Long-term prognosis of patients with heart failure: Follow-up results of journey HF-TR study population

Background: Despite advances in therapeutic management of patients with heart failure, there is still an increasing morbidity and mortality all over the world. In this study, we aimed to present the 3-year follow-up outcomes of patients included in the Journey HF-TR study in 2016 that has evaluated the clinical characteristics and management of patients with acute heart failure admitted to the hospital and present a national registry data. Methods: The study was designed retrospectively between November 2016 and December 2019. Patient data included in the previously published Journey HF-TR study were used. Among 1606 patients, 1484 patients were included due to dropout of 122 patients due to inhospital death and due to exclusion of 173 due to incomplete data. The study included 1311 patients. Age, gender, concomitant chronic conditions, precipitating factors, New York Heart Association, and left ventricular ejection fraction factors were adjusted in the Cox regression analysis. Results: During the 3-year follow-up period, the ratio of hospitalization and mortality was 70.5% and 52.1%, respectively. Common causes of mortality were acute decompensation of heart failure and acute coronary syndrome. Angiotensin receptor blockers, beta-blockers, statin, and sacubitril/valsartan were found to reduce mortality. Hospitalization due to acute decompensated heart failure, acute coronary syndrome, lung diseases, oncological diseases, and cerebrovascular diseases was associated with the increased risk of mortality. Implantation of cardiac devices also reduced the mortality. Conclusions: Despite advances in therapeutic management of patients with heart failure, our study demonstrated that the long-term mortality still is high. Much more efforts are needed to improve the inhospital and long-term survival of patients with chronic heart failure

New approaches in antibiotic therapies in chronic pulmonary diseases

Kronik akciğer hastalıkları, çocukluk çağında hem hasta hem de hekim için önemli sağlık sorunlarından biridir. Tanı yöntemlerindeki gelişmeler sonucu, bu hastalıkların erken dönemde tanımlanması, gelişebilecek komplikasyonların erken tanısı, aşılama yöntemlerinde ilerlemeler ve erken antibiyotik tedavileri sonucu hastaların yaşam sürelerindeki uzama, bu hastalıkları sadece çocukların değil, erişkinlerin de önemli bir sağlık sorunu haline getirilmiştir. Hastalığın prognozunu etkileyen en önemli etmenlerden birisi, üzerine eklenen infeksiyonlardır. Bu yazıda; çocuklarda ve erişkinlerde sık görülen kronik akciğer hastalıklarından olan kistik fibrozis, bronşektazi ve allerjik bronkopulmoner aspergillozda antibiyotik kullanım ilkeleri bu konudaki son gelişmeler eşliğinde tartışılmıştır.Chronic lung diseases are one of the considerable problems in childhood both for physcians and patients. Due to early diagnosis of illness and complications; advances at vaccination methods and antibiotic therapies; life period of patients have been prolonged so not only at childhood but at adults, chronic lung diseases seem to be important healthy problem. One of the most important factors affectting to prognosis of the diseases are concominant infections. This review is an argument of antibiotic usage regimens at cystic fibrosis, bronchiectasis and allergic bronchopulmonary aspergillosis which are the most usual chronic lung diseases seen at childhood and adults

Rotavirus Vaccines

Rotavirus, infantlarda ve küçük çocuklarda ağır gastro- enteritin en sık nedenidir. Dünya genelinde 5 yaş altı ishalli çocuklardaki hastane yatışlarının yaklaşık %40’ında etken rotavirustur. Demokratik virus olarak da bilinen rotavirus, hijyen koşullarından bağımsız olarak, gelişmiş ve gelişmekte olan ülkelerde benzer sıklıkta görülür. Çocukların hemen hepsi 5 yaşına kadar, en az 1 kez rotavirusla enfekte olmaktadır. Ancak rotavirusa bağlı mortalitenin %80’den fazlası gelişmekte olan ülkelerde görülmektedir. Daha önce geçirilmiş rotavirus enfeksiyonunun sonraki atakları %77 oranında, orta- ağır şiddetteki atakları ise %87 oranında engellediği gösterilmiştir. Bu nedenle yaşamın erken dönemindeki aşılama, çocuğun ilk doğal enfeksiyonuna benzer şekil- de, şiddetli rotavirus enfeksiyon ataklarını ve buna bağlı ölümleri önlemede en etkin yöntemdir. Dünya Sağlık Örgütü monovalan veya pentavalan oral rotavirus aşı- sının ulusal bağışıklama programına alınmasını öner- mektedir. Rotavirus aşısının uygulanması sonrasında rotavirus ilişkili mortalite ve morbiditede önemli azalma görülmüştür. Rotavirus aşı uygulaması, mortalitenin çoğunluğunun görüldüğü gelişmekte olan ülkelerde özellikle önemlidir. (J Pediatr Inf 2015; 9: 166-74)Rotaviruses are the most common cause of severe gastroenteritis in infants and children. Rotaviruses are responsible for approximately 40% of all diarrheal hospitalizations among children under 5 years of age worldwide. Rotavirus, which is known as democratic virus, occurs with similar frequency in both developed and developing countries regardless of the hygiene conditions. Almost all children up to 5 years of age are infected with rotavirus at least once. But the majority of death cases towing to rotaviruses occur in children from resource-poor countries. Many investigators have reported that previous rotavirus infections pro- tect against severe disease associated with reinfec- tion. For this reason, vaccination in the early period of infancy is the most important method for protection against severe rotavirus infections and death. World Health Organization recommends rotavirus vaccina- tion. After the introduction of rotavirus vaccines, sig- nificant reduction has been seen in morbidity and mortality because of rotaviruses. Rotavirus vaccine administration is particularly important in developing countries where majority of death cases are observed. (J Pediatr Inf 2015; 9: 166-74

Respiratory Syncytial Virus Infections Respiratuvar Sinsityal Virus Enfeksiyonları

Respiratuvar sinsityal virus (RSV) infant ve çocuklarda saptanan en sık solunum yolu patojenlerindendir. Çocukların hemen hepsi ilk iki yaşta en az bir kez RSV ile enfekte olurlar. RSV enfeksiyonlarında klinik özellikler hastanın yaşına, altta yatan hastalığına, enfeksiyonun primer veya reenfeksiyon oluşuna göre değişir. RSV çocuklarda genellikle üst solunum yolu enfeksiyonu biçiminde görülse de, %20-30 oranında alt solunum yolu enfeksiyonlarına (bronşiyolit ve/veya pnömoni) da yol açar. Bir yaş altı çocuklarda alt solunum yolu enfeksiyonlarının en sık nedeni RSV'dir. Daha önceden sağlıklı olan çocukların çoğunda bu enfeksiyonlar hafif seyreder. Ancak prematürite, kronik akciğer hastalığı, konjenital kalp hastalığı, primer ya da sekonder immün yetmezlikler ağır RSV enfeksiyonları için risk oluştururlar. Tanı çoğunlukla klinik olarak konabilir. Tanısal testler rutin olarak önerilmez. Alt ve üst solunum yolu enfeksiyonlarında tedavi genellikle destekleyicidir. Ribavirin immun yetmezliği olan olgularda kullanılabilir, ancak rutin olarak önerilmemektedir. RSV için rutin bir aşı bulunmamaktadır. RSV spesifik humanize fare monoklonal antikoru 'palivizumab' özellikle riskli gruplarda RSV profilaksisinde etkin ve güvenilirdir.Respiratory syncytial virus (RSV) is one of the most common respiratory pathogens in infants and young children worldwide. Almost all children are infected at least once by the age of 2 years. The clinical manifestations vary depending on age, health status, and whether the infection is primary or secondary. Most RSV-infected children experience upper respiratory tract symptoms and 20% to 30% develop lower respiratory tract disease (e.g., bronchiolitis and/or pneumonia). RSV is the most common cause of lower respiratory tract infection in children younger than 1 year. Most children who have been previously healthy have mild lower respiratory tract infections. However, prematurity, chronic lung disease, congenital heart disease, and primary or secondary immune deficiencies are risk factors for severe RSV infections. Diagnosis can often be clinical. Diagnostic testing is not routinely recommended. The treatment of upper and lower respiratory tract infections is generally supportive. Ribavirin can be used in patients with immune deficiency but is not routinely recommended. There is not a routine vaccine for RSV. The RSV-specific humanized mouse monoclonal antibody -palivizumab- is particularly safe and effective for prophylaxis in high-risk groups

Assessment of membrane type effects on in vitro performance of topical semi-solid products

In vitrorelease tests have been widely used to assess performance of topical products. Any interaction should not be observed between drug and synthetic membrane, but there is no conclusive information about relationship of membrane type and properties of drug substances. In this study, four types of membranes (regenerated cellulose,cellulose acetate, mixed cellulose ester, silicone) were used to evaluatein vitrorelease of hydrophilic, moderately lipophilic and highly lipophilic drug substances from their topical preparations. The relationship between membrane type and drug characteristics was investigated using Strat-M™ membrane resembling to human skin, and excised porcine skin forin vitropermeation studies. The release data revealed that acceptor/donor groups in drug substance and synthetic membrane could hinder drug release through membrane. Mixed cellulose ester or cellulose acetate membranes should be opted forin vitrorelease studies of drugs consisting of abundant, strong acceptor/donor groups.In vitropermeation data showed that druglipophilicitymight come into prominence for these studies. Strat-M™ membrane could be more useful to estimate permeability of lipophilic molecules rather than hydrophilic ones. The results suggest that molecular structure and lipophilicity of drug could be considered to select synthetic membrane used forin vitrorelease and permeation studies