Latest status of non-tuberculous mycobacteria prevalence in Türkiye and the world: Systematic review

Non-tuberculous mycobacteria (NTM) can cause diseases not only in individuals with compromised immune systems but also in those with normal immune function. This study aimed to compare the prevalence of NTM in Türkiye and worldwide between 2012 and 2022. This study was designed following the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) procedure. A systematic search was conducted between January 2012 and September 2022 using different electronic databases, including Pubmed, Medline, Embase, Web of Science, Ebsco, Scopus, Türk Medline, and Google Scholar. During the literature review process, titles and abstracts were examined and the full texts of the studies were accessed. In 13 research articles from Türkiye included in the study, a total of 17.293 samples were studied and a total of 1304 NTM (7.54%) strains were isolated from these samples. Among the 1304 NTM strains reported from Türkiye, the top three most frequently isolated species were M. abscessus (29.83%), M. lentiflavum (14.97%), M. fortuitum (14.38%). In 35 studies included from around the world, a total of 512.626 samples were studied and a total of 12.631 NTM (2.46%) strains were isolated from these samples. Among the 12631 NTM strains isolated, the top three most frequently isolated species were M. intracellulare (28.13%), M. avium (17.70%) and M. abscessus (14.88%). This study unveiled the global prevalence of NTM-infected patients, detailing species distribution and microbiological diagnostic methods. Variations in NTM spread were observed, influenced by diverse factors.

P479 Causative agents of Onychomycosis and associated factors: A 15 year study

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM

 

Objectives

Onychomycosis is a term used to describe nail infections that can cause discoloration, thickening, and separation from the nail bed. These manifestations can cause pain and discomfort and medical intervention may be required. The treatment of this disease is difficult and a time-taking process.

The aim of this study was to determine the frequency and distribution of fungal agents according to age and gender in patients with onychomycosis who applied to our laboratory over a period of 15 years.

Methods

A total of 1337 nail samples, which were sent to the Mycology Laboratory of Istanbul Medical Faculty Hospital, Department of Medical Microbiology between January 2007 and July 2022, were examined with conventional methods.

Calcofluor white and 15% KOH were used for microscopic examination and Sabouraud dextrose agar containing antibiotics with and without cycloheximide was used for culture. Fungi were identified by using conventional methods and/or API, VITEK, or MALDI-TOF MS.

Results

The distribution of 1337 nail samples according to patients’ body region, gender, and age is shown in Table 1. Of the total samples, 945 and 392 were toenails and fingernails respectively. Of the specimens, 1212 (90.6%) were taken from adults and 125 (9.4%) were taken from pediatric patients.

Fungal growth was detected in 139 (11.9%) specimens and one culture showed mixed growth. Yeasts were found to be the most frequent isolated fungi (60.7%) and dermatophytes were at the second place (25.71%). Among yeasts, non-albicans Candida species (76.4%) were found to be more frequent than Candida albicans (17,6%), Trichophyton species were found to be the most frequent dermatophytes (75%). Candida parapsilosis was the most prevalent among identified non-albicans Candida (21.2%). The distribution of fungal agents according to patients’ body region and age is shown in Table 2.

Among the patients with a positive culture, the most frequent underlying comorbidities were diabetes in 16 patients (11.5%) and HIV infection in 4 patients (2.87%). No significant difference was found when culture positivity rates were compared according to age and gender. However, there was a significantly higher rate of culture positivity in fingernails compared to toenails (P < .05).

Conclusion

Onychomycosis agents differ according to regions. In our analyses, we found non-albicans Candida species, especially C. parapsilosis as the most frequent agents of onychomycosis. Because these species are mostly resistant to antifungals this must be kept in mind during therapy.

As comorbidities were only found in a limited number of patients additional studies are needed to find responsible factors.

Multicenter evaluation of AYC.2.2 agar for the isolation of mycobacteria from clinical samples

PURPOSE

The aim of this multicenter study is to evaluate AYC.2.2 agar for the isolation of mycobacteria from clinical samples.

METHODS

Totally 5559 media were tested in 7 centers. AYC.2.2 agar media for the study were prepared by C1 and sent to other centers under appropriate conditions. Other media except AYC.2.2 agar were purchased commercially. The media were subjected to routine laboratory operations in the center where they were sent. After the samples received for routine processing (in all centers, samples were processed with the same method (NALC-NaOH)), they were cultivated on routine media and AYC.2.2 agar afterward.

RESULTS

C1: Average growth time was determined as 12.74±3.74 days with MGIT 960 system; 24.42±4.75 days with LJ and 24.37±4.96 days with AYC.2.2 agar. C2: Average growth time was determined as 18.25±9.32 days with TK-Medium, 28.73±7.44 days with LJ, and 31.72±6.35 days with AYC.2.2 agar. C3: Average growth time was determined as 20.48±7.24 days with Ogawa medium, 20.74±7.12 days with LJ, and 20.26±7.43 days with AYC.2.2 agar. C4: Average growth time was determined as 15.27±6.37 days with MGIT 960 system, 22.14±9.1 days with LJ, and 22±8.45 days with AYC.2.2 agar. C5: Average growth time was determined as 13±4.24 days with MGIT 960 system, 32.16±6.23 days with LJ, and 33±5.73 days with AYC.2.2 agar. C6: Average growth time was determined as 9±3.11 days with MGIT 960 system, 18.68±5.32 days with LJ, and 18.34±4.63 days AYC.2.2 agar. C7: Average growth time was determined as 14.74±7.65 with MGIT 960 system, 26.01±8.21 days with LJ, and 26.24±7.88 days with AYC.2.2 agar.

CONCLUSIONS

In conclusion, similar results were obtained with LJ and Ogawa media and AYC.2.2 agar. Furthermore, more studies should be conducted for isolation of M. tuberculosis and performing antibiotic susceptibility tests using AYC.2.2 agar before it can be used as a routine media in the laboratories.

Is there a Relationship between Serum IGF-1 and Thyroid Nodule, Thyroid or Ovarian Volume in Polycystic Ovarian Syndrome?

Context

Studies investigating the association between serum IGF-1, and thyroid nodule, ovarian or thyroid volume in polycystic ovarian syndrome (PCOS) are limited.

Objective

We aimed to analyze the association between serum IGF-1 level, and ovarian or thyroid volume, or thyroid nodule in PCOS.

Design

The study was performed between June 2017 and August 2019 as prospective design.

Subjects and Methods

Adult females with new-onset PCOS were included. The patients having comorbid illness, or using medication were excluded. Basic tests, thyroid and ovarian sonography were performed. The patients were grouped according to thyroid nodule(absent/present) and ovarian volume (<10mL/≥10mL). We planned to find a positive association between IGF-1, and thyroid nodule, thyroid or ovarian volume in PCOS.

Results

Of total 118 patients, 11(9%) had thyroid nodule. The patients with thyroid nodule had a higher ovarian volume (p=0.006). No correlation was found between GH or IGF-1, and thyroid or ovarian volume. IGF-1 was not a predictor for thyroid nodule or higher ovarian volume. Thyroid nodule was a significant predictor for higher ovarian volume.

Conclusion

Our study is the first to analyze the association between IGF-1 and thyroid nodule in PCOS. We found that thyroid nodule was associated with thyroid and ovarian volume, but IGF-1 was not associated with thyroid nodule, thyroid or ovarian volume.

Association between active pulmonary tuberculosis and circulating microRNAs: a preliminary study from Turkey

Background/aim

Tuberculosis is a public health problem that still remains significant. For prevention, diagnosis, and treatment of tuberculosis more effective novel biomarkers are needed. MicroRNAs can regulate innate and adaptive immune responses, alter host-pathogen interactions, and affect progression of diseases. The relationship between microRNA expression and active pulmonary tuberculosis (APT) has not yet been investigated in the Turkish population. We aimed to test the potential diagnostic value of some microRNAs whose levels were previously reported to be altered in APT patients.

Materials and methods

Using two different references (U6 and miR-93), we compared the expression levels of potentially important microRNAs in serum of APT patients with healthy individuals using quantitative polymerase chain reaction (qPCR).

Results

miR-144 expression level was down-regulated in APT patients when either U6 or miR-93 was used for normalization. When data was normalized with miR-93, a statistically significant decrease in miR-125b (0.8 fold) and miR-146a (0.7 fold) expression levels were observed, while no differences were detected for U6. The receiver operating characteristic suggested that miR-144 may be a candidate biomarker for discriminating APT patients and controls (p < 0.05) both for U6 and miR-93.

Conclusion

These findings suggest that miR-144 can have potential as a biomarker for APT. Using a single reference may be misleading in evaluation of microRNA expression. U6 and miR-93 can be used in combination as references for normalization of serum microRNA expression data.

The antifungal activity and cytotoxicity of silver containing denture base material

OBJECTIVE

Denture base materials are susceptible to fungal adhesion, which is an important etiological issue in the pathogenesis of denture stomatitis. The purpose of this in vitro study was to evaluate the antifungal activity and cytotoxicity of denture base material containing silver microparticles.

MATERIALS AND METHODS

The polymethyl methacrylate (PMMA) denture base material was used, and silver microparticles were added to the polymer powder in different concentrations by volume (0%, 0.25%, 0.5%, and 1%). Their antifungal activity against Candida albicans was assessed in terms of colony-forming units. PMMA disc specimens containing silver microparticles were eluted with culture medium for 1, 2, and 5 days. The cytotoxicity of the eluates to cultured L929 mouse fibroblast cells was evaluated using a real-time cell analysis (RTCA) system and the 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide (MTT) assay.

RESULTS

The antifungal effect against C. albicans increased with the percentage of silver microparticles (P < 0.05). For both tests, both RTCA and the MTT assay, no time- or silver-dependent cytotoxicity of PMMA denture base material containing silver microparticles was observed.

CONCLUSIONS

PMMA denture base material containing silver microparticles have antifungal activity and no cytotoxic effect.

A new colorimetric method for rapid detection of ethambutol and streptomycin resistance in Mycobacterium tuberculosis: crystal violet decolorization assay (CVDA)

Streptomycin (STR) and ethambutol (EMB) are important drugs used for the treatment of tuberculosis. There is a need for fast, reliable and inexpensive methods for detecting resistance to these drugs. The aim of this study was to evaluate the performance of the crystal violet decolorization assay (CVDA) for the detection of STR and EMB resistance that is important drugs in tuberculosis treatment. In this study, drug susceptibility testing was performed on 140 Mycobacterium tuberculosis isolates provided from nine centers. Three tubes were used for each isolate. One of the tubes had a concentration of 2 mg/L STR and the other 5 mg/L EMB. The third was drug-free control tube. Sensitivity, specificity, positive predictive value (PPD), negative predictive value (NPD) and agreement for STR were found to be 81.8%, 94.6%, 87.8%, 91.5% and 90.57%, respectively. For EMB, sensitivity, specificity, PPD, NPD, and agreement were found to be 76%, 98.23%, 90.47%, 94.87% and 94.2%, respectively. The results were obtained in 11.3 ± 2.7 days (8-21 days). CVDA is rapid, reliable, inexpensive, and easy to perform for rapid detection of STR and EMB resistance, and it could be adapted for drug susceptibility testing.

In Vitro Evaluation of Adhesion of Candida albicans on CAD/CAM PMMA-Based Polymers

PURPOSE

To compare the amount of adherent Candida albicans to different CAD/CAM poly(methyl methacrylate) (PMMA)-based polymers and conventional heat-polymerized PMMA after long-term thermal cycling.

MATERIALS AND METHODS

The specimens were subjected to 10,000 thermal cycles (5-55°C) and divided into two groups, uncoated and pellicle-coated. Surface roughness and contact angles of the specimens were measured. The surface morphology was observed with scanning electron microscopy (SEM). An adhesion test was performed by incubating the disk specimens in C. albicans suspensions at 37°C for 2 hours, and the adherent cells were counted under an optical microscope. The data were analyzed statistically using a variance analysis and Tukey HSD post hoc comparison test. The correlation between measurements was tested using a Pearson correlation analysis (α = 0.05).

RESULTS

CAD/CAM polymers generally showed statistically significant lowest Ra and contact angle values, whereas conventional PMMA showed the highest Ra and contact angle values in the uncoated group (p < 0.05). Pellicle coating essentially increased contact angle of all materials and reduced the differences in a number of Candida cells on the materials (p < 0.05). Candida adhesion was statistically significantly greatest on conventional PMMA when compared to CAD/CAM polymers. A strong positive correlation was found between the surface roughness of the specimens (p < 0.05) and the amount of adhered cells, whereas no correlation was found between hydrophobicity of the specimens and the amount of adhered cells (p > 0.05).

CONCLUSIONS

CAD/CAM PMMA-based polymers may be preferable to reduce Candida-associated denture stomatitis in long-term use.

Derotation of the mallet piece: A crucial point in mallet fracture surgery

Mallet fracture is an avulsion of the extensor tendon and fracture of the dorsal rim of the articular surface of distal phalanx at the same time. If a part of the mallet fracture is angled or rotated to such a degree that prevents full anatomic reduction, malunion and deformities may occur as a result. The objective of this study was to describe a new surgical technique to provide derotation of the mallet fracture. A 22G or 21G needle is used like a joystick to reduce the mallet fracture with small, gentle movements. The extension block pinning technique described by Ishiguro was applied after proper alignment had been achieved. Bony union was achieved for all patients 6 weeks later. Derotation of type 2 and 3 mallet pieces with closed reduction to prevent surgical failure is simple but effective.

Evaluation of crystal violet decolorization assay for minimal inhibitory concentration detection of primary antituberculosis drugs against Mycobacterium tuberculosis isolates

In this study we evaluated the crystal violet decolorization assay (CVDA) for detection of minimum inhibitory concentration (MIC) of antituberculosis drugs. 53 isolates were tested in this study and 13 of them were multidrug resistant (MDR) isolates. The antibiotics concentrations were 2-0.06 mg/L for isoniazid (INH) and rifampicin (RIF) and were 16-0.25 mg/L for streptomycin (STM) and ethambutol (EMB). Crystal violet (CV-25 mg/L) was added into the microwells on the seventh day of incubation and incubation was continued until decolorization. Decolorization of CV was the predictor of bacterial growth. Overall agreements for four drugs were detected as 98.1%, and the average time was detected as 9.5 ± 0.89 day after inoculation. One isolate for INH and two isolates for STM were determined resistant in the reference method, but susceptible by the CVDA. One isolate was susceptible to EMB by the reference method, but resistant by the CVDA. All results were concordant for RIF. This study shows that CVDA is a rapid, reliable and suitable for determination of MIC values of Mycobacterium tuberculosis. And it can be used easily especially in countries with limited-sources.

Autologous osteochondral transplantation (mosaicplasty) in articular cartilage defects of the patellofemoral joint: retrospective analysis of 33 cases

OBJECTIVE

The purpose of this retrospective study was to evaluate the results of osteochondral autografting (mosaicplasty) in isolated articular cartilage defects of the patellofemoral joint.

MATERIALS AND METHODS

Thirty-three patients who underwent mosaicplasty for patellofemoral (either patella or trochlea) cartilage defects (modified Outerbridge classification: grades III and IV) of the knee joint were retrospectively reviewed. There were 25 male and 8 female patients with a mean age of 31.3 ± 6.7 (range 22-47) years. The average size of the lesion was 2.4 ± 0.55 cm² (range 1.5-4.0). Patients with patellofemoral malalignment were excluded. All patients were followed at least one year with a mean of 19.3 ± 4.3 months (range 12-24 months) using Lysholm knee score.

RESULTS

The mean preoperative Lysholm knee score was 51.9 ± 2.6 (47-58) points and increased to 85.5 ± 4.2 (75-89) points at the final follow-up. There was a significant increase in Lysholm score during follow-up period (p = 0.0001). The results were good in 24 cases and fair in 9 cases. No patients had poor results. No patients had infection. Five patients had postoperative mild painful hemarthrosis. Of these patients, four were treated with rest, ice, compression (elastic bandage) and elevation and the remaining one was treated by aspiration. No patients needed secondary open or arthroscopic drainage. No systemic complications occurred during the follow-up.

CONCLUSIONS

Mosaicplasty is an effective technique for the treatment of articular cartilage defects of the patellofemoral joint knee which restores the joint function in a short period of follow-up. However, a meticulous surgical technique should be followed to restore the native articular surface and the congruity of the joint.

Multicenter evaluation of crystal violet decolorization assay (CVDA) for rapid detection of isoniazid and rifampicin resistance in Mycobacterium tuberculosis

The aim of this multicenter study was to evaluate the performance of the crystal violet decolorization assay (CVDA) for detection of multidrug resistant tuberculosis (MDR-TB). This study was performed in 11 centers in two phases. A total of 156 isolates were tested for INH and RIF resistance. In the phase I, 106 clinical isolates were tested in the Center 1–7. In the phase 2, 156 clinical isolates were tested in the center 1–6, center 8–11. Eighty six of 156 tested isolates were the same in phase I. Agreements were 96.2–96.8% for INH and 98.1–98.7% for RIF in the phase I-II, respectively. Mean time to obtain the results in the phase I was 14.3 ± 5.4 days. In the phase II, mean time to obtain the results was 11.6 ± 3.5 days. Test results were obtained within 14days for 62.3% (66/106) of isolates in the phase I and 81.4% (127/156) of isolates in the phase II. In conclusion, CVDA is rapid, reliable, inexpensive, and easy to perform for rapid detection of MDR-TB isolates. In addition, it could be adapted for drug susceptibility testing with all drugs both in developed and developing countries.

Investigation of histopathological effects after intra-arterial sugammadex injection in an experimental animal model

PURPOSE

Intra-arterial injection of medications are related to mortality and morbidity. It was aimed to investigate the histopathological effects caused by two different intra-arterial doses of sugammadex, a new selective relaxant binding agent used to reverse the effects of steroidal systemic muscle relaxants used in surgeries carried out under general anesthesia.

METHODS

A total of 15 rabbits were randomly divided into 3 groups. The control group was given 1 mL saline bolus into the central artery of the ear. The other two groups (Group Sgdx2 and group Sgdx16) were given 2 and 16 mg/kg sugammadex, respectively, intra-arterially.

RESULTS

In control group, histopathological evaluation was in normal limits. The cross-sections belonging to Group Sgdx2 did not have any significant pathological change compared with control group (p > 0.05). Edema and single-cell necrosis were significantly higher in Group Sgdx16 when compared to control group (p < 0.05). In comparison to Group Sgdx2, single-cell necrosis was significantly higher in Group Sgdx16 (p < 0.05).

CONCLUSION

Being broadly used in anesthesia, sugammadex should be administered with care because when given by intra-arterial route it may cause tissue damage and tissue loss and the patients' arteries should be carefully checked.

Brain Natriuretic Peptide and the Severity of Aortic Regurgitation: Is There Any Correlation?

We aimed to evaluate the correlation between aortic regurgitation severity and brain natriuretic (BNP) levels as a marker for left ventricular dysfunction. Sixty consecutive male patients (mean age 22 ± 3 years) with isolated chronic aortic regurgitation were enrolled in the study together with a control group of 30 age-matched healthy volunteers (group A). Patients were classified with regard to aortic regurgitation vena contracta width as follows: group B, < 3 mm, mild ( n = 16); group C, ≥ 3 and < 6 mm, moderate ( n = 26); group D, ≥ 6 mm, severe ( n = 18). BNP measurements were performed with a fluorescence immunoassay kit. BNP levels were increased in patients with aortic regurgitation, and severity of regurgitation had a significant influence on BNP levels. This effect can be explained by the volume loading effect of aortic regurgitation.

Investigation of endocrine and immunological response in fat tissue to hyperbaric oxygen administration in rats

Though HBO treatment is becoming more common, the mechanism of action is not fully known. The positive effects of HBO administration on the inflammatory response is thought to be a possible basic mechanism. As a result, we aimed to research whether endocrine and immunological response of fat tissue changes in rats given HBO treatment model. This research was carried out on Wistar albino rats, they were treated with hyperbaric oxygen therapy. Their fatty tissue were taken from the abdomen, gene expression of the cytokines and adipokines were analyzed with Real time PCR method. When the gene expression of hormones and cytokines by fat tissue was examined, the leptin, visfatin, TNF-α, IL-1β and IL-10 levels in the HBO treatment group were statistically significantly increased compared to the control group (p=0.0313, p=0.0156, p=0.0156, p=0.0156, p=0.0313). In conclusion, in our study we identified that HBO administration affected the endochrinological functions of fat tissue.

[Multicenter evaluation of the indirect nitrate reductase assay for the rapid detection of multidrug-resistant tuberculosis]

Multidrug-resistant tuberculosis (MDR-TB) is defined as resistance to at least isoniazid (INH) and rifampicin (RIF), and it complicates the implementation of tuberculosis control programmes. The rapid detection of MDR-TB is crucial to reduce the transmission of disease. The nitrate reductase assay (NRA) is one of the colorimetric susceptibility test methods for rapid detection of MDR-TB and based on the ability of reduction of nitrate to nitrite by Mycobacterium tuberculosis. The aim of this study was to evaluate the performance of the NRA for the rapid detection of MDR-TB. A total of 237 M.tuberculosis complex (MTC) isolates that were identified by the same method (BD MGIT(TM) TBc Identification Test, USA) from nine different medical centers in Turkey were included in the study. The susceptibility results of the isolates against INH and RIF obtained by reference test (Bactec MGIT(TM) 960, BD, USA) were then compared with NRA. In order to ensure consistency between centers, Löwenstein-Jensen (LJ) medium with antibiotics and without antibiotics (growth control) and Griess reagent solution were prepared in a single center (Ondokuz Mayıs University School of Medicine, Medical Microbiology Department) and sent to all participant centers with the standardized test procedure. After the inoculation of bacteria into the test tubes, the tubes were incubated at 37°C, and after seven days of incubation, 500 μl Griess reagent was added to the LJ medium without antibiotics. If a color change was observed, an equal volume of Griess reagent was added to test LJ media with antibiotics. When a color change was observed in LJ media with antibiotics, it was considered that the isolate was resistant to tested antibiotics. Among 237 MTC isolates, 16 were resistant only to INH and nine were resistant only to RIF; 93 isolates (39.2%) were resistant (MDR) and 119 isolates (50.2%) were susceptible to both of the drugs determined with the reference susceptibility test. In the study, five INH-resistant isolates determined with reference method were found susceptible with NRT and eight INH-susceptible isolates determined with reference method were found resistant with NRT. In contrast, one RIF-resistant isolate determined with reference method was found susceptible with NRT and three RIF-susceptible determined isolates were found resistant with NRT. Accordingly, the concordance rate between the reference method and NRA were estimated as 94.5% for INH and 98.3% for RIF. The sensitivity, specificity, positive and negative predictive values of NRA were detected as 95.4%, 93.7%, 92.8% and 96% for INH, and 99%, 97.8%, 97.1% and 99.2% for RIF, respectively. The results of the 111 isolates were obtained on the seventh day, while the rest of the results were obtained between 10-14 days. In conclusion, the data of this multicenter study showed that NRA is a reliable, relatively inexpensive and practical method to perform for the rapid detection of MDR-TB.

Assessment of 35 children with abdominal tuberculosis

BACKGROUND/AIMS

To contribute to the diagnosis and treatment of pediatric abdominal tuberculosis cases by assessing the clinical, laboratory, and radiological features of patients who presented at our clinic and were diagnosed with abdominal tuberculosis.

MATERIALS AND METHODS

Clinical, laboratory, and radiological features were reviewed retrospectively for 35 patients diagnosed with abdominal tuberculosis and followed up at the Pediatric Infectious Diseases Clinic between January 1987 and August 2012.

RESULTS

The study group included 16 female (45.7%) and 19 male (54.3%) patients with an age range of 6 months to 16 years (mean: 9.77±4.36 years). Twenty-nine patients were diagnosed with tuberculosis peritonitis, five patients with intestinal tuberculosis, and one patient with pelvic tuberculosis. The most common signs and symptoms were ascites, abdominal pain, abdominal distention, weight loss, and fever. Mean duration of the complaints was 109 days (range: 10 days to 3 years).

CONCLUSION

Abdominal tuberculosis is a disease with an insidious course without disease-specific clinical and laboratory signs. When the disease is suspected, laparoscopy or laparotomy could be helpful in diagnosis. Employing ultrasound and computed tomography signs, abdominal tuberculosis should be included in differential diagnoses in regions with a high incidence of tuberculosis when there is abdominal pain, weight loss, ascites, history of contact with individuals with tuberculosis, and positive tuberculin skin test when patients have not been Bacillus Calmette Guerin BCG vaccinated.

Mental health problems in children with uncomplicated epilepsy; relation with parental anxiety

Mental health problems and parental anxiety in children with epilepsy were investigated. Parents of 83 children with epilepsy and 172 healthy children were asked to complete Strengths and Difficulties Questionnaire for their children and State-Trait Anxiety Inventory for themselves. In those with epilepsy, 39.8% (n: 33) were girls, 60.2% (n: 50) were boys and their mean age was 9.34 ± 3.99 years. Control group was more successful in school (p < 0.001). Emotional problems score in children with epilepsy was higher than control group (p < 0.001). Case group's behavior problems and attention deficit hyperactivity scores were higher (p < 0.001, p=0.009 respectively). Prosocial behavior scores of the control group were significantly higher (p=0.004). State (p=0.001) and trait (p=0.001) anxiety levels of parents of children with epilepsy were higher. Children with epilepsy have more neuro-behavioral problems; and their parents have greater anxiety levels. Physicians should be in contact with children with epilepsy for the psychological health of the family besides seizure control.

Evaluation of four colourimetric susceptibility tests for the rapid detection of multidrug-resistant Mycobacterium tuberculosis isolates

The purpose of this study is to evaluate four rapid colourimetric methods, including the resazurin microtitre assay (REMA), malachite green decolourisation assay (MGDA), microplate nitrate reductase assay (MNRA) and crystal violet decolourisation assay (CVDA), for the rapid detection of multidrug-resistant (MDR) tuberculosis. Fifty Mycobacterium tuberculosis isolates were used in this study. Eighteen isolates were MDR, two isolates were only resistant to isoniazid (INH) and the remaining isolates were susceptible to both INH and rifampicin (RIF). INH and RIF were tested in 0.25 µg/mL and 0.5 µg/mL, respectively. The agar proportion method was used as a reference method. MNRA and REMA were performed with some modifications. MGDA and CVDA were performed as defined in the literature. The agreements of the MNRA for INH and RIF were 96% and 94%, respectively, while the agreement of the other assays for INH and RIF were 98%. In this study, while the specificities of the REMA, MGDA and CVDA were 100%, the specificity of the MNRA was lower than the others (93.3% for INH and 90.9% for RIF). In addition, while the sensitivity of the MNRA was 100%, the sensitivities of the others were lower than that of the MNRA (from 94.1-95%). The results were reported on the seventh-10th day of the incubation. All methods are reliable, easy to perform, inexpensive and easy to evaluate and do not require special equipment.

Rapid detection of multidrug-resistant Mycobacterium tuberculosis using the malachite green decolourisation assay

Early detection of drug resistance in Mycobacterium tuberculosis isolates allows for earlier and more effective treatment of patients. The aim of this study was to investigate the performance of the malachite green decolourisation assay (MGDA) in detecting isoniazid (INH) and rifampicin (RIF) resistance in M. tuberculosis clinical isolates. Fifty M. tuberculosis isolates, including 19 multidrug-resistant, eight INH-resistant and 23 INH and RIF-susceptible samples, were tested. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and agreement of the assay for INH were 92.5%, 91.3%, 92.5%, 91.3% and 92%, respectively. Similarly, the sensitivity, specificity, PPV, NPV and agreement of the assay for RIF were 94.7%, 100%, 100%, 96.8% and 98%, respectively. There was a major discrepancy in the tests of two isolates, as they were sensitive to INH by the MGDA test, but resistant by the reference method. There was a minor discrepancy in the tests of two additional isolates, as they were sensitive to INH by the reference method, but resistant by the MGDA test. The drug susceptibility test results were obtained within eight-nine days. In conclusion, the MGDA test is a reliable and accurate method for the rapid detection of INH and RIF resistance compared with the reference method and the MGDA test additionally requires less time to obtain results.

Quantifying the financial losses of rangeland degradation due to reduced milk yield in the rangelands of Erzurum Province in Turkey

This study estimated the financial losses associated with lower milk yields in the relatively poor rangeland conditions of the Erzurum Province in Turkey and the factors contributing to the lower milk yields associated with the state of the rangelands, the type of grazing livestock and the demographics of the farmers. The study was conducted in 11 villages in Erzurum Province in 2006 and 2007. The following variables were considered in the study: year, number of milking days in grazing season, age and level of education of the farmers, cattle breed, supplementary feeding during the grazing period, lactation number of the cows, rangeland condition, stocking rate of the rangelands, altitude, the proportion of small ruminants in the herd and the percentage of bare ground of the rangelands. According to the least-squares regression analysis, altitude, stocking rate, the number of milking days in the grazing season and the percentage of bare ground had negative effects on milk yield, whereas all other factors significantly increased milk yield. It was estimated that a 10% deterioration in rangeland condition would result in a reduction in daily milk yield of 1.23 kg per cow, 62 kg ha–1 of rangelands and 1255 kg per farm in a 120-day grazing period. It was also found that the use of concentrate supplements during the grazing season was not cost-effective.

Prevalence and drug resistance of mycobacteria in Turkish cystic fibrosis patients

BACKGROUND

Isolation of mycobacteria in cystic fibrosis (CF) patients is increasingly being reported. Because of having long term antimicrobial treatment, CF patients are at risk of pulmonary infection with especially resistant nontuberculous mycobacteria (NTM) strains. The aim of the present study is to determine the prevalence of mycobacterium spp. and antimicrobial susceptibility in Turkish CF patients.

METHODS

During a 5.5 year study period, 376 sputa from 130 CF patients were analyzed. Antimycobacterial susceptibility testing was performed by the Bactec 460 TB System and the E test method.

RESULTS

Totaly 28 (7.44%) Mycobacterium spp. were isolated from eight (6.15%) CF patients. Five isolates (17.9%) were identified as Mycobacterium tuberculosis complex (MTBC), 14 (50%) as Mycobacterium abscessus and nine (32.1%) as Mycobacterium lentiflavum. All MTBC isolates were found to be susceptible to streptomycin, isoniazid, rifampicin, and ethambutol. Resistance to some antibiotics was detected in some NTM strains. These are the first data about the prevalence of mycobacteria in CF patients from Turkey.

CONCLUSIONS

In pediatric CF patients, specific mycobacterial analysis of sputum specimens and susceptibility testing should be performed for allowing early detection, identification and the possibility of eradication of these bacteria.

Frequency of choroidal abnormalities in pediatric patients with neurofibromatosis type 1

PURPOSE

To investigate the frequency of choroidal abnormalities in pediatric patients with neurofibromatosis type 1 detected by infrared reflectance imaging.

METHODS

The fundus of 38 eyes of 19 patients with neurofibromatosis type 1 was examined using infrared reflectance imaging with optical coherence tomography. Forty eyes of 20 age-matched controls were examined similarly. Each patient was evaluated for the presence and the number of choroidal abnormalities. The correlation between the total number of choroidal abnormalities and the patient's age was studied.

RESULTS

A total of 19 patients (11 females, 8 males) were included. The mean age of the neurofibromatosis group was 8.63 ± 3.15 years (range: 4 to 16 years) and that of the control group was 9.05 ± 3.27 years (range: 4 to 15 years). Choroidal nodules appearing as bright patchy nodules were detected in 15 (78.9%) of 19 patients with neurofibromatosis type 1 and 1 (5%) of 20 control subjects. In terms of the frequency of choroidal abnormalities, the difference was significant between the patients with neurofibromatosis type 1 and the controls (P < .001). There was a positive correlation between the number of choroidal abnormalities in both eyes and the patient's age (r = 0.701, P = .001).

CONCLUSIONS

Choroidal abnormalities are frequent in neurofibromatosis type 1. Choroidal abnormalities detected by infrared reflectance imaging with optical coherence tomography can be used to diagnose neurofibromatosis type 1.

Posterior reversible encephalopathy syndrome in children: report of three cases

PURPOSE

Posterior reversible encephalopathy syndrome (PRES) is a condition characterized by varying degrees of headache, nausea, vomiting, visual disturbances, focal neurologic deficit, and seizures due to severe systemic hypertension. The knowledge of secondary hypertension in children is most commonly due to renal abnormalities, suggesting that the leading cause of PRES in childhood is renal diseases.

METHODS

Three pediatric patients who developed PRES due to various underlying renal diseases were reviewed.

RESULTS

The etiology of hypertension of our patients was all renal problems including atrophic kidney, hydronephrosis secondary to reflux nephropathia, nephrotic syndrome, and acute poststreptococcal glomerulonephritis. While two of them had typical of the parieto-occipital and frontoparietal involvement, the other had brain stem involvement. All of the patients were recovered by the control of high blood pressure.

CONCLUSION

Primary involvement of the brain stem is rare in children. PRES should be taken into account, especially in children with renal disease in the appropriate clinical settings.

Rapid Susceptibility Test for Mycobacterium tuberculosis to Isoniazid and Rifampin with Resazurin Method in Screw-Cap Tubes

Multi-drug resistant (MDR) Mycobacterium tuberculosis is still a serious public health problem all over the world. MDR tuberculosis (MDR-TB) caused by these strains has emerged within the last decade and rapid detection is critical for the effective treatment of patients. Recently, a resazurin microtiter assay plate for detecting MDR strains was developed. In this study, it was adapted to screw-cap tubes and the activity of isoniazid (INH) and rifampin (RIF) to 50 M. tuberculosis clinical isolates was tested by this method for the first time. Results were compared with the radiometric reference method for the susceptibility testing of M. tuberculosis complex. The results of both methods were in 100% and 96% agreement for RIF and INH, respectively. Specificity, sensitivity, positive predictive value and negative predictive value were 91.7%, 100%, 92.8% and 100% for INH, respectively. All of these values were 100% for RIF. Susceptibility testing results were obtained on the 8th day of incubation for 42 isolates and on the 9th day for the other eight strains. Our results indicate that this method is suitable for the early determination of INH and RIF resistance in developing countries because it is inexpensive, rapid and easy to perform.

Comparative evaluation of the microplate nitrate reductase assay and the rezasurin microtitre assay for the rapid detection of multidrug resistant Mycobacterium tuberculosis clinical isolates

The microplate nitrate reductase assay (MNRA) and the rezasurin microtitre assay (REMA) were used for the susceptibility testing of 73 clinical isolates and the results were compared with those that were obtained using the Bactec 460 TB and Bactec MGIT 960 systems. The REMA and the MNRA were performed in 96-well plates. For the REMA, the concentrations of isoniazid (INH) and rifampicin (RIF) ranged from 1.0-0.01 µg/mL and 2.0-0.03 µg/mL, respectively. For the MNRA, the INH concentration was between 1.0-0.03 µg/mL and the RIF concentration was between 2.0-0.06 µg/mL. For the MNRA, the sensitivity, specificity, positive predictive value, negative predictive value and INH/RIF agreement were 100/95.6, 97.6/100, 96.8/100, 100/98 and 98.6/98.6, respectively, and for the REMA, they were 100/91.3, 90.4/100, 88.5/100, 100/96.1 and 94.5/97.2, respectively. Our data suggest that these two rapid, low-cost methods may be inexpensive, alternative assays for the rapid detection of multidrug resistant tuberculosis in low-income countries.

Mid-term results for unicompartmental knee arthroplasty

PURPOSE OF THE STUDY

The purpose of this study was to evaluate clinical and functional results for a series of patients undergoing unicompartmental knee arthroplasty (UKA) at mid-term follow-up.

MATERIAL AND METHODS

This study included 32 patients with isolated medial compartment arthritis who underwent unilateral UKA. Outcomes were assessed using pre- and postoperative Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) scores and Knee Society Score (KSS) metrics.

RESULTS

On physical examination at a follow-up of at least 5 years, mean knee flexion was 121° , mean knee extension was 2°, and mean varus angulation was 2°. At post-operative evaluation, the mean WOMAC score was 96.12 and the mean KSS score was 93. Pre- and postoperative WOMAC and KSS scores were evaluated by paired Student's t-tests; p < 0.001 determined a highly significant difference.

DISCUSSION

Early UKA designs had poor outcomes. Newer implant designs and specific patient selection criteria have been reported to be associated with improved outcomes. This study examined mid-term outcomes (mean duration of follow-up, 5 years).

CONCLUSION

The clinical and functional results of UKA at 5-year follow-up were shown to be satisfactory. Longer follow-up is needed to determine whether UKA provides satisfactory long-term outcomes.