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INTRODUCTION: Although different dual-energy X-ray absorptiometry (DXA) scanners provide different bone mineral density (BMD) values, there is not a gold standard DXA scanner. T-score is used to facilitate the interpretation of BMD, and osteoporosis (OP) is diagnosed based on T-scores. In this retrospective study, we aimed to evaluate the BMD and T-score differences between Lunar Prodigy and Hologic Horizon DXA scanners. METHODOLOGY: Data were collected for patients with previous BMD measurement on Lunar Prodigy and Hologic Horizon DXA scanners within one year in the same medical center. RESULTS: In a total of 55 patients, BMD values of femoral neck/total, and lumbar vertebrae were all lower at Hologic than Lunar (all pâ¯<â¯0.01). The mean T-score difference at the lumbar spine was 0.74⯱â¯0.42 (pâ¯<â¯0.001). Of the 49 patients diagnosed as OP (T-score ≤-2.5) with the Hologic, the diagnoses were changed for 25 individuals (51.0â¯%) with Lunar (pâ¯<â¯0.001). Herewith, although the diagnoses of OP did not change by the repeat technique in other 24 patients (49â¯%), 13 of them (26.5â¯%) were categorized as having "high fracture risk" instead of "very high fracture risk" group (i.e., T-score <-3.0). We observed moderate-to-good reliabilities (with an intraclass correlation coefficient [ICC] of 0.633-0.878 and 0.733-0.842 for BMD and T-scores, respectively) between measurements with the Lunar and Hologic scanners. Except for one measurement in L3, L4, L1-4 vertebrae, the Bland-Altman plot did not reveal any consistent bias between the measurements of the Lunar and Hologic scanners. CONCLUSIONS: The consistency between different DXA scanners (especially for Hologic vs. Lunar) is important for proper management, especially in patients with low T-scores and OP.
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BACKGROUND: The decline in pulmonary function is a predictor of disease progression in patients with cystic fibrosis (CF). This study aimed to determine the decline rate of percent predicted forced expiratory volume in 1 s (ppFEV1) based on the data of the CF Registry of Turkey. The secondary aim was to investigate the risk factors related to the decline in ppFEV1. METHODS: A retrospective cohort study of CF patients over 6 years old, with pulmonary function data over at least 2 years of follow-up was extracted from the national CF registry for years 2017-2019. Patients were classified according to disease severity and age groups. Multivariate analysis was used to predict the decline in ppFEV1 and to investigate the associated risk factors. RESULTS: A total of 1722 pulmonary function test results were available from 574 patients over the study period. Mean diagnostic age was older and weight for age, height for age, and body mass index z scores were significantly lower in the group of ppFEV1 < 40, while chronic Pseudomonas aeruginosa (p < .001) and mucoid P. aeruginosa colonization (p < .001) were significantly higher in this group (p < .001). Overall mean annual ppFEV1 decline was -0.97% (95% confidence interval [CI] = -0.02 to -1.92%). The mean change of ppFEV1 was significantly higher in the group with ppFEV1 ≥ 70 compared with the other (ppFEV1 < 40 and ppFEV1: 40-69) two groups (p = .004). Chronic P. aeruginosa colonization (odds ratio [OR] = 1.79 95% CI = 1.26-2.54; p = .01) and initial ppFEV1 ≥ 70 (OR = 2.98 95% CI = 1.06-8.36), p = .038) were associated with significant ppFEV1 decline in the whole cohort. CONCLUSIONS: This data analysis recommends close follow-up of patients with normal initial ppFEV1 levels at baseline; advocates for early interventions for P. aeruginosa; and underlines the importance of nutritional interventions to slow down lung disease progression.
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We aimed to investigate the relationship among probable sarcopenia, osteoporosis (OP) and supraspinatus tendon (SSP) tears in postmenopausal women. Postmenopausal women screened/followed for OP were recruited. Demographic data, comorbidities, exercise/smoking status, and handgrip strength values were recorded. Probable sarcopenia was diagnosed as handgrip strength values < 20 kg. Achilles and SSP thicknesses were measured using ultrasound. Among 1443 postmenopausal women, 268 (18.6%) subjects had SSP tears. Unilateral tears were on the dominant side in 146 (10.1%) and on the non-dominant side in 55 women (3.8%). In contrast to those without, women with SSP tears had older age, lower level of education, thinner SSP and lower grip strength (all p < 0.05). In addition, they had higher frequencies of hypertension, hyperlipidemia, DM, OP and probable sarcopenia, but lower exercise frequency (all p < 0.05). Binary logistic regression modeling revealed that age [odds ratio (OR): 1.046 (1.024-1.067 95% CI)], hypertension [OR: 1.560 (1.145-2.124 95% CI)], OP [OR: 1.371 (1.022-1.839 95% CI)] and probable sarcopenia [OR: 1.386 (1.031-1.861 95% CI)] were significant predictors for SSP tears (all p < 0.05). This study showed that age, presence of hypertension, probable sarcopenia and OP were related with SSP tears in postmenopausal women. To this end, although OP appeared to be related to SSP tears, SSP tear/thickness evaluation can be recommended for OP patients, especially those who have other risk factors such as older age, higher BMI, hypertension, and probable sarcopenia.
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Hipertensão , Osteoporose , Lesões do Manguito Rotador , Sarcopenia , Humanos , Feminino , Manguito Rotador/patologia , Sarcopenia/complicações , Sarcopenia/epidemiologia , Sarcopenia/patologia , Força da Mão , Pós-Menopausa , Lesões do Manguito Rotador/complicações , Lesões do Manguito Rotador/patologia , Osteoporose/patologia , Hipertensão/patologiaRESUMO
BACKGROUND: This study aimed to analyze the variations (if any) in hospital admissions of patients with any of the five common non-communicable diseases (NCDs), based on secondary analysis of electronic health records of patients admitted to Hacettepe University Hospitals at least once, from January 1, 2018 through June 15, 2021. DESIGN: Data were recruited from hospital's electronic health records on patients with diagnoses of ischemic heart disease, hypertension, diabetes, cancer, and chronic obstructive pulmonary disease, using relevant ICD-10 codes. RESULTS: Compared to the corresponding time span in the pre-pandemic period, the number of hospital admissions of patients with selected five NCDs significantly decreased during the pandemic, with an official start in Turkey on March 11, 2020. Number of total-, out-patient-, and in-patient admissions of NCD patients were significantly lower in the pandemic period compared to the expected values in time series analysis, controlling for patient characteristics, and seasonality. CONCLUSIONS: Study findings suggest that there has been a prominent impediment in NCD patients' access to, and/or use of health care services over the pandemic, which might evolve to higher admission rates, severity and fatality of such patients in the upcoming years. Further studies are warranted for confirmation of our findings in other care settings, with individual-based data on care compensation through settings other than regular admission sites (if any), and/or the reasons for under-use of services.
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COVID-19 , Hospitalização , Doenças não Transmissíveis , Pandemias , Humanos , COVID-19/epidemiologia , Doenças não Transmissíveis/epidemiologia , Doenças não Transmissíveis/terapia , Masculino , Feminino , Turquia/epidemiologia , Pessoa de Meia-Idade , Idoso , Hospitalização/estatística & dados numéricos , SARS-CoV-2 , Adulto , Admissão do Paciente/estatística & dados numéricos , Admissão do Paciente/tendências , Centros de Atenção Terciária/estatística & dados numéricos , Atenção Terciária à Saúde/estatística & dados numéricosRESUMO
The aim of this study was to investigate the frequency of Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and Mycoplasma genitalium in men living with HIV in terms of sociodemographic characteristics and behavioral risk factors. In this cross-sectional, single center study, all HIV-infected male patients, aged ≥ 18 years, including those being followed-up (n= 142) and the new admissions (n= 16) at Hacettepe University, Department of Infectious Diseases between March 1st, 2017 and May 1st, 2018 were included. After obtaining the informed consent form; age, follow-up days in STI-clinic, marital status, education, employment status; STI-related sign and symptoms, prior STI diagnosis, multiple sexual partners during the last year, exchanging sex for money, sexual orientation, drug use, condom use with regular and casual partner and also risk factors regarding partners were inquired as behavioural risk factors. A sample of first-voided urine of each participant was tested for the presence of Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and Mycoplasma genitalium by using nucleic acid amplification test (NAAT) (BD-MAX system, BD Diagnostics, USA) and BD MAX Mycoplasma-Ureaplasma-OSR for BioGX, (BD Diagnostics, The Netherlands). All participants living with HIV, men who have sex with men (MSM) and heterosexual men were grouped as STI-positive and STI-negative and compared. For all statistical analysis, SPSS 24 software was used. During the period of 14 months; the data was determined as follows: median follow-up time was 1138 (IQR= 159.5- 1494.5) days, median age was 35 (IQR= 28-42) years, 73.3% were single, 68.3% were at least college graduates or had higher educational attainment, 78.1% were currently employed. Of the participants, 26.9% reported STI-related sign and symptoms, 50.0% at least one STI episode in the past. Nine (5.6%) M.genitalium, five (3.1%) N.gonorrhoeae, and four (2.5%) C.trachomatis were detected in the urine samples of 17 (10.7%) individuals. N.gonorrhoeae and C.trachomatis were detected simultaneously in only one patient's urine sample. STI-positive patients (n= 17) were determined to be younger compared to STI-negative group [(p= 0.02; 27 years (IQR= 24-37) vs 35 years (IQR= 28-42)], had prominent STI-related signs and symptoms (p< 0.001) and had more multiple sexual partners (p= 0.03). The median CD4+ T lymphocyte count were relatively lower (p= 0.03) in STI-positive patients and plasma HIV RNA level was higher compared to the STI-negative participants (p= 0.05). STI-positive MSM group were younger [p= 0.01; 26 years (IQR= 23.5-29) vs 33 years, (IQR= 28-40)], STI-related signs and symptoms were more prominent (p= 0.02), the frequency of exchanging sex for money/drugs among their partners (p= 0.03) was higher compared to their STI-negative counterparts. Among STI-positive heterosexual patients, the presence of STI-related signs and symptoms (p= 0.04), drug use among their partners (p= 0.04) and plasma HIV RNA level (p<0.01) were significantly higher. STI was identified as an important health problem in this series of men living with HIV, 63.0% of whom had MSM and had a relatively high education level and socioeconomic status. Young age, having multiple partners, drug use, exchanging sex for money/drugs were prominent among the participants and their partners. Public health studies should focus on preventing STIs in young people living with HIV who have behavioral risk factors.
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Infecções por Chlamydia , Infecções por HIV , Mycoplasma genitalium , Minorias Sexuais e de Gênero , Infecções Sexualmente Transmissíveis , Trichomonas vaginalis , Humanos , Masculino , Feminino , Adolescente , Adulto , Chlamydia trachomatis/genética , Trichomonas vaginalis/genética , Neisseria gonorrhoeae/genética , Mycoplasma genitalium/genética , Homossexualidade Masculina , Estudos Transversais , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/diagnóstico , Fatores de Risco , Infecções por Chlamydia/complicações , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/diagnóstico , PrevalênciaRESUMO
BACKGROUND: The consistency of pituitary adenomas affects the course of surgical treatment. PURPOSE: To evaluate the diagnostic capabilities of radiomics based on T1-weighted (T1W) and T2-weighted (T2W) magnetic resonance imaging (MRI) in conjunction with two machine-learning (ML) techniques (support vector machine [SVM] and random forest classifier [RFC]) for assessing the consistency of pituitary adenomas. MATERIAL AND METHODS: The institutional database was retrospectively scanned for patients who underwent surgical excision of pituitary adenomas. Surgical notes were accepted as a reference for the adenoma consistency. Radiomics analysis was performed on preoperative coronal 3.0T T1W and T2W images. First- and second-order parameters were calculated. Inter-observer reproducibility was assessed with Spearman's Correlation (ρ) and intra-observer reproducibility was evaluated with the intraclass correlation coefficient (ICC). Least absolute shrinkage and selection operator (LASSO) was used for dimensionality reduction. SVM and RFC were used as ML methods. RESULTS: A total of 52 patients who produced 206 regions of interest (ROIs) were included. Twenty adenomas that produced 88 ROIs had firm consistency. There was both inter-observer and intra-observer reproducibility. Ten parameters that were based on T2W images with high discriminative power and without correlation were chosen by LASSO. The diagnostic performance of SVM and RFC was as follows: sensitivity = 95.580% and 92.950%, specificity = 83.670% and 88.420%, area under the curve = 0.956 and 0.904, respectively. CONCLUSION: Radiomics analysis based on T2W MRI combined with various ML techniques, such as SVM and RFC, can provide preoperative information regarding pituitary adenoma consistency with high diagnostic accuracy.
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Adenoma , Neoplasias Hipofisárias , Humanos , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/cirurgia , Neoplasias Hipofisárias/patologia , Estudos Retrospectivos , Reprodutibilidade dos Testes , Imageamento por Ressonância Magnética/métodos , Adenoma/diagnóstico por imagem , Adenoma/cirurgia , Adenoma/patologiaRESUMO
OBJECTIVES: The aims of the study were to investigate the relationship between sarcopenia and renin-angiotensin system-related disorders and to explore the effects of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on muscle mass/function and physical performance. DESIGN: This multicenter, cross-sectional study was performed using ISarcoPRM algorithm for the diagnosis of sarcopenia. RESULTS: Of the 2613 participants (mean age = 61.0 ± 9.5 yrs), 1775 (67.9%) were hypertensive. All sarcopenia-related parameters (except chair stand test in males) were worse in hypertensive group than in normotensive group (all P < 0.05). When clinical/potential confounders were adjusted, hypertension was found to be an independent predictor of sarcopenia in males (odds ratio = 2.403 [95% confidence interval = 1.514-3.813]) and females (odds ratio = 1.906 [95% confidence interval = 1.328-2.734], both P < 0.001). After adjusting for confounding factors, we found that all sarcopenia-related parameters (except grip strength and chair stand test in males) were independently/negatively related to hypertension (all P < 0.05). In females, angiotensin-converting enzyme inhibitors users had higher grip strength and chair stand test performance values but had lower anterior thigh muscle thickness and gait speed values, as compared with those using angiotensin II receptor blockers (all P < 0.05). CONCLUSIONS: Hypertension was associated with increased risk of sarcopenia at least 2 times. Among antihypertensives, while angiotensin-converting enzyme inhibitors had higher muscle function values, angiotensin II receptor blockers had higher muscle mass and physical performance values only in females.
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Hipertensão , Sarcopenia , Masculino , Feminino , Humanos , Pessoa de Meia-Idade , Idoso , Sarcopenia/diagnóstico , Força Muscular/fisiologia , Estudos Transversais , Força da Mão/fisiologia , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Antagonistas de Receptores de Angiotensina/farmacologiaRESUMO
BACKGROUND: Vitamin D is an essential fat-soluble vitamin thought to be associated with chronic diseases, mortality and COVID-19. OBJECTIVE: To investigate the association between 25(OH) vitamin D levels and mortality of chronic diseases in subjects aged ≥65 years before and during COVID-19 pandemic. METHODS: A single-center, retrospective study was performed using the hospital database of subjects aged 65 years and older who had undergone vitamin D measurement between 01.01.2019 and 31.12.2021. All patients with vitamin D measurement (N = 2155) were followed as a cohort from the date of serum vitamin D analysis through death date or 01.01.2022. Age, gender, chronic diseases, survival status, date of death of the deceased, laboratory values including complete blood count, liver/renal functions and 25(OH) vitamin D levels were all noted. Subjects were classified into three groups according to their 25(OH) vitamin D levels; severe deficient group (<10 ng/ml), moderate deficient group (10-19.9 ng/ml), and control group (≥20 ng/ml). RESULTS: Data of 1949 subjects were included in this retrospective analysis and 206 of them (10.6%) had at least two vitamin D measurements. Until the time of data collection (01.01.2022), 94 of the cases had died within the last three years, and only five of them had repeated measurements. While the mean vitamin D level was lower, age and frequency of dyslipidemia, coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), arrhythmia, dementia and severe vitamin D deficiency (<10 ng/ml) were higher in subjectswho died (all p<0.05). According to the Cox proportional hazards model; age, presence of CAD, COPD, arrhythmia, dementia, anemia and severe vitamin D deficiency were independently related with mortality (all p<0.05). After adjusted by age, gender, and comorbidities, the probability of death was found to be 1.91 (95% CI=1.12-3.24) times higher in the severe vitamin D deficient group. CONCLUSIONS: The results of this study have shown that - after having adjusted for potential factors - severe vitamin D deficiency (<10 ng/ml) seems to be an independent predictor for non-cancer mortality. Although vitamin D measurement/treatment is very easy and cheap where, on the contrary, severe vitamin D deficiency can be quite mortal.
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COVID-19 , Doença da Artéria Coronariana , Demência , Doença Pulmonar Obstrutiva Crônica , Deficiência de Vitamina D , Humanos , Idoso , Estudos Retrospectivos , COVID-19/epidemiologia , Pandemias , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/epidemiologia , Vitamina D , Doença da Artéria Coronariana/complicações , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/complicações , Demência/epidemiologia , Demência/complicaçõesRESUMO
BACKGROUND: Healthcare workers (HCWs) were seriously affected by the coronavirus disease 2019 (COVID-19). It is a priority to protect HCWs against COVID-19 and ensure the continuity of the health care system. OBJECTIVE: To evaluate the risk factors for COVID-19 in HCWs and the effectiveness of the measures taken on protection. METHODS: A nested case-control study was conducted in two hospitals serving on the same campus which are affiliated with a university from Turkey, between 03.12.2020 and 05.22.2020. We aimed to recruit three controls working in the same unit with the cases diagnosed with COVID-19 by polymerase chain reaction (PCR) and whose SARS-CoV-2 PCR test is negative. Self-reported data were collected from the HCWs by the face-to-face method. Descriptive and analytical methods were used and a logistic regression model was built. RESULTS: The study was completed with 271 HCWs, 72 cases, and 199 controls. Household contact with a COVID-19 patient or a patient with symptoms compatible with COVID-19 was found to be significantly higher in the cases than in the controls (pâ=â0.02, pâ<â0.001). When the measures for control the COVID-19 were analyzed, using a medical mask (ORâ=â0.28, 95% confidence intervalâ=â0.11-0.76, pâ=â0.01) by COVID-19 patient and using the respiratory mask by HCWs (ORâ=â0.13, 95% CIâ=â0.03-0.52, pâ=â0.004) during close contact was found to be protective against COVID-19 transmission. CONCLUSION: This study showed an association with using medical masks by the patients as an important protective precaution for the transmission of COVID-19 to HCWs. Respiratory masks should be used by HCWs while in close contact with COVID-19 patients regardless of aerosol-producing procedures.
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COVID-19 , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , SARS-CoV-2 , Hospitais Universitários , Estudos de Casos e Controles , Turquia/epidemiologia , Pessoal de Saúde , Fatores de Risco , Atenção à SaúdeRESUMO
Purpose: The aim of this study was to determine descriptive characteristics of dental students, to investigate their professional expectations, career decision criteria, and related factors; to examine how (if any) seniority in school affects these. Subjects and methods: During the period of 2018-2019, all 1-5 grade students (n = 754) of Hacettepe University Dental School were invited to participate and those who accepted had filled under observation a standard questionnaire form of 35 questions (83.4%). In the analysis of the data, descriptive statistics, chi-square, Student's t-test and ANOVA and Odds ratio methods were used. Results: In this cross-sectional study, 66% of the group were female, age range was 18-30 (mean±SD= 21.2 ± 1.7). The most common reasons for choosing dentistry were "financial benefits", "job security" and "professional status". "Undertake specialist training" (80.2%) was the most common short-term expectation after graduation; two most common long-term expectations were "having a private clinic" (57.9%) and "completing specialization training" (56.0%). The most important factors affecting the post-graduation working plans were work-life balance and economic stability. Conclusion: It is recommended to provide adequate counseling and guidance to students about potential career paths to maximize a balanced and widely accessible oral health service delivery across the country with more motivated dentists. Qualitative research may improve our understanding of how dental education can be improved to fulfill students' expectations from school, and to motivate dental students towards general practitioning in the future.
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BACKGROUND: Sars-CoV-2 infection influences older individuals at the forefront, and there is still limited data on the COVID-19 vaccine response in the geriatric population. This study aimed to assess antibody response after vaccination with SARS-CoV-2 inactivated vaccine and examine possible factors affecting this response in a geriatric population. METHODS: individuals who have been on at least the 28th day after the second dose of the COVID-19 vaccine were included. Comprehensive geriatric assessment tools and the Clinical Frailty Scale were performed. SARS-CoV-2 spike-specific IgG antibodies were detected and, levels ≥1 U/ml were defined as seropositive, <1 U/ml were defined as seronegative. RESULTS: a total of 497 patients were included and divided into three groups according to the days past after the second dose of the vaccine (Group 1: 28-59 days, Group 2: 60-89 days and Group 3: 90 days and more). Groups included 188, 148 and 171 patients, respectively. Seropositivity rate in each group was 80.9,73.2 and 57.3%, respectively. In Groups 1 and 2, Charlson Comorbidity Index score was higher in the seronegative group (P = 0.023 and P = 0.011, respectively). In Group 3, the prevalence of frailty was significantly higher in the seronegative group (P = 0.002). CONCLUSION: to the best of our knowledge, this is the first study assessing the antibody response after vaccination with Sars-CoV 2 inactivated vaccine in the Turkish geriatric population. Moreover, this is the first study revealing the relationship between antibody response and frailty. Larger studies are needed to confirm the antibody response duration and the association between frailty and COVID-19 vaccine response.
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COVID-19 , Fragilidade , Idoso , Anticorpos Antivirais , Formação de Anticorpos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinas contra COVID-19 , Humanos , SARS-CoV-2 , Vacinas de Produtos InativadosRESUMO
OBJECTIVE: The World Health Organization announced the new coronavirus disease 2019 as a pandemic, as of March 11, 2020. The long-expected method to combat coronavirus disease 2019 pandemic, that is, using an effective and widely available vaccine, has become reality by late 2020. This study was conducted prior to the national coronavirus disease 2019 mass vaccination campaign in Turkey to investigate the individual thoughts, behaviors, and expectations of the academic personnel on coronavirus disease 2019 vac- cination practices, who were among the pionneers in both vaccine trials and real-time coronavirus disease 2019 vaccine jabs. MATERIAL AND METHODS: The Hacettepe University Medical School has a total of 1692 academic personnel. All academicians were reached through their academic email addresses and invited to participate in the survey. Busy academic routines and coronavirus disease 2019-related duties limited response number to 213 academicians, after 3 consecutive reminders at 1 week interval. The survey was conducted using a standardized, 14 question-long questionnaire, using Google forms. RESULTS: Of the 213 participants, 60.6% (n = 129) were females and the average age (± standard deviation) was 40.2 ± 12.0 years. Of all, 17.4% (n = 37) had been reportedly diagnosed to have coronavirus disease 2019 prior to vaccination. A statistically significant posi- tive association was detected between coronavirus disease 2019 vaccination self-experience and recommending such a vaccination for relatives (P < .001); odds of recommendation was 19.5 times (95% CI = 4.2-89.6) higher among coronavirus disease 2019 vaccinated academicians compared to their non-vaccinated counterparts. CONCLUSION: Study participants are amongs the frontline workers, with expectedly the highest exposure rates from severe acute respiratory syndrome coronavirus-2. A significant proportion of academicians also play important role as scientific consultants and role models for the general public. Thus, their thoughts and concerns regarding public preventive measures and coronavirus disease 2019 vaccination practices are important for decisions health policy makers and administrators in charge of vaccine selection, availabil- ity, distribution, and allocation make, besides their self-responsibility in provision of evidence-based vaccine information for the general public, based on local needs and concerns.
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Generating memory T cell responses besides humoral immune responses is essential when it comes to the efficacy of a vaccine. In this study, the presence of memory T cell responses after aluminum-adjuvanted inactivated whole-virion SARS-CoV-2 vaccine (CoronaVac) in seronegative and seropositive elderly individuals were examined. CD4+ and CD8+ memory T cell proliferation and IFN-γ production capacities were evaluated. Additionally, clinical frailty scale (CFS) and FRAIL scales of the individuals were scored. CD4+ memory T cell responses more prominent than CD8+ memory T cells. In seronegative individuals, 80% of them had memory CD4+ and IFN-γ, whereas 50% of them had memory CD4+ and all of them had IFN-γ responses. Additionally, 40% of seronegative patients and 50% of seropositive patients had memory CD8+ responses. To sum up, humoral immune responses are not associated with memory T cell responses, and in seronegative individuals, memory T cell responses can be detected.
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COVID-19 , Hospitalização , Humanos , Modelos Estatísticos , Probabilidade , Prognóstico , SARS-CoV-2RESUMO
BACKGROUND: Injury is the most common cause of preventable morbidity and mortality among children. The aim of this study was to determine the epidemiological characteristics and trends of injury-related mortality in children under five and to provide evidence for future preventive strategies. METHODS: Our study was designed as a descriptive cross-sectional study. National under-five mortality data from the Death Notification System database, entered between January 1st, 2014, and December 31th, 2017, was included in the study. RESULTS: Among all under-five deaths registered in the system, 2,560 injury-related death cases were included in the study. Overall, deaths related to injuries accounted for 4.1% of all deaths in children under five years old. Of all injury deaths, 59.9% of cases were male, 52.7% occurred at home or its close vicinity, and 80.3% were children aged 12-59 months. Injury-related under-five deaths were mainly attributed to traffic injuries (36.5%), falls (12.0%), and suffocation (10.2%). Traffic injuries were the most common cause of injury-related deaths both in infants 0-11 months and children 12-59 months old. The second and third most common causes of injury-related deaths among infants 0-11 months were suffocation and falls, while these were falls and drowning in children aged 12-59 months, respectively. The injury-related under-five mortality rate dropped from 11.3 per hundred thousand in 2014 to 9.1 in 2017. Causes of all unintentional injury-related deaths were associated with season except for other unintentional injuries and exposure to mechanical forces (p < 0.001). CONCLUSIONS: The injury-related mortality rate among children under five years declined from 2014 to 2017, however it is still high. To prevent injuries in children under five, it is important to raise awareness and increase the supervision of children by their caregivers. At the national level, multisectorial cooperation with a holistic approach will be of key importance.
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Afogamento , Ferimentos e Lesões , Cuidadores , Causas de Morte , Criança , Pré-Escolar , Estudos Transversais , Humanos , Lactente , Masculino , Turquia/epidemiologiaRESUMO
OBJECTIVE: We report the hospital outcomes after implementing the blue code system in our hospital and health campus. We also aimed to determine factors related to mortality. METHODS: This is a retrospective observational study of the patients who received cardiopulmonary resuscitation (CPR). All blue code calls for all age groups between March 15, 2013, and April 30, 2015 were analyzed. Logistic regression analysis was performed to find independent predictors of in-hospital mortality. RESULTS: A total of 155 patients from the blue code calls were evaluated. Return of spontaneous circulation was achieved in 45.5% of patients, and 54.8% of the patients had died at the end of the CPR. The hospital discharge rate was 20%. Of all patients, 65% were adults with a survival rate of 7.9%, whereas pediatric patients had a 44.2% survival rate. Asystole and pulseless electrical activity were the predominant electrocardiography rhythms in 92.4% of patients. The comparison of survivors and nonsurvivors revealed that nonsurvivors were older, had more cancer as the comorbidity, had a more cardiac arrest, and sepsis as the underlying cause and had >20 min of CPR. The logistic regression analysis demonstrated the independent risk factors for mortality as arrest at a hospital ward, and sepsis as the underlying cause and being adult patient. CONCLUSION: The performance of the blue code system should be evaluated periodically. Every effort should be made to prevent unexpected cardiac arrests and increase hospital discharge with good neurologic outcomes.
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OBJECTIVE: To evaluate the concerns the parents have with the development of their children and related conditions and investigate how often these concerns are addressed at all levels of the healthcare system. Determining parental perceptions of these issues and highlighting missed opportunities is valuable for improving healthcare services. METHODS: A total of 451 parents attending a medical appointment for their children in outpatient clinics at tertiary, secondary and primary health centers were administered a questionnaire comprised of 45 questions pertaining to their concerns regarding the development of their children and related conditions, including sociodemographic characteristics, practices supporting child development, information resources and personal opinions, such as whether they had sufficient information. RESULTS: The parents of 130 children (28.8%) reported at least one developmental concern. Less than half of the concerned parents had visited a health center for these concerns. The area of greatest concern was language development, but the concerns differed based on setting. Among the related factors, having insufficient information (p = 0.000, OR: 0.375, CI: 0.24-0.58) and not playing with the child (p = 0.029, OR: 0.563, CI: 0.33-0.94) increased the risk of having developmental concerns. Only 15.5% of children were followed up in a developmental and behavioral manner. CONCLUSIONS: The authors observed many concerns and missed opportunities to address them at all levels of health centers. Family physicians were more effective at eliciting these issues than pediatricians. These issues need to be addressed in the health system with consideration of its complexity and integrated culture.
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Família , Pais , Criança , Humanos , Renda , Percepção , Inquéritos e QuestionáriosAssuntos
COVID-19 , Infecções por Coronavirus , COVID-19/terapia , Humanos , Imunização Passiva , Plasma , SARS-CoV-2 , Soroterapia para COVID-19RESUMO
INTRODUCTION: Sleep-disordered breathing (SDB) in primary school children is a significant problem, yet its prevalence is not well known outside large urban settings. Information on the burden and risk factors of SDB in children could be used to improve resource allocation when providing care across a large country. The objectives of this study were to assess the prevalence of SDB among school-aged children comparing rural and urban settings, and to investigate associated risk factors. METHODS: In this cross-sectional study, a random sample of primary school students in Turkey were selected from urban and rural areas and data were collected using the Pediatric Sleep Questionnaire, asthma, and allergic rhinitis questionnaires completed by the parents. RESULTS: Questionnaires were collected from a total of 139 schools from 58 provinces. A total of 11,013 students were contacted, and 9045 (73%) completed the study. There was no difference in the prevalence of SDB between rural and urban settings (16% vs. 15%, p = 0.612). Multivariate logistic regression analysis revealed that current wheezing, current rhinoconjunctivitis, being overweight, parental snoring, and current mold at home were significant risk factors for SDB in both rural and urban children. Current tobacco smoke exposure (OR = 1.48, 95%CI = 1.19-1.85), near roadway air pollution exposure (OR = 1.40, 95%CI = 1.108-1.791), and mold at home in the first year of life (OR = 1.68, 95%CI = 1.26-2.23) were associated with SDB in urban children. History of maternal/paternal adenotonsillectomy was a significant predictor of SDB in the rural setting (OR = 1.63, 95%CI = 1.12-2.39). CONCLUSION: The prevalence of SDB is high in children living in both settings but associated risk factors may vary. Children residing in rural areas should also be screened for sleep-disordered breathing during routine health visits.