1
|
Cohen LE, Hansen CL, Andrew MK, McNeil SA, Vanhems P, Kyncl J, Domingo JD, Zhang T, Dbaibo G, Laguna-Torres VA, Draganescu A, Baumeister E, Gomez D, Raboni SM, Giamberardino HIG, Nunes MC, Burtseva E, Sominina A, Medić S, Coulibaly D, Salah AB, Otieno NA, Koul PA, Unal S, Tanriover MD, Mazur M, Bresee J, Viboud C, Chaves SS. Predictors of Severity of Influenza-Related Hospitalizations: Results From the Global Influenza Hospital Surveillance Network (GIHSN). J Infect Dis 2024; 229:999-1009. [PMID: 37527470 PMCID: PMC11011157 DOI: 10.1093/infdis/jiad303] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 07/13/2023] [Accepted: 07/26/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND The Global Influenza Hospital Surveillance Network (GIHSN) has since 2012 provided patient-level data on severe influenza-like-illnesses from >100 participating clinical sites worldwide based on a core protocol and consistent case definitions. METHODS We used multivariable logistic regression to assess the risk of intensive care unit admission, mechanical ventilation, and in-hospital death among hospitalized patients with influenza and explored the role of patient-level covariates and country income level. RESULTS The data set included 73 121 patients hospitalized with respiratory illness in 22 countries, including 15 660 with laboratory-confirmed influenza. After adjusting for patient-level covariates we found a 7-fold increase in the risk of influenza-related intensive care unit admission in lower middle-income countries (LMICs), compared with high-income countries (P = .01). The risk of mechanical ventilation and in-hospital death also increased by 4-fold in LMICs, though these differences were not statistically significant. We also find that influenza mortality increased significantly with older age and number of comorbid conditions. Across all severity outcomes studied and after controlling for patient characteristics, infection with influenza A/H1N1pdm09 was more severe than with A/H3N2. CONCLUSIONS Our study provides new information on influenza severity in underresourced populations, particularly those in LMICs.
Collapse
Affiliation(s)
- Lily E Cohen
- Ready2Respond p/o The Task Force for Global Health, Decatur, Georgia, USA
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Chelsea L Hansen
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
- Brotman Baty Institute, University of Washington, Seattle, Washington, USA
- PandemiX Center, Department of Science & Environment, Roskilde University, Denmark
| | - Melissa K Andrew
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shelly A McNeil
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Jan Kyncl
- Department of Infectious Diseases Epidemiology, National Institute of Public Health, Prague, Czech Republic
- Department of Epidemiology and Biostatistics, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Javier Díez Domingo
- Fundación Para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO–Public Health), Valencia, Spain
| | - Tao Zhang
- School of Public Health, Fudan University, Shanghai, China
| | - Ghassan Dbaibo
- Center for Infectious Diseases Research, American University of Beirut, Beirut, Lebanon
| | | | - Anca Draganescu
- National Institute for Infectious Diseases “Prof Dr Matei Bals”, Bucharest, Romania
| | - Elsa Baumeister
- Respiratory Virus Laboratory, Virology Department, INEI-ANLIS, Buenos Aires, Argentina
| | - Doris Gomez
- Grupo de Investigación UNIMOL, Facultad de Medicina, Universidad de Cartagena, Cartagena de Indias, Colombia
| | - Sonia M Raboni
- Virology Laboratory, Infectious Diseases Division, Universidade Federal do Paraná, Hospital Pequeno Principe, Curitiba, Paraná, Brazil
| | - Heloisa I G Giamberardino
- Virology Laboratory, Infectious Diseases Division, Universidade Federal do Paraná, Hospital Pequeno Principe, Curitiba, Paraná, Brazil
| | - Marta C Nunes
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elena Burtseva
- Gamaleya Federal Research Center for Epidemiology and Microbiology, Ministry of Health of Russian Federation, Moscow, Russia
| | - Anna Sominina
- Smorodintsev Research Institute of Influenza, St Petersburg, Russia
| | - Snežana Medić
- Institute for Public Health of Vojvodina, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | | | - Afif Ben Salah
- Institut Pasteur de Tunis, Tunis, Tunisia
- Arabian Gulf University, Manama, Bahrain
| | - Nancy A Otieno
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Parvaiz A Koul
- Sheri Kashmir Institute of Medical Sciences, Srinagar, India
| | - Serhat Unal
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
- Turkish Society of Internal Medicine, Ankara, Turkey
| | - Mine Durusu Tanriover
- Turkish Society of Internal Medicine, Ankara, Turkey
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Marie Mazur
- Ready2Respond p/o The Task Force for Global Health, Decatur, Georgia, USA
| | - Joseph Bresee
- Ready2Respond p/o The Task Force for Global Health, Decatur, Georgia, USA
| | - Cecile Viboud
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Sandra S Chaves
- Foundation for Influenza Epidemiology, Fondation de France, Paris, France
| |
Collapse
|
2
|
Er AG, Ding DY, Er B, Uzun M, Cakmak M, Sadée C, Durhan G, Ozmen MN, Tanriover MD, Topeli A, Son YA, Tibshirani R, Unal S, Gevaert O. Multimodal Biomedical Data Fusion Using Sparse Canonical Correlation Analysis and Cooperative Learning: A Cohort Study on COVID-19. Res Sq 2023:rs.3.rs-3569833. [PMID: 38045288 PMCID: PMC10690316 DOI: 10.21203/rs.3.rs-3569833/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Through technological innovations, patient cohorts can be examined from multiple views with high-dimensional, multiscale biomedical data to classify clinical phenotypes and predict outcomes. Here, we aim to present our approach for analyzing multimodal data using unsupervised and supervised sparse linear methods in a COVID-19 patient cohort. This prospective cohort study of 149 adult patients was conducted in a tertiary care academic center. First, we used sparse canonical correlation analysis (CCA) to identify and quantify relationships across different data modalities, including viral genome sequencing, imaging, clinical data, and laboratory results. Then, we used cooperative learning to predict the clinical outcome of COVID-19 patients. We show that serum biomarkers representing severe disease and acute phase response correlate with original and wavelet radiomics features in the LLL frequency channel (𝑐𝑜𝑟𝑟(𝑋 u 𝟏 , Z v 𝟏 ) = 0.596, p-value < 0.001). Among radiomics features, histogram-based first-order features reporting the skewness, kurtosis, and uniformity have the lowest negative, whereas entropy-related features have the highest positive coefficients. Moreover, unsupervised analysis of clinical data and laboratory results gives insights into distinct clinical phenotypes. Leveraging the availability of global viral genome databases, we demonstrate that the Word2Vec natural language processing model can be used for viral genome encoding. It not only separates major SARS-CoV-2 variants but also allows the preservation of phylogenetic relationships among them. Our quadruple model using Word2Vec encoding achieves better prediction results in the supervised task. The model yields area under the curve (AUC) and accuracy values of 0.87 and 0.77, respectively. Our study illustrates that sparse CCA analysis and cooperative learning are powerful techniques for handling high-dimensional, multimodal data to investigate multivariate associations in unsupervised and supervised tasks.
Collapse
|
3
|
Özdede M, Güven AT, Karadeniz Güven D, Uyaroğlu OA, Durusu Tanriover M. The Collateral Benefit of COVID Pandemic: Improved Pharmacological Venous Thromboembolism Prophylaxis Practices in Non-COVID Patients. Int J Gen Med 2023; 16:1069-1079. [PMID: 36992696 PMCID: PMC10042246 DOI: 10.2147/ijgm.s404827] [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: 01/27/2023] [Accepted: 03/17/2023] [Indexed: 03/31/2023] Open
Abstract
Background COVID-19 creates a hypercoagulable state with a wide spectrum of clinical manifestations. Of those, venous thromboembolism (VTE) is prevalent, and numerous studies have highlighted the importance of VTE prophylaxis. Pre-pandemic VTE prophylaxis practices have already been poor, despite guidelines. We hypothesized that the gap between guidelines and practices might have been closed due to increased awareness. Materials and Methods Non-COVID-19 patients hospitalized in the internal medicine ward of a university hospital between January 1st, 2021, and June 30th, 2021, were assessed. VTE risk and thromboprophylaxis requirements were assessed using the Padua Prediction Score (PPS). The results were compared with the findings of the study conducted in the same setting before the pandemic. Results A total of 267 patients were included, and 81 patients (30.3%) received prophylaxis. A total of 128 patients' (47.9%) PPS was ≥ 4, and 69 patients (53.9%) received prophylaxis; 12 low-risk patients (8.6%) received prophylaxis although it was not indicated. Compared to the pre-pandemic figures, both appropriate prophylaxis use and overuse rates have risen. While the increment rate of appropriate prophylaxis was statistically significant, the increment rate of overuse did not reach statistical significance. Patients hospitalized for infectious diseases and respiratory failure were more likely to receive appropriate prophylaxis. Conclusion We have demonstrated a significant increase in appropriate pharmacologic prophylaxis rates among high-risk patients. Besides all the collateral damage the pandemic has created, it might also have brought collateral benefits with regards to VTE prophylaxis.
Collapse
Affiliation(s)
- Murat Özdede
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of General Internal Medicine, Ankara, Turkey
| | - Alper Tuna Güven
- Başkent University Adana Hospitals, Department of Internal Medicine, Division of General Internal Medicine, Adana, Turkey
- Correspondence: Alper Tuna Güven, Başkent University Adana Hospitals, Department of Internal Medicine, Division of General Internal Medicine, Yüreğir, Adana, Turkey, Tel +90 541 802 2135, Email
| | | | - Oğuz Abdullah Uyaroğlu
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of General Internal Medicine, Ankara, Turkey
| | - Mine Durusu Tanriover
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of General Internal Medicine, Ankara, Turkey
| |
Collapse
|
4
|
Bolek H, Ozisik L, Caliskan Z, Tanriover MD. Clinical outcomes and economic burden of seasonal influenza and other respiratory virus infections in hospitalized adults. J Med Virol 2023; 95:e28153. [PMID: 36110064 DOI: 10.1002/jmv.28153] [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] [Received: 06/05/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 01/11/2023]
Abstract
The cost of influenza and other respiratory virus infections should be determined to analyze the real burden of these diseases. We aimed to investigate the clinical outcomes and cost of illness due to respiratory virus infections in hospitalized adult patients. Hospitalized patients who had nasal swab sampling for a suspected viral infection between August 1, 2018 to March 31, 2019 were included. Outcome variables were oxygen requirement, mechanical ventilation need, intensive care unit admission, and cost. At least one viral pathogen was detected in 125 (47.7%) of 262 patients who were included in the study. Fifty-five (20.9%) of the patients were infected with influenza. Influenza-positive patients had higher rates for respiratory support, intensive care unit admission, and mortality compared to all other patients. The average cost of hospitalization per person was 2879.76 USD in the influenza-negative group, while the same cost was 3274.03 USD in the influenza-positive group. Although all of the vaccinated influenza-positive patients needed oxygen support, neither of them required invasive mechanical ventilation or intensive care unit admission. The average hospitalization cost per person was 779.70 USD in the vaccinated group compared to 3762.01 USD in the unvaccinated group. Disease-related direct cost of influenza in the community was estimated as 22 776 075.61 USD in the 18-65 years of age group and 15 756 120.02 USD in the 65 years of age and over group per year. Influenza, compared to other respiratory virus infections, can lead to untoward clinical outcomes and mortality as well as higher direct medical costs in adults.
Collapse
Affiliation(s)
- Hatice Bolek
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Lale Ozisik
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Zafer Caliskan
- Department of Economics, Hacettepe University Faculty of Economics and Administrative Sciences, Ankara, Turkey
| | - Mine Durusu Tanriover
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| |
Collapse
|
5
|
Tanriover MD, Akova M. Time to redefine a primary vaccination series? Lancet Infect Dis 2022; 22:1654-1655. [PMID: 36113536 PMCID: PMC9472667 DOI: 10.1016/s1473-3099(22)00576-x] [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] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/15/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Mine Durusu Tanriover
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara o6230, Turkey; Hacettepe University Vaccine Institute, Ankara, Turkey.
| | - Murat Akova
- Department of Clinical Microbiology and Infectious Diseases, Hacettepe University School of Medicine, Ankara o6230, Turkey,Hacettepe University Vaccine Institute, Ankara, Turkey
| |
Collapse
|
6
|
Er AG, Alonso AAR, Marin-Leon I, Sayiner A, Bassetti S, Demirkan K, Lacor P, Lode H, Lesniak W, Tanriover MD, Kalyoncu AF, Merchante N, Unal S. Community-acquired pneumonia - An EFIM guideline critical appraisal adaptation for internists. Eur J Intern Med 2022; 106:1-8. [PMID: 36272872 DOI: 10.1016/j.ejim.2022.10.009] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/05/2022] [Accepted: 10/11/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND In real-life settings, guidelines frequently cannot be followed since many patients are multimorbid and/or elderly or have other complicating conditions which carry an increased risk of drug-drug interactions. This document aimed to adapt recommendations from existing clinical practice guidelines (CPGs) to assist physicians' decision-making processes concerning specific and complex scenarios related to acute CAP. METHODS The process for the adaptation procedure started with the identification of unsolved clinical questions (PICOs) in patients with CAP and continued with critically appraising the updated existing CPGs and choosing the recommendations, which are most applicable to these specific scenarios. RESULTS Seventeen CPGs were appraised to address five PICOs. Twenty-seven recommendations were endorsed based on 7 high, 9 moderate, 10 low, and 1 very low-quality evidence. The most valid recommendations applicable to the clinical practice were the following ones: Respiratory virus testing is strongly recommended during periods of increased respiratory virus activity. Assessing the severity with a validated prediction rule to discriminate where to treat the patient is strongly recommended along with reassessing the patient periodically for improvement as expected. In adults with multiple comorbidities, polypharmacy, or advanced age, it is strongly recommended to check for possible drug interactions before starting treatment. Strong graded recommendations exist on antibiotic treatment and its duration. Recommendations on the use of biomarkers such as C-reactive protein or procalcitonin to improve severity assessment are reported. CONCLUSION This document provides a simple and reliable updated guide for clinical decision-making in the management of complex patients with multimorbidity and CAP in the real-life setting.
Collapse
Affiliation(s)
- Ahmet Gorkem Er
- Hacettepe University Faculty of Medicine Department of Infectious Diseases and Clinical Microbiology, Turkey
| | | | - Ignacio Marin-Leon
- CIBERESP-IBIS-ROCIO-University Hospital, Fundación Enebro, Seville, Spain
| | - Abdullah Sayiner
- Department of Chest Diseases, Ege University Faculty of Medicine, Izmir, Turkey
| | - Stefano Bassetti
- Division of Internal Medicine and Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Kutay Demirkan
- Department of Clinical Pharmacy, Hacettepe University, Faculty of Pharmacy, Turkey
| | - Patrick Lacor
- Department of Internal Medicine, Infectious Diseases Unit, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Hartmut Lode
- RCCOS, affil. Institute Clinical Pharmacology, Charite Universitätsmedizin Berlin, Germany
| | - Wiktoria Lesniak
- Evidence-Based Medicine Unit, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Mine Durusu Tanriover
- Section of General Internal Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ali Fuat Kalyoncu
- Hacettepe University Faculty of Medicine Department of Chest Diseases Division of Allergy and Clinical Immunology, Turkey
| | - Nicolás Merchante
- Chief of Infectious Disease Department, Valme University Hospital, Associated Professor, University of Seville- Institute of Biomedicine (IBIS), Seville, Spain
| | - Serhat Unal
- Hacettepe University Faculty of Medicine Department of Infectious Diseases and Clinical Microbiology, Turkey.
| |
Collapse
|
7
|
Tanriover MD, Aydin OA, Guner R, Yildiz O, Celik I, Doganay HL, Kose S, Akhan S, Akalin EH, Sezer Z, Ozdarendeli A, Unal S. Efficacy, Immunogenicity, and Safety of the Two-Dose Schedules of TURKOVAC versus CoronaVac in Healthy Subjects: A Randomized, Observer-Blinded, Non-Inferiority Phase III Trial. Vaccines (Basel) 2022; 10:1865. [PMID: 36366373 PMCID: PMC9698857 DOI: 10.3390/vaccines10111865] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 09/29/2023] Open
Abstract
We present the interim results of the efficacy, immunogenicity, and safety of the two-dose schedules of TURKOVAC versus CoronaVac. This was a randomized, observer-blinded, non-inferiority trial (NCT04942405). Volunteers were 18-55 years old and randomized at a 1:1 ratio to receive either TURKOVAC or CoronaVac at Day 0 and Day 28, both of which are 3 μg/0.5 mL of inactivated severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) adsorbed to aluminum hydroxide. The primary efficacy outcome was the prevention of polymerase chain reaction (PCR)-confirmed symptomatic coronavirus disease 2019 (COVID-19) at least 14 days after the second dose in the modified per-protocol (mPP) group. Safety analyses were performed in the modified intention-to-treat (mITT) group. Between 22 June 2021 and 7 January 2022, 1290 participants were randomized. The mITT group consisted of 915 participants, and the mPP group consisted of 732 participants. During a median follow-up of 90 (IQR 86-90) days, the relative risk reduction with TURKOVAC compared to CoronaVac was 41.03% (95% CI 12.95-60.06) for preventing PCR-confirmed symptomatic COVID-19. The incidences of adverse events (AEs) overall were 58.8% in TURKOVAC and 49.7% in CoronaVac arms (p = 0.006), with no fatalities or grade four AEs. TURKOVAC was non-inferior to CoronaVac in terms of efficacy and demonstrated a good safety and tolerability profile.
Collapse
Affiliation(s)
- Mine Durusu Tanriover
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, 06230 Ankara, Türkiye
- Vaccine Institute, Hacettepe University, 06230 Ankara, Türkiye
| | - Ozlem Altuntas Aydin
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Başaksehir Cam and Sakura City Hospital, 34480 Istanbul, Türkiye
| | - Rahmet Guner
- Infectious Diseases and Clinical Microbiology Clinic, Ankara Yildirim Beyazit University, Ankara City Hospital, 06800 Ankara, Türkiye
| | - Orhan Yildiz
- Department of Infectious Diseases and Clinical Microbiology, Erciyes University Faculty of Medicine, 38030 Kayseri, Türkiye
| | - Ilhami Celik
- Department of Infectious Diseases and Clinical Microbiology, Kayseri City Training and Research Hospital, 38080 Kayseri, Türkiye
| | - Hamdi Levent Doganay
- Department of Gastroenterology, Medical Park Pendik Hospital, 34899 Istanbul, Türkiye
- Department of Internal Medicine, Bahcesehir University School of Medicine, 34734 Istanbul, Türkiye
| | - Sukran Kose
- Infectious Diseases Clinic, University of Health Sciences, Izmir Tepecik Training and Research Hospital, 35020 Izmir, Türkiye
| | - Sila Akhan
- Department of Infectious Diseases and Clinical Microbiology, Kocaeli University Faculty of Medicine, 41001 Kocaeli, Türkiye
| | - Emin Halis Akalin
- Department of Infectious Diseases and Clinical Microbiology, Bursa Uludag University Faculty of Medicine, 16059 Bursa, Türkiye
| | - Zafer Sezer
- Department of Medical Pharmacology, Erciyes University Faculty of Medicine, 38030 Kayseri, Türkiye
| | - Aykut Ozdarendeli
- Department of Microbiology, Erciyes University Faculty of Medicine, 38030 Kayseri, Türkiye
- Vaccine Research, Development and Application Centre (ERAGEM), Erciyes University, 38280 Kayseri, Türkiye
| | - Serhat Unal
- Vaccine Institute, Hacettepe University, 06230 Ankara, Türkiye
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, 06230 Ankara, Türkiye
| | | |
Collapse
|
8
|
Sonmezer MC, Dizman GT, Erul E, Sahin TK, Saricaoglu T, Alp A, Tanriover MD, Uzun O, Unal S, Akova M. Relative Vaccine Effectiveness of the Third Dose of CoronaVac or BNT162b2 Following a Two-Dose CoronaVac Regimen: A Prospective Observational Cohort Study from an Adult Vaccine Center in Turkey. Vaccines (Basel) 2022; 10:vaccines10071140. [PMID: 35891304 PMCID: PMC9322864 DOI: 10.3390/vaccines10071140] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 12/04/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) continues to pose a threat to public health with the potential for the emergence of new variants. Vaccines are the milestones to control and slow down the damage of the pandemic. As of January 2021, a two-dose regimen with CoronaVac was authorized in Turkey. Due to the waning seroprevalence rate of SARS-CoV-2 over time, BNT162b2 or CoronaVac has been administered as the third dose following a two-dose CoronaVac regimen as a national vaccination policy. As of 14 January 2021, 5243 volunteers who received two doses of the CoronaVac vaccine at Hacettepe University Adult Vaccine Center were followed prospectively. In our study, relative vaccine effectiveness (VEff) for the third dose of the CoronaVac was 58.24% and 87.27% for BNT162b2 in preventing symptomatic COVID-19 cases. There were no hospitalizations, intensive care unit admissions, or deaths in third-dose booster groups with either BNT162b2 or CoronaVac, yielding 100% effectiveness. Both homologous or heterologous third-dose boosters provided further protection against severe COVID-19 and should be prioritized as an effective strategy to combat the COVID-19 pandemic.
Collapse
Affiliation(s)
- Meliha Cagla Sonmezer
- Infectious Diseases and Clinical Microbiology Department, Hacettepe University Faculty of Medicine, 06100 Ankara, Turkey; (G.T.D.); (T.S.); (O.U.); (S.U.); (M.A.)
- Correspondence: ; Tel.: +90-3123111271
| | - Gulcin Telli Dizman
- Infectious Diseases and Clinical Microbiology Department, Hacettepe University Faculty of Medicine, 06100 Ankara, Turkey; (G.T.D.); (T.S.); (O.U.); (S.U.); (M.A.)
| | - Enes Erul
- Internal Medicine Department, Hacettepe University Faculty of Medicine, 06100 Ankara, Turkey; (E.E.); (T.K.S.); (M.D.T.)
| | - Taha Koray Sahin
- Internal Medicine Department, Hacettepe University Faculty of Medicine, 06100 Ankara, Turkey; (E.E.); (T.K.S.); (M.D.T.)
| | - Tuğba Saricaoglu
- Infectious Diseases and Clinical Microbiology Department, Hacettepe University Faculty of Medicine, 06100 Ankara, Turkey; (G.T.D.); (T.S.); (O.U.); (S.U.); (M.A.)
| | - Alparslan Alp
- Microbiology and Clinical Microbiology Department, Hacettepe University Faculty of Medicine, 06100 Ankara, Turkey;
| | - Mine Durusu Tanriover
- Internal Medicine Department, Hacettepe University Faculty of Medicine, 06100 Ankara, Turkey; (E.E.); (T.K.S.); (M.D.T.)
| | - Omrum Uzun
- Infectious Diseases and Clinical Microbiology Department, Hacettepe University Faculty of Medicine, 06100 Ankara, Turkey; (G.T.D.); (T.S.); (O.U.); (S.U.); (M.A.)
| | - Serhat Unal
- Infectious Diseases and Clinical Microbiology Department, Hacettepe University Faculty of Medicine, 06100 Ankara, Turkey; (G.T.D.); (T.S.); (O.U.); (S.U.); (M.A.)
| | - Murat Akova
- Infectious Diseases and Clinical Microbiology Department, Hacettepe University Faculty of Medicine, 06100 Ankara, Turkey; (G.T.D.); (T.S.); (O.U.); (S.U.); (M.A.)
| |
Collapse
|
9
|
Affiliation(s)
- Mine Durusu Tanriover
- Department of Internal Medicine, Vaccine Institute, Hacettepe University School of Medicine, Ankara, Turkey
| | - Murat Akova
- Department of Infectious Diseases, Vaccine Institute, Hacettepe University School of Medicine, Ankara, Turkey.
| |
Collapse
|
10
|
Al Awaidy ST, Al Slail F, Al Kathiry DAA, Al Mayahi ZK, Koul PA, Tanriover MD. A Case for Enhancing Coverage of Influenza Vaccination in Gulf Cooperation Council Countries in Patients with Diabetes Mellitus during COVID-19. Oman Med J 2021; 36:e325. [PMID: 34912571 PMCID: PMC8652396 DOI: 10.5001/omj.2021.132] [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: 06/16/2021] [Accepted: 11/17/2021] [Indexed: 11/03/2022] Open
Affiliation(s)
- Salah T Al Awaidy
- Communicable Disease Advisor for Health Affairs, Office of HE Undersecretary of Health Affairs, Ministry of Health, Muscat, Oman
| | - Fatima Al Slail
- Directorate of the National Diabetes Prevention and Control Program, Ministry of Health, Riyadh, Saudi Arabia
| | - Dalal Abdul Aziz Al Kathiry
- Directorate of the National Diabetes Prevention and Control Program, Ministry of Health, Riyadh, Saudi Arabia
| | - Zayid K Al Mayahi
- Directorate of Health Services, Ministry of Health, South Batinah Governorate, Oman
| | - Parvaiz A Koul
- Internal and Pulmonary Medicine Department, Sheri Kashmir Institute of Medical Sciences, Srinagar, India
| | - Mine Durusu Tanriover
- Department of Internal Medicine, Division of General Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
11
|
Affiliation(s)
- Mine Durusu Tanriover
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara 06230, Turkey; Hacettepe University Vaccine Institute, Ankara, Turkey
| | - Hamdi Levent Doğanay
- Department of Gastroenterology, Turkish Republic Ministry of Health, Istanbul Provincial Health Directorate, University of Health Sciences Istanbul Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Serhat Unal
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University School of Medicine, Ankara 06230, Turkey; Hacettepe University Vaccine Institute, Ankara, Turkey
| | - Murat Akova
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University School of Medicine, Ankara 06230, Turkey; Hacettepe University Vaccine Institute, Ankara, Turkey.
| |
Collapse
|
12
|
Uyaroğlu OA, Özdede M, Çalık Başaran N, Özışık L, Tanriover MD, Sain Güven G. 'Anxiety is still ongoing!' Evaluation of the effect of the COVID-19 pandemic on anxiety severity of physicians working in the internal medicine department after 1 year: a collaborative cross-sectional study. Intern Med J 2021; 51:1940-1945. [PMID: 34796627 PMCID: PMC8653133 DOI: 10.1111/imj.15558] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 08/19/2021] [Accepted: 09/22/2021] [Indexed: 11/26/2022]
Abstract
The COVID‐19 pandemic has increased anxiety in society and particularly in healthcare workers, as shown with a questionnaire in our centre at the beginning of the pandemic. In this collaborative study, we aimed to evaluate the effects of the pandemic on anxiety 1 year later by applying the same questionnaire to the physicians working in the same department. A total of 77 participants consented to the study. The median age was 28 (interquartile range = 4) years and 55.8% were male. As in the first survey, female gender, having family members over 65 years of age, and having family members with chronic diseases were significantly associated with high anxiety scores and levels. There were no statistically significant differences between the first and second survey participants in any of the anxiety scales, which means anxiety persists.
Collapse
Affiliation(s)
- Oğuz Abdullah Uyaroğlu
- Faculty of Medicine, Department of Internal Medicine, Section of General Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Murat Özdede
- Faculty of Medicine, Department of Internal Medicine, Section of General Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Nursel Çalık Başaran
- Faculty of Medicine, Department of Internal Medicine, Section of General Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Lale Özışık
- Faculty of Medicine, Department of Internal Medicine, Section of General Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Mine Durusu Tanriover
- Faculty of Medicine, Department of Internal Medicine, Section of General Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Gülay Sain Güven
- Faculty of Medicine, Department of Internal Medicine, Section of General Internal Medicine, Hacettepe University, Ankara, Turkey
| |
Collapse
|
13
|
Usta D, Altinok Ersoy N, Korkmaz F, Akyar I, Akyurek Y, Durusu Tanriover M. FALL EVENT REPORTS OF A TERTİARY-CARE HOSPİTAL: A RETROSPECTİVE ANALYSİS. Cyprus J Med Sci 2021. [DOI: 10.5152/cjms.2021.2858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
14
|
Tanriover MD, Fathi A, Raspe M, Novais AG, Uyaroğlu OA. Characteristics and management of asymptomatic SARS-CoV-2 infections. J Basic Clin Physiol Pharmacol 2021; 33:1-7. [PMID: 34517438 DOI: 10.1515/jbcpp-2021-0159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/30/2021] [Accepted: 08/24/2021] [Indexed: 01/19/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has caused and is still causing tremendous morbidity, mortality, and damage to our societies. The disease course of COVID-19 can be unpredictable ranging from asymptomatic infections to multi-organ failure and death. Transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) from an asymptomatic infected individual to others has been observed early in the pandemic. Asymptomatic individuals have been shown to have quantitative SARS-CoV-2 viral loads, there may or may not be radiological and/or laboratory abnormalities. No antiviral therapy has been approved for the treatment of asymptomatic SARS-CoV2- infection. The management of asymptomatic individuals at home requires that the person can be monitored for any signs and symptoms of deterioration and that the requirements for infection prevention and control measures can be fulfilled. It is crucial to properly diagnose and manage asymptomatic COVID-19 cases with effective testing, contact tracing, quarantine, and isolation strategies. Preventing asymptomatic SARS-CoV-2 infections that have a major role in the unhindered transmission of the virus is a milestone to take control of the pandemic. Vaccination has been proven to be the crucial pillar for preventing asymptomatic infections and real-life data will continue to exhibit the effects of community vaccination in breaking the transmission chain of SARS-CoV-2 infections.
Collapse
Affiliation(s)
- Mine Durusu Tanriover
- Department of Internal Medicine, Division of General Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey.,Department of Immunization Policies, Hacettepe University Vaccine Institute, Ankara, Turkey
| | - Anahita Fathi
- Department of Medicine, Division of Infectious Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department for Clinical Immunology of Infectious Diseases, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,German Center for Infection Research, Hamburg-Lubeck-Borstel-Riems, Germany
| | - Matthias Raspe
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Department of Infectious Diseases, Internal and Pulmonary Medicine, Augustenburger Platz 1, 13353 Berlin, Germany
| | | | - Oğuz Abdullah Uyaroğlu
- Department of Internal Medicine, Division of General Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
15
|
Tanriover MD, Doğanay HL, Akova M, Güner HR, Azap A, Akhan S, Köse Ş, Erdinç FŞ, Akalın EH, Tabak ÖF, Pullukçu H, Batum Ö, Şimşek Yavuz S, Turhan Ö, Yıldırmak MT, Köksal İ, Taşova Y, Korten V, Yılmaz G, Çelen MK, Altın S, Çelik İ, Bayındır Y, Karaoğlan İ, Yılmaz A, Özkul A, Gür H, Unal S. Efficacy and safety of an inactivated whole-virion SARS-CoV-2 vaccine (CoronaVac): interim results of a double-blind, randomised, placebo-controlled, phase 3 trial in Turkey. Lancet 2021; 398:213-222. [PMID: 34246358 PMCID: PMC8266301 DOI: 10.1016/s0140-6736(21)01429-x] [Citation(s) in RCA: 559] [Impact Index Per Article: 186.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/10/2021] [Accepted: 06/15/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND CoronaVac, an inactivated whole-virion SARS-CoV-2 vaccine, has been shown to be well tolerated with a good safety profile in individuals aged 18 years and older in phase 1/2 trials, and provided a good humoral response against SARS-CoV-2. We present the interim efficacy and safety results of a phase 3 clinical trial of CoronaVac in Turkey. METHODS This was a double-blind, randomised, placebo-controlled phase 3 trial. Volunteers aged 18-59 years with no history of COVID-19 and with negative PCR and antibody test results for SARS-CoV-2 were enrolled at 24 centres in Turkey. Exclusion criteria included (but were not limited to) immunosuppressive therapy (including steroids) within the past 6 months, bleeding disorders, asplenia, and receipt of any blood products or immunoglobulins within the past 3 months. The K1 cohort consisted of health-care workers (randomised in a 1:1 ratio), and individuals other than health-care workers were also recruited into the K2 cohort (randomised in a 2:1 ratio) using an interactive web response system. The study vaccine was 3 μg inactivated SARS-CoV-2 virion adsorbed to aluminium hydroxide in a 0·5 mL aqueous suspension. Participants received either vaccine or placebo (consisting of all vaccine components except inactivated virus) intramuscularly on days 0 and 14. The primary efficacy outcome was the prevention of PCR-confirmed symptomatic COVID-19 at least 14 days after the second dose in the per protocol population. Safety analyses were done in the intention-to-treat population. This study is registered with ClinicalTrials.gov (NCT04582344) and is active but no longer recruiting. FINDINGS Among 11 303 volunteers screened between Sept 14, 2020, and Jan 5, 2021, 10 218 were randomly allocated. After exclusion of four participants from the vaccine group because of protocol deviations, the intention-to-treat group consisted of 10 214 participants (6646 [65·1%] in the vaccine group and 3568 [34·9%] in the placebo group) and the per protocol group consisted of 10 029 participants (6559 [65·4%] and 3470 [34·6%]) who received two doses of vaccine or placebo. During a median follow-up period of 43 days (IQR 36-48), nine cases of PCR-confirmed symptomatic COVID-19 were reported in the vaccine group (31·7 cases [14·6-59·3] per 1000 person-years) and 32 cases were reported in the placebo group (192·3 cases [135·7-261·1] per 1000 person-years) 14 days or more after the second dose, yielding a vaccine efficacy of 83·5% (95% CI 65·4-92·1; p<0·0001). The frequencies of any adverse events were 1259 (18·9%) in the vaccine group and 603 (16·9%) in the placebo group (p=0·0108) with no fatalities or grade 4 adverse events. The most common systemic adverse event was fatigue (546 [8·2%] participants in the vaccine group and 248 [7·0%] the placebo group, p=0·0228). Injection-site pain was the most frequent local adverse event (157 [2·4%] in the vaccine group and 40 [1·1%] in the placebo group, p<0·0001). INTERPRETATION CoronaVac has high efficacy against PCR-confirmed symptomatic COVID-19 with a good safety and tolerability profile. FUNDING Turkish Health Institutes Association.
Collapse
Affiliation(s)
- Mine Durusu Tanriover
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey; Hacettepe University Vaccine Institute, Ankara, Turkey
| | - Hamdi Levent Doğanay
- Department of Gastroenterology, Turkish Republic Ministry of Health, İstanbul Provincial Health Directorate, University of Health Sciences İstanbul Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Murat Akova
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey; Hacettepe University Vaccine Institute, Ankara, Turkey.
| | - Hatice Rahmet Güner
- Department of Infectious Diseases and Clinical Microbiology, Ankara Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
| | - Alpay Azap
- Department of Infectious Diseases and Clinical Microbiology, Ankara University School of Medicine, Ankara, Turkey
| | - Sıla Akhan
- Department of Infectious Diseases and Clinical Microbiology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Şükran Köse
- Department of Infectious Diseases, Turkish Republic Ministry of Health, İzmir Provincial Health Directorate, İzmir University of Health Sciences Tepecik Training and Research Hospital, İzmir, Turkey
| | - Fatma Şebnem Erdinç
- Department of Infectious Diseases, Turkish Republic Ministry of Health, Ankara Provincial Health Directorate, Ankara Training and Research Hospital, Ankara, Turkey
| | - Emin Halis Akalın
- Department of Infectious Diseases and Clinical Microbiology, Bursa Uludağ University Health Application and Research Centre, Bursa Uludağ University Hospital, Bursa, Turkey
| | - Ömer Fehmi Tabak
- Department of Infectious Diseases and Clinical Microbiology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Hüsnü Pullukçu
- Department of Infectious Diseases and Clinical Microbiology, Ege University School of Medicine, İzmir, Turkey
| | - Özgür Batum
- Department of Chest Diseases, Turkish Republic Ministry of Health, İzmir Provincial Health Directorate, University of Health Sciences Dr Suat Seren Chest Diseases and Surgery Training and Research Hospital, İzmir, Turkey
| | - Serap Şimşek Yavuz
- Department of Infectious Diseases and Clinical Microbiology, İstanbul University, İstanbul School of Medicine, İstanbul, Turkey
| | - Özge Turhan
- Department of Infectious Diseases and Clinical Microbiology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Mustafa Taner Yıldırmak
- Department of Infectious Diseases and Clinical Microbiology, Turkish Republic Ministry of Health, İstanbul Provincial Health Directorate, Prof Dr Cemil Taşcıoğlu City Hospital, İstanbul, Turkey
| | - İftihar Köksal
- Department of Infectious Diseases and Clinical Microbiology, Acıbadem University Atakent Hospital, İstanbul, Turkey
| | - Yeşim Taşova
- Department of Infectious Diseases and Clinical Microbiology, Çukurova University Balcalı Hospital Health Application and Research Centre, Adana, Turkey
| | - Volkan Korten
- Department of Infectious Diseases and Clinical Microbiology, Marmara University School of Medicine, İstanbul, Turkey
| | - Gürdal Yılmaz
- Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University School of Medicine, Trabzon, Turkey; Department of Chest Diseases, Turkish Republic Ministry of Health, Ankara Provincial Health Directorate, Ankara Keçiören Sanatorium, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Mustafa Kemal Çelen
- Department of Infectious Diseases and Clinical Microbiology, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Sedat Altın
- Department of Chest Diseases, Turkish Republic Ministry of Health, İstanbul Provincial Health Directorate, University of Health Sciences İstanbul Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
| | - İlhami Çelik
- Department of Infectious Diseases and Clinical Microbiology, Turkish Republic Ministry of Health, Kayseri City Training and Research Hospital, Kayseri, Turkey
| | - Yaşar Bayındır
- Department of Infectious Diseases and Clinical Microbiology, İnönü University Turgut Özal Health Centre, Malatya, Turkey
| | - İlkay Karaoğlan
- Department of Infectious Diseases and Clinical Microbiology, Gaziantep University Şahinbey Research and Application Centre, Gaziantep, Turkey
| | - Aydın Yılmaz
- Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University School of Medicine, Trabzon, Turkey; Department of Chest Diseases, Turkish Republic Ministry of Health, Ankara Provincial Health Directorate, Ankara Keçiören Sanatorium, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Aykut Özkul
- Department of Virology, Ankara University Faculty of Veterinary Medicine, Ankara, Turkey
| | - Hazal Gür
- Department of Medical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Serhat Unal
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey; Hacettepe University Vaccine Institute, Ankara, Turkey
| |
Collapse
|
16
|
Amiche A, Tanriover MD, Bellier L, Ugur B, Akin L. Cost Utility of Switching From Trivalent to Quadrivalent Influenza Vaccine in Turkey. Value Health Reg Issues 2021; 25:15-22. [PMID: 33485248 DOI: 10.1016/j.vhri.2020.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 10/26/2020] [Accepted: 11/03/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Trivalent influenza vaccines (TIVs) are widely used but protect against only 1 of the 2 co-circulating influenza B virus lineages. Quadrivalent influenza vaccines (QIVs) include a B strain from each lineage to overcome mismatches. The main objective of this study was to determine the cost-utility and budget impact of switching from vaccination with TIV to QIV in the population recommended for influenza vaccination in Turkey. METHODS A static cohort cost-effectiveness model was developed to predict influenza-related costs and outcomes under a QIV versus a TIV program during an influenza season. The model was informed by data from Turkey on influenza strain distribution, influenza-attributable outcomes, and associated costs over the seasons 2010/2011 to 2016/2017. The effectiveness of each strategy was measured through quality-adjusted life-years (QALYs), and comparisons were based on the incremental cost-effectiveness ratio. RESULTS In an average influenza season, the model showed that switching from TIV to QIV would prevent an additional 15 092 cases of influenza, 6311 general practitioner visits, 94 hospitalizations, 13 deaths, and gain 440 QALYs. From the societal perspective, this amounted to total cost savings of international dollars (I$) 1102 710 (US$388 643). The incremental cost-effectiveness ratio when using QIV over TIV was I$55 248/QALY gained. Switching to QIV is mostly cost-effective among older adults with I$36 413.38/QALY. Sensitivity analysis showed that vaccine effectiveness, B strain mismatch, and influenza visits highly impact the cost-effectiveness results. CONCLUSION Switching from TIV to QIV is likely to be cost-effective in Turkey, yet highly dependent on the severity of the influenza season, B strain epidemiology, and vaccine effectiveness.
Collapse
Affiliation(s)
| | - Mine Durusu Tanriover
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | | | | |
Collapse
|
17
|
Abstract
The economic burden of osteoporotic fractures may be much higher than estimated: just the tip of the iceberg. In this letter, we suggest that the cost of these fractures might be underestimated by considering only direct medical cost.
Collapse
Affiliation(s)
- Hatice Bolek
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Gevher Nesibe St, 06100 Sıhhiye, Ankara, Turkey.
| | | | | |
Collapse
|
18
|
Al Awaidy ST, Uyaroğlu OA, Wannous C, Tanriover MD. Addressing Influenza Vaccination in MENA Region during the COVID-19 Pandemic: Decreasing the Effects of the Collision. Oman Med J 2020; 35:e200. [PMID: 33214914 PMCID: PMC7653348 DOI: 10.5001/omj.2020.132] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 11/01/2020] [Indexed: 11/03/2022] Open
Abstract
The Northern Hemisphere, including the Middle East and North Africa (MENA) region, is anxiously waiting for the influenza season as it is expected to coincide with the second peak or wave of the novel coronavirus disease 2019 (COVID-19) pandemic causing fear of a ‘twindemic’, where two epidemics happen at the same time. Influenza cases abruptly declined as a result of the COVID-19 mitigation measures, such as hand hygiene, mask-wearing, and social distancing, as well as missed diagnoses due to sick people avoiding healthcare institutions early in the spring.1 Yet, the world should be prepared for the worst as we are not certain if preventive measures to mitigate COVID-19 transmission can lead to a low upcoming season for influenza in the Northern Hemisphere as has been evident in the Southern Hemisphere during June–August 20201 or it may lead to viral interference resulting in different peaks of the infection.
Collapse
Affiliation(s)
- Salah T. Al Awaidy
- Office of Health Affairs, Ministry of Health, Muscat, Oman
- Middle East, Eurasia and African Influenza Stakeholders Network, Johannesburg, South Africa
- Corresponding author: ✉
| | - Oğuz Abdullah Uyaroğlu
- Department of Internal Medicine, Division of General Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Chadia Wannous
- Future Earth Health Knowledge Action Network, Stockholm, Sweden
| | - Mine Durusu Tanriover
- Department of Internal Medicine, Division of General Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
- Middle East, Eurasia and African Influenza Stakeholders Network, Johannesburg, South Africa
| |
Collapse
|
19
|
Uyaroğlu OA, Başaran NÇ, Ozisik L, Karahan S, Tanriover MD, Guven GS, Oz SG. Evaluation of the effect of COVID-19 pandemic on anxiety severity of physicians working in the internal medicine department of a tertiary care hospital: a cross-sectional survey. Intern Med J 2020; 50:1350-1358. [PMID: 33006419 PMCID: PMC7537014 DOI: 10.1111/imj.14981] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/29/2020] [Accepted: 07/03/2020] [Indexed: 02/01/2023]
Abstract
Background Internists who have an important role in the global response to the COVID‐19 pandemic are under both physical and psychological pressures. Aims To assess the anxiety among physicians working in the internal medicine department of a tertiary care hospital who are on the frontline of the COVID‐19 pandemic. Methods This single‐centre, non‐intervention, cross‐sectional descriptive study was conducted using an online survey questionnaire from 1 April to 14 April 2020. Physicians of the Department of Internal Medicine were invited to participate with a self‐administered questionnaire. The degree of symptoms of anxiety was assessed by the Turkish versions of the 7‐item Generalised Anxiety Disorder scale and Beck Anxiety Inventory, respectively. Results A total of 113 participants consented for the study and completed the questionnaire. The median age was 29 (IQR = 5) years and 53.1% were male. A total of 72 internists (63.7%) worked as ‘frontline’ healthcare workers directly engaged in diagnosing, treating or caring for patients with or suspected to have COVID‐19. Female gender was significantly associated with high scores and levels in all scales compared to the male gender (P < 0.005). Having family members over 65 years old and with chronic diseases were significantly associated with high anxiety scores and levels (P < 0.005). Conclusions In this survey of internists in a university hospital equipped with clinics, wards and intensive care unit for patients with COVID‐19, female gender and having family members over 65 years old and with chronic diseases were associated with increased anxiety levels.
Collapse
Affiliation(s)
- Oğuz Abdullah Uyaroğlu
- Department of Internal Medicine, Division of General Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nursel Çalık Başaran
- Department of Internal Medicine, Division of General Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Lale Ozisik
- Department of Internal Medicine, Division of General Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sevilay Karahan
- Department of Biostatistics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mine Durusu Tanriover
- Department of Internal Medicine, Division of General Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gulay Sain Guven
- Department of Internal Medicine, Division of General Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Serife Gul Oz
- Department of Internal Medicine, Division of General Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
20
|
Affiliation(s)
- Pınar Yildiz
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Internal Medicine, Section of General Internal Medicine, Eskişehir, Turkey.
| | - Mine Durusu Tanriover
- Hacettepe University, Faculty of Medicine, Department of Internal Medicine, Section of General Internal Medicine, Ankara, Turkey
| | - Serhat Unal
- Hacettepe University, Faculty of Medicine, Department of Clinical Microbiology and Infectious Diseases, Ankara, Turkey
| |
Collapse
|
21
|
Tanriover MD, Bagci Bosi T, Ozisik L, Bilgin E, Güzel Tunçcan Ö, Özgen Ö, Tülek N, Özsoy M, Tezer H, Bedir Demirdağ T, Kara A, Basaranoglu ST, Aykac K, Ozkaya-Parlakay A, Gulhan B, Unal S. Poor outcomes among elderly patients hospitalized for influenza-like illness. Curr Med Res Opin 2018; 34:1201-1207. [PMID: 28918667 DOI: 10.1080/03007995.2017.1381078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Global Influenza Hospital Surveillance Network is a worldwide initiative that aims to document the burden of influenza infections among acute admissions and vaccine effectiveness in particular countries. As a partner of this platform, we aimed to determine the frequency of influenza infections among acute admissions with influenza-like illness and the outcomes of enrolled patients during the 2015-2016 influenza season in selected hospitals in Turkey. PATIENTS AND METHODS The investigators screened the hospital admission registries, chart review or available records, and screened all patients hospitalized in the previous 24-48 hours or overnight in the predefined wards or emergency room. A total of 1351 patients were screened for enrollment in five tertiary care referral hospitals in Ankara and 774 patients (57.3% of the initial screened population) were eligible for swabbing. All of the eligible patients who consented were swabbed and tested for influenza with real-time polymerase chain reaction (PCR) based methods. RESULTS Overall, influenza positivity was detected in 142 patients (18.4%). The predominant influenza strain was A H1N1pdm09. Outcomes were worse among elderly patients, regardless of the presence of the influenza virus. Half of the patients over 65 years of age were admitted to the intensive care unit, while one third required any mode of mechanical ventilation and one fourth died in the hospital in that particular episode. CONCLUSION These findings can guide hospitals to plan and prepare for the influenza season. Effective influenza vaccination strategies, particularly aimed at the elderly and adults with chronic diseases, can provide an opportunity for prevention of deaths due to influenza-like illness.
Collapse
Affiliation(s)
- Mine Durusu Tanriover
- a Hacettepe University Faculty of Medicine , Department of Internal Medicine , Ankara , Turkey
| | - Tülay Bagci Bosi
- b Hacettepe University Faculty of Medicine , Department of Public Health , Ankara , Turkey
| | - Lale Ozisik
- a Hacettepe University Faculty of Medicine , Department of Internal Medicine , Ankara , Turkey
| | - Emre Bilgin
- a Hacettepe University Faculty of Medicine , Department of Internal Medicine , Ankara , Turkey
| | - Özlem Güzel Tunçcan
- c Gazi University Faculty of Medicine , Department of Infectious Diseases , Ankara , Turkey
| | - Özge Özgen
- c Gazi University Faculty of Medicine , Department of Infectious Diseases , Ankara , Turkey
| | - Necla Tülek
- d Ankara Training and Research Hospital , Clinic of Infectious Diseases and Clinical Microbiology , Ankara , Turkey
| | - Metin Özsoy
- d Ankara Training and Research Hospital , Clinic of Infectious Diseases and Clinical Microbiology , Ankara , Turkey
| | - Hasan Tezer
- e Gazi University Faculty of Medicine , Department of Pediatrics , Ankara , Turkey
| | - Tugba Bedir Demirdağ
- e Gazi University Faculty of Medicine , Department of Pediatrics , Ankara , Turkey
| | - Ates Kara
- f Hacettepe University Faculty of Medicine , Department of Pediatrics , Ankara , Turkey
| | | | - Kubra Aykac
- f Hacettepe University Faculty of Medicine , Department of Pediatrics , Ankara , Turkey
| | - Aslinur Ozkaya-Parlakay
- g Ankara Hematology Oncology Children's Training and Research Hospital , Pediatric Infectious Disease Department , Ankara , Turkey
| | - Belgin Gulhan
- g Ankara Hematology Oncology Children's Training and Research Hospital , Pediatric Infectious Disease Department , Ankara , Turkey
| | - Serhat Unal
- h Hacettepe University Faculty of Medicine , Department of Infectious Diseases and Clinical Microbiology , Ankara , Turkey
| |
Collapse
|
22
|
Ozisik L, Basaran NC, Oz SG, Guven GS, Tanriover MD. Perceptions and Attitudes of Patients About Adult Vaccination and Their Vaccination Status: Still a Long Way to Go? Med Sci Monit 2017; 23:3178-3184. [PMID: 28662014 PMCID: PMC5501072 DOI: 10.12659/msm.901856] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 01/11/2017] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Immunization is one of the most effective public health measures to prevent disease, but vaccination rates in adult populations still remain below the targets. Patient and physician attitudes about vaccination are important for adult vaccination. In this study, we aimed to determine patient attitudes and perceptions about vaccination and the vaccination coverage rates of adult patients in a university hospital in Turkey. MATERIAL AND METHODS A survey was conducted between October 2014 and May 2015 at the Internal Medicine Outpatient Clinics of a university hospital. Adult patients were asked to fill out a questionnaire on their perceptions and attitudes about vaccination and their vaccination status. RESULTS We interviewed 512 patients ages 19-64 years. Eighty percent of the study population thought that adults should be vaccinated, while only 36.1% of the patients stated that vaccination was ever recommended to them in their adult life. Forty-eight percent of the patients stated that they were vaccinated at least once in their adulthood. The most commonly received vaccine was tetanus vaccine in general, while influenza vaccine was the leading vaccine among patients with chronic medical conditions. While 71.4% of the patients to whom vaccination was recommended received the vaccine, 34.9% of the patients received a vaccine without any recommendation. CONCLUSIONS Although the vaccine coverage rates among adults in this survey were low, the perceptions of patients about adult vaccination were mainly positive and of many of them positively reacted when their physician recommended a vaccine.
Collapse
|
23
|
Ozisik L, Tanriover MD, Altınel S, Unal S. Vaccinating healthcare workers: Level of implementation, barriers and proposal for evidence-based policies in Turkey. Hum Vaccin Immunother 2017; 13:1198-1206. [PMID: 28059668 PMCID: PMC5443379 DOI: 10.1080/21645515.2016.1269992] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 11/29/2016] [Accepted: 12/05/2016] [Indexed: 11/02/2022] Open
Abstract
The role of healthcare workers in life-long vaccination is very important in the means of 2 sided infection, rising patient awareness and being a role model for the patients. Numerous organizations publish guidelines for vaccination of HCWs, while healthcare facilities develop vaccination policies according to the accreditation standards. Nevertheless, vaccination rates among HCWs are far below targets. The obstacles to getting vaccinated or recommending vaccination may include rather universal factors such as the vaccine paradox, however in the case of HCWs, probably a different set of factors are included. The aims of this article are to gain an overview of vaccination strategies for HCWs, to assess the coverage rates of HCWs and make in-depth analyses of the potential barriers to vaccination and potential factors to motivate HCWs for vaccination in Turkey and to compare them with the global picture to improve implementation of policies concerning vaccination of HCWs.
Collapse
Affiliation(s)
- Lale Ozisik
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
| | - Mine Durusu Tanriover
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
| | | | - Serhat Unal
- Hacettepe University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| |
Collapse
|
24
|
Cicek Ari V, Ilarslan YD, Erman B, Sarkarati B, Tezcan I, Karabulut E, Oz SG, Tanriover MD, Sengun D, Berker E. Statins and IL-1β, IL-10, and MPO Levels in Gingival Crevicular Fluid: Preliminary Results. Inflammation 2017; 39:1547-57. [PMID: 27290718 DOI: 10.1007/s10753-016-0390-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 12/30/2022]
Abstract
Statins possess a wide variety of pleiotropic properties that are independent of their lipid-lowering abilities such as attenuating inflammation, oxidative stress, coagulation, platelet aggregation and stimulating bone formation. The aim of the study is to evaluate the effect of statins on clinical periodontal parameters and gingival crevicular fluid (GCF) levels of IL-1β, IL-10, and myeloperoxidase (MPO) in inflammatory periodontal diseases. Seventy-nine subjects with hyperlipidemia and 48 systemically healthy controls (C) were included. Hyperlipidemic patients were either given a diet (HD) or prescribed statin (HS). Patients were classified into three subgroups as those who were periodontally healthy (h), who had gingivitis (g), or who had chronic periodontitis (p). Blood samples were collected for the measurement of lipid profiles. Plaque index (PI), gingival index (GI), probing pocket depth (PD), clinical attachment level (CAL), and percentage of bleeding on probing (BOP) were recorded. Gingival crevicular fluid levels of IL-1β, IL-10, and MPO were measured in order to determine the anti-inflammatory and antioxidant effects of statins. Probing depth values of the HSp group were significantly lower than those of the Cp group. Percentage of BOP of the HSg group was significantly lower than those of the HDg and Cg groups. While the IL-1β level of the HSp group was significantly lower than that of the HDp group, IL-10 levels of the HSg group were significantly higher than those of the HDg group. MPO levels were significantly lower in the HSg group when compared to those in the HDg and Cg groups. Statin use decreased the IL-1β and MPO levels and enhanced IL-10 in GCF. It can be suggested that statins may attenuate periodontal inflammation and progression of periodontal inflammation.
Collapse
Affiliation(s)
- Vuslat Cicek Ari
- Department of Periodontology, Faculty of Dentistry, Hacettepe University, 3rd Floor, Sihhiye, 06100, Ankara, Turkey
| | - Yagmur Deniz Ilarslan
- Department of Periodontology, Faculty of Dentistry, Hacettepe University, 3rd Floor, Sihhiye, 06100, Ankara, Turkey.
| | - Baran Erman
- Pediatric Immunology Division, Ihsan Doğramacı Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Bahram Sarkarati
- Scientific Industrial and Technological Application and Research Center, Abant Izzet Baysal University, Bolu, Turkey
| | - Ilhan Tezcan
- Pediatric Immunology Division, Ihsan Doğramacı Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Erdem Karabulut
- Department of Biostatistics, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Serife Gul Oz
- Department of Internal Medicine, Faculty of Medicine, Section of General Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Mine Durusu Tanriover
- Department of Internal Medicine, Faculty of Medicine, Section of General Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Dilek Sengun
- Department of Periodontology, Faculty of Dentistry, Hacettepe University, 3rd Floor, Sihhiye, 06100, Ankara, Turkey
| | - Ezel Berker
- Department of Periodontology, Faculty of Dentistry, Hacettepe University, 3rd Floor, Sihhiye, 06100, Ankara, Turkey
| |
Collapse
|
25
|
Unal S, Tanriover MD, Ascioglu S, Demirkazik A, Ertenli I, Eskioglu E, Guler K, Kiraz S, Ozbakkaloglu M, Ozer B, Tukek T, Akyar S, Erdem Y. Turkish doctors' cohort: healthy despite low screening. Postgrad Med 2016; 129:393-398. [PMID: 27960640 DOI: 10.1080/00325481.2017.1272399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 10/20/2022]
Abstract
OBJECTIVES We aimed to determine the prevalence of chronic diseases and unhealthy lifestyle behaviors of Turkish doctors as compared with the general population and the frequency of compliance with preventive clinical practices among doctors. METHODS This was an observational, prospective cohort study that enrolled graduates between 1975 and 2004 from six medical schools in Turkey. Data on demographics, disease conditions, and unhealthy lifestyle behaviors were gathered. Preventive care practices were analyzed with regards to age and gender. RESULTS A total of 7228 doctors participated in the study. Comparison with the national data revealed higher hyperlipidemia and coronary artery disease rates. While 54.5% of the doctors had a doctor visit in the last 12 months, only 31.5% of those over 40 years of age reported a recent blood pressure measurement. Colon cancer screening rate over 50 years of age with any of the acceptable methods was only 3%. One-fourth of the female doctors over 40 years of age underwent mammography within the last two years. Only 7.1% of the doctors over 65 years of age and 10% of the doctors having an indication for a chronic disease had a pneumococcal vaccine, while nearly one-fifth had no hepatitis B vaccine. CONCLUSION In this cohort of mainly middle-aged Turkish doctors, the age-standardized rates of chronic diseases were lower than the rates in the general population except for the rates of hyperlipidemia and coronary artery disease. However, doctors did show quite low rates of receipt of screening practices. These results might provoke questions about how to use Turkish doctors' health behaviors to further improve doctors' and, relatedly, patients' health.
Collapse
Affiliation(s)
- Serhat Unal
- a Department of Infectious Diseases and Clinical Microbiology , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Mine Durusu Tanriover
- b Department of Internal Medicine, Division of General Internal Medicine , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Sibel Ascioglu
- a Department of Infectious Diseases and Clinical Microbiology , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Ahmet Demirkazik
- c Department of Internal Medicine, Division of Medical Oncology , Ankara University School of Medicine , Ankara , Turkey
| | - Ihsan Ertenli
- d Department of Internal Medicine, Division of Rheumatology , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Erdal Eskioglu
- e Department of Internal Medicine , Numune Training and Research Hospital , Ankara , Turkey
| | - Kerim Guler
- f Department of Internal Medicine , Istanbul University Faculty of Medicine , Istanbul , Turkey
| | - Sedat Kiraz
- d Department of Internal Medicine, Division of Rheumatology , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Mert Ozbakkaloglu
- g Department of Internal Medicine , Tepecik Training and Research Hospital , Izmir , Turkey
| | - Birol Ozer
- h Department of Internal Medicine, Division of Gastroenterology , Başkent University Faculty of Medicine , Adana , Turkey
| | - Tufan Tukek
- f Department of Internal Medicine , Istanbul University Faculty of Medicine , Istanbul , Turkey
| | - Serra Akyar
- i Institute of Population Studies , Hacettepe University , Ankara , Turkey
| | - Yunus Erdem
- j Department of Internal Diseases, Division of Nephrology , Hacettepe University Faculty of Medicine , Ankara , Turkey
| |
Collapse
|
26
|
Aksoy DY, Durusu Tanriover M, Unal S, Dizdar O, Kalyoncu U, Karakaya J, Unal S, Kale G. Burnout syndrome during residency in internal medicine and pediatrics in a country without working time directive. Int J Health Care Qual Assur 2016; 27:223-30. [PMID: 25786186 DOI: 10.1108/ijhcqa-12-2012-0127] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to demonstrate burnout syndrome among internal medicine and pediatrics residents in a country that does not have the working time directive (WTD) and also to determine the risk factors and consequent impact on efficient functioning in clinical areas. DESIGN/METHODOLOGY/APPROACH A 57-item questionnaire was given to internal medicine and pediatrics residents. Responses from 22 pediatrics and 33 internal medicine residents were evaluated. FINDINGS Demographic findings, burnout scores, having hobbies, social activities and reading books unrelated to medicine were similar between the two groups. Six pediatrics residents (27.3 per cent) and 11 (33.3 per cent) internal medicine residents met the criteria for clinically significant burnout. Personal accomplishment scores and reading books unrelated to medicine were found to be related to burnout. ORIGINALITY/VALUE Burnout is a syndrome characterized by depersonalization, emotional exhaustion and a low sense of personal accomplishment. It is important to document burnout in countries where WTDs are not implemented. Further studies might demonstrate burnout's effect on patient safety, service quality and physician's performance.
Collapse
Affiliation(s)
- Duygu Yazgan Aksoy
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Ozisik L, Tanriover MD, Rigby S, Unal S. ADVICE for a healthier life: Adult Vaccination Campaign in Europe. Eur J Intern Med 2016; 33:14-20. [PMID: 27185062 DOI: 10.1016/j.ejim.2016.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 04/18/2016] [Accepted: 04/27/2016] [Indexed: 10/21/2022]
Abstract
Immunization is one of the most effective public health measures to prevent disease. Despite relatively good vaccination rates in childhood in many parts of the world, vaccines to prevent diseases are underused in the adult population and adult vaccination rates are still far below the target. The European Federation of Internal Medicine (EFIM), declared that 'internal medicine must focus on better care for individuals, better health care for populations and lower costs'. Adult vaccination is a good example of a public health initiative aimed at reducing morbidity and mortality, but awareness of the need for adult vaccination and uptake of the programs across Europe is variable. The Adult Vaccination Campaign in Europe (ADVICE) was developed with an aim to raise awareness for adult vaccination and to understand the dynamics of the vaccination practices and the possible barriers against achieving targeted vaccination rates in Europe. In order to reach vaccination targets, we need evidence based, up to date guidelines; recommendations at national and international levels; surveillance for vaccination rates; and opportunities to provide vaccines more readily. Leadership at a European level and a firm research and action agenda are crucial. The European Federation of Internal Medicine can take the lead as it declared its interest on 'better care for individuals, better health care for populations'. Hence, we consider ADVICE a very timely and very valuable initiative to draw a roadmap to improve adult vaccination rates in Europe.
Collapse
Affiliation(s)
- Lale Ozisik
- Hacettepe University, Department of Internal Medicine, Ankara, Turkey
| | | | - Shirley Rigby
- Consultant Internal Medicine, South Warwickshire NHS Foundation Trust, Warwick CV34 5BW, UK
| | - Serhat Unal
- Hacettepe University, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| |
Collapse
|
28
|
Ozisik L, Tanriover MD, Saka E. Autoimmune Limbic Encephalitis and Syndrome of Inappropriate Antidiuretic Hormone Secretion Associated with Lamotrigine-induced Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) Syndrome. Intern Med 2016; 55:1393-6. [PMID: 27181555 DOI: 10.2169/internalmedicine.55.6035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Drug rash with eosinophilia and systemic symptoms (DRESS) is a severe drug hypersensitivity reaction characterized by rash, fever and multi-organ failure. Limbic encephalitis (LE) is a rare disorder characterized by cognitive dysfunction with memory disturbance, seizures and psychiatric symptoms. We herein present an unusual case of DRESS syndrome due to lamotrigine with reactivation of Epstein-Barr virus, which developed autoimmune LE and syndrome of inappropriate antidiuretic hormone secretion. Discontinuation of lamotrigine, administration of methylprednisolone and intravenous immunoglobulin led to improvement. The LE in this case might have been caused by an autoimmune inflammatory mechanism associated with DRESS syndrome.
Collapse
Affiliation(s)
- Lale Ozisik
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Turkey
| | | | | |
Collapse
|
29
|
Ozisik L, Tanriover MD, Calik Basaran N, Oz SG, Unal S. Missed opportunities for Hepatitis B vaccination among diabetic patients. Hum Vaccin Immunother 2015; 11:2806-10. [PMID: 26366628 PMCID: PMC5054786 DOI: 10.1080/21645515.2015.1070999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 06/16/2015] [Accepted: 07/03/2015] [Indexed: 01/29/2023] Open
Abstract
Many infectious diseases in adults can be prevented by a 'life-long vaccination strategy'. Hepatitis B disease burden was shown to be higher in diabetic patients. American Advisory Committee on Immunization Practices recommends to vaccinate diabetic patients against hepatitis B since 2011. In this study, we aimed to determine hepatitis B virus serology status to determine the rates of diabetic patients who have indications for hepatitis B vaccination. The electronic database of the hospital was searched to identify adult patients aged above 18 years and with hemoglobin A1C levels of 6.5% or above, who have been seen at General Medicine Outpatient Clinics of a university hospital during a 3-year period. A total of 5187 patients were included in the study. After exclusion of patients with an incomplete serological panel, 1358 patients were included for further analyses. Twenty-nine percent of the patients had indication for hepatitis B vaccination, whereas only 8% were vaccinated. This study showed that nearly one third of patients who had hepatitis B serological data had an indication for hepatitis B vaccination and this is a clear reflection of the need to keep a lifelong vaccination log and inquire vaccination data.
Collapse
Affiliation(s)
- Lale Ozisik
- Department of Internal Medicine; Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mine Durusu Tanriover
- Department of Internal Medicine; Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nursel Calik Basaran
- Department of Internal Medicine; Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - S Gul Oz
- Department of Internal Medicine; Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Serhat Unal
- Department of Infectious Diseases and Clinical Microbiology; Hacettepe University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
30
|
Ersoy EO, Tanriover MD, Kara A, Ocal S, Gulsun M, Ozisik L, Topeli A. Pulmonary artery to aorta ratio is correlated with pulmonary artery pressure, but not with mortality in critically ill COPD patients. J Crit Care 2015. [DOI: 10.1016/j.jcrc.2015.04.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
31
|
Abstract
AIM Continuous ambulatory peritoneal dialysis (PD) has become a treatment modality for end stage renal disease with a peak of its use in 1990 s. The aim of this study was to examine the peritonitis rates, causative organisms and the risk factors of peritonitis in a large group of patients in our center. METHODS The study was conducted in the Nephrology Department of a University Hospital in Turkey. Patients in the PD programme between January 2000 and January 2006 were included. Cohort-specific and subject specific peritonitis incidence, and peritonitis-free survival were calculated. Causative organisms and risk factors were evaluated. RESULTS Totally 620 episodes of peritonitis occurred in 440 patients over the six years period. Peritonitis rates showed a decreasing trend through the years (0.79 episodes/patient-year 2000-2003 and 0.46 episodes/patient-year 2003-2006). Cohort-specific peritonitis incidence was 0.62 episodes/patient-years and median subject-specific peritonitis incidence was 0.44 episodes/patient-years. The median peritonitis-free survival was 15.25 months (%95 CI, 9.45-21.06 months). The proportion of gram-negative organisms has increased from 9.8% to 17.3%. There was a significant difference in the percentage of culture negative peritonitis between the first three and the last three years (53.1% vs. 43.2%, respectively). Peritonitis incidence was higher in patients who had been transferred from HD, who had catheter related infection and who had HCV infection without cirrhosis. CONCLUSIONS Our study showed significant trends in the peritonitis rates, causative organisms and antibiotic resistance. Prior HD therapy, catheter related infections and HCV infection were found to be risk factors for peritonitis.
Collapse
Affiliation(s)
- Lale Ozisik
- a Department of Internal Medicine , Hacettepe University Faculty of Medicine, Ankara , Turkey and
| | - Fatma Nurhan Ozdemir
- b Department of Nephrology , Baskent University Faculty of Medicine, Ankara , Turkey
| | - Mine Durusu Tanriover
- a Department of Internal Medicine , Hacettepe University Faculty of Medicine, Ankara , Turkey and
| |
Collapse
|
32
|
Tanriover MD, Oz SG, Sozen T. Ten-year follow-up in pregnancy and lactation-associated osteoporosis: sequential therapy with strontium ranelate and ibandronate. Spine J 2015; 15:1164-5. [PMID: 25925624 DOI: 10.1016/j.spinee.2014.10.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 10/19/2014] [Indexed: 02/03/2023]
Affiliation(s)
- Mine Durusu Tanriover
- Department of Internal Medicine, Faculty of Medicine, Section of General Internal Medicine, Hacettepe University, Sıhhiye, 06100, Ankara, Turkey
| | - S Gul Oz
- Department of Internal Medicine, Faculty of Medicine, Section of General Internal Medicine, Hacettepe University, Sıhhiye, 06100, Ankara, Turkey
| | - Tumay Sozen
- Department of Internal Medicine, Faculty of Medicine, Section of Endocrinology, Near East University TRNC Mersin 10, North Nicosia, Turkey
| |
Collapse
|
33
|
Soyler C, Tanriover MD, Ascioglu S, Aksu NM, Arici M. Urine neutrophil gelatinase-associated lipocalin levels predict acute kidney injury in acute decompensated heart failure patients. Ren Fail 2015; 37:772-6. [DOI: 10.3109/0886022x.2015.1033324] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
|
34
|
Tanriover MD, Rigby S, van Hulsteijn LH, Ferreira F, Oliveira N, Schumm-Draeger PM, Weidanz F, Kramer MHH. What is the role of general internists in the tertiary or academic setting? Eur J Intern Med 2015; 26:9-11. [PMID: 25477144 DOI: 10.1016/j.ejim.2014.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 11/07/2014] [Accepted: 11/11/2014] [Indexed: 10/24/2022]
Abstract
The changing demography of European populations mandates a vital role for internists in caring for patients in each level of healthcare. Internists in the tertiary or academic setting are highly ranked in terms of their responsibilities: they are clinicians, educators, researchers, role models, mentors and administrators. Contrary to the highly focused approach of sub-specialties, general internists working in academic settings can ensure that coordinated care is delivered in the most cost-conscious and efficient way. Moreover, internal medicine is one of the most appropriate specialties in which to teach clinical reasoning skills, decision-making and analytical thinking, as well as evidence based, patient oriented medicine. Internists deal with challenging patients of the new millennium with a high burden of chronic diseases and polypharmacy; practice personalised medicine with a wide scientific background and so they are the perfect fit to establish and implement new tools for scientific research. In conclusion, internal medicine is developing a new identity as a specialty in its own right. The European Federation of Internal Medicine supports the concept of academic internists and calls upon the member countries to construct academic (general) internal medicine departments in their respective countries. As 'internal medicine is the cornerstone of every national healthcare system', academic (general) internal medicine should strive to be the cornerstone of every integrated, patient-centred, modern medical care and training system.
Collapse
|
35
|
Yardim MS, Cilingiroglu N, Yaman N, Koc AS, Kaplan A, Aydın B, Umutlu MR, Tanriover MD, Turhan O. Inappropriate Utilization of Emergency Services as a Health System Provision Challenge: An Example from a University Hospital in Ankara, Turkey between 1-7 February 2014. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku165.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
36
|
Tanriover MD, Soyler C, Ascioglu S, Cankurtaran M, Unal S. Low seroprevalence of diphtheria, tetanus and pertussis in ambulatory adult patients: the need for lifelong vaccination. Eur J Intern Med 2014; 25:528-32. [PMID: 24814432 DOI: 10.1016/j.ejim.2014.04.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 02/11/2014] [Accepted: 04/21/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Tetanus, diphtheria, pertussis and measles are vaccine preventable diseases that have been reported to cause morbidity and mortality in adult population in the recent years. We aimed to document the seropositivity rates and vaccination indication for these four vaccine preventable diseases among adult and elderly patients who were seen as outpatients in a university hospital. METHODS Blood samples for tetanus, diphtheria, pertussis and measles antibodies were obtained. Results were evaluated with regards to protection levels and booster vaccine indications according to the cut-off values. RESULTS A total of 1367 patients consented for the study and 1303 blood samples were available for analysis at the end of the study. The antibody levels against measles conferred protection in 98% of patients. However, 65% of the patients had no protection for diphtheria, 69% had no protection for tetanus and 90% of the patients had no protection for pertussis. Only 1.3% of the study population had seropositivity against three of the diseases-Tdap booster was indicated in 98.7%. Multivariable logistic regression showed that tetanus protection decreased with increasing age. Having a chronic disease was associated with a lower rate of protective antibodies for pertussis. CONCLUSIONS We demonstrated very low rates of protection against three of the vaccine preventable diseases of childhood-diphtheria, pertussis and tetanus. Booster vaccinations are required in adult life in accordance with national and international adult vaccination guidelines. The concept of "lifelong vaccination" should be implemented and every encounter with the patient should be regarded as a chance for catch-up.
Collapse
Affiliation(s)
- Mine Durusu Tanriover
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Section of General Internal Medicine, 06100, Sıhhiye, Ankara, Turkey.
| | - Canan Soyler
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Section of General Internal Medicine, 06100, Sıhhiye, Ankara, Turkey
| | - Sibel Ascioglu
- Hacettepe University Faculty of Medicine, Department of Infectious Diseases Clinical Microbiology, 06100, Sıhhiye, Ankara, Turkey
| | - Mustafa Cankurtaran
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Section of Geriatrics, 06100, Sıhhiye, Ankara, Turkey
| | - Serhat Unal
- Hacettepe University Faculty of Medicine, Department of Infectious Diseases Clinical Microbiology, 06100, Sıhhiye, Ankara, Turkey
| |
Collapse
|
37
|
Unal M, Aksoy DY, Aydın Y, Tanriover MD, Berker D, Karakaya J, Guler S. Carotid artery intima-media thickness and erectile dysfunction in patients with metabolic syndrome. Med Sci Monit 2014; 20:884-8. [PMID: 24869934 PMCID: PMC4049947 DOI: 10.12659/msm.889771] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Metabolic syndrome (MS) has become a pandemic in Turkey, as is the case globally. Increase in carotid artery intima-media thickness (CIMT) and erectile dysfunction (ED) may be evident before the clinical signs of cardiovascular disease appear. We aimed to investigate the prevalence of increased CIMT and ED as markers of atherosclerotic disease in patients with MS. Material/Methods Thirty-two patients with MS and 29 healthy controls were included. Anthropometric and biochemical parameters, along with total testosterone (TT), high sensitive C-reactive protein (hs-CRP), were recorded. Carotid artery intima-media thickness was measured. Erectile dysfunction was assessed with International Index of Erectile Function. Results Patients with MS had higher BMI, fasting plasma glucose, post-prandial plasma glucose, insulin, HOMA-IR, total cholesterol, triglycerides, hs-CRP, and CIMT, whereas TT levels were lower (p<0.0001). The prevalence and severity of erectile dysfunction were higher in patients with MS (p<0.0001). Erectile dysfunction scores correlated inversely with CIMT. MS patients with ED were older and had higher CIMT compared to those without ED. Increase in age and HOMA and decrease in TT increased the risk of ED. When KIMT exceeding the 95th percentile of healthy controls was accepted as a risk factor for CVD, presence of ED was the only determinant for this increase. Conclusions Erectile dysfunction was more prevalent and severe in patients with MS and correlated with subclinical endothelial dysfunction. Total testosterone deficiency was prominent among MS patients. Presence of ED points to an increased risk of cardiovascular disease when MS is present.
Collapse
Affiliation(s)
- Mustafa Unal
- Department of Endocrinology and Metabolism, Numune Research and Training Hospital, Ankara, Turkey
| | - Duygu Yazgan Aksoy
- epartment of Endocrinology and Metabolism, Numune Research and Training Hospital, Ankara, Turkey
| | - Yusuf Aydın
- Department of Internal Medicine, Section of Endocrinology and Metabolism, Duzce University, Duzce, Turkey
| | - Mine Durusu Tanriover
- Department of Internal Medicine, Section of General Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Dilek Berker
- Department of Endocrinology and Metabolism, Numune Research and Training Hospital, Ankara, Turkey
| | - Jale Karakaya
- Department of Biostatistics, Hacettepe University, Ankara, Turkey
| | - Serdar Guler
- Department of Endocrinology and Metabolism, Numune Research and Training Hospital, Ankara, Turkey
| |
Collapse
|
38
|
Tutluer S, Tanriover MD, Emri S. Systemic glucocorticoid and anti-tuberculosis therapy in a patient with coexisting tuberculosis and anthracosis. Sarcoidosis Vasc Diffuse Lung Dis 2013; 30:308-311. [PMID: 24351622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 05/31/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND Tuberculous lymphadenitis is a common condition in underdeveloped and developing countries. Anthracosis is the black pigmentation of bronchi caused by the deposition of carbon, silica and quartz particles in the macrophages of the bronchial mucosa and submucosa. There is a potential relationship between bronchial anthracofibrosis and tuberculosis (TB). OBJECTIVES A 66 year old woman was referred to a chest diseases clinic when non-productive cough was noticed during a preoperative examination. Computerized tomography (CT) of thorax showed an infiltration in the right upper lobe and a lesion in the right apical lobe adjacent to the trachea. Extensive diagnostic tests including mediastinoscopic lymph node excision were performed. Anthracosis and coexisting tuberculosis were diagnosed. RESULTS Directly observed anti-TB therapy was immediately initiated. Systemic prednisolone was initiated at a dose of 30 mg/day and tapered slowly to the maintenance dose. Control thorax CT taken two months after the initiation of therapy revealed that the right upper lobe bronchus was open and atelectasis of the right upper lobe was resolved. Mediastinal calcified lymph nodes and fibrotic changes of both apical regions were observed. Being in the 10th month of the therapy, the patient is still totally asymptomatic in follow-ups. CONCLUSIONS Glucocorticoid therapy may raise some concerns in patients with TB. Here, we present a case with anthracosis and coexistent TB, who responded very well to simultaneous anti-TB and glucocorticoid therapy.
Collapse
Affiliation(s)
| | - M D Tanriover
- Hacettepe University Faculty of Medicine, Ankara, Turkey; Department of Internal Medicine;.
| | | |
Collapse
|
39
|
Ocal S, Durusu Tanriover M, Ocal A, Yilmaz A, Doruk S, Erkorkmaz U, Topeli Iskit A, Coplu L. The Coexistence of Heart and Lung Diseases in Patients with Chronic Dyspnoea that is Unexplained By Clinical Evaluation. Erciyes Med J 2013. [DOI: 10.5152/etd.2013.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
40
|
Tanriover MD, Guven G, Buldukoglu C, Diker O, Halacli B, Yildirim G, Topeli A. Should every adult patient in the hospital have an internist? SAO PAULO MED J 2013; 131:283-4. [PMID: 24141302 PMCID: PMC10871829 DOI: 10.1590/1516-3180.2013.1314719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 07/05/2013] [Indexed: 11/22/2022] Open
Affiliation(s)
- Mine Durusu Tanriover
- MD. Associate Professor, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | - Goksel Guven
- MD. Resident, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | - Cagin Buldukoglu
- MD. Resident, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | - Omer Diker
- MD. Resident, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | - Burcin Halacli
- MD. Resident, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | - Gonul Yildirim
- Nurse. Administrator, Adult Hospital Nursing Administration, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | - Arzu Topeli
- MD. Professor, Department of Internal Medicine and Medical Intensive Care, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| |
Collapse
|
41
|
Tanriover MD, Portakal O, Hapa A, Tekinel Y, Dagdelen S, Buyukasik Y, Arici M. Extremely high parathyroid hormone concentrations associated with pityriasis rubra pilaris and monoclonal gammopathy of unknown significance: a clinical dilemma. Bone 2012; 51:847-50. [PMID: 22906636 DOI: 10.1016/j.bone.2012.08.109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 07/31/2012] [Accepted: 08/03/2012] [Indexed: 10/28/2022]
Abstract
We present a case with extremely high parathyroid hormone (PTH) concentrations in the order of hundred thousands accompanied by dermatological and hematological diseases. After several diagnostic interventions, no malignancy could be demonstrated except monoclonal gammopathy of unknown significance. The dermatological findings were taken to be manifestations of the hematological disease. Since the first serum intact PTH concentration of the patient was found to be higher than 2500 pg/ml, dilution study was performed and found to be 215,977 pg/ml. The high concentration of serum PTH was taken to be falsely high due to assay interference. This concentration was checked from three different paths; a test for linear dilution was performed, the test was repeated with another method and the sample was treated to remove or inhibit interfering substances. The results were compatible with endogenous antibody interference, presumed to be a result of monoclonal gammopathy. The extremely high PTH concentrations were not only due to assay interference, but also secondary hyperparathyroidism, which was evident by the decrease in PTH concentrations with calcium and vitamin D treatments.
Collapse
Affiliation(s)
- Mine Durusu Tanriover
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey.
| | | | | | | | | | | | | |
Collapse
|
42
|
Castrejón I, McCollum L, Tanriover MD, Pincus T. Importance of patient history and physical examination in rheumatoid arthritis compared to other chronic diseases: results of a physician survey. Arthritis Care Res (Hoboken) 2012; 64:1250-5. [PMID: 22371298 DOI: 10.1002/acr.21650] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To survey physicians' opinions concerning the relative importance of 5 clinical encounter components-vital signs, patient history, physical examination, laboratory tests, and ancillary studies-in the diagnosis and management of 8 chronic diseases. METHODS A SurveyMonkey internet survey was e-mailed to 7,265 US physicians, including 3,542 rheumatologists and 3,723 nonrheumatologists, with the following query: "Please indicate the relative importance of 5 sources of information-vital signs, patient history, physical examination, laboratory tests, and ancillary studies-in diagnosis of congestive heart failure (CHF), diabetes mellitus, hypercholesterolemia, hypertension, lymphoma, pulmonary fibrosis, rheumatoid arthritis (RA), and ulcerative colitis." The response options were 0-20%, 21-40%, 41-60%, 61-80%, and 81-100%. A second query with an identical structure addressed management of the 8 diseases. The proportions of physicians who estimated each component as most (or tied for most) important in diagnosis or in management were computed. RESULTS The survey was completed by 313 physicians (154 rheumatologists and 159 nonrheumatologists). More than 90% estimated vital signs as most important for hypertension, and laboratory tests for diabetes mellitus and hypercholesterolemia. More than 70% estimated ancillary studies as most important for lymphoma, pulmonary fibrosis, and ulcerative colitis. Patient history and physical examination were estimated as most important for RA and CHF by ≥50% of nonrheumatologists. CONCLUSION RA and CHF were the only 2 of the 8 diseases studied for which ≥50% of nonrheumatologists estimated a patient history and physical examination as most important for diagnosis and management. Confirmation and extension of these observations in actual care may have implications for reimbursement and organization of clinical care.
Collapse
|
43
|
Tutluer S, Tanriover MD, Guven GS. Cowden syndrome: a major indication for extensive cancer surveillance. Med Oncol 2011; 29:1365-8. [PMID: 21394636 DOI: 10.1007/s12032-011-9896-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 03/01/2011] [Indexed: 10/18/2022]
Abstract
Cowden syndrome (CS) or multiple hamartoma syndrome is a rare genetic disorder related to increased cellular proliferation of ectodermal, mesodermal, and endodermal tissues. It is characterized by multiple hamartomas and malignant neoplasms. Cancers of the breast, thyroid, endometrium, and skin are the most prevalent ones. Although close surveillance for cancer is required, many cases are undiagnosed or diagnosis comes at a late stage, partly due to the variable phenotype of the disease. Detection of multiple skin lesions of different characteristic in a patient with other local and systemic pathologies prompts further evaluation for CS. A case of CS, whose diagnosis is based upon skin lesions, alimentary tract polyposis, mental dullness, and history of spinal arteriovenous malformations, is discussed in this report.
Collapse
Affiliation(s)
- Seda Tutluer
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, 06100 Sihhiye, Ankara, Turkey
| | | | | |
Collapse
|
44
|
Durusu Tanriover M, Bora Tatar G, Uluturk TD, Dayangac Erden D, Tanriover A, Kilicarslan A, Oz SG, Erdem Yurter H, Sozen T, Sain Guven G. Evaluation of the effects of vitamin D receptor and estrogen receptor 1 gene polymorphisms on bone mineral density in postmenopausal women. Clin Rheumatol 2010; 29:1285-93. [PMID: 20697762 DOI: 10.1007/s10067-010-1548-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 07/22/2010] [Accepted: 07/26/2010] [Indexed: 11/25/2022]
Abstract
The aim of this study is to evaluate the effects of estrogen receptor 1 (ESR1) and vitamin D receptor (VDR) gene polymorphisms on bone mineral density (BMD) in a group of previously untreated osteoporotic women. Effects of demographic, environmental, and hormonal factors were also evaluated in this context. Fifty women who did not have a prior diagnosis or treatment of osteoporosis were compared with 50 nonosteoporotic postmenopausal women. Demographic and morphometric characteristics, medical history, dietary habits, exercise history, and sunlight exposure were recorded. The diagnosis of osteoporosis was made with regard to BMD measurements with DEXA. Blood samples were obtained for serum biochemistry, bone turnover markers, and VDR and ESR1 gene polymorphism analysis. Polymorphic sites of VDR and ESR1 genes were amplified by polymerase chain reaction and examined using restriction fragment length polymorphism. Bb genotype was significantly higher in the osteoporotic group when compared to controls (p=0.022). Each 1 U decrease in the body mass index (BMI) increased the risk of osteoporosis by 8% independent of the genotype. We could not observe a significant effect of ESR1 polymorphism on BMD or osteoporosis risk. The interaction of ApaI and BsmI genotypes were found to be significant (p=0.041) and the AaBb genotype, when corrected for BMI, was shown to increase the risk of osteoporosis five times (p=0.005). However, the results demonstrated insignificant p values when correction for multiple testing was performed with the Bonferroni method in the logistic regression model. A predominance of Bb genotype of the VDR gene was evident in this group of postmenopausal Turkish women. Moreover, the combined genotype AaBb conferred a five times increased risk for osteoporosis when corrected for clinical variables.
Collapse
Affiliation(s)
- Mine Durusu Tanriover
- Department of Internal Medicine, Section of General Internal Medicine, Hacettepe University Faculty of Medicine, and Department of Orthopedics and Traumatology, Gazi Mustafa Kemal Public Hospital, 06100, Sihhiye, Ankara, Turkey.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Kramer MHH, Akalin E, Alvarez de Mon Soto M, Bitterman H, Ferreira F, Higgens C, Schumm-Draeger PM, Köberling J, Tanriover MD, Bauer W. Internal medicine in Europe: how to cope with the future? an official EFIM strategy document. Eur J Intern Med 2010; 21:173-5. [PMID: 20493417 DOI: 10.1016/j.ejim.2010.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
46
|
Tanriover MD, Ascioglu S, Altun B, Uzun O. Galactomannan on the stage: prospective evaluation of the applicability in routine practice and surveillance. Mycoses 2010; 53:16-25. [PMID: 20091935 DOI: 10.1111/j.1439-0507.2008.01652.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Invasive aspergillosis (IA) presents a diagnostic and therapeutic dilemma for the physicians who take care of the patients with severe underlying diseases and immunosuppression. This study aimed to evaluate the usefulness of serum galactomannan (GM) measurements in the routine practice and surveillance of IA along with possible caveats in diagnosis and treatment. Adult patients with high-risk haematological malignancies admitted to the Internal Medicine wards during the 2-year study period were followed up by daily visits for vital signs, existing or newly developing signs and symptoms, clinical and laboratory findings. Blood samples were analysed for GM levels by the ELISA method at the end of the study period. Data of 58 hospitalisation episodes in 45 patients were analysed. Proven IA was diagnosed in one patient, probable IA was diagnosed in four patients. The sensitivity was 60% and the specificity was 21% when the index cut-off for positivity was accepted as 0.5. The yield of GM testing may be influenced by many variables and each centre should evaluate the usefulness of this test in its own conditions.
Collapse
Affiliation(s)
- Mine Durusu Tanriover
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | | | | | | |
Collapse
|
47
|
|
48
|
Tanriover MD, Oz SG, Sozen T, Kilicarslan A, Guven GS. Pregnancy- and lactation-associated osteoporosis with severe vertebral deformities: can strontium ranelate be a new alternative for the treatment? Spine J 2009; 9:e20-4. [PMID: 18790681 DOI: 10.1016/j.spinee.2008.06.451] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2008] [Accepted: 06/28/2008] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Pregnancy- and lactation-associated osteoporosis is an uncommon condition that may be a consequence of preexisting low bone density, loss of bone mineral content during pregnancy, and increased bone turnover. PURPOSE To present a case of severe osteoporosis associated with pregnancy and lactation and its treatment protocol. STUDY DESIGN/SETTING A tertiary care hospital. PATIENT SAMPLE A young female after twin pregnancy presenting with severe osteoporosis. METHODS The diagnosis was done on the basis of bone mineral density (BMD) measurement. The patient was treated with first alendronate and then strontium ranelate. She was considered as a candidate for kyphoplasty. RESULTS A dramatic increase in the BMD and palliation of back pain were observed. CONCLUSIONS Strontium ranelate may be a new alternative in the treatment of pregnancy- and lactation-associated osteoporosis.
Collapse
Affiliation(s)
- Mine Durusu Tanriover
- Department of Medicine, Section of General Medicine, Faculty of Medicine, Hacettepe University, Sihhiye, Ankara, Turkey.
| | | | | | | | | |
Collapse
|
49
|
Durusu Tanriover M, Demir Onal E, Uslu N, Onder S, Gurakan F. Chronic liver disease or tuberculosis: could it be Niemann-Pick disease? Eur J Intern Med 2008; 19:e107-8. [PMID: 19046704 DOI: 10.1016/j.ejim.2008.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Revised: 06/24/2008] [Accepted: 07/07/2008] [Indexed: 10/21/2022]
Affiliation(s)
- Mine Durusu Tanriover
- Hacettepe University Hospital, Department of Internal Medicine, 06100, Ankara, Turkey.
| | | | | | | | | |
Collapse
|
50
|
Tanriover MD, Guven GS, Onal ED. Needlestick injury to a patient. J Postgrad Med 2008; 54:232. [DOI: 10.4103/0022-3859.41812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|