Distance Education in Medical Schools: the Experience and Opinions of Academicians and Students

DergiPark: 819194tmsjAims: This study aims to identify the thoughts and opinions of medical schools’ students and academicians about the distance medical education and examination system that has been rapidly applied during the COVID-19 pandemic Methods: A ques- tionnaire was prepared via Google Forms which consisted of a total of 3 sections. Informed consent was obtained in the first section and participants were directed to “student” or “academician” section. There were 28 questions for the students and 24 questions for the academicians. Categorical variables were demonstrated as numbers and percentages, whereas continuous variables were presented as minimum, maximum, and mean values. Chi-squared test was used to compare preclinic and clinic year students, and the academicians in preclinic, medical, and surgical fields. Results: A total of 321 participants completed the questionnaire. The mean participant ages were 21.4 years and 41.68 years for the students and the academicians, respectively. Only 30% of the students thought the distance education lessons were beneficial while it was 35.5% for the academicians. 25.8% of the academicians and 29.6% of the students were indecisive on the matter. When the examination process was taken into account 67.7% of the academicians and 56.9% of the students thought the online examinations were not reliable. Conclusion: It is predicted that the pandemic process will continue in the next academic years. Considering the current situation, distance education seems to be the best option to ensure that the learning process can continue while protecting the health of students and academicians. Although distance education is not sufficient by itself in medical education during and after the COVID-19 pandemic, it is a method that should be used in almost every field of medical education, especially in the preclinical phase. Both the distance education, and online examination process require improvements and they are needed to be supported with face to face lectures and practices

Comparison of immunogenicity and reactogenicity of inactivated SARS-CoV-2 vaccine (CoronaVac) in previously SARS-CoV-2 infected and uninfected health care workers

The effects of inactivated SARS-CoV-2 vaccine (CoronaVac) on previously naturally infected individuals are unknown. This study compared immunogenicity and reactogenicity of CoronaVac in once naturally infected health-care workers (HCWs) and uninfected HCWs. All HCWs were immunized with two doses of CoronaVac (600 U/0.5 ml) intramuscularly at a 28-day interval. Adverse reactions were obtained by web-based questionnaires or telephone calls seven days after each vaccine dose. Detection of antibody levels against the receptor-binding domain (RBD) of SARS-CoV-2 spike protein was done four weeks after the second dose of the vaccine. We enrolled 103 previously naturally infected and 627 uninfected HCWs. The mean time for vaccination after the first nasopharyngeal SARS-CoV-2 positivity was 64 days (range: 15-136 days) in previously naturally infected HCWs. Among the previously naturally infected HCWs, 41 (40%) were asymptomatic, 52 (50%) had mild upper respiratory tract infections, 10 (105) had pneumonia, and only 6 (5%) were hospitalized. Any reported adverse reactions, either from the first dose or the second dose of vaccine administration, did not differ between previously infected and uninfected HCWs. Anti-RBD antibody titers were obtained in 50 (51%) of 103 previously infected HCWs and 142 (23%) of 627 uninfected HCWs. Anti-RBD antibody titers were significantly higher in HCWs with a previous natural infection (median 1220 AU/ml, range: 202-10328 AU/mL) than in uninfected HCWs (median: 913 AU/ml, range: 2.8-15547 AU/mL, p = .032). CoronaVac administration was safe and may elicit higher antibody responses in previously naturally infected individuals

Comparison of immunogenicity and reactogenicity of inactivated SARS-CoV-2 vaccine (CoronaVac) in previously SARS-CoV-2 infected and uninfected health care workers

The effects of inactivated SARS-CoV-2 vaccine (CoronaVac) on previously naturally infected individuals are unknown. This study compared immunogenicity and reactogenicity of CoronaVac in once naturally infected health-care workers (HCWs) and uninfected HCWs. All HCWs were immunized with two doses of CoronaVac (600 U/0.5 ml) intramuscularly at a 28-day interval. Adverse reactions were obtained by web-based questionnaires or telephone calls seven days after each vaccine dose. Detection of antibody levels against the receptor-binding domain (RBD) of SARS-CoV-2 spike protein was done four weeks after the second dose of the vaccine. We enrolled 103 previously naturally infected and 627 uninfected HCWs. The mean time for vaccination after the first nasopharyngeal SARS-CoV-2 positivity was 64 days (range: 15-136 days) in previously naturally infected HCWs. Among the previously naturally infected HCWs, 41 (40%) were asymptomatic, 52 (50%) had mild upper respiratory tract infections, 10 (105) had pneumonia, and only 6 (5%) were hospitalized. Any reported adverse reactions, either from the first dose or the second dose of vaccine administration, did not differ between previously infected and uninfected HCWs. Anti-RBD antibody titers were obtained in 50 (51%) of 103 previously infected HCWs and 142 (23%) of 627 uninfected HCWs. Anti-RBD antibody titers were significantly higher in HCWs with a previous natural infection (median 1220 AU/ml, range: 202-10328 AU/mL) than in uninfected HCWs (median: 913 AU/ml, range: 2.8-15547 AU/mL, p = .032). CoronaVac administration was safe and may elicit higher antibody responses in previously naturally infected individuals

Diagnostic-therapeutic approach for acute diarrheal children in our pediatric outpatient clinics; direct medical cost analysis

İshal, tüm dünyada çocukluk yaş grubu için önemli bir sağlık sorunudur. Akut ishal için literatürde iyi belirlenmiş tanı ve tedavi akış şemaları mevcuttur. Çoğu zaman hastalar bu şemalara göre izlenmemekte, uygunsuz hastane yatışları yapılmakta, gereksiz tetkik ve tedaviler uygulanmaktadır. Çalışmamız akut ishal tanısı alan 342 hasta ile yapıldı. Hastaların 156 sı (%45,6) kız, 186 sı (%54,4) erkekti. Olguların %82,7 si çocuk acile, %17,3 ü genel çocuk polikliniğine (GÇP) başvurmuştur. Ortalama yaş 52,2 ± 56,4 ay olarak saptandı. En sık başvuru şikayetinin ishal ve kusma olduğu belirlendi (%30,4). Sadece %5 hastada değişik derecelerde dehidratasyon saptandı. Tetkik edilen hasta sayısı 257 (%75,1) olup, en sık (%52,6) istenen tetkik dışkı wright boyamasıydı. Sadece beslenme önerileri ile çıkışı yapılan hasta oranı %71,3 olup, %28,7 hastaya herhangi bir medikal tedavi uygulandığı belirlendi. En sık uygulanan medikal tedavi %14,6 oranla damar içi sıvı tedavisi idi. Çalışmamızda SGK ya gönderilen çıkış fatura verilerine göre direk tıbbi maliyet analizi yapıldı. Kişi başı ortalama olarak toplam hastane maliyeti 38,17 ± 22,23 ¨ (Türk Lirası), toplam tetkik maliyeti 18,49 ± 16,14 ¨, hastanede uygulanan tedavi maliyetide 4,39 ± 10,31 ¨ olarak hesaplandı. Güncel ve kabul görmüş akış şemaları önerilerince hastalara uygulanan tetkik ve tedaviler belirlenip, uygun ve uygun olmayan tetkik ve tedavi maliyetleri hesaplandı. Uygun ve uygunsuz tetkik maliyetleri sırasıyla kişi başı ortalama 5,42 ± 9,82 ¨ ve 13,04 ± 14,80 ¨ olarak bulundu. Uygun ve uygun olmayan hastanede tedavi maliyeti ise sırasıyla kişi başı ortalama 0,42 ± 3,48 ¨ ve 3,96 ± 9,88 ¨ olarak bulundu. Uygunsuz tetkik maliyeti, tüm tetkik maliyetinin %70 ini, uygunsuz hastanede tedavi maliyeti ise tüm tedavi maliyetinin %90 ını oluşturmaktaydı. Çalışmamızda çocuk acil ve GÇP ne başvuran hastalar tanı-tedavi yaklaşımı ve direk maliyet analizleri açısından karşılaştırıldı. İki grup arasında demografik özellikler açısından anlamlı fark yoktu. Başvuru şikayetleri karşılaştırıldığında ishal şikayeti GÇP grubunda, kusma şikayeti ise çocuk acil grubunda anlamlı olarak fazla bulundu (p<0,05). Fizik muayene bulguları ve dehidratasyon dereceleri açısından iki grup arasında anlamlı fark saptanmadı. İstenen tetkikler karşılaştırıldığında ise; CBC, CRP, serum ürik asit düzeyi, dışkı Gr-Wr boyama, dışkıda RV antijeni aranması ve dışkı kültürünün GÇP grubunda anlamlı oranda fazla istendiği belirlendi. Tedavi yaklaşımı incelendiğinde ise antibiyotik ve damar içi sıvı tedavisinin çocuk acil grubunda anlamlı oranda fazla uygulandığı saptandı. Toplam hastane maliyeti GÇP ve çocuk acil grubunda sırasıyla kişi başı ortalama 41,15 ± 19,44 ¨ ve 37,54 ± 22,75 ¨ olarak hesaplandı Toplam hastane maliyeti ve uygun hastanede tedavi maliyeti iki grupta benzer bulundu. Diğer tüm maliyetler GÇP grubunda anlamlı olarak fazla saptandı. Başta çocuk hekimleri olmak üzere sağlık hizmeti sunan tüm bireylerin akut ishal için uygun tetkik ve tedavi yaklaşımlarını uygulamalarını hedefleyerek, sağlık hizmetleri maliyetlerinin azaltılmasının mümkün olacağı düşünüldü.Diarrhea is a major health problem all over the world for the pediatric age group. Well defined guidelines for the diagnosis and treatment of acute diarrhea are available in the literature. However, patients usually are not followed as per these guidelines and made inappropriate hospitalized, unnecessary laboratory tests and treatments are applied. Our study included 342 acute diarrheal patients (156 females and 186 males). The study was performed 283 (82.7%) patients were admitted to the pediatric emergency department and 59 (17.3%) patients were admitted to general pediatric outpatient clinics (GPOC). The mean age was 52.2 ± 56.4 months. The most common complaint was diarrhea and vomiting (30.4%). Only 5% of patients had varying degrees of dehydration. Laboratory tests were requested from 257 (75.1%) patients and the most common requested test was (52.6%) stool wright examination. 71.3% of patients were discharged with only dietary advice and other medical treatments were applied 28.7% of the patients. The most applied medical treatment is intravenous fluid therapy (14.6%). Within the study direct medical cost analysis has been executed by using National Social Security Institution bills. The cost of the avarage case of acute diarrheal is 38,17 ± 22,23 ¨ (Turkish Liras) and the avarage cost of laboratory tests is 18,49 ± 16,14 ¨. The avarage cost of treatment in hospital is calculated as 4,39 ± 10,31 ¨. The cost of proper and improper laboratory and treatment costs are calculated as per current and well known guidelines. Proper and improper laboratory costs are 5,42 ± 9,82 ¨ and 13,04 ± 14,80 ¨, respectively. Proper and improper treatment in hospital costs are also calculated 3,96 ± 9,88 ¨ and 0,42 ± 3,48 ¨, respectively. Improper laboratory cost is correspond to 70% of all laboratory cost and improper treatment in hospital cost is correspond to 90% of all treatment in hospital. In our study, pediatric emergency and GPOC groups are compared in accordence with diagnostic, therapeutic management and direct medical cost. There was no significant difference between the two groups from the point of demographic characteristics (age, gender). Diarrhea complaint at the GCOP group is higher than pediatric emergency group. Vomit complaint at the pediatric emergency group is higher than GCOP. There was no significant difference between the two groups from the point of physical examination findings and degree of dehydration. CBC, CRP, serum uric acid levels, stool gram-wright test, stool RV antigen and stool culture tests were conducted at the GCOP group more than pediatric emergency group. Antibiotics and intravenous fluid therapy are executed at the emergency group more than GCOP group. Cost analysis of the two groups were compared and it is found that total hospital cost and proper treatment in hospital cost are similar. All other costs was higher in GCOP group. Total hospital cost in GCOP and pediatric emergency groups are 41,15 ± 19,44 ¨ and 37,54 ± 22,75 ¨ respectively. The medical costs can be reduced by following proper diagnostic and treatment management for acute diarrhea by health personals especially pediatricians

Human Immunodeficiency Virus (HIV)-Negative and Human Herpes Virus-8 (HHV-8)-Positive Primary Effusion Lymphoma: A Case Report and Review of the Literature

Primary effusion lymphoma (PEL) is a rare type of non-Hodgkin lymphoma that presents with serosal effusion in body cavities, without obvious tumor masses. Although PEL occurs in immunocompromised patients that are human immunodeficiency virus (HIV) positive, it also occurs in immunocompetent human herpes virus-8 (HHV-8)-positive patients. Herein we present an immunocompetent, HIV-negative, CD-20-negative, HHV-8-positive patient with pleural effusion that was diagnosed as PEL. The CHOP protocol and talc pleurodesis were administered. HHV-8 plays a causative role in PEL and is important for differentiating PEL from other types of lymphoma. As such, in addition to pleurodesis antiviral treatment should be considered for optimal treatment outcome

Comparison of clinical and laboratory features and treatment options of 237 symptomatic and asymptomatic children infected with SARS-CoV-2 in the early phase of the COVID-19 pandemic in Turkey

Since the first report of COVID-19 in December 2019, little is known about therapeutic usage of hydroxychloroquine in pediatric patients with COVID-19. We retrospectively retrieved data for SARS-CoV-2 PCR positive pediatric patients from 20 hospitals in 8 different cities in Turkey. We obtained patients' epidemiological, clinical, laboratory features and drugs used for treatment of COVID-19. 237 nasopharyngeal swab SARS-CoV-2 PCR positive children were included into the study from March 26 to June 20, 2020. The mean age of asymptomatic children (118±62 months) was found to be higher than that of symptomatic children (89±69 months). Symptomatic children had a significantly lower mean lymphocyte count and higher mean CRP, D-dimer value, procalcitonin and LDH than asymptomatic children in univariate analysis. Out of 156 children, 78 (50%) children received Hydroxychloroquine-containing regimen, 15 of them were treated with hydroxychloroquine + azithromycin + oseltamivir, 44 were treated with hydroxychloroquine + azithromycin and 21 were only treated with hydroxychloroquine. Among the 156 patients who received medical treatment, 90 (58%) patients had pre and/or post-treatment ECG performed upon them. However, none of them either reported ECG abnormalities or a need for discontinuation of hydroxychloroquine because of adverse drug reaction

A rare and emerging pathogen: Raoultella planticola identification based on 16S rRNA in an infant

Raoultella planticola is rarely associated with clinical infection, and a limited number of pediatric cases have been reported. Herein we report a case of bacteremia presumptively secondary to bilateral conjunctivitis in an infant caused by R. planticola which was successfully treated with piperacillin-tazobactam. It should be kept in mind that R. planticola can be a pathogen in pediatric age groups. Keywords: Infant, Conjunctivitis, Bacteremia, Raoultell