Infectious diseases are one of the primary healthcare problems worldwide, leading to millions of deaths annually. To develop effective control and prevention strategies, we need reliable ...computational tools to understand disease dynamics and to predict future cases. These computational tools can be used by policy makers to make more informed decisions.
In this study, we developed a computational framework based on Gaussian processes to perform spatiotemporal prediction of infectious diseases and exploited the special structure of similarity matrices in our formulation to obtain a very efficient implementation. We then tested our framework on the problem of modeling Crimean-Congo hemorrhagic fever cases between years 2004 and 2015 in Turkey.
We showed that our Gaussian process formulation obtained better results than two frequently used standard machine learning algorithms (i.e., random forests and boosted regression trees) under temporal, spatial, and spatiotemporal prediction scenarios. These results showed that our framework has the potential to make an important contribution to public health policy makers.
Background The change in hepatitis B surface antibody (anti-HBs) titers after chemotherapy (CT) in patients with hematological malignancy, affecting factors, and its clinical implications have not ...been sufficiently understood. Therefore, we aim to evaluate the change in anti-HBs titers and hepatitis B virus reactivation (HBVr) after CT. Methods This retrospective study enrolled patients with hematological malignancies who received CT between 2013 and 2021. All patients were followed up for HBVr and a change in anti-HBs titers for one year. Results Overall, 192 patients were included. In total, 33.9% of the patients were anti-HBs (+) and 26% of the patients were anti-HBc (+) ± anti-HBs (+). Hepatitis B virus (HBV) prophylaxis was given to 35 (70%) of 50 Anti-HBc (+) patients. Tenofovir disoproxil fumarate and entecavir prophylaxis were initiated in 25 (71.4%) and 10 (28.6%) patients, respectively. A significant decrease was found in anti-HBs titers of all patients (p=0.017). A significant decrease was also found in anti-HBs titers of HBc IgG (+) patients and those who received four or more courses of CT (p=0.025; p=0.041). HBVr was not diagnosed in any of the patients. Conclusion Chemotherapeutic agents administered for hematological malignancy have serious immunosuppression effects. In these patients, anti-HBs titers may decrease or become negative one year after CT. Anti-HBs titer before CT or its change after CT may not constitute a risk for HBVr patients who received HBV prophylaxis in line with current guidelines and these recommendations.
Background This study aims to contribute to peritonitis management strategies by comparing the demographic, clinical, and laboratory characteristics of patients diagnosed with spontaneous bacterial ...peritonitis (SBP), peritoneal dialysis-related peritonitis (PDrP), and secondary peritonitis. Methods This study included 86 patients diagnosed with peritonitis between 2016 and 2022. Patients were categorized and compared as SBP, PDrP, and secondary peritonitis. Results SBP was diagnosed in 36% of patients, secondary peritonitis in 36% and PDrP in 28%. The mean age of patients with PDrP is 43.71 ± 14.74, which is significantly lower compared to those with SBP and secondary peritonitis (p<0.001). Patients with hypertension (HT), chronic kidney disease (CKD), and those undergoing dialysis most commonly have PDrP whereas those without HT, without CKD, and not undergoing dialysis are most often diagnosed with secondary peritonitis (p=0.002, p<0.001, p<0.001). In peritoneal fluid cultures, the growth of Gram-positive bacteria was most commonly identified in patients with PDrP, while the growth of Gram-negative bacteria was most frequently seen in patients with secondary peritonitis (p=0.018). CRP levels and sedimentation rates were found to be higher in patients with secondary peritonitis (p<0.001, p=0.003). Conclusion The distinct characteristics observed across different types of peritonitis underscore the importance of tailored approaches to diagnosis and treatment. Parameters such as CRP levels, sedimentation rates, and patient age could serve as valuable indicators in discerning between various types of peritonitis. When selecting empirical antibiotic therapy, it's crucial to consider coverage for Gram-positive pathogens in cases of PDrP and Gram-negative pathogens in secondary peritonitis.
The participation of the people in health decisions may be structured in various levels. One of these is participation in decisions for the treatment. "Advanced directives" is one of the examples for ...the participation in decisions for the treatment.
We wanted to determine the decisions on advanced life support at the end-stage of life in case of a life-threatening illness for the people themselves and their first degree relatives and the factors effecting these decisions.
The cross-sectional study was conducted with volunteers among patients and patient relatives who applied to all polyclinics of the Ankara Numune Training and Research Hospital except the emergency, oncology and psychiatry polyclinics between 15.12.2012 and 15.03.2013.
A questionnaire, the Hospital Anxiety Depression (HAD) scale, and Templer's Death Anxiety Scale (TDA) were applied to all individuals. SPSS for Win. Ver. 17.0 and MS-Excel 2010 Starter software bundles were used for all statistical analysis and calculations.
The participants want both themselves and their first degree relatives included in end-stage decision-making process. Therefore, the patients and their families should be informed adequately during decision making process and quality communication must be provided.
Participants who have given their end-stage decisions previously want to be treated according to these decisions. This desire can just be possible by advanced directives.When moral and material loads of end-stage process are taken into consideration, countries, in which advanced directives are practiced, should be examined well and participants' desire should be evaluated in terms of practicability.
•Needlestick and sharps injuries are a serious problem for health care workers (HCWs).•As a result of these injuries, HCWs may be infected with bloodborne pathogens.•HCWs may not know what to do ...after an injury and may not report the situation.•A hospital infection control committee can take an active role in this issue.•Training is important for the proper management of needlestick and sharps injuries.
The risk of occupational transmission of bloodborne pathogens to health care workers is primarily associated with needlestick and sharps injuries (NSIs). However, most NSIs are not reported, and most health care workers are not aware of postexposure procedures.
Data for NSIs reported in our hospital between 2008 and 2016 were reviewed retrospectively.
A total of 546 staff members reported NSIs. Of these, 376 (68.9%) were women. NSIs were more commonly reported by trainee nurses (243 44.5%), followed by nurses (121 22.2%), cleaning staff (108 19.8%), and doctors (49 9%). The rate of postexposure interventions was 13% in 2008 and 92.6% in 2016 (P < .0001; χ2 = 82.866). NSI rates also show that the number of applications with NSIs increased over the years. When occupational blood exposure was examined, the number of bloodborne pathogens was 50 (9.3%) cases of hepatitis B virus, 30 (5.6%) cases of hepatitis C virus, 3 cases of Crimean-Congo hemorrhagic fever, 1 case of HIV, and 2 cases of hepatitis B virus and hepatitis C virus coinfection.
Over the years, the increase in both the appropriate intervention rate and the number of reports to the hospital infection control committee after NSIs shows that regular training regarding NSIs is effective.
Hospital infection control committees may play a more active role in raising awareness in this regard and thus reducing the rate of unreported NSIs.
INTRODUCTION: Pulmonary function tests are a necessary and applicable method in the practice of family medicine. Our aim in this study was to determine the utilization rates of spirometry or ...peak-flow meter devices among family physicians who work in Turkey and the factors that influence this usage. METHODS: This descriptive study included physicians working in the family medicine system in Turkey. Surveys were sent to physicians via e-mail. When a sufficient number of responses(n=380) were obtained in two months (May 2018-July 2018), the study was terminated. RESULTS: Among the responding physicians, 81.50% (n=310) had a peak-flow meter and 1.50% (n=59) had a spirometer, while11% (n=42) of the physicians had neither of these devices. On the other hand, 66.30% (n=252) of the physicians stated that they did not use the spirometer or peak-flow meter, 6.60% (n=25) used the peak-flow meter, and 3.70%(n=14) used the spirometer. When asked about the reasons for not using the existing devices, the most common reason was that they thought that the tests were not effective in family medicine and the second most common reason was not knowing how to use them. It was found that, 79.70% (n = 303) of physicians requested a course on spirometry and peak-flow meter. DISCUSSION AND CONCLUSION: It was determined that the usage rates of peak-flow meter or spirometry devices, which are required in family medicine, are very low. In order to provide better service in primary care, more training is needed, both in medical faculties and after graduation.
Objective: Our aim is to evaluate trends in the direct and indirect causes’ distribution using data from National Maternal Mortality Surveillance (2012–2015).
Study design: A population-based ...retrospective review was performed on all pregnancy-associated maternal deaths in Turkey from 2012 to 2015. Causes of death were grouped into direct and indirect maternal deaths and compared in the context of distribution. Maternal mortality rate was reported. Statistics included chi-square test or Fisher’s exact test for categorical variables.
Results: Between 2012 and 2015 there were 812 maternal deaths. The maternal mortality rate was 15.4 deaths per 100,000 live births in 2012 as compared to 13.7 in 2015. Direct maternal deaths in Turkey declined from 59.5% in 2012 to 45% in 2015 while indirect maternal deaths increased from 45% in 2012 to 55% in 2015 (p = 0.045). The leading direct causes of maternal deaths were postpartum hemorrhage. The major indirect causes of maternal deaths were circulatory system diseases.
Conclusion: Direct maternal deaths in Turkey appear to be declining. This data will aid the management of maternal deaths.
Broad-spectrum empirical antimicrobials are frequently prescribed for patients with coronavirus disease 2019 (COVID-19) despite the lack of evidence for bacterial coinfection.
We aimed to ...cross-sectionally determine the frequency of antibiotics use, type of antibiotics prescribed, and the factors influencing antibiotics use in hospitalized patients with COVID-19 confirmed by polymerase chain reaction.
The study was a national, multicenter, retrospective, and single-day point prevalence study.
This was a national, multicenter, retrospective, and single-day point-prevalence study, conducted in the 24-h period between 00:00 and 24:00 on November 18, 2020, during the start of the second COVID-19 peak in Turkey.
A total of 1500 patients hospitalized with a diagnosis of COVID-19 were included in the study. The mean age ± standard deviation of the patients was 65.0 ± 15.5, and 56.2% (n = 843) of these patients were men. Of these hospitalized patients, 11.9% (n = 178) were undergoing invasive mechanical ventilation or ECMO. It was observed that 1118 (74.5%) patients were receiving antibiotics, of which 416 (37.2%) were prescribed a combination of antibiotics. In total, 71.2% of the patients had neither a clinical diagnosis nor microbiological evidence for prescribing antibiotics. In the multivariate logistic regression analysis, hospitalization in a state hospital (
< 0.001), requiring any supplemental oxygen (
= 0.005), presence of moderate/diffuse lung involvement (
< 0.001), C-reactive protein > 10 ULT coefficient (
< 0.001), lymphocyte count < 800 (
= 0.007), and clinical diagnosis and/or confirmation by culture (
< 0.001) were found to be independent factors associated with increased antibiotic use.
The necessity of empirical antibiotics use in patients with COVID-19 should be reconsidered according to their clinical, imaging, and laboratory findings.
Adherence to medication is an important aspect of preventing drug resistance and treatment failure in patients receiving nucleos(t)ide analogues for chronic hepatitis B.
To assess adherence to ...nucleoside/nucleotide analogues in chronic hepatitis B treatment and to determine factors associated with non-adherence.
Cross-sectional study.
The study enrolled 85 chronic hepatitis B patients who had been receiving nucleoside/nucleotide analogues for ≥3 months. A questionnaire was completed by patients themselves, and adherence was evaluated based on patients' self-reporting. The use of at least 95% of the drugs in the previous month was considered as adequate adherence.
Adherence was adequate in 82.4% of patients. Female gender (p=0.003), unemployment (p=0.041) and lower monthly family income (p=0.001) were related to lower adherence. Better adherence was significantly linked to adequate basic knowledge regarding chronic hepatitis B (p=0.049), longer treatment duration than 12 months (p<0.001), previous use of other medications for chronic hepatitis B (p=0.014) and regular follow-up by the same physician (p<0.001).
Counselling patients about their disease state and the consequences of non-adherence is an important intervention for enhancing adherence. Naïve patients should be followed up more frequently to reinforce adherence.
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