Evaluation of 105 cases with tuberculous pleurisy

Tuberculous pleurisy has still importance in the group of exudative pleurisy. In this study we aimed to evaluate clinical, radiological, biochemical, bacteriological and histopathological findings of 105 cases with tuberculous pleurisy retrospectively, between January 1999 and December 2002. Female/male ratio was approximately 1/9 and mean age was 32.6 (range: 15-68). The common symptoms were chest pain (75.2%), cough (54.3%) and dyspnea (47.6%). In 17% cases parenchymal lesions were seen in the chest radiography while parenchymal lesions were found 52% of patients by computed tomography. Adenosine deaminase levels in pleural fluid were high in 80% of cases. PPD reactions was found positive in 84.7% of case. Sputum was studied in 52 cases. In 6 (11.5%) patients both ARB and culture were positive but in 4 (7.7%) patients was only culture positive. Pleural fluid ARB examination of all patients was negative whereas culture was positive only in 5 (5%) of patients. In two patients pleural biopsy material culture was positive for ARB. Cytological examination of pleural fluid revealed lymphocyte predominance in 81 (81%) of cases. Eighty one patients had pleural biopsy and pathologic evaluation revealed tuberculosis in 59 (73%) of them. At the end of the treatment 24 (23%) patients had pleural thickening. Pleural fluid LDH level of the patients with pleural thickening was higher than the other patients significantly (p=0.024). It is concluded that, pleural biopsy is the most effective diagnostic method for the tuberculous pleurisy and in the patient with elevated pleural LDH level, pleural thickening seems more.     

Effect of Intraperitoneal Curcumin Instillation on Postoperative Peritoneal Adhesions

Objective

The aim of this study was to determine the effect of curcumin on adhesion formation in a rat cecum abrasion model.

Materials and Methods

Thirty Wistar rats were randomized into three groups; the control group received saline, the curcumin group received 10 mg/kg of curcumin after cecal abrasion, and in the sham group the abdominal wall was closed without any abrasion to the cecum. On day 15, adhesions were assessed blindly using a standardized scale, and histopathological samples were taken and examined.

Results

There were no incisional hernias or wound dehiscences in any animals of the three groups. A comparison of adhesion scores showed a significant difference between the curcumin (median = 1) and the control group (median = 2; p < 0.05). The grade of inflammation of the curcumin (median = 1) and the sham (median = 0) group was significantly lower than that of the control group (median = 3; p < 0.01 and p < 0.001, respectively). Hydroxyproline levels were significantly lower in the sham (48.3 ± 11.8 µg/mg) and the curcumin (63.8 ± 13.9 µg/mg) group compared to the control group (85.7 ± 22.1 µg/mg; p < 0.05).

Conclusion

These data suggest that curcumin, administered intraperitoneally, was effective in the prevention of peritoneal adhesion formation.Key Words: Curcumin, Intraperitoneal adhesion, Adhesion formation     

Intravenous iron therapy as a possible risk factor for atherosclerosis in end-stage renal disease

Atherosclerosis is a disease of the arterial wall, with increasing wall thickness representing an early event in the progression of the disease. It has been suggested that iron overload, as assessed by increased serum ferritin concentration, may be a risk factor for atherosclerosis. The aim of this study was to investigate the relationship between the influence of intravenous (IV) iron therapy and ferritin levels and carotid intima media thickness (C-IMT) in dialysis patients. Sixty patients (51 +/- 14) years were divided into two groups according to their IMT obtained by ultrasound; group I (high risk) and group II (low risk). The parameters assessed were serum creatinine, urea, calcium, phosphorus, hemoglobin, albumin, uric acid, iron, ferritin, and lipid levels. Thirty-eight patients (88%) in group I and 5 patients (12%) in group II received IV iron therapy while 5 patients (29%) in group I and 12 patients (71%) in group II (P < 0.001) did not receive IV iron therapy. Ferritin levels were higher in group I than in group II (581 +/- 303 and 306 +/- 224) (P < 0.001). C-IMT measurements correlated with serum ferritin and with the intravenous iron dose received during the 24 months preceding the study (r = 0.315, P = 0.015; r = 0.471, P = 0.001). The findings indicate that IV iron therapy and elevated serum ferritin levels may cause an increase in the incidence of atherosclerosis.     

Gingival crevicular fluid interleukin-36β (-1F8), interleukin-36γ (-1F9) and interleukin-33 (-1F11) levels in different periodontal disease

Background

Periodontal inflammation is driven by the coordinated action of a number of factors, including the IL-1 family. Our study aimed to examine the levels of interleukin (IL)-36β, IL-36γ and IL-33 levels in gingival crevicular fluid (GCF) from patients with different periodontal diseases.

Materials and methods

A total of 80 subjects, 20 patients with generalized aggressive periodontitis (G-AgP), 20 patients with chronic periodontitis (CP), 20 with gingivitis and 20 periodontally healthy subjects were included. Periodontal status was evaluated by measuring probing depth, clinical attachment loss, papillary bleeding index and plaque index. GCF cytokine levels were analysed by ELISA.

Results

CP, gingivitis and healthy groups had similar GCF IL-36β total amount (p > 0.008). G-AgP group had elevated IL-36β total amount compared to CP group (p < 0.008). G-AgP group had similar GCF IL-36β total amount to gingivitis and healthy groups (p > 0.008). GCF IL-36γ and IL-33 total amounts of the study groups were similar (p > 0.05).

Conclusions

The present study demonstrated for the first time the presence of IL-36β, IL-36γ and IL-33 GCF levels with different periodontal diseases. High levels of IL-36-β in the AgP group in comparison to CP group might suggest that periodontitis in the aggressive form could be related to the increase in GCF IL-36β.     

Immunosuppressive Medication Adherence in Kidney Transplant Patients

Objectives

To assess the degree of immunosuppressive medication adherence in kidney transplant patients (KTPs) and to determine if there is a difference in the rate of adherence to tacrolimus (Tac), cyclosporine (CsA) and sirolimus (Sir).

Subjects and Methods

From a total of 63 KTPs treated at the Clinic of Nephrology, Clinical Centre Niš, Serbia, 60 participated in the study by responding to questionnaires. They were divided into the adherence group (n = 43) and the nonadherence group (n = 17) according to their degree of adherence which was measured using a validated survey form, the simplified medication adherence questionnaire. The KTP adherence to the different immunosuppressive regimens (Tac, CsA and Sir) was compared. Statistical analysis was performed using the Student t test.

Results

Adherence was observed in 43 (71.7%) patients, and only 17 (28.3%) did not follow the prescribed therapy. The estimated glomerular filtration rate was significantly lower in the nonadherence group (38.52 ± 18.22 ml/min) than in the adherence group (52.43 ± 16.91 ml/min, p < 0.05). With regard to the Tac level, a significant difference was also found between the adherers and the nonadherers (6.30 ± 2.06 vs. 5.0 ± 1.52 ng/ml, p < 0.05).

Conclusion

The KTPs in this study demonstrated a high level of adherence. Nonadherence was associated with worse graft function and a lower Tac level. Knowledge about the degree of adherence could help the early identification of nonadherent patients and the development of strategies to improve this.Key Words: Adherence, Immunosuppressants, Kidney transplantation, Tacrolimus     

Magnetic chitosan oligomer-sulfonate-stearic acid triple combination as cisplatin carrier for site-specific targeted on MCF-7 cancer cells: Preparation,characterization and in vitro experiments

In this study, a new amphiphilic target-specific adsorbent, chitosan oligomer-sulfonate-stearic acid triple combination (S-Cho-SA), and magnetic chitosan oligomer-sulfonate-stearic acid triple combination (M-S-Cho-SA) by oleic acid (OA)-modified Fe₃O₄ via hydrophobic interaction are fabricated. By modifying the nanoparticle surfaces and having the ability to magnetically allow the target region, these particles attract attention as important particles used in targeting mechanisms in cancer therapy. With magnetic nanoparticles and an external magnetic field, it is possible to transport therapeutic agents to the target site and keep them in the desired effect zone for a longer period of time. These new adsorbents are characterized by scanning electron microscopy (SEM), attenuated total reflection Fourier transform infrared (ATR FT-IR) spectroscopy, nuclear magnetic resonance (NMR), X-ray diffraction (XRD), vibrating sample magnetometer (VSM), and thermogravimetric analysis (TG/DTA). After chemical characterization, it is complexed with cisplatin (CDDP). The magnetic adsorbents were loaded with high efficiency (>50%), and the release experiments exhibited that cisplatin is released more at pH 4.5 compared with pH 7.4 at 37°C. It showed better drug release results under a magnetic field for magnetic adsorbents (36% for pH 4.5 and 3.6% for pH 7.4). The biocompatibility of the prepared adsorbents was demonstrated via the XTT assay in MCF-7 cell lines. The results also exhibited that S-Cho-SA and M-S-Cho-SA were biocompatible, and free cisplatin and cisplatin-complexed adsorbents showed an antiproliferative effect. The results showed that these new cisplatin-loaded (M-S-Cho-SA) nanoparticles are good candidates for thermotherapy in cancer treatment in the future, as they can provide selectivity by site-specific targeting and hold onto an alternative magnetic field due to the magnetic nature of the nanoparticles.     

Challenges around quantifying uncertainty in a holistic approach to hard-to-heal wound management: Health economic perspective

Treatment of hard-to-heal wounds involves a holistic approach for choosing between available treatment options. However, evidence for informing these choices is sparse, introducing uncertainty into decisions about the optimum treatment pathways that reflect the vast heterogeneity in this patient population. This paper discusses the existing clinical and health economic literature in order to provide insight into sources of uncertainty in the evaluation of the holistic approach to management of the hard-to-heal wounds, and how this uncertainty can be appropriately reflected in research. We identified three key sources of uncertainty in the evaluation of chronic wound treatments, namely heterogeneity in aetiology and patient populations, heterogeneity in treatment pathways, and challenges around capturing all relevant outcomes. Reflecting these complexities requires sophisticated modelling of treatment sequencing and long-term outcomes. The paper discusses how the scope specification, scenario analyses, and sensitivity analyses can be used to fully characterise analytical uncertainty.