Myelosuppression in Patients with Prolonged use of Piperacillin/Tazobactam

Objectives: The use of piperacillin-tazobactam in hospital acquired infections requiring long treatment periods maycause adverse effects including myelosuppression. Myelosuppression results in rare, but potentially serious clinic manifestations such as neutropenia, thrombocytopenia, leukemia and anemia. The objective of this study was to investigatethe incidence and characteristics of myelosuppression in patients with prolonged use of piperacillin-tazobactam.Methods: Inpatients followed-up and treated in Kahramanmaras Sutcu Imam University Medical Faculty Hospital andMMT Gaziantep American Hospital between April 1, 2017 and December 31, 2018 were included in the study. Patients’demographic data, biochemical laboratory outcome, duration and dose of antibiotic treatment, comorbidities, sideeffects of antibiotic therapy were recorded and analyzed.Results: A total of 34 inpatients who received antibiotic therapy with piperacillin-tazobactam due to various diagnoseswere included in the study. The mean duration of PTZ use was found as 11.9±6.31 days. Of all patients, 19 (55.9%) usedantibiotics for longer than 10 days, while 15 (44.1%) used PTZ for 10 days or shorter. The mean duration of antibioticuse was found as 12.2 days in patients aged 65 years and over, while this duration was 11.5 days in patients aged under65 years. Five patients (14.7%) developed neutropenia. Neutropenia was developed in 14.8 days of PTZ treatment onaverage. The mean duration of returning to normal values was found as 1.8 days in these patients. Neutropenia wasdeveloped at the 4th week of the treatment in 60% of these patients.Conclusion: It should be kept in mind that myelosuppression may be encountered especially during prolonged PTZtherapy, and full blood count monitoring should be performed carefully and closely in these patients

Evaluation and comparison of tick detachment techniques and technical mistakes made during tick removal

BACKGROUND: Tick is among the important ectoparasites of humans and animals. Ticks may transmit disease-causing pathogens to humans. Tick contact may be resulted in several viral and bacterial infections, including Crimean-Congo Hemorrhagic Fever. Timely removal of ticks with appropriate methods is important in prevention of disease transmission. There are many methods reported for tick detachment. In this study, we aimed to evaluate two of them, suture lassoing and freezing and to compare both methods and to examine technical mistakes with these techniques. METHODS: This study was designed as a prospective cross-sectional study, and included the ticks detached by healthcare professionals or directly by patients who presented to the emergency department due to tick contact. The ticks were recorded as larvae, nymphs, and adults according to their growth period. Ticks detachment types with surgical sutures and removal mistakes were recorded. RESULTS: The majority (77.4%) of the ticks were removed by healthcare professionals and a lower rate by patients themselves with hand (22.6%). No technical mistake was found in 72 (77.4%) patients, and the tick was detached as a whole, while detached broken in 15 (16.1%) patients, and the tick was detached as a whole, but the sutures were attached wrong in six (6.5%) patients. Tick broken off due to technical mistakes was most commonly seen in the ticks removed by the individuals themselves. CONCLUSION: The results of this study suggest that when appropriately and correctly used, both suture lassoing and tweezers are effective in tick removal. Public awareness-raising and training programs should be increased on this issue. © 2020, Turkish Association of Trauma and Emergency Surgery. All rights reserved

It Could Have Been Protected but Wasn't

INTRODUCTION[|]Introduction: Percutaneous injuries create shared occupational risk for all health workers. These injuries can lead to a loss of workforce and a decrease in the quality of health services by causing physical and psychiatric disorders. Our study aimed to identify the epidemiology of incised wounds that have occurred within the past four years effectiveness of preventive measures at the Kahramanmaraş Sütçü İmam University Faculty of Medicine Hospital.[¤]METHODS[|]Method This research was carried out with the retrospective study of incised wound cases that occurred at the KSU Faculty of Medicine Hospital between January 1, 2013 and December 31, 2016. Health personnel were examined in terms of gender, professional group, form of injury, locations of injury, compliance with protective barriers used, and precautions taken. The acquired data were evaluated in Microsoft Excel using numerical and percentage calculations.[¤]RESULTS[|]Findings: Of the injured health personnel, 61% were women and 39% were men. Of the group of injured personnel comprises nurses with 39% (94), followed by intern nurses 27% (65), sanitation personnel with 24% (56), doctors with 8% (18), three laboratory technicians, and two data-entry personnel. The most frequently injured bodily region was the left hand with 51.2% (122), followed by the right hand with 43.6% (104). The most frequent injury took place while covering the tip of a needle with 36%. No type of protective equipment was used for 71% of the health personnel who were included in the study.[¤]DISCUSSION AND CONCLUSION[|]Results: The fact that the most injuries occurred in nursing and sanitation personnel in the study produced the result of the provision of the education necessary to minimize contact with hands of cutting and perforating tools and for the propagation of the use of medical waste containers that provide for distancing the waste materials used, because the most frequent form of injury was recapping needle points. That there was high noncompliance with the use of protective equipment revealed that health workers needed to be subjected to certain, periodic training. In addition to this, the care for injuries and the provision of training in which the infection control committee needed to be referred to in situations of injury was brought to the forefront.[¤

Anxiety levels of healthcare personnel in different stages of COVID-19 pandemic: A nationwide study from Turkey

Aim: SARS CoV-2 transmission in healthcare personnel was first reported on January 20, 2020. The aim of this study was to evaluate the anxiety levels experienced by healthcare personnel in Turkey during the COVID-19 pandemic and the factors affecting these levels.Material and Methods: A survey investigating sociodemographic features and examining anxiety levels was conducted among approximately 1000 healthcare personnel who were expected to take active roles in the pandemic across Turkey. The survey was conducted in three stages: before the pandemic spread to Turkey, at the beginning of the pandemic and when the pandemic became prominent. A logistic regression analysis was performed to determine the factors affecting anxiety and predictors of anxiety levels.Results: In the first survey, always (odds ratio, 15.781; p<0.01) and often (odds ratio, 5.365; p<0.05) media use, in the second survey media use (p<0.05) and profession (odds ratio, 0.021; p<0.05) and in the third survey, marital status (odds ratio, 17.716; p<0.01) and gender (odds ratio, 4.431; p<0.05) were determined as the predictors of anxiety related to COVID-19.Discussion: As a result of this study, healthcare personnel groups were defined (women, nurses, married people) who need special intervention and support to provide spiritual comfort when working on the front line in the fight against COVID-19. Further comprehensive studies are needed of the extent of psychological support required by healthcare personnel and to whom and how this support should be provided

Association Between Bifurcation Angle and Coronary No-reflow Following Primary Percutaneous Coronary Intervention in Patients

Objective:Percutaneous coronary intervention (PCI) has become the treatment method for patients presenting with ST elevation myocardial infarction (STEMI). One of the well-known complications of PCI is no-reflow. Studies demonstrated a relationship between endothelial dysfunction and disturbed vascular flow due to angulation of vascular tree. Although the relationship between hemodynamic alterations and coronary angulation is evident, there is a lack of detailed analysis in terms of hemodynamic changes between vascular geometry and coronary no-reflow. We aimed to elucidate the relationship between vascular geometry and coronary no-reflow.Method:We reviewed PCI database of our hospital and enrolled a total of 120 patients with STEMI, who developed no-reflow following PCI, and sex and age matched 80 patients with normal flow. For each group, demographic and clinical characteristics, laboratory values and two dimensional quantitative coronary angiography measurements were evaluated.Results:Patients with no-reflow had a higher prevalence of hypertension and diabetes mellitus. In addition, serum C-reactive protein levels were higher in patients with no-reflow compared to patients with normal flow (p<0.001). On the other hand, serum hemoglobin levels were significantly lower in patients with no-reflow compared to patients with normal flow (p<0.001). With respect to 3 dimensional coronary measurements, calculated bifurcation angle of left anterior descending artery (LAD) and circumflex artery (CX) was significantly wider in the no-reflow group than in the control group [110.9° (21.8°) vs. 85.9° (15.8°), p<0.001].Conclusion:Our data showed that a strong association existed between bifurcation angle of LAD-CX and no-reflow phenomenon in STEMI patients who underwent PCI

Is there a link between pre-existing antibodies acquired due to childhood vaccinations or past infections and COVID-19? A case control study

Background: There is growing evidence indicating that children are less affected from COVID-19. Some authors speculate that childhood vaccinations may provide some cross-protection against COVID-19. In this study, our aim was to compare the circulating antibody titers for multiple childhood vaccine antigens, as an indicator of the state of immune memory between patients with COVID-19 and healthy controls, with a specific aim to identify the association between disease severity and antibody titrations which may indicate a protective function related to vaccine or disease induced memory. Methods: This study is a case-control study including 53 patients with COVID-19 and 40 healthy volunteers. COVID-19 severity was divided into three groups: asymptomatic, mild and severe. We measured the same set of antibody titers for vaccine antigens, and a set of biochemical and infection markers, in both the case and control groups. Results: Rubella (p = 0.003), pneumococcus (p = 0.002), and Bordetella pertussis (p 0.0001) titers were found to be significantly lower in the case group than the control group. There was a significant decline in pneumococcus titers with severity of disease (p = 0.021) and a significant association with disease severity for Bordetella pertussis titers (p = 0.014) among COVID patients. Levels of AST, procalcitonin, ferritin and D-dimer significantly increased with the disease severity Discussion: Our study supports the hypothesis that pre-existing immune memory, as monitored using circulating antibodies, acquired from childhood vaccinations, or past infections confer some protection against COVID-19. Randomized controlled studies are needed to support a definitive conclusion. © 2021 PeerJ Inc.. All rights reserved

HIV seropositivity in a penal institution in Turkey: a cross- sectional study

WOS: 000458773500011Objective: We aimed to determine the seroprevalence of human immunodeficiency virus (HIV) in a penal institution campus in Turkey, and to query its risk factors. Methods: Participants were selected randomly from blocks of residents who were under judgement process in a penal institution campus. All participants were males aged >= 18 years in this cross-sectional study. Questionnaire conducted on participants included the following: age, marital status, living location, education, income, use of cigarette, use of alcohol, use of illicit drugs, having tattoo, collective personal materials of hygiene, blood transfusion, sexual orientation, use of condom. Blood specimens of participants were tested for anti-HIV antibodies. Results: Among 495 prisoners on remand, three were HIV-positive. Prevalence of HIV infection was determined as 0.61%. All HIV-positives were married and lived in Istanbul. Two of them were primary school graduates, and one of them was a high school graduate. Two of them had yearly income less than 400 USD. All denied use of illicit intravenous drugs. They have extramarital sex, and were not using condoms. Conclusions: It was remarkable that prevalence of HIV infection among prisoners on remand was almost 60-fold higher than those of the general population. Giving information about HIV infection and its routes of transmission to prisoners and screening them on a routine basis on admission to penal institutions are the primary steps to control HIV infection

Understanding the approach of family physicians in Turkey to the problem of vaccine rejection

Vaccines not only protect individuals, but also prevent the spread of vaccine-preventable diseases in the community. Vaccine rejection in Turkey increased 125-fold between 2012 and 2019. Thus, this cross-sectional study aimed to investigate the level of knowledge of family physicians about vaccination, which can be the keystone of vaccine rejection. Evaluations were also made of vaccine recommendations, practice, and confidence in vaccine safety. The study was conducted using a 41-item questionnaire, completed by 804 (3.3%) family physicians serving in Turkey. The most common reasons for vaccine rejection were found to be fear of disease from the vaccine substance at the rate of 53.7% (n = 298), religious reasons at 32.3% (n = 179), disbelief of protection at 9.9% (n = 55), and fear of infertility at 4.1% (n = 23). Logistic regression analysis was applied to determine the factors affecting the power of the family physician’s recommendation. The results showed that age >41 years (OR = 1.625 (1.129–2.34)), having self-efficacy (OR = 1.628 (1.183–2.24)) and belief in the usefulness of the vaccine made a positive contribution to the power to recommend vaccines (OR = 1.420 (1.996–1.012)). The results of this study demonstrated that training on vaccines and vaccine-preventable diseases has a positive effect on self-efficacy (p < .0001). This study can be considered of value as the first to demonstrate the beliefs and attitudes of family physicians in Turkey. Further training courses to increase knowledge of vaccines, vaccine-preventable diseases, and communication skills would be of benefit for family physicians