[Diagnosis of septic arthritis and initial antibiotic treatment]. / Septik artritte tani ve baslangiç antibiyotik tedavisi.

OBJECTIVES: This study was designed to determine the similarities and differences in clinical, laboratory and radiographic presentation of septic arthritis in childhood and at adult ages, to find out its etiological profile, and to establish an antibiotic treatment protocol for the initial period and for patients in whom the causative agent could not be identified. METHODS: Thirty-four patients (age range 15 months to 85 years) who underwent surgery with a diagnosis of septic arthritis were retrospectively studied in two groups, namely, children-adolescents (age = or < 15 years ; 16 patients) and adults (age >15 years; 18 patients). Clinical and laboratory findings of septic arthritis were compared with operation findings. The etiological profile and sensitivity patterns were investigated. RESULTS: Unflatering features in both groups were clinical findings of decreased range of motion and tenderness, laboratory findings of elevated erythrocyte sedimentation rate and C-reactive protein, and domination of polymorphonuclear leukocytes in the joint fluid. Gram staining of the joint fluid was highly informative in terms of probable bacteria. During the first two years of life, the most common bacteria were H. influenzae and S. pneumoniae, and after two years, staphylococci and streptococci. Ciprofloxacin and sulbactam-ampicillin were found effective against most of the Gram-positive microorganisms isolated in both groups. CONCLUSION: The most useful test for septic arthritis is arthrosynthesis and macroscopic and microscopic analyses of the material. Gram staining is of great help in the planning of initial antibiotic treatment. For patients older than two years of age, treatment with sulbactam-ampicillin is effective against staphylococci and streptococci, and amikacin against Gram-negative bacteria. Detection of Gram-negative bacteria in patients younger than two years should bring H. influenzae in mind, for which ampicillin must be the first choice.

The distinct genetic pattern of ALS in Turkey and novel mutations.

The frequency of amyotrophic lateral sclerosis (ALS) mutations has been extensively investigated in several populations; however, a systematic analysis in Turkish cases has not been reported so far. In this study, we screened 477 ALS patients for mutations, including 116 familial ALS patients from 82 families and 361 sporadic ALS (sALS) cases. Patients were genotyped for C9orf72 (18.3%), SOD1 (12.2%), FUS (5%), TARDBP (3.7%), and UBQLN2 (2.4%) gene mutations, which together account for approximately 40% of familial ALS in Turkey. No SOD1 mutations were detected in sALS patients; however, C9orf72 (3.1%) and UBQLN2 (0.6%) explained 3.7% of sALS in the population. Exome sequencing revealed mutations in OPTN, SPG11, DJ1, PLEKHG5, SYNE1, TRPM7, and SQSTM1 genes, many of them novel. The spectrum of mutations reflect both the distinct genetic background and the heterogeneous nature of the Turkish ALS population.