Comparison of humoral immune response in heterologous and homologous COVID-19 booster vaccine groups using CoronaVac and mRNA-based BNT162b2 vaccines

BACKGROUND

Heterologous COVID-19 booster vaccination is an alternative strategy to homologous vaccination, especially in developing countries, due to shortages, delays, or unequal distribution of COVID-19 vaccines. We compared cohorts vaccinated with different vaccine combinations to investigate whether a heterologous booster dose of mRNA-based BNT162b2 vaccine boosts the immune response in individuals primed with the CoronaVac vaccine.

METHODS

Anti-RBD IgG is generally measured 4 weeks after primary immunization and 4 weeks after booster vaccination. Data on anti-receptor-binding domain (anti-RBD) IgG antibody titers and clinical characteristics were provided by infection control units.

RESULTS

The highest median anti-RBD IgG antibody titers (14589 AU/mL) after primary immunization was observed in the group vaccinated with two doses of BNT162b2 vaccine. Antibody titers were lower 4 months or more after the second CoronaVac vaccine dose in CoronaVac recipients with or without previous COVID-19. In the homologous COVID-19 booster vaccine group (primed with two doses of CoronaVac 4 weeks apart and a single booster dose of CoronaVac) the median anti-RBD titers decreased from 1025 to 242 AU/mL before the booster dose. In the heterologous group (primed with two doses of CoronaVac 4 weeks apart and a single booster dose of BNT162b2), the median anti-RBD titer increased to 31624 AU/mL, a 132-fold increase, 16 days after the booster dose.

CONCLUSIONS

After the second dose of CoronaVac, protective neutralizing antibody levels decrease over time, and a booster dose is required. Heterologous COVID-19 booster vaccination with BNT162b2 is effective at boosting neutralizing antibody levels.

Peripheral innate and adaptive immune cells during COVID-19: Functional neutrophils, pro-inflammatory monocytes, and half-dead lymphocytes

BACKGROUND

A better understanding of innate and adaptive cells in COVID-19 is necessary for the development of effective treatment methods and vaccines.

METHODS

We studied phenotypic features of innate and adaptive immune cells, oxidative burst, phagocytosis, and apoptosis. One hundred and three patients with COVID-19 were grouped according to their clinical features into the categories of mild (35%), moderate (40.8%), and severe (24.3%).

RESULTS

Monocytes were CD16⁺ pro-inflammatory monocytes and tended to shed their HLA-DR, especially in severe cases (p < 0.01). Neutrophils were mature and functional, although a decline of their CD10 and CD16 was observed (p < 0.01). No defect was found in the reactive oxygen species production and their apoptosis. The percentage of natural killer cells was in the normal range, whereas the percentages of CD8⁺ NK and CD56⁺ T lymphocytes were found to be high (p < 0.01). Although the absolute numbers of all lymphocyte subsets were low and showed a tendency for a gradual decrease in accordance with the disease progression, the most decreased absolute number was that of B lymphocytes, followed by CD4⁺ T cells in the severe cases. The percentages of double-negative T cells; HLA-DR⁺ CD3⁺ and CD28^- CD8⁺ subsets were found to be significantly increased. Importantly, we demonstrated the increased baseline activation of caspase-3 and increased lymphocyte apoptosis.

CONCLUSION

We suggest that SARS-CoV-2 primarily affects the lymphocytes and not the innate cells. The increased baseline activation of Caspase-3 could make the COVID-19 lymphocytes more vulnerable to cell death. Therefore, this may interrupt the crosstalk between the adaptive and innate immune systems.

Immunological parameters associated with the severity of COVID-19 pneumonia in kidney transplant recipients

Purpose

An outbreak of a novel respiratory disease due to coronavirus species was emerged in 2019 and named as Coronavirus Disease-2019 (COVID-19). Clinical and immunological factors affecting the course of COVID-19 in kidney transplant recipients (KTR) are not well-known.

Methods

In this prospective observational study, we presented 20 KTR with COVID-19 pnemonia and examined the factors predicting the severity of COVID-19. A total of 10 KTR without COVID-19 was used as control group. Lymphocyte subsets were determined by flow cytometry. In 13/20 patients, immunophenotyping was repeated 1 week later.

Results

Mean age of the patients was 50 ± 9 years. Patients were classified as mild–moderate (oxygen saturation: SO₂ > 90%) and severe disease groups (SO₂ ≤ 90%). Serum albumin and hemoglobin were lower and CRP, fibrinogen and peak d-dimer were higher in severe group. Peak CRP was inversely associated with nadir SO₂ (r =  − 0.68, p = 0.001). Neutrophil/lymphocyte ratio was higher in severe group (p = 0.01). CD3 + and CD4 + cells were lower and NK cell percentage (CD16 + 56 +) was higher in severe group. Percentage of spontaneously activated CD8 cells (CD8 + CD69 +) was higher in severe group. In comparison of KTR with and without COVID-19, CD8 + cells were lower but NK cell percentage was higher in KTR with COVID-19.

Conclusion

In this pilot study, increased NK cells, activated CD8 + cells and decreased CD3 + and CD4 + cells were associated with severity of COVID-19 in KTR. Peripheral immunophenotyping of lymphocyte subtypes may provide prognostic information about the clinical course of COVID-19 in KTR.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11255-021-02947-y.

Comparison of immunogenicity and reactogenicity of inactivated SARS-CoV-2 vaccine (CoronaVac) in previously SARS-CoV-2 infected and uninfected health care workers

The effects of inactivated SARS-CoV-2 vaccine (CoronaVac) on previously naturally infected individuals are unknown. This study compared immunogenicity and reactogenicity of CoronaVac in once naturally infected health-care workers (HCWs) and uninfected HCWs. All HCWs were immunized with two doses of CoronaVac (600 U/0.5 ml) intramuscularly at a 28-day interval. Adverse reactions were obtained by web-based questionnaires or telephone calls seven days after each vaccine dose. Detection of antibody levels against the receptor-binding domain (RBD) of SARS-CoV-2 spike protein was done four weeks after the second dose of the vaccine. We enrolled 103 previously naturally infected and 627 uninfected HCWs. The mean time for vaccination after the first nasopharyngeal SARS-CoV-2 positivity was 64 days (range: 15–136 days) in previously naturally infected HCWs. Among the previously naturally infected HCWs, 41 (40%) were asymptomatic, 52 (50%) had mild upper respiratory tract infections, 10 (105) had pneumonia, and only 6 (5%) were hospitalized. Any reported adverse reactions, either from the first dose or the second dose of vaccine administration, did not differ between previously infected and uninfected HCWs. Anti-RBD antibody titers were obtained in 50 (51%) of 103 previously infected HCWs and 142 (23%) of 627 uninfected HCWs. Anti-RBD antibody titers were significantly higher in HCWs with a previous natural infection (median 1220 AU/ml, range: 202–10328 AU/mL) than in uninfected HCWs (median: 913 AU/ml, range: 2.8–15547 AU/mL, p = .032). CoronaVac administration was safe and may elicit higher antibody responses in previously naturally infected individuals.

Hemoglobin A1c-related histologic characteristics of symptomatic carotid plaques

Background

The aims of our study were to compare the histomorphological characteristics of carotid plaques and glycosylated hemoglobin (HbA1c), which are risk factors for ischemic stroke, in patients who underwent carotid endarterectomy for carotid artery stenosis. Moreover, we aimed to identify the structures that were histologically affected by symptomatic carotid plaques in cases with elevated HbA1c.

Materials and Methods

A total of 64 patients who presented with ischemic stroke and had not previously been diagnosed with diabetes were retrospectively evaluated. All stroke risk factors were reviewed. Carotid plaques were graded separately by two different pathologists through microscopic assessment of the following parameters: plaque rupture, lipid core, fibrous cup thickness, inflammation, intraplaque hemorrhage, thrombus, calcification, necrotic core, and neovascularization. An HbA1c value <6.3% was accepted as normal or indicative of prediabetes (group 1), whereas patients with values ranging between 6.3-7.4%, 7.5-8.4%, and >8.4% were categorized into the effectively controlled (group 2), less effectively controlled (group 3), and uncontrolled (group 4) groups, respectively.

Results

The mean age of the patients was 73.0 ± 4.5 years in group 1, 69.7 ± 2.3 years in group 2, 66.0 ± 8.5 years in group 3, and 62.7 ± 7.1 years in group 4. A negative correlation was present between age and HbA1c. Smoking, hypertension, low-density lipoprotein cholesterol levels, and triglyceride levels were not significantly different among the four groups. According to the HbA1c classifications, the fibrous cup thickness was 2.64 ± 0.3 mm in group 1, 1.85 ± 0.4 mm in group 2, 1.68 ± 0.5 mm in group 3, and 1.45 ± 0.6 mm in group 4. The fibrous cup became thinner as the HbA1c value increased. Other parameters of unstable carotid plaques did not differ among the HbA1c groups.

Conclusions

Increased HbA1c values seem to contribute to plaque instability through the formation of a thin fibrous cup. Thus, of the carotid artery plaque parameters including fibrous cup thickness, plaque rupture, lipid core, inflammation, intraplaque hemorrhage, thrombus, calcification, necrotic core, and neovascularization, fibrous cup thickness is the only histomorphological feature that affected by HbA1c.

Predictors of fatality in influenza A virus subtype infections among inpatients in the 2015-2016 season

BACKGROUND

Infection with the influenza A virus can cause severe disease and mortality. The effect of the different subtypes of influenza on morbidity and mortality is not yet known in Turkey. The aim of this study was to describe the predictors of fatality related to influenza A infection among hospitalized patients in Istanbul during the 2015-2016 influenza season, and to detail the differences between infections caused by H3N2 and H1N1.

METHODS

This was a multicenter study performed by the Istanbul Respiratory Infections Study Group of The Turkish Society of Clinical Microbiology and Infectious Diseases (KLİMİK), among patients hospitalized for influenza in Istanbul during the 2015-2016 influenza season.

RESULTS

A total of 222 patients hospitalized with laboratory-confirmed influenza during the 2015-2016 season were included in the study, of whom 25 (11.2%) died. The fatality rate was significantly higher among patients older than 65 years of age and those with chronic heart and kidney diseases (p<0.001), chronic neurological diseases (p=0.009), and malignancies (p=0.021). Thrombocyte counts were lower in those who died than in those who survived (p<0.004). The median alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, creatinine phosphokinase, and C-reactive protein levels were higher among fatal cases. In the multivariate analysis for the prediction of fatality, being >65years old (odds ratio (OR) 6.9, 95% confidence interval (CI) 2.07-23.08, p=0.002), being infected with influenza A(H3N2) (OR 4.2, 95% CI 1.27-14.38, p=0.019), and a 1-day delay in antiviral use (OR 1.28, 95% CI 1.01-1.63, p=0.036) were found to be associated with an increased likelihood of fatality.

CONCLUSIONS

The case fatality rate of influenza A(H3N2) was significantly higher than that of influenza A(H1N1). Detection of the infection, allowing the opportunity for the early use of antiviral agents, was found to be important for the prevention of fatality. The vaccination should be prioritized for at-risk groups.

Importance of arterial distensibility in patients with vasovagal syncope

OBJECTIVE

Vasovagal syncope (VS) has a significant place in the etiology of syncope; tilt table (TT) test is used for identification of patients with vasovagal syncope (VS); however, the repeatability of the TT test is low. Upon repeated administration of TT test to patients with a positive result, the test may reveal a negative result. This feature of the test renders it inadequate particularly in evaluating therapeutical efficacy in patients receiving treatment. The left ventricular (LV) volume changes are important in the pathology of VS; in addition, LV volume changes are directly affected by the changes in the arterial system and therefore, the present study investigated arterial distensibility (AD) in this patient population.

PATIENTS AND METHODS

A total of 142 VS patients with a positive TT test result (A group) and 93 healthy individuals (B group) were enrolled in the study. The patients received tilt training treatment for 6 months. VS patients were further classified into two: syncope (+) or syncope (-) subgroup according to having at least one or more syncope episode during the 6 months of training program. All patients and controls underwent Doppler echocardiography and AD measurement which were repeated at the end of 6th month in syncope (+) and (-) subgroups.

RESULTS

The mean AD value of patients in group A was significantly lower than that of participants in group B (0.39 ± 0.1 vs. 0.42 ± 0.1, p = 0.025). In Group A, AD was significantly correlated with left ventricular diastolic filling time (DFT), isovolumetric relaxation time and right ventricular DFT (r = 0.38, p < 0.05; r = -0.42, p < 0.05; r = 0.35, p < 0.05, respectively). Syncope (+) subgroup had lower mean AD value compared to syncope (-) subgroup (0.38 ± 0.1 vs. 0.44 ± 0.1, p < 0.001).

CONCLUSIONS

AD may have valuable contribution to understanding the pathophysiology underlying VS and AD may be used in evaluating therapeutical efficacy for vasovagal syncope.

Virulence Genes and Antibiotic Susceptibilities of Uropathogenic E. coli Strains

BACKGROUND

The aim of this study is to detect the presence of and possible relation between virulence genes and antibiotic resistance in E. coli strains isolated from patients with acute, uncomplicated urinary tract infections (UTI).

METHODS

62 E. coli strains isolated from patients with acute, uncomplicated urinary tract infections (50 strains isolated from acute uncomplicated cystitis cases (AUC); 12 strains from acute uncomplicated pyelonephritis cases (AUP)) were screened for virulence genes [pap (pyelonephritis-associated pili), sfa/foc (S and F1C fimbriae), afa (afimbrial adhesins), hly (hemolysin), cnf1 (cytotoxic necrotizing factor), aer (aerobactin), PAI (pathogenicity island marker), iroN (catecholate siderophore receptor), ompT (outer membrane protein T), usp (uropathogenic specific protein)] by PCR and for antimicrobial resistance by disk diffusion method according to CLSI criteria.

RESULTS

It was found that 56 strains (90.3%) carried at least one virulence gene. The most common virulence genes were ompT (79%), aer (51.6%), PAI (51.6%) and usp (56.5%). 60% of the strains were resistant to at least one antibiotic. The highest resistance rates were against ampicillin (79%) and co-trimoxazole (41.9%). Fifty percent of the E. coli strains (31 strains) were found to be multiple resistant. Eight (12.9%) out of 62 strains were found to be ESBL positive. Statistically significant relationships were found between the absence of usp and AMP - SXT resistance, iroN and OFX - CIP resistance, PAI and SXT resistance, cnf1 and AMP resistance, and a significant relationship was also found between the presence of the afa and OFX resistance.

CONCLUSIONS

No difference between E. coli strains isolated from two different clinical presentations was found in terms of virulence genes and antibiotic susceptibility.

Predictors of fatality in pandemic influenza A (H1N1) virus infection among adults

Background

The fatality attributed to pandemic influenza A H1N1 was not clear in the literature. We described the predictors for fatality related to pandemic influenza A H1N1 infection among hospitalized adult patients.

Methods

This is a multicenter study performed during the pandemic influenza A H1N1 [A(H1N1)pdm09] outbreak which occurred in 2009 and 2010. Analysis was performed among laboratory confirmed patients. Multivariate analysis was performed for the predictors of fatality.

Results

In the second wave of the pandemic, 848 adult patients were hospitalized because of suspected influenza, 45 out of 848 (5.3%) died, with 75% of fatalities occurring within the first 2 weeks of hospitalization. Among the 241 laboratory confirmed A(H1N1)pdm09 patients, the case fatality rate was 9%. In a multivariate logistic regression model that was performed for the fatalities within 14 days after admission, early use of neuraminidase inhibitors was found to be protective (Odds ratio: 0.17, confidence interval: 0.03-0.77, p = 0.022), nosocomial infections (OR: 5.7, CI: 1.84-18, p = 0.013), presence of malignant disease (OR: 3.8, CI: 0.66-22.01, p = 0.133) significantly increased the likelihood of fatality.

Conclusions

Early detection of the infection, allowing opportunity for the early use of neuraminidase inhibitors, was found to be important for prevention of fatality. Nosocomial bacterial infections and underlying malignant diseases increased the rate of fatality.

Non-valvular atrial fibrillation in the elderly; preliminary results from the National AFTER (Atrial Fibrillation in Turkey: Epidemiologic Registry) Study

OBJECTIVE

This study aimed at the assessment of the clinical approach to atrial fibrillation (AF) in the older population and the consistency with the guidelines based on the records of the multicenter, prospective AFTER (Atrial Fibrillation in Turkey: Epidemiologic Registry) study.

PATIENTS AND METHODS

2242 consecutive patients admitted to the Cardiology Outpatient Clinics of 17 different tertiary Health Care Centers with at least one AF attack determined on electrocardiographic examination, were included in the study. Among the patients included in the study, 631 individuals aged 75 years and older were analyzed.

RESULTS

The mean age of the patients was determined as 80.3±4.2 years. The most frequent type of AF in geriatric population was the persistent-permanent type with a percentage of 88%. 60% of the patients with AF were female. Hypertension was the most common co-morbidity in patients with AF (76%). While in 16% of patients a history of stroke, transient ischemic attack or systemic thromboembolism was present, a history of bleeding was present in 14% of the patients. 37% of the patients were on warfarin treatment and 60% of the patients were on aspirin treatment. In 38% of the patients who were on oral anticoagulant treatment, INR level was in the effective range.

CONCLUSIONS

The rate of anticoagulant use in the elderly with AF was 37% and considering the reason of this situation was the medication not being prescribed by the physician, one should pay more attention particularly in the field of treatment.

Crigler-Najjar syndrome type I in a Turkish newborn caused by a novel mutation and Gilbert type genetic defect

Crigler-Najjar syndrome (CNS), caused by deficiency of bilirubin uridine diphosphate glucuronosyltransferase (UGT) 1A1, is a rare and autosomal recessive inherited disorder characterized by severe unconjugated nonhemolytic hyperbilirubinemia since birth. We present a girl with CNS type I caused by a novel mutation and Gilbert type genetic defect. Gilbert's Syndrome (GS) and CNS type I both involve abnormalities in bilirubin conjugation secondary to deficiency of bilirubin UGT. The combined defects even in benign genetic forms were shown to cause more serious clinical disease. The patient has been treated with daily home-based phototherapy for more than nine months and considered as a candidate for liver transplantation.

Liver transplant in a patient with active pulmonary tuberculosis

OBJECTIVES

Immunosuppressive treatment generally increases the severity of active infection. Therefore, liver transplant is contraindicated in the presence of active tuberculosis. Despite the importance of supportive treatment, liver transplant is the only treatment for fulminant hepatic failure.

MATERIALS AND METHODS

We report a case of successful liver transplant for fulminant hepatic failure in the presence of active tuberculosis infection.

RESULTS

We immediately performed a liver transplant from a live donor. The patient received low-dose immunosuppressive treatment and antituberculosis treatment. The patient was cured and discharged on the 25th day after surgery. We stopped antituberculosis treatment 10 months after discharge. The patient has been followed for 32 months after transplant with normal graft function and has been free of pulmonary tuberculosis infection.

CONCLUSIONS

Liver transplant can be performed in cirrhotic patients with active infections, such as tuberculosis, as a life-saving procedure.

Mycotic ascending aortic pseudoaneurysm at aortic cannulation site

Mycotic aneurysm of the aorta is a rare but highly fatal complication of coronary bypass surgery. A 49-year-old man developed mycotic pseudoaneurysm in the ascending aorta after coronary bypass in another hospital. Computed tomography showed the pseudoaneurysm originated from the previous aortic cannulation site. The defect was successfully repaired with pericardial-pledgeted sutures.

Craniovertebral junction Pott's disease

Pott's disease of the craniovertebral junction is extremely rare. The authors studied the immediate and long-term outcome after transoral decompression, occipitocervical stabilization with fusion and antitubercular therapy (ATT) in patients who had neurological deficits due to craniovertebral junction (CVJ) tuberculosis. This is a retrospective study of the management and outcome in 10 consecutive patients in whom features of spinal cord (with or without) compression were observed, and CVJ tuberculosis was diagnosed in two different neurological departments between 1990 and 2002. They ranged in age from 15 to 72 years. The onset of symptoms was either acute or subacute. Patients presented with neck and occipital pain (90%), progressive tetraparesia (40%), sensory symptoms (40%), neck stiffness (30%) and urinary dysfunction (20%). The disease caused spinal cord compression in six patients, atlantoaxial dislocation in five patients, basilar impression in one and upper vertebral column destruction without dislocation in three. Two patients presented with multiple spinal tuberculosis. Antitubercular therapy was used in all cases for 15 months. Surgical treatment performed in all patients. Four patients underwent transoral drainage of retropharyngeal abscess with granulation tissue and one odontoidectomy. Six patients then underwent occipitocervical (occiput -C3 or -C4) fusion with insertion of titanium plate and screw. Postoperatively, ATT was prescribed for 15 months. At long-term follow-up (median 50.2 months), functional status considerably improved. Two patients died 2 months later due to myocardial infarction. Patients with CVJ with features of cervical myelopathy are ideally treated with transoral decompressive procedures followed by occipitocervical fusion, because this therapy provides immediate neurological improvement, stability and allows early mobilization. The long-term prognosis in patients with this disease is excellent, provided it is treated with appropriate surgical intervention and with adequate duration of ATT. This approach provides excellent access to this region, with a low operative morbidity and no mortality.

Regional pollen load: effect on sensitisation and clinical presentation of seasonal allergic rhinitis in patients living in Ankara, Turkey

BACKGROUND

Although Gramineae pollens are the main reason for seasonal allergy in many parts of Europe, the influence of regional flora on sensitisation and symptoms has always been a topic of interest. The aim of this study was to document the sensitisation to pollens and to evaluate their clinical importance in patients with seasonal allergic rhinitis living in Ankara/central Anatolia.

METHODS

The study included those subjects with seasonal allergic rhinitis living in Ankara. Skin prick testing with a panel of common aeroallergens as well as grass, individual tree and weed pollens predominant in the region was performed. The patients were followed by symptom-medication scores during the same season in which regional pollens were also counted.

RESULTS

The final eligible study consisted of 54 subjects (F/M: 26/28; mean age: 29.4 years). Trees were the most common pollen source consisting of 95 % of the total amount, followed by grasses (3 %) and weeds (2 %). Sensitisation to Gramineae, to at least one weed; and to tree pollens were 100 %, 85.2 % and 94.4 %, respectively. The most common positive skin tests among tree pollens were to Oleaceae (59.2 %), Aesculus (57.4 %); and Tilia (42.5 %) despite low pollen counts. Chenopodiaceae (88 %) and Plantago (63 %) were the most sensitised weed pollens, with high pollen counts. All patients had significant symptoms during May and June.

CONCLUSION

Although Gramineae pollens seem to be major allergens for seasonal allergic rhinitis in Ankara, the particular role of tree pollens and weed pollens cannot be discarded on symptom development in sensitised patients.

Effects of nucleoside analogues on liver regeneration 70% partially hepatectomized rats

The alternatives for prophlaxis and treatment of recurrent hepatitis B virus infection have increased since new oral nucleoside analogues have become available. We conducted this experimental study to investigate the effect in the liver of these agents on the expression of transforming growth factor alpha (TGF-alpha) and on proliferation index, estimated by Ki-67. Thirty male Wistar albino rats were randomized into three groups: group A (n = 10) received adefovir dipivoxil (40 mg/kg/d per gavage); group B (n = 10), lamivudine (L; 30 mg/kg/d per gavage); and group C (n = 10) did not receive any treatment and were the control group. Groups A and B were treated for 3 days. Animal treatment began on day -1. After performing 70% partial hepatectomy on day 0, all rats were sacrificed on postoperative day 2 to harvest liver tissues for histopathological examination. We stained and indexed Ki-67 and TGF-alpha immunohistochemically on the hepatectomy surface and in the parenchyma, Ki-67 and TGF-alpha indices were significantly higher in group A compared with group B (P = .001 and P = .004, respectively, and P = .003 and P = .001, respectively). When the L group was compared with the control group for results on the hepatectomy surface and the parenchyma, Ki-67 and TGF-alpha indexes were insignificantly different (P = .6 and P = .3, respectively, and P = .1 and P = .6, respectively). Based on the results of this experimental study, we concluded that Adefovir dipivoxil has greater proliferative effect on liver parenchyma and in the cut surface than does lamivudine.

[Investigation of intestinal parasites in AIDS patients]

In this study, enteric parasites were investigated in the stool samples of 38 AIDS patients (23 with chronic diarrhea and 15 without diarrhea) prospectively. At least three stool samples from each patient were investigated microscopically for ova or trophozoites. The samples were concentrated with formol-ether method and wet preparations stained with lugol were examined. In addition, the concentrated samples were stained with modified asid-fast (Kinyoun's), rhodamine-auramine, modified trichrom and calcoflor methods. Enteric parasites were detected in 18 (47%) of the 38 patients, 16 patients harbored a single parasite, and 2 patients were found to be infected with more than one parasite. Only one (7%) of 15 AIDS patients without diarrhea, were found to be infected with Giardia lamblia. On the other hand, 17 (74%) of 23 AIDS patients with chronic diarrhea were found to be infected with various enteric parasites. Cryptosporidium spp. was detected in 9 (39%) of these 23 patients, and in 2 of them Microsporidium spp. accompanied Cryptosporidium. In 2 (9%) of these 23 patients G. lamblia were detected, while Isospora belli, Blastocystis hominis, Entamoeba histolytica, Strongyloides stercoralis and Trichuris trichiura were detected in one patient each. As a result, the detection rate of emerging parasites, including Cryptosporidium spp, Microsporidium spp, I. belli, B. hominis, and S. stercoralis was significantly higher than conventional parasites (39% versus 13%; z=2.34, p=0.01), and CD4 T cell counts were found to be significantly lower among AIDS patients with chronic diarrhea than those without diarrhea (x2=34.33, p<0.001).

Cardiac hydatid cysts located in both the left ventricular apex and the intraventricular septum: case report

Cardiac hydatid cyst is rarely encountered and constitutes 0.5%-2% of all hydatid cases. Although left ventricular (LV) location for hydatid cysts has been frequently reported, the involvement of both the left ventricle and the interventricular septum (IVS) has not been previously reported in the literature. We present a case of cardiac hydatid cyst with fatal recurrent cerebral embolism and the unusual involvement of both LV and IVS demonstrated by transthoracic echocardiography.

The value of hemodynamic changes induced by carotid sinus massage on the diagnosis of coronary artery disease

The aim of this study is to investigate the value of hemodynamic changes induced by carotid sinus massage (CSM) on the diagnosis of coronary artery disease (CAD). A total 108 patients (mean age, 54 +/- 10 years, range 33-70) who had no significant stenosis in the carotid artery by duplex ultrasonography (USG) and no history of syncope were included in this study. Carotid sinus massage was performed before coronary angiography with monitoring of electrocardiography and blood pressure. The patients were divided into three groups according to response to CSM: group 1 patients had a decrease in blood pressure or < 10 beats/minute (bpm); group 2 patients had a decrease between 10 and 20 bpm; and group 3 patients had > 20 mm Hg decrease in blood pressure or > 20 bpm. Coronary angiography was performed after CSM in all patients. There was single-vessel disease (VD) in 23 cases, two-VD in 24 cases, and three-VD in 35 cases. Coronary angiography results were normal in 26 cases. The changes in systolic and diastolic blood pressures and heart rate before and after CSM correlated with number of VD. These changes were highest in patients with three-VD, but lowest in patients with normal coronary angiography. The number of diseased vessels and total coronary artery score were lowest in group 1, but highest in group 3. The specificity and sensitivity of CSM-induced > 10 mm Hg in blood pressure (BP) or > 10 bpm changes in heart rate in the diagnosis of CAD were 85% and 71%, respectively. The positive and negative predictive values were 93% and 49%, respectively in the diagnosis of CAD. At the end of this study, we concluded that CSM induced the fall in blood pressure and heart rate and was correlated with number of diseased vessels and the score of coronary artery disease. As dichotomized values, the decrease of > 10 mm Hg in blood pressure and/or > 10 bpm has highest specificity, sensitivity, and positive predictive value in the diagnosis of CAD.

The effect of glucose-insulin-potassium solution on ventricular late potentials and heart rate variability in acute myocardial infarction

BACKGROUND

Blunted heart rate variability (HRV) and presence of ventricular late potentials (VLPs) are known to correlate with an increased risk of ventricular tachycardia and sudden cardiac death in acute myocardial infarction (AMI). In the present study, we investigated the effect of glucose-insulin-potassium (GIK) solution on the VLPs and HRV in AMI.

METHODS

Seventy-two consecutive patients with first Q wave AMI were randomized to GIK solution and placebo. HRV analysis and ambulatory electrocardiographic recordings were taken in all patients between 24 and 48 h. Sub-maximal exercise testing and echocardiography were performed and signal-averaged electrocardiography (SAECG) was recorded before discharge.

RESULTS

Total filtered QRS duration (FQRS: 102 +/- 7 versus 108 +/- 11 ms; P < 0.05), low-amplitude signal (LAS: 25 +/- 8 versus 32 +/- 11 ms; P < 0.01) and frequency of VLPs (21 versus 45%; P < 0.05) were found to be significantly lower while root-mean-square voltage of the terminal 40 ms of QRS (RMS-40: 45 +/- 18 versus 36 +/- 20 microV; P < 0.05), and left ventricular ejection fraction (EF: 55 +/- 6 versus 48 +/- 7; P < 0.05) were significantly higher in the GIK group when compared to placebo. During the hospital period, the presence and frequency of post-myocardial infarction angina were significantly lower in the GIK group (15 versus 29%, P < 0.05), whereas an insignificant decrease in frequency of ventricular arrhythmias was observed in these patients. On HRV analysis, there was no significant difference between two groups in either time domain (SD, SDNN, RMS-SD) or frequency domain (HF, LF, LF/HF ratio) parameters.

CONCLUSION

GIK solution may be beneficial to VLPs, ischaemic events, and left ventricular systolic performance in the early period of AMI. This therapy has no significant effect on HRV in AMI patients.

[The relation between infarction localization and late potentials]

OBJECTIVE

There are controversies about the relation between infarction localization and late potentials (LP) following acute myocardial infarction (AMI). To evaluate this issue 124 consecutive patients with first Q-wave AMI fulfilling the inclusion criteria were enrolled in this signal--averaged ECG (SAECG) study.

METHODS

The patients were divided into three groups according to infarction localization: anterior (Group I n = 62; 50%), inferior (Group II: n = 42; 34%) and both inferior and right ventricular (RV) involvement (Group III n = 20; 16%). SAECG records were performed during the second week. LP results were evaluated as positive when at least two of the major criteria (QRS > 114 ms, LAS 40 > 38 ms, RMS < 20 V) were obtained. Tukey--Cramer multivariate analysis was performed.

RESULTS

Positive LP results were obtained in 29% of group I, 35.7% of group II and 55% of group III patients. Patients with both inferior and RV involvement had a significantly higher positive LP results independent from left ventricular ejection fraction.

CONCLUSION

Therefore, increased risk of arrhythmia in those patients with both inferior MI localization and RV involvement should be taken into consideration.

Contribution of the peak exercise QT dispersion to the accuracy of an exercise test during the evaluation of coronary artery disease

OBJECTIVE

Regional defects in ventricle repolarization are extremely sensitive to ischaemia which can be measured as QT dispersion (QTd). We investigated the role of QTd calculated at the time of peak exercise during treadmill studies.

METHODS AND RESULTS

Thirty-three women and eighty men, whose treadmill test results and coronary angiography studies had been examined, were divided into four groups according to the test results: 1) subjects with a negative treadmill test and without significant stenosis results in the angiography, were considered normal (N; n = 35); 2) subjects with both a positive exercise test and a significant presence of stenotic coronary arteries, were considered true positive (TP; n = 52); 3) subjects with a positive exercise test, but without significant stenosis results in the angiography, were considered false positive (FP; n = 14); 4) subjects with a negative treadmill study, despite significantly stenotic arteries, were considered false negative (FN; n = 12). All subjects were evaluated on the basis of age, significant ST-segment depression, peak heart rate, rest and peak exercise QT, and QpT (measured from the beginning of the QRS complex to the highest point of the T wave) dispersion, and corrected (QTcd, QpTcd) values for heart rate. The most significant differences were observed between the N and the TP groups in terms of QTd and QTcd (p < 0.01), with a higher correlation (r = 0.48). A significant relationship was also observed in terms of QpT and QpTcd values during peak exercise (p < 0.01). The sensitivity of the peak exercise QTcd and QTcd > or = 70 ms in determining coronary artery disease was found to be 74%. In cases of QTcd > or = 70 ms, in addition to ST-segment depression, the test was found to be less sensitive, but more specific at 96%.

CONCLUSION

It suggests that when peak exercise QTd and QpTd values are taken into account, with the exception of the ST-segment depression, the accuracy of the exercise test will increase and false positive results will decrease.

Relation between QT dispersion and ventricular arrhythmias in uncomplicated isolated mitral valve prolapse

Complications of mitral valve prolapse (MVP), among which serious ventricular arrhythmia and sudden death are of major importance, affect many individuals due to the high incidence of MVP itself in the community despite the actual low incidence of these complications. The present study investigated the incidence and distribution of ventricular arrhythmias according to their severity and relationship with the QT interval and dispersion of repolarization in uncomplicated isolated MVP (IMVP) cases. Fifty-eight uncomplicated IMVP patients, 33 patients with accompanying tricuspid valve prolapse (TVP), to compare its relationship with ventricular arrhythmia, and 60 age- and sex-matched control subjects were enrolled in the study. Individuals with accompanying cardiac or systemic disease, or who were on drug therapy that could potentially affect QT characteristics, were excluded. The incidence of ventricular arrhythmia was 48% in the IMVP group and 64% in the TVP group; the difference was statistically insignificant. In addition, the differences of the QT and Q peak T values were insignificant, whereas QT dispersion (QTd) and Q peak T dispersion (QpeakTd) values were significantly higher in the patient group (60+/-14, 54+/-14 ms, respectively) compared with the control group (42+/-10, 38+/-10 ms, respectively, p<0.001). Complex ventricular arrhythmias (Lown Grade > or =III) in the IMVP group had a significant relationship with QTd and QpeakTd (p<0.001), but not with QT or QpeakT. As a result of the study, it is concluded that TVP accompanying MVP does not increase the incidence of ventricular arrhythmia, that ventricular arrhythmia is related to QT dispersion rather than QT interval in IMVP, that the QT dispersion is a fairly good marker for identifying the high-risk group for serious ventricular arrhythmia and sudden death, and that QpeakT dispersion measurement is an additional indicator that could be an alternative when QT is difficult to determine in conditions such as high heart rate or the presence of U wave.

Treatment of Bartholin's cyst and abscess: excision versus silver nitrate insertion

In a prospective randomized study, intracavitary silver nitrate (AgNO3) stick insertion (n = 25) was compared to the conventional excision technique (n = 25) for Bartholin's cyst or abscess. Two groups were similar with regard to age, previous Bartholin's cyst/abscess and size of the cyst. Operation and healing time was significantly shorter in the AgNO3 group (P < 0.001, P < 0.001, respectively). Chemical burning in the vulva was observed in one patient in the AgNO3 group, whereas hematoma on the operation site occurred in two patients in the excision group. Scar formation was found in two patients in whom excision was performed. Patients were followed for a period of 2 years and recurrence was not found in any of the cases in both groups. We conclude that, AgNO3 insertion treatment for Bartholin's cyst and abscess is as effective as excision and is associated with fewer complications. Because it is simple and inexpensive, it is an attractive alternative treatment modality for this common gynecological disease.