Infection Risk Prediction in Healthcare Settings: Lessons from COVID-19 Contact Tracing.

Objective: Contact tracing aids epidemic control by enabling early detection and isolation without overburdening healthcare systems despite potential challenges. This study aimed to evaluate the practical application of contact and risk assessment-based models in predicting SARS-CoV-2 infection following exposure among healthcare workers in a large tertiary public university hospital in Türkiye. Materials and Methods: The study was designed as a retrospective cohort study, including contact tracing data from 3389 exposed healthcare workers from March 23, 2020, to October 22, 2021. Contact-based (mask use, contact duration and distance) and exposure risk-assessment-based (low, medium, high-risk) models with and without having symptoms were generated using logistic regression. SARS-CoV-2 infection was defined as having a positive SARS-CoV-2 RT-PCR test result. Adjustments were made to the models for demographic and occupational variables, previous infection, and vaccination. Model parameters were compared. Results: Of 3389 exposed healthcare workers, 2451 underwent RT-PCR testing. Among those tested, RT-PCR positivity was 5.9% (144/2451). Lack of personal protective equipment use (odds ratio [OR]=1.64, 95% confidence interval [CI]=1.03-2.66) and ≥15 minutes of contact duration (1.89, 1.21-3.09) were significantly associated with RT-PCR positivity. In the risk-assessment model, being a high-risk contact increased the odds of RT-PCR positivity (OR=2.76, 95% CI=1.61-5.03). Adding the presence of symptoms to contact-based and risk assessment models improved model parameters (Akaike information criterion [AIC]: from 1086.1 to 1083.1; Tjur's R2: from 0.016 to 0.019, respectively). Conclusion: The inclusion of being symptomatic improved the contact-based and risk assessment-based models. Institutions should be encouraged to incorporate symptom inquiries into risk assessment protocols in response to newly emerging respiratory virus epidemics. Institutions lacking the capacity for extensive contact tracing are recommended, at minimum, to track symptomatic exposed workers for epidemic control.

Clinical Significance of Pleural Lactate Measurement in Critically Ill Patients with Parapneumonic Pleural Effusion.

OBJECTIVE: Pleural fluid pH measurement is recommended for tube thoracostomy decisions in complicated parapneumonic pleural effusions. However, pleural fluid pH may be affected by blood pH in critically ill patients with common systemic acid-base disorders. We aimed to investigate the use of pleural fluid lactate to distinguish culture-positive parapneumonic effusions from other pleural effusions. MATERIAL AND METHODS: This prospective observational study included 121 eligible patients (51 female and 70 male). All patients with pleural effusion who underwent thoracentesis were assessed. Pleural fluid lactate was measured by a blood gas analyzer. RESULTS: Of the 121 patients, 30 (24.8%) were transudate and 91 (75.2%) were exudate. Of the 91 patients with exudative pleural effusion, 61 were diagnosed as culture-negative parapneumonic, 13 as culture-positive parapneumonic, 9 as malignant, and 8 as other exudative effusion. There was a strong positive linear association between serum pH and pleural fluid pH (R = 0.77, P < .001). The post hoc tests for pleural fluid lactate revealed there was a significant difference between culture-positive parapneumonic versus culture-negative parapneumonic groups (P = .004), culture-positive parapneumonic versus transudative effusion groups (P < .001), culture-negative parapneumonic versus transudative effusion groups (P = .008) and lastly; malignant effusion versus transudative effusion groups (P = .001). Receiver operating characteristics curve analysis for culture-positive parapneumonic indicated a cutoff of 4.55 mmol/L for pleural fluid lactate to have a sensitivity of 76.9% and a specificity of 84.3% (positive predictive value: 37%, negative predictive value: 96.8%). CONCLUSION: A cutoff of 4.55 mmol/L of pleural fluid lactate can be used as a useful tool to distinguish culture-positive parapneumonic effusions from other effusions in critically ill patients.

Combined Effects of Prone Positioning and Airway Pressure Release Ventilation on Oxygenation in Patients with COVID-19 ARDS.

Objective: Coronavirus disease 2019 (COVID-19) can cause acute respiratory distress syndrome (ARDS). Invasive mechanical ventilation (IMV) support and prone positioning are essential treatments for severe COVID-19 ARDS. We aimed to determine the combined effect of prone position and airway pressure release ventilation (APRV) modes on oxygen improvement in mechanically-ventilated patients with COVID-19. Methods: This prospective observational study included 40 eligible patients (13 female, 27 male). Of 40 patients, 23 (57.5%) were ventilated with APRV and 17 (42.5%) were ventilated with controlled modes. A prone position was applied when the PaO2/FiO2 ratio <150 mmHg despite IMV in COVID-19 ARDS. The numbers of patients who completed the first, second, and third prone were 40, 25, and 15, respectively. Incident barotrauma events were diagnosed by both clinical findings and radiological images. Results: After the second prone, the PaO2/FiO2 ratio of the APRV group was higher compared to the PaO2/FiO2 ratio of the control group [189 (150-237)] vs. 127 (100-146) mmHg, respectively, (P=0.025). Similarly, after the third prone, the PaO2/FiO2 ratio of the APRV group was higher compared to the PaO2/FiO2 ratio of the control group [194 (132-263)] vs. 83 (71-136) mmHg, respectively, (P=0.021). Barotrauma events were detected in 13.0% of the patients in the APRV group and 11.8% of the patients in the control group (P=1000). The 28-day mortality was not different in the APRV group than in the control group (73.9% vs. 70.6%, respectively, P=1000). Conclusion: Using the APRV mode during prone positioning improves oxygenation, especially in the second and third prone positions, without increasing the risk of barotrauma. However, no benefit on mortality was detected.

Overweight and obesity in preschool children in Turkey: A multilevel analysis.

Childhood obesity/overweight is a worldwide concern and its prevalence is increasing in many countries. The first aim of this study is to analyse the trends in overweight and obesity among children under the age of five in Turkey based on the new World Health Organization (WHO) standards, using data from the 'five-round of the Turkey Demographic and Health Surveys' (TDHSs). The second aim is to examine whether or not the maternal/household and individual-level factors are associated with overweight/obesity using TDHS 2003, 2008, and 2013 datasets. A total sample of 14,231 children under the age of five were extracted from the TDHS in 1993, 1998, 2003, 2008, and 2013 to determine the prevalence of the trend. Pooled data from 8,812 children were included in the analysis to examine factors associated with overweight/obesity. Taking into account the clustered data structure, multilevel logistic regression models were utilised. In 1993, 1998, 2003, 2008, and 2013 the prevalence of overweight children was 5.3%, 4.9%, 10.0%, 11% and 11.6%, respectively. The factors that were independently associated with overweight/obesity were as follows: living in single-parent households (adjusted odds ratio (aOR) = 2.27, 95%CI = 1.21-4.26), compared to living in dual-parent households; having an obese mother (aOR = 4.25, 95%CI = 1.73-10.44), overweight mother (aOR = 3.15, 95%CI = 1.29-7.69), and a normal-weight mother (aOR = 2.70, 95%CI = 1.11-6.59) compared to having an underweight mother; being aged between 13-24 months (aOR = 1.72, 95%CI = 1.30 to 2.27), compared to being aged 0-12 months; male gender (aOR = 1.30, 95%CI = 1.11 to 1.53); being stunted (aOR = 2.18, 95%CI = 1.74 to 2.73); high birth weight (aOR = 1.55, 95%CI = 1.08 to 2.23) compared to low birth weight. In addition, overweight was higher in children of mothers who had completed primary school (aOR = 1.21, 95%CI = 1.01 to 1.59) than children of mothers who had not completed primary school. These findings reveal that, over the years, there has been a substantial increase in obesity/overweight among children which demonstrates the importance of evaluating the overweight indicators at the maternal/household level.

The presence of symptoms within 6 months after COVID-19: a single-center longitudinal study.

BACKGROUND: Characterizing the post-COVID health conditions is helpful to direct patients to appropriate healthcare. AIMS: To describe the presence of symptoms in COVID-19 patients within 6 months after diagnosis and to investigate the associated factors in terms of reporting symptoms. METHODS: Data of DEU-COVIMER (a telephone interview-based COVID-19 follow-up center established in a tertiary care hospital) was analyzed for SARS-CoV-2 RNA positive participants aged ≥ 18 years from November 1st, 2020, to May 31st, 2021. Symptom frequencies were stratified by demographic and clinical characteristics at one, three, and 6 months after diagnosis. With the patients who had symptoms at baseline, generalized estimating equations were applied to identify the factors associated with reporting of symptoms. RESULTS: A total of 5610 patients agreed to participate in the study. Symptom frequency was 37.2%, 21.8%, and 18.2% for the first, third, and sixth months. Tiredness/fatigue, muscle or body aches, and dyspnea/difficulty breathing were the most common symptoms in all time frames. In multivariate analysis, older age, female gender (odds ratio OR 1.74, 95% confidence interval 1.57-1.93), bad economic status (OR 1.37, 1.14-1.65), current smoking (OR 1.15, 1.02-1.29), being fully vaccinated before COVID-19 (OR 0.53, 0.40-0.72), having more health conditions (≥ 3 conditions, OR 1.78, 1.33-2.37), having more symptoms (> 5 symptoms, OR 2.47, 2.19-2.78), and hospitalization (intensive care unit, OR 2.18, 1.51-3.14) were associated with reporting of symptoms. CONCLUSIONS: This study identifies risk factors for patients who experience post-COVID-19 symptoms. Healthcare providers should appropriately allocate resources prioritizing the patients who would benefit from post-COVID rehabilitation.

West Nile Virus Seroprevalence in Manisa Province: A Population-based Study.

Objective: West Nile Virus (WNV), which causes widespread outbreaks in different parts of the world, is a risk to public health in Turkey, too. Community-based study data are needed to identify measures against possible outbreaks. This study aimed to determine the seroprevalence of community-based WNV in Manisa and to investigate the relationship between sociodemographic and socioeconomic variables. Methods: We included individuals older than two years of age (N=1,317,917) registered in the Manisa Province Family Medicine Information System. Selected participants (n=1233) were determined by a simple random sampling method. Specific IgG antibodies against WNV were investigated in serum samples using a commercial ELISA test (Euroimmun, Germany). The relationship between age, gender, location, education and income level, occupation, population density, altitude, the location of the toilet in the house, and the presence of hypertension, diabetes mellitus and cardiovascular disease variables were analyzed by chi-square, Fisher's exact test and t-test. Adjusted odds ratio (OR) with95% confidence interval (CI) for each variable were calculated by the logistic regression method to explain potential risks. Results: WNV IgG antibodies were detected in 47 (3.8%) sera samples by ELISA. Seroprevalence was significantly correlated with independent variables of advanced age, presence of hypertension, diabetes mellitus and cardiovascular disease, low level of education and income, living in low altitude areas and the location of the toilet. In multivariate analysis; age (every one-year increase) (OR:1.05; 95% CI:1.02-1.07; p <0.001), equivalent annual income per capita below 3265 TL (OR:3.21; 95% CI: 1.53-6.73; p=0.002), and living areas below 132 meters altitude (OR=3.21; 95% CI 1.26-8.15; p=0.014) were found to be the risk factors for WNV seropositivity. Conclusion: In Manisa province, WNV IgG seroprevalence was detected as 3.8% with ELISA method. Older age, low income and living in regions with a low altitude were found to be associated with increased seropositivity significantly.

Transmission dynamics and timing of key events for SARS-CoV-2 infection in healthcare workers.

BACKGROUND: Healthcare workers (HCWs) have increased risk for SARS-CoV-2 infection via contacts in hospitals, as well as via transmission in the community. Serial interval, which is defined as the time between symptom onsets in an infector-infectee pair, and the incubation period are key parameters in determining the control strategies for COVID-19. This study aimed to evaluate surveillance of HCWs and estimate the serial interval and incubation period of COVID-19. METHODS: A total of 149 HCWs and 36 certain infector-infectee pairs between 19th March 2020 and 1st November 2020 in a university hospital were included in the study. Epidemiological characteristics were recorded. Serial interval and incubation period were estimated using parametric accelerated failure time models. RESULTS: Forty HCWs (26.8%) were detected via contact-based surveillance. Of 100 HCWs epidemiologically linked with a confirmed COVID-19 case, 36 (36%) had contact with a colleague. The median serial interval was 3.93 days (95% CI: 3.17-4.83). Of symptomatic HCWs, 97.5% had developed symptoms 13.71 (95% CI: 9.39-18.73) days after symptom onset of the primary case. The median incubation period was 3.99 (95% CI: 3.25-4.84) days. Of symptomatic HCWs, 97.5% developed symptoms within 9.49 (95% CI: 6.75-12.20) days after infection. CONCLUSIONS: The serial interval and the incubation period of COVID-19 in HCWs were shorter than in the general population. Rigorous contact tracing and isolation of infected HCWs could have resulted in shorter serial intervals. Implementation of more stringent in-hospital control measures focussed on transmission between HCWs should be considered.

Cause-of-death distributions and mortality trends in Turkey between 2009 and 2017.

BACKGROUND: Making the right decisions in the field of public health depends on the reliable recording of statistical data such as death and birth. There have been radical changes and innovations in the death registration since 2009 in Turkey to improve reporting. AIMS: To examine the distribution and the trend of causes of death between the years 2009 and 2017 in Turkey. STUDY DESIGN: Descriptive study. METHODS: In this study, the causes of death were evaluated in three groups used in the Global Burden of Disease study. Group I included infectious, maternal, perinatal, and nutritional conditions; group II included noncommunicable diseases; and group III included injuries. Age-standardized mortality rates were calculated per 100,000 according to age, sex, and cause of death. Joinpoint regression was used to evaluate the trend in mortality rates. In addition, the leading causes of death were also determined. RESULTS: In total, age-standardized mortality rates increased significantly on average annually (1.5% per year). When the trends of causes of death were examined according to gender, there was a significant increase in deaths from group I in both genders and a significant increase in deaths from group III in males, whereas there was no statistically significant change in deaths from group II between 2009 and 2017. CONCLUSION: A significant quantitative improvement in death registration was seen in Turkey between the years 2009 and 2017. This is due to the increase in the number of reported deaths. The change in the distribution of causes of death is noteworthy. This research can provide the basis for further researches that will examine the change in causes of death.

Health care-associated invasive Candida infections in children.

The aims of the study were to examine the distribution of Candida spp. isolated from sterile body sites, the antifungal susceptibility of the isolates to amphotericin B, and fluconazole, risk factors and clinical outcomes associated with invasive health care-associated Candida infections in neonates and children. Between January 2007 and January 2012, the patients with invasive candidiasis were detected from microbiology laboratary records and medical records were examined retrospectively. Candida spp. were isolated from sterile body sites in 94 patients. The most common underlying diseases were prematurity in neonates and surgery in children. Parenteral nutrition, stay in intensive care unit (ICU), and mechanical ventilation (MV) were major risk factors in neonates. Hospitalization before infection and immunosuppressant therapy were significantly more frequent in children. Of Candida infection episodes, 29.8% was due to C. albicans and 70.2% was due to non-albicans Candida spp. The most common isolated species was C. parapsilosis. Of the Candida species, 90.8% were sensitive, and 9.2% were resistant to fluconazole. The rate of amphotericin B resistant was 1.3%; 23.4% of the patients died in the first 30 days. The main variables associated with mortality were neonates, prematurity, stay in the ICU, parenteral nutrition, MV, length of stay, amphotericin B susceptibility, and high levels of C-reactive protein.

Predictive Factors for Lymph Node Metastasis and the Effect on Survival in Early Gastric Cancer Patients with Radical Gastric Resection.

OBJECTIVES: Selected patients with early gastric cancer (GC) are treated endoscopically. Lymph node metastasis (LNM) in the T1 stage may also be detected during surgical resection for early GC. The aim of this study was to determine factors associated with LNM and the effect on survival. METHODS: A total of 63 patients with tumor invasion stage T1a or T1b who were operated on for early GC between 2010 and 2018 were included in the study. Parameters were investigated retrospectively to identify predictive factors for LNM and overall survival. Significance was defined with a 2-sided p-value of <0.05. RESULTS: Among the 63 patients, 21 (33.3%) had LNM. Lymphovascular invasion (LVI) (p=0.02) and a high-grade tumor (p=0.02) were significantly associated with LNM. The overall survival rate was 73.0%. The number of patients with LNM was greater among the deceased patients compared with the censored group (p=0.03). The median follow-up time of the entire group was 28 months (range: 12-55 months) while it was 23 months (range: 7-39 months) in the deceased group and 33.5 months (15.5-60 months) in the censored group (p=0.06). The mean survival was 62.36 months in patients with LNM and 71.99 months in those without LNM (p=0.09). The cut-off value determined for the neutrophil-to-lymphocyte ratio (NLR) was 2.33 and it was an effective value in survival analysis (p<0.05). CONCLUSION: Surgical treatment should be considered for early GC patients with high-grade tumors and cases demonstrating LVI. The overall survival was shorter in patients with a high NLR value and LNM.