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
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
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
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.
Open Access
Determinants of mortality in a large group of hemodialysis patients hospitalized for COVID-19
(2021-01-14T00:00:00Z) Turgutalp, Kenan; Ozturk, Savas; Arici, Mustafa; Eren, Necmi; Gorgulu, Numan; Islam, Mahmut; Uzun, Sami; Sakaci, Tamer; Aydin, Zeki; Sengul, Erkan; Demirelli, Bulent; Ayar, Yavuz; Altiparmak, Mehmet Riza; Sipahi, Savas; Mentes, Ilay Berke; Ozler, Tuba Elif; Oguz, Ebru Gok; Huddam, Bulent; Hur, Ender; Kazancioglu, Rümeyza; Gungor, Ozkan; Tokgoz, Bulent; Tonbul, Halil Zeki; Yildiz, Alaattin; Sezer, Siren; Odabas, Ali Riza; Ates, Kenan; KAZANCIOĞLU, RÜMEYZA
Background Maintenance hemodialysis (MHD) patients are at increased risk for coronavirus disease 2019 (COVID-19). The aim of this study was to describe clinical, laboratory, and radiologic characteristics and determinants of mortality in a large group of MHD patients hospitalized for COVID-19. Methods This multicenter, retrospective, observational study collected data from 47 nephrology clinics in Turkey. Baseline clinical, laboratory and radiological characteristics, and COVID-19 treatments during hospitalization, need for intensive care and mechanical ventilation were recorded. The main study outcome was in-hospital mortality and the determinants were analyzed by Cox regression survival analysis. Results Of 567 MHD patients, 93 (16.3%) patients died, 134 (23.6%) patients admitted to intensive care unit (ICU) and 91 of the ones in ICU (67.9%) needed mechanical ventilation. Patients who died were older (median age, 66 [57–74] vs. 63 [52–71] years, p = 0.019), had more congestive heart failure (34.9% versus 20.7%, p = 0.004) and chronic obstructive pulmonary disease (23.6% versus 12.7%, p = 0.008) compared to the discharged patients. Most patients (89.6%) had radiological manifestations compatible with COVID-19 pulmonary involvement. Median platelet (166 × 103 per mm3 versus 192 × 103 per mm3, p = 0.011) and lymphocyte (800 per mm3 versus 1000 per mm3, p < 0.001) counts and albumin levels (median, 3.2 g/dl versus 3.5 g/dl, p = 0.001) on admission were lower in patients who died. Age (HR: 1.022 [95% CI, 1.003–1.041], p = 0.025), severe-critical disease clinical presentation at the time of diagnosis (HR: 6.223 [95% CI, 2.168–17.863], p < 0.001), presence of congestive heart failure (HR: 2.247 [95% CI, 1.228–4.111], p = 0.009), ferritin levels on admission (HR; 1.057 [95% CI, 1.006–1.111], p = 0.028), elevation of aspartate aminotransferase (AST) (HR; 3.909 [95% CI, 2.143–7.132], p < 0.001) and low platelet count (< 150 × 103 per mm3) during hospitalization (HR; 1.864 [95% CI, 1.025–3.390], p = 0.041) were risk factors for mortality. Conclusion Hospitalized MHD patients with COVID-19 had a high mortality rate. Older age, presence of heart failure, clinical severity of the disease at presentation, ferritin level on admission, decrease in platelet count and increase in AST level during hospitalization may be used to predict the mortality risk of these patients.
Open Access
Role of Probiotics in the Management of COVID-19: A Computational Perspective
(2022-01-01T00:00:00Z) Nguyen, Quang Vo; Chong, Li Chuin; Hor, Yan-Yan; Lew, Lee-Ching; Rather, Irfan A.; Choi, Sy-Bing
Coronavirus disease 2019 (COVID-19) was declared a pandemic at the beginning of 2020, causing millions of deaths worldwide. Millions of vaccine doses have been administered worldwide; however, outbreaks continue. Probiotics are known to restore a stable gut microbiota by regulating innate and adaptive immunity within the gut, demonstrating the possibility that they may be used to combat COVID-19 because of several pieces of evidence suggesting that COVID-19 has an adverse impact on gut microbiota dysbiosis. Thus, probiotics and their metabolites with known antiviral properties may be used as an adjunctive treatment to combat COVID-19. Several clinical trials have revealed the efficacy of probiotics and their metabolites in treating patients with SARS-CoV-2. However, its molecular mechanism has not been unraveled. The availability of abundant data resources and computational methods has significantly changed research finding molecular insights between probiotics and COVID-19. This review highlights computational approaches involving microbiome-based approaches and ensemble-driven docking approaches, as well as a case study proving the effects of probiotic metabolites on SARS-CoV-2.
Open Access
Is there a link between pre-existing antibodies acquired due to childhood vaccinations or past infections and COVID-19? A case control study
(2021-02-01T00:00:00Z) SÜMBÜL, BİLGE; Sumbul, Hilmi Erdem; OKYAY, RAMAZAN AZİM; Gulumsek, Erdinc; ŞAHİN, AHMET RIZA; Boral, Baris; Kocyigit, Burhan Fatih; Alfishawy, Mostafa; Gold, Jeffrey; Tasdogan, Ali Muhittin; SÜMBÜL, BİLGE
Background: There is growing evidence indicating that children are less affected from COVID-19. Some authors speculate that childhood vaccinations may provide some cross-protection against COVID-19. In this study, our aim was to compare the circulating antibody titers for multiple childhood vaccine antigens, as an indicator of the state of immune memory between patients with COVID-19 and healthy controls, with a specific aim to identify the association between disease severity and antibody titrations which may indicate a protective function related to vaccine or disease induced memory. Methods: This study is a case-control study including 53 patients with COVID-19 and 40 healthy volunteers. COVID-19 severity was divided into three groups: asymptomatic, mild and severe. We measured the same set of antibody titers for vaccine antigens, and a set of biochemical and infection markers, in both the case and control groups. Results: Rubella (p = 0.003), pneumococcus (p = 0.002), and Bordetella pertussis (p < 0.0001) titers were found to be significantly lower in the case group than the control group. There was a significant decline in pneumococcus titers with severity of disease (p = 0.021) and a significant association with disease severity for Bordetella pertussis titers (p = 0.014) among COVID patients. Levels of AST, procalcitonin, ferritin and D-dimer significantly increased with the disease severity. Discussion: Our study supports the hypothesis that pre-existing immune memory, as monitored using circulating antibodies, acquired from childhood vaccinations, or past infections confer some protection against COVID-19. Randomized controlled studies are needed to support a definitive conclusion
Open Access
The impact of COVID-19 on familial Mediterranean fever: a nationwide study
(2021-05-25T00:00:00Z) Günendi, Zafer; Yurdakul, Fatma Gül; Bodur, Hatice; Cengiz, Ahmet Kıvanç; Uçar, Ülkü; Çay, Hasan Fatih; Şen, Nesrin; Keskin, Yaşar; Gürer, Gülcan; Melikoğlu, Meltem Alkan; Altıntaş, Duygu; Deveci, Hülya; Baykul, Merve; Nas, Kemal; Çevik, Remzi; Karahan, Ali Yavuz; Toprak, Murat; Ketenci, Sertaç; Nayimoğlu, Mehmet; Sezer, İlhan; Demir, Ali Nail; Ecesoy, Hilal; Duruöz, Mehmet Tuncay; Yurdakul, Ozan Volkan; Sarıfakıoğlu, Ayşe Banu; Ataman, Şebnem; KESKİN, YAŞAR; YURDAKUL, OZAN VOLKAN
The study aimed to evaluate the impact of the coronavirus disease 2019 (COVID-19) in patients with familial Mediterranean fever (FMF) and to assess the relationships between FMF characteristics and severe COVID-19 outcomes such as hospitalization. The study was planned within a national network of 21 different centers. Demographics, FMF-related clinical and genetic characteristics, and COVID-19 outcomes were obtained. A total of 822 patients with FMF (mean age of 36 years) were included in the study. Fifty-nine of them (7%) had a COVID-19 diagnosis confirmed by real-time PCR test or chest CT findings. Most FMF patients with COVID-19 (58) had mild and moderate disease activity. All patients were on colchicine treatment. However, 8 of them (13.6%) were not compliant with colchicine use and 9 of them (15.3%) were colchicine resistant. Twelve FMF patients with COVID-19 were hospitalized. There were 4 patients requiring oxygen support. COVID-19 related complications were observed in 2 patients (1 thromboembolism, 1 acute respiratory distress syndrome). Hospitalized COVID-19 patients with FMF were older than non-hospitalized patients (median ages: 51 and 31 years, respectively; p: 0.002). Other FMF-related characteristics were similar between the groups. FMF-related characteristics were not found to be associated with poor outcomes in COVID-19. Thus, FMF may not be a risk factor for poor COVID-19 outcomes.
Open Access
Inactive SARS-CoV-2 vaccine generates high antibody responses in healthcare workers with and without prior infection.
(2021-11-22T00:00:00Z) Dinc, HARİKA ÖYKÜ; Saltoglu, Nese; Can, Gunay; Balkan, Ilker Inanc; Budak, Beyhan; Ozbey, Dogukan; Caglar, Bilge; Karaali, Rıdvan; Mete, Bilgul; Tuyji Tok, Yesim; Ersoy, Yagmur; Ahmet Kuskucu, Mert; Midilli, Kenan; Ergin, Sevgi; Kocazeybek, Bekir Sami; DİNÇ, HARİKA ÖYKÜ
Background and objectives: Healthcare workers (HCWs) were among the first groups to be vaccinated in Turkey. The data to be obtained by the vaccination of HCWs would guide wide spread vaccination programs. Materials and methods: The study included 330 HCWs working at Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty Hospital and vaccinated with inactive CoronaVac (Sinovac Life Sciences, China) SARS-CoV-2 vaccine in two doses (28 days apart). Anti-Spike /RBD IgG levels were measured 14 days after the first dose and 28 days after the second dose. Chemiluminescent microparticle immunoassay (CMIA) (ARCHITECT IgG II Quant test, Abbott, USA), which is 100% compatible with plaque reduction neutralization test (PRNT), was used. Results: Of the participants, 211 (63.9%) were female, 119 (36.1%) were male, and mean age was 39.6 ± 7.7 years. In those without prior COVID-19 history; (n = 255) antibody positivity was detected as 48.2% (95% CI: 42.1-54.3) 14 days after the first dose of vaccine, and 99.2% (95% CI: 98.1-100) at day 28 after the second dose. Antibody titers were significantly lower in patients with hypertension (p = 0.011). In those with prior history of COVID-19 (n = 75); both the antibody positivity rates after the first vaccine (48.2% vs 100%, p = 0.000) and the anti-spike/RBD antibody levels after the second vaccine (with a ≥ 1050 AU/mL titer equivalent to PRNT 1/80 dilution) was significant than infection-naive group (25.9% vs. 54.7%, p = 0.000). Antibody positivity after two doses of vaccination for all study group was 99.4% (95% CI: 98.6-100). Conclusions: Two doses CoronaVac produce effective humoral immunity in HCWs. Antibody response is significantly higher in those with prior history of COVID-19 than infection-naive group. Given no significant benefit of the second dose, a single shot of vaccination may be sufficient for those with prior history of COVID-19. Monitoring humoral and cellular immune responses, considering new variants, is required to validate this approach.
Open Access
The neutralization effect of montelukaston SARS-CoV-2 is shown by multiscale in silicosimulations and combined in vitro studies
(2021-10-19T00:00:00Z) Durdagi, Serdar; Avsar, Timucin; Orhan, Muge Didem; Serhatli, Muge; Balcioglu, Bertan Koray; Ozturk, Hasan Umit; Kayabolen, Alisan; Cetin, Yuksel; Aydinlik, Seyma; Bagci-Onder, Tugba; Tekin, Saban; Demirci, Hasan; Guzel, Mustafa; Akdemir, ATİLLA; Calis, Seyma; Oktay, Lalehan; Tolu, Ilayda; Butun, Yasar Enes; Erdemoglu, Ece; Olkan, Alpsu; Tokay, Nurettin; Işık, Şeyma; Ozcan, Aysenur; Acar, Elif; Buyukkilic, Sehriban; Yumak, Yesim; AKDEMİR, ATİLLA
Small molecule inhibitors have previously been investigated in different studies as possible therapeutics in the treatment of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). In the current drug repurposing study, we identified the leukotriene (D4) receptor antagonist montelukast as a novel agent that simultaneously targets two important drug targets of SARS-CoV-2. We initially demonstrated the dual inhibition profile of montelukast through multiscale molecular modeling studies. Next, we characterized its effect on both targets by different in vitro experiments including the enzyme (main protease) inhibition-based assay, surface plasmon resonance (SPR) spectroscopy, pseudovirus neutralization on HEK293T/hACE2+TMPRSS2, and virus neutralization assay using xCELLigence MP real-time cell analyzer. Our integrated in silico and in vitro results confirmed the dual potential effect of montelukast both on the main protease enzyme inhibition and virus entry into the host cell (spike/ACE2). The virus neutralization assay results showed that SARS-CoV-2 virus activity was delayed with montelukast for 20 h on the infected cells. The rapid use of new small molecules in the pandemic is very important today. Montelukast, whose pharmacokinetic and pharmacodynamic properties are very well characterized and has been widely used in the treatment of asthma since 1998, should urgently be completed in clinical phase studies and, if its effect is proved in clinical phase studies, it should be used against coronavirus disease 2019 (COVID-19).
Open Access
Perceptions of dental students towards online education during the COVID-19 pandemic
(2021-12-01T00:00:00Z) Sarıalioğlu Güngör, Ayça; Şeşen Uslu, Yeşim; SARIALİOĞLU GÜNGÖR, AYÇA; DÖNMEZ, NAZMİYE
Purpose: This study evaluated the usage habits, attitudes, and perceptions of undergraduate dental students toward distance (online) learning and identified variables related to those attitudes. Materials and methods: The study included 1,605 undergraduate dental students who participated voluntarily. The data collection tool consisted of a distance learning attitude scale, a questionnaire on personal information, and open-ended questions. The perceptions of dental students to distance education according to the year and type of dental school they attended were evaluated. Results: Most students expressed that distance learning in dental courses was not as effective as traditional face-to-face education (59.1%, n=949). While students studying at state universities had a more negative view of distance education, the satisfaction scores of the first-year students were found to be significantly lower than the other students (p<0.05). Conclusion: Dental students were generally unhappy with the interruption of traditional education caused by COVID-19 and having to continue their education online. However, under the circumstances, they saw it as an advantage allowing them to continue their education and avoid a complete suspension.