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KORTEN, VOLKAN

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    PublicationOpen 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, Volkan
    Epidemics 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.
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    PublicationOpen Access
    Relationship of the cycle threshold values of SARS-CoV-2 polymerase chain reaction and total severity score of computerized tomography in patients with COVID 19
    (ELSEVIER SCI LTD, 2020-12) KARAHASAN, AYŞEGÜL; Yagci, Aysegul Karahasan; Sarinoglu, Rabia Can; Bilgin, Huseyin; Yanilmaz, Ozgur; Sayin, Elvan; Guneser, Deniz; Guncu, Mehmet Mucahit; Doyuk, Zahide; Can, Baris; Kuzan, Beyza Nur; Aslan, Bulent; Korten, Volkan; Cimsit, Cagatay
    Aim: Studies analyzing viral load in COVID-19 patients and any data that compare viral load with chest computerized tomography (CT) severity are limited. This study aimed to evaluate the severity of chest CT in reverse transcriptase polymerase chain reaction (RT-PCR)-positive patients and factors associated with it. Methodology: SARS-CoV-2 RNA was extracted from nasopharyngeal swab samples by using Bio-speedy viral nucleic acid buffer. The RT-PCR tests were performed with primers and probes targeting the RdRp gene (Bioexen LTD, Turkey) and results were quantified as cycle threshold (Ct) values. Chest CT of SARS-CoV-2 RNA-positive patients (n = 730) in a period from 22 March to 20 May 2020 were evaluated. The total severity score (TSS) of chest CT ranged 0-20 and was calculated by summing up the degree of acute lung inflammation lesion involvement of each of the five lung lobes. Results: Of the 284 patients who were hospitalized, 27 (9.5%) of them died. Of 236 (32.3%) patients, there were no findings on CT and 216 (91.5%) of them were outpatients (median age 35 years). TSS was significantly higher in hospitalized patients; 5.3% had severe changes. Ct values were lower among outpatients, indicating higher viral load. An inverse relation between viral load and TSS was detected in both groups. CT severity was related to age, and older patients had higher TSS (p < 0.01). Conclusion: Viral load was not a critical factor for hospitalization and mortality. Outpatients had considerable amounts of virus in their nasopharynx, which made them contagious to their contacts. Viral load is important in detecting early stages of COVID-19, to minimize potential spread, whereas chest CT can help identify cases requiring extensive medical care. (C) 2020 Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.
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    PublicationOpen 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, Volkan
    Objective: 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.
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    PublicationOpen 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.