We report a case of definite rheumatoid arthritis and co-existing gout. Although gout and rheumatoid arthritis are relatively common entities individually, the co-existence of these two conditions is rare.

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BACKGROUND: Acute bacterial meningitis (ABM) remains a significant worldwide cause of death in adults. Even in the antibiotic era, the mortality rate in ABM remains significant and has been reported in the range of 8-40%. AIM: The aim of this study was to assess the characteristics of epidemiology, clinical manifestations, treatment modalities and outcome of patients with ABM in Southeast Turkey. SETTINGS AND DESIGN: This retrospective study included all cases of community-acquired ABM diagnosed and treated in Dicle University Hospital between June 1996 and December 2002. METHODS AND PATIENTS: The study group consisted of 186 adult patients (110 male, 76 female) with ABM, those patients who are older than 14 years, followed up at Dicle University Hospital from June 1996 to December 2002. Patients' charts were retrospectively reviewed, clinical characteristics were recorded and final data were analyzed. STATISTICAL ANALYSIS: In statistical analyses, the Chi-square test was used for binary variables and Student's t-test for continuous variables. RESULTS: The patients' mean age was 30.2 ± 15.3 years (range 14 to 90 years). On admission, typical symptoms of meningitis were found in most of the patients: headache in 92.5%, fever in 88.2%, and nuchal rigidity in 80.1%. The main predisposing factor for ABM was otitis media (40 patients, 21.5%) and closed head trauma (12 patients, 6.5%). Streptococcus pneumonia was the most common identified pathogen. Twenty-nine patients (15.6%) died during hospitalization period. In multivariate analyses, the significant mortality factor was found as initial level of consciousness, low cerebrospinal fluid/blood glucose ratio, high erythrocyte sedimentation rate and initial treatment by penicillin G. CONCLUSIONS: Although still remains as a serious infection, early diagnosis and effective treatment may reduce fatal outcome and improve the course of the disease in patients with ABM. Ceftriaxone should be considered as the drug of choice for initial empirical therapy, while waiting culture results and vancomycin must be withheld for patients having increased risk of penicillin resistant pneumococci strains.

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BACKGROUND: At least 50 percent of the injections administered each year are unsafe, more particularly in developing countries, posing serious health risks. An initial assessment to describe injection practices; their determinants and adverse effects can prevent injection-associated transmission of blood borne pathogens by reducing injection frequency and adoption of safe injection practices. AIMS: To assess the injection practices in a large metropolitan city encompassing varied socio-cultural scenarios. STUDY SETTING AND DESIGN: Field based cross sectional survey covering urban non-slum, slum and peri-urban areas of a large metropolitan city. METHODS AND MATERIAL: Injection prescribers, providers and community members selected by random sampling from the study areas. Pre tested questionnaires assessed knowledge and perceptions of study subjects towards injections and their possible complications. Observation of the process of injection and prescription audit also carried out. STATISTICAL ANALYSIS: MS Access for database and SPSS ver 11 for analysis. Point estimates, 95percent confidence intervals, Chi Square, t test, one-way ANOVA. RESULTS: The per capita injection rate was 5.1 per year and ratio of therapeutic to immunization injections was 4.4:1. Only 22.5percent of injections were administered with a sterile syringe and needle. The level of knowledge about HIV and HBV transmission by unsafe injections was satisfactory amongst prescribers and community, but inadequate amongst providers. HCV was known to a very few in all the groups. The annual incidence of needle stick injuries among providers was quite high. CONCLUSION: A locally relevant safe injection policy based on multi disciplinary approach is required to reduce number of injections, unsafe injections and their attendant complications.

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Internet is the biggest medical library in the world. It has transformed the way many health seekers find health information. Seekers on net have exponentially increased from 54 million in 1998 to 110 million in 2002 (U.S. figures) and are ever increasing. Act of looking for health or medical information is the third most popular activities online. Search engines are used by almost 81% of the e-patients to look for the information they want. Internet is fast becoming an influential force as more than 70% consumers say that the information on the net has influenced their treatment decisions. However, the reliability of all the health information available on the Internet is questionable. Numerous studies have indicated deficiencies in the quality of information on the Internet. Due to technical and commercial reasons, the results provided by various search engines can be potentially biased. Only about a quarter of health seekers thoroughly check the source, timeliness of information every time they search for health information. In fact, most adults from USA, Japan, France and Germany who participated in a recent survey thought online health care information to be trustworthy, of good quality, easy to understand and easy to find. Efforts are now being taken to ensure the quality of health information on the Internet. Patients need to be educated about the worthiness of a site and also be prescribed the right sites to be consulted for information.

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BACKGROUND: Elevated neutrophil myeloperoxidase may have a role in the diagnosis of megaloblastic erythropoiesis. AIMS: To study the differentiating role of myeloperoxidase index in megaloblastic and aplastic anemia. SETTINGS AND DESIGN: The myeloperoxidase index (MPXI) was studied in 96 patients with megaloblastic and aplastic anemia diagnosed on bone marrow aspiration and biopsy examinations. METHODS AND MATERIALS: MPXI was measured with Technicon H1 (Bayer) automated analyzer. Nonparametric Mann-Whitney statistical test was used to compare the MPXI values between groups. RESULTS: The mean MPXI in megaloblastics and aplastic anemia was 18.3 and 1.8 (p<0.001) respectively. MPXI >20 denoted megaloblastic and MPXI <-11.6 denoted aplastic anemia. CONCLUSION: MPXI measurement may assist differentiation of megaloblastic from aplastic anemia, while MPXI >20 rules out aplastic and MPXI <-11.6 rules out megaloblastic anemia.

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In a young adult patient having situs solitus with dextrocardia the attempted pulmonary artery catheter placement for emergency mitral valve replacement required an unduly long length (50cm) of catheter insertion to get into right ventricle and then into pulmonary artery. Although catheter coiling was suspected initially, chest x-ray taken after successfully placement revealed an uncommon congenital anomalous venous connection i.e. right internal jugular opening into left sided superior vena cava then into inferior vena cava after running all along the left border of the heart. With the result, it required to pass 50cm of PA catheter to get into right ventricle in our patient. This emphasizes the need to look for abnormal venous connections during echocardiography and x-ray screening in congenital heart disease. Fluoroscopy is recommended when an unusual length of pulmonary artery catheter insertion is required to enter the pulmonary artery.

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