Can we use endocan level to determine severity of pancreatitis?

Background and study aims: Endothelial cell specific molecule-1 (ESM-1), also known as endocan, is a soluble proteoglycan secreted by human vascular endothelial cells. In some studies, it has been found that endocan have important effects on cell adhesion, inflammation and angiogenesis. In this study, we aimed to evaluate the endocan level in patients with pancreatitis and the availability of endocan level in determining the severity of the disease. Patients and methods: A total of 42 patients with pancreatitis and 33 healthy individuals were included in the study. The serum endocan levels in patients were evaluated 1st and 3 th days after the symptom's onset. Current scoring systems and the relationship between the severity of the disease and endocan levels were evaluated. Results: The endocan levels of the patients on day 1 are significantly correlated only with the APACHE II score (p=0.039 r=0.319), while the endocan values on day 3 are significantly correlated with the BISAP (bedside index of severity in acute pancreatitis) (p=0.013 r=0.380), APACHE II (Acute Physiology and Chronic Health Evaluation)(p<0.001; r=0.53) and Ranson (p=0.037 r=0.32) scores. The cutoff level of endocan (day 3) was calculated 92.2 pg/ml (83% sensitivity and 50% specificity; p=0.039 area under the curve 0.706) for severe pancreatitis when considering the patients with a score of 8 or higher in the APACHE II scoring system. Conclusion: Serum endocan level can be used as a marker of prognosis in patients with pancreatitis. However, studies involving large populations are needed on this matter.

A case of septicaemia, meningitis and pneumonia caused by Streptococcus bovis type II.

We present a case of septicaemia, pneumonia and meningitis due to Streptococcus bovis type-II in a patient who had undergone a total hip prosthesis under general anaesthesia three weeks earlier. This organism is an uncommon human pathogen that sometimes causes bacteraemia and endocarditis and is usually connected with colon pathology and dental procedures. In the reported case, there were no risk factors for S. bovis infection except for the hip operation. S. bovis type II sensitive to penicillin was isolated from all blood and pleural fluid cultures. The patient recovered and was discharged from hospital two weeks after presentation.

Epidemiological, clinical and laboratory features of brucellosis: a prospective evaluation of 120 adult patients.

This prospective study was carried out in the department of infectious diseases of Gaziantep University between January 1997 and December 1999 to evaluate the epidemiological, clinical and laboratory features of brucellosis in south-eastern Turkey. One hundred and twenty consecutive patients with active brucellosis were enrolled. The commonest way of transmission was ingestion of milk products from diseased animals. Brucella melitensis was isolated in the specimens of 31 (45.5%) of 68 patients. The commonest abnormalities on physical examination were fever (66.6%), hepatomegaly (63.3%) and splenomegaly (56.6%). Osteoarticular involvement was found in 34 patients (28.3%). Fifteen (12.5%) patients had ocular involvement. Hepatitis, orchiepididymitis, pulmonary involvement and meningitis were found in one (0.8%), four (6.8%), three (2.5%) and one (0.8) patient, respectively. The commonest haematological abnormalities were relative lymphomonocytosis (71.6%) and anaemia (36.6%). In conclusion, brucellosis continues to be a common health problem in communities where the consumption of unpasteurised dairy products is common. Since prevention is as important as early diagnosis in reducing the morbidity of brucellosis, we suggest that improving current health policies with additional educational programmes is essential.

A randomized clinical trial of topical paromomycin versus oral ketoconazole for treating cutaneous leishmaniasis in Turkey.

An open-labeled, randomized clinical trial to evaluate the efficacy of paromomycin ointment as compared with ketoconazole was conducted on seventy-two patients of both sexes and different ages with the confirmed diagnosis of cutaneous leishmaniasis (CL). All patients had a complete clinical evaluation for other diseases. Patients were excluded if they were pregnant or nursing or if they had serious concomitant diseases. Patients were divided randomly into two treatment groups: in the first group 40 patients were treated with an ointment containing 15% paromomycin sulfate and 12% methylbenzothonium chloride in white soft paraffin (labeled as p-ointment by El-On1) twice daily for 15 days. Treated lesions were left uncovered. The second group consisted of 32 patients who received ketoconazole 400 mg/day orally for 30 days. This dosage was reduced to 200 mg/day for patients below 12 years of age. In all cases the diagnosis was based on positive smear and/or culture. Direct smears were prepared from the exudate obtained by a small incision made at the edge of the lesion with a sterile surgical blade or lancet and stained using the Giemsa method for leishmania bodies (Fig 1). In smear negative and suspected cases aspirates taken by puncturing the lesions were inoculated onto NNN (Novy, McNeal, Nicolle) medium for culture. The cultures were incubated at 28 degrees C and the development of motile promastigotes was observed. Clinical and parasitological evaluations of the patients were performed at the end of the treatment period and 4 weeks post-treatment. A cure was defined as complete healing and disappearance of the lesion or reversible hypopigmentation at the site of lesion. Incomplete or partial improvement was defined as a reduction in the size of a lesion and the absence of parasites on smear or culture. A treatment failure was defined as the absence of any changes in the lesion and persistence of parasites on smear or culture.

Epididymo-orchitis due to brucellosis.

A diagnosis of epididymo-orchitis due to brucellosis was made in 13 patients between 1989 and 1991. Both testis and epididymis were involved in 8 patients, 3 had bilateral epididymo-orchitis and 2 presented with orchitis alone. Patients were treated with a combination of 200 mg doxycycline and 600 mg rifampicin daily for 6 weeks and complete resolution was achieved in 10.