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During the coronavirus pandemic, increasing evidence has confirmed that the SARS-CoV-2 virus is susceptible to increased risk of stroke. On the other hand, the relationship between the SARS-CoV-2 virus and CADASIL was among the topics discussed in the literature with a small number of cases. In this case report, we present multiple cerebral infarcts in an asymptomatic CADASIL patient and we aim to shed light on the complex nature of cerebrovascular manifestations of the SARS-CoV-2 virus. A 50-year-old man with an unremarkable past medical history was admitted to our department with fever and neurologic manifestations on the 6th day of self-isolation due to positive reverse-transcriptase-polymerasechain-reaction assay in a nasopharyngeal sample for SARS-CoV-2. Neurological deficits were related to the acute vascular lesions located in the border-zone areas of both hemispheres, corpus callosum, and cerebellar peduncles on brain MRI. Lesions in chronic nature in the bilateral subcortical white matter predominantly involving the external capsule and temporal poles were also challenging. As a result of a comprehensive study that could explain the neurological status and imaging findings, the CADASIL diagnosis is reached by genetic testing for NOTCH-3. The experience, in this case, suggests considering patients with suspicious MRI findings for CADASIL diagnosis during the coronavirus pandemic. Further studies are needed to explain the underlying pathophysiological mechanisms related to cerebrovascular manifestations of SARS-CoV-2.Copyright © 2022 by Turkish Cerebrovascular Diseases Society.
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BACKGROUND: Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a systemic disease leading to renal complications of pauci-immune focal and segmental necrotizing crescentic glomerulonephritis (PI-NCGN). CASE DESCRIPTION: We present a 57-year-old female patient with rapidly progressive glomerulonephritis, multiple systemic infections [candidiasis and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)], severe weight loss, arthralgia, positive myeloperoxidase ANCA, acute deterioration of cardiac function and NCGN with heavy deposition of immunoglobulin (Ig) A and complement 3 (C3) in kidney biopsy. After two months of follow-up and appropriate treatments [methylprednisolone (60 mg/day), cyclophosphamide (15 mg/kg)], our patient recovered from multiple life-threatening infections, including candidiasis treated by fluconazole and SARS-CoV-2 treated by methylprednisolone and acute cardiac failure. In addition, she was saved from dialysis despite all poor prognostic factors. CONCLUSION: AAV might lead to immune complex deposition in kidneys due to different pathogenetic mechanisms like complement activation and immune complex formation, apart from losing tolerance to neutrophil proteins. HIPPOKRATIA 2022, 26 (2):86-88.
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This study aims to determine the relationships among students' self-learning capability, lecturers' teaching competencies, COVID-19 conditions, and students' learning outcomes during online teaching in tourism higher education. This study also investigates the role of distance education tools on the relationship between behavioral factors and learning outcomes. The study adopted a mixed-methods approach, including an experimental design and a quantitative model. A qualitative experimental study to evaluate the students' attitudes and behaviors during distance education was followed by quantitative research. A hypothesized conceptual model was tested using structural equation modeling to analyze the relationships among the factor groups and the mediating role of distance learning tools. As a result, while "students' self-learning capabilities” and "lecturers' teaching competencies” had a positive impact on "students' learning outcomes”, "COVID-19 conditions” had a negative impact. All hypotheses were supported. © 2023 ICHRIE.
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Introduction or Background: The long-term effects of COVID-19 infection on the respiratory system in children are not yet known. Aims and Objectives: To determine the long-term effects of COVID-19 infection on the respiratory system of children by evaluating pulmonary function tests. Method(s): In this multicenter study, COVID-19 PCR positive children(>=6years) were evaluated prospectively with pulmonary function tests(spirometry, plethysmography and CO diffusion) at 3rd and 6th months follow-up. The results were evaluated retrospectively based on clinical symptoms, physical examination findings, radiological and laboratory tests of the patients in the acute phase of the infection. Result(s): At 3rd month evaluation of 270 COVID-19 PCR positive pediatric patients, mean FEV1 96.85+/-16.84%,FVC 96.06+/-16.84% were found;at 6th month, mean FEV1 100,03+/-15.98%,FVC 100.62+/-16.87. At the 3rd month, statistically significant differences were found between FEV1<80%(n:28),FEV1>80%(n:242) groups due to the presence of additional diseases(p<0.001),having respiratory(p=0.006) and cardiovascular(p=0.004) system pathological examination findings, interlobular septal thickening(p=0.020) on thorax CT, high level of CRP(p=0.032),IL6(p=0.048),ferritin(p=0,020) during the infection period. Having COVID-19 pneumonia was found to be non-effective on spirometric test results. No difference was found between the 3rd and 6th month spirometry results of the same patient. Conclusion(s): After recovery of COVID-19 infection, children who have additional diseases, and pathological examination and radiological findings during the infection period, may have functional respiratory changes;so they should be monitored with pulmonary function tests.
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Objective: The COVID-19 pandemic has led to major changes in healthcare around the world, including postponing elective surgery. The aim of this study is to examine the COVID-19 test results in pediatric patients who are asymptomatic and have no history of contact with a COVID-19 case prior to their scheduled elective surgery. Material(s) and Method(s): This prospective study has evaluated pediatric patients who were asymptomatic and had no contact history with a COVID-19 case and who were scheduled for elective surgery between 01.05.2020-31.10.2020 in one of the world's largest pediatric hospitals. Nasopharyngeal swab (PCR) samples were obtained from all patients one day before the scheduled elective surgery. Result(s): Eight hundred twelve patients in this study had a mean age of 6.98 +/- 4.37 years. The PCR test was positive in 4 patients (0.49%), and one patient had diarrhea during the quarantine period of 15 days. Conclusion(s): The low PCR positivity rate in patients scheduled for elective surgery after a detailed history and physical examination raises the question whether elective surgery can be planned without testing. Pediatric surgeons can continue elective surgical procedures by taking precautions, but without requesting PCR, in patients who are asymptomatic and have no suspicious contact history. Copyright © 2022 Ankara Pediatric Hematology Oncology Training and Research Hospital. All rights reserved.
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Objective: We aimed to evaluate the demographic, epidemiological, and clinical characteristics of children with coronavirus disease-2019 (COVID-19), and to determine variations of the clinical presentation of the disease by age. Method: A total of 104 confirmed COVID-19 patients aged between 0-18 years were retrospectively analyzed. The study period was between March 15, 2020 and July 1, 2020. A confirmed COVID-19 was defined as a child who has positive real-time reverse transcription-polymerase chain reaction (rRT-PCR). The patients were analyzed in terms of demographic, epidemiological, clinical, laboratory and imaging features, and clinical outcomes.
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Introduction: As a high-efficacy multiple sclerosis (MS) treatment, cladribine necessitates empirical data from diverse populations. Objective(s): To study the efficacy and safety data of cladribine treatment in a real-world setting. Method(s): Patients from eight MS clinics in Turkey were involved in the study. We retrieved the demographic, clinical, MRI, safety, laboratory, COVID-19, and pregnancy records of patients with at least six months of follow-up on cladribine treatment. Result(s): Our study included 210 MS patients (52 males, 158 females;193 relapsing and 17 relapsing-progressive MS). The mean age at MS disease onset was 27.6 years (+/-8.5). Before cladribine treatment, 56.7% of patients used first-line, and 41.9% used both first and second-line therapies. During a mean follow-up period of 13.0 months (+/-4.7) following cladribine treatment, 5.7% of patients experienced a relapse. The shortest duration of relapse following cladribine administration was one week, and the longest duration was 15.3 months. Interestingly, 50% of the relapses occurred within the first three months. Among relapsing patients, five switched from fingolimod, two from dimethylfumarate, and one from ocrelizumab and interferon-beta. The mean annualized relapse rate was 0.41 (+/-0.41) in the two years preceding cladribine and 0.11 (+/-0.55) one year following treatment. At baseline, the mean EDSS score was 2.47 (+/-1.63), and 51.9% of patients ranked below EDSS 3. EDSS progression was observed in 7.6% of patients following cladribine treatment. On cladribine, eight patients (9.4%) exhibited radiological progression. There was no difference in NEDA status between patients switching from first or second-line therapy (p=0.43). COVID was observed in 73 patients, 54 of them had a mild disease course, six had a moderate disease course, and one had a severe disease course. There have been no COVID-related fatalities. There were five pregnancies documented, three of which are currently ongoing. One of the pregnancies ended with healthy childbirth, while the other was terminated in the first trimester with a miscarriage. Conclusion(s): Despite the relatively short duration of follow-up, our study demonstrates that cladribine is effective in providing NEDA. Moreover, switching from fingolimod to cladribine may increase the likelihood of early relapse.
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Objective: It is thought that hyperinflammation has an important role in the pathogenesis of severe COVID-19 and tests that determine the de-gree of inflammation can be used to predict the severity of the disease. From this point of view, we aimed to determine the hematological parameters that can predict the severity of COVID-19 in pediatric patients. Material and Methods: Symptomatic and SARS-CoV-2-PCR test positive 105 children were included to study. Seventy-nine patients had mild, 26 had moderate to severe COVID-19 at admission. Data about their demo-graphic characteristics, clinical and laboratory findings were collected from their medical records. Correlations between the hematological parameters and disease severity of patients were investigated by using uni-variate and multivariate regression analyses. Predictive value of different diagnostic markers was studied. Results: Mean age was older (177 months vs. 70 months) and mean body mass index (BMI) was higher (18.8 kg/m2 vs. 25.0 kg/m2) in patients with severe COVID-19 than those with mild. Univariate analysis showed that mean leucocyte (WBC), lymphocyte, eosinophiles, and platelet counts were lower;mean platelet volume (MPV), neutrophil to lympho-cyte ratio (NLR), and derived neutrophil to lymphocyte ratio (dNLR) were higher in severe COVID-19 group (p< 0.05). Multivariant analysis showed low lymphocyte (OR 0.072) and WBC count (OR 0.085), high dNLR (OR 2.14) and MPV (OR 2.35) indexes were the most valuable parameters to predict disease severity, ROC curve analysis revealed lymphocyte count has superior predictive value (<1.55 /mm3 has 84.6% sensitivity, 70.9% specificity) than other CBC parameters have. Conclusion: Low lymphocyte and leukocyte count, high MPV and dNLR values have significant predictive value in predicting COVID-19 severity. In particular, lymphopenia appears to be a valuable parameter to identify patients at high risk for severe disease and initiate accurate treatment to prevent disease deterioration.
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Objective: Communication difficulties are considered the most significant consequence of hearing loss. This study aimed to determine whether surgical face masks, which have been mandatory throughout the COVID-19 pandemic, have an effect on speech comprehension scores in geriatric lip-reading patients with hearing loss and to raise awareness of the need for solutions to this problem. Materials and Method: Patients with moderate and higher sensorineural or mixed bilateral symmetrical hearing loss who stated that they lip-read to better understand during communication were included in the study. The patients’ speech comprehension scores were gathered while the audiologist wore a surgical mask and then a transparent mask, respectively. Results: Twelve (33,3%) of the patients were female, and 24 (66.7%) were male. The mean age of the patients was 66.64±1.53 years. The mean speech comprehension scores of the patients when the audiologist was wearing a surgical mask (38.25±14.33) and a transparent mask (67.81 ± 14.30), respectively, were compared. The surgical mask significantly affected speech comprehension scores, and the Cohen d value of the effect size was 2.06. As such, the surgical face mask had a great effect on these patients’ speech comprehension scores. Conclusions: In elderly lip-reading patients who suffer from hearing loss, seeing the lip movements of the speaker, especially in hospital applications, promotes more effective communication. Transparent face masks can be considered a solution.
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Globalization is a term explaining the increasing connectivity and cross-border activity among nations in economic, business, trade, tourism, migration, and cultural activities. Globalization has been the most contentious concept that has been evaluated according to political biases and national interests. Therefore, this paper aims at analyzing globalization in context of conceptual evolution, dynamics and factors enlarging globalization, the evaluation of globalization and finally the reasons for the decline of globalization. Covid 19 pandemic and its interaction with globalization will also be scrutinized as well. The major outcome of the study sets forth that the actual evolution of globalization has taken place with capitalist progress. It has been a major force in the further progress of globalization Although we are in a declining process of globalization, it is clear that it will survive with humanity as long as human beings exist.
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Objective: The clinical features of COVID-19 range from asymptomatic disease to severe pneumonia or even death. Therefore, many researchers have investigated the factors that could affect the severity of COVID-19. We aimed to assess the impact of aero-allergen sensitization and allergic diseases on the severity of COVID-19. Materials and Methods: We included 60 adult patients with symptomatic COVID-19 and allocated them into two groups equal in number as having severe and non-severe COVID-19. We evaluated the demographic features and allergic diseases in addition to clinical, laboratory and radiological findings of COVID-19. Skin prick tests (SPTs) with common aero-allergens, serum total IgE levels and blood eosinophil counts were evaluated 3 months after the patient's recovery from COVID-19. Results: The mean age of the patients was 52 ± 11 years and 73.3% of the patients were male. There was no significant difference between the two groups in terms of age, gender, smoking habits, obesity and comorbidities. Although the frequency of sensitization to aeroallergens and the allergic diseases were similar, the history of allergic diseases in the family was higher in the severe group (p<0.001). The polysensitization in SPTs was associated with the presence of a cytokine storm during the infection (p=0.02). Total IgE levels and blood eosinophil counts were not significantly different between the two groups. Conclusion: The presence of atopy or allergic diseases does not seem to be related to the severity of COVID-19. However, polysensitization and a family history of allergic diseases are more prominent in those having a cytokine storm and severe COVID-19, respectively.
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Introduction: Although Phase III trial results of many COVID-19 vaccines were reported, the literature regarding community results is inadequate for Corona Vac. This study aims to evaluate the experience gained during the vaccination process among health care workers (HCWs), the measured antibody responses and the factors affecting the response. These findings will contribute to the literature in this field. Materials and Methods: Anti-SARS-CoV-2 (anti-spike) antibodies were measured by ELISA in blood samples taken at least 28 days (28-32) after the second CoronaVac among 264 HCWs vaccinated twice with an interval of 28 days. Information from individuals was collected with an online participation form. Results: A total of 264 HCWs (166 females (63%), 98 males (37%) whose ages werebetween 23-69 (mean 44.22 +/- 11.58) were included independent of their COVID-19 history in the study. After vaccination, 2211CWs (8.3%) were unresponsive, 25 (9.5%) HCWs among responders had a weak antibody response, and 217 (82.2%) had afull antibody response according to the test kit manufacturer. For HCWs with and without a COVID-19 infection history, the full antibody response rates were 91.7% and 77.5%, respectively. The antibody titres tended to be lower in HCWs with no prior COVID-19 infection (p= 0.046). In our study, antibody response was found to be significantly lower in males (p= 0.043). There was a significant decrease in antibody response with advancing age (p= 0.002 Chi-square test, p= 0.030 Spearman coefficient), and the difference was highly significant (p= 0.017) above the age of 60. Conclusion: In this study, it was determined that 91.7% of healthcare workers (weak in 9.5% and full in 82.2%) developed anti-spike antibodies with CoronaVac. It was determined that the factors affecting the development of antibodies were gender, age, and the state of having COVID-19.
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This article argues that a clear correlation exists between disease and the prevailing social functioning. In this respect, every disease can be seen as a metaphor for the age and society in which it emerges. In other words, every period carries a form of disease that bears traces of the dominant lifestyle. This study approaches the epidemic as a kind of sociological projection in the context of studying modern culture and continues the discussion along the lines critically opened by Susan Sontag (2005). lust as Sontag examined disease as a metaphor, this article debates the discourses on masks, social distancing, and hygiene within the scope of COVID-19 along a specific sociological axis around the concepts of speed, control, information, hyper-medicalization, and death as the dominant indicators of contemporary culture. For this purpose, the study seeks answers to the following questions through the leading social theorists of the field such as Bauman, Baudrillard, Turner, Furedi and Chul-Han: How does the global epidemic and the current health discourse embodied in it appear within the sociological context? What thoughts and tendencies emerge when examining the pandemic portrait as a social metaphor? For example, what kind of relationship exists between hygiene and cultural fears;among distance, social isolation, and avoidance;and between masks and the superficial idea of death concealed behind quantification? Undoubtedly, the pandemic is a critical breaking point in the history of modern medicine and has forced not only global health practices but also many value judgments to both paradoxically be accepted and questioned.
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Purpose: The world is going through unprecedented times since the beginning of the COVID-19 pandemic. Billions of people will be vaccinated in the next few years. This mass vaccination effort requires setting up complex cold chain organizations and meticulous coordination of distribution networks. Keeping coronavirus vaccines at appropriate temperatures during the distribution process is not easy;however, it is one of the key factors battling against COVID-19. The purpose of this paper is to discuss and identify the essential logistics capabilities of cold storage and logistics service providers during the COVID-19 vaccine distribution. Methodology: First, we identify the prominent risks that cold chain distributors encounter during vaccine transportation by conducting an in-depth literature review and an interview with the vice president of one of the largest air cargo companies in the world. Then we discuss logistics capabilities for the mitigation of these risks. Finally, we explore the Turkish Cargo's cold chain footprint enlargement strategy during the pandemic. Findings: Cold chain logistics requires special attention to specific capabilities due to the nature of the cargoes being transported. On-time delivery time, special storage and transport equipment, and process monitoring ability are among the core capabilities for cold chain logistics service providers. Ensuring the reliable and effective distribution of temperature-sensitive vaccines is crucial since millions of lives depend on them. Originality: This study is one of the first papers investigating the cold chain capabilities of air cargo distributors during the COVID-19 pandemic. © 2021 Proceedings of the Hamburg International Conference of Logistics. All rights reserved.
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Purpose: COVID-19 caused a highly uncertain environment and introduced a radical change in the airline industry. In that time, idle capacity due to drastic decline in passenger traffic, change in travel rules, and increases in air cargo demand have emerged as the main challenges. Effective responses to these issues became a fundamental requirement for airlines' survival and sustainability of supply chains. Organizational flexibility plays a vital role in dealing with those situations. Flexibility allows airline companies to adapt to changing environmental conditions and take advantage of opportunities. This study aims to explain the strategies of airline companies in Turkey to the COVID-19 crisis based on organizational flexibility. Methodology: This study is structured on the qualitative research method. We interviewed five experts and compiled information by reviewing various publications on COVID-19. We analyzed obtained information within the framework of organizational flexibility. Findings: The results indicated that airlines mitigate the effects of COVID-19, mostly through protective and exploitative maneuvers of organizational flexibility. Airlines focus more on cost reduction and saving strategies as protective maneuvers, while exploitative maneuvers focus more on the cargo market. Originality: This study is novel in that it examined airlines' responses to COVID-19 within the framework of organizational flexibility. © 2021 Proceedings of the Hamburg International Conference of Logistics. All rights reserved.
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Due to a lack of preparation, teachers were not emotionally or cognitively prepared to use new approaches. Teachers discovered that while teaching online, elementary school teachers face various challenges. Summarizing and categorizing the difficulties encountered by primary school teachers in compulsory distance education will add to the literature, ensuring the dissemination of online instruction technological tools at both the distance education and primary education levels. The study sought to categorize the difficulties encountered by primary teachers. In order to figure out the purpose of the study, the study data including primary teachers in the COVID-19 period was synthesized. The study was accepted as a meta-synthesis. The education database ERIC was searched using the keywords “Primary Teacher”, “Distance Education”, and “Online Education”;and 79 studies were located as a result of the search. After eliminating ineligible studies, 23 of the 79 collected studies remained. As a result, students, parents, infrastructure, and teachers are all affected by the challenges. Cutting-edge technologies and a strong internet infrastructure are required for online education. Teachers are unable to maintain the minimum level of compulsory distance education due to limited internet connection and a lack of technological resources in many places. As a result of the strain, teachers felt inadequate. In many classrooms in poor countries, there is a lack of access to professional expertise and help for the use and integration of ICTs. COVID-19 has made this an issue for almost all schools, not just those in underdeveloped countries. The importance of online learning for elementary children and teachers has gotten considerably less attention. Teachers can take pedagogical diversity professional development training online and experience it as if they were students. The practical advantage of identifying the difficulties that teachers have faced is to aid teachers in overcoming such obstacles and to give the appropriate assistance. Successful distance education can only be achieved when teachers are supported in all areas of difficulty. © 2022 by the authors.
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Objective: This study aims to follow the fluctuations in affective responses to COVID-19 such as anxiety, stress, anger, and fear of the community parallel to the changes in the regulations and the course of the pandemic. Method: In a serial cross-sectional study, online data were collected on COVID-19-related anxiety, stress, anger, and fear. 5474 participants, who were aged between 18-73 and residing in different regions of Turkey, are included in the analyses. Emotional fluctuations across five waves were analyzed with four separate one-way ANOVAs for all emotions. Results: Statistically significant differences were observed between waves in terms of COVID-19 related anxiety, stress, anger, and fear (p < .05). As all emotions tended to increase up until the third wave, where all emotions tended to decrease except anger after the third wave. Discussion: Changes in the contextual factors, such as managing the pandemic, uncertainty, and vaccination, emerge as stressors and create an atmosphere of fear and worry, and affect individuals emotionally. Consequently, psychological problems such as mood and anxiety disorders may increase in the coming years.
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Objective: This study aims to follow the fluctuations in affective responses to COVID-19 such as anxiety, stress, anger, and fear of the community parallel to the changes in the regulations and the course of the pandemic. Method: In a serial cross-sectional study, online data were collected on COVID-19-related anxiety, stress, anger, and fear. 5474 participants, who were aged between 18-73 and residing in different regions of Turkey, are included in the analyses. Emotional fluctuations across five waves were analyzed with four separate one-way ANOVAs for all emotions. Results: Statistically significant differences were observed between waves in terms of COVID-19 related anxiety, stress, anger, and fear (p <.05). As all emotions tended to increase up until the third wave, where all emotions tended to decrease except anger after the third wave. Discussion: Changes in the contextual factors, such as managing the pandemic, uncertainty, and vaccination, emerge as stressors and create an atmosphere of fear and worry, and affect individuals emotionally. Consequently, psychological problems such as mood and anxiety disorders may increase in the coming years. © 2021 ANP Publishing. All rights reserved.
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Objective: Elective operations had to be postponed due to the COVID-19 pandemic that emerged in the last quarter of 2019 and affected the whole world in a short time. However, for emergencies such as myocardial infarction (MI), unfortunately, this is not possible. We aimed to evaluate the management of ST-segment elevation myocardial infarction (STEMI) before and during the COVID-19 pandemic. Methods: One hundred and eleven consecutive patients with STEMI between April 2020 and May 2020 and 149 patients with STEMI 1 year before the pandemic in the same period were included in the study. Groups were compared in terms of the treatments applied, pre-post-dilatation, duration of the procedure, hospitalization, and the primary end-point. Death due to MI or complications of MI was the primary end-point. Results: The mean age of the patients was 59.7 +/- 123 (n = 195 [75%] male). The two groups were similar in terms of gender, diabetes mellitus, hypertension, hyperlipidemia, smoking, and laboratory results. Although the median duration of the door balloon in the pandemic was similar (39 and 37 minutes, respectively;P = .342), the procedure times were shorter, the mean total hospitalization times were longer, and the differences were statistically significant (P = .022 and <.001, respectively). In the study group, 68 patients had pre-dilatation and 30 had post-dilatation during the procedure. The two groups were similar in terms of the primary end-point (P = .196). Conclusion: Percutaneous intervention should be the routine procedure to STEMI patients during the pandemic period, despite the positive possibility of COVID-19 and the risk of transmission.