Effects of the COVID-19 pandemic on follow-ups and immunization: An example from a district

Aim: We aim to compare the past trajectory of immunization services and different types of follow-ups with their current states during the COVID-19 pandemic. Methods: This cross-sectional study was conducted in a district of Istanbul in February 2020, and included 138 Family Medicine Units. Services were compared monthly between 2019 and 2020, based on the antenatal, postpartum, infant, child follow-ups, and vaccine doses provided by the units. To examine the impact of the pandemic, the April-December periods of both years were also compared. Results: It was found that follow-ups and immunizations were continued without any decline despite an increase in delayed vaccines. When the monthly mean number of delayed vaccines were compared, the mean number of delayed vaccines was significantly higher in April-May-June 2020 than in the same months of the previous year. Conclusion: Performance scores of different services do not differ according to the descriptive characteristics of physicians. Although physicians are successful in services such as follow-ups, delayed vaccines are prevalent among them as well. While services that can be carried out remotely seem to be continued, services that require face-to-face contact are interrupted. Interventions should be done to ensure the sustainability of indispensable services even during extraordinary times

Correlation between the serum and tissue levels of oxidative stress markers and the extent of inflammation in acute appendicitis

OBJECTIVES: To determine the serum and tissue levels of markers of impaired oxidative metabolism and correlate these levels with the histopathology and Alvarado score of acute appendicitis patients. METHOD: Sixty-five acute appendicitis patients (mean age, 31.4±12.06 years; male/female, 30/35) and 30 healthy control subjects were studied. The Alvarado score was recorded. Serum samples were obtained before surgery and 12 hours postoperatively to examine the total antioxidant status, total oxidant status, paraoxonase, stimulated paraoxonase, arylesterase, catalase, myeloperoxidase, ceruloplasmin, oxidative stress markers (advanced oxidized protein products and total thiol level) and ischemia-modified albumin. Surgical specimens were also evaluated. RESULTS: The diagnoses were acute appendicitis (n = 37), perforated appendicitis (n = 8), phlegmonous appendicitis (n = 12), perforated+phlegmonous appendicitis (n = 4), or no appendicitis (n = 4). The Alvarado score of the acute appendicitis group was significantly lower than that of the perforated+phlegmonous appendicitis group (p = 0.004). The serum total antioxidant status, total thiol level, advanced oxidized protein products, total oxidant status, catalase, arylesterase, and ischemia-modified albumin levels were significantly different between the acute appendicitis and control groups. There was no correlation between the pathological extent of acute appendicitis and the tissue levels of the markers; additionally, there was no correlation between the tissue and serum levels of any of the parameters. CONCLUSIONS: The imbalance of oxidant/antioxidant systems plays a role in the pathogenesis acute appendicitis. The Alvarado score can successfully predict the presence and extent of acute appendicitis

COVID-19 prevalence among primary healthcare workers

COVID-19 pandemisiyle mücadelede ön safta görev yapan sağlık çalışanlarında hastalığa yakalanma riski toplumun birçok kesimine kıyasla daha yüksektir. Risk altındaki bazı grupların zaman zaman taranması vakaların erken dönemde tespiti için önemlidir. Ülkemizde filyasyon, vaka ve temaslı takibi uygulamaları ilçe sağlık müdürlüğü (İlçe SM) ve aile sağlığı merkezi (ASM) çalışanları tarafından yürütülmektedir. Bu çalışmanın amacı, birinci basamak sağlık çalışanlarında COVID-19 görülme sıklığının incelenmesidir. Tanımlayıcı kesitsel türde olan bu araştırmanın evrenini Nisan 2020 itibariyle İstanbul ili Üsküdar ilçesinde görev yapmakta olan 627 birinci basamak sağlık hizmeti çalışanı oluşturmaktadır. 13-30 Nisan 2020 tarihlerinde İlçe SM tarafından yapılan SARS-CoV-2 PCR testi taramasına katılan 586 sağlık çalışanına ait veriler dahil edilerek, tarama dönemine ait nokta prevalans ve Nisan 2020-Nisan 2021 dönemine ait süre prevalans hesaplanmıştır. Katılımcıların yaş ortalaması 38,5±10,3 olup %73,7’si kadındır ve %68,3’ü ASM’de görev yapmaktadır. Tarama sonucuna göre tüm grupta %8,5 olan nokta prevalans; İlçe SM’de %15,1 ve ASM’de %5,5’tir (p<0,001). Süre prevalans ise tüm grupta %25,9 olup İlçe SM’de %34,9 ve ASM’de %21,8’dir (p=0,001). 30.04.2021 itibariyle katılımcıların %17,1’i hiç aşı yaptırmamıştır. ASM çalışanlarına göre daha kalabalık bir ortamda görev yapan İlçe SM çalışanlarında hastalığın daha sık görülmesi hem kurum içi temas ve vaka kümelenmesi açısından dikkatli olunması hem de vakalarla temas edilirken kişisel koruyucu önlemlere üst düzeyde uyulması gerektiğine işaret etmektedir. Aşı uygulamasının başlangıcından 3,5 ay geçmesine rağmen aşı yaptırmayan sağlık çalışanlarının azımsanmayacak düzeyde olması dikkat çekicidir.Healthcare workers have been fighting against the COVID-19 pandemic with a higher risk than many parts of the population. Screening of some specific groups at regular intervals is important to detect cases earlier. Case and contact tracing (filiation) in Turkey are carried out by the district health directorates (DHD) and family health centers (FHC). The aim of this study is to examine the COVID-19 prevalence among primary healthcare workers. The population of this cross-sectional study consists of 627 primary healthcare workers in Uskudar, Istanbul as of April 2020, including the data on 586 healthcare workers who participated in the SARS-CoV-2 PCR-test screening on 13-30 April 2020. The point prevalence of the screening period and the period prevalence of April 2020-April 2021 were calculated. 68.3% of the participants were working in FHC. According to the screening results, the point prevalence was 8.5% in the whole group, 15.1% in DHD and 5.5% in FHC (p<0.001). The period prevalence was 25.9% in the whole group, 34.9% in DHD and 21.8% in FHC (p=0.001). As of 4/30/2021 17.1% of the participants have never been vaccinated. The fact that the disease is more common among the DHD staff, it is necessary to be careful regarding workplace contact and case clustering, and to maintain personal protective measures strictly during contact tracing. It is noteworthy that the level of health workers who did not get vaccinated despite the fact that 3.5 months have passed since the start of the vaccination is not to be underestimated

Gastrointestinal quality of life in patients with asymptomatic cholelithiasis after laparoscopic cholecystectomy

To assess the outcome of laparoscopic cholecystectomy for asymptomatic cholelithiasis before and after laparoscopic cholecystectomy using a specific quality of life instrument for gastrointestinal disorders in adults : The Gastrointestinal Quality of Life Index (GIQLI) was used to study the quality of life in patients before and after laparoscopic cholecystectomy : Seventy one patients completed the GIQLI questionnaire both preoperatively and after a minimum postoperative follow-up of three months. Mean preoperative score was 126.8±14.07 out of a theoretical maximum score of 144.After three months, the score had significantly improved to 136.6±9.31, close to the range for the normal population. Not only items assessing gastrointestinal symptoms but also the domains of physical, social, and emotional function improved significantly. The most marked improvements were achieved in patients with the lowest preoperative scores. Laparoscopic cholecystectomy significantly improves the quality of life in patients with cholelithiasis who are asymptomatic or have nonspecific gastrointestinal symptoms that cannot be explained by another gastrointestinal pathology.Bu çalısmada asemptomatik kolelitiyazis olgularının ameliyat öncesi ve ameliyat sonrası hayat kalitesi degerlendirilmistir. Hastaların ameliyat öncesi ve sonrası hayat kalitelerinin ölçümü gastrointestinal hayat kalitesi indeksi parametreleri kullanılarak belirlenmistir. Çalısmaya alınan 71 hasta ameliyat öncesi ve ameliyattan en az 3 ay sonra gastrointestinal hayat kalitesi indeksine göre sorgulanmıstır. Preoperatif dönemde ortalama skor 126.8±14.07, 3 ay sonra yapılan sorgulamada ise ortalama 136.6±9.31 olup normal populasyona yakın bir oranda saptanmıstır. (toplam skor 144). Gastrointestinal semptomlarının yanı sıra fiziksel, sosyal ve duygusal durumlarında da anlamlı düzelme gözlenmistir.Düsük skorlu hastalarda bu iyilesmedaha belirgindir. Asemptomatik kolelitiyazisli hastalarda baska gastrointestinal patolojilerle açıklanamayan nonspesifik semptomların laparoskopik kolesistektomiyle iyilesme gösterdigi, hastaların hayat kalitelerinde anlamlı bir artıs oldugu görülmektedir

Akut koroner olaylarda endotelinin rolü

Bu prospektif klinik çalışmada; AMI ve UAP'lı hastalarda, atheroskleroz ve akut koroner iskemik olayların fizyopatolojisinde önemli rol oynadığı düşünülen ETlerin, akut olay esnasındaki plazma düzeylerinin tesbiti ve farkh yöntemlerle tedavi edilen hastalarda plazma ET düzeylerinin zaman içindeki seyrinin takibi amaçlandı. Çalışmaya klinik, biyokimyasal ve elektrokardiyografik olarak AMI tanısı konmuş 20 hastanın, çeşidi nedenlerle trombolitik tedavi yapılamayan 10 tanesi iskemi grubu ve trombolitik tedavi yapılan 10 tanesi ise farmakolojik reperfüzyon grubu olarak alındı. Yeni başlayan angina progresif angina ve postmiyokard infarktüs angina nedeniyle selektif koroner anjiografileri yapılan ve PTCA karan alınan 11 hasta girişimsel reperfüzyon grubu olarak alındı. Çalışmaya alınan tüm olguların CPK, CK-MB, SGOT, LDH enzimlerinin günlük takibi yapıldı. Total kolesterol, LDL, HDL, trigliserid düzeyleri tesbit edildi. Ekokardiyografi ve/veya ventrikülografi ile EF'leri tesbit edildi, îskemi grubunda hastaneye kabulde, 1. saatte ve 7. saatte, farmakolojik reperfüzyon grubunda kabulde, trombolitik tedavi bitiminde 15 dakika sonra ve 7. saatte, plazma ETı düzeyleri için kan örneği alındı, Girişimsel reperfüzyon grubunda ise işlem öncesi, işlemden 15 dakika sonra ve 7. saatte plazma ETı düzeyleri için kan örneği alındı. İskemi grubundaki 10 olgudan 2'si (%20) kadın, 8'i (%80) erkek ve yaş ortalamaları 61.3±12.4 yıl idi. Farmakolojik reperfüzyon grubundaki 10 olgudan biri (%10) kadın, 9'u (%90) erkek ve yaş ortalamaları 51.4±8.7 yıldı. Girişimsel reperfüzyon grubundaki 11 olgudan biri (%9.1) kadın, 10'u (%90.9) erkek ve yaş ortalamaları 53.5±11.5 yıl idi. Olgular arasında yaş, cinsiyet, EF, T Kol, trigliserid açısından bir fark yoktu. Enzimlerin karşılaştırılmasında, sadece CK-MB düzeyleri karşılaştırıldı. İskemi ve farmakolojik reperfüzyon gruplarında, girişimsel reperfüzyon grubuna göre CK-MB düzeyleri istatistiksel açıdan anlamlı olarak (p<0.0001) yüksekti. İlk alınan ETı düzeyleri yönünden gruplar arasında bir fark yoktu. 2. ETı düzeylerinde ise iskemi grubu ile farmakolojik reperfüzyon grubu arasında fark yokken, iskemi ve 41farmakolojik reperfüzyon grublannda girişimsel reperfüzyon grubuna göre anlamlı olarak (p<0.05) (p<0.01) yüksekti. 3. ETı değerleri yönünden farmakolojik ve girişimsel reperfüzyon grublan arasında fark yokken, iskemi grubunda hem farmakolojik (p<0.02) ve nemde girişimsel reperfüzyon (p<0.01) grubundan anlamlı yüksek bulundu. L, 2. ve 3. ETı değerleri iskemi grubunda anlamlı olarak artmış bulunurken (p<0.01) ve (p<0.01), farmakolojik reperfüzyon grubunda 2. ETı değeri 1. ve 3. ETı değerlerinden anlamlı olarak yüksekti (p<0.05) ve (p<0.05) ve 1. ve 3. ETı değerleri arasında anlamılı farklılık yoktu. Girişimsel reperfüzyon grubunda 1., 2. ve 3. ET] değerleri anlamlı olarak (p<0.01), (p<0.05) azalmıştı. Sonuç olarak; iskemi grubunda ETı değerleri düzenli şekilde artarken, girişimsel reperfüzyon grubunda azamaktadır. Farmakolojik reperfüzyon grubunda ise reperfüzyondan hemen sonra ETı düzeylerinde artış görülürken, 7. saatte anlamlı azalma gözlenmektedir. Literatürdeki normal değerlere, göre akut iskemik koroner olaylarda plazma ETı düzeyleri anlamlı olarak yüksek bulunmuştur. Reperfüzyon sağlanamayan olgularda, ET yükselişi devam ederken reperfüzyon sağlanan olgularda hızlı bir düşüş saptanmaktadır.Endothelins are thought to play an important role in pathophysiology of atherosclerosis and acute coronary ischemic events in patients with acute myocardial infarction (AMI) and unstable angina (UAP). In this prospective clinical study; we aimed to determine plasma levels of endothelins during acute ischemic event and we followed the course of plasma endothelin levels in patients treated with different methodes. 20 patients diagnosed as AMI by clinical, biochemical and electrocardiographical findings are included in the study. 10 of them couldn't take thrombolytic thraphy and was accepted ischemia group. The other group talcing thrombolytic thraphy was accepted as pharmacological reperfusion group. Cases with new onset angina, progressive angina and post MI angina for which PTCA are planned as result of coronary aniography were taken as interventional reperfusion group. Daily follow up of CPK, CK-MB, SGOT and LDH enzymes was made in all patients. Total cholesterol, LDL, HDL and TG level were determined. Ejection fraction was calculated by echocardiography and/or ventriculography. Blood samples were taken for ET plasma levels on admission, at 1st and 7th hours in ischemic group; on admission, 15 minutes after thrombolytic thraphy and at 7th hour in pharmacological reperfusion group. In interventional reperfusion group, blood samples were taken before and 15 minutes after procedure and at 7th hour. 2 of 10 cases in ischemia group were female, and 8 of them (80%) were male with a mean age of 61.3 ± 12.4 years. 1 of 10 cases in pharmacological reperfusion group was female (10%), 9 of them were males with a mean age of 51.4 ± 8.7 years. One female (9.1%) and 10 male (90.9%) 11 cases as total with a mean age of 53.5 ± 11.5 years were included interventional reperfusion group. There was no different between cases from the point of age, sex, EF, T. chol. and tryglycelides. As enzymes only CK-MB levels were compared. It was significantly higher (p<0.0001) in ischemic and pharmacologic reperfusion groups as compared to 43interventional reperfusion group there was no difference between groups in the first ET levels. In second ET levels while there was no difference between ischemia and pharmacological reperfusion group, it was significantly higher (p<0.05) (p<0.01) in these groups as compared to interventional reperfusion group. Third ET levels were found significantly higher (p<0.02) (p<0.01) in ischemia group than the other groups although there was no signicant difference between pharmacological and interventional reperfusion groups. Although 1st, 2nd and 3rd ET levels (p<0.01) (p<0.01) increased significantly in ischemia group 2nd ET level was significantly higher (p<0.05) (p<0.05) than 1st and 3rd ones and also there was no significant difference between 1st and 3rd levels in pharmacological reperfusion group. In interventional reperfusion group, all ET levels decreased significantly (p<0.0l) (p<0.05). As a conclusion; ET levels increased progressively in ischemia group while decreasing in interventiol reperfusion group. In pharmacological reperfusion group, ET level increased soon after reperfusion and significant decreased was observed at 7th hour plasma ET levels were found significanly higher in acute ischemic coronary events as compared to normal values in literature. A rapid decrease was observed in cases with succesfull reperfusion while it continues to increase in others

Cardiac enzymes and troponin I levels displaying myocardial injury in patients with coronary artery disease undergoing succesfully percutaneous coronary interventions

AMAÇ: Çalışmamızda komplikasyonsuz PTCA ve intrakoroner stent uygulanan koroner arter hastalarında oluşabilecek minimal miyokard hasarının saptanmasında kardiyak enzimler ve cTn I nin klinik kullanılabilirliğini araştırdık. GEREÇ VE YÖNTEM: Çalışmaya toplam 71 hasta alındı. Bu hastalardan işlem sırasında AMI gelişen 1 hasta ve anjiyografik yan dal oklüzyonu gözlenen 10 hasta çalışma dışı bırakıldı. Sonuçta 49'u (%81,7) erkek, 11'i (%18,3) kadın 60 hasta çalışma grubunu oluşturdu. Tüm olgular işlem öncesi hastaneye yatırıldı. En az iki günlük tedaviden sonra PTCA ve/veya stent uygulandı. Hastalardan hemen işlem öncesinde bir defa, işlem sonrası 6 ve 18 saat olmak üzere iki kan örneği alındı. Kardiyak enzimler ve troponin I düzeyleri çalışıldı. PTCA sonrası akut oklüzyon gelişen, anjiyografik olarak gösterilebilen yan dal tıkanması olan ve akut miyokard infarktüsü seyrinde yapılan PTCA lar çalışma dışı bırakıldı. BULGULAR: Troponin düzeylerinde gözlenen değişiklikler troponin I için infarktüs cut-off sınırı olan 1,5 ng/ml ye ulaşmadı. Ancak işlem öncesi ile işlem sonrası 6 saat (1,29±0,72 ng/ml) ve 18. saat (1,10±0,53ng/ml) değerler arasında istatistiksel olarak anlamlı artış vardı (p0,05). SONUÇ: İşlem öncesi ve sonrası cTnI düzeylerindeki farklılığın diğer kardiyak enzimlerin duyarlı olmadığı minimal miyokardiyal hasara bağlı olduğu düşünüldü. Bu minimal hasar balon şişirilmesi esnasında oluşan iskemi ve lezyon bölgesindeki anjiografik olarak görülemeyen küçük yan dal tıkanmasına bağlı olarak veya distal mikroembolizasyona bağlı olarak oluşabilir. Sonuç olarak Troponin I PTCA sonrası hastaların takibinde oluşabilecek minimal miyokardiyal nekrozun saptanmasında kullanılabilecek hassas bir metot olabileceği kanısına varıldı.AIM: We aimed to investigate the clinical value of cardiac enzymes and troponin I to detect the myocardial damage likely to develop in patients with coronary artery disease undergoing PTCA and intracoronary stenting. MATERIAL AND METHOD: Forty nine males (81.7%) (mean age 63,2 ±8,6) and 11 females (mean age 65,6±8,2) as a total of 60 patients undergoing intervention were included in the study. Forty two of them (70,0%) were applied in coronary stenting. All cases were hospitalized. After 2 days long treatment, PTCA and/or stenting was performed. Three venous blood samples were taken from the patients just prior to the intervention and at 6th and 18th hours thereafter. Cardiac enzyme and troponin I levels were studied. Cases complicated by acute occlusion or angiographically demonstrated side-branch occlusion and patients undergoing PTCA during the course of acute myocardial infarction were excluded. RESULTS: Changes in the levels of Tn I didn't reach the cut-off point for infarction, that's 1,5 ng/ml. But, difference between the value measured prior to the intervention and at 6th and 18th hours thereafter was statistically significant (p0,05). CONCLUSION: This minor damage may occur as a result of ischemia caused by inflation of balloon or a side branch occlusion that could not be demonstrated by angiographically can this damage. Consequently measurements of Tn I levels is a sensitive method that can be used to detect myocardial necrosis likely to develop during follow up of patients after PTCA

In-Hospital cost comparison of transcatheter closure versus surgical closure of secundum atrial septal defect

Introduction: We compared transcatheter and surgical closure of secundum atrial septal defects (ASDs) in terms of cost in this study. Materials and Methods: Between 2006 and 2015, 291 consecutive patients having secundum ASD, in whom percutaneous or surgical closure was performed, were included in this study. We compared the in-hospital cost of transcatheter versus surgical ASD closure in these patients. Results: We collected totaly 291 patients, 214 transcatheter and 77 surgical closure procedures, retrospectively. Patients with a surgical closure had a longer length of stay (11.8 ± 3.8 days vs. 2.8 ± 1.6 days, P < 0.001). There was no in-hospital mortality in two groups. Costs denominated in Turkish lira (TL) and United States Dollar (USD) of transcatheter closure were higher than that of surgical closure (TL 10955.6 ± 183.4 vs. TL 6016.7 ± 371.9 P < 0.001; USD 6531.2 ± 149.62 vs. USD 3896.2 ± 234.7 P < 0.001). The cost of percutaneous ASD closure increase does not correlate with the dollar rate on the annual basis. This with the supplier firms has excessive profits in the first year of the study. Conclusion: Compared with other countries with regard to cost, transcatheter ASD closure is a more expensive treatment than surgical closure in our country