Hospitalized pandemic influenza A (H1N1) patients in a university hospital

The purpose of this study was to describe the demographic and clinical features of hospitalized patients with the pandemic H1N1 influenza A virus infection in a tertiary care hospital in Central Anatolia, Turkey. The patients, all over 16 years of age and hospitalized for influenza-like symptoms between 1 November 2009 and 31 December 2009, were retrospectively identified from the records of the Infectious Diseases Department. Eighty patients whose diagnoses were confirmed by real-time PCR were included in this study. The median age of the patients was 27 years; 41 of them were male. Thirty-seven of the patients had a radiologically proven pneumonia. Eighteen of 37 (48.6%) patients with pneumonia had an underlying co-morbid medical condition, and 14 required intensive care unit admission. Patients with pneumonia had higher levels of C-reactive protein. All patients but one received oseltamivir treatment. Six patients with pneumonia received only antiviral therapy, while 31 of the patients with pneumonia received concomitant antibiotic therapy. Three patients who required mechanical ventilatory support died due to respiratory insufficinency. Although our study implicates the later periods of the pandemic, there were no significant differences for patients’ characteristics between our study and previous reports from the countries where the pandemic first occurred.     

Molecular epidemiology of the Bacillus anthracis isolates collected throughout Turkey from 1983 to 2011

The main perspective of this study was to determine cross-transmissions amongst anthrax cases and provide detailed information regarding the genotypes of Bacillus anthracis isolates circulating in Turkey. A total of 251 B. anthracis isolates were obtained from human (93 isolates), animal (155 isolates), and environmental (three isolates) samples in various provinces of Turkey. All isolates were susceptible to quinolones, vancomycin, tigecycline, and linezolid, but not to ceftriaxone. Excluding human isolates, one of the animal isolates was found to be resistant to penicillin, erythromycin, and doxycycline. Multiple-locus variable-number tandem repeats analysis including 8 loci (MLVA8) revealed 12 genotypes, in which genotype 43 was observed at the highest frequency (41.8?%), followed by genotype 35 (25.5?%) and genotype 27 (10.4?%). Major subtype A3.a was the predominant cluster, including 86.8?% of the isolates. The MLVA25 analysis for the 251 isolates yielded 62 different genotypes, 33 of which had only one isolate, while the remaining 29 genotypes had 2 to 43 isolates, with a total of 218 isolates (86.9?%). These findings indicate very high cross-transmission rates within anthrax cases in Turkey. The genotypes diagnosed in Turkey are populated in the A major cluster. Penicillin prescribed as the first-choice antibiotic for the treatment of anthrax is still effective.     

Arterial bending angle and wall morphology correlate with slow coronary flow: Determination with multidetector CT coronary angiography

Background and purpose

The purpose of this study was to assess angulations and vessel wall morphology that could lead to bending head loss in the RCA and LMCA arteries of patients with slow coronary flow (SCF) evaluated by MDCT coronary angiography.

Methods

The study involved 51 patients (45 males, mean age: 59.6 years) who were diagnosed with SCF by coronary angiography. Diagnosis of SCF was based on thrombolysis in myocardial infarction (TIMI) frame count. Fifty-one patients with absence of slow flow were selected as the control group. The angulations of the main coronary arteries with the aorta were measured from the axial images obtained through MDCT coronary angiography, and the findings were recorded. In addition, the coronary artery walls of these patients were evaluated. For statistical analysis, SPSS for Windows 10.0 (SPSS Inc., Chicago, IL) was used. For comparisons of the angles, either independent samples t test or the Mann-Whitney U test was used where appropriate.

Results

The results of the study indicated that 38 patients had SCF in the LAD. Comparisons of patients with SCF with the controls revealed that in the patients with SCF, the mean angle of the LMCA with the aorta (40.9 ± 20.5°) was statistically significantly smaller than the mean angle of the LMCA with the aorta in the control cases (71.8 ± 11°). In 12 patients, slow flow was detected in the RCA. Those with slow flow in the RCA had significantly smaller angles (mean: 33.2 ± 20.4°) than the other cases (mean: 78.9 ± 10.7°).

Conclusion

A small angle of origin of the main coronary arteries from the aorta, measured on MDCT examinations is correlated with slow blood flow in those vessels, as calculated by the TIMI frame count in catheter coronary angiography.     

Exposure to anthrax toxin alters human leucocyte expression of anthrax toxin receptor 1

Anthrax is a toxin‐mediated disease, the lethal effects of which are initiated by the binding of protective antigen (PA) with one of three reported cell surface toxin receptors (ANTXR). Receptor binding has been shown to influence host susceptibility to the toxins. Despite this crucial role for ANTXR in the outcome of disease, and the reported immunomodulatory consequence of the anthrax toxins during infection, little is known about ANTXR expression on human leucocytes. We characterized the expression levels of ANTXR1 (TEM8) on human leucocytes using flow cytometry. In order to assess the effect of prior toxin exposure on ANTXR1 expression levels, leucocytes from individuals with no known exposure, those exposed to toxin through vaccination and convalescent individuals were analysed. Donors could be defined as either ‘low’ or ‘high’ expressers based on the percentage of ANTXR1‐positive monocytes detected. Previous exposure to toxins appears to modulate ANTXR1 expression, exposure through active infection being associated with lower receptor expression. A significant correlation between low receptor expression and high anthrax toxin‐specific interferon (IFN)‐γ responses was observed in previously infected individuals. We propose that there is an attenuation of ANTXR1 expression post‐infection which may be a protective mechanism that has evolved to prevent reinfection.     

Recombinant human interleukin-1 receptor antagonist in severe traumatic brain injury: a phase II randomized control trial

Traumatic brain injury (TBI) is the commonest cause of death and disability in those aged under 40 years. Interleukin-1 receptor antagonist (IL1ra) is an endogenous competitive antagonist at the interleukin-1 type-1 receptor (IL-1R). Antagonism at the IL-1R confers neuroprotection in several rodent models of neuronal injury (i.e., trauma, stroke and excitotoxicity). We describe a single center, phase II, open label, randomized-control study of recombinant human IL1ra (rhIL1ra, anakinra) in severe TBI, at a dose of 100 mg subcutaneously once a day for 5 days in 20 patients randomized 1:1. We provide safety data (primary outcome) in this pathology, utilize cerebral microdialysis to directly determine brain extracellular concentrations of IL1ra and 41 cytokines and chemokines, and use principal component analysis (PCA) to explore the resultant cerebral cytokine profile. Interleukin-1 receptor antagonist was safe, penetrated into plasma and the brain extracellular fluid. The PCA showed a separation in cytokine profiles after IL1ra administration. A candidate cytokine from this analysis, macrophage-derived chemoattractant, was significantly lower in the rhIL1ra-treated group. Our results provide promising data for rhIL1ra as a therapeutic candidate by showing safety, brain penetration and a modification of the neuroinflammatory response to TBI by a putative neuroprotective agent in humans for the first time.