Heart rate variability and heart rate turbulence in patients with chronic obstructive pulmonary disease

Background: In chronic obstructive pulmonary disease (COPD) patients, functional and structural changes of the respiratory system greatly influence cardiovascular autonomic functions. Determining autonomic balance may be important in understanding the pathophysiology of COPD and useful clinically in the treatment of COPD patients. Heart rate variability (HRV) and heart rate turbulence (HRT) are useful tools in assessing the autonomic neurovegetative function. Our aim in this study was to evaluate the HRV and HRT variables in COPD patients. Twenty five moderate to severe COPD patients and 25 healthy subjects were included in this study. Methods: Pulmonary function tests and echocardiographic examination, arterial blood gases analysis were performed, HRV and HRT analysis were assessed from a 24-hour Holter recording. Results: When HRV and HRT parameters were compared, COPD patients had significantly decreased sNN50 total, pNN50, SDANN, SDNN, SDNNI, rMSDD in time domain HRV parameters, and the values of the HRT onset was significantly less negative in COPD patients. Although the values of the HRT slope were lower in COPD patients, there was no significant difference between the two groups. We also found a correlation between HRT and HRV parameters. Conclusions: In addition to HRV parameters, HRT onset was significantly different in COPD patients. In our opinion, the combination of HRV variables and HRT onset may be simple and elegant ways of evaluating cardiac autonomic functions. New investigations of HRT and HRV in COPD patients have a potential importance for improving risk stratification and therapeutic approaches, and understanding the autonomic outcomes of the disease process

Detection of CMV DNA in intraocular fluid samples in patients clinically diagnosed with viral uveitis by molecular methods

Background: Latent Cytomegalovirus (CMV) infections may be reactive in consequence of immunosuppression. Recently, CMV-associated uveitis cases have also been reported in immunocompetent individuals. Aim: The aim of this study was to obtain epidemiological data by evaluating CMV DNA PCR results, clinical characteristics and risk factors of patients diagnosed with viral uveitis. Methods: Between the years 2011-2017, anterior chamber fluid samples of 35 patients with viral uveitis sent from the ophthalmology clinic to the Virology Laboratory were included in this study. CMV DNA real-time PCR results were evaluated. Results: CMV DNA positivity was detected in 9 (26%) of the 35 patients. CMV DNA positivity was highest (13%) in over 60 years (p=0.02). Acute recurrent uveitis in 44% (4/9) of patients, single eye involvement in 78% (7/9) and anterior uveitis in 44% (4/9) were found. Conclusion: In this study, CMV DNA positivity was detected in 26% of the patients with viral uveitis. Considering the presentations of a small number of cases related to CMV uveitis in our country, this study is important due to being the most comprehensive study in our country

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

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

The relationship between serum lipid parameters and renal frame count in hypertensive patients with normal renal functions

Yolcu, Mustafa (Arel Author)Objective: Atherosclerosis can contribute to renovascular disease, and high cholesterol level is an independent risk factor for disease progression. Renal frame count (RFC) is an objective angiographic method of measuring macrovascular blood flow in the main renal artery and its segmental branches. The aim of the present study was to demonstrate relationship between serum lipid parameters and RFC. Methods: In this cross-sectional study, 116 hypertensive patients were allocated into 2 groups according to serum low-density lipoprotein (LDL) levels. Group 1 comprised 60 patients with LDL = 130 mg/dL. The patients were also divided into 2 groups according to total cholesterol (TC) levels (52 patients in group with TC = 200 mg/dL). Results: Group 2 had higher mean RFC than Group 1 (p<0.001). RFC of both kidneys in Group 2 was significantly higher than results in Group 1 (p<0.001 and p=0.023, respectively). We found similar significant results in comparison of TC-based patient groups. RFC had positive correlation with smoking, TC, and LDL (r=0.326, p=0.035; r=0.393, p=0.010; and r=0.386, p=0.012, respectively). In multivariate linear regression analysis, LDL, TC, smoking, and creatinine clearance were independent predictors of RFC. Conclusion: In conclusion, in hypertensive patients with normal renal function, LDL, TC, and smoking may be predictors of RFC and aggressive risk factor modification may help to reduce the risk of renal failure

A patient with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA syndrome) and 13 live births

Yolcu, Mustafa (Arel Author) --- PubMed ID: 30729975Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) or Bland-White-Garland syndrome is a rarely seen congenital anomaly. Adult and infantile types are defined according to the degree of collateral development between the left coronary artery (LCA) and right coronary artery (RCA). If left untreated, ALCAPA has a 90% mortality rate in the first year of life, primarily due to myocardial ischaemia and heart failure. The degree of collateral development and the related LCA perfusion in ALCAPA syndrome determine the occurrence of symptoms. Herein, we present a case of a female patient who had previously, without any symptoms, given live birth to 13 babies. She had been experiencing exertional angina, which started long after the delivery of her 13th child. Since our patient had well-developed collaterals to the LCA, she was asymptomatic and able to give birth to the children via the vaginal route without any problems. Having well-formed collateral vessels between the RCA and LCA may prevent patients from developing symptoms, and even stressful conditions such as pregnancy may be tolerable

Chemical Contents of Red Clover Genotypes on Crop Improvement Systems as Livestock Feed

A field experiment was conducted in 2000-2001 at the Research Station of East Anatolia Agricultural Research Institute in Pasinler of Erzurum province in Turkey. In this study, 25 red clovers (Trifolium pratense L.) genotypes were evaluated in terms of chemical contents for animal feeding in the 2 years results. The red clover genotypes were sown in the spring of 2000. The experiment was designed a randomized complete block with replicated 4 times. The genotypes were harvested in 50% flowering once in 2000 and 3 times in 2001. There were significant differences in N (p<0.05), Mg (p<0.05), Zn (p<0.05), Fe (p<0.05), Mn (p<0.01) and Cu (p<0.01) contents but no in Na content among the red clover genotypes. According to 2 years results, especially L-818 line and Xiashao cultivar in N; L-1881 and L-812 line in Mg; Redwent cultivar, L-77, L-1922 lines and Lucrun cultivars in Zn; L-77 line, Redwent cultivar, L-812, L-1922 lines and Lucrun cultivar in Fe; L-79 line, Redwent cultivar and L-77 line in Mn; L-79 line, Redwent cultivar and L-77 line in Cu had higher chemical contents than the others for animal feeding. The genotypes rich in terms of chemical content can be successfully used to meet the requirement the forage quality of animal and to gain new quality red clover genotypes for animal nutrition