Homologous and Heterologous Covid-19 Booster Vaccinations Against SARS-CoV-2 Infection in the Elderly.

A third booster doses for the 2019 coronavirus disease (COVID-19) is widely used all over the world, especially in risky individuals, with the recommendation of WHO. The purpose of this study was to evaluate the effectiveness of mRNA (BNT162b2), and CoronaVac (Sinovac Biotech) vaccines as a reminder dose following two doses of CoronaVac against COVID-19 infection, serious illness, and mortality in the geriatric population aged 75 and older during the delta variant dominant period. Our study comprised 2730 individuals the age of 75 and older in total, of which 1082 (39.6%) were male and 1648 (60.4%) were female. The vaccine effectiveness (VE) of 2 doses of CoronaVac + 1 dose of BNT162b2 vaccine combination against COVID-19 was determined as 89.2% (95% Confidence interval (CI) 80.7-93.9%), while the VE of 3 doses of CoronaVac vaccine was determined as 80.4% (95% CI 60.5-90.2%). Geriatric patients who received three doses of CoronaVac vaccine did not need intensive care. No deaths were observed in the vaccinated groups. While the VE of vaccination with 2 doses of CoronaVac + 1 dose of BNT162b2 was 41.8% (95% CI 0-74.1%) against hospitalization, 64.4% (95% CI 0-94.7%) against intensive care unit admission, the VE of vaccination with three doses of the CoronaVac was 78.2% (95% CI 0-96.5%) against hospitalization. In conclusion, our research showed that, even with the emergence of viral variants, a third dose of the CoronaVac and BNT162b2 vaccines is highly effective against symptomatic SARS-CoV-2 infection. Third-dose vaccination regimens, including heterologous and homologous vaccines, can be an effective tool in controlling the COVID-19 pandemic and the emergence of new variants.

Reliability and validity of the Diabetic foot self-care questionnaire in Turkish patients.

AIM: This study was conducted to examine the psychometric, properties of the Turkish version of the Diabetic, Foot Self-Care, Questionnaire. METHODS: This was a descriptive- methodological study conducted on 193 diabetes patients. Data were collected, using Descriptive, Information Form and Diabetic Foot Self-Care Questionnaire. Data were analyzed using exploratory factor analysis, item-total score correlation, Cronbach's alpha, and test-retest analysis. RESULTS: The Diabetic, Foot Self-Care, Questionnaire consists of 16 items and three sub-dimensions. The three sub-dimensions recorded a variance of 58.137%. The total Cronbach's alpha coefficient of the Turkish version of the Diabetic, Foot Self-Care, Questionnaire was 0.87, and Cronbach's alpha values of its sub-dimensions were 0.71 and 0.88. The two-month test-retest credibility interpreted with intra-class correlation was 0.97. CONCLUSIONS: It has been shown that the questionnaire is a valid and reliable tool for assessing foot self-care behavior in diabetic patients.

Effectiveness of Inactivated and mRNA COVID-19 Vaccines Against SARS-CoV-2 Infection, Severe Disease and Mortality in the Geriatric Population.

Older age (>60 years) has been identified as the main risk factor for COVID-19. In this study, we aimed to evaluate the efficacy of Pfizer-BioNTech and CoronaVac vaccines against COVID-19 infection, serious illness, and mortality in the geriatric population. We found that 2 doses of CoronaVac vaccine were ineffective in protecting against COVID-19 infection in people over 65 years of age, while the vaccine efficacy (VE) of the mRNA vaccine against COVID-19 was 80% (95% CI 70-87). The VE of full vaccination with BioNTech was 89% (95% CI 53-97) against hospitalization, 79% (95% CI 0-97) against death, and 79% (95% CI 0-97) against intensive care unit (ICU) admission. However, the VE of full vaccination with CoronaVac was 50% (95% CI 33-63) against hospitalization, 53% (95% CI 26-70) against ICU admission, and 56% (95% CI 30-73) against death. In conclusion, we found that the mRNA vaccine has higher efficacy against severe COVID-19 infection and mortality in the geriatric population than the inactivated vaccine. Booster doses of vaccines should be considered in increasing the effectiveness of inactivated vaccines. Given the potential of SARS-CoV-2 mutations evading vaccination protection and the risk of reduced immunity over time, regular monitoring of vaccine effectiveness in the real world is critical.

SARS CoV-2 reinfection rate is higher in the Omicron variant than in the Alpha and Delta variants.

BACKGROUND AND OBJECTIVES: Many mutations in variants for instance Delta and Alpha are associated with immune evasion and higher infectious potential. There are uncertainties regarding Omicron. In this regard, we aimed to compare the frequency of reinfection of SARS CoV-2 variants in our hospital between April 22, 2021 and January 26, 2022. METHOD: The reinfection rates and demographic characteristics of a total of 27,487 COVID-19 patients infected with different SARS CoV-2 variants were examined. RESULTS: Reinfection was found in 26 (0.46%) of 5554 Alpha, 209 (1.16%) of 17,941 Delta, and 520 (13.0%) of 3992 Omicron variants. A statistically significant difference was observed between the reinfection rates of the variants (p = 0.000). The mean reinfection days were calculated as 204.4 ± 51.1 in the Alpha variant, 291.2 ± 58.2 in the Delta variant, and 361.2 ± 131.6 in the Omicron variant (p = 0.000). It was observed that 16.5% of reinfection cases caught COVID-19 for the second time 3-6 months after the first COVID-19 infection, 36.7% after 6-12 months, and 46.8% after more than 12 months. There was a significant difference between the times in reinfection cases. Most reinfections occurred more than 12 months apart. Among those with a reinfection time > 12 months, 0% had Alpha, 3.4% had Delta, and 96.6% had Omicron variants. CONCLUSION: The highest reinfection rate was observed in the Omicron variant. Reinfection was approximately 30 times more frequent in the Omicron variant than in the Alpha variant and 10 times more frequent in the Delta variant.

Impact of empagliflozin on left atrial mechanical and conduction functions in patients with type 2 diabetes mellitus.

OBJECTIVE: Empagliflozin, an oral anti-diabetic drug that inhibits the sodium-dependent glucose co-transporter 2 (SGLT2), has pleiotropic effects on the myocardium. The aim of the study is to investigate the effect of empagliflozin on atrial electromechanical delay (AEMD) and the left atrial (LA) mechanical functions in patients with type 2 diabetes mellitus (DM). METHOD: In total 62 patients (40.3% female, mean age 50.5 ± 8.6 years old) with type 2 DM were enrolled to the study. Participants were used a SGLT2 inhibitor (empagliflozin 10-25 mg/daily) for 6 months. Patients were examined initially and after 6 months with echocardiography. LA volume was recorded, atrial conduction times were measured using tissue Doppler imaging (TDI). RESULTS: No significant change was observed in LA volumes (maximal, minimal, and presystolic), total emptying and passive emptying volume at the end of 6 months; however, there was a significant decrease in active emptying volume (8.3 ± 2.9 ml/m2 vs. 7.9 ± 2.9 ml/m2 , p = 0.04). The posteroanterior lateral, septal, and tricuspid conduction times significantly decreased after the empagliflozin treatment. The decrease in right inter-AEMD was statistically significant (13.25 ± 10.21 ms vs. 10.85 ± 9.14 ms, p = 0.011). The changes in inter-AEMD were found to be correlated with the changes in LA active emptying volume (r = 0.408). CONCLUSION: Empagliflozin may enhance the structure and electrical conductions of the atrium and may prevent DM patients from DM-2-related functional disorder and arrhythmia.

Risks of catching COVID-19 according to vaccination status of healthcare workers during the SARS-CoV-2 Delta variant dominant period and their clinical characteristics.

The exposure of healthcare workers (HCWs) to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has been a major concern since the beginning of the coronavirus disease 2019 (COVID-19) pandemic. The study aimed to investigate the relationship between vaccination status and the status of catching COVID-19 in HCWs working in a Training and Research Hospital in Turkey, and the clinical course of the disease in those who were caught. The vaccination status of 1279 HCWs working at Siirt Training and Research Hospital during the period when the SARS-CoV-2 Delta variant was dominant, their cases of catching COVID-19 during this period, and the clinical course of the disease in patients with COVID-19 were investigated retrospectively.  We found that the rate of COVID-19 transmission was lowest in fully vaccinated HCWs (p < 0.05). The rate of COVID-19 transmission in HCWs who received two doses of BioNTech vaccine (4.4%) and two doses of CoronaVac+ one dose of BioNTech vaccines (2.7%) was considerably lower than those without vaccination (26.2%) (p < 0.05). The transmission rate was lowest among those vaccinated with two doses of CoronaVac+ one dose of BioNTech. Hospitalization was not required in fully vaccinated HCWs. The lymphocyte count was found to be significantly higher in fully vaccinated patients than incompletely vaccinated and unvaccinated patients. Although C-reactive protein (CRP), d-dimer, and ferritin values were higher in unvaccinated and partially vaccinated patients than in fully vaccinated patients, the differences were not statistically significant. As a result, the transmission rate of COVID-19 was lowest in fully vaccinated HCWs and in those vaccinated with two doses of CoronaVac+ one dose of BioNTech. In fully vaccinated HCWs, hospitalization was not needed.

Association of viral load with age, gender, disease severity, and death in severe acute respiratory syndrome coronavirus 2 variants.

In this study, the relationship between viral load, demographic characteristics, and disease information in 1007 (48.5%) patients with Delta variant (B.1.617.2), and 1070 (51.5%) patients with Alpha variant (B1.1.7) were investigated. We found that there was a significant difference in viral load between patients who died from the Alpha variant and those who were discharged (p < 0.05). Nevertheless, no significant difference was observed in patients with the Delta variant. The viral load in patients who died from the Alpha variant was significantly higher than those who were discharged (p < 0.05). The viral load was found to be higher in females in patients with the Delta variant, whereas it was very close in males and females in patients with the Alpha variant (p > 0.05). No significant difference was detected between the cycle threshold values (Ct) and disease severity. In terms of the mean Ct values, statistical differences were observed in patients with Delta and Alpha variants. The Alpha variant was found to have a higher viral load than the Delta variant. Furthermore, the Delta variant was found to be higher in the 40-year-old and under-age group than the Alpha variant, whereas the Alpha variant was higher in the groups over 40 years old. Although the rate of moderate and severe patients in the Alpha variant was found to be higher, the rate of mild survivors was found to be higher in the Delta variant. In conclusion, the increase in vaccination before the appearance of the Delta variant in our region may have influenced the viral load and clinical status of the patients.

Evaluation of bacterial agents isolated from endotracheal aspirate cultures of Covid-19 general intensive care patients and their antibiotic resistance profiles compared to pre-pandemic conditions.

BACKGROUND: Early reports have shown that critically ill patients infected with SARS-CoV-2 have a high prevalence of nosocomial pneumonia, particularly ventilator-associated pneumonia (VAP). METHOD: In the present study, we determined the bacterial agents isolated from endotracheal aspirate (ETA) cultures of Covid-19 general intensive care patients and evaluated the antibiotic resistance profiles of common bacterial agents compared to the pre-pandemic period. RESULTS: While a total of 119 significant growths with polymicrobial growths were detected in the ETA cultures of 73 (7.5%) of 971 patients hospitalized in the intensive care unit before the pandemic, 87 significant growths were detected in the ETA cultures of 67 (11.1%) of 602 patients hospitalized in the Covid-19 intensive care unit (ICU) after the pandemic. While 61 (83.6%) of patients in the ICU died before the pandemic, 63 (94.0%) of patients in the Covid-19 ICU died after the pandemic. In terms of age, gender, and mortality, there was no significant difference between the two ICUs (p > 0.05). Before the pandemic, the mean length of stay in the ICU was 33.59 ± 32.89 days, and after the pandemic, it was 13.49 ± 8.03 days. This was a statistically significant difference (p < 0.05). Acinetobacter baumannii (28.5%), Klebsiella pneumoniae (22.6%), Pseudomonas aeruginosa (15.9%), Staphylococcus aureus (6.7%), Escherichia coli (7.5%), Candida spp. (5.0%) were the most prevalent causal microorganisms discovered in pre-pandemic ICU ETA samples, whereas A. baumannii (54.0%), K. pneumoniae (10.3%), P. aeruginosa (6.8%), E. faecium (8%), and Candida spp.(13.7%) were the most common causative microorganisms detected in Covid-19 ICU ETA samples. Except for tigecycline, antibiotic resistance rates in A. baumannii strains increased following the pandemic. Only tobramycin showed a significant difference in the increase of resistance among these antibiotics (p = 0.037). The rate of tigecycline resistance, on the other hand, was 17.6% before the pandemic and 2.2% afterward (p < 0.05). After the pandemic, increased resistance of K. pneumoniae strains to colistin, meropenem, ertapenem, amoxicillin-clavulanic acid, piperacillin-tazobactam, ciprofloxacin, tigecycline, and cefepime antibiotics was observed. However, these increases were not statistically significant. Except for imipenem, antibiotic resistance rates in P. aeruginosa strains increased following the pandemic. The increase in resistance of ceftazidime and levofloxacin was statistically significant (p < 0.05). CONCLUSION: As a result, the Covid-19 pandemic requires intensive care follow-ups at an earlier age and with a more mortal course. Although the length of stay in the intensive care unit has been shortened, it is observed that this situation is observed due to early mortality. In P. aeruginosa strains, a significant difference was detected in the resistance increase of the ceftazidime and levofloxacin (p < 0.05) and with the exception of tigecycline, antibiotic resistance rates in A. baumannii strains increased following the pandemic. Only tobramycin showed a significant difference in the increase of resistance among these antibiotics (p = 0.037). Secondary infections in patients create more difficult treatment processes due to both Covid-19 and increasing antibiotic resistance today.