Il-6 and UGT1A1 variations may related to furosemide resistance in heart failure patients

Furosemide is a diuretic and is used for the treatment of patients with heart failure (HF). It has been found that in some HF patients, the drug does not treat patients efficiently. This condition is named as furosemide resistance. In this study, it is aimed to investigate the relationship between UDP-glucuronosyltransferase 1 (UGT1A1) and interleukine-6 (IL-6) variations with furosemide resistance in HF patients. Sixty HF patients using furosemide (patient group) and 30 healthy individuals (control group) were enrolled in this study. Patients were divided into two subgroups as non-responders (furosemide resistant) group (n = 30) and the responders (non-resistant) group (n = 30) according to the presence of furosemide resistance (n = 30). Variations in the first exon of UGT1A1 and rs1800795 and rs1800796 variations in IL-6 were analyzed by direct sequencing and real-time polymerase chain reaction (RT-PCR), respectively. The effects of newly detected mutations on 3-D protein structure were analyzed by in silico analysis. At the end of the study, 11 variations were detected in UGT1A1, of which nine of them are novel and eight of them cause amino acid change. Also, rs1800795 and rs1800796 variations were detected in all the groups. When patient and control groups were compared with each other, rs1800796 mutation in IL-6 was found statistically high in the patient group (p = 0.027). When the three groups were compared with each other, similarly, rs1800796 mutation in IL-6 was found statistically high in the non-responders group (p = 0.043). When allele distributions were compared between the patient and control groups, the C allele of rs1800795 mutation in IL-6 was found statistically high in the patient group (p = 0.032). When allele distributions were compared between the three groups, 55T-insertion in UGT1A1 was found statistically high in the non-responders group (p = 0.017). According to in silico analysis results, two variations were found deleterious and six variations were detected as probably damaging to protein functions. Our study may contribute to the elucidation of pharmacogenetic features (drug response-gene relationship) and the development of individual-specific treatment strategies in HF patients using furosemide.

POS1370 INCREASED INFERIOR VENA CAVA WALL THICKNESS AS A SIGN OF VENOUS INFLAMMATION IN BEHÇET’S DISEASE

Background

Vascular involvement of Behçet’s disease (BD) involves both arterial and venous vessels of all sizes [1]. Femoral (superficial, deep, and common) and popliteal veins are the most frequently affected veins. We have previously shown that femoral wall thickness is increased in BD patients and can be used as a diagnostic test [2].

However, many other sites including vena cava inferior/superior and pulmonary arteries may also be involved [3]. Despite the dominance of venous vessel involvement, there is limited data assessing the large veins in BD.

Objectives

In this study, we aimed to assess inferior vena cava wall thickness (IVC) by transthoracic echocardiography (TTE) in BD compared with healthy controls.

Methods

Patients with BD (n=70) and age and sex-matched healthy controls (n=51) were included in this study. Assessment of inferior vena cava (IVC) wall thickness was performed by an experienced cardiologist blinded to cases. Measurement of IVC wall thickness was made at end-expiration and approximately 0.5 to 2.0 cm proximal to the ostium of the right atrium as demonstrated in Figure 1.

Figure 1.

Measurement of inferior vena cava wall thickness by transthoracic echocardiography

Results

IVC wall thickness of patients with BD (0.29 mm (SD: 0.03) was significantly higher than healthy controls (0.26 mm (SD: 0.03) (p<001). Although IVC wall thickness was higher in patients with BD with vascular involvement (0.30 mm (SD:0.04) and history of pulmonary embolism (0.30 mm (SD:0.04)), the difference did not reach statistical significance. There was no difference between IVC wall thicknesses in patients who used immunosuppressive and anti-TNF treatments due to major organ involvement, compared to those who did not. Similarly, no difference is observed between IVC thicknesses among Behçet’s patients according to age, gender, and activity status at the last visit. Although no correlation was found between IVC wall thicknesses, disease duration, and BDCAF scores at the last visit in the BD group, there was a low-grade correlation between age and IVC wall thickness (r=0.31, p=0.09)

Conclusion

Increased IVC wall thickness shows vasculitic involvement of large venous structures in BD and can be easily measured by TTE which is an easily accessible, noninvasive modality without radiation. The role of IVC wall thickness assessment for the diagnosis or management of BD requires further studies.

References

[1]Alibaz-Oner, F. and H. Direskeneli, Management of vascular Behçet’s disease. Int J Rheum Dis, 2019. 22 Suppl 1: p. 105-108.

[2]Alibaz-Oner, F., et al., Femoral vein wall thickness measurement: A new diagnostic tool for Behçet’s disease. Rheumatology (Oxford), 2021. 60(1): p. 288-296.

[3]Alibaz-Oner, F., et al., Behçet disease with vascular involvement: effects of different therapeutic regimens on the incidence of new relapses. Medicine (Baltimore), 2015. 94(6): p. e494.

Disclosure of Interests

None declared

POS1369 PULMONARY ARTERY WALL THICKNESS IS INCREASED IN BEHÇET’S DISEASE

Background

Behçet’s Disease (BD) is a unique systemic vasculitis that mainly involves veins, in contrast to other vasculitides [1, 2]. Prior studies showed that pulmonary arteries have a similar structure with systemic veins in terms of wideness, thin-walled, increased compliance, and low resistance [3]. We have recently shown increased venous wall thickness in lower extremity veins of BD patients.

Objectives

In this study, we aimed to assess pulmonary artery (PA) wall thickness by transthoracic echocardiography (TTE) in BD compared to healthy controls and patients with non-inflammatory pulmonary embolism (NIPE).

Methods

Patients with BD (n=77), NIPE (n=33) and healthy controls (n=57) were included in the study. PA wall thickness was measured with TTE by a cardiologist blinded to cases. PA wall thickness was measured from the mid-portion of the main PA (approximately 1 to 2 cm distal to the pulmonary valve) as demonstrated in Figure 1.

Figure 1.

Measurement of pulmonary artery wall thickness by Transthoracic Echocardiography

Results

PA wall thickness was significantly lower in controls (0.36 mm (SD:0.03) compared to NIPE (0.44 mm (SD:0.05) and BD (0.44 mm (SD:0.06) (p<0.001 for both). PA wall thickness was also found to be significantly higher in BD patients with major organ involvement (0.47 mm (SD:0.04) compared to healthy controls and NIPE (p <0.001 and p=0.006, respectively). PA wall thickness was similar between BD and NIPE (p= 0.6). Among patients with BD, PA wall thickness was significantly lower in patients with only mucocutaneous involvement compared to patients with major organ involvement (0.37 mm vs 0.47 mm, p< 001), it was also similar between patients with only mucocutaneous involvement and healthy controls (0.37 mm vs 0.36 mm, p= 0.3). PA wall thickness was comparable between patients with vascular and non-vascular major organ involvement (0.46 mm vs 0.47 mm, p= 0.3). Patients with vascular and non-vascular major organ involvement had significantly higher PA wall measurements compared with NIPE patients (p= 0.04, p= 0.02, respectively).

Conclusion

We found that PA wall thickness was significantly higher in BD with major organ involvement compared to BD patients with only mucocutaneous involvement regardless of major organ involvement type. These results suggest that increased PA wall thickness in BD may be the predictor of the major organ involvement during follow-up.

References

[1]Ambrose N, Pierce IT, Gatehouse PD, Haskard DO, Firmin DN. Magnetic resonance imaging of vein wall thickness in patients with Behçet’s syndrome. Clin Exp Rheumatol. 2014;32(4 Suppl 84): S99-102.

[2]Boulon C, Skopinski S, Constans J. Vein inflammation and ultrasound in Behçet’s syndrome. Rheumatology (Oxford). 2016;55(10):1750.

[3]Suresh K, Shimoda LA. Lung Circulation. Compr Physiol. 2016;6(2):897-943. Published 2016 Mar 15. doi:10.1002/cphy.c140049

Disclosure of Interests

None declared

Correction to: Prediction of unfavorable outcomes in cryptococcal meningitis: results of the multicenter infectious Diseases International Research Initiative (ID-IRI) cryptococcal meningitis study

In the original version of this article, Mustafa Sunbul was not included in the list of authors for this article. The name has been added accordingly.

International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010-2015: Device-associated module

BACKGROUND

We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2010-December 2015 in 703 intensive care units (ICUs) in Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific.

METHODS

During the 6-year study period, using Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 861,284 patients hospitalized in INICC hospital ICUs for an aggregate of 3,506,562 days.

RESULTS

Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the INICC medical-surgical ICUs, the pooled rate of central line-associated bloodstream infection, 4.1 per 1,000 central line-days, was nearly 5-fold higher than the 0.8 per 1,000 central line-days reported from comparable US ICUs, the overall rate of ventilator-associated pneumonia was also higher, 13.1 versus 0.9 per 1,000 ventilator-days, as was the rate of catheter-associated urinary tract infection, 5.07 versus 1.7 per 1,000 catheter-days. From blood cultures samples, frequencies of resistance of Pseudomonas isolates to amikacin (29.87% vs 10%) and to imipenem (44.3% vs 26.1%), and of Klebsiella pneumoniae isolates to ceftazidime (73.2% vs 28.8%) and to imipenem (43.27% vs 12.8%) were also higher in the INICC ICUs compared with CDC-NHSN ICUs.

CONCLUSIONS

Although DA-HAIs in INICC ICU patients continue to be higher than the rates reported in CDC-NSHN ICUs representing the developed world, we have observed a significant trend toward the reduction of DA-HAI rates in INICC ICUs as shown in each international report. It is INICC's main goal to continue facilitating education, training, and basic and cost-effective tools and resources, such as standardized forms and an online platform, to tackle this problem effectively and systematically.

Two-dimensional speckle tracking echocardiography is useful in early detection of left ventricular impairment in patients with Crohn's disease

OBJECTIVE

Crohn's disease (CD) is a chronic inflammatory bowel disease that can affect the entire gastrointestinal tract. Cardiac involvement is considered very rare. Pericarditis, myocarditis, endocarditis, cardiomyopathy and complete heart block are some of the cardiac extraintestinal manifestations of CD. The aim of this study was to explore the left ventricular (LV) functions with two-dimensional (2D) speckle tracking echocardiography (STE) in patients with CD with normal cardiac functions.

PATIENTS AND METHODS

We enrolled 50 consecutive patients with CD and 50 age and sex matched healthy controls. All patients underwent a transthoracic echocardiogram with evaluation of LV functions with 2D STE.

RESULTS

Baseline characteristics were similar between patients with CD (24 male, mean age: 41.0 ± 13.9 years) and controls (24 male, mean age: 40.1 ± 7.3 years). Although conventional echocardiographic parameters were similar between two groups, global longitudinal strain was significantly lower in patients with CD compared to controls (19.6 ± 3.3 versus 21.2 ± 2.9, p = 0.014). Correlation analysis revealed that Crohn's Disease Activity Index is inversely correlated with LV global longitudinal strain (r = -0.703, p < 0.001) in patients with CD. We also evaluated inflammatory parameters such as CRP, erythrocyte sedimentation rate, and complete blood counts in patients with CD. Correlation analysis revealed that only platelet value is weakly correlated with Crohn's Disease Activity Index (r = 0.311, p = 0.083).

CONCLUSIONS

Crohn's disease is associated with impairment in LV global longitudinal myocardial function. Crohn's Disease Activity Index is also strongly correlated with LV global longitudinal strain. 2D-STE may be an useful method for early detection of LV impairment in patients with CD.

Managing atypical and typical herpetic central nervous system infections: results of a multinational study

There have been many studies pertaining to the management of herpetic meningoencephalitis (HME), but the majority of them have focussed on virologically unconfirmed cases or included only small sample sizes. We have conducted a multicentre study aimed at providing management strategies for HME. Overall, 501 adult patients with PCR-proven HME were included retrospectively from 35 referral centres in 10 countries; 496 patients were found to be eligible for the analysis. Cerebrospinal fluid (CSF) analysis using a PCR assay yielded herpes simplex virus (HSV)-1 DNA in 351 patients (70.8%), HSV-2 DNA in 83 patients (16.7%) and undefined HSV DNA type in 62 patients (12.5%). A total of 379 patients (76.4%) had at least one of the specified characteristics of encephalitis, and we placed these patients into the encephalitis presentation group. The remaining 117 patients (23.6%) had none of these findings, and these patients were placed in the nonencephalitis presentation group. Abnormalities suggestive of encephalitis were detected in magnetic resonance imaging (MRI) in 83.9% of the patients and in electroencephalography (EEG) in 91.0% of patients in the encephalitis presentation group. In the nonencephalitis presentation group, MRI and EEG data were suggestive of encephalitis in 33.3 and 61.9% of patients, respectively. However, the concomitant use of MRI and EEG indicated encephalitis in 96.3 and 87.5% of the cases with and without encephalitic clinical presentation, respectively. Considering the subtle nature of HME, CSF HSV PCR, EEG and MRI data should be collected for all patients with a central nervous system infection.

Healthcare-associated Crimean-Congo haemorrhagic fever in Turkey, 2002-2014: a multicentre retrospective cross-sectional study

Healthcare-related transmission of Crimean-Congo haemorrhagic fever (CCHF) is a well-recognized hazard. We report a multicentre retrospective cross-sectional study undertaken in Turkey in 2014 in nine hospitals, regional reference centres for CCHF, covering the years 2002 to 2014 inclusive. Data were systematically extracted from charts of all personnel with a reported health care injury/accident related to CCHF. Blood samples were tested for CCHF IgM/IgG by enzyme-linked immunosorbent assay and/or viral nucleic acid detection by PCR after the injury. Fifty-one healthcare-related exposures were identified. Twenty-five (49%) of 51 resulted in laboratory-confirmed infection, with a 16% (4/25) overall mortality. The main route of exposure was needlestick injury in 32/51 (62.7%). A potential benefit of post-exposure prophylaxis with ribavirin was identified.

Plasma oxytocin levels are reduced in Slovak autistic boys

BACKGROUND

Obstructive sleep apnea (OSA) is characterized by reductions in breathing amplitude during sleep caused by an obstructed or collapsed upper airway. The neutrophil to lymphocyte ratio (NLR) has been proposed as a novel biomarker for systemic inflammatory response. The aim of the present study was to evaluate the relationship between NLR and OSA.

METHODS

The study population consisted of 195 consecutive patients with clinical suspicion of OSA. Full night polysomnography was performed for all patients. Patients with an apnea hypopnea index (AHI) ≥ 5 were considered to have OSA. NLR was calculated as the ratio of neutrophil count to lymphocyte count.

RESULTS

While 130 patients (91 male, mean age: 49.9 ± 9.8 years) had OSA, 65 patients (42 male, mean age: 48.7 ± 10.2 years) had normal findings according to AHI scores. Cardiovascular risk factors such as hypertension, hyperlipidemia, diabetes mellitus and smoking were more common in patients with OSA. Patients with OSA had significantly higher NLR than controls (1.87 ± 0.80 vs 1.49 ± 0.48, p=0.005). AHI score was significantly correlated with NLR (r=0.228, p=0.001). NLR and presence of hyperlipidemia were independent predictors of OSA (OR: 2.451, 2.850, p=0.001, 0.004, respectively). NLR of 1.62 or higher predicted OSA with a sensitivity of 56.2 % and specificity of 63.1 %.

CONCLUSIONS

NLR was higher and also correlated with AHI score in patients with OSA which has not been reported previously. NLR more than 1.62 was an independent predictor of OSA. A simple, cheap white blood cell count may also give an idea about the presence and severity of OSA (Tab. 3, Fig. 3, Ref. 30).

Left ventricular strain and strain rate by two-dimensional speckle tracking echocardiography in patients with subclinical hypothyroidism

AIM

Subclinical hypothyroidism (SH) is an asymptomatic condition defined by increased serum thyroid-stimulating hormone (TSH) with normal free thyroid hormone levels. Heart is a major target organ for thyroid hormone action. The aim of this study was to evaluate cardiac functions in patients with SH by speckle tracking imaging.

PATIENTS AND METHODS

We included 23 consecutive patients with untreated SH (Group A; 7 male, mean age: 40.9±1.6 years) and 21 patients with treated SH (Group B; 6 male, mean age: 40.2±2.1 years). The control group included 25 healthy volunteers (8 male, mean age: 39.9±2.8 years). Left ventricular (LV) functions were assessed with speckle tracking imaging.

RESULTS

Age and sex distributions were similar among the groups. Mean serum TSH and free T4 levels were 11.7±2.9 µIU/mL, 1.16±0.06 ng/dL for group A; 2.6±0.3 µIU/mL, 1.35±0.09 ng/dL for group B; 1.4±0.3 µIU/mL, 1.31±0.09 ng/dL for controls, respectively (p = 0.001, p = 0.122). The untreated SH patients had significantly lower LV strain and strain rate values compared to controls. The treated SH patients had higher LV strain and strain rate values compared to untreated SH patients although the difference was not statistically significant. The treated SH patients had lower LV strain and strain rate values compared to controls but the difference was not statistically significant.

CONCLUSIONS

Untreated SH is associated with impairment in LV longitudinal myocardial function. Speckle tracking echocardiography appears to be useful both for early detection of LV impairment in patients with SH and documentation of improvement in myocardial deformation parameters with treatment.

Right ventricular longitudinal deformation parameters and exercise capacity : prognosis of patients with chronic thromboembolic pulmonary hypertension

OBJECTIVE

Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive disease characterized by increased pulmonary vascular resistance resulting in pulmonary hypertension and right heart failure. The six-minute walk test (6MWT) distance is associated with the prognosis of CTEPH patients. Speckle tracking echocardiography (STE) is a reliable method for determining ventricular function. The aim of this study was to assess and compare the right ventricular (RV) function of CTEPH patients according to their 6MWT distances.

METHODS

Forty-nine consecutive CTEPH patients (mean age, 50 ± 16 years; 22 male) who were referred to our center for pulmonary thromboendarterectomy (PTE) were included in the study. All patients underwent the 6MWT and right heart catheterization (RHC). Standard echocardiography and STE were performed on all patients before PTE. Patients were divided into two groups based on their 6MWT distance being less or more than 300 m.

RESULTS

Patients with a shorter 6MWT distance had a significantly larger RV, while they had a significantly lower RV fractional area change and higher myocardial performance index suggesting impaired RV function. Both RV basal-lateral strain and strain rate measures were significantly lower in patients with shorter 6MWT distances than those with longer 6MWT distances. Similarly, they had lower RV basal-septal, mid-lateral, and global strain measures. 6MWT distances were correlated with RV basal-lateral and mid-lateral strain measures (r = 0.349, p = 0.025 and r = 0.415, p = 0.008, respectively).

CONCLUSION

Our data suggest that RV myocardial deformation parameters are associated with 6MWT distances. Determination of RV dysfunction by STE may be helpful in identifying patients with a poor prognosis.

Endothelial dysfunction is an independent risk factor for stroke patients irrespective of the presence of patent foramen ovale

BACKGROUND

Paradoxical embolization through the patent foramen ovale (PFO) is the major cause of most cryptogenic stroke cases. However, the presence of PFO may simply be an incidental finding in these patients, and endothelial dysfunction may be the underlying reason of ischemic stroke. The aim of this study was to compare the endothelial function of cryptogenic stroke patients according to the presence of PFO.

METHODS

Sixty consecutive patients with cryptogenic stroke referred for transesophageal echocardiography (TEE) and 39 consecutive nonstroke patients referred for TEE examination because of suspected PFO were included in the study. Endothelial functions were assessed by brachial artery ultrasonography. PFO was diagnosed by the presence of right-to-left passage of contrast bubbles during TEE. Stroke and nonstroke patients were further subdivided into two groups according to the presence of PFO.

RESULTS

Stroke patients had significantly lower flow-mediated dilation (FMD) values than nonstroke patients (8.36 ± 4.38 % vs. 12.57 ± 4.90 %, p < 0.001). The stroke patients with PFO had significantly lower FMD measures than nonstroke patients with PFO (6.60 ± 3.98 % vs. 10.84 ± 4.40 %, p = 0.001). Similarly, cryptogenic stroke patients without PFO had significantly lower FMD measures than nonstroke patients without PFO (9.90 ± 4.18 % vs. 14.22 ± 4.88, p = 0.002). Logistic regression analysis showed FMD as an independent predictor of cryptogenic stroke when adjusted by age, sex, and presence of PFO (odds ratio: 0.809, 95 % confidence interval: 0.719-0.911, p < 0.001). An FMD value of  11.30 % or lower predicted cryptogenic stroke with a sensitivity of 78.3 %, a specificity of 66.7 %, and positive and negative predictive values of 78.3 and 66.7 %, respectively.

CONCLUSION

Endothelial dysfunction seems to play a more important role than PFO in the underlying mechanism of cryptogenic stroke.

Torsade de pointes. A rare cause of syncope in severe aortic stenosis

The evaluation of syncope in severe aortic stenosis usually requires intense work-up. Mechanical obstruction should not always be implicated as the underlying cause of syncope. Syncope at rest may be rarely associated with ventricular arrhythmias. We present a patient with severe aortic stenosis who experienced syncopal events due to torsade de pointes.

Distinguishing hepatitis B virus (HBV) genotype D from non-D by a simple PCR

Different HBV genotypes have characteristic geographical distribution, which is important epidemiologically. HBV strains have been classified into eight different genotypes (A-H) on the basis of >8% differences in the entire genomic sequence. Genotypes A and D are predominant in Europe, Africa, and the USA, genotypes B and C are restricted to East Asia, genotype E is found in Africa, and genotype F is found in indigenous populations in Central and South America. Genotype D is prevalent in the Turkish population. HBV genotype D shows a 33-bp deletion in the pre-S1 region that accounts for their smaller genomic size (3182 bp). This deletion can be used to facilitate the identification of genotype D. A primer in the pre-S1 region was designed to discriminate genotype D from non-D by PCR. Sixty genotype D (40 acute and 20 chronic) and 4 genotype A sera identified by restriction fragment length polymorphism (RFLP) were included in the study. Using this simple PCR method, all genotype D sera were identified correctly and the test was able to detect HBV DNA at 1000 genomes per ml. An advantage of this method is that it can differentiate in a mixture of genotypes (genotype D from non-D) provided that one isn't present below 1 x 10(4) copies/ml. In conclusion this method is rapid (approximately 5h) and it will contribute to the epidemiological study of HBV in high prevalence areas of genotype D. It can also differentiate between genotype D from non-D in cases of co-infection.

Informal consultations in infectious diseases and clinical microbiology practice

Informed consultation between physicians is an important part of medical practice. The aim of the study was to evaluate the nature and frequency of such consultations in infectious diseases and clinical microbiology practice. This study was done in five university hospitals. Twenty-one infectious diseases and clinical microbiology specialists participated in informal ('curbside') consultations. In a written questionnaire, physicians were asked to report the number and nature of the informal consultations (ICs) they were asked to provide. A total three hundred and sixty-two such consultations were carried out during a three-month period. The ICs occurred most frequently in the hospital (82.3%). Most of the ICs from outside the hospital were by telephone. Most of the ICs (54.4%) were requested by fellows of specialists. 78.7% of the ICs were requested during working hours. 58.8% of consultations took less than 5 min, 18.8% took 6-10 min, 15.2% took 11-20 min, and 7.2% took over 20 min. The four most common reasons for obtaining ICs were to: help to select an appropriate treatment plan (41.4%), help to select an appropriate prophylaxis (19.3%), interpret laboratory data (10.2%), and provide information about antibiotics (10.2%). 30.1% of ICs resulted in subsequent formal consultation and only four patients (1.1%) were transferred to the consultants' clinics. Informal consultations are a frequent occurrence in the practice of infectious diseases and clinical microbiology (ID&CM). Physicians use this sort of consultation to select an appropriate treatment plan and obtain medical information. This study confirms the importance of the ID&CM specialists as a resource for medical personnel.

Rattus norvegicus acting as reservoir of leptospira interrogans in the Middle Black Sea region of Turkey, as evidenced by PCR and presence of serum antibodies to Leptospira strain

Leptospirosis, a common form of zoonosis, especially in rainy countries, is caused by Leptospira interrogans. In our region of Turkey this type of disease has often been encountered in connection with rice harvesting and we therefore attempted to evaluate the prevalence of L. interrogans in wild rats in our region. Fifty-nine Rattus norvegicus rats were trapped alive in different areas of an approximately 100 km stretch of seashore in the Middle Black Sea region of Turkey. L. interrogans was determined by PCR in sera, kidney and brain tissue. Sixteen (27.1%) kidney samples and 10 brain tissue samples (16.9%) were positive for L. interrogans. No PCR positivity was seen in sera samples. Five sera were positive by microagglutination test. A large proportion of wild rats in our region were found to be carriers of L. interrogans. We conclude that people who are exposed to rat urine in their daily life are at risk of acquiring L. interrogans.

Predictors of outcome in patients with tuberculous meningitis

OBJECTIVE

To assess predictors of mortality and neurological sequelae in patients with tuberculous meningitis (TBM).

METHODS

Patients with TBM treated at 12 university hospitals in Turkey between 1985 and 1997 were evaluated using a standardised protocol applied retrospectively. Variables associated with hospital mortality as well as with the presence of neurological sequelae at 6 months were determined using logistic regression models.

RESULTS

Four hundred and thirty-four patients between the ages of 13 and 83 years (mean 33 years) were evaluated. Sixty-eight per cent of these patients presented with Medical Research Council Stage II or III. One hundred and one patients (23.3%) died and 67 (27%) of evaluable survivors had neurological sequelae. In multi-variable analysis, convulsion (OR 3.3, 95%CI 1.2-9.0, P = 0.02), comatose mental status (OR 6.0, 95%CI 3.6-10.2, P = 0.01), and delayed or interrupted treatment (OR 5.1, 95%CI 2.4-11.2, P = 0.01) were shown to be predictors for mortality. The presence of extra-meningeal tuberculosis (OR 2.1, 95%CI 1.1-4.2, P = 0.035), cranial nerve palsy (OR 2.6, 95%CI 1.4-4.2, P = 0.01), hemiparesia/focal weakness (OR 9.3, 95%CI 3.8-22.6, P = 0.01), hemiplegia/multiple neurological deficit (OR 7.1, 95%CI 2.14-23.38, P = 0.01) and drowsiness (OR 4.2, 95%CI 2.04-8.82, P = 0.01) were independent predictors of neurological sequelae at 6 months following hospital discharge.

CONCLUSION

The results of this study emphasise the importance of prompt and uninterrupted anti-tuberculosis therapy for tuberculous meningitis. The presence of seizures or coma on admission to hospital are important predictors for mortality, while the presence of focal neurological signs is a predictor for persistent neurological sequelae in survivors.

A comparison of the efficacy of cefuroxime axetil and intramuscular benzathine penicillin for treating streptococcal tonsillopharyngitis

Throat cultures were performed on 297 children suspected of tonsillopharyngitis on clinical findings. Group A beta-haemolytic streptococci (GABHS) were isolated from 86 patients (41 males/45 females) aged 6-15 (mean (SD) 7.8 (0.04)) years. They were randomly allocated to receive oral cefuroxime axetil for 10 days (group 1) or one dose of benzathine penicillin by intramuscular injection (group 2) and responses were evaluated 2 weeks later. Clinical cure was observed in 95% of group 1 and 96% of group 2 and bacteriological cure in 86 and 84% of groups 1 and 2, respectively. Our results show that intramuscular benzathine penicillin remains an effective treatment for GABHS and that oral cefuroxime axetil is also effective.