Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
Browse
60 results
Search Results
Item Diyabet tedavisinde kullanılan ilaçların covıd-19 enfeksiyonuna etkilerinin retrospektif olarak araştırılması(Başkent Üniversitesi Tıp Fakültesi, 2023) Saraçoğlu, Yaşar Ozan; Turhan İyidir, Özlemİlk kez Aralık 2019 tarihinde tespit edilen yeni bir koronavirüs olan SARS-CoV-2 etkeninin sebep olduğu COVID-19 hastalığı tüm dünyada pandemiye sebep olmuştur. Hastalık özellikle ileri yaş ve ek hastalıkları olan popülasyonda ciddi morbidite ve mortalite sebebidir. Yapılan bu retrospektif çalışmada tip 2 diyabet tedavisinde kullanılan ilaçların COVID-19 enfeksiyonuna etkilerinin incelenmesi amaçlanmıştır. Çalışmada Başkent Üniversitesi Ankara Hastanesi Endokrinoloji ve Metabolizma Hastalıkları Bilim Dalı Merkez ve Ümitköy polikliniklerine, Türkiye'de pandeminin başlangıcı olarak kabul edilen 11 Mart 2020 ile 31 Temmuz 2021 tarihleri arasında başvuran tip 2 diyabet tanısı bulunan 6430 hastadan çalışmaya dahil edilme kriterlerini karşılayan 431 vaka incelenmiştir. Hastalık şiddeti, hastaların demografik, klinik, laboratuvar özellikleri; COVID-19 sebebi ile hastane yatış ihtiyacı, yoğun bakım ünitesinde takip ihtiyacı, mekanik ventilasyon ihtiyacı olup olmaması, COVID-19 hastalığı öncesi, hastalık sırasında ve sonrasında kullandıkları antidiyabetik ilaç grupları, COVID-19 aşı türü incelenmiştir. Tip 1 diyabet tanısı olanlar, gestasyonel diyabet tanısı olanlar, yeni tanı konulan diyabet hastaları veya başvurudan önce 6 ay içinde diyabet tanısı konulmuş hastalar, diyabet tanısı konulduğu halde ilaç kullanmayanlar ve son 6 ay içerisinde ilaç tedavisinde değişiklik olanlar çalışma dışı bırakılmıştır. Ayrıca, Başkent Üniversitesi medikal bilgi sisteminde verileri yetersiz olan veya telefonla ulaşılamayanlar ve e-Nabız verilerine ulaşılamayanlar veya bu verilere ulaşılması için rıza göstermeyen hastalar da çalışma dışı bırakılmıştır. Sülfonilüre tedavisi alanların %48'inde dispne görülürken, almayanların %23'ünde dispne saptandı (p=0,010). Dispne için çoklu lojistik modelinde, sülfonilüre ve HbA1c düzeyi değişkenleri analiz edilmiştir. Çoklu lojistik regresyon analizi sonucunda sadece sülfonilüre değişkeni anlamlı bulunmuştur. Dispne riski; sülfonilüre kullananlarda kullanmayanlara göre 3,146 kat fazladır. Çalışmamızda anti-diyabetik ilaç gruplarının hastalık seyrine veya ağırlığına olumlu ya da olumsuz bir etkisi olmadığı gösterilmiştir. Yalnızca enfeksiyon sırasında, sülfonilüre grubu ilaçların daha dikkatli kullanılmasını, gerektiğinde doz azaltılmasını veya kesilmesini, bu kararın da hastanın iştah-oral alım durumu ve kan glikoz takibine göre verilmesi gerektiğini düşünüyoruz. Çalışmamızın konusu hala birçok açıdan aydınlatılmayı bekleyen, yeni çalışmalara ihtiyaç duyulan bir alan olup iyi tasarlanmış prospektif çalışmalar ile antidiyabetik ajanların COVID-19 kliniğinde olumlu ve olumsuz etkileri incelenmesine ihtiyaç duyulmaktadır. COVID-19 disease, caused by a new coronavirus, SARS-CoV-2, which was first detected in December 2019, has caused a pandemic all over the world. The disease has caused serious morbidity and mortality, especially in the population with advanced age and additional diseases. In this retrospective study, it was aimed to examine the effects of drugs used in the treatment of type 2 diabetes on COVID-19 infection. In the study, 431 cases meeting the inclusion criteria of 6430 patients with type 2 diabetes who applied to Başkent University Ankara Hospital Endocrinology and Metabolic Diseases Department Center and Ümitköy polyclinics between March 11, 2020, which is considered as the beginning of the pandemic in Turkey, and July 31, 2021, were examined. Disease severity, demographic, clinical and laboratory characteristics of patients; the need for hospitalization due to COVID-19, the need for follow-up in the intensive care unit, the need for mechanical ventilation, the antidiabetic drug groups used before, during and after the COVID-19 disease, the types, and doses of the COVID-19 vaccine, the short and long-term after recovery from the disease period complications were examined. Patients with a diagnosis of type 1 diabetes, those with a diagnosis of gestational diabetes, newly diagnosed diabetes patients, or patients who were diagnosed with diabetes within 6 months before admission, those who did not use medication despite being diagnosed with diabetes, and those who had a change in medication in the last 6 months were excluded from the study. In addition, patients with insufficient data in the Başkent University medical information system or those who could not be reached by phone, and those whose e-Nabız data could not be reached or who did not consent to access these data were also excluded from the study. While dyspnea was observed in 48% of those who received sulfonylurea treatment, 23% of those who did not receive it had dyspnea (p=0.010). In the multiple logistic model for dyspnea, sulfonylurea and HbA1c level variables were analyzed. As a result of multiple logistic regression analysis, only the sulfonylurea variable was found to be significant. risk of dyspnea; It is 3.146 times higher in sulfonylurea users than in non-users.In our study, it was shown that the antidiabetic drug groups did not have a positive or negative effect on the course or severity of the disease. We think that sulfonylurea drugs should be used more carefully only during infection, dose reduction or discontinuation when necessary, and this decision should be made according to the patient's appetite and oral intake status and blood glucose monitoring. The subject of our study is still a field that needs to be clarified in many ways and new studies are needed, and there is a need to examine the positive and negative effects of antidiabetic agents in the COVID-19 clinic with well-designed prospective studies.Item Evaluation of the COVID-19 Rapid Antigen Test(2023) Sanli, Ozlem Oguc; Kuscu, Ozlem Ozkan; Incekas, Caner; 0000-0001-7899-0233; 0000-0001-9019-423XIntroduction: Coronavirus disease, is an infectious disease caused by the SARS-CoV-2. The gold standard method to diagnose is the reverse transcriptase polymerase chain reaction test. Rapid antigen tests can also be used for diagnosis. This study aims to compare the results of these two methods.Materials and Methods: Between November 2021 and July 2022, the study included 1811 patients who visited the emergency depart-ment with coronavirus-related symptoms and signs. Respiratory samples from these patients were simultaneously evaluated using both reverse transcriptase polymerase chain reaction and rapid antigen tests. The reverse transcriptase polymerase chain reaction tests were conducted using the BioSpeedy SARS-CoV-2 reverse transcriptase polymerase chain reaction kit (Bioeksen-Turkiye), while the rapid antigen tests were performed using the RapidForTM SARS-CoV-2 Ag (Vitrosens-Germany).Results: The comparison of the reverse transcriptase polymerase chain reaction test and rapid antigen test results showed a 90.67% sensitivity, 98.28% specificity, 91.27% positive predictive value, 98.15% negative predictive value, and 97.02% (1757/1811) accuracy. Qualitative results of both tests exhibited a very good agreement (Kappa= 0.892, p< 0.001). According to the reverse transcriptase polymerase chain reaction test, the sensitivity of the rapid antigen test was found to be 100% in 28 samples with a cycle threshold <17, 100% in 78 samples with a cycle threshold <20, 98.33% in 120 samples with a cycle threshold <22, and 96.28% in 215 samples with a cycle threshold <25.Conclusion: When the results of the study are evaluated, it is seen that the use of the rapid antigen test for screening purposes and confirmation of patients with negative test results by Reverse transcriptase polymerase chain reaction will provide advantages in terms of both time and cost. Due to the low sensitivity and high positive predictive value of the vitrosens rapid antigen test, we think that this test can be used in the first stage to accelerate the diagnosis of patients with high viral load, who are more likely to be infectious, to prevent transmission and to start their treatment quickly.Item Evaluation of Inflammation-Based Prognostic Risk Scores in Predicting in-Hospital Mortality Risk in Hospitalized COVID-19 Patients: A Cross-Sectional Retrospective Study(2023) Celik, Casit Olgun; Ozer, Nurtac; Ciftci, Orcun; Torun, Serife; Yavuz Colak, Meric; Muderrisoglu, Ibrahim Haldun; 0000-0002-6530-6153; 0000-0002-7190-5443; 0000-0002-0294-6874; 38633908; ABF-1652-2021; AAD-5477-2021; AAA-4360-2021Objective: Systemic inflammatory parameters are predictors of poor prognosis in COVID-19 patients. This study evaluated whether the prognostic nutritional index, which was also related to nutrition risk and other inflammation-based prognostic scores, was predictive of in-hospital mortality in COVID-19 patients.Materials and Methods: This was a retrospective cross-sectional single-center study. Based on the exclusion criteria, 151 patients over 18 years old diagnosed with COVID-19 and hospitalized in the intensive care unit between March 2020 and December 2020 were eligible for this study. Multivariable logistic regression analysis was performed to evaluate the predictive value of the Glasgow Prognostic Score (GPS), Prognostic Index (PI), Prognostic Nutritional Index (PNI), and Systemic Inflammatory Index (SII).Results: In the univariate analyses, age, diabetes mellitus (DM), chronic kidney disease, acute kidney injury, hypothyroidism, hospitalization stay, lactate dehydrogenase (LDH), as-partate aminotransferase (AST), D-dimer, ferritin, C-reactive protein (CRP), albumin, hemoglobin level, platelet count, urea, creatinine level, PNI, GPS were significantly associated with mortality. However, in the multivariable logistic regression analysis of the inflamma-tion-based prognostic scores, only PNI was statistically significant in predicting in-hospital mortality (OR=0.83; [95% CI=0.71-0.97]; p=0.019).Conclusion: PNI is a more useful and powerful tool among these inflammation-based prognostic risk scores in predicting in-hospital mortality in COVID-19 patients.Item Which Sequence Should Be Used in the Thorax Magnetic Resonance Imaging of COVID-19: A Comparative Study(2023) Ates, Ayse sule; Yagdiran, Burak; Taydas, Onur; Faruk Ates, OmerBackground and aim: To evaluate and compare magnetic resonance imaging (MRI) sequences that could potentially be used in the diagnosis of coronavirus disease 2019 (COVID-19). Materials and methods: Included in the study were 42 patient who underwent thorax computed tomography (CT) for COVID-19 pneumonia and thorax MRI for any reason within 24 h after CT. The T2-weighted fast spin echo periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) (T2W-FSE-P), fast imaging employing steady-state acquisition, T2 fat-saturated FSE, axial T1 liver acquisition with volume acceleration (LAVA) and single-shot FSE images were compared in terms of their ability to show COVID-19 findings. Results: The mean age of the patients was 47.2 +/- 24 years. Of the patients, 22 were male (52.4%) and 20 (47.6%) were female. The interobserver intraclass coefficient (ICC) for the image quality score was the highest in the T2W-FSE-P sequence and lowest in the T1 LAVA sequence. All of the lesion-based evaluations of the interobserver agreement were statistically significant, with the kappa value varying between 0.798 and 0.998. Conclusion: All 5 sequences evaluated in the study were successful in showing the parenchymal findings of COVID-19. Since the T2W-FSE-P sequence had the best scores in both interobserver agreement and ICC for the image quality score, it was considered that it can be included in thorax MRI examinations to assist the diagnosis of COVID-19.Item Clinical Characteristics and Outcomes of Nosocomial COVID-19 in Turkey: A Retrospective Multicenter Study(2023) Yildirim, Suleyman; Yilmaz, Celalettin; Polat, Gulru; Baris, Serap; Basyigit, Ilknur; Kaya, Ilknur; Anar, Ceyda; Bozkurt, Mihriban; Baykal, Husnu; Dirol, Hulya; Ozbey, Gamzenur; Ozsari, Emine; Cireli, Emel; Cirak, Ali; Tatar, Dursun; Gayaf, Mine; Karaoglanoglu, Selen; Aydin, Yener; Eroglu, Atilla; Olcar, Yildiz; Yildirim, Berna; Gursoy, Bengul; Yilmaz, Deniz; Niksarlioglu, Elif; Eren, Ramazan; Erdem, Aysegul; Tor, Muge Meltem; Fakili, Fusun; Colak, Mustafa; Ercelik, Merve; Tabaru, Ali; Ediboglu, OzlemObjective: To identify the clinical characteristics and outcomes of hospital-acquired SARS-CoV-2 infection during the vaccination period nationwide in Turkey. Methods: COVID-19 patients followed in the pandemic services across Turkey between January 1, 2021, and March 31, 2022 were investigated retrospectively. Nosocomial COVID-19 was defined as a patient neither diagnosed with COVID-19 nor suspected COVID-19 at the hospital admission and was confirmed COVID-19 >= 5 days after hospital admission. The primary outcome of this study was in-hospital mortality; demographic features and vaccination status was compared between survivors and non survivors. Results: During the study period, 15 573 COVID-19 patients were followed in 18 centers and 543 (3.5%) patients were nosocomial COVID-19. Most patients with nosocomial COVID-19 (80.4%) were transferred from medical wards. 162 (29.8%) of the patients with nosocomial COVID-19 admitted to the intensive care unit due to disease severity and 138 (25.4%) of the patients died during hospital stay. Advanced age (>= 65 years) and number of comorbid diseases (>= 2) was found to be associated with mortality in nosocomial COVID-19 (OR 1.74, 95% CI 1.11-2.74 and OR 1.60, 95% CI 1.02-2.56, respectively). Vaccination was associated with survival in nosocomial COVID-19 (OR 0.25, 95% CI0.16-0.38). Conclusions: Patients with nosocomial COVID-19 had increased admission to intensive care units and higher mortality rate. Vaccination can decrease the in-hospital mortality rate.Item Simultaneous Sudden Hearing Loss and Peripheral Facial Paralysis in a Patient With Covid-19(2023) Ozer, Fulya; Alkan, Ozlem; https://orcid.org/0000-0001-5381-6861; 34219500; ABC-1809-2020Although peripheral facial paralysis and sudden sensorineural hearing loss are not as common as anosmia, they are reported neurological manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We present a 62-year-old, serologically COVID-19 positive woman with seventh and eighth nerve involvement showed electrophysiologically with Auditory Brainstem Response and electroneurography and radiologically with internal acoustic canal magnetic resonance imaging. This single case report suggests a possible association between the SARS-CoV-2 infection with simultaneous sudden sensorineural hearing loss and isolated facial paralysis. However, further studies are needed to determine whether this relationship is coincidental or occasional.Item Psychological Factors Responsible for Low Adherence To Mask-Wearing Measures During The COVID-19 Pandemic(2022) Kilic, Cengiz; Yildiz, M. Irem; Emekli, Esra; Gulsen, Gulhan; Alp, Anil; 36416230; HHZ-1045-2022BackgroundThe COVID-19 pandemic has led to >6 million deaths. Anti-mask movements may decrease the effects of preventive measures. Psychological factors that may be related to anti-mask behaviour are not well researched. AimsThis study aims to determine the psychological correlates of anti-mask attitudes and behaviour in an online general population sample, focusing on the possible role of claustrophobia. MethodData on attitudes and behaviour toward mask-wearing were collected from an online sample of 3709 people. Predictors of both anti-mask attitudes and behaviour were assessed with linear and logistic regression analyses. ResultsFew people (3.3%) were overtly opposed to mask-wearing; mask opposition was more common in men than women. Predictors of negative attitude toward mask-wearing and low adherence to mask-related measures were similar and included male gender, lower education, lower income, being employed, having had COVID-19 and lower COVID-19-related anxiety. Psychopathology measures did not show a prediction, whereas claustrophobia had a significant prediction that was over and above those of other predictors. Avoidance behaviour had similar predictors, except for higher COVID-19-related anxiety. ConclusionsAlthough low adherence to mask-wearing during the pandemic was not related to having a mental disorder, it may partly be caused by psychological factors. Those who had a negative attitude also reported lower adherence behaviour, and were characterised by being male, having lower education, being employed and having lower COVID-19-related anxiety; claustrophobia was a strong predictor of attitude. Understanding psychological factors responsible for low adherence may help to decrease morbidity and mortality in future pandemics.Item Acute Appendicitis During Coronavirus Disease 2019 in Turkiye: Changes in Clinical Approach, Treatment, and Diagnosis Modalities: A Retrospective and Cohort Study(2022) Ersoz, Siyar; Bozkurt, Mehmet Abdussamet; Kulle, Cemil Burak; Elhan, Atilla Halil; Gulcu, Baris; Tarim, Ismail Alper; Bozbiyik, Osman; Yasar, Necdet Fatih; Atalay, Vafi; Yonder, Huseyin; Yalav, Orcun; Kuzu, Mehmet Ayha; Karakayali, Feza Yarbug; 36453790BACKGROUND: The novel coronavirus disease 2019 (COVID-19) has resulted in major changes in health-care systems and emergency surgical interventions. Here, we examined patients with acute appendicitis who presented to emergency departments and compared diagnosis, treatment, and post-treatment processes before and during the pandemic period and investigated how the pandemic affected management of acute appendicitis. METHODS: A national, multicenter, and cohort study model was designed that included patients older than 18 years of age diagnosed with acute appendicitis clinically and/or radiologically, with patients compared before (pre-pandemic period: January 1-April 30, 2019) and after (pandemic period: January 1-April 30, 2020) the pandemic. Our investigation included comparisons of pre-operative imaging methods, presence of plastron appendicitis/abscess, conservative/surgical approach, type of anesthesia given, laparoscopic/ open surgical approach, bowel resection rates, drain insertion rates, and presence of post-operative complications RESULTS: For the two study groups, 8972 patients from 69 centers were examined, with 4582 patients operated in the pre-pandemic period and 4234 patients operated in the pandemic period. During the pandemic period, 63.6% of patients underwent open surgery, whereas 34.4% had laparoscopic surgery. Although 60 patients (1.3%) requested non-operative follow-up in the pre-pandemic period, 94 patients (2.2%) requested this in the pandemic period. When conditions of patients were evaluated regardless of their own wishes, 114 patients (2.4%) before and 163 patients (3.8%) during the pandemic received non-operative follow-up. CONCLUSION: Our study did not show the direct correlation between the application of COVID-19-related restrictions and the severity of acute appendicitis. Although non-operative management rates have been increased during the COVID-19 period, the incidences of both complicated and the uncomplicated appendicitis were similar during the COVID-19 crisis period. Given this information non-operative management can be employed for patients diagnosed with appendicitis.Item SARS-Cov-2 Infection Might Be A Predictor of Mortality in Intracerebral Hemorrhage(2023) Mowla, Ashkan; Shakibajahromi, Banafsheh; Shahjouei, Shima; Baharvahdat, Humain; Harandi, Ali Amini; Rahmani, Farzad; Mondello, Stefania; Rahimian, Nasrin; Cernigliaro, Achille; Hokmabadij, Elyar Sadeghi; Ebrahimzadeh, Seyed Amir; Ramezani, Mahtab; Mehrvar, Kaveh; Farhoudi, Mehdi; Naderi, Soheil; Fenderi, Shahab Mahmoudnejad; Pishjoo, Masoud; Alizada, Orkhan; Purroy, Francisco; Requena, Manuel; Tsivgoulis, Georgios; Zand, Ramin; 36455388Background: SARS-CoV-2 infection may be associated with uncommon complications such as intracerebral hemorrhage (ICH), with a high mortality rate. We compared a series of hospitalized ICH cases infected with SARS-CoV-2 with a non-SARS-CoV-2 infected control group and evaluated if the SARS-CoV-2 infection is a predictor of mortality in ICH patients.Methods: In a multinational retrospective study, 63 cases of ICH in SARS-CoV-2 infected patients admitted to 13 tertiary centers from the beginning of the pandemic were collected. We compared the clinical and radiological characteristics and in-hospital mortality of these patients with a control group of non-SARS-CoV-2 infected ICH patients of a previous cohort from the country where the majority of cases were recruited.Results: Among 63 ICH patients with SARS-CoV-2 infection, 23 (36.5%) were women. Compared to the non-SARS-CoV-2 infected control group, in SARS-CoV-2 infected patients, ICH occurred at a younger age (61.4 +/- 18.1 years versus 66.8 +/- 16.2 years, P = 0.044). These patients had higher median ICH scores ([3 (IQR 2-4)] versus [2 (IQR 1-3)], P = 0.025), a more frequent history of diabetes (34% versus 16%, P = 0.007), and lower platelet counts (177.8 +/- 77.8 x 109/L versus 240.5 +/- 79.3 x 109/L, P < 0.001). The in-hospital mortality was not significantly different between cases and controls (65% versus 62%, P = 0.658) in univariate analysis; however, SARS-CoV-2 infection was significantly associated with in-hospital mortality (aOR = 4.3, 95% CI: 1.28-14.52) in multivariable analysis adjusting for potential confounders.Conclusion: Infection with SARS-CoV-2 may be associated with increased odds of in-hospital mortality in ICH patients.Item European Society of Clinical Microbiology and Infectious Diseases Guidelines for Coronavirus Disease 2019: An Update on Treatment of Patients with Mild/Moderate Disease(2022) Bartoletti, Michele; Azap, Ozlem; Barac, Aleksandra; Bussini, Linda; Ergonul, Onder; Krause, Robert; Martin-Quiros, Alejandro; Pano-Pardo, Jose Ramon; Power, Nicholas; Sibani, Marcella; Szabo, Balint Gergely; Tsiodras, Sotirios; Zollner-Schwetz, Ines; Rodriguez-Bano, Jesus; 36028088Scope: Despite the large availability of vaccines, coronavirus disease 2019 (COVID-19), induced by severe acute respiratory syndrome coronavirus 2, continues to be a major threat for health-care providers and fragile people. A number of options are now available for outpatients with mild-to-moderate COVID-19 at the risk of disease progression for the prevention of deaths or hospitalization. Methods: A European Society of Clinical Microbiology and Infectious Diseases COVID-19 guidelines task force was established by the European Society of Clinical Microbiology and Infectious Diseases Executive Committee. A small group was established, half appointed by the chair and the remaining selected based on an open call. Each panel met virtually once a week. For all decisions, a simple majority vote was used. A long list of clinical questions using the population, intervention, comparison, outcome format was developed at the beginning of the process. For each population, intervention, comparison, outcome, two panel members performed a literature search, with a third panelist involved in case of inconsistent results. Voting was based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Recommendations: In this update, we focus on anti-viral agents, monoclonal antibodies (mAbs) and other treatment options proposed for patients with mild or moderate COVID-19 who are at the risk of hospitalization or death. Although the use of anti-virals is recommended, especially nirmatrelvir/ritonavir and remdesivir or, alternatively, molnupirarvir, the administration of mAbs against the spike protein strictly depends on circulating variants or the ability to test timely for variants and sub-variants. At the time of writing (AprileJune 2022), the only active mAb was tixagevimab/cilgavimab given the predominance of the Omicron BA.2, BA.3, BA.4 and BA.5 sub-lineages in Europe. However, considering that the epidemiological scenario is extremely dynamic, constant monitoring of variants of concern is mandatory. Michele Bartoletti, Clin Microbiol Infect 2022;28:1578