Update on spondyloarthropathies

Spondyloarthropathies are a cluster of interrelated and overlapping chronic inflammatory rheumatic diseases that primarily include ankylosing spondylitis, reactive arthritis, and the arthritis associated with psoriasis and inflammatory bowel diseases. The primary pathologic sites are the entheses (the sites of bony insertion of ligaments and tendons); the axial skeleton, including the sacroiliac joints; the limb joints; and some nonarticular structures, such as the gut, skin, eye, and aortic valve. Although spondyloarthropathies are not associated with rheumatoid factor, they show a strong association with HLA-B27; however, this association varies markedly among various spondyloarthropathies and among ethnic groups. The most widely used classification criterion, from the European Spondyloarthropathy Study Group, encompasses the currently recognized wider disease spectrum, with a sensitivity and specificity that generally exceed 85%. Spondyloarthropathies occur in genetically predisposed persons and are triggered by environmental factors, but the cellular and molecular mechanisms of inflammation are not yet fully understood. Chlamydial and many enterobacterial infections can trigger reactive arthritis, but an infectious trigger for ankylosing spondylitis has not yet been established. HLA-B27 itself is involved in enhancing genetic susceptibility, but the underlying molecular basis is still unknown; additional genes include the putative susceptibility genes for Crohn disease, ulcerative colitis, and psoriasis. A specific susceptibility gene for Crohn disease, NOD2, is located on chromosome 16q12, and one of the candidate genes for psoriasis, PSORS1, has been mapped to a 60-kb fragment on chromosome 6p, which is telomeric to the HLA-C locus. This paper reviews the efficacy of anti-tumor necrosis factor-alpha therapy and other therapeutic advances.     

Morphometry of the anterior third ventricle region as a guide for the subfrontal (translaminaterminalis) approach

The anterior third ventricle region acquires clinical significance in benign and malignant tumors and cyst formations, of which craniopharyngiomas and gliomas are the most common. The subfrontal approach is one of the most preferred approaches for removing these tumors. In this study, the microsurgical anatomy of 81 Turkish, adult cadaveric hemispheres was examined to provide morphometric data of the region. These measurements from the anterior third ventricle region serve as a guide for neurosurgeons during surgical approach for removing anterior third ventricle tumors.     

X-ray powder diffraction patterns for certain fluoroquinolone antibiotic drugs

X-ray powder diffraction (XRD) data for six pure fluoroquinolone antibiotic drugs, ciprofloxacin, norfloxacin, enrofloxacin, ofloxacin, pefloxacin and sparfloxacin have been obtained using a powder diffractometer. The drugs were scanned from a Bragg angle (2theta) of 10 degrees to 70 degrees. The obtained data were tabulated in terms of the lattice spacing (A) and relative line intensities (I/I(I)). This new information may be useful for the identification of these drugs.     

Echocardiographic evaluation in patients with hypogonadotropic hypogonadism

OBJECTIVE: To assess cardiac function in patients with hypogonadotropic hypogonadism. STUDY DESIGN: We studied heart structure and left ventricular systolic and diastolic function by echocardiography in 38 patients with hypogonadotropic hypogonadism (34 men and 4 women, mean age 24 +/- 4 years) and in 30 healthy subjects (25 men and 5 women, mean age 22 +/- 3 years). Left ventricular end-diastolic diameter, end-systolic diameter, left ventricular septal wall thickness, posterior wall thickness and ejection fractions were measured by M-mode echocardiography. Parameters of mitral flow were measured by pulsed wave Doppler echocardiography. RESULTS: Between patients with and without hypogonadotropic hypogonadism, there were no significant differences in echocardiographic measurements. CONCLUSION: Cardiac function is normal in patients with hypogonadotropic hypogonadism.     

Nosocomial ocular infection--a prospective study

Nosocomial infection of the eye is an uncommon complication, acquired during the course of hospital management. It may prolong the disease process or even destroy the eye. The overall incidence varies considerably by hospital services. To ascertain the various types of ocular infections and its responsible pathogens, a laboratory-based, nosocomial ocular infection control study was performed in a large referral hospital during a period of January 1997 to June 1999. The study revealed 29 cases (0.08%) of culture proven ocular infections, out of 35,758 total admission during the period of one calendar year. Fifty-one eyes of 29 cases (22 bilateral) had nosocomial infection. Staphylococcus aureus (9), Staphylococcus epidermidis (8) and Pseudomonas aeruginosa (5), were the most frequent bacteria. Laboratory investigations helped in initiation and modification of specific antimicrobial therapy and also prognosis. Proper surveillance with the help of laboratory investigations has effective role in the management of nosocomial ocular infection.     

A case presentation of bilateral simultaneous Bell's palsy

Bilateral simultaneous facial paralysis is an extremely rare clinical entity. Unlike the unilateral form, bilateral facial paralysis seldom falls into Bell's category. It is most often a special finding in a symptom complex of a systemic disease; many of them are potentially life-threatening, and therefore the condition warrants urgent medical intervention. Lyme disease, Guillian-Barre syndrome, Bell's palsy, leukemia, sarcoidosis, bacterial meningitis, syphilis, leprosy, Moebius syndrome, infectious mononucleosis, and skull fracture are the most common cause of bilateral facial paralysis. Here we present a 16-year-old patient with bilateral simultaneous Bell's palsy.     

Tetanus immunization in pregnant women: evaluation of maternal tetanus vaccination status and factors affecting rate of vaccination coverage

The objectives of this study were to determine the tetanus vaccination status for pregnant women, and to examine the effects of various factors on tetanus toxoid (TT) vaccination coverage during pregnancy in reproductive-age women. Four-hundred and ninety-three postpartum women who had live births at a hospital in Ankara were interviewed and information was collected on the mothers' sociodemographic characteristics, TT vaccination history, and prenatal care during the pregnancy studied. The rates for no vaccination, one-dose vaccination, and two-dose vaccination were 53.3%, 18.9%, and 27.8%, respectively. The vaccinated women (with at least one dose) were significantly younger, of lower parity, and had attended more prenatal care visits than the unvaccinated women. Of the women who attended at least one prenatal care check-up, only about half were vaccinated. Significantly more rural women were vaccinated against tetanus than urban women. Current vaccination rates with TT during pregnancy were found to be well below universal levels. Turkey needs to launch effective mass media campaigns that target urban and suburban populations, and inform and motivate women to request vaccination against tetanus.     

Tetanus immunization in pregnant women. Serum levels of antitetanus antibodies at time of delivery

The objective of this study was to determine the tetanus immunity status of pregnant women at the time of delivery according to tetanus toxoid (TT) vaccination coverage during their most pregnancy. The serum anti-tetanus antibody levels of 493 mothers who had live births at a hospital in Ankara were determined by enzyme-linked immunosorbent assay (ELISA). Protected women were defined as those with serum antibody levels 0.6 IU/ml. Overall, 69.0% of mothers had protective tetanus antibody titers at the time of delivery. The rates of protection for mothers who had received no vaccination, one TT dose, or two TT doses during pregnancy were 46.4, 93.5, and 95.6%, respectively. Vaccinating every pregnant woman with at least one dose of TT would be an affordable and effective way to protect against neonatal tetanus, and would be a step toward eliminating the deaths that continue to occur due to this preventable disease in Turkey.