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Güner AE, Kiziltas S, Babalik A, Sahin E, Sibel A, Safak M, Kiliçaslan Z. Outcomes of latent tuberculosis infection treatment in Istanbul. Int J Mycobacteriol 2022; 11:442-447. [PMID: 36510932 DOI: 10.4103/ijmy.ijmy_196_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background and Aim Increasing the extensity of latent tuberculosis infection (LTBI) treatment which is one of the important parameters of tuberculosis (TB) control and completing the treatment in success are important. The purpose of this study is to evaluate LTBI treatment indications and treatment outcomes of patients who received LTBI treatment in İstanbul between 2016 and 2018. Methods The treatment outcomes of people who started LTBI treatment registered in TB dispensaries in Istanbul between 2016 and 2018 were analyzed retrospectively according to the variables of the age groups, gender, dispensary subgroups, and prevention treatment indications. Data collected from the health institutions were evaluated. Results 26.920 patients received LTBI treatment in all Istanbul TB dispensaries between 2016 and 2018. The evaluation of LTBI treatment indications; contact 15.696, Tuberculin skin test (TST) positivity 2224, immunosuppression 8746, TST conversion 58, sequelae lesion 15, and other indications are identified as 181. The groups which diagnosed with TB disease, mortality, transfer, other, and still in treatment are excluded from the analysis of LTBI treatment outcomes. A total of 25.253 patients were analyzed. 65 percent of the patients had completed LTBI treatment. Variables effective for treatment outcomes are analyzed with logistic regression. Treatment discontinuation was statistically significantly lower in 2017 (odds ratio [OR]: 0.906 confidence interval [CI] [95%] [0.849-0.968]) and 2018 (OR: 0.635 CI [95%] [0.594-0.679]) compared to 2016. Treatment lost to follow-up was statistically significantly lower in those receiving LTBI treatment with the indication of tuberculin skin test positivity (OR: 0.541 CI [95%] [0.487-0.600]) and the indication of immunosuppression (OR: 0.284 CI [95%] [0.142-0.569]) compared to those who received LTBI treatment due to contact. When the treatment results are evaluated according to the TB incidence of the region where the dispensaries are located, treatment lost to follow-up was higher in 101-200 per 100,000 incidence group (OR: 1.201 CI [95%] [1.123-1.285]) and incidence of 201-370 per 100,000 (OR: 1.461 CI [95%] [1.358-1.572]). Treatment lost to follow-up was higher in dispensaries on the European side (OR: 1.293 CI [95%] [1.203-1389]) and the 0-35 age group (OR: 1.248 CI [95%] [1.168-1.333]). Conclusion In conclusion, the treatment completion rate should be improved for an effective LTBI treatment which is one of the important parameters of targeted TB elimination. Particularly people under the age of 35 years and regions with high-TB incidence should receive special care and close follow-up.
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Affiliation(s)
- Abdullah Emre Güner
- Department of Public Health, University of Health Sciences, Hamidiye Faculty of Medicine, Istanbul, Turkey
| | - Sule Kiziltas
- Department of Chest Diseases, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Aylin Babalik
- Department of Chest Diseases, University of Health Sciences, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, Istanbul, Turkey
| | - Esra Sahin
- Department of Public Health Services, Provincial Directorate of Health, Istanbul, Turkey
| | - Al Sibel
- Department of Public Health Services, Provincial Directorate of Health, Istanbul, Turkey
| | - Mine Safak
- Department of Public Health Services, Provincial Directorate of Health, Istanbul, Turkey
| | - Zeki Kiliçaslan
- Department of Chest Diseases, Istanbul University Faculty of Medicine, Istanbul, Turkey
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Gülhan R, Eryüksel E, Gülçebi İdriz Oğlu M, Çulpan Y, Toplu A, Kocakaya D, Tigen E, Ertürk Şengel B, Sili U, Olgun Yıldızeli Ş, Balcan MB, Elçi A, Bulut C, Karaalp A, Yananlı HR, Güner AE, Hatipoğlu M, Karakurt S, Korten V, Ratnaraj N, Patsalos P, Ay P, Onat F. Pharmacokinetic characterization of favipiravir in patients with COVID-19. Br J Clin Pharmacol 2022; 88:3516-3522. [PMID: 35014080 DOI: 10.1111/bcp.15227] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 12/17/2021] [Accepted: 12/31/2021] [Indexed: 11/28/2022] Open
Abstract
This prospective observational study describes the pharmacokinetic characteristics of favipiravir in adult patients hospitalized for mild to moderate COVID-19 with a positive RT-PCR test. Favipiravir was administered for 5 days, with a loading dose of 3200 mg and a maintenance dose of 1200 mg/day. Serial blood samples were collected on Day-2 and Day-4 of the therapy. Laboratory findings of the patients (n=21) and in-hospital mortality were recorded. Favipiravir concentrations exhibited substantial variability and a significant decrease during the treatment of COVID-19. The median favipiravir trough concentration (C0-trough ) on Day-2 was 21.26 (IQR, 8.37-30.78) μg/mL whereas it decreased significantly to 1.61 (IQR, 0.00-6.41) μg/mL on Day-4, the area under the concentration versus time curve decreased by 68.5%. Day-2-C0-trough of female patients was higher than male patients. Our findings indicate that favipiravir concentrations show significant variability during the treatment of COVID-19 and therapeutic drug monitoring may be necessary to maintain targeted concentrations.
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Affiliation(s)
- Rezzan Gülhan
- Department of Medical Pharmacology, Marmara University School of Medicine, Istanbul, Turkey
| | - Emel Eryüksel
- Department of Pulmonary Medicine and Critical Care, Marmara University School of Medicine, Istanbul, Turkey
| | | | - Yekta Çulpan
- Department of Medical Pharmacology, Marmara University School of Medicine, Istanbul, Turkey
| | - Aylin Toplu
- Department of Medical Pharmacology, Marmara University School of Medicine, Istanbul, Turkey
| | - Derya Kocakaya
- Department of Pulmonary Medicine and Critical Care, Marmara University School of Medicine, Istanbul, Turkey
| | - Elif Tigen
- Department of Infectious Disease and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Buket Ertürk Şengel
- Department of Infectious Disease and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Uluhan Sili
- Department of Infectious Disease and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Şehnaz Olgun Yıldızeli
- Department of Pulmonary Medicine and Critical Care, Marmara University School of Medicine, Istanbul, Turkey
| | - Mehmet Baran Balcan
- Department of Pulmonary Medicine and Critical Care, Marmara University School of Medicine, Istanbul, Turkey
| | - Abdullah Elçi
- Istanbul Health Directorate Public Health Laboratory-3, Istanbul, Turkey
| | - Cenk Bulut
- Istanbul Health Directorate Public Health Laboratory-3, Istanbul, Turkey
| | - Atila Karaalp
- Department of Medical Pharmacology, Marmara University School of Medicine, Istanbul, Turkey
| | - Hasan Raci Yananlı
- Department of Medical Pharmacology, Marmara University School of Medicine, Istanbul, Turkey
| | | | | | - Sait Karakurt
- Department of Pulmonary Medicine and Critical Care, Marmara University School of Medicine, Istanbul, Turkey
| | - Volkan Korten
- Department of Infectious Disease and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Neville Ratnaraj
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - Philip Patsalos
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - Pınar Ay
- Department of Public Health, Marmara University School of Medicine, Istanbul, Turkey
| | - Filiz Onat
- Department of Medical Pharmacology, Marmara University School of Medicine, Istanbul, Turkey.,Department of Medical Pharmacology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
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Güner AE, Sürmeli A, Kural K, Şahin E, Alkan P, Kocayiğit E, Hatipoğlu M, Birinci Ş, Memişoğlu K, Maral I. First known COVID-19 case and contact tracing efforts in İstanbul, Turkey. Turk J Med Sci 2021; 51:1653-1658. [PMID: 33929142 PMCID: PMC8573937 DOI: 10.3906/sag-2103-30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/30/2021] [Indexed: 11/03/2022] Open
Abstract
Background/aim COVID-19 has now become a global pandemic. Understanding the routes of transmission is vital in the mitigation and suppression of the disease. İstanbul has become one of the disease’s epicenters. This study aims to describe the first COVID-19 case and contact tracing efforts around it in İstanbul. Materials and methods The descriptive study was conducted in İstanbul, Turkey. The first COVID-19 cases and those associated with them were investigated with contact tracing, and primary and secondary cases were described. Results The source case was an individual who returned to Turkey from international travel at the beginning of March and tested PCR (–). The index case is the brother of the source case and is considered the first PCR (+) case diagnosed in İstanbul. Contact tracing revealed 23 PCR (+) cases, 14 of which resulted in hospitalization and three deaths. Conclusions This study described cases of the first COVID-19 cluster in İstanbul. Moreover, contact tracing was used in this first cluster. This contributed to contact tracing algorithms in Turkey.
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Affiliation(s)
- Abdullah Emre Güner
- Department of Public Health Services, İstanbul Health Directorate, İstanbul, Turkey
| | - Aral Sürmeli
- Medical Rescue Association of Turkey, İstanbul, Turkey
| | - Kemal Kural
- Department of Public Health Services, İstanbul Health Directorate, İstanbul, Turkey
| | - Esra Şahin
- Department of Public Health Services, İstanbul Health Directorate, İstanbul, Turkey
| | - Perihan Alkan
- Department of Infectious Diseases, Istanbul Health Directorate, İstanbul, Turkey
| | - Erdoğan Kocayiğit
- Department of Public Health Services, İstanbul Health Directorate, İstanbul, Turkey
| | - Mustafa Hatipoğlu
- Department of Public Health Services, İstanbul Health Directorate, İstanbul, Turkey
| | - Şuayip Birinci
- Ministry of Health, Government of Turkey, Ankara, Turkey
| | | | - Işıl Maral
- Department of Public Health, Medeniyet University School of Medicine, İstanbul, Turkey
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Maral I, Yaylalı E, Güçlü H, İkiışık H, Güner AE. [Evaluation of Non-Pharmaceutical Interventions for Reducing Contact Rate in COVID-19 Pandemic: R0 Estimation and Modeling for Istanbul]. MIKROBIYOL BUL 2021; 55:389-405. [PMID: 34416804 DOI: 10.5578/mb.20219808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
After the declaration of the coronavirus-2019 (COVID-19) pandemic and the detection of the COVID-19 case in Turkey, a series of non-pharmaceutical measures were implemented to reduce the number of contacts at the national level. The aim of this study was to determine the change in the epidemic reproduction rate (R0) with non-pharmaceutical interventions including curfews starting with the first reported case in Istanbul and to evaluate the effectiveness of interventions by estimating the number of cases and deaths using a dynamic compartmental model. While keeping transmission probability (beta) as 3% and incubation period as seven days, we developed five scenarios that represented nonpharmaceutical interventions The first scenario was "if nothing was done" and the last scenario was "curfew". The contact matrix of 16 age-groups created by Prem et al. was used in the study as the contact matrix of "if nothing was done" as scenario 1. For all other scenarios (2-5) contact matrices assumptions were created and R0 values were calculated for the whole of Istanbul according to age groups for all five scenarios. For each scenario, "the number of cases and COVID-related deaths" for one year from the day the first case was detected were calculated with the mathematical modeling method. In the absence of any intervention, R0 value was estimated as 2.86 in Istanbul. Among age-groups, the largest R0 value was observed in ages 15-19, 10-14, 5-9, 20-24 and the values were 5.22, 4.37, 3.32, and 3.33; respectively. Due to school closings and flexible work hours, R0 values decreased to 2.02, 1.84, 1.63 and 1.85 in the same age-groups. With the addition of a curfew for the population under the age of 20 to the above measures, the R0 values for all age groups were reduced to less than one. When R0 values for Istanbul was 2.86 and 1.55 based on our model results, the number of cases and deaths per year were determined as approximately 14 million and 2 million and 2.5 million and 327.000, respectively. School closures were determined as the most effective non-pharmaceutical intervention. Non-pharmaceutical measures with the addition of curfews under the age of 20 and over the age of 65 to the school closings and flexible working hours were identified as effective methods in controlling the COVID-19 epidemic in Istanbul. While the results of this study may not reflect real life data, it has the potential of helping public health policy makers to decide on which non-pharmaceutical interventions are the most effective.
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Affiliation(s)
- Işıl Maral
- İstanbul Medeniyet University Faculty of Medicine, Department of Public Health, Istanbul, Turkey
| | - Emine Yaylalı
- İstanbul Technical University Faculty of Management, Department of Industrial Engineering, Istanbul, Turkey
| | - Hasan Güçlü
- Istanbul Medeniyet University Faculty of Medicine, Department of Biostatistics and Medical Informatics, Istanbul, Turkey
| | - Hatice İkiışık
- İstanbul Medeniyet University Faculty of Medicine, Department of Public Health, Istanbul, Turkey
| | - Abdullah Emre Güner
- TR Ministry of Health, Istanbul Provincial Health Directorate, Head of Public Health Services, Istanbul, Turkey
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Güner AE, Memişoğlu K, Birinci Ş. Preemptive action saves lives in a pandemic: closing the Grand Bazaar before the COVID-19 infection starts. Turk J Med Sci 2020; 50:2075-2076. [PMID: 33128359 PMCID: PMC7775691 DOI: 10.3906/sag-2008-169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/29/2020] [Indexed: 12/02/2022] Open
Affiliation(s)
- Abdullah Emre Güner
- Public Health Services, İstanbul Health Directorate, Ministry of Health of Turkey, İstanbul, Turkey
| | - Kemal Memişoğlu
- İstanbul Health Directorate, Ministry of Health of Turkey, İstanbul, Turkey
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