RESUMO
INTRODUCTION: Chronic kidney disease (CKD) patients have more frequent sleep disorders and cardiovascular disease than normals. Since arterial stiffness as a risk factor of atherosclerosis can be evaluated with pulse wave velocity (PWV), we aimed to investigate the prevalance of sleep quality (SQ) and the relationship between SQ and risk factors of atherosclerosis and whether there is a relationship between SQ and PWV (the indicator of arterial stiffness) in predialysis CKD patients. METHODS: This cross-sectional study was carried out in CKD patients followed at the Nephrology Department in Konya, Turkey, between November 2014 and March 2015. A total of 484 CKD patients were screened. Of the 484 patients, 285 patients were excluded. The remaining 199 CKD patients without cardiovascular disease at stage 3, 4, and 5 (predialysis) were included in the final study. The SQ of the patients was evaluated by the Pittsburgh Sleep Quality Index (PSQI). PWV was measured by using a single-cuff arteriography device (Mobil-O-Graph PWA, a model pulse wave analysis device; IEM). RESULTS: A total of 199 predialysis CKD patients were included in the study, 73 of whom (36.7 %) were 'poor sleepers' (global PSQI >5). Patients with poor SQ were older than those with good SQ (p = 0.077). SQ was worse in female patients compered to male patients (p = 0.001). SQ was worse in obese patients. As laboratory parameters, serum phosphorus, LDL cholesterol, and triglycerides levels correlated positively with SQ (respectively; r = 0.245, p&0.001; r = 0.142, p = 0.049; r = 0.142, p = 0.048). The indicator of arterial stiffness, PWV, was higher in patients with poor SQ (p = 0.033). Hyperphosphatemia and female gender are determined as risk factors for poor SQ in multivariate analysis (p = 0.049, ExpB = 1.477; p = 0.009, ExpB = 0,429, respectively). CONCLUSIONS: Our study showed for the first time that there is a relationship between SQ and risk factors of atherosclerosis in predialysis CKD patients.
Assuntos
Insuficiência Renal Crônica/epidemiologia , Transtornos do Sono-Vigília/epidemiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Aterosclerose/epidemiologia , Estudos Transversais , Feminino , Humanos , Hiperfosfatemia/epidemiologia , Masculino , Pessoa de Meia-Idade , Análise de Onda de Pulso , Fatores de Risco , Fatores Sexuais , Turquia/epidemiologia , Rigidez Vascular , Adulto JovemRESUMO
This article describes the prevalence of antibiotic resistance and predictors of mortality for healthcare-associated (HA) Gram-negative bloodstream infections (GN-BSI). In total, 831 cases of HA GN-BSI from 17 intensive care units in different centres in Turkey were included; the all-cause mortality rate was 44%. Carbapenem resistance in Klebsiella pneumoniae was 38%, and the colistin resistance rate was 6%. Multi-variate analysis showed that age >70 years [odds ratio (OR) 2, 95% confidence interval (CI) 1.22-3.51], central venous catheter use (OR 2.1, 95% CI 1.09-4.07), ventilator-associated pneumonia (OR 1.9, 95% CI 1.1-3.16), carbapenem resistance (OR 1.8, 95% CI 1.11-2.95) and APACHE II score (OR 1.1, 95% CI 1.07-1.13) were significantly associated with mortality.
Assuntos
Bacteriemia/mortalidade , Infecção Hospitalar/mortalidade , Farmacorresistência Bacteriana , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/isolamento & purificação , Infecções por Bactérias Gram-Negativas/mortalidade , Adulto , Idoso , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Feminino , Bactérias Gram-Negativas/classificação , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Turquia/epidemiologiaRESUMO
Although the clinical features of congenital muscular torticollis are well known, the cause of this disorder still remains hypothetical. The role of heredity is not well established, because there have been only a few studies on it. We presented a family in which five members suffer from CMT in three generations, two of whom were operated on. According to the pattern in the pedigree, probably an autosomal dominant condition could be considered.
Assuntos
Torcicolo/genética , Adolescente , Criança , Feminino , Humanos , Masculino , Músculo Esquelético/anormalidades , Linhagem , Torcicolo/congênito , Torcicolo/cirurgiaAssuntos
Antibacterianos/efeitos adversos , Gestão de Antimicrobianos/estatística & dados numéricos , Farmacorresistência Bacteriana/efeitos dos fármacos , Uso Excessivo de Medicamentos Prescritos/efeitos adversos , Antibacterianos/uso terapêutico , Gestão de Antimicrobianos/legislação & jurisprudência , Gestão de Antimicrobianos/tendências , Humanos , Testes de Sensibilidade Microbiana , Uso Excessivo de Medicamentos Prescritos/tendências , TurquiaRESUMO
BACKGROUND: Since sternal surgical site infections (SSIs) can be life-threatening, every effort should be made to reduce their rate of occurrence. AIM: To measure the rate of sternal SSIs after open heart surgery and to define the efficacy of infection control interventions in reducing this rate. METHODS: Surveillance of sternal SSIs was carried out prospectively for adult patients who underwent sternotomy between 2005 and 2012. Infection control interventions that were undertaken during the study period at different time intervals were prophylaxis with cefazolin or vancomycin, surveillance of sternal SSIs and feedback, preoperative nasal Staphylococcus aureus screening and decolonization with mupirocin, isolation of patients infected with or colonized by meticillin-resistant S. aureus, appropriate management of perioperative blood glucose level and chlorhexidine/alcohol usage for skin antisepsis. FINDINGS: There were 479 sternal SSIs in 18,460 patients during the study period (2.59%). The most frequent causes of sternal SSIs were coagulase-negative staphylococci (CoNS) (36%) and S. aureus (31%). Infection control interventions reduced the rate of sternal SSIs from 3.63% in 2005 to 1.65% in 2012 (P < 0.0001). CONCLUSION: Our study shows that the rate of sternal SSIs can be decreased with proper infection control interventions. However, the interventions that were undertaken were effective only in reducing the rate of sternal SSIs caused by S. aureus. It is time to find interventions to control sternal SSIs caused by CoNS, the pathogen responsible for most sternal SSIs in hospitals where S. aureus SSIs are successfully controlled.