Gülçin TELLİ DİZMAN ,
Gökhan METAN ,
Cağlayan AYAZ ,
Hayriye ALTUNAY ,
Mertcan UZUN ,
Gamze GÜRSOY ,
Zahit TAŞ , Gizem KARAHAN,
Farida AHMADOVA ,
Tuğba SARIOĞLU ,
Zeynep Cansu ÇALIŞKAN ,
ALPASLAN ALP ,
Meliha Çağla SÖNMEZER ,
Ahmet İNKAYA , Ahmet Görkem ER,
Şehnaz ALP ,
Oğuz Abdullah UYAROĞLU ,
Mine Durusu TANRIÖVER ,
Nursel ÇALIK BAŞARAN ,
GAMZE DURHAN ,
Figen BAŞARAN DEMİRKAZIK ,
Ömrüm UZUN ,
Murat AKOVA ,
Serhat ÜNAL
Background/aim: We aimed to analyze the usefulness of such a reserved area for the admission of the patients’ symptoms suggesting
COVID-19 and compare the demographic and clinical characteristics of the patients with COVID-19 and without COVID-19 who were admitted to C1 during the first month of the COVID-19 outbreak in our hospital.
Materials and methods: A new area was set up in Hacettepe University Adult Hospital to limit the contact of COVID-19 suspicious patients with other patients, which was named as COVID-19 First Evaluation Outpatient Clinic (C1). C1 had eight isolation rooms and two sampling rooms for SARS-CoV-2 polymerase-chain-reaction (PCR). All rooms were negative-pressurized. Patients who had
symptoms that were compatible with COVID-19 were referred to C1 from pretriage areas. All staff received training for the appropriate use of personal protective equipment and were visited daily by the Infection Prevention and Control team.
Results: One hundred and ninety-eight (29.4%) of 673 patients who were admitted to C1were diagnosed with COVID-19 between
March 20, 2020, and April 19, 2020. SARS-CoV-2 PCR was positive in 142 out of 673 patients. Chest computerized tomography (CT)
was performed in 421 patients and COVID-19 was diagnosed in 56 of them based on CT findings despite negative PCR. Four hundred and ninety-three patients were tested for other viral and bacterial infections with multiplex real-time reverse-transcriptase PCR (RTPCR). Blood tests that included complete blood count, renal and liver functions, d-dimer levels, ferritin, C- reactive protein, and procalcitonin were performed in 593 patients. Only one out of 44 healthcare workers who worked at C1 was infected by SARS-CoV-2.
Conclusion: A well-planned outpatient care area and teamwork including internal medicine, microbiology, and radiology specialists
under the supervision of infectious diseases specialists allowed adequate management of the mild-to-moderate patients with suspicion of COVID-19.
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Ayşe KARATAŞ ,
Ümit Yavuz MALKAN ,
Mustafa VELET ,
Haluk DEMİROĞLU ,
Yahya BÜYÜKAŞIK ,
Gülçin TELLİ DİZMAN ,
Ahmet İNKAYA ,
Batuhan ERDOĞDU ,
Olgu Erkin ÇINAR ,
Elifcan ALADAĞ ,
Salih AKSU ,
İbrahim HAZNEDAROĞLU ,
Osman ÖZCEBE ,
Nilgun SAYINALP ,
Hakan GÖKER
Background/aim: The disease caused by SARS-CoV-2 was named as COVID-19. There is as yet insufficient information about the effects of HSCT on the clinical course of COVID-19. In the present study, we aimed to investigate the clinical course of COVID-19 in patients who had undergone HSCT. Materials and methods: We analyzed baseline characteristics, clinical course and findings of COVID-19, hospitalization and death rates, overall survival, and case fatality rates of HSCT recipients diagnosed with COVID-19 retrospectively. Results: 57.6% of the patients underwent AHSCT, and 42.4% underwent allo-HSCT. 60.6%, 27.3%, and 12.1% of the patients had mild, moderate, and severe COVID-19 or critical illness, respectively. Overall, 45.5% were hospitalized, 12.1% required intensive care, and 9.1% necessitated invasive mechanical ventilation. The total CFR was 9.1% in HSCT recipients, 22.2% in patients with active hematologic malignancy, and 4.2% in patients without active hematologic malignancy. Conclusion: It can be concluded that mortality of HSCT recipients is lower in patients whose primary disease is in remission compared to ones that are not in remission. Further studies with larger group patients are needed in order to delineate the effects of COVID-19 on HSCT patients. Key words: Hematopoietic stem cell transplantation, bone marrow transplant, COVID-19
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Amaç: HIV ile yaşayan kişilerde damgalanma, sağlık hizmetlerinin etkin biçimde kullanımının önünde engel oluşturmakta, ruh sağlığını etkilemekte ve tedavi uyumsuzluğuna yol açabilmektedir. Damgalanmanın farklı bileşenlerinin değerlendirilebilmesi, uygun koruma ve müdahale stratejilerinin geliştirilebilmesi için gereklidir. Bu çalışmada Berger HIV ile İlgili Damgalanma Ölçeği’nin (Berger-HİDÖ) Türkçeye çevrilip uyarlanarak geçerlik ve güvenilirliğinin incelenmesi amaçlanmıştır. Yöntem: Kırk maddeden oluşan, 4’lü Likert tipi yanıtlanan özbildirim ölçeğinin Türkçe formu, HIV infeksiyonu nedeniyle izlenen 95 kişiye Beck Depresyon Envanteri (BDE), Rosenberg Benlik Saygısı Ölçeği (RBSÖ) ve sosyodemografik veri formu ile birlikte uygulanmıştır. Bulgular: İlk bakış geçerliliği yeterli bulunan ölçeğin maddeleri açıklayıcı faktör analizinde dört faktöre yüklenmiştir: İçselleştirilmiş Damgalanma (16 madde); Toplumsal Tutumla İlgili Endişeler (12 madde); Olumsuz Kendilik İmajı (dokuz madde); Açılmayla İlgili Endişeler (sekiz madde). Bulgular gereği bir madde çıkarıldıktan sonra, bu yapının varyansın %46,71’ini açıkladığı görülmüştür. Dört alt ölçeğin iç tutarlılık güvenilirlik Cronbach alfa katsayıları 0,802 ile 0,934 arasında hesaplanmıştır. BDE puanı ile Berger-HİDÖ’nün İçselleştirilmiş Damgalanma, Toplumsal Tutumla İlgili Endişeler ve Açılmayla İlgili Endişeler alt ölçek puanları arasında zayıf (rs =0,214, p=0,047; rs =0,295, p=0,006; rs =0,353, p=0,001), Olumsuz Kendilik İmajı alt ölçek puanı ile iyi derecede korelasyon saptanmıştır (rs =0,617, p<0,001). RBSÖ puanı ile Berger-HİDÖ’nün Olumsuz Kendilik İmajı alt boyut puanı arasında istatistiksel olarak anlamlı, orta derecede pozitif korelasyon bulunmuştur (rs =0,434; p<0,001). Sonuç: Berger-HİDÖ Türkçe formu bu örneklemde HIV ile ilgili damgalanma düzeylerini ölçmede geçerli, güvenilir bir araç olarak bulunmuştur.
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Nursel ÇALIK BAŞARAN ,
Oğuz Abdullah UYAROĞLU ,
Gülçin TELLİ DİZMAN ,
Lale ÖZIŞIK ,
Taha Koray ŞAHİN ,
Zahit TAŞ ,
Ahmet İNKAYA ,
Sevilay KARAHAN ,
Şehnaz ALP ,
ALPASLAN ALP ,
Gökhan METAN ,
Pınar ZARAKOLU ,
Gülay SAİN GÜVEN ,
Gül Şerife ÖZ ,
Arzu TOPELİ ,
Ömrüm UZUN ,
Murat AKOVA ,
Serhat ÜNAL
Background/aim: Despite the fact that the COVID-19 pandemic has been going on for over 5 months, there is yet to be a standard management policy for all patients including those with mild-to-moderate cases. We evaluated the role of early hospitalization in combination with early antiviral therapy with COVID-19 patients in a tertiary care university hospital. Materials and methods: This was a prospective, observational, single-center study on probable/confirmed COVID-19 patients hospitalized in a tertiary care hospital on COVID-19 wards between March 20 and April 30, 2020. The demographic, laboratory, and clinical data were collected. Results: We included 174 consecutive probable/confirmed COVID-19 adult patients hospitalized in the Internal Medicine wards of the University Adult Hospital between March 20 and April 30, 2020. The median age was 45.5 (19–92) years and 91 patients (52.3%) were male. One hundred and twenty (69%) were confirmed microbiologically, 41 (23.5%) were radiologically diagnosed, and 13 (7.5%) were clinically suspected (negative microbiological and radiological findings compatible with COVID-19); 35 (20.1%) had mild, 107 (61.5%) moderate disease, and 32 (18.4%) had severe pneumonia. Out of 171 cases, 130 (74.3%) showed pneumonia; 80 were typical, and 50 showed indeterminate infiltration for COVID-19. Patients were admitted within a median of 3 days (0-14 days) after symptoms appear. The median duration of hospitalization was 4 days (0-28 days). In this case series, 13.2% patients were treated with hydroxychloroquine alone, 64.9% with hydroxychloroquine plus azithromycin, and 18.4% with regimens including favipiravir. A total of 15 patients (8.5%) were transferred to the ICU. Four patients died (2.2%). Conclusion: In our series, 174 patients were admitted to the hospital wards for COVID-19, 69% were confirmed with PCR and/or antibody test. At the time of admission, nearly one fifth of the patients had severe diseases. Of the patients, 95.4% received hydroxychloroquine alone or in combination. The overall case fatality rate was 2.2%. Key words: COVID-19, noncritical illness, hydroxychloroquine, favipiravir
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Objective: On 30 January 2020, WHO declared that coronavirus disease 2019 (COVID-19) outbreak has met the criteria for a Public Health Emergency of International Concern. Here, we report the clinical features and outcome of the first two cases of COVID-19 in a university hospital in Turkey, who were house-mate internists.Case Presentation:Our first patient was a 28-year-old female who works as a resident in the Internal Medicine Department of a 1200-bed, tertiary care University Hospital. Her initial symptom was fatigue. She developed dry cough, nausea, and myalgia. She had no fever, no shortness of breath, or any other complaints. As the 2019-nCoV PCR test was positive, oral hydroxychloroquine and azithromycin were commenced. After the positive PCR test of the first patient, we screened 85 subjects who had unprotect-ed exposure to her; most of them were her colleagues and other healthcare workers. Test results of all but one were negative. The only person with a positive test result was the 35-year-old female who was the housemate and also a colleague of the first patient. Discussion:These two cases showed us the desperate situation of COVID-19. To fight an infectious disease that had a high transmission rate, it is important to the infection chain between source and vulnerable subject and transmission route. Unfortunately, to find all infected sources is not possible every time, due to asymptomatic or mild cases, or with low sensitivity diagnostic tests. So, we need to do vigorous isolation pre-cautions and to test more people to end up this pandemic
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Objective: Immunocompromised patients are at a greater risk of developing intestinal parasite infections. In this study, we examined the presence of Enterocytozoon bieneusi, Encaphalitozoon intestinalis and other intestinal protozoa in stool samples of immunosuppressed patients. Methods: A total of 100 stool samples were obtained from patients receiving chemotherapy because of solid organ tumour with haematological malignancies and those receiving immunosuppressive treatment because of rheumatic diseases, organ transplant patients and patients receiving treatment for HIV-related infections. Stool samples were examined by using the native-lugol method in which the stool concentration, modified Kinyoun acid-fast and trichrome staining methods and parasite presence were analysed. The stool samples were also examined for the presence of Enterocytozoon bieneusi and Encephalitozoon intestinalis using an indirect fluorescent antibody method. Results: Intestinal parasites were detected in 12% of all patients. The distribution of intestinal parasites in patients were 7% Blastocystis spp., 2% Blastocystis spp. + Dientamoeba fragilis, 1% Blastocystis spp. + Entamoeba coli, 1% Blastocystis spp. + Giardia intestinalis and 1% G. intestinalis. Microsporidia spp. were detected in 4% of all patients by the IFAT method and in 8% of all patients by calcoflour staining method. Conclusion: In our study, the most prevalent parasite detected in the immunosuppressed patients was Blastocystis spp. The pathogenesis of Blastocystis spp. remains to be controversial, and their role in immunocompromised patients continues to remain unknown. Although these rates detected in our study are similar to the prevalence in the normal population, it is important to study these microorganisms in immunocompromised patients in terms of the associated decreasing morbidity and mortality rates.
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Aralık 2019 tarihinde tanımlanan yeni koronavirüs hastalığı (COVID-19) için etken olan SARS-CoV-2’ye karşı etkinliği kısmen gösterilmiş tedavi seçenekleri olmakla birlikte sağ kalım üzerine etkisi kanıtlanmış bir ilaç henüz geliştirilememiştir. Farklı endikasyonlar için kulla-nılmakta veya geliştirilmekte olan birçok kimyasal, in vitro çalışmalarda gözlenen etkilerine dayanılarak, tedavi amaçlı kullanıma alın-mıştır. Bu ilaçlardan biri olan favipiravir ilk olarak pandeminin başlangıç merkezi olan Wuhan’da kullanılmıştır. İnfeksiyonun dünyaya yayılmaya başlamasından itibaren İtalya, Japonya, Rusya, Ukrayna, Özbekistan, Moldova ve Kazakistan, Bangladeş, Mısır, Hindistan gibi ülkelerin yanı sıra ülkemizde de kullanılmaktadır. Favipiravirin etkinliğini değerlendirmek için yapılmış ve yayımlanmış az sayıda çalışma vardır ancak çok sayıda çalışma devam etmektedir. Bu derlemede literatürde favipiravirin COVID-19 tedavisinde etkinliğini bildi-ren çalışma ve vaka raporlarının gözden geçirilmesi ve değerlendirilmesi amaçlanmıştır. Kaynak taramasıyla 223 sonuca ulaşılmıştır, bu sonuçlardan 210 yazıya tam erişim sağlanabilmiştir ve toplam 34 yazı analize dahil edilmiştir. Derleme kapsamında favipiravirin farma-kolojisi başlığı altında farmakokinetik, farmakodinamik özelliklere ek olarak istenmeyen etkiler ve ilaç etkileşimlerinden bahsedilmiştir. Favipiravir, COVID-19 hastalarının tedavisi için seçeneklerden biridir ancak çok daha fazla hastanın dahil edildiği ve daha uzun takip sürelerini içeren randomize, kontrollü çalışmaların planlanması ve devam eden çalışmaların sonuçlarının değerlendirmesi gerekmektedir.
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Oğuz Abdullah UYAROĞLU ,
Yusuf Ziya ŞENER ,
Murat ÖZDEDE ,
Nursel ÇALIK BAŞARAN ,
Lale ÖZIŞIK ,
Taha Koray ŞAHİN ,
Uğur CANBOLAT ,
Ahmet İNKAYA ,
Hikmet YORGUN ,
Gülay SAİN GÜVEN ,
Kudret AYTEMİR
Objective: We aimed to evaluate the degree of QTc prolongation and associated factors in patients with COVID-19 in association with their usage of hydroxychloroquine (HCQ) with or without the combination of azithromycin (AZ) and/or favipiravir (FAV). Methods: This single-center, retrospective study was conducted in a tertiary care university hospital. We retrospectively examined the pre- and post-treatment electrocardiogram (ECG) records of 74 patients. Results: The median age was 44 (interquartile range [IQR] 27), and 34 (45.5%) of them were women. All these 74 patients were treated with HCQ. Sixty-three of them (83.2%) were treated with AZ, and eight patients (10.8%) also were treated with plus favipiravir. All ECGs were in sinus rhythm, and arrhythmia was not developed in any patients. The median (IQR) baseline QTc of 74 patients was 400 (375- 421) milliseconds, the median (IQR) post-treatment QTc was 418 milliseconds (391-432), and the change was statistically significant (P < .001). There was no statistically significant difference in QTc prolongation between treatment groups. In the linear regression model, moderate disease activity, higher Modified Early Warning Score (MEWS) score ( 2), and heart rate were independent predictors. QTc prolongation of more than 60 milliseconds was observed in five patients (6.7%). Post-treatment QTc value of over 500 milliseconds was observed in three patients (4%), and the drugs were discontinued. Conclusions: This is the first study that demonstrates that MEWS score and disease severity are related to higher QTc prolongation values. HCQ, AZ, and FAV should be safely used in patients with lower MEWS score and without the severe disease, in conjunction with QTc follow-up.
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İlim IRMAK ,
Ebru ÇELEBİOĞLU ,
Damla KARADENİZ GÜVEN ,
Khurshud HUSEYNOVA ,
Ahmet İNKAYA ,
Berrin ER ,
Ali Korhan SIĞ ,
Dolunay GÜLMEZ ,
SEVTAP ARIKAN AKDAĞLI ,
Dilber ADEMHAN TURAL ,
DENİZ DOĞRU ERSÖZ ,
Uğur ÖZÇELİK ,
Nural KİPER ,
Ali Fuat KALYONCU
Background/aim: Cystic fibrosis is an autosomal recessive disease with a defect in mucociliary activity that is characterized by recurrent pulmonary infections. Bacterial agents frequently implicated in airway colonization are Haemophilus influenzae, Staphylococcus spp., and Pseudomonas spp. Fungal isolation from sputum is common in adults. However, growth of fungal agent only in sputum culture in patients with cystic fibrosis is insufficient for the diagnosis of fungal diseases. There is limited data about the clinical significance of fungal isolation in sputum cultures. The aim of the study was to investigate the clinical outcomes andsignificance of fungal isolation from sputum samples in adult CF. Materials and methods: This retrospective study included patients who have been admitted between October 2017 and January 2019 in an adult cystic fibrosis unit. Patients were grouped according to fungal pathogenicity as; fungal disease group, colonization group, and nonisolated group. The data of the last one year, including demographics, clinical data, laboratory, treatment modalities, results of cultured bacteria and fungus from sputum samples, respiratory function parameters, frequency of exacerbation, and hospitalizationwere compared between groups. Results: A total of 330 sputum samples from 88 adult patients with CF were collected. Patients were divided into 3 groups, the fungal disease group (n = 10, 11.4%), colonization group (n = 49, 55.7%), and nonisolated group (n = 29, 32.9%). Presence of pulmonary exacerbation, number of admissions to emergency department, and the number of positive cultures for bacteria from sputum were higher in the fungal disease group (p = 0.03, p = 0.01 and p < 0.001). The fungal disease group had higher rate of antibiotics by parenteral routethan other groups (p = 0.001) whereas lung functions were similar. Use of nutritional supplementation and parenteral antibiotherapy were the factors associated with elevated risk of fungal isolation. Conclusion: Frequent use of parenteral antibiotics and use of nutritional supplementation were found to be independent risk factors for fungal isolation from sputum in adult CF. Key words: Adult cystic fibrosis, sputum, fungi
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Koronavirüs-19 hastalığı (COVID-19), ilk kez 2019 yılı sonunda Çin’in Wuhan şehrinde tanımlanmıştır. Hızla tüm dünyaya yayılarak,üç yüz binden fazla insanın ölümüne neden olmuştur. Henüz bilinen etkin aşı ve tedavisi yoktur. Hastalık patogenezi anlaşılmadanaşı ve özgün tedavi geliştirilmesi mümkün değildir. Ağır solunum yetmezlik sendromu koronavirüsü (SARS-CoV) ve Ortadoğu solunumsendromu koronavirüsü (MERS-CoV) salgınlarından elde edilen bilgiler, COVID-19 patogenezinin aydınlatılmasına katkı sağlayabilir.Yapılan tüm çalışmalara rağmen SARS-CoV-2 patogenezinde pek çok nokta hala tam olarak anlaşılamamıştır. Aşırı immün yanıtınortaya çıkması, solunum yetmezliği ve hatta ölüme kadar gidebilen komplikasyonlara yol açar. COVID-19 sırasında kompleman sistemi,sitokin salınımı ve inflamasyon, endotel hasarı, koagülasyon kaskadı, hücresel ve hümoral immünite hepsi birlikte immün patogenezdeoldukça önemli bir rol oynamaktadır. Bu derlemede; COVID-19’un ortaya çıkışı, SARS-CoV-2’ye karşı oluşan immün yanıt ve konaközelliklerinin hastalığın ciddiyeti ile olan ilişkisi, antikor yanıtları ve immün patogenez, hiperkoagülasyonun olası nedenleri tartışılacakolup etkili bir aşı ve spesifik tedavi geliştirilmesi yolunda perspektif kazandırma amaçlanmıştır.
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