The Clinical Use of the Pneumonia Severity Index and the COVID-GRAM Score in Patients Diagnosed with COVID-19

Introduction: Confirmed prognostic scales, such as the Pneumonia Severity Index (PSI), are commonly employed to guide treatment for patients with pneumonia. COVID-19 pneumonia-specific scores like COVID GRAM have been developed for assessing mortality risk and the requirement for intensive care,. In this study, our objective was to examine the predictive value of both non-specific and disease-specific scoring systems in assessing clinical severity and 28-day mortality in patients with COVID-19. Materials and Methods: Patients with positive COVID-19 PCR tests were included in the study. The parameters of the COVID-GRAM score include age, imaging findings, number of comorbidities, clinical findings such as dyspnea and altered consciousness, as well as lactate dehydrogenase and direct bilirubin levels. The patients were evaluated according to both the results of the scoring systems and their clinical status of severe pneumonia and mild-moderate pneumonia. Demographic characteristics, comorbidities, baseline laboratory parameters, and time to death were obtained from electronic medical records. Results: A total of 188 patients, 107 of whom were male, were included in our study. The 28-day mortality rate was 21.2%. Mortality increased with prolonged hospital stay (p= 0.009). Upon evaluating the scoring systems, it was observed that both the PSI score and COVID-GRAM values were significantly higher in individuals who had a fatal outcome (p= 0.001 and p= 0.019, respectively). A noticeable increase in mortality rates was observed across risk groups (from group I to V) among patients categorized based on PSI scoring. We performed a ROC curve analysis to calculate the cutoff values of these scoring systems in estimating 28-day mortality. In the PSI scoring system, the sensitivity was 95%, and the specificity was 18.9%. In the COVID-GRAM score, the sensitivity was 92.5%, and the specificity was 17.6%. Both scores were statistically significant in predicting 28-day mortality (p< 0.001). Conclusion: Comparative data on scoring systems will provide valuable insights into the scientific literature, aiding in the appropriate allocation of resources and facilitating decisions regarding close patient monitoring during the peak phases of the pandemic. As our understanding of COVID-19 continues to expand, the incorporation of additional variables into the COVID-GRAM score holds the potential to enhance its utility and effectiveness

Sağlık Çalışanlarının İnfluenza Aşısına Yaklaşımı

Amaç: Ülkemizde sağlık çalışanlarına, 2002 yılından itibaren, isteğe bağlı olarak, her yıl ücretsiz influenza aşısı temin edilmesine rağmen, aşılanma oranları düşük seyretmektedir. Bu çalışma 2 farklı hastanede bulunan sağlık çalışanlarının influenza aşısına yaklaşımlarını saptamak amacıyla yapılmıştır. Materyal metod: Bu çalışma 2-9 Ocak 2019 tarihlerinde Kırıkhan Devlet Hastanesi ve Ağrı Devlet Hastanesi çalışanlara ait demografik özellikler ve influenza aşısıyla ilgili on soruya, yüz yüze görüşülerek alınan cevapların anket formuna kaydedildiği, tanımlayıcı tipte bir çalışmadır. Veriler SPSS programı kullanılarak analiz edildi. İstatistiksel açıdan p değeri &lt;0.05 düzeyi anlamlı olarak kabul edildi. Bulgular: Çalışmaya iki farklı merkezden 31 doktor, 215 yardımcı sağlık personeli, 72 diğer sağlık personeli ve 52 şirket personeli katıldı. Katılımcıların 134 (%36,1)’ünün hayatında en az 1 kez aşı yaptırdığı öğrenildi. Eğitim düzeyi arttıkça aşı yaptırma oranın arttığı görüldü. İnfluenza aşısı yaptırmak istememenin nedenlerinin başında, aşının gerekliliğine inanmama (%26) ve diğer korunma yöntemlerini tercih etme (%22,1)geliyordu. İnfluenzadan korunma yolları sorulduğunda %64 düzenli beslenme, spor yapma ve C vitamini takviyesi alma diye cevap verirken yalnızca %5,7’si influenza aşısı olma cevabını vermiştir. Sonuç: İnfluenza aşısı ile ilgili yapılacak eğitimlerle, çalışmamızda ve diğer çalışmalarda saptanan aşı olmama nedenleri de göz önünde tutularak, aşıların gerekliliğinin, etkinliğinin, düşük yan etkilerinin iyi anlatılması gerekir. Aynı zamanda hastane çalışanlarından öneriler alınarak konu ile ilgili bilgilerin aktarılması için yeni stratejiler geliştirilebilir

An Evaluation of Health Workers’ Measles, Rubella, Mumps, and Chickenpox Infection and Vaccination Status (A Nationwide Multi-Center Study)

Giriş: Kızamık, kızamıkçık, kabakulak (KKK) ve suçiçeği hastalıkları aşı ile önlenebilir hastalıklar arasında yer almaktadır. Sağlık çalışanlarının enfeksiyon hastalıklarına karşı bağışıklık ve aşılanma durumlarının bilinmesi, duyarlı personelin belirlenmesi ve ardından uygun aşılama programlarının geliştirilmesi enfeksiyonların önlenmesi ve kontrolü için önemlidir. Amaç: Ülke genelini kapsayan çok merkezli olarak gerçekleştirilen bu çalışmada, KKK ve suçiçeği gibi döküntülü hastalıklarla karşılaşma riski fazla olan sağlık çalışanlarının hastalık geçirme, test yaptırma ve aşılanma durumlarının belirlenmesi amaçlanmıştır. Yöntemler: Sağlık çalışanlarının demografik özelliklerini, KKK ve suçiçeği hastalığını geçirme ve aşılanma durumlarını öğrenmeye yönelik bir anket formu oluşturulmuş ve bu form web sayfası üzerinden online ulaşılabilen bir link aracılığıyla sağlık çalışanlarına iletilerek katılımcıların anketteki soruları yanıtlamaları istenmiştir. Bulgular: Çalışmaya Türkiye’de toplam yedi bölgeden 12.475 sağlık çalışanı katıldı. Katılımcıların 8099 (%64,9)’u kadın, 4376 (%35,1)’i erkek ve yaş ortalaması 35.4±9.4 yıl idi. KKK ve suçiçeği geçirmeme durumları %22,4-34,9 arasında idi. Sağlık çalışanlarının KKK ve suçiçeği aşılanma durumları sorgulandı. KKK için katılımcıların %22,3’ü (n=2784), suçiçeği aşısı için katılımcıların %22’si (n=2748) bu soruya cevap vermedi. KKK ve suçiçeği aşısı yaptıranlar sırasıyla 2048 (%21,1) ve 4451 (%45,8) idi. KKK ve suçiçeği serolojisi baktırmayan sağlık çalışanlarının sayısı sırasıyla 8953 (%79), 9010 (%80,1), 9363 (%83,5) ve 9591 (%85,4) idi. Kızamık IgG serolojisi baktıran 2383 kişiden %77,6’sı kızamık IgG pozitif, 2233 kişinin %81,5’i kızamıkçık IgG pozitif, 1854 kişinin %81.6’sı kabakulak IgG pozitif ve 1644 kişinin %83,6’sı suçiçeği IgG sonucu pozitifdi. Katılımcıların cinsiyet, yaş ve meslek gruplarına göre KKK ve suçiçeği aşısı yaptırma durumları değerlendirildiğinde istatiksel anlamlılık yoktu (p>0.05). Sonuç: Çalışmamızda serolojik sonuçlarına baktırmayan sağlık çalışanlarının oranının fazla olması ülke genelinde bu konudaki eksiklikleri ön plana çıkarmaktadır. Sağlık çalışanlarının serolojik değerlendirmeleri işe başlamadan önce kontrol edilmeli ve gerekli aşı programına alınmalıdır.Objective: Measles, rubella, mumps (MRM) and chickenpox are diseases that can be prevented by vaccination. Knowledge of health workers’ immunity to infectious diseases and vaccination status, the identification of susceptible individuals, and subsequent appropriate vaccination programs are essential to the prevention and control of infections. Aim: the purpose of this nationwide multi-center study was to investigate the infection, testing, and vaccination status of health workers, individuals at greater risk of encountering exanthematous diseases such as MRM and chickenpox. Method: A questionnaire intended for eliciting health workers’ demographic characteristics, MRM and chickenpox infection, and vaccination status was produced, and participants were asked to respond with the form being dispatched through a link available online via the web page. Results: A total of 12,475 health workers from the seven regions of Turkey participated, 8099 participants (64.9%) women and 4376 (35.1%) men, with a mean age of 35.4±9.4 years. Infection rates for measles, rubella, mumps, and chickenpox ranged between 22.4% and 3 4.9%. H ealth w orkers’ M RM a nd c hickenpox vaccination status was investigated, with 22.3% (n=2784) not answering that question for MRM vaccination, and 22% (n=2748) not responding for chickenpox vaccination. Numbers of participants vaccinated against MRM and chickenpox performed were 2048 (21.1%) and 4451 (45.8%), respectively. Numbers of health workers not having measles, rubella, mumps or chickenpox serological tests performed were 8953 (79%), 9010 (80.1%), 9363 (83.5%), and 9591 (85.4%). of the 2383 individuals having measles IgG serological tests performed, 77.6% were measles IgG positive, 81.5% of 2233 individuals were rubella IgG positive, 81.6% of 1854 participants were rubella IgG positive, and 83.6% of 1644 participants were chickenpox IgG positive. No statistically significant associations were determined between participants’ age, sex, or occupational group and MRM and chickenpox vaccination status (p>0.05). Conclusion: the high rates of health workers not having serological tests performed in this study indicates a weakness in this area in Turkey as a whole. Serological examinations should be performed before health workers commence employment, and they must be enrolled in the appropriate vaccination programs

Reactivation rates in patients using biological agents, with resolved HBV infection or isolated anti-HBc IgG positivity

Background/Aims: Tumor necrosis factor-? (TNF-?) inhibitors and ustekunimab are widely used in autoimmune diseases. It is known that these biological agents cause the reactivation of hepatitis B virus (HBV). There is no standardized strategy to prevent the reactiva- tion in patients with evidence of a previous HBV infection. In our study, anti-HBc IgG-positive patients who received a biological agent were evaluated in terms of HBV reactivation. Materials and Methods: Patients who were followed up for the use of biological agents in our clinic were evaluated retrospectively. Pa- tients with isolated anti-HBc IgG positivity were included in the study. The HBV reactivation data were recorded from the patients’ files retrospectively. Results: Two hundred and seventy-eight patients who received biological treatment were evaluated. Twenty-nine patients with isolated anti-HBc IgG positivity or resolved HBV infection were included in the study. The HBV reactivation was seen in 5 patients (17.2%). Of these patients, 3 were using adalimumab, 1 infliximab, and 1 ustekunimab. It was controlled by antiviral therapy that was started in the early period. Conclusion: Drugs that block TNF-? and ustekunimab cause an increase in viral replication. In literature, the HBV reactivation rate was approximately 1% in HBsAg-negative, anti-HBC IgG-positive cases, whereas it was found to be as high as 17.2% in our study. Patients receiving the immunomodulator therapy should be evaluated for HBV serology before treatment and carefully monitored for HBV reac- tivation during and after treatment

15-year evaluation of changes in the HBsAg positivity rate in pregnant women in Turkey: the prominent effect of national vaccination

Background: The detection of hepatitis B surface antigen positivity in pregnant women before delivery is crucial to preventing mother-to-child transmission of hepatitis B virus.Aims: This study aimed to evaluate the status and rate of testing for hepatitis B surface antigen, rate of hepatitis B surface antigen positivity, hepatitis B surface antigen positivity distribution rate by age, and changes in hepatitis B surface antigen positivity rate in pregnant women over the study period.Methods: We conducted a multicentre, cross-sectional, descriptive study covering the period January 2005 to June 2019 for 2 145 668 pregnant women from 27 provinces in all 7 regions of Turkey, collected using Microsoft Excel before statistical analysis.Results: We found that 1 012 593 (47.1%) pregnant women were tested for hepatitis B surface antigen over the 15-year period, out of which 11 471 (1.1%) were hepatitis B surface antigen-positive. Overall, 97% of the hepatitis B surface antigen positive women were born before 1998, the year that national HBV vaccination was launched in Turkey. The rate of hepatitis B surface antigen positivity in that group was 1.1%, compared with 0.3% among women born after 1998.Conclusion: There was a downward trend in the hepatitis B surface antigen positivity rate among pregnant women in the younger age groups, especially among those born after universal hepatitis B vaccination was inaugurated, and low rate of HBsAg testing during pregnancy

Healthcare personnel’s attitude and coverage about tetanus vaccination in Turkey: a multicenter study

The tetanus vaccine is not routinely given to Turkish adults. Protective tetanus immunity decreases with age. Health-care personnel (HCPs), who are role models in the field of health, are a target group in order to achieve a higher rate of tetanus vaccination in the community. This study was designed to evaluate attitudes and coverage regarding tetanus vaccination among a large sample of Turkish HCPs. This cross-sectional epidemiologic study was conducted from July to August 2019. A questionnaire was sent to HCPs using social media. Of the 10,644 HCPs included in the study, 65% were female. Overall, the tetanus vaccination coverage (TVC) among HCPs was 78.5% (95% CI: 77.7%-79.3%). TVC was significantly higher among physicians [83.4% (95% CI: 82%-84.6%); p < .001] compared with all other HCPs except nurses. Older age (≥40 years) and length of professional experience were significantly correlated with TVC. Of the 8353 HCPs who received tetanus vaccines during their lifetime, 73.03% received tetanus vaccination in the past 10 years. The self-vaccination rate for protection against tetanus was 13.1%. Acute injuries (25.42%) and pregnancy (23.9%) were the most common reasons for having the tetanus vaccine. One-third (33.7%) of HCPs did not have information about whether pregnant women could receive tetanus vaccinations. This survey study provided excellent baseline information about HCPs’ coverage rates and attitudes regarding tetanus vaccination. The present results suggested that tetanus boosters for HCPs should be established as soon as possible, and revealed that the HCPs younger than 30 years with relatively less professional experience and all other HCPs except nurses and physicians should be identified as the target population for future intervention programs