Effect of COVID-19 Pandemic on Patients Who Have Undergone Liver Transplantation: Retrospective Cohort Study.

BACKGROUND: In liver transplant (LT) recipients, immunosuppressive therapy may potentially increase the risk of severe COVID-19 and may increase the mortality in patients. However, studies have shown conflicting results, with various studies reporting poor outcomes while the others show no difference between the LT recipients and healthy population. The aim of this study is to determine the impact of the COVID-19 pandemic on survival of LT recipients. METHODS: This is a retrospective cohort study analyzing the data from 387 LT recipients diagnosed with COVID-19. LT recipients were divided into two groups: survival (n = 359) and non-survival (n = 28) groups. A logistic regression model was used to determine the independent risk factors for mortality. Machine learning models were used to analyze the contribution of independent variables to the mortality in LT recipients. RESULTS: The COVID-19-related mortality rate in LT recipients was 7.2%. Multivariate analysis showed that everolimus use (p = 0.012; OR = 6.2), need for intubation (p = 0.001; OR = 38.4) and discontinuation of immunosuppressive therapy (p = 0.047; OR = 7.3) were independent risk factors for mortality. Furthermore, COVID-19 vaccination reduced the risk of mortality by 100 fold and was the single independent factor determining the survival of the LT recipients. CONCLUSION: The effect of COVID-19 infection on LT recipients is slightly different from the effect of the disease on the general population. The COVID-19-related mortality is lower than the general population and vaccination for COVID-19 significantly reduces the risk of mortality.

Evaluation of Nurses' Vaccine Hesitancy, Psychological Resilience, and Anxiety Levels During COVID-19 Pandemic.

OBJECTIVE: This study aimed to evaluate the vaccine hesitancy, psychological resilience, and anxiety levels of nurses during the COVID-19 pandemic. MATERIALS AND METHODS: This cross-sectional study was conducted with 676 nurses working at the survey time. Sociodemographic features, the status of hesitancy against the COVID-19 vaccine, the Coronavirus Anxiety Scale, and the Brief Resilience Scale were used in the questionnaire form to collect the data. RESULTS: Most participants (68.6%; n=464) stated they were hesitant about the COVID-19 vaccine. A sig- nificantly higher rate of hesitancy was detected in the age group of 20-39 years, those who did not have COVID-19 vaccine, and those who did not think the COVID-19 vaccine is protective (P < .05). It was determined that 6.8% (n=46) of the nurses had COVID-19 anxiety. A significantly higher rate of anxiety was detected in the age group of 40 years and older, those working in the emergency department, and those working in the COVID-19 unit during the pandemic period (P < .05). The median Brief Resilience Scale score of nurses is 19(6). A negative, weak, and significant relationship was found between the Brief Resilience Scale and Coronavirus Anxiety Scale scores (P = .001). CONCLUSION: During the pandemic, higher rates of anxiety were detected in healthcare personnel and those working in COVID-19 units. It was also found that as the level of anxiety increased, the level of psychological resilience decreased. To reduce the anxiety level and strengthen the psychological resilience of nurses, the cornerstones of the health system, fast, effective, and curative interventions should be made.

Effect of the COVID-19 Pandemic on the Psychological Health of Patients Who Underwent Liver Transplantation Due to Hepatocellular Carcinoma.

BACKGROUND: The primary aim of this study was to compare liver transplant (LT) recipients with and without hepatocellular carcinoma (HCC) in terms of COVID-19-related depression, anxiety, and stress. METHOD: A total of 504 LT recipients with (HCC group; n = 252) and without HCC (non-HCC group; n = 252) were included in the present case-control study. Depression Anxiety Stress Scales (DASS-21) and Coronavirus Anxiety Scale (CAS) were used to evaluate the depression, stress, and anxiety levels of LT patients. DASS-21 total and CAS-SF scores were determined as the primary outcomes of the study. Poisson regression and negative binomial regression models were used to predict the DASS and CAS scores. The incidence rate ratio (IRR) was used as a coefficient. Both groups were also compared in terms of awareness of the COVID-19 vaccine. RESULTS: Poisson regression and negative binomial regression analyses for DASS-21 total and CAS-SF scales showed that the negative binomial regression method was the appropriate model for both scales. According to this model, it was determined that the following independent variables increased the DASS-21 total score: non-HCC (IRR: 1.26; p = 0.031), female gender (IRR: 1.29; p = 0.036), presence of chronic disease (IRR: 1.65; p < 0.001), exposure to COVID-19 (IRR: 1.63; p < 0.001), and nonvaccination (IRR: 1.50; p = 0.002). On the other hand, it was determined that the following independent variables increased the CAS score: female gender (IRR:1.75; p = 0.014) and exposure to COVID-19 (IRR: 1.51; p = 0.048). Significant differences were found between the HCC and non-HCC groups in terms of median DASS-21 total (p < 0.001) and CAS-SF (p = 0.002) scores. Cronbach's alpha internal consistency coefficients of DASS-21 total and CAS-SF scales were calculated to be 0.823 and 0.783, respectively. CONCLUSION: This study showed that the variables including patients without HCC, female gender, having a chronic disease, being exposed to COVID-19, and not being vaccinated against COVID-19 increased anxiety, depression, and stress. High internal consistency coefficients obtained from both scales indicate that these results are reliable.

Effect of COVID-19 Pandemic on Patients Who Have Undergone Liver Transplantation Because of Hepatocellular Carcinoma.

BACKGROUND AND AIM: Many clinical studies have shown that the COVID-19 case fatality rate is higher in older patients, those with comorbidities, those with immunosuppressive conditions, and those who stay in the intensive care unit. This study aims to evaluate the clinical outcomes of 66 liver transplant (LT) patients with primary liver cancer who were exposed to COVID-19 infection. METHODS: Demographic and clinical data of 66 patients with primary liver cancer (hepatocellular carcinoma = 64, hepatoblastoma = 1, cholangiocarcinoma = 1) who underwent LT in our institute and were exposed to COVID-19 infection between March 2020 and November 2021 were analyzed in this cross-sectional study. The following data of the patients were recorded: age, sex, body mass index (kg/m2), blood group, underlying primary liver disease, smoking, tumor characteristics, post-transplant immunosuppressive agents, COVID-19 symptoms, hospitalization, intensive care unit stay, intubation, and other clinical features. RESULTS: There were 55 (83.3%) male and 11 (16.7%) female patients, with a median age of 58 years. Sixty-four patients were exposed to COVID-19 only once, whereas the remaining 2 patients were exposed 2 and 4 times, respectively. After exposure to COVID-19, it was determined that 37 patients used antiviral drugs, 25 were hospitalized, 9 were followed in the intensive care unit, and 3 were intubated. One intubated patient was under hospital follow-up because of biliary complications before exposure to COVID-19, and this patient died from sepsis. CONCLUSION: The low mortality rate of LT patients with primary liver cancer exposed to COVID-19 infection can be attributed to background immunosuppression that prevents cytokine storm. However, it is appropriate to support this study with multicenter studies to make strong comments on this issue.

Immunosuppressive Medication Adherence in Patients With Hepatocellular Cancer Who Have Undergo Liver Transplantation: A Case Control Study.

BACKGROUND: We aimed to compare the adherence to immunosuppressive medication use in patients who underwent liver transplantation (LT) due to hepatocellular carcinoma (HCC) and non-HCC reasons. METHODS: The study population was determined as 242 patients with HCC and 1290 patients with non-HCC who had LT performed in our institute between March 2002 and November 2021; all these patients were contacted by phone in March 2022. The sample size was calculated using the MedCalc software program, and the number of patients required in each group was determined as 111 patients. Furthermore, we used the sample.int function, a random integer generator in the R (version 4.1.2) software program. Whereas demographic and clinical parameters were determined as independent variables, the immunosuppressive medication adherence scale (IMAS) score was determined as a dependent variable. Patients were evaluated by the IMAS. This 11-item IMAS scale evaluates the lowest compliance score as 11 and the highest as 55. RESULTS: Out of a total number of 221 patients, 161 (72%) were men and 60 (27.1%) were women, with a median age of 58 years (IQR: 14); one patient in the non-HCC group was excluded due to lack of data. Among the HCC and non-HCC groups, significant differences were found in terms of the variables of age (P = .003), IMAS score (P < .001), sex (P = .001), working status (P = .004), chronic diseases (P = .008), tacrolimus alone (P < .001), tacrolimus plus everolimus (P < .001), and often medication changes (P < .001). A statistically significant correlation was found between the IMAS score and whether the patients had HCC (P < .001) and frequently changing immunosuppressive drugs (P = .023). CONCLUSION: This study showed that patients with frequent drug changes or non-HCC etiology had better adherence to immunosuppressive drug use.

Effect of Pre-Transplant Covid-19 Exposure on Post-Liver Transplant Clinical Outcomes.

BACKGROUND: COVID-19 has led to an unprecedented global health crisis. This situation caused an immediate reduction in solid organ transplantation activity. This study aimed to present the follow-up results of patients with chronic liver disease who underwent liver transplantation (LT) after a history of COVID-19 infection. METHODS: Sociodemographic characteristics and clinicopathological data of 474 patients who underwent LT at Inonu University Liver Transplant Institute between March 11, 2020 and March 17, 2022 were prospectively recorded and analyzed retrospectively. Among these, the data of 35 patients with chronic liver disease who were found to be exposed to COVID-19 infection in the pre-LT period were analyzed for this study. RESULTS: The median body mass index, Child score, and Model for end-stage liver disease/ Pediatric end-stage liver disease scores of the 35 patients were calculated as 25.1 kg/m2 (IQR: 7.4), 9 points (IQR: 4), and 16 points (IQR: 10), respectively. Graft rejection occurred in 4 patients at a median of 25 days post-transplant. Five patients underwent retransplantation at a median of 25 days post-transplant. The most common cause of retransplantation is early hepatic artery thrombosis. There were 5 deaths during postoperative follow-up. Mortality developed in 5 (14.3%) patients exposed to COVID-19 infection in the pretransplant period, whereas mortality occurred in 56 (12.8%) patients not exposed to COVID-19 infection. There was no statistically significant difference in mortality between the groups (P = .79). CONCLUSIONS: The results of this study showed that exposure to COVID-19 before LT does not affect post-transplant patients and graft survival.

Knowledge levels, attitudes, and awareness of nurses toward organ donation.

OBJECTIVE: The aim of this study was to assess the knowledge, attitudes, and practices of nurses in Turkiye concerning organ donation. METHODS: This survey-based, descriptive cross-sectional study was conducted from January 2020 to March 2020, recruiting 560 of 850 nurses currently working in a tertiary university hospital with a face-to-face interview technique. The questionnaire consisted of 35 questions evaluating sociodemographic features, organ donation knowledge level, attitude, and nurses' awareness. RESULTS: This study showed that only 6.5% of the nurses donated their organs. While 31.9% stated that they are willing to consider organ donation in the future, 41.3% were not decided about organ donation yet, and 27% rejected organ donation in any condition. Among the nurses who refused organ donation, 69.6% had no specific reason and 10.6% worried that their organs might be taken without proper diagnosis of brain death. About 10% denied organ donation for religious beliefs, and 5% were because of concerns about body integrity. Hesitation about procuring organs for commercial purposes was present in 7.2% of the nurses. Following a possible diagnosis of brain death of a relative, 33.8% of the nurses said that they would consent for organ donation to him/her, whereas 47.1% were not sure about this issue. Among the nurses, 76.6% agreed on a possible living-related organ donor for a close relative, 53.3% accepted receiving an organ from a close relative if required. Furthermore, this investigation showed that nurses who reported attending previous seminars, conferences, or training programs about organ donation have significantly better donation rates and stronger attitudes toward organ donation. Nurses who donated their organs are found to know better about brain death irreversibility, understand better the related national legal regulations for organ donation, and are more informed about the compatibility of organ donation with religious beliefs. CONCLUSION: This study showed that nurses have a relatively positive attitude toward donation and transplantation but are unwilling to bequeath their organs. This study underlines the indispensable contribution of nurses promoting organ donation and highlights the need for well-structured educational programs to enhance their role in organ donation and transplantation.

Evaluation of Vaccine Hesitancy and Anxiety Levels among Hospital Cleaning Staff and Caregivers during COVID-19 Pandemic.

It is important to vaccinate individuals working in the field of health who are more at risk compared to society during the pandemic period. The aim of this study was to evaluate the vaccine hesitancy and anxiety levels of hospital cleaning staff and caregivers during the COVID-19 pandemic. This descriptive type cross-sectional study was conducted with 460 hospital cleaning staff and caregivers. Demographic and social characteristics form, Coronavirus Anxiety Scale (CAS), and Vaccine Hesitancy Scale (VHS) adapted to the pandemic were used in the questionnaire form used to collect the data of the study. It was determined that the rates of hesitation against the COVID-19 vaccine and childhood vaccine were 42.2% (n = 194) and 10.9% (n = 50), respectively. Less than half of the participants (44.6%) believe that the COVID-19 vaccine is protective. COVID-19 anxiety (CAS score ≥ 9 point) was detected in 19.6% of participants and statistically significant differences were found between patients with (n = 90) and without (n = 370) anxiety regarding gender (p < 0.001), working unit (p = 0.002), vaccination status (p = 0.023) and history of psychological disease (p = 0.023). It has been shown that the VHS-total scores of those who are not vaccinated, those who are hesitant about vaccination, those who do not think that the vaccine is protective, and those who state that there is no need for a legal obligation in vaccination are higher. When participants were asked about the most anxious situation during the COVID-19 period, the highest response rate was 62.4% for my parents' exposure to COVID-19. The most anxious situation among participants is their parents' exposure to COVID-19. Although participants are highly vaccinated, they have serious hesitancy about the COVID-19 vaccine. This study also showed that there was a parallel relationship between COVID-19 anxiety and vaccine hesitancy.

Medical students' knowledge, attitudes and awareness toward organ donation.

OBJECTIVE: This survey study aimed to evaluate medical students' attitudes, knowledge, and awareness toward organ donation. METHODS: For this questionnaire-based cross-sectional study, 1000 medical students were interviewed, out of which 950 students agreed to participate in the study and were enrolled. A questionnaire form consisting of 29 questions was used to determine the students' socio-demographic characteristics and rate their knowledge, attitudes, and behaviors about organ donation. RESULTS: While 95.5% (n = 907) of the students stated that they had not donated organs, 41.1% stated that they had not yet decided to donate organs, and 59.7% stated that they had no specific reason for them not donating organs. Out of the participants, 68.1% stated that organ donation complies with the Islamic rules; 40.7% stated that the Directorate of Religious Affairs issued a fatwa on organ donation, and 39.4% stated that there are legal regulations on organ donation in the country. While 22.1% of the students stated that a person with brain death could come back to life, 19.7% stated that they did not know about this issue. The students who had donated organs and who did not show significant differences regarding the answers given to the questions about whether organ donation complies with religious rules (p < 0.001), where one must apply to donate organs (p = 0.032), the will to donate the organs of a relative with brain death (p = 0.004), and whether preaching in mosques and foundations is needed to increase organ donation rates (p = 0.042). Although there was a correlation between the students' grade and their attitude and knowledge about organ donation, this correlation was weak and showed no parallelism with increasing grades. CONCLUSION: This study indicates that medical students have inadequate knowledge, attitudes, and behaviors about organ donation. In our opinion, it is of paramount importance to provide physician candidates, who should set an example for society, with periodic training on organ donation throughout their academic life in shaping the national organ donation policy in the future.

Analysis of risk factors affecting the development of peptic ulcer perforation: case-control study.

AIM: The aim of the to determine the risk factors associated with increased risk of peptic ulcer perforation (PUP). MATERIAL AND METHODS: The demographic, clinic, and biochemical parameters of 65 patients (PUP group) who underwent PUP surgery at our clinic between June 2009 and September 2016 were compared with the data of 134 patients (control group) who underwent endoscopy at a gastroenterology clinic for dyspeptic complaints. The control group were matched at random in a 1 : 2 ratio with the PUP group. Univariate analyses were used to compare different variables and variables with clinical significance, and p ≤ 0.05 was used in the backward stepwise logistic regression model. RESULTS: This study included 65 patients with peptic ulcer perforation aged 17 to 92 years (PUP group) and 134 patients with dyspeptic complaints aged 18 to 87 years (control group). Univariate analysis showed that statistically significant differences were found between groups in terms of non-steroidal anti-inflammatory drugs usage (p = 0.042; OR = 1.868), smoking (p < 0.001; OR = 5.124), old age (p = 0.003), low body mass index (BMI) (p < 0.001), and low hemoglobin (Hb) (p = 0.002). However multivariate analysis showed that increasing age (p = 0.004; OR = 1.035), smoking (p = 0.007; OR = 3.591), decreasing Hb (p = 0.042; OR = 1.277), and decreasing BMI (p < 0.001; OR = 1.669) were independent clinically significant risk factors for development of PUP. CONCLUSIONS: This study showed that decreased BMI, decreased Hb, increased age, and smoking were independent risk factors for development of PUP. Thus, this group of patients needs particular attention paid to suggestive symptoms with early diagnosis and optimal management of peptic ulcer disease.

Fascioliasis presenting as colon cancer liver metastasis on 18F-fluorodeoxyglucose positron emission tomography/computed tomography: A case report.

BACKGROUND: Fascioliasis is caused by watercress and similar freshwater plants or drinking water or beverages contaminated with metacercariae. Fascioliasis can radiologically mimic many primary or metastatic liver tumors. Herein, we aimed to present the treatment process of a patient with fascioliasis mimicking colon cancer liver metastasis. CASE SUMMARY: A 35-year-old woman who underwent right hemicolectomy due to cecum cancer was referred to our clinic for management of colon cancer liver metastasis. Both computed tomography and 18F-fluorodeoxyglucose positron emission tomography revealed several tumoral lesions localized in the right lobe of the liver. After a 6-course FOLFOX (folinic acid, fluorouracil, oxaliplatin) and bevacizumab regimen, the hypermetabolic state on both liver and abdominal lymph nodes continued, and chemotherapy was extended to a 12-course regimen. The patient was referred to our institute when the liver lesions were detected to be larger on dynamic liver magnetic resonance imaging 6 weeks after completion of chemotherapy. Right hepatectomy was performed, and histopathological examination was compatible with fascioliasis. Fasciola hepatica IgG enzyme-linked immunosorbent assay was positive. The patient was administered two doses of triclabendazole (10 mg/kg/dose) 24 h apart. During the follow-up period, dilatation was detected in the common bile duct, and Fasciola parasites were extracted from the common bile duct by endoscopic retrograde cholangiopancreatography (ERCP). Triclabendazole was administered to the patient after ERCP. CONCLUSION: Parasitic diseases, such as those caused by Fasciola hepatica, should be kept in mind in the differential diagnosis of primary or metastatic liver tumors, such as colorectal cancer liver metastasis, in patients living in endemic areas.