Assessment of the knowledge, attitudes, and behaviors of individuals presenting to family medicine polyclinics for COVID-19 and influenza vaccines: a study in a Turkish population

BACKGROUND: Vaccines are one of the most important weapons in protection against diseases, especially pandemics lacking available treatment. The objective of this study was to investigate the knowledge, attitudes, and behaviors of individuals presenting to family medicine polyclinics for COVID-19 and influenza vaccines. METHOD(S): The cross-sectional descriptive study comprised healthy individuals who presented to family medicine polyclinics in Ankara Training and Research Hospital, Ankara, Turkiye between 10 December 2020 and 31 January 2021. Data on participants' knowledge and attitudes for COVID-19 and influenza vaccines were collected through questionnaire surveys. In total, 521 individuals aged older than 18 years were included in the study. RESULT(S): If a COVID-19 vaccine were available, 34.4% (N.=179) of respondents would be vaccinated, and 35.3% (N.=184) of respondents would not consider vaccination. Of those considering COVID-19 vaccination, 55.3% (N.=99) of respondents deemed the vaccine an effective way of providing protection against the virus. Increased willingness to have the COVID-19 vaccine was associated with the following factors: considering the influenza vaccine an effective protection method (P<0.001), a history of influenza vaccination (P=0.003), and concern about COVID-19 related death rates (P=0.008). CONCLUSION(S): The most common reasons for COVID-19 vaccine hesitancy and refusal were fear of vaccine-related side effects and a lack of perceived research evidence on the vaccine. Having a positive view of the influenza vaccine had a positive impact on attitudes toward the COVID-19 vaccine.Copyright © 2022 EDIZIONI MINERVA MEDICA.

The Evaluation of Telehealth Services during the Covid-19 Pandemic on Levels of Psychological Growth

Objective: The COVID-19 pandemic is considered a traumatic event. The aim of this study was to examine the effects of telehealth services offered at the Istanbul University, Istanbul Faculty of Medicine to health workers with presumed COVID-19 or close contact with a suspected/confirmed COVID-19 patient on pandemic management, vaccination, and psychological growth at one year after diagnosis.Material and Methods: The cohort study included 237 employees with COVID-19/risky contact who were monitored remotely via a telehealth service provided between April 6 and July 31, 2020. First, they were followed up for 21 days with the telehealth service. Second, they were invited by phone to complete an online questionnaire and 94 (39.7%) of them participated. The questionnaire included questions about pandemic-related difficulties experienced during the last year and the Posttraumatic Growth Inventory (PTGI).Results: Of the 234 employees, 172 (73.5%) and 164 (70.1%) had the first and second doses of the COVID-19 vaccine, re spectively. Employees who did not need psychological support had significantly lower PTGI change in self-perception and total scores than those who did not/could not receive psychological support (p=0.007 and p=0.016, respectively). Employees who used personal protective equipment (PPE) more carefully had a significantly higher PTGI self-perception score (p=0.005), life philosophy (p=0.014), interpersonal relationships (p=0.011), and total score (p=0.004) than employees who reported that they did not change how they use PPE and were sometimes careless.Conclusion: The results of our study suggest that health workers are showing evidence of posttraumatic growth by seeing the positives as well as the negatives caused by the pandemic.

The Effects of the COVID-19 Pandemic on Clinical and Laboratory Follow-up of Patients Diagnosed With Chronic Hepatitis B: A Multicenter, Prospective, Observational Study

Background: Chronic hepatitis B (CHB) patients who are under the treatment of antiviral agents should be monitored in routine control visits. However, during the COVID-19 pandemic, the visits were interrupted. Objectives: This study aimed to investigate whether these patients were affected regarding clinical, laboratory, and treatment out-comes. Methods: This prospective study consisted of CHB patients aged > 18 who were applied to 3 tertiary centers between 14 February and 30 March 2022. The patients were selected from the ones who regularly applied to outpatient clinics and under the treatment of antiviral agents before the pandemic. The demographic and laboratory values, including serologic, biochemistry, and molecular results, were compared between the 2 groups who came and did not come to control visits. Results: A total number of 220 patients were included. More than half (n = 142, 64.5%) were female. The median age was 44 years (19-73). A hundred and forty-two (64.5%) patients did not come to control visits during the pandemic. The most common reason was anxiety about COVID-19. The tenofovir treatment was replaced with entecavir (ETV) due to osteopenia and with alafenamide due to osteopenia and/or renal failure. The previous agents were re-started in 27 (79.5%) patients who discontinued the treatment. Conclusions: The COVID-19 pandemic negatively impacted the follow-up of CHB patients. In this regard, 15.5% of patients stopped their treatments. The patients who stopped their follow-ups and continued tenofovir disoproxil fumarate (TDF) had proteinuria and decreases in bone mineral density (BMD) and estimated glomerular filtration rate (eGFR) levels. © 2022, Author(s).

Impact of the COVID-19 Pandemic on Inherited Metabolic Diseases: Evaluation of Enzyme Replacement Treatment Adherence with Telemedicine

Aim: During the coronavirus disease-2019 (COVID-19) pandemic, visiting the hospital and getting regular infusions can be difficult for patients with chronic illnesses. Telemedicine may offer a good option for the management of chronic diseases such as lysosomal storage diseases (LSD). Material(s) and Method(s): LSD patients at the Unit of Metabolic Diseases of Ege University were contacted by phone between April, 2020 and March, 2021 during the COVID-19 pandemic. Telemedicine appointments were performed at intervals every month or three months, depending on the patients' compliance with their treatment. Result(s): Ninety-two LSD patients [Mucopolysaccharidosis (MPS) I, MPS II, MPS IVA, MPS VI, MPS VII, Gaucher, Fabry, and Pompe] were included in this study. The total skipped treatment rate within one year was 17.1%. Most of the months of interruption were consonant with the time of social isolation. The treatment interruption in patients under 18 years was lower than in patients over 18 years. A positive correlation was detected between the age of patients and the interruption of treatment. Conclusion(s): The curfew periods might be one of the causes of missed treatment sessions. Telemedicine is a good method to improve the continuity of treatment. This study showed that the number of interrupted enzyme replacement treatments could be decreased via ongoing telemedicine appointments. © Copyright 2022 by Ege University Faculty of Medicine, Department of Pediatrics and Ege Children's Foundation The Journal of Pediatric Research, published by Galenos Publishing House.

Organising a Chambers Information Service

This article, written by Michelle Celik, outlines some of the working practices for an information professional in a barristers' chambers, highlighting how the culture differs to that of law firms. Michelle describes how the role has evolved since she began working in a set of chambers and the impact that Covid-19 has played on information provision in recent years. She discusses the importance of external libraries to the needs of barristers and her own relationship with the staff within chambers.

Anesthesia Management in Cesarian Section in Pregnant Patients with COVID-19 Diagnoses

Aim: The recommendation to avoid general anesthesia in pregnant women with coronavirus disease-2019 (COVID-19) and to use neuraxial blockade techniques, if possible, has not changed over time. On the other hand, general anesthesia also has to be applied to some patients in clinical practice. In this study, we evaluated anesthesia management, maternal outcomes, and clinical course in pregnant women with COVID-19 who delivered by cesarean section. Method(s): One hundred and seven pregnant women with COVID-19 who underwent cesarean sections between October 2020 and April 2021 were included in the study. Anesthesia methods, presenting symptoms, comorbidities, laboratory test results, and radiological data at admission, length of hospital stay, intensive care unit admissions, and mortality rates were retrospectively analyzed. Result(s): Out of 107 pregnant women, 85 underwent cesarean surgery under spinal anesthesia and 22 under general anesthesia. Forty patients (37%) had at least one symptom, whereas sixty-seven (63%) had no symptoms at all. Fifty percent of symptomatic and only 6% of asymptomatic pregnant women were admitted to the intensive care unit, and there was a significant difference between them. Mortality was 30% in symptomatic patients and only 1% in asymptomatic patients, and the difference in mortality was significant (p<0.05). Conclusion(s): Since the risk of intensive care and mortality is higher, particularly in symptomatic pregnant women with COVID-19, these patients should be evaluated, operated and followed up by experienced teams. Copyright © 2022 by The Medical Bulletin of Istanbul Haseki Training and Research Hospital The Medical Bulletin of Haseki published by Galenos Yayinevi.

COVID-19 Measures in Public Procurements: Regulations for Sustainable Procurements

Through its presence in Turkey as in all countries, the COVID-19 pandemic has made its impact felt in all areas of state administration, especially in the health sector. Public procurements are seen as an important tool of development and sustainability by the United Nations and have also been very important in this period, both in terms of procuring medical supplies as well as in ensuring developmental continuity. For this reason, governments have taken a series of measures to ensure that public procurement processes are managed efficiently and effectively under these economic conditions. The measures primarily relate to the types of tender and the procedures for ensuring sustainability in public procurement while also including financial measures. The main objective of the measures taken regarding public procurement is to ensure that procurements in extraordinary periods are made quickly to eliminate any potential grievances. For the process to function quickly and smoothly, new regulations have been made regarding tender and announcement periods, with several facilitating measures having been taken with regard to tender procedures. During the pandemic process, some countries have given administrations wide discretionary powers in managing measures related to public procurement, while others have given administrations limited discretionary powers and equipped them with more discretionary powers. In this process, the use of electronic tools has also increased significantly, and administrations and suppliers are observed to have taken a series of measures to encourage and facilitate the use of electronic tools. In addition, efforts have also been made to inform the public. Financial measures related to public procurement were mostly aimed at meeting the extraordinary resource needs of contracting authorities, while suppliers aimed to improve their financial situations that had deteriorated due to the pandemic measures. Inferences have been made regarding the measures taken for public procurement during the pandemic by analyzing various countries, in particular Turkey and the European Union.

The relationship between social media addiction levels and alexithymia in young people at home during pandemic process

This study was conducted to determine the relationship between social media addiction levels and alexithymia in young people who were at home during the pandemic process. The descriptive and cross-sectional study was conducted with 520 young people between 01.01.2021-15.01.2021. Data were collected using a personal information form, Social Media Addiction Scale and Toronto Alexithymia Scale. Kruskal-Wallis, Mann-Whitney U tests and correlation and regression analysis were used to evaluate the data. The total score average of the Social Media Addiction Scale of the youth was 94.65 +/- 37.63 and the total score average of the Toronto Alexithymia Scale was 50.04 +/- 12.14. It was determined that 44.6% of the Toronto Alexithymia Scale received 51 points. A positive and moderate correlation was found between Social Media Addiction Scale and Toronto Alexithymia Scale (r = 0.463, p = 0.001). Social media addiction was found to affect alexithymia by 21.3% according to the regression analysis. It has been determined that the social media addiction levels of the young people are medium and their alexithymia levels are high. It has been found that there is a significant relationship between social media addiction and alexithymia. Copyright © 2023, Eduem - Editora da Universidade Estadual de Maringa. All rights reserved.

A rare but mortal condition: case series of three COVID-19 patients with spontaneous rectus sheath hematoma

Coronavirus disease 2019 (COVID-19) could emerge not only as viral pneumonia but also as a cardiovascular disease. Thromboprophylaxis has been recommended by the current guidelines, especially COVID-19 patients who are hospitalized. On the other hand, these drugs might cause serious bleeding complications. Hereby, we aimed to report three cases with spontaneous rectus sheath hematoma (RSH) developed after being administered thromboprophylaxis for severe COVID-19 pneumonia. In this case series, we draw attention to the rare, but mortal complication of the COVID-19 thromboprophylaxis regimen.

Predicting the Effect of COVID-19 on Education Process in Turkey

COVID-19 has affected education. Education is one of the areas affected. Although many countries closed educational institutions, as the government policy offered, Turkey continued through distance education. The aim of this study is finding out the effects of distance education on assignments and exams, distance education satisfaction level, and effects of some factors ( gender, employment status, state of education, age) on education. Sampling group consisted of 683 volunteer parents of students selected by simple random sampling method. "Distance Education Activities Satisfaction Scale" was developed for data collection Results show that gender and employment status created a significant difference in distance education satisfaction level;and state of education created a significant difference in effect of distance education on assignments and exams, distance education satisfaction level, and effect of COVID-19 on education. Furthermore, the effect of COVID-19 on education was predicted by some variables;effect of distance education on assignments and exams, parents' state of education and distance education satisfaction level.

Blood Types and Severity of COVID-19

Aim: Since blood types first appeared, their association with diseases caused by microorganisms has been further investigated with several studies for many years. The bond of blood groups described as A, B, AB, and O with coronavirus has been the research subject in many countries.We aimed to elucidate whether there was a relationship between blood types and Rh factor and contracting COVID-19 disease and disease severity. Methods: The study was designed as a retrospective case-control study. Between March 2020-February 2021, 1110 patients were included (538 cases, 572 controls). Disease severity was classified according to where patients were treated: those who were outpatients considered as “mild disease”, hospitalized in a hospital ward considered as “moderate disease”, and treated in the intensive care unit were considered as “severe disease”. Results: The number of people with blood type A was 447 (40.3%), blood type B was 197 (17.7%), blood type AB was 90 (%8), and blood type O was 376 (33.9%). There was no significant difference between the case and control groups according to the blood types. A 3.93 times increase of developing mild illness was detected compared to the control group in Rh-positive individuals. The rate of developing a severe disease was higher in females with blood type A than a mild disease, and A blood type caused the disease to be severe compared to other blood groups in females. Conclusion: We concluded that blood type A caused more severe disease than other blood types in females, and females with B blood type survived the disease as outpatients. Our study can shed light on pathophysiological investigation of the relationship between COVID-19 disease causing a pandemic with high mortality and virulence and blood types. © 2021, Eurasian Society of Family Medicine. All rights reserved.

Difficulties experienced in providing care of infants in the neonatal intensive care unit during COVID-19

In this study, it was aimed to determine the difficulties in receiving care for infants who are in neonatal intensive care during the pandemic process. In this phenomenological study, interviews were conducted with semi-structured questions with the participants. While collecting the data, both observation and interview techniques were used. The situations that prevent getting care from nurses are as follows. The inability to establish skin-to-skin contact with the infant, the problems caused by the equipment that nurses have to wear, and the fear of COVID-19. Conditions that prevent receiving care from the mother are as follows: removal of family visits, interruption of kangaroo care, failure to initiate breastfeeding. As a result, infants faced many difficulties in receiving care during the pandemic period and their care could not be applied properly and regularly.

The effect of hydroxychloroquine and azithromycin on the QTc interval in patients with Covid-19

Background and Aim: The exact treatment method of Covid-19 has not been found so far. However, some small-scale studies have shown the potential benefit of hydroxychloroquine/chloroquine (hydroxychloroquine treatment in our country) and azithromycin in Covid-19 treatment. It is known that these drugs (alone or combined use) may increase the risk of malignant arrhythmia such as torsades de pointes (polymorphic ventricular tachycardia) with prolonged QT interval. There is no data showing the effect of Favipiravir on cardiac arrhythmia. In this study, we aimed to investigate the effect of hydroxychloroquine and azithromycin on the QTc interval in patient with Covid-19. Methods: Patients who hospitalized in our center between March and May 2020 for Covid-19 and treated with recommendations of Republic of Turkey Ministry of Health SARS-CoV-2 guide included in our study. The data of 142 consecutive patients who received hydroxychloroquine and/or azithromycin treatment were retrospectively analyzed and the QTc interval in ECG was calculated with the Bazzet formula. Patients who were already using hydroxychloroquine (i.e. because of autoimmune disease etc), hypersensitivity to hydroxychloroquine and/or azithromycin and patients who use drugs other than hydroxychloroquine and/or azithromycin that can prolong the QT interval were excluded. Patients with baseline QTc 500 milliseconds (msec) or longer were also excluded from the study. According to the protocol, ECG was performed all patients before treatment, and ECG controls were performed on the 1st, 3rd and 5th days of the treatment. Results: The mean age of the study population was 46.9±17.3. A total of 142 patients (50.7% male and 49.3% female), received hydroxychloroquine therapy, 36 patients (25%) received hydroxychloroquine monotherapy, while 106 patients (75%) received hydroxychloroquine and azithromycin combination therapy (Table 1). Majority of the patients were in sinus rhythm (%95,1) with mean baseline heart rate of 81.9±14.7 beats per minute. Mean baseline QTc values of 142 patients were 417.3±24 msec, ranging between 356-486 msec. There were no significant differences between the baseline, 1st, 3rd and 5th day's QTc values of two groups. (p>0.05). When each groups were evaluated for QTc prolongation during the therapy period, it was observed that the baseline QTc interval was significantly prolonged with treatment in both the hydroxychloroquine group and the hydroxychloroquine + azithromycin group (Table 2) (p<0.05). There were no patients required discontinuation of these medications, no malign arrhythmia and no arrhythmogenic deaths due to QTc prolongation (Table 3). Conclusions: Although treatment-related QTc prolongation is observed in our study population, no malignant arrhythmia was observed. Close monitoring of the treatment process by cardiologist and the predetermination of patients with long onset QTc distances are considered to be the most important factor in the safe management of the treatment.

Duzce university hospital in the pandemic process: in terms of chief physician. (Pandemi deneyimleri.) [Turkish]

We aimed to compile the effects of the preparations on the new coronavirus outbreak (Covid-19) in the largest pandemic, which is still visible in the world. Pandemics have caused millions of people to become ill, disabled and death for centuries. Thanks to past pandemics that deeply affect the society health, socially and economically, preparations have been made again against possible pandemics. Preparations may not go as planned. Desperation may occur for unforeseen situations. Despite these despair, the tool that can contribute in practice besides the basic principles in combating pandemics can be obtained from the past. Like every pandemic, the pandemic will end one day. Those applied and not implemented after the outbreak will be evaluated and will remain a lesson from the past for future outbreaks.