Background/aim: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in Turkey on March 10, 2020 and the number of the patients are increasing day by day. Coronavirus disease 2019 (Covid-19) has high mortality rates in intensive care units (ICUs). We aimed to describe the demographic characteristics, comorbidities, treatment protocols, and clinical outcomes among the critically ill patients admitted to the ICU of our hospital. Materials and methods: This cohort study included 103 consecutive patients who had laboratory confirmed Covid-19 and admitted to ICU of Sakarya University Training and Research Hospital between March 19 and April 13, 2020. The final date of the follow-up was April 18. Results: The mean age of the patients was 69.6 ± 14.1 years. Most of the patients had increased CRP (99%), serum ferritin (73.8%), d-dimer (82.5%), and hs-troponin levels (38.8%). 34 patients (33%) had lymphocytopenia, 24 patients (23.3%) had thrombocytopenia. 63 patients (61.2%) developed acute respiratory distress syndrome (ARDS), 31 patients (30.1%) had acute kidney injury, and 52 patients (50.5%) had multiple organ dysfunction syndrome (MODS) during follow-up. Sixty-two patients (60.2%) received mechanical ventilation. As of April 18, of the 103 patients, 52 (50.5%) had died, 30 (29.1%) had been discharged from the ICU, 21 (20.4%) were still in the ICU. Conclusions: Covid-19 has high mortality rates in ICU. Patients with elevated procalcitonin, hs-troponin, d-dimer, and CRP levels and lower platelet count at admission have higher mortality.Key words: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), coronavirus disease 2019 (Covid-19), intensive care unit

Background/aim: We aimed to identify clinical settings of renal transplant patients with COVID-19. Materials and methods: In this retrospective study, we included kidney transplant inpatients with laboratory confirmed COVID-19 who had been discharged or had died by October 1st, 2020. Characteristics of the patients, including basal and last outpatient biochemical parameters were recorded. Discontinuation or dosage reduction of immunosuppressives and other treatment information was documented. Results: Twenty patients were included in this study, of whom 18 were discharged and 2 died in hospital. The mean duration of hospitalization and follow-up were 9.7 ± 6.4 days and 4.5 ± 2.0 months, respectively. Fourteen patients (70%) were male and mean age was 48.0 ± 10.3 years. At admission, all had immunosuppression withdrawn and were started on methylprednisolone 16 mg/ day (50%) or dexamethasone (50%). Tacrolimus/m-TOR inhibitors were reduced by 50% and all antimetabolites were discontinued. Hemodialysis was needed for 10% of patients. Acute kidney injury was detected in 25% of the patients. With respect to hospitalization time and complications, there was no significant difference between patients who used dexamethasone and those who did not (P > 0.05). The discontinued immunosuppressives were resumed within 2 to 4 weeks after discharge according to the severity of disease. No rehospitalization or acute rejection was detected during the follow-up of the patients.Conclusion: Renal transplant patients are considered a high risk group for COVID-19. It can be said that discontinuation or reducing dosages of immunosuppressives may be effective and safe in kidney transplant patients.Key words: COVID-19, SARS-CoV-2, kidney transplantation, immunosuppression, mortality, acute rejection

Background/aim: The COVID-19 infection, which started in Wuhan City, China, in December 2019, turned into a pandemic in a very short time, affecting mainly the elderly and those with serious chronic illnesses. COVID-19 infections have been observed to have a high mortality rate, especially in patients undergoing maintenance hemodialysis. Materials and methods: Forty-two patients over 18 years of age who underwent a maintenance hemodialysis program at our unit, who tested positive for COVID-19 by PCR from nasopharyngeal swabs, and/or who were observed to have disease-related signs in their CTs were included in the study. Results: In this study, 23 of 42 patients receiving hemodialysis support in our clinic were included. The median age was 67 years old (min: 35; max: 91 years), and all of our patients had primary hypertension and other comorbidities. Their clinical evaluation showed that dry cough (47.8%) and shortness of breath (47.8%) were the most common symptoms. Fever was less pronounced (30.4%). The median time from the onset of symptoms to hospitalization was 1 day (min: 0; max:), and the time from hospitalization to death was 18 days (min: 1; max: 22). Transfer from the inpatient ward to the ICU took a median of 7 days (min: 1; max: 13). Among the 23 patients, 3 died during follow-up, and 20 were discharged with full recovery. Baseline ferritin, procalcitonin levels, and CRP/albumin rates were higher, and neutrophil/lymphocyte levels were lower in patients who eventually died. In these patients, despite being nonsignificant, there were more diabetic patients, and the D-dimer levels were higher than 1000 ugFEU/L. Conclusion: The COVID-19 infection is associated with increased mortality in chronic kidney diseases patients. Despite being nonsignificant, there was a trend towards increased mortality in patient with diabetes, D-dimer levels >1000 ugFEU/L, higher ferritin and prokalsitonin levels, an increased CRP/albumin ratio, and a lower neutrophil/lymphocyte ratio.Key words: Chronic renal failure, hemodialysis, COVID-19

Background/aim: It is very important for the efficient use of limited capacity and the success of treatment to predict patients who may need ICU with high mortality rate in the Covid-19 outbreak. In our study, it was aimed to investigate the value of the radiological involvement on initial CT in demonstrating the ICU transfer and mortality rate of patients. Materials and methods: All PCR-positive patients were included in the study, whose CT, PCR, and laboratory values were obtained simultaneously at the time of first admission. Patients were divided into 4 groups in terms of the extent of radiological lesions. These groups were compared in terms of intensive care transfer needs and Covid-related mortality rates. Results: A total of 477 patients were included in the study. Ninety of them were group 0 (no lung involvement), 162 were group 1 (mild lesion), 89 were group 2 (moderate lesion), and 136 were group 3 (severe lung involvement). A significant relationship was found between the extensiveness of the radiological lesion on CT and admission to intensive care and mortality rate. As the initial radiological involvement amounts increased, the rate of ICU transfer and mortality increased. The mortality rates of the groups were 0%, 3%, 12.3%, and 12.5%, respectively, and the difference was significant (p < 0.001). Similarly, the ICU transfer rates of the groups were 2.2%, 5.6%, 13.5%, and 17.7%, respectively, and the difference was significant (p < 0.001). Conclusion: In conclusion, in our study, the strong relationship between the initial radiological extent assessment and the need for intensive care and mortality rates has been demonstrated, and we believe that our results will make a significant contribution to increase the success of the health system in predicting patients who may progress, helping clinicians and managing pandemics.Key words: Covid-19, extensiveness of radiological lesions, intensive care, mortality rate

Background/aim: There is no study in the literature in which only chest computed tomography (CT) findings of deceased cases obtained at admission were examined, and the relationship between these findings and mortality was evaluated. Materials and methods: In this retrospective study, a total of 117 deceased patients with COVID-19 infection confirmed by positive polymerase chain reaction and undergone chest CT were enrolled. We evaluated initial chest CT findings and their relationship, location, prevalence, and the frequency with mortality. Results: The mean age of patients was 73 ±18 years; 71 of all patients were male and 46 were female. The predominant feature was pure ground-glass opacity (GGO) lesion (82.0%), and 59.8% of cases had pure consolidation. There was no cavitation or architectural distorsion. Pericardial effusion was found in 9.4% the patients, and pleural effusions were found in 15.3% of them. Mediastinal lymphadenopathy was only 11.9% in total. Conclusion: In deceased patients, on admission CTs, pure consolidation, pleural and pericardial effusion, mediastinal LAP were more common than ordinary cases. It was these findings that should also raise the concern when they were seen on chest CT; therefore, these radiologic features have the potential to represent prognostic imaging markers in patients with COVID-19 pneumonia.Key words: Chest computed tomography, COVID-19 infection, mortality

Background/aim: During the intense periods of the COVID-19 pandemic, legal measures were taken for its containment. However, since legal precautions cannot be implemented continuously, hand washing, mask usage and obeying social distance rules are important in combating the pandemic. Complying with these rules is mostly individual decisions. The behavior of individuals has a prominent place in the course of the pandemic. In this study, we aimed to develop a scale which could measure compliance with outbreak measures. Materials and methods: This study was conducted in two stages after evaluation of the content validity of the item pool formed by the research group by experts. For construct validity, the scale subdimensions were determined in 250 people between the ages of 18-70 years at the first stage and the definitive version of the 20-item scale was constructed. In the second stage, exploratory factor analysis was repeated in a group of 484 people, and confirmatory factor analysis was performed. Cronbach’s alpha coefficients, Spearman-Brown coefficients, test-retest methods were used to determine reliability. Results: The variance explanation of the scale consisting of 20 items and two subdimensions in the explanatory factor analysis is 63.434% (n = 484). Confirmatory factor analysis resulted in CMIN/DF = 3.540, RMR = 0.043, NFI Delta 1 = 0.928, TLI rho 2 = 0.939, CFI = 0.947, RMSEA = 0.072, SRMR = 0.0368. Cronbach’s alpha value of the scale is 0.95; and the Spearman Brown coefficient equal length analysis resulted in 0.928. The temporal consistency of the scale was evaluated with the test-retest method (P = 0.893). The structure, content validity, temporal consistency, item discrimination, and internal consistency were evaluated and found to have acceptable valid, reliable properties. Conclusion: The outbreak prevention recommendation compliance scale is a valid and reliable tool with which compliance with the prevention plans can be evaluated.Key words: Outbreak, outbreak prevention, prevention recommendations, reliability, validity

Giriş: COVID-19 semptomları; hafif semptomlardan ciddi solunum yetmezliği tablosuna kadar geniş bir dağılım gösterir. Bu klinik tabloların ne kadar sürdüğü ve hastalığın uzun dönem etkileri henüz net değildir. Bu çalışmanın amacı COVID-19 tanısı alan hastaların tanı aldıktan en az 30 gün sonraki semptom karakteristiklerini tanımlamaktır. Materyal ve Metod: Çalışmamıza en az 30 gün önce hastanemize COVID-19 uyumlu klinik bulgularla başvuran ve nazofaringeal sürüntüde SARS-CoV-2 PCR pozitifliği saptanan 129 hasta alındı. Poliklinik kontrollerinde veya telefon görüşmesiyle yapılan anket çalışması ile hastaların COVID-19 tanısından 30 gün sonraki mevcut semptomları sorgulandı ve cevapları analiz edildi. Bulgular: Çalışmamıza alınan 129 hastadan 70’i kadın ve 59’u erkekti. Hastaların yaş ortalaması 53.8 olup; 67 kişide en az bir komorbidite mevcuttu. Hastaların %43’ü COVID-19 nedeniyle hastanede yatmış olup, hastaların %7’si de yoğun bakımda takip edilmişti. En sık görülen semptomlar; yorgunluk (%67), kas ağrısı (%65), sırt ağrısı (%38), öksürük (%31) ve nefes darlığı (%26) idi. Sonuç: COVID-19 tanısı konulduğunda öncelikli şikayetler solunum sistemi semptomları iken; en az 1 ay geçtikten sonra devam eden semptomların daha çok kas ağrıları ve yorgunluk olduğu görüldü. Çalışmaya sadece ayaktan takip edilen ve 30 gün içinde taburcu edilen hastaların alınmış olması ve yoğun bakıma yatış öyküsü olan hastaların sayısının az olması çalışmanın kısıtlığı olarak değerlendirildi.

Introduction: In this study, we aimed to compare the place of throat mouthwash in the diagnosis of COVID-19 and the detection values of SARS-Cov-2 in naso-oropharyngeal swab (NOS) and mouthwash samples. Materials and Methods: NOS and mouthwash water samples were taken from the patients simultaneously. Mouthwash sampling was obtained by himself. For the NOS sample; after the swab sample was taken from the patient’s oropharynx with a dacron tip swab, with the same swab. RNA isolation from combined oral/nasal swab samples was performed with the EZ1 (Qiagen, Germany) device. Statistical analyses were performed using the SPSS software version 21.0. Results: The diagnostic efficacy of throat mouthwash and combined NOS samples taken from 106 volunteers were compared (56 males, mean age 42.9 years). The diagnostic sensitivity of the mouthwash was 60.71%, specificity 98.65%, positive predictive value 94.44% and negative predictive value 86.9% compared to the results of the NOS. According to these results, although mouthwash is a specific test, its sensitivity to NOS is not satisfactory. The value of kappa was substantial agreement as 0.668, and it was found statistically significant (<0.001). Conclusion: Throat mouthwash is a promising noninvasive technique for diagnosis, monitoring and infection control in patients with COVID-19 infection and reduces the risk of transmission for the healthcare provider.

Objective: Favipiravir is recommended for treatmentof COVID-19 by the Turkey National Treatment Guideline for COVID-19. It has been widely used for COVID19 infected patients in Turkey. Fluorescence of the nailswith certain topical and systemic drugs with Wood’s lampwas and reported in the English literature. This study isdesigned to determine the fluorescence effect of favipiravir in the nails of COVID-19 patients.Materials and Methods: Eighty five patients withCOVİD-19 infection who were treated with favipiravirand/or hydroxychloroquine and 50 healthy volunteers’nails were examined by Wood’s lamp. Fluorescence andtherapeutic interest were recorded. Data were compared.Results: Seventy one of the patients (83.5% ) had fluorescent nails under UV radiation in the patient group,where no fluorescence was observed in the healthy controlgroup.Conclusion: Fluorescence of the nails in the patientswith confirmed COVID-19 infection who were treatedwith favipiravir is a common finding.

Objective: In this study, we aimed to determine the factors that contribute to the early determination of mortality risk in patients hospitalized with COVID-19.Methods: We included 941 adult inpatients (474 male [50.4%], mean age, 53.5±17.0. The patients were divided into two groups: the discharge group and the death group. Epidemiological data, medical history, underlying comorbidities, laboratory findings, chest computed tomographic scans, real-time reverse transcription polymerase chain reaction detection results, and survival data were obtained with retrospective recordings on admission and follow-up. The statistical relationship between survival data and parameters was analyzed. A mathematical model was created from the data of both groups.Results: While 863 patients survived, 78 were non-survivors. During the study period, the preliminary case fatality rate of the inpatients was 8.3%. The mean age of the non-survivors was 71.7±11.2 SD ( P <0.001). Laboratory findings showed that mortality was high in those with high D-dimer, sodium, lactate dehydrogenase (LDH), troponin, creatine kinase-myocardial band (CK-MB), ferritin, blood lactate, activated partial thromboplastin time, and high blood glucose levels ( P <0.05). Furthermore, mortality was high in patients with low albumin, lymphocyte, and platelet levels ( P <0.05). The logistic regression model showed that advanced age, hypertension, high D-Dimer (>1000 ng/ml), high C-reactive protein (CRP), CK-MB, and LDH, and low lymphocyte count were associated with poor prognosis.Conclusions: According to week 1 data of patients with COVID-19, advanced age, hypertension, D-Dimer, CRP, CK-MB, high LDH, and low lymphocyte were associated with poor prognosis. We believe that this model will be useful in predicting patient mortality.

Objective: The aim of this study was to investigate the efficacy of favipiravir (FVP) in severe COVID-19.Methods: This is a retrospective study of 142 COVID-19 patients with severe pneumonia signs, who received inpatient treatment between March 15 and May 20, 2020. The patients were divided into two groups according to the use of FVP treatment; group 1 (n = 99) included patients who treated with FVP and group 2 (n = 43) who didn’t receive FVP.Results: Mean age was 66.47 ± 11.89 in group 1, and 68.58 ± 14.78 in group 2. Forty patients (40.4%) in group 1 and 22 (51.2%) in group 2 were treated in the intensive care unit (P > 0.05). The proportion of eosinophil, tendency of increasing thrombocyte counts and eosinophil/neutrophil ratio in FVP group was significantly higher than non-FVP group (p < 0.05). In Group 1, patients had significantly reduced erythroid series, and elevated uric acid levels as side effects of FVP. With respect to complications during hospitalization, there was no significant difference among the groups for mechanical ventilator requirement, acute kidney injury, dialysis requirement and sepsis (P > 0.05). The mortality rates in Group 1 (n = 26 [26.3%]) were lower than those in group 2 (n = 16 [37.2%]), but it was not statistically significant.Conclusions: While the treatment of COVID-19 pneumonia options were limited during the initial stages of the pandemic, the FVP may be effective in severe cases. To confirm this effect, randomized controlled studies are needed in patients of all disease severities.

Amaç: Sağlık bakım ilişkili enfeksiyon (SBİE)’ların yenidoğan yoğun bakım ünite (YYBÜ)’lerinde önemli morbidite ve mortalite nedenidir. Bu çalışmada altı yıllık zaman diliminde YYBÜ’deki SBİE’ler ve ilişkili faktörlerin değerlendirilmesi amaçlandı. Gereç ve Yöntemler: Çalışma YYBÜ’de 1 Ocak 2013-31 Aralık 2018 tarihleri arasında yapıldı. YYBÜ’de gelişen SBİE’ler retrospektif olarak değerlendirildi. YYBÜ günlük aktif sürveyansla takip edildi. SBİE tanısı Center for Disease Control and Prevention (CDC) kriterlerine göre konuldu. YYBÜ’de yatan hasta sayısı, hasta günü, tespit edilen SBİE, invaziv araç kullanım oranı ve tespit edilen patojenler değerlendirildi. Bulgular: Bu araştırmada 2196 hasta, 33652 hasta günü, 4157 ventilatör günü, 3343 umbilikal kateter günü, 5210 santral venöz kateter günü ve 92 üriner kateter günü değerlendirildi. SBİE hızı %4.78 (105/2196) ve insidans dansitesi ‰3.12 (105/33652)’di. SBİE dağılımları değerlendirildiğinde; SBİE’nin 101 (%96.1)’i kan dolaşımı enfeksiyonu (KDE), ikisi (%1.90) pnömoni, biri (%0.95) merkezi sinir sistemi enfeksiyonu ve biri (%0.95) yumuşak doku enfeksiyonuydu. SBİE sıklığı 2500 gr dan büyük bebeklerde daha az (%1.02) iken, 751-1000 gr arası bebeklerde daha fazla (%23.95)’di (p<0.001). Etken dağılımına göre; %59.0 (62/105)’u gram negatif bakteri (GNB), %41.0 (43/105)’i gram pozitif bakteri (GPB) kaynaklıydı. En sık izole edilen GNB’ler; Klebsiella spp. (%34.2), Enterobacter spp. (%12.3) ve en sık izole edilen GPB’ler; Stafilokoklardı (%37.0). İnvaziv araç ilişkili enfeksiyon hızları değerlendirildiğinde; santral venöz kateter ilişkili KDE hızı ‰ 0.95, umbilikal kateter ilişkili KDE hızı ‰2.09’du. Sonuç: SBİE’ler içinde en sık görüleni KDE’di. İnvaziv girişimler ve düşük doğum ağırlığı enfeksiyon riskini artıran faktörler olarak saptandı. SBİE gelişme sıklığı bebek doğum ağırlığı ile ters orantılıydı. Düşük doğum ağırlıklı bebeklerde daha hassas enfeksiyon kontrol önlemlerinin gerektiği düşünüldü.

Amaç SARS-CoV-2 virüsünün etkeni olduğu COVİD-19 enfeksiyonu salgın oluşturan önemli bir hastalıktır. COVİD-19 hastalarının birçoğunda kanama ve pıhtılaşma bozukluklarının geliştiği yapılan çalışmalarla gösterilmiştir. Çalışmamızda, ağırlıklı olarak pıhtılaşma eğilimi gözlenen bu hasta grubunda, vücudun doğal antikoagülan proteinleri olan Antitrombin-3 (AT3), protein C (PC) ve protein S (PS) düzeylerinin incelenmesi amaçlandı. Gereç ve Yöntem 15 Mart-31 Mayıs tarihleri arasında COVID-19 tanısıyla hastaneye yatışı yapılan 22 hasta çalışmaya alındı. Hastaların yaşı, cinsiyeti, kronik hastalıkları, servis / yoğun bakım yatışı, AT3, PC, PS düzeyleri, PT, aPTT, INR, D-Dimer, fibrinojen, rutin laboratuar parametreleri ve mortalite oranları retrospektif olarak değerlendirildi. Bağımsız değişkenler ile yoğun bakım ihtiyacı ve mortalite oranları istatistiksel olarak karşılaştırıldı. Bulgular Çalışmaya 14’ü servis, 8’i yoğun bakım ünitesinde (YBÜ) takip edilen toplam 22 hasta dahil edildi. Hastaların 17’si (%77,3) erkek, yaş ortalaması 66.6±33,78 yıl idi. Toplam 20 (%90,9) hastanın en az bir kronik hastalığı vardı. Bunların %36,3 sı Diyabet (DM), %54,5 ‘i hipertansiyon idi. Hastalarda nefes darlığı (%86,3) ve öksürük (%77,2) en sık görülen şikayetler idi. Takibinde 4 hastada ölüm gerçekleşti. Tartışma Servis- YBÜ hastaları ve mortal- nonmortal hastalar olarak yapılan iki farklı karşılaştırmalar arasında, AT3, PC, PS, düzeyleri arasında istatistiksel olarak anlamlı bir farklılık saptanmadı. Mortal hastalarda nonmortal gruba göre ortalama PTT düzeyleri anlamlı olarak yüksek bulunurken, faktör 9 düzeyleri de YBÜ grubunda servis hastalarına göre anlamlı olarak yüksek tespit edildi. Sonuç Çalışmamız sonuçlarına göre COVID-19 hastalarında AT3, PC ve PS düzeyleri ile hastalık şiddeti arasında ilişki tespit edilmedi.

Objective There are limited number of researches to investigate the causes of vaccine rejection among adults. In this study, it aimed to invetsigate the attitudes and behaviors of adults towards vaccination. Materials and Methods The study group consisted of totally 500 patients and their relatives who applied to outpatient clinics of Sakarya University Training and Research Hospital between January 24 and February 22, 2019. The data were collected by survey consisting of five demographic questions and nine multiple choice questions investigating behavior and attitudes towards vaccination. Data were analyzed with IBM SPSS 20. p <0.05 was considered significant. Results The guidance of health workers is the key determinant of vaccination decision. (93.8%). Tetanus is the most common vaccine (98.6%) whereas the least is meningococcal vaccine (22.6%). Human Papillomavirus (HPV) and shingles are the least administered vaccines (0.6%). Mercury in the vaccine is the most important reason that prevent people from vaccination (23.4%). If the vaccines were free of charge, 14.6% of the respondents wanted to vaccinate all the vaccines. Meningococcus (19.8%) and diphtheria (19.6%) vaccines were the least preferred. The average age (34.24 years) of those acquiring information on vaccination from the internet was significantly lower than those who did not (40.5 years) (p p<0.001). Conclusion According to our results, Information about adult vaccination is not well-known in our society. For this purpose, it is necessary for the health professionals to embrace vaccination studies in adults and expand awareness about adult vaccines by more effective use of online platforms. Hence, health managers, non-governmental organizations, universities and press should work collaboratively.

Amaç Sars-Corona Virüsü (SARS-CoV-2), 2019 yılının aralık ayında ilk kez Çin’de görülen ve şiddetli akut solunum yetmezliğine neden olan bir virüstür. Diyabet tüm dünyada morbidite ve mortalitenin önemli sebeplerinden biridir. Diyabetik hastalarda koronavirüs enfeksiyonun morbidite ve mortalitenin yüksek olduğu saptanmaktadır. Çalışmamızda kliniğimizde Covid-19 nedeniyle takip edilen diyabetik hastalarda lipid profili, Hba1c, kan şekeri profilinin morbidite ve mortalite üzerine etkisinin geriye dönük olarak analizinin yapılmasını amaçladık. Gereç ve Yöntem İç hastalıkları kliniğinde 15/03/20 ile 01/07/20 tarihleri arasında Covid-19 nedeniyle takip edilen 31 diyabet tanısı olan oral anti diyabetik ve/veya insülin kullanan hasta çalışmaya dahil edildi. Hasta dosyaları taranarak anamnez, laboratuvar, tedavi ve hastalığın ilerleyişi formlara kaydedildi. Diyabetik hastalardaki koronavirüs enfeksiyonlarında hastaların Hba1c, kan şekeri profili ve lipid profilinin yoğun bakım ihtiyacı için risk faktörü olarak kullanılmasının ek bir fayda getirip getirmediği istatistiksel yöntemlerle analiz edildi. Bulgular 31 hastanın tamamı boğaz ağrısı, öksürük, ateş ve nefes darlığı gibi tipik bulgular ile hastaneye başvurdu. Hastaların tamamında BT ve PCR testi mevcuttu. PCR pozitif saptanan 18 hasta (%58,1) ve Tipik BT tutulumu olan 30 hasta (%96,8) saptandı. 31 hastanın 17’sinde; hipoksi, takipne ve hipotansiyon gibi sebeplerle yoğun bakım ihtiyacı gelişti. Yoğun bakım ihtiyacı olan 17 hastanın 10’u mortal seyretti. Açlık kan şekeri yüksekliği ile yoğun bakım ihtiyacı ve mortalite arasında anlamlı ilişki saptandı. HbA1C ve lipit profili ile yoğun bakım ihtiyacı arasında anlamlı ilişki yoktu. Mortal grupta LDL ve total kolesterol anlamlı düzeyde düşük tespit edildi. Sonuç Diyabetik hasta grubunda kötü glisemik kontrol ve lipit parametreleri hastalığın ilerleyişini öngörmede faktör olarak dikkate alınmalıdır.

Amaç: Ampirik antibiyotik tedavisi, enfeksiyon kaynağınınhenüzbelirlenemediğidurumlardahekimlerinateşiolanhastalarayaygınolarakuyguladıklarıbiryöntemdir.Bu çalışmanın amacı, nedeni bilinmeyen ateşi olan hastalarda (NBA) ampirikantibiyotiktedavisindemaliyet-etkininflamatuarparametreleribelirlemektir. GereçveYöntemler: KankültürlerialınmışolanNBA iletakipedilentoplam 577 hasta enfeksiyonabağlıateşgrubu (EBAG,n:203) veenfeksiyonabağlıolmayanateşgrubu (EBOAG,n:374) olarakikigrubaayrıldıvebeşyıllıkverileri hasta bilgikayıtsistemindengeriyedönükolarakincelendi. Tam kan test sonuçlarından nötrofil sayısı, lenfosit sayısı parametresine oranlanarak nötrofil lenfosit oranı ve trombosit lenfosit oranı değerleri hesaplandı. Bulgular: Toplam 577 hasta enfeksiyonabağlıateşgrubu (EBAG) veenfeksiyonabağlıolmayanateşgrubu (EBOAG) olarakikigrubaayrıldı. İlk antibiyotikkullanımsüreleri EBAG veEBOAG'dasırasıyla 4.54 ± 3.08 (1-14)günve 5.35 ± 3.8 (1–21)gündü(p = 0.023). Nötrofil-lenfositoranı (NLO) EBAG’da 8.00 (3.00-15.00)iken, EBOAG’da 5.00 (3.00-9.00)idi (p = 0.001). Trombosit-lenfositoranı (TLO) EBAG’da 21.00(9.00-41.00)iken, EBOAG’da 16.00 (7.25-27.75)idiveanlamlıdeğildi (p = 0.165). Sonuç:Nötrofillenfositoranırutinkantestlerindenbakılabilenvepahalıbiryöntemolmamasınedeniyle, nedenibelirlenemeyenateşli (NBA)hastalardaavantajlıbirtanımetoduolarakkullanılabilir.

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Giriş: İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji (İHKM) alanının uzmanlık eğitiminde araştırma görevlilerinin (AG) gelişimini izlemek için gelişim sınavlarının yapılması gereklidir. Ancak, bu sınavların hazırlanması, yapılması ve değerlendirilmesi bazı incelikleri ve tecrübeyi gerektirmektedir. Bu araştırmada, İHKM uzmanlık alanında eğitim ve yeterlilik kurulu (EMEK) tarafından çevrimiçi yapılan araştırma görevlileri gelişim sınavlarından elde edilen verilerin gözden geçirilmesi amaçlanmıştır.Materyal ve Metod: İHKM alanında AG için yıl içinde iki kez çevrimiçi biçimlendirici gelişim sınavları yapılmaktadır. Bu araştırmada 2014- 2018 arasında yapılan sınavlar değerlendirmeye alınmıştır. Her sınavın geçerlik ve güvenirlik incelemeleri, soruların zorluk ve ayırt edicilik indeksleri hesaplanmıştır. Doğru olarak cevaplanmasında zorluk çekilen konu başlıkları belirlenmiştir.Bulgular: Sınavlara giren AG sayısında yıllar içinde artış olduğu görülmüştür. Sınavların güvenirlik katsayısı (cronbach alfa) değeri en düşük 0.69, en yüksek 0.92 olarak bulunmuştur. Öğrencilerin sınav başarısının ortalama 69’un üzerinde olduğu görülmüştür. Soru bankasına aktarılabilmesi için bazı soruların yeniden gözden geçirilmesi gerektiği bulunmuştur. Klinikte az görülen hastalıkların ve temel mikrobiyoloji sorularının daha az oranda doğru olarak cevaplandığı, klinikte sıkça görülen hastalıkların ise daha yüksek oranda doğru olarak cevaplandığı görülmüştür.Sonuç: Uzmanlık eğitiminde, çevrimiçi yapılan gelişim sınavları ulusal düzeyde yapılacak olan ölçme ve değerlendirmeleri kolaylaştırmaktadır. İnternet üzerinden yapılan sınav deneyimimizin artmasına rağmen hala sınavlarımızda geliştirilmesi gereken yönlerin olduğu görülmüştür

Fever of unknown origin (FUO) is defined as temperature higher than 38.3°C on several occasions for at least three weeks and undiagnosed after one week of study in the hospital. The most prevalent causes of FUO are infections, connective tissue diseases and malignancies. Connective tissue diseases are seen in elderly patients as temporal arteritis and polymyalgia rheumatica .Polymyalgia rheumatica (PMR) is a rheumatic disease seen after the age of 50 for which the etiology is not precisely known. Almost half of the affected patients frequently have low grade fever, malaise and poor appetite. Typical clinical characteristics are pain in both shoulders and morning stiffness. Along with this case followed up at our clinic with a complaint of fever continuing for three weeks and weakness in the arms, we will review PMR.

Amaç: HIV (Human Immunodeficiency Virus) (+) gebe yönetiminde, tarama testleri ve viral yük incelemeleri, etkiliantiretroviral tedavi, sezaryen ile doğum ve emzirmeden kaçınma en güncel konulardır. Bu çalışmada kadın hastalıklarıve doğum (KD) hekimlerinin HIV (+) gebe yönetimi konusundaki bilgi, tutum ve davranışlarının incelenmesiamaçlanmıştır.Gereç ve Yöntemler: Demografik bilgiler ve literatürden destek alınarak HIV (+) gebe yönetimine yönelik hazırlananonline/dijital anket ile KD hekimlerine ulaşılarak konu ile alakalı bilgi, tutum ve davranışları belirlenmeye çalışıldı.Bulgular: Toplam 125 katılımcının 52’si (%41,6) erkek, 86’sı (%68,8) uzman hekim, 13’ü (%10,4) araştırma görevlisi,34’ü (%27,2) 20 yıl ve üzeri mesleki deneyime sahip, 115’i (%92) gebelerden düzenli olarak Anti-HIV testi istemekteolup 77’sinin (%61,6) en az bir kez Anti-HIV pozitif gebe hastası olmuş, 49’u (%39,2) bugüne kadar Anti-HIV pozitifgebe takibi yapmış, 51’i (%40,8) ise Anti-HIV pozitif en az bir gebeye doğum yaptırmıştı. Hekimlerin 121’i (%96,8)Anti-HIV pozitif gebeleri doğrulama testlerine yönlendirirken 19’u (%15,2) Anti-HIV pozitif anneye emzirmemesikonusunda bilgi vermediğini belirtti. Doğum sırasında HIV RNA düzeyleri >1000 kopya/mL veya viral yükübilinmeyen Anti-HIV pozitif gebede IV zidovudin uygulanmasının bebeğe bulaş riskini azalttığını bilenler 79 (%63,2)iken HIV (+) anneden doğana profilaksi amaçlı altı hafta zidovudin kullananlar 55’tir (%44). Anti-HIV (+) annenindoğum şekli için “Viral yükü <50 kopya/ml olan gebelerde vajinal doğum yapabilir” diyenler 35 (%28), “Her halükârdasezaryen” diyenler 43’tür (%34,4). Ante, intra ve postpartum dönemlerde Antiretroviral tedavi (ART) ile HIV'invirolojik baskılanmasıyla, yenidoğana perinatal HIV bulaşı %1’lerin altına düşebilir diyenler 47’dir (%37,6).Sonuç: KD hekimlerine, emzirmeme konusu başta olmak üzere tarama testleri/proflaksi konusu hatırlatılmalı veeğitimlerin düzenliliği sağlanmalıdır.