Serum Procalcitonin as a Biomarker for the Prediction of Bacterial Exacerbation and Mortality in Severe Copd Exacerbations Requiring Mechanical Ventilation

Background: Procalcitonin (PCT) is being used as a marker of bacterial infections. Although there are several studies showing the diagnostic yield of PCT to differentiate bacterial involvement in chronic obstructive pulmonary disease exacerbations (COPDE), the prognostic yield of PCT in severe COPDE has been studied less. Objectives: The primary aim was to determine whether the level of serum PCT at admission in severe COPDE serves as a prognostic biomarker for hospital mortality. The secondary aim was to determine the role of PCT in identifying a bacterial exacerbation. Methods: A total of 63 COPDE patients (median age 71 years; male 58.7%) were retrospectively analyzed from our intensive care unit database. Results: The hospital mortality rate was 23.8%. Admission PCT levels were higher in patients who died during hospitalization (0.66 vs. 0.17 ng/ml; p = 0.014). This association between hospital mortality and serum PCT level remained significant in a multivariate analysis; for every 1 ng/ml increase in PCT level, hospital mortality increased 1.85 times (odds ratio; 95% confidence interval: 1.07-3.19; p = 0.026). The optimal admission PCT threshold was 0.25 ng/ml in order to discern patients who had bacterial exacerbation with a sensitivity of 63%, a specificity of 67%, and a negative predictive value of 80%. The negative predictive value increased to 89% when both the admission and followup PCT levels remained <0.25 ng/ml. Conclusion: This study shows that admission PCT levels have a prognostic importance in estimating hospital mortality among patients with severe COPDE. A PCT level <0.25 ng/ml at the time of admission and during follow-up is suggestive of the absence of a bacterial cause of COPDE. (C) 2016 S. Karger AG, BaselWoSScopu

Obstrüktif uyku apneli ve horlayan erişkin erkek hastaların dentofasiyal özelliklerinin değerlendirilmesi

&lt;p&gt;&lt;strong&gt;ÖZET &lt;/strong&gt;&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Amaç:&lt;/strong&gt; Bu çalışmanın amacı obstrüktif uyku apne sendromu (OUAS) olan erişkin erkek hastaların kraniofasiyal morfolojik özellikleri değerlendirmektir.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Gereç ve Yöntem&lt;/strong&gt;: Çalışmada 80 erkek hastanın (60 OUAS, 20 horlama hastası) lateral sefalogramları değerlendirildi. Bireyler Grup 1: horlama (AHİ&amp;lt;5); Grup 2: hafif OUAS (5£ AHİ&amp;lt;15); Grup 3: orta OUAS(15£ AHİ&amp;lt;30) ; Grup 4: şiddetli OUAS (AHİ&lt;strong&gt; &lt;/strong&gt;³30) olarak değerlendirildi. Sefalogramlar üzerinde hyoid, dil kökü ve yumuşak damak konumu, kranioservikal postür ve havayolu genişliğini belirleyen ölçümler yapıldı. Gruplar arasındaki farklar normal dağılım gösteren değişkenlerde tek yönlü varyans analizi ve Duncan testiyle, normal dağılım göstermeyen değişkenlerde Kruskal Wallis testi  ve Bonferroni düzeltmesi uygulanarak Mann Whitney U testiyle yapıldı.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Bulgular:&lt;/strong&gt; Gruplar karşılaştırıldığında hyoid pozisyonu, yumuşak damak konumu, kranioservikal postür ve havayolu genişliğini gösteren ölçümlerde istatistiksel anlamlılık gösteren bir fark bulunmadı (p&amp;gt;0.05). Dil kökü konumunu gösteren PNS-V (mm) değeri şiddetli OUAS grubu ile diğer gruplar arasında istatistiksel olarak anlamlı fark gösterdi (p&amp;lt;0.05). Dil kökü ile ilgili diğer ölçümlerde ise gruplar arasında anlamlı fark bulunmadı (p&amp;gt;0.05).&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Sonuçlar: &lt;/strong&gt;İncelenen popülasyonda şiddetli OUAS grubunda dil kökünün daha aşağıda konumlandığı belirlenmiş, diğer kraniofasiyal değişkenlerde gruplar arasında fark görülmemiştir.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Anahtar kelimeler:&lt;/strong&gt; Obstrüktif uyku apnesi sendromu, horlama, sefalometri, kraniofasiyal.&lt;/p&gt; &lt;p&gt;&lt;strong&gt; &lt;/strong&gt;&lt;/p&gt; &lt;p&gt;&lt;strong&gt; &lt;/strong&gt;&lt;/p&gt; &lt;p&gt;&lt;strong&gt;ABSTRACT&lt;/strong&gt;&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The aim of this study was to evaluate the craniofacial morphology of adult male patients with obstructive sleep apnea syndrome (OSAS).&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Materials and Methods:&lt;/strong&gt; Cephalograms of 80 male patients (60 OSAS, 20 snoring) were evaluated. Subjects were grouped as, Group 1: snoring (AHI&amp;lt;5); Group 2: mild OSA (5£ AHI&amp;lt;15);  Group 3: moderate OSA (15£ AHI&amp;lt;30) ; Group 4: severe OSA (AHI ³30). Measurements were made to evaluate hyoid bone position, tongue base and soft palate, craniocervical extension and the airway width. Statistical significance was determined with one-way ANOVA and Duncan test for variables showing normal distribution. Kruskal Wallis test and Mann Whitney U test with Bonferroni correction were used to evaluate the variables that were not normally distibuted.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; No significant differences were found in hyoid bone position, soft palate position, craniocervical extension and the airway width (p&amp;gt;0.05). PNS-V (mm), was significantly different between severe OSA group and the other groups (p&amp;lt;0.05). The other measurements on tongue base showed no difference between groups (p&amp;gt;0.05).&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; In this study population, the tongue base was more inferiorly positioned in the severe OSA group whereas the other craniofacial variables showed no difference between groups.&lt;/p&gt; &lt;strong&gt;Key words: &lt;/strong&gt;Obstructive sleep apnea syndrome, snoring, cephalometry, craniofacial

The Effects of Antimicrobial Resistance and the Compatibility of Initial Antibiotic Treatment on Clinical Outcomes in Patients With Diabetic Foot Infection

We aimed to determine pathogen microorganisms, their antimicrobial resistance patterns, and the effect of initial treatment on clinical outcomes in patients with diabetic foot infection (DFI). Patients with DFI from 5 centers were included in this multicenter observational prospective study between June 2018 and June 2019. Multivariate analysis was performed for the predictors of reinfection/death and major amputation. A total of 284 patients were recorded. Of whom, 193 (68%) were male and the median age was 59.9 +/- 11.3 years. One hundred nineteen (41.9%) patients had amputations, as the minor (n = 83, 29.2%) or major (n = 36, 12.7%). The mortality rate was 1.7% with 4 deaths. A total of 247 microorganisms were isolated from 200 patients. The most common microorganisms were Staphylococcus aureus (n = 36, 14.6%) and Escherichia coli (n = 32, 13.0%). Methicillin resistance rates were 19.4% and 69.6% in S aureus and coagulase-negative Staphylococcus spp., respectively. Multidrug-resistant Pseudomonas aeruginosa was detected in 4 of 22 (18.2%) isolates. Extended-spectrum beta-lactamase-producing Gram-negative bacteria were detected in 20 (38.5%) isolates of E coli (14 of 32) and Klebsiella spp. (6 of 20). When the initial treatment was inappropriate, Klebsiella spp. related reinfection within 1 to 3 months was observed more frequently. Polymicrobial infection (p = .043) and vancomycin treatment (p = .007) were independent predictors of reinfection/death. Multivariate analysis revealed vascular insufficiency (p = .004), hospital readmission (p = .009), C-reactive protein > 130 mg/dL (p = .007), and receiving carbapenems (p = .005) as independent predictors of major amputation. Our results justify the importance of using appropriate narrow-spectrum empirical antimicrobials because higher rates of reinfection and major amputation were found even in the use of broad-spectrum antimicrobials

Practical approaches for the treatment of chronic heart failure: Frequently asked questions, overlooked points and controversial issues in current clinical practice

Heart failure (HF) is a progressive disorder associated with impaired quality of life, high morbidity, mortality and frequent hospitalization and affects millions of people from all around the world. Despite further improvements in HF therapy, mortality and morbidity remains to be very high. The life-long treatment, frequent hospitalization, and sophisticated and very expensive device therapies for HF also leads a substantial economic burden on the health care system. Therefore, implementation of evidence-based guideline-recommended therapy is very important to overcome its worse clinical outcomes. However, HF therapy is a long process that has many drawbacks and sometimes HF guidelines cannot answers to every question which rises in everyday clinical practice. In this paper, commonly encountered questions, overlooked points, controversial issues, management strategies in grey zone and problems arising during follow up of a HF patient in real life clinical practice have been addressed in the form of expert opinions based on the available data in the literature

Increased Myocardial Vulnerability And Autonomic Nervous System Imbalance In Obstructive Sleep Apnea Syndrome

Background: Obstructive steep apnea syndrome (OSAS) is characterized by the repeated episodes of upper airway obstruction during steep, leading to significant hypoxia. Noninvasive evaluation of autonomic nervous system (ANS) and myocardial vulnerability may help determination of OSAS patients who are under high risk of malignant cardiac arrhythmias. The aim of this study was to show the effects of OSAS on predictors of arrhythmias by the evaluation of heart rate turbulence (HRT), heart rate variability (HRV) and QT dynamicity reflecting the ANS balance and myocardial vulnerability. Methods: After polysomnographic study, 80 patients with OSAS and 55 age matched OSAS (-) subjects were included in the study. Twenty-four-hour Hotter monitoring was performed in all subjects. HRT, HRV and QT dynamicity parameters were calculated. Results: Turbulence slope was significantly decreased in OSAS patients whereas turbulence onset was increased (P < 0.001). QT/RR slopes were significantly increased for QT end and QTapex (P < 0.001). In HRV analysis, autonomic balance changed in favor of sympathetic system at night in OSAS patients. Furthermore, HRT and QT dynamicity parameters are found to be correlated with Apnea-Hypopnea Index (AHI). Conclusion: OSAS is associated with a significant worsening in HRV, HRT, and QT dynamicity parameters. Our results may indicate that HRV and QT dynamicity parameters can be useful noninvasive methods that may detect autonomic nervous system activity and ventricular vulnerability in OSAS. (c) 2006 Elsevier Ltd. All rights reserved.WoSScopu

Demographics of patients with heart failure who were over 80 years old and were admitted to the cardiology clinics in Turkey

WOS: 000468584300005PubMed ID: 30930455Objective: Heart failure (HF) has a high prevalence and mortality rate in elderly patients; however, there are few studies that have focused on patients older than 80 years. The aim of this study is to describe and compare the age-specific demographics and clinical features of Turkish elderly patients with HF who were admitted to cardiology clinics. Methods: The Epidemiology of Cardiovascular Disease in Elderly Turkish population (ELDER-TURK) study was conducted in 73 centers in Turkey, and it recruited a total of 5694 patients aged 65 years or older. In this study, the clinical profile of the patients who were aged 80 years or older and those between 65 and 79 years with HF were described and compared based on the ejection fraction (EF)-related classification: HFrEF and HFpEF (is considered as EF: >= 50%). Results: A total of 1098 patients (male, 47.5%; mean age, 83.5 +/- 3.1 years) aged 80 years and 4596 patients (male, 50.2 %; mean age, 71.1 +/- 4.31 years) aged 65-79 years were enrolled in this study. The prevalence of HF was 39.8% for patients who were >= 80 years and 27.1% for patients 65-79 years old. For patients aged >= 80 years with HF, the prevalence rate was 67% for hypertension (HT), 25.6% for diabetes mellitus (DM), 54.3% for coronary artery disease (CAD), and 42.3% for atrial fibrilation. Female proportion was lower in the HFrEF group (p=0.019). The prevalence of HT and DM was higher in the HFpEF group (p= 80 years with HFrEF (p<0.01). Conclusion: HF is common in elderly Turkish population, and its frequency increases significantly with age. Females, diabetics, and hypertensives are more likely to have HFpEF, whereas CAD patients are more likely to have HFrEF.Turkish Society of CardiologyThis study was supported by Turkish Society of Cardiology

Impact of Obesity on the Metabolic Control of Type 2 Diabetes: Results of the Turkish Nationwide Survey of Glycemic and Other Metabolic Parameters of Patients with Diabetes Mellitus (TEMD Obesity Study)

Background: Obesity is the main obstacle for metabolic control in patients with type 2 diabetes. Turkey has the highest prevalence of obesity and type 2 diabetes in Europe. The effect of obesity on the metabolic control, and the macro-and microvascular complications of patients are not apparent. Objectives: This nationwide survey aimed to investigate the prevalence of overweight and obesity among patients with type 2 diabetes and to search for the impact of obesity on the metabolic control of these patients. We also investigated the independent associates of obesity in patients with type 2 diabetes. Methods: We consecutively enrolled patients who were under follow-up for at least 1 year in 69 tertiary healthcare units in 37 cities. The demographic, anthropometric, and clinical data including medications were recorded. Patients were excluded if they were pregnant, younger than 18 years, had decompensated liver disease, psychiatric disorders interfering with cognition or compliance, had bariatric surgery, or were undergoing renal replacement therapy. Results: Only 10% of patients with type 2 diabetes (n = 4,648) had normal body mass indexes (BMI), while the others were affected by overweight (31%) or obesity (59%). Women had a significantly higher prevalence of obesity (53.4 vs. 40%) and severe obesity (16.6 vs. 3.3%). Significant associations were present between high BMI levels and lower education levels, intake of insulin, antihypertensives and statins, poor metabolic control, or the presence of microvascular complications. Age, gender, level of education, smoking, and physical inactivity were the independent associates of obesity in patients with type 2 diabetes. Conclusion: The TEMD Obesity Study shows that obesity is a major determinant of the poor metabolic control in patients with type 2 diabetes. These results underline the importance of prevention and management of obesity to improve health care in patients with type 2 diabetes. Also, the results point out the independent sociodemographic and clinical associates of obesity, which should be the prior targets to overcome, in the national fight with obesity. (c) 2019 The Author(s) Published by S. Karger AG, Base