The histopathological evaluation of small fiber neuropathy in patients with vitamin B12 deficiency

Small fiber neuropathy (SFN), due to loss of A-delta and unmyelinated C fibers, is a cause of neuropathic pain. Although the patients with vitamin B12 deficiency are included in SFN studies in the literature, there is no histopathological study investigating the small fiber loss solely in patients with vitamin B12 deficiency. In this pilot study, we aim to demonstrate the intraepidermal nerve fiber density (IENFD) in skin punch biopsy of patients with vitamin B12 deficiency. Ten patients with vitamin B12 deficiency suffering from neuropathic pain and as control group ten patients with vitamin B12 deficiency without neuropathic pain were included. Neurological examination, electrophysiological evaluation, and DN4 questionnaire were performed. Subsequently, skin punch biopsy 10 cm above the lateral malleolus was done. The biopsy samples were stained with PGP9.5 antibody, and IENFD was determined. IENFD was low in two groups compared to their age normative values. The median of IENFD was 3.345 (1.12–5.32) in patients with neuropathic pain and 6. 20 (4.6–9.8) in controls (p < 0.001). Our pilot study showed that vitamin B12 deficiency causes symptomatic as well as asymptomatic small fiber loss like diabetes mellitus.     

Cerebrospinal fluid levels of nitric oxide and nitrotyrosine in neonates with mild hypoxic-ischemic encephalopathy

The objective of this study was to determine the role of cerebral nitric oxide and its powerful oxidant peroxynitrite following mild birth asphyxia. The cerebrospinal fluid levels of nitric oxide and 3-nitrotyrosine as a marker for peroxynitrite are measured in neonates with mild hypoxic-ischemic encephalopathy. Based on the classification of Sarnat and Sarnat, term neonates with mild hypoxic-ischemic encephalopathy and neurologically normal neonates suspected of sepsis were taken as the control group. Nitric oxide measurements were done by chemiluminescence, and nitrotyrosine measurements were made by high-performance liquid chromatography. The Mann Whitney U-test was used, and a Pvalue < .05 was considered significant. Eleven patients with grade 1 hypoxic-ischemic encephalopathy and nine controls were included. The gestational age and birthweights were similar in both groups. Neither of the cerebrospinal fluid levels of nitric oxide (8.60 +/- 0.49 micromol/L) and nitrotyrosine (0.45 +/- 0.33 micromol/L) of the neonates with hypoxic-ischemic encephalopathy showed significant differences from that of the means of nitric oxide (8.66 +/- 1.07 micromol/L) and nitrotyrosine levels (0.25 +/- 0.13 micromol/L) of the controls. These data suggest that the oxidative stress is not overexpressed to lead nitric oxide and peroxynitrite to play a pathologic role in the early phase of mild hypoxic-ischemic encephalopathy of the newborn.     

Sweet's syndrome in a woman with a prothrombin gene (G20210A) mutation

A 46‐year‐old woman was admitted to our hospital with tender, erythematous plaques on her palms of 1‐year duration ( Fig. 1 ). She had a history of fever and upper respiratory tract infection. On dermatological examination, there were found to be tender erythematous papules and plaques on the palms. Physical examination was normal. Ophthalmologic examination revealed bilateral episcleritis. Laboratory tests showed the following values: white blood cell count, 15,600 cells/µL with 3% band forms, 74% segmented neutrophils, 3% monocytes, and 20% lymphocytes; red blood cell count, 4.53 × 10⁶ cells/µL; hemoglobin, 13.2 g/dL; hematocrit value, 40.9%, and platelet count, 241 × 10⁹ platelets/µL. The erythrocyte sedimentation rate was 52 mm/ h, and the C‐reactive protein level was 38.8 mg/dL. Cultures from blood and throat swabs for bacteria revealed no pathogenic growths. Urinanalysis, liver and kidney function tests were within normal limits. Antinuclear, anti‐DNA, and antiphospholipid antibodies were negative, and total C3 and C4 complement levels were normal. In histopathological examination, large infiltrates of neutrophils and nuclear dust were seen in a diffuse pattern within the edematous dermis. There were scattered neutrophils within the epidermis. The vascular endothelial cells were plump, but there was no fibrin in the wall of the venules ( Figs 2 and 3 ). In addition, there was a heterozygous prothrombin (G20210A) gene mutation in rapid polymerase chain reaction (PCR) analysis. She had no history of venous thrombosis or hematologic disorders. The following coagulation and thrombophilic tests were normal: activated protein C ratio (2.6; normal > 2), protein C (84%; normal: 78–106%), prothrombin time (9.8 s; normal: 7–13 s), activated partial thromboplastin time (29.6 s; normal: 22.6–35.0 s), fibrinogen (312 mg/dL; normal: 146–400 mg/dL), bleeding time (30 s, Duke method), and clotting time (5 min, Lee‐White method). Chest X‐ray, abdominal ultrasound findings and tumor marker levels were normal. Based on clinical, laboratory and histopathological findings a diagnosis of Sweet's syndrome associated with prothrombin gene mutation was made. The skin lesions resolved rapidly on treatment with wet compresses of Burrow's solution and oral prednisolone (1 mg/kg). The dose of prednisolone was gradually reduced, and was discontinued after 4 weeks.

Figure 1 Open in figure viewer PowerPoint Erythematous plaques on the palmar aspect of the hand     

Tear production during the neonatal period

PURPOSE: To measure tear secretion in term and preterm infants to assess whether tear secretion correlates with the maturity of the infants and to evaluate the changes in tear production during the neonatal period. DESIGN: Prospective, observational case series. METHODS: Ninety-six term and 22 preterm medically stable infants were studied. Post-conceptional age and birth-weight of each infant were recorded. Tear secretion was measured by the Schirmer test before (total tear secretion) and after (basal tear secretion) the instillation of topical anesthetic agent. Both eyes were tested consecutively. The initial tear measurements were performed within the first 2 days of life, and tear measurements were repeated at 2 weeks and 4 weeks after birth. RESULTS: The mean total tear production was 16.3 (+/-3.6) mm in term and 7.4 (+/-3.2) mm in preterm infants. The mean basal tear production was 7.3 (+/-3.2) mm in term and 3.5 (+/-1.3) mm in preterm infants. Total tear secretion significantly correlated with birth-weight (r, 0.42, P =.04) and post-conceptional age (r, 0.56, P =.006) in preterm infants. For term infants, total tear secretion significantly increased at 2 weeks (18.1 +/- 3.4 mm, P <.001) and 4 weeks (19.5 +/- 4.1 mm, P <.001) after birth. For preterm infants, a significant increase in total tear production was observed at the fourth week (11.5 +/- 3 mm, P <.001). CONCLUSION: Tear production in newborns depends on the maturity of the infants and increases substantially during the neonatal period. Preterm infants have reduced tear secretion compared with term infants.     

Traumatic stress responses in treatment-seeking earthquake survivors in Turkey

This study examined the incidence of posttraumatic stress disorder (PTSD) and depression in 1,027 earthquake survivors who were consecutively referred to a community center at a mean of 14 months after the August 1999 earthquake in Turkey. Seventy-seven percent of referrals were women. The estimated rates of PTSD and major depression were 63% and 42%, respectively. More severe PTSD symptoms related to greater fear during the earthquake, female gender, lower education, loss of friends, shorter time since the earthquake, and material loss. More severe depression symptoms related to female gender, longer time since the earthquake, lower educational level, loss of a family member, and past psychiatric illness. In conclusion, long-term public mental health policies are needed for postearthquake psychological problems. These policies need to take into account the risk factors for traumatic stress and the gender differences in referral patterns. The differential stressor-response relationship may have important implications for treatment.     

Effect of handedness on learning subgingival scaling with curettes: a study on manikins

The aim of the present study was to evaluate the influence of systematic manikin-head training and the effectiveness of subgingival scaling applied with hand instruments (curettes) by right- and left-handed dental students on dental chairs (traditional) designed for right-handers. A questionnaire focusing on handedness was administered to 69 voluntary dental students in the third class at the School of Dentistry during pre-participation examination. Handedness was assessed using the Turkish version of the Edinburgh Handedness Inventory. Then, 18 dental students were specially selected in 2 equal groups according to hand preference: consistent right-handers with Geschwind Scores of +100 (5 female and 4 male) and consistent left-handers with Geschwind Scores of -100 (5 female and 4 male). These two untrained dental student groups received 10 weeks manikin-head training. Subgingival scaling was performed with hand instruments (Gracey curettes) in manikin-head mounted on right-sided dental chairs. At 6 test days each dental student had to instrument 12 test teeth. Effectiveness of subgingival scaling was evaluated by adoption of a grading system. This system had scores from 0 to 3 and was defined by illustrated and described criteria. Statistical analysis was carried out with SPSS. Two groups were statistically compared on all test days. The yet-untrained left-handed dental students begin with a relatively high the mean score of 2.25, compared to the yet-trained right-handed dental students with 1.93, which was statistically significant (p > .05). The right-handed dental students reached the mean score of 0.53, whereas the left-handed dental students reached the mean score of 0.87 on test day 6. Significant differences in the mean scores were found between the two groups for overall surfaces (p < .05), the distal surfaces (p < .01), lingual surfaces (p < .01), and each group of teeth (p < .05). But there was no statistically significant difference between the 2 groups of students on all test day, except for test day 3 in terms of the mean scores for the facial and mesial surfaces (p > .05). Learning success was observed a high level in both groups through systematical training (p < .0001). The present study has documented that the left-handed dental students were less successful than the right-handed dental students in subgingival scaling, except for mesial and facial surfaces. However although training on right-sided chairs, they were quite similar to their right-handed counterparts in terms of learning success.     

Gender- and age-related distinctions for the in vivo prooxidant state in Fanconi anaemia patients

Some selected oxidative stress parameters were measured in 56 Fanconi anaemia (FA) patients (42 untransplanted and 14 transplanted), 54 FA heterozygotes (parents) and 173 controls. Untransplanted FA patients showed a highly significant increase in leukocyte 8-hydroxy-2'-deoxyguanosine (8-OHdG) (P = 0.00003) and a borderline increase (P = 0.076) in urinary levels of 8-OHdG versus child controls. These increases were more pronounced in female FA patients (P = 0.00005 for leukocyte 8-OHdG and P = 0.021 for urinary 8-OHdG). Female FA patients also displayed a highly significant excess of spontaneous chromosomal breaks versus male patients (P = 0.00026), in the same female:male ratio ( approximately 1.4) as detected for both leukocyte and urine 8-OHdG levels. Plasma methylglyoxal (MGlx) levels were increased in untransplanted FA patients versus child controls (P = 0.032). The increases in leukocyte and urinary 8-OHdG and in MGlx levels were detected in young FA patients (< or =15 years), whereas patients aged 16-29 years failed to display any differences versus controls in the same age group. A significant increase in oxidized:reduced glutathione (GSSG:GSH) ratio was observed (P = 0.046) in the FA patients aged < or =15 years, whereas those aged 16-29 years, both untransplanted and transplanted, displayed a decrease (P = 0.06) in the GSSG:GSH ratio versus the controls of the respective age groups. No significant changes were detected in plasma levels of vitamin C, vitamin E or uric acid. Transplanted FA patients showed lesser alterations in leukocyte 8-OHdG and in GSSG:GSH ratio versus untransplanted patients. The parents of FA patients displayed a significant increase in plasma MGlx levels (P = 0.0014) versus adult controls. The results suggest a gender- and age-related modulation of oxidative stress in FA patients. The observed increase in urinary 8-OHdG in untransplanted FA patients suggests a proficient removal of oxidized DNA bases.