Seroprevalence of Bordetella pertussis immunoglobulin G antibodies among children in Samsun, Turkey

In this study, we aimed to investigate anti-pertussis immunoglobulin (Ig) G antibodies in the serum of children in our region vaccinated against pertussis with four doses. Between August 2008-2009, antibody levels to Bordetella pertussis (B. pertussis) antigens were studied in 385 serum samples from healthy children aged 1.5-18 years (y) vaccinated against pertussis in Samsun, Turkey. The study population was divided into six groups according to ages: 1.5-3 y; 4-5 y; 6-8 y; 10-12 y; 13-15 y; and 16-18 y. IgG antibodies to B. pertussis antigens were measured with a commercial ELISA kit. Mean age of the children was 9.6 +/- 5.3 y. Anti-pertussis IgG titers were positive in 48.3% of the cases. The lowest positivity rate was determined in the 4-5 y age group (28.1%) and the highest rate in the 16-18 y age group (64.2%). Geometric mean titer of anti-pertussis antibodies was 39.2 IU/ml, and again the lowest value was obtained in the 4-5 y age group (23.3 IU/ml) and the highest in the 16-18 y age group (51.4 IU/ml). The antibody levels to B. pertussis antigens significantly decrease 4-6 years after vaccination and again increase in school children, possibly due to natural infection.     

Use of the NMDA antagonist magnesium sulfate during monitored anesthesia care for shockwave lithotripsy

PURPOSE: To assess whether intravenous magnesium sulfate infusion affects analgesic requirements during monitored anesthesia care (MAC) for shockwave lithotripsy (SWL). PATIENTS AND METHODS: Fifty patients in ASA class I or II undergoing SWL with MAC were randomized into two groups. Induction of MAC was produced by bolus doses of midazolam 0.03 mg/kg(-1) and fentanyl 0.5 microg/kg(-1) followed by intravenous infusion of midazolam 0.015 to 0.06 mg/kg(-1)/hr(-1) with fentanyl supplementation 0.2 microg/kg(-1). In addition, group I patients received magnesium sulfate 30 mg/kg(-1) intravenously as a bolus dose followed by a continuous infusion of 10 mg/kg(-1) /hr(-1) beginning 15 minutes before induction of sedation. The midazolam infusion rate and additional fentanyl doses were adjusted by verbal analog scale (VAS) measurements, observer assessment sedation score (OAA/S), and achieving a target bispectral index (BIS) in a range of 70 to 90. At the end of SWL, the total midazolam and total fentanyl consumptions were recorded, and the serum magnesium concentration was measured. RESULTS: Magnesium caused significant decreases in the total consumption of midazolam (P = 0.001) and fentanyl (P = 0.001). The VAS values at the 15th, 20th, and 25th minute in group I were significantly lower than in group II. In group I, hemodynamic and arterial oxygen parameters were better than in group II. CONCLUSION: A magnesium bolus and infusion can be utilized to reduce analgesic requirements under MAC during SWL.     

Lupus mastitis is not a surgical disease

A 23-year-old woman with a 2-year history of discoid lupus (SLE) presented with a right lateral upper quadrant breast mass. Physical examination revealed a 5 cm irregular, hard lesion suggestive of a breast malignancy. Ultrasound-guided fine needle aspiration biopsy of the mass confirmed the diagnosis as lupus mastitis. Differential diagnosis of a breast mass in a patient with SLE must include the possibility of lupus mastitis. Surgical resection is usually not necessary, and medical treatment can be implemented successfully.     

Determination of lowest possible contrast volume in computed tomography pulmonary angiography by using pulmonary transit time

Purpose

The aim of this study was to assess the effectiveness of the modified test-bolus (mTB) method in computed tomography pulmonary angiography (CTPA).

Materials and methods

The Institutional Review Board approved this retrospective study. We reviewed 24 patients (nine men, 15 women; age range, 21–88 years) in whom CTPA was performed either by Bolus-Tracking (BT) (n = 12) or mTB (n = 12) methods. Pulmonary transit time (PTT) was used to determine scan delay time and contrast volume in the mTB group. The contrast volume, radiation dose, quantitative measures, and qualitative scores of enhancement were compared. The chi-squared test, Mann–Whitney U test, and κ statistics were used. The significance level was 0.05.

Results

The effective dose (P = 0.028) and contrast volume (P < 0.001) was significantly lower in the mTB group than those in the BT group. The difference in the quantitative measures and qualitative scores of enhancement between groups was statistically insignificant (P = 0.729, P = 0.635, respectively). Significantly fewer artefacts were observed in the mTB group (P = 0.024).

Conclusion

By taking into account PTT, mTB appears to be a promising method for tailoring CTPA to the patient with the use of less contrast material and resulting in fewer artifacts.     

Circulating and Local Bone Marrow Renin-angiotensin System in Leukemic Hematopoiesis: Preliminary Evidences

Until last the decade, the renin-angiotensin system (RAS) was considered as a circulating endocrine system. It is now known that there are local RASs in many tissues. It has also recently been hypothesized that there exists a local bone marrow (BM) RAS with paracrine/autocrine pathobiological functions. The aim of this study was to detect BM and peripheral blood levels of the essential RAS components in normal and leukemic hematopoiesis.

Concentrations of renin and angiotensin-converting enzyme (ACE) were assayed in BM aspirates and in simultaneously drawn peripheral blood samples of 16 pre-chemotherapy leukemic and 10 post-treatment megaloblastic anemia patients with normal blood counts, as controls.

In the leukemia group, the ACE concentration was found to be significantly higher in the BM (38±6.2 U/l) than in the peripheral blood (29.5±5.3 U/l), (p=0.029). In the leukemia group, although the BM renin concentration was higher than the peripheral blood levels (21.3±8.3 vs. 18.6±6.2 U/l), this difference was not statistically significant (p=0.196). In the control group, mean BM renin levels were insignificantly lower than in the peripheral blood (8.6±3 vs. 12.1±4.6 pg/ml) (p=0.059). In the leukemia group, serum ACE levels positively correlated with BM and peripheral blood blast percentages (p<0.05). Serum LDH level (p<0.01), BM blast (p<0.05) and peripheral blast percentages (p<0.01) were inversely correlated with serum potassium in the leukemia group.

The results of this study can be considered as the preliminary evidence supporting the hypothesis of the presence of a local BM RAS. Further, molecular biologic and immunohistochemical studies are needed to shed light on this important subject. A better understanding of the interrelationships of RAS and hematopoiesis will bring new insights into the pathobiology and even novel therapies for such neoplastic diseases.     

Behcet’s disease presenting with sudden-onset paraplegia due to anterior spinal artery involvement: 1-year follow-up of rehabilitation in conjunction with medication

A 26-year-old male patient with sudden-onset paraplegia was presented. Clinical and imaging evaluation revealed isolated spinal cord lesions at thoracal levels and anterior spinal arterial involvement. Diagnosis of Behcet’s disease was established with associating clinical findings with medical history. Vigorous medication and rehabilitation program were performed. Through the 1-year rehabilitation period in conjunction with medication, strength and functions improved gradually. A satisfactory functional gain as a rehabilitative goal in independence in activities of daily living and long-distance ambulation achieved around 4 months. The patient reached full independence after 1-year. As conclusion, Behcet’s disease can present with sudden-onset paraplegia. In case of no evident etiology for paraplegia in young male, neuro-Behcet’s disease also should be kept in mind. Contrary to assumption, early aggressive treatment and continuous rehabilitation in conjunction with medication might provide good prognosis with excellent clinical outcome in spinal cord involvement. Satisfactory functional recovery should be expected only after 3–4 months, and complete independence can be achieved after 1 year.     

Effects of verapamil and nifedipine on different parameters in lipopolysaccharide-induced septic shock

Septic shock has a high mortality rate due to the hypotension and circulatory disorder that occurs during its pathogenesis. Recently, humoral factors such as cytokines and nitric oxide became important in the complex pathophysiology of septic shock because there is a close relationship between the determined levels of these humoral factors and the responses to the therapy and survival periods. Verapamil and nifedipine are calcium channel blockers commonly used in the pharmacotherapy of cardiovascular disorders. In the present study these drugs were investigated in the rat septic shock model. In vivo hemodynamic parameters were recorded using a data acquisition system in endotoxin-induced septic shock in rats. The animals were followed for 5 h and blood pressure, rectal temperature, and ECG were recorded. Blood samples were collected at 1 h and 5 h time points after the injection of endotoxin, and serological samples were stored at −25°C. Subsequently, tumor necrosis factor-α, interleukin-10 (enzyme-linked immunosorbent assay), and nitrite (Griess reagent) were determined in these serological samples. Significant correlations were observed between these humoral factors and the disordered hemodynamic factors. A reversal of changes was observed in the levels of serum cytokines, nitrite levels, and hemodynamic parameters with verapamil and nifedipine preadministration (P < 0.05). Additionally, superoxide dismutase (SOD), catalase, and malondialdehyde (MDA) were determined in livers obtained from these animals at the end of the experiments, and these results were compared to hemodynamic parameters and cytokines. Nifedipine and verapamil increased the levels of MDA and SOD but did not change catalase activity.