03 - Sağlık ve Kaliteli Yaşam

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03 - Sağlık ve Kaliteli Yaşam

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AMAÇ 3: SAĞLIKLI BİREYLER Çocuk ölüm oranlarının azaltılması, anne sağlığının iyileştirilmesi, HIV/AIDS, sıtma ve diğer hastalıklar ile mücadelede büyük aşama kaydetmiş durumdayız. 1990 yılından bu yana, önlenebilir çocuk ölümlerinde dünya genelinde %50’yi aşan azalma olmuştur. Anne ölümleri de dünya genelinde %45 azalmıştır. 2000 ile 2013 arasında HIV/AIDS bulaşma oranı %30 azalmış, 6,2 milyonu aşkın insan sıtmadan kurtarılmıştır. Bu ölümler; önleme ve tedavi, eğitim, aşı kampanyaları, cinsel ve üreme sağlığı hizmetleri vasıtasıyla önlenebilir. Sürdürülebilir Kalkınma Amaçları; AIDS, verem, sıtma ve diğer bulaşıcı hastalık salgınlarını 2030 yılına kadar ortadan kaldırmaya yönelik cesur bir taahhüttür. Amaç, herkesin genel sağlık hizmeti, güvenli ve erişilebilir ilaç ve aşıya kavuşmasını sağlamaktır. Aşı araştırma ve geliştirmelerinin desteklenmesi, bu sürecin vazgeçilmez bir parçasıdır.

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Open Access
Synthetic DNA Vaccines Adjuvanted with pIL-33 Drive Liver-Localized T Cells and Provide Protection from <i>Plasmodium</i> Challenge in a Mouse Model.
(2020-01-10T00:00:00Z) Reeder, SM; Reuschel, EL; Bah, MA; Yun, K; Tursi, NJ; Kim, KY; Chu, J; Zaidi, FI; Yilmaz, I; Hart, RJ; Perrin, B; Xu, Z; Humeau, L; Weiner, DB; Aly, Ahmed Sayed Ibrahım; ALY, AHMED SAYED IBRAHıM
The need for a malaria vaccine is indisputable. A single vaccine for Plasmodium pre-erythrocytic stages targeting the major sporozoite antigen circumsporozoite protein (CSP) has had partial success. Additionally, CD8+ T cells targeting liver-stage (LS) antigens induced by live attenuated sporozoite vaccines were associated with protection in human challenge experiments. To further evaluate protection mediated by LS antigens, we focused on exported pre-erythrocytic proteins (exported protein 1 (EXP1), profilin (PFN), exported protein 2 (EXP2), inhibitor of cysteine proteases (ICP), transmembrane protein 21 (TMP21), and upregulated in infective sporozoites-3 (UIS3)) expressed in all Plasmodium species and designed optimized, synthetic DNA (synDNA) immunogens. SynDNA antigen cocktails were tested with and without the molecular adjuvant plasmid IL-33. Immunized animals developed robust T cell responses including induction of antigen-specific liver-localized CD8+ T cells, which were enhanced by the co-delivery of plasmid IL-33. In total, 100% of mice in adjuvanted groups and 71%–88% in non-adjuvanted groups were protected from blood-stage disease following Plasmodium yoelii sporozoite challenge. This study supports the potential of synDNA LS antigens as vaccine components for malaria parasite infection.
Open Access
Comparative Evaluation of Orthostatic Hypotension in Patients with Diabetic Nephropathy.
(2021-07-20T00:00:00Z) Aytaş, Gamze; Elçioğlu, Ömer C; Kazancıoğlu, Rümeyza; Gürsu, Meltem; Artan, A Serra; Yabacı, Ayşegül; Soysal, PINAR; Bilgi, Kadir; Özçelik, Semra; KAZANCIOĞLU, RÜMEYZA; ELÇİOĞLU, ÖMER CELAL; GÜRSU, MELTEM; YABACI TAK, AYŞEGÜL; SOYSAL, PINAR; ÖZÇELİK, SEMRA
Introduction: Orthostatic hypotension (OH) affects 5-20% of the population. Our study investigates the presence of OH in diabetic nephropathy (DNP) patients and the factors affecting OH in comparison with nondiabetic chronic kidney disease (NDCKD) patients. Method: Patients presented to the nephrology clinic, and those who consented were included in the study. DNP was defined by kidney biopsy and/or clinical criteria. NDCKD patients of the same sex, age, and eGFR were matched to DNP patients. Demographic parameters and medications were obtained from the records. OH was determined by Mayo clinic criteria. The same researcher used an electronic device to measure blood pressure (BP). All samples were taken and analyzed the same day for biochemical and hematologic parameters and albuminuria. Results: 112 (51 F, 61 M, mean age: 62.56 ± 9.35 years) DNP and 94 (40 F, 54 M, mean age: 62.23 ± 10.08 years) NDCKD patients were included. There was no significant difference between DNP and NDCKD groups in terms of OH prevalence (70.5 vs. 61.7%, p = 0.181). Male patients had significantly higher OH prevalence than female patients (74.7 vs. 60.0%, p = 0.026). There was no significant difference in change in systolic BP between the groups (24.00 [10.00-32.00] mm Hg vs. 24.00 [13.75-30.25] mm Hg, p = 0.797), but the change in diastolic BP was significantly higher in the DNP group (8.00 [2.00-13.00] mm Hg vs. 6.00 [2.00-9.00] mm Hg, p = 0.025). In the DNP group, patients with OH had significantly higher uric acid levels than those without OH (7.18 ± 1.55 vs. 6.36 ± 1.65 mg/dL, p = 0.017). And, 73.7% of patients on calcium channel blockers developed OH (p = 0.015), and OH developed in 80.6% of 36 patients on alpha-blockers (p = 0.049). Conclusion: OH prevalence is very high in CKD, and etiology of CKD does not have a statistically significant effect on the frequency of OH, despite a difference that could be meaningful clinically. Therefore, patients with CKD are checked for OH, with or without concurrent diabetes mellitus. Evaluation of postural BP changes should be a part of nephrology practice.
Open Access
Impacts of Demographic and Clinical Characteristics on Disease Severity and Mortality in Patients with Confirmed COVID-19
(2021-01-01T00:00:00Z) Az, Adenn; Sogut, Ozgur; Akdemir, Tarik; Ergenc, Huseyin; Dogan, Yunus; ÇAKIRCA, MUSTAFA; ÇAKIRCA, MUSTAFA
Background: We investigated potential predictive factors for mortality and disease severity from demographic and clinical data, comorbidities, and laboratory findings in patients with confirmed COVID-19 who were consecutively admitted to our tertiary hospital. Methods: In this retrospective, single-center, observational study, we enrolled consecutive 540 adult patients who had COVID-19 confirmed by a molecular method. Patients were categorized into three groups based on disease severity. Patients’ demographic and clinical characteristics, mortality rates, and mortality-associated factors were analyzed. Results: The overall mortality rate was 4.3% (23/540). Disease severity was mild in 40.9% (n = 221), severe in 53.7% (n = 290), and critical in 5.4% (n = 29) of the patients. There were significant differences among groups in terms of median white blood cell (WBC), hemoglobin, neutrophil, lymphocyte, and thrombocyte counts, as well as C-reactive protein (CRP), procalcitonin, lactate dehydrogenase (LDH), creatinine, albumin, D-dimer, ferritin, troponin, and fibrinogen levels. Furthermore, there were significant differences between surviving and non-surviving patient groups in terms of median WBC, hemoglobin, neutrophil, and lymphocyte counts, as well as CRP, procalcitonin, LDH, creatinine, albumin, D-dimer, and ferritin levels. CRP level (odds ratio [OR]: 1.020, 95% confidence interval [CI]: 1.009– 1.032; p < 0.001), and CURB-65 score (OR: 4.004, 95% CI: 1,288–12,447; p = 0.017) were independently associated with disease severity and mortality. Conclusion: On admission, WBC, neutrophil, lymphocyte, and platelet counts can be used to predict disease severity in patients with COVID-19. CRP, ferritin, LDH, creatinine, troponin, D-dimer, fibrinogen, and albumin levels can also be used to predict disease severity in these patients. Finally, elevated CRP level and high CURB-65 score were predictors of disease severity and mortality.
Open Access
The relationship of neutrophil to lymphocyte ratio with testicular cancer
(2020-01-01) İlktaç, Abdullah; Akbulut, Habib; Akçay, Muzaffer; Ersöz, Cevper; Doğan, Bayram; İLKTAÇ, ABDULLAH; DOĞAN, BAYRAM; ERSÖZ, CEVPER; AKÇAY, MUZAFFER; AKBULUT, HABİB
Purpose: To assess the relationship between testicular germ cell tumors (TGCT) and neutrophil to lymphocyte ratio (NLR) and to determine whether this ratio can be used as a serum tumor marker. Material and Methods: Sixty-one patients with testicular germ cell tumors were included into the study. Patients were grouped as localized and non-localized. Histologically patients were categorized as seminoma and nonseminomatous germ cell tumors. Complete blood cell count was measured the day before surgery and at the postoperative 1st month. Preoperative and postoperative mean NLR values were compared. Results: Thirty-six patients (59%) had seminomas and 25 patients (41%) had nonseminomatous testicular cancer. Forty-fi ve patients (73.8%) had localized and 16 patients (26.2%) had non-localized testicular cancer. There was a statistically signifi cant difference between preoperative and postoperative mean NLR of the localized patients (p=0.001) but no such difference was detected for non-localized patients (p=0.576). Nineteen patients with localized seminomas had normal preoperative serum tumor markers. There was a signifi cant difference between preoperative and postoperative mean NLR in this group of patients (p=0.010). Twenty-six patients with localized tumors had preoperative increased serum tumor markers which normalized after orchiectomy. Mean NLR of these patients signifi cantly decreased from 3.10±2.13 to 1.62±0.59 postoperatively (p=0.010). Conclusions: NLR appears to be a useful marker for TGCT. It is successful in predicting localized and non-localized disease in early postoperative period.
Open Access
Can CA-125 Predict Lymph Node Metastasis in Epithelial Ovarian Cancers in Turkish Population?
(2014-01-01T00:00:00Z) Sudolmus, Sinem; Koroglu, Nadiye; Yildirim, Gokhan; Ulker, Volkan; Gulkilik, Ahmet; DANSUK, RAMAZAN; DANSUK, RAMAZAN
Objective. The role of single preoperative serum CA-125 levels in predicting pelvic or paraaortic lymph node metastasis in patients operated for epithelial ovarian cancer has been investigated. Methods. 176 patients diagnosed with epithelial ovarian carcinoma after staging laparotomy between January 2002 and May 2010 were evaluated retrospectively. Results. The mean, geometric mean, and median of preoperative serum CA-125 levels were 632,6, 200,29, and 191,5 U/mL, respectively. The cut-off value predicting lymph node metastases in the ROC curve was 71,92 U/mL, which is significant in logistic regression analysis (P = 0.005). The preoperative log CA-125 levels were also statistically significant in predicting lymph node metastasis in logistic regression analysis (P = 0.008). Conclusions. The tumor marker CA-125, which increases with grade independent of the effect of stage in EOC, is predictive of lymph node metastasis with a high rate of false positivity in Turkish population. The high false positive rate may obscure the predictive value of CA-125.
Open Access
Protective and therapeutic effects of pyrrolidine dithiocarbamate in a rat tongue cancer model created experimentally using 4-nitroquinoline 1-oxide.
(2020-11-01T00:00:00Z) Doğan, R; Hafız, AM; Gucin, Z; Ozer, OF; Ozturan, O; Yenigun, Alper; DOĞAN, REMZI; GÜCİN, ZÜHAL; ÖZER, ÖMER FARUK; YENİGÜN, ALPER; ÖZTURAN, ORHAN
Open Access
COVID-19 Pandemic and Surge Capacity
(2020-08-01T00:00:00Z) Karakoç, Miraç Nevzat; Erdoğan, Özcan; ERDOĞAN, ÖZCAN
Disasters and pandemics experienced in recent years have shown the importance of emergency preparedness. Effectively responding to events leading to a large influx of patients that disrupt daily operations requires increased capacity. Not much resources may be available to recover losses in the current healthcare system. Therefore, plans should be made for the overflow capacity to accommodate a large number of patients before the disaster. In the face of a complex emergency epidemic, it is very important to identify and verify resources from the beginning of the outbreak in order to scale and use efficiently. It is necessary to make alternative plans and produce solutions against the worst possible scenario. In Coronavirus disease-2019 pandemics, as in all disasters and pandemics, trying to reduce the number of cases for overflow capacity, establishing alternative health facilities, minimizing the resource consumption of patients and increasing the bed capacity should be basic strategies. The need for excess resources arising in the overflow capacity experienced in a pandemic should be evaluated correctly and planning should be done accordingly. Therefore, it is necessary to create alternative areas. Projecting the underground car parks of the hospitals as underground hospitals in case of a nature-related disaster, and evaluating other closed areas within this scope; Again, the parks and reserve areas in the cities should be planned for the establishment of field hospitals against different scenarios against each natural disaster situation. With these plans, physical area demands that will occur in response to the overflow capacity can be supplied.
Open Access
Antibody Response to SARS-CoV-2 Vaccines in People with Severe Obesity
(2022-07-01T00:00:00Z) KARA, ZEHRA; Akcin, Ruveyda; DEMİR, Ahmet Numan; DİNÇ, HARİKA ÖYKÜ; Taskin, Halit Eren; KOCAZEYBEK, BEKİR SAMİ; YUMUK, VOLKAN DEMİRHAN; DİNÇ, HARİKA ÖYKÜ
Aim: Obesity is a disease complicating the course of COVID-19 and SARS-CoV-2 vaccine effectiveness in adults with obesity may be compromised. Our aim is to investigate the spike-protein receptor-binding domain antibody titers against BNT162b2 mRNA and inactivated SARS-CoV-2 (CoronaVac) vaccines in people with severe obesity. It is anticipated that the results to be obtained may provide invaluable information about future SARS-CoV-2 vaccination strategies in this vulnerable population. Methods: A total of 124 consecutive patients with severe obesity (age > 18 years, BMI ≥ 40 kg/m2) presenting between August and November 2021 were enrolled. The normal weight control group (age > 18, BMI 18.5-24.9 kg/m2) was recruited from 166 subjects who visited the vaccination unit. SARS-CoV-2 spike-protein antibody titers were measured in patients with severe obesity and in normal weight controls who received two doses of BNT162b2, or CoronaVac vaccines. SARS-CoV-2 IgG Nucleocapsid Protein antibody (NCP Ab) testing was performed to discover prior SARS-CoV-2 infection. Blood samples were taken from individuals at 4th week and after 2nd dose of vaccination. SARS-CoV-2 IgG antibody titers were determined by quantitative serological methods. Results: A total of 290 individuals (220 female, 70 male) who have received two doses of BNT162b2 or CoronaVac vaccines were enrolled in the study. Seventy had prior SARS-CoV-2 infection. In 220 subjects (non-prior infection) vaccinated with BNT162b2 or CoronaVac, the antibody titers against SARS-CoV-2 spike antigen of patients with severe obesity were significantly lower than normal weight controls (p = 0.001, p = 0.001 respectively). In seventy subjects with prior SARS-CoV-2 infection, spike antigen antibody titers in patients with severe obesity, vaccinated with BNT162b2 or CoronaVac, were not significantly different from normal weight controls (p = 0.1, p = 0.1 respectively). In patients with severe obesity, with and without prior SARS-CoV-2 infection, spike antigen antibody levels of those vaccinated with BNT162b2 were found to be significantly higher than those vaccinated with CoronaVac (p = 0.043, p < 0.001 respectively). Conclusion: Patients with severe obesity generated significantly reduced antibody titers against SARS-CoV-2 spike antigen after CoronaVac and BNT162b2 vaccines compared to people with normal weight. Antibody levels in patients with severe obesity vaccinated with BNT162b2 were found to be significantly higher than those vaccinated with CoronaVac. People living with severe obesity should be prioritized for COVID-19 vaccination and BNT162b2 vaccine may be recommended for this vulnerable population.
Open Access
State and trait anxiety among medical staff during the first month of COVID-19 pandemic: A sample from Turkey
(2021-08-01T00:00:00Z) ŞAHAN, EBRU; TANGİLNTİZ, AİSE; ŞAHAN, EBRU; TANGİLNTİZ, AİSE
Objectives During the COVID-19 pandemic, excessive workload, a rapidly changing workplace environment, the danger of carrying the virus and transmitting the disease to their families, relatives and those they live with creates stress for the medical workers. In our study, we aimed to evaluate the state and trait anxiety levels of healthcare professionals who encounter patients with suspected COVID-19 infection and related factors. Method Data were collected from healthcare professionals working with patients diagnosed or suspected with COVID-19 via online self-report questionnaire between 9-19 April 2020. The state (STAI-S) and trait anxiety (STAI-T) scale was used to measure anxiety. Results A total of 291 healthcare professionals, 216 women and 75 men, participated in the study. Women-s state and trait anxiety were significantly higher than men-s. 11 participants without any lifetime psychiatric illness experienced psychiatric symptoms and consulted to a psychiatrist. The state anxiety of those who have children, nurses and those working in branches directly related to the pandemic (Infectious Diseases, Respiratory Diseases, Emergency Medicine, Internal Medicine, Radiology, Anesthesiology and Reanimation) was higher than others. The state anxiety of those who thought they were not protected with personal protective equipment and those who did not stay in their own home was higher than others. Conclusions At the forefront of the fight against COVID-19, there are medical personnel who pay a serious psychological cost. Especially in terms of anxiety, we should pay attention to women, workers with children, nurses and people working in branches that are directly related to pandemics.
Open Access
Discordance between Serum Neutralizing Antibody Titers and the Recovery from COVID-19
(2020-09-25T00:00:00Z) Koç, Mm; Kalkan, Yazıcı; Çetin, Nesibe Selma; Doymaz, Mz; Sümbül, B; Durdu, B; YAZICI, MERVE; MERİÇ KOÇ, MELİHA; ÇETİN, NESİBE SELMA; KARAASLAN, ELİF; OKAY, GÜLAY; DURDU, BÜLENT; SÜMBÜL, BİLGE; DOYMAZ, MEHMET ZIYA
The recent pandemic of COVID-19 has caused a tremendous alarm around the world. Details of the infection process in the host have significant bearings on both recovery from the disease and on the correlates of the protection from the future exposures. One of these factors is the presence and titers of neutralizing Abs (NAbs) in infected people. In the current study, we set out to investigate NAbs in the recovered subjects discharged from the hospital in full health. Serum samples from a total of 49 documented consecutive COVID-19 subjects were included in the study. All the subjects were adults, and serum samples collected during the discharge were tested in viral neutralization, enzyme immunoassay (EIA), and Western immunoblot tests against viral Ags. Even though a majority of the recovered subjects had raised significant NAb titers, there is a substantial number of recovered patients (10 out of 49) with no or low titers of NAbs against the virus. In these cohorts as well as in patients with high NAb titers, viral Ag binding Abs were detectable in EIA tests. Both NAb titers and EIA detectable Abs are increased in patients experiencing a severe form of the disease, and in older patients the Ab titers were heightened. The main conclusion is that the recovery from SARS-CoV-2 infection is not solely dependent on high NAb titers in affected subjects, and this recovery process is probably produced by a complex interplay between many factors, including immune response, age of the subjects, and viral pathology.