Approaches of the healthcare staff in a tertiary healthcare service providing hospital for seasonal influenza vaccination

Introduction: Seasonal influenza had many epidemics and pandemics throughout history and caused millions of people getting sick with severer progress and even death in the risk group. Having the influenza vaccination is essential for healthcare staff to protect their health as well as other individuals of the society. The present study aimed to determine the approaches of all healthcare personnel and candidates in Rize Training and Research Hospital providing tertiary healthcare services and to analyze their causes for not having the vaccination.Methods: The present cross-sectional research was carried out in Rize (Turkey). A questionnaire applied to 898 volunteers among 2200 hospital staff. Results: It was detected that the median age of the participants is 25 years; 61.0% of the participants are female; 59.8% of them are single; 69.8% do not have any children and 38.0% have a graduate degree. The rate of having vaccination once within lifetime was detected as 41.6% and the highest rate was observed in the physician group whereas the lowest rate was observed in the nursing student group. The causes for avoiding to have the vaccination included the considerations about the ineffectiveness of the vaccination, having influenza and the delay of arrival of the vaccination to the hospital. However, the rate of having vaccination was determined as 2.6% within all healthcare staff for this year. The majority of the participants who had the vaccination consisted of the nurses who consider themselves within the risk group. Conclusions: A significant decrease was detected in the vaccination rates of the healthcare staff when compared with previous years. The awareness should be increased to increase the vaccination rates. For this purpose, training should be organized, and the sustainability of such training should be provided

The effects of Coronavirus disease-2019 (COVID-19) pandemic on routine antenatal care visits and complications of pregnancy

OBJECTIVE: Routine follow-up of pregnancy is a comprehensive care process starting from planning of pregnancy that involves rational and careful use of medical, psychological, and social support. In this study, our objective was to compare the adherence rate to routine antenatal follow-up program during the COVID-19 pandemic with that of previous years among pregnant women, in an effort to shed light on health policies to be developed similar events in the future. METHODS: This retrospective cross-sectional study was carried out between March 11, 2019, when isolation measures were initiated in the context of precautionary steps taken in Turkey against the COVID-19 pandemic, and June 1, 2020, when the "normalization" was initiated. RESULTS: During the study period in 2020, the proportion of cesarean sections were higher, 61.1%, as compared to previous years (p=0.27). The stillbirths were numerically lower (1.2%, p=0.77), but the rate of spontaneous abortions was significantly higher (19.6%, p=0.009). The number of follow-up visits per pregnancy was lower than in previous years (3.8, p=0.02), although the proportion of patients visiting the outpatient units for regular controls to the overall patient group increased as compared to previous years (52.0%). CONCLUSION: During the flare-up of the COVID-19 pandemic (i.e. between March and June 2020), the rate of obstetric/neonatal morbidity and mortality except spontaneous abortion was not significantly higher as compared to the corresponding period in previous years. However, considering the potential increase in the risk of obstetric complications during a pandemic, specialized management programs targeting basic pregnancy follow-up services should be developed

Correlation of suicidal thoughts and toxoplasmosis in patients with depression

Objective We investigated the correlation between serum anti-Toxplasma gondii IgG and suicidal thoughts in depressive patients. Methods Depressive patients with (n = 100) and without (n = 100) suicidal thoughts along with 100 healthy control subjects were recruited for this study. In all three groups, a semi-structured clinical interview form called Structured Clinical Interview for DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) Axis-I Disorder (SCID-I), Hamilton Depression Rating Scale (HAMD), suicidal behavior scale, and a sociodemographic data form were completed. Sera from all participants were taken, and anti-toxoplasma IgG was measured by Enzyme Linked Immunosorbent Assay (ELISA)-Chemiluminescent Microparticle Immunoassay. Statistical analysis of the data was performed. Results The serum anti-toxoplasma IgG levels of patients with suicidal thoughts were significantly higher than those without suicidal thoughts and the controls, which were 80.04 +/- 40.66, 78 +/- 14.82, and 19.98 +/- 14.65, respectively, p < 0.001. There was no correlation between toxoplasma IgG and HAMD score in patients lacking suicidal thoughts (r = -0.112, p = 0.463). Conclusion This study shows a correlation between seropositivity for anti-Toxoplasma gondii IgG and depression with suicidal thoughts

Hepatit B enfeksiyonu olan hastalarda yaşanılan zorlukların değerlendirilmesi

Objectives: Although stigma is well defined in people with a chronic disease or condition, it has not been studied much in individuals infected with hepatitis B virus (HBV). The study is one of the first descriptive individual studies conducted on this subject in our country. Our aim in this study was to evaluate the stigma experiences and concerns of individuals living with HBV, their sharing of their illness with the environment, and the state of being affected by their social relationships. Materials and Methods: Patients with hepatitis B surface antigen positivity who were admitted to the infectious diseases outpatient clinic were surveyed through face-to-face interviews. Epidemiological data, stigma experiences and anxiety states, people with whom they shared their illness, the reasons for not sharing, the impairment of social relations were questioned. Results: It was found that 19.5% of 390 individuals infected with HBV who participated in our study were "exposed" to stigma in various ways, and 27.4% were "worried" about experiencing this condition. In research, 19.9% of women, 41.4% of university graduates, and 34.8% of divorced or widowers were found to experience higher stigma (p=0.002, p=0.02 and p<0.001, respectively). It was determined that 56.7% of the participants did not share their illnesses, and this need increased with stigma experiences and anxiety. It was found that individuals mostly shared their disease status with their first-degree relatives (p<0.001). Conclusion: The fact that individuals infected with HBV experience different forms of stigma or experience anxiety suggests that there is a need to investigate these conditions and develop treatment interventions

Is liver biopsy necessary in patients with chronic hepatitis B with normal alanine aminotransferase level?

Objectives: If not treated early, morbidity and mortality will remain high in hepatitis B virus infection. In this study, it was aimed to analyze the liver biopsy results of patients with chronic hepatitis B with normal alanine aminotransferase (ALT) levels. Materials and Methods: The study was conducted retrospectively. The patients who were admitted in the infectious diseases and clinical microbiology outpatient clinic, had liver biopsy and received treatment between 01.09.2019 and 01.12.2019, were included. Results: A total of 169 patients were included in the study. Of the individuals, 95 (56.2%) were female, with a mean age of 42.4 +/- 11.15 years. The rates of having an histological activity index (HAI) score of 6/18 and above and a fibrosis stage of 2/6 or more (90%, 100%, respectively) in patients with ALT level above upper limit of normal (ULN) were higher than in patients with ALT level below ULN (63.6% and 79.1%, respectively) (p=0.001 and p=0.002, respectively). When 129 patients with ALT level below ULN were evaluated in subgroup analyses. HAI score was 6 or higher in 59 (58.4%) of the hepatitis B e antigen (HBeAg) negative patients, and fibrosis stage was 2 or higher in 76 (75.2%) patients. In patients with ALT below ULN and HBeAg positivity, the rates of HAI score of 6 and above and fibrosis stage of 2 and above were found to be statistically significantly higher than in HBeAg negative patients. Conclusion: Liver fibrosis and necroinflammation may develop in patients with normal ALT levels. In making the biopsy decision, ALT level should be considered together with other factors that may affect liver damage

Evaluating vaccine rejection during COVID-19 pandemic

Amaç: Aşılar, tıbbın insanlığa sağladığı en büyük başarılar arasında olup bugüne kadar milyonlarca kişinin yaşamını kurtarmıştır. Ülkemizde 2017 yılında 23 binden fazla aile aşı reddi talebinde bulunmuştur. Geçmişte salgın hastalıkların yıkıcı etkilerinin pek çok sosyal, coğrafi, ekonomik, kültürel etkilere yol açtığı gözlenmiştir. Bu çalışmada amacımız; COVID-19 pandemisi sırasında Türkiye’de normalleşme sürecinin başlaması sonrasında, geçmişte çocuklarına aşı yaptırmayan ebeveynler ile görüşerek aşı reddi oranlarında bir değişiklik olup olmadığını değerlendirmektir. Gereç ve Yöntemler: Kesitsel tipteki bu araştırmada aşı reddinde bulunan aileler telefon ile aranarak onayları alındıktan sonra anket çalışması gerçekleştirilmiştir. Görüşmeler, ülkemizde “normalleşme sürecinin” başlangıcı olan Haziran 2020 sonrasında gerçekleştirilmiş, ailelerin aşı reddine ilişkin görüşlerinin COVID-19 pandemisinden etkilenip etkilenmediği araştırılmıştır. Bulgular: Aşı reddinde bulunan 82 aile çalışmaya katılmayı kabul etmiş ve anket gerçekleştirilmiştir. Hepatit A aşısı ret oranının (%6,5) diğer aşılara göre yüksek, Hepatit B aşısı ret oranının (%2,1) ise diğer aşılara göre düşük olduğu belirlenmiştir. Aşı reddi için en sık sebep “içeriğine güvenmeme” (%43) olarak gözlenmiştir. Ailelerin tamamı COVID19 pandemisi kontrol önlemleri kapsamında normalleşme sürecine geçilmesi sonrasında da çocuklarına aşı yaptırmayı düşünmediklerini belirtmiştir. Çocuklarına aşı yaptırmayan ebeveynlere “COVID-19 aşısı olsa kendinize yaptırır mısınız” sorusu sorulduğunda %35,7’si olumlu yanıt vermişlerdir. Sonuç: Çalışmamızda COVID-19 pandemisi için ülkemizde normalleşme sürecine geçilmesi sonrasında ailelerin çocuklarına aşı yaptırma konusunda fikirlerinin değişmediği gözlenmiştir. Aşıların bireysel ve toplumsal faydaları düşünüldüğünde aşı ret oranlarını azaltmaya yönelik çalışmaların önemi ortaya çıkmaktadır.Aim: Vaccines are one of the most tremendous medical success in human history and have saved millions of people until this day. There are more than 23 thousand families who had rejected vaccines in our country in 2017. Outbreaks caused numerous social, geographic, economic, and cultural devastations in the past. This study aims to reveal the change in the ratio of people who refused vaccines after the COVID-19 pandemic. Material and Methods: This cross-sectional study was conducted via phone interviews with families who rejected vaccines by calling the people who refused to use vaccines after they agreed to join the study. The talks have been made after June 2020, which is also the starting of “normalization process” in our country. It is researched whether the patients' relatives' decisions have been changed during COVID-19.. Results: 82 families who refuse to vaccine their children accepted to join the study. Refusing rate for Hepatitis A (6.5%) vaccine was higher among other vaccines, and refusing rate for Hepatitis B (2.1%) vaccine was lower among all vaccines. Of the reasons for refusing vaccines, “Not trusting the substance” (43%) was higher than other causes. When it is asked parents, who refused to vaccines for their children “Do you use for yourself if a vaccine for a COVID-19 invented?” 37.7% of the participant gave an affirmative answer. Conclusion: At the end of our study, we concluded that the parents' thoughts about vaccines for their children have not changed after the pandemic of COVID-19. Taking direct, indirect, and protective effects of vaccines into consideration on individuals, the importance of studies about decreasing the refusal of vaccines becomes significant

Strain relatedness in gram-negative bacteremia: Cause or contamination?

Aim: Bloodstream infections are a major cause of mortality, 25% of which are associated with gram-negative bacteremia. To avoid the inappropriate use of antibiotics, it is important to differentiate the bacteremia from contamination. In general, gram-positive bacteria were more likely to be contaminants than gram-negative-bacteria. There is little information in the literature concerning the epidemiology of gram-negative bacteria isolated from sequential blood cultures. Therefore, we aimed to examine the molecular epidemiology of gram-negative bacteria isolated from sequential blood cultures. Material and Methods: A total of 56 patients (112 samples and strains) with two or more sequential positive blood cultures for gram-negative bacteria with the same antibiogram were included in the study. Pulsed-field gel electrophoresis (PFGE) and arbitrarily primed PCR (AP-PCR) were performed for the determination of strain relatedness. Results: While PFGE analysis demonstrated relatedness in 6 isolates, AP-PCR demonstrated 9 relatedness in 112 isolates. Discussion: The results of our study suggest that, although the possibility of contamination is very low in gram-negative bacteremia, this can still take place, as shown in sequential blood cultures with the same antibiogra

COVID-19 infection in pregnancy: A single-center experience in Rize in the Eastern Black Sea Region

Aim: In this study, it was aimed to share the clinical experiences of mothers and their babies (perinatal, natal) who encountered severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during pregnancy. Material and Methods: The study was carried out retrospectively, 62 pregnant individuals were diagnosed with the 2019 coronavirus disease (COVID-19). Demographic characteristics, clinical course, laboratory and radiological findings and clinical results of the baby were evaluated by examining electronic and file records. Results: The average age of the 62 pregnant women included in the study was 29.8 +/- 4.7 (19-42) years, and the average gestational week at the time of admission was 28.5 +/- 10.4 (5-40) weeks. More than half of the patients (80,6%) on admission were in their third trimester. The most common initial symptoms were cough (45.2%), myalgia (43.5%),) fever (21%). In total, 15 of the pregnant women had evidence of COVID-19 pneumonia in lung involvement. The PCR test results of all pregnant women were positive. There were three cases admitted to the intensive care unit, one of whom was due to gestational diabetes. No maternal mortality was recorded. One gestation ended in a miscarriage and two women gave birth prematurely. One stillbirth occurred at the 33h week of gestation. Among 22 neonates, two were admitted to the neonatal intensive care unit. Neonatal mortality, congenital malformation, and mother- to- child transmission were not observed in newborns. Discussion: The results of our study suggest that the clinical course of COVID-19 infection in pregnant women was mostly asymptomatic/mild

Polyclonal outbreak of bacteremia caused by Burkholderia cepacia in the intensive care unit

Aim: Burkholderia cepacia is a multidrug-resistant, opportunistic pathogen of humans and outbreaks of infection in hospitals have been described. In this study, we aimed to report an outbreak in patients without cystic fibrosis or chronic granulomatous disease involving different species of Burkholderia cepacia. Material and Methods: A small outbreak of nosocomial Burkholderia cepacia complex occurred in a 6-bed intensive care unit. We isolated Burkholderia cepacia from blood cultures of the patients admitted to our intensive care unit. All isolates from patients and the environment were identified by standard microbiological techniques and VITEK system. Antibiotic susceptibility testing was performed using Kirby Bauer's disk diffusion method and the VITEK system Results: All isolates exhibited identical patterns of antibiotic susceptibility and all isolates were sensitive to trimethoprim-sulfamethoxazole, ceftazidime and meropenem. The isolates were typed using pulsed-field gel electrophoresis using the restriction enzymes XbaI and SpeI. Accordingly, while 4 strains were similar, one was different. Discussion: The experience from this outbreak reminded us of the importance of outbreak investigation in such small outbreaks and keeping the health care workers educated and constant attention on this issue. The results of this study emphasized once again the necessity to maintain our sensitivity to the basic principles of sanitation and to raise our awareness of such outbreaks

Distribution and antimicrobial susceptibilities of stenotrophomonas maltophilia strains ısolated from various clinical samples: an 8-year study

Amaç: Hastane enfeksiyonları ve buna bağlı mortalitenin artması çoklu ilaç direncine sahip fırsatçı patojenleri her zamankinden daha fazla gündeme getirmiştir. Bunlar arasında yer alan stenotrophomonas maltophilia önemi giderek artan fırsatçı bir patojendir. Bu çalışmanın amacı,sekiz yıllık süre boyunca hastanemizde çeşitli klinik örneklerden izole edilmiş S. maltophilia izolatlarının dağılımını ve antimikrobiyal duyarlılıklarını araştırmaktır. Yöntemler: Ocak 2011-Aralık 2019 tarihleri arasında çeşitli klinik örneklerden izole edilen toplam 149 S. maltophilia suşunun antimikrobiyallere direnç oranları araştırıldı. Bakteri identifikasyonu ve antibiyotik duyarlılığı rutin konvansiyonel mikrobiyolojik yöntemler ve VİTEK 2 kompakt otomatize sistem (BioMerieux, France) ile yapılmıştır. Bulgular: S. maltophilia en sık yoğun bakım ünitelerinde izole edilirken 50 (%33,5), en az 1 örnekle ( %0,6) Kardiyovasküler cerrahi servisi, Pediatri servisinden izolasyon gerçekleşmiştir. Örneklerin 85’i (%57,) solunum yolu izolatları olurken (trakeal aspirat, lavaj, balgam), en az 1 örnek ( %0,6) ile plevra ve eklem sıvısı olmuştur. Karbapenemlere doğal direnç gösteren S. maltophilia’da levofloksasin direnci % 6 iken, trimetoprim/sulfametoksazol’de %12, seftazidim’de %45 olarak tespit edilmiştir. Tartışma ve Sonuç: Çalışmada saptanan yüksek direnç oranları nedeniyle, S. maltophilia suşlarının etken olduğu nozokomiyal enfeksiyonların tedavisinde mümkün olduğunca in vitro duyarlılık testlerinin yapılması gerekir. Bunun yapılamadığı durumlarda ise tedavi planlamasında trimetoprim-sulfametoksazol ve levofloksasin iyi birer tedavi seçeneğidir. Ayrıca tedaviye başlamadan önce kolonizasyon - etken ayrımı klinik bulgularda göz önünde tutularak birlikte karar verilmelidirObjective: Hospital infections which associated with increased mortality have brought opportunistic pathogens like Stenotrophomonas maltophilia, with multiple drug resistance into focus. The aim of this study was to investigate the distribution and antimicrobial susceptibility of S. maltophilia isolates obtained from various clinical samples in our hospital for a period of eight years. Method: Antimicrobial resistance rates of 149 strains of S. maltophilia isolated from various clinical samples between January 2011 and December2019 were investigated. Bacterial identification and antibiotic susceptibility were performed with routine conventional microbiological methods and the VITEK 2 compact automated system (BioMerieux, France). Results: While S. maltophilia was most frequently isolated in intensive care units, from a total of 50 samples (33.5%), the rate was 0.6% (1 sample) the cardio vascular surgery service and pediatrics services. 85 (57%) of the samples were respiratory tract isolates (tracheal aspirate, lavage, sputum) with at least 1 (0.6%) pleural and joint fluid. Among these isolates of S maltophilia, which shows natural resistance to carbapenems, resistance for levofloxacin was 6% and for trimethoprim/ sulfamethoxazole was 12%. Conclusion: Due to the high resistance rates observed in the study, in vitro susceptibility tests should be used as much as possible in the treatment of nosocomial infections caused by S. maltophilia strains. In cases where this is not possible and empirical treatment is required, trimethoprim-sulfamethoxazole and levofloxacin are reasonable treatment options. Also, before starting treatment, the separation between colonization and agent should be decided in accordance with the clinical findings