Occurence and genotype distributionof Cryptosporidium spp.,and Giardia duodenalis in sheep in Siirt, Turkey.

Cryptosporidium spp., and Giardia duodenalis are intestinal protozoan parasites known to infect humans and various animals and cause diarrhea. This study aimed at determining the prevalence and genotype of Cryptosporidium spp. and Giardia duodenalis in sheep in different locations of Siirt province. The fecal material for this study was collected from 500 sheep in different locations of Siirt province, Turkey. Fecal samples obtained from sheep were examined for Cryptosporidium spp. by Kinyoun Acid Fast staining and the Nested PCR method. Microscopic and Nested PCR methods revealed a prevalence of 2.4% (12/500) and 3.6% (18/500), respectively. Sequence analysis revealed the presence of C. ryanae, C. andersoni, and zoonotic C. parvum. In terms of Giardia duodenalis, 8.4% (42/500) and 10.2% (51/500) prevalence was determined using Nativ-Lugol and Nested PCR methods, respectively. Using sequence analysis, zoonotic assemblages A and B as well as assemblages E and D were detected. As a result of this study, both the prevalence of Cryptosporidium spp. and Giardia duodenalis and the presence of species that appear to be host-specific, as well as those known to be zoonotic, were revealed. A large-scale study is needed to understand the impact of these agents on sheep farming and their consequences on human health.

EMPTY SELLA IN A PATIENT WITH CLINICAL AND BIOCHEMICAL DIAGNOSIS OF ACROMEGALY.

Background: Acromegaly is an acquired disorder related to excessive production of growth hormone (GH) and insulin-like growth factor-1 (IGF-1). Empty sella (ES) is an anatomical condition of sella turcica that is partially or completely filled with cerebrospinal fluid mainly due to intrasellar herniation of subarachnoid space. Here, we describe a patient who presented with clinical and biochemical features of acromegaly and who had an ES on pituitary magnetic resonance imaging (MRI). Case report: A 73-year-old male patient was consulted in our clinic because of the acromegalic phenotype while planning for colorectal adenocarcinoma surgery. The patient noticed gradual enlarging of his hands, feet and nose for 30 years, but never consulted to any clinician for this reason. Serum GH was 20.6 ng/mL (normal <3 ng/mL) and IGF-1 was 531 ng/mL (normal, 69-200 ng/ml). An oral glucose tolerance test showed no suppression of GH values. T1-weighted MRI revealed an ES. 18F-FDG PET/CT and Ga-DOTATADE PET/CT did not show any finding consistent with ectopic GH secretion. Growth hormone releasing hormone (GHRH) was within the normal range (<100mg/dL). He was treated with long-acting octreotide 20 mg per 28 days. At the 6th month of treatment, serum GH and IGF-1 levels were decreased to 5.45 ng/mL and 274 ng/mL, respectively. Conclusion: The mechanism underlying the association of acromegaly and ES remains unclear. Apoplexy on existing pituitary adenoma and then formation of necrosis can proceed to ES. Since our patient did not have a history of pituitary apoplexy and we could not find any reason for secondary ES, we considered primary ES.

Co-existence of familial Mediterranean fever and multiple sclerosis in two patients.

ABSTRACT Two female patients, aged 23 and 25 years-old diagnosed with Familial Mediterranean fever (FMF) were presented with ataxia and headache. Multiple sclerosis plaques were detected in their spinal and cranial MRI and diagnosis of multiple sclerosis was established. Genetic analysis demonstrated M694 V mutation (one homozygous and the other heterozygous) in both of the patients. Although it is quite rare, coexistence of familial Mediterranean fever and multiple sclerosis should be kept in the mind.

Diffusion tensor magnetic resonance imaging in patients with multiple sclerosis and its relationship with disability.

Multiple sclerosis is a chronic inflammatory demyelinating disease of the central nervous system. Diffusion tensor magnetic resonance imaging (DTI) can yield important information on the in vivo pathological processes affecting water diffusion. The aim of this study was to quantitatively define water diffusion in normal-appearing white matter (NAWM) distant from the plaque, in the plaque, and around the plaque, and to investigate the correlation of these changes with clinical disability. Conventional MRI and DTI scans were conducted in 30 patients with MS and 15 healthy individuals. Fractional anisotropy maps and visible diffusion coefficients were created and integrated with T2-weighted images. Regions of interest (ROIs) were placed on the plaques on the same side, white matter around the plaques and NAWM on the opposite side. Only the white matter of healthy individuals in the control group, and FA and ADC values were obtained for comparison. The highest FA and lowest ADC were detected in the control group at the periventricular region, cerebellar peduncle and at all ROIs irrespective of location. There was a significant difference in comparison to the control group at all ROIs in patients with MS (p < 0.001 for all comparisons). No significant correlation between diffusion parameters and expanded disability state scale (EDSS) scores was found in patients with MS. DTI may provide more accurate information on the damage due to the illness, compared to T2A sequences, but this damage may not be correlated with the clinical disability measured by EDSS score.

Comparison of double inversion recovery and conventional magnetic resonance brain imaging in patients with multiple sclerosis and relations with disease disability.

Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system, predominantly affecting the white matter, but also the grey matter. Aim of this study was to detect MS lesions with double inversion recovery (DIR), fluid-attenuated inversion recovery (FLAIR) and T2-weighted magnetic resonance (MR) techniques and determine the sensitivity of these techniques, and the correlation between the number of lesions and expanded disability state scale (EDSS) scores. Thirty-four patients with MS (20 females and 14 males) were included in this study. DIR and conventional MR (T2-A, FLAIR) sequences were obtained. Lesions were counted and classified as belonging to one of seven anatomical regions: cortical, juxtacortical, deep grey matter, deep white matter, mixed white matter-grey matter, periventricular white matter and infratentorial. The correlation between lesion number and EDSS scores was investigated. DIR images showed more intracortical and mixed white matter-grey matter lesions in comparison with both FLAIR and T2 sequences (p=0, p=0 respectively). There was a significant difference between mean lesion numbers at the juxtacortical region, obtained with DIR and T2-weighted images (p = 0.002). The total number of lesions obtained with all methods was similar. DIR brain imaging had the highest sensitivity in the detection of cortical and mixed white matter - grey matter lesions, compared with FLAIR and T2 sequences. In addition, the lesions obtained with DIR images were more easily visualized.

Diffusion abnormality of corpus callosum in Alzheimer's disease.

This study investigated diffusion abnormalities in the parts of corpus callosum (CC) of patients with Alzheimer's disease (AD) using diffusion tensor magnetic resonance imaging (DT-MRI). Twenty-one patients with AD and 20 healthy volunteers participated in the study. MRI was performed with a 1.5 T system. Conventional MR images and diffusion tensor images were obtained for all participants. We divided the CC into three parts as rostrum, body and splenium. The apparent diffusion coefficiency (ADC) and fractional anisotropy (FA) were measured in all parts. FA values for the CC were lower in AD patients than the values of controls. In AD patients the lowest values were found in the rostrum of the CC and CC body FA values were also lower than the splenium, but the difference did not reach statistical significance. DT-MRI is a promising technique to investigate microstructural changes in white matter regions in AD. Early detection of the disease has been increasingly studied in AD. Further studies with larger populations are needed to confirm the role of diffusion tensor imaging in the evaluation of memory impairment.

Secondary corpus callosum abnormalities associated with antiepileptic drugs in temporal lobe epilepsy. A diffusion tensor imaging study.

Epilepsy is more than a grey-matter disorder affecting large white matter connections of the brain with seizure generation and propagation. The mechanism for such changes remains unclear. The purpose of this study was to investigate the microstructural changes in the corpus callosum in temporal lobe epilepsy (TLE) patients and whether these abnormalities are related to antiepileptic drug (AED) therapy. Ten TLE patients receiving AED therapy, ten TLE patients with no therapy and ten controls were included in the study. The regions of interest in the corpus callosum were outlined to each Witelson region (WR). Fractional anisotrophy (FA), apparent diffusion coefficient (ADC), three main diffusivity values (λ1, λ2, λ3) and tractography were acquired from each WR. DTI indices of these tracts and each WR were compared between the three subject groups and correlates examined with clinical variables that included duration of epilepsy, gender, AED type and AED therapy exposure. In TLE subjects with receiving AED therapy significantly (p<0.05) decreased FA and increased ADC values of corpus callosum were obtained when compared to the other groups. There was no significant relationship between AED type and DTI indices. Analysis of eigen values in the splenium of corpus callosum (WR7) showed λ1 values were significantly decreased in relation to AED medication duration (p<0.05). FA values of rostrum and corpus showed a reduction with duration of epilepsy. TLE is associated with abnormal integrity of corpus callosum white matter tracts. AED therapy may cause additional damage on secondary degeneration and medication time effects especially on the splenium of corpus callosum.