Temporal Trends in the Epidemiology of HIV in Turkey.

OBJECTIVE: The aim of this study was to analyze the temporal trends of HIV epidemiology in Turkey from 2011 to 2016. METHODS: Thirty-four teams from 28 centers at 17 different cities participated in this retrospective study. Participating centers were asked to complete a structured form containing questions about epidemiologic, demographic and clinical characteristics of patients presented with new HIV diagnosis between 2011 and 2016. Demographic data from all centers (complete or partial) were included in the analyses. For the cascade of care analysis, 15 centers that provided full data from 2011 to 2016 were included. Overall and annual distributions of the data were calculated as percentages and the Chi square test was used to determine temporal changes. RESULTS: A total of 2,953 patients between 2011 and 2016 were included. Overall male to female ratio was 5:1 with a significant increase in the number of male cases from 2011 to 2016 (p<0.001). The highest prevalence was among those aged 25-34 years followed by the 35-44 age bracket. The most common reason for HIV testing was illness (35%). While the frequency of sex among men who have sex with men increased from 16% to 30.6% (p<0.001) over the study period, heterosexual intercourse (53%) was found to be the most common transmission route. Overall, 29% of the cases presented with a CD4 count of >500 cells/mm3 while 46.7% presented with a CD4 T cell count of <350 cells/mm3. Among newly diagnosed cases, 79% were retained in care, and all such cases initiated ART with 73% achieving viral suppression after six months of antiretroviral therapy. CONCLUSION: The epidemiologic profile of HIV infected individuals is changing rapidly in Turkey with an increasing trend in the number of newly diagnosed people disclosing themselves as MSM. New diagnoses were mostly at a young age. The late diagnosis was found to be a challenging issue. Despite the unavailability of data for the first 90, Turkey is close to the last two steps of 90-90-90 targets.

The microbiological diagnosis of tuberculous meningitis: results of Haydarpasa-1 study.

We aimed to provide data on the diagnosis of tuberculous meningitis (TBM) in this largest case series ever reported. The Haydarpasa-1 study involved patients with microbiologically confirmed TBM in Albania, Croatia, Denmark, Egypt, France, Hungary, Iraq, Italy, Macedonia, Romania, Serbia, Slovenia, Syria and Turkey between 2000 and 2012. A positive culture, PCR or Ehrlich-Ziehl-Neelsen staining (EZNs) from the cerebrospinal fluid (CSF) was mandatory for inclusion of meningitis patients. A total of 506 TBM patients were included. The sensitivities of the tests were as follows: interferon-γ release assay (Quantiferon TB gold in tube) 90.2%, automated culture systems (ACS) 81.8%, Löwenstein Jensen medium (L-J) 72.7%, adenosine deaminase (ADA) 29.9% and EZNs 27.3%. CSF-ACS was superior to CSF L-J culture and CSF-PCR (p <0.05 for both). Accordingly, CSF L-J culture was superior to CSF-PCR (p <0.05). Combination of L-J and ACS was superior to using these tests alone (p <0.05). There were poor and inverse agreements between EZNs and L-J culture (κ = -0.189); ACS and L-J culture (κ = -0.172) (p <0.05 for both). Fair and inverse agreement was detected for CSF-ADA and CSF-PCR (κ = -0.299, p <0.05). Diagnostic accuracy of TBM was increased when both ACS and L-J cultures were used together. Non-culture tests contributed to TBM diagnosis to a degree. However, due to the delays in the diagnosis with any of the cultures, combined use of non-culture tests appears to contribute early diagnosis. Hence, the diagnostic approach to TBM should be individualized according to the technical capacities of medical institutions particularly in those with poor resources.

Possible formation of chiral polarons in graphene.

A theoretical investigation of the possible existence of chiral polaron formation in graphene is reported. We present an analytical method to calculate the ground-state of the electron-phonon system within the framework of the Lee-Low-Pines theory. On the basis of our model, the influence of electron-optical phonon interaction on the graphene electronic spectrum is investigated. We considered only the doubly degenerate optical phonon modes of E(2g) symmetry near the zone center Γ. It is analytically shown that the energy dispersions of both valence and conduction bands of the pristine graphene differ significantly from those obtained through the standard electron self-energy calculations arising from the electron-optical phonon interactions. In this paper, we also show for the first time that the degenerate band structure of the graphene promotes the chiral polaron formation. Furthermore, due to the k-dependent nature of the polaronic self-energy, in analogy with quantum chromodynamics, we also propose a running electron-phonon coupling constant as a function of energy.

Efficacy of levamisole on experimental endometriosis.

OBJECTIVE: To investigate the efficacy of levamisole on experimental endometriosis. METHODS: After the implantation of endometrial tissue on abdominal peritoneum, 40 rats were randomized to 1 of 4 equal intervention groups. Levamisole (2 mg/rat) was applied subcutaneously to group "L" once a week. Depot medroxyprogesterone acetate (3 mg/kg) was applied intramuscularly to group "M" twice at 4-week intervals. Leuprolide (0.075 mg/kg) was applied subcutaneously to group "G" twice at 4-week intervals. Saline (0.1 cm(3)/rat) was applied subcutaneously to group "C" once a week for 8 weeks. The efficacy of levamisole was determined by volume measurement and characterizing the histological structure of the implants. RESULT: Volume increase of the implants in group C (P<0.05), and volume decrease in groups M, G, and L was found (P<0.05, P<0.01, and P<0.01, respectively.) Stromal tissue and glandular activity were not different between groups L and G. CONCLUSION: Levamisole was found to be as effective as leuprolide in regression of the volume of endometriotic implants.

Fas (CD95) and bcl-2 expression in active skin lesions of Behçet's disease.

Over-expression of bcl-2 in lymphocytes has an important role in some immunological and inflammatory diseases. Fas (CD95) is a cell surface molecule that mediates receptor-triggered apoptosis in various cells including autoreactive T cells. In this study we investigated bcl-2 and Fas (CD95) expression in dermal lymphocytes in active skin lesions of Behçet's disease (BD) and in skin biopsy samples with chronic, non-specific inflammations. Tissue sections of 29 skin lesions of Behçet's disease and of 10 chronic non-specific inflammatory process cases from the archives of the Ondokuz Mayis University's Pathology Department were immunohistochemically stained for bcl-2 and Fas (CD95), and lymphocytes in the dermal infiltrate were evaluated for cytoplasmic staining. bcl-2 staining was observed in the skin lesions of 22 cases (75.8%) of Behçet's disease. bcl-2 staining was detected in two (20%) control skin biopsy samples with non-specific chronic inflammation. Fas (CD95) positivity was not detected in lymphocytes in Behçet's disease-related skin lesions. Fas (CD95) staining was observed in only three skin biopsy samples with non-specific chronic inflammation. bcl-2 and Fas (CD95) staining values in Behçet's and non-specific inflammation groups were significantly different (P < 0.01); differences in the bcl-2 staining values between Behçet's patients with mucocutaneous involvement only and mucocutaneous and other systemic involvements were not significant (P > 0.05). Expression of bcl-2 and loss of Fas (CD95) expression in dermal lymphocytes may play a role in the development of skin lesions and may account for the chronic course with periodic exacerbations in BD.

Primary-adenocarcinoma of Bartholin's gland: a case report.

Up to now, about 300 primary adenocarcinoma carcinomas of Bartholin's gland have been reported in the literature. A new case of a 57-year-old woman with primary carcinoma of Bartholin's gland is reported. The patient underwent radical vulvectomy and has been healthy for 18 months.

Overexpression of bcl-2 in lymphocytes of psoriatic skin.

Bcl-2 overexpression in lymphocytes play an important part in immunological and inflammatory diseases. In the present study, we investigated the bcl-2 expression in dermal lymphocytes of psoriatic skin biopsy samples. From the archives of the Department of Pathology, Ondokuz Mayis University Medical School (Samsun, Turkey), tissue sections belonging to 28 psoriasis cases and 10 chronic non-specific inflammatory skin disease cases were immunohistochemically stained by bcl-2. Positive staining was semiquantitatively graded from 1+ to 4+. Of the 28 psoriasis cases 20 were found to express bcl-2. Our data suggest that bcl-2-mediated inflammation plays a part in the pathogenesis and recurrent character of psoriasis.

Correlation of proliferating cell nuclear antigen and bcl-2 expression with tumor front grading and metastasis in laryngeal squamous cell carcinoma.

This study was designed to examine the immunohistochemical expression of proliferating cell nuclear antigen (PCNA) and bcl-2 protein in 45 cases with advanced laryngeal squamous cell carcinoma who had undergone total laryngectomy with unilateral modified radical neck dissection, and the relation of this expression to some prognostic factors such as tumor front grading and neck lymph node metastases. Sections were reevaluated for routine histologic grade, tumor front grading and neck lymph node metastases, and were stained with monoclonal antibodies against PCNA and bcl-2. Significant correlation was present between the severity of PCNA expression and incidence of lymph node metastasis (p<0.05). No correlation was found between the severity of PCNA expression and tumor front grading. Bcl-2 expression did not associate with either parameters. In conclusion, PCNA is important in predicting prognosis and no association is present between the bcl-2 protein expression and prognostic factors.

Histopathological evaluation of the connective tissue of the vaginal fascia and the uterine ligaments in women with and without pelvic relaxation.

This study aimed to compare connective tissue components within the uterine ligaments histopathologically in women with and without pelvic relaxation. The tissue samples obtained from the histopathologic specimens of 24 patients with uterine descensus who underwent vaginal hysterectomy and from twenty-one patients with no pelvic relaxation, in whom total abdominal hysterectomies were performed for benign reasons, were used as the study and control groups, respectively. From each hysterectomy material, samples for histological examination were taken from the vaginal fascia and from the cardinal, the uterosacral and the round ligaments (4 samples for each patient). The amount of collagen, cellularity and elastic fibers within the connective tissue were evaluated and scored by the co-author pathologist. Mann-Whitney U and Student t tests were used for the statistical analysis. The patients with pelvic relaxation had significantly higher scores of collagen and fewer scores of cellularity within the connective tissue samples, compared with the ones without relaxation (p < 0.01, p < 0.01). It was concluded that decreased fibroblasts and increased collagen content might be the key factors associated with pelvic support disorders.

Is Bone-wax an injectable urologic material?

OBJECTIVE: Injection of endoscopic material for reflux and incontinence therapies became popular in urology because of its simplicity and repeatability. Research is going on to develop an ideal injectable material. In this experimental study we investigated whether the bone wax used for osteotomy hemostasis in orthopedic and neurosurgical operations could be used as an injectable material. MATERIALS AND METHODS: A total of 20 rabbits were included in the study: 6 underwent a sham operation, and in the remaining 14 rabbits, 0.5 ml bone wax liquefied with n-butyl acetic acid was injected submucosally via a 20-gauge needle at three different points on the anterior bladder wall. Cystectomy was performed on the 15th day in 2 rabbits (group I), on the 60th day in 2 (group II) and on the 150th day in 10 (group III). 0.20 ml bone wax was also injected subcutaneously and intramuscularly 7 days before cystectomy in group III. Bladders were examined macroscopically and histopathologically. All animals' lungs, livers, kidneys, spleens and brains were also removed and examined histologically. RESULTS: Submucosal swellings of bone wax maintained their localizations and shapes in all groups and all of the 42 bone-wax injection sites could be easily identified. Histologically, slight edema around the implant was seen in group I. In group II, collagen was increased around the implants and minimal hyperplasia of the epithelium overlaying bone wax was noted. 150 days after the injections, moderate collagen production and a mild increase in vascularity were seen around the implants. There was no macroscopic or microscopic evidence that implants migrated to locations other than the injection sites. CONCLUSIONS: When injected to the bladder submucosa, bone wax seems to be inert and biocompatible, encouraging further research to develop it as an alternative agent in the endoscopic treatment of vesicoureteral reflux and sphincteric incontinence.

p53 and bcl-2 overexpression as associated risk factors in patients 40 years old or less with transitional cell carcinoma of the bladder.

OBJECTIVES: Transitional cell carcinoma (TCC) of the bladder in younger patients has historically a favourable prognosis. bcl-2 and p53 genes are implicated in cell cycle regulation with roles on programmed cell death. Presence of nuclear accumulation of p53 and cytoplasmic accumulation of bcl-2 were proposed to confer a growth advantage to tumour cells. In this study, we investigated the roles of p53 and bcl-2 as prognostic factors in TCC of bladder in patients younger than 40 years. PATIENTS AND METHODS: From 1986 to 1998, 25 patients younger than 40 years were treated for TCC of bladder in our hospital. Of the tumour specimens, 24 were adequate for evaluating p53 and bcl-2 oncoproteins (group I). As a control (group II), we randomly selected 30 patients older than 50 years treated for bladder cancer in this period. Two oncoproteins were detected by immunohistochemical analysis in paired tumour tissue specimens in both groups. Retrospectively obtained clinical follow-up data were available, with a mean follow-up of 44 and 25.5 months in groups I and II, respectively. Relations between tumour recurrences and progression with positivity of bcl-2 and p53 were investigated. RESULTS: Expression of bcl-2 was observed in 13 (54.1%) and 11 (36.7%) and nuclear p53 accumulation in 9 (37.5%) and 17 (56.7%) of groups I and II, respectively. In the presence of p53 expression, tumours showed significantly more progression in group I (55 vs. 6.7%) and group II (41.1 vs. 0%). Recurrence rates were not significantly different in tumours with and without nuclear p53 overexpression in both groups. Also, recurrence and progression rates were not significantly different in tumours with and without cytoplasmic bcl-2 overexpression in both groups. Grade (G) and stage appeared as important prognostic factors in both groups since 60% of GIII tumours showed progression in group I, but none of GI and GII tumours. Similarly, 75% of T3 tumours progressed, while these rates were 25 and 25% for T1-T2 tumours in group I. In group II, 31.2, 25 and 0% of GIII, GII and GI tumours progressed, while 50, 41.6 and 0% of T3, T2 and T1 tumours progressed, respectively. CONCLUSIONS: Nuclear p53 expression in TCC appears to be associated with a poorer prognosis in both younger and older patients. Although cytoplasmic bcl-2 overexpression is found in the majority of tumours in the younger group, it is not associated with tumour progression and recurrence.

Expression of bcl-2 protein in active skin lesions of Behçet's disease.

BACKGROUND: Expression of bcl-2 protein has been shown to play an important role in the pathogenesis of some inflammatory as well as neoplastic disorders. In this study we have investigated the presence of bcl-2 protein in active skin lesions of Behçet's disease and compared these results with normal skin samples of Behçet's disease (BD) patients and BD unrelated leukocytoclastic vasculitis. METHODS: Active skin lesions of 23 Behçet's disease patients, normal skin samples of seven Behçet's disease patients, and archival biopsy specimens of 23 cutaneous leukocytoclastic vasculitis were investigated for the presence of bcl-2 protein by immunohistochemical methods. Results of staining were assessed semiquantitatively. Chi-square tests were used for statistical analysis. RESULTS: Expression of bcl-2 protein were demonstrated in 16 of 23 (69.5%) and 8 of 23 (34.7%) patients with Behçet's disease and leukocytoclastic vasculitis, respectively. There were statistically significant difference between two groups (x2 = 4.27, P < 0.05). None of the normal skin samples of Behçet's disease patients showed bcl-2 expression. CONCLUSION: Expression of bcl-2 protein may play a particular role in the development of skin lesions in Behçet's disease by causing prolonged survival of infiltrating lymphocytes.

Giant adrenal myelolipoma: case report and review of the literature.

Myelolipoma is a tumor-like growth composed of mature fat tissue and bone marrow elements. It occurs in the adrenal gland or as an isolated soft tissue mass. It may be associated with endocrine disorders such as hermaphroditism, Cushing's disease, Addison's disease and obesity of unknown cause. These lesions rarely measure more than 5 cm in diameter, although giant tumors have been reported in the literature. The fifth largest surgically resected adrenal myelolipoma in the literature is reported and its clinical associations and, macroscopic and microscopic features are discussed.

Effect of vitamin E and pentoxifylline on glycerol-induced acute renal failure.

The pathogenesis of acute renal failure may involve, among other causes, ischemia, vascular congestion, arachidonic acid pathways, and reactive oxygen metabolites. The aim of this study is to evaluate the effects of pentoxifylline and vitamin E on the prevention of experimental acute renal failure induced by glycerol. Eighty-five Sprague-Dawley rats weighing 170-230 g were included in the study. The rats were randomly divided into four groups: group 1 was given 1 ml saline; group 2, glycerol; group 3, glycerol plus vitamin E, and group 4, glycerol plus pentoxifylline. Extent of histological renal tubular necrosis and regeneration in each animal were graded. Blood urea nitrogen, serum creatinine, and creatine kinase concentrations were measured. Mean blood urea nitrogen and serum creatinine concentrations and tubular injury scores were significantly lower in group 1 than in groups 2-4 (p < 0.001), but there were no significant differences among groups 2-4. We conclude that postinsult administration of vitamin E and pentoxifylline does not have a beneficial effect on prevention and severity of acute renal failure and that controlled, multicenter studies involving a large number of patients are needed to clarify this subject.

Behcet's disease and AA-type amyloidosis.

Behcet's disease (BD) is a multisystem disorder characterized by vasculitis. To our knowledge, 52 patients with BD and amyloidosis have previously been described in the literature. Nephrotic syndrome was the most common type of presentation of amyloidosis in these patients. The prognosis of patients with BD and amyloidosis has not been reported before. In this report, we present a patient with BD and AA-type amyloidosis and analyze the prognosis in these patients. Follow-up and prognosis have been reported in 23 patients. Ten of these 23 patients died and most of these deaths occurred within 3 months after the diagnosis of amyloidosis. End-stage renal disease developed shortly in 4 patients. BD should be considered in the differential diagnosis of AA amyloidosis. In conclusion, the cases with BD and amyloidosis carry poor prognosis.

Relationship between endomyometritis and the duration of premature membrane rupture.

In this study, correlation between duration of premature rupture of the membranes (PROM) and the degree of membrane, decidua, and myometrium infections were histologically investigated. The study was carried on 61 women with term pregnancy (30 with PROM, 31 control group). During cesarean section, a full-thickness biopsy specimen of the uterine wall from serosa to decidua was obtained with scissors. Chorioamnionitis was histopathologically identified by neutrophilic leukocyte (NL) infiltration of the membranes. Endometritis or myometritis were diagnosed when the acute inflammatory process extended to the decidua or the myometrium successively. It was found that the presence and depth of NL infiltration significantly correlates with the interval between rupture of membranes and termination of pregnancy.

Hepatitis C in haemodialysis and nonuraemic patients: a histopathological study.

Hepatitis C virus (HCV) is the major cause of posttransfusion non-A, non-B hepatitis. Haemodialysis patients carry the risk of HCV infection. The aim of this study is to compare the morphological changes related to chronic HCV infection found in haemodialysis and nonuraemic patients. Liver biopsies from nine haemodialysis patients and 37 patients with normal renal function were studied. This study shows that haemodialysis patients may have less active and progressive chronic hepatitis C than patients with normal renal function. The number of patients in this study is limited, therefore further studies are needed for definite conclusion.