Foot deformities in rheumatoid arthritis patients and their effects on foot functions.

OBJECTIVE: Foot problems are common clinical disorders in patients with Rheumatoid Arthritis (RA). The aim of this study was to investigate the frequency and impact of foot and ankle problems in patients with RA. PATIENTS AND METHODS: A total of 164 feet of 82 RA patients with a diagnosis of one year or more were evaluated. Deformities including HV, CT, SF, PC, PP, MPS, MPV, and HT were examined in all RA patients. The Foot Function Index was used to measure the impact of these deformities on pain, disability, and movement limitations. Radiological changes were measured using the modified Larsen score. RESULTS: The frequency of deformity in RA patients was found to be 95.1%, with HV deformity being the most common at 84.1%. There was a statistically significant relationship between SF, HV, PP, and PC deformities and disease duration. In our sample of 82 patients, 70 (85.3%) reported past or present foot pain complaints. The most common site of pain was the ankle joint, with 44 (53.7%) patients experiencing ankle pain. A statistically significant increase in the frequency of ankle pain was found as DAS28 scores, body mass index (BMI), and disease duration increased. There was also a correlation between an increase in DAS28 scores and the frequency of forefoot pain. A significant correlation was found between MPV, HV, PP, and PC deformities and high FFI scores. Larsen radiological scores were not correlated with foot-ankle pain or duration of pain. CONCLUSIONS: These findings suggest that foot deformities are common in RA, and it is important to address them early in the disease course to minimize functional disability and improve quality of life.

The role of oxidized phospholipids in COVID-19-associated hypercoagulopathy.

OBJECTIVE: There is more pronounced hypercoagulation in COVID-19 infection than in other viral lung infections. Oxidized phospholipids (OxPLs) appear in COVID-19-infected lungs due to oxidative stress, after which they promote the induction of tissue factor (TF) expression and inflammatory programmers in monocytes, as well as activate endothelial cells to recruit and bind to monocytes. Therefore, we aimed to demonstrate the role of OxPLs in inflammatory and procoagulant responses in COVID-19 infection. PATIENTS AND METHODS: Patients with a positive SARS-CoV-2 polymerase chain reaction test and ten healthy donors were included in the study. Peripheral blood was drawn at inclusion for OxPAPC, IFN-γ, and CCL2 serum level measurements. Clinical data were collected from electronic patient medical files. The serum levels of OxPAPC, IFNγ, and CCL2 were measured by immune assays. RESULTS: Seventy-two patients were included in the study. OxPAPC and CCL2 were higher in the patients than in the controls (<0.003 and 0.011, respectively). INF-γ did not significantly differ between groups. There was no difference between the patients with lung involvement and those without CCL2, INF-γ, and OxPAPC. D-dimer, CRP, and ferritin were higher in the patients with lung involvement. Serum levels of INF-γ and CCL2 were positively correlated with each other (r:0.757, p<0.0001), but no correlation was detected between OxPAPC and INF-γ or CCL2. There was no correlation between OxPAPC and hematologic or biochemical parameters. CONCLUSIONS: OxPAPC, which is thought to contribute to hypercoagulability, was found to be high in the patients with Covid-19 infection. The role of OxPLs in COVID-19-associated hypercoagulopathy should be investigated further in experimental models and in larger patient groups.

Upflow packed bed Anammox reactor used in two-stage deammonification of sludge digester effluent.

The sludge digester effluent taken from a full scale municipal wastewater treatment plant (WWTP) in Istanbul, Turkey, was successfully deammonified using a laboratory scale two-stage partial nitritation (PN)/Anammox (A) process and a maximum nitrogen removal rate of 1.02 kg N/m3/d was achieved. In the PN reactor, 56.8 ± 4% of the influent NH4-N was oxidized to NO2-N and the effluent nitrate concentration was kept below 1 mg/L with 0.5-0.7 mg/L of dissolved oxygen and pH of 7.12 ± 12 at 24 ± 4°C. The effluent of the PN reactor was fed to an upflow packed bed Anammox reactor where high removal efficiency was achieved with NO2-N:NH4-N and NO3-N:NH4-N ratios of 1.32 ± 0.19:1 and 0.22 ± 0.10:1, respectively. The results show that NH4-N removal efficiency up to 98.7 ± 2.4% and total nitrogen removal of 87.7 ± 6.5% were achieved.

Hepatitis A seroprevalence in children and young adults in Istanbul, Turkey: seroprevalence change and associated factors.

Hepatitis A is a widespread infectious disease. The prevalence of the disease is closely related to socioeconomic status (SES) and environmental factors. Understanding its prevalence is essential for instituting appropriate precautions. The aim of this study was to determine the prevalence of hepatitis A and evaluate the associated demographic features in children and young adults in Istanbul. In total, 630 individuals between the ages of 5-24 were included in the study. They were classified into four age groups (5-9, 10-14, 15-19 and 20-24 years). The seropositivity of hepatitis A in the whole study population was 40%. Age-specific prevalence was 11.4% in children 5-9 years old, 29% in those 10-14 years old, 49.7% in those 15-19 years old and 69% in those 20-25 years old. Seropositivity was associated with increasing age, low SES, large family size, low maternal educational level, use of unsafe drinking water and living in regions with poor infrastructure and incomplete urbanization. When we compared our results with previous seroprevalence studies performed in Istanbul, we found an epidemiological shift towards increasing age. Factors associated with changes in prevalence were urbanization and associated infrastructure improvement, knowledge of the disease by the population, use of good hygiene and use of vaccination in those at high risk.

Bloodstream infections in a medical-surgical intensive care unit: incidence, aetiology, antimicrobial resistance patterns of Gram-positive and Gram-negative bacteria.

In the present study, the incidence and antimicrobial resistance patterns of the microorganisms that caused bloodstream infections (BSIs) in a medical-surgical intensive care unit during the years 2005-2007 were determined. The mean BSI incidence density was 6.56 per 1000 patient-days. The incidence density increased linearly during the study period (from 3.57 to 9.60 per 1000 patient-days). Staphylococcus aureus was most frequently isolated (47.3%), followed by Enterococcus spp. (10.8%) and Candida spp. (10.1%). There was a high rate of resistance to several of the prescribed antimicrobials among the bacteria isolated from patients with BSIs.

Bacterial brain abscesses: prognostic value of an imaging severity index.

AIM: To assess the correlation between imaging findings [computed tomography (CT) or magnetic resonance imaging (MRI)] and neurological status before and after the treatment of bacterial brain abscesses. MATERIALS AND METHODS: CT and MRI images of 96 patients with brain abscesses were retrospectively evaluated in terms of the number, location and size of lesions, and the presence and extent of perilesional oedema and midline shift. An imaging severity index (ISI) based on these different radiological parameters was calculated. Initial Glasgow Coma Scale (GCS) scores and ISI were assessed and the prognostic value of these two indices was calculated. The Pearson correlation test, Mann-Whitney test, Chi-square test, receiver-operating characteristic (ROC) analysis, together with comparison of ROC analyses and Fisher's exact test were used. RESULTS: There was a negative correlation between ISI and the initial GCS values: ISI increased as the GCS score decreased, indicating an inverse relationship (r=-0.51, p<0.0001). There was a significant difference between the ISI and GCS scores of patients with an adverse event compared with patients with good recovery. Outcome was significantly worse in patients with initial ISI over the calculated cut-off values of 8 points or GCS scores under the cut-off value of 13 points. CONCLUSION: ISI is a useful prognostic indicator for bacterial brain abscess patients and correlates strongly with the patient outcome for all parameters studied. ISI score had a better prognostic value than GCS.

Posterior leukoencephalopathy after combination chemotherapy in a patient with lymphoma.

Posterior leukoencephalopathy syndrome is a recently described syndrome involving mainly parieto-occipital gray/white matter of the brain. It occurs secondary to various clinical entities, like hypertension and immunosuppressive therapy. Few cases after combination chemotherapy have been reported. This study describes a 36-year-old woman with primary refractory T-cell lymphoma, who developed central nervous system toxicity due to treatment with intrathecal methotrexate and intravenous ifosfamide, idarubicine and etoposide given as a salvage regimen. Both clinical features as well as magnetic resonance imaging findings were typical for posterior leukoencephalopathy syndrome. The patient died despite anti-hypertensive therapy and haemodialysis. Central nervous system toxicity related to chemotherapeutics and posterior leukoencephalopathy syndrome are discussed briefly.

Study of visual evoked potentials in the assessment of the central optic pathways in leprosy patients.

We evaluated the possible involvement of central optic pathways (COP) in leprosy patients with visual evoked potentials, an easy, sensitive and reliable noninvasive method for evaluation of COP. In 37 patients with lepromatous leprosy and in 37 age-matched controls, we measured reversal pattern visual evoked potentials (RP-VEP) and nerve conduction parameters. The mean latency value of positive peak P100 in leprosy patients was significantly delayed compared to that of controls (patients, 108.02+/-9.61 ms in left eye and 108.23+/-8.51 ms in right eye; controls, 96.22+/-4.20 ms in left eye and 95.75+/-4.03 ms in right eye; p<0.05). Abnormally delayed P100 latency was recorded in 5 of 37 leprosy patients (13.5%). The mean amplitude of P100 latency in leprosy patients was smaller than that of controls (patients, 8.7+/-5.6 micro V in left eye and 9.5+/-4.8 micro V in right eye; controls, 10.7+/-4.6 micro V in left eye and 10.5+/-5.1 micro V in right eye), but this difference was not significant. No correlation was observed between abnormalities of RP-VEP and sensorimotor nerve conduction parameters. This study suggests that involvement of COP may develop in patients with lepromatous leprosy. RP-VEP measurement, which can be easily and rapidly performed in an EMG laboratory using standard equipment, can show these alterations.

Study of visual evoked potentials in the assessment of the central optic pathways in leprosy patients

We evaluated the possible involvement of central optic pathways (COP) in leprosy patients with visual evoked potentials, an easy, sensitive and reliable noninvasive method for evaluation of COP. In 37 patients with lepromatous leprosy and in 37 age-matched controls, we measured reversal pattern visual evoked potentials (RP-VEP) and nerve conduction parameters. The mean latency value of positive peak P100 in leprosy patients was significantly delayed compared to that of controls (patients, 108.02+/-9.61 ms in left eye and 108.23+/-8.51 ms in right eye; controls, 96.22+/-4.20 ms in left eye and 95.75+/-4.03 ms in right eye; p<0.05). Abnormally delayed P100 latency was recorded in 5 of 37 leprosy patients (13.5%). The mean amplitude of P100 latency in leprosy patients was smaller than that of controls (patients, 8.7+/-5.6 micro V in left eye and 9.5+/-4.8 micro V in right eye; controls, 10.7+/-4.6 micro V in left eye and 10.5+/-5.1 micro V in right eye), but this difference was not significant. No correlation was observed between abnormalities of RP-VEP and sensorimotor nerve conduction parameters. This study suggests that involvement of COP may develop in patients with lepromatous leprosy. RP-VEP measurement, which can be easily and rapidly performed in an EMG laboratory using standard equipment, can show these alterations.

The influence of information on social and occupational outcome in mental illness on the attitudes of students in Turkey.

BACKGROUND: In this article, we have tried to evaluate the influence of a series of determinants of stigmatization of mental illness. METHOD: 700 final year students of a University in Istanbul were asked to read one of 14 different hypothetical case stories. The stories contained different combinations of characteristics assumed to play a role in stigmatization. Each vignette was presented to 50 students. The stories were collected after five minutes and the following scales were completed: Characteristics Scale and Skill Assessment Scale. Analysis was conducted on each scale. RESULTS: We found a statistically significant difference among the groups given different hypothetical cases (vignettes). According to the post-hoc analysis, only the subjects given the vignette in which social and occupational outcome information were lacking showed statistically significant difference from the rest of the population. CONCLUSION: This study suggests that information on social and occupational outcome of mental illness influences the general perception of the mentally ill.

The effect of asphyxia on gut blood flow in term neonates.

Transcutaneous Doppler ultrasound measurements were made of the superior mesenteric artery of 25 term infants to correlate the intestinal blood flow with neonatal acid-base status as measured in umbilical artery blood and newborn condition as reflected by Apgar score. Compared with the babies whose umbilical artery pH was higher than 7.20 (peak systolic velocity: 84.1 cn/sn, mean velocity 48.6 cm/sn), the blood flow of superior mesenteric artery was significantly decreased in the newborn babies whose umbilical artery pH was less than 7.20 (peak systolic velocity 48.8 cm/sn, mean velocity = 32.6 cm/sn). Although no such relationship existed between Apgar scores and superior mesenteric artery blood flow indices, a significant linear correlation between superior mesenteric artery blood flow and umbilical artery pH was noted. A reduction of intestinal circulation was observed during umbilical cord blood acidemia and hypoxemia.

Bactericidal activity of the fluoroquinolone DU-6859a alone and in combination with other antimicrobial agents against multiresistant enterococci.

The in vitro activity of DU-6859a (DU) alone and in combination with various antimicrobials was evaluated against multiresistant enterococci including some isolates with defined gyrA mutations. DU produced rapid in vitro killing against most enterococci that lacked resistance to ciprofloxacin, but it was not bactericidal against strains with MICs of ciprofloxacin of > or = 8 micrograms/ml, or against one of four strains with an MIC of ciprofloxacin of 4 micrograms/ml. The combination of DU with rifampin was antagonistic against two of two isolates tested. Combinations of DU and novobiocin, gentamicin, or a beta-lactam (amoxicillin, ampicillin-sulbactam, or amoxicillin-clavulanate) were generally indifferent. When different beta-lactams were used together, with or without DU, bactericidal activity was observed against some isolates. Despite the absence of synergistic interactions with other agents, DU is a promising fluoroquinolone for use against enterococci, although prior development of resistance to currently available fluoroquinolones diminishes some of its effect.

Synthetic bactericidal peptide based on CAP37: a 37-kDa human neutrophil granule-associated cationic antimicrobial protein chemotactic for monocytes.

CAP37 (cationic antimicrobial protein of molecular mass 37 kDa) is a multifunctional protein isolated from the granules of human neutrophils. It is antibiotic and chemotactic and binds lipopolysaccharide. A synthetic peptide, amino acid sequence NQGRHFCGGALIHARFVMTAASCFQ, based on residues 20-44 of CAP37 protein mimics its antibiotic and lipopolysaccharide binding action. Peptide 20-44, at the concentrations tested, has antibacterial activity against Salmonella typhimurium, Pseudomonas aeruginosa, Escherichia coli, Enterococcus faecalis, and Staphylococcus aureus. The bactericidal action of the peptide was pH dependent, with maximum activity at pH 5.0 and pH 5.5 and decreased activity at pH 7.0. Various truncations, substitutions, and other modifications in the sequence deteriorate its activity. Free sulfhydryl groups and/or disulfide bridge formation are required for optimum antibiotic activity, since substitution of serines for, or alkylation of, cysteine residues 26 and 42 eliminates bactericidal activity. Evidently amino acids 20-44 represent an important, perhaps principal, antibacterial domain of CAP37. This peptide should provide new insight into the mechanism of antimicrobial activity of CAP37 and may serve as a model for new, useful, synthetic antibiotics.