This study examines the effects of the bundle of antimicrobial stewardship measures for prophylactic antibiotics among thoracic surgery patients. A local protocol, based on current guidelines starting from December 2014, was developed by the Infection Control and Thoracic Surgery Teams. The effects of this protocol were assessed by monitoring a total of 1380 patients before and after its implementation from January 1, 2011, to December 31, 2022.

Objective: Improvements in SARS-CoV-2 diagnosis with easy, rapid and cost-effective approaches are required to control the COVID-19 pandemic. Antigen tests result in 5 to 30 minutes, providing an advantage over polymerase chain reaction (PCR) in duration. We tested the performance of the i-test COVID-19 rapid antigen test to real-time reverse transcriptase PCR in 200 symptomatic COVID-19 suspected patients. The cycle threshold (Ct) values of the patients were found to be between 21.6 and 34.4. The Ct value of 10 patients who tested positive in the PCR test was >30. We found that the sensitivity and specificity of the antigen test were 80.6 % and 93.7 %, respectively, for samples with a Ct value of <30, and overall agreement between antigen and PCR test was 91.6 % for these samples. i-test COVID-19 rapid antigen test can be used for screening in schools, factories, nursing homes, and everywhere where PCR test is unavailable.

Objective: The study aimed to investigate the reliability of ChatGPT’s answers to medical questions, including those sourced from patients and guide recommendations. The focus was on evaluating ChatGPT’s accuracy in responding to various types of infectious disease questions. Materials and Methods: The study was conducted using 200 questions sourced from social media, experts, and guidelines related to various infectious diseases like urinary tract infection, pneumonia, HIV, various types of hepatitis, COVID-19, skin infections, and tuberculosis. The questions were arranged for clarity and consistency by excluding repetitive or unclear ones. The answers were based on guidelines from reputable sources like the Infectious Diseases Society of America (IDSA), Centers for Disease Control and Prevention (CDC), European Association for the Study of Liver Disease (EASL) and Joint United Nations Programme on HIV/AIDS (UNAIDS) AIDSinfo. According to the scoring system, completely correct answers were given 1-point, and completely incorrect ones were given 4-points. To assess reproducibility, each question was posed twice on separate computers. Repeatability was determined by the consistency of the answers’ scores. Results: In the study, ChatGPT was posed with 200 questions: 107 from social media platforms and 93 from guidelines. The questions covered a range of topics: urinary tract infections (n=18 questions), pneumonia (n=22), HIV (n=39), hepatitis B and C (n=53), COVID-19 (n=11), skin and soft tissue infections (n=38), and tuberculosis (n=19). The lowest accuracy was 72% for urinary tract infections. ChatGPT answered 92% of social media platform questions correctly (scored 1-point) versus 69% of guideline questions (p =0.001; OR=5.48, 95% CI=2.29-13.11). Conclusion: Artificial intelligence is widely used in the medical field by both healthcare professionals and patients. Although ChatGPT answers questions from social media platforms quite properly, we recommend that healthcare professionals be conscientious when using it.

Objective: Contact tracing aids epidemic control by enabling early detection and isolation without overburdening healthcare systems despite potential challenges. This study aimed to evaluate the practical application of contact and risk assessment-based models in predicting SARS-CoV-2 infection following exposure among healthcare workers in a large tertiary public university hospital in Türkiye. Material and Methods: The study was designed as a retrospective cohort study, including contact tracing data from 3389 exposed healthcare workers from March 23, 2020, to October 22, 2021. Contact-based (mask use, contact duration and distance) and exposure risk-assessment-based (low, medium, high-risk) models with and without having symptoms were generated using logistic regression. SARS-CoV-2 infection was defined as having a positive SARS-CoV-2 RT-PCR test result. Adjustments were made to the models for demographic and occupational variables, previous infection, and vaccination. Model parameters were compared. Results: Of 3389 exposed healthcare workers, 2451 underwent RT-PCR testing. Among those tested, RT-PCR positivity was 5.9% (144/2451). Lack of personal protective equipment use (odds ratio [OR]=1.64, 95% confidence interval [CI]=1.03-2.66) and ≥15 minutes of contact duration (1.89, 1.21-3.09) were significantly associated with RT-PCR positivity. In the risk-assessment model, being a high-risk contact increased the odds of RT-PCR positivity (OR=2.76, 95% CI=1.61-5.03). Adding the presence of symptoms to contact-based and risk assessment models improved model parameters (Akaike information criterion [AIC]: from 1086.1 to 1083.1; Tjur’s R2: from 0.016 to 0.019, respectively). Conclusion: The inclusion of being symptomatic improved the contact-based and risk assessment-based models. Institutions should be encouraged to incorporate symptom inquiries into risk assessment protocols in response to newly emerging respiratory virus epidemics. Institutions lacking the capacity for extensive contact tracing are recommended, at minimum, to track symptomatic exposed workers for epidemic control.

Objective: Patients with COVID-19 accompanying cancer have been reported to have higher morbidity and mortality. In this study, we aimed to evaluate the high-dose high intravenous anakinra treatment response and outcome in patients with COVID-19-associated cytokine storm accompanying cancer. Methods: This retrospective observational study was carried out at a tertiary referral center between September 01, 2021, and February 01, 2022, in Turkey. The study population consisted of two groups: patients receiving high-dose intravenous anakinra and patients treated with standard care. Results: Data from 146 patients in the anakinra group and 114 patients in the control group were analyzed. Malignancy frequency was 11% (n=16) in the anakinra group and 7% (n=8) in the control group. In survival analysis, a significantly lower survival rate was observed in patients with malignancy than those without in the control group (log-rank: p=0.002) and patients with malignancy in the control group compared to the anakinra group (log-rank: p=0.013). However, it did not differ between patients with and without malignancy in the anakinra group (log-rank: p=0.9). Conclusion: In the control group, mortality was higher in patients with malignancy compared to those without malignancy, but not in the anakinra group. Also, mortality was higher in patients receiving SoC compared to anakinra. Intravenous high-dose anakinra treatment is safe and effective in patients with COVID-19 accompanying cancer.

Objective: This study aimed to determine the predictors for significant hepatic abnormality (SHA), a treatment indication, by assessing demographic, laboratory, and radiological results of chronic hepatitis B (CHB) patients who underwent liver biopsy. Materials and Methods: In this retrospective study, individuals with untreated hepatitis B e-antigen (HBeAg)-negative CHB infection were enrolled. Multivariate analysis modeling was conducted with parameters identified as predictors for SHA in univariate analysis. Optimal threshold levels for variables to predict SHA in patients with chronic hepatitis B were determined based on receiver operating characteristic (ROC) curve analysis. Results: A total of 566 patients with untreated chronic hepatitis B were included in the cohort; 61% (345/566) were male, and the median age was 41 years (interquartile range [IQR]=34-50). Notably, 36.9% (209/566) had SHA. In the multivariate analysis, utilizing different models, age, gender, HBV-DNA, LDL, ALT, and platelet count were identified as the most reliable predictors for SHA in CHB patients. For predicting SHA, the area under the ROC curve values of HBV-DNA, AST, and ALT were 0.704 (sensitivity=62.8%, specificity=76.2%; p<0.0001), 0.747 (sensitivity=51.9%, specificity=88.9%; p<0.0001), and 0.737 (sensitivity=68.6%, specificity=68.4%; p<0.0001), respectively. Conclusion: In our study, age, male gender, ALT, AST, HBV-DNA, LDL cholesterol, platelet count, and FIB-4 score were independent predictors of SHA in HBeAg-negative chronic hepatitis B. The most sensitive parameters for SHA were LDL and ALT. The most specific param- eters were age, AST, and APRI score. SHA may occur in patients with high HBV-DNA levels, even if ALT values are normal in HBeAg-negative patients.

Objective: Antimicrobial resistance can lead to morbidity and mortality in serious infections. Therefore, this study aimed to evaluate the knowledge and attitudes of patients admitted to the outpatient clinics of our hospital about the rational use of antibiotics. Materials and Methods: Patients who applied to Infectious Diseases and Internal Diseases Polyclinics between August 01, 2021 and February 01, 2022 were included. After obtaining written consent from those who agreed to participate in the study, a face-to-face questionnaire was applied to evaluate their knowledge and attitudes about antibiotic use. Results: A total of 735 patients were included in the study; 64.1% were women, and the mean age was 40±15 years. The median of the total correct score on the scale measuring the patients’ knowledge level in the study was 5. It was determined that individuals who scored 5 or less did not have sufficient knowledge, and those who scored above 5 had sufficient knowledge. Female gender, being single, being a university graduate, and hav- ing a middle income were associated with sufficient knowledge level (p<0.05). The rates of self-starting or using antibiotics until the complaints subsided were higher in the group with insufficient knowledge (p<0.05). Conclusions: The knowledge level of our patients regarding antibiotic use provided better results in all parameters, such as the number of visits to the doctor, self-starting antibiotics, using the antibiotic in the appropriate indication, and complying with the duration. The knowledge level was found to be associated with the appropriate antibiotic use.

Objective: Reuse of medical devices poses risks concerning technical issues and patient safety. In this study, we aimed to examine the structural changes in catheters that occur due to the reuse with the aid of electron microscopy. Materials and Methods: The effects of hydrogen peroxide (HP) and ethylene oxide (EO) sterilization on four percutaneous transluminal coronary angioplasty (PTCA) catheters and control PTCA catheters were examined by scanning electron microscope (SEM). Each catheter sample was divided into four parts during the SEM examination, and a total of 20 pieces were examined. Catheters were reprocessed through every regular sterilization step and used solely for the study, not in patients. Statistical evaluations of histological scoring made on images obtained from scanning electron microscopic images were made using the GraphPad Prism 8 program. Results: Electron microscopical examination showed that HP sterilization caused more robust and deeper lines compared to EO. These distortions increased directly with the increase in the reprocessing cycle. In EO, no significant damage was detected within five cycles in contrast to HP; however, the harmful effects of EO were seen over five cycles. Unprocessed samples had no damage. Outer and inner deterioration was significantly higher in the EO>5 group and HP>5 group than in the control group. However, the bacterial contamination score in the EO>5 group was higher than the control group. Conclusion: Our findings showed that HP and EO sterilizations caused some deterioration in the inner and outer surfaces of PTCA catheter samples. We recommend reprocessing using EO, the least damaging method, when necessary, and paying attention not to exceed five cycles when necessary.

Oral cancer is most common in developing countries, but is also seen in the rest of the world. In more than 90% of cases, squamous cell is found. Treatment is surgical with or without subsequent adjuvant therapy. Patients with tumors have a higher risk of thrombosis, assuming that the underlying pathophysiological mechanism is endothelial dysfunction. The presented case describes the development of acute thrombosis of the right common femoral artery in a patient with late diagnosed carcinoma of the floor of the oral cavity after a consecutive treatment with cisplatin, 5-fluorouracil and cetuximab. A 62-year-old man was diagnosed with squamous cell carcinoma of the floor of the oral cavity, with subsequent surgical resection and radiotherapy. Due to recurrence, a laryngectomy was performed and 6 courses of chemotherapy with cisplatin, 5-fluorouracil and cetuximab were followed. 2 days after the last infusion, acute peripheral arterial thrombosis was developed. Cancer and applied antitumor therapy exert a synergistic effect on coagulation activation. The exact mechanisms by which thrombotic complications occur are not fully understood. They suggest a toxic damage to the vascular endothelium, which leads to a decreased expression of nitric oxide synthetase and, accordingly, vasodilation, a decrease in anticoagulants and an increase in the levels of procoagulants such as tissue factor, which activates coagulation and induces the activation of platelets. The general practitioner occupies a central role in the health care system in a number of countries. In order to be able to perform its complex activities and successfully solve diverse health problems it is necessary to possess specific knowledge and skills from various fields of medicine.

Abstract Diaphragmatic eventration is commonly seen following high-energy traumas, particularly due to traffic accidents and falls from significant heights. This pathology has the potential to influence both the gastrointestinal and cardiorespiratory systems, presenting with a variety of symptoms. A 45-year-old male patient, with a history of trauma from falling off a tree, sought medical attention at our clinic with dyspeptic complaints and symptoms of shortness of breath. During the physical examination, diminished sounds were detected in the right lung field, along with epigastric tenderness. For diagnostic purposes, a posteroanterior chest radiograph (CXRs) and thoracic computed tomography (CT) scan were obtained. A subsequent bronchoscopy, performed with a pulmonology consultation, revealed decreased diaphragmatic movements. Taking into account the findings, a thoracic surgery treatment plan was devised for the patient. This case report underscores the significance of considering the seldom-encountered pathology of diaphragmatic eventration in patients presenting with dyspeptic and respiratory complaints. Keeping in mind that patients with such symptoms frequently turn to family physicians, it highlights the pivotal role of a multidisciplinary primary care approach in initiating the diagnostic trajectory.

Objective: The aim of our study was to investigate whether there is a relationship between shoulder complex pathologies and cervical disc herniations. Methods: This study retrospectively included 524 patients with both dominant extremity shoulder and neck magnetic resonance examinations obtained from the information processing unit of Düzce University Faculty of Medicine between 01.08.2009-01.08.2023. The results were compared in Statistical Package for Social Sciences (SPSS). Results: A total of 524 patients, 153 (29.2%) males and 371 (70.8%) females, with a mean age of 51.17±13.70 (range, 13-93) years, were included in the study.According to the statistical analysis of our study, 410 of the participants had supraspinatus pathology, 234 had infraspinatus pathology, 243 had subscapularis pathology and 11 had teres minor pathology. In addition, a statistically significant relationship was found between other shoulder pathologies and herniations at the C4-C5 and C5-C6 disc level (p

Objective: This research aims to examine the knowledge level and awareness of Faculty of Medicine students about medical artificial intelligence technologies. Methods: In this study involving students studying at Medical Faculties in Turkey, descriptive questionnaire, and the Medical Artificial Intelligence Readiness Scale for Medical Students (MAIRS-MS) were used. The suitability of continuous variables for normal distribution was tested with the Shapiro-Wilk test. Descriptive statistics for continuous variables are presented as mean and standard deviation or median (Q1-Q3). Descriptive statistics for categorical variables are reported as frequencies and percentages. Homogeneity of variances was evaluated with the Levene test. Mann Whitney U test was used to compare the scale subdimension and total scores according to two independent groups; One-way Analysis of Variance or Kruskal Wallis test was used to compare the scale subdimensions and total scores according to more than two independent groups. Dunn-Bonferroni test was used for multiple comparisons if there was a significant difference between the groups. The relationship between MAIRS-MS subdimensions and MAIRS-MS score was evaluated with the Spearman correlation coefficient. MAIRS-MS reliability was determined by Cronbach alpha value. The value of p

Objective: In patients with juvenile idiopathic arthritis (JIA), bone metabolism may be negatively affected due to both the activity of the disease and the medications used. Our study aimed to investigate the necessity of evaluating 25 hydroxyvitamin D (25 (OH) Vit D), calcium (Ca), phosphorus (P), alkaline phosphatase (ALP) levels and possible related factors in the follow-up of patients diagnosed with JIA. Method: The records of 68 patients with JIA were retrospectively evaluated. Disease subtypes, medications used, and whether they were in remission or active disease were reviewed. Results: 25 OH Vit D levels were low in 14.7% of patients with JIA compared to the control group. 66.6% of the patients with systemic arthritis had high ALP levels. 25 OH Vit D level was low in 16.6% of steroid users, and Vitamin D level was low in 55.5% of the patients in the active disease group. It was determined that patients in the active disease group had the highest ALP and lowest vitamin D levels compared to patients in remission with and without medication. Conclusion: Bone metabolism in patients with JIA is negatively affected. Since vitamin D plays a crucial role in bone metabolism, it was emphasized that vitamin D levels should be evaluated especially during active disease and supplements should be provided for patients with low vitamin D levels.

Objective: Respiratory pandemics cannot be prevented from spreading if the mask is not worn correctly. This study aims to determine people's awareness of mask use and the factors that influence mask use during a period when masks are mandatory. Materials and Methods: This descriptive study was conducted in a university hospital during the COVID-19 pandemic (June 2020), when mask use was mandatory. Participants were asked to complete a questionnaire on socio-demographic characteristics and mask use. Results: In the presented study, 705 people were included. The mean age of the participants was 35.86±8.77 (18-65) years old and 71.2% (n=502) were male, and 45.5% (n=321) were university graduates. Full compliance with the pandemic rules was achieved by 83.7% of women (n=170) and 58.0% of men (n=291) (p

Objective: The aim of this study was to investigate the effects of individually designed insoles on physical activity level, balance and functional performance in patients with pes planus. Methods: 38 participants were divided into 2 groups as 3D printed (n=20) and placebo(n=18). In the 3D printed group, medial longitudinal arch support, medial wedge of the foot, medial heel wedge and transverse arch support were given to the insoles according to the needs of the participants. The placebo group received placebo insoles. Range of motion, muscle strength, static and dynamic balance, physical and physical activity levels were measured at baseline, and eight weeks later (clinicaltrials.gov ID: NCT05306886). Results: Muscle strengths of the plantar flexion and eversion increased after the use of insoles in the 3D printed and placebo groups (p0.05), but there were significant improvements in dynamic balance in both groups (p

Objective: In this study, we aimed to develop a valid and reliable scale to measure the level of awareness of people about COVID-19. Methods: A total of 244 people participated in the research. The item pool was created in line with the literature and expert opinions. The prepared items were examined by four experts in terms of content validity, language, and expression, and a 28-item scale form was created. Following these stages, the first form consisting of 28 items was applied to 29 people as a pilot study. Explanatory and confirmatory factor analyses were employed to test the construct validity. Results: As a result of the explanatory factor analysis, it was determined that the scale consisted of 15 items and 3 sub-dimensions. These sub-dimensions were respectively named “Protection”, “Knowledge of COVID”, and “Effort to Obtain Information”. When the fit indices obtained from the confirmatory factor analysis results were examined, we saw that the three-factor scale construct had a high fit at an acceptable level. Conclusions: Based on the data obtained from this study, we concluded that the COVID-19 awareness scale was valid and reliable to evaluate the awareness level of people. Keywords Awareness; COVID-19; Validity; Reliability; Scale

Objective: Prostate-specific antigen (PSA) is a marker used to detect prostate cancer. When high PSA values are detected, a prostate biopsy is performed considering the possibility of prostate cancer. PSA elevation is not specific to prostate cancer, but may also be caused by conditions such as benign prostatic hyperplasia (BPH), urinary tract infection, and chronic prostatitis. Prostate cancer is not detected in approximately 66% of patients undergoing a biopsy, and patients are exposed to unnecessary biopsy and biopsy complications. Chronic prostatitis is detected in approximately 40% of these biopsies. The two-glass test is based on examining urine before and after rectal examination, which is used in diagnosing chronic prostatitis. In this study, we aimed to reveal the two-glass test’s effectiveness in predicting the incidence of prostatitis and inflammation in patients with a PSA value of 2.5-10 ng/ml and who underwent prostate needle biopsy. Methods: Fifty-two male patients, aged between 50 and 78 years, with PSA values between 2.5 and 10 ng/ml, who applied to our clinic were included in the study. EPS-two-glass test and prostate biopsy were applied to all patients. EPS; is a sample obtained by removing the fluid from the urethra after a prostate massage; VB-3; shows the urine produced by taking about 10 ml of urine voided after massage. EPS and VB3 detect prostate infection. Under the microscope, ≥10 leukocytes were considered significant for prostate inflammation. According to the pathology results, the patients were divided into 3 groups; prostate cancer, BPH, and chronic prostatitis. The chronic prostatitis group was classified according to the histopathological calcification described by Nickel. Results: In this study, the ratio of chronic prostatitis was found to be 38%. VB3 positivity was found to be statistically significant in the chronic prostatitis group compared to the other groups (p = 0.028). Although there was no statistically significant difference between the prevalence of inflammation and PSA elevation, PSA was found to be higher in the multifocal inflammation subgroup than in the focal inflammation patient group. Conclusion: The relationship between chronic prostatitis and PSA elevation remains a mystery. Although no statistical relationship was found between inflammation and PSA elevation in this study, the significant correlation between chronic prostatitis and VB3 positivity reinforces the possibility of this relationship. We believe that our results will form the basis for further studies to avoid unnecessary biopsies.

Objectives: This study aims to compare of CHA₂DS₂VASc and R₂CHA₂DS₂VASc score estimation of in-hospital mortality among COVID-19 patients and find a new scoring system that can better predict the hospital mortality by adding some laboratory parameters to the CHA₂DS₂VASc and R₂CHA₂DS₂VASc scores. Methods: This is a cross-sectional study. A total of 1076 COVID-19 patients with confirmed COVID-19 PCR tests were included from September 2020 to March 2021. Age, sex, comorbidity, laboratory, survival times, and death status of the patients were recorded. The scores CHA₂DS₂VASc and R₂CHA₂DS₂VASc of each patient were calculated. A new mortality prediction score was created to establish the most effective model with logistic regression analysis, including laboratory values. Results: Of the 1076 patients hospitalized for COVID-19, 15.1% died, while 84.9% survived. There was no significant difference between the two groups in sex. All comorbidities were significantly higher in the deceased than in the survivors (p

Objective :In Parkinson’s disease (PD), lower urinary tract symptoms (LUTS) are common with a prevalence ranging from 25% to 57%. Patients who are resistant to medical treatment for LUTS may require urodynamic examination and pressure flow study (UD-PFS) to better comprehend the bladder's dynamics. To be able to comprehend the pathophysiology of LUTS, UD-PFS examinations should be performed. In this study, the demographics and clinical properties of PD patients were presented along with their UD-PFS examinations. Method : The data of 155 patients with PD followed up between 2010-2020 were retrospectively analyzed. UD-PFS was applied to 42 PD patients resistant to medical treatment of LUTS. Patients' demographic and clinical data with their UD-PFS findings were studied separately. Result : Twenty-eight of the patients underwent UD-PFS were male, and 14 were female. In UD, the first urinary sensation was 86.00±68.77cc, and the maximum cystometric capacity was 322.07±194.25cc. Sixteen patients had a hypo-compliant bladder, 25 (59.5%) had a normo-compliant bladder. In PFS, Q max and peak detrusor pressure during voiding were 12.72±10.08 mL/sec and 43.93±15.56 cm-H2O, respectively. Stress-type urinary incontinence was detected in 6 (15%) of the patients. When evaluating the detrusor activity, neurogenic detrusor overactivity in 18 (44%) patients, detrusor areflexia in 8 (19%) and normal UD-PFS in 16 (22%) patients. Conclusion: The majority of the patients presented with neurogenic detrusor overactivity accompanied by diminished bladder capacity and hypersensitivity. In the selected PD patients who are resistant to medical treatment with LUTS clinics, UD-PFS provides useful scientific information about the LUTS clinics of patients and may be helpful in treatment management.