The necessity of culture for the diagnosis of tinea pedis

BACKGROUND: This study examined the consistency between the clinical diagnosis of tinea pedis and the results of direct fungal examination, prepared with 10% potassium hydroxide, and culture. METHODS: 2,427 patients clinically diagnosed with tinea pedis who presented to the mycology laboratory were reviewed retrospectively for the outcomes of direct fungal examination and culture. RESULTS: Direct examination was positive in 54.3% and culture was positive in 36.6% of the cases. The sensitivity and specificity of direct microscopy were 95.7% and 69.6%, respectively CONCLUSIONS: The clinical diagnosis of tinea pedis can be misleading, since it features lesions that can also be present in some other skin diseases and direct microscopy may be insufficient to confirm the diagnosis. Therefore, we suggest using culture for a definitive diagnosis.     

Do baby wet wipes change periurethral aerobic flora?

There is massive enteric bacterial colonization in the periurethral region during infancy. Fecal soiling is considered to be responsible for this colonization. We hypothesized that baby wet wipes containing chemical cleansing compounds, which are used for the cleaning of babies after diaper soiling, could be a contributing factor in this colonization. Thus, the effect on periurethral flora of two different methods of baby cleaning was compared. Periurethral culture samples were obtained from 173 infants who were cleaned with baby wet wipes (Group A, n = 96) or water and napkins (Group B, n = 77) after diaper soiling. The colonization of uropathogens and the presence of flora were analyzed. The results of the periurethral cultures were similar in both groups. The rates of uropathogen colonization only, uropathogen and skin flora colonization, and skin flora only or no growth in Groups A and B were 18.7, 61.5, and 19.8%, and 14.3, 66.2, and 19.5, respectively. The differences between the groups were statistically insignificant (P > 0.05); however, there was no significant difference in the frequency of uropathogen isolation between males and females. We therefore concluded that baby wet wipes are as safe as water for the cleaning of babies after diaper soiling.     

Plasma visfatin levels in patients with newly diagnosed and untreated type 2 diabetes mellitus and impaired glucose tolerance

Visfatin, a new adipokine, facilitates adipogenesis and has insulin-mimetic properties. We aimed to investigate the plasma visfatin levels in patients with newly diagnosed and untreated type 2 diabetes mellitus (T2DM) and impaired glucose tolerance (IGT), who had no obesity or hypertension. Twenty-two patients with T2DM, 18 subjects with IGT and 40 healthy controls were enrolled. Visfatin levels were measured along with the BMI, blood pressure, lipids, glucose, insulin, adiponectin and hsCRP levels, and HOMA-IR indexes. Age, sex and BMI were similar in all groups. Visfatin levels were higher in the diabetic group than the controls (p=0.01). There was no significant difference in the visfatin levels between the T2DM and IGT groups as well as IGT group and healthy controls. Plasma visfatin concentrations did not differ between men and women. Visfatin levels did not correlate with BMI, blood pressure, plasma adiponectin, insulin, hsCRP, glucose and lipid levels or HOMA-IR indexes in the three groups. These results indicate that hyperglycemia causes an increase in plasma visfatin levels and, as in people with T2DM but not with IGT, this increase gets more prominent as the glucose intolerance worsens.     

The effect of the timing of hip fracture surgery on the activity of daily living and mortality in elderly

The optimal time for the operation of hip fractures in elderly is not clear. Most of the data indicate that early operation is associated with better prognosis and improved health quality. We aimed to investigate the effect of timing of surgical intervention on the frequency of post-operative complications, recovery of weight bearing ability, total hospitalization time and activities of daily living (ADL) scores. Sixty five patients subjected to surgical repair were followed up. All were evaluated for their ADL before fracture, post-operative 1st, 3rd, 6th and 12th month. The patients operated within 5 days after hospitalization constituted the early group (n = 38, 24 females, 14 males; mean age = 76.16 +/- 7.08 years), and the patients operated after the fifth day served as the late group (n = 27, 18 females, 9 males; mean age = 75.81 +/- 7.50). Time of recovery of weight bearing ability and total hospitalization time were significantly higher in the late group (P < 0.05). ADL scores in 1st, 3rd and 6th month after surgery were significantly lower (P < 0.05), and death rates on post-operative 1st and 12th month were significantly higher in the late group (P < 0.05). Elderly, operated within 5 days of the hip fracture have increased survival time and better life quality than those operated after the fifth day of the admission. The data supports the previous reports which indicate the necessity of the early operation of elderly hip fractures.     

Acute aortic valve regurgitation secondary to blunt chest trauma.

Blunt injury to the cardiac valves leads to progressive acute ventricular failure, which often requires urgent surgical management. In this case report, we describe an acute aortic valve rupture caused by air-bag inflation during an automobile accident. Laceration of an aortic valve cusp was treated successfully with urgent aortic valve replacement. A concomitant orthopedic injury was treated electively 15 days after cardiac surgery Acute aortic valve rupture is a very rare complication of blunt chest trauma. We discuss how to diagnose and manage this potentially catastrophic event.     

Efficacy of micronized flavonoid fraction in healing of clean and infected wounds

Purified micronized flavonoid fraction, comprising 90% diosmin and 10% hesperidin, is basically used as a phelebotonic and vasculoprotector agent. It also has anti-inflammatory and anti-edematous actions. This study was designed to evaluate the efficacy of micronized flavonoid fraction in clean and infectious wounds. Sixty Guinea pigs were separated into 2 main groups and 6 subgroups. The first three groups had clean wounds and the other three groups had infected wounds contaminated withS. aureus. Then these main groups were separated into 3 subgroups. The first subgroups was treated with 60 mg/kg/day micronized flavonoid fraction per oral, the second ones was treated with topical 60 mg/kg/day micronized flavonoid fraction, and the thrid ones had no treatment. Infected wounds were obtained by contamining the wounds withS. aureus. There were no significant differences in wound healing between the groups that have clean wounds (p>0.05). In the groups with infected wounds, orally and topically treated guina pigs had accelerated wound healing compared to the untreated control group (p<0.05), confirmed with surface area measurements and histopathological evaluation. Healing showed no difference between the groups treated orally and topically. This study showed that oral or topical administration of micronized flavonoid fraction in the infected wounds is beneficial, while it has no significant effect in clean wounds.     

Comparison of extra-pulmonary and pulmonary tuberculosis cases: factors influencing the site of reactivation.

SETTING: Mycobacterium tuberculosis bacilli spread by the hematogenous route during primary infection and reactivate later. OBJECTIVE: To compare factors influencing the reactivation site. DESIGN: A total of 236 pulmonary tuberculosis (PTB) and 139 extra-pulmonary TB (EPTB) cases were compared in terms of age, co-morbid disease, immunosuppressive drug use, history of contact with a PTB case in a close relative, history of tuberculosis, smoking habit and alcohol intake. RESULTS: The sex ratio of EPTB and PTB cases was significantly different (P < 0.001): respectively 74% of EPTB cases and 34% of PTB cases were females; 53.3% of PTB cases and 23% of EPTB cases were smokers (P < 0.001); and the disease appeared within the first 5 years after contact in 23.7% of EPTB cases compared to 72.6% in PTB cases (P < 0.001). In logistic regression analysis, gender (OR = 3.69), smoking habit (OR = 0.54) and interval between contact and disease (OR = 1.07) were found to influence the reactivation site. CONCLUSION: The probability of PTB development was higher in males, in smokers and within the first 5 years of contact. In contrast, the probability of EPTB development was higher in females and after 5 years of contact.     

Successful treatment with adefovir of one patient whose cryoglobulinemic vasculitis relapsed under lamivudine therapy and who was diagnosed to have HBV virologic breakthrough with YMDD mutations

We report a patient whose cryoglobulinemic vasculitis recurred due to reactivation of lamivudine-resistant HBV. Our patient with hepatitis B-related cryoglobulinemic vasculitis was administered lamivudine. Her vasculitis regressed, ALT normalized, HBV-DNA became negative. Under lamivudine therapy, her cryoglobulinemic cutaneous vasculitis recurred. ALT increased significantly; it was found that tyrosine-methionine-aspartate-aspartate (YMDD) motif in the DNA polymerase gene had been replaced by YIDD. Adefovir was added to lamivudine. During follow-up, her purpura disappeared, ALT normalized, HBV-DNA became negative. Our patient is the first whose cryoglobulinemic vasculitis recurred under lamivudine, who had a HBV virologic breakthrough with YMDD mutation, and was successfully treated with adefovir.     

Relationship between control of ventricular rate in atrial fibrillation and systemic coagulation activation in patients with mitral stenosis

BACKGROUND AND AIM OF THE STUDY: Systemic thromboembolism is a major complication in patients with mitral stenosis (MS), especially in those who have atrial fibrillation (AF). It has been suggested that systemic coagulation activity may be increased in these patients. The study aim was to investigate the relationship between control of ventricular rate and systemic coagulation factors in patients with MS and AF by measuring plasma levels of prothrombin fragment (PF) 1+2, thrombin-antithrombin III complex (TAT) and plasminogen activator inhibitor-1. METHODS: Fifty-four consecutive patients with moderate to severe MS and AF were included in the study. Patients with resting heart rates < 100 beats per min were considered as having a controlled ventricular response rate (group A; n = 28) and those with > 100 beats per min as an uncontrolled ventricular response rate (group B; n = 26). RESULTS: Group A patients had a lower mean mitral gradient and pulmonary artery pressure than group B patients (11 +/- 6 versus 15 +/- 5 and 35 +/- 7 versus 39 +/- 8; p < 0.05, respectively). Plasma concentrations of PF 1+2 (4.17 +/- 2.1 versus 2.95 +/- 1.21; p < 0.01) and TAT III (4.61 +/- 1.75 versus 3.12 +/- 1.01; p < 0.01) were elevated in group B compared with group A. Similarly, group B patients had higher plasminogen activator inhibitor-1 levels than group A patients (7.87 +/- 3.8 versus 5.8 +/- 2.9; p < 0.05). A significant correlation was found between heart rate and plasma PF 1+2 and TAT levels. Multiple logistic regression analysis revealed that heart rate and mean mitral gradient were independent predictors of systemic coagulation activation. CONCLUSION: Besides contributing towards hemodynamic and symptomatic relief, the control of AF rate in MS patients induces a drastic decline in coagulation activation, and may also reduce the incidence of thromboembolism.