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Objective: This study included participants from Hacettepe University 4th, 5th, and 6th-grade students of Medical School and 4th and 5th-grade students of Dental School;and aimed to evaluate the general health status, COVID-19 history, vaccination status, and SARS-CoV-2 antibody levels of the participants to support their physical and social health, during the pandemic period. Methods: A prospective cohort study was conducted with an integrated, matched, nested case-control study. Sociodemographic characteristics, life habits, COVID-19 history, vaccination status, compliance with mask-distance-hygiene rules, and risks (if any) for COVID-19 were inquired via online questionnaires. Physical examinations, complete blood count, biochemistry tests, and anti-SARS-CoV-2 anti-spike antibody tests were conducted for all consenting participants. All analyses were established using depersonalized data. Results: Of the 778 participants completing the baseline visit in June-July 2021, the percentages of those vaccinated with at least one, two, and three/more doses of COVID-19 vaccine were 99.1%, 98.0%, and 11.7%, respectively;one had four doses. The median (minimum-maximum) time since the last vaccination was 134 (34-166) days for those vaccinated with two doses [CoronaVac (Sinovac Life Sciences, Beijing, China)] and 25 (14-56) days for those vaccinated with three doses [two doses of CoronaVac and a last dose of Pfizer-BioNTech mRNA vaccine (ComirnatyR). The third dose was applied at a median of 164 (151-202) days after the second dose, and all were heterologous in type. The median (minimum-maximum) antibody level for the overall group was 53.55(0-5680) BAU/mL: 47.19 BAU/mL in those who received two doses, with a more than 100 times increase after a third dose (4943.64 BAU/mL). Of the 522 participants followed up to October 1, 2021, 6 PCR-positive symptomatic participants were diagnosed with COVID-19: the incidence rate was 4/1000 person-months. Conclusion: A 100-fold neutralizing antibody level following the third dose demonstrated the importance of a booster dose. Given the time lag between doses, antibody measurements of BioNTech recipients should be repeated in the upcoming months. Booster selection should involve antibody level, variant sensitivity of the vaccine, and individual characteristics of the recipient.
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Objective: This study included participants from Hacettepe University 4th, 5th, and 6th-grade students of Medical School and 4th and 5th-grade students of Dental School;and aimed to evaluate the general health status, COVID-19 history, vaccination status, and SARS-CoV-2 antibody levels of the participants to support their physical and social health, during the pandemic period. Method(s): A prospective cohort study was conducted with an integrated, matched, nested case-control study. Sociode-mographic characteristics, life habits, COVID-19 history, vaccination status, compliance with mask-distance-hygiene rules, and risks (if any) for COVID-19 were inquired via online questionnaires. Physical examinations, complete blood count, biochemistry tests, and anti-SARS-CoV-2 anti-spike antibody tests were conducted for all consenting partici-pants. All analyses were established using depersonalized data. Result(s): Of the 778 participants completing the baseline visit in June-July 2021, the percentages of those vaccinated with at least one, two, and three/more doses of COVID-19 vaccine were 99.1%, 98.0%, and 11.7%, respectively;one had four doses. The median (minimum-maximum) time since the last vaccination was 134 (34-166) days for those vaccinated with two doses [CoronaVac (Sinovac Life Sciences, Beijing, China)] and 25 (14-56) days for those vaccinated with three doses [two doses of CoronaVac and a last dose of Pfizer-BioNTech mRNA vaccine (Comirnaty). The third dose was applied at a median of 164 (151-202) days after the second dose, and all were heterologous in type. The median (minimum-maximum) antibody level for the overall group was 53.55(0-5680) BAU/mL: 47.19 BAU/mL in those who received two doses, with a more than 100 times increase after a third dose (4943.64 BAU/mL). Of the 522 participants followed up to October 1, 2021, 6 PCR-positive symptomatic participants were diagnosed with COVID-19: the incidence rate was 4/1000 person-months. Conclusion(s): A 100-fold neutralizing antibody level following the third dose demonstrated the importance of a booster dose. Given the time lag between doses, antibody measurements of BioNTech recipients should be repeated in the upcoming months. Booster selection should involve antibody level, variant sensitivity of the vaccine, and individual characteristics of the recipient.Copyright © 2023, DOC Design and Informatics Co. Ltd.. All rights reserved.
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The limited success of employment-based social protection measures under the diverging patterns of post-COVID-19 recovery rekindled interest in a social policy framework known as the Basic Income (BI) support. We test the potential of the BI program using five alternative scenarios ranging from households with income less than half of median income to all adults with estimates of their respective fiscal costs. We then employ an applied general equilibrium model to analyze the economy-wide effects and welfare implications for Turkey in the long run through 2030. We evaluate the macroeconomic and welfare effects of both a business-as-usual fiscal program and an alternative (green BI scenario) comprising of (i) carbon tax levied on the fossil fuel producing industry;(ii) corporate income taxation policy reform that aims at expanding the revenue base and consolidation of the fiscal space of the government;and (iii) restructuring of public consumption expenditures by introducing rationality and efficiency in the structure of fiscal expenditures. Our model solutions reveal that a green BI scenario not only achieves a higher GDP and welfare in the medium to long run but also helps Turkey to reduce its carbon emissions in line with the global policy challenges of a green recovery. © The Author(s), 2023. Published by Cambridge University Press.
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Objective: The purpose of this study is to describe the imaging characteristics and outcomes of COVID-19 vaccine-related axillary adenopathy and subsequent follow-up.
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Introduction: In this study, we aimed to retrospectively evaluate the characteristics of mucormycosis cases seen in our clinic during the COVID-19 pandemic, the management of their treatment and the SARS-CoV-2 variants that were dominant at that time. Method(s): The medical records of patients diagnosed with rhino-orbital mucormycosis between March 2020 and July 2022 were retrospectively evaluated. Result(s): Nine patients were diagnosed with rhino-orbital mucormycosis. Of these patients, six were male and three were female, and the patients were between the ages of 65-75 (mean 69.2). After the diagnosis of mucormycosis, antifungal treatment was initiated with liposomal amphotericin-B. Eight patients underwent surgery within 48 hours, only one patient refused to undergo surgery. Conclussions: Mucormycosis is a rapidly progressing opportunistic fungal infection. Therefore, the most basic criteria determining mortality is the early detection of about mucormycosis infection and to diagnose it as soon as possible, especially in patients with an underlying immunosuppressive condition. Once a diagnosis of mucormucosis has been established, risk factors, especially blood sugar regulation, should be corrected. Furthermore, systemic and local antifungal therapy shuold be initiated, and urgent debridement should be performed. Copyright © 2022, Geriatrics Society. All rights reserved.
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Women and girls are more disadvantaged in times of crisis, and their chances of surviving and fleeing are limited. As the Syrian crisis enters its eleventh year, Turkey alone hosts the largest population (over 3.7 million). It aimed to evaluate essential reproductive health services in the shadow of the pandemic that deepens the crisis. The research was conducted in April 2021 with 637 married Syrian refugee women aged 15-49 living in Ankara (mean age: 29.6). The median age at first marriage was 17, and consanguinity with her spouse was 29.8%. 8.6% were illiterate. 36.3% did not/could not benefit from public hospitals free of charge, and 89.8% did not have health insurance. 96.7% had a previous pregnancy (median:4). Since the pandemic's beginning, 35.6% have been pregnant (n = 219), and 14% are still pregnant (n = 86). Of 133 women whose pregnancies ended during this period, 78.2% gave birth (n = 104) and 21.8% miscarried. 12.8% of pregnancy was terminated at home (n = 17, 14 of which could not receive support from anyone). 41.1% of those who became pregnant during the pandemic were not followed up in pregnancy;45.1% of those whose pregnancies ended were not followed up in the puerperium. 29.5% of all the participants stated that they had not used any birth control method. The most common reason for not using family planning is fear of harm to health and their spouse's disapproval. Only 3.3% of those currently using birth control methods stated difficulty accessing birth control methods. The most used information resources about pregnancy, childbirth and contraception methods were hospitals and Migrant Health Centres. This study is funded through the UK Research and Innovation GCRF Research for Health In Conflict (R4HC-MENA), developing capability, partnerships and research in the Middle and Near East (MENA) [ES/P010962/1]. Key messages • In refugee crises, women's health should be structured as a separate heading in the health system and unmet sexual health needs should be met, especially in culture-oriented primary care services. • Women should be empowered with a health system where women can determine their own needs and make decisions about their bodies.
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Background & Objective: Tension-type headache (TTH) is the most common primary headache. TTH worsens quality of life and is related to various psychosocial factors. We aimed to examine the severity of headache (intensity, frequency, and duration), analgesic use, quality of life (QoL), and the impact of COVID pandemic-induced stress in TTH patients. Method(s): TTH cases seen at neurology outpatient clinics in 15 centers in Turkey were included in the study. A questionnaire incorporating sociodemographic and medical information, headache features, sleep quality, general quality of life, and impact of the pandemic event was administered to the subjects. Result(s): A total of 975 TTH patients were evaluated. Headache severity was higher in women as well as in patients with a history of COVID-19 contact. Women, those with chronic diseases, and cases with a COVID-19 contact history had worse perceptions of quality of life and were affected to a greater extent by the pandemic. The factors affecting the impact of the pandemic were female gender and difficulty in access to health services for headache. Co-existing chronic diseases and lost productive time due to headaches were negative determinants for both QoL and the impact of the pandemic. Conclusion(s): Our results show that the COVID pandemic severely worsened the headache burden, quality of life and mental health of TTH patients. These findings can guide us in the clinical approach to TTH cases. Copyright © 2022, ASEAN Neurological Association. All rights reserved.
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INTRODUCTION: In the coronavirus disease 2019 (COVID-19) pandemic, there may be a decrease in the number of acute stroke intervention and acute treatment, and delays in treatment periods. In this study, it was aimed to compare the clinical features of patients presenting with acute stroke during the COVID-19 pandemic and in the pre-pandemic period. METHODS: Patients hospitalized with the diagnosis of cerebrovascular disease (CVD) between January 01, 2019 and May 31, 2021 were included in the study. Demographic characteristics and stroke risk factors of the patients were recorded. Stroke type and ischemic disease subtypes were determined, and patients' admission National Institutes of Health Stroke Scale (NIHSS) score, symptom-door time, door-consultation time, door-to-door Needle time and door-groin puncture time, intravenous tissue type plasminogen activator (IV tPA) and endovascular thrombectomy (EVT) applications were recorded. Discharge modified Rankin Scale (mRS) and NIHSS scores and mortality rates were evaluated. Patients hospitalized in two separate periods of 14 months each were compared by dividing them into pre-pandemic and pandemic periods. RESULTS: Before COVID-19, 316 patients (female 45.25%, age: 66.75±13.68 years) and during the pandemic period 341 (female 41.94%, age: 68.34±13.55 years) patients were included in the study. During the pandemic period, an increase in the number of hemorrhagic CVD and transient ischemic attacks, a decrease in the number of ischemic stroke and cerebral venous thrombosis (CVT) hospitalizations, a decrease in cardioembolic strokes and an increase in lacuner ischemic CVD subtypes were observed (p<0.01). The number of large vessel atherosclerosis, IV tPA and EVT were found to be similar before and after the pandemic. In the pandemic period, although it did not reach statistical significance compared to the pre-pandemic period, prolongation was recorded in the symptom-door, door-consultation, door-needle and door-groin puncture times (p>0.05). The COVID-19 test was positive after hospitalization in 5 (1.8%) patients with ischemic stroke hospitalized during the pandemic period. During the pandemic period, admission NIHSS, discharge NIHSS and mRS scores and mortality rates were found to be significantly higher between hemorrhagic and ischemic stroke patients (p<0.01). DISCUSSION AND CONCLUSION: The COVID-19 pandemic adversely affects the management of acute stroke. The duration of acute stroke treatment is delayed due to pre-hospital and in-hospital reasons. With the heavy burden of stroke during the pandemic period, poor clinical outcome and high mortality are observed.
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Background: Necrotizing periodontal diseases (NPD) are fuso-spirochetal infections causing ulceration and destruction of periodontal tissues and associate with impaired host response. Elevated bacterial levels of Prevotella intermedia, Veillonella and Streptococci present in NPD lesions were detected in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Description of the procedure: A 40-year-old female, non-smoker patient was referred to the clinic with complaints of fever, halitosis, bad taste, severe gingival pain and bleeding. The patient reported a history of COVID-19 a month prior to any symptoms. Extra and intraoral examinations revealed submandibular lymphadenopathy, plaque accumulation, necrotic areas covered with pseudo-membranes, spontaneous gingival bleeding and suppuration. Alveolar bone loss was detected in the radiographic examination. Since periodontal pocket formation was present, the clinical diagnosis of the case was necrotizing gingivitis as a result of previously occurred periodontitis. During the first visit, necrotic areas were gently swabbed with 3% H2O2 moistened cotton pellets and oral hygiene instructions were given. Systemic antibiotic (metronidazole 500 mg 2 × 1) was prescribed for 5 days and rinsing with 0.12% chlorhexidine and 3% H2O2 was recommended. Three days later, since the acute complaints were reduced, clinical periodontal parameters were recorded and nonsurgical periodontal treatment (NSPT) was performed in 4 sessions in 2 weeks. One month after NSPT, all clinical periodontal parameters were recorded again. Outcomes: Following NSPT with the combination of systemic antibiotic regimen, all symptoms were resolved leading to the dissolution of necrotic areas. All clinical parameters were improved after NSPT. Conclusions: This case may be an evidence that COVID-19 could be a contributing factor for the appearance of NPD. Since COVID-19 leads to an altered immune response of the patient, a suitable environment becomes present orally for bacteria causing infections that result in NPD. The importance of routine intra-oral examination for COVID-19 patients is highlighted.
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Objective Assess the impact of COVID-19 on patient-breast radiologist interactions and evaluate the relationship between safety measure-constrained communication and physician wellbeing. Methods A 41-question survey on the perceived effect of COVID-19 on patient care was distributed from June 2020 to September 2020 to members of the Society of Breast Imaging and the National Consortium of Breast Centers. Non-radiologists and international members were excluded. Anxiety and psychological distress scores were calculated. A multivariable logistic model was used to identify demographic and mental health factors associated with responses. Results Five hundred twenty-five surveys met inclusion criteria (23% response rate). Diminished ability to fulfill patients' emotional needs was reported by 46% (221/479), a response associated with younger age (OR, 0.8 per decade;P < 0.01), higher anxiety (OR, 2.3;P < 0.01), and higher psychological distress (OR, 2.2;P = 0.04). Personal protective equipment made patient communication more difficult for 88% (422/478), a response associated with younger age (OR, 0.8 per decade;P = 0.008), female gender (OR, 1.9;P < 0.01), and greater anxiety (OR, 2.6;P = 0.001). The inability to provide the same level of care as prior to COVID-19 was reported by 37% (177/481) and was associated with greater anxiety (OR, 3.4;P < 0.001) and psychological distress (OR, 1.7;P = 0.03). Conclusion The majority of breast radiologists reported that COVID-19 has had a negative impact on patient care. This perception was more likely among younger radiologists and those with higher levels of anxiety and psychological distress.
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Background: The COVID-19 pandemic has affected the world in every aspect. Many universities and education centres adapted their teaching to online education1. Virtual simulation has been endorsed by stakeholders not only for teaching healthcare students and workers, but also to be counted as practice hours for students2. We propose an approach to facilitate simulation-based education (SBE) online in an interactive manner for multiple participants. Methods: Visually enhanced mental simulation (VEMS) is a low fidelity yet very immersive and engaging educational activity used for participants to practise non-technical skills such as decisionmaking and communication while others observe3. Unlike ordinary mental simulation, participants can engage in VEMS as in a full-scale scenario-based simulation session, while being observed by peers. It is supported with visual elements such as a patient poster and laminated equipment cards for participants to illustrate the actions performed. Actions and patient parameters are also recorded with the timing by a facilitator on a white board. The scenario is followed by a debriefing involving all participants and observers. Recommendations: VEMS can be adapted to the online environment and be facilitated through platforms such as Microsoft Teams, Skype, Zoom, GoToMeeting, or Cisco WebEx easily using a shared screen with Microsoft PowerPoint and their associated chat function or the facilitator's web camera facing a noticeboard. A patient pictogram and transparent background equipment images can be used in PowerPoint to illustrate the actions verbalised by the participants. The facilitator can speak as the patient and illustrate and write down everything in PowerPoint as the participants engage in the scenario, so all the other session attendees can observe. Everyone can then attend the scenario debriefing online. Conclusion: Online VEMS offers an opportunity for participants to practise non-technical and communication skills. It is a low fidelity and low-cost approach to facilitating SBE that still needs to be tested with actual learners for ease of use, acceptability, and educational effectiveness.
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Objective: During the ongoing coronavirus disease-2019 (COVID-19) pandemic, the overall number of patients presented to dermatology outpatient clinics has decreased. This study aims to examine the number of elderly patients presented to dermatology outpatient clinics during the ongoing COVID-19 pandemic, the periodic variation in the number of patients, and the most common reasons for their presentation. Material and Methods: This study retrospectively analyzed 448 presentations of 381 patients aged 60 years between March 11 and May 31, 2020. These cases were evaluated considering the age, gender, presentation diagnoses, presence of chronic diseases, the urgency of complaints, duration of symptoms, and whether they had contracted COVID-19.