Knowledge and Attitudes of Patients About the Rational Use of Antibiotics.

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 having 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). Conclusion: 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.

The usability of neopterin in determining disease course in COVID-19.

OBJECTIVES: To investigate the usability of neopterin in demonstrating the progression of COVID-19. As a result of uncontrolled activation of COVID-19 monocytes and macrophages, IFN gamma increases and the resulting inflammatory response causes organ damage. IFN released from T cells causes an increase in gamma neopterin levels. Therefore, measurement of neopterin levels can be used to indicate immune system activation and disease progression. METHODS: The study was carried out prospectively in two different centers. The patients were divided into two groups (mild-moderate and severe) and clinical, laboratory, imaging findings and neopterin levels at hospitalization were compared. RESULTS: 100 patients were included in our study, 41 of these patients were male. Forty-six patients were identified as severe COVID-19. C-reactive protein, lymphocyte count, fibrinogen, D dimers, lactate dehydrogenase, procalcitonin, troponin and neopterin levels were significant in indicating disease severity. (p<0.05). In ROC analysis, 0.642 for neopterin, 0.698 C-reactive protein, 0.331 lymphocyte count, 0.679 procalcitonin, 0.633 fibrinogen, 0.667 D dimers, 0.655 troponin and 0.706 lactate dehydrogenase were detected and these values were significant. CONCLUSION: In our study, neopterin was detected as an important indicator in determining the course of COVID-19.

Prospective Evaluation of Infections in Geriatric Patients in Intensive Care Units.

Objective: Nosocomial infections (NIs) are major health problems with morbidity and mortality. Geriatric patients require intensive care unit (ICU) admission more frequently, and serious challenges occur during treatment. We aimed to evaluate the risk factors of NI and mortality in geriatric patients admitted to the ICU. Materials and Methods: The study was conducted between April 2018 and April 2019 in two hospitals. We prospectively recorded the data on the forms prepared according to daily ICU visits. Results: During the study period, 600 patients were hospitalized in the ICUs. Geriatric patients constituted 446 (74.3%) of the total number. The NI rate was 59% in adult patients and 80% in geriatric patients. The most frequent NI in geriatric patients was pneumonia (42%). Furthermore, the need for mechanical ventilation support, prolongation of hospital stay, total parenteral nutrition, and tracheostomy were statistically higher in geriatric patients with NI. The mortality rate in geriatric patients was statistically higher than in non-geriatric. We found the rates of prolonged hospitalization, NI development, malignancy, and cerebrovascular disease diagnosis significantly higher in geriatric patients than in non-geriatric patients. Conclusion: NI and mortality rate are higher in geriatrics than in adult patients. Pneumonia is the most common type of NI in the ICU. Identification of risk factors regarding NI and mortality in geriatric patients in ICU will contribute to developing strategies for prevention.

COVID-19 in Elderly Patients: Risk Factors for Disease Severity.

Objective: Determining the clinical characteristics associated with SARS-COV-2 infection may contribute to reducing mortality in elderly patients, considering the age-related sensitivity and the excess of complications. Our study aimed to evaluate the factors that determine the severity of the disease in elderly patients followed up in our hospital. Materials and Methods: The files of definite or probable COVID-19 patients over 65 years old who were followed up by the infectious diseases clinic of our hospital between March 15 and October 1, 2020, were evaluated retrospectively. Results: A total of 134 patients were included in the study, 52.2% of the patients were male, and the mean age was 75.11±7.15 (min 65-max 94). Multimorbidity was detected in 42.5% of the patients, and the most common comorbidities were hypertension (53.7%) and diabetes mellitus (36.6%). Severe COVID-19 was present in 39.6% of patients. The most common complaints were fatigue (70.9%), cough (59.7%), and shortness of breath (59%). When the patients' computed tomography (CT) images of thorax were evaluated, ground-glass was observed in 94.8% (n=127), infiltration in 42.5% (n=57), and consolidation in 32.8% (n=44). Involvement was bilateral in 93.3% (n=125) of the patients. The most common antiviral treatment used for patients was favipiravir 73.1% (n=98). The average hospitalization period of the patients was 12±6.36 days, the rate of follow-up in the intensive care unit was 20.1% (n=27), and death occurred in 9.7% (n=13) of the patients. In the multivariate analysis, cough and shortness of breath at admission, atelectasis and pleural effusion on thorax CT were found to be significant for severe COVID-19 disease (p<0.05). Conclusion: Providing early medical support to these patients, especially, in the presence of cough and shortness of breath on admission and the presence of pleural effusion and atelectasis on thoracic CT, may help reduce the poor clinical course.

Foot self-care in diabetes mellitus: Evaluation of patient awareness.

AIMS: To assess diabetic patients' knowledge and practices regarding foot care. METHODS: This study was conducted as a cross-sectional study in 1030 patients between November 2017 and February 2018.The descriptive survey instrument was developed by the investigators. Survey content and format were based on prior surveys and guidelines. The survey sought socio-demographic characteristics of the patients and the level of knowledge about diabetic foot care practice. RESULTS: 29.5% of patients had bad foot care, 49.6% of patients had moderate foot care and 20.8% of patients had good foot care. There were no significant differences between patient groups in regard to age, gender, foot infection history and having undergone amputation surgery. We found that patients who good at foot care had higher education status (p<0.001), were more likely live in a city (p<0.001), had higher income (p<0.001), had been trained about foot care (p<0.001) and were more likely to have type I DM (p=0.015). Disease duration was longer in those who had good foot care compared to the other groups (p=0.010). CONCLUSIONS: The mean knowledge and practice scores of our patients were moderate, indicating that much is to be done for the education of patients on this matter. We also found that knowledge about the importance of this practice, education status and disease duration had significant influence on the practice of foot-care in patients with DM.

Influenza vaccination prevalence among the elderly and individuals with chronic disease, and factors affecting vaccination uptake.

OBJECTIVE: Our aim is to evaluate influenza vaccination rates among the elderly and individuals with underlying chronic disease, and factors that affect vaccination uptake. METHODS: The study comprised individuals aged 18-65 years with underlying chronic diseases, and individuals aged over 65 years. Literature-based questionnaires prepared by the researcher regarding vaccination were completed through face-to-face interviews by the principal investigator. RESULTS: A total of 818 participants were included in the study, 257 (31.4%) were males. The mean age of participants was 57.47 ± 14.11 years; 274 (33.5%) were aged 65 years and over. One hundred and three (12.6%) participants stated that they received vaccinations against influenza annually, and 144 (17.6%) stated that they had vaccination against influenza in the 2015/16 or 2016/17 season. Fifty-two (19%) participants aged more than 65 years stated that they received vaccinations against influenza annually, 75 (27.4%) stated that they had vaccination against influenza in the 2015/16 or 2016/17 season. The most commonly determined reasons for not receiving vaccination were not knowing that it was necessary (34%) and believing that vaccination was not necessary because they were healthy (26%). Statistically significantly more participants who gained their knowledge from a physician were vaccinated than those whose knowledge came from other sources (p < 0.05). Participants who considered that they had sufficient information about influenza were vaccinated more frequently, the results were statistically significant (p < 0.05). CONCLUSION: Informing target risk groups about influenza vaccination by physicians and increasing awareness about influenza may contribute to increasing vaccination rates.