Neuromuscular Diseases and Rehabilitation

Neuromuscular diseases (NMDs) are a heterogeneous group of diseases that are inherited or acquired, resulting from an abnormality in the anterior horn motor cells, peripheral nerves, neuromuscular junctions, or muscles

The prevalence of Giardia intestinalis and Entamoeba histolytica/dispar in Van Regional Training and Research Hospital: A four-year monitoring

Objective: The aim of this retrospective study was to determinethe frequency rates of Giardia and E.histolytica/E.dispar and their distribution by years as well as agegroups and gender distribution during a four-year period.Materials and methods: A total of 9911 stool samplessent to our laboratory between January 2008 and December2011 were tested for parasites. Native-Lugol and formolethyl acetate sedimentation methods were utilized formicroscopic identification of Entamoeba sp. and Giardiatrophozoites and cysts in fresh stool samples. Additionally,trichrome staining was performed in stool sampleswhere the distinctive diagnosis could not be confirmed.Results: From a total of 9911 stool samples analyzedduring the study, 4.7% were positive for Giardia and 6.2%were positive for Entemoeba histolytica/ Entemoeba dispar.Of Giardia-positive patients 57% were male and 43%female. Similarly, 56% of Entemoeba histolytica/ Entemoebadispar positive patients were male and 44% werefemale. Both parasites’ higher frequency rates seen inmale groups were found statistically significant (p<0.01).Conclusion: It is seen that intestinal protozoon infectionsare still present as an important public health problemin our region. In order to prevent this problem, personalhygiene and sanitation rules education for community aswell as infrastructure improvements are necessary.Key words: Giardia, Entemoeba histolytica/ Entemoeba dispar, prevalenc

Samarium-153 Therapy and Radiation Dose for Prostate Cancer

Prostate cancer (PC) is one of the most frequent malignancies in Western countries. At initial diagnosis, bone metastases are present in 15–30% of cases. These metastases cause some complications including bone fracture, hypercalcemia, and bone pain, which significantly affect patients’ quality of life. Radionuclide treatment was created as an alternative to external palliative radiotherapy in the treatment of bone pain arising from bone metastasis of PC. The basic principle of the radionuclide treatment of pain is that the uptake of radioactive material is kept in a high amount that is enough to constitute a proper clinical impact in the tumor, and it is kept at a low dose enough to avoid the occurrence of significant adverse effects in other organs (commonly in the bone marrow). Samarium-153 ethylenediaminetetramethylenephosphonic acid (153Sm-EDTMP) is a radiopharmaceutical compound that has an affinity for skeletal tissue and concentrates in areas of increased bone turnover, localizes in the skeleton, and is excreted via glomerular filtration. Medical staff preparing and administering radiopharmaceuticals in nuclear medicine, whether for diagnostic imaging or for therapeutic application, may receive significant radiation doses to their hands, particularly the fingers. Sm-153 treatment can be used as an effective and safe treatment alternative in the management of metastatic bone pain. Radiation protection of the public and the environment after Sm-153 EDTMP therapy is important

Evaluation of internal dosimetry methods in nuclear medicine applications

Nükleer tıp uygulamalarında tanı ve tedavi amaçlı birçok radyonüklid kullanılır. Vücuttaki farklı organlar tarafından soğurulan radyasyon dozunun bilinmesi bu uygulamaların risklerinin ve yararlarının değerlendirilebilmesi açısından oldukça önemlidir. İnternal dozimetri vücut içindeki radyonüklidler ile dokuda depo edilen radyasyon enerjisinin uzaysal ve zamansal dağılımı ve miktarının belirlenmesi ile ilgilenir. Nükleer tıpta tiroid kanseri ve hipertiroidi tedavisinde yaygın kullanımı olan I-31 radyoizotopunun yanında, son yıllarda hepatosellüler karsinoma ve nöroendokrin tümör tedavisinde rutin uygulamaya giren Lu-177 ve Y-90 radyoizotopları da başarı ile uygulanmaktadır. Risk değerlendirilmesi açısından, organ doz hesapları Medikal İnternal Radyasyon Dozimetri (MIRD) tarafından belirlenen standart uygulamanın yanısıra, hastaya spesifik olarak kinetik ve anatomik parametrelerin değerlendirilmesi açısından önemlidir. Bu çalışmada internal dozimetri hesaplarında kullanılan metotlar ele alınmış, bu metodlarda farklı yaş ve cinsiyetlerdeki bireyleri temsil eden uygun modeller, matematiksel formulasyonlar ile açıklanmıştır.Many radionuclides are used for diagnostic and therapeutic in nuclear medicine applications. The knowledge of radiation dose absorbed by different organs in the body is critical to evaluate known risks and benefits of these applications. Internal dosimetry deals with the determination of the amount and the spatial and temporal distribution of radiation energy deposited in tissue by radionuclides within the body. Widely used in nuclear medicine in the treatment of thyroid cancer and hyperthyroidism radioisotope I-131, as well as routine practice in recent years into the treatment of hepatocellular carcinoma and neuroendocrine tumor Lu-177 and Y-90 also successfully applied to radioisotopes. In terms of risk assessment, the organ dose calculations Medical Internal Radiation Dosimetry (MIRD), as well as the application of the standard set by the patient-specific parameters in the evaluation of kinetics and anatomy is important. The methods used internal dosimetry calculations in this study are considered and the appropriate models representing individuals of different ages and regardless of gender are described with mathematical formulations

Van depreminin su-kaynaklı bazı bulaşıcı hastalıklar üzerine etkisi

Objective: In this study, it was aimed to compare the isolation frequency of some water-borne disease causing microorganisms in pediatric patients before and after Van earthquake in order to determine the potential impact of earthquake on those selected infectious diseases. Methods: The laboratory test results of Adenovirus, Rotavirus, Hepatitis A virus (HAV), Giardia intestinalis and E.histolytica/dispar which were requested from 0-14 years old children, during six months before and six months after Van earthquake which took place on 23 October 2011, were retrospectively reviewed. Results: Adenovirus, Rotavirus, Anti HAV IgM and E.histolytica/dispar showed reduction in the isolation frequency rate during the six months period after the earthquake compared with the same period of previous year. The reduction rates in the isolation frequencies of Rotavirus and E.histolytica/dispar were found to be statistically significant (p<0.001). In contrast, Giardia intestinalis isolation frequency was significantly higher in the six months period after the earthquake (<0.001). Conclusion: Disaster management programme which was conducted after Van earthquake have been shown to be effective in preventing water-borne infectious diseases. Taking special precautions against Giardia spp. after earthquakes should be kept in mind

Antibiotics resistance of Stenotrophomonas maltophilia strains isolated from various clinical specimens

Background: A limited number of antibiotics are recommended for the therapy of Stenotrophomonas maltophilia infections due to therapy difficulties caused by its numerous mechanisms of resistance.Objectives: In this study conducted over a period of approximately 5 years we aimed to determine resistance rates of S. maltophilia based on drug classification recommended by Clinical and Laboratory Standards Institute.Methods: A total of 118 S. maltophilia strains isolated from various clinical specimens between January 2006 and June 2012 were included in the study. BD Phoenixautomated microbiology system (Becton Dickinson, USA) was utilized for species level identification and antibiotic susceptibility testing.Results: Sixty seven of S. maltophilia strains were isolated from tracheal aspirate isolates, 17 from blood, 10 from sputum, 10 from wound and 14 from other clinical specimens. Levofloxacin was found to be the most effective antibiotic against S. maltophilia strains with resistance rate of 7.6%. The resistance rates to other antibiotics were as follows: chloramphenicol 18.2%, trimethoprim-sulfamethoxazole 20.3% and ceftazidime 72%.Conclusion: The study revealed that S. maltophilia is resistant to many antibiotics. The treatment of infections caused by S. maltophilia should be preferred primarily as levofloxacin, chloramphenicol, and TMP-SXT, respectively.Keywords: Stenotrophomonas maltophilia, antibiotic, resistanc

The evaluation of vancomycin-resistant enterococci and carbapenamase producing Klebsiella colonization among ICU-Hospitalized Patients

Background: Multi-drug resistant organisms, especially Vancomycin-Resistant Enterococcus (VRE) and Carbapenam Resistant Klebsiella pneumoniae (KPC), are serious health threat. Early detection of resistant bacteria colonization amongpatients in intensive care units (ICUs) not only enables effective treatment but more importantly prevents disease and limits transmission. Therefore, we aimed to to assess the frequency of VRE and KPC colonization via rectal swab sampling. Methods: The study was carried out in ICUs of a tertiary hospital. Two rectal swab samples were collected within the first 24 hours of admission and another one was taken every subsequent 15 days to test for for VRE and KPC carriage. Results: A total 316 rectal swab samples taken from 230 patients. Forty-seven patients were screened at least 2 times. 183 patients were not further screened due to discharge, exitus or transfer to other wards. Thirty-six patients (16%) were determinedto be VRE (+). The most frequently isolated strain was E. faecium (80.5%) and its most common genotype was VanA (87.5%). Seven patients (3%) were identified as KPC (+). OXA-48 type crbapenamase was confirmed in all KPC isolates. Conclusion: This study shows that VRE and KPC colonization continues to be a serious threat in ICUs. Keywords: Carbapenam resistant klebsiella pneumoniae; vancomycin-resistant enterococci; intensive care units

Antibiotics resistance of Stenotrophomonas maltophilia strains isolated from various clinical specimens.

Background: A limited number of antibiotics are recommended for the therapy of Stenotrophomonas maltophilia infections due to therapy difficulties caused by its numerous mechanisms of resistance. Objectives: In this study conducted over a period of approximately 5 years we aimed to determine resistance rates of S. maltphilia based on drug classification recommended by Clinical and Laboratory Standards Institute. Methods: A total of 118 S. maltphilia strains isolated from various clinical specimens between January 2006 and June 2012 were included in the study. BD Phoenixautomated microbiology system (Becton Dickinson, USA) was utilized for species level identification and antibiotic susceptibility testing. Results: Sixty seven of S. maltphilia strains were isolated from tracheal aspirate isolates, 17 from blood, 10 from sputum, 10 from wound and 14 from other clinical specimens. Levofloxacin was found to be the most effective antibiotic against S. maltphilia strains with resistance rate of 7.6%. The resistance rates to other antibiotics were as follows: chloramphenicol 18.2%, trimethoprim-sulfamethoxazole 20.3% and ceftazidime 72%. Conclusion: The study revealed that S. maltphilia is resistant to many antibiotics. The treatment of infections caused by S. maltphilia should be preferred primarily as levofloxacin, chloramphenicol, and TMP-SXT, respectively

Ectopic opening of the common bile duct and duodenal stenosis: an overlooked association

<p>Abstract</p> <p>Background</p> <p>Ectopic opening of the common bile duct into the duodenal bulb (EO-CBD-DB) is a rare disease that may be complicated by duodenal ulcer, deformity, stenosis and biliary stones. The aim of this study is to report clinical presentations, endoscopic diagnosis and treatment of this entity as well as to investigate its association with duodenal stenosis.</p> <p>Methods</p> <p>Gastroduodenoscopic findings and radiological imaging were evaluated for ectopic papilla and duodenal stenosis. Diagnostic methods, endoscopic procedures and long-term outcomes of the endoscopic treatment were presented.</p> <p>Results</p> <p>EO-CBD-DB was found in 74 (77.1%) of the 96 patients with duodenal deformity/stenosis (79 male, 17 female, mean age: 58.5, range: 30-87 years). The papilla with normal appearance was retracted to the bulb in 11 while it was at its usual location in the remaining 11. The history of biliodigestive surgery was more common in patients with EO-CBD-DB who were frequently presented with the common bile duct stone-related symptoms than the other patients. Thirteen (17.6%) of the patients with EO-CBD-DB were referred to surgery. Endoscopic treatment was completed in 60 (81.1%) patients after an average of 1.7 (range: 1-6) procedures. These patients were on follow-up for 24.8 (range: 2-46) months. Endoscopic intervention was required in 12 (20%) of them because of recurrent biliary problems. Treatment of the patient who had stricture due to biliary injury during laparoscopic cholecystectomy is still continued.</p> <p>Conclusions</p> <p>The presence of EO-CBD-DB should be considered particularly in middle-aged male patients who have duodenal deformity/stenosis. Endoscopic treatment is feasible in these patients. The long-term outcomes of endoscopic therapy need to be compared with surgical treatment.</p

F-18 FDG PET/BT Çekilen Hastalarda Karaciğer ve Kan Havuzu için Bazal SUV Aralığı

Introduction: The aim of the study was to define the baseline SUVmax range in the liver and blood pool of patients undergoing fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) imaging. Methods: Five hundred and thirty-one patients (264 females, 267 males; mean age: 59.6±13.4 years) who were admitted to our department for PET/CT imaging before treatment were included in the study. Patient preparation, acquisition parameters and reconstruction protocols were standardized for all patients prior to PET/CT imaging. The mean serum glucose levels and mean age of the patients were calculated. These patients were divided into 10 groups as esophagus, stomach, colon, rectum, larynx, lung, breast, endometrium, ovarian cancers and lymphoma. 2D region of interests were plotted to calculate the mean SUV values in the right lobe of the liver and the aortic arch for the blood pool. Results: Normal Gaussian distributions of mean SUV changes for liver and blood pool were obtained. Mean SUVmax and SUVmean values for liver were 2.73±0.22 and 2.34±0.16, respectively, and 1.80±0.2 and 1.57±0.14 for blood pool, respectively. Conclusion: It was concluded that the obtained SUV ranges may provide ease of application in the clinic in evaluating qualitative tumor response and comparing tumor/background ratios in cancer patients.Giriş: Çalışmanın amacı, florodeoksiglukoz-pozitron emisyon tomografi/bilgisayarlı tomografi görüntüleme (FDG-PET/BT) yapılan hastaların karaciğer ve kan havuzundaki bazal SUVmaks aralığının tanımlanmasıdır. Yöntemler: Bölümümüze tedavi öncesi PET/BT görüntüleme için gelen 531 hasta (264 kadın, 267 erkek; yaş ortalaması 59,6±13,4 yıl) çalışmaya dahil edildi. Tüm hastalar için PET/BT görüntüleme öncesi hasta hazırlığı, aküzisyon parametreleri ve rekonstrüksiyon protokolleri standardize edildi. Hastaların ortalama serum glukoz seviyeleri ve yaş ortalamaları hesaplandı. Bu hastalar özofagus, mide, kolon, rektum, larinks, akciğer, meme, lenfoma, endometrium ve over kanserleri olmak üzere 10 gruba ayrıldı. Karaciğerin sağ lobuna ve kan havuzu için aort kavisine ortalama SUV değerlerinin hesaplanabilmesi için 2 boyutlu ilgi alanı bölgeleri çizildi. Bulgular: Hastaların gruplar arası karaciğer ve kan havuzu için ortalama SUV değişimlerinin normal Gaussian dağılımları elde edildi. Ortalama SUVmaks ve SUVort değerleri karaciğer için sırasıyla 2,73±0,22, 2,34±0,16; kan havuzu için 1,80±0,2, 1,57±0,14 olarak hesaplandı. Sonuç: Elde edilen SUV aralıklarının kanserli olgularda kalitatif tümör cevabı değerlendirmede ve tumör/background oranlarını kıyaslamada klinikte uygulama kolaylığı sağlayabileceği kanaatine varıldı