COVID-19 Vaccination Scenarios:A Cost-Effectiveness Analysis for Turkey

As of March 2021, COVID-19 has claimed the lives of more than 2.7 million people worldwide. Vaccination has started in most countries around the world. In this study, we estimated the cost-effectiveness of strategies for COVID-19 vaccination for Turkey compared to a baseline in the absence of vaccination and imposed measures by using an enhanced SIRD (Susceptible, Infectious, Recovered, Death) model and various scenarios for the first year after vaccination. The results showed that vaccination is cost-effective from a health care perspective, with an incremental cost-effectiveness ratio (ICER) of 511 USD/QALY and 1045 USD/QALY if vaccine effectiveness on transmission is equal or reduced to only 50% of effectiveness on disease, respectively, at the 90% baseline effectiveness of the vaccine. From a societal perspective, cost savings were estimated for both scenarios. Other results further showed that the minimum required vaccine uptake to be cost-effective would be at least 30%. Sensitivity and scenario analyses, as well as the iso-ICER curves, showed that the results were quite robust and that major changes in cost-effectiveness outcomes cannot be expected. We can conclude that COVID-19 vaccination in Turkey is highly cost-effective or even cost-saving

Determination Of Medication Adherence And Related Factors Among People Living With Hiv/Aids In A Turkish University Hospital

Background/aim: Widespread use of antiretroviral treatment (ART) has led to decrease in the incidence of HIV/AIDS-related mortality. Besides the availability of ART, medication adherence is essential for treatment success. There is a scarcity of data reported from Turkey regarding ART adherence among people living with HIV/AIDS (PLWHA). Therefore, this study was undertaken to determine medication adherence and related factors among PLWHA in Turkey. Materials and methods: The sample consisted of 158 PLWHA, who were being followed up at Infectious Diseases Outpatient Clinic of Hacettepe University Hospital. Data were collected using an individual questionnaire and the Turkish version of the Morisky Medication Adherence Scale. Results: The median patient age was 38 years, 80.4% were male, and 51.3% were married. The median duration of both HIV infection and ART was 3 years. Sixty-one percent used two drug regimens. Sixty-one percent were highly adherent to ART while 37.9% were moderately adherent. `the absence/presence of social support resources, disease duration, ART duration, and being informed about the ART regimen were statistically associated with medication adherence. Conclusion: Our results suggest that medication adherence is excellent among Turkish PLWHA. Interventions, including effective social support, and continuous counseling about ART, might further boost the adherence of PLWHA.WoSScopu

Evaluation of 255 HIV/AIDS Cases: Hacettepe Cohort, Ankara, Turkey

The first HIV/AIDS case has been reported in 1985 in Turkey, and since then 8238 cases have registered until June 2014 according to the records of Turkish Ministry of Health. The aim of this retrospective study was to evaluate the epidemiological data and clinical features of HIV/AIDS patients admitted to our center. A total of 255 HIV-infected patients admitted to our clinic between January 1986 and January 2013, whose data obtained from file records, were included in the study. Most of the patients were male (193/255, 75.6%) and Turkish citizens (216/255, 84.7%), with the mean age of 38.0 +/- 11.6 (age range: 19-80) years. Approximately 25.4% (46/181) were university graduates. The most frequent route of transmission was through a heterosexual intercourse (161/255, 63.1%). In our study group, there were 34 men who had sex with men, and the majority of these cases (n=26, 76.5%) were diagnosed in or after the year 2006, while 23.5% (n=8) before 2006. This difference was found statistically significant (p= 100.000 copies/ml). The disease could be categorized in 246 cases, 54.1% were HIV-positive and 45.9% were in AIDS stage. Patients diagnosed after 2006 had lower rate of AIDS when compared to the patients diagnosed before 2006 (33.6% vs. 60.7%, respectively; p<0.005). Two hundred patients were followed up more than three months (median: 41 months), and 138 patients (of them 79 were HIV-positive, and 59 were in AIDS stage) were still in follow up at the end of study period. Throughout the follow-up, 29 cases (29/255, 11.4%) had died. It was concluded that, the surveillance of data from HIV/AIDS patients would be beneficial to determine and predict the complications of the disease.WoSTr-Dizi

Plasmodium falciparum Malaria: Evaluation of Three Imported Cases

Among Plasmodium species the causative agent of malaria in Turkey is P.vivax, however the incidence of imported falciparum malaria cases is steadily increasing. P.falciparum may cause severe malaria with the involvement of central nervous system, acute renal failure, severe anemia or acute respiratory distress syndrome. Furhermore most of the casualties due to malaria are related with P.falciparum. There is recently, a considerable increase in malaria infections especially in tropical areas. In this report, three cases, who have admitted to our hospital with three different clinical presentations of falciparum malaria, and all shared common history of travelling to Africa were presented. First case was a 27 years old, male patient who returned from Malawi seven days ago where he stayed for two weeks. He admitted to our hospital with the complaints of sensation of cold, shivering and fever. In physical examination his body temperature was 37.9 degrees C, C-reactive protein level was high, and the other systemic results were normal. The second case was a 25 years old, male patient who returned from Gambia two weeks ago. He was suffering from fever, headache, shivering and unable to maintain his balance. The patient's body temperature was 38 degrees C. Laboratory tests revealed hyperbilirubinemia and thrombocytopenia. Parasitological examination of the Giemsa-stained peripheral blood smear of these two patients demonstrated ring forms compatible with P.falciparum. Treatment was commenced with arthemeter plus lumefantrine, resulting with complete cure. Third case was a 46 years old, male patient who had been working in Uganda, and returned to Turkey two weeks ago. He had sudden onset of fever, headache, nausea and vomiting and impaired consciousness. His peripheral blood smear revealed ring-formed trophozoites and banana-shaped gametocytes of P.falciparum. Arthemeter plus lumefantrine therapy was started, however, he developed severe thrombocytopenia and jaundice under treatment. His general condition was detoriated and the patient lost his consciousness. As the patient's clinical signs were compatible with sepsis ceftriaxone plus clindamycin were added to the antiparasitic treatment emprically. Due to the development of acute tubular necrosis, the patient have undergone hemodialysis. On the 9(th) day of therapy the complaints and laboratory findings of the patient have improved, so he was discharged. However, visual defects due to retinopathy and severe neurocognitive impairment that were thought to be the complications of malaria continued in his follow-ups. As a result, it should be keep in mind that both the African students who have come to our country for education from endemic regions and as well as the returned citizens of our country who have gone to work in endemic areas, are under risk of malaria and it is very important to consider malaria in the distinctive diagnosis of patients with the complaints of fever, headache, nausea, vomiting and muscle pain.WoSScopusTr-Dizi

Refractory Giardiasis in an Immunosuppressed Patient in Turkey

Giardiasis is an infection of the small intestine caused by the protozoan parasite Giardia duodenalis. In immunocompetent patients the infection is usually self-limited and no treatment may be needed. Immunodeficiency, however, is a predisposing factor for the development of severe Giardia infection. In this report, a case of recurrent giardiasis refractory to nitroimidazoles and nitazoxanides presented. A 28-year-old male patient with hypogammaglobulinemia admitted to our hospital because of chronic diarrhoea. Microscopic examination of stool revealed a high number of Giardia trophozoites and cysts. Treatment with higher doses and a longer course of metronidazole, trimethoprim-sulfamethoxazole, ornidazole and albendazole failed. Administration of nitazoxanide, which has been reported to be effective against Giardia duodenalis refractory to nitroimidazoles, was commenced, but his symptoms persisted and stool samples demonstrated Giardia trophozoites and cysts again.WoSScopu

Polypharmacy And Drug-Related Problems Among People Living With Hiv/Aids: A Single-Center Experience

Background/aim: The HIV-infected population is aging, and the concomitant comorbidities increase the likelihood of polypharmacy. There is a scarcity of data for determining drug-related problems in people living with HIV/AIDS (PLWHA). Materials and methods: This cross-sectional study was carried out between 1 September 2015 and 1 July 2016. All patients underwent a face-to-face interview with a clinical pharmacist. PCNE Classification V 7.0 was used classify incident drug-related problems (DRPs). Results: The mean age of the patients was 40.4 +/- 13.06 years. The rate of polypharmacy was 66.1% in patients with comorbidities and 12.3% in those without comorbidities (P 3 ART drugs was associated with more DRPs in the logistic regression model (odds ratio: 8.299, 95% confidence interval: 1.924-35.803). Fifty-eight interventions were performed in 45 (24.9%) patients. Clinical pharmacist interventions were performed in 18.9% of patients without polypharmacy and in 38.9% of patients with polypharmacy (P < 0.001). Conclusion: DRPs and polypharmacy are common among elderly PLWHA. More interventions are warranted to boost the quality of life in aging PLWHA.WoSScopu

The Investigation Of Strongyloides Stercoralis Seroprevalence In Immunosupressed Patients In Turkey

Background/aim: In immunosuppressed patients, strongyloidiasis can be lifethreatening because of hyperinfection or dissemination. Therefore, diagnosis of S. stercoralis is important in immunosuppressed patients with chronic strongyloidiasis. In this study, our objective was to investigate the presence of S. stercoralis antibodies by an ELISA method in immunosuppressed patients. Materials and methods: A total of 100 immunosuppressed patients' sera were included in the study. Forty-two of the patients were receiving immunosuppressive therapies for cancer or being treated for hematopoietic malignancies, 38 of the patients were receiving immunosuppressive drugs for rheumatic diseases, 14 were receiving immunosuppressive therapies for liver transplantation. Two of the patients were being treated for HIV infection and 4 were being treated for hypogammaglobulinemia. As control group, 50 individuals without a known disease were included in the study. The presence of IgG antibodies against S. stercoralis was investigated with a commercial ELISA kit. Results: S. stercoralis antibody test was positive in 4 of 100 (4%) sera from immunosuppressed patients. All control patients were negative for S. stercoralis. Conclusion: Strongyloidiasis can be a lifelong chronic infection if not treated. In patients who are going to receive immunosuppressive therapy, it should be tested before treatment, as it can become a disseminated and life-threatening infectious disease.WoSScopu

Evaluation Of The Relation Between Hepatic Fibrosis And Basic Laboratory Parameters In Patients With Chronic Hepatitis B Fibrosis And Basic Laboratory Parameters

Background: The hepatitis B virus is an important healthcare problem. According to current clinical practice, a liver biopsy is required for the diagnosis and treatment of chronic liver disease. However, a liver biopsy is an invasive, inconvenient procedure, which requires an expert pathologist opinion. Therefore requirement of biochemical tests, which are considered to indicate hepatic fibrosis and may be repeated easily, increases gradually today. Objectives: This study evaluated the correlation between hepatic fibrosis and routine laboratory values in patients with chronic hepatitis B. Patients and Methods: The files of 456 patients with CHB (chronic hepatitis B) who were referred to the infectious diseases and clinical microbiology clinic between January 2009 and March 2012 were screened retrospectively. Liver biopsy samples were examined according to Ishak scoring. Laboratory parameters and histopathology reports were recorded, and correlations between the fibrosis grade and laboratory parameters were analyzed. Results: There were 320 male and 136 female patients, with a mean age 36.7 +/- 12.1 years. According to liver biopsy results, a low fibrosis score (stage 0-2) was detected in 281 patients (61.6%), and a high fibrosis score ( stage 3-5) was detected in 175 patients (38.4%). Patients with a high fibrosis score had significantly higher ALT (alanine amino transferase), AST (aspartate aminotransferase), and HBV-DNA values and a significantly lower platelet count compared with those with a low fibrosis score (P=0.001, 0.001, 0.025, and 0.001, respectively). A positive correlation was detected between the fibrosis score and age, BMI, HAI, ALT, and AST values, and a negative correlation was detected between the fibrosis score and albumin and platelet counts. In the regression analysis performed to evaluate the factors associated with high-stage fibrosis, fibrosis was determined to be associated with thrombosis, ALT, and gender. The results of the regression analysis demonstrated that the risk of fibrosis was 4.6 fold higher in men. Conclusions: According to the results obtained in our study, advanced age, higher BMI, AST, ALT, and HBV-DNA levels, and low albumin and platelet levels are correlated with advanced fibrosis in patients with CHB.WoSScopu

Is Serum High-Mobility Group Box 1 (Hmgb-1) Level Correlated with Liver Fibrosis in Chronic Hepatitis B?

Background: High-mobility group box 1 (HMGB1), identified as an alarmin molecule, was shown to have a role in virus-triggered liver injury. We aimed to evaluate the association between serum levels of HMGB1 and liver fibrosis. Method: This cross-sectional case-control study included 189 chronic hepatitis B (CHB) patients and 51 healthy controls. All patients underwent liver biopsy and modified Knodell scoring system used to determine the fibrosis level in CHB patients. Serum HMGB1 levels were determined with enzyme-linked immunosorbent assay (ELISA). Results: Mean serum HMGB1 levels of patients (58.1 ± 54.7) were found to be higher than those of the control group (7.1 ± 4.3) (P = .001). HMGB1 levels of patients with advanced-stage fibrosis (stage 4 and 5) were detected to be higher than those of patients with early-stage fibrosis (stage 1–3). However, this difference was not statistically significant (P > .05). Albumin levels of fibrosis 3 and 4 patients were lower than fibrosis 1 and 2 patients. ALT, HBV DNA, and AFP levels of fibrosis 5 patients were significantly higher than fibrosis 1 and 2 patients, and their platelet and albumin levels are lower than fibrosis 1 and 2 patients (P < .001). In a logistic regression model, fibrosis levels were correlated with ALT values and inversely correlated with albumin levels. Conclusion: In this study, we demonstrated that serum HMGB1 levels increase in the early course of liver injury and this increase is not correlated with severity of the liver damage.WoSScopusPubMe

Comparison Of Risk Category Predictions Of Framingham Risk Score (Frs), Atherosclerotic Cardiovascular Disease Risk Score (Ascvd), Systematic Coronary Risk Evaluation (Score) And Data Collection On Adverse Events Of Anti-Hiv Drugs (D:A:D) In Hiv Infected Patients

Background Cardiovascular disease (CVD) is a major cause of mortality in HIV infected patients. Agreement between commonly used risk prediction equations for classification of high-risk individuals is varied in different populations. We aimed to compare the degree of agreement of four CVD risk calculators in a multicenter cohort. Methods A cross-sectional study was conducted among adult HIV patients who are followed in five tertiary centers between July 2016 and February 2017. Inclusion criteria were: age 40–74 years, without known CVD and not receiving statins. All necessary information to calculate risk scores were collected during follow-up visits with a standardized form. Web-based tools for each score were used for calculations. Persons were considered at higher risk if 10-year CVD risks ≥20% with FRS-CVD, >10% with SCORE for high-risk countries, >7.5% for ASCVD, and 5 year risk ≥5% with DAD or if they had additional risk factors defined for each score for automatic high-risk stratification. Based on the interpretation of CVD risk, the patients were placed in two categories: low/medium and high/very high. Agreement between scores was assessed by Cohen’s kappa (κ) statistics. Results Of 667 patients who were active during the study period, CVD scores of 527 HIV-infected patients (82% male) were assessed. Median (interquartile range) age was 48 (43–54) years. Prevalence of CVD risk factors were: 11% family history of early-onset CVD, 50% current smokers, 57% overweight or obese, 22% hypertension, and 8% diabetes mellitus. The prevalence of high CVD scores or risk equivalents was high ranging from 20.3% to 36.3%. The DAD-full, DAD-reduced, ASCVD and SCORE had 83.9%, 85%, 83.5% and 93.2% agreement compared with the FRS-CVD (κ = 0.55, 0.59, 0.61 and 0.80), respectively. European AIDS Clinical Society, European Society of Cardiology, Adult Treatment Panel-III and 2013 American College of Cardiology/American Heart Association guidelines would recommend statin therapy for 35.1%, 21.8%, 31.9% and 36.4% of patients, respectively. Conclusion We found moderate/substantial agreement among risk prediction tools evaluated in this study. Agreement was high for lower scores and at higher ages. Whether those scores accurately estimate risk at population level needs further evaluation. Disclosures All authors: No reported disclosures.PubMe