Healthcare personnel's attitude and coverage about tetanus vaccination in Turkey: a multicenter study.

The tetanus vaccine is not routinely given to Turkish adults. Protective tetanus immunity decreases with age. Health-care personnel (HCPs), who are role models in the field of health, are a target group in order to achieve a higher rate of tetanus vaccination in the community. This study was designed to evaluate attitudes and coverage regarding tetanus vaccination among a large sample of Turkish HCPs. This cross-sectional epidemiologic study was conducted from July to August 2019. A questionnaire was sent to HCPs using social media. Of the 10,644 HCPs included in the study, 65% were female. Overall, the tetanus vaccination coverage (TVC) among HCPs was 78.5% (95% CI: 77.7%-79.3%). TVC was significantly higher among physicians [83.4% (95% CI: 82%-84.6%); p < .001] compared with all other HCPs except nurses. Older age (≥40 years) and length of professional experience were significantly correlated with TVC. Of the 8353 HCPs who received tetanus vaccines during their lifetime, 73.03% received tetanus vaccination in the past 10 years. The self-vaccination rate for protection against tetanus was 13.1%. Acute injuries (25.42%) and pregnancy (23.9%) were the most common reasons for having the tetanus vaccine. One-third (33.7%) of HCPs did not have information about whether pregnant women could receive tetanus vaccinations. This survey study provided excellent baseline information about HCPs' coverage rates and attitudes regarding tetanus vaccination. The present results suggested that tetanus boosters for HCPs should be established as soon as possible, and revealed that the HCPs younger than 30 years with relatively less professional experience and all other HCPs except nurses and physicians should be identified as the target population for future intervention programs.

Apoptosis kinetics at reperfusion period in patients with acute ST-Segment Elevation Myocardial Infarction undergoing primary percutaneous coronary intervention and treated with thrombolytic therapy.

OBJECTIVE: To evaluate the kinetics of cardiomyocyte apoptosis in patients undergoing primary percutaneous coronary intervention and thrombolytic therapy in order to elucidate the dark side of reperfusion injury. METHODS: The prospective descriptive study was conducted at Istanbul University Cardiology Institute, Istanbul, Turkey, between June 2010 and December 2012. It comprised patients with persistent ST-segment elevation myocardial infarction who were divided into two groups. Patients in group 1 were treated with percutaneous coronary intervention, while those in group 2 received thrombolytic therapy. Cell death detection enzyme-linked immunosorbent assay kit was used for the analysis of cardiomyocyte apoptosis. Venous blood samples were collected to determine the apoptotic activity from the patients at the beginning of thrombolysis in myocardial infarction grade 3 of reperfusion in infarct-related artery according to thrombolysis in myocardial infarction classification, and after reperfusion provided at 6, 12, 24 and 72 hours. Creatine kinase, peak creatine kinase myocardial band and troponin levels were determined on admission and during 24hours of ST-segment elevation myocardial infarction . SPSS 15 was used for statistical analysis. RESULTS: There were 92 patients in the study; 48(51.6%) in group 1 and 44(48.4%) in group 2.There was no significant correlation between peak apoptotic activity levels at 72 hours of reperfusion and peak creatine kinase myocardial band (r=0.05;p=0.66) or the troponin (r=0.10;p=0.38) levels at 24 hours of ST-segment elevation myocardial infarction. Apoptotic activity levels increased at 72 hours compared to the baseline both for group 1 (p<0.001) and group 2(p<0.001). CONCLUSIONS: Reperfusion injury was not primarily related to apoptosis and it was a slowly progressive benign event in patients with ST-segment elevation myocardial infarction-acute coronary syndrome. Also, the negative impact of percutaneous coronary intervention was not available on reperfusion injury.

Identification of Candida species and susceptibility testing with Sensititre YeastOne microdilution panel to 9 antifungal agents.

OBJECTIVES: To determine the species incidence and susceptibility pattern to 9 antifungal agents of yeasts isolated from various clinical specimens of colonized or infected patients treated in the coronary and surgical intensive care units (ICU).  METHODS: A total of 421 ICU patients were treated at the Cardiology Institute, Istanbul University, Istanbul, Turkey between June 2013 and May 2014, and 44 Candida species were isolated from blood, urine, endotracheal aspiration fluid, sputum, and wounds of 16 ICU patients. Identification of Candida was performed using CHROMagar. Antifungal susceptibility was determined by a Sensititre YeastOne colorimetric microdilution panel.  RESULTS: Candida albicans (C. albicans) was the most commonly observed microorganism 23 (54%); the other microorganisms isolated were Candida tropicalis 12 (27%), Candida glabrata 5 (11%), Candida parapsilosis 1 (2%), Candida lusitaniae 1 (2%), Candida sake 1 (2%), and Geotrichum capitatum 1 (2%). All isolates were susceptible to amphotericin B and 5-flucytosine. Geotrichum capitatum excepted, the other isolates were also susceptible to anidulafungin, micafungin, and caspofungin. Candida parapsilosis was found to be susceptible to all the studied antifungals. High MIC rates for azole group of antifungal drugs were found for C. albicans, C. tropicalis, and C. glabrata. The rate of colonisation was 3.8% (16/421). Only 0.7% (3/421) patients out of a total of 421 developed candidemia.  CONCLUSION: We found that the yeast colonization and infection rates of patients in our ICUs are very low. Candida albicans is still the most common species. We detected a decreasing susceptibility to azole compounds.

Evaluation of Cell Counting in Body Fluids: Comparison of Two Automated Hematology Analyzers with Manual Microscopy.

BACKGROUND: Manual microscopic analysis (MMA) of body fluids has been widely replaced by automated systems. The aim of this study was to assess the performances of the Sysmex XN-1000 (XN-1000) and UniCel DxH800 (DxH800) for body fluid analysis and compare their results with MMA and with each other. METHODS: Red blood cell (RBC), WBC and WBC-differential counts of 142 body fluid samples (7 cerebrospinal, 28 pleural, 107 ascitic fluids) were performed using DxH800, XN-1000, and MMA. RESULTS: The within-run and between-days CVs% were lower than 10% for both systems except MONO of DxH800. Both analyzers demonstrated good linearity and minimal carry-over. The comparison of the XN-1000 and DxH800 with manual counting and each other revealed good correlation (r > 0.90 for both). CONCLUSIONS: Automated systems introduce standardized and accurate performances to analyze biologic fluids. They are also beneficial for reducing turn-around time and laboratory costs.

The importance of apoptotic activity and plasma NT-proBNP levels in patients with acute exacerbation of decompensated heart failure and their relation to different drugs and comorbidities.

OBJECTIVE: To demonstrate the presence and importance of apoptotic activity in heart failure during acute exacerbations and to investigate the effects of different drugs used and co-morbidities on levels of N-Terminal pro-Brain Natriuretic Peptide and apoptotic activity on admission and during hospitalisation. METHODS: The descriptive study was conducted at the emergency department of Istanbul University Cardiology Institute between October 2010 and May 2011 and comprised patients with complaints of shortness of breath, and who were evaluated as acutely exacerbated decompensated heart failure with an aetiology of ischaemic or dilated cardiomyopathy. Apoptotic activity and N-Terminal pro-Brain Natriuretic Peptide levels were measured on admission and on the seventh day of treatment. SPSS 15 was used for statistical analysis. RESULTS: Of the 89 patients in the study, 67(75%) were males. Overall mean age of the study sample was 61 +/- 12 years. Patients who had N-Terminal pro-Brain Natriuretic Peptide levels higher than 6000 pg/ml on admission had greater in-patient mortality rate (p < 0.001). N-Terminal pro-Brain Natriuretic Peptide levels decreased significantly on the seventh day of treatment compared to the admission values (p < 0.012). Apoptotic activity levels, although not statistically significant, increased on the seventh day compared with admission values (p < 0.12). Apoptotic activity levels on the 7th day were associated with in-patient deaths (p < 0.002). Dopamine infusion in the treatment group during hospitalisation significantly increased apoptotic activity (p < 0.035), whereas there was a trend towards decreased apoptotic activity levels with spironolactone (p < 0.07). Treatment with beta-blockers did not change apoptotic activity levels (p < 0.751), whereas lack of beta-blocker therapy increased apoptotic activity (p < 0.02). CONCLUSION: N-Terminal pro-Brain Natriuretic Peptide may be an important risk predictor in decompensated heart failure exacerbations during hospatilasation but not apoptotic activity. Beta-blocker therapy seems to positively affect the process of apoptosis.

Microtubule inhibition therapy by colchicine in severe myocarditis especially caused by Epstein-Barr and cytomegalovirus co-infection during a two-year period: a novel therapeutic approach.

The co-infection of Epstein-Barr virus and Cytomegalovirus rarely gains multi-pathogenicity and leads to viral myocarditis. Also, it may lead to progressive heart failure or sudden death. We present a case series of five patients who were monitored for the impact of low-dose colchicine therapy as adjunct to conventional heart failure therapy. Epstein-Barr virus, Cytomegalovirus and other viral antibodies were determined by enzyme-linked immunosorbent assay method. Adjuvant low-dose colchicine therapy (2x0.5 mg twice daily) was prescribed for addition to the conventional heart failure therapy of these patients and it wsa continued for two years. Ejection fractions of echocardiographic examinations in all patients were 21%, 18%, 25%, 20% and 21% before low-dose colchicine therapy. After two years of treatment, the values increased to 59%, 45%, 40%, 25% and 41%, respectively. The early implementation of low-dose colchicine in these patients seemed to have beneficial effects on overall survival.

An unusual form of Naxos disease and its improvement by adjuvant low-dose colchicine therapy.

We evaluated a female patient with an unusual form of Naxos disease, who presented with central cyanosis and clubbing, simulating congenital heart disease. Adjuvant low-dose colchicine therapy (0.5 mg once daily) showed positive effects and has been continued for six months. Colchicine has anti-inflammatory and anti-fibrotic properties. It inhibits mitosis by disrupting tubulin assembly and enhances cellular apoptosis. Follow-up showed improvement in the patient's clinical status, with a dramatic disappearance of the electrical storm and reductions in cyanosis and palmoplantar hyperkeratosis. Low-dose colchicine may be safe and effective in patients with Naxos disease and may reduce related complications.

Cases of active infective endocarditis in a university hospital during a 10-year period.

OBJECTIVE: To determine the features of patients with active infective endocarditis, and to identify causative microorganisms in blood and/or valve cultures. METHODS: The retrospective study was conducted at the Surgical Intensive Care Unit of Istanbul University Cardiology Institute, Istanbul, Turkey, and comprised 22 patients with clinical evidence of the affliction who underwent operation between January 2001 and December 2010. Modified Duke Criteria was used for the diagnosis of the condition. Frequencies and percentages were calculated. RESULTS: The mean age of the patients was 46.68 +/- 18 years, and 12 (54.5%) were male. Native valve endocarditis was present in 13 (59.1%) cases and prosthetic valve endocarditis was present in 9 (40.9%). Rheumatic heart disease was the commonest underlying heart disease (n = 12; 54.5%). None of patient was intravenous drug abuser and positive for human immunodeficiency virus. Operative mortality was 18% (n = 4). Vegetation and abscess formation were detected in 19 (86.3%) cases. Blood culture positivity was 50% (n =11). Staphylococci was the most common causative micro-organism (n = 4; 36.3%), followed by Streptococci (n = 3; 27.3%), and 1 (9.1%) each for Enterococci, Brucella species, Candida albicans and Stenotrophomonas maltophilia. Positive cultures from vegetations and tissue retrieved at the operation was not detected. CONCLUSION: Active IE remains a severe disease affecting the young population in our study and rheumatic heart disease continues to be the most underlying heart disease. Culture negativity was found to be very high and prior antibiotic therapy may be the prime reason.

A Coronary Septic Embolism in Double Prosthetic Valve Endocarditis Presenting as Acute Anteroseptal ST-Segment-Elevation Myocardial Infarction.

Acute myocardial infarction caused by septic embolism is usually fatal. A 40-year-old male patient who presented within 30 minutes of severe chest pain was admitted to the emergency department. An electrocardiogram showed a maximum 6 mm of acute ST elevations at V1-V4 derivations. His body temperature was as high as 38.5ºC. Blood cultures were taken three times before parenteral ampicillin/ sulbactam treatment was administered. Later, coagulase negative staphylococci (Methicillin Sensitive Staphylococcus epidermidis) were identified from his blood cultures. Coronary angiographic examination was performed. Lobulated contours of a septic embolus was shown in the mid region of left anterior descending artery as an outcome. Trans-esophageal echocardiography showed; mobile multiple vegetations on the prosthetic mitral and aorta valves. After six weeks of antibiotherapy, he was completely healed and discharged from hospital.Six months later, he was rehospitalized and died because of complications of recurrent infective endocarditis.

Warfarin-induced bilateral renal hematoma causing acute renal failure.

Acute renal failure due to bilateral hematoma is a rare complication of anticoagulant warfarin therapy. A 43-year-old man presented with complaints of hematuria and abdominal pain. He had been receiving warfarin for six years, after placement of an aortic valve prosthesis. One week prior to admission, he sustained a urinary tract infection which was treated with third-generation cephalosporin and indomethacin. His serum creatinine level was 1.8 mg/dl with an INR of 15. Three days later, he developed anuria and was treated with hemodialysis. Renal ultrasonography disclosed moderate bilateral hydronephrosis. Computed tomography without contrast enhancement showed bilateral extensive hyperdense thickening of the renal and ureteral walls and high-attenuation areas. Conservative treatment was preferred and diuresis resumed spontaneously, lumbar pain disappeared, and serum creatinine level returned to normal. One month later, renal computed tomography was found normal.

Multiple angiomatous mitral valve cysts leading to floppy mitral valve syndrome.

We report an extremely rare case of cystic-tumor like formations that originated from the mitral valve tissue affected by verrucous endocarditis, leading to floppy mitral valve syndrome. These cystic tumoral formations were discovered during two-dimensional echocardiographic examination of a 46 year-old woman with cardiac symptoms of palpitation, dyspnea, and exertional angina pectoris. Multiple cysts were attached to the anterior mitral leaflet, resulting in pansystolic pseudoparachute-like floppy mitral valve prolapse, and severe mitral regurgitation. The patient underwent prosthetic mitral valve replacement following removal of the mitral valve and multiple cystic-tumoral formations. She had an uneventful postoperative course. Histological diagnosis was diffuse angiomatous cystic development of vasculatory tumor-like structures due to verrucous endocarditis.

[New discoveries in the mechanisms of apoptosis and cell survival and novel potential therapeutic strategies]. / Hücrede apoptoz ve sagkalim mekanizmalarinin kesfedilmesi ve yeni potansiyel tedavi stratejileri.

New discoveries in the mechanisms of apoptosis and cell survival have been a major breakthrough in biological sciences in recent years of the new millennium. Apoptosis is genetically programmed cell death in any nucleated cells of the organism. This type of cell death occurs through different mechanisms from those seen in necrosis and complement lysis of any cell, without affecting the neighboring cells. In the nature, apoptosis and cell survival are very important not only for the elimination of cells that acquire unstable features, become useless and detrimental to the organism, but also for the mechanisms of numerous biological events and disorders seen during the lifespan of many organisms--from the embryological period to death. The discovery of mechanisms of apoptosis and cell survival has enabled the development of new therapeutic strategies in heart diseases, cancers, neurodegenerative diseases, AIDS, and many disorders. Combination of opportunities afforded by degenerative medicine with those of new therapeutic approaches of regenerative medicine such as stem-cell therapy and somatic cell nuclear transfer will possibly introduce new horizons and rational therapeutic approaches in the foreseeable future.

Antimicrobial resistance among Gram-negative bacteria isolated from intensive care units in a Cardiology Institute in Istanbul, Turkey.

Antibiotic resistance among Gram-negative rods (GNRs) causing hospital-acquired infections poses a threat, particularly to intensive care unit (ICU) patients. This study was undertaken in order to achieve the following: to detect the frequency of GNRs isolated from coronary and surgical ICUs at the Institute of Cardiology, Istanbul University, between January 2000-December 2002; to compare the resistance of these GNRs to selected antibiotics; and to determine the prevalence of extended-spectrum beta-lactamases (ESBLs). A total of 367 isolates were obtained from 171 patients. Susceptibility testing and detection of ESBLs were performed using the E-test method. Ceftazidime-clavulanate was used for the detection of ESBLs. The majority of microorganisms were isolated from the respiratory tract (45.5%) and blood (36.7%). Acinetobacter baumannii was the most frequently isolated GNR (24.5%), followed by Pseudomonas aeruginosa (22%). ESBL positivity was found to be 21.1%. High rates of the ESBLs of Escherichia coli and Klebsiella pneumoniae were observed, i.e., 27.7 and 57.5%, respectively. High rates of resistance to all antibiotics studied were observed. The most active agent against the majority of the isolates was imipenem (79.2%), followed by levofloxacin (77%) and ciprofloxacin (71%).

In vitro susceptibility of yeasts isolated from patients in intensive care units to fluconazole and amphotericin B during a 3-year period.

Fungal infections have increased dramatically in recent years and candidemia is a major risk factor for morbidity and mortality in intensive care units (ICUs). Candidemia has been considered to be a nosocomial infection that is strongly associated with neutropenia, recent surgery or presence of intravascular lines, and previous colonization is an independent risk factor. We evaluated the in vitro efficacy of fluconazole and amphotericin B against yeasts isolated from various clinical specimens of colonized or infected patients treated in the ICUs of the Institute of Cardiology, Istanbul University. A total of 1397 ICU patients were treated at the Institute of Cardiology between January 2000 and December 2002. A total of 117 yeasts isolated from 97 patients were included in this study. These ICU patients were hospitalized for a mean of 29 days. All yeasts were identified by conventional methods and using the API (20C AUX, ID 32C) system (Bio Meriéux, France). Susceptibility to fluconazole and amphotericin B was evaluated using the E-test (AB Biodisk, Solna, Sweden). The most commonly isolated yeast was Candida albicans (72.6%), followed by Candida tropicalis (16.2%), Candida kefyr, Candida krusei, Candida parapsilosis, Trichosporon mucoides and Geotrichum spp. Fluconazole and amphotericin B MIC90 values were 0.75 microg/ml; 0.19 microg/ml and 1 microg/ml; 0.38 microg/ml for C. albicans and C. tropicalis, respectively. All Geotrichum spp. were found to be susceptible-dose dependent (SDD) (MIC=16-32 microg/ml) to fluconazole. Two C. albicans, two C. tropicalis, one C. krusei and one Geotrichum spp. had a MIC value of > or = 0.38 microg/ml for amphotericin B. The rate of colonization was 3.36% (47/1397). Only 10 (0.71%) patients out of a total of 1397 developed candidemia during the period of the investigation. Of these, 7 (70%) were caused by non-albicans Candida spp.

Report of a case with polymicrobial endocarditis related to multiresistant strains.

We present a patient with polymicrobial endocarditis who had been operated on previously for a mycotic aneurysm and was seen at the cardiology clinic because of palpitations related to effort. A transesophageal echocardiogram revealed a 15-mm vegetation on his aortic valve. Staphylococcus epidermidis and Corynebacterium striatum were isolated from the blood cultures. Both strains were multiresistant (susceptible to 3 antibiotics at most) against chemotherapy in vitro. Microbiological eradication was not achieved from blood cultures even after applying antimicrobial therapy with effective antibiotics as determined with an antibiotic susceptibility test. For this reason, the patient underwent valve replacement. He was discharged from hospital in fairly good health.