Primary Epstein-Barr virus (EBV) infection is almost always a self-limited disease characterized by sore throat, fever, and lymphadenopathy. Hepatic involvement is usually characterized by mild elevations of aminotransferases and resolves spontaneously. Although isolated gallbladder wall thickness has been reported in these patients, acute acalculous cholecystitis is an atypical presentation of primary EBV infection. We presented a young women admitted with a 10-day history of fever, nausea, malaise who had jaundice and right upper quadrant tenderness on the physical examination. Based on diagnostic laboratory tests and abdominal ultrasonographic findings, cholestasis and acute acalculous cholecystitis were diagnosed. Serology performed for EBV revealed the acute EBV infection. Symptoms and clinical course gradually improved with the conservative therapy, and at the 1-month follow-up laboratory findings were normal. We reviewed 16 adult cases with EBV-associated AAC in the literature. Classic symptoms of EBV infection were not predominant and all cases experienced gastrointestinal symptoms. Only one patient underwent surgery and all other patients recovered with conservative therapy. The development of AAC should be kept in mind in patients with cholestatic hepatitis due to EBV infection to avoid unnecessary surgical therapy and overuse of antibiotics.
Immune thrombocytopenia (ITP) is an autoimmune disease characterized by dysregulation of T cells. Programmed death (PD) 1 and programmed death 1 ligand 1 (PD-L1) are cosignaling molecules, and the major role of the PD-1 pathway is the inhibition of self-reactive T cells and to protect against autoimmune diseases. We measured levels of serum soluble PD 1 (sPD-1) and serum soluble PD-L1 (sPD-L1) in 67 patients with ITP (24 newly diagnosed ITP [ndITP], 43 chronic ITP [cITP]) and 21 healthy controls (HCs). We determined decreased serum sPD-1 levels both in patients with ndITP and in patients with cITP when compared to HC. Moreover, there was a positive correlation between sPD-1 levels and platelet counts. The sPD-L1 levels were decreased in patients with ndITP when compared to patients with cITP. This is the first study investigating PD-1 signaling pathway in ITP. Decreased sPD-1 levels may have a role in ITP pathogenesis as without the inhibitory regulation of PD-1, sustained activation of T cells may cause inflammatory responses which is the case in ITP.
Amyloidosis refers to a variety of conditions in which amyloid proteins are abnormally deposited in organs and/or tissues. The most common forms of systemic amyloidosis are primary amyloidosis (PA) of light chains and secondary amyloidosis (SA) caused by chronic inflammatory diseases such as rheumatoid arthritis (RA). Although involvement of the thyroid gland by amyloid is a relatively common phenomenon, clinically significant enlargement of the thyroid owing to amyloid deposition is a rare occurrence. In SA, the deposition of amyloid associated (AA) protein is associated with atrophy of thyroid follicles. The clinical picture of these patients is characterized by rapid, painless thyroid gland enlargement which may be associated with dysphagia, dyspnea, or hoarseness. Thyroid function is not impaired in most cases. Although amyloid goitre secondary to systemic amyloidosis due to chronic inflammatory diseases is relatively common, specifically related to RA is much more uncommon one and it is reported less in the literature. In this report, A 52-old-year female patient with amyloid goiter associated with amyloidosis secondary to rheumatoid arthritis is presented.
OBJECTIVES: In this study, it was aimed to investigate whether or not platelet-rich plasma (PRP) causes intraabdominal adhesions and therefore, whether or not PRP can be used safely in intra-abdominal operations. METHODS: Of the total of 35 animals, 5 were used as donors for the preparation of platelet-rich plasma (PRP). The surgical procedures were performed on the remaining 30 animals. These rats were randomized and divided into 3 groups of 10. In Group 1, no adhesion induction was performed. Adhesion was induced by cecal abrasion and peritoneal resection model in Groups II and IIII. In Group 2, no treatment was given. In Group 3, 1 cc PRP was applied on the cecum. The rats were sacrifi ced on postoperative day 21. RESULTS: According to adhesion scores, the difference between the sham and PRP groups was not statistically signifi cant. There was also no signifi cant difference between the control and PRP groups, but the adhesion scores in the PRP group was lower than those in the control group. On histopathological evaluation, the difference between the sham and PRP groups was not statistically signifi cant. There was also no signifi cant difference between the control and PRP groups, but the average fi brosis and infl ammation scores in the PRP group were lower than those in the control group. CONCLUSION: The results of the present study have demonstrated that PRP neither reduced nor exacerbated postoperative adhesions. Thus, PRP can be used safely in experimental and clinical studies where it will be applied intra-abdominally (Tab. 2, Fig. 3, Ref. 11).
Bu çalışmada yoğun bakım ünitesindeki (YBÜ) hastane enfeksiyonlarının (HE) enfeksiyon odağı, patojenlerin dağılımı ve risk faktörleri açısından değerlendirilmesi amaçlandı. Yöntemler: YBÜ'de 48 saatten fazla kalan 80 hasta çalışmaya dahil edildi. Hastaların epidemiyolojik özellikleri, invaziv girişimler ve diğer risk faktörleri kaydedildi. Kültürler, patojenlerin tanımlanması ve antibiyotik duyarlılık testleri standart mikrobiyolojik yöntemlerle yapıldı. Bulgular: HE gelişen 56 hastanın 26 (%50)'sında pnömoni, 15 (%28,8)'inde kan dolaşımı enfeksiyonu ve 6 (%11.5)'sında üriner sistem enfeksiyonu saptandı. Klebsiella pneumoniae (%23.5), Pseudomonas aeruginosa (%19,6) ve Acinetobacter spp. (%15,6) sırasıyla en sık saptanan etken mikroorganizmalar idi. Klebsiella pneumoniae izolatlarında genişlemiş spektrumlu beta laktamaz (GSBL) oranı %91,6, karbapenem direnci %15,6, Pseudomonas aeruginosa ve Acinetobacter spp. izolatları için de karbapenem direnci sırasıyla %60 ve %100 olarak saptandı. Hemodiyaliz, enteral beslenme, total parenteral beslenme, 10 günden uzun süreli yatış HE gelişimi açısından bağımsız risk faktörleri olarak saptandı. "Acute Physiology and Chronic Health Evaluation" (APACHE) II skoru, YBÜ'de yatış süresi ve YBÜ öncesi hastanede yatış süresi de HE gelişen grupta daha yüksek bulundu. Sonuç: Hastanemiz YBÜ'de pnömoni en sık görülen HE olarak saptandı ve Gram-negatif basillerdeki karbapenem direnci dikkat çekici ölçüde yüksek bulundu. Enfeksiyon kontrol önlemlerinin dikkatli bir şekilde uygulanması, invaziv girişimlerin doğru endikasyonlarda uygulanması ve gereksiz uzun dönem yatışlardan kaçınılması gerektiği düşünüldü.
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