Long-term oral ciprofloxacin in the treatment of prosthetic valve endocarditis due to Pseudomonas aeruginosa.

Prosthetic valve endocarditis caused by Pseudomonas aeruginosa is refractory to medical treatment alone and early valve replacement is necessary. We describe a 40-year-old patient in whom endocarditis developed in the early postoperative period, and reoperation was not considered feasible. Ciprofloxacin was administered orally in order to suppress bacteremia for 36 months. Long-term oral ciprofloxacin may provide an opportunity in the treatment of prosthetic valve endocarditis caused by Ps. aeruginosa in patients who are unfavorable candidates for reoperation.     

May maternal anti-mullerian hormone levels predict adverse maternal and perinatal outcomes in preeclampsia?

Background: Prediction of preeclampsia and adverse maternal and perinatal outcomes with biomarkers has been proposed previously. Anti-mullerian hormone (AMH) is a growth factor, which is primarily responsible of the regression of the mullerian duct, but also used to predict ovarian reserve and decreases with age similar to the fertility.

Aim: To evaluate the predictive role of maternal anti-mullerian hormone (mAMH) in adverse maternal and perinatal outcomes in preeclampsia.

Methods: This prospective case-control study was conducted at current high-risk pregnancy department in a tertiary research hospital and 45 cases with preeclampsia classified as study group and 42 as control group. Data collected and evaluated were; age, body mass index (BMI), marriage duration (MD), gestational weeks (GW), gravidity, parity, mode of delivery, birth weight, newborn Apgar score, newborn gender, maternal complication, perinatal outcome, some laboratory parameters and mAMH. The association between mAMH levels and maternal and fetal outcomes were evaluated.

Results: There were no statistically significant differences between groups in terms of age, BMI, MD, gravidity, parity and newborn gender (p?>?0.05). GW, vaginal delivery, birth weight, newborn Apgar score, were statistically significantly lower in preeclamptic patients when compared with non-preeclamptic patients (p?<?0.001). Adverse maternal and perinatal outcomes were statistically significantly higher in the study group (p?<?0.001). The laboratory values [alanine transaminase (ALT), aspartate transaminase (AST), blood urea nitrogen (BUN), creatinine, lactic dehydrogenase (LDH), uric acid and fibrinogen) were statistically significantly lower in the control group (p?<?0.001). The mAMH level was significantly lower in the preeclamptic group (p: 0.035). There was no correlation between mAMH levels and demographic and clinical parameters. The area under the ROC curve (AUC) was 0.590 and the cut-off value was 0.365?ng/ml with sensitivity of 67.4% and specificity of 47.1% for mAMH. Logistic regression analysis showed a statistically insignificance between mAMH and maternal complication and perinatal outcome (p: 0.149).

Conclusion: According to this study, mAMH level was lower in preeclamptic patients than in normal pregnants, and is found to be a discriminative factor with low sensitivity and specificity. There was no relationship between mAMH and adverse maternal and perinatal outcomes. Further randomized controlled studies with more participants are needed to evaluate the accurate effects of mAMH levels on preeclampsia and should increase the power of mAMH levels in predicting the preeclampsia.     

Effects of Forward Model Errors on EEG Source Localization

Subject-specific four-layer boundary element method (BEM) electrical forward head models for four participants, generated from magnetic resonance (MR) head images using NFT (www.sccn.ucsd.edu/wiki/NFT), were used to simulate electroencephalographic (EEG) scalp potentials at 256 recorded electrode positions produced by single current dipoles of a 3-D grid in brain space. Locations of these dipoles were then estimated using gradient descent within five template head models fit to the electrode positions. These were: a spherical model, three-layer and four-layer BEM head models based on the Montreal Neurological Institute (MNI) template head image, and these BEM models warped to the recorded electrode positions. Smallest localization errors (4.1–6.2 mm, medians) were obtained using the electrode-position warped four-layer BEM models, with largest localization errors (~20 mm) for most basal brain locations. When we increased the brain-to-skull conductivity ratio assumed in the template model scalp projections from the simulated value (25:1) to a higher value (80:1) used in earlier studies, the estimated dipole locations moved outwards (12.4 mm, median). We also investigated the effects of errors in co-registering the electrode positions, of reducing electrode counts, and of adding a fifth, isotropic white matter layer to one individual head model. Results show that when individual subject MR head images are not available to construct subject-specific head models, accurate EEG source localization should employ a four- or five-layer BEM template head model incorporating an accurate skull conductivity estimate and warped to 64 or more accurately 3-D measured and co-registered electrode positions.     

Decontamination Techniques of Pathogen Bacteria in Meat and Poultry

Means of controlling or even improving the safety of food products is to decontaminate the carcasses or products during or at the end of the production line. The decontamination of meat and poultry can help to reduce human foodborne infections. However, process hygiene to prevent contamination should never be neglected. Some techniques of decontaminating raw meat and poultry meat products are discussed in this review.     

Is There a Role for On-Site Evaluation of Thyroid Fine Needle Aspiration to Reduce the Nondiagnostic Rate?

The use of immediate on-site evaluation of fine-needle aspiration biopsy (FNAB) specimens can determine the adequacy of specimens and provides a specific preliminary diagnosis. In this prospective study, we evaluated the impact of on-site assessment of thyroid FNAB performed under ultrasound guidance. Totally, 204 (170 female, 34 male) patients (102 on site, 102 control group) were included. The patients were randomized on site and regular cytologic examination groups. Quick May-Grünwald Giemsa stain was used for on-site examination and FNA was continued until adequate aspirate for optimal cytological examination. Two (2.0 %) of the 102 patients evaluated with on-site examination had a nondiagnostic result. However, 16 (15.7 %) of the 102 patients examined by regular cytologic examination method, had nondiagnostic result. The difference between these two groups was statistically significant (p?<?0.0001). The major cause of a nondiagnostic thyroid FNAB specimen is the failure to aspirate a sufficient number of cells necessary for diagnosis cystic lesions. Immediate on-site evaluation can significantly decrease the nondiagnostic rate of thyroid FNAB specimens.