platelet-lymphocyte ratio in prediction of outcome of acute heart failure.

AIM: To examine the role of the ratios of platelet or neutrophil to lymphocyte count (PLR or NLR) in predicting hospital death and long-term mortality in acute heart failure (AHF). Methods & materials: The records of 554 admissions from 354 patients discharged from VAWNY with AHF between 2011 and 2015 were reviewed. The associations between admission PLR or NLR and hospital and long-term mortality were assessed by univariate and multivariate analyses. RESULTS: PLR was similar regarding hospital mortality. Long-term mortality was higher in the third tertile PLR (PLR >210; p = 0.034). Neither PLR nor NLR was an independent predictor of mortality. CONCLUSION: Although higher PLR was associated with long-term mortality, it failed to independently predict the prognosis of AHF.

The zebrafish genome editing toolkit.

Zebrafish (Danio rerio) is a unique model organism at the functional intersection between a high fecundity and conserved vertebrate physiology while being amenable to a multitude of genome editing techniques. The genome engineering field has experienced an unprecedented rate of growth in the recent years since the introduction of designer endonucleases, such as zinc finger nucleases, transcription activator-like effector nucleases, and clustered regularly interspaced short palindromic repeats-Cas9 systems. With the ever-evolving toolset available to the scientific community, the important question one should ask is not simply how to make a mutant line, but rather how best to do so. For this purpose, understanding the toolset is just one end of the equation; understanding how DNA is repaired once double-strand breaks are induced by designer endonucleases, as well as understanding proper fish handling and line maintenance techniques, are also essential to rapidly edit the zebrafish genome. This chapter is outlined to provide a bird's-eye view on each of these three components. The goal of this chapter is to facilitate the adoption of the zebrafish as a model to study human genetic disease and to rapidly analyze the function of the vertebrate genome.

Predicting outcome in acute heart failure, does it matter?

BACKGROUND: Acute heart failure (AHF) is a cardiac condition with multiple aetiologies that carries a high fatality rate. The development of heart failure following a coronary event has a poor prognosis. The main aim of this study was to predict in-hospital and long-term prognosis of AHF based on co-morbidities, physical and paraclinical findings at the time of admission. METHODS: The charts from 366 AHF patients, admitted for the first time during a 4-year period at a major university hospital, were reviewed. In addition to the demographic information, a comprehensive social and medical history was obtained. Presenting symptoms and physical findings were also recorded along with admission values of laboratory and myocardial injury markers. Echocardiographic examination was performed and recorded. Angiographic findings were only recorded in patients with acute coronary ischaemia. Univariate and multivariate analyses were performed to examine the relative contribution of clinical factors on in-hospital and long-term mortality. RESULTS: Preceding acute coronary syndrome (STEMI/NSTEMI) was the strongest predictor of in-hospital death for AHF (OR 3.74; 1.94-7.22, P = 0.001). Multivariate binary logistic regression identified that older age, female gender presence of acute myocardial infarction (higher cTNI or higher CKMB levels), lower blood pressure, lower LVEF and higher WBC were independently associated with long-term mortality. CONCLUSION: AHF following an acute coronary syndrome carries a higher fatality rate. Higher levels of cardiac injury markers and white blood cell counts may present as a poor prognostic indicator secondary to an acute ischaemic event.

Right Valsalva Sinus Aneurysm Protruding Into the Right Ventricle: A Case Report.

A separation between the aortic media and annulus fibrosus causes a rare cardiac abnormality called sinus of Valsalva aneurysm (SVA) that may be congenital or acquired. It is more prevalent in the right coronary sinus (65%-85%) but it has been seen rarely in non-coronary (10%-30%) or Left coronary sinus (<5%). The most common complication is rupture of the Aneurysm. We present an 80-year-old male with expanding right Valsalva sinus aneurysm and protruding into right ventricle. The conventional treatment is surgical repair under cardio-pulmonary bypass or percutaneous catheter closure. The aneurysm was successfully excised surgically under direct guidance of trans-esophageal echocardiography (TEE).

The validity of the VA surgical risk tool in predicting postoperative mortality among octogenarians.

BACKGROUND: To examine the validity of Veterans Affair-VA risk assessment tool in predicting the perioperative and overall mortality among octogenarians. METHODS: This is a single-institution retrospective observational study, in which the clinical information of 1,618 octogenarians were extracted from the VA Surgical Quality Improvement Program database. VA risk assessment tool and ASA classification were used to predict the probability of postoperative mortality and morbidity. Multiple risk groups were compared for mortality using multiple logistic regressions. RESULTS: There were 570 survivors and 1,048 nonsurvivors. VA risk tool strongly predicted perioperative 30-day mortality in receiver operator characteristic curve analysis (area under the curve: .82 ± .02). The power of this tool, while acceptable, was less in predicting overall mortality (area under the curve: .68 ± .01). Age, dialysis, a history of congestive heart failure, functional status, transfusion, and weight loss were also associated with increased rate of death within 30 days. CONCLUSIONS: VA risk tool predicted both perioperative and overall mortality. Relatively strong power of this tool in predicting overall mortality may be unique to this age group because of their advanced age.

Simultaneous intracerebral haemorrhages; which came first, the supra-tentoral or the infra-tentorial one?

The occurrence of simultaneous spontaneous non-traumatic hypertensive intracerebral haemorrhages (ICHs) is a rare event that carries a considerable morbidity and mortality. These haematomas constitute 0.7-2% of all hypertensive ICHs. We report a 42-year-old man with ischaemic heart disease who presented with sudden severe pancephalic headache, repeated vomiting and left-sided weakness. His work-up revealed two right-sided ICHs: putamenal and cerebellar.

[Penicillinase activity of staphylococci and their sensitivity to penicillin G and oxacillin (author's transl)]. / Stafilokoklarin penicillinase aktivitesi ve penicillin G ile oxacillin'e duyarliligi.

The penicillinase activities of 169 strains of staphylococci isolated from outpatients were detected by a simple technique that gives the result in 10 minutes on benzylpenicillin and bromocresol purple absorbed Whatman No 1 filter papers. Seventy three out of 100 S. aureus strain and 4 out of 69 S. albus were found to have the enzyme. The ratio of penicillin G resistance among S. aureus and S. albus were found to be 89% and 41% respectively. Six strains (6%) of S. aureus and 5 (7%) S. albus were resistant to both antibiotics. When the findings were compared with those previously reported in Turkey, it was seen that the proportion of the penicillinase + strains and the incidence of resistance in staphylococci to both kinds of penicillins was increased.

[Brucellosis outbreak in Oltan village of Ankara (author's transl)]. / Ankara'nin Oltan köyündeki brusellozis salgini.

There has been significant increase in the number of brucellosis cases admitted to our clinic within first 6 months of 1979. Since most of the cases were from Ayas, Polatli and Oltan villages we visited Oltan and examined 97 persons 23 of whom had complaints of fever, arthralgia and sweating. In addition to previous 5 cases, 5 more patients were found to have antibody titers of 160-640. In the control group none of the randomly chosen outpatients had titers higher than 40. Three milk samples taken from 12 sheep also had antibodies against brucella. Six B. melitensis strains isolated from these and the other patients were sensitive to terramycin, rifampicin and streptomycin; but resistant to sulfonamide, chloramphenicol and clindamycin. Four of them were sensitive to bactrim and ampicillin. In this paper, the findings of 17 cases of brucellosis other than from those of Oltan have also been presented.

[Interactions between antibiotics (author's transl)]. / Antibiyotikler arasindaki etkilesimler: (Sinerjizm ve antagonizm'in klinik önemi).

Combined antibiotic therapy has been used frequently to obtain broader antibacterial spectrum because of increased antibiotic resistance in microorganisms. However, antibiotics should not be combined for purposes of synergy except in certain serious infections or in infections which cannot be treated with a single drug. Other than antagonism, potential deleterious effects of combined therapy such as broader suppression of normal bacterial flora, greater risk of secondary infections and increased adverse reactions may occur during the treatment. The results of in vivo and in vitro studies in the use of combinations may be different and sometimes good clinical results can be observed with a combined therapy which is antagonistic in vitro. But, this antagonistic interaction will no be sufficient. Therefore, at the beginning of the antibiotic therapy pathogenicity of the infectious agent, defence mechanisms of the patient and the type of interaction between antibiotics must be carefully considered.

[Fungal infections following renal transplantation]. / Böbrek transplantasyonundan sonra görülen mantar enfeksiyonlari.

Following the immunosuppressive treatment, applied after renal transplantations, infectious diseases are seen more frequently. Inspite of more frequency of bacterial infections, they can usually be controlled because of their easier diagnosis and treatment. However the mycotic diseases are usually fatal because of their easier diagnosis and treatment. However the mycotic diseases are usually fatal because of the difficulty in their diagnosis and treatment. The immunosuppressive treatment agents are cytotoxic medicines, codticosteroids, antilymphocytic sera (or antithymocytic sera) and radiation. The mycotic infections, more often encountered are candidiasis, aspergillosis, nocardiosis, cryptococcosis and phycomycosis. There are certain medicines used today in the treatment of deep mycotic infections. These are amphotericine B, 5 fluorocytosine and imidazol derivatives.