Prevalence and predictive features of metabolic dysfunction-associated steatotic liver disease in type 1 diabetes.

AIMS/HYPOTHESIS: The prevalence and severity of metabolic dysfunction-associated steatotic liver disease (MASLD) in type 1 diabetes remain unclear. Therefore, we investigated the prevalence and severity of MASLD in type 1 diabetes and assessed which clinical features are most important in predicting MASLD severity. METHODS: A total of 453 individuals with type 1 diabetes (41.6 ± 15.0 years, 64% female, body mass index [BMI] 25.4 ± 4.2 kg/m2, and HbA1c 55.6 ± 12 mmol/mol) underwent vibration-controlled transient elastography (VCTE), with a controlled attenuation parameter (CAP) score for steatosis (≥280.0 dB/m) and a liver stiffness measurement (LMS) for fibrosis (≥8.0 kPa). A machine learning Extra-Trees classification model was performed to assess the predictive power of the clinical features associated with type 1 diabetes with respect to steatosis and fibrosis. RESULTS: The prevalence of hepatic steatosis and fibrosis was 9.5% (95% CI, 6.8-12.2) and 3.5% (95% CI, 1.8-5.2). Higher LMS was associated with a longer duration of type 1 diabetes (median 30.5 [IQR 18.0-39.3] years vs 15.0 [IQR 6.0-27.0] years), and individuals were older, had a higher BMI (mean 27.8 ± 5.2 vs 25.3 ± 4.1 kg/m2), and a higher CAP score (mean 211.4 ± 51.7 dB/m vs 241.4 ± 75.6 dB/m). The most important predictive features of fibrosis were duration of type 1 diabetes, age, and systolic blood pressure, with a mean ± SD area under the curve of 0.73 ± 0.03. CONCLUSION: Individuals with type 1 diabetes and high blood pressure, older age, higher BMI, and longer duration of disease could be considered at high-risk for developing MASLD.

Evaluation of visceral adipose tissue thickness in precocious puberty.

OBJECTIVE: Although there is a relationship between earlier onset of puberty and increased adiposity tissue. Publications in the literature on adiposis in patients with central precocious puberty (CPP) and visceral fat thickness (VFT) have conflicting results. So, in this study, we aimed to evaluate the relationship between sexual maturation and obesity in the development of early puberty and to examine their relationship with pelvic sonographic parameters. PATIENTS AND METHODS: A total of 126 girls [patients - premature thelarche (PT) and CPP - and controls] were included in this study. Anthropometric and ultrasonographic evaluations were made by the same pediatric endocrinologist and pediatric radiologist, respectively. Pubertal stages were made according to the Tanner stages. Height, weight, and body mass index were measured as anthropometric measurements, and visceral, subcutaneous, and transabdominal fat thicknesses were measured in sonographic evaluation. RESULTS: The study population was divided into three groups: 44 healthy subjects to Group 1, 23 patients with PT to Group 2, and 59 patients with CPP to Group 3. When we evaluated the anthropometric and ultrasonographic parameters according to pubertal status, significant differences, especially between Group 1 and Group 3, were observed in all data. In the multiple logistic regression analysis, the endometrial thickness (OR = 7.521, p < 0.001) and VFT (OR = 1.530, p < 0.001) were found to be independent predictors of precocious puberty. CONCLUSIONS: It has been found that VFT and endometrial thickness measurements, which are evaluated quickly and accurately by USG, are important predictors of prepubertal precociousness.

Evaluation of the effects of Ankaferd haemostat application on bone regeneration in rats with calvarial defects: histochemical, immunohistochemical and scintigraphic study.

BACKGROUND: Bone wax, a haemostatic agent, is widely used in craniospinal surgical procedures for a long time, in spite of controversial results regarding its negative influence upon bone regeneration. In this experimental study, the effects of Ankaferd Blood Stopper (ABS), as an alternative haemostatic agent, were evaluated through histochemical, immunohistochemical and scintigraphic studies. MATERIALS AND METHODS: The total of 30 adult female Wistar albino rats was randomly divided into three groups: intact control group (n = 10), bone wax group (n = 10), and ABS group (n = 10). Surgically, a 3.0 mm hole in diameter was drilled on the right side of calvarium of the rats using a Class Mini Grinder set in all three groups, as described previously. At the end of 8 weeks, bone healing and connective tissue alterations surrounding drilled calvarial defect areas of the rats were determined via haematoxylin and eosin and the Mallory's trichrome staining and anti-bone sialoprotein immunohistochemistry. Image Pro Express 4.5 programme was used for histomorphometric calculation of new bone and fibrotic tissue areas. All statistical analyses were made with SPSS 25.0 and analysis of variance (one-way ANOVA) followed by Bonferroni post hoc test was performed, p < 0.001 was considered as significance level. RESULTS: Histomorphometrically, it was found that he had the largest hole diameter and the least fibrotic scar area in the bone-wax group. In the bone wax group, it was observed that the material closed the hole and there was only a fibrotic scar tissue in the area between the bone tissue at the edge of the hole and bone wax, and a fibrotic tissue was formed in the bone wax area. During the histological procedure, this bone-wax material was poured and the sections were seen as a gap in this area. In the ABS haemostat group, the smallest hole diameter and the least fibrotic scar tissue were observed. Fibrotic scar tissue close to each other was found in the ABS haemostat and bone wax groups. Histological analysis of samples also showed a statistical significance for fibrotic connective tissue area between groups (p < 0.05). Scintigraphically, osteoblastic activity related to blood flow in the animal taken from the group with application of ABS haemostat was more pronounced compared to the other two groups. CONCLUSIONS: In our study, it has been concluded that the ABS yields affirmative effects on the bone healing, while bone wax leads to negative impact on the bone regeneration. Scintigraphic, histochemical and immunohistochemical data support the affirmative impact of the ABS haemostat application upon the bone regeneration apart from the quick stop of haemorrhage.

Effect of the Fascia Graft Size on Healing Rate of Cavities in Patients Undergoing CWD Tympanomastoidectomy: A Clinical Prospective Study.

OBJECTIVES: To evaluate the effects of size of temporal fascia graft on healing of the mastoid cavity in patients undergoing canal wall down (CWD) procedures. MATERIALS AND METHODS: The study included 32 patients (ages from 10 to 69 years) who were performed CWD tympanomastoidectomy from 2016 to 2018. Patients were divided into 2 different groups randomly based on size of fascia used in the operations. Group 1 consisted of 19 patients with temporal muscle fascia large enough to extend up to antrum by passing through over the facial ridge. Group 2 consisted of 13 patients with fascia of a size hardly enough to create a middle ear space, which were quite smaller than those the first group. It was also observed that whether or not the type of pathology (cholesteatoma, granulation tissue or both) had an effect to the epithelialization time of the cavity. RESULTS: Thirty-two patients met inclusion criteria. Nineteen patients were randomized to study (large fascia) group and 13 patients were to control (small fascia) group. The mean duration for epithelialization of cavities with study group-large grafts was 34.10 days and that was 39.76 days in control group-small grafts. According to type of pathology; in cases with cholesteatoma, with granulation, and cases of coexisting granulation with cholestatoma; the mean epithelialization times were 38.73, 31.33 and 34.42 days, with respectively. CONCLUSION: Placement of larger fascia graft to line the mastoidectomy cavity facilitate rapid epithelialization and healing in patients undergoing CWD tympanomastoidectomy. Further studies with larger groups would be beneficial to confirm this result in the aspect of statistical significance.

Histopathological Effects of Bone Cement on Cartilage Tissue.

INTRODUCTION: Glass ionomer bone cement is frequently applied with cartilage grafts in otology, even as a single unit. OBJECTIVE: This experimental study was performed to investigate the histopathological effects of bone cement on cartilage tissue. METHODS: The study was conducted between January 2018 and April 2018 and used 12 New Zealand White rabbits. The right ears of the rabbits constituted the study group, while the left ears were the controls. Ketac Cem Radiopaque (3 M Germany) was used as glass ionomer cement. Tissue samples from the rabbits were subjected to histopathological analysis to compare acute and chronic inflammation, foreign body reaction, angiogenesis, collagenesis, fibrosis, necrosis, cartilage fracture, osseous metaplasia, and loss of chondrocyte nuclei between the groups. RESULTS: The rates of cartilage fracture (P = 0.044), foreign body reaction (P < 0.001), acute inflammation (P = 0.009), chronic inflammation (P = 0.002), and angiogenesis (P = 0.003) were significantly higher in the study group compared with the controls. The study group showed some degree of necrosis; no necrosis was observed in the control group, but the difference was not statistically significant (P = 0.101). There were no significant differences in fibrosis, collagenesis, osseous metaplasia, or loss of chondrocyte nuclei between the groups. CONCLUSIONS: This study showed that application of bone cement can cause acute and chronic inflammation, foreign body reactions, angiogenesis, and cartilage fractures. Further studies are needed to determine the long-term effects of bone cement on cartilage.

Effect of Septoplasty on Cardiopulmonary Functions in the Patients With Nasal Obstruction.

OBJECTIVE: In this study, the authors aimed to investigate whether septoplasty has an effect on cardiopulmonary functions in the patients with nasal obstruction. METHODS: A total of 53 patients with nasal obstruction due to septum deviation were included in the study. All the patients were performed septoplasty operation. Echocardiography and spirometric analysis were performed to assess cardiopulmonary functions before and after the operation (6 months postoperatively). The same evaluation was done for the degree of nasal obstruction by visual analogue scale. The preoperative and postoperative values were compared with each other. RESULTS: Of the total 53 patients, 44 were males (83%) and 9 were female (17%). The mean age was 31.71 ±â€Š9.46. The preoperative and postoperative mean right ventricular volumes were 2.0736 and 2.0906, respectively. The preoperative and postoperative mean left ventricular volumes were 4.4264 and 4.3528, respectively. The preoperative and postoperative mean cardiac septal thicknesses were 0.9642 and 0.9358, respectively. The mean value of preoperative cardiac posterior wall thicknesses was 0.8849, whereas the postoperative value was measured as 0.8340. The preoperative and postoperative mean pulmonary artery pressures were 27.8302 mmHg and 23.6415, respectively, and this was statistically significant (P < 0.001). The preoperative and postoperative mean forced vital capacities (FVC) were 4.3221 and 4.5564, respectively, and this was statistically significant (P < 0.001). The preoperative and postoperative mean 1st second forced expiratory volumes (FEV1) were 3.6698 and 3.8085, respectively, and this was statistically significant (P < 0.001). The mean value of preoperative FEV1/FVC was 84.9811, whereas postoperative mean value was measured as 83.8019 and this was statistically significant (P < 0.001). CONCLUSION: In this study, the authors observed that septoplasty has positive effect on cardiopulmonary functions in the patients with nasal obstruction due to nasal septum deviation. The authors also claim that septoplasty may be a preventive procedure for future pathologies of cardiopulmonary functions.

Can Mean Platelet Volume Be a Surrogate Marker of Inflammation in Rheumatic Diseases?

BACKGROUND: In humans, it has been suggested that low-level mean platelet volume (MPV) may be related to secondary thrombosis due to inflammation. For this reason, MPV can be used as a marker showing inflammation in the body. OBJECTIVES: To evaluate the association of MPV with erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Disease Activity Score-28 (DAS-28), and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in patients with rheumatic diseases. METHODS: The study consisted of 261 patients with rheumatoid arthritis (203 females, 77.8%; 58 males, 22.2%), 85 patients with ankylosing spondylitis (57 males, 67.1%; 28 females, 32.9%), 56 patients with familial Mediterranean fever (32 females, 57.1%; 24 males, 42.9%) and 194 patients (139 females, 71.6%; 55 males, 28.4%) with other rheumatic diseases (Behçet's disease, psoriatic arthritis, spondyloarthropathy, systemic lupus erythematosus, systemic sclerosis, or undifferentiated connective tissue disease). RESULTS: There was an inversely significant correlation between MPV and ESR and CRP in patients with rheumatoid arthritis (r = -0.164, p = 0.008). Mean platelet volume was negatively correlated with DAS-28-ESR/CRP (r = -0.393, p < 0.001) in rheumatoid arthritis. Mean platelet volume was inversely correlated with BASDAI (r = -0.580, p < 0.001) in ankylosing spondylitis. In the group with familial Mediterranean fever (especially M694V homozygous), there was a negative correlation between MPV and ESR and CRP (p < 0.001). Mean platelet volume and CRP were negatively correlated in psoriatic arthritis (r = -0.599, p = 0.011). Mean platelet volume and ESR were inversely related in patients with systemic lupus erythematosus (r = -0.421, p = 0.045). There was a negative correlation between MPV and ESR (r = -0.219, p = 0.002), and between MPV and CRP (r = -0.208, p = 0.004) in other rheumatic diseases. CONCLUSIONS: The lower MPV level surrogates active and/or chronic inflammatory state in the body. Thus, MPV may be used as a negative acute-phase reactant in rheumatic diseases.

Pectoralis major myofascial flap in salvage laryngectomy.

OBJECTIVE: The main purpose of this study was to evaluate the effect of the pectoralis major myofascial flap on pharyngocutaneous fistula formation and time to oral feeding. METHODS: This retrospective study reviewed 155 total laryngectomies. Patients were divided into two main groups. Group 1 included 110 patients who were treated primarily by total laryngectomy and group 2 comprised 45 patients who were treated by salvage laryngectomy with or without a pectoralis major myofascial flap. RESULTS: The use of a pectoralis major myofascial flap did not have a significant effect on pharyngocutaneous fistula formation in the salvage group (p = 0.376). When comparing the oral feeding day of patients with pharyngocutaneous fistula, a significant difference was observed between the salvage group with pectoralis major myofascial flap reinforcement and the salvage group without pectoralis major myofascial flap reinforcement (p = 0.004). DISCUSSION: Our study demonstrated that pectoralis major myofascial flap reinforcement did not decrease the rate of pharyngocutaneous fistula formation. Instead, it prevented the formation of large fistulas that would require surgical management, and showed a similar time to oral feeding and length of hospital stay to primary laryngectomy.

Respiratory epithelial adenomatoid hamartoma (REAH) of the nasopharynx with high 18F-FDG uptake on PET/CT.

Respiratory epithelial adenomatoid hamartoma (REAH) is a rare benign non-neoplastic sinonasal lesion that usually presents in the nasal cavity, paranasal sinuses, or olfactory cleft. We report a case of nasopharynx REAH mimicking a malignant tumour with incidental high 18-FDG uptake in a patient with colon cancer. Less than five similar cases have been reported to date, and this is the first case of REAH to show high uptake on PET/CT scans. Although hamartoma arising from the nasopharynx region is very rare, it should be considered in the differential diagnosis because it is a benign lesion and complete surgical resection is curative.

Determination and clinical correlation of markers of inflammation in unvaccinated patients with varicella-zoster infection.

BACKGROUND: Chicken pox is commonly known as a benign exenthamatous disease of childhood, occasionally neurologic or hemorrhagic complications, or even death may ensue. Early predictors of severity of disease have yet to be identified. TNF-alpha and IL-6 stimulate virus-specific immunoglobulin production and it has been postulated that determination of levels of these cytokines may be useful as a prognostic factor. PATIENTS AND METHODS: Patients who were diagnosed with a varicella-zoster virus (VZV) infection in the Outpatient Clinic of the Department of Pediatric Infectious Diseases were evaluated for eligibility. Laboratory assays included an evaluation of complete blood counts, erythrocyte-sedimentation rate (ESR), c reactive protein (CRP), and the number of tumor necrosis factor-alpha/interleukin-6-(TNF-alpha/IL-6-) producing mononuclear cells as determined by flow cytometry. RESULTS: A total of 339 patients (320 with chickenpox and 19 with shingles) were enrolled. Blood samples could only be obtained from 81 of the 320 patients with chickenpox. Patients were also divided into three groups depending on the number of skin (vesicular) lesions. (group 1, ≤ 50 lesions; group 2, 51-100 lesions; group 3, >100 lesions). Correlation analyses did not reveal the presence of a statistically significant correlation between number of skin lesions with either of white blood cells (WBC) count (p = 0.231), ESR (p = 0.879) or CRP (p = 0.373). The mean percentage of TNF-alpha-producing mononuclear cells was significantly higher in group 2 compared to group 3 (p = 0.003). A similar difference was observed with regard to IL-6-producing mononuclear cells, albeit bordering on statistical significance (p = 0.058). CONCLUSIONS: Decreased expression of the cytokines TNF-alpha and IL-6 may be responsible for the development of a more severe clinical picture in patients with VZV infection, and determination of intracellular levels of these cytokines may be of benefit for early identification of patients who may have a more severe clinical course.

Effects of diosmine-hesperidine on experimental colonic anastomosis.

AIM: Our goal was to determine the effects of a diosmine-hesperidine combination on wound healing in a rat model of colonic anastomosis. MATERIALS AND METHODS: In this study, 20 Wistar Albino female rats were randomized into four experimental groups containing five rats in each group. A segment of 1 cm of colon was excised 4 cm proximally to the peritoneal reflection in all rats without carrying out any mechanical or antibacterial bowel preparation. Colonic anastomosis was performed with interrupted, inverting sutures of 6/0 polypropylene. Beginning from the first postoperative day, the rats in Groups II and IV received 100 mg/kg per day of diosmine-hesperidine via orogastic route by 4F fine feeding catheter. RESULTS: A significant difference was detected between groups in terms of their hydroxyproline levels (p<0.05); the hydroxyproline level of Group I was significantly lower than that of the other groups while no significant difference was noted between Groups II and III. CONCLUSION: The administration of diosmine-hesperidine increased the amount of collagen and bursting pressures at the anastomotic site and thus had favorable influences on the healing of colonic anastomosis (Tab. 1, Fig. 3, Ref. 33).

Localized acute generalized exanthematous pustulosis with amoxicillin and clavulanic acid.

Acute generalized exanthematous pustulosis (AGEP) is a rare skin disorder, characterized by acute development of numerous, pin-head sized, nonfollicular pustules on erythematous skin, with high fever and neutrophilia. The condition is frequently caused by hypersensitivity reaction to drugs or viral infections. Diagnosis is established according to clinical and histological criteria. Herein, we report a 17-year-old girl with localized AGEP related to the use of amoxicillin-clavulanate.

The role of cervical thymectomy in surgical treatment of secondary hyperparathyroidism.

OBJECTIVE: Parathyroid glands are frequently found in the thymus. We aimed to investigate the frequency of inferior parathyroid glands, and supernumerary glands located in the thymus in our series of renal hyperparathyroidism. METHODS: From January 2004 to September 2008, subtotal parathyroidectomy and cervical thymectomy was performed in 25 consecutive patients. Of these 25 patients, reoperation was carried out for one patient with persistent hyperparathyroidism and one patient with recurrent hyperparathyroidism. Operative details and pathology results were prospectively collected and reviewed. RESULTS: In 13 of 25 (52%) patients, at least one parathyroid gland was found in the thymus. In 7 (28 %) patients, at least one inferior gland was located in the thymus. In 7 patients (28%), supernumerary glands were found in the thymic tongue. One patient had both inferior and supernumerary glands in the thymus. In 8 patients (32%), 10 supernumerary glands were detected. The frequency of rudimentary and proper supernumerary glands were 5 (50%) and 5 (50%), respectively. Seven (3 proper and 4 rudimentary) of 10 supernumerary glands (70%) glands were located in the thymus. CONCLUSIONS: Thymectomy contributed to the treatment of 52% of patients. We conclude that to minimize the risk for missing parathyroid glands, thymectomy should be considered as a routine part of total parathyroidectomy with autotransplantation and subtotal parathyroidectomy in addition to careful cervical exploration for secondary hyperparathyroidism (Tab. 1, Ref. 27).

Risks and outcome of fungal infection in neutropenic children with hematologic diseases.

In this retrospective study, we report the results of antifungal treatments (AFTs) in febrile neutropenic episodes in patients with acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML) and aplastic anemia (AA) in our center. From January 2004 to December 2005, a total of 52 patients and 221 febrile neutropenic episodes were evaluated. AFT was started in 96 (43%) of the 221 episodes. Amphotericin B and fluconazole were used in 44 (46%) and 52 (54%) febrile neutropenic episodes, respectively. Microbiologically or histopathologically evident fungal infections were detected in 35 of 96 febrile neutropenic episodes. The mortality rate due to fungal infection was higher in patients with AA (7/8 patients) and AML (7/12 patients) than in ALL patients (1/32). Mortality for the whole group was 28%. When the mortality rate was compared between the two treatment groups (amphotericin B vs fluconazole), mortality was significantly higher in patients receiving amphotericin B [n = 14 (93%) and n = 1 (7%), respectively].

Pediatric pleural effusions: etiological evaluation in 492 patients over 29 years.

Pediatric pleural effusions present a changing profile over time, both in terms of etiological subgroups and causative microorganisms in parapneumonic effusions. This retrospective study aimed to review pediatric pleural effusions in a large cohort over a 29-year period, with special emphasis on the etiological subgroups and microbiological causes of parapneumonic effusions. The medical records of 492 pediatric patients were reviewed for a comparison of subgroups of pleural effusions and microbiological causes of parapneumonic effusions between three decades. Parapneumonic effusions (381 patients) made up 77.4% of the group. Tuberculous pleurisy decreased, but malignant effusions doubled in number over time. A causative microorganism was identified in 34.6% overall, with Staphylococcus aureus and Streptococcus pneumoniae being the two most common. Relative frequency of S. aureus decreased, whereas pneumococci and Haemophilus influenzae were more frequent in recent years.

Animal carcass and eyelid anthrax: a case report.

Anthrax is a worldwide zoonosis of herbivores, which is caused by the spore-forming bacteria Bacillus anthracis, and humans become infected when they are exposed to infected animals and their tissues or the organism directly. In this report, we present a 13-year-old boy who developed eyelid anthrax after contact with a sheep carcass during his summer holiday that resulted in eyelid anthrax and cicatricial ectropion.

Preseptal and orbital cellulitis: 15-year experience with sulbactam ampicillin treatment.

The infection of the orbita and ocular tissues can result in severe local and systemic complications. We aimed to determine the predisposing factors for preseptal and orbital cellulitis, the clinical and routine laboratory differences between orbital and preseptal cellulitis, and the change in the spectrum of the pathogens and the antibiotics used in the last 10 years. One hundred thirty-nine patients, hospitalized in Hacettepe University Faculty of Medicine Children's Hospital between 1 January 1990 and 31 December 2003 with diagnosis ofperiorbital or orbital cellulitis, were reviewed retrospectively. Ten of the patients (7%) had orbital and 129 (93%) had preseptal cellulitis. The male/female ratio was 1.7:1. The average age (mean+/-standard deviation) was 5.7+/-4 years. The seasonal distribution was most marked in spring and fall periods. When compared with preseptal cellulitis, the mean blood cell count, erythrocyte sedimentation rate and C-reactive protein levels were significantly higher in patients with orbital cellulitis. Staphylococcus aureus was isolated in 13 (41.9% of total microbiologically confirmed cases), coagulase-negative staphylococcus in 8 (25.8%), and H. influenza type b in 2 patients (6%). Thirty out of 77 clinical sample cultures (39%) were positive. In clinical studies, etiological agents of orbital and preseptal cellulitis could be identified in only 20-30% of cases, so in clinical practice treatment is usually empiric. We observed that sulbactam-ampicillin was a safe and effective choice of treatment in orbital and preseptal cellulitis in our cases.

Cytomegalovirus hepatitis and ganciclovir treatment in immunocompetent children.

Ganciclovir treatment in children with cytomegalovirus (CMV) infection is still controversial and only indicated in selected cases. The aim of thi study was to evaluate clinical and demographic features of CMV hepatitis in immunocompetent children and to determine the effect of ganciclovir treatment in these patients retrospectively. The study was carried out in a group o 29 children with CMV hepatitis. All the patients were investigated for signs of infection, inborn errors of metabolism, genetic diseases, extrahepatic biliary atresia and other causes of hepatitis. Two patients with congenital CMV infection and two patients with biliary atresia were excluded from the study group. The patients included in the study were divided into two groups: non-cholestatic hepatitis (n=16) as Group I and cholestatic hepatitis (n=9) as Group II. Four (25%) patients in the non-cholestatic group and four (44.4 in the cholestatic group were treated with ganciclovir for a median of 21 days. The mean age was 9.6+/- 10.9 months (median age 6 months) in Group I, while cholestatic hepatitis patients in Group II were significantly younger, with a mean age of 2.7+/-0.9 months (p<0.01). The most prominent symptoms at admission were diarrhea and vomiting (25%) in Group I. In Group I, all cases (100%) and in Group II, three of four cases (75%) treated with ganciclovir had recovery from acute CMV hepatitis. In the non-cholestatic group, no relapses were observed while one patient in the cholestatic group relapsed and progressed into chronic liver disease. Patients who received supportive treatment showed a marked decrease in GGT, ALT, AST and bilirubin levels spontaneously and no relapses of hepatitis were observed in at least one year of follow-up. Although ganciclovir therapy is not indicated particularly in immunocompetent cases, since most were self-limited infections, in case of progressive and persistent hepatitis, such as in our cases, ganciclovir was a treatment option; no side effect due to ganciclovir therapy was observed in our cases. Although ganciclovir seems to be effective in progressive CMV hepatitis, multicenter randomized studies in a large study group are necessar to determine the efficacy and indications for ganciclovir treatment.

Piperacillin/tazobactam plus amikacin versus carbapenem monotherapy as empirical treatment of febrile neutropenia in childhood hematological malignancies.

A prospective, randomized clinical trial was conducted to compare the efficacy of piperacillin/tazobactam and amikacin combination with carbapenem monotherapy for the empirical treatment of febrile neutropenic episodes of children with acute lymphoblastic leukemia or acute myeloblastic leukemia. Patients aged 2-16 years with hematological malignancies who had febrile neutropenia were randomly assigned to receive piperacillin/tazobactam (80 mg/kg piperacillin/10 mg/kg tazobactam, q6h) combined with amikacin (PTA) (7.5 mg/kg, q12h) or meropenem or imipenem (20 mg/kg, q8h) (C). Response to antimicrobial therapy, evaluated for etiological agents, was measured. Duration of fever, neutropenia, and hospitalization, mortality, and the need for additional antibiotics or antifungal drugs were compared for the treatment success between the two groups. Out of 87 febrile neutropenic episodes that were evaluable for comparison, 46 patients received PTA and 41 patients were treated with carbapenems (imipenem or meropenem). Overall, the microbiologically documented infection rate was 21.9%, with Staphylococcus epidermidis as the most common cause of bacteremia. The rate of treatment modification was 56.5% in the PTA group and 53.6% in the carbapenem group with no statistical difference (p > .05). There was no infection-related mortality during the study period. There was no difference between the two regimens for durations of fever, neutropenia, and hospitalization (p > .05 for all categories). PTA was as effective as carbapenem monotherapy as an initial empirical regimen in febrile neutropenic episodes of pediatric hematological malignancies.

[Investigation of Listeria monocytogenes serotype O antibodies in maternal and cord sera and the evaluation of risk factors for listeriosis in pregnant women]. / Anne ve kordon serumlarinda Listeria monocytogenes serotip O antikorlarinin arastirilmasi ve gebelerde listeriyoz risk faktörlerinin degerlendirilmesi.

Listeria monocytogenes may lead to intrauterine infections which can be treated if diagnosed promptly. However, there is not a rapid routine screening test with high specificity and sensitivity for the diagnosis of listeriosis during pregnancy. We investigated the presence of different L. monocytogenes O antibodies for diagnosis of listeriosis in 275 paired maternal-cord sera using the agglutination test, and aimed to evaluate the correlation between poor pregnancy outcomes, level of L. monocytogenes serotype O antibodies and risk factors for listeriosis. Maternal-cord bloods were collected from a total of 275 pregnant women (age range 16-38 years) between April-August 2002 from a State Hospital in Ankara. A total of 550 sera were tested against antigens with the O formulation of serotypes 1/2c, 3b, 4ab, 4c, 4d by tube agglutination method and titers > or = 1/320 were considered as positive. Sixtynine patients with the history of poor pregnancy outcomes were in group I, while 206 patients with no obstetric pathology in previous pregnancies were in group II. L. monocytogenes antibodies to one or more serotypes were detected in 21.5% (59/275) of the patients, the rate being 20.3% in group I and 21.8% in group II. No statistically significant difference was detected between the two study groups (p > 0.05), indicating that this test was not an appropriate marker for the diagnosis of listeriosis during pregnancy. The total rate of positive results in cord sera was 0.7% (2/275) and the positive two sera were from samples in group II. The follow-up of the newborns, including the two cord blood positive ones, revealed no fetomaternal infection. The most frequently detected serotypes were 4ab (40%) and 1/2c (37%). Risk factors such as non-specific febrile illness during pregnancy (p < 0.001), consumption of ready-made food (p = 0.008), consumption of raw milk and milk products (p < 0.001) were found to be related to the presence of > or = 1/320 titers of L. monocytogenes antibodies. The major limiting factor in this study was the inability to obtain second serum samples from the mothers and newborns following delivery, to confirm the diagnosis by seroconversion. These results emphasize the need for the development of rapid, simple and reliable tests, alternative to culture methods, for the early and proper diagnosis of Listeria infections during pregnancy.