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Abstract Background Tuberculous meningitis (TBM) represents a diagnostic and management challenge to clinicians. The “Thwaites’ system” and “Lancet consensus scoring system” are utilized to differentiate TBM from bacterial meningitis but their utility in subacute and chronic meningitis where TBM is an important consideration is unknown. Methods A multicenter retrospective study of adults with subacute and chronic meningitis, defined by symptoms greater than 5 days and less than 30 days for subacute meningitis (SAM) and greater than 30 days for chronic meningitis (CM). The “Thwaites’ system” and “Lancet consensus scoring system” scores and the diagnostic accuracy by sensitivity, specificity, and area under the curve of receiver operating curve (AUC-ROC) were calculated. The “Thwaites’ system” and “Lancet consensus scoring system” suggest a high probability of TBM with scores ≤4, and with scores of ≥12, respectively. Results A total of 395 patients were identified; 313 (79.2%) had subacute and 82 (20.8%) with chronic meningitis. Patients with chronic meningitis were more likely caused by tuberculosis and had higher rates of HIV infection (P

Fluorescence Resonance Energy Transfer (FRET) is a well-known methodology for detection and quantitation of structural changes of proteins in solution. FRET requires site-specific protein labeling with two fluorophores, one of which functions as an energy donor and the other one as an energy acceptor. However, the site-specific labeling of protein is often complex and difficult, particularly when inserting two fluorophores in specific sites. We have examined several protein labeling approaches with a varying degree of success. Described here is a dual labeling strategy that worked reproducibly in a number of protein targets and we believe will be applicable to a variety of proteins, which have few or no native cysteine (Cys) residues. We have successfully double-labeled DnaA protein of Bacillus anthracis, which lacks intrinsic Cys residues. A cysteine residue was inserted at the N-terminus by in vitro mutagenesis and a Cys-Cys-Phe-Gly-Cys-Cys (CCPGCC) sequence at the C-terminus by PCR. This protein was labeled site-specifically with a fluorescein derivative, FlAsH, at the CCPGCC sequence followed by Alexa568 maleimide at the N-terminus Cys residue. Structural changes of the protein with nucleotide, DNA and an inhibitor protein binding were determined by FRET analysis of the double-labeled protein. This comprehensive novel methodology for site-specific protein labeling with different fluorophores is applicable for understanding different in vitro proteomic structural studies. Here, we describe a verified technique used for FRET spectral analysis and quantitative evaluation of structural changes using fluorophore labeled DnaA protein constructs as an example. Method name: Site-specific fluorescence labeling of proteins and analysis of structural changes in solution by Fluorescence Resonance Energy Transfer (FRET), Keywords: FRET analysis, FlAsH, Alexa568 maleimide, steady-state photon counting spectrofluorometer, Site-specific labeling, intramolecular distance determination, conformational changes

Pollen morphology of six taxa of the genus Convolvulus (Convolvulus assyricus , C. betonicifolius subsp. betonicifolius, C. cataonicus, C. galaticus, C. lineatus, and C. pseudoscammoni, provided by Cumhuriyet University, Faculty of Science Herbarium (CUFH) (Sivas-Turkey) were investigated. Three of these taxa, C. assyricus, C. cataonicus, and C. pseudoscammonia, are endemic to Turkey. Pollen grains were prepared by the method of Wodehouse and evaluated mainly for four diagnostic characteristics: pollen type, pollen shape, apertureties, and ornamentation. Following the measurements and observations, pollen grains were photographed under an optical and a scanning electron microscope. The pollen grains of the examined taxa are all 3-zonocolpate. The pollen shape is oblate, suboblate, oblate spheroidal or prolate spheroidal. The nexine is thinner than the sexine or equal, and the tectum is reticulated and rarely or densely perforated in all species except C. pseudoscammonia. Colpus borders and tapering ends are distinct and the colpus area is gemmate and granulate in all examined species

Aspergillus thyroiditis is a rare disorder detected in immunocompromised patients during disseminated infections. Early management is essential to prevent high mortality. A 61-year-old allogeneic stem cell male recipient presented with painful thyroid nodular enlargement. He had low TSH and low free T4 levels. The thyroid ultrasound showed a hypoechoic nodule; biopsy indicated suppurative Aspergillus thyroiditis. He was successfully treated by amphotericin B.

Brucellosis is a zoonotic infectious disease, which mainly present with lymphoreticular system invovement. However any organ system can be attacked by the microorganism. In this paper we present a 52-year-old female patient who was admitted to the Infectious Diseases Department with complaints of fatigue, arthralgias, fever, and weight loss. In the medical examination and radiological analysis bilateral pleural effusions and hepatosplenomegaly were detected. Serum transaminase levels were two times higher than the upper limits of normal. Abdominal ultrasound revealed sludge in the gallbladder and multiple hypodense splenic lesions (the largest was 1 cm in diameter). Brucella melitensis was isolated from the blood culture of the patient. Rifampicin (600 mg/day) and doxycycline (200 mg/day) therapy was started. Follow-up chest radiography and ultrasonography revealed the absence of pleural effusion. Splenic lesions and hepatosplenomegaly were totally regressed. The patient has been followed for 3 months after 6 week antibiotic regimen without recurrence. Brucellosis was expected to be the cause of all pathological signs.

Abstract Background and objectives An effective treatment option is not yet available for SARS-CoV2, which causes the COVID-19 pandemic and whose effects are felt more and more every day. Ivermectin is among the drugs whose effectiveness in treatment has been investigated. In this study; it was aimed to investigate the presence of gene mutations that alter ivermectin metabolism and cause toxic effects in patients with severe COVID-19 pneumonia, and to evaluate the effectiveness and safety of ivermectin use in the treatment of patients without mutation. Materials and methods Patients with severe COVID19 pneumonia were included in the study, which was planned as a prospective, randomized, controlled, single-blind phase 3 study. Two groups, the study group and the control group, took part in the study. Ivermectin 200 mcg/kg/day for 5 days in the form of a solution prepared for enteral use added to the reference treatment protocol -hydroxychloroquine + favipiravir + azithromycin- of patients included in the study group. Patients in the control group were given only reference treatment with 3 other drugs without ivermectin. The presence of mutations was investigated by performing sequence analysis in the mdr1/abcab1 gene with the Sanger method in patients included in the study group according to randomization. Patients with mutations were excluded from the study and ivermectin treatment was not continued. Patients were followed for 5 days after treatment. At the end of the treatment and follow-up period, clinical response and changes in laboratory parameters were evaluated. Results A total of 66 patients, 36 in the study group and 30 in the control group were included in the study. Mutations affecting ivermectin metabolism was detected in genetic tests of six (16.7%) patients in the study group and they were excluded from the study. At the end of the 5-day follow-up period, the rate of clinical improvement was 73.3% (22/30) in the study group and was 53.3% (16/30) in the control group (p = 0.10). At the end of the study, mortality developed in 6 patients (20%) in the study group and in 9 (30%) patients in the control group (p = 0.37). At the end of the follow-up period, the average peripheral capillary oxygen saturation (SpO2) values of the study and control groups were found to be 93.5 and 93.0%, respectively. Partial pressure of oxygen (PaO2)/FiO2 ratios were determined as 236.3 ± 85.7 and 220.8 ± 127.3 in the study and control groups, respectively. While the blood lymphocyte count was higher in the study group compared to the control group (1698 ± 1438 and 1256 ± 710, respectively) at the end of the follow-up period (p = 0.24); reduction in serum C-reactive protein (CRP), ferritin and D-dimer levels was more pronounced in the study group (p = 0.02, p = 0.005 and p = 0.03, respectively). Conclusions According to the findings obtained, ivermectin can provide an increase in clinical recovery, improvement in prognostic laboratory parameters and a decrease in mortality rates even when used in patients with severe COVID-19. Consequently, ivermectin should be considered as an alternative drug that can be used in the treatment of COVID-19 disease or as an additional option to existing protocols.

INTRODUCTION[|]To investigate placental immunohistochemical findings and Doppler parameters in normal pregnancies and women with preeclampsia (PE).[¤]METHODS[|]Doppler measurements of umbilical, uterine, and spiral arteries of 23 PE and 12 normal pregnancies followed and delivered between 2008 and 2010 were performed and recorded. Placental specimens were obtained at birth and the microvessel density of spiral arteries was measured immunohistochemically using placental tissue CD 34 antibody expression. Three vessels with the most intense CD34 density were evaluated.[¤]RESULTS[|]There were no significant differences in the umbilical artery pulsatility index (PI), resistance index (RI), or systolic/diastolic ratio (S/D) between the PE and normal pregnancies. The spiral and uterine artery RI, PI, and SD ratios, however, were significantly higher in the PE group. There was no statistically significant difference in the mean microvessel density between the 2 groups.[¤]DISCUSSION AND CONCLUSION[|]The role of the placenta in the development of PE is unquestionable. Vascular pathologies and blood flow characteristics demonstrate significant differences and deteriorations compared with normal pregnancies. Further research is needed to further define the precise pathology.[¤]

Brucellosis is a zoonotic infectious disease, which mainly present with lymphoreticular system invovement. However any organ system can be attacked by the microorganism. In this paper we present a 52-year-old female patient who was admitted to the Infectious Diseases Department with complaints of fatigue, arthralgias, fever, and weight loss. In the medical examination and radiological analysis bilateral pleural effusions and hepatosplenomegaly were detected. Serum transaminase levels were two times higher than the upper limits of normal. Abdominal ultrasound revealed sludge in the gallbladder and multiple hypodense splenic lesions (the largest was 1 cm in diameter). Brucella melitensis was isolated from the blood culture of the patient. Rifampicin (600mg/day) and doxycycline (200 mg/day) therapy was started. Follow-up chest radiography and ultrasonography revealed the absence of pleural effusion. Splenic lesions and hepatosplenomegaly were totally regressed. The patient has been followed for 3 months after 6 week antibiotic regimen without recurrence. Brucellosis was expected to be the cause of all pathological signs. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Neutropenia is a critical risk factor for invasive fungal infections (IFIs). We retrospectively performed this study to assess the performance of the D-index, a new test that combines both the duration and the severity of neutropenia, in predicting IFIs among patients with acute myelogenous leukemia. METHODS: Fifteen patients with IFIs and 28 patients who did not develop IFIs were enrolled in the study. The D-index was defined as the area over the neutrophil curve, whereas the cumulative- D-index (c-D-index) was the area over the neutrophil curve from the start of neutropenia until the first clinical manifestation of IFI. RESULTS: The D-index and the c-D-index tended to be significantly higher in patients with IFIs, with medians of 10,150 (range: 4000- 22,000) and 5300 (range: 2300-22,200), respectively (p=0.037 and p=0.003, respectively). The receiver operating characteristic analyses showed that there was a cutoff point of 3875 for the D-index in predicting IFI; the sensitivity, specificity, and positive and negative predictive values were 100%, 67.9%, 35.4%, and 100%, respectively. There was also a cutoff point of 4225 for the c-D-index in predicting IFI; the sensitivity, specificity, and positive and negative predictive values for the c-D-index were 93.3%, 71.4%, 36.6%, and 98.4%. DISCUSSION AND CONCLUSION: The D-index and especially the c-D-index could be useful tools with high negative predictive value to exclude as well as to predict IFIs in the management of neutropenic patients.

INTRODUCTION: The increased risk of infection for patients caused by construction and renovation near hematology inpatient clinics is a major concern. The use of high-efficiency particulate absorption (HEPA) filters can reduce the risk of infection. However, there is no standard protocol indicating the use of HEPA filters for patients with hematological malignancies, except for those who have undergone allogeneic hematopoietic stem cell transplantation. This quasi-experimental study was designed to measure the efficacy of HEPA filters in preventing infections during construction. METHODS: Portable HEPA filters were placed in the rooms of patients undergoing treatment for hematological malignancies because of large-scale construction taking place near the hematology clinic. The rates of infection during the 6 months before and after the installation of the portable HEPA filters were compared. A total of 413 patients were treated during this 1-year period. RESULTS: There were no significant differences in the antifungal prophylaxis and treatment regimens between the groups. The rates of infections, clinically documented infections, and invasive fungal infections decreased in all of the patients following the installation of the HEPA filters. When analyzed separately, the rates of invasive fungal infections were similar before and after the installation of HEPA filters in patients who had no neutropenia or long neutropenia duration. HEPA filters were significantly protective against infection when installed in the rooms of patients with acute lymphocytic leukemia, patients who were undergoing consolidation treatment, and patients who were neutropenic for 1-14 days. DISCUSSION AND CONCLUSION: Despite the advent of construction and the summer season, during which environmental Aspergillus contamination is more prevalent, no patient or patient subgroup experienced an increase in fungal infections following the installation of HEPA filters. The protective effect of HEPA filters against infection was more pronounced in patients with acute lymphocytic leukemia, patients undergoing consolidation therapy, and patients with moderate neutropenia.

Four endemic taxa of Onobrychis Mill. genus, some of them being classified in the endangered threat category, were investigated for root and stem anatomy. Onobrychis quadrijuga, O. argyrea subsp. argyrea, O. tournefortii and O. albiflora were studied in regard to specific anatomy for the first time within the hereby study. Anatomical characters as the size and shape of the periderm, cortex, cambium cells in root and epidermis, collenchyma, cortex, cambium and pith cells in stem belonging to these four Onobrychis taxa were determined in detail. Based on the roots and stems measurements and analysis, specific anatomical differences between species were revealed.

Summary: Q fever has rarely been reported and can be difficult to diagnose, especially in immunocompromised patients. In the present report, we describe an unusual case of Q fever that presented as peritonitis and was treated with long-term combination therapy with doxycycline, ciprofloxacin and rifampicin for five weeks in a patient who had been on peritoneal dialysis for six years due to hypertensive nephropathy. Keywords: Q fever, Coxiella burnetii, Peritonitis

In this study, anatomical and palynological properties of Chaerophyllum astrantiae Boiss. & Bal. and C. aureum L. were determined for the first time. Cross sections of roots, stems, stem leaves and fruits of both species were examined. The leaves are amphistomatic and mesophyll is bifacial. The fruit has 2 vittae on commissural face and 4 vittae on lateral and dorsal faces in both species. The palynological studies revealed that, C. astrantiae and C. aureum have tricolporate pollen type and perforate exine ornamentation under light microscope. Ratio of polar axis to equatorial axis is 2.15 in C. astrantiae and 2.05 in C. aureum. Thus, pollen shape is perprolate for both of the species.

In this paper, anatomical, palynological and seed micromorphological properties of an endemic plant Matthiola anchoniifolia Hub.-Mor. are recorded for the first time. A description and descriptive illustrations of the species are given based on the collected specimens for morphological study. Seed surface of M. anchoniifolia is examined by scanning electron microscope. The seed of M. anchoniifolia was compressed, brownish in colour and the cells of testa were nearly 60-80 μm in diameter and ranged from isodiametric, tetragonal or pentagonal. The anticlinal walls were straight or weakly curved while the outer periclinal walls were concave to flat with smooth surface. In anatomical study, cross sections of root, stem and stem leaf are examined. The root had secondary structure. Periderm consists of 5-8 layers of cells for phellem. Cortex consists of 9-12 layered parenchymatic tissue under the periderm. Secondary phloem ring-shaped, 6-9 layered and consists of companion cells and grouped sieve tubes. Stem had primary structure when analyzed. It is circular with a few irregular ribs in cross section. Cortex is 8-12 layered and parenchymatous. Stoma cells are present on both epidermis. Leaf is isobilateral. There are unicellular and ramified hairs on both surface. Palisade parenchyma cells are 1-2 layered and spongy parenchyma cells are 5-12 layered. M. anchoniifolia has tricolpate pollen type, prolate pollen shape and reticulate exine ornamentation.

OBJECTIVE: Patients with neutropenia due to cancer chemotherapy are prone to severe infections. Cancer patients can experience >1 infectious episode during the same period of neutropenia. This study aimed to determine the etiological and clinical characteristics of secondary infectious episodes in cancer patients with febrile neutropenia and to identify the factors associated with the risk of secondary infectious episodes. METHODS: All cancer patients that received antineoplastic chemotherapy at Ankara University, School of Medicine, Department of Hematology between May 2004 and May 2005 and developed neutropenia were included in the study. Data were collected using survey forms that were completed during routine infectious diseases consultation visits. Categorical data were analyzed using the chi-square test, whereas Student's t-test was used for continuous variables. Multivariate logistic regression analysis was performed to identify independent predictors of secondary infections (SIs). RESULTS: SIs were observed during 138 (53%) of 259 febrile neutropenic episodes. Of the 138 episodes, 89 (64.5%) occurred in male patients with a mean age of 40.9 years (range: 17-76 years). In total, 80% of the SIs were clinically or microbiologically documented. Factors on d 4 of the initial febrile episode were analyzed via a logistic regression model. The presence of a central intravenous catheter (OR: 3.01; P < 0.001), acute myeloid leukemia (AML) as the underlying disease (OR: 2.12; P = 0.008), diarrhea (OR: 4.59; P = 0.005), and invasive aspergillosis (IA) during the initial febrile episode (OR: 3.96; P = 0.009) were statistically significant risk factors for SIs. CONCLUSION: Among the cancer patients with neutropenia in the present study, AML as the underlying disease, the presence of a central venous catheter, diarrhea, and IA during the initial febrile episode were risk factors for the development of SIs.