The investigation of the role of dendritic cells in the development of atherosclerosis

Dendritik hücreler (DH) antijen sunan hücreler ailesinin önemli elemanlarından biridir. Bağışıklık sisteminin antijene cevabını başlatır, artırır veya yavaşlatabilirler. Bu hücreler ilk olarak 1868 yılında cilt dokusunda bulunmuş ve "Langerhans Hücreleri" olarak adlandırılmıştır. 1973 yılında ise Ralph Steinman tarafından dalakta gösterilmişlerdir. Daha sonra işlevlerine ve bulundukları dokuya göre DH'lerin çeşitli alt tipleri tanımlanmıştır. Ateroskleroz; damar dokusunda kontrol edilemeyen lipid depolanması ile giden kronik ve ciddi bir sağlık problemidir. Ateroskleroz konusundaki klinik çalışmalar uzun yıllardır yapılmakla birlikte bu kontrolsüz lipid depolanma olayını başlatan ve ilerleten immünobiyolojik hücresel parametrelerin araştırılması son yıllarda daha çok önem kazanmıştır. Şimdiye kadar aterosklerozda özellikle monositler ve makrofajların rolleri ile ilgili pek çok çalışma yapılmıştır. Burada sunulan tez çalışmasında, DH'lerin aterosklerozda görülen kronik enflamatuvar süreci yöneten elemanlar olduğu öne sürülerek patolojideki rolleri araştırılmıştır. Tez çalışmasına dahil edilen 29 kişinin 6 tanesi negatif kontrol grubunu oluşturmaktadır; bu grupta koroner arter hastalığı (KAH) olmayan, ancak mitral kapak replasmanı (MVR) veya aort kapak replasmanı (AVR) ameliyatı geçirmiş 5 hasta ile 1 tane sağlam-sağlıklı gönüllü bulunuyordu. Çalışmaya dahil edilen diğer 23 hasta ise çeşitli derecelerde aterosklerozu olup bu nedenle koroner arter bypass cerrahisi (CABG) geçirmiş hastalardı. CABG operasyonu geçiren 23 hastadan 9'unda aynı zamanda diabetes mellitusu (DM) vardı. Negatif kontrol grubundaki hiç bir hastada DM tespit edilmedi. Hastalardan operasyon öncesi alınan periferik venöz kan örneklerinden önce mononükleer lökositler; daha sonra da magnetik separasyon yöntemi ile dendritik ön hücre izolasyonu yapıldı. Bu hücreler okside LDL'li (ox-LDL'li) ve LDL'siz ortamlarda 37°C'da 48 saat, %5 karbondioksitli, su ceketli inkübatörde bekletildikten sonra, CD 80, CD86, CD45, CD11c, CD141, CD14, HLA-DR, LIN, CD123 yüzey antijenlerinin tesbiti için akan hücre ölçer analizleri yapıldı. Koroner arter hastalığı olmayan kontrol grubunda CD86 düzeyi en yüksek saptandı. Koroner arter hastalığı olmayan hastalardan izole edilen ve ox-LDL ile uyarılan DH'ler de belirgin yüksek CD86 eksprese ettiği gözlendi. Hem koroner arter hastalığı hem de DM olan hasta grubunda, DM olmayanlara göre ox-LDL ile uyarımın CD86 ekspresyonunu belirgin olarak baskıladığı saptandı. Bu tez çalışmasında aterosklerozun artan patolojisi ile birlikte DM olan grupta dendritik hücrelerin giderek artan oranda inhibisyona uğradığı tespit edilmiştir. KAH olmayan kişilerde en yüksek düzeyde DH aktivasyonu gözlenmiştir, buna karşın KAH olan ancak DM olmayan hastalarda daha az DH aktivasyonu tespit edilmiştir. Normal koroner arterlere sahip bireylerde okside LDL ile uyarı sonrası CD86 aktivasyon düzeylerinde yaklaşık 3 kat artış olduğu gözlenmiştir.Dendritic cells are an important elements of antigen presenting cell family. They have been assumed to begin, tolerize or supress the antigenic response of immunologic cascade. They were first recognized as "Langerhans Cells" in the skin in 1868. Then they were visualized in spleen by Ralph Steinman in 1973. Since then they have been classified into subtypes according to their functions and presence in different tissues. Atherosclerosis has been considered as a chronic health problem defined by dysregulated lipid storage in vascular tissue. Although many clinical studies have been performed in atherosclerosis, researchers have just started to focuse on immunologic parameters that propagate and accelerate the inflamation related to this dysregulated lipid storage in recent years. There have been many studies in atherosclerosis on the role of monocytes and macropaghes. The role of Dendritic cell was investigated by suggesting that these cells involved in the thesis study were the managing staff in the process of atherosclerosis. The study group consisted of 29 subjects. Among the negative control group of 6 subjects; 5 had no coronary artery disease and would undergo mitral valve or aortic valve replacement operation, and 1 was a completely healthy person. Among coronary artery disease group 23 patients had different degrees of atherosclerosis and would undergo coronary artery bypass surgery (CABG). Among 23 CABG patients, 9 had Diabetes Mellitus (DM). DM was not diagnosed in any of negative control group. Mononuclear phagocytes were isolated from peripheral blood samples of patients before they underwent surgery and dendritic cells were isolated with magnetic separation. The isolated cells were cultured with or without oxidized LDL (ox-LDL). Then flowcytometric analysis was performed for CD80, CD86, CD45, CD11c, CD141, CD14, HLA-DR, LIN, CD123. The highest CD86 level was found in negative control group. Besides, DCs isolated from subjects with normal coronary arteries had highest CD86 expression in response to ox-LDL stimulation. DCs from patients with atherosclerosis and DM, CD86 response to ox-LDL stimulation was evidently more more suppressed comparedto DCs of non-diabetic group.In this thesis work; we have found that dendritic cells have been suppressed with increasing pathology of atherosclerosis in coronary artery patients who also had DM. The highest level of DC activation was observed in patients who do not have CAD althoughless DC activation was detected in patients with CAD but not DM. In persons with normal coronary arteries, CD86 levels after ox-LDL stimulation was detected to increase 3 folds

Retrospective Analysis of Culture Results of Cases with Acute Vulvovaginitis: University Experience

OBJECTIVE: To analyse the results of the vaginal cultures and find out the prevalence of pathogens in patients with acute vulvovaginitis, retrospectively. STUDY DESIGN: Vaginal cultures results of patients with the diagnosis of acute vulvovaginitis were analyzed retrospectively between June 2005 and January 2006. RESULTS: Totally 241 patients were included in the study within 6 months time period. Mean age of patients was 30,63±6,87 changing between 19 and 57 years. While there was no pathogen detected in 18,3% (44/241) of vaginal cultures, various pathogens growed in 81,7% (197/241) of cultures. Normal vaginal flora was detected in 70,6% (139/197) of cultures with growth. The second most common pathogen was Candida subspecies with a rate of 14,2% (28/197). Other pathogens were Candida albicans, E.coli, Gardnerella vajinalis, Klebsiella pneumonia, Candida subspecies and Klebsiella, Candida albicans and Klebsiella, Candida albicans and Gardnerella vajinalis with a rate of %7,1 (14/197), %4,1 (8/197), %2 (4/197), %0,5 (1/197), %0,5 (1/197), %0,5 (1/197) and %0,5 (1/197) respectively. CONCLUSION: The most frequent pathogen detected in culture of patients with acute vulvovaginitis was candida subspecies in our clinic

The Seroprevalance of Epstein-Barr Virus (EBV) in Children Aged Between 1-18 and Applied to Medical Hospital of Inonu University

Epstein-Barr Virus (EBV) has been shown to be the cause of infectious mononucleosis (IM) and has been proved in association with several malignant diseases. EBV infection during infancy and early childhood is mild or subclinical generally, but 50 to 75% of primary infections in young adults may be associated with classical IM. The aim of this study was determine the seroprevalance of EBV specific antigens in children aged 1-18 years and submitted to Medical Hospital of Inönü University and the rate of infection in different age groups. In this respect 660 sera samples were examined for anti-EBV-VCA IgG, IgM and anti-EBNA-1 IgG antibodies by Enzyme-Linked Immunosorbent Assay (ELISA) and 603 (91.3%) specimens were found positive. In patients that admitted to hospital the seropositivity of EBV was 45.1, 85.7, 89.8, 91.2, 96, 96.7 and 96.9 percent at the age range of 1-2 years old, 3-5, 6-8, 9-11,12-14,15-17 and over 18 years of age, respectively. It is obvious that most children had been infected by EBV in early childhood especially from 3 to 5 years of age. The seroprevalance of EBV infection increased with the advancing age and reached 96 percent in the adolescence group

A PNEUMONIA CASE CAUSED BY CEDECEA LAPAGEI

Cedecea spp. which are the members of Enterobacteriaceae family, are mostly isolated from sputum and their clinical importance is not yet demonstrated. This report presents a pneumonia case caused by Cedecea lapagei. A 38-years-old male patient admitted to Inonu University Faculty of Medicine Emergency department with prediagnosis of subarachnoid haemorrhage was operated and transferred to Intensive Care Unit of Reanimation where he underwent artificial ventilation. On the third day of hospitalization his temperature was 39 degrees C, white blood cell count was 27.000/ml and he was still unconscious. He had a history of chronic obstructive pulmonary disease. Chest X-ray revealed opacities in the right lower lobe and mucoid tracheal secretion ensued following tracheal entubation performed after operation. Direct microscopic examination of bronchoalveolar lavage (BAL) fluid yielded abundant number of leukocytes and gram-negative bacilli. Bacteria isolated from BAL specimen were identified as C.lapagei by Phoenix 100 (Becton Dickinson, USA) automated system and also by API 20E kit (Biomerieux, France). Upon the initiation of intravenous amikacin (1 x 1 g) and meropenem (3 x 1 g), the signs of infection decreased in intensity, however, the patient was lost due to subarachnoid hemorrhage on the 12(th) day of hospitalization. In this case it was estimated that C.lapagei pneumonia originated from the aspiration of upper airway secretion owing to unconsciousness of the patient. Although there were reports of Cedecea infections in the literature, this was the first documented case of C.lapagei pneumonia when the accessible related literature was concerned

Herpes Simplex Hepatitis in an Immune-Competent Adult: A Case Report

Hepatitis due to herpes simplex virus is a rare complication of primary or secondary herpes simplex virus infection in immunocompetent adults. A case of herpes simplex virus hepatitis in a healthy adult is presented in this report. The case recovered without progression of fulminant hepatitis

Effect of standardized hands-on-training in caregivers of children with tracheostomy

Introduction: The pediatric tracheostomy related mortality mostly occurs due to accidental decannulation and cannula obstruction. The caregivers may be discharged with inadequate knowledge. Aims and objectives: Simulation training can highlight skills regarding tracheostomy care. Our aim is to investigate if a standardized hands-on-training improves knowledge and skills among caregivers. Methods: Before the traning, we applied a pretest to caregivers in order to assess their knowledge and current practises. Skills were evaluated by two simulation scenarios in a patient model: cannula change and aspiration. After one hour theoretical and practical hands-on training, the same post-test was applied, skills were reevaluated regarding cannula change and aspiration with practical tests. Results: The multicenter study included 65 caregivers of patients with tracheostomy. The median score of the theoretical test including 23 questions improved from 12 to 18 (p<0.001). The specific knowledge questions that were considered critical for tracheostomy care including minimum number of aspiration per day, required frequency of tracheostomy cannula change, solutions recommended for tracheostomy skin care, the pressure for the aspiration, mean duration of aspiration and the depth of aspiration also improved significantly after the education (p<0.001 for all of the specific questions). There was a significant improvement in both cannula change and aspiration skills regarding median scores of correct steps in procedures (p<0.001). Conclusions: A standardized hands-on training is highly effective to increase the rate of proper practices for tracheostomy care and should be implemented for all centers