Correlation of myeloid-derived suppressor cells with C-reactive protein, ferritin and lactate dehydrogenase levels in patients with severe COVID-19.

The novel coronavirus disease 2019 (COVID-19) remains a global health emergency, and understanding the interactions between the virus and host immune responses is crucial to preventing its lethal effects. The expansion of myeloid-derived suppressor cells (MDSCs) in COVID-19, thereby suppressing immune responses, has been described as responsible for the severity of the disease, but the correlation between MDSC subsets and COVID-19 severity remains elusive. Therefore, we classified patients according to clinical and laboratory findings-aiming to investigate the relationship between MDSC subsets and laboratory findings such as high C-reactive protein, ferritin and lactate dehydrogenase levels, which indicate the severity of the disease. Forty-one patients with COVID-19 (26 mild and 15 severe; mean age of 49.7 ± 15 years) and 26 healthy controls were included in this study. MDSCs were grouped into two major subsets-polymorphonuclear MDSCs (PMN-MDSCs) and monocytic MDSCs-by flow cytometric immunophenotyping, and PMN-MDSCs were defined as mature and immature, according to CD16 expressions, for the first time in COVID-19. Total MDSCs, PMN-MDSCs, mature PMN-MDSCs and monocytic MDSCs were significantly higher in patients with COVID-19 compared with the healthy controls (P < .05). Only PMN-MDSCs and their immature PMN-MDSC subsets were higher in the severe subgroup than in the mild subgroup. In addition, a significant correlation was found between C-reactive protein, ferritin and lactate dehydrogenase levels and MDSCs in patients with COVID-19. These findings suggest that MDSCs play a role in the pathogenesis of COVID-19, while PMN-MDSCs, especially immature PMN-MDSCs, are associated with the severity of the disease.

[Evaluation of Annexin-1 (ANXA-1), Annexin-2 (ANXA-2) and Bone Morphogenetic Protein-7 (BMP-7) Serum Levels in Patients Followed Up With A Diagnosis of COVID-19]. / COVID-19 Tanisiyla Takip Edilen Hastalarda Annexin-1 (ANXA-1), Annexin-2 (ANXA-2) ve Kemik Morfogenetik Protein-7 (BMP-7) Serum Düzeyinin Degerlendirilmesi.

Coronavirus disease 2019 (COVID-19) is a global health problem caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). SARS-CoV-2 infection may present with clinical pictures ranging from asymptomatic or mild forms to respiratory failure requiring intensive care follow-up and mechanical ventilation. The course of this disease with different clinical presentations raises many immunological questions. This study aimed to evaluate the serum levels of Annexin-1 (ANXA-1), Annexin-2 (ANXA-2) and bone morphogenetic protein-7 (BMP-7) in patients diagnosed with COVID-19 and to investigate whether these markers are associated with lung involvement. The study was conducted in 173 patients who were followed and treated with the diagnosis of COVID-19 and 51 healthy control group. Patients were primarily divided into two groups based on the presence of typical lung involvement (ground glass opacities, consolidation, and both) in the thoracic computed tomography (CT) scans for COVID-19. Those who found to have involvement in thoracic CT scans were divided into three groups as mild (< 33%), moderate (34-66%), and severe (> 67%) according to the extent of their lesions. Of the 173 patients included in the study, 130 had typical thoracic CT involvement for COVID-19, while 43 did not. ANXA-1, ANXA-2 and BMP-7 values were found to be higher in the patients than the control group (p= 0.001, p= 0.001, p= 0.001). ANXA-2 levels were higher in patients with thoracic CT involvement than those without thoracic CT involvement (p= 0.023). In addition, when the patients were evaluated according to their thorax CT involvement levels, it was found that as the lung involvement levels increased, ANXA-2 increased, ANXA-1 decreased, and BMP-7 levels did not change. While the increase in ANXA-2 was statistically significant, the decrease in ANXA-1 was not found statistically significant. When the relationship between the laboratory parameters and the thorax CT involvement level was evaluated; it was found that , the lymphocyte and thrombocyte counts decreased as the thorax CT involvement increased, and lactate dehydrogenase (LDH), ferritin, procalcitonin (PCT), C-reactive protein (CRP), D-dimer and troponin levels were increased. While no significant correlation was found between ANXA-1 and BMP-7 and laboratory parameters, a positive correlation was found between ANXA-2 and leukocyte count, LDH, troponin, PCT, ferritin, D-dimer, and CRP. The data obtained in our study suggest that the ANXA-2 level at the time of admission was related with the lung involvement and the level of involvement of the disease. As a result, molecular studies are needed today to understand the pathogenesis of COVID-19 and to investigate new treatment targets. Evaluation of ANXA-2 level may be important in predicting the level of lung involvement due to COVID-19.

The role of CD8+ regulatory T cells and B cell subsets in patients with COVID-19.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has a wide clinical spectrum from asymptomatic to mild, moderate, and severe cases. There are still many unknowns about the role of immunoregulatory mechanisms in COVID-19. We aimed to study regulatory T cells (Tregs) and B cell subsets and evaluate their correlations with severity of COVID-19. METHODS: In total, 50 patients with COVID-19 confirmed by PCR (mean age = 49.9 ± 12.8 years) and 40 healthy control (mean age = 47.9 ± 14.7 years) were included in this study. The patients were classified as 14 mild (median age = 35.5 [24-73] years), 22 moderate (median age = 51.5 [28-67] years) and 14 severe (median age = 55.5 [42-67] years). Within 24 h of admission, flow cytometry was used to assess the lymphocyte subsets, Tregs and Bregs without receiving any relevant medication. RESULTS: In all patients with COVID-19, the proportion of CD3+CD8+ T cells was reduced (p = 0.004) and the CD8+ Tregs were increased compared with control (p = 0.001). While the levels of regulatory B cells, plasmablasts, and mature naive B cells were found to be significantly high, primarily memory B-cell levels were low in all patients compared with controls (p < 0.05). Total CD3+ T cells were negatively correlated with the length of stay in the hospital (r = -0.286, p = 0.044). DISCUSSION: The changes in T and B cell subsets may show the dysregulation in the immunity of patients with COVID-19. In this context, the association between CD8+ Tregs and COVID-19 severity may help clinicians to predict severe and fatal COVID-19 in hospitalized patients.

Relationship Between the Fibrinogen-to-Albumin Ratio and SYNTAX Score in Patients with Non-St-Elevation Myocardial Infarction.

BACKGROUND: Despite the association of fibrinogen-to-albumin ratio (FAR) with the extent, severity, and complexity of coronary artery disease (CAD) in patients with ST-elevation myocardial infarction (STEMI) and stable CAD, no studies to date have specifically addressed this issue in patients with non-STEMI (NSTEMI). OBJECTIVES: This study aimed to evaluate whether a relationship exists between FAR and the SYNergy between Percutaneous Coronary Intervention with TAXus (SYNTAX) score in patients with NSTEMI. METHODS: In this prospective cross-sectional study, 330 patients with NSTEMI who had undergone coronary angiography in an academic medical center were divided into two groups: those with an intermediate/high (≥23) SYNTAX score (241 patients) and those with a low SYNTAX score < 23 (89 patients). SYNTAX score was computed by two highly experienced cardiologists (who were blinded to the study data) using an online SYNTAX calculator. Fibrinogen and albumin levels were measured in all patients, and FAR was calculated. RESULTS: Multivariate logistic regression analysis showed that FAR (odds ratio [OR]: 1.478, 95% confidence interval [CI]: 1.089-2.133, p = 0.002), low-density lipoprotein (OR: 1.058, 95% CI: 1.008-1.134, p = 0.026), and troponin I (OR: 1.219, 95% CI: 1.015-1.486, p = 0.031) were independent predictors of the SYNTAX score. In a receiver operating characteristics analysis, a cutoff FAR value of 95.3 had an 83% sensitivity and an 86% specificity (area under the curve [AUC]: 0.84, p < 0.001) for the prediction of SYNTAX scores ≥23 in NSTEMI patients. CONCLUSION: These results indicate that FAR is a useful tool to predict intermediate-high SYNTAX scores in NSTEMI patients.

Impact of low molecular weight heparin administration on the clinical course of the COVID-19 disease

Background: Lymphopenia is the most important criterion of mortality and discharging feature for patients infected with coronavirus disease 2019 (COVID-19). This study aimed to investigate the clinical impact of a low molecular weight heparin (LMWH) treatment on the clinical course of COVID-19. Materials and methods: Patients' clinical symptoms, radiologic outcomes, hematologic, biochemical, D-dimer, and C-reactive protein (CRP) results were obtained from their medical records. Participants were separated into 2 groups: one was treated with LMWH and the other was not. Improvement in the patients was compared before and after treatment. Results: Ninety-six patients who were diagnosed with COVID-19 between April and May 2020 were retrospectively analyzed. The multivariable analysis showed that the count of lymphocytes, D-dimer, and CRP levels were significantly improved in the LMWH group, as compared to the control group (OR, (95% CI) 0.628 (0.248­0.965), P < 0.001); OR, (95% CI) 0.356 (0.089­0.674), P < 0.001, respectively). The area under the receiver operating characteristic (ROC) curve analysis was AUC: 0.679 ± 0.055, 0.615 ± 0.058, and 0.633 ± 0.057, respectively; the ß-value was found to be ­1.032, ­0.026, and ­0.465, respectively. Conclusion: The LMWH treatment group demonstrated better laboratory findings, including recovery in the lymphocyte count, CRP, and D-dimer results.

Relationship between Selvester ECG Score and Cardiovascular Outcomes in Patients with Non-ST Elevation Myocardial Infarction.

BACKGROUND: Early risk stratification plays a crucial role in the treatment of non-ST-elevation myocardial infarction (NSTEMI). Selvester score is an electrocardiography (ECG)-based method for estimating infarcted myocardial mass, however it has not been studied in NSTEMI before. In this study, we aimed to investigate the relationship between Selvester score and cardiovascular outcomes in a 1-year follow-up period in NSTEMI patients. METHODS: One hundred and forty-three consecutive patients with NSTEMI were analyzed. TIMI and GRACE risk scores were calculated accordingly. Selvester score was calculated on surface ECG as reported in prior studies. Syntax score was calculated using an online calculator. The study population was divided into two groups based on a cut-off value from receiver operating characteristic curve analysis for the discriminative ability of Selvester score for mortality: low score (≤ 4), and high score (> 4) groups. RESULTS: Age was higher, left ventricle ejection fraction and high-density lipoprotein-cholesterol levels were significantly lower, and TIMI, GRACE and SYNTAX scores were significantly higher in the high Selvester score group. In multivariate Cox regression analysis, ejection fraction [hazard ratio (HR): 0.926, 95% confidence interval (CI): 0.883-0.971, p = 0.002] and Selvester score > 4 (HR: 3.335, 95% CI: 1.306-8.503, p = 0.012) were found to be independent predictors of adverse events after 1 year of follow-up. CONCLUSIONS: Selvester score is a fast and feasible method that has prognostic value for mortality and other major adverse outcomes in low and intermediate risk NSTEMI patients treated with urgent percutaneous coronary intervention for 12 months.

Noninvasive cardiac output measurement based optimization in nonresponders of cardiac resynchronization therapy.

BACKGROUND: Cardiac resynchronization therapy (CRT) is an important and effective therapy for end-stage heart failure (HF). Nonresponse to CRT is one of the main obstacles to its application in clinical practice. Herein, we investigated the utilization of the optimization technique using noninvasive cardiac output measurement (NICOM) based Mobil-O-Graph device that measures several circulation parameters noninvasively. METHODS: Seventy-five CRT nonresponder HF patients with an implanted CRT device were included. Patients were randomized equally to 3 groups: NICOM, echocardiographic, and empirical optimization groups. After 3 months of optimization, changes in six minutes walk test (6-MWT), cardiac output (CO), left ventricular ejection fraction (LVEF), and end-systolic volume (LVESV) were measured. New York Heart Association (NYHA) class and hospitalization for HF were also determined. RESULTS: There were no statistically significant differences among the three groups in terms of demographics, baseline characteristics. In the NICOM group, the 6-MWT, LVEF, CO, and LVESV measurements showed significant improvements compared to baseline values (P < .05). There was no significant improvement in 6-MWT, LVEF, CO, NYHA class, and LVESV in Echo and Empirical groups after 3 months (P > .05). 6-MWT, CO, LVESV percentages, and hospitalization for HF were significantly different between the groups (P < .05). In post hoc analyzes, the percentages of the change in 6-MWT, CO, LVESV, and hospitalization for HF were significantly higher in the NICOM group (P < .017). CONCLUSIONS: This study suggests that Mobil-O-Graph device optimization according to CO measures does appear to have potential hemodynamic and clinical benefits in nonresponder CRT patients. Use of Mobil-O-Graph device as an option for optimization of CRT devices can be an attractive method of improving CRT outcomes.

Tp-e interval and Tp-e/QT ratio and their association with left ventricular diastolic dysfunction in Fabry disease without left ventricular hypertrophy.

INTRODUCTION: In the early stage of the Fabry disease, diastolic dysfunction can occur before left ventricular hypertrophy (LVH). Cardiovascular complications, most of which are seen as malignant arrhythmias and heart failure, are the leading causes of death in these patients. The aim of the present study was to assess repolarization parameters of Fabry patients in early stage (without LVH) and to show the relationship between these parameters and left ventricular diastolic dysfunction. METHODS: This cross-sectional single center study was carried out with newly diagnosed 23 Fabry patients and 20 healthy individuals, between April 2016 and September 2019. Diagnosis of Fabry disease was based on a measurement of enzyme activity in leukocytes and was confirmed by genetic analysis. Basic, demographic and clinical features were reviewed. The risk of ventricular arrhythmia was evaluated by calculating the electrocardiographic, the Tp-e and QT interval, corrected QT (QTc), Tp-e/QT and Tp-e/QTc ratios. Left ventricular systolic and diastolic dysfunctions were evaluated using echocardiography. RESULTS: Tp-e interval (86.9 ±â€¯6.2 vs. 73.8 ±â€¯6.3 ms; p < 0.001), Tp-e/QT ratio (0.23 ±â€¯0.008 vs. 0.21 ±â€¯0.01; p < 0.001) and Tp-e/QTc ratio (0.21 ±â€¯0.007vs. 0.18 ±â€¯0.017; p < 0.001) were significantly higher in Fabry patients than the control group. There was a significant positive correlation between Tp-e interval and E/e' ratio (r = 0.626, p = 0.003) and Tp-e/QTc ratio and E/e' ratio (r = 0.578, p = 0.008) in Fabry patients. CONCLUSION: Our study showed that the Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio, which are evaluated electrocardiographically in patients with pre-hypertrophic Fabry patients, are prolonged compared to normal healthy individuals. The most significant finding was the positive correlation found between repolarization parameters and LV diastolic dysfunction. These results may be indicative of an early subclinical cardiac involvement in Fabry patients, considering the diastolic dysfunction severity.

Evaluation of Tp-e interval and Tp-e/QT ratio in major burn patients.

INTRODUCTION: Major burn injury is an acute stress reaction with systemic effects. Major burn injury has been associated with a number of cardiovascular dysfunctions, including ventricular arrhythmias. The mechanism of increased ventricular arrhythmias in burn patients uncertain. The aim of the present study was to evaluate the ventricular repolarization by using the Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio as candidate markers of ventricular arrhythmias in patients with major burn patients. In addition, the relationship between the repolarization parameters and the CRP(C-reactive protein) and ABSI(Abbreviated Burn Severity Index) score was investigated. METHODS: 55 major burn patients, 55 age and sex matched healthy subjects were included in the study between January 2017 and September 2019. The risk of ventricular arrhythmias was evaluated by calculating the electrocardiographic Tp-e and QT interval, corrected QT(QTc), Tp-e/QT and Tp-e/QTc ratios. ABSI score was calculated in burn patients. Left ventricular functions were evaluated by echocardiography. RESULTS: Tp-e interval (80.7 ±â€¯5.7 vs. 67.4 ±â€¯5.7; p < 0.001), Tp-e/QT ratio (0.21 ±â€¯0.01 vs. 0.18 ±â€¯0.01; p < 0.001) and Tp-e/QTc ratio (0.20 ±â€¯0.01 vs.0.17 ±â€¯0.01; p < 0.001) were significantly higher in major burn patients than the control group. There was a significant positive correlation between Tp-e interval, Tp-e/QTc ratio and ABSI score in major burn patients (r = 0.870, p < 0.001, r = 0.312, p = 0.020 consecutively). CONCLUSION: Our study showed for the first time in literature that the Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio, which were evaluated electrocardiographically in major burn patients, were prolonged compared with normal healthy individuals. A positive correlation was determined between repolarization parameters and ABSI score. Whether these changes increase the risk of ventricular arrhythmia deserve further studies. TAKE-HOME MESSAGE: Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio, which were evaluated electrocardiographically in major burn patients, were prolonged compared with normal healthy individuals and a positive correlation was found between these repolarization parameters and burn severity.

Frontal QRS-T angle predicts syntax score in patients with non-ST elevation myocardial infarction.

BACKGROUND: Early risk stratification based on SYNTAX score plays a crucial role to identify the need for early invasive strategy in patients with NSTEMI. The predictive role of frontal QRS-T angle [f(QRS-T)] on the atherosclerotic burden of CAD is less clear in NSTEMI patients. In this study, we aimed to investigate the relationship between f(QRS-T) and SYNTAX score in NSTEMI patients. METHODS: A total of consecutive 269 patients with the diagnosis of NSTEMI transferred to coronary care unit were included in the study. f(QRS-T) was calculated as the absolute value of the difference between the frontal plane QRS and T axes based on automatic report of ECG machine. Syntax score was computed using an online SYNTAX score calculator by well-experienced two cardiologists blinded to the study data. The study population was divided into two groups based on the SYNTAX score low SYNTAX score (≤23), and high SYNTAX score (>23). RESULTS: Left ventricle ejection fraction (LVEF) (p = 0.001), hemoglobin (p = 0.03) and HDL-C (p = 0.04) levels were lower in the intermediate-high SYNTAX group. Age (72.1 ± 12.5 vs. 64.6 ± 9.4 respectively; p < 0.001), LAD as infarct-related artery 30 (%65.2) vs. 50 (%29.1) respectively; (p = 0.001), f(QRS-T) (100.5 ± 55.3 vs. 65.1 ± 53.1 respectively p = 0.006), troponin I peak (p = 0.06) were higher among patients with intermediate-high Syntax score. In receiver-operating characteristic (ROC) curve analysis, the value for f(QRS-T) to detect syntax score ≥ 23 with a sensitivity of 77% and specificity of 63% was 73,5° in NSTEMI patients(AUC = 0.69). Univariate logistic regression analysis identified that age, LVEF, HDL-C, hemoglobin, infarct-related artery, f(QRS-T) were significantly associated with SYNTAX score. Multivariate logistic regression analysis showed that age (OR: 1.135, 95% CI: 1.039-1.153, p = 0.045), infarct related artery-LAD (OR: 2.897, 95% CI: 1.023-8.209, p = 0.001) and f(QRS-T) (OR: 3.587, 95% CI: 1.093-11.772, p = 0.001) were the independent predictors of SYNTAX score. CONCLUSION: In NSTEMI patients, f(QRS-T) has been found to be a useful decision-making tool to predict SYNTAX score to assess early invasive strategy.

Evaluation of electrocardiographic ventricular repolarization variables in patients with newly diagnosed COVID-19.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is a newly recognized infectious disease that has spread rapidly. COVID-19 has been associated with a number of cardiovascular complications, including arrhythmias. The mechanism of ventricular arrhythmias in patients with COVID-19 is uncertain. The aim of the present study was to evaluate the ventricular repolarization by using the Tp-e interval, QT dispersion, Tp-e/QT ratio, and Tp-e/QTc ratio as candidate markers of ventricular arrhythmias in patients with newly diagnosed COVID-19. In addition, the relationship between the repolarization parameters and the CRP (C-reactive protein) was investigated. METHODS: 75 newly diagnosed COVID-19 patients, 75 age and sex matched healthy subjects were included in the study between 20th March 2020 and 10th April 2020. The risk of ventricular arrhythmias was evaluated by calculating the electrocardiographic Tp-e and QT interval, Tp-e dispersion, corrected QT(QTc), QT dispersion (QTd), corrected QTd, Tp-e/QT and Tp-e/QTc ratios. CRP values were also measured in patients with newly diagnosed COVID-19. RESULTS: Tp-e interval (80.7 ±â€¯4.6 vs. 70.9 ±â€¯4.8; p < .001), Tp-e / QT ratio (0.21 ±â€¯0.01 vs. 0.19 ±â€¯0.01; p < .001) and Tp-e/QTc ratio (0.19 ±â€¯0.01 vs.0.17 ±â€¯0.01; p < .001) were significantly higher in patients with newly diagnosed COVID-19 than the control group. There was a significant positive correlation between Tp-e interval, Tp-e/QTc ratio and CRP in patients with newly diagnosed COVID-19 (rs = 0.332, p = .005, rs = 0.397, p < .001 consecutively). During their treatment with hydroxychloroquine (HCQ), azithromycin and favipiravir, ventricular tachycardia episodes were observed in in two COVID-19 patients during their hospitalization in the intensive care unit. CONCLUSION: Our study showed for the first time in literature that the Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio, which are evaluated electrocardiographically in patients with newly diagnosed COVID-19, were prolonged compared with normal healthy individuals. A positive correlation was determined between repolarization parameters and CRP. We believe that pre-treatment evaluation of repolarization parameters in newly diagnosed COVID-19 would be beneficial for predicting ventricular arrhythmia risk.

Effect of diode laser application as an adjunct to nonsurgical periodontal therapy on the reduction of red complex microorganisms in type 2 diabetics with chronic periodontitis.

Bactericidal and detoxification effects of diode laser (DL) have been reported in periodontal treatment. The objective of this study was investigating the additional effect of DL with nonsurgical periodontal treatment on the red complex bacteria in type 2 diabetes mellitus (DM) patients with chronic periodontitis (CP). Sixty type 2 DM patients with chronic periodontitis (CP) were randomly assigned in two parallel groups to receive scaling root planning (SRP, n = 30) or SRP followed by DL periodontal pocket irradiation (SRP + DL, n = 30). Recording of clinical parameters and subgingival plaque sampling were performed at baseline, and post therapy (1 and 3 months after treatment). Amounts of Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia were evaluated with quantitative RT-PCR. Significant reductions for numbers of all three bacterial species were observed at 1 and 3 months compared with baseline for both treatments (p < 0.001), but no significant differences were found between two groups regarding bacterial reductions at these follow-up time points. No additional benefit of DL as an adjunct to nonsurgical periodontal therapy was recognized in the reduction of P. gingivalis, T. denticola, and T. forsythia for type 2 DM patients with CP. Further studies are required to clarify the effects of diode laser on the other periodontopathogens.

[Investigation of Antibiotic Resistance and Virulence Factors of Enterococcus faecium and Enterococcus faecalis Strains Isolated from Clinical Samples]. / Klinik Örneklerden Izole Edilen Enterococcus faecium ve Enterococcus faecalis Izolatlarinin Antibiyotik Direnci ve Virülans Faktörlerinin Arastirilmasi.

Enterococci, which are commonly found in the environment, cause serious infections despite the absence of well-defined virulence factors and toxins. Knowing the virulence properties of enterococci is important to understand the complex pathogenic structures. In this study, we aimed to investigate the virulence factors (asa1, hyl, cylA, efa, ebp, ace, esp, gelE, sprE, fsrA, fsrB, fsrC genes, gelatinase activity, hemolysin, hydrogen peroxide and biofilm production) and antibiotic resistance of Enterococcus faecium and Enterococcus faecalis strains isolated from clinical specimens. A total of 110 enterococcus isolates which were accepted as infectious agents were included in the study. The polymerase chain reaction method was used to identify the isolates and to detect virulence genes. Characteristics of hemolysis, biofilm formation, hydrogen peroxide production and gelatinase activity were investigated by phenotypic methods. The antibiotic susceptibility test was performed with VITEK 2 automated system. E.faecalis ATCC 29212 standard strain was used as a quality control in all tests. Of the 110 enterococci isolates included in the study, 61 were identified as E.faecium and 49 as E.faecalis. The efa gene was the most frequently detected virulence gene (92.7%), followed by ace (83.6%), esp (66.4%), ebp (60.0%), cylA (50.9%), hyl (46.4%), asa1 (45.5%), gelE, sprE, fsrC (33.6%), fsrA (12.7%) and fsrB (11.8%). All genes except hyl were higher in E.faecalis isolates and the difference was statistically significant (p<0.05). Twenty-five (51%) E.faecalis and 1 (1.6%) E.faecium isolates had beta-hemolysis and the difference was statistically significant (p= 0.000). Seven (11.5%) E.faecium and 4 (8.2%) E.faecalis isolates formed biofilm, but the difference was not statistically significant (p> 0.05). Two (3.3%) E.faecium and 14 (28.6%) E.faecalis isolates exhibited gelatinase activity and the difference between the two species was statistically significant (p= 0.000). Hydrogen peroxide production was not detected in any of the isolates. The highest resistance rate was determined against ciprofloxacin (70.9%). The resistance to ampicillin was 69.1%, high level streptomycin 65.1%, high level gentamicin 39.4%, vancomycin and teicoplanin 4.5%, and linezolid 1.8%. In conclusion, our data indicated that virulence factors except hyl gene and biofilm production were higher in E.faecalis isolates but E.faecium isolates were more resistant to antibiotics. In order to prevent infection of such virulent or resistant isolates in the hospital setting, infection control measures must be followed. In vivo studies are needed for the better understanding of the virulence of enterococci.

[Evaluation of Patients Diagnosed with COVID-19 in Terms of Risk Factors]. / COVID-19 Tanili Hastalarin Risk Faktörleri Açisindan Degerlendirilmesi.

Coronaviruses are RNA viruses that can cause disease in the upper and lower respiratory tract in humans and animals. Lately, a new coronavirus causing pneumonia cases was detected in Wuhan, China in December 2019. Soon after, the name of the virus was identified as the "severe acute respiratory syndrome coronavirus-2", and the World Health Organization named the disease coronavirus disease-2019 (COVID-19). In our country, the first cases began to appear in the second week of March. In this study, we aimed to investigate the demographic characteristics and risk factors of patients with the diagnosis of COVID-19. A total of 100 patients (53 female and 47 male) were included in our study. The patients included in the study were randomly selected from the registration system and their information was evaluated retrospectively. The mean age of the patients was 54.42 (Age range= 20-90). When the risk factors for catching the disease were evaluated; it was determined that there was at least one risk factor in 46 patients; 30 patients had close contact with the COVID-19 patient in the social environment (30%) and 16 patients had a travel history outside the city in the last 14 days (16%). The most common symptoms in our patients were; cough (93%), fever (42%), dyspnea (22%), weakness (8%), sore throat (7%), diarrhea (6%), headache (5%) and sputum (2%). The most common comorbid conditions in our patients were detected as hypertension (42%), diabetes mellitus (DM) (21%), congestive heart failure (10%), allergic asthma (7%), chronic obstructive pulmonary disease (6%), rheumatoid arthritis (3%), coronary artery disease (2%), solid organ tumour (2%), depression (1%) and epilepsy (1%). The mean age of our 15 patients who were monitored in intensive care unit was 65 y (± 11.46), the mean age of 85 patients followed in the service was 52.55 (± 16.35) and this difference was statistically significant (p= 0.006). When these two groups were compared in terms of comorbid diseases, the presence of DM was 40% higher (n= 6) in intensive care patients, and this difference was statistically significant (p= 0.05). In addition, the majority [11 patients (73%)] of the patients hospitalized in the intensive care unit were male (p= 0.03). When smoking was evaluated as a risk factor for serious illness, 4 of 11 patients (26%) in intensive care unit had a smoking history, while none of the patients who have died due to COVID-19 had a smoking history. These findings suggested to us that smoking does not increase the severity of COVID-19 disease. As a result, knowledge about the disease should be increased rapidly by sharing the studies on risk factors, transmission routes and clinical features of COVID-19 infection, which affects the whole world.

Comparative evaluation of salivary microbial levels and periodontal status of patients wearing fixed and removable orthodontic retainers.

INTRODUCTION: The purpose of this study was to compare and evaluate salivary microbial levels and periodontal status in patients using a fixed lingual retainer, a removable vacuum-formed retainer, or a Hawley retainer after orthodontic treatment with fixed appliances. METHODS: Forty-five patients who finished their orthodontic treatment with fixed appliances and were about to start the retention phase were randomly divided into the following 3 groups of 15 individuals each: the fixed lingual retainer group, the vacuum-formed retainer group, and the Hawley retainer group. Periodontal measurements, such as the plaque index, gingival index, probing depth, and bleeding on probing, were obtained at the following 4 time points: at debonding (T0) and 1 week (T1), 5 weeks (T2), and 13 weeks (T3) after debonding. Saliva samples were collected 3 times in total: at T0, T2, and T3. A quantitative analysis for Streptococcus mutans and Lactobacillus casei was performed with the use of real-time polymerase chain reaction. The Kruskal-Wallis test and 1-way analysis of variance were used for the statistical comparisons of the groups. RESULTS: No statistically significant difference in salivary S mutans and L casei levels was found among the 3 groups (P >0.05). They showed no statistically significant differences in plaque index, gingival index, bleeding on probing, and probing depth values (P >0.05). All periodontal parameters showed statistically significant decreases from T0 to T3 in all 3 groups (P <0.001). The S mutans and L casei levels were decreased significantly from T2 to T3 in the lingual retainer and Hawley retainer groups, whereas they decreased significantly from T0 to T3 in the vacuum-formed retainer group. CONCLUSIONS: Fixed and removable orthodontic retainers do not differ in salivary S mutans and L casei levels and periodontal status. With all retainers, regardless of whether they are fixed or removable, oral hygiene improved after orthodontic treatment with fixed appliances.

[Investigation of Streptococcus pyogenes virulence factors and typing by multiple locus variable number tandem repeat fingerprinting (MLVF) method]. / Streptococcus pyogenes izolatlarinin virülans faktörlerinin arastirilmasi ve "multiple locus variable number tandem repeat fingerprinting (MLVF)" yöntemi ile tiplendirilmesi.

Streptococcus pyogenes is an important bacterial pathogen that colonizes the throat and skin of human beings and causes a wide variety of diseases ranging from mild infections like pharyngitis, tonsillitis and impetigo to severe invasive infections such streptococcal toxic shock syndrome, septicemia, and necrotizing fasciitis, and produces a wide variety of virulence factors. The aim of this study was to investigate the antibiotic resistance, virulence genes; [pyrogenic exotoxin genes (speA, C, G, H, I, J, K, L, M, smeZ and ssa), deoxyribonuclease genes (sdaB, spd3, sdc ve sdaD), protease genes (speB, spyCEP ve scpA) and inhibitor genes (mac and sic)] of S.pyogenes strains isolated from throat cultures of patients with symptomatic tonsillo-pharyngitis and typing by multiple locus variable number tandem repeat fingerprinting (MLVF) method. One hundred and fifty S.pyogenes isolates were identified by conventional methods and streptococcus group A latex kit (Biomerieux, France). Antibiotic susceptibility tests were performed by Kirby-Bauer disk diffusion method as recommended by Clinical and Laboratory Standards Institute. DNA isolation was performed by using a commercial DNA isolation kit (Qiagen, Germany) in accordance with manufacturer's recommendations. The virulence genes were determined by multiplex PCR. MLVF method was performed with multiplex PCR using specific primers for repeated sequences within bacterial genome. All of the S.pyogenes isolates were susceptible to penicillin G, cefotaxime, ceftriaxone, chloramphenicol, clindamycin, erythromycin, levofloxacin, vancomycin and linezolid. Among streptococcal pyrogenic exotoxin genes the most frequent gene was smeZ (90.0%) followed by speG (88.0%), speC (58.7%), ssa (42.7%), speA (33.3%), speJ (24.0%), speK (18.7%), speH (14.0%), speI (13.3%), speL and speM (9.3%). Of the DNase genes, sdaB was detected in all strains (100%), spd3, sdc, sdaD genes were determined as 64.7%, 36.0%, 24.7% respectively. Protease genes (speB, spyCEP, scpA) and mac gene from the inhibitor genes were positive in all strains, and sic gene was positive in only 3 (2.0%) of the isolates. Thirty-two different patterns that contained two or more isolates were determined by MLVF analysis. Ninety one isolates were included in any of the 32 different patterns, while 59 isolates were defined as sporadic isolates. In conclusion, S.pyogenes isolates collected from throat cultures of patients with symptomatic tonsillo-pharyngitis in Konya/Turkey were susceptible to all antibiotics studied and have carried a very high rate of virulence factors. However the isolates were mostly clonally unrelated and sporadic. This study is the first report in Turkey, in which S.pyogenes isolates were typed by the MLVF method and a large number of virulence factors were investigated.

[Investigation of various virulence factors of Klebsiella pneumoniae strains isolated from nosocomial infections]. / Hastane enfeksiyonu etkeni Klebsiella pneumoniae izolatlarinda çesitli virülans faktörlerinin arastirilmasi.

Klebsiella pneumoniae is an opportunistic pathogen that commonly affects immunosuppressed patients and causes nosocomial infections. K.pneumoniae has a variety of virulence factors, especially capsule polysaccharide, hypermucoviscosity (HV), fimbriae, toxins and determinants for iron acquisition. The aim of this study was to detect the virulence factors in K.pneumoniae strains isolated from nosocomial infections in two years. Fifty three K.pneumoniae strains isolated from the samples of patients with nosocomial infections in the Medical Microbiology Laboratory of Selcuk University Faculty of Medicine Hospital between 2011 and 2013 were included in the study. Identification and antimicrobial susceptibilities of the isolates were performed by VITEK 2 automatic system. Biofilm formation,α-hemolysin, capsule and HV were investigated by phenotypic methods. Polymerase chain reaction (PCR) was used to detect virulence genes encoding adhesins (fimH-1, mrkD, kpn, ycfM), siderophores (entB: enterobactin, iutA: aerobactin, irp-1, irp-2, ybtS, fyuA: yersiniabactin, iroN: catechols receptor), protectines or invasins (rmpA, magA, traT) and toxins (hlyA, cnf-1). Of the 53 K.pneumoniae isolates,12 (22.6%) were isolated from in patients of reanimation intensive care unit, 8 (15.1%) medical oncology, 7 (13.2%) newborn intensive care unit and 26 (49%) other clinics. The distribution of the isolates according to the samples was as follows: urine (n= 14), blood (n= 13), wound (n= 8), drainage fluid (n= 10), broncho-alveolar lavage (n= 7), and cerebrospinal fluid (n= 1). Isolates which were resistant to meropenem were 5.7% and production of extended spectrum beta-lactamase (ESBL) was 71.7%. The capsule, biofilm formation, and HV were observed in 100%, 79.2%, and 1.9% of the isolates, respectively. Production of α-hemolysin was not detected in any of the isolates. The genes; entB (96.2%), ycfM (86.8%), and mrkD (83.0%) showed high prevalence. The other genes were detected in different ratios: fimH-1 (64.2%), fyuA (54.7%), kpn (49.1%), ybtS (41.5%), irp-1(41.5%), irp-2 (37.7%), traT (11.3%) and iutA (5.7%). Virulence genes; iroN, rmpA, magA, hlyA and cnf-1 were not detected in any of the isolates. Enterobactin had the highest rate among siderophores, and ycfM and mrkD in adhesins. The capsule and biofilm formation were commonly found in the isolates. Hypermucoviscosity was only found in one isolate but associated genes were not detected. Alfa hemolysin production and hlyA gene were not determined. As a result, it seems that the basis of the pathogenicity of K.pneumoniae strains isolated from nosocomial infections are capsule, adhesins, enterobactin and ability of biofilm formation. There is a need for new studies for the continuous monitoring of toxin and invasion ability as well as antibiotic resistance in the control of hospital infection caused by K.pneumoniae.

Identification and antifungal susceptibility of Candida species isolated from bloodstream infections in Konya, Turkey.

BACKGROUND: In this study, our aim was to identify Candida species isolated from bloodstream infections and to determine their susceptibilities to various antifungal agents to demonstrate the local resistance profiles and to guide empirical treatment for clinicians. METHODS: Two hundred Candida isolates (95 Candida albicans, 105 non-albicans Candida strains) were included in the study. Candida species were identified by conventional, biochemical and molecular methods. Antifungal susceptibility tests for amphotericin B, fluconazole, voriconazole, posaconazole, caspofungin and anidulafungin were performed with broth microdilution method according to the Clinical and Laboratory Standards Institute M27-A3 document. RESULTS: Of the 200 Candida strains, the most prevalent species were C. albicans (47.5 %), Candida glabrata (18.0 %) and Candida parapsilosis complex (14.0 %). All Candida species except for three (1.5 %) Candida kefyr strains were susceptible to amphotericin B. Only one (2.8 %) C. glabrata was resistant to fluconazole (MIC ≥ 64 µg/ml), and the others (97.2 %) exhibited dose-dependent susceptibility. All species, but C. glabrata strains, were susceptible to fluconazole. Resistance to voriconazole, posaconazole, caspofungin and anidulafungin was not detected in any strain. CONCLUSION: Candida albicans were susceptible to all antifungal drugs. Three C. kefyr strains were resistant to amphotericin B. Only one C. glabrata was resistant to fluconazole. All the strains were susceptible to voriconazole, posaconazole, caspofungin and anidulafungin. In vitro antifungal susceptibility tests should be performed to select of appropriate and effective antifungal therapy, and monitor the development of resistance.

Increased Platelet-to-Lymphocyte Ratios and Low Relative Lymphocyte Counts Predict Appropriate Shocks in Heart Failure Patients with ICDs.

BACKGROUND: Platelet-to-lymphocyte ratio (PLR) and relative lymphocyte count (L%) are commonly available tests that can be obtained from complete blood count. The aim of this study was to investigate the association between appropriate defibrillator therapy and PLR, and whether decreased lymphocyte count may predict appropriate implantable cardioverter defibrillator (ICD) shocks in heart failure (HF) patients. METHODS: A total of 147 patients with ischemic or non-ischemic HF who underwent ICD implantation for primary prevention were enrolled in this study. Peripheral venous blood samples were drawn on the same day as ICD implantation. White blood cell counts with differentials, red blood cell indices, and platelet counts were calculated with an automated blood cell counter. All patients were evaluated according to the presence of appropriate ICD therapy. RESULTS: Baseline ejection fraction was significantly lower in the appropriate shock received group (p = 0.040). Median PLR was significantly higher and L% was significantly lower in the appropriate shock received group (p < 0.001). In both ischemic and non-ischemic HF groups, median L% was significantly lower in the appropriate shock received group (p < 0.001; p = 0.006, respectively). In multivariable logistic regression analysis, only L% showed a strong association with appropriate shock therapy (p < 0.001). CONCLUSIONS: Higher PLRs are related to appropriate shocks in patients that received ICD with lower EF. Furthermore, decreased L% is independently associated with appropriate shocks in HF.

Relationship between retinopathy and asymptomatic atherosclerosis determined by measurement of carotid intima-media thickness in patients with type 2 diabetes mellitus.

OBJECTIVE: Presence of diabetic retinopathy (DR) may be used as an early marker of atherosclerosis in type 2 diabetes mellitus (DM) patients. This study aimed to investigate the relationship between the presence of DR and carotid intima-media thickness (CIMT), which is an indicator of early atherosclerosis in patients with type 2 DM. METHODS: Thirty DM patients with retinopathy (DR group), 28 DM patients without retinopathy (non-DR group), and 27 healthy controls (control group) were included in the study. CIMT was assessed using a high-resolution B-mode ultrasonography device. RESULTS: Mean CIMT was found to be 0.9±0.17 mm in the DR group, 0.8±0.16 mm in the non-DR group, and 0.7±0.13 mm in the control group. CIMT was found to be statistically significantly higher in the DR group compared to the other 2 groups (p<0.001). When multivariate analysis was performed, presence of DR still remained as an independent risk factor for increased CIMT values. CONCLUSION: Presence of DR in type 2 DM patients is an independent risk factor in terms of increased CIMT, which is considered to be a finding of subclinical atherosclerosis. Therefore, we believe that type 2 DM patients with retinopathy should be closely followed in terms of cardiovascular events.