Hemichorea associated with polycythaemia vera

Abstract Chorea is a rare complication of polycythaemia vera. Polycythaemic chorea occurs predominantly in females and usually in generalised form. We present a 66-year-old woman with acute onset hemichorea-ballism with no vascular pathology in the basal ganglia region. A clear relationship was observed between the onset of chorea and worsening of haematological parameters in the patient. After repeated phlebotomies the patient's clinical status was improved. Polycythaemic chorea must be considered, especially in the elderly, as early diagnosis leads to effective treatment and prevention of complications.     

Erectile dysfunction due to venous incompetence treated by dorsal vein ligation

The authors describe 14 cases of erectile dysfunction. The sites of leakage were detected by duplex or colour flow Doppler sonography. Treatment by dorsal vein ligation resulted in fairly good early responses, however, at 4-month follow-up the great majority of patients returned to the original functional state.     

Rapid screening for bacteriuria in pregnancy

Summary We evaluated a bioluminescence assay as a screening test for the detection of bacteriuria in pregnancy. A total of 1,000 urine specimens from a randomly selected group of pregnant women undergoing prenatal surveillance was investigated. Sequential dilution of urine specimens on CLED agar plates served as a reference method. Set against the reference group, bioluminescence screening scored a 93% sensitivity, a 78% specificity and a 99% predictive accuracy for negative results. All urine specimens were also analysed chemically for the presence of nitrite and leucocyte esterase by dip sticks. Dip sticks proved to be insufficient because of poor sensitivities of 54% and 59%, respectively. The bioluminescence assay is an effective, time- as well as labor-saving but questionably cost-effective method for the detection of bacteriuria in pregnancy.

---

Rascher Nachweis der Bakteriurie bei Schwangeren

Zusammenfassung In der vorliegenden Studie prüften wir die klinische Wertigkeit eines Biolumineszenz-Verfahrens zum Nachweis der Bakteriurie bei Schwangeren. Insgesamt wurden 1000 Routine-Harnproben von Schwangeren untersucht. Als Referenzmethode diente die sequentielle Verdünnung der Harnproben und Ausstreichen auf CLED-Agarplatten. Eine signifikante Bakteriurie konnte mit der Biolumineszenz-Methode mit einer Sensitivität von 93% und einer Spezifität von 78% erkannt werden. Die Voraussagewahrscheinlichkeit für negative Resultate war 99%. Gleichzeitig untersuchten wir alle Harnproben auf Vorhandensein von Nitrit und Leukozyten-Esterase mittels Teststreifen. Die Sensitivitäten lagen nur bei 54% bzw. 59%. Mit Hilfe der Biolumineszenz-Methode kann eine signifikante Bakteriurie bei Schwangeren rasch, verläßlich, aber nur bei relevanter Probenanzahl auch kostengünstig nachgewiesen werden.

     

Evaluation of antinuclear antibodies by indirect immunofluorescence and line immunoassay methods′: four years′ data from Turkey

The presence of antinuclear antibodies (ANAs), directed against intracellular antigens, is a hallmark of systemic autoimmune rheumatic diseases. The indirect immunofluorescence (IIF) assay is among the most commonly used routine methods for ANA detection as the screening test. The objective of the study was to evaluate ANA patterns in a 4‐year period retrospectively. All 19 996 serum samples that were sent to the Laboratory of Medical Microbiology of the tertiary Hospital by any hospital department between 1 January 2009 and 1 January 2013 with a request to test for ANA, anti‐ENA or both were included in the study. Of these samples, 4375 (21.9%) were ANA‐IIF‐positive and 15621 (78.1%) were ANA‐IIF‐negative. The presented ANA‐positive samples consisted of 2392 (54.67%) homogenous, 818 (18.70%) speckled, 396 (9.05%) centromere, 242 (5.53%) nucleolar, 213 (4.87%) nuclear dots, 178 (4.07%) cytoplasmic (except for actin and golgi), 24 (0.55%) actin, 9 (0.21%) golgi, 53 (1.21%) nuclear membrane and 50 (1.14%) mixed pattern. Totally 7800 samples were examined by LIA. Of these samples, 3440 were positive and 4307 were negative with IIF and LIA. In addition, 22 samples were detected as IIF‐positive but LIA‐negative, whereas the rest 31 samples were IIF‐negative but LIA‐positive. ANA patterns in 22 IIF‐positive samples were homogenous (9), speckled (5), golgi (4), cytoplasmic (3) and nucleolar (1). SSA/Ro‐52, SSB/La and Scl‐70 positivity were detected in 31 IIF‐negative/LIA‐positive samples by LIA. The present study comes forward with its overall scope, which covers 4‐year data obtained in tertiary hospital located in the western part of Turkey.     

Impact of obesity treatment on gastroesophageal reflux disease

Gastroesophageal reflux disease(GERD) is a frequently encountered disorder. Obesity is an important risk factor for GERD, and there are several pathophysiologic mechanisms linking the two conditions. For obese patients with GERD, much of the treatment effort is focused on weight loss and its consistent benefit to symptoms, while there is a relative lack of evidence regarding outcomes after novel or even standard medical therapy is offered to this population. Physicians are hesitant to recommend operative anti-reflux therapy to obese patients due to the potentially higher risks and decreased efficacy, and these patients instead are often considered for bariatric surgery. Bariatric surgical approaches are broadening, and each technique has emerging evidence regarding its effect on both the risk and outcome of GERD. Furthermore, combined antireflux and bariatric options are now being offered to obese patients with GERD. However, currently Rouxen-Y gastric bypass remains the most effective surgical treatment option in this population, due to its consistent benefits in both weight loss and GERD itself. This article aims to review the impact of both conservative and aggressive approaches of obesity treatment on GERD.     

Comparison of renal resistive index among patients with Type 2 diabetes with different levels of creatinine clearance and urinary albumin excretion

Diabet. Med. 29, 1043–1046 (2012) Aim To evaluate the prevalence of increased renal resistive index and related factors among patients with Type 2 diabetes with different levels of creatinine clearance and urinary albumin excretion. Methods Laboratory analyses, including calculation of 24‐h urinary albumin excretion and 24‐h creatinine clearance, and renal doppler ultrasonography to measure renal resistive index, were carried out for patients newly diagnosed with Type 2 diabetes mellitus. Results Participants were classified into four groups according to 24‐h creatinine clearance and 24‐h urinary albumin excretion levels. Group 1 was composed of 73 patients (54.1%) with normal 24‐h creatinine clearance and 24‐h urinary albumin excretion. Group 2 was composed of 34 (25.2%) patients with normal 24‐h creatinine clearance and increased 24‐h urinary albumin excretion. Group 3 was composed of 14 (10.4%) patients with decreased 24‐h creatinine clearance and normal 24‐h urinary albumin excretion. Group 4 was composed of 14 (10.4%) patients with both decreased 24‐h creatinine clearance and increased 24‐h urinary albumin excretion . In total, 41 patients (30.4%) had increased renal resistive index levels. Comparison of the four groups with respect to increased renal resistive index revealed: among group 1 patients, 10 (13.7%) had increased renal resistive index levels; among group 2 patients, 14 (41.2%) had increased renal resistive index levels; among group 3 patients, eight (57.1%) had increased renal resistive index levels; among group 4 patients, nine (64.3%) had increased renal resistive index levels (P < 0.0001 for trend). In multivariate regression, 24‐h creatinine clearance (P < 0.0001), but not 24‐h urinary albumin excretion, was related to increased renal resistive index levels. Conclusion Renal resistive index levels were highest in patients with Type 2 diabetes with both decreased 24‐h creatinine clearance and increased 24‐h urinary albumin excretion, whereas they were lowest in patients with normal creatinine clearance and normal urinary albumin excretion.     

Lupus vulgaris in a pediatric patient: a clinicohistopathological diagnosis

Lupus vulgaris is the most common form of cutaneous tuberculosis which usually occurs in patients previously sensitized to Mycobacterium tuberculosis. We present a case of a 10-year-old boy who was diagnosed as lupus vulgaris clinically and histopathologically. He had well demarcated, irregularly bordered, pink, infiltrated plaques on his left cheek showing apple-jelly appearance on diascopy. The histopathological examination showed tuberculoid granulomas with Langhans type giant cells. The Mantoux reactivity was in normal limits, and no acid-fast bacilli was found in the lesion, either by direct stained smears or by culture. The lesions showed marked improvement on anti-tuberculosis treatment. We want to emphasize that histopathological examination has diagnostic value in lupus vulgaris in correlation with clinical appearance, when direct analysis or culture is negative.     

HIV Prevalence and Related Behaviors Among People Who Inject Drugs in Iran from 2010 to 2020

AIDS and Behavior - Injection drug use has been the leading route of HIV transmission in Iran. We assessed HIV prevalence, risk behaviors, and uptake of prevention services among people who inject...