COVID-19 in pediatric nephrology centers in Turkey

Background/aim: There is limited data on COVID-19 disease in children with kidney disease. We aimed to investigate the characteristics and prognosis of COVID-19 in pediatric nephrology patients in Turkey. Materials and methods: This was a national, multicenter, retrospective cohort study based on an online survey evaluating the data between 11th March 2020 and 11th March 2021 as an initial step of a detailed pediatric nephrology COVID-19 registry. Results: Two hundred and three patients (89 girls and 114 boys) were diagnosed with COVID-19. One-third of these patients (36.9%) were between 10–15 years old. Half of the patients were on kidney replacement therapy: kidney transplant (KTx) recipients (n = 56, 27.5%), patients receiving chronic hemodialysis (n = 33, 16.3%) and those on peritoneal dialysis (PD) (n = 18, 8.9%). Fifty-four (26.6%) children were asymptomatic. Eighty-two (40.3%) patients were hospitalized and 23 (28%) needed intensive care unit admission. Fifty-five percent of the patients were not treated, while the remaining was given favipiravir (20.7%), steroid (16.3%), and hydroxychloroquine (11.3%). Acute kidney injury developed in 19.5% of hospitalized patients. Five (2.4%) had MIS-C. Eighty-three percent of the patients were discharged without any apparent sequelae, while 7 (3.4%) died. One hundred and eight health care staff were infected during the study period. Conclusion: COVID-19 was most commonly seen in patients who underwent KTx and received HD. The combined immunosuppressive therapy and frequent exposure to the hospital setting may increase these patients’ susceptibility. Staff infections before vaccination era were alarming, various precautions should be taken for infection control, particularly optimal vaccination coverage

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Evaluation of tooth-supported fixed prostheses encountered failures in Southeastern Anatolia Region

Amaç: Geleneksel diş destekli sabit protezlerin (GDSP) başarısızlığı pek çok araştırmaya konu olmuştur. Başarısızlıkların giderilmesi için yapılacak restorasyon ve bunun sonuçları hakkında öngörülü olunması önemlidir. Bu çalışmanın amacı GDSP'lerde başarısızlık düzeylerine ilişkin insidans sunmak ve prognoz açısından başarısızlık düzeyleri ile hasta cinsiyeti, yaşı, protez yapım materyali, üye sayısı ve kullanım süresi arasındaki ilişkiyi araştırmaktır. Yöntem: GDSP'sine bağlı şikayet ile başvuran 413 hasta muayene edildi. Protezlere ilişkin problemler, başarısızlık düzeyi sınıflaması kullanılarak cinsiyet, yaş, protez materyali, üye sayısı, ve kullanım süresi bakımından değerlendirildi. Aralarındaki ilişki, çapraz tablolar ile Pearson ki-kare, tekyönlü-ANOVA ve Spearman korelasyon testleri kullanılarak istatistiksel olarak analiz edildi (?=0.05). Bulgular: Başarısızlık sınıfı ile hasta cinsiyeti arasında ilişki bulunamazken (p>0.05), başarısızlık sınıfı ile protez yapım materyali arasında ilişki bulundu (p=0.014). Sınıf ile kullanım süresi, sınıf ile hasta yaşı ve sınıf ile protez üye sayısı arasında ileri düzeyde istatistiksel ilişki olduğu gözlendi (p0.05). Sonuç: Bu araştırmanın sonuçları, belirgin GDSP şikayeti ile kliniğe başvuran hastaların, çözülmesi görece zor bir problemle hekimin karşısına çıkabileceğini, güncel olmayan yapım materyali kullanılmış GDSP'lerin yüksek sınıfta değerlendirilme ihtimalinin yüksek olduğunu, uzun süreli kullanımda olan GDSP'lerde başarısızlık şiddetinin yüksek olacağını, protez üye sayısı ve hasta yaşı arttıkça GDSP'lerde gözlenen başarısızlık düzeyinin artacağını göstermiştir.Objective: The failure of conventional tooth-supported fixed prostheses (CTFP) has been a subjected to a many research studies. It is important to have a perspective for the correction of possible failures and consequences of such corrections. The aimed of this study was to present the incidence data on failure levels of CTFPs and to investigate the relation between failure levels, and patient gender and age, prosthesis material, number of unites and duration of use from prognosis's perspective of view. Methods:complaints related to their CTFPs were examined. Problems related to prostheses were assessed using a failure level classification in regard to gender, age, prosthesis material, number of unites, and duration of use. Relation between variables was statistically analysed using crosstabulations, Pearson chi-square, one-way-ANOVA and Spearman correlation tests (?=0.05). Results: There was no relation between failure class and patient gender (p>0.05), whereas there was one between failure class and prosthesis material (p=0.014). Significant statistical relation was observed between class and duration of prosthesis use, patient age, and the number of prosthesis units (p<0.01). There was also a relation between age and duration of use (p<0.01), and number of units (p<0.05), but not between the duration of use and number of units (p>0.05). Conclusion: As conclusions of the present study; it should be expected that patients referred to clinic with significant CTFP complaints to present with relatively hard-to-solve complications, prostheses made of out-of-date materials to show with higher class failures, and failure severity of CTFPs to increase in patients with higher age, for prostheses with higher number of units and longer duration of use

The effect of counselling programmes involving expressive activities with semi-structured groups on self-concealment levels of adolescents

The aim of this study was to investigate the effects of counselling programmes based on expressive activities with semi-structured groups, on the self-concealment levels of adolescents. The research was carried out using a pretest-posttest control group design. The dependent variable of the present research, is the psychological counselling programme conducted with a semi-structured group based on expressive activities. The research was carried out with 18 6th and 7th grade secondary school students (10 female and 8 male). The Self-Concealment Scale was used as data collection tool. In this research, the use of nonparametric tests was preferred, as the sample was smaller than 30. Therefore, it was determined whether there is a statistically significant difference between the arithmetic means of the experimental and control groups' pretest, posttest and trail test scores by use of Wilcoxon signed-rank test, to determine the effects of a psychological counselling programme with semi-structured group based on expressive activities. Also, it was determined whether there was a statistically significant relationship between the pretest, posttest and trail intervention scores received by the intervention and control group students from the Self-Concealment Scale, using Mann-Whitney U test. The research results revealed that the "psychological counselling programme based on expressive activities with semi-structured groups" was significantly effective in alleviation of self-concealment levels, and this effect was also maintained in follow-up evaluations. The obtained results are discussed in the light of related literature findings and recommendations are proposed accordingly

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

Mutational landscape of severe combined immunodeficiency patients from Turkey

Severe combined immunodeficiency (SCID) has a diverse genetic aetiology, where a clinical phenotype, caused by single and/or multiple gene variants, can give rise to multiple presentations. The advent of next-generation sequencing (NGS) has recently enabled rapid identification of the molecular aetiology of SCID, which is crucial for prognosis and treatment strategies. We sought to identify the genetic aetiology of various phenotypes of SCIDs and assessed both clinical and immunologic characteristics associated with gene variants. An amplicon-based targeted NGS panel, which contained 18 most common SCID-related genes, was contumely made to screen the patients (n = 38) with typical SCID, atypical SCID or OMENN syndrome. Allelic segregations were confirmed for the detected gene variants within the families. In total, 24 disease-causing variants (17 known and 7 novel) were identified in 23 patients in 9 different SCID genes: RAG1 (n = 5), RAG2 (n = 2), ADA (n = 3), DCLRE1C (n = 2), NHEJ1 (n = 2), CD3E (n = 2), IL2RG (n = 3), JAK3 (n = 4) and IL7R (n = 1). The overall success rate of our custom-made NGS panel was 60% (39.3% for NK+ SCID and 100% for NK- SCID). Incidence of autosomal-recessive inherited genes is more frequently found in our cohort than the previously reported populations probably due to the high consanguineous marriages in Turkey. In conclusion, the custom-made sequencing panel was able to identify and confirm the previously known and novel disease-causing variants with high accuracy.Istanbul Bilgi University; Bilimsel Arastirma Projeleri Birimi, Istanbul Universites

The clinical course of SARS-CoV-2 infection among children with rheumatic disease under biologic therapy: a retrospective and multicenter study.

The effects of biological disease-modifying antirheumatic drugs (bDMARDs) in the clinical course of COVID-19 on children with underlying rheumatologic diseases have not been fully demonstrated. To evaluate the course of COVID-19 infection in patients with rheumatic disease receiving bDMARD treatment. This was a retrospective, multicenter study conducted in pediatric patients infected by SARS-CoV-2 and under bDMARDs therapy. The study population consisted of 113 patients (72 female/41 male). The mean age of the patients was 12.87 +/- 4.69 years. The primary diagnosis of the cohort was as follows: 63 juvenile idiopathic arthritis, 35 systemic autoinflammatory diseases, 10 vasculitides, and five cases of connective tissue diseases. The mean duration of the primary disease was 4.62 +/- 3.65 years. A total of 19 patients had additional comorbid diseases. Thirty-five patients were treated with canakinumab, 25 with adalimumab, 18 with etanercept, 10 with infliximab, nine with tocilizumab, six with rituximab, four with anakinra, three with tofacitinib, and one with abatacept. The median exposure time of the biological drug was 13.5 months. Seventy-one patients had symptomatic COVID-19, while 42 were asymptomatic. Twenty-four patients required hospitalization. Five patients presented with MIS-C. The hospitalized patients were younger and had a shorter duration of rheumatic disease compared to ambulatory patients, although the difference was not statistically significant. Steroid usage, presence of fever, and dyspnea were more common among the hospitalized patients. A worsening in the course of both COVID-19 and current disease was not noticed under bDMARDs, however, to end with a strong conclusion multicentric international studies are required