Neonatal tetanus in the South-Eastern region of Turkey: changes in prognostic aspects by better health care

Neonatal tetanus is an important health problem with an estimated 500,000 deaths per year worldwide, particularly in developing countries. We analysed 56 cases of neonatal tetanus (NNT), retrospectively, who were admitted to Diyarbakir Children State Hospital between 1994 and 2001. In 1998 an intervention in a childcare intensive unit was conducted, which included a nurse education programme, increasing the number of nurses and other health staff, and more qualified management of cases. The mean age of patients was 7.9 days at admission, and the male:female ratio was 1:6. Eleven per cent of the cases had body weight under 2500 g. The mean hospitalization period was 9.9 days. All patients were born at home without medical help and 28.6 per cent were from urban areas. The case fatality rate that was formerly 88.5 per cent, decreased to 53.6 per cent by the intervention conducted in 1998. Based on our findings, we can say that improved hospitalization conditions and intensive care may reduce mortality. Enforcing preventive policies both in rural and urban areas is of great importance in the least developed regions.     

Salmonellosis and ulcerative colitis. A causal relationship or just a coincidence

Coincidence of salmonellosis and ulcerative colitis is a rare clinical problem. Salmonella infection was reported to complicate the ulcerative colitis, as either facilitating its occurrence or activation. In this article, we present a case with salmonellosis whose clinicopathological findings also suggested ulcerative colitis. The patient improved rapidly after taking additional mesalazine to norfloxacin treatment. We conclude that salmonella infection might have either been coincidentally present or might have triggered an early ulcerative colitis in this patient who did not have history of inflammatory bowel diseases. In case of persistent severe diarrhea despite appropriate treatment, the possibility of a coincident inflammatory bowel disease such as ulcerative colitis should always be considered, especially in endemic regions for salmonellosis.     

Atypisches Ruhe-EKG bei einem Patienten mit positiver Familienanamnese für den plötzlichen Herztod

Zusammenfassung Das Brugada-Syndrom gehört zu den primär kardialen Leitungsstörungen ohne erkennbare strukturelle Herzerkrankung und ist mit lebensgefährlichen ventrikulären Rhythmusstörungen assoziiert. Es ist eine autosomal dominante Erbkrankheit mit unterschiedlicher Penetranz und Bevorzugung des weiblichen Geschlechts. Eine endemische Häufung findet sich in Südostasien, im Mittelmeerraum sowie in Japan. Die jährliche Mortalität liegt weltweit bei etwa 30 pro 100.000 Einwohner. Der Gendefekt liegt auf dem SCN5A-Gen, auf dem kardiale Natriumkanäle kodiert sind. Zurzeit gibt es lediglich Empfehlungen für die Diagnosestellung, es liegen keine strengen Diagnosekriterien vor. Die Diagnose beruht auf einem auffälligen Ruhe-EKG (ST-Strecken-Hebungen in V₁ und V₂ mit inkomplettem Rechtsschenkelblock, häufig PQ-Zeit-Verlängerungen), der klinischen Symptomatologie und einer positiven Familienanamnese. Die derzeit empfohlene Therapie besteht in der Implantation eines internen Defibrillators. Zusammenfassend sollte bei Patienten mit auffälligem Ruhe-EKG und einem anamnestischen familiären plötzlichen Herztod das Brugada-Syndrom als wichtige Differenzialdiagnose in Betracht gezogen werden.

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Fanconi anemia A due to a novel frameshift mutation in hotspot motifs: lack of FANCA protein

Homozygosity for a frameshift mutation at codon 1213 of FANCA gene was identified in a Turkish patient. Immunoprecipitation-western blot analysis showed the complete absence of the FANCA protein band. This novel mutation, a deletion of T at position 3639 in exon 37 (3639delT), is responsible for the disease and causes premature termination of translation 32 aa downstream. The deletion is (i) the T residue of 2 overlapping TGAGGC and CCTG hot spot motifs, (ii) flanked by several direct repeats, (iii) surrounded by the highly GC rich region that have frequently been identified at the site of human DNA deletions. The patient is the third living child of a first degree cousin marriage. The major abnormalities of the patient at the age of 6 months were growth retardation, microcephaly, hypoplastic right thumb, distal displacements of both thumbs and pelvic displacement of left kidney. Hematological presentation of the disease started before the age of 4 years.     

Randomized study comparing omeprazole with ranitidine as anti-secretory agents combined in quadruple second-line Helicobacter pylori eradication regimens

BACKGROUND: Few data are available on the efficacy of second-line H. pylori eradication regimens. AIM: To compare the efficacy of either omeprazole or ranitidine in a second-line quadruple regimen in patients with duodenal ulcer or erosive duodenitis. PATIENTS AND METHODS: A total of 37 patients with erosive duodenitis and 119 with duodenal ulcer who have failed eradication of H. pylori with double or triple regimens, without metronidazole, were randomly assigned to receive tripotassium dicitrato bismuthate 600 mg t.d.s. + metronidazole 500 mg t.d.s. + tetracycline hydrochloride 500 mg t.d. s. combined with either omeprazole 20 mg b.d. (group O, 78 patients) or ranitidine 300 mg b.d. (group R, 78 patients) for 14 days. H. pylori eradication was verified by histology, rapid urease test and 13C-urea breath test. STATISTICS: t-test, chi2-test. RESULTS: A total of 143 patients had a post-treatment endoscopy. Eradication rates were: intention-to-treat: group O 77% (67-87), group R 76% (66-85), P=0.85; per protocol analysis: group O 86% (77-95), group R 82 (71-93), P=0.58. Side-effects were frequent but mild. CONCLUSIONS: Omeprazole 20 mg b.d. and ranitidine 300 mg b.d. were equally effective as antisecretory agents combined in a second-line quadruple eradication regimen.     

Effect of Pilates Training on People With Fibromyalgia Syndrome: A Pilot Study

Altan L, Korkmaz N, Bingol Ü, Gunay B. Effect of Pilates training on people with fibromyalgia syndrome: a pilot study.ObjectiveTo investigate the effects of Pilates on pain, functional status, and quality of life in fibromyalgia, which is known to be a chronic musculoskeletal disorder.DesignRandomized, prospective, controlled, and single-blind trial.SettingPhysical medicine and rehabilitation department.ParticipantsWomen (N=50) who had a diagnosis of fibromyalgia syndrome (FMS) according to the American College of Rheumatology criteria.InterventionThe participants were randomly assigned into 2 groups. In group 1, a Pilates exercise program of 1 hour was given by a certified trainer to 25 participants 3 times a week for 12 weeks. In group 2, which was designed as the control group, 25 participants were given a home exercise (relaxation/stretching) program. In both groups, pre- (week 0) and posttreatment (week 12 and week 24) evaluation was performed by one of the authors, who was blind to the group allocation.Main Outcome MeasuresPrimary outcome measures were pain (visual analog scale) and Fibromyalgia Impact Questionnaire (FIQ). Exploratory outcome measures were number of tender points, algometric score, chair test, and Nottingham Health Profile.ResultsTwenty-five Pilates exercise and 24 relaxation/stretching exercise participants completed the study. In group 1, significant improvement was observed in both pain and FIQ at week 12 but only in FIQ at 24 weeks. In group 2, no significant improvement was obtained in pain and FIQ at week 12 and week 24. Comparison of the 2 groups showed significantly superior improvement in pain and FIQ in group 1 at week 12 but no difference between the 2 groups at week 24.ConclusionsWe suggest Pilates as an effective and safe method for people with FMS. Our study is the first clinical study designed to investigate the role of the Pilates method in FMS treatment. We believe that further research with more participants and longer follow-up periods could help assess the therapeutic value of this popular physical exercise method.     

T‐Wave Variability Detects Abnormalities in Ventricular Repolarization: A Prospective Study Comparing Healthy Persons and Olympic Athletes

Background: Sudden cardiac death in athletes is more common than in the general population. Routine screening procedures are performed to identify competitors at risk. A new Holter‐based parameter analyzes variation of the ventricular repolarization (TVar). The aim of this study was to evaluate differences in electrocardiogram (ECG), Echo, and Holter (H) in competitive athletes compared to a healthy control group consisting of medical students (MS). Methods: A total of 40 athletes (19 females, Olympic team, Luxembourg) and 40 MS (22 females) were examined by means of a resting ECG, treadmill exercise (TE), echocardiogram (Echo), as well as H recordings during a routine screening visit. To analyze TVar, a 20‐minute H recording at rest (sampling rate 1000 per second) was performed. Moreover, heart rate variability (HRV) as well as HR turbulence (HRT) was computed. Results: No differences in demographic variables were detected. Quantification of HRV detected a significant increase in the vagal component of autonomic cardiac modulation. In contrast, no differences for HRT were found. Echo parameter demonstrated a thicker septal wall without differences of the posterior wall. TVar values were normal in range, but did differ significantly between the two groups. No correlation between TVar and echo as well as Holter parameters was detected. Conclusions: TVar was able to demonstrate significant differences in terms of alterations of ventricular activation. This might indicate an early change of myocardial repolarization representing a substrate for life‐threatening arrhythmia. Larger studies on the predictive value of TVar including follow‐up are necessary to confirm this preliminary finding.     

The metabolic correction of erythrocyte function in patients with pulmonary tuberculosis complicated by pulmonary heart failure

In 80 patients with pulmonary tuberculosis aggravated by stage I-IIB cardiopulmonary insufficiency, the multimodality therapy included vektarion improving the ventilation/perfusion correlations (29 patients) and the combination of metabolic correctors (glutamevit and riboxin) (51 patients). The population analysis of peripheral blood erythrocytes (by the method of acidic erythrograms), the fractional composition of hemoglobin, the concentration of 2,3-diphosphoglycerine acid and the isozymic spectrum of LDH in erythrocytes served as methods of the treatment efficacy control. The treatment with vektarion noticeably reduced hypoxemia which was accompanied by positive shifts in erythrocyte metabolism and in the hemoglobin spectrum, producing but a negligible action on the population composition of erythrocytes. The combination of the metabolic correctors exerted a lesser effect on the fractional composition of hemoglobins, producing a well-defined positive action on erythrocyte function, decelerating the processes of their ageing. It is concluded that the highest positive effect may be produced by the combined use of all the three drugs bearing in mind their action mode.     

Spinal osteochondroma: a report on six patients and a review of the literature

Introduction  

Osteochondromas are the most common benign tumour of the bone. They occur in two forms as solitary and hereditary multiple form. Osteochondromas are generally located on the metaphysis of the long bones. From 1 to 4% of osteochondromas occur in the spine. Spinal osteochondromas can cause cord and root compression and also be asymptomatic. In the diagnosis of osteochondromas, radiological methods are very important.