Investigation of left ventricular changes according to valve type in patients with surgical replacement due to isolated aortic stenosis.

OBJECTIVE: The aim of this study was to investigate postoperative left ventricular changes [left ventricular mass (LVM), left ventricular mass index (LVMI), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), patient-prosthesis mismatch (PPM), pulmonary artery pressure (PAP), gradients, and ejection fraction (EF)] according to the valve type used in patients undergoing aortic valve replacement (AVR) due to isolated aortic stenosis. METHODS: A total of 199 patients with isolated AVR due to aortic stenosis between 2010 and 2020 was retrospectively investigated. Four groups were identified according to the valve type used (mechanical, bovine pericardium, porcine and sutureless). Pre-operative and first year postoperative transthoracic echocardiography findings for the patients were compared. RESULTS: Mean age was 64.4 ± 13.0 years, while the gender distribution was 41.7% women and 58.3% men. Of the valves used in patients, 39.2% were mechanical, 18.1% were porcine, 8.5% were bovine pericardial and 34.2% were sutureless valves. Analysis independent of the valve groups observed LVEDD, LVESD, maximum gradient, mean gradient, PAP, LVM and LVMI values reduced significantly postoperatively (p < 0.001). EF was observed to increase by 2.1% (p = 0.008). Comparisons of the four valve groups revealed that LVEDD, LVESD, maximum gradient, mean gradient, LVM and LVMI significantly decreased in all groups. EF significantly increased only in the sutureless valve group (p = 0.006). Analysis of PPM groups showed that LVESD, maximum gradient, mean gradient, PAP, LVM and LVMI were significantly reduced in all groups. In the normal PPM group, there was an improvement in EF, which was significantly different to the other groups (p = 0.001), while in the severe PPM group, EF appeared to be reduced ( p = 0.19).

Outcomes of latent tuberculosis infection treatment in Istanbul.

Aim: Increasing the extensity of latent tuberculosis infection (LTBI) treatment which is one of the important parameters of tuberculosis (TB) control and completing the treatment in success are important. The purpose of this study is to evaluate LTBI treatment indications and treatment outcomes of patients who received LTBI treatment in Istanbul between 2016 and 2018. Methods: The treatment outcomes of people who started LTBI treatment registered in TB dispensaries in Istanbul between 2016 and 2018 were analyzed retrospectively according to the variables of the age groups, gender, dispensary subgroups, and prevention treatment indications. Data collected from the health institutions were evaluated. Results: 26.920 patients received LTBI treatment in all Istanbul TB dispensaries between 2016 and 2018. The evaluation of LTBI treatment indications; contact 15.696, Tuberculin skin test (TST) positivity 2224, immunosuppression 8746, TST conversion 58, sequelae lesion 15, and other indications are identified as 181. The groups which diagnosed with TB disease, mortality, transfer, other, and still in treatment are excluded from the analysis of LTBI treatment outcomes. A total of 25.253 patients were analyzed. 65 percent of the patients had completed LTBI treatment. Variables effective for treatment outcomes are analyzed with logistic regression. Treatment discontinuation was statistically significantly lower in 2017 (odds ratio [OR]: 0.906 confidence interval [CI] [95%] [0.849-0.968]) and 2018 (OR: 0.635 CI [95%] [0.594-0.679]) compared to 2016. Treatment lost to follow-up was statistically significantly lower in those receiving LTBI treatment with the indication of tuberculin skin test positivity (OR: 0.541 CI [95%] [0.487-0.600]) and the indication of immunosuppression (OR: 0.284 CI [95%] [0.142-0.569]) compared to those who received LTBI treatment due to contact. When the treatment results are evaluated according to the TB incidence of the region where the dispensaries are located, treatment lost to follow-up was higher in 101-200 per 100,000 incidence group (OR: 1.201 CI [95%] [1.123-1.285]) and incidence of 201-370 per 100,000 (OR: 1.461 CI [95%] [1.358-1.572]). Treatment lost to follow-up was higher in dispensaries on the European side (OR: 1.293 CI [95%] [1.203-1389]) and the 0-35 age group (OR: 1.248 CI [95%] [1.168-1.333]). Conclusion: In conclusion, the treatment completion rate should be improved for an effective LTBI treatment which is one of the important parameters of targeted TB elimination. Particularly people under the age of 35 years and regions with high-TB incidence should receive special care and close follow-up.

Investigation of respiratory tract coinfections in Coronavirus disease 2019 infected and suspected cases.

OBJECTIVE: The aim of our study is to determine the risk of coinfection with COVID-19 due to the high prevalence of viral agents in Istanbul in autumn (September, October, and November) and winter (December and January) and to investigate the effects of age, gender, season and clinical features on the development of coinfection with COVID-19. METHODS: In the routine studies of our hospital, COVID-19, reverse transcriptase polymerase chain reaction (RTA kit, Turkiye) and Multiplex PCR Bio-Fire (Bio Merieux Company, France) methods were studied from the nasopharyngeal swab sample and the data were recorded. A total of 400 people with a mean age (7.91±17.80) were included in the study by retrospective scanning. RESULTS: Considering the virus distribution, Respiratory syncytial virus (RSV), COVID-19, rhino/entero virus did not show a significant difference in autumn and winter, while H. metapneumovirus, adeno virus, influenza A significantly higher rates were observed in winter months. Parainfluenza (1, 2, 3, 4) and Corona OC43 were detected at a higher rate in autumn compared to other viruses. Double and triple coinfection rates with other viral agents were high for 2 years and younger. CONCLUSION: The risk of coinfection of COVID-19 with influenza A, RSV, parainfluenza, and rhino/entero virus was found to be higher than other viral agents. Especially in winter, the risk of coinfection with influenza A and COVID-19 increases. In terms of treatment management, coinfection should be investigated in risky patients and influenza a vaccine should be offered to risky groups.

HPV prevention in women aged 30-65 in Istanbul: Effect of early diagnosis of cervical cancer.

OBJECTIVE: Earlier detection and timely interventions against cancers are well known to reduce the morbidity and mortality. Screening programs provide opportunity to detect cancers as early as precancerous stages. Cancers of cervix of uterus are one of the cancers that have widely applicable screening methods and are one of the three cancer types that have population-based screening program in Turkiye. In this article, it is aimed to evaluate cervical cancer screenings in Istanbul. METHODS: The study methodology for cervical cancer screening conducted between 2015 and 2020 in Istanbul, Turkiye's largest city, was introduced. The results obtained in the first round of screening of 723,068 women with the human papillomavirus (HPV) method as a new methodology are discussed. RESULTS: As a summary of results, the HPV positivity ratio was found to be 6.5% and the positivity rate was higher in younger women. The results also show that majority of the subjects with positive result were infected with more than 1 strains of HPV. Most prevalent subtypes detected were HPV16, HPV51, HPV31, HPV52, and HPV66, respectively. Total detection rate for any of the high-risk HPV subtypes was 29.95%. CONCLUSION: Although HPV-16 is the highest subtype to be infected and total percentage of infection with any high-risk strains is approximating to one-third of the total positivity, cytological results revealed only 8.1% meaningful results.

Pharmacokinetic characterization of favipiravir in patients with COVID-19.

This prospective observational study describes the pharmacokinetic characteristics of favipiravir in adult patients hospitalized for mild to moderate COVID-19 with a positive RT-PCR test. Favipiravir was administered for 5 days, with a loading dose of 3200 mg and a maintenance dose of 1200 mg/day. Serial blood samples were collected on Day 2 and Day 4 of the therapy. Laboratory findings of the patients (n = 21) and in-hospital mortality were recorded. Favipiravir concentrations exhibited substantial variability and a significant decrease during the treatment of COVID-19. The median favipiravir trough concentration (C0-trough ) on Day 2 was 21.26 (interquartile range [IQR], 8.37-30.78) µg/mL, whereas it decreased significantly to 1.61 (IQR, 0.00-6.41) µg/mL on Day 4, the area under the concentration-time curve decreased by 68.5%. Day 2 C0-trough of female patients was higher than male patients. Our findings indicate that favipiravir concentrations show significant variability during the treatment of COVID-19 and therapeutic drug monitoring may be necessary to maintain targeted concentrations.

Evaluation of patients with COVID-19 and the United Kingdom mutations in a training and research hospital in Istanbul.

OBJECTIVE: This study aims to evaluate the patient clinics by studying Variant of Concern (VOC) Polymerase Chain Reaction (PCR) on conventional PCR-positive samples in a training and research hospital COVID test center in Istanbul. METHODS: The study is a descriptive type and VOC PCR from all samples (from a total of 1300 samples) which detected positive by conventional PCR in a training and research hospital COVID test center between February 2 and 9, 2021. The United Kingdom mutation (VOC 202012/01, B.1.1.7) has been studied. Clinics parameters of the patients were evaluated from Public Health Management System (HSYS) records. The statistical significance was taken as p<0.05 in the analysis. RESULTS: Within the scope of the research, 1300 PCR-positive COVID-19 patients were evaluated. VOC mutation was positive in 26.1% of all patients (339 persons), and 5.8% of patients (75 persons) were hospitalized. While 3.2% (11 persons) of those with VOC positivity were hospitalized, 6.7% (64 persons) of VOC negatives were hospitalized (p=0.020). About 18.2% of hospitalized VOC positives (two persons) and 23.4% of VOC negatives (15 persons) are in intensive care. CONCLUSION: When VOC mutation was examined in all admitted and hospitalized patients, it was detected that VOC mutation was less frequent in hospitalized patients. No relationship between hospitalization and intensive care stay and VOC mutation was detected. It is recommended to determine with studies the contagiousness of patients with VOC mutations.

[Evaluation of Non-Pharmaceutical Interventions for Reducing Contact Rate in COVID-19 Pandemic: R0 Estimation and Modeling for Istanbul]. / COVID-19 Salgininin Kontrolünde Ilaç Disi Tedbirlerden Temas Sayisini Azaltmaya Yönelik Kisitlamalarin Etkinliginin Degerlendirilmesi: R0 Hesaplamasi ve Modelleme Çalismasi ile Istanbul Örnegi.

After the declaration of the coronavirus-2019 (COVID-19) pandemic and the detection of the COVID-19 case in Turkey, a series of non-pharmaceutical measures were implemented to reduce the number of contacts at the national level. The aim of this study was to determine the change in the epidemic reproduction rate (R0) with non-pharmaceutical interventions including curfews starting with the first reported case in Istanbul and to evaluate the effectiveness of interventions by estimating the number of cases and deaths using a dynamic compartmental model. While keeping transmission probability (beta) as 3% and incubation period as seven days, we developed five scenarios that represented nonpharmaceutical interventions The first scenario was "if nothing was done" and the last scenario was "curfew". The contact matrix of 16 age-groups created by Prem et al. was used in the study as the contact matrix of "if nothing was done" as scenario 1. For all other scenarios (2-5) contact matrices assumptions were created and R0 values were calculated for the whole of Istanbul according to age groups for all five scenarios. For each scenario, "the number of cases and COVID-related deaths" for one year from the day the first case was detected were calculated with the mathematical modeling method. In the absence of any intervention, R0 value was estimated as 2.86 in Istanbul. Among age-groups, the largest R0 value was observed in ages 15-19, 10-14, 5-9, 20-24 and the values were 5.22, 4.37, 3.32, and 3.33; respectively. Due to school closings and flexible work hours, R0 values decreased to 2.02, 1.84, 1.63 and 1.85 in the same age-groups. With the addition of a curfew for the population under the age of 20 to the above measures, the R0 values for all age groups were reduced to less than one. When R0 values for Istanbul was 2.86 and 1.55 based on our model results, the number of cases and deaths per year were determined as approximately 14 million and 2 million and 2.5 million and 327.000, respectively. School closures were determined as the most effective non-pharmaceutical intervention. Non-pharmaceutical measures with the addition of curfews under the age of 20 and over the age of 65 to the school closings and flexible working hours were identified as effective methods in controlling the COVID-19 epidemic in Istanbul. While the results of this study may not reflect real life data, it has the potential of helping public health policy makers to decide on which non-pharmaceutical interventions are the most effective.

ICU admission rates in Istanbul following the addition of favipiravir to the national COVID-19 treatment protocol.

OBJECTIVE: The objective of this study was to understand the observational relationship between adoption of favipiravir into the national COVID-19 treatment protocol and intensive care unit (ICU) admission rates in Istanbul due to COVID-19. METHODS: Data were harvested from the "Public Health Management System-HSYS," which collate centrally the records of all known cases of COVID-19. The total number of cases, numbers admitted to ICU, and number undergoing intubation were compared between 2 time periods: 11th of March, the date on which the first case in Turkey was confirmed, to 30th of March; and March 30, to 10th of April, 5 days after Favipiravir was introduced into the treatment algorithm when, the records were examined. RESULTS: The percentage of patients requiring ICU admission diminished from 24% to 12%, whilst the percentage intubated fell from 77% to 66%. These differences were both statistically significant. CONCLUSION: The addition of favipiravir to the national COVID-19 treatment protocol may explain this rapid decrease in the rate of ICU admissions and intubation.

First known COVID-19 case and contact tracing efforts in Istanbul, Turkey

Background/aim: COVID-19 has now become a global pandemic. Understanding the routes of transmission is vital in the mitigation and suppression of the disease. Istanbul has become one of the disease's epicenters. This study aims to describe the first COVID-19 case and contact tracing efforts around it in Istanbul. Materials and methods: The descriptive study was conducted in Istanbul, Turkey. The first COVID-19 cases and those associated with them were investigated with contact tracing, and primary and secondary cases were described. Results: The source case was an individual who returned to Turkey from international travel at the beginning of March and tested PCR (­). The index case is the brother of the source case and is considered the first PCR (+) case diagnosed in Istanbul. Contact tracing revealed 23 PCR (+) cases, 14 of which resulted in hospitalization and three deaths. Conclusions: This study described cases of the first COVID-19 cluster in Istanbul. Moreover, contact tracing was used in this first cluster. This contributed to contact tracing algorithms in Turkey.

Evaluation of patients with COVID-19 diagnosis for chronic diseases.

AIM: COVID-19 is one of the most consequential pandemic in world history. Chronic diseases, which are risk factors that increase the case fatality rates, have been the leading cause of death all over the world. This study was aimed at detecting coexisting chronic diseases in patients hospitalized with a diagnosis of COVID-19. MATERIAL AND METHOD: The study was carried out with data from 229 patients in an intensive care unit, from June 1st through June 30th. 2020. The inclusion criteria of the study was as follows: (1) having a COVID-19 diagnosis confirmed by PCR test; (2) being hospitalized in the relevant intensive care unit within the dates of the study; and (3) having their data accessible through the hospital automation system. Through literature; chronic diseases of the patients and their effects on the COVID-19 process were evaluated. Statistical analyzes were performed using the Statistical Package for Social Sciences (SPSS) version 24.0 (IBM Corp.; Armonk, NY, USA). RESULTS: The average age of the patients studied were 61.4 years. While the average symptom duration was 8.2 days; total hospitalization period was 13.1 days. The average length of stay of patients (n = 75) who were sent to intensive care unit was 10.1. The most common chronic disease among patients was hypertension with 47.2%. This was followed by diabetes mellitus (32.8%) and heart disease (27.5%), respectively. In the population studied, cough (59.4%), fever (58.5%) and shortness of breath (45.9%) were found to be the most common symptoms. Leukopenia, impairments in liver and muscle enzymes, abnormal C-reactive protein, ferritin and d-dimer levels were the important biochemical tests. CONCLUSION: Particular attention should be paid to the elderly COVID-19 patients with chronic diseases, especially DM, HT and cancer.

The urine foaming test in COVID-19 as a useful tool in diagnosis, prognosis and follow-up: Preliminary results.

OBJECTIVE: We aimed to develop a simple, rapid urine test based on the level of foaming that occurs in the urine sample due to the excretion of peptide structures containing amino acids specific to the antigenic structure of COVID-19. In this study, we present the preliminary results of the first clinical study with a newly developed urine foaming test (UFT). METHODS: This study was conducted in a tertiary hospital in Istanbul. After obtaining the approval of the ethics committee, urine samples were taken from three groups of patients whose informed consent was obtained. The groups were created according to the COVID-19 Diagnostic Guide of Ministry of Health: A: outpatients with suspected COVID-19, B: inpatients for follow-up and treatment, C: patients treated in intensive care unit (ICU). Also, 30 healthy volunteers were included as the control group D. Urine samples taken from all groups were delivered to the laboratory. 2.5 ml urine sample was added to the test tube and shaken for 15 seconds and the level of foam formed was visually evaluated according to the color scale. Other data of the patients were obtained from the hospital information management system and the physician caring for the patient. The clinical status, PCR test results, computed tomography (CT), if any, laboratory tests, and UFT results were compared and the level of statistical significance was expressed as p≤0.05 in the 95% confidence intervals (CI). Performance characteristics, such as sensitivity, specificity, positive and negative predictive value of the UFT, were statistically calculated according to the RT-PCR result and/or CT. RESULTS: A statistically significant difference was observed between UFT distributions of the control, outpatient, inpatient and ICU patients (p=0.0001). The results of UFT orange and red in inpatients and ICU patients were statistically significantly higher than in the control and outpatient groups. The diagnostic accuracy of UFT was detected in all group, the pooled sensitivity was 92% (95% CI: 87-95%) and specificity was 89% (95% CI: 80-98%). CONCLUSION: Our preliminary results suggest that the UFT is useful, particularly in predicting the clinical severity of COVID-19. The UFT could be recommended as a point of care test, rapid and non-invasive method in the diagnosis and follow-up of COVID-19.

A comparative analysis of the COVID-19 pandemic response: The case of Turkey.

OBJECTIVE: COVID-19 has spread worldwide and leads to an increased risk of mortality. We aimed to analyze what actions have been effective in fighting COVID-19 in Turkey with a comparison to pandemic-affected countries. METHODS: This was a retrospective observational cross-sectional study. The Republic of Turkey Ministry of Health official web page includes data reported daily from 11 March to 26 April. Global COVID-19 data were recorded daily from https://www.worldometers.info/coronavirus/country/. Data were analyzed for 31 days according to Intensive Care Unit (ICU) admission, intubation and mortality rates. Segmented regression analysis was used. The results from COVID-19-affected countries were compared with the results from Turkey for the first 65 days. RESULTS: In total, 889.742 tests were performed (positive=110.130 [12.37%]). The mortality rate was 2.55% (n=2805) on 27 April 2020. The annual percent change (APC) values of the cases showed 5 segments ([23.1], [14.7] [11.4], [3.7], [0.7]; each p=0.001). ICU admission showed 4 segments (APC: [3.1, p=0.001], [-2.2, p=0.10], [-7.6, p=0.001], [-4.5, p=0.001]). The decline of APC for intubation rates showed 5 segments (APC: [1.1, p=0.10], [-1.1,p=0.001], [-2.0, p=0.001], [-0.4, p=0.40], [-2.7, p=0.001]). The mortality rates showed 4 segments (APC: [-6.3, p=0.001], [8.4, p=0.001], [0.2, p=0.30], [1.4, p=0.001]). Deaths were reported per 1 million individuals for the first 65 days: Spain 11.6%, Italy 11.4%, UK 11.3%, France 11.1%, USA 10.3%, Germany 8.4%, Iran 8.2%, Turkey 7.5%, South Korea 4.1% and China 2.4%. CONCLUSION: Public health policies and protocols to combat COVID-19 helped control the spread and decrease positive cases and mortality rates in Turkey. Turkey managed COVID-19 better than Spain, Italy, UK, France, USA and Turkey managed COVID-19 similarly to Germany and Iran. China and South Korea were best at managing COVID-19.