Person: SİLİ, ULUHAN
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SİLİ
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ULUHAN
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Publication Open Access Effect of video camera monitoring feedback on hand hygiene compliance in neonatal intensive care unit, an interventional study(2023-01-02) SİLİ, ULUHAN; MEMİŞOĞLU, ASLI; ÖZEK, EREN; KEPENEKLİ KADAYİFCİ, EDA; Bilgin H., SİLİ U., Pazar N., Kucuker I., Kepenekli E., Yanar M. A., MEMİŞOĞLU A., ÖZEK E., Adhikari N. K., Pinto R., et al.Background: The purpose of this study was to determine whether use of a video camera surveillance system for hand hygiene (HH) monitoring, video-based education, and feedback could improve the HH compliance in a neonatal intensive care unit (NICU). Methods and materials: This was an interventional before-after trial conducted in a level-III NICU between July 2019 and June 2020. HH compliance was measured using randomly selected video-camera footage in the baseline, intervention, and maintenance periods. After the baseline, an intervention consisting of feedback and education with video scenarios was implemented. The primary outcome was change in HH compliance. The compliance rates were analyzed as an interrupted time series (ITS) with a segmented regression model adjusted for autocorrelation for each study period. Results: We identified a total of 8335 HH indications. There were non significant increases in the total compliance rate (9.0%, 95% CI -2% to 20%) at the time of intervention and in the compliance rate after intervention (0.26%, 95% CI -0.31% to 0.84%) per day. The hand hygiene compliance before patient contact significantly increased (19.8%, 95% CI, 4.8%-34.8%). Incorrect glove use improved non-significantly with the intervention (-3.4%, 95% CI -13.4% to 6.7%). Conclusion: In this study of HH monitoring using video-camera footage combined with an intervention including feedback and education, there were inconsistent improvements in HH compliance. However, these improvements were not sustained in the long term. Frequent feedback and education may be required to sustain high compliance.Publication Open Access Molnupiravir compared to nirmatrelvir/ritonavir for covid-19 in high-risk patients with haematological malignancy in Europe. A matched-paired analysis from the EPICOVIDEHA registry(2023-10-01) SİLİ, ULUHAN; Salmanton-García J., Marchesi F., Koehler P., Weinbergerová B., Čolović N., Falces-Romero I., Buquicchio C., Farina F., van Praet J., Biernat M. M., et al.Introduction: Molnupiravir and nirmatrelvir/ritonavir are antivirals used to prevent progression to severe SARS-CoV-2 infections and decrease hospitalisation and mortality rates. Nirmatrelvir/ritonavir was authorised in Europe in December 2021, whereas molnupiravir is not yet licensed in Europe as of February 2022. Molnupiravir may be an alternative to nirmatrelvir/ritonavir because it is associated with fewer drug-drug interactions and contraindications. A caveat for molnupiravir is the mode of action induces viral mutations. Mortality rate reduction with molnupiravir was less pronounced than that with nirmatrelvir/ritonavir in patients without haematological malignancy. Little is known about the comparative efficacy of the two drugs in patients with haematological malignancy at high-risk of severe COVID-19. Thus, molnupiravir and nirmatrelvir/ritonavir were compared in a cohort of patients with haematological malignancies. Methods: Clinical data from patients treated with molnupiravir or nirmatrelvir/ritonavir monotherapy for COVID-19 were retrieved from the EPICOVIDEHA registry. Patients treated with molnupiravir were matched by sex, age (±10 years), and severity of baseline haematological malignancy to controls treated with nirmatrelvir/ritonavir. Results: A total of 116 patients receiving molnupiravir for the clinical management of COVID-19 were matched to an equal number of controls receiving nirmatrelvir/ritonavir. In each of the groups, 68 (59%) patients were male; with a median age of 64 years (interquartile range [IQR] 53-74) for molnupiravir recipients and 64 years (IQR 54-73) for nirmatrelvir/ritonavir recipients; 56.9% (n=66) of the patients had controlled baseline haematological malignancy, 12.9% (n=15) had stable disease, and 30.2% (n=35) had active disease at COVID-19 onset in each group. During COVID-19 infection, one third of patients from each group were admitted to hospital. Although a similar proportion of patients in the two groups were vaccinated (molnupiravir n=77, 66% vs. nirmatrelvir/ritonavir n=87, 75%), more of those treated with nirmatrelvir/ritonavir had received four vaccine doses (n=27, 23%) compared with those treated with molnupiravir (n=5, 4%) (P<0.001). No differences were detected in COVID-19 severity (P=0.39) or hospitalisation (P=1.0). No statistically significant differences were identified in overall mortality rate (P=0.78) or survival probability (d30 P=0.19, d60 P=0.67, d90 P=0.68, last day of follow up P=0.68). Deaths were either attributed to COVID-19, or the infection was judged by the treating physician to have contributed to death. Conclusions: Hospitalisation and mortality rates with molnupiravir were comparable to those with nirmatrelvir/ritonavir in high-risk patients with haematological malignancies and COVID-19. Molnupiravir is a plausible alternative to nirmatrelvir/ritonavir for COVID-19 treatment in patients with haematological malignancy.Publication Open Access A qualitative study of hand hygiene compliance among health care workers in intensive care units(J INFECTION DEVELOPING COUNTRIES, 2019-02-28) TEKER SAYIN, AYŞE GÜLSEN; Ay, Pinar; Teker, Ayse Gulsen; Hidiroglu, Seyhan; Tepe, Pinar; Surmen, Aysen; Sili, Uluhan; Korten, Volkan; Karavus, MeldaIntroduction: Studies indicate that adherence to hand hygiene guidelines is at suboptimal levels. We aimed to explore the reasons for poor hand hygiene compliance. Methodology: A qualitative study based on the Theory of Planned Behavior as a framework in explaining compliance, consisting four focus group discussions and six in-depth interviews. Results: Participants mostly practiced hand hygiene depending on the sense of dirtiness and cleanliness. Some of the participants indicated that on-job training delivered by the infection control team changed their perception of emotionally based hand hygiene to indication based. Direct observations and individual feedback on one-to-one basis were the core of this training. There was low social cohesiveness and a deep polarization between the professional groups that led one group accusing the other for not being compliant. Conclusions: The infection control team should continue delivering one-to-one trainings based on observation and immediate feedback. But there is need to base this training model on a structured behavioral modification program and test its efficacy through a quasi-experimental design. Increasing social cohesiveness and transforming the blaming culture to a collaborative safety culture is also crucial to improve compliance. High workload, problems related to work-flow and turnover should be addressed.Publication Open Access Successful treatment of an invasive fungal infection caused by Talaromyces sp. with voriconazole(ELSEVIER SCIENCE BV, 2015-06) BİLGİN, HÜSEYİN; Sili, Uluhan; Bilgin, Huseyin; Masania, Rikesh; Eryuksel, Emel; Cimsit, Nun I. Cagatay; Ayranci, Gulcicek; Richardson, Malcolm; Korten, VolkanInvasive fungal infections (lFl) are on the rise due to increasing numbers of immunosuppressed and critically ill patients. A malignant-looking pulmonary nodule in an immunosuppressed patient may indeed be caused by a fungal organism. We report a patient, who was eventually diagnosed with an IFI caused by an agent of hyalohyphomycosis, Talaromyces sp determined via molecular methods and succesfully treated with voriconazole. (C) 2015 The Authors, International Society for Human and Animal Mycology Published by Elsevier B.V.Publication Open Access Survival in multiple myeloma and SARS-COV-2 infection through the COVID-19 pandemic: Results from the epicovideha registry(2023-01-01) SİLİ, ULUHAN; Musto P., Salmanton-García J., Sgherza N., Bergantim R., Farina F., Glenthøj A., CENGİZ SEVAL G., Weinbergerová B., Bonuomo V., Bilgin Y. M., et al.Patients affected by multiple myeloma (MM) have an increased risk of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection and subsequent coronavirus (20)19 disease (COVID-19)-related death. The changing epidemiological and therapeutic scenarios suggest that there has been an improvement in severity and survival of COVID-19 during the different waves of the pandemic in the general population, but this has not been investigated yet in MM patients. Here we analyzed a large cohort of 1221 patients with MM and confirmed SARS-CoV-2 infection observed between February 2020, and August 2022, in the EPICOVIDEHA registry from 132 centers around the world. Median follow-up was 52 days for the entire cohort and 83 days for survivors. Three-hundred and three patients died (24%) and COVID-19 was the primary reason for death of around 89% of them. Overall survival (OS) was significantly higher in vaccinated patients with both stable and active MM versus unvaccinated, while only a trend favoring vaccinated patients was observed in subjects with responsive MM. Vaccinated patients with at least 2 doses showed a better OS than those with one or no vaccine dose. Overall, according to pandemic waves, mortality rate decreased over time from 34% to 10%. In multivariable analysis, age, renal failure, active disease, hospital, and intensive care unit admission, were independently associated with a higher number of deaths, while a neutrophil count above 0.5 × 109/L was found to be protective. This data suggests that MM patients remain at risk of SARS-CoV-2 infection even in the vaccination era, but their clinical outcome, in terms of OS, has progressively improved throughout the different viral phases of the pandemic.Publication Open Access COVID-19 in vaccinated adult patients with hematological malignancies. Preliminary results from EPICOVIDEHA(2021) SİLİ, ULUHAN; Pagano, Livio; Salmanton-García, Jon; Marchesi, Francesco; Lopez-Garcia, Alberto; Lamure, Sylvain; Itri, Federico; Gomes da Silva, Maria; Dragonetti, Giulia; Falces-Romero, Iker; van Doesum, Jaap; Sili, Uluhan; Labrador, Jorge; Calbacho, Maria; Bilgin, Yavuz; Weinbergerová, Barbora; Serrano Gomez, Laura Milena; Ribera, Josep-Maria; Malak, Sandra; Loureiro-Amigo, Jose; Glenthøj, Andreas; Cordoba, Raul; Nunes Rodrigues, Raquel; Gonzalez-Lopez, Tomas Jose; Karlsson, Linda Katharina; Jimenez, Maria-Jose; Hernández-Rivas, José-Ángel; Jaksic, Ozren; Racil, Zdenek; Busca, Alessandro; Corradini, Paolo; Hoenigl, Martin; Klimko, Nikolai; Koehler, Philipp; Pagliuca, Antonio; Passamonti, Francesco; Cornely, OliverPublication Open Access Marmara Üniversitesi Pendik Eğitim ve ID_x000D_ Araştırma Hastanesi’nde 2014-2018 Yılları_x000D_ Arasındaki Kronik Hepatit C Prevalansı,_x000D_ Genotip Dağılımı ve Tedavi Yanıtları(2020) ERTÜRK ŞENGEL, BUKET; Betül ERTÜRK ŞENGEL;Tuğçe BAŞARI;Elif TÜKENMEZ TİGEN;Rabia CAN SARINOĞLU;Barış CAN;ULUHAN SİLİ;Volkan KORTENHepatit C dünyada yaygın olarak görülen ve mortaliteye neden olabilen ciddi bir hastalıktır.Bu çalışmada Marmara Üniversitesi Pendik Eğitim ve Araştırma Hastanesi’nebaşvuran hastalarda anti-HCV seropozitiflik sıklığının ve kronik viral hepatit C (HCV)tanısı konarak tedavi verilen hastaların genotip dağılımları ile tedavi başarılarınındeğerlendirilmesi amaçlanmıştır. Çalışmada retrospektif olarak Ocak 2014-Aralık 2018tarihleri arasında anti-HCV istemi yapılan serum örnekleri taranmıştır. Reaktif bulunanörneklerin HCV RNA pozitiflikleri ile genotip dağılımları ve kronik HCV tanısı ile tedaviverilen hastaların kalıcı viral yanıt başarı oranları değerlendirilmiştir. Total 76,413 hastadan100,100 serum örneğinde anti-HCV istemi yapılmış ve 1,808 (% 2,36) hastadapozitif bulunmuştur. Bu hastaların 1,286’sında (% 71) HCV RNA bakılmış ve 291 (% 23)hastada pozitif saptanmıştır. HCV RNA tespit edilen hastalarda 129’una (% 44) hastanemizdekronik HCV tanısı ile tedavi verilmiştir. En sık genotip 1b saptanmış olup, tedavisonrası 24’üncü haftada kalıcı viral yanıt hastaların % 87’sinde elde edilmiştir. Sonuçolarak antiviral tedavi ile virolojik başarı oranları yüz güldürücü olsa da halen tanı vetedavi alması gereken ancak tespit edilemeyen hasta sayısı da oldukça yüksektir.Publication Metadata only Comparison of Cellular immunity in Patients with Chronic Hepatitis B, Inactive Hepatitis B Surface Antigen Carriers and Spontaneously Recovered Individuals(H G E UPDATE MEDICAL PUBLISHING S A, 2014) SİLİ, ULUHAN; Arslan, Ferhat; Mert, Ali; Sili, Uluhan; Tabak, Fehmi; Ozturk, Recep; Ozaras, ResatDifferent clinical outcomes of acute HBV infection have been partially explained by individual differences in immune response. In this study We investigated interferon gamma (IFN-gamma) secretion of peripheral blood mononuclear cells (PBMC) in vitro against specific (Hepatitis B core antigen; recombinant HBcAg) and non-specific (CMV, EBV, Influenza peptide pool; CTL CFF peptide pool plus) antigens using enzyme linked immunospot (ELISPOT) assay in 7 patients with chronic hepatitis B (CHB group), 8 inactive carriers of HBV (carrier group) and 8 subjects who spontaneously recovered from acute HBV infection as detected by anti-HBs positivity (immune group). Phytohemaglutinin served as the positive test control. Response against recombinant HBcAg was 88 +/- 35, 50 +/- 110, 105 +/- 150 spot forming cell (SFC) /10(5) PBMC, in CHB, carrier and immune groups, respectively. HBeAg-specific T-cell response was slightly higher in the immune group; however, statistically there was no significant difference between the groups. Assessment of cellular immunity by IFN-gamma ELISPOT was not sufficient to explain the various outcomes of HBV infection such as resolution, chronicity and carriership.Publication Open Access Improved Clinical Outcome of COVID-19 in Hematologic Malignancy Patients Receiving a Fourth Dose of Anti-SARS-CoV-2 Vaccine: An EPICOVIDEHA Report(2022-11-25) SİLİ, ULUHAN; Salmanton-García J., Marchesi F., Glenthøj A., Bilgin Y. M., Van Praet J., Dávila-Valls J., Martín-Pérez S., Labrador J., Van Doesum J., Falces-Romero I., et al.Publication Metadata only Association of latitude and altitude with covid-19 symptoms: SCCM discovery virus registry analysis(2022-01-01) SİLİ, ULUHAN; Tekin A., Qamar S., Bansal V., Singh R., Sharma M., Bogojevic M., Deo N., LeMahieu A., Hanson A., Schulte P., et al.