Person: KORTEN, VOLKAN
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KORTEN
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VOLKAN
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Publication Open Access Diagnostic performance between RT-PCR and chest CT in outpatients with clinically suspected COVID-19(2023-08-01) TİGEN, ELİF; ERTÜRK ŞENGEL, BUKET; ÇİMŞİT, CANAN; APAYDIN KAYA, MEMNUNE ÇİĞDEM; KORTEN, VOLKAN; TİGEN E., ERTÜRK ŞENGEL B., ÇİMŞİT C., PERK GURUN H., APAYDIN KAYA M. Ç., KORTEN V.Objective: To investigate the diagnostic performance between chest computed tomography (CT) and reverse transcription-polymerase chain reaction (RT-PCR) in outpatients with suspected coronavirus disease 2019 (COVID-19). Patients and Methods: Between March and June 2020, a total of 812 patients with clinically suspected COVID-19 who underwent both chest CT and initial-single RT-PCR on admission to outpatient units were retrospectively enrolled. CT severity-score (CT-SS) was calculated and data were matched with PCR results. Results: Of 812 patients, 54% (439/812) had positive RT-PCR results, and 47% (425/812) had a positive chest CT scan. With RT-PCR results as reference, the sensitivity, specificity, accuracy of chest CT in defining COVID-19 infection were 60%, (95% CI 56-65%, 265/439 patients), 57% (95% CI 52-62%, 213/373), 59% (95% CI 55-62%, 478/812), respectively. Three hundred eighty-seven (47%) patients had no CT findings, 380/812 (46.8%) had mild, 45/812 (5.5%) had moderate, and no patients in the severe group Conclusion: Chest CT did not show high sensitivity for the diagnosis of COVID-19 for outpatients. We suggest RT-PCR should be the primary diagnostic tool. Chest CT might be considered if there is a strong clinical suspicion with repeatedly negative RT-PCR test results, ensuring infection prevention and control measures can be preserved.Publication Open Access Transmission of SARS-CoV-2 in Different Districts of a County in Istanbul, March to September 2020(SAGE PUBLICATIONS INC, 2021-07) TOPUZOĞLU, AHMET; Bilgin, Huseyin; Topuzoglu, Ahmet; Korten, VolkanEpidemics caused by airborne viruses in cities with large populations create a big problem as in the current COVID-19 pandemic. Cramped lifestyle, busy workplaces, crowded public transportation, and higher household member counts are responsible for the transmission of the disease. In Turkey, Istanbul has taken the lead in the number of cases since the beginning of the epidemic. The excess population density is the major cause for disease transmission. It is essential to monitor the contaminated regions with geographical information systems on city maps. Outbreak maps visualize and help analyze the patterns of transmission and serve as a communication and education tool. A dynamic heat map video of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) polymerase chain reaction positive cases in a county of Istanbul was generated. The heat map visualizes how the epidemic spread to all the districts and the cumulative cases increased in one county of Istanbul with real attack rates.Publication Open Access Clinical characteristics and risk factors associated with severe disease and outcome of patients with COVID-19(2022-03-01) KORTEN, VOLKAN; Ozel A. S., Altunal L. N., Aydin M., Unal B., Cam G., Ozer M. C., KORTEN V.Introduction: Since the beginning of the pandemic, factors associated with mortality in patients with corona virus infection disease 2019 (COVID-19) have been investigated. Comorbidities and increased age have been frequently reported to be associated with mortality. We aimed to evaluate the factors associated with unfavorable outcome of patients with COVID-19 at an early period of the pandemic. Methodology: This single center, retrospective, observational study was conducted among laboratory confirmed COVID-19 patients hospitalized between March 11 and May 5, 2020, at Umraniye Training and Research Hospital, Istanbul, Turkey. The effects of the severity of illness, comorbidities, symptoms, and laboratory findings on the clinical outcome were evaluated. Factors associated with unfavorable outcome (necessity of mechanical ventilation or death) were examined using Cox proportional hazards models. Results: Out of a total of 728 patients, 53.8% were men and median age 54 years. The 30-day mortality rate was 4.9% among all hospitalized patients. A logistic regression model identified six predictors of unfavorable clinical outcome: age, severity of illness, the numbers of comorbidities, lymphopenia, high levels of C-reactive protein, and procalcitonin. Conclusions: The mortality rate was lower among the patients with COVID-19, hospitalized during the early period of the pandemic. Older age, higher severity score on admission, the numbers of comorbidities, higher levels of C-reactive protein, procalcitonin, and lymphopenia were identified to be associated with unfavorable outcome of the hospitalized patients with COVID-19.Publication Open Access Medication reconciliation service in hospitalized patients with infectious diseases during coronavirus disease-2019 pandemic: An observational study(2023-08-01) ENVER, CÜNEYD; ERTÜRK ŞENGEL, BUKET; SANCAR, MESUT; KORTEN, VOLKAN; OKUYAN, BETÜL; ENVER C., ERTÜRK ŞENGEL B., SANCAR M., KORTEN V., OKUYAN B.Objectives: To determine the prevalence and type of medication discrepancies and factors associated with unintentional discrepancies and identify the rate of hospital readmission and emergency service visit within 30 days after discharge among hospitalized patients with infectious diseases and receiving clinical pharmacist-led medication reconciliation during the coronavirus disease-2019 (COVID-19) pandemic. Materials and Methods: This observational study was conducted in the internal medicine and infectious diseases wards of a tertiary university hospital between July 2020 and February 2021 among hospitalized adult patients with infectious diseases. Medication reconciliation service (including patient counseling) was provided in person or by telephone. The number and type of medication discrepancies detected during the medication reconciliation services, the acceptance rate of pharmacists’ recommendation, and factors associated with having at least one unintentional medication discrepancy at admission were evaluated. At follow-up, hospital readmission and emergency service visit within 30 days after discharge were assessed by telephone. Results: Among 146 patients, 84 (57.5%) had at least one unintentional discrepancy at admission. Only three unintentional discrepancies were determined in three patients at hospital discharge. All the pharmacists’ recommendations for medication discrepancies were accepted by the physicians. Having COVID-19 [odds ratio (OR): 2.25, 95% confidence interval (CI): 1.15-4.40; p<0.05], being at a high risk for medication error (OR: 2.01, 95% CI: 1.03-3.92; p<0.05), and higher number of medications used at home (OR: 1.41, 95% CI: 1.23-1.61; p<0.001) were associated with having at least one unintentional discrepancy at admission. The rates of 30 day hospital readmission and admission to the emergency medical service were 12.3% and 15.8%, respectively. Conclusion: Medication reconciliation service provided by in-person or by telephone was useful for detecting and solving unintentional medication discrepancies during the COVID-19 pandemic.Publication Open Access Tocilizumab treatment in severe COVID-19: a multicenter retrospective study with matched controls(SPRINGER HEIDELBERG, 2022-03) ERTÜRK ŞENGEL, BUKET; Mert, Ali; Vahaboglu, Haluk; Arslan, Ferhat; Batirel, Ayse; Saracoglu, Kemal Tolga; Bastug, Aliye; Cagatay, Atahan; Irmak, Ilim; Dizman, Gulcin Telli; Ertenli, Ihsan; Altunal, Lutfiye Nilsun; Sengel, Buket Erturk; Bayram, Mehmet; Omma, Ahmet; Amikishiyev, Shirkhan; Aypak, Adalet; Bes, Cemal; Bolukcu, Sibel; Icten, Sacit; Topeli, Arzu; Bektas, Murat; Arslan, Birsen Yigit; Ozturk, Sinan; Comoglu, Senol; Aydin, Selda; Kucuksahin, Orhan; Icacan, Ozan Cemal; Ince, Burak; Aghamuradov, Sarvan; Mutlu, Melek Yalcin; Simsek, Funda; Emre, Salih; Ustun, Cemal; Ergen, Pinar; Aydin, Ozlem; Koc, Meliha Meric; Sevindik, Omur Gokmen; Odabasi, Zekaver; Korten, Volkan; Bodur, Hurrem; Guner, Rahmet; Unal, Serhat; Kocak, Mehmet; Gul, AhmetCoronavirus disease-2019 (COVID-19) associated pneumonia may progress into acute respiratory distress syndrome (ARDS). Some patients develop features of macrophage activation syndrome (MAS). Elevated levels of IL-6 were reported to be associated with severe disease, and anti-IL-6R tocilizumab has been shown to be effective in some patients. This retrospective multicenter case-control study aimed to evaluate the efficacy of tocilizumab in hospitalized COVID-19 patients, who received standard of care with or without tocilizumab. Primary outcome was the progression to intubation or death. PSMATCH (SAS) procedure was used to achieve exact propensity score (PS) matching. Data from 1289 patients were collected, and study population was reduced to 1073 based on inclusion-exclusion criteria. The composite outcome was observed more frequently in tocilizumab-users, but there was a significant imbalance between arms in all critical parameters. Primary analyses were carried out in 348 patients (174 in each arm) after exact PS matching according to gender, ferritin, and procalcitonin. Logistic regression models revealed that tocilizumab significantly reduced the intubation or death (OR 0.40, p = 0.0017). When intubation is considered alone, tocilizumab-users had > 60% reduction in odds of intubation. Multiple imputation approach, which increased the size of the matched patients up to 506, provided no significant difference between arms despite a similar trend for intubation alone group. Analysis of this retrospective cohort showed more frequent intubation or death in tocilizumab-users, but PS-matched analyses revealed significant results for supporting tocilizumab use overall in a subset of patients matched according to gender, ferritin and procalcitonin levels.Publication Open Access Evaluation of different respiratory samples and saliva for the detection of SARS CoV-2 RNA(MARMARA UNIV, FAC MEDICINE, 2021-01-22) KARAHASAN, AYŞEGÜL; Can Sarinoglu, Rabia; Guneser, Deniz; Erturk Sengel, Buket; Korten, Volkan; Karahasan Yagci, AysegulObjective: We aimed to analyse the positivity rate and cycle threshold values indicating viral loads for SARS CoV-2 among different respiratory specimens and also to evaluate the diagnostic efficacy of saliva samples. Materials and Methods: We included combined oropharyngeal and nasopharyngeal swab (cONS), sputum, and tracheal aspirate (TA) specimens of patients. Unpreserved saliva samples were collected prospectively from hospitalized patients within 72 hours of admission. SARS CoV-2 RNA was extracted by using Bio-Speedy viral nucleic acid buffer than RT-PCR was performed with Bio-Speedy COVID-19 qPCR detection kit. Results: Retrospective evaluation revealed SARS CoV-2 RNA in 19.66% of cONS (n: 5819), 30.77% of sputum (n: 39), 29.41% of TA samples (n: 34) from 4812 patients. In the majority (86.72%) of the samples, the first cONS sample was positive. Consecutive cONS and sputum/TA samples were investigated in 52 patients of whom 11 were positive with either of these samples. Saliva positivity was detected in 60% of cONS positive (n: 20) and 30% of cONS negative (n: 12) patients. Conclusion: Although, cONS samples show the greatest diagnostic guidance, repeated sampling from multiple sites of the respiratory tract increases the possibility of COVID-19 diagnosis. Saliva samples might be considered as an alternative specimen.Publication Open Access Liver stiffness is associated with disease severity and worse clinical scenarios in coronavirus disease 2019: A prospective transient elastography study(WILEY, 2021-09) KORTEN, VOLKAN; Demirtas, Coskun Ozer; Keklikkiran, Caglayan; Ergenc, Ilkay; Sengel, Buket Erturk; Eskidemir, Gunes; Cinel, Ismail; Odabasi, Zekaver; Korten, Volkan; Yilmaz, YusufBackground Pre-existing chronic liver disease is currently considered a poor prognostic factor for coronavirus disease 2019 (COVID-19). The present study aimed to investigate the association of liver stiffness measurement (LSM) with disease severity and clinical course of COVID-19. Methods We prospectively recruited consecutive hospitalised adult patients with COVID-19 in a 3-month period. Demographic, laboratory, clinical and vibration-controlled transient elastography (VCTE) features were recorded at entry, and all patients were prospectively followed-up. Severe liver fibrosis was defined as an LSM value higher than 9.6 kPA. Multivariate logistic regression analysis was performed to reveal factors associated with disease severity and outcomes. Results Out of 98 eligible patients with COVID-19, 12 (12.2%) had severe liver fibrosis. Patients with severe liver fibrosis had higher baseline disease severity (P = .022), more commonly required oxygen treatment at entry (P = .010), and had intensive-care unit (ICU) requirements during the 6 (1-39)-day median follow-up time (P = .017). The presence of severe liver fibrosis was independently associated with disease severity (odds ratio (OR): 7.685, 95% confidence interval (CI): 1.435-41.162, P = .017) and ICU requirement (OR: 46.656, 95% CI: 2.144-1015.090, P = .014). LSM was correlated with alanine aminotransferase levels (P = .005, r: 0.283), but not with other markers of acute hepatic injury or inflammation. Conclusion Initial VCTE application might help physicians identify patients who are more likely to have severe illness or worse clinical outcomes, in addition to other well-established clinical and laboratory factors. Further multicentre prospective studies are warranted to validate our results.Publication Metadata only Clinical Pharmacist-Led Medication Review in Hospitalized Confirmed or Probable Patients with COVID-19 During the First Wave of COVID-19 Pandemic(2024-01-01) ÜNDER, DUYGU; ENVER, CÜNEYD; DEMİRCİ, MUHAMMED YASİR; AYHAN, YUNUS EMRE; ÖZGAN, BETÜL; İLERLER, ENES EMİR; OKUYAN, BETÜL; ERTÜRK ŞENGEL, BUKET; KOCAKAYA, DERYA; SİLİ, ULUHAN; TİGEN, ELİF; KARAKURT, SAİT; KORTEN, VOLKAN; SANCAR, MESUT; ÜNDER D., ENVER C., DEMİRCİ M. Y., AYHAN Y. E., ÖZGAN B., İLERLER E. E., OKUYAN B., ERTÜRK ŞENGEL B., KOCAKAYA D., SİLİ U., et al.Objectives: Drug-related problems (DRPs) result in serious problems among hospitalized patients, high rates of morbidity and mortality, and increased healthcare costs. This study aimed to identify DRPs by clinical pharmacist-led medication review in hospitalized probable patients with coronavirus disease-2019 (COVID-19) during the first wave of the COVID-19 pandemic. Materials and Methods: This retrospective cross-sectional study was conducted at the COVID-19 inpatient services of a tertiary university hospital in Türkiye for 3 months (between March 2020 and June 2020) and included hospitalized confirmed or probable COVID-19 patients. The World Health Organization and Turkish Ministry of Health Guidelines case definitions were used to define confirmed and probable COVID-19 patients. Six clinical pharmacy residents provided medication review services during their education and training. DRPs were classified based on the Pharmaceutical Care Network Europe V9.00. The physician’s acceptance rate of clinical pharmacists’ recommendations was assessed. Results: Among 202 hospitalized patients with probable or confirmed COVID-19, 132 (65.3%) had at least one drug-related problem. Two hundred and sixty-four DRPs were identified. Drug selection (85.6%) and dose selection (9.2%) were the most common causes of these problems. Among the 80 clinical pharmacist interventions, 48.8% were accepted by the physicians. Conclusion: Clinical pharmacists identified a significant number of DRPs during the COVID-19 pandemic, particularly those related to drug interactions and drug safety, such as adverse drug reactions. This study highlights the importance of detecting and responding to DRPs in the COVID-19 pandemic.Publication Open Access Impact of tocilizumab on clinical outcomes in severe COVID-19 patients and risk of secondary infection: A case-control study(MARMARA UNIV, FAC MEDICINE, 2021-05-25) ERTÜRK ŞENGEL, BUKET; Sengel, Buket Erturk; Ozel, Serra; Gul, Fethi; Ilgin, Can; Tigen, Elif Tukenmez; Altunal, Luftiye Nilsun; Kabadayi, Feyyaz; Sili, Uluhan; Aydin, Mehtap; Odabasi, Zekaver; Cinel, Ismail; Korten, VolkanObjective: This study aimed to identify the effect of tocilizumab (TCZ) on clinical outcomes in severe COVID-19 patients. Material and Methods: We included hospitalized COVID-19 patients with an initial WHO scale >= 4. We matched the patients with baseline characteristics by using propensity scores. Then, we selected patients with C-reactive protein levels above 30 and showing an upward trend. We assessed the effect of TCZ in patients on clinical outcomes by using Mann - Whitney U and Chi-square tests. Results: Of 200 patients who had an initial WHO scale >= 4, 42 (21%) were given it? in addition to standard of care (SOC). Twenty-five patients (50%) needed mechanical ventilation (MV) in the TCZ group, compared with 35 (21%) of 158 patients with SOC (p<0.01). Nineteen (45%) and 37 (23%) patients died in 30 days in these groups, respectively (p <0.01). The secondary infection rate was significantly higher in the TCZ group (p=0.004). However, no difference was observed in all these parameters in the propensity score-matched cohort (14 patients in ICZ and 14 in the SOC group) (p=0.45, 0.45, 1.0 respectively). Conclusions: Tocilizumab does not provide a beneficial effect on MV requirement and mortality in severe COVID-19, and it does not increase the risk of secondary bacterial infection.Publication Open Access COVID-19 hastalığı nedeniyle ayaktan takip edilen erişkin hastaların 28 gün içinde hastaneye yatış insidansı ve etkileyen faktörler(2023-09-01) SİLİ, ULUHAN; APAYDIN KAYA, MEMNUNE ÇİĞDEM; KORTEN, VOLKAN; AY, NADİYE PINAR; BİLGİN H., TOPUZOĞLU A., SİLİ U., APAYDIN KAYA M. Ç., CAN SARINOĞLU R., KORTEN V., AY N. P.Amaç: Çalışmanın amacı, ayaktan takip edilen COVID-19 hastalarında ilk başvurunun ardından 28 günlük dönem - deki hastaneye yatış insidansının ve hastaneye yatış ile ilişkili risk faktörlerinin belirlenmesidir. Yöntemler: Retrospektif kohort olarak planlanan çalışmada, hastaların sosyodemografik özellikleri, başvuru şikayet - leri, komorbidite varlığı ve viral yükü gösteren döngü eşik (cycle threshold - Ct) değerleri bağımsız değişkenler olarak, başvurudan sonraki 28 günlük hastaneye yatış ise bağımlı değişken olarak tanımlandı. Hastaneye yatışa neden olan faktörler tek ve çok değişkenli istatistiksel analizlerle incelendi. Çok değişkenli istatistiklerde Cox regresyon analizi yapıldı ve etki büyüklüğü “hazard ratio” (HR) ile ifade edildi. İstatistiksel anlamlılık düzeyi p<0.05 olarak belirlendi. Bulgular: Çalışmaya 368 hasta dahil edildi. Ortanca (25.-75. persantil) yaşı 36 (28-45) yıl olarak saptanan hastaların %46.1’i kadındı. İlk 28 günde hastaneye yatış 65 (%17.7) hastada gerçekleşti. Çok değişkenli analizde ≤29 yaş refe - rans alındığında; ≥50 yaş [HR=4.1, %95 güven aralığı (GA)=1.7-9.6], 40-49 yaş (HR=3.0, %95 GA=1.3-6.6) ve 30-39 yaş (HR=1.6, %95 GA=0.6-3.6), başvuru anında ateş ve/veya üşüme titreme (HR=2.3, %95 GA=1.3-4.1), nefes darlığı (HR=2.0, %95 GA=1.1-3.4), yorgunluk/bitkinlik (HR=1.9, %95 GA=1.0-3.5), kusma (HR=3.0, %95 GA=1.5-5.8) ve boğaz ağrısı (HR=0.4, GA=0.2-0.8) hastaneye yatışın bağımsız belirleyicileri olarak saptandı. Hipertansiyon varlığı (HR=2.2, %95 GA=1.0-4.4) yatışı öngördüren tek komorbidite olarak belirlendi. Sonuç: İleri yaş, sistemik ve alt solunum yolu infeksiyon bulgularının varlığı ve hipertansiyon, 28 gün içinde yatış riskini artırırken, boğaz ağrısının olması yatış riskini azaltan faktör olarak belirlendi. Boğaz ağrısının yatış riskini düşürmesi, hastalığın hafif bir üst solunum yolu infeksiyonu olarak atlatılacağı ve yatış gerektirmeyeceği şeklinde yo - rumlanabilir. Bu çalışmada eksik veriler nedeniyle riski artırabilecek tüm faktörler değerlendirilemedi. Yatış riskini daha doğru tahmin eden bir model oluşturabilmek için başvuru anındaki klinik, laboratuvar ve radyolojik bulguların da dahil edildiği çalışmalara ihtiyaç vardır.