The relationship between the severity of intellectual and developmental disabilities (IDDs) in adults with IDDs and eating and drinking problems and nutritional status.

BACKGROUND: Adults with intellectual and developmental disabilities (IDDs) experience eating, drinking and swallowing problems, such as chewing problems, choking, gagging, coughing during eating, aspiration and rumination syndrome, which may lead to poor nutritional status. This study aimed to determine the relationship between IDD levels, eating, drinking and swallowing problems and nutritional status in adults with IDDs. METHODS: The sample consisted of 71 participants (37 men and 34 women) with a mean age of 22.5 ± 7 years (range 18-60 years). Professionals classified intellectual disability as mild, moderate or severe. The Screening Tool of Feeding Problems scale was applied to the caregivers of adults with IDDs to identify eating, drinking and swallowing problems. Dietary intake was assessed using a 24-h dietary recall and a food and nutrition photograph catalogue. The researchers measured body weight, height and middle upper arm circumference. Body mass index was calculated. Four body mass index categories were determined: underweight (<18.5 kg/m2 ), normal weight (18.5-24.9 kg/m2 ), overweight (25.0-29.9 kg/m2 ) and obese (≥30 kg/m2 ). Chi-squared tests were used to detect the relationship between IDD levels and eating and drinking problems, and analysis of variance tests were conducted to detect the relationship between IDD levels with anthropometric measurements and dietary intake. RESULTS: Participants had mild (42.3%; n = 30), moderate (29.6%; n = 21) or severe IDD (28.2%; n = 20). They were underweight (12.7%; n = 9), normal weight (59.2%; n = 42) or overweight and/or obese (28.2%; n = 20). Participants with severe IDD had significantly higher Screening Tool of Feeding Problems 'nutrition-related behaviour' and 'eating and drinking skill deficit problem' sub-scale scores than those with mild IDD. However, the groups had no significant difference in 'food refusal and selectivity' sub-scale scores. Participants with severe IDD also had anorexia prevalence similar to those with mild IDD. The groups did not significantly differ in anthropometric measurements, daily energy intake and macronutrient and micronutrient intake. CONCLUSIONS: While adults with severe IDD had more eating and drinking skill deficits (e.g. chewing problems and independent eating difficulties) and nutrition-related behaviour problems than those with mild IDD, the eating, drinking and swallowing problems, which may critically affect their food intake, were similar to adults with mild IDD. The anthropometric measurements and energy and nutrient intakes of adults with severe IDD were not significantly different from those with mild IDD consistently. Findings indicate that nutritional deficiencies and nutritional behaviour problems may be avoidable in adults with IDDs.

Sandfly surveillance and investigation of Leishmania spp. DNA in sandflies in Kosovo.

In the past decade, leishmaniasis seems to be re-emerging in Balkan countries. There are serious implications that Kosovo is a visceral leishmaniasis endemic region with autochthonous transmission; nevertheless, surveillance of vectors, reservoirs or the disease is not yet established. Gaining knowledge about sandfly vector species is a prerequisite for the development of a monitoring and control plan in the future. After a long gap in research of over 70 years, sandfly studies in Kosovo were resumed in 2014. During this presence/absence study, nine sandfly species were detected: Phlebotomus papatasi, Ph. perfiliewi, Ph. tobbi, Ph. neglectus, Ph. simici, Ph. balcanicus, Ph. alexandri, Ph. mascittii and Sergentomyia minuta. Three species are new with regard to the fauna of Kosovo - Ph. alexandri, Ph. balcanicus and Ph. mascittii. Besides increased diversity, changes in the number of collected specimens and distribution range of species were recorded, with Ph. neglectus being the most dominant species with the widest distribution. Testing of randomly chosen females for Leishmania spp. DNA resulted the in detection of L. tropica in a specimen of Ph. neglectus. The presence of numerous vector species in the sandfly fauna of Kosovo pose a threat for the re-emergence of vector-borne diseases. Therefore, continuous surveillance is recommended with regular updates on vector distribution and abundance.

An update on Toscana virus distribution, genetics, medical and diagnostic aspects.

BACKGROUND: Toscana virus is an arbovirus transmitted by sand flies within the Mediterranean area where it can cause febrile illness and neuroinvasive infections during the seasonal circulation period of the vector. Although it is an important cause of meningitis and encephalitis, it remains a neglected virus with limited published data, as demonstrated by <250 peer-reviewed articles since the 1970s. OBJECTIVE: The last review article on Toscana virus was published in 2012. The aim was to compile peer-reviewed articles to provide an updated review highlighting recent findings to complement previous review articles. SOURCES: PubMed database was searched using the 'Toscana virus' keyword from 2010 to present. A total of 152 articles were retrieved and identified studies were assessed for novel information on virus genetics, and geographic and medical aspects compared with existing knowledge reported in previous review articles. CONTENT: Studies addressing medical, veterinary and entomological aspects have provided evidence that Toscana virus is present in North Africa, in the Balkan Peninsula, and in most of the Mediterranean islands. Besides the two previously recognized genetic lineages, a novel evolutionary lineage has been identified in the Balkan Peninsula. Co-circulation of two genetic lineages has been demonstrated in France, in Turkey and in Croatia. In addition to meningitis and meningo-encephalitis, which have been reported for 40 years, various neuroinvasive forms have been recently reported such as Guillain-Barré syndrome, hydrocephalus, myositis, fasciitis, polymyeloradiculopathy, deafness and facial paralysis. IMPLICATION: Because it is endemic in countries bordering the Mediterranean, physicians should include Toscana virus in the differential diagnosis of patients presenting with febrile illness and/or neurological manifestations.

Relationship of Popliteus Sulcus Depth and Tibiofemoral Rotational Alignment with Popliteus Tendinitis in Professional Folk Dancers Exposed to Turnout Positions: An MRI Analysis.

AIMS: The popliteus musculotendinous unit plays the major role in range of motion, rotation and stabilization of the knee. Frequent repetition of the rotational strains such as turnout in dancers may be the cause of popliteus tendinitis. In addition, popliteus sulcus depth (PSD) and PSD/lateral condyle width (LCW) ratio are also highly related with popliteal tendinitis in professional folk dancers. In this study, we evaluated the association between clinically diagnosed popliteus tendinitis and PSD with analysis of the PSD/LCW ratio as measured on MRI and tibiofemoral rotational alignment in professional folk dancers. This study was intended to clarify any anatomical liability to popliteal tendinitis in professional folk dancers. Therefore, we looked for the anatomical variances affecting popliteal musculotendinous unit. METHODS: Thirty-two MRI scans from 32 members of a professional folk dance group (mean age 30.2±7.9 yrs, range 18-38) were analyzed retrospectively. Popliteal tendinitis was detected in 5 knees (5 dancers). The relationship of popliteal tendinitis to the tibiofemoral rotational angles (condilary twist angle, posterior codilary angle, posterior tibiofemoral angle), PSD, and PSD/LCW ratio were investigated. RESULTS: The popliteus tendinitis group had statistically significantly higher PSD and PSD/LCW ratio than the group without popliteal tendinitis (p=0.0001). There was no statistically significant difference between the two groups in the tibiofemoral rotational angles. CONCLUSION: In addition to long hours of practice and the turnout position, PSD and PSD/LCW ratio can place the professional folk dancer at increased risk for popliteus tendon injury.

Neglected vector-borne bacterial diseases and arboviruses in the Mediterranean area.

Arthropod vectors can transmit pathogenic microorganisms from one vertebrate to another during their blood meal. Although some vector-borne diseases have been eradicated in the Mediterranean area, such as malaria and dengue, recent endemic microorganisms (Toscana virus, Rickettsia spp.) remain neglected even though they cause many more cases. New diagnostic tools and innovative tools for the identification and characterization of vector species and microorganisms have been developed at IHU Méditerranée Infection, either internally or through collaborative and integrated projects. We have detected Rickettsia slovaca as a human pathogen and have described the disease; we have shown that Rickettsia felis can be transmitted by Anopheles mosquitoes; we have emphasized the increasing importance of bedbug (Cimex lectularius) as a potential vector of Bartonella quintana; and we have described the Toscana virus, a major agent of meningitis and meningoencephalitis which was disseminated in North Africa and Central and Eastern Europe, where it frequently cocirculates with a large number of newly described phleboviruses transmitted by sand flies.

Criteria for Ending the Distal Fusion at the L3 Vertebra vs. L4 in Surgical Treatment of Adolescent Idiopathic Scoliosis Patients with Lenke Type 3C, 5C, and 6C Curves: Results After Ten Years of Follow-up.

Introduction The selection of the most distal caudal vertebra in spinal fusion surgeries in adolescent idiopathic scoliosis patients with structural lumbar curvatures is still a matter of debate. The aim of this study was to determine the preoperative radiological criteria on the traction X-rays under general anesthesia (TrUGA) for selection between the L3 and L4 vertebrae and to assess the efficacy of these criteria via the long-term results of patients with Lenke Type 3C, 5C, and 6C curves. Methods Radiological data of 93 patients (84 females, 9 males) who met the inclusion criteria were retrospectively evaluated. The relationship between the L3 vertebra and the central sacral vertebral line, the portion of the L3 vertebra in the stable zone of Harrington, the parallelism of the L3 with the sacrum, and the tilt and rotation of the L3 on TrUGA radiographs were evaluated for the selection of the lowest instrumented vertebrae (LIV). Clinical results were analyzed using the Scoliosis Research Society-22 (SRS-22) questionnaire. Results The mean follow-up period of the study group was 149.3 months. According to the Lenke classification, 29 patients had Type 3C, 33 had Type 5C, and 31 had Type 6C curves. The preoperative analysis was based on standing anteroposterior (AP), supine traction, and bending X-rays, and the L3 vertebra was selected as the LIV in 37 patients (40%). These X-rays suggested L4 as the LIV in 56 patients (60%); however, based on our study criteria, the L3 vertebra was selected. No significant loss of correction was observed nor additional surgery due to decompensation was required in the follow-up period. Conclusion  The use of TrUGA radiographs with the identified criteria is an efficient alternative method in the selection of the LIV in patients with Lenke Type 3C, 5C, and 6C curves.

Characterization of antibody response in neuroinvasive infection caused by Toscana virus.

OBJECTIVES: Among sandfly-borne pathogens, Toscana virus (TOSV) is a prominent cause of summer meningitis in Mediterranean Europe. Here, we assessed the kinetics of anti-TOSV antibodies over time in 41 patients diagnosed with TOSV meningitis or meningoencephalitis in northeastern Italy. METHODS: Acute and follow-up serum samples were collected up to 20 months after diagnosis of TOSV infection and tested for the presence of specific antibody using immunoenzymatic and indirect immunofluorescence assays. In addition, maturation of anti-TOSV IgG over time was evaluated as well as production of neutralizing antibodies. RESULTS: Specific IgM and IgG response was present at diagnosis in 100% of patients; TOSV-specific IgM and IgG were detected in patients' sera up to 6 and 20 months after diagnosis, respectively. The avidity index (AI) increased over the first month after infection in 100% of patients and most cases exceeded 60% by Day 30 post infection. The AI subsequently plateaued then declined at 20 months after diagnosis. Finally, neutralization assay to TOSV was performed in 217 sera collected from 41 patients; 69.6% of tested samples resulted in reactive and moderate levels of neutralizing antibodies observed during all phases of infection despite high titres of total anti-TOSV IgG. CONCLUSIONS: Specific antibody response develops rapidly and is long-lasting for neuroinvasive TOSV infection. Serodiagnosis of neuroinvasive TOSV requires simultaneous detection of specific IgM and IgG. Moderate levels of neutralizing antibodies were maintained over the study period, while the protective role of antibodies lacking neutralizing activity is unclear and requires further evaluation.

Skin traction in hip spica casting for femoral fractures in children.

BACKGROUND: The purpose of this study was to evaluate the skin traction in hip spica casting when applied as the standard treatment for children with femoral shaft fractures. METHODS: A total of 207 patients with femoral fractures were treated with this method. The average age was 4.7 years. After the application of skin traction, the fracture of the femur was reduced and was placed in a hip spica cast. Traction was continued in the cast. RESULTS: All fractures united within 4-8 weeks. No significant residual angular deformities were seen in any of the children. The only complication was refracture in two children who fell after removal of the cast. None of the children required external shoe lifts, epiphysiodesis, antibiotics, irrigation, or débridement. CONCLUSIONS: Skin traction and a well-molded hip spica cast is a safe, reliable treatment option for isolated, closed femoral fractures in children 2-7 years of age.

Immunohistochemical detection of p53 protein in human prostatic cancer.

Tissue sections from 73 radical-prostatectomy specimens were studied immunohistochemically for the presence of p53 protein. In seven specimens numerous tumor cells showed a strong nuclear immunostaining. An additional 27 revealed a more discrete and focal accumulation of p53 protein. Comparison of the pathologic characteristics of the p53-negative and -positive groups showed that the presence of p53 protein closely correlated with more advanced tumor stages (p < 0.00001), with higher primary (p = 0.0004), combined (p < 0.0001) and worst (p < 0.0001) Gleason grades, and with larger total (p = 0.0001) and high-grade (p < 0.0001) tumor volumes. No staining was found in areas of benign hyperplasia or in well-differentiated tumor zones. Our results suggest that the accumulation of p53 protein to immunohistochemically detectable concentrations is not a feature of low-grade cancer. This finding implies that abnormal p53 accumulation might be involved in the process of prostatic cancer progression.

Enhancement of hybridization efficiency in interphase cytogenetics on paraffin-embedded tissue sections by microwave treatment.

To enhance the efficiency of in situ hybridization in interphase cytogenetics on formalin-fixed and paraffin-embedded tissue sections we studied the effect of microwave heating as an addition to tissue pretreatment. The modified protocol resulted in a reduction of proteolytic digestion time and of effective enzyme concentration. Apart from that, reproducibility was raised and in large sections successful hybridization was more homogenous. We conclude, that the given technical recommendations should be useful for the study of chromosomal aberrations in routinely processed tissues.

Frequency and distribution of numerical chromosomal aberrations in prostatic cancer.

Prostatic cancer frequently shows striking morphological heterogeneity and multifocal growth. To better understand the relationship between chromosomal changes and pathological characteristics, 31 routinely processed radical prostatectomy specimens were studied for the presence of numerical chromosomal aberrations by in situ hybridization with centromeric nucleic acid probes specific for chromosomes 7, 10, 17, X, and Y. In 24 of the cases preoperative core biopsy specimens were available and were examined with the probe for the X chromosome. In eight of the prostatectomy specimens chromosome numbers consistent with a normal male karyotype were found. Three cases, besides diploid chromosome numbers, showed a focal doubling of hybridization signals, consistent with tetraploidy. The other 20 cases displayed numerical chromosomal aberrations to a various degree. In this group the appearance of numerical chromosomal aberrations often showed considerable local heterogeneity, generally coinciding with morphological dedifferentiation, and was significantly correlated with tumor stage (P = .0004) as well as primary (P = .0068), worst (P = .0002), and combined (P < .0001) Gleason grades, total tumor volume (P = .0448), and the volume of tumor with Gleason grades 4 or 5 (P < .0001). In four of the 24 core biopsy specimens no residual tumor tissue was left for cytogenetic examination. In the remaining 20 biopsy specimens the presence or absence of numerical changes matched the result obtained on the corresponding prostatectomy specimen. We conclude that in prostatic cancer the presence of numerical chromosomal aberrations is associated with advanced disease. Especially in low differentiated tumors local heterogeneity in 2 chromosome numbers can be very marked. It is possible to forecast the presence or absence of numerical chromosomal changes on preoperative core biopsy specimens.

Numerical chromosomal aberrations in prostate cancer: correlation with morphology and cell kinetics.

Eleven routinely processed radical prostatectomy specimens were studied for the presence of numerical chromosomal aberrations by means of in situ hybridization with nucleic acid probes specific for chromosomes 7, 10, 17, X, and Y. Cytogenetic information was correlated with morphology, tumour stage and volume as well as with cell kinetics, the latter being assessed by immunohistochemistry with antibodies raised against the proliferative cell nuclear antigen (PCNA) and against a formalin-resistant epitope of the Ki-67 antigen, MIB 1. In 5 of 11 cases, numerical aberrations of at least one chromosome were found. The cases with normal chromosome numbers were those with the smallest volumes of Gleason grade 4 and/or 5 tumour (mean 0.5 cm3) and represented tumours restricted to the prostate. Tumours with aberrations in the number of detected chromosomes showed advanced stages and large volumes of high-grade tumour (mean 12.5 cm3). All 4 tumours with positive surgical margins were recruited from a group with marked local heterogeneity in chromosome numbers. Immunostaining with MIB 1 and PCNA was most intense in areas of high-grade tumour and was positively correlated with the emergence of chromosomal aberrations. The data suggest that the appearance of numerical chromosomal aberrations in prostate cancer coincides with aggressive tumour behaviour and could be used as an additional prognostic marker.

[Significance of numerical chromosome aberrations in prostate cancer]. / Zur Bedeutung numerischer chromosomaler Aberrationen in Karzinomen der Prostata.

Thirty-one routinely processed radical prostatectomy specimens were examined for the presence of numerical chromosomal aberrations by in situ hybridization with centromeric nucleic acid probes specific for chromosomes 7, 10, 17, X, and Y. In eight of the prostatectomy specimens, chromosome numbers consistent with a normal male karyotype were found. Three cases, in addition to diploid chromosome numbers, showed a focal doubling of hybridization signals, consistent with tetraploidy. The other 20 cases displayed more or less marked numerical chromosomal aberrations. In this group, the appearance of numerical chromosomal aberrations often showed considerable local heterogeneity and was significantly correlated with tumor stage, Gleason grades, and tumor volume. We conclude that in prostatic cancer the presence of numerical chromosomal aberrations is associated with advanced disease. Especially in low differentiated tumors local heterogeneity in chromosome numbers can be very marked.

[The prevalence of intestinal parasites in the students of two primary schools in Ankara]. / Ankara'daki iki ilkokulun ögrencilerinde barsak parazitleri dagilimi.

Four hundred stool samples obtained from two different primary school students were examined for intestinal parasite. Cellophane tape technique was also applied in order to detect the Enterobiasis incidence. It has been observed that the parasite incidence were 13.5% in TED College Students whereas 30.5% in the Incesu Primary School. It has been also concluded that the highest infection rate was connected with two parasites, namely Giardia intestinalis (11.5%) and Enterobius vermicularis (8%).

[Causative agents of urinary tract infections and sensitivity to antibiotics]. / Idrar yolu enfeksiyonlarinda etkenler ve antibiyotiklere duyarlilik.

Our study was done on the outpatients and inpatients of Ankara Numune Hospital who were diagnosed as having urinary tract infections. When 301 cultures with positive results were evaluated. Gram-negative bacteria were found most frequently (E. coli 45.2%, Klebsiella 23.2%, Enterobacter 16.6%, Proteus 11.5%, S. aureus 2.2%, Pseudomonas 1.3%). By using the disc diffusion method, the effectiveness of antibiotic discs of amikacin, tobramycin, netilmycin, cephoperazone, cephotoxime, cephtizoxime, cephradine, cephuroxime, carbenicillin, piperacillin, ofloxacin, nalidixic acid and sulbactam/ampicillin on the isolated strains were investigated. Ofloxacin (92.35%), cephotaxime (72.6%) and nalidixic acid (62.10%) were found to be the most effective while cephradine (7.96%), carbenicillin (11.8%) and piperacillin (14.96%) were found to be the least effective antibiotics.