Predictive performance of CT for adverse outcomes among COVID-19 suspected patients: a two-center retrospective study

The aim of the study was to compare the performance of various computed tomography (CT) reporting tools, including zonal CT visual score (ZCVS), the number of involved lobes, and Radiological Society of North America (RSNA) categorization in predicting adverse outcomes among patients hospitalized due to the lower respiratory symptoms during the coronavirus disease 2019 (COVID-19) pandemic. A total of 405 patients admitted with severe respiratory symptoms who underwent a chest CT were enrolled. The primary adverse outcome was intensive care unit (ICU) admission of patients. Predictive performances of reporting tools were compared using the area under the receiver operating characteristic curves (AUC ROC). Among the 405 patients, 39 (9.63%) required ICU support during their hospital stay. At least two or more observers reported a typical and indeterminate COVID-19 pneumonia CT pattern according to RSNA categorization in 70% (285/405) of patients. Among these, 63% (179/285) had a positive polymerase chain reaction (PCR test for the SARS-CoV-2 virus. The median number of lobes involved according to CT was higher in patients who required ICU support (median interquartile range [IQR], 5[3; 5] vs. 3[0; 5]). The median ZCVS score was higher among the patients that subsequently required ICU support (median [IQR], 4[0; 12] vs. 13[5.75; 24]). The bootstrap comparisons of AUC ROC showed significant differences between reporting tools, and the ZCVS was found to be superior (AUC ROC, 71-75%). The ZCVS score at the first admission showed a linear and significant association with adverse outcomes among patients with the lower respiratory tract symptoms during the COVID-19 pandemic

In a real-life setting, direct-acting antivirals to people who inject drugs with chronic hepatitis c in Turkey

Background: People who inject drugs (PWID) should be treated in order to eliminate hepatitis C virus in the world. The aim of this study was to compare direct-acting antivirals treatment of hepatitis C virus for PWID and non-PWID in a real-life setting. Methods: We performed a prospective, non-randomized, observational multicenter cohort study in 37 centers. All patients treated with direct-acting antivirals between April 1, 2017, and February 28, 2019, were included. In total, 2713 patients were included in the study among which 250 were PWID and 2463 were non-PWID. Besides patient characteristics, treatment response, follow-up, and side effects of treatment were also analyzed. Results: Genotype 1a and 3 were more prevalent in PWID-infected patients (20.4% vs 9.9% and 46.8% vs 5.3%). The number of naïve patients was higher in PWID (90.7% vs 60.0%), while the number of patients with cirrhosis was higher in non-PWID (14.1% vs 3.7%). The loss of follow-up was higher in PWID (29.6% vs 13.6%). There was no difference in the sustained virologic response at 12 weeks after treatment (98.3% vs 98.4%), but the end of treatment response was lower in PWID (96.2% vs 99.0%). In addition, the rate of treatment completion was lower in PWID (74% vs 94.4%). Conclusion: Direct-acting antivirals were safe and effective in PWID. Primary measures should be taken to prevent the loss of follow-up and poor adherence in PWID patients in order to achieve World Health Organization’s objective of eliminating viral hepatitis

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Diyetle Alınan Doymuş Yağ Asitleri veya Fruktozun Böbrek ve Kalpte Bazı Pro-İnflamatuar Sitokinler Üzerine Etkisi

In recent years, it has been hypothesized that dietary high consumption of fructose or saturated fatty acids may play a role in the aetiology of chronic diseases by activating the pro-inflammatory mechanisms in blood and tissues. The aim of this study was to investigate the possible effects of high saturated fatty acids or high fructose containing diet on proinflammatory cytokines of plasma and storage tissues including kidney and heart. In the previous study, in which tissues were obtained, C57BL/6 type mice (n=40, 8 weeks-old), after the standardization period of 2 weeks, were divided into 4 groups and fed with standart chow (Control), high monounsaturated fatty acids (MUFA), high saturated fatty acids (SFA), high fructose (FRU) containing diets ad libitum for 15 weeks. At the end of dietary period, the mice were euthanized, then blood and tissues were isolated and the study was terminated. It was determined that feed intake in FRU group was higher than other groups (p0,05). According to western-blot analysis, TNF-α, IL-1β and IL-6 expression of kidney and heart tissues increased in SFA and FRU groups. Results suggests that the dietary high fructose or high saturated fatty acids might be a risk factor for chronic diseases and should therefore be limited by considering pro-inflammatory response processes in plasma blood and tissues.Son yıllarda, diyetle tüketimi artan fruktoz ve doymuş yağ asitlerinin, kan ve dokularda pro-inflamatuar yanıt sürecini aktive ederek kronik hastalıkların etiyolojisinde rol oynayabileceği düşünülmektedir. Bu çalışmanın amacı, doymuş yağ asitleri veya fruktozu yüksek içeren diyetin farelerin plazma ile kalp ve böbrek gibi bazı organlarda pro-inflamatuar sitokin düzeyleri üzerine olası etkilerinin incelenmesidir. Dokuların elde edildiği bir önceki çalışmada C57BL/6 tipi fareler (n=40, 8 haftalık) 2 haftalık standardizasyon sürecinin ardından 4 farklı gruba ayrılarak; izokalorik standart yem (kontrol), tekli doymamış yağ asitleri (MUFA), doymuş yağ asitleri (SFA) ve fruktozu (FRU) yüksek içeren diyetler ile ad libitum 15 hafta süresince beslenmiştir. Diyet dönemi sonunda ötenazi yapılan farelerin kan ve dokuları izole edilerek deney sonlandırılmıştır. Diyet müdahalesi döneminde en yüksek yem tüketimi FRU grubunda saptanmıştır (p0,05). Western-blot bulgularına göre, SFA ve FRU gruplarında böbrek ve kalp dokularının TNF-α, IL-1β ve IL-6 ekspresyon düzeylerinin artış gösterdiği saptanmıştır. Sonuçlar; diyetle fruktoz veya doymuş yağ asitlerinin yüksek alımının, kan ve dokularda aktive ettiği pro-inflamatuar yanıt süreçleri göz önüne alınarak, kronik hastalıklar için bir risk faktörü olabileceğini ve bu nedenle tüketiminin sınırlanması gerektiğini desteklemektedir

Palmitoleik Asidin Bazı Kronik Hastalıklardaki Rolü: Kısa Derleme

Günümüzde obezite, dislipidemi, kardiyovasküler hastalıklar, tip 2 diyabet gibi kronik hastalıkların görülme sıklığıartmaktadır. Diyet örüntüsünün kronik hastalıkların oluşumu ve ilerlemesindeki rolü iyi bilinmektedir. Yeterli vedengeli bir diyette bulunması gereken en önemli parçalardan birisi, besinlerle alınan yağlardır. Özellikle son yıllardadiyetle alınan toplam yağ miktarının yanı sıra farklı yağ asitlerinin rolü üzerinde durulmaktadır. Bu yağ asitlerinden biriolan palmitoleik asit on altı karbonlu, tekli doymamış bir yağ asididir. Palmitoleik asit, başlıca adipoz doku vekaraciğerde metabolize olmaktadır. Vücutta bulunan miktarları doku ve bölgeye spesifik olarak değişmektedir. Bununlabirlikte, palmitoleik asidin bazal konsantrasyonları metabolik süreçlere bağlı olarak değişim göstermektedir. Bu nedenlepalmitoleik asidin adipoz dokudan salınan bir “lipokin” olabileceği ve palmitoleik asit metabolizmasının kronikhastalıkların önlenmesinde etkili olabileceği düşünülmektedir. Palmitoleik asidin etkilerini açıklamak için dahakapsamlı kohort, longitudinal ve randomize kontrollü çalışmalara ihtiyaç bulunmaktadır. Bu derlemede obezite, tip 2diyabet, kardiyovasküler hastalıklar gibi kronik hastalıkların oluşumunda palmitoleik asit takviyesinin olası rolü güncelçalışmalar eşliğinde incelenmiştir

The Effects Of Dietary High Fructose And Saturated Fatty Acids On Chronic Low Grade Inflammation In The Perspective Of Chronic Diseases

In recent years, the role of chronic low grade inflammation in the emergence of chronic diseases has been emphasized. Chronic low grade inflammation is a metabolic process characterized by systemic circulation and increased inflammatory mediators and some proinflammatory cytokines in various tissues. C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-alpha), interleukin-1 (IL-1), interleukin-4 (IL-4), interleukin-6 (IL-6), toll like receptor-4 (TLR-4) are some proinflammatory molecules that play a role in the chronic low grade inflammation. Recent studies have shown that fructose and saturated fatty acids, which are consumed with increased consumption of processed foods in the current diet, might trigger chronic low grade inflammation. In this review, the effects of dietary high fructose and saturated fatty acids on development of chronic low grade inflammation through some proinflammatory mediators were examined.Wo

Characteristics of Patients With Rheumatoid Arthritis in Turkey: Results From the Turkish League Against Rheumatism Rheumatoid Arthritis Registry

Conclusion: The majority of patients with RA in Turkey are middle-aged homemakers. Despite the high rates of disease-modifying anti-rheumatic drugs use, the majority of patients had moderate and high disease activity. These findings indicate that treatment needs of RA patients are not met sufficiently

Management of Rheumatoid Arthritis: Consensus Recommendations From the Turkish League Against Rheumatism

Objectives: Taking new developments in the management of rheumatoid arthritis (RA) and the economic conditions of our country into account, the Turkish League Against Rheumatism (TLAR) aimed to develop national treatment recommendations for the management of RA; thus, they consulted with national experts for their opinions

Quality of life and related variables in patients with ankylosing spondylitis

To evaluate quality of life (QoL) and related variables in patients with ankylosing spondylitis (AS), a chronic inflammatory disease of the spine