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Parasitic myomas occur especially after laparoscopic myomectomy and its incidence increases due to the use of morcellators. Parasitic myomas can rarely occur at the port entry site, being more commonly seen on the intestines, the omentum, the ureter, the bladder, and the diaphragm in different periods after surgery, with the average duration being 24 months. In this article, we present the case of parasitic myoma developing secondary to the port site in a 45-year-old nulliparous woman after the use of laparoscopic myomectomy and morcellation 8 years ago. The patient presented with complaints of pelvic pain and a palpable mass in the left trocar incision line, and an appearance compatible with multiple myomas in the subcutaneous tissue of the left trocar incision line. Besides, myomas were also observed in the mesentery of the rectosigmoid colon and at the uterus in the present study. Numerous and large myomas were observed in the uterus, in the mesentery of the rectosigmoid colon, on the left pelvic peritoneum, and under the skin corresponding to the port entrance. The pathological examination of the myomas excised was reported as leiomyoma. In this article, the diagnosis, the treatment, the possible risk factors, and the complications of myomas were discussed in the light of the literature.

Aim: Echinococcosis, caused by Echinococcus species, is an important zoonotic disease causing major health problems in humans and animals. Herein, we aimed to evaluate the epidemiology, clinical and laboratory parameters, radiological, serological, pathological, and treatment protocols of followed-up cases of hydatidosis. Methods: A total of 550 patients diagnosed with hydatid cyst disease were included in this study. Patients who were positive for one or more of the enzyme-linked immunosorbent assay or indirect hemagglutination test, pathological results, or radiological findings were examined. The data analyzed were collected from nine centers between 2008 and 2020. Records were examined retrospectively. Results: Among the patients, 292 (53.1%) were women and 258 (46.9%) were men. The patients' mean age was 44.4 +/- 17.4 years. A history of living in rural areas was recorded in 57.4% of the patients. A total of 435 (79.1%) patients were symptomatic. The most common symptoms were abdominal pain in 277 (50.4%), listlessness in 244 (44.4%), and cough in 140 (25.5%) patients. Hepatomegaly was found in 147 (26.7%), and decreased breath sounds were observed in 124 (22.5%) patients. Radiological examination was performed in all cases and serological methods were also applied to 428 (77.8%) patients. The most frequently applied serological test was IHA (37.8%). A single cyst has been found in 66% patients. Hepatic involvement occurred in 327 (59.4%), pulmonary involvement was found in 128 (23.3%), whereas both of them were recorded in 43 (7.8%) patients. Splenic involvement was only detected in nine (1.6%) patients. Echinococcus granulosus (72.5%) was most frequently detected. Cyst diameters of 56.9% of the patients were in the range of 5-10 cm. A total of 414 (75.2%) patients received albendazole as an antiparasitic. Mortality was noted in nine (1.6%) patients. Conclusion: Echinococcosis is an important public health problem in Turkey. It can affect the social, economic, and political structures of the community. Public education and awareness are extremely important.

BackgroundTuberculous meningitis (TBM) represents a diagnostic and management challenge to clinicians. The“Thwaites’ system” and “Lancet consensus scoring system” are utilized to differentiate TBM from bacterial meningitis but their utility in subacute and chronic meningitis where TBM is an important consideration is unknown.MethodsA multicenter retrospective study of adults with subacute and chronic meningitis, defined by symptoms greater than 5 days and less than 30 days for subacute meningitis (SAM) and greater than 30 days for chronic meningitis (CM). The “Thwaites’ system” and “Lancet consensus scoring system” scores and the diagnostic accuracy by sensitivity, specificity, and area under the curve of receiver operating curve (AUC-ROC) were calculated. The “Thwaites’ system” and “Lancet consensus scoring system” suggest a high probability of TBM with scores ≤4, and with scores of ≥12, respectively.ResultsA total of 395 patients were identified; 313 (79.2%) had subacute and 82 (20.8%) with chronic meningitis. Patients with chronic meningitis were more likely caused by tuberculosis and had higher rates of HIV infection (P P P ConclusionBoth criteria can be helpful in distinguishing TBM from bacterial meningitis, but only the Lancet consensus scoring system can help differentiate TBM from meningitis caused by fungal, viral and unknown etiologies even though significant overlap occurs and the overall diagnostic accuracy of both criteria were either poor or fair.

Aim: Familial Mediterranean Fever (FMF) is the most frequent and historically the oldest autosomal recessive autoinflammatory disorder. No pathogen or auto-antibody has been shown to be associated with FMF. The disorder manifests with bouts of fever and abdominal pain, which are called “attacks”. In the present study, we aimed to find the most frequent mutations in the MEFV gene in the Turkish population. Methods: Thousand eight hundred and forty patients with an initial diagnosis of FMF were enrolled in the study. DNA was extracted from the peripheral blood according to the kit protocol. Twenty-two target sequences of the MEFV gene were amplified with polimeraze chain reaction and sequenced with the pyrosequencing method. Results: When the patients were divided into two groups according to age, the mean age of 866 patients was 8.5±7.5 years in

Diabetes mellitus (DM) is a metabolic disorder characterized by hyperglycaemia due to insulin production/secretion disorder or insulin resistance caused by various pathogenetic mechanisms. T helper cells (Th) play an important role in the pathogenesis of the disease. In our study, peripheral blood mononuclear cells (PBMC) were isolated from peripheral blood samples from newly diagnosed, 1 year and 5 year type 1 diabetes (T1D) patients (8 patients) and 8 healthy controls, and cultured for 24 hours under unstimulated and stimulated conditions. After culture, the cell ratios of Th1, Th2, Th17, and regulator T (Treg) and the intracellular levels of IFN-γ, TNF-α, IL-10, TGF-β, IL-5, IL-13, IL-17 and IL-21 cytokines were evaluated using Flow Cytometry; whereas mRNA expressions of the transcription factors T-bet, GATA3, ROR-γt and FOXP3 of these cells were determined by Real-Time PCR. Reduced CD4+CD25high cell ratios were detected in newly diagnosed T1D patients under unstimulated conditions. CD4+CD25high cells were found to be reduced in the newly diagnosed and 1 year group of patients compared to healthy controls under IL-2 stimulated conditions. Intracellular IFN-γ and TNF-α levels were low in all patients under unstimulated and IL-12 stimulated conditions. IL-17A and IL-21 were found to be high in patients with unstimulated and IL-6 stimulated conditions. Expressions of IL-10 and TGF-β have been observed to be reduced in patients. Th1/Th2, Th17/Treg and Th1/Treg ratios were higher in the patient groups. FOXP3 and GATA3 mRNA expressions were found to be low in patients, while RORγt and T-bet mRNA levels were higher than healthy controls under stimulated and unstimulated conditions. Our results suggest that Th cell subgroups play an important role in the pathogenesis of T1D. Disclosure B. Aydin Ozgur: None. S. Cinar: None. D. Ozturk: None. E. Coskunpinar: None. A.O. Gurol: None. M. Yilmaz: None.

Infective endocarditis is a growing problem with many shifts due to ever-increasing comorbid illnesses, invasive procedures, and increase in the elderly. We performed this multinational study to depict definite infective endocarditis. Adult patients with definite endocarditis hospitalized between January 1, 2015, and October 1, 2018, were included from 41 hospitals in 13 countries. We included microbiological features, types and severity of the disease, complications, but excluded therapeutic parameters. A total of 867 patients were included. A total of 631 (72.8%) patients had native valve endocarditis (NVE), 214 (24.7%) patients had prosthetic valve endocarditis (PVE), 21 (2.4%) patients had pacemaker lead endocarditis, and 1 patient had catheter port endocarditis. Eighteen percent of NVE patients were hospital-acquired. PVE patients were classified as early-onset in 24.9%. A total of 385 (44.4%) patients had major embolic events, most frequently to the brain (n = 227, 26.3%). Blood cultures yielded pathogens in 766 (88.4%). In 101 (11.6%) patients, blood cultures were negative. Molecular testing of vegetations disclosed pathogens in 65 cases. Overall, 795 (91.7%) endocarditis patients had any identified pathogen. Leading pathogens (Staphylococcus aureus (n = 267, 33.6%), Streptococcus viridans (n = 149, 18.7%), enterococci (n = 128, 16.1%), coagulase-negative staphylococci (n = 92, 11.6%)) displayed substantial resistance profiles. A total of 132 (15.2%) patients had cardiac abscesses; 693 (79.9%) patients had left-sided endocarditis. Aortic (n = 394, 45.4%) and mitral valves (n = 369, 42.5%) were most frequently involved. Mortality was more common in PVE than NVE (NVE (n = 101, 16%), PVE (n = 49, 22.9%), p = 0.042)., SCOPUS: ar.j, info:eu-repo/semantics/published

Neurosyphilis (NS) has different clinical manifestations and can appear during any stage of syphilis. We aimed to identify the factors affecting poor outcome in NS patients. Patients with positive cerebrospinal fluid Venereal Disease Research Laboratory test, and positive serological serum treponemal or nontreponemal tests were classified as definite NS. The data of 141 patients with definite NS were submitted from 22 referral centers. Asymptomatic NS, syphilitic meningitis, meningovascular syphilis, tabes dorsalis, general paresis, and taboparesis were detected in 22 (15.6%), 67 (47.5%), 13 (9.2%), 10 (7%), 13 (9.2%), and 16 patients (11.3%), respectively. The number of HIV-positive patients was 43 (30.4%). The most common symptoms were headache (n = 55, 39%), fatigue (n = 52, 36.8%), and altered consciousness (50, 35.4%). Tabetic symptoms were detected in 28 (19.8%), paretic symptoms in 32 (22.6%), and vascular symptoms in 39 patients (27.6%). Eye involvement was detected in 19 of 80 patients (23.7%) who underwent eye examination and ear involvement was detected in eight of 25 patients (32%) who underwent ear examination. Crystallized penicillin was used in 109 (77.3%), procaine penicillin in seven (4.9%), ceftriaxone in 31 (21.9%), and doxycycline in five patients (3.5%). According to multivariate regression analysis, while headache was a protective factor in NS patients, double vision was significantly associated to poor outcome. We concluded that double vision indicated unfavorable outcome among NS patients. A high clinical suspicion is needed for the diagnosis NS. As determined in our study, the presence of headache in syphilitic patients can help in early diagnosis of central nervous system disease.

Introduction: Primary percutaneous coronary intervention (PPCI) is the preferred treatment of ST segment elevation myocardial infarction (STEMI). Manual thrombectomy catheters developed to prevent distant embolization are theoretically attractive; however, their clinical efficacy remains controversial. The effects of manual thrombectomy catheters on angiographically visible distal embolisation (AVDE) have not been studied so far. The aim of this study was to evaluate the effects of manual thrombectomy during PPCI on AVDE and to investigate whether there are differences in the incidence of AVDE according to the catheters used. Material and methods: Six hundred thirty-six consecutive patients undergoing primary PCI were included in the study between January 2010 and December 2012. Patients were divided into two groups: the PCI only group (465 patients) and the PCI plus manual thrombectomy group (171 patients). Results: Thrombus aspiration was associated with higher AVDE (13.55% vs. 26.9%, p = 0.0001), lower thrombolysis in myocardial infarction frame rate (2.49 ±0.86 vs. 2.79 ±0.57, p = 0.0001), lower myocardial blush grade (2.31 ±0.87 vs. 2.47 ±0.7, p = 0.016), lower ejection fraction (EF) (49.9 ±8.5 vs. 46.1 ±9.6, p = 0.0001) and higher maximal troponin release (15.7 ±16 vs. 9.4 ±11, p = 0.0001). No difference was observed in terms of mortality between the groups in follow-up (5.2% vs. 9.03%, p = 0.12). Angiographically visible distal embolisation was observed more frequently with Invatec catheters (p = 0.0001). Conclusions: Angiographically visible distal embolisation during primary PCI occurs in a significant number of patients treated with manual thrombectomy. The results indicated that the incidence of AVDE may be different depending on the thrombectomy catheters used.

WOS: 000388827200008, PubMed ID: 27138335, Objective Neuroimaging abnormalities in central nervous system (CNS) brucellosis are not well documented. The purpose of this study was to evaluate the prevalence of imaging abnormalities in neurobrucellosis and to identify factors associated with leptomeningeal and basal enhancement, which frequently results in unfavorable outcomes. Methods Istanbul-3 study evaluated 263 adult patients with CNS brucellosis from 26 referral centers and reviewed their 242 magnetic resonance imaging (MRI) and 226 computerized tomography (CT) scans of the brain. Results A normal CT or MRI scan was seen in 143 of 263 patients (54.3 %). Abnormal imaging findings were grouped into the following four categories: (a) inflammatory findings: leptomeningeal involvements (44), basal meningeal enhancements (30), cranial nerve involvements (14), spinal nerve roots enhancement (8), brain abscesses (7), granulomas (6), and arachnoiditis (4). (b) White-matter involvement: white-matter involvement (32) with or without demyelinating lesions (7). (c) Vascular involvement: vascular involvement (42) mostly with chronic cerebral ischemic changes (37). (d) Hydrocephalus/cerebral edema: hydrocephalus (20) and brain edema (40). On multivariate logistic regression analysis duration of symptoms since the onset (OR 1.007; 95 % CI 1-28, p = 0.01), polyneuropathy and radiculopathy (OR 5.4; 95 % CI 1.002-1.013, p = 0.044), cerebrospinal fluid (CSF)/serum glucose rate (OR 0.001; 95 % CI 000-0.067, p = 0.001), and CSF protein (OR 2.5; 95 % CI 2.32.7, p = 0.0001) were associated with diffuse inflammation. Conclusions In this study, 45 % of neurobrucellosis patients had abnormal neuroimaging findings. The duration of symptoms, polyneuropathy and radiculopathy, high CSF protein level, and low CSF/serum glucose rate were associated with inflammatory findings on imaging analyses.

Aim: Enterococci are located in the intestinal flora of animals and humans and have become a major cause of healthcare-associated infections over the years. In this study, related factors were investigated for the isolation of vancomycin-resistant enterococci (VRE) from rectal swab specimens of patients admitted to the internal medicine service.Material and Methods: TRectal swab samples were obtained from 316 patients. VITEK-2 (bioMerieux, Marcy l’Etoile, France) automated system was used for identification of enterococci. Vancomycin susceptibility was studied by Kirby-Bauer disc diffusion method. Resistant strains were confirmed by vancomycin E-test (bioMerieux).Results: VRE was growth in 70 (22.2%) of 316 patients included in the study. According to the univariate analysis results which comparing patients who were colonized with VRE to the control group; These were found, the duration of hospitalization for VRE colonized patients was significantly longer, the usage of glycopeptide and metronidazole increased the VRE colonization and VRE colonized patients were found to have more parenteral feeding. It was determined that hemoglobin, thyroxine and albumin values of patients colonized with VRE were lower. According to the logistic regression analysis, patients with VRE colonization had a higher rate of history in the intensive care unit and higher gamma glutamyl transferase value. Conclusion: It was determined that the hospitalization history in intensive care unit is a risk factor for VRE colonization and especially in patients transported from intensive care unit. Patients colonized with VRE have been found to have higher GGT values and new research on this topic is considered to be needed.

WOS: 000349144300018, PubMed ID: 25821319, Objectives: To compare the efficacy of colistin (COL) monotherapy versus non-COL based combinations in the treatment of bloodstream infections (BSIs) due to multidrug resistant Acinetobacter spp.(MDR-A) . Materials and Methods: Retrospective data of 107 MDR-A BSI cases from 27 tertiary centers in Turkey were included. Primary End-Point: 14-day mortality. Secondary End-Points: Microbial eradication and clinical improvement. Results: Thirty-six patients in the COL monotherapy (CM) group and 71 in the non-COL based combinations (NCC) group were included in the study. Mean age was 59.98 20 years (range: 18-89) and 50.5% were male. Median duration of follow-up was 40 days (range: 9-297). The 14-day survival rates were 52.8% in CM and 47.23% in NCC group (P = 0.36). Microbiological eradication was achieved in 69% of CM and 83% of NCC group (P = 0.13). Treatment failure was detected in 22.9% of cases in both CM and NCC groups. Univariate analysis revealed that mean age (P = 0.001), Charlson comorbidity index (P = 0.03), duration of hospital stay before MDR-A BSI (P = 0.04), Pitt bacteremia score (P = 0.043) and Acute Physiology and Chronic Health Evaluation II score (P = 0.05) were significant in terms of 14-day mortality. Advanced age (P = 0.01) and duration of hospital stay before MDR-A BSI (P = 0.04) were independently associated with 14-day mortality in multivariate analysis. Conclusion: No significant difference was detected between CM and non-COL based combinations in the treatment of MDR-A BSIs in terms of efficacy and 14-day mortality.

WOS: 000446000200057, PubMed ID: 30256855, Sepsis is a severe clinical syndrome owing to its high mortality. Quick Sequential Organ Failure Assessment (qSOFA) score has been proposed for the prediction of fatal outcomes in sepsis syndrome in emergency departments. Due to the low predictive performance of the qSOFA score, we propose a modification to the score by adding age. We conducted a multicenter, retrospective cohort study among regional referral centers from various regions of the country. Participants recruited data of patients admitted to emergency departments and obtained a diagnosis of sepsis syndrome. Crude in-hospital mortality was the primary endpoint. A generalized mixed-effects model with random intercepts produced estimates for adverse outcomes. Model-based recursive partitioning demonstrated the effects and thresholds of significant covariates. Scores were internally validated. The H measure compared performances of scores. A total of 580 patients from 22 centers were included for further analysis. Stages of sepsis, age, time to antibiotics, and administration of carbapenem for empirical treatment were entered the final model. Among these, severe sepsis (OR, 4.40; CIs, 2.35-8.21), septic shock (OR, 8.78; CIs, 4.37-17.66), age (OR, 1.03; CIs, 1.02-1.05) and time to antibiotics (OR, 1.05; CIs, 1.01-1.10) were significantly associated with fatal outcomes. A decision tree demonstrated the thresholds for age. We modified the quick Sequential Organ Failure Assessment (mod-qSOFA) score by adding age (> 50 years old = one point) and compared this to the conventional score. H-measures for qSOFA and mod-qSOFA were found to be 0.11 and 0.14, respectively, whereas AUCs of both scores were 0.64. We propose the use of the modified qSOFA score for early risk assessment among sepsis patients for improved triage and management of this fatal syndrome.

The beneficial effects of the transcatheter aortic valve implantation (TAVI) on echocardiographic parameters including left atrial (LA) and left ventricular (LV) functions were described by previous studies. The aim of this study was to analyze the effects of TAVI on left atrial appendage (LAA) function assessed by transthoracic and transesophageal echocar-diography.Fifty-five patients with severe symptomatic aortic stenosis were included in this prospective study. LAA early and late emptying velocities, LAA filling velocity, peak early diastolic (EM), late diastolic (AM), and systolic (SM) velocities were measured with pulsed wave Doppler and tissue Doppler imaging, and E/Em ratio was calculated before and 7.1 ± 2.8 days after TAVI. A subgroup analysis was performed in accordance with the left ventricular ejection fraction (LVEF) of the patients and the severity of their LV diastolic dysfunction.Although the post-procedure peaks and mean gradients of the patients decreased sig-nificantly, the LVEF increased significantly in those who had low LVEF before the procedure. The post-procedure E/Em ratio decreased significantly (p0.001). The post-procedural LAA mean filling velocity and EM velocity were significantly higher than the pre-procedural filling velocity (p0.001, p = 0.002, respectively). In the subgroup analysis, the post-procedural LAA filling velocity, early and late LAA emptying velocities, in addition to the mean velocity of the EM, AM, and SM were significantly higher than before the procedure in patients with LVEF of50% and E/Em ratios of15.LAA function improved soon after the TAVI procedure, especially in patients with low LVEF and marked LV diastolic dysfunction.

Introduction: The inflammatory process has been reported to be associated with aortic dissection (AD) from the development to the prognosis. The aim of the study was to investigate a relationship between the neutrophil to lymphocyte ratio (NLR) and in-hospital outcomes in patients with acute aortic dissection (AAD) who underwent surgical repair. Methods: One hundred and eighty-four patients who were admitted with the diagnosis of type A AAD who underwent surgical repair at two large tertiary hospitals. According to their NLR, 91 patients had high NLR (>6.0) and 93 patients had low NLR (⩽6.0). Results: The frequency of major bleeding, hospital-related infection, multi-organ dysfunction and mortality in hospital were higher in the high NLR group compared to the low NLR group. NLR, WBC count and operation duration were found to be independent predictors for in-hospital mortality. Conclusions: The novel inflammatory marker NLR may be used to predict worse outcomes and hospital mortality in patients with AAD treated by surgical repair.

Purpose There are different clinical cardiac applications of dual source computed tomography (DSCT). Here, we aimed to compare the DSCT with the transthoracic echocardiography (TTE) for evaluating the Wilkins score and planimetric mitral valve area (MVA) of a rheumatic stenotic mitral valve. Materials and Methods We prospectively evaluated mitral valvular structure and function in 31 patients with known mitral stenosis undergoing electrocardiogram-gated, second-generation DSCT, in our heart center for different indications. Mitral valve was evaluated using Wilkins score, and also, the planimetric MVA was assessed. Results We found a significant difference between MVAs determined by DSCT (average 1.42 ± 0.44 cm2) and MVAs determined by TTE (average 1.35 ± 0.43 cm2; difference 0.07 ± 0.16 cm2; P = 0.018). Linear regression analysis revealed a good correlation between the two techniques (r = 0.934; P < 0.0001). The limits of agreement for DSCT and TTE in the Bland–Altman analysis were ±0.31 cm2. DSCT using TTE as the reference enabled good discrimination between mild and moderate-to-severe stenosis and had an area under the ROC curve of 0.967 (CI 0.912–1.023; P < 0.0001). Wilkins scores obtained by DSCT (7.51 ± 1.17, range 5–10) and TTE (8.16 ± 1.27, range 6–10) had a moderate correlation (r = 0.686; P < 0.0001). Conclusion We found that planimetric MVA measurements assessed by DSCT were closely correlated with MVA calculations by TTE. The moderate correlation was observed for the Wilkins score.

Ozyilmaz, Sinem/0000-0003-4829-8400 WOS: 000366307800014 PubMed ID: 25179317 Background: The risk of thrombus formation in the left atrium is known to be very high in patients with both mitral stenosis (MS) and atrial fibrillation (AF). However, that risk should not be ignored in patients with MS in sinus rhythm (SR). The aim of this study was to determine the clinical, echocardiographic, and biochemical factors that could have a determining role in the formation of a left atrial (LA) thrombus in patients with MS in SR. Method: A total of 207 consecutive patients with MS who underwent both transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) for diagnosis or to investigate the presence of a thrombus in the LA and appendage were enrolled in this study. Results: LA thrombus was detected in 21 of 207 patients. CHA(2)DS(2)-VASc score was not found to be a predictor of LA thrombosis in patients with MS in SR, despite the higher CHA(2)DS(2)-VASc scores observed in those patients. The mitral valve area and mitral valve gradient were not predictive of LA thrombus development; however, LA anteroposterior diameter (LAAPD) was found to be a predictor of LA thrombosis. Levels of high sensitivity-C-reactive protein and uric acid were higher in the patients with LA thrombosis, but only uric acid was found to be a predictor of LA thrombosis in multivariate analysis. Conclusions: A larger LAAPD and an elevated serum uric acid level were found to be independent predictors of LA thrombosis in patients with MS in SR.

We investigated the utility of the preprocedural red cell distribution width (RDW) for predicting contrast-induced acute kidney injury (CI-AKI) in patients with ST-segment-elevation myocardial infarction (STEMI) who underwent a primary percutaneous coronary intervention.A total of 630 consecutive patients who were routinely referred to coronary angiography for STEMI were included in the present study.CI-AKI was observed in 79 patients (12.5%). The RDW, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and the mean platelet volume were significantly higher in the CI-AKI group than in the non-CI-AKI group (P0.001, P=032, P=0.025, and P=0.039, respectively). Serum total bilirubin and direct bilirubin levels were not different among the study groups. Using multivariate logistic regression analysis, we found that left ventricular ejection fraction [odds ratio (OR)=0.972, 95% confidence interval (CI) 0.945-0.998, P=0.033], estimated glomerular filtration rate (OR=0.970, 95% CI 0.959-0.981, P0.001), contrast volume (OR=1.007, 95% CI 1.002-1.012, P=0.009), and RDW (OR=1.406, 95% CI 1.120-1.792, P=0.005) were independent predictors of CI-AKI.Red blood cell distribution width, an inexpensive and easily measurable laboratory variable, is associated independently with the development of CI-AKI. Our data suggest that RDW may be a useful marker in CI-AKI risk stratification.

Increased levels of visfatin, a novel adipocytokine, are reported in atherosclerosis, obesity, and type 2 diabetes. The aim of the present study was to investigate the relationship between coronary slow flow (CSF) and visfatin in patients undergoing elective coronary angiography for suspected coronary artery disease. A total of 140 recruited participants (90 patients with CSF and 50 controls) were divided into two groups according to their coronary flow rates. Coronary flow was quantified by thrombolysis in myocardial infarction (TIMI) frame count (TFC). Serum visfatin levels were higher in the CSF group than in the control group (3.29 ± 1.11 vs. 2.70 ± 1.08 ng/ml, p = 0.003). A significant correlation was found between TFC and visfatin (r = 0.535, p

After prostate biopsy, serious and life-threatening infections of resistant strains can develop and therefore fluoroquinolones for prophylaxis is widely used. This study aimed to examine infections in patients undergoing transrectal prostate biopsy with quinolone prophylaxis and to review the articles reported in this respect. Patients and Methods: In this study, 14 cases who followed for the development of infection after transrectal ultrasonography guided prostate biopsy between the years 2005-2010 at the Department of Infectious Diseases and Clinical Microbiology of Haydarpasa Numune Training and Research Hospital were retrospectively evaluated. Results: Ten patients (%71.4) developed sepsis, 3 patients (21.4%) urinary tract infection (UTI), and 1 patient (7.1%) acute bacterial prostatitis. In seven out of 14 patients (50%) bacteria growth was in blood culture, in 12 patients (85.7%) was in urine and in 5 patients (35.7%) was in both. E. coli was identified as the causative agent in all of the cases being the rate of extended spectrum of 􀀁-lactamases (ESBL) in E. coli strains was 42.8%, quinolone resistance 92.8 %. Conclusion: This study suggested that fluoroquinolone resistant E. coli should be considered as an important causative agent in infections after transrectal prostate biopsy.

Introduction: Epstein-Barr virus (EBV), also known as human herpesvirus 4, is the causative agent of infectious mononucleosis. Infection with EBV is associated with multiple malignancies. The aim of this study was to determine the seroprevalence and risk factors for seropositivity. Materials and Methods: This study was conducted in Haydarpaşa Numune Training and Research Hospital in İstanbul between August 2012 and October 2012. Epstein-Barr virus viral capsid antigen IgG antibody was measured using ELISA in 500 cases. Age, gender, occupation, education level, family income, the area and type of residence, and chronic illness of the participants were also evaluated. Differences between risk groups were statistically analyzed. Results: The mean age of the 500 study participants was 47.7±19.1 (15-87) years and 289 (57.8%) were male. Mean EBV seropositivity was 96.4%, and 91% of the cases became seropositive for EBV by 15 years of age. No significant associations with age, gender, occupation, education level, family income, area and type of residence, and chronic illness were detected. Conclusion: Epstein-Barr virus seropositivity rates were very high and about 91% of the cases become seropositive for EBV by 15 years of age. There was no significant relationship between risk factors and seroprevalence of EBV.

Background: Extended spectrum beta-lactamase (ESBL) producing organisms causing urinary tract infections are increasing in incidence and becoming a serious health problem due to their resistance to large number of antibiotics. Objectives: To investigate the ESBL prevalence of Escherichia coli and Klebsiella spp. which are isolated from urine samples for both in and outpatients with their resistance profiles. Methods: From 2004 to 2012, a total of 13975 isolates (12897 E. coli, 1078 Klebsiella spp.) were included in this study. The antibiotic susceptibility was tested using Kirby–Bauer disk diffusion method and Vitek2 System (bioMerieux, France) according to CLSI. Results: Our data showed a significant increasing in ESBL prevalence from 12.5% to 44.7% (P < 0.001) for inpatients; from 9.6% to 22.8% (P < 0.001) for outpatients in E. coli and from 25% to 60.5% (P < 0.003) for inpatients; from 12% to 25% (P < 0.095) for outpatients in Klebsiella spp. For E. coli, the increase was significantly high in both of males and females (P < 0.001). However, for Klebsiella spp. it was significantly high in male patients (P < 0.001). The resistance rates of antibiotics for the ESBL producing E. coli, and Klebsiella spp. showed a significant increase. These rates were higher than 70% for fluoroquinolones, amoxicillin-clavulanic acid and trimethoprim-sulfamethoxazole. Even carbepenem resistance reached to 7% in the outpatients and 15% in inpatients for ESBL producing Klebsiella spp. Conclusions: Our study demonstrated a significant increase in the prevalence of ESBL producing E. coli and Klebsiella spp. and a remarkable carbapenem resistance trend in the ESBL producing Klebsiella spp. isolated from urine samples.

Objective: We aimed to investigate suspected cases of mushroom poisoning that were admitted to the emergency department of a metropolitan education and research hospital. Material and Methods: Suspicious cases of mushroom poisoning and determined mushroom poisoning patients were investigated in the medical records of patients who were older than 18 years old in 1 year. We examined patient’s demographic information, admission date, complaints, time of complaint starting, and clinical and laboratory findings. Treatments and results were evaluated. Results: We analyzed 74 patients who were diagnosed with mushroom poisoning. The most common complaints of the patients were nausea and vomiting. Increases in the number of admission were observed in November and December. A total of 25 patients were externed from emergency medicine, and 39 patients were hospitalized. 5 patients treatment with hemodialysis and both of them died. Conclusion: Mushroom poisoning is known to vary according to seasonal distribution, type of mushroom, geographic shape, and climate of the region. Therefore, emergency physicians should investigate the characteristics and ecology of the region and the geographic shape, so that provision services can facility the emergency departments principles working and organizated. The importance of regional characteristics is lost in a metropolitan hospital. (JAEM 2014; 13: 162-5)

We assessed the prognostic value of the platelet to lymphocyte ratio (PLR) in primary percutaneous coronary intervention (pPCI). Patients (n = 440) with acute myocardial infarction (AMI) who underwent pPCI were divided into 2 groups: low PLR ( 137). “Thrombolysis In Myocardial Infarction” (TIMI) flow grades and Syntax scores (SXS) were calculated from initial angiograms. In-hospital mortality rate and cardiac adverse events were obtained from medical records. Patients with high PLR had more no-reflow, higher SXS and higher mortality rate (p 22 (specificity 52% and sensitivity 61%) and adverse events (specificity 67% and sensitivity 63%). In multivariate regression analysis, PLR was an independent risk factor for no-reflow, SXS>22 and in-hospital adverse events. In addition to PLR, we present ...

Background: Although it has declined in developed countries, mitral valve stenosis is problematic in developing countries; its main cause is rheumatic fever. In patients with rheumatic mitral stenosis (RMS), ongoing chronic inflammation may resultin the progression of valvular damage and the formation of spontaneous echocardiographic contrast (SEC). Aim: We investigated the role of the neutrophil/lymphocyte ratio (NLR) as an indicator of ongoing inflammation and independentpredictive risk factor for SEC in RMS patients. Methods: A total of 112 patients (mean age 46 ± 10.6; 73.2% female) with RMS who underwent both transthoracic echocardiography and transoesophageal echocardiography were enrolled; the control group comprised 100 healthy volunteers (mean age 44 ± 9.1; 62% female). Patients were divided into two subgroups according to the formation of SEC in the left atrium and appendage. Haematological and biochemical indices were measured in all patients and controls. Result: NLR was higher in the patients than controls (2.6 ± 1.15 vs. 1.71 ± 0.53, p < 0.001). In addition, it was higher in the SEC-positive group (mean age 47 ± 10.3; 68.4% female) compared to the SEC-negative group (mean age 44 ± 10.7; 78.2% female; 3.21 ± 1.25 vs. 1.97 ± 0.55, p < 0.001). In multivariate analysis, NLR (odds ratio [OR] 20.602, 95% confidence interval [CI] 4.678–90.731; p < 0.001) and left atrial diameter (OR 5.966, 95% CI 2.166–16.429; p = 0.01) were found tobe independent predictors of SEC in RMS patients. Conclusions: RMS patients exhibit on-going inflammation; NLR is a good marker of this. The formation of SEC is associated with inflammation and NLR is an independent predictive risk factor for SEC.

We hypothesized that contrast media volume–estimated glomerular filtration rate (CV–e-GFR) ratio may be a predictor of contrast media-induced acute kidney injury (CI-AKI). We investigated the associations between CV–e-GFR ratio and CI-AKI in 597 patients undergoing primary percutaneous coronary intervention (pPCI). An absolute ≥0.3 mg/dL increase in serum creatinine compared with baseline levels within 48 hours after the procedure was considered as CI-AKI; 78 (13.1%) of the 597 patients experienced CI-AKI. The amount of contrast during procedure was higher in the CI-AKI group than in those without CI-AKI (153 vs 135 mL, P = .003). The CV–e-GFR ratio was significantly higher in patients with CI-AKI than without (2.3 vs 1.5, P < .001). In multivariate analysis, independent predictors of CI-AKI were low left ventricular ejection fraction ( P = .018, odds ratio [OR] = 0.966), e-GFR 2 ( P < .001, OR = 5.917). In conclusion, CV–e-GFR ratio is significantly associated with CI-AKI after pPCI.

Objective: Healthcare workers (HCWs) are at risk for occupational injury associated with contaminated blood and body fluids. This study aims to examine the frequency and type of occupational injuries and to determine best practices after exposure. Methods: A cross-sectional study was conducted in Haydarpaşa Teaching Hospital in December 2010. The questionnaires were completed by healthcare workers with face-to-face interviews. The questionnaire was evaluated occupational injuries in the hospital practice. Results: In total, 300of 350 healthcare practitioners (85.7%) answered the questions; 125 (41.6%) of them were nurses, 96 (32.0%) were physicians, 36 (12.0%) were cleaning staff, 23 (7.6%) were student nurses, and 20 (6.6%) were laboratory technicians. The number of HCWs who contact with blood and body fluids was 175 (58.3%). Forty-five HCWs (15.0%) have had injuries in the past year. The physicians had significantly lower injury rates (p=0.004), while nurses had significantly higher (p, Amaç: Sağlık çalışanları, kontamine kan ve vücut sıvıları ile mesleki yaralanma açısından risk altındadır. Bu çalışmanın amacı, mesleki yaralanmanın sıklığını, şeklini saptamak ve maruziyet sonrası uygulamaları belirlemektir.Yöntemler: Haydarpaşa Eğitim Hastanesi’nde 2010 yılı Aralık ayında kesitsel bir çalışma yapıldı. Sağlık çalışanları ile yüz yüze görüşülerek anket formları dolduruldu. Ankette sağlık çalışanlarına hastane hizmetleri sırasında yaşadıkları mesleki yaralanmalar soruldu.Bulgular: Anketin ulaştığı 350 sağlık çalışanından 300’ü (% 85,7) soruları yanıtladı. Sağlık personelinin 125’i (% 41,6) hemşire, 96’sı (% 32,0) doktor, 36’sı (% 12) temizlik personeli, 23’ü (% 7,6) öğrenci hemşire, 20’si (% 6,6) laboratuvar teknisyeni idi. Kan ve vücut sıvılarıyla maruziyet oranı 175 (% 58,3) olarak belirlendi. Sağlık personelinin 45’inde (%15,0) son bir yıl içerisinde yaralanma yaşadığını bildirdi. Sağlık personeli arasında kıyaslama yapıldığında; doktorlarda istatistiksel olarak anlamlı şekilde düşük (p=0,004), hemşirelerde istatistiksel olarak anlamlı şekilde yüksek (p

Introduction: Many studies have reported the diagnostic and prognostic value of haemoglobin A1c (HbA1c) levels in patients with acute coronary syndrome. However, the short- and long-term prognostic value of HbA 1c level in patients with ST elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) is controversial. Aim: To investigate whether admission HbA 1c level has a prognostic value for in-hospital, short-, and long-term cardiovascular (CV) mortality and major adverse cardiovascular events in patients with STEMI undergoing primary PCI. Material and methods: This prospective study included 443 consecutive patients with STEMI who underwent primary PCI between September 2010 and July 2012. The patients were divided into three groups based on admission HbA1c levels: group I (HbA 1c ≤ 5.6%), group II (HbA 1c 5.7–6.4%), and group III (HbA 1c ≥ 6.5%). The in-hospital, 1-month, and 1-year CV events of all 3 patient groups were followed up. Results: A significant association was found between HbA 1c level and 1-year primary clinical outcomes, including CV mortality, non-fatal reinfarction, and stroke (p = 0.037). In addition, age, Killip class > 1, and left ventricular ejection fraction were found to be independent predictors of long-term CV mortality in multivariate analysis (hazard ratios (95% confidence interval) 1.081 (1.020– 1.146), 4.182 (1.171–14.935), and 0.832 (0.752–0.920); p = 0.009, p = 0.028, and p < 0.001, respectively). Conclusions: In this study, we demonstrated that increased admission HbA 1c levels were associated with higher rates of major adverse CV events, including mortality, non-fatal reinfarction, and stroke, in patients with STEMI who underwent primary PCI.

Background Herpes simplex virus (HSV) encephalitis is associated with adverse clinical outcomes in 50% of patients. The use and impact of adjunctive steroids in improving the prognosis of this devastating disease is unknown. Methods A multicenter international retrospective study of adults (age >15 years) with confirmed HSV encephalitis. An adverse clinical outcome was defined as death or survived with sequelae. Results A total of 438 adults with HSV encephalitis were enrolled. The mean age was 50.58 years (15.94, SD), 226 (51.6%) were female and 59 (13.5%) were immunosuppressed. New onset seizures were seen in 91 (20.8%) patients and the median Glasgow coma scale was 14 (13–15, IQR). A total of 73 (16.6%) patients received adjunctive steroids during their hospitalization. Adjunctive steroids were given more frequently to patients with fever (84.5% vs. 66.7%, P = 0.003), seizures (38.3% vs. 17.3%, P < 0.001), abnormalities on MRI (77.7% vs. 61.8%, P = 0.017), lower mean Glasgow coma scales (10.42 vs. 11.3, P = 0.013) and it was also associated with a longer length of stay (median duration of 23 days vs. 20 days, P = 0.012). Adjunctive steroids were not associated with an impact on adverse clinical outcomes (46.6% vs. 46.9%, P = 0.95). Conclusion Adjunctive steroids in HSV encephalitis are used more commonly in the sicker patients and are not associated with a benefit in clinical outcomes. Disclosures All authors: No reported disclosures.

Background Poor right ventricular function is an independent prognostic marker for mortality in heart failure patients. Echocardiographic studies concerning effects of levosimendan on right ventricular function performed second measurements just after or 24 hours after levosimendan infusion. We aimed to detect sustained effects of levosimendan infusion on right ventricular systolic function.Method The study consisted of 47 patients with acutely decompensated heart failure with NYHA class III or IV symptoms. Levosimendan was infused for 24 hours. Before and 5 days after the initiation of infusions, functional class was assessed, NT-proBNP levels and LVEF, RVEF, using tissue Doppler imaging, RV isovolumic myocardial acceleraton (IVA), peak myocardial velocity during isovolumic contraction (IVV), peak systolic velocity during ejection period (Sa), early (E’) and late (A’) diastolic velocities, and E’/A’ ratio were measured.Results NYHA class improved and NT-proBNP levels were significantly reduced. LVEF and ...

A 37 year-old female patient in whom the transthoracic echocardiography examination revealed dilatation of left heart chambers with left ventricular ejection fraction of 30% and moderate-to-severe mitral valve regurgitation was admitted to our hospital. On 2DTEE examination, mitral valve was normal; however, on 3D images, clefts of both anterior and posterior leaflets were revealed. Isolated cleft mitral valve without any other feature of atrioventricular septal defect is uncommon. 2D echocardiography has limited capability in defining the complex 3D anatomic characteristics of the cleft. 3DTEE allows to visualize the cleft position, morphology, and size, and it is important for surgical planning.

Background and aim: Epicardial adipose tissue (EAT) is a metabolically active visceral fat depot that plays an important role in the pathogenesis of coronary atherosclerosis. Due to its asymmetrical distribution, the relation between location-specific EAT measurements and coronary atherosclerosis remains unclear. Our study investigated the relationship between location-specific EAT volume and coronary atherosclerotic plaque burden that was detected by coronary computed tomography angiography (CCTA) in type 2 diabetic patients without coronary artery disease (CAD) history. Methods: A total of 157 consecutive diabetic patients who had undergone CCTA were included retrospectively. After evaluation of the CCTA images, the study population was divided into two groups according to the presence of coronary atherosclerosis. In both groups, total and left atrioventricular groove EAT volumes were measured. Results: Total and left atrioventricular groove EAT volumes were significantly associated with coronary atherosclerosis, but only left atrioventricular groove EAT volumes were an independent predictor for CAD. Also, total and left atrioventricular groove EAT volumes were positively correlated with C-reactive protein values (p = 0.0001/p = 0.0001) and the number of coronary atherosclerotic segments (p = 0.0001/p = 0.0001). Conclusions: Left atrioventricular groove EAT volume is an independent predictor of CAD in type 2 diabetic patients without CAD history. Left atrioventricular groove EAT volume may be used to identify type 2 diabetic patients who may require early CAD intervention because of the potential risk of coronary atherosclerosis.

WOS: 000379252100027, PubMed ID: 27085724, There have been many studies pertaining to the management of herpetic meningoencephalitis (HME), but the majority of them have focussed on virologically unconfirmed cases or included only small sample sizes. We have conducted a multicentre study aimed at providing management strategies for HME. Overall, 501 adult patients with PCR-proven HME were included retrospectively from 35 referral centres in 10 countries; 496 patients were found to be eligible for the analysis. Cerebrospinal fluid (CSF) analysis using a PCR assay yielded herpes simplex virus (HSV)-1 DNA in 351 patients (70.8%), HSV-2 DNA in 83 patients (16.7%) and undefined HSV DNA type in 62 patients (12.5%). A total of 379 patients (76.4%) had at least one of the specified characteristics of encephalitis, and we placed these patients into the encephalitis presentation group. The remaining 117 patients (23.6%) had none of these findings, and these patients were placed in the nonencephalitis presentation group. Abnormalities suggestive of encephalitis were detected in magnetic resonance imaging (MRI) in 83.9% of the patients and in electroencephalography (EEG) in 91.0% of patients in the encephalitis presentation group. In the nonencephalitis presentation group, MRI and EEG data were suggestive of encephalitis in 33.3 and 61.9% of patients, respectively. However, the concomitant use of MRI and EEG indicated encephalitis in 96.3 and 87.5% of the cases with and without encephalitic clinical presentation, respectively. Considering the subtle nature of HME, CSF HSV PCR, EEG and MRI data should be collected for all patients with a central nervous system infection. (C) 2016 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

WOS: 000384527500014, PubMed ID: 27625226, Aims: There is no report on the factors affecting the resolution of symptoms related to meningitis during treatment of tuberculous meningitis (TBM). Thus, we examined the factors associated with early therapeutic responses. Materials and Methods: This multicenter study included 507 patients with microbiologically confirmed TBM. However, 94 patients eligible for the analysis were included in this study from 24 centers. Six out of 94 patients died and the statistical analysis was performed with 88 survivors. Early and late responder groups were compared in the statistical analysis. P < 0.05 were considered to show a significant difference. Results: In the multivariate analysis, the presence of vasculitis (P = 0.029, OR = 10.491 [95% CI, 1.27u86.83]) was found to be significantly associated with a delayed fever response whereas hydrocephalus was associated with altered mental status for 9 days duration (P = 0.005, OR = 5.740 [95% CI, 1.68u19.57]). According to linear regression analysis, fever was significantly persisting (7 days) in the presence of vasculitis (17.5 vs. 7, P< 0.001) and hydrocephalus (11 vs. 7, P = 0.029). Hydrocephalus was significantly associated with persisting headache (21 vs. 12, P = 0.025), delayed recovery of consciousness (19.5 vs. 7, P = 0.001), and a delay in complete recovery (21 vs. 14, P = 0.007) in the linear regression analysis. Following institution of treatment, the complaints seemed to disappear in up to 2 weeks among TBM survivors. Conclusions: In the absence of hydrocephalus or vasculitis, one week of anti-tuberculosis treatment seems to be adequate for the resolution of TBM symptoms. Hydrocephalus and vasculitis delay the resolution of TBM symptoms in response to antimycobacterial treatment.

The data related to the distribution of other focal infections in central nervous system (CNS) infection patients is inconsistent in medical literature. Infectious Diseases International Research Initiative (ID-IRI) has been carrying on multicenter and multinational studies since 2008 and provided bulk of information on pneumococcal meningitis, brucellar meningitis, tuberculous meningitis, and herpetic meningoencephalitis as the largest case series in the literature. In this study, the databases of ID-IRI studies were reanalyzed and one fourth of pneumococcal and brucellar meningitis patients, and slightly less than half of tuberculous meningitis patients had another focal involvement out of CNS. Herpetic meningoencephalitis had only 7% coexistent other focal involvement. Consequently, the treating clinician should not undervalue the presence of another site of involvement in a CNS infection patient. Hence, diagnostic and therapeutic interventions for other site of involvement in due course of CNS infectious diseases should seriously be taken into consideration.

We presented an interstitial pneumonia case developed due to very rarely seen cytomegalovirus (CMV) in a 66 year-old female patient who had systemic lupus erythematosus (SLE). This patient who was on prednisolone and cyclophosphamide developed high fever, dyspnea and rales in lungs, high CRP, leukopenia, and thrombocytopenia after 11 days of cyclophosphamide treatment. Interstitial infiltration was detected in thoracic tomography. CMV antigen and CMV-DNA by RT-PCR were positive in blood. It was considered as CMV pneumonia. Ganciclovir treatment was started. CMV antigen became negative in the 14th days of the treatment. Clinical improvement was observed at the same time. It is necessary to remember CMV as the agents responsible for causing pneumonia due to high mortality in immunosuppressive host such as SLE. In the blood CMV antigen and CMV DNA investigation may contribute to the diagnosis in that bronchoalveolar lavage cannot be performed. J Microbiol Infect Dis 2011; 1(2): 80-83

Brucellosis is a zoonotic infection and has endemic characteristics. Neurobrucellosis is an uncommon complication of this infection. The aim of this study was to present unusual clinical manifestations and to discuss the management and outcome of a series of 18 neurobrucellosis cases. Initial clinical manifestations consist of pseudotumor cerebri in one case, white matter lesions and demyelinating syndrome in three cases, intracranial granuloma in one case, transverse myelitis in two cases, sagittal sinus thrombosis in one case, spinal arachnoiditis in one case, intracranial vasculitis in one case, in addition to meningitis in all cases. Eleven patients were male and seven were female. The most prevalent symptoms were headache (83%) and fever (44%). All patients were treated with rifampicin, doxycycline plus trimethoprim-sulfamethoxazole or ceftriaxone. Duration of treatment (varied 3-12 months) was determined on basis of the CSF response. In four patients presented with left mild sequelae including aphasia, hearing loss, hemiparesis. In conclusion, although mortality is rare in neurobrucellosis, its sequelae are significant. In neurobrucellosis various clinical and neuroradiologic signs and symptoms can be confused with other neurologic diseases. In inhabitants or visitors of endemic areas, neurobrucellosis should be kept in mind in cases that have unusual neurological manifestations. Keywords: neurobrucellosis, serology, diagnosis, neuroimaging