Serosurveillance study on transmission of H5N1 virus during a 2006 avian influenza epidemic.

In 2006 an outbreak of avian influenza A(H5N1) in Turkey caused 12 human infections, including four deaths. We conducted a serological survey to determine the extent of subclinical infection caused by the outbreak. Single serum samples were collected from five individuals with avian influenza whose nasopharyngeal swabs tested positive for H5 RNA by polymerase chain reaction, 28 family contacts of the cases, 95 poultry cullers, 75 individuals known to have had contact with diseased chickens and 81 individuals living in the region with no known contact with infected chickens and/or patients. Paired serum samples were collected from 97 healthcare workers. All sera were tested for the presence of neutralizing antibodies by enzyme-linked immunoassay, haemagglutination inhibition and microneutralization assays. Only one serum sample, from a parent of an avian influenza patient, tested positive for H5N1 by microneutralization assay. This survey shows that there was minimal subclinical H5N1 infection among contacts of human cases and infected poultry in Turkey in 2006. Further, the low rate of subclinical infection following contact with diseased poultry gave further support to the reported low infectivity of the virus.

Hyperhydroxyprolinaemia detected in newborn screening with tandem mass spectrometry.

Hydroxyproline has the same integer molecular weight as leucine and isoleucine and is quantified with these by tandem mass spectrometry. An infant was diagnosed with hyperhydroxyprolinaemia following further evaluation of an elevated "leucine" level in newborn screening by tandem mass spectrometry.

Hyperhomocysteinemia and restenosis.

OBJECTIVE: This study was undertaken to assess the effect of plasma homocysteine level on angiographic restenosis 6 months after coronary angioplasty. METHODS: The plasma homocysteine level was measured in 100 consecutive patients at the time of coronary angioplasty, 56 patients who attended a 6-month follow-up angiogram being enrolled to the study; the 44 patients without a control coronary angiogram were not enrolled. Patients with and without angiographic restenosis were designated as groups A (n = 34) and B (n = 22) respectively. RESULTS: The baseline demographic (groups A and B), angiographic (groups A and B) and procedural characteristics were similar in both groups. The mean plasma homocysteine level (SD) was 15.2 (7.7) and 11.1 (2.5) mumol/l in groups A and B respectively (P = 0.007; 95% CI -6.9 to -1.1). With respect to the plasma homocysteine level, the upper and the lower thirds were compared by binary logistic regression (the lower third homocysteine level being < 10.6 mumol/l and the upper third homocysteine level > 14.1 mumol/l). The angiographic restenosis rate for the lower and upper tertiles was 47.4% and 89.5% respectively (P = 0.01; OR = 9.4; 95% CI 1.6-52.7). After adjustment for age and sex, the statistical significance did not change (P = 0.013; OR = 9.43; 95% CI 1.6-54.9). Even after adjustment for age, sex, smoking, hypertension, hypercholesterolemia, and diabetes mellitus, there was a statistically significant difference between the upper and lower tertiles (P = 0.008; OR = 41.3; 95% CI 2.6-635). CONCLUSION: Increased plasma homocysteine level and diabetes mellitus were independent risk factors for angiographic restenosis after percutaneous transluminal coronary angioplasty and coronary stenting.

Vitamin A supplementation in acute diarrhea.

BACKGROUND: Vitamin A supplementation reduces the severity of subsequent diarrheal episodes. This study was conducted to examine the effect of single oral high-dose vitamin A supplementation on the duration of acute diarrhea in 6- to 12-month-old infants who are not malnourished. METHOD: In this double-blind, randomized, placebo-controlled study, infants who were admitted to Hacettepe University Ihsan Dogramaci Children's Hospital Diarrheal Diseases Training and Treatment Unit with acute diarrhea were randomly assigned either to a group receiving a single oral dose of 100,000 IU vitamin A or placebo. There were 60 infants in each group. All infants were followed up until the diarrheal episode ended. Serum vitamin A levels were determined both at admission and 2 weeks later. RESULTS: No effect of vitamin A supplementation could be demonstrated on either the total duration of diarrhea (7.4 +/- 3.2 days in the treatment group vs. 7.8 +/- 3.1 days in the placebo group) or on its duration after intervention (3.8 +/- 2.3 days in the treatment group vs. 3.9 +/- 1.9 days in the placebo group; P > 0.05 for both comparisons). Serum vitamin A levels were not significantly different at admission (23.5 +/- 9.7 microg/dL in the treatment group vs. 24.1 +/- 9.7 microg/dL in the placebo group; P > 0.05) nor at the end of a follow-up period of 2 weeks (treatment: 33.3 +/- 13.7 microg/dL, placebo: 35.2 +/- 11.2 microg/dL; P > 0.05). However, the increase in serum vitamin A levels at the end of the 2-week follow-up interval for infants in both the treatment and placebo groups were found to be significant compared with levels at admission (P < 0.01). The mean weight gain in both groups were similar by the end of the first month (6.9 +/- 5.0% in the treatment group vs. 6.3 +/- 4.2% in the placebo group; P > 0.05). CONCLUSION: No effect of oral vitamin A supplementation on serum vitamin A levels, duration of diarrhea, or weight gain during an acute diarrheal episode could be demonstrated in our study group of infants between 6 and 12 months of age who had no malnutrition.

The correlation between prostate-specific antigen and age. Analysis of prostate-specific antigen values from 4,846 Turkish men with symptomatic benign prostatic hyperplasia.

OBJECTIVE: To analyze serum prostate-specific antigen (PSA) levels of men proven to have benign prostatic hyperplasia (BPH) and to document any correlation between PSA, age and resected or enucleated prostate tissue. PATIENTS AND METHODS: Serum PSA values, age and weight of specimens of 4,846 men who underwent prostatectomy in the Ankara region between January 1, 1991, and December 24, 1995, were reviewed retrospectively. RESULTS: Serum PSA values correlated directly with age (Pearson's r = 0.45, p < 0.00001). The mean PSA values of men in each decade of age differed significantly (p < 0.0001) from all other decades. However, the correlation between the weight of the prostatectomy specimen and age or PSA did not reach statistical significance. CONCLUSION: The effect of age on PSA is evident in men with symptoms of BPH. The existence of symptomatic BPH should also be considered together with age when interpreting PSA levels.

Hemoglobin analysis by capillary zone electrophoresis.

The analysis of haemoglobin is routine in medical laboratories for the purpose of assessing blood disorders and related pathologies. Haemoglobin is structurally diverse and possesses many variant forms, some disease-producing. With recent improvements in technology, capillary electrophoresis is now being adapted in the clinical laboratory. This paper describes the analysis of haemoglobin variants using uncoated fused-silica capillaries. The effects of using different buffer salts at different concentrations with different buffer pH values to separate haemoglobin variants in these capillaries are described.

An artificial intelligent diagnostic system with neural networks to determine genetical disorders and fetal health by using maternal serum markers.

OBJECTIVE: To develop an artificial intelligent diagnostic system with neural networks to determine genetical disorders and fetal health problems by using maternal serum markers ('Triple Test') and maternal age. STUDY DESIGN: A total of 112 pregnant women were referred to Fetal Medicine Unit of Hacettepe University Hospital for fetal ultrasonography and chromosome analysis with different indications. All patients underwent genetic amniocentesis or fetal blood sampling under ultrasound guidance. Gross malformations and hydrops fetalis were detected in 15 and 5 fetuses, respectively. We have found chromosomal abnormality in 7 cases. 'Triple Test' is offered to all patients and serum levels of alpha-fetoprotein, human chorionic gonadotropin and unconjugated estriol were analyzed by radioimmunoassay. In this study, we have used supervised artificial neural network structure to develop a diagnostic system. Our system's input parameters are maternal age, gestational age and 'Triple Test' results. Our system consists of two different artificial neural network modules whose decision-making logics are different. One of them is designed to search genetical disorders while the other one is for the assessment of fetal well-being. Confusion matrix is used for statistical evaluation. RESULTS: The discriminatory power of the artificial neural network to search genetical disorders and fetal well-being is found to be highly significant (z = 10.583 and z = 10.424, respectively). CONCLUSION: This system brings objectively to the evaluation of 'Triple Test' results and can be used both for the detection of genetical disorders and fetal well-being. Nevertheless, the analysis program's performance is limited to input information and knowledge and medical expert expert can not get more than he or she has donated the system.

Familial selective vitamin B12 malabsorption (Imerslund-Gräsbeck syndrome) in a pool of Turkish patients.

Thirty-six patients with Imerslund-Gräsbeck syndrome are presented. The mean ages at presentation and diagnosis were 4.7 +/- 3.7 years and 7.2 +/- 4.2 years, respectively. The mean hemoglobin level was 5.8 +/- 2.2 g/dL, the mean cell volume was 104.9 +/- 11.6 fL, the white blood cell count was 4479 +/- 2022/mm3, and the serum vitamin B12 level was 96.9 +/- 73 pg/mL. At diagnosis, 5 of the 36 patients, aged 5 to 16 years, had neurologic symptoms. All the patients had severe megaloblastic changes in bone marrow precursor cells. Proteinuria was detected in 78% of them. Patients with proteinuria had a younger age of onset (P < 0.0001) and diagnosis (P < 0.001) compared with those without proteinuria. In all patients, vitamin B12 excretion unbound to intrinsic factor after a flushing dose of vitamin B12 was lower than normal, and there was no appreciable correction in urinary vitamin B12 excretion after binding of intrinsic factor. The impairment of vitamin B12 absorption studies in Schilling tests; however, showed great variation among patients. Serum haptoglobin values were close to zero in all patients, indicating the presence of that intravascular hemolysis in Imerslund-Gräsbeck syndrome. Variations among patients in the age of presentation, degree of impairment of vitamin B12 absorption, and presence or absence of proteinuria suggest a heterogeneity in etiology of Imerslund-Gräsbeck syndrome at the molecular level.

Neonatal lymphocyte subpopulations of the cases with neural tube defects.

Neural tube defects (NTDs) are among the most common congenital malformations of central nervous system and are frequently associated with other organ system abnormalities. In order to evaluate the immunological changes in such patients, we examined the lymphocyte subpopulations of 13 newborns with NTDs and 32 healthy newborns. Leukocyte counts, absolute neutrophil and lymphocyte counts were lower in the babies with NTDs. Also the lymphocyte subpopulations such as percentages and absolute counts of T-cells, CD4+ cells, and CD45+ cells showed statistically significant decreases. These findings suggest that the affected babies are immunosuppressed.

Lactational failure--study of risk factors in Turkish mothers.

Risk factors for lactational failure in puerperium were investigated. Sixty mothers with inadequate daily milk supply for their babies were the lactational failure group, and 60 mothers with similar age having babies with similar age and weight were chosen as the control group. Low prolactin levels, low serum iron and low serum ferritin levels and low aldosterone values and birth in community hospitals were associated with significantly increased risk of deficient lactation. High income of the family, increase osmolality of breastmilk, high systolic blood pressure of the mother, birth by cesarean section were some of the variables that increased the risk that could not reach the level of significance. Prematurity of the baby was not among the risk factors if the gestational ages were more than 30 weeks. It is concluded that physicians awareness of the factors that may adversely effect the initiation and continuation of lactation is vital. Correcting iron deficiency even if it is not overt, sparing more time for the mothers discussing the benefits of breastmilk to their babies, and avoiding cesarean section if possible may help increase the incidence of breastmilk feeding.

Maternal lymphocyte subsets in the cases with neural tube defects.

Neural tube defects (NTDs) are among the most prevalent of congenital malformations. Organ system anomalies and certain changes in the thymus gland have also been reported. Lymphocyte subset changes can be expected in infants with NTD as a result of these thymic anomalies. We investigated lymphocyte subpopulations in twenty-one mothers of NTD cases in order to evaluate the maternal immunological alterations. The mothers of twenty-one healthy infants were chosen as a control group. Pregnancy is known to be associated with a depression in cellular immunity. We found, however, some additional changes in cellular immunity in the mothers of NTDs. The CD4/CD8 ratios were significantly lower than those of control mothers (p = 0.044). This difference was related to the increased percentage of CD8 cells found in mothers of NTDs (p = 0.004). These results suggest that immunosuppression is more evident in the mothers of babies with NTDs.

Hirsutism due to the treatment with L-thyroxine in patients with thyroid pathology.

There are many factors involved in the aetiology of hirsutism. It is well known that some drugs may cause hirsutism as a side effect, such as phenytoin, diazoxide, minoxidil etc. In Turkey, where the endemic goiter constitutes an important health problem, the value of suppression therapy with thyroid hormone still carries a special importance. We established the increasing tendency of hirsutism in patients treated with L-thyroxine (L-T4) for various thyroid pathology. That is why we decided to evaluate the role of thyroid hormones in the aetiology of hirsutism observed in patients treated with L-T4. We determined the total and free T3, T4, TSH, TBG, Plasma Cortisol transcortin, delta-4-androstenedione, FSH, LH, prolactin, total and free testosterone, estradiol, progesterone, sex hormone-binding globulin (SHBG), dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulphate (DHEAS) and 17 hydroxyprogesterone (17 OH Pg) levels in serum or plasma in a group of female patients who were taking L-T4 daily, regularly at least for 6 months and complaining of the occurrence of hirsutism. We demonstrated in these patients SHBG, transcortin and estradiol levels significantly lower than controls (p less than 0.001, p less than 0.05 and p less than 0.05, respectively) and DHEAS level significantly higher than controls (p less than 0.001). An important correlation was found between TBG and SHBG levels (r:0.536, p less than 0.05) and also between total and free testosterone levels (r:0.952, p less than 0.001).

Serum bactericidal and opsonic activities in chronic lymphocytic leukemia and multiple myeloma.

Susceptibility to infection is widely recognized as the major cause of morbidity and mortality in patients with CLL and MM. The present study was designed to investigate the serum bactericidal (SBA) and serum opsonic activities (SOA) in 12 CLL and 12 MM patients, and results were compared to 20 normals. SBA and SOA were measured by a new radiometric assay. SBA was found to be normal in 11 patients with CLL and in all 12 patients with MM. In contrast, SOA was significantly lower in 11 out of 12 patients with CLL. Ten of twelve patients with MM also had significantly lower SOA compared to those of controls. No correlation was detected between the serum immunoglobulin and complement levels of the patients or between the degree of the opsonic defect and the incidence of infection. In mixture experiments, untreated normal serum partially corrected the opsonic activity of CLL and MM serum. The results suggest the presence of a possible inhibitor in the serum of patients with two well-known B-lymphocyte-derived disorders.

Serum bactericidal and opsonic activities in patients with non-alcoholic cirrhosis.

The increased susceptibility to infection suggests that patients with cirrhosis have abnormalities in host defense mechanisms. In the present study, serum bactericidal and opsonic activity were evaluated in patients with non-alcoholic cirrhosis. Seven (28 per cent) of 25 patients had diminished bactericidal activity and 14 (61 per cent) of 23 were found to have reduced opsonic activity. Serum C3, C4, and CH50 concentrations were significantly low in patients with diminished bactericidal activity. There was a strong correlation between complement levels and bactericidal activity. Deficient bactericidal and opsonic activities may explain the increased susceptibility to infections in patients with cirrhosis.

Bactericidal activity of ascitic fluid in patients with nephrotic syndrome.

Patients with nephrotic syndrome are unusually susceptible to infections, including primary peritonitis. In this study, we have evaluated nine adult patients with nephrotic syndrome and ascites for ascitic fluid bactericidal activity, complement and immunoglobulin concentrations. Eight of nine patients had diminished ascitic fluid bactericidal activity while twelve control peritoneal fluids had normal bactericidal activity. Complement (C3 and C4) and immunoglobulin (IgG and IgM) concentrations were significantly lower in nephrotic syndrome ascitic fluid than peritoneal fluid from normal subjects. These findings may explain the high occurrence rate of primary peritonitis in nephrotic patients with ascites.

Measurement of nasal mucociliary activity in man with 99mTc-labelled resin particles.

The mucociliary activity in normal and pathological nasal mucosa was studied with a gamma camera using 99mTc-labelled resin particles. The mucus flow rate was investigated under physiological conditions in the following groups of subjects: normal, allergic rhinitis, vasomotor rhinitis, primary atrophic rhinitis, and laryngectomized. The mean flow rates obtained were 5.7 +/- 2.2, 1.5 +/- 0.5, 1.9 +/- 0.8, 0.0, and 4.8 +/- 1.9 mm/min respectively. When the results were compared, the differences between the normal and allergic rhinitis groups, and the normal and vasomotor rhinitis groups were statistically significant (p less than 0.05). However, the differences between the normal and laryngectomized groups, and the allergic and vasomotor rhinitis groups were insignificant (p greater than 0.05).