E-ISSN: 2791-8823
Volume: 2  Issue: 1 - April 2022

Page I

Merih Cetinkaya
Page II

3.COVID-19 Vaccination During Pregnancy
Halil Grsoy Pala
doi: 10.4274/csmedj.galenos.2022.2022-3-1  Pages 1 - 7
A global health crisis named coronavirus disease-2019 (COVID-19) pandemic was caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). COVID-19 pandemic created an immediate occasion to establish strategies for vaccination. Increasing evidence suggests the pregnancy-related COVID-19 risks substantially above the risk of non-pregnant woman. Women with pregnancy and lactation were not included in COVID-19 vaccination studies. To date, subsequent data from pregnant COVID-19 vaccinated women showed safety and efficacy during pregnancy. There is no evidence of harmful effects on pregnancy, fetal development, parturition and postnatal development both directly and indirectly for the COVID-19 vaccines. Vaccination for pregnant women is a healthy and safe way to prevent infection of SARS-CoV-2 and should be considered. From the knowledge of similar prior non-COVID-19 vaccine trials experience, reproductive and developmental toxicology trials from animals, datas from trials of humans and different advisory committees of healthcare have published guidelines supporting vaccination for COVID-19 during pregnancy and breastfeeding.

4.Effects of Adjuvant Chemotherapy on Insulin Resistance in Patients with Early Breast Cancer
Izzet Doan, Yksel rn, Handan Onur
doi: 10.4274/csmedj.galenos.2022.2022-1-7  Pages 8 - 13
Objective: To assess the effect of adjuvant chemotherapy on insulin resistance in patients with early breast cancer.
Material and Methods: Twenty-three non-diabetic patients were included. Patients were prospectively evaluated before, during, and after chemotherapy. Demographic, anthropometric, histopathological features, and treatment data were recorded. Blood samples were taken to evaluate fasting blood glucose, fasting insulin levels, and HbA1c. Homeostatic model assessment for insulin resistance (HOMA-IR) score measured using fasting blood glucose and fasting insulin levels.
Results: Overall, pre- and post-chemotherapy mean weights were comparable (70.17 kg vs. 71.43). Prechemotherapy mean HOMA-IR was 4.99 and significantly higher than the control group of the healthy population (p=0.008). The mean values of the HOMA-IR score before, during, and after chemotherapy were 4.99, 3.47, and 3.13, respectively. Although the mean HOMA-IR decreased after chemotherapy, these decreases were not statistically significant (p=0.089). The mean fasting glucose levels before, during, and after chemotherapy were 95.5, 101.9, and 94.1 mg/dL, respectively. Before, during, and after chemotherapy, the mean fasting insulin levels were 21.43, 13.32, and 13.28 μIU/mL, respectively.
Conclusion: In the study, we observed a higher rate of insulin resistance in patients with breast cancer. The mean values of the HOMA-IR score decreased during and after chemotherapy.

5.Intubation Biomarkers in COVID Critical Care Patients
Derya Tatlsuluolu, Glin Hilal Alay, Gldem Turan
doi: 10.4274/csmedj.galenos.2022.2021-12-3  Pages 14 - 18
Objective: The coronavirus disease-2019 (COVID-19) pandemic is an important cause of mortality worldwide and has created a serious burden for intensive care units (ICU). Many biomarkers have been studied in terms of mortality and are used routinely. This study aims to look at the laboratory data of patients transferred to the intensive care as well as the laboratory data on the day of intubation to try to figure out which biomarkers can help predict the intubation procedure.
Material and Methods: Patients in the COVID ICU had their records retrospectively reviewed. The study comprised patients who received oxygen therapy at the time of admission and had a positive polymerase chain reaction (PCR) test in the ICU, as well as patients who were endotracheal intubation after 24 h due to respiratory distress and/or other complications. Patients information was gleaned from the hospitals computer database and patient files. The data of patients hospitalized in the COVID ICU were reviewed retrospectively. Patients who received oxygen therapythe firstirst admission with PCR test positive at ICU and patients who were intubated after 24 h due to respiratory distress and/or other accompanying reasons were included in the study. The data of the patients were obtained from the hospital computer database and patient files.
Results: Lactate dehydrogenase, fibrinogen, ferritin, D-dimer, international normalized ratio (INR), WBC, neutrophil, neutrophil lymphocyte ratio (NLR), I-granulocyte, Sequential Organ Failure Assessment score (p<0.001) and pro-C, urea, INR, hemoglobin, lymphocyte scores were compared when the patients were intubated upon admission. There was a statistically significant difference in the values (p<0.05).
Conclusion: Acute phase reactants (AFR) increase in COVID-19 pneumonia. In the follow-up of the disease, it can be used in I-granulocytes with NLR as well as the increase in AFR.

6.Evaluation of the Route of Transmission and Clinical Course of SARS-CoV-2 Infection in Healthcare Workers at Istanbul Medipol University Hospital
Glseren Polat, Hatice Kbra Arslan, Feride Mimarolu, brahim Polat
doi: 10.4274/csmedj.galenos.2022.2022-1-2  Pages 19 - 25
Objective: Healthcare workers (HCW) have been the occupational group at highest risk of coronavirus disease-2019 infection despite early availability of guidelines for infection control, administrative management, and application of required conditions on field since the beginning of the pandemic. In this survey study our aim is to investigate environmental and individual factors which facilitate transmission of the virus among HCW in order to target preventative measures to be taken in the future.
Material and Methods: This current study is a single center based retrospective study conducted by analysing 446 telephone surveys conducted on HCW in Medipol Mega University Hospital who tested positive for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) between 15.03.2020-14.01.2021. Demographic details, comorbidities, department of work, occupation, symptoms, clinical course, choice of pulmonary imaging, use and availability of personel protective equipment (PPE) as well as adherance to social distancing rules was determined.
Results: Among the 3,013 HCWs at our hospital, 877 (29%) were tested positive for SARS-CoV-2, of which 446 were included in the survey. It was shown that 337 (85%) of those included in the study were adherent to the infection prevention protocols. Despite the high application of preventative measures at our hospital in-hospital transmission rates were still found to be high. In-hospital transmission was observed to be in groups of workers simultaneously among different departments of the hospital. The source of transmission was unknown in 33.78% of our HCW. Advanced age and those with comorbidities were found to have higher rates of severe infection. Infection rate was low in pregnant HCW due to the granted administrative leave.
Conclusion: Overall transmission of the infection among HCW is seen to be substantially in-hospital. More extensive training and education should be given to hospital staff who do not comply with infection control guidelines as well as to those who are unable to identify the source of transmission. Supervision of the implementation of hospital infection control policies, screening of asymptomatic cases as well as evaluation of PPE quality is valuable in the protection of HCW. In the event of a pandemic, elderly healthcare workers and those who have comorbidities may benefit from working in secluded environments within the hospital due to the severe course of disease seen in this group of patients.

7.After COVID-19 Infection Extended Intensive Care Process and Assessment of its Cost
Alev zta, Burcu Ileri Fikri, Murat nsel, Gldem Turan
doi: 10.4274/csmedj.galenos.2022.2022-2-1  Pages 26 - 29
Objective: In coronavirus disease-2019 (COVID-19), the length of stay (LOS) in the intensive care unit (ICU) is about a month. In this case series, we assessed the reason for the long LOS in ICU and the cost analysis.
Material and Methods: The study was designed retrospectively. We investigated 533 patients and identified 9 patients with a hospital stay of more than 30 days.
Results: Generally, 9 patients were admitted to the ICU with clinical findings that were not specific for COVID-19. During the ICU follow-up, we observed that secondary infection and acute respiratory distress syndrome developed in all the patients. Simultaneously, we determined that the prolonged ICU stay caused additional costs.
Conclusion: In the terms of COVID-19 pandemic; the prolongation LOS in ICU leads to cost increase and negative affects the health system.

8.Management of Patient by a Pulmonary Embolism Response Team in the Emergency Department
Kemal ener, zgr Klkesmez, Banu Arslan, Kbra Selok, Ramazan Gven, Mcahit Kap
doi: 10.4274/csmedj.galenos.2021.2021-10-1  Pages 30 - 33
Pulmonary embolism (PE) occurs when the pulmonary arterial system is blocked by a thrombus. Mortality is attributed to the right ventricle failure due to the increased pressure load. In this case, patient was successfully treated with catheter-mediated local thrombolytic therapy by a Pulmonary Embolism Response Team (PERT). A 70-year-old male patient was transferred to our emergency department for further evaluation and treatment, with a prediagnosed PE. Consultant physicians (PERT) of cardiology, pulmonology, interventional radiology, and thoracic surgery were called to the emergency department and evaluated the patient. After a deliberate discussion, PERT members reached a consensus on catheter-mediated thrombolytic therapy for the patient. The patient had no symptoms or complaints over that one-month period. We believe that establishing a PERT is essential in terms of beginning the most appropriate treatment faster and reducing the mortality.

9.Treatment of Isolated Penile Fourniers Gangrene: A Case Report and Current Literature Review
Emre Can Polat, Muammer Bozkurt
doi: 10.4274/csmedj.galenos.2022.2022-1-3  Pages 34 - 37
Fourniers gangrene (FG) is rapidly progressive necrotizing fasciitis of genital, perineal and perianal regions. Usually seen in patients with accompanying predisposing factors. Here, we report a case of FG with isolated penile necrosis in a 70-year-old diabetic male patient with a permanent foley catheter who presented to the emergency department with the complaint of blackish discoloration and purulent discharge in the penis for 4 days. Examination of external genital area showed ulcerated and necrotic lesions on the glans and shaft of the penis and scrotum and testes were normal. Broad spectrum intravenous antibiotics were given and surgical debridement was performed. A penectomy was performed and a neo-mea was created. In the presence of FG of the penis, early diagnosis and aggressive surgical treatment increases the chance of survival.

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