Glycemic variability leads to higher levels of auto-oxidized oxysterol species in patients with type 1 diabetes mellitus.

PURPOSE: Hyperglycemia and glycemic variability (GV) are associated with oxidative stress in patients with diabetes mellitus (DM). Oxysterol species, produced by the non-enzymatic oxidation of cholesterol, are potential biomarkers of oxidative stress. This study examined the relationship between auto-oxidized oxysterols and GV in patients with type 1 DM. METHODS: Thirty patients with type 1 DM using a continuous subcutaneous insulin infusion pump therapy and a healthy control group (n = 30) were included in this prospective study. A Continuous Glucose Monitoring System device was applied for 72 h. Blood samples were taken for oxysterols produced by non-enzymatic oxidation [7-ketocholesterol (7-KC) and cholestane-3ß, 5α, 6ß-triol (Chol-Triol)] levels at 72 h. Short-term glycemic variability parameters, mean amplitude of glycemic excursions (MAGE), the standard deviation of glucose measurements (Glucose-SD), and mean of daily differences (MODD) were calculated with continuous glucose monitoring data. HbA1c was used to evaluate glycemic control and HbA1c-SD (the SD of HbA1c over the past year) for long-term glycemic variability. RESULTS: 7-KC and Chol-triol levels were significantly higher in the study group than in the control group. Strong positive correlations were found between 7-KC with MAGE(24-48 h) and Glucose-SD(24-48 h). 7-KC was positively correlated with MAGE(0-72 h) and Glucose-SD(0-72 h). No significant correlation was found between HbA1c and HbA1c -SD with oxysterol levels. The regression models showed that SD(24-48 h) and MAGE(24-48 h) predicted 7-KC levels while HbA1c did not. CONCLUSIONS: Glycemic variability leads to higher levels of auto-oxidized oxysterol species in patients with type 1 DM independent of long-term glycemic control.

Headless cannulated screw and external fixator in the treatment of type C distal femur fractures: Effect of early mobilization on clinical outcomes.

Distal femur fractures occur due to high-energy trauma in young patients and with low-energy traumas in osteoporotic elderly patients. Implants selected for use in the treatment of distal femur fracture should provide stable fixation and allow early mobilization especially at elder patients. We aimed to investigate the effects of the headless cannulated screw and external fixator combination on the early mobilization of the patients and postoperative complications. Twenty-one patients with Type C distal femur fracture were included in the study.The fracture lines were temporarily fixed with K wires. After the fracture reduction with headless cannulated screws a tubular external fixator with carbon fiber rods was applied to bridge the knee joint. The external fixators were removed at the 6th week follow-up, and the patients were forced to perform knee flexion as much as they could tolerate. The 6th month KSS scores of the patients were 44.3 (34-60) and the 18th month KSS scores were 77.5 (60-88).Preoperative VAS score was 8(7-10) and postoperative VAS score was 4(3-6).Knee flexion of the patients at 6th months was 95.9 (80-110 degrees) and at 6th months knee flexion was 114.5 (100-125 degrees). Superficial pin site infection was observed at 4 patients and regressed with antibiotic therapy. Combination of cannulated screws with an external fixator for joint restoration in type C distal femur fractures allows early mobilization and reduces postoperative morbidity.

Nail breakage in patients with hypertrophic pseudoarthrosis after subtrochanteric femur fracture: treatment with exchanging nail and decortication.

In this study, we aimed to show the results of exchange nail and decortication in patients whose subtrochanteric femur fractures were treated with intramedullary nails and subsequently developed fracture nonunion and nail breakage com- plications. This study consisted of patients presenting with subtrochanteric femur fractures between January 2013 and April 2019 who underwent surgery and later experienced nail breakage due to hypertrophic nonunion. There were a total of 10 patients aged 26-62 years (Avg 40,30, SD: 9,989). Nine patients were smokers, and 1 patient had diabetes and hypertension. Three patients were admitted to the trauma center due to a car accident and 7 patients were admitted because of a fall. The infection parameters of all patients were normal. All patients had pathological movement complications and pain at the fracture site. Preoperatively, medulla diameter was measured with standard radiography in all patients. The diameters of the old nails applied to the patients ranged from 10 to 12 mm, and the diameters of the newly applied nails ranged from 14 to 16 mm. The fracture lines of all patients were opened to remove the broken nails, and decortication was performed. No additional autograft or allograft was applied to any patient. Union was achieved in all patients. We conclude that the use of larger diameter nails in conjunction with decortication will prevent nail breakage, improve healing and provide early union in patients with subtrochanteric femur fractures with hypertrophic pseudoarthrosis.

A new etiological cause for anterior cruciate ligament injury: E-Scooter.

The usage of electric scooters has been popular because it is a cheap and fast transportation method. Its use has increased in recent years because public transportation is less preferred during the covid-19 pandemic and in parallel, the publications reporting e-scooter accidents are increasing. There is no article examining the relationship between e-scooter and anterior cruciate ligament (ACL) injury in current literature. We aim to examine the relationship between e-scooter accidents and ACL injury incidence. Patients over the age of 18 years who applied to our orthopedics outpatient clinic with the diagnosis of ACL injury between January 2019- June 2021 were evaluated. 80 e-scooter accidents resulting with ACL tears were reviewed. The electronic medical records of the patients were reviewed retrospectively. Information about the age, gender, trauma history of the patients, and type of trauma was obtained. Fifty-eight patients had a history of falling while stopping the scooter, and 22 patients had a history of falling after hitting something. Anterior cruciate ligament reconstruction was performed with hamstring tendon grafts in 62(77,5%) of the patients included in the study. 18 (22,5%) patients were followed up with functional physical therapy exercises because they did not want to be operated on. Various bone or soft tissue injuries while using e-scooters have been reported in the literature until now. ACL injury is also seen quite frequently after these traumas, and necessary information and warnings should be given to the users to prevent ACL injuries.

Extreme ultraviolet light from a tin plasma driven by a 2-µm-wavelength laser.

An experimental study of laser-produced plasmas is performed by irradiating a planar tin target by laser pulses, of 4.8 ns duration, produced from a KTP-based 2-µm-wavelength master oscillator power amplifier. Comparative spectroscopic investigations are performed for plasmas driven by 1-µm- and 2-µm-wavelength pulsed lasers, over a wide range of laser intensities spanning 0.5 - 5 × 1011 W/cm 2. Similar extreme ultraviolet (EUV) spectra in the 5.5-25.5 nm wavelength range and underlying plasma ionicities are obtained when the intensity ratio is kept fixed at I1µm/I2µm = 2.4(7). Crucially, the conversion efficiency (CE) of 2-µm-laser energy into radiation within a 2% bandwidth centered at 13.5 nm relevant for industrial applications is found to be a factor of two larger, at a 60 degree observation angle, than in the case of the denser 1-µm-laser-driven plasma. Our findings regarding the scaling of the optimum laser intensity for efficient EUV generation and CE with drive laser wavelength are extended to other laser wavelengths using available literature data.

Relationship between healthy lifestyle behaviors and health related quality of life in turkish school-going adolescents.

BACKGROUND: The aim of this study is to determine the relationship between healthy lifestyles behaviours and health-related quality of life (HRQOL) among Turkish school-going adolescents. SUBJECTS AND METHODS: This cross-sectional study was conducted among 413 students studying in a secondary school of Istanbul, Turkey. Data were collected using a questionnaire containing socio-demographic characteristics, health promoting lifestyle behaviors and the Turkish generic health-related quality of life questionnaire for children (Kid-KINDL). Data were analyzed using descriptive statistics, t-test, Pearson's product-moment correlation, and a hierarchical multiple regression analysis. RESULTS: Univariate statistics showed that gender, school grade, parental education level, monthly income, and all healthy lifestyles behaviours except for fruit and vegetable intake were associated with adolescents' HRQOL. Multivariate statistics indicated that participation in social activities and talking about their problems were the most important predictors of better HRQOL. Healthy lifestyles behaviours, especially talking about their problems to close friends and/or family members and participation in leisure-time social activity were related to better HRQOL of Turkish adolescents, independently of socio-demographic factors. CONCLUSION: Collaborative efforts among providers of school health and counseling services are urgently needed to improve all aspects of adolescent health.

Narrowband and tunable anomalous transmission filters for spectral monitoring in the extreme ultraviolet wavelength region.

We present the first experimental demonstration of a novel type of narrowband and wavelength-tunable multilayer transmission filter for the extreme ultraviolet (EUV) region. The operating principle of the filter is based on spatially overlapping the nodes of a standing wave field with the absorbing layers within the multilayer structure. For a wavelength with a matching node pattern, this increases the transmission as compared to neighboring wavelengths where anti-nodes overlap with the absorbing layers. Using Ni/Si multilayers where Ni provides strong absorption, we demonstrate the proper working of such anomalous transmission filter. The demonstration is carried out at the example of 13.5 nm wavelength and at normal incidence, providing a 0.27 nm-wide transmission peak. We also demonstrate wavelength tunability by operating the same Ni/Si filter at different wavelengths by varying the angle of incidence. As the multilayer filter is directly deposited on the active area of an EUV-sensitive photodiode, this provides an extremely compact device for easy spectral monitoring in the EUV. The transmission spectrum of the filter is modeled and found to be in good agreement with the experimental data. The agreement proves that such filters and compact monitoring devices can be straightforwardly designed and fabricated, as desired, also for other EUV wavelengths, bandwidths and angles of incidence, thereby showing a high potential for applications.

Does detection of a large for gestational age (LGA) fetus in fetal anomaly scan (FAS) require an early oral glucose screening test (OGTT) and can LGA fetus be detected at birth?

OBJECTIVE: Gestational diabetes mellitus (GDM) complications increase with late diagnosis and late treatment, so early diagnosis and treatment is one of the most important factors in preventing complications. We tried to find an answer to the question of whether the detection of large for gestational age (LGA) fetus in fetal anomaly scan (FAS) requires earlier oral glucose screening test (OGTT) and predicts LGA fetus at birth. PATIENTS AND METHODS: Pregnant women who underwent fetal anomaly scan and gestational diabetes screening at the Department of Obstetrics and Gynecology, University of Health Sciences, Tepecik Training and Research Hospital between 2018 and 2020 were included in this large retrospective cohort study. FAS was routinely performed between 18-22 weeks in our hospital. 75 grams of OGTT was used for gestational diabetes screening and it was performed between 24-28 weeks. RESULTS: This large retrospective cohort study was performed on 3,180 fetuses, 2,904 appropriate for gestational age (AGA) and 276 LGA, in the second trimester. The prevalence of GDM was significantly higher in the LGA group (OR 2.44, 95% CI 1.66-3.58; p < 0.001). Insulin requirement for blood glucose regulation was significantly higher in the LGA group (OR 3.6, 95% CI 1.68-7.7; p = 0.001). Fasting and 1st hour OGTT values were similar between the groups, but 2nd hour OGTT values were significantly higher in the second trimester LGA group (p = 0.041). The prevalence of LGA newborns at birth was higher in second trimester LGA fetuses than in fetuses with AGA (21.1% vs. 7.1%, p < 0.001). CONCLUSIONS: The fact that the estimated fetal weight (EFW) measured in the second trimester FAS is LGA may be related to GDM in the future and LGA fetus at birth. A more detailed GDM risk questioning should be performed to these mothers and OGTT should be considered when additional risk factors are detected. In addition to all these, glucose regulation may not be possible with diet alone in mothers who have LGA in the second trimester ultrasound and who may have GDM in the future. These mothers should be monitored more closely and more carefully.

Clinical Experience With the Use of Gauze-based Negative Pressure Wound Therapy.

UNLABELLED:  Purpose. In this preliminary study, gauze-based negative pressure wound therapy (NPWT) was used to accelerate granulation tissue forma- tion and promote closure in a number of wound types. The authors aimed to evaluate the efficacy of gauze-based NPWT using the Chariker-Jeter technique for wounds requiring delayed closure. METHODS: A retrospective review was conducted of 50 patients with wounds not suitable for imme- diate primary closure. After initial irrigation, debridement, and antibiotic therapy, Chariker-Jeter technique NPWT was used and dressings were changed at 24- to 48-hour intervals before secondary closure or primary closure. In addition, a 4-point category scoring system (severe, moderate, mild, and none) was used to evaluate pain. Semi-quantitative data also were obtained. RESULTS: Wound size decreased considerably, granulation tissue formation was accelerated, and exudate was reduced and removed by the end of the treatment. The patients were followed for 12 months. Pre- and post-treatment averages of the wound surface areas were 90.21 ± 74.97 cm2 and 35.71 ± 53.63 cm2, respectively (P < 0.001). Average duration of treatment was 12.98 ± 3.18 days and average wound size reduction following the treatment was 64.61% ± 30.42%. Granulation tissue was clinically observed in all wounds by day 5. Six cases healed without any operation; the others required various reconstructive methods to cover the wounds. After surgical intervention, only 3 patients treated with gauze-based NPWT had a recurrence. No infections were observed during the follow-up period. According to the pain form, only 2 patients had severe pain. CONCLUSION: The gauze-based NPWT was found to be a safe and cost-effective method in temporary soft-tissue management of chronic nonhealing wounds suitable delayed closure. .

Safety and effectiveness of interferon alpha-2a in treatment of patients with Behçet's uveitis refractory to conventional treatments.

PURPOSE: To evaluate the intermediate-term safety and effectiveness of interferon alpha-2a (IFNalpha2a) in patients with Behçet's uveitis (BU) refractory to corticosteroids and immunosuppressive agents. DESIGN: Open, nonrandomized, uncontrolled, interventional, prospective study. PARTICIPANTS: Fifty-three patients (106 eyes) with active, vision-threatening BU who failed to respond to conventional treatments. INTERVENTION: In 53 patients, acute inflammation was suppressed with effective prednisolone dosage (1-2 mg/kg/day, tapered to 10 mg within 4-6 weeks). The patients were treated with IFNalpha2a 4.5 million international units (MIU) 3 times per week for the first 3 months followed by IFNalpha2a 3 MIU 3 times per week for the next 3 months. Observation or other treatment methods were performed according to the decision tree developed for this study. MAIN OUTCOME MEASURES: Remission and complete response (primary outcome measures), frequency of uveitis attacks, visual acuity (VA), and adverse effects (secondary outcome measures). RESULTS: During 2 years of follow-up (median 65 months, range 12-130 months), compliance with the therapy was excellent. At the end of 1-year follow-up, treatment response was obtained in 45 of 53 patients (84.9%). The mean attack rate of 3.6+/-1.1 per year (range, 2-8) decreased to 0.56+/-0.75 (range, 0-4) per year (P=0.001). Visual acuity improved (> or = 0.2 logarithm of the minimum angle of resolution units from initial VA) in 30 eyes (28.3%) and worsened in 12 eyes (11.3%). Five patients (9.4%) did not respond to the initial treatment, and 3 patients (5.6%) developed severe adverse effects, including psoriasis, epileptic seizure, and extreme tiredness. Fifteen patients (28.3%) were off treatment for all the medications and disease free for 28+/-13.1 months (range, 12-50 months). CONCLUSIONS: These results suggest that IFNalpha2a may be a valuable treatment option in BU that is refractory to corticosteroids and conventional immunosuppressive agents. The possible role of IFNalpha2a as a first-line agent in BU should be validated in randomized controlled clinical trials against newly described biologic agents. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Prominent radiative contributions from multiply-excited states in laser-produced tin plasma for nanolithography.

Extreme ultraviolet (EUV) lithography is currently entering high-volume manufacturing to enable the continued miniaturization of semiconductor devices. The required EUV light, at 13.5 nm wavelength, is produced in a hot and dense laser-driven tin plasma. The atomic origins of this light are demonstrably poorly understood. Here we calculate detailed tin opacity spectra using the Los Alamos atomic physics suite ATOMIC and validate these calculations with experimental comparisons. Our key finding is that EUV light largely originates from transitions between multiply-excited states, and not from the singly-excited states decaying to the ground state as is the current paradigm. Moreover, we find that transitions between these multiply-excited states also contribute in the same narrow window around 13.5 nm as those originating from singly-excited states, and this striking property holds over a wide range of charge states. We thus reveal the doubly magic behavior of tin and the origins of the EUV light.

Ciprofloxacin-associated seizures in a patient with underlying thyrotoxicosis: case report and literature review.

BACKGROUND: Ciprofloxacin-associated seizures (CAS) occur most commonly in patients with special risk factors that may cause accumulation of drug (high doses of the drug, old age, renal insufficiency, drug interactions) or that may decrease the threshold of epileptogenic activity (electrolyte abnormalities, history of seizures, electroconvulsive therapy). OBJECTIVE: To report thyrotoxicosis as a risk factor previously not heralded for the development of CAS. CASE SUMMARY: A 24-year-old woman was admitted to the hospital because of convulsions, severe myopathy, and acute renal failure after taking ciprofloxacin for sinusitis, and urinary tract infections. Prior to ciprofloxacin ingestion, she had no seizure history, was not receiving any other medication, and her routine laboratory results including creatinine and electrolytes were within normal ranges. Electroencephalogram suggested epileptiform waves. Cranial magnetic resonance imaging was normal. Further laboratory examinations documented thyrotoxicosis in association with postpartum thyroiditis. DISCUSSION: In the reviewed literature, all cases of CAS occurred in the presence of at least one risk factor for CAS. CONCLUSIONS: CAS appear to be restricted to individuals with predisposing risk factors, therefore it is always necessary to search such fact. When a physician encounters the possibility of CAS, in addition to previously described risk factors, thyrotoxicosis should also be considered in the differential diagnosis. Further, in patients with untreated thyrotoxicosis, antibiotics other than ciprofloxacin might be preferable for therapy.

Simultaneous triple organ specific autoantibody profiling in adult patients with type 1 diabetes mellitus and their first-degree relatives.

AIMS: We aimed to document prevalence and clinical presentations of seropositivities for glutamate decarboxylase (GAD)-antibody, celiac's disease (CD) and autoimmune thyroiditis (AIT) in adult patients with type 1 diabetes mellitus (T1DM), and their first-degree relatives. METHODS: Sixty-five patients with T1DM, 124 first-degree relatives and 65 healthy controls were screened for GAD-antibody, anti-thyroid peroxidase (ATPO), anti-thyroid stimulating hormone receptor (TSHR), anti-tissue transglutaminase and anti-gliadin antibodies in a matched case-control study. RESULTS: Prevalence of more than one seropositivity for CD-associated antibodies in T1DM-group is 6.0 times increased, compared with controls (p < 0.05). ATPO seropositivity is 5.3 times increased in T1DM group (p < 0.05), but TSHR antibody is comparable with controls (p > 0.05). Seropositivities for T1DM, AIT and CD are 4.3, 1.9 and 2.4 times more prevalent among first-degree relatives respectively, compared with controls (p < 0.05). Pathologically confirmed cases with CD among first-degree relatives were all identified at screening. In contrast, all of pathologically confirmed cases with CD in T1DM group, were either previously diagnosed or symptomatic at time of screening. In the group of patients with T1DM, 31% of seropositive cases for anti-ATPO were clinically latent for AIT, and 74% of ATPO (+) cases were identified at current screening study. Sixty-four per cent of ATPO (+) first-degree relatives were clinically latent for AIT, and 54% were identified at screening. CONCLUSION: Type 1 diabetes mellitus, CD and AIT represent a significant overlap in an adult population with already-diagnosed T1DM and their first-degree relatives. With regard to clinical presentations, CD was less likely to be clinically silent than AIT among patients with T1DM.

Autoimmune polyendocrine syndrome with atrial septal defect.

Atrial septal defect is frequently reported with genetic syndromes. But, to the best of our knowledge, it has not been reported with autoimmune polyendocrine syndrome. Here, the case of a 44-year-old-woman with concomitant involvement of the salivary gland, thyroid, intestines, and, possibly endocrine pancreas, diagnosed with autoimmune polyendocrine syndrome type II, is reported with accompanying atrial septal defect. Celiac disease, Hashimoto thyroiditis, and Sjögren syndrome were symptomatic and laboratory confirmed diagnosis; anti-glutamic acid decarboxylase antibody was positive but asymptomatic for type-1 diabetes. She was known to have sinus venosus type atrial septal defect diagnosed at 38 years old, when she had tiredness and chest pain.

A rare diarrheic parasite in a liver transplant patient: Isospora belli.

We describe the first case of isosporiasis in a liver transplant patient. Watery diarrhea due to Isospora belli was observed in a woman who had undergone liver transplantation 8 months prior. She was successfully treated with trimethoprim-sulfamethoxazole. This parasite should be taken into consideration as an opportunistic infection in transplant patients who need increased hygienic awareness.

Legionnaire's disease: a nosocomial outbreak in Turkey.

Six nosocomial cases of Legionella pneumophila occurred over a two-week period, with one further case being diagnosed retrospectively after 30 days. Strains isolated from the hospital water system were clonally related to a single sputum isolate. A sero-epidemiological investigation into legionella exposure amongst staff and inpatients was undertaken at the eight-year-old Inonu University Medical Centre in Turkey, which has 600 beds and central air conditioning. There is no disinfection programme for the hospital water system. A total of 500 serum samples (400 hospital staff and 100 inpatients) were screened for antibody to L. pneumophila by enzyme-linked immunosorbent assay (ELISA). Seroreactive cases were confirmed by a four-fold antibody rise in ELISA, a high indirect immunofluorescent assay (IFA) antibody titre or a positive urinary antigen test. ELISA showed that 24 (6%) of the 400 hospital staff and seven (7%) of the 100 inpatients had antibody titres higher than the cut-off value. ELISA-seroreactive cases were followed for two to four weeks. Of these subjects, seven (three patients and four staff) showed a four-fold rise in antibody titre by ELISA, six (three patients and three staff) had a high IFA titre, three patients with pneumonia had a positive urinary antigen test, and one of these patients also had a positive sputum culture. In addition, 22 water distribution systems were screened for the presence of L. pneumophila by culture. L. pneumophila was isolated from 15 sites. Pulsed-field gel electrophoresis typing indicated that all strains isolated from water systems were identical and clonally related to the strain isolated from sputum. Superheating and flushing of water systems were undertaken with legionella being re-isolated from four sites. Repeated superheating and flushing eliminated legionella completely. This study demonstrated that rapid detection of L. pneumophila and adequate superheating and flushing of water systems are effective for elimination and reduction of spread of this organism.

Ingestion of IH636 grape seed proanthocyanidin extract to prevent selenite-induced oxidative stress in experimental cataract.

PURPOSE: To investigate whether dietary supplementation with IH636 grape seed proanthocyanidin extract (GSPE) prevents selenite-induced cataract. SETTING: Department of Ophthalmology, Gulhane Military Medical Academy, Ankara, Turkey. METHODS: Thirty Spraque-Dawley rat litters were put randomly into 3 groups. In group 1 (n = 10), sodium selenite (30 nmol/g body weight) was injected subcutaneously on postpartum day 10. In group 2 (n = 10), sodium selenite (30 nmol/g body weight) was injected on postpartum day 10 and oral GSPE (100 mg/kg body weight) was given for 1 week after sodium selenite injection. Only subcutaneous saline was injected in group 3 (control, n = 10). The development of cataract was assessed for 3 weeks, and its density was graded and photographed with a slitlamp. Removed rat lenses were analyzed for glutathione (GSH) and malondialdehyde (MDA). RESULTS: All of the rats in group 1 had cataract between stage 6 and stage 3. In group 2, only 5 of 10 eyes had cataract between stage 3 and stage 2 and no cataract occurred in the remaining 5 rats. The difference between mean cataract stages in group 1 and group 2 was significant (P<.05). The mean GSH level in group 1 was significantly lower than in group 2 and controls (P<.05). The mean MDA level in group 1 was significantly higher than in group 2 and controls (P<.05). CONCLUSIONS: IH636 grape seed proanthocyanidin extract effectively suppressed cataract formation in rats. Routine consumption of grape seed proanthocyanidin extract in the form of food or dietary supplement may offer a prophylactic measure against onset and progression of cataract.

Aicardi syndrome: an unusual case associated with pineal gland cyst and ventricular septal defect.

Aicardi syndrome is a cerebroretinal disorder consisting of a heterogeneous spectrum of clinical findings that includes the triad of infantile spasms, agenesis of the corpus callosum, and chorioretinal lacunae. This report describes a 6-month-old girl who has all of the essential features suggestive of Aicardi syndrome, as well as a pineal gland cyst and ventricular septal defect. Although the characteristic features of Aicardi syndrome have been described, its association with pineal gland cyst and ventricular septal defect has not been reported in the literature.

Hypericin-enhanced argon laser photocoagulation for subfoveal choroidal neovascular membrane in age-related macular degeneration: a pilot study.

PURPOSE: To evaluate the efficacy and safety of hypericin-enhanced argon laser photocoagulation (H-ALP) in the treatment of subfoveal choroidal neovascular membrane (CNM) secondary to age-related macular degeneration (ARMD). METHODS: After preliminary studies for definition of parameters, argon-green laser was administered 4 hours after single dose of oral 1800 mg hypericin (Saint-John's wort tablets, 0.3%, 300 mg) with a subthreshold light fluence, 24 J/cm2 in 34 eyes (20 with subfoveal classical and 14 with subfoveal occult CNM). Additionally, histopathologic examination was done in two eyes destined for enucleation and exenteration. Maintenance therapy (one tablet, twice a day) was performed for the following 6 months. Anatomic (complete closure of CNM) and functional success (improvement of final visual acuity in three or more Snellen lines) were analyzed with minimum 6-month follow-ups. RESULTS: Histopathologic examinations revealed photothrombosed choriocapillaries together with minimal retinal pigment epithelial disruption in H-ALP exposed areas. One to four (mean 1.88+/-0.91) treatment sessions were applied in 6 to 29 months (mean 12.2+/-5.1 months) follow-up period. Twenty-three (67.6%) eyes had 12 months follow-up. Two eyes in each group had functional success (20% in subfoveal classical and 14.3% in subfoveal occult CNM), which had a minimum 12-month follow-up. Anatomic success was achieved in 16 of 20 (80%) eyes with subfoveal classical and 10 of 14 (71.4%) eyes with subfoveal occult CNM. Severe gastric irritation was noted in 1 (2.9%) and pigment epithelial rupture in 2 (5.9%) patients. CONCLUSIONS: H-ALP is a novel and low-cost treatment for subfoveal CNM secondary to ARMD. It seems its efficacy depends on the photodynamic and antiproliferative properties of hypericin. Comparative studies are required to apply this new technique in ophthalmic practice.

[Antimicrobial susceptibility and serotype distribution of pneumococci strains isolated from meningitis patients]. / Menenjitli hastalardan izole edilen pnömokoklarin serotip dagilimi ve antibiyotiklere duyarliliklari.

Treatment of life threatening pneumococcal infections such as meningitis has recently become problematic due to the emergence of antibiotic resistant strains. Antimicrobial susceptibility data usually derived from the studies that included all clinical pneumococcal isolates. However, resistance patterns of this microorganism isolated from meningitis cases in our country are not exactly known. The aim of this study was to determine the antimicrobial susceptibility and serotypes of Streptococcus pneumoniae strains isolated from meningitis cases. This retrospective study was designed in three university hospitals in Turkey and 72 pneumococci isolated from patients with meningitis were evaluated. In this study disk diffusion test and E-test methods were used to determine the susceptibility of pneumococci to some antibiotics. All S. pneumoniae isolates were serotyped using Quellung reaction. Although resistance for oxacillin was found by disc diffusion method in 11 isolates, only six of them were found to be resistant by E-test. By the latter procedure, no resistance was recorded against ceftriaxone and meropenem, while chloramphenicol resistance was found as 1.4%. In our study, erythromycin, ciprofloxacin and levofloxacin resistance were 2.8%, TMP-SMX resistance was 26.4%, while no vancomycin resistance was detected by disk diffusion. In evaluation of 72 pneumococci, we found 16 different serotypes and four isolates could not be serotyped. The serogroup 23 (n: 19) was the most common one followed by serotype 19 (n: 9) and serotype 14 (n: 7). Of six resistant isolates, three pneumococci were serogroup 23 and the remaining were from three different serotype/serogroups 11, 14 and 19. As a result penicillin resistance in pneumococci isolated from meningitis was low and there was no resistance to ceftriaxone. It seems that ceftriaxone is an appropriate choice for empirical treatment of meningitis in our patients. These findings also revealed that pneumococcal polysaccharide capsule vaccines in use cover most of the invasive pneumococcal serotypes.