Epidemiology and clinical characteristics of hospitalized elderly patients for heart failure with reduced, mid-range and preserved ejection fraction

Introduction:: Elderly patients hospitalized with heart failure (HF) have high mortality rates and require& specific evidence based theraphy, however there are few studies which have focused on patients older than 80 years hospitalized with HF. The aim of the present study is to evaluate the overall clinical characteristics, management, and in-hospital outcomes of elderly patients hospitalized with HF.Methods:: Journey-HF study was conducted in 37 different centers in Turkey and recruited 1606 patients who were hospitalized with HF between September 2015 and September 2016. In this study, clinical profile of patients >= 80 years old and 65-79 years old hospitalized with HF were described and compared based on EF-related classification: HFrEF (HF with reduced ejection fraction), HFmrEF (HF with mid-range ejection fraction) and HFpEF (HF with preserved ejection fraction).Results:: A total of 1034 elder patients (71.6% 65-79 years old and 28.4% >= 80 years old) were recruited. Of the 65-79 years old patients 67.4% had HFrEF, 16.2% had HFmrEF and 16.3% had HFpEF. Among patients >= 80 years old 61.6% had HFrEF, 15.6% had HmrEF and 22.8% had HFpEF.When compared with patients with HFrEF and HFmrEF, patients >80 years old with HFpEF were more likely to be older, have atrial fibrilation (AF), and less likely to have diabetes mellitus (DM), coronary artery disease (CAD) or to be recieving an angiotensin-converting enzyme inhibitor (ACEi) or beta blocker theraphy. When compared to patients 65-79 years old with HFpEF, patients >= 80 years with HFpEF had a higher rate of AF and less likely DM. Acute coronary syndrome was the most common precipitant factor for hospitalization in both age groups with HFrEF group. Arrhythmia was a major precipitant factor for hospitalization of patients >= 80 years old with HFpEF. Non-compliance with theraphy was a major problem of patients >= 80 years old with HFrEF.Conclusion:: Elderly patients with HFrEF, HFmrEF and HFpEF each had characterized unique patient profiles and the guideline recommended medications were less likely to be used in these patient populations. In hospital mortality rate is worrisome and reflects a need for more specific tretment strategy

Kronik hepatit C virus infeksiyonlu hastalarda infeksiyon kaynakları ile hepatit C virus genotipleri arasındaki ilişki

Amaç: Kronik hepatit C'li hastalarda hepatit C virusunun bulaş yolları araştırılmış ve virusun genotipleri ile bulaş yolları arasındaki ilişki incelenmiştir. Yöntem ve Gereç: Genotipleme,revers hibridizasyon, Line Probe assay, yöntemi ile gerçekleştirilmiştir. Bulgular: 108 HCV RNA pozitif hastada, dört farklı genotip ve bazı mix genotipler saptanmıştır.1b genotipi en yaygın genotip olarak bulunmuştur (n=82) Hastaların altısının 1a, altısının 3a, dördünün 2a/2c, üçünün 2a, birinin 4c/4d genotipinde oldu¤u belirlenmiştir. Altı hastada, üçü genotip 1a+1b, ikisi genotip 1b+4a, biri ise genotip 1b+2a şeklinde, mikst genotip saptanmıştır.Altı hastada mikst genotip belirlenmiştir. Bunların üçü 1a+1b, ikisi 1b+4a, biri de 1b+2a/2c genotipinde saptanmıştır. Bütün hasta gruplarında en yaygın genotip 1b idi.108 hastanın %38.8'inde kan ve kan ürünleri transfüzyonu, %16.6'sında cerrahi girişim, %15.7'sinde diş tedavisi ve %12.9'unda diyaliz öyküsü mevcuttu. Sonuç: Kan donörlerinde rutin kan testleri yaptırmaları zorunlu olmadan önce, HCV infeksiyonunun en yaygın bulaşma yolu kan transfüzyonu ile olmaktaydı. Çalışmamızda,dövme, piercing, iatrojenik infeksiyonlar ve damar içi ilaç kullanımı gibi, bulaş açısından risk faktörlerinin hiçbiri bu hastalarda kaydedilmemiştir. Cerrahi işlem öyküsü bulunan hastalarda en yaygın genotip 1b saptanmıştır. Tüm hasta populasyonunda genotip 1b %75.9 oranında saptanmıştır.Background/aims: Hepatitis C virus transmission routes in chronic hepatitis C patients, the relationship between the viral genotype and the transmission routes were studied. Material and Methods: Genotyping was performed by using a commercial reverse hybridization method, Line Probe Assay. Results: Genotyping of 108 HCV RNA positive patients revealed four different types (1,2,3, and 4) and some mixed types. Subtype 1b was the most common (n=82). Subtype 1a and 3a were detected in six patients, 2a/2c was detected in seven patients, and 4c/4d was detected in one patient respectively. Six subjects revealed mixed infections. Three of them were 1a+1b, two of them were 1b+4a, and one of them was 1b+2a/2c.Genotype 1b was most common in all groups.In 38,8% of the 108 patients with a history of blood or blood product transfusions,16,6% of patients with a history of surgery, 15,7% of patients had an anamnesis of dental treatment and, 12,9% of patients receiving dialysis. Conclusion: Before the routine screening of blood donor practices became mandatory, the most common route of HCV infection was blood transfusions. The other risk factors of transmission such as tattoos, piercings, iatrogenic infections and intravenous drug usage have not been recorded for any of these patients in our study. The patient with a history of surgery had the genotype 1b as the most common genotype. The genotype 1b was determined in 75,9% of the whole patient population of the study

Cyclospora cayetanensis in Two Immunocompetent Patients in Istanbul

Cyclospora cayetanensis is a frequently reported microorganism which causes diarrhea in both immunocompromised and immunocompetent patients. Despite new information on this emerging pathogen, significant gaps remain in our knowledge. There is a need to accurately diagnose and get information because the coccidian parasites are nearly never diagnosed, even upon the clinician’s request. Two immunocompetent patients with Cyclospora cayetanensis infections were presented and literatur was reviewed in this manuscript

Akut koroner sendrom sonrası erken dönem izlemde özelleşmiş korunma polikliniklerinin rolü

Objective: This study aimed to investigate the effect of specialized prevention clinics and standard clinics follow-ups on secondary protection after acute coronary syndrome (ACS) on cardiovascular risk factors.Methods: A total of 118 patients who received thrombolytic therapy after being diagnosed with ST-segment elevation myocardial infarction were followed up for 6 months. After ACS, patients in a specialized prevention clinic (Group 1) (n=67) and those in a standard clinic (Group 2) (n=51) were compared in terms of the change in their lifestyle, management of risk factors, and drug compliance.Results: No significant difference was found between groups in terms of baseline clinical and laboratory findings except for triglyceride level (Group 1: median 174 mg/dL; Group 2: median 136 mg/dL; p=0.039). Six months after indexing, smoking cessation (72.4% vs. 50%, p=0.037), diet compliance (43% vs.19.6%, p=0.012), and exercise rates (31% vs. 13.7%, p=0.044) were significantly higher in Group 1. Although the weight control rate was higher in Group 1, no significant difference was noted between the groups (27% vs. 15.6%, p=0.219). The rate of systolic and diastolic blood pressures ;gt;140/90 mm Hg was significantly higher in Group 2 (23.5% vs. 9%, p=0.029) at 6 months. The median low-density lipoprotein cholesterol (LDL-C) value was significantly lower in Group 1 patients (Group 1: 91 mg/dL; Group 2: 102 mg/dL; p=0.042). Moreover, the rate of LDL-C ;lt;=70 mg/dL or ;gt;=50% reduction compared with baseline was significantly higher in Group 1 (32.8% vs. 13.7%, p=0.016). Although the recommended treatments were similar in both groups, the statin use rate was significantly higher in Group 1 (95.5% vs. 80.3%, p=0.021) at 6 months.Conclusion: The results of the study showed that specialized prevention clinics were more effective during the management of cardiovascular risk factors after ACS.Amaç: Akut koroner sendrom (AKS) sonrasında ikincil korumada yapılandırılmış poliklinik ile standart poliklinik takibinin kardiyovasküler risk faktörlerinin kontrolündeki etkisinin araştırılması.Yöntemler: ST-segment yükselmeli miyokart enfarktüsü tanısıyla trombolitik tedavi alan 118 hasta altı ay takip edildi. Akut koroner sendrom sonrasında yapılandırılmış poliklinikte (Grup 1) takipli hastalar (n=67) ile standart poliklinikte (Grup 2) takipli hastalar (n=51); yaşam şekli değişikliği, risk faktörlerinin yönetimi ve ilaç uyumu açısından karşılaştırıldı.Bulgular: Gruplar arasında trigliserit düzeyi dışında (Grup 1 medyan 174 mg/dL, Grup 2 medyan 136 mg/dL; p=0.039) bazal klinik ve laboratuvar özellikleri açısından fark saptanmadı. İndeks olaydan altı ay sonra Grup 1'de sigara bırakma (%72.4'e karşın %50; p=0.037), önerilen diyete uyma (%43'e karşın %19.6; p=0.012) ve egzersiz yapma oranları (%31'e karşın %13.7; p=0.044) anlamlı olarak daha yüksek idi. Kilo kontrol oranı Grup 1'de daha yüksek olmasına rağmen gruplar arasında anlamlı fark saptanmadı (%27'ye karşın %15.6; p=0.219). Altıncı ayda sistolik ve diyastolik kan basıncı >140/90 mmHg olanların oranı Grup 2' de anlamlı olarak daha yüksek saptandı (%23.5'e karşın %9; p=0.029). Grup 1 hastalarında medyan LDL-K değeri belirgin olarak düşük saptandı (Grup 1, 91 mg/dL, Grup 2, 102 mg/dL; p=0.042). Ayrıca LDL-K =70 mg/dL veya bazale göre >=%50 azalma olanların oranı Grup 1'de belirgin yüksek idi (%32.8'e karşın %13.7; p=0.016). Altıncı ay kontrolde önerilen tedaviler açısından fark yok iken Grup 1'de statin kullanım oranı belirgin yüksek idi (%95.5'e karşın %80.3; p=0.021).Sonuç: Çalışmamızın sonuçları yapılandırılmış polikliniklerin AKS sonrasında kardiyovasküler risk faktörlerinin yönetiminde daha etkin olduğu göstermektedir