Fetuin‐A and interleukin‐18 levels in ankylosing spondylitis

Aim: Interleukin‐18 (IL‐18) and fetuin‐A have been implicated in atherosclerosis. Preliminary evidence suggests that ankylosing spondylitis (AS) is associated with an increased risk of atherosclerosis. The aim of the present study was to investigate possible abnormalities in IL‐18 and fetuin‐A levels in AS. Methods: Subjects without established cardiovascular (CV) risk factors were studied. Fasting glucose, serum lipids, high sensitive C‐reactive protein (hsCRP), erythrocyte sedimentation rate, IL‐18 and fetuin‐A were assessed. Patients were also evaluated with the Bath Ankylosing Spondylitis Metrology Index, Bath Ankylosing Spondylitis Functional Index, and the Bath Ankylosing Spondylitis Disease Activity Index. Results: Fourty‐five patients with AS (37.4 ± 9.7 years; 35M/10F) and 29 controls (35.5 ± 11.1 years; 21M/8F) were studied. Fetuin‐A levels were significantly higher in AS patients compared to controls (1023.5 ± 171.6 vs. 856.9 ± 207.9 μg/mL, P < 0.001). IL‐18 levels were also higher in the AS group but the difference was not significant (184 ± 186 vs. 140 ± 115, P = 0.1). Significant but weak correlations were found between fetuin‐A, IL‐18, hsCRP, low density lipoprotein cholesterol, and triglyceride levels (P < 0.05; r = 0.4, 0.3, 0.2, and 0.3 respectively). Comparison of subjects with respect to the treatment type, disease activity and history of peripheral arthritis yielded no difference regarding fetuin‐A and IL‐18 between groups. Conclusion: Fetuin‐A and IL‐18 levels seem to be increased in AS patients regardless of disease activity and treatment type.     

Pediatric visceral Leishmaniasis in Turkey

BACKGROUND: Visceral Leishmaniasis (VL) type in Turkey is consistent with the Mediterranean type of VL, a fatal debilitating disease, which is mostly seen in infants. METHODS: Hospital records of 19 children with VL were retrospectively reviewed. The period of the study was from January 2000 to December 2003. RESULTS: The median age of the patients was 36 months. None was coinfected with human immunodeficiency virus or known to be immunocompromised. Fever, pallor, hepatomegaly, splenomegaly, thrombocytopenia and elevated C-reactive protein were observed in all cases, anemia in 18 (95%), leucopenia in 17 (89.4%) and elevated erythrocyte sedimentation rate in 14 (77.7%) of the cases. A bone marrow aspirate was obtained in all cases and Leishmania amastigotes were detected in 15 (78.9%). Fifteen patients (78.9%) were treated initially with meglumine antimonate and four (21%) with sodium stibogluconate. The four patients who received sodium stibogluconate suffered from adverse side-effects during treatment and were subsequently treated with lipid formulations of amphotericin B. CONCLUSIONS: Presentation of VL in the pediatric age group in Turkey is characterized by pallor, fever, splenomegaly and hepatomegaly. Hematological and biochemical indices are typical with cytopenias, hypoalbuminemia, and hyperproteinemia. In most of the cases, microscopic examination provided a positive diagnosis and the remaining patients were diagnosed by serology. Lipid formulations of amphotericin B may be useful in cases of treatment failure with antimonials or significant adverse effects of the drug.     

Development of nursing documentation for use in the outpatient oncology setting

In response to the particular demands upon patients and nursing staff in the outpatient setting, and the identification of a need for nursing orientated documentation, a new nursing documentation system has been developed and implemented within an oncology day unit. The documentation is used by the nursing team engaged in the care of patients receiving outpatient chemotherapy treatment. The system consists of documents for the initial and ongoing assessment, planning, implementation and evaluation of nursing care. These include pretreatment patient self-assessment forms, flowsheets for the documentation of chemotherapy treatment and administration and a record for information and teaching given to patients and significant others. Referrals to other services and health care professionals are also documented. This tool is designed to ensure a high standard of nursing intervention and maximize quality of life in this group of patients. An audit is planned to evaluate the effectiveness of this tool and highlight any areas requiring improvement or modification. There are also plans to further develop this system for use in the inpatient and community setting.     

Effect of urothelium on bladder contractility in diabetic rats

AIM: It is known that physiopathological changes in diabetes affect the function of the bladder. In this study, we aimed to demonstrate the possible effects of diabetes on the urothelium during this physiopathological process. METHODS: Diabetes was induced in rats by tail vein injection of 35 mg/kg streptozotocin. Eight weeks later, intact and denuded bladder strips were prepared from these rats. Electrical field stimulation (EFS; 0.5-32 Hz), carbachol (10(-8)-10(-3) mol/L; cumulative dosage-response curves) and KCl (120 mmol/L) were used for the evaluation of the contractile responses. All responses were expressed as mg tension developed per mg of bladder tissue. Weights of rats and of their bladders, blood glucose levels, and frequency- and concentration-response curves were compared using anova, the paired t-test and the independent t-test. Differences were considered significant at P<0.05. RESULTS: Although no differences related to the weight of bladders of the control and diabetic groups were observed, there were differences in blood glucose levels and body weights between the two groups. Similarly, although there were no differences between the data obtained with EFS and KCl from tissues with intact and denuded strips in the control group, carbachol responses significantly differed between intact and denuded strips in the non-diabetic group. These differences were not observed in the diabetic group. In the control groups, in the presence of additional strips with intact urothelium placed in the medium containing denuded tissue, the differences in contractile responses between the intact control strip and the denuded strip disappeared. CONCLUSIONS: Diabetes possibly changes the interaction between the relaxant factors that are released from urothelium and muscarinic stimulation, but these interactions are not completely understood yet. Consequently, the response of the bladder to contractile stimulants is also affected. Further studies are required to reveal the mechanism by which diabetes influences the urothelium.