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We aimed to investigate the relationship among probable sarcopenia, osteoporosis (OP) and supraspinatus tendon (SSP) tears in postmenopausal women. Postmenopausal women screened/followed for OP were recruited. Demographic data, comorbidities, exercise/smoking status, and handgrip strength values were recorded. Probable sarcopenia was diagnosed as handgrip strength values < 20 kg. Achilles and SSP thicknesses were measured using ultrasound. Among 1443 postmenopausal women, 268 (18.6%) subjects had SSP tears. Unilateral tears were on the dominant side in 146 (10.1%) and on the non-dominant side in 55 women (3.8%). In contrast to those without, women with SSP tears had older age, lower level of education, thinner SSP and lower grip strength (all p < 0.05). In addition, they had higher frequencies of hypertension, hyperlipidemia, DM, OP and probable sarcopenia, but lower exercise frequency (all p < 0.05). Binary logistic regression modeling revealed that age [odds ratio (OR): 1.046 (1.024-1.067 95% CI)], hypertension [OR: 1.560 (1.145-2.124 95% CI)], OP [OR: 1.371 (1.022-1.839 95% CI)] and probable sarcopenia [OR: 1.386 (1.031-1.861 95% CI)] were significant predictors for SSP tears (all p < 0.05). This study showed that age, presence of hypertension, probable sarcopenia and OP were related with SSP tears in postmenopausal women. To this end, although OP appeared to be related to SSP tears, SSP tear/thickness evaluation can be recommended for OP patients, especially those who have other risk factors such as older age, higher BMI, hypertension, and probable sarcopenia.
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Hipertensión , Osteoporosis , Lesiones del Manguito de los Rotadores , Sarcopenia , Humanos , Femenino , Manguito de los Rotadores/patología , Sarcopenia/complicaciones , Sarcopenia/epidemiología , Sarcopenia/patología , Fuerza de la Mano , Posmenopausia , Lesiones del Manguito de los Rotadores/complicaciones , Lesiones del Manguito de los Rotadores/patología , Osteoporosis/patología , Hipertensión/patologíaRESUMEN
INTRODUCTION: Although different dual-energy X-ray absorptiometry (DXA) scanners provide different bone mineral density (BMD) values, there is not a gold standard DXA scanner. T-score is used to facilitate the interpretation of BMD, and osteoporosis (OP) is diagnosed based on T-scores. In this retrospective study, we aimed to evaluate the BMD and T-score differences between Lunar Prodigy and Hologic Horizon DXA scanners. METHODOLOGY: Data were collected for patients with previous BMD measurement on Lunar Prodigy and Hologic Horizon DXA scanners within one year in the same medical center. RESULTS: In a total of 55 patients, BMD values of femoral neck/total, and lumbar vertebrae were all lower at Hologic than Lunar (all pâ¯<â¯0.01). The mean T-score difference at the lumbar spine was 0.74⯱â¯0.42 (pâ¯<â¯0.001). Of the 49 patients diagnosed as OP (T-score ≤-2.5) with the Hologic, the diagnoses were changed for 25 individuals (51.0â¯%) with Lunar (pâ¯<â¯0.001). Herewith, although the diagnoses of OP did not change by the repeat technique in other 24 patients (49â¯%), 13 of them (26.5â¯%) were categorized as having "high fracture risk" instead of "very high fracture risk" group (i.e., T-score <-3.0). We observed moderate-to-good reliabilities (with an intraclass correlation coefficient [ICC] of 0.633-0.878 and 0.733-0.842 for BMD and T-scores, respectively) between measurements with the Lunar and Hologic scanners. Except for one measurement in L3, L4, L1-4 vertebrae, the Bland-Altman plot did not reveal any consistent bias between the measurements of the Lunar and Hologic scanners. CONCLUSIONS: The consistency between different DXA scanners (especially for Hologic vs. Lunar) is important for proper management, especially in patients with low T-scores and OP.
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BACKGROUND: The consistency of pituitary adenomas affects the course of surgical treatment. PURPOSE: To evaluate the diagnostic capabilities of radiomics based on T1-weighted (T1W) and T2-weighted (T2W) magnetic resonance imaging (MRI) in conjunction with two machine-learning (ML) techniques (support vector machine [SVM] and random forest classifier [RFC]) for assessing the consistency of pituitary adenomas. MATERIAL AND METHODS: The institutional database was retrospectively scanned for patients who underwent surgical excision of pituitary adenomas. Surgical notes were accepted as a reference for the adenoma consistency. Radiomics analysis was performed on preoperative coronal 3.0T T1W and T2W images. First- and second-order parameters were calculated. Inter-observer reproducibility was assessed with Spearman's Correlation (ρ) and intra-observer reproducibility was evaluated with the intraclass correlation coefficient (ICC). Least absolute shrinkage and selection operator (LASSO) was used for dimensionality reduction. SVM and RFC were used as ML methods. RESULTS: A total of 52 patients who produced 206 regions of interest (ROIs) were included. Twenty adenomas that produced 88 ROIs had firm consistency. There was both inter-observer and intra-observer reproducibility. Ten parameters that were based on T2W images with high discriminative power and without correlation were chosen by LASSO. The diagnostic performance of SVM and RFC was as follows: sensitivity = 95.580% and 92.950%, specificity = 83.670% and 88.420%, area under the curve = 0.956 and 0.904, respectively. CONCLUSION: Radiomics analysis based on T2W MRI combined with various ML techniques, such as SVM and RFC, can provide preoperative information regarding pituitary adenoma consistency with high diagnostic accuracy.
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Adenoma , Neoplasias Hipofisarias , Humanos , Neoplasias Hipofisarias/diagnóstico por imagen , Neoplasias Hipofisarias/cirugía , Neoplasias Hipofisarias/patología , Estudios Retrospectivos , Reproducibilidad de los Resultados , Imagen por Resonancia Magnética/métodos , Adenoma/diagnóstico por imagen , Adenoma/cirugía , Adenoma/patologíaRESUMEN
The aim of this study was to investigate the frequency of Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and Mycoplasma genitalium in men living with HIV in terms of sociodemographic characteristics and behavioral risk factors. In this cross-sectional, single center study, all HIV-infected male patients, aged ≥ 18 years, including those being followed-up (n= 142) and the new admissions (n= 16) at Hacettepe University, Department of Infectious Diseases between March 1st, 2017 and May 1st, 2018 were included. After obtaining the informed consent form; age, follow-up days in STI-clinic, marital status, education, employment status; STI-related sign and symptoms, prior STI diagnosis, multiple sexual partners during the last year, exchanging sex for money, sexual orientation, drug use, condom use with regular and casual partner and also risk factors regarding partners were inquired as behavioural risk factors. A sample of first-voided urine of each participant was tested for the presence of Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and Mycoplasma genitalium by using nucleic acid amplification test (NAAT) (BD-MAX system, BD Diagnostics, USA) and BD MAX Mycoplasma-Ureaplasma-OSR for BioGX, (BD Diagnostics, The Netherlands). All participants living with HIV, men who have sex with men (MSM) and heterosexual men were grouped as STI-positive and STI-negative and compared. For all statistical analysis, SPSS 24 software was used. During the period of 14 months; the data was determined as follows: median follow-up time was 1138 (IQR= 159.5- 1494.5) days, median age was 35 (IQR= 28-42) years, 73.3% were single, 68.3% were at least college graduates or had higher educational attainment, 78.1% were currently employed. Of the participants, 26.9% reported STI-related sign and symptoms, 50.0% at least one STI episode in the past. Nine (5.6%) M.genitalium, five (3.1%) N.gonorrhoeae, and four (2.5%) C.trachomatis were detected in the urine samples of 17 (10.7%) individuals. N.gonorrhoeae and C.trachomatis were detected simultaneously in only one patient's urine sample. STI-positive patients (n= 17) were determined to be younger compared to STI-negative group [(p= 0.02; 27 years (IQR= 24-37) vs 35 years (IQR= 28-42)], had prominent STI-related signs and symptoms (p< 0.001) and had more multiple sexual partners (p= 0.03). The median CD4+ T lymphocyte count were relatively lower (p= 0.03) in STI-positive patients and plasma HIV RNA level was higher compared to the STI-negative participants (p= 0.05). STI-positive MSM group were younger [p= 0.01; 26 years (IQR= 23.5-29) vs 33 years, (IQR= 28-40)], STI-related signs and symptoms were more prominent (p= 0.02), the frequency of exchanging sex for money/drugs among their partners (p= 0.03) was higher compared to their STI-negative counterparts. Among STI-positive heterosexual patients, the presence of STI-related signs and symptoms (p= 0.04), drug use among their partners (p= 0.04) and plasma HIV RNA level (p<0.01) were significantly higher. STI was identified as an important health problem in this series of men living with HIV, 63.0% of whom had MSM and had a relatively high education level and socioeconomic status. Young age, having multiple partners, drug use, exchanging sex for money/drugs were prominent among the participants and their partners. Public health studies should focus on preventing STIs in young people living with HIV who have behavioral risk factors.
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Infecciones por Chlamydia , Infecciones por VIH , Mycoplasma genitalium , Minorías Sexuales y de Género , Enfermedades de Transmisión Sexual , Trichomonas vaginalis , Humanos , Masculino , Femenino , Adolescente , Adulto , Chlamydia trachomatis/genética , Trichomonas vaginalis/genética , Neisseria gonorrhoeae/genética , Mycoplasma genitalium/genética , Homosexualidad Masculina , Estudios Transversales , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/diagnóstico , Factores de Riesgo , Infecciones por Chlamydia/complicaciones , Infecciones por Chlamydia/epidemiología , Infecciones por Chlamydia/diagnóstico , PrevalenciaRESUMEN
BACKGROUND: Sars-CoV-2 infection influences older individuals at the forefront, and there is still limited data on the COVID-19 vaccine response in the geriatric population. This study aimed to assess antibody response after vaccination with SARS-CoV-2 inactivated vaccine and examine possible factors affecting this response in a geriatric population. METHODS: individuals who have been on at least the 28th day after the second dose of the COVID-19 vaccine were included. Comprehensive geriatric assessment tools and the Clinical Frailty Scale were performed. SARS-CoV-2 spike-specific IgG antibodies were detected and, levels ≥1 U/ml were defined as seropositive, <1 U/ml were defined as seronegative. RESULTS: a total of 497 patients were included and divided into three groups according to the days past after the second dose of the vaccine (Group 1: 28-59 days, Group 2: 60-89 days and Group 3: 90 days and more). Groups included 188, 148 and 171 patients, respectively. Seropositivity rate in each group was 80.9,73.2 and 57.3%, respectively. In Groups 1 and 2, Charlson Comorbidity Index score was higher in the seronegative group (P = 0.023 and P = 0.011, respectively). In Group 3, the prevalence of frailty was significantly higher in the seronegative group (P = 0.002). CONCLUSION: to the best of our knowledge, this is the first study assessing the antibody response after vaccination with Sars-CoV 2 inactivated vaccine in the Turkish geriatric population. Moreover, this is the first study revealing the relationship between antibody response and frailty. Larger studies are needed to confirm the antibody response duration and the association between frailty and COVID-19 vaccine response.
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COVID-19 , Fragilidad , Anciano , Anticuerpos Antivirales , Formación de Anticuerpos , COVID-19/epidemiología , COVID-19/prevención & control , Vacunas contra la COVID-19 , Humanos , SARS-CoV-2 , Vacunas de Productos InactivadosRESUMEN
INTRODUCTION: Sleep-disordered breathing (SDB) in primary school children is a significant problem, yet its prevalence is not well known outside large urban settings. Information on the burden and risk factors of SDB in children could be used to improve resource allocation when providing care across a large country. The objectives of this study were to assess the prevalence of SDB among school-aged children comparing rural and urban settings, and to investigate associated risk factors. METHODS: In this cross-sectional study, a random sample of primary school students in Turkey were selected from urban and rural areas and data were collected using the Pediatric Sleep Questionnaire, asthma, and allergic rhinitis questionnaires completed by the parents. RESULTS: Questionnaires were collected from a total of 139 schools from 58 provinces. A total of 11,013 students were contacted, and 9045 (73%) completed the study. There was no difference in the prevalence of SDB between rural and urban settings (16% vs. 15%, p = 0.612). Multivariate logistic regression analysis revealed that current wheezing, current rhinoconjunctivitis, being overweight, parental snoring, and current mold at home were significant risk factors for SDB in both rural and urban children. Current tobacco smoke exposure (OR = 1.48, 95%CI = 1.19-1.85), near roadway air pollution exposure (OR = 1.40, 95%CI = 1.108-1.791), and mold at home in the first year of life (OR = 1.68, 95%CI = 1.26-2.23) were associated with SDB in urban children. History of maternal/paternal adenotonsillectomy was a significant predictor of SDB in the rural setting (OR = 1.63, 95%CI = 1.12-2.39). CONCLUSION: The prevalence of SDB is high in children living in both settings but associated risk factors may vary. Children residing in rural areas should also be screened for sleep-disordered breathing during routine health visits.
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Salud Rural/estadística & datos numéricos , Síndromes de la Apnea del Sueño/epidemiología , Salud Urbana/estadística & datos numéricos , Adolescente , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Masculino , Prevalencia , Factores de Riesgo , Instituciones Académicas , Encuestas y Cuestionarios , Turquía/epidemiologíaRESUMEN
To investigate the effect of US performed immediately before breast conserving surgery (BCS) by radiologist accompanied by the surgeon. All patients scheduled for BCS in the last year (group 1, n = 46) were evaluated with US immediately before surgery. About 108 patients (group 2) who were treated with BCS before the study were included as the control group. Tumor size and localization, the distances between tumor-skin and tumor-pectoralis muscle fascia were noted. Re-excision rate due to positive margins was significantly lower in group 1. Statistically significant difference was detected in re-excision rates for nonpalpable tumors. Preoperative US is an effective and practical method.
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Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/cirugía , Mastectomía Segmentaria/métodos , Ultrasonografía Mamaria , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/patología , Femenino , Humanos , Márgenes de Escisión , Persona de Mediana Edad , Músculos Pectorales , Cuidados Preoperatorios , Estudios Prospectivos , Adulto JovenRESUMEN
Background: Evidence suggests that advice from motivated physicians to their smoking patients is effective in promoting smoking cessation. Yet, detection rate of smokers is often low and, the proportion of smokers receiving special advice to quit varies. This study aimed to detect how frequently European physicians enquire about their patients' smoking status, and to compare and contrast how (if any) smokers benefit from physicians' enquiry and/or advice about smoking cessation. Methods: The study was based on secondary analysis of data from six European countries that conducted Global Adult Tobacco Survey, namely, Greece, Poland, Romania, Russia, Turkey and Ukraine. Results: Out of Global Adult Tobacco Survey participants who were smoking 12 months preceding the survey and had 'at least one visit to a physician' before the survey, half were asked by their physicians about their smoking status and only 37.7% got a brief advice from their physicians to quit smoking. Remarkably, 25% of current smokers did not get any advice from their physicians to quit even when the smoking status was enquired. The adjusted odds ratio was found as 1.55 (95% confidence interval=1.29-1.87) for the association between physician's enquiry about smoking status of a patient and his/her attempt to quit smoking. Conclusion: Even a simple enquiry of the physician about smoking status of a patient could be effective in smoking cessation, yet, enquiry and advice rates are still far below expected. Regardless of the reason for admission, each contact with a patient should be used as an opportunity to combat smoking-related health risks.
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Actitud del Personal de Salud , Promoción de la Salud/métodos , Motivación , Relaciones Médico-Paciente , Médicos/psicología , Cese del Hábito de Fumar/métodos , Población Blanca/psicología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Grecia , Promoción de la Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Polonia , Rumanía , Federación de Rusia , Cese del Hábito de Fumar/estadística & datos numéricos , Encuestas y Cuestionarios , Turquía , Ucrania , Población Blanca/estadística & datos numéricos , Adulto JovenRESUMEN
The knowledge about the viral etiologies causing respiratory disease in adults is limited. Viral respiratory diseases may lead deterioration in certain patient populations. The aim of this study was to determine the viral etiologies of influenza-like illness among patients requiring hospitalization and to document the risk factors for mortality. This prospective study was performed in one of the 7 centers in Turkey in the context of influenza surveillance by the Global Influenza Hospital Surveillance Network. A 35-bed Adult Emergency Service and 10-bed Acute Care Unit were screened for consequent recruitment of eligible patients daily, on weekdays only. ICD-10 codes in the electronic health records and direct patient encounters were used to screen for the following eligibility diagnoses: acute respiratory tract infection, asthma, heart failure, pneumonia, influenza, chronic obstructive lung disease, dyspnea/respiratory abnormality, respiratory symptoms, cough and fever. A total of 334 patients who were admitted with the eligible ICD-10 codes within the 24th and 48th hours were screened during the study period and of those eligible ones, 106 consented and were swabbed. Nasal or nasopharyngeal swabs were collected using Virocult (Medical Wire & Equipment, UK) and sent to the central laboratory in 1-3 days. Swabs were collected and specimens were introduced to real-time polymerase chain reaction based multiplex kits, as well as, ABI 7500 platform with CDC primers and probes. A total of 106 patients were swabbed. Hospital mortality was 12.2%. More than one fourth of the patients needed a sort of mechanical ventilation support and at least one organ failure developed in one third of the patients. One or more viral pathogens were detected in 56 (52.8%) of the swabbed patients, with influenza H3N2 being the most prevalent one. Having a lower body mass index (OR, 0.845, p= 0.034) was associated with mortality. Chronic lung diseases were shown to confer a survival advantage (OR, 0.127, p= 0.009). Community acquired viral respiratory infections might lead to significant compromise in adult patients. Prevention of malnutrition might result in better outcomes in patients who need acute admission. The survival advantage of those with chronic lung diseases warrants further investigation.
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Hospitalización/estadística & datos numéricos , Gripe Humana/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Subtipo H3N2 del Virus de la Influenza A/aislamiento & purificación , Gripe Humana/virología , Masculino , Persona de Mediana Edad , Nasofaringe/virología , Nariz/virología , Estudios Prospectivos , Factores de Riesgo , Turquía/epidemiología , Adulto JovenAsunto(s)
COVID-19 , Hospitalización , Humanos , Modelos Estadísticos , Probabilidad , Pronóstico , SARS-CoV-2RESUMEN
BACKGROUND: The aim of this study was to assess health-related quality of life (HRQOL) among chronic hepatitis B (CHB) patients in Turkey and to study related factors. METHODS: This multicenter study was carried out between January 01 and April 15, 2015 in Turkey in 57 centers. Adults were enrolled and studied in three groups. Group 1: Inactive HBsAg carriers, Group 2: CHB patients receiving antiviral therapy, Group 3: CHB patients who were neither receiving antiviral therapy nor were inactive HBsAg carriers. Study data was collected by face-to-face interviews using a standardized questionnaire, Short Form-36 (SF-36) and Hepatitis B Quality of Life (HBQOL). Values equivalent to p < 0.05 in analyses were accepted as statistically significant. RESULTS: Four thousand two hundred fifty-seven patients with CHB were included in the study. Two thousand five hundred fifty-nine (60.1 %) of the patients were males. Groups 1, 2 and 3, consisted of 1529 (35.9 %), 1721 (40.4 %) and 1007 (23.7 %) patients, respectively. The highest value of HRQOL was found in inactive HBsAg carriers. We found that total HBQOL score increased when antiviral treatment was used. However, HRQOL of CHB patients varied according to their socio-demographic properties. Regarding total HBQOL score, a higher significant level of HRQOL was determined in inactive HBV patients when matched controls with the associated factors were provided. CONCLUSIONS: The HRQOL score of CHB patients was higher than expected and it can be worsen when the disease becomes active. Use of an antiviral therapy can contribute to increasing HRQOL of patients.
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Hepatitis B Crónica , Calidad de Vida , Adulto , Anciano , Antivirales/uso terapéutico , Estudios Transversales , Femenino , Indicadores de Salud , Hepatitis B Crónica/tratamiento farmacológico , Hepatitis B Crónica/psicología , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Estudios Prospectivos , TurquíaAsunto(s)
COVID-19 , Infecciones por Coronavirus , COVID-19/terapia , Humanos , Inmunización Pasiva , Plasma , SARS-CoV-2 , Sueroterapia para COVID-19Asunto(s)
Densidad Ósea , Osteoporosis , Absorciometría de Fotón , Femenino , Fuerza de la Mano , Humanos , Japón , Fuerza Muscular , PosmenopausiaRESUMEN
INTRODUCTION: Hypophosphatemia may cause acute respiratory failure and tissue hypoxia. In this study we investigated the effect of hypophosphatemia on weaning success. PATIENTS AND METHODS: A nested case-control study was conducted in a retrospective cohort of 76 patients who received invasive mechanical ventilation in 2005-2010 in the Medical Intensive Care Unit (MICU) of university hospital. Case patients (failure group) were those who could not be weaned in the first trial or who required post-extubation mechanical ventilation after first extubation. Control patients (success group) were successfully extubated in the first weaning attempt. RESULTS: Frequency of hypophosphatemia (P level < 2.5 mg/dL) at admission was 23.7%. Weaning failure rate was 71.1%. Risk of weaning failure in the presence of hypophosphatemia was 88.9%, whereas risk in the absence of hypophosphatemia was 65.5%, resulting in risk ratio of 1.36 (1.06 - 1.74) (p= 0.096). Mean (± SD) P levels in the success and failure groups were 3.6 ± 1.0 and 3.2 ± 1.0 mg/dL, respectively (p= 0.113). Logistic regression analysis revealed four independent risk factors which were presence of underlying chronic pulmonary disease, high organ dysfunction score (SOFA) at admission, high blood urea nitrogen at the day of weaning trial and low P level at admission to predict weaning failure. Each 1 mg/dL increment in P level resulted in decreased probability of weaning failure with an OR of 0.43 (0.21-0.88). CONCLUSION: In conclusion, a relation between hypophosphatemia and weaning failure was determined which has to be confirmed with prospective cohort and interventional studies with adequate power.
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Hipofosfatemia/complicaciones , Enfermedades Pulmonares/complicaciones , Enfermedades Pulmonares/terapia , Desconexión del Ventilador , Adulto , Anciano , Estudios de Casos y Controles , Enfermedad Crónica , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Estudios Prospectivos , Estudios Retrospectivos , Factores de Riesgo , Insuficiencia del TratamientoRESUMEN
The aim of this study was to evaluate methicillin-resistant Staphylococcus aureus (MRSA) bacteremia cases who were followed at the Infectious Diseases Unit of Internal Medicine Department, at Hacettepe University Adult and Oncology Hospitals between January 2004-December 2011. A total of 198 patients, of them 99 had positive MRSA blood cultures (case group), and 99 without MRSA bacteremia (control group) who were selected randomly among patients at the same wards during the same time period, were included in the study. Demographic data, risk factors for MRSA bacteremia and antibiotic use of case (60 male, 39 female; mean age: 59.37 ± 16.96 yrs) and control (60 male, 39 female; mean age: 59.11 ± 17.60 yrs) groups were obtained from the patient files and the hospital data system and were compared. Methicillin susceptibility was determined by the cefoxitin (30 µg, BD, USA) disc diffusion method and confirmed by mecA PCR test. Antimicrobial susceptibilities were also determined by disc diffusion and Etest (BioMerieux, France) methods according to CLSI guidelines. There was no statistically significant difference between the two groups according to age, gender, presence of an underlying chronic disease, burn, hemodialysis, malignancy or immunosupression (p> 0.05). The results of the univariate analysis revealed that antibiotic use and parameters most likely to be associated with MRSA bacteremia (obesity, cerebrovascular event, hospitalization history, central/arterial catheter, presence of tracheostomy, invasive/non-invasive mechanical ventilation, use of proton pump inhibitors, H2 receptor blockers, sucralfate, nasogastric or urinary tubes, gastrostomia, total parenteral nutrition, acute organ failure and surgical operation) were found to be statistically higher in the case group (p< 0.05). Median length of hospital stay was also higher in the case group (59 days versus 8 days; p< 0.001). Multivariate regression analysis indicated that obesity (OR= 7.98; p= 0.013), central venous catheterization (OR= 6.65; p= 0.005), nasogastric tube (OR= 16.58; p< 0.001) and use of H2 receptor blockers (OR= 4.41; p= 0.010) were independent risk factors. The number of patient given at least one antibiotic (92 in case group, 51 in control group) was statistically higher than those who were not (48 in case group, 7 in control group) (OR= 14.86; p< 0.001). Use of antibiotics [ampicillin-sulbactam and/or amoxicillin-clavulanate, fluoroquinolones, aminoglycosides, piperacillin-tazobactam (TZP), meropenem (MEM), imipenem (IPM), vancomycin (VAN), cephalosporins and teicoplanin (TEC)] were found to be statistically significantly higher in the case group by univariate analysis (p< 0.05). In multivariate analysis, it was determined that TZP (OR= 6.82; p< 0.001), IPM (OR= 3.97; p= 0.023) and VAN (OR= 8.46; p= 0.001) use were independent risk factors in MRSA bacteremia. The duration of MEM (p= 0.037) and cephalosporin use (p< 0.001) were significantly longer in the case group, however there was no statistically significant difference between the duration of use of other antibiotics (p> 0.05). All MRSA isolates were mecA gene positive (n= 99), the resistance rates for ciprofloxacin, rifampin, gentamicin, tetracyclin, cefoxitin, erythromycin and clindamycin were 95%, 95%, 94%, 96%, 98%, 71% and 36%, respectively. All of the isolates were found to be susceptible to trimethoprim-sulfamethoxazole, VAN, TEC, tigecycline, linezolid and daptomycin. Mortality rates in patients who were infected with MRSA strains exhibiting vancomycin MIC value of ≤ 1.0 µg/ml (n= 49) and with MRSA strains exhibiting MIC > 1.0 µg/ml (n= 50) were 34.6% (17/49) and 60% (30/50), respectively. This difference was found to be statistically significant (p= 0.012). Thus it was concluded that the mortality rate increased in patients infected with MRSA with high (> 1.0 µg/ml) vancomycin MIC value. The results of this study indicated that obesity, presence of central venous catheter and nasogastric tube, and the use of H2 receptor blockers, IPM, TZP and VAN were independent risk factors for MRSA bacteremia. This was the first study showing the relationship between increasing mortality and high vancomycin MIC values in MRSA bacteremia in Turkey.
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Bacteriemia/tratamiento farmacológico , Bacteriemia/epidemiología , Staphylococcus aureus Resistente a Meticilina , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/epidemiología , Adulto , Anciano , Antibacterianos/clasificación , Antibacterianos/uso terapéutico , Bacteriemia/complicaciones , Estudios de Casos y Controles , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Pruebas Antimicrobianas de Difusión por Disco , Femenino , Humanos , Tiempo de Internación , Masculino , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Persona de Mediana Edad , Análisis Multivariante , Análisis de Regresión , Factores de Riesgo , Infecciones Estafilocócicas/complicaciones , Factores de Tiempo , Turquía/epidemiologíaRESUMEN
BACKGROUND: This study aimed to analyze the variations (if any) in hospital admissions of patients with any of the five common non-communicable diseases (NCDs), based on secondary analysis of electronic health records of patients admitted to Hacettepe University Hospitals at least once, from January 1, 2018 through June 15, 2021. DESIGN: Data were recruited from hospital's electronic health records on patients with diagnoses of ischemic heart disease, hypertension, diabetes, cancer, and chronic obstructive pulmonary disease, using relevant ICD-10 codes. RESULTS: Compared to the corresponding time span in the pre-pandemic period, the number of hospital admissions of patients with selected five NCDs significantly decreased during the pandemic, with an official start in Turkey on March 11, 2020. Number of total-, out-patient-, and in-patient admissions of NCD patients were significantly lower in the pandemic period compared to the expected values in time series analysis, controlling for patient characteristics, and seasonality. CONCLUSIONS: Study findings suggest that there has been a prominent impediment in NCD patients' access to, and/or use of health care services over the pandemic, which might evolve to higher admission rates, severity and fatality of such patients in the upcoming years. Further studies are warranted for confirmation of our findings in other care settings, with individual-based data on care compensation through settings other than regular admission sites (if any), and/or the reasons for under-use of services.
Asunto(s)
COVID-19 , Hospitalización , Enfermedades no Transmisibles , Pandemias , Humanos , COVID-19/epidemiología , Enfermedades no Transmisibles/epidemiología , Enfermedades no Transmisibles/terapia , Masculino , Femenino , Turquía/epidemiología , Persona de Mediana Edad , Anciano , Hospitalización/estadística & datos numéricos , SARS-CoV-2 , Adulto , Admisión del Paciente/estadística & datos numéricos , Admisión del Paciente/tendencias , Centros de Atención Terciaria/estadística & datos numéricos , Atención Terciaria de Salud/estadística & datos numéricosRESUMEN
BACKGROUND: The decline in pulmonary function is a predictor of disease progression in patients with cystic fibrosis (CF). This study aimed to determine the decline rate of percent predicted forced expiratory volume in 1 s (ppFEV1) based on the data of the CF Registry of Turkey. The secondary aim was to investigate the risk factors related to the decline in ppFEV1. METHODS: A retrospective cohort study of CF patients over 6 years old, with pulmonary function data over at least 2 years of follow-up was extracted from the national CF registry for years 2017-2019. Patients were classified according to disease severity and age groups. Multivariate analysis was used to predict the decline in ppFEV1 and to investigate the associated risk factors. RESULTS: A total of 1722 pulmonary function test results were available from 574 patients over the study period. Mean diagnostic age was older and weight for age, height for age, and body mass index z scores were significantly lower in the group of ppFEV1 < 40, while chronic Pseudomonas aeruginosa (p < .001) and mucoid P. aeruginosa colonization (p < .001) were significantly higher in this group (p < .001). Overall mean annual ppFEV1 decline was -0.97% (95% confidence interval [CI] = -0.02 to -1.92%). The mean change of ppFEV1 was significantly higher in the group with ppFEV1 ≥ 70 compared with the other (ppFEV1 < 40 and ppFEV1: 40-69) two groups (p = .004). Chronic P. aeruginosa colonization (odds ratio [OR] = 1.79 95% CI = 1.26-2.54; p = .01) and initial ppFEV1 ≥ 70 (OR = 2.98 95% CI = 1.06-8.36), p = .038) were associated with significant ppFEV1 decline in the whole cohort. CONCLUSIONS: This data analysis recommends close follow-up of patients with normal initial ppFEV1 levels at baseline; advocates for early interventions for P. aeruginosa; and underlines the importance of nutritional interventions to slow down lung disease progression.