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Health-care associated bacteremia in geriatric cancer patients with febrile neutropenia

Aydemir H. | Piskin N. | Kokturk F. | Gökmen A. | Akduman D.

Article | 2013 | Journal of Geriatric Oncology4 ( 2 ) , pp.190 - 195

Objective: The aim of this study was to determine the epidemiology, clinical manifestations, and outcome of health-care associated bacteremia in geriatric cancer patients with febrile neutropenia. Materials and Methods: We retrospectively evaluated cancer patients with febrile neutropenia aged ? 60. years with culture proven health-care associated bacteremia between January 2005 and December 2011. The date of the first positive blood culture was regarded as the date of bacteremia onset. Primary outcome was the infection related mortality, defined as the death within 14. days of bacteremia onset. Results: The two most common pathogen . . .s responsible for bacteremia were Staphylococcus epidermidis (36.1%) and Escherichia coli (31.5%), with high rates of methicillin resistance and extended-spectrum ß-lactamase (ESBL) production, respectively. There were no statistically significant differences in infection related mortality rate according to the type of malignancy (p. =0.776). By the univariate analysis, factors associated with 14. day mortality among febrile neutropenic episodes were prolonged neutropenia (p. =0.024), persistent fever (p. =0.001), hospitalization in ICU (p < 0.001) and the initial clinical presentations including respiratory failure (p < 0.001), hepatic failure (p. =0.013), hematological failure (p < 0.001), neurological failure (p < 0.001), severe sepsis (p < 0.001), and septic shock (p. =0.036). Multivariate analysis showed that persistent fever was an independent factor associated with infection related mortality (odds ratio, 18.0; 95% confidence interval, 5.2-62.6; p < 0.001). Conclusions: The only independent risk factor for mortality was persistent fever. Although the most frequently isolated pathogens were S. epidermidis and E. coli, high rates of methicillin resistance and ESBL production were found respectively. © 2012 Elsevier Inc Daha fazlası Daha az

Long Term Cardiovascular Outcome Based on Aspirin and Clopidogrel Responsiveness Status in Young ST-Elevated Myocardial Infarction Patients

Somuncu, Mustafa Umut | Demir, Ali Riza | Karakurt, Seda Tukenmez | Karakurt, Huseyin | Karabag, Turgut

Article | 2019 | ARQUIVOS BRASILEIROS DE CARDIOLOGIA112 ( 2 ) , pp.138 - 145

Background: A subset of patients who take antiplatelet therapy continues to have recurrent cardiovascular events which may be due to antiplatelet resistance. The effect of low response to aspirin or clopidogrel on prognosis was examined in different patient populations. Objective: We aimed to investigate the prevalence of poor response to dual antiplatelet therapy and its relationship with major adverse cardiovascular events (MACE) in young patients with ST-elevation myocardial infarction (STEMI). Methods: In our study, we included 123 patients under the age of 45 with STEMI who underwent primary percutaneous intervention. A screeni . . .ng procedure to determine both aspirin and clopidogrel responsiveness was performed on the fifth day of admission. We followed a 2x2 factorial design and patients were allocated to one of four groups, according to the presence of aspirin and/or clopidogrel resistance. Patients were followed for a three-year period. A p-value less than 0.05 was considered statistically significant. Results: We identified 48% of resistance against one or more antiplatelet in young patients with STEMI. More MACE was observed in patients with poor response to dual platelet therapy or to clopidogrel compared those with adequate response to the dual therapy (OR: 1.875, 1.144-3.073, p < 0.001; OR: 1.198, 0.957-1.499, p = 0.036, respectively). After adjustment for potential confounders, we found that poor responders to dual therapy had 3.3 times increased odds for three-year MACE than those with adequate response to the dual therapy. Conclusion: Attention should be paid to dual antiplatelet therapy in terms of increased risk for cardiovascular adverse events especially in young patients with STEMI Daha fazlası Daha az

Comparison of EuroScore and STS (The Society of Thoracic Surgeons) risk scoring systems in isolated coronary artery bypass surgery [Koroner bypass cerrahi·si·nde EuroScore ve STS (The Society of Thoracic Surgeons) ri·sk skorlama yöntemleri·ni·n karşilaştirilmasi]

Kandemir Ö. | Büyükateş M. | Turan S.A. | Atalay A. | Tokmakoglu H.

Article | 2007 | Gazi Medical Journal18 ( 2 ) , pp.78 - 80

Objective: To compare the feasibility of the EuroScore and STS (The Society of Thoracic Surgeons) risk scoring systems for predicting the surgical mortality of isolated coronary artery bypass surgery patients. Materials and Methods: The risk scoring of 148 patients who were operated on between November 2002 and December 2005 was performed prospectively according to the EuroScore and STS risk scoring systems. The predicted and observed mortality rates according to each scoring system were compared. Results: Hospital mortality was 2% (3 patients). The predicted mortality rate according to EuroScore was 3.4±2.2%, whereas it was 3.0±2.1 . . .% for STS. There were no significant differences between predicted and observed mortality rates according to either scoring system. The area under the receiver operating characteristic curve was 0.83 for EuroScore and was 0.82 for STS (p>0.05). Conclusion: Both scoring systems were efficient for predicting mortality rates for our patient population. It is an advantage of STS that it also gives valuable information about morbidity Daha fazlası Daha az

Evaluating the efficiency of long term oxygen therapy and mortality in chronic obstructive pulmonary disease [Kronik obstrüktif akciğer hastalığında uzun süreli oksijen tedavisi etkinliğinin ve mortalitenin değerlendirilmesi]

Türkoğlu N. | Örnek T. | Atalay F. | Erboy F. | Altınsoy B. | Tanrıverdi H. | Uygur F.

Article | 2015 | European Journal of General Medicine12 ( 1 ) , pp.18 - 25

It has been shown that Long Term Oxygen Therapy (LTOT) improves polycythemia secondary to hypoxemia and right heart failure, decreases pulmonary hypertension, improves quality of life and increases life expectancy in COPD patients. In our study we aimed to evaluate clinical data, mortality, patient's adherence and efciency of the therapy in COPD patients receiving LTOT. Mean age was 70.5%±9.7 and 57% of the participiants were male. It was shown that one year hospital admission count after LTOT (0.56±0.79) was decreased according to one year hospital admission count before LTOT (1.14±1.64). When arterial blood gas values after LTOT c . . .ompared to the values at the time prescription PaO2 was increased (47.9±4, 53.4±9) and PaCO2 was decreased (56.1±11, 50.5±11). Although there was no signifcant diference in pulmonary artery pressure after LTOT, a signifcant increase was determined in hematocrit (38.37±6, 40.14±6). 41.1% of the patients had at least once device maintanence, and after LTOT only 38.4% had a clinical control due to COPD. The most common reason for irregular use was lack of necessity. Mean daily oxygen usage was 13.88±4.35 hours/day and 68.8% of the patients were using 15 hours or more. Mean follow-up of the patients were 17.85±14.53 (1-55) months and mortality rate in this period was 67%. Mortality was higher in LTOT with 15hours/day or more compared to less than 15 hours (respectively 54.6%, 12.5%). In conclusion, all patients with an indication for LTOT should be followed by national registry system and monitored in terms of technical services. Patients adherence and routine controls should be provided. Key words: COPD, mortality, concentrator, oxygen, LTOT © 2015, TIP ARASTIRMALARI DERNEGI. All rights reserved Daha fazlası Daha az

Ultrafiltration is not superior than diuretics in type 4 cardiorenal sydrome

Hür E. | Acar A. | Magden K. | Yildirim I. | Yayar O. | Köse S. | Yildiz G.

Article | 2014 | Turkish Nephrology, Dialysis and Transplantation Journal23 ( 1 ) , pp.20 - 25

Objective: Cardiorenal syndrome (CRS) describes a dysregulation of the heart and kidneys affecting each other. Recently hemodialysis treatments were used more frequently. Aim was to analyze the effects of conventional diuretic and UF treatments. Material and Methods: Thirty-four Type 4 CRS diagnosed patients were included. Baseline characteristics were recorded. Echocardiography measured at the admission and at the end of the treatment. Results: The mean age 67.4±9.3 (51-93) years and follow-up period were 15.9±11.5 months. The patients were grouped as diuretic group, n=12 and UF group, n=22. At the beginning mitral valve A wave, bl . . .ood urea nitrogen and creatinine values were higher in the UF group while creatinine values were higher in the UF group compared to diuretic group at the end of the study. Although basal ejection fraction (EF) values were not different, it was higher in the UF group at the end of the study (42.38±12.70 % and 29±3.67 %, p 0.05). Conclusion: In Type 4 CRS, mortality and hospital admissions were not reduced by UF treatment but cardiac function assessed by EF was significantly improved suggesting this therapy to be beneficial in appropriate patients Daha fazlası Daha az

Treatment of ventilator-associated pneumonia (VAP) caused by Acinetobacter: results of prospective and multicenter ID-IRI study

Erdem H. | Cag Y. | Gencer S. | Uysal S. | Karakurt Z. | Harman R. | Aslan E.

Article | 2019 | European Journal of Clinical Microbiology and Infectious Diseases , pp.20 - 25

Ventilator-associated pneumonia (VAP) due to Acinetobacter spp. is one of the most common infections in the intensive care unit. Hence, we performed this prospective-observational multicenter study, and described the course and outcome of the disease. This study was performed in 24 centers between January 06, 2014, and December 02, 2016. The patients were evaluated at time of pneumonia diagnosis, when culture results were available, and at 72 h, at the 7th day, and finally at the 28th day of follow-up. Patients with coexistent infections were excluded and only those with a first VAP episode were enrolled. Logistic regression analysi . . .s was performed. A total of 177 patients were included; empiric antimicrobial therapy was appropriate (when the patient received at least one antibiotic that the infecting strain was ultimately shown to be susceptible) in only 69 (39%) patients. During the 28-day period, antibiotics were modified for side effects in 27 (15.2%) patients and renal dose adjustment was made in 38 (21.5%). Ultimately, 89 (50.3%) patients died. Predictors of mortality were creatinine level (OR, 1.84 (95% CI 1.279–2.657); p = 0.001), fever (OR, 0.663 (95% CI 0.454–0.967); p = 0.033), malignancy (OR, 7.095 (95% CI 2.142–23.500); p = 0.001), congestive heart failure (OR, 2.341 (95% CI 1.046–5.239); p = 0.038), appropriate empiric antimicrobial treatment (OR, 0.445 (95% CI 0.216–0.914); p = 0.027), and surgery in the last month (OR, 0.137 (95% CI 0.037–0.499); p = 0.003). Appropriate empiric antimicrobial treatment in VAP due to Acinetobacter spp. was associated with survival while renal injury and comorbid conditions increased mortality. Hence, early diagnosis and appropriate antibiotic therapy remain crucial to improve outcomes. © 2019, Springer-Verlag GmbH Germany, part of Springer Nature Daha fazlası Daha az

Factors effecting the duration of hospitalization and mortality in patients with community-acquired pneumonia [Toplum kökenli pnömoni olgularinda hastanede yatiş süresi ve mortaliteyi etkileyen faktörler]

Pişkin N. | Aydemir H. | Öztoprak N. | Akduman D. | Çelebi G. | Seremet A.K.

Article | 2009 | Mikrobiyoloji Bulteni43 ( 4 ) , pp.597 - 606

Community-acquired pneumonia (CAP) is a common infectious disease with high morbidity and mortality. In this study, demographic features, underlying conditions, causative pathogens and factors affecting length of hospital stay and mortality were retrospectively investigated in patients who were diagnosed as CAP and followed-up in our unit between January 2005-December 2007. Among 97 patients 65 (67%) were male, 32 (33%) were female and the mean age was 62.7 (age range: 18-94) years. Patients were grouped according to criteria of Turkish Thoracic Society into four groups; 22 were group 2 (patients with risk factors, without aggrevati . . .ng factors), 59 were group 3 (patients with aggravating factors), and 16 were group 4 (patients who have necessity for intensive care) CAP. The patients have also been grouped according to criteria of American Thoracic Society (CURB-65 score = Confusion, Urea > 7 mmol/L, Respiratory rate ? 30/min, low Blood pressure and being ? 65 years old), as group I (n= 65), group II (n= 20), and group III (n= 12). During follow-up 11 (11.3%) patients required mechanical ventilation support and 6 (6.2%) patients have died. Causative pathogens were isolated from 14 (23.3%) out of 27 well-qualified sputum samples obtained from 60 patients who could produce sputum (8 Streptococcus pneumoniae, 2 methicillin-sensitive Staphylococcus aureus, 2 Klebsiella pneumoniae, 1 Haemophilus influenzae, 1 Moraxella catarrhalis). Thirty-seven of cases were treated with levofloxacin, 10 with moxifloxacin, 24 with ceftriaxone ± clarithromycin, 16 with sulbactam-ampicillin ± ciprofloxacin, 10 with beta-lactam/beta-lactamase inhibitor combinations, and fever declined within 2.5 days in 83 (85.6%) of them. The mean duration of hospital stay was estimated as 11.1 days. In the evaluation of the factors that affect the length of hospital stay, being ? 65 years old, gender, underlying conditions, central venous catheterisation, presence of nasogastric tube, positive culture result, previous antibiotic treatment, fever continuing for > 3 days despite antibiotic therapy and scoring groups were not determined as risk factors (p> 0.05 for all of these parameters). However, mechanical ventilation was found as a significant risk factor (p< 0.05). In the evaluation of the factors that affect mortality, mechanical ventilation (p< 0.001), staying in intensive care unit (p< 0.001), being group 4 CAP (p< 0.001) and fever continuing for > 3 days despite antibiotic therapy (p= 0.05) were found to be significant risk factors. In conclusion, length of hospital stay, mortality and treatment costs in CAP patients could be reduced by defining the risk factors and starting empirical antibiotic therapy according to the national and international guidelines Daha fazlası Daha az

Evaluation of right atrium-to-right ventricle diameter ratio on computed tomography pulmonary angiography: Prediction of adverse outcome and 30-day mortality

Oz I.I. | Altinsoy B. | Serifoglu I. | Sayin R. | Buyukuysal M.C. | Erboy F. | Akduman E.I.

Article | 2015 | European Journal of Radiology84 ( 12 ) , pp.2526 - 2532

Objective The aim of this study was to examine the association between right atrium (RA) and right ventricle (RV) diameters on computed tomography (CT) pulmonary angiography in response to acute pulmonary embolism (APE), in addition to 30-day mortality and adverse outcomes in patients with APE. Methods This retrospective study was accepted by the institutional ethics committee. From January 2013 to March 2014, 79 hospitalized adult patients with symptomatic APE were included. Inclusion criteria were a CT pulmonary angiography positive for pulmonary embolism, availability of patient records, and a follow-up of at least 30 days. A rev . . .iew of patient records and images was performed. The maximum diameters of the heart chambers were measured on a reconstructed four-chamber heart view, and the vascular obstruction index was calculated on CT pulmonary angiography. Results There were statistically significant relationships in both the RA/RV diameter ratio and the RV/left ventricle (LV) diameter ratio between patients with and without adverse outcomes (p < 0.001 and 0.002, respectively). Furthermore, there was a statistically significant difference in the RA/RV diameter ratio, but not in the RV/LV diameter ratio, between those with and without 30-day mortality (p = 0.002 and 0.148, respectively). Conclusions Measurement of the RA/RV diameter ratio may be an alternative and useful method for predicting 30-day mortality and adverse outcome in patients with APE. © 2015 Elsevier Ireland Ltd. All rights reserved Daha fazlası Daha az

Evaluation of clinical data and mortality among COPD patients receiving domiciliary NIMV therapy

Örnek T. | Erboy F. | Atalay F. | Altinsoy B. | Tanriverdi H. | Uygur F. | Tor M.

Article | 2014 | Turk Toraks Dergisi15 ( 3 ) , pp.112 - 116

OBJECTIVES: Domiciliary non-invasive mechanical ventilation (NIMV) is presumed to decrease hospital admissions and mortality in very severe chronic obstructive pulmonary disease (COPD) patients. This study was aimed to investigate the clinical data and mortality among COPD patients receiving domiciliary NIMV treatment. MATERIAL AND METHODS: A total of 40 COPD patients who were prescribed domiciliary NIMV at discharge between January 2010 and December 2011 were contacted by phone regarding their current health status, and the electronic patient charts of 34 patients who used NIMV regularly were retrospectively reviewed. RESULTS: The . . .mean age of the patients was 67±15 years and 59% of them were females. The mean length of hospital stay was 14.5±6.82 days. Rate of admission to intensive care unit and use of invasive mechanical ventilation was 56% and 27%, respectively. The median follow up duration was 17 months. The 6-months, 1-year, 2-years and overall mortality rates were 24%, 38%, 50% and 56%, respectively. For patients surviving at least one year after domiciliary NIMV initiation (n=21), the mean number of hospitalizations in the year before-and after-NIMV initiation were 1.38±1.28 and 0.57±0.93 (p=0.003), respectively. Mean daily NIMV use was 8.91±4.46 hours. Mean daily NIMV use of the patients with a lifespan ?2 years was higher than that of the patients with a lifespan >2 years (11.82±4.02 hours/day versus 6.0±2.62 hours/day, respectively) ( Daha fazlası Daha az

Cesarean section with relative indications versus spontaneous vaginal delivery: Short-term outcomes of maternofetal health

Arikan I. | Barut A. | Harma M. | Harma I.M. | Gezer S. | Ulubasoglu H.

Article | 2012 | Clinical and Experimental Obstetrics and Gynecology39 ( 3 ) , pp.288 - 292

Aim: The aim of the study was to compare maternal and perinatal mortality and short-term outcomes of maternal and perinatal health between a cesarean group with relative indications and a vaginal delivery group. Methods: A total of 1,119 patients were included; 582 were delivered by spontaneous vaginal birth and 537 delivered by cesarean section without labor. The indication for cesarean section was tocophobia and fear of childbirth for all patients. Maternal and perinatal morbidity and mortality were compared between the groups. Results: No maternal mortality was recorded. Maternal morbidity was significantly lower in the vaginal b . . .irth group than the cesarean group (7 vs 30, p < 0.05). Perinatal mortality (2 vs 0) and perinatal morbidity were not significantly different between the two groups (33 vs 17). The vaginallly delivered group had significantly higher newborn hospitalization rates than the cesarean group (p < 0.05), but hospitalization time did not differ. Newborns with the first minute Apgar score below 7 were higher in the cesarean group (p < 0.05). Fifth minute Apgar scores and umblical cord pH values were similiar. Cesarean neonates weighed more than vaginally delivered ones (p < 0.05). Conclusion: Short-term maternal complications were more frequently seen in cesarean deliveries with relative indications than spontanous vaginal deliveries but no difference was found in perinatal mortality and morbidity. There is a clear need for research on health outcomes for mothers and infants associated with cesarean delivery without any medical indication Daha fazlası Daha az

Piperacillin-tazobactam versus carbapenem therapy with and without amikacin as empirical treatment of febrile neutropenia in cancer patients: Results of an open randomized trial at a University hospital

Oztoprak N. | Piskin N. | Aydemir H. | Celebi G. | Akduman D. | Keskin A.S. | Gokmen A.

Article | 2010 | Japanese Journal of Clinical Oncology40 ( 8 ) , pp.761 - 767

Objective: Empirical beta-lactam monotherapy has become the standard therapy in febrile neutropenia. The aim of this study was to compare the efficacy and safety of piperacillin-tazobactam versus carbapenem therapy with or without amikacin in adult patients with febrile neutropenia. Methods: In this prospective, open, single-center study, 127 episodes were randomized to receive either piperacillin-tazobactam (4 × 4.5 g IV/day) or carbapenem [meropenem (3 × 1 g IV/day) or imipenem (4 × 500 mg IV/day)] with or without amikacin (1 g IV/day). Doses were adjusted according to renal function. Clinical response was determined during and at . . . completion of therapy. Results: One hundred and twenty episodes were assessable for efficacy (59 piperacillin-tazobactam, 61 carbapenem). Mean duration of treatment was 14.8 ± 9.6 days in the piperacillin-tazobactam group and 14.7 ± 8.8 days in the carbapenem group (P> 0.05). Mean days of fever resolution were 5.97 and 4.48 days for piperacillin-tazobactam and carbapenem groups, respectively (P> 0.05). Similar rates of success without modification were found in the piperacillin-tazobactam (87.9%) and in the carbapenem groups (75.4%; P > 0.05). Fungal infection occurrence rates were 30.5 and 18% in piperacillin-tazobactam and carbapenem groups, respectively (P = 0.05). Antibiotic modification rates were 30.5 and 13.1% (P = 0.02) and the addition of glycopeptides to empirical antibiotic regimens rates were 15.3 and 44.3% for piperacillin-tazobactam and carbapenem groups, respectively (P = 0.001). The rude mortality rates were 14% (6/43) and 29.3% (12/41) in piperacillin-tazobactam and carbapenem groups, respectively (P = 0.08). Conclusions: The effect of empirical regimen of piperacillin-tazobactam regimen is equivalent to carbapenem in adult febrile neutropenic patients. © The Author (2010). Published by Oxford University Press. All rights reserved Daha fazlası Daha az

General characteristics and prognostic factors of pneumonia cases developed during pandemic (H1N1) influenza-a virus infection in Turkey

Özlu T. | Bülbül Y. | Taşbakan S. | Kiliç H. | Kuyucu T. | Yildiz T. | Özdemir T.

Article | 2013 | Balkan Medical Journal30 ( 1 ) , pp.68 - 73

Objective: Unlike seasonal influenza, seen in previous years, the strain identified in the 2009 influenza-A pandemic involved high mortality. In this study, prognostic factors and general characteristics of pneumonia cases developed in Turkey during the H1N1 pandemic between October 2009 and January 2010 were analyzed. Study Design: Multicenter retrospective study. Material and Methods: This multicentric retrospective study was conducted between August and October 2010 and patients' data were collected by means of standard forms. Results: The study included 264 pneumonia cases, collected from 14 different centers. Mean age was 47.5± . . .18.6 years. Nineteen patients (7.2%) were pregnant or had a new birth and comorbid diseases were detected in 52.3% of all patients. On admission, 35 (13.8%) cases had altered mental status. Overall, 32.6% were treated in intensive care units (ICU) and invasive/non-invasive mechanical ventilation was performed in 29.7%. The mean duration of ICU stay was 2.9±6.2 and total hospital stay was 12.0±9.4 days. Mortality rate was 16.8% (43-cases). The length of ICU treatment, total hospital stay, and mortality were significantly higher in H1N1-confirmed patients. Mortality was significantly higher in patients with dyspnea, cyanosis, and those who had altered mental status on admission. Patients who died had significantly higher rate of peripheral blood neutrophils, lower platelet counts, higher BUN, and lower SaO2 levels. Conclusion: This study showed that pneumonia developed during H1N1 pandemic in our country had resulted in a high mortality. Mortality was especially high among patients with cyanosis, altered mental state and those with lower SaO2. © Trakya University Faculty of Medicine Daha fazlası Daha az

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