Effetcs of platelet function on the haemorrhagic manifestations and mortality in Crimean-Congo haemorrhagic fever

Crimean-Congo haemorrhagic fever (CCHF) is a viral zoonotic disease which can lead to life-threatening with haemorrhagic manifestations. We aimed here in this study was to evaluate the effect of the platelet count and volume-related indices, such as the mean platelet volume (MPV), platelet distribution width (PDW) which is a measure of platelet anisocytosis and plateletcrit, in the haemorrhagic manifestations and mortality seen in CCHF cases. We retrospectively examined data derived from 173 patients. The age, gender, alanine transaminase (ALT), aspartate transaminase (AST), platelet counts and MPV, PDW and PCT values upon admission (MPV1, PDW1 and PCT1) and those values measured at the time when the PLT was at the lowest level (MPV2, PDW2 and PCT2), haemorrhagic manifestations and the mortality status of patients diagnosed with CCHF were recorded. ALT and AST values were higher among the haemorrhagic patients when compared with the others (p<0.001), while platelet 1 (PLT1), platelet 2 (PLT2), plateletcrit 1 (PCT1), plateletcrit 2 (PCT2) and platelet distribution width 2 (PDW2) values were significantly lower (p=0.001, p<0.001, p=0.002, p<0.001 and p=0.003, respectively). A negative correlation was documented between haemorrhage and the PLT1, PLT2, PCT1, PCT2 and PDW2 (r=-0.255, r=-0.415, r=-0.241, r=-0.377, r=-0.223, respectively); however, there was a positive correlation between haemorrhage and mortality (r=0.34). This was the first study evaluating the platelet functions in CCHF, such as the PLT, PDW and PCT, in CCHF correlated with the mortality and haemorrhagic manifestations. The platelet functions contribute as much to the prediction of haemorrhage and mortality as the PLT. The present study suggests that the PCT and PDW values could be beneficial in anticipating the inclination toward haemorrhage and mortality. © 2018, EDIMES Edizioni Medico Scientifiche. All rights reserved

Wissen und Einstellungen zum Demenzsyndrom von Personen mit türkischem Migrationshintergrund in Köln

Mit der Untersuchung zu Wissen und Einstellungen zum Demenzsyndrom im Fokus der hausärztlichen Versorgung wurde erstmals für Deutschland ein migrationsbezogener Ansatz in Auseinandersetzung mit dem Demenzsyndrom innerhalb der türkischen Personengruppe gewählt. Mit zunehmendem Alter der Migranten steigt die Wahrscheinlichkeit an einem Demenzsyndrom zu erkranken. Die gesundheitliche Versorgung der an Demenz erkrankten Menschen stellt eine gesamtgesellschaftliche Herausforderung dar. Es gibt Hinweise darauf, dass Wissensdefizite bezüglich dementieller Erkrankungen bei türkischen Migranten mit der geringen Inanspruchnahme von unterstützenden Gesundheitsmaßnahmen sowie sprachlichen und kulturellen Aspekten zusammenhängen. Barrieren in der hausärztlichen Versorgung der türkischen Migranten und damit zusammenhängend ihre speziellen Erfahrungen mit dem Demenzsyndrom wurden kaum untersucht. Eine Querschnittsstudie basierend auf einer Zufallsbruttostichprobe von 500 Frauen und Männern in Köln wurde durchgeführt. Ein selbst entwickelter, schriftlich auszufüllender, standardisierter Fragebogen in deutscher und türkischer Sprache wurde im Juni 2018 postalisch an die Probanden versandt. Bei einer Teilnahmerate von 17,6 % lagen für diese Studie insgesamt 78 ausgefüllte Fragebögen von Personen mit türkischer Staatsbürgerschaft im Alter ab 60 Jahren vor. Im Anschluss erfolgten multivariable Analysen der Antworten. Ein Großteil der Personen mit türkischem Migrationshintergrund schätzte den allgemeinen Gesundheitszustand als nicht gut ein. Zudem wurden die Deutschkenntnisse von 47,5 % der Teilnehmer als „schlecht“ bis „sehr schlecht“ beurteilt. Viele Teilnehmer hatten aufgrund sprachlicher Aspekte Schwierigkeiten, medizinische Informationen beim Hausarzt zu verstehen. Trotz der Angst (65,4 %), an Demenz zu erkranken, hatten türkische Teilnehmer einen offenen Umgang mit der Erkrankung, indem sie das Gespräch im Erkrankungsfall aufsuchen würden. Sie waren insgesamt wenig über die Demenz informiert und hatten einen hohen Informationsbedarf. Um den Wissenslücken gerecht zu werden, sollten Aufklärungskampagnen zum Demenzsyndrom mehr an Bedeutung gewinnen. Beispielweise könnten Informationsmaterialien in türkischer Sprache in hausärztlichen Praxen für Patienten zur Verfügung gestellt werden. Der subjektiv oft nicht gut beurteilte Gesundheitszustand könnte eventuell auf mögliche Verbesserungspotenziale der gesundheitlichen Lage der türkischen Migranten hindeuten. Weiterführende Studien mit zielgruppenspezifischen Erhebungsinstrumenten zu spezifischen Krankheiten und Risikofaktoren sind denkbar, um mögliche Defizite in der Gesundheitsversorgung identifizieren zu können

A Review of Architects' Corner Building Design Approaches

Köşenin tasarımı, mimari tasarım alanında önemli bir problem olarak yer almakta ve kent köşelerinin anlamsal olarak kentlinin sosyal yaşamındaki önemi vurgulanmaktadır. Bu çalışma, mimaride köşelerin anlamına ve mimarların köşe bina tasarımı yaklaşımlarına odaklanmaktadır. Bu amaç doğrultusunda mimarlara uygulanmak üzere sorgulama metni tasarlanmış ve veri analizi yöntemi olarak parametrik hipotez testleri içerisinde yer alan bağımsız örneklem t testi uygulanmıştır. T test grubunda veriler köşe parselde bina tasarlayanlar/tasarlamayanlar olmak üzere analiz edilmiş ve anlamlılık analizinde ölçüt olan, ″005″ değerine eşit veya küçük bir değer izlenmemiştir. Değerlendirme sonucunda köşe parselde bina tasarlayan ve tasarlamayan mimarlar arasında anlamlı bir farklılık görülmemiştir.In architectural design, designing a corner building is considered to be a major problem and the significance of the meaning of urban corners is emphasized. The aim of this study, focusing on the corner is to investigate the meanings attributed by architects to the design of a corner building. Within this aim, the methodology is adopted for the study, involving literature review, designing and the implementation of questionnaire. For the data analysis, the t-test, which shows whether any significant difference exists between two independent groups is used. In conclusion, no significant difference is found between the architects who had and had not designed corner buildings, based on their answers

Odnos krimsko-kongoanske hemoragijske groznice i klime: utječe li klima na broj ovih bolesnika?

Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne viral zoonosis. The incidence of zoonotic diseases has been shown to be affected by climatic factors. In this study, we evaluated patients endemic to the CCHF region and examined the relationship between the number of patients and climatic properties of the region where they lived. The study included 548 CCHF patients. Along with the patient demographic and clinical characteristics, we recorded temperature, humidity and precipitation in the places where they lived at the time of their admission to the hospital. In addition to temperature, humidity and precipitation at the time of patient admission, these values were assessed at one month and three months prior to admission. The relationship between the number of patients and the above-mentioned values was examined. Humidity at the time of and one month prior to hospital admission, and precipitation three months prior to hospital admission were found to affect the number of patients admitted to the hospital for CCHF. In conclusion, climate appeared to affect the number of CCHF patients. We believe that the number of patients presenting to the hospital with CCHF could be predicted by taking into account climatic properties of the places where CCHF has been recorded, along with under-taking necessary measures.Krimsko-kongoanska hemoragijska groznica (KKHG) je virusna zoonoza koju prenose krpelji. Dokazano je da klimatski čimbenici utječu na incidenciju zoonotskih bolesti. U ovom smo istraživanju ispitivali bolesnike endemske za područje KKHG te odnos broja bolesnika i klimatskih svojstava područja u kojem oni žive. U istraživanje je bilo uključeno 548 bolesnika s KKHG. Uz demografske i kliničke značajke bolesnika bilježili smo temperaturu, vlagu i količinu padalina u mjestu gdje su bolesnici živjeli u vrijeme prijma u bolnicu. Uz vrijednosti temperature, vlage i količine padalina u vrijeme prijma bolesnika u bolnicu, vrijednosti ovih parametara procijenjene su za jedan mjesec i tri mjeseca prije prijma u bolnicu. Tada smo ispitali odnos broja bolesnika i gore spomenutih vrijednosti. Pokazalo se da razina vlage u vrijeme prijma i jedan mjesec prije prijma u bolnicu, kao i količina padalina tri mjeseca prije prijma u bolnicu utječu na broj bolesnika primljenih u bolnicu zbog KKHG. U zaključku, čini se da klima utječe na broj bolesnika s KKHG. Vjerujemo da bi se broj bolesnika koji dolaze u bolnicu zbog KKHG mogao predvidjeti uzimajući u obzir klimatska svojstva u mjestima gdje je zabilježena KKHG, a time bi se isto tako mogle poduzeti odgovarajuće mjere

In a real-life setting, direct-acting antivirals to people who inject drugs with chronic hepatitis c in Turkey

Background: People who inject drugs (PWID) should be treated in order to eliminate hepatitis C virus in the world. The aim of this study was to compare direct-acting antivirals treatment of hepatitis C virus for PWID and non-PWID in a real-life setting. Methods: We performed a prospective, non-randomized, observational multicenter cohort study in 37 centers. All patients treated with direct-acting antivirals between April 1, 2017, and February 28, 2019, were included. In total, 2713 patients were included in the study among which 250 were PWID and 2463 were non-PWID. Besides patient characteristics, treatment response, follow-up, and side effects of treatment were also analyzed. Results: Genotype 1a and 3 were more prevalent in PWID-infected patients (20.4% vs 9.9% and 46.8% vs 5.3%). The number of naïve patients was higher in PWID (90.7% vs 60.0%), while the number of patients with cirrhosis was higher in non-PWID (14.1% vs 3.7%). The loss of follow-up was higher in PWID (29.6% vs 13.6%). There was no difference in the sustained virologic response at 12 weeks after treatment (98.3% vs 98.4%), but the end of treatment response was lower in PWID (96.2% vs 99.0%). In addition, the rate of treatment completion was lower in PWID (74% vs 94.4%). Conclusion: Direct-acting antivirals were safe and effective in PWID. Primary measures should be taken to prevent the loss of follow-up and poor adherence in PWID patients in order to achieve World Health Organization’s objective of eliminating viral hepatitis

Infection prevention and control practice for Crimean-Congo hemorrhagic fever - A multicenter cross-sectional survey in Eurasia

<div><p>Background</p><p>Crimean Congo Hemorrhagic Fever (CCHF) is a life threatening acute viral infection that presents significant risk of nosocomial transmission to healthcare workers.</p><p>Aim</p><p>Evaluation of CCHF infection prevention and control (IP&C) practices in healthcare facilities that routinely manage CCHF cases in Eurasia.</p><p>Methods</p><p>A cross-sectional CCHF IP&C survey was designed and distributed to CCHF centers in 10 endemic Eurasian countries in 2016.</p><p>Results</p><p>Twenty-three responses were received from centers in Turkey, Pakistan, Russia, Georgia, Kosovo, Bulgaria, Oman, Iran, India and Kazakhstan. All units had dedicated isolation rooms for CCHF, with cohorting of confirmed cases in 15/23 centers and cohorting of suspect and confirmed cases in 9/23 centers. There was adequate personal protective equipment (PPE) in 22/23 facilities, with 21/23 facilities reporting routine use of PPE for CCHF patients. Adequate staffing levels to provide care reported in 14/23 locations. All centers reported having a high risk CCHFV nosocomial exposure in last five years, with 5 centers reporting more than 5 exposures. Education was provided annually in most centers (13/23), with additional training requested in PPE use (11/23), PPE donning/doffing (12/23), environmental disinfection (12/23) and waste management (14/23).</p><p>Conclusions</p><p>Staff and patient safety must be improved and healthcare associated CCHF exposure and transmission eliminated. Improvements are recommended in isolation capacity in healthcare facilities, use of PPE and maintenance of adequate staffing levels. We recommend further audit of IP&C practice at individual units in endemic areas, as part of national quality assurance programs.</p></div

First results of the “Lean European Open Survey on SARS-CoV-2-Infected Patients (LEOSS)”

Abstract Purpose Knowledge regarding patients’ clinical condition at severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection is sparse. Data in the international, multicenter Lean European Open Survey on SARS-CoV-2-Infected Patients (LEOSS) cohort study may enhance the understanding of COVID-19. Methods Sociodemographic and clinical characteristics of SARS-CoV-2-infected patients, enrolled in the LEOSS cohort study between March 16, 2020, and May 14, 2020, were analyzed. Associations between baseline characteristics and clinical stages at diagnosis (uncomplicated vs. complicated) were assessed using logistic regression models. Results We included 2155 patients, 59.7% (1,287/2,155) were male; the most common age category was 66–85 years (39.6%; 500/2,155). The primary COVID-19 diagnosis was made in 35.0% (755/2,155) during complicated clinical stages. A significant univariate association between age; sex; body mass index; smoking; diabetes; cardiovascular, pulmonary, neurological, and kidney diseases; ACE inhibitor therapy; statin intake and an increased risk for complicated clinical stages of COVID-19 at diagnosis was found. Multivariable analysis revealed that advanced age [46–65 years: adjusted odds ratio (aOR): 1.73, 95% CI 1.25–2.42, p = 0.001; 66–85 years: aOR 1.93, 95% CI 1.36–2.74, p  85 years: aOR 2.38, 95% CI 1.49–3.81, p < 0.001 vs. individuals aged 26–45 years], male sex (aOR 1.23, 95% CI 1.01–1.50, p = 0.040), cardiovascular disease (aOR 1.37, 95% CI 1.09–1.72, p = 0.007), and diabetes (aOR 1.33, 95% CI 1.04–1.69, p = 0.023) were associated with complicated stages of COVID-19 at diagnosis. Conclusion The LEOSS cohort identified age, cardiovascular disease, diabetes and male sex as risk factors for complicated disease stages at SARS-CoV-2 diagnosis, thus confirming previous data. Further data regarding outcomes of the natural course of COVID-19 and the influence of treatment are required

The effective management of the historic urban context : an assessment of local conservation practice

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