Is late adolescence a real risk factor for an adverse outcome of pregnancy?

Objective: To compare the obstetrical and neonatal outcomes of late adolescent (LA) and adult pregnancies.

Methods: Between January 2012 and December 2012, a total of 313 late adolescent pregnant aged between 16 and 19 years and 418 adult pregnant women aged between 20 and 35 years having given birth in our maternity service were enrolled into this case–control study. The demographic and clinical data were reviewed from hospital database and patients’ medical records.

Results: The incidence of preterm birth (PB) in the LA group was significantly higher than in the adult group (p?=?0.001), while the incidence of gestational diabetes mellitus was significantly lower (p?=?0.001). The mean birth weight and the rate of delivered macrosomic fetuses in the study group were lower than in the control group (p?=?0.03). The LA group had significantly higher rate of vaginal delivery when compared to the adult group (p?=?0.001). Both the rate of pregnancy induced hypertensive disorders and postpartum hemorrhage were not statistically different between the two groups (p?=?0.31; p?=?0.38, respectively). The LA group had lower rate of stillbirth when compared to the adult group; however, the difference was statistically insignificant (0.3% versus 1.2%) (p?=?0.24).

Conclusions: The LA pregnancy should be closely followed up during their antenatal care period due to the significantly higher rate of PB.     

Vancomycin-resistant enterococci colonization in a neonatal intensive care unit: who will be infected?

Objective: To determine the incidence of vancomycin-resistant enterococcus (VRE) colonization in our neonatal intensive care unit (NICU) over five-year period, rate of progression to VRE infection and associated risk factors.

Methods: A retrospective analysis of a prospective surveillance for VRE colonization and health care-associated infections was made. Contact precautions were taken against colonization, although the application varied over the years due to repairs in the unit.

Results: VRE rectal colonization was detected in 200/1671 neonates (12%) admitted to NICU. It showed great interannual variability from 1.9% to 30.3%. Sytemic VRE infection developed in 6/200 VRE-colonized patients (3%) within a median of 9 days (range: 3–58 days). The risk factors for VRE infection development identified in the univariate analysis were long hospital stay (≥30 days), necrotizing enterocolitis, surgical procedure, extraventricular drainage, receipt of amphotericin B and receipt of glycopeptides after detection of VRE colonization. Crude in-hospital mortality was higher in neonates who developed a systemic VRE infection (p?<?0.001).

Conclusion: Maintaining physical conditions in the unit favorable for infection control and rational use of antibiotics are essential in the control of VRE colonization and resultant infections. Special attention should be directed to VRE-colonized babies carrying the risk factors.     

Vitamin D insufficiency in a boy with obsessive–compulsive disorder

Vitamin D deficiency not only causes low bone mass but also may lead to neuropsychiatric disorders. In the present case, vitamin D supplementation reduced obsessive–compulsive disorder (OCD) symptoms associated with streptococcal infection in a 7‐year‐old boy. Sudden onset of symptoms, including excessive hand washing and fear of touching anything, had occurred 1 month before presentation. Although there are few studies on a possible causal relationship between vitamin D and neuropsychiatric disorders, the present report; together with previous data, suggest an etiological role of vitamin D‐related immune processes.     

Role of the Neutrophil-Lymphocyte Ratio in the Differential Diagnosis of Exudative Pleural Effusion

OBJECTIVES:Pleural effusion is a common diagnostic and clinical problem. The differential diagnosis of pleural effusion may be difficult and may require several procedures, including invasive ones. Certain studies have investigated biochemical parameters to facilitate the diagnosis of exudative pleural effusion; however, it remains a challenging problem in clinical practice. We aimed to investigate the potential role of the neutrophil-lymphocyte ratio, which can be easily obtained by determining the cell count of the pleural fluid, in the differential diagnosis of exudative pleural effusion.METHODS:Records from patients who underwent thoracentesis and pleural fluid analysis between May 1, 2013, and March 1, 2015, were obtained from the electronic database of our hospital. The patients who met the inclusion criteria were divided into five groups according to their diagnosis: malignant pleural effusion, para-malignant pleural effusion, para-pneumonic effusion, tuberculosis-related effusion or other. The neutrophil-lymphocyte ratio value was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count. The patient groups were compared according to the given parameter.RESULTS:A total of 465 patients who met the inclusion criteria among 1616 patients with exudative pleural effusion were included in the study. The mean neutrophil-lymphocyte ratio value was significantly lower in tuberculosis-related pleural effusion compared to malignant, para-pneumonic and para-malignant effusions (p=0.001, p=0.001, p=0.012, respectively). The areas under the curve for tuberculosis pleurisy compared to malignant, para-pneumonic and para-malignant effusions were 0.38, 0.36, and 0.37, respectively. Lower cut-off values had higher sensitivity but lower specificity for tuberculosis pleurisy, while higher cut-off values had higher specificity but lower sensitivity for this condition.CONCLUSION:The pleural fluid neutrophil-lymphocyte ratio, which is an inexpensive, reproducible, and easily calculated hematological parameter, may facilitate the differential diagnosis of pleural effusion.     

In vitro release and In vivo biocompatibility studies of biomimetic multilayered alginate-chitosan/β-TCP scaffold for osteochondral tissue

Biomimetic three-layered monolithic scaffold (TLS) intended for the treatment of osteocondral defects was prepared by using alginate, chitosan and β-tricalcium phosphate (β-TCP) to study drug release behavior of the alternative drug delivery system and to investigate the therapeutic efficacy of the scaffold. Dexamethasone sodium phosphate (Dex) as a model drug was incorporated into the scaffold by solvent sorption method and in vitro release studies were conducted. In addition, the scaffold was implanted into the defects formed in the trochlea of Sprague–Dawley rats to assess the healing potential of the TLS on the osteochondral defect against reference Maioregen® comparatively. The release studies showed that after an initial burst at 3rd h, dexamethasone is released slowly during a 72-h period. In vivo studies indicated that the TLS has good tissue biocompatibility and biodegradation rate and showed better results during osteochondral healing process compared to the reference. All results demonstrated that the alginate-chitosan/β-TCP scaffold could be evaluated as a good candidate for osteochondral tissue applications.     

Peripheral neuropathy in patients with diabetes mellitus presenting as Bell's palsy

The aim of this study is to evaluate the peripheral nerves in diabetes mellitus with or without peripheral facial paralysis (PFP). A total of 49 diabetic patients with PFP within the last year (23 females, mean age 60.3 +/- 9.3), and 83 diabetic patients without PFP (41 females, mean age 59.5 +/- 9.9) were enrolled. The neurological examination, eye-blinking response, needle EMG and electrophysiological parameters of peripheral nerves were evaluated. The neuropathic pain, other positive and negative sensory symptoms were statistically more frequent in controls than the PFP group, while no difference was noted in total neuropathy score. Sural sensorial nerve action potential amplitudes were same in both groups, but median nerve amplitudes were significantly lower in the PFP group. It is suggested that PFP is not a part of multifocal neuropathy in diabetes mellitus. However, at least some parts of the nerve conduction studies were involved, focal neuropathies were more frequent while sensory neuropathies with small nerve fiber involvement were less frequent in diabetes patients with PFP.     

Monosomy 7 mosaicism in metastatic choroidal melanoma

Uveal melanoma is the most common primary intraocular malignancy in adults. Several cytogenetic studies on uveal melanoma cells have revealed that the majority of these cells harbor alterations in chromosomes 3, 6, and 8. This report describes the results of cytogenetic analysis performed on a fresh choroidal melanoma tissue sample from a patient with cerebellar metastasis. Monosomy 7 mosaicism was observed. To our knowledge, monosomy 7 has not been reported in patients with uveal melanoma. We suggest that observation of monosomy 7 may be related to an aggressive clinical behavior and unusual cerebellar metastasis in uveal melanoma. Further data are necessary to define the exact role of monosomy 7 in the pathogenesis and evolution of uveal melanoma.     

Effect of octenidine dihydrochloride on viability of protoscoleces in hepatic and pulmonary hydatid diseases

BACKGROUND: Use of effective scolicidal agents during puncture, aspiration or injection of a scolicidal agent and reaspiration (PAIR) and surgery for hydatid cysts are essential to reduce the recurrence rate. In this in vitro study, we tried to determine the scolicidal property of a new agent, octenidine dihydrochloride, and of various agents in different concentrations and exposure times. MATERIAL AND METHODS: Echinococcus granulosus protoscoleces were obtained from six patients with liver (n=3) and lung (n=3) hydatid cysts. Various concentrations of octenidine dihydrochloride (0.1%, 0.01% and 0.001% diluted form), povidone iodine (10%, 1% and 0.1% diluted) and 20% saline were used in this study. Viability of protoscoleces was determined with dye-uptake (0.1% eosin) and flame cell activity. RESULTS: Octenidine dihydrochloride 0.1% had strong scolicidal effect in 15 min and octenidine dihydrochloride 0.01% in 30 min. Sixty percent of protoscoleces lost viability at 5 min with octenidine dihydrochloride 0.1%. Viability ratio decreased to 20% at 10 min, and all of them died at 15 min. Povidone iodine 10% and 1% had strong scolicidal effects after 15- and 30 min of exposure, respectively. Saline 20% killed all the protoscoleces in 30-min exposure. CONCLUSION: Because of the rapid and strong scolocidal effectiveness of octenidine dihydrochloride on protoscoleces, it may be used as a scolocidal agent during both perioperative and in the PAIR method.     

A validated capillary electrophoretic method for the determination of indacaterol and its application to a pharmaceutical preparation

Indacaterol is a new inhaled ultra-long acting ${\beta }_2$-agonist. It has been recently approved in the European Union for the treatment of chronic obstructive pulmonary disease. This paper reports, for the first time, a method for the determination and validation of Indacaterol (IND) using an internal standard in capsules. Capillary electrophoretic separation was performed on an uncoated fused-silica capillary (50 cm effective length, 75 μm i.d.) and background electrolyte composed of 20 mmol L^?1 of sodium tetraborate buffer, 15% (v/v) methanol (pH = 10.0) with the application of 20 kV of potential; 10 s at 5 × 10³ N m^?2 (50 mbar) of injection time; and wavelength of 200 nm and 25 °C of temperature. The linearity was evaluated in the range of 4.90 × 10^?6 mol L^?1 (2.50 μg mL^?1) and 3.94 × 10^?5 mol L^?1 (20.00 μg mL^?1), with R = 0.9993 for inter-day. LOD and LOQ values were 2.18 × 10^?8 mol L^?1 (0.011 μg mL^?1) and 7.25 × 10^?8 mol L^?1 (0.037 μg mL^?1) for inter-day, respectively. The precision values were 0.50–1.06% for intra-day and 2.12% for inter-day as RSD%. The accuracy was tested by the standard addition method with the recovery values being between 98.79 and 99.09 as percentages with RSD% interval of 0.01–0.80. The developed method was validated according to ICH guidelines. Indacaterol was successfully determined in Arcapta^® capsule dosage form by the validated CE method with a relative error of 0.28%. The result was within the requirements of the USP 34-NF29. Therefore, the validated method may be used for the determination of Indacaterol in its capsules in quality control laboratories.     

Surface roughness and adherence of Candida albicans on soft lining materials as influenced by accelerated aging

AIM: Candida albicans (C. albicans) has been widely associated with the etiology of denture-related stomatitis and has been found on soft denture lining materials. The aim of this study was to examine the surface roughness and adherence of C. albicans to saliva coated and non-coated soft lining materials by subjecting them to an in vitro accelerated aging test. METHODS AND MATERIALS: Samples were prepared from three soft lining materials (Visco Gel, Ufi Gel P, Molloplast B). Surface roughness measurements and adhesion of C. albicans were examined before and after an aging process. The stimulated human whole saliva was used to assess its effect on adhesion. RESULTS: The aging process promotes the surface roughness of soft lining materials. The aging surface roughness of Visco Gel was significantly higher than Ufi Gel P and Molloplast B. No significant difference was observed between non-aged and uncoated materials, but aged and uncoated soft lining materials showed a greater adherence of C. albicans. No significant difference was observed between non-aged and saliva coated materials, but aged and saliva coated soft lining materials showed a greater adherence of C. albicans. CONCLUSIONS: Candidosis induced by C. albicans is the most common fungal infection. Awareness of susceptibility of soft lining materials to the adherence of C. albicans is an important factor in their selection. The use of soft lining materials with smooth surfaces minimizes the adherence of C. albicans.