Reduced phosphorylated Foxp3 levels in Crimean Congo haemorrhagic fever

Crimean-Congo haemorrhagic fever (CCHF) is a severe human infection which can lead to fatal consequences. Acute CCHF patients were previously shown to exhibit frequencies of regulatory T-cell (T_reg) but lower T_reg-mediated suppressive activities than the healthy counterparts. This study aims is to investigate the phosphorylation levels of Foxp3 protein (master regulator of T_reg cells) in CCHF patients. Blood samples collected from 18 CCHF patients and nine healthy volunteers were used to isolate peripheral blood mononuclear cells (PBMCs). Total and phosphorylated Foxp3 expression levels in the isolated PBMC samples were monitored by western blot and quantified using ImageJ software. Total Foxp3 expression levels in CCHF patients displayed decreasing trend, but not significantly. In contrast, significantly lower expression levels of phosphorylated Foxp3 were reported in CCHF patients. Our results suggest a possible association between Foxp3 dephosphorylation and CCHF pathogenesis. Nevertheless, more studies are required to evaluate the effect of Foxp3 dephosphorylation on T_reg function, which would not only help to enlighten the CCHF pathogenesis but also contribute to the development of effective treatment strategies.

Medial gastrocnemius muscle flap for the reconstruction of unhealed amputation stumps

OBJECTIVE

Unhealed amputation stumps after transtibial amputation are common and often require reamputation futher up the leg. The aim of our study is to describe our experience with medial gastrocnemius muscle flap coverage following a transtibial amputation.

METHOD

We retrospectively examined the records of patients who had an unhealed transtibial amputation stump who were then treated with a medial gastrocnemius muscle flap.

RESULTS

We identified seven patients, all had diabetes mellitus and an initial amputation by the long posterior flap technique. All of the flap reconstructions of the amputation stumps ultimately survived. A mild knee flexion contracture was seen in two amputees, whereas full range of motion in the knee was observed in the remaining five amputees. None have required further surgical intervention.

CONCLUSION

Medial head of gastrocnemious flap is an option for the reconstruction of the unhealed stump, particularly in the cases where stump shortening will not be feasible.

Emergency peripartum hysterectomy: our experience

PURPOSE

To investigate the incidence of and reasons for emergency peripartum hysterectomy (EPH) between 2009 and 2013 in our hospital, one of the three hospitals with the highest rates of delivery in Turkey.

METHODS

A retrospective study. Seventy-six peripartum hysterectomies were evaluated. We compared the modes of delivery and examined whether bilateral internal iliac artery ligation was performed.

RESULTS

The incidence of EPH was 0.77 in 1000. The majority of cases involved multiparity, uterine rupture, placenta praevia, or placental invasion abnormalities. The most frequent reason for EPH was uterine atony (64.5 %). There was no statistically significant relationship with mode of delivery; however, the complication rate and requirement for fresh frozen plasma were significantly (p < 0.01) related to whether bilateral internal iliac artery ligation was performed.

CONCLUSION

Uterine atony was the most common indication for EPH. The most important step to avoid performing EPH is to calculate patients' risks for postpartum bleeding. Postpartum haemorrhage may not be preventable, but when it happens, obstetricians must be prepared to perform EPH, and in high-risk patients, to perform internal iliac artery ligation.

Spinal tanycytic ependymoma with diffusion restriction on MRI

Tanycytic ependymoma is a rare spindle-cell variant of ependymoma derived from tanycytes. Primitive neuroectodermal tumors usually have diffusion restriction, whereas ependymomas do not. Here, we present a case of tanycytic ependymoma with diffusion restriction. As far we are aware, this is the first case of tanycytic ependymoma in the English literature with diffusion restriction.

Frequencies of four genetic polymorphisms in the CYP1A2 gene in Turkish population

Cytochrome P450 (CYP) 1A2 gene is involved in the metabolic activation of several carcinogens and altered metabolization of some clinically used drugs. We aimed to investigate the distributions of genetic polymorphisms -3860 (G/A)(CYP1A2*1C) and -2467 (T/del)(CYP1A2*1D) in the 5'-flanking region and -739 (T/G)(CYP1A2*1E) and -163(C/A)(CYP1A2*1F) in the first intron of the CYP1A2 gene in 110 unrelated healthy Turkish volunteers by PCR-RFLP technique. The frequencies of each polymorphism in Turkish population were found as 0.04, 0.92, 0.01, 0.27 for CYP1A2*1C, CYP1A2*1D, CYP1A2*1E, CYP1A2*1F, respectively. Compared with other populations, CYP1A2*1D has been found to be significantly increased in Turkish population. On the other hand, in general, the frequencies of the other polymorphisms were concordant with those in the Egyptian and Caucasian populations, and were different from those in the Japanese, Chinese and Ethiopian populations. Our results suggest that due to increased frequency of CYP1A2*1D in Turkish population, functional significance of CYP1A2*1D should be evaluated. It might be screened to determine the relationship between CYP1A2*1D and CYP1A2 related drug metabolisms in associated groups.

Relationship between periodontal findings and the TNF-alpha Gene 1031T/C polymorphism in Turkish patients with Behçet's disease

BACKGROUND

Genetic factors that predispose individuals to Behçet's disease (BD) and periodontal disease. Tumour necrosis factor-alpha (TNF-alpha) has been implicated in the pathogenesis of both BD and periodontal disease. The relationship with periodontitis and the pathogenesis of BD has not yet been determined.

OBJECTIVE

The aim of the present study was to investigate the possible relation of the periodontal scores and single nucleotide polymorphism of TNF-alpha-1031T/C with BD compared with healthy controls (HC) and recurrent aphtous stomatitis (RAS). We also sought to determine the effects of periodontal condition and TNF-alpha-1031T/C polymorphism on clinical severity of BD.

METHODS

Eighty-two unrelated patients with BD, 42 RAS patients and 77 HC were enrolled in the study. Periodontal status of all subjects was evaluated according to the World Health Organization community periodontal index of treatment needs (CPITN). For genotyping, polymerase chain reaction-restriction fragment length polymorphism was employed.

RESULTS

The mean CPITN was observed to be higher in patients with BD compared with HC and RAS (P < 0.001). TNF-alpha-1031C allele was significantly higher in patients with BD (P = 0.023) and RAS (P = 0.007) compared with HC. Mean CPITN was higher in CC genotype compared with other genotypes (P = 0.004). Moreover, CPITN and CC genotype was found to be correlated with the severity of the disease.

CONCLUSIONS

Our data indicate that the TNF-alpha-1031T/C gene polymorphism (CC genotype) is a risk factor for periodontitis, RAS and BD patients and also suggests that long-term periodontal follow-up and education of oral hygiene in patients with BD may help to prevent the development and/or progression of the disease.

Determination of the effect of a single hemodialysis session on retrobulbar blood hemodynamics by color Doppler ultrasonography

BACKGROUND

Retrobulbar hemodynamic alterations can occur during hemodialysis sessions, and patients with chronic renal failure may experience visual problems.

PURPOSE

To evaluate the effect of single-session hemodialysis on retrobulbar vessel hemodynamics by color Doppler ultrasonography.

MATERIAL AND METHODS

Thirty-five patients were included in the study. Retrobulbar blood flows were examined before and after dialysis sessions. Doppler spectral patterns of retrobulbar blood flow were evaluated. The t test for paired samples and the Wilcoxon matched-pairs signed-rank test were used for comparing the flow values before and after dialysis.

RESULTS

Systolic and diastolic blood flow velocities of the ophthalmic artery, central retinal artery, central retinal vein, nasal posterior ciliary artery, and temporal posterior ciliary artery were found to be decreased bilaterally after hemodialysis sessions. No significant change was observed in resistivity index values after hemodialysis sessions.

CONCLUSION

Our findings reveal that retrobulbar circulation was disturbed after a single hemodialysis session.

Brucellar spondylodiscitis: a case report

Brucellosis is a common zoonosis which still remains as a major health problem in certain parts of the world. Osteoarticular involvement is the most frequent complication of brucellosis, in which the diagnosis of brucellar spondylodiscitis is often difficult since the clinical presentation may be obscured by many other conditions. Herein, we reported an uncommon case of spondylodiscitis due to brucella in an elderly male who had diabetes mellitus and degenerative spinal disease as underlying conditions. The diagnosis was established by using magnetic resonance imaging after the brucella-agglutination test was found to be positive. The diagnosis was also confirmed by positive blood culture. A high degree of suspicion in the diagnosis of brucellar spondylitis is essential to reduce the delay for the treatment. Thus, it should be essentially included in the differential diagnosis of longstanding back pain particularly in regions where brucellosis is endemic. Screening serologic tests for brucella should be used more widely in cases with low index of suspicion, especially in endemic areas.

Methylenetetrahydrofolate reductase C677T polymorphism in adult patients with lymphoproliferative disorders and its effect on chemotherapy

Methylenetetrahydrofolate reductase (MTHFR) is one of the most critical enzyme in folic acid metabolism, and it converts 5,10-MTHF to 5-MTHF. 5,10-MTHF is required for conversion of uridilate to thymidylate. On the other side, MTHFR enzyme causes methylation of homocysteine into methionine, leading to methylation of DNA. Chemotherapeutic agents have different effects, but DNA is the target for most of them. Because folate is the cornerstone in DNA synthesis, we analysed herein if the polymorphisms in MTHFR gene can alter the susceptibility of lymphoproliferative disease risk and if it has an effect on chemotherapy response. One hundred fifty-six patients with lymphoid malignancies and 82 healthy controls were included into the study. Neither gene frequencies nor allel frequencies were found to increase lymphoproliferative disease risk significantly in both overall group and subgroups. Although it was not statistically significant, we found a 2.7-fold increased risk in acute lymphocytic leukaemia (ALL)/Burkitt lymphoma patients with TT genotype [odds ratio (OR), 2.7; 95% confidence interval (CI), 0.88-8.2] than CC genotype but a 1.7-fold decreased risk with TT genotype in diffuse large B-cell lymphoma (DLBCL; OR, 0.58; 95% CI, 0.17-1.88) and a 1.8-fold decreased risk in Hodgkin's lymphoma with TT genotype (OR, 0.55; 95% CI, 0.10-2.87) than CC genotype. The chemotherapy response was analysed in DLBCL, Hodgkin's lymphoma and ALL/Burkitt's lymphoma because these patients received standard chemotherapy protocols. No significant difference was detected between responder and non-responders according to MTHFR T677C polymorphism, but the patients who had TT genotype respond 1.75-fold worse than CC (OR, 0.57; 95% CI, 0.07-4.64) in ALL patients (p=0.59), and in DLBCL, CT genotype revealed a 1.8-fold worse response than CC genotype (OR, 0.54; 95% CI, 0.17-1.7), but TT genotype revealed 2.6-fold better response rates than patients with CC genotype (OR, 2.6; 95% CI, 0.26-26.8). As a conclusion, MTHFR C677T polymorphism does not increase the risk of lymphoproliferative disease, and it does not have an effect on chemotherapy response significantly; however, the patients with TT genotype have a slightly increased risk for ALL, and they also respond worse than CC genotype. TT genotype slightly decreases the risk of DLBCL, and the patients have much favorable response rates.

The effect of MDR1 (ABCB1) polymorphism on the pharmacokinetic of tacrolimus in Turkish renal transplant recipients

There is marked interindividual variability in trough blood levels of tacrolimus (TRL) following standard dosing. TRL is a substrate for P-glycoprotein (P-gp), the product of the multidrug resistance-1 (MDR1)(ABCB1) gene. P-gp acts as a membrane efflux pump, which affects TRL absorption from the gut. Some of the single nucleotide polymorphisms (SNP) of ABCB1 gene are associated with pharmacokinetic characteristics of TRL. The objective of this study was to determine the role of ABCB1 C3435T polymorphism on TRL dose requirements, trough values and dose-adjusted trough TRL concentrations among Turkish renal transplant recipients. Renal transplant recipients receiving TRL (n=92) were genotyped for ABCB1. TRL daily doses, trough concentrations, dose-adjusted trough concentrations, demographic features, and clinical data were obtained at 1, 6, and 12 months after renal transplantation. The frequency of the ABCB1 3435 CC genotype was 30.4%, whereas 47.8% of patients were 3435 CT and 21.7% of patients were 3435 TT. TRL daily doses were significantly lower among patients with the 3435 TT genotype at months 1 and 6. At 6 and 12 months after transplantation patients who were homozygous for the ABCB1 3435 CC showed significantly lower dose-adjusted trough TRL concentrations compared with subjects of 3435 TT and CT genotypes. Knowledge of ABCB1 genotype may be useful to adjust the optimal dose of TRL in transplant patients, thereby rapidly achieving target concentrations.

A challenging problem. Vertebral pseudoaneurysm and arteriovenous fistula involving vertebral artery and ipsilateral internal jugular vein due to craniocervical penetrating trauma

SUMMARY

Vertebral pseudoaneurysm and arteriovenous fistulas are very rare and are commonly due to penetrating trauma to craniocervical region. A 20-year-old man was presented with progressive swelling and pulsatile mass on the left side of his face. He had been stabbed two weeks ago on the left side of his face. Doppler Ultrasound revealed large left vertebral pseudoaneursym and arteriovenous fistulisation with the ipsilateral internal jugulat vein. MR Angiography and conventional angiography confirmed arteriovenous fistula between left vertebral artery and ipsilateral internal jugular vein and large pseudoaneurysm formation on vertebral artery. Arteriovenous fistula was closed surgically and embolized with surgicell. But the pseudoaneurysm was treated with endovascular covered stent placement.

Intracranial Lipoma of the Sylvian Fissure: MR and CT Findings

We present the CT and MR features of a rare intracranial lipoma located in the right sylvian fissure in a patient who presented with a five-year history of headache. The lesion was well demonstrated on Fluid Attenuated Inversion Recovery (FLAIR), Turbo Spin Echo (TSE), T1 weighted and fat supressed T2 weighted sequences.

An unusual case of hydatid disease located in the erector spinae muscle

We present a case of hydatid disease localized to the erector spinae muscle. A 60-year-old male was admitted to our hospital with back pain. The diagnosis was made preoperatively by US, CT, and MRI. They showed hydatid disease in erector spinae muscle. Cysts and some part of the erector spinae muscle were resected. Postoperatively pathology confirmed the diagnosis.