Josef Yayan - Academia.edu (original) (raw)

Papers by Josef Yayan

International journal of medical sciences, 2015

Past studies have shown that aspirin and statins decrease the rate and severity of exacerbation, ... more Past studies have shown that aspirin and statins decrease the rate and severity of exacerbation, the rate of hospitalization, and mortality in chronic obstructive pulmonary disease (COPD). Although these studies are relatively new, there is evidence that new therapeutic strategies could prevent exacerbation of COPD. This article examines retrospectively the possibility of using aspirin and statins to prevent exacerbation and infection in patients with COPD. All patients with COPD were identified from hospital charts in the Department of Internal Medicine, Saarland University Medical Center, Germany, between 2004 and 2014. The study examined 514 medical reports and secured a study population of 300 with COPD. The mean age was 69 ± 10 years (206 men, 68.7%, 95% CI, 63.4-73.9; 94 women, 31.3%, 95% CI, 26.1-36.6). The study results did not show a causal relationship between aspirin and statins and prevention of exacerbation and infection in patients with COPD. In contrast, in this study...

North American Journal of Medical Sciences, 2013

Alteplase is used to treat acute ischemic stroke. However, it has several documented adverse effe... more Alteplase is used to treat acute ischemic stroke. However, it has several documented adverse effects, including the development of orolingual angioedema (OA). Although, OA is a rare side-effect, it is thought to be life-threatening and is difficult to treat. Until date, little is known about this condition and a better understanding of OA may contribute to improve the morbidity and mortality amongst patients that develop this condition. Using the PubMed and Medknow databases, we searched for peer reviewed published articles on OA after alteplase administration in 1950-2012. We gathered demographic data and investigated the relationship between the location of OA, neurological symptoms and the site of cerebral ischemia. In addition, we studied the effects of hypertensive premedication on OA development. We identified 19 published manuscripts that fulfilled our search criteria. These manuscripts reported 41 cases of OA after alteplase administration. We found that this condition is associated with cerebral ischemia (P < 0.012) and that 65.9% (n = 27) of patients who developed OA had a hypertensive drug as a premedication. Although OA is a rare side-effect of alteplase, it can occur depending upon the localization of acute cerebral ischemia.

Clinical Interventions in Aging, 2014

Previous studies have shown different relationships between traditional cardiovascular risk facto... more Previous studies have shown different relationships between traditional cardiovascular risk factors for coronary artery disease (CAD) in very elderly people. Although new associations with CAD have been reported, there is also evidence of the possibility of new therapeutic strategies for the treatment or prevention of CAD. Design: This article retrospectively examines the possible association of traditional cardiovascular risk factors with CAD in very elderly people aged 90 years. This study represents the hypothesis that the elderly aged 90 years have a different cardiovascular profile with respect to CAD than patients 90 years old. Methods: Data on all patients aged 90 years who received a cardiac catheterization were collected from hospital charts from the within the study period of 2004-2013. The cardiovascular risk profiles were compared in patients aged 90 years with and without CAD after cardiac catheterization. Results: One hundred and six out of 67,976 (0.2%, mean age 91.6±1.8 years, 40 female [37.7%]; 95% confidence interval [CI]: 0.1-0.2), and out of a total of 114 of the very elderly patients, were found to have CAD. From the results of this study, the author could establish only a causal relationship between hypertension and CAD in very elderly people (P=0.005). At best, this is just an association with a higher risk of CAD in this age group. Several studies with similar outcomes are needed to establish causality. Conclusion: This study could find no link between CAD and traditional risk factors, except for hypertension.

Medicine, 2014

Current uses of culture-independent tools in previous studies have shown a significant relationsh... more Current uses of culture-independent tools in previous studies have shown a significant relationship between microbiota and asthma. Although these studies are relatively new, there is also evidence of the possibility of new therapeutic strategies for the treatment or prevention of asthma. This article retrospectively examines the possible association between microorganisms and asthma. Data on all patients with different types of asthma were collected from hospital charts from the Department of Internal Medicine, Saarland University Medical Center, Germany, within the study period of 2011 to 2012. The tracheal secretions of asthmatics obtained by bronchoalveolar lavage, bronchial aspirates through flexible bronchoscopy, and directly in sputum were examined microbiologically for microorganisms. Thirty-one (10.47%, 95% CI, 6.98-13.96) of a total of 296 patients were found to have asthma microorganisms in their airways. We could not establish a causal relationship between microorganisms and asthma based on the results of our study (P = 0.893). Additionally, acute respiratory infections did not affect the microbiological colonization in asthmatics' airways (P = 0.472). We were unable to find a direct association between asthma and the microbiome based on existing diagnostic techniques.

PLoS ONE, 2014

Coronary artery disease (CAD) is caused by an acute myocardial infarction and is still feared as ... more Coronary artery disease (CAD) is caused by an acute myocardial infarction and is still feared as a life-threatening heart disease worldwide. In order to identify patients at high risk for CAD, previous studies have proposed various risk assessment scores for the prevention of CAD. The most commonly used risk assessment score for CAD worldwide is the Framingham Risk Score (FRS). The FRS is used for middle-aged people; hence, its appropriateness has not been demonstrated to predict the likelihood of CAD occurrence in very elderly people. This article examines the possible predictive value of FRS for CAD in very elderly people over 90 years of age. Data on all patients over 90 years of age who received a cardiac catheter were collected from hospital charts from the Department of Internal Medicine, Saarland University Medical Center, and HELIOS Hospital Wuppertal, Witten/Herdecke University Medical Center, Germany, within a study period from 2004 to 2013. The FRSs and cardiovascular risk profiles of patients over 90 years of age with and without CAD after cardiac catheterization were compared. One hundred and seventy-five (91.15%, mean age 91.51±1.80 years, 74 females [42.29%]; 95% confidence interval [CI], 0.87-0.95) of a total 192 of the very elderly patients were found to have CAD. Based on the results of our study, the FRS seems to provide weak predictive ability for CAD in very elderly people (P = 0.3792). We found weak prediction power of FRS for CAD in nonagenarians.

Drug Design, Development and Therapy, 2014

Vascular Health and Risk Management, 2013

Vascular Health and Risk Management, 2012

Background: Patients with angina pectoris or myocardial infarction frequently present without evi... more Background: Patients with angina pectoris or myocardial infarction frequently present without evidence of cardiac-specific heart enzymes by laboratory analysis or specific pathologic electrocardiogram findings. The current study analyzed the efficacy of the erythrocyte sedimentation rate as an additional potential indicator for coronary heart disease, the aim being to enable quicker identification of patients with angina pectoris or myocardial infarction so that they can be more rapidly treated. Methods: Patients with angina pectoris or myocardial infarction who had undergone a heart catheter examination were included in the study. The diagnosis of acute coronary heart disease was made by the physician who performed coronary angiography. Patients without coronary heart disease were used as a control group. The erythrocyte sedimentation rate was measured in all patients. Patients with angina pectoris or myocardial infarction and an inflammatory or tumor disease were excluded. Results: The erythrocyte sedimentation rate was prolonged in 79 (58.09%) of 136 patients; 69 (50.74%) patients (95% confidence interval ±8.4%, 42.34%-59.14%) had coronary heart disease and a prolonged erythrocyte sedimentation rate. The erythrocyte sedimentation rate was prolonged in ten (7.35%) patients (95% confidence interval ±4.39%, 2.96%-11.74%) without coronary heart disease by coronary angiography. The specificity of the erythrocyte sedimentation rate for coronary heart disease was 70.59% and the sensitivity was 67.65%. Conclusion: Erythrocyte sedimentation rate may be a useful additional diagnostic criterion for coronary heart disease.

International Journal of General Medicine, 2012

Alteplase (recombinant tissue plasminogen activator) has been used in the treatment of acute isch... more Alteplase (recombinant tissue plasminogen activator) has been used in the treatment of acute ischemic stroke for 10 years. The application of this drug is considered safe and effective. However, alteplase is also associated with side effects. The author is reporting on an unusual side effect of angioedema that is triggered by alteplase. Angioedema occurs through alteplase according to this study at a frequency of 5.88% (95% confidence interval: 0.98% to 28.76%). In this case immunoglobulin G was slightly increased. The relative risk to get an angioedema compared between the two genders is elevated in men 3.3 (95% confidence interval: 0.15% to 71.90%; P = 0.4423), who were 3.3 times more likely to suffer than women. The use of angiotensin-converting-enzyme (ACE) inhibitors is considered a possible risk factor for the occurrence of angioedema with concomitant administration of tissue plasminogen activator. The angioedema may occur with use of alteplase at any time, so treatment with this drug must always be carried out in intensive care and doctors must be ready for intubation if necessary.

International Journal of General Medicine, 2012

For the last 15 years, alteplase (recombinant tissue plasminogen activator) has been used widely ... more For the last 15 years, alteplase (recombinant tissue plasminogen activator) has been used widely throughout the world for the treatment of acute ischemic stroke. Although considered to be safe and effective, like all drugs, alteplase has side effects. This retrospective cohort study was conducted in the intensive care unit of the department of internal medicine in a mid-size peripheral acute hospital in Germany. Patients with acute ischemic stroke who underwent alteplase-induced thrombolysis were investigated. Among the 1017 patients admitted for stroke investigation, 23 (2.26%) received thrombolytic therapy consisting of intravenous alteplase. Of these, six patients (26.09%) experienced complications, ie, four (17.39%) had intracerebral hemorrhage, one (4.35%) developed orolingual angioedema, and one (4.35%) had a hematoma on the right arm. After treatment with alteplase, two (33.33%) patients in the study group (n = 6) died because of intracerebral hemorrhage and one (16.67%) died because of aspiration pneumonia. One (5.88%) patient in the control group (n = 17) died of cerebral edema. The incidence of stroke and number of patients treated with alteplase in the examined hospital subunit has not increased in recent years. Also, in this study, no statistically significant difference was found in the incidence of various complications occurring during treatment for acute ischemic stroke with alteplase, but intracerebral hemorrhage was the most common complication.

International Journal of General Medicine, 2012

Clinical Interventions in Aging, 2013

Alteplase has traditionally been the only pharmacologic agent available for treating acute ischem... more Alteplase has traditionally been the only pharmacologic agent available for treating acute ischemic stroke worldwide, and is considered an effective and safe therapeutic drug for acute cerebral ischemia. However, the drug is usually indicated for use in patients aged ,81 years due to insufficient literature regarding the drug's safety in older individuals. Nevertheless, the elderly can benefit from alteplase after they experience an acute ischemic stroke. Age differences have been observed in the clinical presentation of acute ischemic stroke; however, the safety and efficacy of alteplase for patients with acute ischemic stroke do not depend on age or sex. Evidence of an increasing rate of intracerebral hemorrhage among the elderly with acute ischemic stroke, following alteplase treatment, has not been reported. Severe intracranial hemorrhage is a known side effect of alteplase but is not associated with age in patients with acute ischemic stroke. Alteplase can be used safely and effectively to treat elderly patients who suffer an acute ischemic stroke, including those over the age of 80 years.

Clinical Interventions in Aging, 2013

Background: Pulmonary embolism (PE) can be an acute, life-threatening emergency, and studies sugg... more Background: Pulmonary embolism (PE) can be an acute, life-threatening emergency, and studies suggest that advanced age is a risk factor for this condition. However, the literature is scarce regarding PE in patients above the age of 90 years. This study examined the relative risk for PE in the very elderly (.90 years) compared with that in the elderly (80-89 years). Methods: A retrospective study was performed examining very elderly patients diagnosed with PE in the Department of Internal Medicine at the University Hospital Homburg/Saar in Germany between 2004 and 2012. Elderly patients (aged 80-89 years) diagnosed with PE served as controls. PE was confirmed by contrast-enhanced chest computed tomography or ventilation perfusion scintigraphy in both groups. A total of 2230 patients were examined for PE in this study. Of these, 15 (0.67%) in the study group and 197 (8.83%) in the control group underwent further evaluation for PE. Results: After performing a radiological examination, 11 (73.3%, including six [54.55%] women) of the 15 study patients (mean age 91.6 ± 1.67 years) and 148 (75.1%, including 93 [62.84%] women) of the 197 controls (mean age 84.0 ± 2.59 years) were confirmed to have PE. There was a significantly lower proportion of the very elderly enrolled in the study (P , 0.001). There were no significant differences in clinical presentation, cardiovascular risk factors, electrocardiograms, blood gas analyses, radiological diagnoses, or acute comorbidities between the groups. However, the very elderly were more likely to experience minor bleeding in the extremities (P = 0.016) and to have more chronic diseases (P , 0.001). An increased relative risk of PE was not detected in the very elderly (relative risk 0.98, P = 0.88). Furthermore, d-dimer, troponin T, and high-sensitive troponin T levels had limited predictive value for PE in the very elderly. There were no significant differences in the number of hospital admissions, intensive care or ward treatments, or duration of hospitalization. Conclusion: The relative risk for PE in the very elderly is not higher than that in the elderly.

Clinical Interventions in Aging, 2012

The aim of this study was to examine the trend in increasing life expectancy in relation to heart... more The aim of this study was to examine the trend in increasing life expectancy in relation to heart attack and cardiac catheterization. Methods: A retrospective study of very elderly patients over 90 years of age (study group) and between 70 and 79 years of age (control group) with myocardial infarction and acute coronary syndrome who underwent coronary angiography was conducted. Results: A total of 1100 cardiac catheterizations were performed in the cardiac catheterization laboratory of Vinzentius-Hospital in Landau, Germany from 2007 to 2011. The number of coronary angiographies performed in patients aged over 90 years and those aged 70-79 years was 36 and 354, respectively, during this same time period. No increase in the number of evidence-based therapy for coronary heart disease by cardiac catheterization was observed in the very elderly patients over this time period. Conclusion: An increase in the number of patients aged over 90 years and a rise in heart attacks, as evaluated by coronary angiography, could not be found in this study.

Clinical Interventions in Aging, 2012

Advances in Experimental Medicine and Biology, 2015

Asthma and chronic obstructive pulmonary disease (COPD) are two of the most common chronic lung d... more Asthma and chronic obstructive pulmonary disease (COPD) are two of the most common chronic lung diseases worldwide. Distinguishing between these different pulmonary diseases can be difficult in practice because of symptomatic similarities. A definitive diagnosis is essential for correct treatment. This review article presents the different symptoms of these two chronic inflammatory lung diseases following a selective search of the PubMed database for relevant literature published between 1996 and 2012. While cough occurs in both diseases, asthmatics often have a dry cough mainly at night, which is often associated with allergies. In contrast, COPD is usually caused by years of smoking. Paroxysmal dyspnea, which occurs in asthma, is characterized by shortness of breath, while in COPD it occurs during physical exertion in early stages and at rest in later stages of the disease. Asthma often begins in childhood or adolescence, whereas COPD occurs mainly in smokers in later life. It is possible to live with asthma into old age, whereas the life expectancy of patients with COPD is significantly limited. Currently, there is no general curative treatment for either disorder.

International Journal of Medical Sciences, 2015

Group B Streptococcus is a primary source of pneumonia, which is a leading cause of death worldwi... more Group B Streptococcus is a primary source of pneumonia, which is a leading cause of death worldwide. During the last few decades, there has been news of growing antibiotic resistance in group B streptococci to penicillin and different antibiotic agents. This clinical study retrospectively analyzes antimicrobial resistance in inpatients who were diagnosed with group B streptococcal pneumonia. All of the required information from inpatients who were identified to have group B streptococcal pneumonia was sourced from the database at the Department of Internal Medicine of HELIOS Clinic Wuppertal, Witten/Herdecke University, in Germany, from 2004-2014. Antimicrobial susceptibility testing was performed for the different antimicrobial agents that were regularly administered to these inpatients. Sixty-six inpatients with a mean age of 63.3 ± 16.1 years (45 males [68.2%, 95% CI 60.0%-79.4%] and 21 females [31.8%, 95% CI 20.6%-43.0%]) were detected to have group B streptococcal pneumonia within the study period from January 1, 2004, to August 12, 2014. Group B Streptococcus had a high resistance rate to gentamicin (12.1%), erythromycin (12.1%), clindamycin (9.1%), and co-trimoxazole (3.0%), but it was not resistant to penicillin, cefuroxime, cefotaxime, or vancomycin (P < 0.0001). No resistance to penicillin, cefuroxime, cefotaxime, or vancomycin was detected among inpatients with pneumonia caused by group B streptococci.

Advances in Experimental Medicine and Biology, 2015

Central sleep apnea (CSA) is a sleep-related disorder characterized by pauses in breathing during... more Central sleep apnea (CSA) is a sleep-related disorder characterized by pauses in breathing during sleep when the brain respiratory network momentarily interrupts transmission of impulses to the respiratory musculature. CSA presents significant problems being an independent risk factor for cardiovascular events and death. There are several available treatment options according to CSA severity. Currently, adaptive servo-ventilation is considered best for CSA patients. The goal of the present study was to retrospectively investigate different treatment methods employed for CSA, such as different modes of ventilation, oxygen therapy, and drugs to determine the most effective one. Data were obtained from hospital records during 2010-2015. The diagnosis of CSA and the optimal treatment method were supported by polysomnography examinations. Devices used during sleep to support breathing included continuous positive airway pressure, bi-level positive airway pressure, or adaptive servo-ventilation. We classified 71 (2.9 %) patients as having CSA from 2,463 patients with sleep-disordered breathing. Of those 71 patients, 54 (76.1 %, 95 % CI 66.2-86.0 %) were male and 17 (23.9 %, 95 % CI 14.0-33.8 %) were female, and they had a mean age of 67.1 ± 14.1. Four (5.6 %) patients underwent a combination therapy, 39 (54.9 %) received a ventilator in proper ventilation mode, 25 (35.2 %) received oxygen therapy, 7 (9.9 %) received medication, and 4 (5.6 %) received no treatment. We conclude that although the majority of patients needed treatment for central sleep apnea, a clear advantage in using ventilators when compared to oxygen therapy or drug therapy could not be found.

Advances in Experimental Medicine and Biology, 2015

Older people are often especially susceptible to pneumonia and bacteria may develop resistance to... more Older people are often especially susceptible to pneumonia and bacteria may develop resistance to antibiotics quicker in the elderly, whose immune systems gradually diminish. This study analyses, retrospectively, resistance to antibiotics in high-risk elderly patients with fatal pneumonia. Records of all patients aged over 65 who did not survive a bout with pneumonia were gathered from the records of the Department of Pneumology of HELIOS Clinic in Wuppertal, Germany from the period of 2004-2014. Susceptibility testing was executed for the study population, whose pneumonia was triggered by various kinds of bacteria. We detected 936 pneumonia patients of the overall mean age of 68.0 ± 13.6 years, with the following pneumonia types: 461 (49.3 %) community-acquired, 354 (37.8 %) nosocomial-acquired, and 121 (12.9 %) aspiration pneumonia. There were 631 (67.4 %) males and 305 (32.6 %) females there. We identified 672 (71.8 %) patients who had a high risk for pneumonia, especially staphylococcal pneumonia (p < 0.0001). The elderly patients had a higher risk of dying from pneumonia (2.9 odds ratio, 95 % confidence interval 1.8-4.6; p < 0.0001); of the 185 pneumonia-related deaths, 163 (88.1 %) were in the elderly. In those with fatal staphylococcal pneumonia, a high antibiotic resistance rate was found for piperacillin-tazobactam (p = 0.044), cefuroxime (p = 0.026), cefazolin (p = 0.043), levofloxacin (p = 0.018), erythromycin (p = 0.004), and clindamycin (p = 0.025). We conclude that elderly patients with staphylococcal pneumonia show resistance to common antibiotics. However, no significant antibiotic resistance could be ascribed for other types of pneumonia in these patients.

BMC Infectious Diseases, 2015

The widespread overuse of antibiotics promotes the development of antibiotic resistance in bacter... more The widespread overuse of antibiotics promotes the development of antibiotic resistance in bacteria, which can cause severe illness and constitutes a major public health concern. Haemophilus species are a common cause of community- and nosocomial-acquired pneumonia. The antibiotic resistance of these Gram-negative bacteria can be prevented through the reduction of unnecessary antibiotic prescriptions, the correct use of antibiotics, and good hygiene and infection control. This article examines, retrospectively, antibiotic resistance in patients with community- and nosocomial-acquired pneumonia caused by Haemophilus species. The demographic, clinical, and laboratory data of all patients with community- and nosocomial-acquired pneumonia caused by Haemophilus species were collected from the hospital charts at the HELIOS Clinic, Witten/Herdecke University, Wuppertal, Germany, within a study period from 2004 to 2014. Antimicrobial susceptibility testing was performed for the different antibiotics that have been consistently used in the treatment of patients with pneumonia caused by Haemophilus species. During the study period of January 1, 2004, to August 12, 2014, 82 patients were identified with community- and nosocomial-acquired pneumonia affected by Haemophilus species. These patients had a mean age of 63.8 ± 15.5 (60 [73.2 %, 95 % CI 63.6 %-82.8 %] males and 22 [26.8 %, 95 % CI 17.2 %-36.4 %] females). Haemophilus species had a high resistance rate to erythromycin (38.3 %), ampicillin (24.4 %), piperacillin (20.8 %), cefuroxime (8.5 %), ampicillin-sulbactam (7.3 %), piperacillin-sulbactam (4.3 %), piperacillin-tazobactam (2.5 %), cefotaxime (2.5 %), and levofloxacin (1.6 %). In contrast, they were not resistant to ciprofloxacin in patients with pneumonia (P = 0.016). Haemophilus species were resistant to many of the typically used antibiotics. Resistance toward ciprofloxacin was not detected in patients with pneumonia caused by Haemophilus species.

International journal of medical sciences, 2015

Past studies have shown that aspirin and statins decrease the rate and severity of exacerbation, ... more Past studies have shown that aspirin and statins decrease the rate and severity of exacerbation, the rate of hospitalization, and mortality in chronic obstructive pulmonary disease (COPD). Although these studies are relatively new, there is evidence that new therapeutic strategies could prevent exacerbation of COPD. This article examines retrospectively the possibility of using aspirin and statins to prevent exacerbation and infection in patients with COPD. All patients with COPD were identified from hospital charts in the Department of Internal Medicine, Saarland University Medical Center, Germany, between 2004 and 2014. The study examined 514 medical reports and secured a study population of 300 with COPD. The mean age was 69 ± 10 years (206 men, 68.7%, 95% CI, 63.4-73.9; 94 women, 31.3%, 95% CI, 26.1-36.6). The study results did not show a causal relationship between aspirin and statins and prevention of exacerbation and infection in patients with COPD. In contrast, in this study...

North American Journal of Medical Sciences, 2013

Alteplase is used to treat acute ischemic stroke. However, it has several documented adverse effe... more Alteplase is used to treat acute ischemic stroke. However, it has several documented adverse effects, including the development of orolingual angioedema (OA). Although, OA is a rare side-effect, it is thought to be life-threatening and is difficult to treat. Until date, little is known about this condition and a better understanding of OA may contribute to improve the morbidity and mortality amongst patients that develop this condition. Using the PubMed and Medknow databases, we searched for peer reviewed published articles on OA after alteplase administration in 1950-2012. We gathered demographic data and investigated the relationship between the location of OA, neurological symptoms and the site of cerebral ischemia. In addition, we studied the effects of hypertensive premedication on OA development. We identified 19 published manuscripts that fulfilled our search criteria. These manuscripts reported 41 cases of OA after alteplase administration. We found that this condition is associated with cerebral ischemia (P < 0.012) and that 65.9% (n = 27) of patients who developed OA had a hypertensive drug as a premedication. Although OA is a rare side-effect of alteplase, it can occur depending upon the localization of acute cerebral ischemia.

Clinical Interventions in Aging, 2014

Previous studies have shown different relationships between traditional cardiovascular risk facto... more Previous studies have shown different relationships between traditional cardiovascular risk factors for coronary artery disease (CAD) in very elderly people. Although new associations with CAD have been reported, there is also evidence of the possibility of new therapeutic strategies for the treatment or prevention of CAD. Design: This article retrospectively examines the possible association of traditional cardiovascular risk factors with CAD in very elderly people aged 90 years. This study represents the hypothesis that the elderly aged 90 years have a different cardiovascular profile with respect to CAD than patients 90 years old. Methods: Data on all patients aged 90 years who received a cardiac catheterization were collected from hospital charts from the within the study period of 2004-2013. The cardiovascular risk profiles were compared in patients aged 90 years with and without CAD after cardiac catheterization. Results: One hundred and six out of 67,976 (0.2%, mean age 91.6±1.8 years, 40 female [37.7%]; 95% confidence interval [CI]: 0.1-0.2), and out of a total of 114 of the very elderly patients, were found to have CAD. From the results of this study, the author could establish only a causal relationship between hypertension and CAD in very elderly people (P=0.005). At best, this is just an association with a higher risk of CAD in this age group. Several studies with similar outcomes are needed to establish causality. Conclusion: This study could find no link between CAD and traditional risk factors, except for hypertension.

Medicine, 2014

Current uses of culture-independent tools in previous studies have shown a significant relationsh... more Current uses of culture-independent tools in previous studies have shown a significant relationship between microbiota and asthma. Although these studies are relatively new, there is also evidence of the possibility of new therapeutic strategies for the treatment or prevention of asthma. This article retrospectively examines the possible association between microorganisms and asthma. Data on all patients with different types of asthma were collected from hospital charts from the Department of Internal Medicine, Saarland University Medical Center, Germany, within the study period of 2011 to 2012. The tracheal secretions of asthmatics obtained by bronchoalveolar lavage, bronchial aspirates through flexible bronchoscopy, and directly in sputum were examined microbiologically for microorganisms. Thirty-one (10.47%, 95% CI, 6.98-13.96) of a total of 296 patients were found to have asthma microorganisms in their airways. We could not establish a causal relationship between microorganisms and asthma based on the results of our study (P = 0.893). Additionally, acute respiratory infections did not affect the microbiological colonization in asthmatics' airways (P = 0.472). We were unable to find a direct association between asthma and the microbiome based on existing diagnostic techniques.

PLoS ONE, 2014

Coronary artery disease (CAD) is caused by an acute myocardial infarction and is still feared as ... more Coronary artery disease (CAD) is caused by an acute myocardial infarction and is still feared as a life-threatening heart disease worldwide. In order to identify patients at high risk for CAD, previous studies have proposed various risk assessment scores for the prevention of CAD. The most commonly used risk assessment score for CAD worldwide is the Framingham Risk Score (FRS). The FRS is used for middle-aged people; hence, its appropriateness has not been demonstrated to predict the likelihood of CAD occurrence in very elderly people. This article examines the possible predictive value of FRS for CAD in very elderly people over 90 years of age. Data on all patients over 90 years of age who received a cardiac catheter were collected from hospital charts from the Department of Internal Medicine, Saarland University Medical Center, and HELIOS Hospital Wuppertal, Witten/Herdecke University Medical Center, Germany, within a study period from 2004 to 2013. The FRSs and cardiovascular risk profiles of patients over 90 years of age with and without CAD after cardiac catheterization were compared. One hundred and seventy-five (91.15%, mean age 91.51±1.80 years, 74 females [42.29%]; 95% confidence interval [CI], 0.87-0.95) of a total 192 of the very elderly patients were found to have CAD. Based on the results of our study, the FRS seems to provide weak predictive ability for CAD in very elderly people (P = 0.3792). We found weak prediction power of FRS for CAD in nonagenarians.

Drug Design, Development and Therapy, 2014

Vascular Health and Risk Management, 2013

Vascular Health and Risk Management, 2012

Background: Patients with angina pectoris or myocardial infarction frequently present without evi... more Background: Patients with angina pectoris or myocardial infarction frequently present without evidence of cardiac-specific heart enzymes by laboratory analysis or specific pathologic electrocardiogram findings. The current study analyzed the efficacy of the erythrocyte sedimentation rate as an additional potential indicator for coronary heart disease, the aim being to enable quicker identification of patients with angina pectoris or myocardial infarction so that they can be more rapidly treated. Methods: Patients with angina pectoris or myocardial infarction who had undergone a heart catheter examination were included in the study. The diagnosis of acute coronary heart disease was made by the physician who performed coronary angiography. Patients without coronary heart disease were used as a control group. The erythrocyte sedimentation rate was measured in all patients. Patients with angina pectoris or myocardial infarction and an inflammatory or tumor disease were excluded. Results: The erythrocyte sedimentation rate was prolonged in 79 (58.09%) of 136 patients; 69 (50.74%) patients (95% confidence interval ±8.4%, 42.34%-59.14%) had coronary heart disease and a prolonged erythrocyte sedimentation rate. The erythrocyte sedimentation rate was prolonged in ten (7.35%) patients (95% confidence interval ±4.39%, 2.96%-11.74%) without coronary heart disease by coronary angiography. The specificity of the erythrocyte sedimentation rate for coronary heart disease was 70.59% and the sensitivity was 67.65%. Conclusion: Erythrocyte sedimentation rate may be a useful additional diagnostic criterion for coronary heart disease.

International Journal of General Medicine, 2012

Alteplase (recombinant tissue plasminogen activator) has been used in the treatment of acute isch... more Alteplase (recombinant tissue plasminogen activator) has been used in the treatment of acute ischemic stroke for 10 years. The application of this drug is considered safe and effective. However, alteplase is also associated with side effects. The author is reporting on an unusual side effect of angioedema that is triggered by alteplase. Angioedema occurs through alteplase according to this study at a frequency of 5.88% (95% confidence interval: 0.98% to 28.76%). In this case immunoglobulin G was slightly increased. The relative risk to get an angioedema compared between the two genders is elevated in men 3.3 (95% confidence interval: 0.15% to 71.90%; P = 0.4423), who were 3.3 times more likely to suffer than women. The use of angiotensin-converting-enzyme (ACE) inhibitors is considered a possible risk factor for the occurrence of angioedema with concomitant administration of tissue plasminogen activator. The angioedema may occur with use of alteplase at any time, so treatment with this drug must always be carried out in intensive care and doctors must be ready for intubation if necessary.

International Journal of General Medicine, 2012

For the last 15 years, alteplase (recombinant tissue plasminogen activator) has been used widely ... more For the last 15 years, alteplase (recombinant tissue plasminogen activator) has been used widely throughout the world for the treatment of acute ischemic stroke. Although considered to be safe and effective, like all drugs, alteplase has side effects. This retrospective cohort study was conducted in the intensive care unit of the department of internal medicine in a mid-size peripheral acute hospital in Germany. Patients with acute ischemic stroke who underwent alteplase-induced thrombolysis were investigated. Among the 1017 patients admitted for stroke investigation, 23 (2.26%) received thrombolytic therapy consisting of intravenous alteplase. Of these, six patients (26.09%) experienced complications, ie, four (17.39%) had intracerebral hemorrhage, one (4.35%) developed orolingual angioedema, and one (4.35%) had a hematoma on the right arm. After treatment with alteplase, two (33.33%) patients in the study group (n = 6) died because of intracerebral hemorrhage and one (16.67%) died because of aspiration pneumonia. One (5.88%) patient in the control group (n = 17) died of cerebral edema. The incidence of stroke and number of patients treated with alteplase in the examined hospital subunit has not increased in recent years. Also, in this study, no statistically significant difference was found in the incidence of various complications occurring during treatment for acute ischemic stroke with alteplase, but intracerebral hemorrhage was the most common complication.

International Journal of General Medicine, 2012

Clinical Interventions in Aging, 2013

Alteplase has traditionally been the only pharmacologic agent available for treating acute ischem... more Alteplase has traditionally been the only pharmacologic agent available for treating acute ischemic stroke worldwide, and is considered an effective and safe therapeutic drug for acute cerebral ischemia. However, the drug is usually indicated for use in patients aged ,81 years due to insufficient literature regarding the drug's safety in older individuals. Nevertheless, the elderly can benefit from alteplase after they experience an acute ischemic stroke. Age differences have been observed in the clinical presentation of acute ischemic stroke; however, the safety and efficacy of alteplase for patients with acute ischemic stroke do not depend on age or sex. Evidence of an increasing rate of intracerebral hemorrhage among the elderly with acute ischemic stroke, following alteplase treatment, has not been reported. Severe intracranial hemorrhage is a known side effect of alteplase but is not associated with age in patients with acute ischemic stroke. Alteplase can be used safely and effectively to treat elderly patients who suffer an acute ischemic stroke, including those over the age of 80 years.

Clinical Interventions in Aging, 2013

Background: Pulmonary embolism (PE) can be an acute, life-threatening emergency, and studies sugg... more Background: Pulmonary embolism (PE) can be an acute, life-threatening emergency, and studies suggest that advanced age is a risk factor for this condition. However, the literature is scarce regarding PE in patients above the age of 90 years. This study examined the relative risk for PE in the very elderly (.90 years) compared with that in the elderly (80-89 years). Methods: A retrospective study was performed examining very elderly patients diagnosed with PE in the Department of Internal Medicine at the University Hospital Homburg/Saar in Germany between 2004 and 2012. Elderly patients (aged 80-89 years) diagnosed with PE served as controls. PE was confirmed by contrast-enhanced chest computed tomography or ventilation perfusion scintigraphy in both groups. A total of 2230 patients were examined for PE in this study. Of these, 15 (0.67%) in the study group and 197 (8.83%) in the control group underwent further evaluation for PE. Results: After performing a radiological examination, 11 (73.3%, including six [54.55%] women) of the 15 study patients (mean age 91.6 ± 1.67 years) and 148 (75.1%, including 93 [62.84%] women) of the 197 controls (mean age 84.0 ± 2.59 years) were confirmed to have PE. There was a significantly lower proportion of the very elderly enrolled in the study (P , 0.001). There were no significant differences in clinical presentation, cardiovascular risk factors, electrocardiograms, blood gas analyses, radiological diagnoses, or acute comorbidities between the groups. However, the very elderly were more likely to experience minor bleeding in the extremities (P = 0.016) and to have more chronic diseases (P , 0.001). An increased relative risk of PE was not detected in the very elderly (relative risk 0.98, P = 0.88). Furthermore, d-dimer, troponin T, and high-sensitive troponin T levels had limited predictive value for PE in the very elderly. There were no significant differences in the number of hospital admissions, intensive care or ward treatments, or duration of hospitalization. Conclusion: The relative risk for PE in the very elderly is not higher than that in the elderly.

Clinical Interventions in Aging, 2012

The aim of this study was to examine the trend in increasing life expectancy in relation to heart... more The aim of this study was to examine the trend in increasing life expectancy in relation to heart attack and cardiac catheterization. Methods: A retrospective study of very elderly patients over 90 years of age (study group) and between 70 and 79 years of age (control group) with myocardial infarction and acute coronary syndrome who underwent coronary angiography was conducted. Results: A total of 1100 cardiac catheterizations were performed in the cardiac catheterization laboratory of Vinzentius-Hospital in Landau, Germany from 2007 to 2011. The number of coronary angiographies performed in patients aged over 90 years and those aged 70-79 years was 36 and 354, respectively, during this same time period. No increase in the number of evidence-based therapy for coronary heart disease by cardiac catheterization was observed in the very elderly patients over this time period. Conclusion: An increase in the number of patients aged over 90 years and a rise in heart attacks, as evaluated by coronary angiography, could not be found in this study.

Clinical Interventions in Aging, 2012

Advances in Experimental Medicine and Biology, 2015

Asthma and chronic obstructive pulmonary disease (COPD) are two of the most common chronic lung d... more Asthma and chronic obstructive pulmonary disease (COPD) are two of the most common chronic lung diseases worldwide. Distinguishing between these different pulmonary diseases can be difficult in practice because of symptomatic similarities. A definitive diagnosis is essential for correct treatment. This review article presents the different symptoms of these two chronic inflammatory lung diseases following a selective search of the PubMed database for relevant literature published between 1996 and 2012. While cough occurs in both diseases, asthmatics often have a dry cough mainly at night, which is often associated with allergies. In contrast, COPD is usually caused by years of smoking. Paroxysmal dyspnea, which occurs in asthma, is characterized by shortness of breath, while in COPD it occurs during physical exertion in early stages and at rest in later stages of the disease. Asthma often begins in childhood or adolescence, whereas COPD occurs mainly in smokers in later life. It is possible to live with asthma into old age, whereas the life expectancy of patients with COPD is significantly limited. Currently, there is no general curative treatment for either disorder.

International Journal of Medical Sciences, 2015

Group B Streptococcus is a primary source of pneumonia, which is a leading cause of death worldwi... more Group B Streptococcus is a primary source of pneumonia, which is a leading cause of death worldwide. During the last few decades, there has been news of growing antibiotic resistance in group B streptococci to penicillin and different antibiotic agents. This clinical study retrospectively analyzes antimicrobial resistance in inpatients who were diagnosed with group B streptococcal pneumonia. All of the required information from inpatients who were identified to have group B streptococcal pneumonia was sourced from the database at the Department of Internal Medicine of HELIOS Clinic Wuppertal, Witten/Herdecke University, in Germany, from 2004-2014. Antimicrobial susceptibility testing was performed for the different antimicrobial agents that were regularly administered to these inpatients. Sixty-six inpatients with a mean age of 63.3 ± 16.1 years (45 males [68.2%, 95% CI 60.0%-79.4%] and 21 females [31.8%, 95% CI 20.6%-43.0%]) were detected to have group B streptococcal pneumonia within the study period from January 1, 2004, to August 12, 2014. Group B Streptococcus had a high resistance rate to gentamicin (12.1%), erythromycin (12.1%), clindamycin (9.1%), and co-trimoxazole (3.0%), but it was not resistant to penicillin, cefuroxime, cefotaxime, or vancomycin (P < 0.0001). No resistance to penicillin, cefuroxime, cefotaxime, or vancomycin was detected among inpatients with pneumonia caused by group B streptococci.

Advances in Experimental Medicine and Biology, 2015

Central sleep apnea (CSA) is a sleep-related disorder characterized by pauses in breathing during... more Central sleep apnea (CSA) is a sleep-related disorder characterized by pauses in breathing during sleep when the brain respiratory network momentarily interrupts transmission of impulses to the respiratory musculature. CSA presents significant problems being an independent risk factor for cardiovascular events and death. There are several available treatment options according to CSA severity. Currently, adaptive servo-ventilation is considered best for CSA patients. The goal of the present study was to retrospectively investigate different treatment methods employed for CSA, such as different modes of ventilation, oxygen therapy, and drugs to determine the most effective one. Data were obtained from hospital records during 2010-2015. The diagnosis of CSA and the optimal treatment method were supported by polysomnography examinations. Devices used during sleep to support breathing included continuous positive airway pressure, bi-level positive airway pressure, or adaptive servo-ventilation. We classified 71 (2.9 %) patients as having CSA from 2,463 patients with sleep-disordered breathing. Of those 71 patients, 54 (76.1 %, 95 % CI 66.2-86.0 %) were male and 17 (23.9 %, 95 % CI 14.0-33.8 %) were female, and they had a mean age of 67.1 ± 14.1. Four (5.6 %) patients underwent a combination therapy, 39 (54.9 %) received a ventilator in proper ventilation mode, 25 (35.2 %) received oxygen therapy, 7 (9.9 %) received medication, and 4 (5.6 %) received no treatment. We conclude that although the majority of patients needed treatment for central sleep apnea, a clear advantage in using ventilators when compared to oxygen therapy or drug therapy could not be found.

Advances in Experimental Medicine and Biology, 2015

Older people are often especially susceptible to pneumonia and bacteria may develop resistance to... more Older people are often especially susceptible to pneumonia and bacteria may develop resistance to antibiotics quicker in the elderly, whose immune systems gradually diminish. This study analyses, retrospectively, resistance to antibiotics in high-risk elderly patients with fatal pneumonia. Records of all patients aged over 65 who did not survive a bout with pneumonia were gathered from the records of the Department of Pneumology of HELIOS Clinic in Wuppertal, Germany from the period of 2004-2014. Susceptibility testing was executed for the study population, whose pneumonia was triggered by various kinds of bacteria. We detected 936 pneumonia patients of the overall mean age of 68.0 ± 13.6 years, with the following pneumonia types: 461 (49.3 %) community-acquired, 354 (37.8 %) nosocomial-acquired, and 121 (12.9 %) aspiration pneumonia. There were 631 (67.4 %) males and 305 (32.6 %) females there. We identified 672 (71.8 %) patients who had a high risk for pneumonia, especially staphylococcal pneumonia (p < 0.0001). The elderly patients had a higher risk of dying from pneumonia (2.9 odds ratio, 95 % confidence interval 1.8-4.6; p < 0.0001); of the 185 pneumonia-related deaths, 163 (88.1 %) were in the elderly. In those with fatal staphylococcal pneumonia, a high antibiotic resistance rate was found for piperacillin-tazobactam (p = 0.044), cefuroxime (p = 0.026), cefazolin (p = 0.043), levofloxacin (p = 0.018), erythromycin (p = 0.004), and clindamycin (p = 0.025). We conclude that elderly patients with staphylococcal pneumonia show resistance to common antibiotics. However, no significant antibiotic resistance could be ascribed for other types of pneumonia in these patients.

BMC Infectious Diseases, 2015

The widespread overuse of antibiotics promotes the development of antibiotic resistance in bacter... more The widespread overuse of antibiotics promotes the development of antibiotic resistance in bacteria, which can cause severe illness and constitutes a major public health concern. Haemophilus species are a common cause of community- and nosocomial-acquired pneumonia. The antibiotic resistance of these Gram-negative bacteria can be prevented through the reduction of unnecessary antibiotic prescriptions, the correct use of antibiotics, and good hygiene and infection control. This article examines, retrospectively, antibiotic resistance in patients with community- and nosocomial-acquired pneumonia caused by Haemophilus species. The demographic, clinical, and laboratory data of all patients with community- and nosocomial-acquired pneumonia caused by Haemophilus species were collected from the hospital charts at the HELIOS Clinic, Witten/Herdecke University, Wuppertal, Germany, within a study period from 2004 to 2014. Antimicrobial susceptibility testing was performed for the different antibiotics that have been consistently used in the treatment of patients with pneumonia caused by Haemophilus species. During the study period of January 1, 2004, to August 12, 2014, 82 patients were identified with community- and nosocomial-acquired pneumonia affected by Haemophilus species. These patients had a mean age of 63.8 ± 15.5 (60 [73.2 %, 95 % CI 63.6 %-82.8 %] males and 22 [26.8 %, 95 % CI 17.2 %-36.4 %] females). Haemophilus species had a high resistance rate to erythromycin (38.3 %), ampicillin (24.4 %), piperacillin (20.8 %), cefuroxime (8.5 %), ampicillin-sulbactam (7.3 %), piperacillin-sulbactam (4.3 %), piperacillin-tazobactam (2.5 %), cefotaxime (2.5 %), and levofloxacin (1.6 %). In contrast, they were not resistant to ciprofloxacin in patients with pneumonia (P = 0.016). Haemophilus species were resistant to many of the typically used antibiotics. Resistance toward ciprofloxacin was not detected in patients with pneumonia caused by Haemophilus species.