision to be made in the case of community-acquired pneumonia (CAP) is whether hospitalization of the patient is mandatory. In this study, we aimed to investigate whether the addition of oxygenation parameters to CURB-65 has diagnostic value in predicting mortality in CAP. PATIENTS AND METHODS: A total of 903 CAP patients were included in the study. Patients with a CURB-65 score of 0 and 1 were classified as Group 1 and patients with a CURB-65 score of 2 or more were classified as Group 2. The prediction of mortality through Pneumonia Severity Index (PSI), CURB-65 and CURBS-65/CURBP-65 with the addition of SaO2 and PaO2 values; hence the four different models, was compared among all patient groups. RESULTS: As a result, 3.3% of the cases in Group 1 and 12.7% of the cases in Group 2 died. In both CURB-65 groups, it was noted that the frequency of patients with SaO2 <90% was significantly higher in the dead group than in the alive patient group (p=0.009 and p=0.001, respectively). In the univariate analysis, PaO2<60, and SaO2<90 were significantly associated with mortality. Model 2 (CURBS-65) and Model 3 (CURBP- 65) were examined, SaO2<90 (OR 2.08) was found to have an effect on death. In predicting mortality by the receiver operating characteristics (ROC) analysis, it was understood that the CURBS-65 score had a slightly higher area under the curve (AUC) value than CURB-65. CONCLUSIONS: As a result, it has been shown that the use of CURBS-65 scoring instead of CURB-65 clinical scoring may be more useful in predicting mortality.

Morphological evaluation and clinical significance of the supracondylar process and supratrochlear foramen: an anatomic and radiological study.

BACKGROUND: In our literature review, we did not encounter any study examining the supracondylar process (SP) and the supratrochlear foramen (STF) with a three-dimensional (3D) reconstruction method. The present study aimed to evaluate SP and STF morphologically by employing the 3D reconstruction method and emphasize their clinical significance. MATERIALS AND METHODS: The research was carried out on dried human humeri of unknown sex and without pathological alterations. A total of 81 humeri (42 right, 39 left) were obtained from the Departments of Anatomy of Gazi University Faculty of Medicine and Lokman Hekim University Faculty of Medicine. The morphometric measurements of SP and STF were made with a digital vernier calliper. The computed tomography images acquired for radiological evaluation were analysed with the 3D reconstruction method. RESULTS: The narrower distal medullary canal widths of humeri with STF were found to be statistically significant. No statistically significant difference was found between the transverse diameters (TD), vertical diameters (VD), the distance of the medial edge to the medial epicondyle, and the distance of the lateral edge to the lateral epicondyle of the supratrochlear foramen of the right and left humeri. CONCLUSIONS: The supracondylar process is often evaluated by mistake as a pathological condition of the bone, not as a normal anatomical variation. Knowing different shapes and dimensions, e.g. the TD and VD distance in which STF emerges, can assist in avoiding the misinterpretation of radiographs.

Social contact patterns of infants in deciding vaccination strategy: a prospective, cross-sectional, single-centre study.

Social contact between individuals is believed to be a fundamental cause in the transmission of many respiratory tract infections. Because they have not yet been fully vaccinated, infants are at high risk for contracting whooping cough, influenza and their serious complications. Therefore, determining infant social contact patterns is an important step in protecting them from respiratory tract infection. This study included 1200 healthy infants (<12 months of age). Social contact diaries were used to estimate the frequency and nature of the infants' social contacts. This survey also gathered information regarding the infants' respiratory symptoms and their frequency of attendance at crowded places over a period of 1 week. The diary return rate was 83.8% (N = 1006), and there was a total of 4706 contacts reported for these infants. The median daily contact number per capita was 4 (range 1-18). The median number of contacts with adolescents was 0 (range 0-7). Of the infants, 50.3% had contact with non-household individuals. The mothers had the longest contacts with their babies. Contacts with school children, frequency of attendance at crowded places and age were determined to be significant effective factors for reporting respiratory symptoms. Results suggest that school-age siblings and the mothers should be primarily vaccinated, and parents should keep their babies away from crowded places for protecting their infants.

The use of a prostacyclin analog, iloprost, as an adjunct to uterus preservation with histidine-tryptophan-ketoglutarate solution.

INTRODUCTION: Although assisted reproductive techniques have made most causes of both male and female infertility treatable, uterine factor infertility is not able to therapy. Therefore, transplantation of the uterus has been suggested as a future possible cure. Organ preservation solutions seek to reduce reperfusion injury. Since iloprost is an antioxidant with cytoprotective properties, we investigated its potential positive effects in histidine-tryptophan-ketoglutarate (HTK) solution after 4 or 24 h cold storage period of the rat uterus. METHODS: We divided 24 female Wistar-albino rats into four groups: Group 1 had the uterus tissue stored in HTK solution at 4 °C for 4h. Group 2, the tissue was stored in HTK solution combined with iloprost (10(-8) M) for 4h at 4 °C. The same procedures were repeated for 24 h for Groups 3 and 4 respectively. Tissue levels of malondialdehyde (MDA) and nitric oxide (NO), as indicators of oxidative stress were determined with histopathological evaluations. RESULTS: MDA and NO levels were compared between the group 1 vs 3; and 2 vs 4. No significant difference was observed between the groups. Cold storage for 24 h produced alterations in histological appearances that were mitigated by the addition of iloprost to HTK solution. CONCLUSION: In conclusion, addition of iloprost to HTK solution reversed the histological alterations after 24h-cold storage of the rat uterus.

Expression of human neutrophil proteins in acne vulgaris.

BACKGROUND: In acne vulgaris patients, the presence of a dysregulation of the production of innate and specific antimicrobial peptides has been postulated. OBJECTIVE: This study aims to determine whether human neutrophil proteins (HNP) 1-3 are expressed in acne patients. MATERIALS AND METHODS: HNP 1-3 expression was investigated in 35 acne patients treated with isotretinoin and in 25 healthy subjects. At the beginning of the study, two skin biopsies were taken from acne patients; one biopsy was taken from an established pustule and one from uninvolved skin, and the biopsies were repeated after treatment. Only one biopsy was obtained from controls. RESULTS: The statistical analysis showed that pustular lesions of acne patients had significantly higher levels of perivascular and interstitial HNP 1-3 expression when compared with the biopsy of uninvolved skin of these patients (P = 0.003, P = 0.001, respectively) and with that of healthy controls (P = 0.007, P = 0.014, respectively). Isotretinoin treatment achieved a decrease in the perivascular and interstitial HNP 1-3 expression of pustular lesions (P = 0.01, P = 0.001, respectively). CONCLUSION: Our current study demonstrates the novel observation that a recently identified antimicrobial peptide, HNP 1-3, is expressed in neutrophils of acne inflammation but not in uninvolved skin of these patients. These results suggest that HNP 1-3 may contribute to the development of inflammatory lesions of acne.

Factors affecting intraocular pressure measured by noncontact tonometer.

PURPOSE: To investigate the mean values of intraocular pressure (IOP) measured with noncontact tonometer (NCT) and evaluate the factors that may affect IOP. METHODS: A total of 850 subjects who were admitted to our clinic between March 2005 and February 2006 were recruited for the study. Subjects having blepharitis, conjunctivitis, corneal diseases, glaucoma suspicion, or glaucoma were not accepted to the study. All subjects were questioned about systemic diseases. IOP measurement with NCT and central corneal thickness (CCT) with ultrasound pachymetry were performed for each patient between 9 and 11 AM. RESULTS: The mean ages of 367 (43.2%) male subjects and 483 (56.8%) female subjects were 43.9+/-18.1 and 40.7+/-18.0 years +/- SD, respectively. Since right and left eye IOP, CCT, and keratometric values were significantly correlated, right eye values were used for statistical purposes. Mean IOP values in males and females were 13.2+/-3.0 and 13.5+/-2.9 mmHg, respectively. Mean CCT values were 552.5+/-34.7 mum for males and 550.1+/-34.3 mum for females. In multiple regression analysis, IOP was found to be associated with gender, refractive error, CCT, and the presence of diabetes mellitus (DM). CONCLUSIONS: Gender, CCT, the presence of DM, and refractive error may be significantly associated with IOP in this particular population.

Factors influencing central corneal thickness in a Turkish population.

PURPOSE: The aim of this study is to find out the central corneal thickness (CCT) values for a Turkish patient group and to investigate the possible influences of age, sex, IOP, refractive status, keratometry readings, systemic disorders (hypertension, diabetes mellitus, hyperlipidemia, heart disease and asthma) on CCT values. MATERIALS AND METHODS: Six hundred twenty five subjects (276 male (44%), 349 female (56%)) of ages 6 to 88 years were recruited. Subjects who had corneal diseases, purulent conjunctivitis or blepharitis were excluded. Refraction and keratometry readings were made by MRK-3100 premium auto-ref/keratometer, IOP was measured by Reichert AT-555 auto noncontact pneumotonometer. RESULTS: Mean age was 44.1 +/- 16.6 years +/- SD for male subjects, 41.0 +/- 16.9 for females. Mean CCT +/- SD values for male was 552.2 +/- 35.9 microm, for female was 552.3 +/- 35.4 microm, respectively. There was no significant difference between right and left eye CCT values for both genders. Age and CCT was not correlated for the whole study group but there was a slight negative correlation in male subjects. IOP and CCT had moderately significant correlation for males and females. There was a slight significant correlation between Kh-Kv and CCT values for the whole group. In a multivariate regression model only Kv values seemed to affect CCT values. DISCUSSION: There are studies showing the variation of CCT values among different nations and ethnicities. There is no agreement about the relationship between age, IOP, Kh-Kv, spherical equivalence of refractive error, systemic disorders, menopause and CCT. In our study CCT was correlated with Kh-Kv and IOP in correlation analysis but in multivariate regression analysis only Kv appeared to influence corneal thickness.

Tetanus immunization in pregnant women: evaluation of maternal tetanus vaccination status and factors affecting rate of vaccination coverage.

The objectives of this study were to determine the tetanus vaccination status for pregnant women, and to examine the effects of various factors on tetanus toxoid (TT) vaccination coverage during pregnancy in reproductive-age women. Four-hundred and ninety-three postpartum women who had live births at a hospital in Ankara were interviewed and information was collected on the mothers' sociodemographic characteristics, TT vaccination history, and prenatal care during the pregnancy studied. The rates for no vaccination, one-dose vaccination, and two-dose vaccination were 53.3%, 18.9%, and 27.8%, respectively. The vaccinated women (with at least one dose) were significantly younger, of lower parity, and had attended more prenatal care visits than the unvaccinated women. Of the women who attended at least one prenatal care check-up, only about half were vaccinated. Significantly more rural women were vaccinated against tetanus than urban women. Current vaccination rates with TT during pregnancy were found to be well below universal levels. Turkey needs to launch effective mass media campaigns that target urban and suburban populations, and inform and motivate women to request vaccination against tetanus.

Tetanus IgG antibody levels in children aged 12 to 47 months in Turkey.

Tetanus is a serious disease with high mortality, which is very difficult to treat but can be prevented easily by vaccination. The number of tetanus cases reported in Turkey was 42 in 1996 and 51 in 1997. This study was carried out on children aged 12 to 47 months who have vaccination cards in the No. l Health Centre in Batikent district in Ankara, Turkey. Forty-one of the children had received 3 doses (Group 1) of tetanus vaccine, and 47 of them had received 4 doses of the vaccine (Group 2). Anti-toxoid IgG antibody in blood sera was quantified by using the enzyme-linked immunosorbent assay technique. In Group 1, antibody levels more than 0.01 IU/mL were found in 47%, 43%, and 45% of blood sera of children aged 12 to 23 months, 24 to 35 months, and 36 to 47 months, respectively. These rates in Group 2 were found to be 91%, 88%, and 60%, respectively. The protective antibody response (>1 IU/mL) was found to be higher for children in Group 2 than in Group 1, but both rates declined with age. Checking immunization status periodically and giving vaccine doses as required are essential to increase the antibody response. Further, it is a must in developing countries where vaccination efforts are hindered by cold-chain problems, underoptimum application practice, and high prevalence of concomitant infections.

Tetanus immunization in pregnant women. Serum levels of antitetanus antibodies at time of delivery.

The objective of this study was to determine the tetanus immunity status of pregnant women at the time of delivery according to tetanus toxoid (TT) vaccination coverage during their most pregnancy. The serum anti-tetanus antibody levels of 493 mothers who had live births at a hospital in Ankara were determined by enzyme-linked immunosorbent assay (ELISA). Protected women were defined as those with serum antibody levels > or = 0.6 IU/ml. Overall, 69.0% of mothers had protective tetanus antibody titers at the time of delivery. The rates of protection for mothers who had received no vaccination, one TT dose, or two TT doses during pregnancy were 46.4, 93.5, and 95.6%, respectively. Vaccinating every pregnant woman with at least one dose of TT would be an affordable and effective way to protect against neonatal tetanus, and would be a step toward eliminating the deaths that continue to occur due to this preventable disease in Turkey.