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What is this summary about? This is a summary of an article about part of a clinical study for the BNT162b2 COVID-19 vaccine, also called the Pfizer-BioNTech vaccine. The article was published in the New England Journal of Medicine in September 2021. The part of the study described in the article began in July 2020 and is ongoing. This means that the final results may be different from the results included in this summary. What happened in this study? The participants in this study received 2 injections of either the BNT162b2 vaccine or a placebo, 21 days apart. The placebo looked like the BNT162b2 vaccine but had no active vaccine in it. None of the trial participants or study teams knew who received vaccine or placebo. What were the results? Most of the reactions to the injections were mild or moderate and lasted for a short period of time. The most common reactions were pain at the injection site, extreme tiredness (fatigue), and headache. These reactions usually happened in the first 7 days after receiving a vaccine dose. A small number of participants had severe reactions to the vaccine. Compared to participants who received the placebo, participants who received the BNT162b2 vaccine were much less likely to become ill if they were infected with the virus that causes COVID-19. The vaccine also had very good efficacy at preventing severe COVID-19. Participants in South Africa who received the BNT162b2 vaccine were less likely to become ill after infection with the beta variant of the virus compared to participants who received the placebo. The beta variant was very common in South Africa when the study was taking place. Clinical Trial Registration: NCT04368728 ( ClinicalTrials.gov )

An outbreak investigation was initiated after detecting an increase in the number of patients with Stenotrophomonas maltophilia bloodstream infections (SM-BSIs) througout the hospital. S. maltophilia was isolated from the cultures of blood-gas ınjectors containing liquid heparin. The incidence density of SM-BSIs decreased significantly after prohibiting the use of those injectors.

Amaç: Bu çalışmada yoğun bakımda yatan COVID-19 tanılı gebe ve lohusalarda mortalite prediksiyon modeli oluşturarak APACHE II, SAPS II ve SOFA skorları ile karşılaştırılması amaçlanmıştır. Gereç ve Yöntem: Hastanemizin COVID-19 yoğun bakım ünitelerine yatan Covid-19 tanısı doğrulanmış gebe ve lohusaların demografik, laboratuvar, radyolojik ve klinik verileri geriye dönük olarak kaydedildi. Bulgular: Çalışmaya dahil edilen 50 hastadan 13’ü kaybedildi. Yaş ortalaması ölen grupta 35.54±4.24 yıl, yaşayan grupta 30.03±4.91 yıl idi (p=0.002). Lojistik regresyon modeli, yaş, lenfopeni, yüksek CRP ve IL-6 düzeylerinin mortalite ile ilişkili olduğunu ortaya koydu. Modelin mortalite (AUC) için prediktif gücü 0.946±0.045 (p

Contains fulltext : 293869.pdf (Publisher’s version ) (Open Access) Antimicrobial resistance (AMR) has been exacerbated by the inappropriate use of diagnostics, leading to excessive prescription of antimicrobials, and is an imminent threat to global health. Diagnostic stewardship (DS) is an auxiliary to antimicrobial stewardship (AMS) and comprises ordering the right tests, for the right patient, at the right time. It also promotes the judicious use of rapid and novel molecular diagnostic tools to enable the initiation of proper antibiotic therapy, while avoiding excessive use of broad-spectrum antibiotics. Proper interpretation of test results is crucial to avoid overdiagnosis and excessive healthcare costs. Although many rapid diagnostic tools have been developed with a high diagnostic yield, they are often limited by accessibility, cost, and lack of knowledge regarding their use. Careful consideration of clinical signs and symptoms with knowledge of the local epidemiology are essential for DS. This enables appropriate interpretation of microbiological results. Multidisciplinary teams that include well trained professionals should cooperate to promote DS. Challenges and barriers to the implementation of DS are mostly caused by scarcity of resources and lack of trained personnel and, most importantly, lack of knowledge. The lack of resources is often due to absence of awareness of the impact that good medical microbiology diagnostic facilities and expertise can have on the proper use of antibiotics. 01 juli 2023

Due to the COVID-19 infection, which was recognized as a global pandemic by the WHO on March 11, 2020, the number of cases and disease-related deaths increases day by day globally. For this reason, antiviral agents used in treatment and vaccines, the most effective weapon in prevention, continue to be the most popular topic of the plan. Several situations are expected to affect the course of the pandemic. The loss of the ability of the virus to mutate and cause disease, the fact that those who become immunized by having the disease in the society reach a critical rate and create social immunity (herd immunity), and the provision of social immunity with effective vaccination can be counted as some of these situations. Candidate vaccines in the clinical phase among RNA-based vaccines: This review aimed to examine COVID-19 vaccine candidates using RNA technology and compile its current data. We used PubMed, Google Scholar, and World Health Organization (WHO) databases. Also, we followed up on the latest news and developments on vaccine companies’ websites. Conclusion: Vaccination trials, which started due to the seriousness and urgency of the situation that we are in, continue exceptionally quickly and effectively. As per the WHO›s data on July 9, 2021, there have been 291 vaccine trials, 107 of which are in the clinical phase, and 18 (16%) of the vaccine candidates in the clinical phase are RNA-based vaccines. Also, the number of RNA-based vaccines with ongoing preclinical trials is 2

Background BNT162b2 is a lipid nanoparticle–formulated, nucleoside-modified RNA vaccine encoding a prefusion-stabilized, membrane-anchored severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) full-length spike protein. BNT162b2 is highly efficacious against coronavirus disease 2019 (Covid-19) and is currently approved, conditionally approved, or authorized for emergency use worldwide. At the time of initial authorization, data beyond 2 months after vaccination were unavailable. Methods In an ongoing, placebo-controlled, observer-blinded, multinational, pivotal efficacy trial, we randomly assigned 44,165 participants 16 years of age or older and 2264 participants 12 to 15 years of age to receive two 30-μg doses, at 21 days apart, of BNT162b2 or placebo. The trial end points were vaccine efficacy against laboratory-confirmed Covid-19 and safety, which were both evaluated through 6 months after vaccination. Results BNT162b2 continued to be safe and have an acceptable adverse-event profile. Few participants had adverse events leading to withdrawal from the trial. Vaccine efficacy against Covid-19 was 91.3% (95% confidence interval [CI], 89.0 to 93.2) through 6 months of follow-up among the participants without evidence of previous SARS-CoV-2 infection who could be evaluated. There was a gradual decline in vaccine efficacy. Vaccine efficacy of 86 to 100% was seen across countries and in populations with diverse ages, sexes, race or ethnic groups, and risk factors for Covid-19 among participants without evidence of previous infection with SARS-CoV-2. Vaccine efficacy against severe disease was 96.7% (95% CI, 80.3 to 99.9). In South Africa, where the SARS-CoV-2 variant of concern B.1.351 (or beta) was predominant, a vaccine efficacy of 100% (95% CI, 53.5 to 100) was observed. Conclusions Through 6 months of follow-up and despite a gradual decline in vaccine efficacy, BNT162b2 had a favorable safety profile and was highly efficacious in preventing Covid-19. (Funded by BioNTech and Pfizer; ClinicalTrials.gov number, NCT04368728.)

SARS-CoV-2 genetic variants from alpha (first detected in the UK) to delta (discovered in India this spring) to lambda (currently Argentina, Brazil, Chile, Colombia, Ecuador, and Peru) have been emerging and circulating the world. Also, these variants have raised concerns about the continued effectiveness of COVID-19 vaccines. In this review, influential variants cause countries to review their vaccine strategies, create new vaccine programs, and accelerate existing vaccine studies. The effectiveness of currently available COVID-19 vaccines on variants is discussed. It is also intended to shed light on what should be known about the necessity of third doses.

The aim of this study was to determine the in-vitro activity of fosfomycin against Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) isolates and the frequency of OXA-48, NDM, KPC, VIM, IMP types of carbapenemases in the carbapenem-resistant (CR) groups. A total of 346 isolates (126 E. coli and 220 K. pneumoniae) from nosocomial bloodstream infections were included. Carbapenem and fosfomycin susceptibility were tested by Etest (bioMerieux, France) and agar dilution methods, respectively and evaluated in accordance with EUCAST criteria. The presence of OXA-48, NDM, KPC, VIM, IMP types of carbapenemases were conducted by using PCR method. Of the total 346 isolates, 185 (41 E. coli, 144 K. pneumoniae) were CR. Fosfomycin susceptibility of E. coli was higher than 95% and was not statistically significant between the CR and carbapenem-susceptible (CS) groups. Fosfomycin susceptibility of CS and CR K. pneumoniae was 90.7% and 69.4%, respectively, and statistically significantly lower in CR group. Of the total 185 CR isolates, 163 (32 E. coli, 131 K. pneumoniae) were producing carbapenemases. OXA-48 was the prominent carbapenemase type produced by E. coli (96.8%) and K. pneumoniae (70.9%). The frequency of NDM and KPC types produced by K. pneumoniae was 20.6% and 15.2%, respectively. Fosfomycin has substantial in-vitro activity against nosocomial CS and CR E. coli and CS K. pneumoniae bloodstream isolates. However, due to the risk of emerging resistance with fosfomycin monotherapy, combination therapy should be considered to obtain the possible additive or synergistic activity. Emerging fosfomycin resistance of CR K. pneumoniae isolates is alarming and OXA-48 is still the prominent carbapenemase type in Turkey.

The number of cases and disease-dependent deaths continue to increase worldwide due to the COVID-19 infection accepted as a global pandemic by the World Health Organization on March 11, 2020. Therefore, the antivirals used in treatment and vaccines that are the most effective weapons for protection remain the most popular topic on the agenda. There are a few conditions that might have an impact on the course of the pandemic, including the mutation of the virus and losing its ability to cause disease, generating herd immunity by reaching a critical rate of immunized people in the community due to the disease, and ensuring herd immunity through effective vaccination. Vaccine trials, which have started owing to the severity and urgency of the situation we are in, continue highly rapidly and effectively. According to the March 2, 2021 data of WHO, there are 258 vaccine trials, 76 of which are at the clinical phase, and 9 of the vaccine trials that are at the clinical phase are RNA-based vaccines. In our study, it was aimed to investigate RNA-based COVID-19 vaccine candidates and review their current data.

Despite the advances in antiretroviral treatment (ART), persistent inflammation remained a challenge. We analyzed the inflammatory-score changes through 2-years in people living with HIV (PLWH) treated with different antiretroviral regimes. This study was conducted in Hacettepe University HIV/AIDS Treatment and Research Center. PLWH diagnosed between 2014 and 2020 were included. Inflammatory and metabolic markers (CD4/CD8 ratio, C-reactive protein (CRP), Systemic Inflammatory Index (SII), Neutrophil-Lymphocyte Ratio (NLR), Mean Platelet Volume (MPV), Platecrite (PCT), and Low-Density Lipoprotein/High-Density Lipoprotein (LDL/HDL), Platelet-to-Lymphocyte Ratio (PLR) and ARTs were captured from database through 2-years from the diagnosis. The 2-year change (Δ) in markers was calculated and compared by ART type (backbone and 3rd agent). Mann-Whitney-U test and T-test were used for statistical analysis. This study included 205 PLWH; 175 (85.4%) were male, and the mean age was 38.98 (±10.88) years. The number of PLWH with suppressed viremia (

Background Despite the COVID-19 pandemic has been going on over 5 months, there is yet to be a standart management policy for all patients including to those mild-to-moderate cases. We evaluated the role of a combined effort of early hospitalization in combination with early antiviral therapy with COVID-19 patients in a tertiary care university hospital. Materials and Methods This was a prospective, observational, single center study on probable/confirmed COVID-19 patients hospitalized in a tertiary care hospital COVID-19 wards between March 20- April 30, 2020. Critically-ill patients requiring intensive care unit (ICU) at the time of admission were excluded. The demographic, laboratory, and clinical data were collected. Results We included 174 consecutive probable/confirmed COVID-19 adult patients hospitalized in the Internal Medicine wards of the University Adult Hospital between March 20 and April 30, 2020. The median age was 45.5 (19-92) years and 91 patients (52.3% ) were male. 120 (69%) were confirmed microbiologically, 41 (23.5%) radiologically diagnosed and, 13 (7.5%) were clinically suspected (negative microbiological and radiological findings compatible with COVID-19). According to WHO definitions, 35 (20.1%) had mild, 107 (61.5%) moderate disease, and 32 (18.4%) had severe pneumonia. Of 130/171 ( 74.3%) showed pneumonia; 80 were typical, 50 indeterminate infiltration for COVID-19. Patients admitted within a median of 3 days (0-14 days) after symptoms appear. The median duration of hospitalization was 4 days (0 - 28 days). In this case series, 13.2% patients were treated with hydroxychloroquine alone, 64.9% with hydroxychloroquine plus azithromycin, and 18.4% with regimens including favipiravir. A total of 15 patients (8.5%) were transferred to the ICU. Four patients died (2.2%). Conclusion In our series, early of 174 patients admitted to the hospital wards for COVID-19, 69% confirmed with PCR and/or antibody test. On the admission nearly one fifth of the patients had severe diseases. 95.4% of the patients received HQ alone or in combination. The overall case fatality rate was 2.2%.

There are treatment options with partially shown efficacy against SARS-CoV-2. A drug with proven effect on survival has not yet been developed for the new coronavirus disease (COVID-19) defined in December 2019. Many chemicals that are being used or developed for different indications have been used for COVID-19 treatment, based on their effects observed in in vitro studies. Favipiravir, one of these drugs, was first used in Wuhan, the starting center of the pandemic. Since the spread of the infection to the world, it has been used in our country as well as countries such as Italy, Japan, Russia, Ukraine, Uzbekistan, Moldova and Kazakhstan, Bangladesh, Egypt, India. There are few studies conducted and published to evaluate the effectiveness of favipiravir, but many studies are ongoing. In this review, it was aimed to review and evaluate the studies and case reports reporting the efficacy of favipiravir in the treatment of COVID-19. With the literature search, 223 results were reached, 210 articles were fully accessed, and a total of 34 articles were included in the analysis. In the scope of the review, under the title of pharmacology of favipiravir, adverse effects and drug interactions in addition to pharmacokinetic and pharmacodynamic properties are mentioned. Favipiravir is one of the options for the treatment of COVID-19 patients, but randomized, controlled trials involving much more patients and longer follow-up periods need to be planned and the results of ongoing trials evaluated.

To the editor, Favipiravir (FVP) was developed against the influenza virus infection and licensed for the treatment of influenza in Japan [1]. In addition to influenza viruses, FVP demonstrates a broad-spectrum activity against many RNA viruses including Ebola, Lassa, rabies, and severe fever with thrombocytopenia [2]. FVP exhibited a comparable in vitro efficacy against SARS-CoV-2 with remdesivir in a cell culture model [3].The authors would like to acknowledge the contributions of numerous physicians, nurses, and healthcare personnel of Hacettepe University's COVID-19 response team for their selfless efforts in follow-up and care of the patients. Authors declare that there is no conflict of interest.

Background/aim The COVID-19 pandemic originated in Wuhan, China, in December 2019 and became one of the worst global health crises ever. While struggling with the unknown nature of this novel coronavirus, many researchers and groups attempted to project the progress of the pandemic using empirical or mechanistic models, each one having its drawbacks. The first confirmed cases were announced early in March, and since then, serious containment measures have taken place in Turkey. Materials and methods Here, we present a different approach, a Bayesian negative binomial multilevel model with mixed effects, for the projection of the COVID-19 pandemic and we apply this model to the Turkish case. The model source code is available at https://github.com/kansil/covid-19. We predicted the confirmed daily cases and cumulative numbers from June 6th to June 26th with 80%, 95%, and 99% prediction intervals (PI). Results Our projections showed that if we continued to comply with the measures and no drastic changes were seen in diagnosis or management protocols, the epidemic curve would tend to decrease in this time interval. Also, the predictive validity analysis suggests that the proposed model projections should have a PI around 95% for the first 12 days of the projections. Conclusion We expect that drastic changes in the course of COVID-19 in Turkey will cause the model to suffer in predictive validity, and this can be used to monitor the epidemic. We hope that the discussion on these projections and the limitations of the epidemiological forecasting will be beneficial to the medical community, and policy makers.

Background Sars-CoV-2 infection influences older individuals at the forefront, and there is still limited data on the COVID-19 vaccine response in the geriatric population. This study aimed to assess antibody response after vaccination with SARS-CoV-2 inactivated vaccine and examine possible factors affecting this response in a geriatric population. Methods individuals who have been on at least the 28th day after the second dose of the COVID-19 vaccine were included. Comprehensive geriatric assessment tools and the Clinical Frailty Scale were performed. SARS-CoV-2 spike-specific IgG antibodies were detected and, levels ≥1 U/ml were defined as seropositive, Results a total of 497 patients were included and divided into three groups according to the days past after the second dose of the vaccine (Group 1: 28–59 days, Group 2: 60–89 days and Group 3: 90 days and more). Groups included 188, 148 and 171 patients, respectively. Seropositivity rate in each group was 80.9,73.2 and 57.3%, respectively. In Groups 1 and 2, Charlson Comorbidity Index score was higher in the seronegative group (P = 0.023 and P = 0.011, respectively). In Group 3, the prevalence of frailty was significantly higher in the seronegative group (P = 0.002). Conclusion to the best of our knowledge, this is the first study assessing the antibody response after vaccination with Sars-CoV 2 inactivated vaccine in the Turkish geriatric population. Moreover, this is the first study revealing the relationship between antibody response and frailty. Larger studies are needed to confirm the antibody response duration and the association between frailty and COVID-19 vaccine response.

Healthcare workers may be exposed to various aerosols formed during patient care and treatment. Transmission of bacterial or viral infections to the healthcare staff by this route can be life threatening. Worldwide, many national and international occupational health and safety organizations consider medical masks and respirators as an important element of protecting healthcare workers against exposure to hazardous aerosol particles. With the recent COVID-19 pandemic, the features and standards of masks that should be used in different settings have become an important topic of discussion. The masks produced in compliance with standards are widely used against harmful aerosols and protect the user when properly installed. These medical and respiratory masks are among the important personal protection equipment widely used in healthcare to prevent transmission of bacterial and viral infections as well as COVID-19. Here, it was aimed to review the structural features and performance test standards of the masks used during medical procedures.

Background/aim: COVID-19 Coronavirus disease of 2019 is an infectious disease outbreak later on declared as a pandemic, caused by the SARS-CoV-2 severe acute respiratory syndrome coronavirus-2 . It spreads very rapidly and can result in severe acute respiratory failure. The clinical studies have shown that advanced age and chronic diseases increase the risk of infection. However, influence of the blood groups on COVID-19 infection and its outcome remains to be confirmed. The aim of this study is to investigate whether there exists a relationship between the blood groups of the patients and risk of SARS-CoV-2 infection and the clinical outcomes in COVID-19 patients. Material and method: 186 patients with PCR confirmed diagnosis of COVID-19 were included in this study. Age, sex, blood groups, comorbidities, need for intubation and intensive care unit follow up and mortalities of the patients were analyzed retrospectively. 1881 healthy individuals, who presented to the Hacettepe University Blood Bank served as the controls. Results: The most frequently detected blood group was blood group A 57% amongst the COVID-19 patients. This was followed by blood group O 24.8% . The blood group types did not affect the clinical outcomes. The blood group A was statistically significantly more frequent among those infected with COVID-19 compared to controls 57% vs. 38%, P < 0.001; OR: 2.1 . On the other hand, the frequency of blood group O was significantly lower in the COVID-19 patients, compared to the control group 24.8% vs. 37.2%, P: 0.001; OR: 1.8 . Conclusions: The results of the present study suggest that while the blood group A might have a role in increased susceptibility to the COVID-19 infection, the blood group O might be somewhat protective. However, once infected, blood group type does not seem to influence clinical outcome.

Objectives: Dyslipidemia is one of the risk factors for atherosclerotic cardiovascular disease. Cardiovascular events decrease with decreasing LDL-C levels and all guidelines emphasize the importan...

Identification of pathogens is critical as point-of-care applications, where various types of methods may be used for this purpose along with certain disadvantages for each method. To overcome these disadvantages and to build instruments that are simple, compact, user-friendly, cost-effective with quick response time and ideal for mass production are the biggest goals of research on this subject. Although many biosensing instruments are available, plasmonic makes it less difficult and more accurate to observe binding behavior at molecular level than many other types. Due to its noninvasive character, real-time, and label-free detection opportunities, plasmonic has now become an important optical biosensing platform for various applications ranging from pharmaceutical and biological sciences to diagnostic purposes and global health services. This chapter focuses on recent developments in the detection and quantification of bacteria and viruses using plasmonic biosensors based on nanoparticles, which are one of the promising candidates as biomedical instruments for medical diagnostics in the near future. Description of biosensors, including bioreceptors and transducers, and the nanoparticle-based plasmonic systems commonly used to detect the identification of bacteria and viruses are provided. Future problems and strategies are also discussed.

Introduction It was previously demonstrated that seasonal influenza incidence was significantly decreased during the COVID-19 pandemic, possibly due to respiratory and hygiene precautions. From this point, we hypothesized that the COVID-19 precautions could lead to a decrease in nosocomial infection rates in oncology inpatient wards. Methods We evaluated the nosocomial infection rates in an inpatient palliative oncology ward in the first 3 months of the COVID-19 pandemic in our country and compared this rate with the same time frame of the previous year in our institution. Results The percentage of nosocomial infections complicating the hospitalization episodes were significantly reduced in the first 3 months of the pandemic compared to the previous year (43 vs. 55 nosocomial infection episodes; 18.6% vs. 32.2%, p = 0.002). The decrease in the nosocomial infections was consistent in the different types of infections, namely pneumonia (4.8% vs. 7.6%), urinary tract infection (5.2% vs. 7.6%), bacteremia (5.2% vs. 7%) and intraabdominal infections (2.6% vs. 3.5%). The median monthly disinfectant use was significantly increased to 98 liters (interquartile range: 82 – 114) in 2020 compared to 72 L (interquartile range: 36 – 72) in 2019 ( p = 0.046). Conclusion The continuation of the simple and feasible hygiene and distancing measures for healthcare workers and patient relatives and adaptations for earlier discharge could be beneficial for preventing nosocomial infections in oncology wards. These measures could be implemented routinely even after the COVID-19 pandemic for patient safety, especially in settings with higher nosocomial infection rates like inpatients palliative care units.

Bordetella pertussis infection remains an important health problem in adults due to the increasing prevalence in recent years. Pertussis in adults can be easily overlooked or misdiagnosed. We aimed to determine the prevalence of pertussis in adult patients with acute cough and the clinical features of the pertussis cases.Internal Medicine and Pulmonology inpatient wards and outpatient clinics were screened between March 2017 and June 2018. Patients with cough duration between 1 week and 1 month were enrolled. Those who were on antibiotics for more than 5 days were excluded. A total of 115 patients were enrolled. Nasopharyngeal swabs were taken and real-time polymerase chain reaction analyses were done.According to the pertussis case definition, 47.8% of the patients were diagnosed with probable pertussis. We found the prevalence of pertussis as 3.5% in our cohort. All of the patients with pertussis had a history of paroxysmal cough with a mean duration of 20 days.These results show that pertussis continues to be a health problem for adults and may present with acute cough. The growing number of adult pertussis cases suggest that vaccination of children is inadequate to prevent pertussis and the concept of 'lifelong vaccination' should be strengthened.

Objective We aimed to investigate the incidence of adverse pregnancy outcomes including preterm birth, preeclampsia (PE), and fetal growth restriction (FGR) in pregnant women with COVID‐19 according to the gestational age. Methods This retrospective study included 167 pregnant women who were hospitalized with confirmed COVID‐19. The patients were divided into three groups according to the time of diagnosis as follows: 24 weeks of gestation (n = 129). Medical records of the patients were reviewed retrospectively and adverse pregnancy outcomes were analyzed. Results A total of 49 (29.3%) patients had an active COVID‐19 infection at the time of delivery, while 118 (70.7%) gave birth after the infection was cleared. Twenty‐three patients had preterm birth and the gestational age was

The aim of this study was to determine the in-vitro activity of fosfomycin against

BACKGROUND Pneumococcal diseases (PN) and herpes zoster (HZ) are preventable infections in the adult population. AIMS This study aimed to identify the vaccination rates at 1 year after pharmacist-led provision of information in the community. The objectives were to reveal the reasons for not being vaccinated and to determine opinions and awareness of PN and HZ vaccination among public. METHODS A prospective study was conducted in five social and solidarity centres in Turkey. Participants were educated by a pharmacist about PN and HZ diseases, vaccinations and reimbursement status, respectively. All participants were followed by telephone 1 year after to determine their vaccination status. RESULTS A total of 155 participants (72.9% male; mean age was 68.72 ± 9.04 years) were included. With respect to PN and HZ vaccines, it was found that 40% and 12.7% of participants knew about the respective vaccines. Following the pharmacist's educational session, 52.9% and 51.6% were willing to have the respective vaccine, but only 5.7% and 0.8% respectively got vaccinated 1 year after the educational session. Perceived disease severity, provision of information by a pharmacist, and reimbursement status of the vaccines were not associated with the vaccination rates. CONCLUSIONS The public obtain information on vaccines from friends and family members, which may result in misinformation and inappropriate behaviour in vaccination. Although educational sessions provided by pharmacists did not increase the actual vaccination rates for PN and HZ, public willingness to vaccination has increased.

BackgroundBNT162b2 is a lipid nanoparticle-formulated, nucleoside-modified RNA vaccine encoding a prefusion-stabilized, membrane-anchored SARS-CoV-2 full-length spike protein. BNT162b2 is highly efficacious against COVID-19 and is currently authorized for emergency use or conditional approval worldwide. At the time of authorization, data beyond 2 months post-vaccination were unavailable.MethodsIn an ongoing, placebo-controlled, observer-blinded, multinational, pivotal efficacy study, 44,165 ≥16-year-old participants and 2,264 12-15-year-old participants were randomized to receive 2 doses, 21 days apart, of 30 µg BNT162b2 or placebo. Study endpoints reported here are vaccine efficacy (VE) against laboratory-confirmed COVID-19 and safety data, both up to 6 months post-vaccination.ResultsBNT162b2 continued to be safe and well tolerated. Few participants had adverse events leading to study withdrawal. VE against COVID-19 was 91% (95% CI 89.0-93.2) through up to 6 months of follow-up, among evaluable participants and irrespective of previous SARS-CoV-2 infection. VE of 86%-100% was seen across countries and in populations with diverse characteristics of age, sex, race/ethnicity, and COVID-19 risk factors in participants without evidence of previous SARS-CoV-2 infection. VE against severe disease was 97% (95% CI 80.3−99.9). In South Africa, where the SARS-CoV-2 variant of concern, B.1.351 (beta), was predominant, 100% (95% CI 53.5, 100.0) VE was observed.ConclusionWith up to 6 months of follow-up and despite a gradually declining trend in vaccine efficacy, BNT162b2 had a favorable safety profile and was highly efficacious in preventing COVID-19. (ClinicalTrials.govnumber,NCT04368728)

Purpose To present the antibiotic prescription trend between 2011-2018 at primary healthcare in Turkey in order to evaluate the effects of interventions at national level for providing rational prescription of antibiotics. Methods Electronic prescription data of the family physicians collected from January 1, 2011 to December 31, 2018 in 81 provinces of Turkey were recorded through the Prescription Information System and screened for the antimicrobial drugs. The interventions to promote rational antibiotic use during 2011-2018 in Turkey includes reminding the legislation to stop access of antibiotics without prescription, monitoring of antibiotic prescription behaviors of primary healthcare physicians, and education of healthcare workers and the public on the appropriate use of antibiotics. Results A total of 1 054 261 396 prescriptions for outpatients of all age groups were recorded during this period. Of the prescriptions written by family physcians, 34.94% were containing at least one antibiotic in 2011, which declined to 24.55% in 2018. Antibiotics constituted 13.99% of all the items in prescriptions in 2011 and 10.47% in 2018. Percentage of total antibiotic expenditure to the total drug expanditure decreased from 14.14% to 4.12% during 2011-2018. The most commonly prescribed antibiotics were amoxicillin and enzyme inhibitor combination, cefdinir, and cefuroxime during 2011-2018, with an increasing trend for prescription of first-line antibiotic, amoxicillin, in recent years. Conclusions Governmental interventions at national level have contributed to reducing antibiotic prescription and increasing preference of first-line antibiotics at primary healthcare level in Turkey over a course of 8 years. Turkey's model of governmental interventions may set an example for other countries with high consumption of antibiotics, and contribute to the actions against antimicrobial resistance worldwide.

Amac: Bu calismanin amaci, yogun bakim hastalarinda antibiyotiklerin diger ilaclarla olan etkilesimlerini, hastanelerde siklikla basvurulan 3 farkli online ilac-ilac etkilesim veri tabani ile saptamak, bu veri tabanlarini karsilastirmak ve ilac etkilesimlerinin klinik onemini klinik eczaci tarafindan degerlendirmektir. Yontem: Kasim-Aralik 2015 tarihleri arasinda bir universite hastanesi Dahiliye Yogun Bakim Unitesi’nde yatmakta olan ve en az bir antibiyotik kullanan hastalar calismaya dahil edilmistir. Hastalarin kullandigi ilaclar arasindaki etkilesimler; Micromedex , Medscape ve Drugs.com online veri tabanlarinin ilac-ilac etkilesim bolumleri ile analiz edilmis ve antibiyotiklerle olan potansiyel ilac-ilac etkilesimleri belirlenmistir. Veri tabanlarinda gozlenen potansiyel ilac-ilac etkilesimlerinin sayisi ve derecesi arasindaki farklar tespit edilmistir. Saptanan etkilesimlerin klinik acidan onemi bir klinik eczaci tarafindan degerlendirilmistir. Bulgular: Altmis iki hastada toplam 42, 112 ve 91 ilac etkilesimi Micromedex , Medscape ve Drugs.com tarafindan sirasiyla belirlenmistir. Saptanan bu etkilesimlerin klinik onemi degerlendirildiginde, en fazla Medscape veri tabani ile saptanan ilac etkilesimleri 15’i (%35,7) klinik olarak anlamli bulunmustur. Sonuc: Etkilesimlerin degerlendirilmesinde sadece veri tabanlari ile saptanmayip ayni zamanda klinik eczaci ve klinisyenlerin klinik anlamliligi goz onunde bulundurdugu bir yaklasim izlenmelidir.

Introduction: Fever of unknown origin (FUO) is one of the most challenging clinical situations. Although several studies have shown a relatively benign course of patients that remain undiagnosed, long-term outcoms of patients with a certain diagnosis are still non-established. To describe the follow-up results of patients investigated for FUO, with a certain diagnosis. Materials and Methods: Data from patients admitted to the inpatient clinics of Hacettepe University Hospital inpatients Department of Internal Medicine with the complaint of FUO were collected prospectively from March 2015 to September 2017. Patients with an uncertain diagnosis after all diagnostic procedures were excluded. Patients were divided into 3 main subgroups: rheumatologic, infectious and malignant groups. We compared Kaplan-Meier curves for all diagnosis-to-death time frames with the standart log-rank test. p< 0.05 was considered as statistically significant. Results: A total of 106 patients were included, 58 (55%) of them were female. Median age was 48 (18-81) years. Patients were also divided into three subgroups: rheumatologic (RHE) (n= 49, 46.2%), infectious (INF) (n= 28, 26.4%) and malignant (MLG) (n= 29, 27.4%) causes; adult-onset Still’s disease (n= 20; 41% of), tuberculosis (n= 9; 32%) and lymphoma (n= 19; 66%) were the most common diagnosis among the groups, respectively. While there was no survival difference between the rheumatologic and infectious group, both of these groups had better survival than the malignant group (ROM-INF p= 0.13; ROM-MLG p= 0.001; INF-MLG p= 0.022). Among the female patients, there was only a significant survival difference between the rheumatologic and malignant group (ROM-INF p= 0.15; ROM-MLG p= 0.007; INF-MLG p= 0.42). Conclusion: Among the patients evaluated for FUO, survival rate was lower in patients who had a malignant diagnosis. Despite having lost its statistical significance after stratification for gender, mortality rate of the infectious group was followed the malignant group. Early diagnosis and treatment of infections may lower mortality rates. Further large-scaled epidemiological studies are needed.

Objectives: Colistin is a vital antibiotic used in multidrug-resistant infections. Its most important side effect is nephrotoxicity. Colistin is a weak acid. This study aims to evaluate whether urine alkalinization is protective in the nephrotoxicity of colistin. Methods: Twenty-eight male Sprague-Dawley rats were divided into groups. Group I ( n = 4) was injected with intramuscular distilled water twice a day for 7 days. Group II ( n = 8) was injected with 750,000 IU/kg/day colistin for 7 days. Group III ( n = 8) was injected with the same dose of colistin after their urinary pH was ≥7 through the addition of bicarbonate in their drinking water. Group IV ( n = 8) was injected with the same dose of colistin after their urine density fell below 1010 through the addition of NaCl molds in their food and 12.6 mg/L NaCl in their drinking water. Results: According to tubular degenerations (scored 0–5), group I scored 0, group II scored 4.25, group III scored 2, and group IV scored 1.5. In groups III and IV, protection was achieved ( p = 0.001). The bicarbonate group was not superior to the NaCl group ( p = 0.789). In transmission electron microscopy, group III had more microvilli integrity and autophagic vacuoles compared to group IV. Group IV had mitochondrial swelling and cristae lysis. A lower urine density was related to lower tubular scores ( p = 0.001). Conclusions: Colistin was highly nephrotoxic without protection. Light microscopy findings revealed that urinary alkalinization and NaCl hydration were similarly protective. Urine alkalinization further prevents ultrastructural changes as revealed by electron microscopy.

Background/aim Widespread use of antiretroviral treatment (ART) has led to decrease in the incidence of HIV/AIDS-related mortality. Besides the availability of ART, medication adherence is essential for treatment success. There is a scarcity of data reported from Turkey regarding ART adherence among people living with HIV/AIDS (PLWHA). Therefore, this study was undertaken to determine medication adherence and related factors among PLWHA in Turkey. Materials and methods The sample consisted of 158 PLWHA, who were being followed up at Infectious Diseases Outpatient Clinic of Hacettepe University Hospital. Data were collected using an individual questionnaire and the Turkish version of the Morisky Medication Adherence Scale. Results The median patient age was 38 years, 80.4% were male, and 51.3% were married. The median duration of both HIV infection and ART was 3 years. Sixty-one percent used two drug regimens. Sixty-one percent were highly adherent to ART while 37.9% were moderately adherent. The absence/presence of social support resources, disease duration, ART duration, and being informed about the ART regimen were statistically associated with medication adherence. Conclusion Our results suggest that medication adherence is excellent among Turkish PLWHA. Interventions, including effective social support, and continuous counseling about ART, might further boost the adherence of PLWHA

Laboratory testing is critical for sexually transmitted infections (STIs) as most of the infected people usually have no symptoms. It is known that having HIV and STI coinfection increases the risk of HIV transmission. Sensitive tests are required for the infection control. The aim of this study was to compare the 2 different diagnostic tests-an immunochromatographic (IC) test and a real-time polymerase chain reaction (Rt-PCR) assay-for screening Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma spp. and Mycoplasma spp. in HIV-infected men. The tests were evaluated in terms of sensitivity, specificity, rapidity, sample types and cost per test. Eighty HIV-infected adult men who were admitted to Hacettepe University Faculty of Medicine Hospital STIs Outpatient Clinic between October 2017-April 2018 were included in the study. Urine and urethral swab samples were collected from each patient. Urine samples were tested by BDMAX (Becton-Dickinson, Canada) assay, Chlamydia antigen cassette test (Monlab, Spain) and Mycoview test (Zeakon, France). Urethral swabs were tested by Gonorrhoeae cassette test (Monlab, Spain). In 18 (22.5%) of the 80 HIV-infected individuals, the presence of at least one of the four agents was detected by Rt-PCR method. A total of 23 agents were reported as one N.gonorrhoeae (1/80), two C.trachomatis (2/80), seven Mycoplasma spp. (7/80), 13 Ureaplasma spp. (13/80). In five (27.7%) patients, Ureaplasma spp. and Mycoplasma spp. were detected simultaneously. Twelve of 23 bacteria detected by Rt-PCR were also detected by IC tests; however, the remaining 11 bacteria (one N.gonorrhoeae, two C.trachomatis, four Ureaplasma spp., four Mycoplasma spp.) were not detected. When IC tests were compared to the gold standard test Rt-PCR, the sensitivity was 47.8% (11/23) and the positive-predictive value was 100% (11/11). Sixteen patients had STI-related signs and symptoms whereas 64 were asymptomatic. Only two of the 18 men with positive-Rt-PCR test results had STI-related symptoms. It was concluded that all individuals with risky behaviours should undergo STIs screening regardless of their symptoms. As obtaining urethral samples could create difficulty for the patients as well as for the physicians, using urine samples determined to be more convenient. In our study the sensitivity of IC tests found to be insufficiently low. It was concluded that in STI screening the use of Rt-PCR method, which has high sensitivity, specificity and ability to give results on the same day although a high cost test could be preferred on high risk groups such as HIV-infected individuals with no signs of infection.