Is bronchial provocation test positivity associated with blood eosinophil count and cut-off value?

OBJECTIVE: Asthma is characterized by airway hyperresponsiveness due to chronic inflammation in the airways. One of the main cells involved in airway inflammation is eosinophils. In the current study, a bronchial provocation test (BPT) was performed to demonstrate airway hyperresponsiveness. We investigated the relationship between BPT and blood eosinophil count and the cut-off value of blood eosinophil count. PATIENTS AND METHODS: In this study, we retrospectively evaluated the data of 246 patients who visited our immunology and allergy clinic, a tertiary reference center, with asthma symptoms between May 2017 and March 2020 and underwent BPT with methacholine for the diagnosis of asthma. The cases were grouped according to the level of BPT positivity and negativity. RESULTS: Of 246 patients, BPT was positive in 90 (36.6%) and negative in 156 (63.4%). The blood eosinophil measurement of the BPT-positive cases was found to be statistically significantly higher than that of the BPT-negative cases (135 vs. 119 cells/µl, respectively, p=0.029). When BPT is grouped according to positivity levels, there was no statistically significant difference in blood eosinophil measurements between subgroups (p=0.174). As a result of the evaluations, the cut-off point obtained for the blood eosinophil count was determined as ≥226 cells/µl. For the blood eosinophil count, for the cut-off value of ≥226 cells/µl, sensitivity was 30.0%, specificity 87.7%, positive predictive value 58.7%, and negative predictive value 68.3%. CONCLUSIONS: This study shows that BPT positivity is associated with blood eosinophil count. The cut-off value (≥226 cells/µl) determined for blood eosinophil count may be helpful when planning BPT and evaluating the diagnosis of asthma.

Acute monoarthritis in children: clinical and laboratory factors distinguishing septic arthritis from noninfectious inflammatory arthritis.

OBJECTIVE: Distinguishing septic arthritis from specific inflammatory arthritis in children with acute monoarthritis can be a clinical challenge. This study aimed to assess the diagnostic performance of presenting clinical and laboratory findings for distinguishing septic arthritis from common forms of noninfectious inflammatory arthritis in children with acute monoarthritis. PATIENTS AND METHODS: Children presented for the first episode of monoarthritis were retrospectively reviewed and then divided into two groups: (1) the septic group, 57 children with true septic arthritis, and (2) the non-septic group, 60 children with several types of noninfectious inflammatory arthritis. Several clinical findings and serum inflammatory markers on admission were documented. RESULTS: Univariate analyses demonstrated that body temperature, weight-bearing status, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell count (WCC), absolute neutrophil count (ANC), and neutrophil percentage (NP) levels were significantly higher in the septic group than in the non-septic group (p<0.001 for each variable). Based on the ROC analysis, optimum diagnostic cut-off values were 63 mg/L for CRP, 6,300/mm3 for ANC, 53 mm/h for ESR, 65% for NP, 37.1°C for body temperature, and 12,100/mm3 for WCC. While children with no presenting factor had a 4.3% risk of having septic arthritis, those with six predictors had a risk of 96.2%. CONCLUSIONS: A CRP level of ≥63 mg/L is the best independent predictor of septic arthritis among the commonly used serum inflammatory markers (ESR, WCC, ANP, NP). It should be borne in mind that a child with zero predictors may still have a 4.3% risk of septic arthritis. Thus, clinical assessment is still imperative in managing children presenting with acute mono-arthritis.

Lumen reconstruction with magnetic compression anastomosis technique in a patient with complete esophageal stricture.

Background: Complete esophageal obstruction (CEO) is a rare condition of which treatment options are challenging. Surgery is the main treatment with high morbidity and mortality rates. Magnetic compression anastomosis (MCA) is a novel technique developed to restore lumen patency in gastrointestinal and biliary tracts. However, MCA experience is limited in respect of esophageal strictures. Case Report: We present a 26-year-old patient having CEO. Magnets are inserted endoscopically to both sides of the obstructed area via oral and retrograde (through the gastrostomy tract) route. On day 8, magnets stuck together and were removed endoscopically through the oral route. Subsequently, sessions of balloon dilatations and triamcinolone injection were performed. The patient's complaint of aphagia resolved after the treatment process. Conclusion: In conclusion, MCA is an alternative technique that can be used to restore lumen patency in esophageal strictures and also avoids complications of surgical interventions.

Successful topical application of Ankaferd blood stopper in a patient with life-threatening fundal variceal bleeding despite cyanoacrilate injection.

Gastric variceal bleeding is a common problem in patients with cirrhosis and despite early endoscopic and/or pharmacological therapy, variceal bleeding cannot be controlled or recurs early in about 10 to 20% of patients with considerable morbidity and mortality rates. For this reason, effective control of active bleeding varices is of great importance for the prevention of late complications. Although endoscopic band ligation and sclerotherapy are the choice of endoscopic treatment modalities with various grades of success, limited data is available for the use of Ankaferd Blood Stopper (ABS) for the controlling of variceal bleeding due to gastric varices. We herein present a unique case of gastric variceal bleeding despite cyanoacrilate injection, which was successfully controlled with topical ABS application.

Clinical characteristics of patients with diabetic polyneuropathy: the role of clinical and electromyographic evaluation and the effect of the various types on the quality of life.

OBJECTIVE: This study was performed to identify the relationship between the quality of life and polyneuropathy which is one of the complications of diabetes. METHODS: Total 111 patients with diabetes mellitus were taken into the study as type 1 and type 2. Patients were accepted having polyneuropathy according to their electroneuromyography (ENMG) results. To evaluate the quality of life in the patients Short Form 36 (SF-36) and World Health Organization Quality of Life Questionnaire abbreviated version (WHOQOL-BREF) were used. RESULTS: Clinical polyneuropathy was found in 46% of the patients, while polineuropathy was found in 63% of the patients with evaluation ENMG. The patients with polyneuropathy had poor quality of life according to SF-36 and WHOQOL-BREF (p < 0.001). The mean quality of life scores of patients who had sensoriomotor and mix polyneuropathy, were lower than sensory type and axonal polyneuropathy. CONCLUSION: Diabetic polyneuropathy influences the quality of life in a negative way. The quality of life scores of patients who had polyneuropathy continuing with mixed pathogenesis and sensoriomotor type, become worse for this reason, even if the patients do not have any clinical polyneuropathy, this being evaluated with ENMG.

Seroepidemiological survey of Rhodoccocus equi infection in asymptomatic horses from Bursa, Izmir and Istanbul provinces, Turkey.

In order to assess the Rhodococcus equi infection in three provinces of Turkey (Bursa, Izmir and Istanbul), 696 sera from healthy foals and adult horses were tested by indirect ELISA using a R. equi reference strain (ATCC 6939) as antigen. 103 sera (14.80%) with titres >0.646 resulted positive. Seroprevalence was significantly higher (P=0.0053) in male than in female horses of Istanbul province, although higher antibody titres (mean value) were observed in the female group of Bursa and Izmir provinces with differences estimated between provinces (P=0.0002). Seroprevalence was correlated with age: foals aged less than 1 year (P<10(-4)) and horses from 5 to 10 years old (P=0.018) resulted more infected in Bursa and Izmir provinces. Our findings indicate that R. equi infection actually occurs in all investigated provinces, suggesting the importance of serological survey to diagnose the infection and to prevent the zoonotic risk.

Canine coronavirus infection in Turkish dog population.

Canine coronavirus (CCoV) is one of the most important viral agents affecting the gastrointestinal system of dogs. In this study virological and serological investigations were performed to demonstrate the existence and prevalence of CCoV infection in a Turkish dog population. A total of 269 animals were subjected to the study. Of 179 dogs tested for CCoV antibodies, 112 (62.5%) were found to be positive by serum neutralization test, while 133 (74.3%) were positive by ELISA. The highest prevalence (94.2%) was detected in kennel dogs. Detection of CCoV genome in faeces was performed in samples from 90 diarrhoeic puppies by reverse transcription-polymerase chain reaction. Fourteen (15.5%) faeces were positive for CCoV RNA, five of which were characterized as CCoV type I. The widespread CCoV infection in the Turkish dog population may be attributed as an important cause of viral diarrhoea in dogs.

Reasons for non-vaccination during national immunization days: a case study in Istanbul, Turkey.

OBJECTIVE: The member states of the 41st World Health Assembly agreed to aim for the global eradication of polio by the year 2000. Turkey adopted this goal and made substantial progress. In this report, we present the results of a coverage and risk factor survey conducted to evaluate vaccine delivery during the 1999 national immunization days (NIDs) in a large district of Istanbul, Turkey. This study provides important information regarding risk factors and reasons for non-vaccination during the NIDs, defines rumours about the NIDs, and provides estimates of vaccination coverage. SETTING AND PARTICIPANTS: A survey was conducted 3-10 days after the second round of 1999 NIDs using the standard expanded programme on immunization cluster survey method, for each of 10 health centre areas in Umraniye. In total, 2102 children were included in the analysis. RESULTS: The vaccination coverage rate was 82.2%. Logistic regression analysis showed increased risk of non-vaccination in people who did not know the purpose of the NIDs, who had not had contact with a mobile vaccination team, who were unvaccinated in the first round of 1999 NIDs and who lived in the area of the Central Health Centre. Use of primary-level state healthcare facilities for routine childhood immunizations, and living in the area of the Adem Yavuz Health Centre had significant positive effects on vaccination. CONCLUSIONS: To achieve better results, better publicity of national campaigns using mass media, and improved use of mobile teams, are necessary.

Very early morning increase in onset of ischemic stoke.

A study was conducted on 525 consecutive patients ranging in age from 36 years to 86 years to determine whether diurnal variation occurs in the onset of acute ischemic stroke. There was a clear (Dmax=0.19, P<0.01) diurnal variation with a significant (t=-4.96, P<0.001) peak between four a.m. and six a.m. Strokes occurred more often during the two hours following awakening than during any other time of the day. The peak time of ischemic stroke in our study was about two hours earlier than in previous reports, probably because of the different waking times of the studied populations. We concluded that the time of awakening influences the circadian distribution rather than the time of day itself.

Effect of circulating pattern and complicating factors on outcome for ruptured anterior communicating artery aneurysms.

We reviewed outcome for ruptured anterior communicating artery (ACoA) aneurysm in 40 patients and attempted to establish its relationships with circulating pattern and complicating factors. Circulation Type-1 and Type-2 were associated with a better outcome than Type-3 and Type-4. Apart from arterial hypertension and cerebral infarction, all the complicating factors, i.e., vasospasm, brain oedema, intraparenchymal and/or intraventricular haemorrhage and hydrocephalus were related with an increased risk for poor outcome, but the broad outcome was more depended on circulating pattern for anterior cerebral territories.