The spectrum of diseases causing fever of unknown origin in Turkey: a multicenter study.

OBJECTIVE: The purpose of this trial was to determine the spectrum of diseases with fever of unknown origin (FUO) in Turkey. METHODS: A prospective multicenter study of 154 patients with FUO in twelve Turkish tertiary-care hospitals was conducted. RESULTS: The mean age of the patients was 42+/-17 years (range 17-75). Fifty-three (34.4%) had infectious diseases (ID), 47 (30.5%) had non-infectious inflammatory diseases (NIID), 22 (14.3%) had malignant diseases (MD), and eight (5.2%) had miscellaneous diseases (Mi). In 24 (15.6%) of the cases, the reason for high fever could not be determined despite intensive efforts. The most common ID etiologies were tuberculosis (13.6%) and cytomegalovirus (CMV) infection (3.2%). Adult Still's disease was the most common NIID (13.6%) and hematological malignancy was the most common MD (7.8%). In patients with NIID, the mean duration of reaching a definite diagnosis (37+/-23 days) was significantly longer compared to the patients with ID (25+/-12 days) (p=0.007). In patients with MD, the mean duration of fever (51+/-35 days) was longer compared to patients with ID (37+/-38 days) (p=0.052). CONCLUSIONS: Although infection remains the most common cause of FUO, with the highest percentage for tuberculosis, non-infectious etiologies seem to have increased when compared with previous studies.     

Is multiple sclerosis a risk factor for atherosclerosis?

BackgroundMultiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system. We aimed to discuss possible predisposing factors to atherosclerosis such as carotid intima-media thickness (CIMT) and high-sensitivity C-reactive protein (Hs-CRP) levels in MS.MethodsThirty-five ambulatory patients with relapsing-remitting MS (RRMS) (22 females and 13 males) and 34 healthy controls (21 females and 13 males) with similar demographic variables were included. Blood cell counts, cholesterol levels, vitamin D and B12, Hs-CRP levels, body mass index (BMI), history of smoking, and CIMT of both groups, Expanded Disability Status Scale (EDSS) scores, and disease duration of patients were recorded. Patients with a history of other vascular diseases such as hypertension, diabetes mellitus, peripheral artery disease, and acute relapses were excluded.ResultsSixty-nine participants were included. The mean age of the study population was 35.8 ± 7.1 years. Right CIMT was significantly greater in the patient population (P < 0.001). Spearman's correlation coefficient between age and right CIMT was r = 0.41, P = 0.01. When we compared the Hs-CRP with a cut-off value of ≤ 3, the right, left, and mean CIMT levels were not statistically significant (P = 0.17; P = 0.22; P = 0.15). The mean serum vitamin D levels were higher in the patient group and this was statistically significant (P < 0.001). The statistically significant factors identified with univariate analysis with P < 0.2 were further entered into multivariate modelling.ConclusionCIMT seems to be affected in patients with MS by means of the disease itself and age. Thus, CIMT might reflect the predisposition to subclinical atherosclerosis more than Hs-CRP. Further investigation in a large MS population is still needed.     

Clinical Significance of Serum Soluble Fas,Fas Ligand and Fas in Intrahepatic Lymphocytes in Chronic Hepatitis C

Hepatitis C Virus (HCV) is a major etiological agent of chronic hepatitis, cirrhosis and hepatocellular carcinoma. Fas-mediated apoptosis is the major cause of hepatocyte damage during liver disease. The present work was performed to study the fas system (Fas-FasL and soluble Fas) in chronic hepatitis C infection. Also, to correlate the degree of liver cell damage with the Fas system. The study was carried out on 45 patients positive for HCV RNA by nested RT-PCR in addition to 13 HCV negative control subjects. Wedge liver biopsies samples were obtained from patients and controls during abdominal operations for determination of cellular expression of Fas and Fas-L on hepatocytes and infiltrating lymphocytes respectively by flow cytometry. Histological activity index (HAI) was determined in chronic HCV patients. Also blood samples were taken from patients and controls for determination of sFas. There was statistically insignificant difference in Fas expression in hepatocytes of patients (P?=?0.34) in comparison to control. Meanwhile, there was a statistically significant decrease in FasL expression in patients compared to control (P< 0.001) and statistically significant increase in soluble Fas in patients compared to control (P < 0.001). The HAI of liver fibrosis for all patients were within mild score with mean ± SD 4 ± 0.5. From this study, we could conclude that Fas system is one of the important pathways regulating the response to HCV infection. Increased serum sFas in HCV patients is accompanied by down-regulation of Fas/Fas-L expression resulting in inhibition of apoptosis in liver cells as a process for elimination of virus infected cells and this may ultimately leads to chronicity of the disease.     

Microbiological and SEM assessment of atraumatic restorative treatment in adult dentition

Objectives

To investigate the practicability of atraumatic restorative treatment (ART) in adults in terms of marginal adaptation of restorations and microbiological changes in residual carious dentin.

Materials and methods

The occlusal dentin caries of 25 permanent molar teeth were removed with hand instruments. The total counts of bacteria (TCB) and the facultative anaerobic bacteria (FAB), mutans streptococci (MS), and Lactobacillus spp. (LB) counts in the affected dentin were evaluated quantitatively. The weights of the samples were measured with an electronic balance (Shimadzu, Type AX200, Japan). The cavities were restored with glass ionomer cement (Ketac^TM Molar Easymix, ESPE Dental AG, Seefeld, Germany). Twenty replicas of randomly selected ART restorations were prepared and marginal adaptation was evaluated by scanning electron microscopy (SEM). After 6 months, the same protocols were repeated. Data were analyzed with paired sample t-tests, Wilcoxon t-tests, Pearson and Spearman correlations, and chi-square tests (p<0.05).

Results

In the sixth month, restoration loss and pulpitis were not observed. The mean weight of samples removed from the cavity floor was less than the baseline (0.014±0.009 and 0.023±0.013 g, respectively) (p<0.01), and the counts of total bacteria, FAB, MS, and LB significantly decreased compared to baseline (p<0.01). The frequency of marginal gaps was increased (p< 0.01).

Conclusions

ART showed that the counts of microorganisms decreased after 6 months although the marginal gap rates of restorations increased.

Clinical relevance

ART can be a reliable treatment approach in adults for 6 months due to the decrease in microorganism counts, although gaps exist.

     

Evaluation of adipokines and inflammatory mediator expression levels in patients with periodontitis and peri-implantitis: a cross-sectional study

Clinical Oral Investigations - The aim of this study was to analyze the mRNA and protein expression of adiponectin, leptin, visfatin, tumor necrosis factor (TNF)-α, and interleukin (IL)-6...     

The effects of decontamination methods of dental implant surface on cytokine expression analysis in the reconstructive surgical treatment of peri-implantitis

Odontology - The aim of this trial was to analyze the effect of implant surface decontamination procedures combined with reconstructive surgical treatment (RST) of peri-implantitis on gene...     

Sustainable waste management and recycling of Zn–Al layered double hydroxide after adsorption of levofloxacin as a safe anti-inflammatory nanomaterial

Inorganic nano-layered double hydroxide (LDH) materials are used in the catalytic field, and have demonstrated great applicability in the pharmacological fields. In the current study, we report Zn–Al LDH as an adsorbent for levofloxacin (levo). The physical and chemical properties of the prepared material before and after adsorption were monitored using X-ray diffraction, Fourier-transform infrared (FT-IR) spectroscopic analysis, energy dispersive X-ray spectroscopy (EDX), Brunauer–Emmett–Teller (BET) surface area measurements, high-resolution transmission electron microscopy (HRTEM), and field emission scanning electron microscopy (FESEM). Density functional theory (DFT) calculations for levo and its protonated species were studied at the B3LYP/6-311G (d,p) level of theory. The removal percentage of levo was 73.5%. The adsorption isotherm was investigated using nine different models at pH 9, where the obtained correlation coefficients (R²) using the Redlich–Peterson and Toth models were 0.977. The thermodynamic parameters ΔS°, ΔG° and ΔH° were estimated and discussed in detail. Also, to support the adsorption research field, the applicability of the formed waste after the adsorption of levo onto Zn–Al LDH was investigated for medical purposes. The toxicity of levo in both normal and nanocomposite form was studied. Neither toxicological symptoms nor harmless effects were exhibited throughout the in vivo study. The oral anti-inflammatory activity, tested using 6% formalin to produce edema in the footpad, was manifested as a significant increase of 37% in the anti-inflammatory effect of the Zn–Al LDH/levo nanocomposite compared to levo in its normal form.

Zn-Al LDH was synthesized using the co-precipitation method, characterized and used as an efficient adsorbent for the removal of levofloxacin. The safety and toxicity of the administered Zn-AL LDH/levo as a safe anti-inflammatory material.     

Convalescent plasma therapy in patients with COVID-19

IntroductionPassive antibody therapy has been used to immunize vulnerable people against infectious agents. In this study, we aim to investigate the efficacy of convalescent plasma (CP) in the treatment of severe and critically ill patients diagnosed with COVID-19.MethodThe data of severe or critically ill COVID-19 patients who received anti-SARS-CoV-2 antibody-containing CP along with the antiviral treatment (n = 888) and an age-gender, comorbidity, and other COVID-19 treatments matched severe or critically ill COVID-19 patients at 1:1 ratio (n = 888) were analyzed retrospectively.ResultsDuration in the intensive care unit (ICU), the rate of mechanical ventilation (MV) support and vasopressor support were lower in CP group compared with the control group (p = 0.001, p = 0.02, p = 0.001, respectively). The case fatality rate (CFR) was 24.7 % in the CP group, and it was 27.7 % in the control group. Administration of CP 20 days after the COVID-19 diagnosis or COVID-19 related symptoms were associated with a higher rate of MV support compared with the first 3 interval groups (≤5 days, 6?10 days, 11?15 days) (p=0.001).ConclusionCP therapy seems to be effective for a better course of COVID-19 in severe and critically ill patients.     

The Evaluation of Left Ventricular Functions with Tissue Doppler Echocardiography in Adults with Celiac Disease

Background/Aim:

The aim of this study was to investigate the effects of celiac disease on cardiac functions using tissue Doppler echocardiography (TDE).

Patients and Methods:

The study included 30 patients with celiac disease (CD) and 30 healthy volunteers. Echocardiographic examinations were assessed by conventional echocardiography and tissue Doppler imaging. The peak systolic velocity (S^''m), early diastolic myocardial peak velocity (E^''m), late diastolic myocardial peak velocity (A^''m), E^''m/A^''m ratio, myocardial precontraction time (PCT^''m), myocardial contraction time (CT^''m), and myocardial isovolumetric relaxation time (IVRT^''m), E to E^''m ratio were measured.

Results:

In pulsed wave Doppler echocardiography, mitral late diastolic flow (A) velocity and E to E^''m ratio were significantly higher (P = 0.02 and P = 0,017), E/A ratio was significantly lower (P = 0.008) and IVRT was significantly prolonged (P = 0.014) in patients with CD. In TDE, S^''m, E^''m, and E^''m/A^''m ratio were significantly lower, IVRT^''m was longer (P = 0.009) from septal mitral annulus and S^''m, E^''m, E^''m/A^''m ratio were significantly lower, PCT^''m, PCT/ET ratio, IVRT^''m were longer, and MPI was higher from lateral mitral annulus in celiac group than controls.

Conclusion:

Our study confirms that patients with CD have impaired diastolic function. More importantly, we also demonstrated an impairment of myocardial systolic function in patients with CD by TDE. We recommend using TDE in addition to conventional echocardiography parameters for the cardiovascular risk assessment of patients with CD.     

Occurrence of a mosquito vector in bird houses: Developmental consequences and potential epidemiological implications

Even with continuous vector control, dengue is still a growing threat to public health in Southeast Asia. Main causes comprise difficulties in identifying productive breeding sites and inappropriate targeted chemical interventions. In this region, rural families keep live birds in backyards and dengue mosquitoes have been reported in containers in the cages. To focus on this particular breeding site, we examined the capacity of bird fecal matter (BFM) from the spotted dove, to support Aedes albopictus larval growth. The impact of BFM larval uptake on some adult fitness traits influencing vectorial capacity was also investigated. In serial bioassays involving a high and low larval density (HD and LD), BFM and larval standard food (LSF) affected differently larval development. At HD, development was longer in the BFM environment. There were no appreciable mortality differences between the two treatments, which resulted in similar pupation and adult emergence successes. BFM treatment produced a better gender balance. There were comparable levels of blood uptake and egg production in BFM and LSF females at LD; that was not the case for the HD one, which resulted in bigger adults. BFM and LSF females displayed equivalent lifespans; in males, this parameter was shorter in those derived from the BFM/LD treatment. Taken together these results suggest that bird defecations successfully support the development of Ae. albopictus. Due to their cryptic aspects, containers used to supply water to encaged birds may not have been targeted by chemical interventions.