Objective: It was aimed to evaluate long‐term radiological changes in severe coronavirus disease 2019 (COVID‐19) patients, to investigate pulmonary function, exercise capacities, and health‐related quality of life results.Methods: Sixty‐five patients with severe COVID‐19 pneumonia were evaluated in the sixth month after discharge from the hospital. Spirometry, 6 min walking test (6MWT), and short form of health‐related quality of life scale (SF‐36) were applied in the sixth month. Chest computed tomography (CT) was performed and the findings were grouped according to lung involvement.Results: Forty‐nine male and 16 female patients were included in the study. Forced expiratory volume in 1 s (FEV1)% values of 18 patients (30.5%), forced vital capacity (FVC)% values of 27 patients (45.8%), and 6MWT of 13 patients (23.2%) were found lower than expected in the sixth month. On the SF‐36 scale, physical function, energy‐vitality, social functionality, pain, and general health parameters were found lower than normal. Minimal interstitial changes in chest CT were seen in 26 patients. Nine patients had lung area involvement between 10% and 50% of the surface, there was a correlation between FEV1% and FVC% values in this group. There was severe pulmonary fibrosis in four patients. There was a correlation between pulmonary function and physical function and general perception of health from SF‐36 scale subparameters.Conclusion: Functional and radiological abnormalities were detected in a significant number of patients in the sixth month after severe COVID‐19 pneumonia. A systematic monitoring plan must be established to assess and properly manage the long‐term problems that may arise.
1 December 2013 in European Journal of Internal Medicine
Maintaining optimal adherence to antiretroviral therapy (ART) is essential for optimizing the management of HIV infection. The aim of this study is to explore ART adherence rates in Turkey. Included in this study were a total of 263 HIV-infected patients followed up by the ACTHIV-IST (ACTion against HIV in Istanbul) Study Group affiliated with four tertiary hospitals. The study population included patients 18 years of age or older who were on ART for over 12 months. Adherence was assessed by the medication possession ratio (MPR) calculated for each patient using data (a list of all drugs dispensed within the previous year for that patient) obtained from pharmacy medication records. In addition, patients completed a self-report questionnaire addressing missed doses and the AIDS Clinical Trials Group (ACTG) adherence questionnaire. The study was reviewed and approved by the Ethics Committee of Cerrahpasa Medical Faculty. Patient ages ranged from 19 to 71 years. Two hundred and thirty-one patients were male (88%). Two hundred and twenty-four patients (85%) had optimal adherence (MPR ≥95%). During the course of ART, 236 patients (90%) reported no missed doses in the past 4 days of their treatment, whereas 206 patients (78%) reported no missed doses in the past month. Simply forgetting was the most common reason for nonadherence. MPR was associated with virologic rebound. Major factors affecting adherence were being female, taking antituberculosis drugs, having an opportunistic infection, being able to take all or most of the medication as directed, and being aware of the need to take medication exactly as instructed to prevent the development of drug resistance. Adherence to ART measured by MPR and self-report surveys is relatively high in Turkey when compared with other countries, which probably led to high ART success rates.
Background: Managing Pseudomonas aeruginosa bloodstream infections (BSIs) is challenging due to increasing antimicrobial resistance, limited therapeutic options, and high mortality rates. In this study, we aimed to identify 30-day mortality risk factors and assess infectious diseases consultants’ preferences for combination or monotherapy. Methods: The study was conducted in four hospitals in Istanbul, Turkey, involving 140 adult ICU beds and 336,780 ICU-bed-days between 1 January 2014, and 31 December 2021. A total of 157 patients were included in the study. Cox proportional hazard regression was performed to assess the factors on 30-day mortality. Results: The 30-day mortality rate was 44.6% (70/157). Higher Charlson Comorbidity Index (CCI) score, severe sepsis, primary bloodstream infection, being in COVID-19 pandemic period, and infection caused by MDR strain were associated with higher hazard of 30-day mortality. Combination therapy was more commonly used in patients with BSIs with MDR or DTR (difficult-to-treat) strains but did not significantly improve the hazard of 30-day mortality. Conclusions: Targeted interventions and vigilant management strategies are crucial for patients with defined risk factors. While infectious disease consultants tended to favor combination therapy, particularly for drug-resistant strains, our analysis revealed no significant impact on 30-day mortality hazard. The increased incidence of P. aeruginosa BSIs during the pandemic emphasizes the need for infection control measures and appropriate antibiotic prescribing practices.