Türkiye’deki çocuklarda enterovirüs ve parechovirüse bağlı viral aseptik menenjit sürveyansı

ÖZETTÜRKİYE’ DEKİ ÇOCUKLARDA ENTEROVİRÜS VE PARECHOVİRÜSEBAĞLI VİRAL ASEPTİK MENENJİT SÜRVEYANSIAmaç: Enterovirüsler, aseptik menenjit olgularının %85-95’ ine neden olur.Enterovirüslere bağlı viral aseptik menenjit (VAM) çocuklarda uzun dönemdesekellere neden olabilir. Son yıllarda parechovirüse bağlı olarak da VAM olgularıtanımlanmıştır. Ülkemizde VAM‘ ye neden olan etkenlere yönelik tek merkezlibölgesel küçük çalışmalar yapılmış olmasına rağmen ülke genelini yansıtacakenterovirüse bağlı VAM sürveyansı mevcut değildir. Parechovirüs epidemiyolojisiile ilgili ise ülkemizde henüz epidemiyolojik araştırma rapor edilmemiştir. Bunedenle çalışmamızda ülkemizdeki enterovirüs ve parechovirüse bağlı VAM sıklığınıgöstermeyi amaçladık.Gereç ve Yöntem: Ülkemizdeki 37 merkezde, Mayıs 2006- Ocak 2009 tarihleriarasında menenjitten şüphelenilen hastalardan beyin omurilik sıvısı (BOS) örnekleritoplanmıştır. BOS kültüründe ve polimeraz zincir reaksiyonu (PZR) yöntemi ileetken olarak bakteri tanımlanmamış ve Dünya Sağlık Örgütü’ nün bakteriyelmenenjit tanımına uymayan olgulara ait toplam 657 BOS örneği çalışmaya alınmıştır.Enterovirüs ve parechovirüs RNA BOS’ da reverz transkriptaz-PZR yöntemi ileçalışılmıştır. VP1 bölgesinin direkt DNA dizisi aracılığıyla da enterovirüslSonuç: İncelenen BOS örneklerinde parechovirüs saptanamamıştır. Enterovirüssıklığı ise literatüre göre daha düşük saptanmıştır. Bu sonucun nedeni olarak,çalışmaya alınan hastaların büyük kısmının ateş odağı araştırması açısından lomberponksiyon yapılan hastalardan oluşması olarak düşünülmüştür. Bu çalışmaülkemizde yapılan ilk enterovirüs ve parechovirüse bağlı VAM sürveyansıdır.Ülkemizde enterovirüs ve parechovirüse bağlı VAM sıklığı, dolaşan enterovirüs veparechovirüslerin yaygınlığı ve filogenetik analizinin yapılması ve bu sayeİNGİLİZCE ÖZET (ABSTRACT)VIRAL ASEPTIC MENINGITIS SURVEILLANCE DUE TOENTEROVIRUSES AND PARECHOVIRUSES AMONG CHILDREN INTURKEYBackground and Objectives: Enteroviruses are responsible for 85-95% of cases ofaseptic meningitis. Viral aseptic meningitis (VAM) due to enteroviruses can causelong-term sequelae in children. VAM cases caused by parechoviruses also identifiedrecently. Although there are small-scale or single-center regional studies about thecausative agents of VAM, there is not enough data related with epidemiology ofenteroviruses and parechoviruses in our country. Therefore in the present study, weaimed to show the frequency of VAM due to enteroviruses and parechovirusesthrough whole country.Methods: Cerebrospinal fluid (CSF) samples were collected from patients withsuspected meningitis between May 2006 and January 2009 from 37 centers inTurkey. A total of 657 CSF samples of cases who not meet the definition ofbacterial meningitis identified by World Health Organization and were negative bybacteriological culture and polymerase chain reaction (PCR) were enrolled in thestudy. Enteroviruses and parechoviruses RNA were investigated in CSF by reversetranscription-PCR and specific genotypes of enteroviruses were identified by directDNA sequencing of the VP1 region.Results: A total of 657 CSF samples were negative for parechovirus. Enteroviruseswere detected in 13 (2%) of 657 CSF specimens analyzed. Identified enteroviruseswere echovirus 14 (n:1), echovirus 9 (n:1), coxsackievirus B 4 (n:1), and unknownserotype (n:10). The patients’ ages ranged from 1 month to 126 months. Frequencyof symptoms and findings in enteroviruses positive cases were as follows; fever(69%), nuchal rigidity (38%), Kernig sign (23%), Brudzinski sign (23%) lethargy(23%), rash (15%), and focal neurologic signs (7%).Conclusion: Parechoviruses were not detected in CSF specimens analyzed. Thefrequency of enteroviruses was lower than literature. Since most of the patientsparticipated in the study consist of the patients who had lumbar puncture in terms ofresearch focus of the fever but not considered the forefront of meningitis. This studyis the first surveillance of VAM due to enteroviruses and parechoviruses in ourcountry. In order to early recognition of possible epidemics of aseptic meningitisespecially due to enteroviruses and parechoviruses continuous national surveillancestudies are needed. This surveillance may also help obtaining phylogenetic datarelated with those viruses.Key Words: Viral aseptic meningitis, enteroviruses, parechoviruses, surveillance,child

Overlap of symptoms of dyspepsia and gastroesophageal reflux in the community

WOS: 000254135600003PubMed ID: 17450489Background/aims: Dyspepsia and gastroesophageal reflux disease are common chronic diseases. In the clinical setting, some patients express both problems together; however, little is known about the real prevalence of the presence of the two symptoms. Turkey is particularly interesting because of differences observed from developed countries. We aimed to derive data from our previous prevalence of gastroesophageal reflux disease study and evaluate the overlap of the two symptoms. Methods: We used a previously validated and culturally adapted reflux questionnaire, which was translated into Turkish. The questionnaire was applied to 630 randomly selected subjects older than 20 years living in a population of 8857 adults. Results: 28.6% (180 / 630) of all responders defined dyspepsia within the last 12-month period. When symptom prevalence was considered at least weekly, the prevalence was 10% for heartburn, 15.6% for acid regurgitation, and 20% for either symptom. While the prevalence of gastroesophageal reflux disease was 29.4% in patients with dyspepsia, dyspepsia was found in 43. 1% of patients with gastroesophageal reflux disease. Only 21% of symptomatic subjects or 8.4% of the entire study population had both symptoms. Dyspepsia was defined as the most bothersome symptom. 54.3% of all dyspeptic patients and 67.3% with both gastroesophageal reflux disease and dyspepsia used a gastric medication (p>0.05). 29.9% of subjects with dyspeptic symptoms defined antacid consumption and 28.3% acid inhibitor therapy. Conclusion: Dyspepsia was defined as the most bothersome symptom compared to gastroesophageal reflux disease symptoms. The prevalence of dyspepsia in patients with gastroesophageal reflux disease is more common than vice versa. However, the overlap of the two symptom groups was lower than expected in this low-income, Caucasian population

Effects of ethanol and extract of cigarette smoke on the rabbit buccal mucosa

WOS: 000285881100005PubMed ID: 20923442Aim: The combination of smoking and drinking alcohol has a high association with diseases of squamous epithelium within the human oral cavity. Therefore, a study was done to assess the impact of these agents alone or in combination on the squamous epithelium using as model the buccal epithelium from rabbit oral cavity. Methods: Buccal epithelium was mounted in Ussing chambers to monitor electrical parameters during exposure to ethanol (5-40%) or to Ringer extract of cigarette smoke (EOCS) from one to six cigarettes dissolved in 10 ml Ringer either alone or with combination. Results: Exposure to EOCS reduced in a dose dependent manner above 2 cigarettes/10 ml transmural electrical potential difference (PD), short-circuit current (I-sc), increased transmural electrical resistance (R). Morphology showed from generalize tissue edema to patchy necrosis with the increasing concentrations. Ethanol alone raised PD, I-sc and R at lower concentrations (5%) and lowered PD, I-sc and R at higher concentrations (40%). The combination of 5% ethanol, EOCS-1cigarette/10 ml reduced PD, I-sc by 58% and increased R by 29%. Unlike exposure to 5% EtOH and EOCS-1, 10% EtOH combined with EOCS-1 produces a harmful effect by dropping PD and I-sc. Conclusion: Both, simultaneous, and sequential, use of these agents enhanced their negative impact on these parameters. The enhancement of these effects are not due to solubulization of additional tobacco products by EtOH or by or by EtOH enhancing smoking noxious effect. Histopathologic damage needs higher concentrations of ethanol and EOCS combination and changes were more profound compared to the sum of the isolated effects of both agents.National Institutes of HealthUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USA [R01-DK36013]This study is supported by National Institutes of Health grant R01-DK36013

COVID-19 in hospitalized infants aged under 3 months: multi-center experiences across Turkey

To investigate coronavirus disease 2019 (COVID-19) in infants aged 0 to 3 months because there is currently a significant gap in the literature on the subject. A cross-sectional study was conducted with the involvement of 19 medical centers across Turkey and 570 infants. The majority of the patients were male (58.2%), and the three most common symptoms were fever (78.2%), cough (44.6%), and feeding intolerance (39.9%). The results showed that a small percentage of infants had positive blood (0.9%) or urine cultures (10.2%). Most infants presented with fever (78.2%). Children without underlying conditions (UCs) had mostly a complicated respiratory course and a normal chest radiography. Significant more positive urine culture rates were observed in infants with fever. A higher incidence of respiratory support requirements and abnormal chest findings were seen in infants with chronic conditions. These infants also had a longer hospital stay than those without chronic conditions. Conclusions: Our study discloses the clinical observations and accompanying bacterial infections found in infants aged under 3 months with COVID-19. These findings can shed light on COVID-19 in infancy for physicians because there is limited clinical evidence available. What is Known: • COVID-19 in infants and older children has been seen more mildly than in adults. • The most common symptoms of COVID-19 in infants are fever and cough, as in older children and adults. COVID-19 should be one of the differential diagnoses in infants with fever. What is New: • Although most infants under three months had fever, the clinical course was uneventful and respiratory complications were rarely observed in healthy children. • Infants with underlying conditions had more frequent respiratory support and abnormal chest radiography and stayed longer in the hospital