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Clinical Management of COVID-19: Conceptual Framework COVID-19临床管理:概念框架
Pub Date : 2020-04-08 DOI: 10.36519/2020-0003
J. Rello, R. Serrano
This work is licensed under a Creative Commons Attribution-Non Commercial 4.0 International License. In the treatment of COVID-19, attention is focused on expensive, high technology equipment such as sophisticated ventilators or extracorporeal membrane oxygenation (ECMO), which requires highly trained health care workers and aggressive pharmacological measures with weak evidence of efficacy (1). However, low-cost, primary health care has a higher life-saving potential.
本作品采用知识共享署名-非商业4.0国际许可协议。在COVID-19的治疗中,人们的注意力集中在昂贵的高科技设备上,如复杂的呼吸机或体外膜氧合(ECMO),这需要训练有素的卫生保健工作者和积极的药理措施,但疗效证据不足(1)。然而,低成本的初级卫生保健具有更高的挽救生命的潜力。
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引用次数: 2
Infections caused by extended-spectrum β-lactamase-producing Enterobacteriaceae: clinical and molecular epidemiology and treatment strategies 广谱产β-内酰胺酶肠杆菌科引起的感染:临床和分子流行病学及治疗策略
Pub Date : 2019-12-25 DOI: 10.36519/idcm.2019.19026
A. Aslan, M. Akova
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引用次数: 0
Reviewers-2019 评论家- 2019
Pub Date : 2019-12-25 DOI: 10.36519/idcm.2019.19031
Murat Akova
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引用次数: 0
Public knowledge and attitudes regarding antibiotic use in Ankara, Turkey 土耳其安卡拉关于抗生素使用的公众知识和态度
Pub Date : 2019-12-25 DOI: 10.36519/idcm.2019.19025
A. Azap, Tugrul Orhan Akin, M. Basçavus, Elvin Ercan, Devrim Deniz Kuscu, Irem Namal, M. Yilmaz
Objective: Turkey is one of the countries with the highest antibiotic consumption per capita and suffers widespread antimicrobial resistance. However, few studies are measuring the knowledge, attitude and behaviour regarding antibiotic use in Turkey. We aimed to describe the awareness, knowledge, beliefs, attitude and behaviour of the society regarding antibiotic use and antimicrobial resistance. Materials and Methods: The study was carried out at a large shopping mall with 60 000-75 000 visitors daily in the capital city of Turkey, Ankara. We applied a questionnaire to the visitors who accepted to participate for two days. The data were collected on demographics, knowledge, attitude and beliefs concerning antibiotic use and awareness of judicious antibiotic use (JAU) and related factors. Results: Of the 1044 people who attended the study, 554 were male (52.1%). The average age of the participants was 37.7. JAU was found to be high (10/10 points) in 127 participants (12.2%). JAU was statistically high among people who were informed about the potential harms of inappropriate antibiotic use by physicians (p<0.001), who had university degree (p=0.005), who did not used to use antibiotics without prescriptions (p<0.001), and who did not use antibiotics within the last year (p<0.001). Conclusion: Awareness and knowledge about JAU in Ankara were low. There are misbeliefs and inappropriate attitudes in terms of antibiotic use and antimicrobial resistance. Necessary precautions should be taken immediately to improve this issue.
目的:土耳其是人均抗生素消费量最高的国家之一,并且普遍存在抗生素耐药性。然而,很少有研究衡量土耳其关于抗生素使用的知识、态度和行为。我们的目的是描述的意识,知识,信念,态度和行为的社会对抗生素的使用和抗菌素耐药性。材料和方法:本研究在土耳其首都安卡拉的一个大型购物中心进行,每天有6万至75 000名游客。我们向同意参加两天活动的参观者发放了一份调查问卷。收集人口统计学、抗生素使用知识、态度和信念、明智使用抗生素意识(JAU)及相关因素。结果:参与研究的1044人中,男性554人(52.1%)。参与者的平均年龄为37.7岁。127名参与者(12.2%)的JAU较高(10/10分)。JAU在被医生告知不适当使用抗生素的潜在危害(p<0.001)、拥有大学学位(p=0.005)、在没有处方的情况下没有使用过抗生素(p<0.001)以及在过去一年内没有使用过抗生素(p<0.001)的人群中具有较高的统计学意义。结论:安卡拉地区对JAU的认识程度较低。在抗生素使用和抗菌素耐药性方面存在着误解和不适当的态度。应立即采取必要的预防措施来改善这一问题。
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引用次数: 4
“One Health” and Promoting the Concept in the Journal “一个健康”与期刊理念的推广
Pub Date : 2019-10-10 DOI: 10.36519/idcm.2019.19021
Ö. Azap
One Health is an innovative global approach aiming to tighten the collaboration and communication in all aspects of human, animal and environmental health. The areas of One Health approach include food safety, the control of zoonoses, and combatting antibiotic resistance (1). The term “one health” was first introduced to the scientific community at an Expert Consultation in Canada in 2009, but the concept has been well known since the 1800s (2). Dr Rudolf Virchow (1821-1902) coined the term “zoonosis” to indicate an infectious disease that is passed between humans and animals (3).
“同一个健康”是一种创新的全球办法,旨在加强人类、动物和环境卫生各方面的合作与沟通。“同一个健康”方法的领域包括食品安全、人畜共患病控制和对抗抗生素耐药性(1)。“同一个健康”一词最初是在2009年加拿大的一次专家咨询会上引入科学界的,但这个概念自19世纪以来就广为人知(2)。鲁道夫·韦尔肖博士(1821-1902)创造了“人畜共患病”一词,指的是一种在人与动物之间传播的传染病(3)。
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引用次数: 1
Early Detection of Fungal Infection in an Immunosuppressed Patient Demonstrated by Thorax CT: Suspicion is the Best Marker! 胸部CT显示免疫抑制患者真菌感染的早期发现:怀疑是最好的标志!
Pub Date : 2019-10-07 DOI: 10.36519/idcm.2019.19016
G. Durhan, Y. Baytar, Orhan Macit Ariyurek
6-year-old man with acute lymphoblastic leukemia developed neutropenic fever 12 days after induction chemotherapy. The focus of infection could not be found by clinical examination, chest radiography and routine cultures and em-piric antimicrobial treatment was started. As the fever persisted, computerized tomography (CT) of the thorax was performed, and a nodule with a diameter of 2 mm in the upper lobe of the right lung was detected (Fig 1 & 2). Absence of the lesion in the previous CT led us to think about a possible focus of infection. A follow-up CT taken one week later revealed that the size of nodule increased rapidly and reached a diameter of 13 mm (Fig 3). Fungal infection, especially angioinvasive aspergillosis, was considered in the differential diagnosis. A galactomannan index level of 2.0 in the bronchoalveolar lavage fluid further supported the radiological diagnosis. After antifungal treatment, including liposomal amphotericin B, the focus of infection re-gressed (Fig 4). The patient was discharged with the regression of fever and neutropenia. The findings of chest radiographs are seldom specific for the detection of a particular pathogen in the
6岁男性急性淋巴细胞白血病患者在诱导化疗12天后出现中性粒细胞减少热。临床检查、胸片及常规培养均未发现感染病灶,开始进行抗菌药物治疗。由于持续发热,对胸部进行CT检查,发现右肺上叶有一个直径2mm的结节(图1和图2)。在之前的CT检查中未见病变,我们考虑可能是感染灶。一周后复查CT,结节大小迅速增大,直径达13mm(图3)。鉴别诊断考虑真菌感染,尤其是血管侵袭性曲霉病。支气管肺泡灌洗液半乳甘露聚糖指数2.0进一步支持影像学诊断。经抗真菌治疗,包括两性霉素B脂体治疗,感染病灶消退(图4)。患者发热、中性粒细胞减少消退出院。胸片的发现很少是特定的检测一种特定的病原体
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引用次数: 0
Lessons from the Crimean War: How Hospitals were Transformed by Florence Nightingale and Others 克里米亚战争的教训:弗洛伦斯·南丁格尔和其他人如何改变医院
Pub Date : 2019-10-07 DOI: 10.36519/idcm.2019.19020
Ugurgul Tunc
Istanbul,
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引用次数: 0
Pattern of Antibiotic Prescriptions in Dentistry in Turkey: Population Based Data from the Prescription Information System 土耳其牙科抗生素处方模式:处方信息系统中基于人口的数据
Pub Date : 2019-10-07 DOI: 10.36519/idcm.2019.19010
M. Aydın, C. Koyuncuoğlu, İpek Kirmizi, F. Isli, M. Aksoy, A. Alkan, A. Akıcı
This work is licensed under a Creative Commons Attribution-Non Commercial 4.0 International License. ABSTRACT Objective: Irrational use of antibiotics is a significant global health care problem which causes antibiotic resistance. Population-based antibiotic prescribing data in dentistry have not been extensively studied in Turkey and many other countries. This study aimed to describe the antibiotic prescription attitudes of dentists in Turkey by using population-based data. Materials and Methods: Data on systemic antibiotics prescribed by dentists to the Turkish Medicines and Medical Devices Agency’s Prescription Information System were retrospectively collected between January 1, 2013, and August 31, 2015. Results: The rate of antibiotic-containing prescriptions was 82.4%. The overall number of drugs per prescription was 2.18, and the overall number of antibiotics per prescription was 1.01. Antibiotics were more frequently prescribed to females (53.8%) and adults (73.5%). According to the World Health Organization Anatomical Therapeutic Chemical (ATC)-3 analysis, “J01C, beta-lactam antibacterials, penicillins” were the most commonly prescribed agents (71.3%). In ATC-4 subgroup analysis, “J01CR, penicillin combinations, including beta-lactamase inhibitors” were the most commonly prescribed agents (60.9%). In ATC-5 subgroup analysis, “J01CR02, amoxicillin and enzyme inhibitor” were the most frequently prescribed agents (57.6%), followed by “J01FA02, spiramycin” (10.7%). Metronidazole, which is commonly used in dental infections, was not frequently prescribed by Turkish dentists. Conversely, spiramycin was prescribed more frequently than anticipated. Conclusion: The present data show a high antibiotic prescribing rate among dentists in Turkey. Turkish dentists prefer to prescribe broad-spectrum antibiotics. This extremely high prescribing rate reflects the irrational use of antibiotics by Turkish dentists. Training programs on rational antibiotic use are required for dentists to reduce prescription rate.
本作品采用知识共享署名-非商业4.0国际许可协议。摘要目的:抗生素不合理使用是导致抗生素耐药的重大全球性卫生保健问题。在土耳其和许多其他国家,牙科中基于人群的抗生素处方数据尚未得到广泛研究。本研究旨在通过使用基于人口的数据来描述土耳其牙医的抗生素处方态度。材料和方法:回顾性收集2013年1月1日至2015年8月31日期间牙医向土耳其药品和医疗器械管理局处方信息系统开具的全身性抗生素处方数据。结果:处方含抗生素率为82.4%。单处方总药品数为2.18种,单处方总抗生素数为1.01种。女性(53.8%)和成人(73.5%)使用抗生素较多。根据世界卫生组织解剖治疗化学(ATC)-3分析,“J01C、β -内酰胺类抗菌药、青霉素”是最常用的处方药物(71.3%)。在ATC-4亚组分析中,“J01CR、青霉素联合用药,包括β -内酰胺酶抑制剂”是最常用的处方药物(60.9%)。在ATC-5亚组分析中,“J01CR02、阿莫西林和酶抑制剂”是最常用的处方药物(57.6%),其次是“J01FA02、螺旋霉素”(10.7%)。甲硝唑通常用于治疗牙齿感染,但土耳其牙医并不经常开这种药。相反,螺旋霉素的使用频率比预期的要高。结论:目前的数据显示土耳其牙医的抗生素处方率很高。土耳其牙医更喜欢开广谱抗生素。这一极高的处方率反映了土耳其牙医对抗生素的不合理使用。牙医需要进行合理使用抗生素的培训,以降低处方率。
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引用次数: 4
Ombitasvir/ Paritaprevir/ Ritonavir + Ribavirin Combination Therapy in Hepatitis C Virus Infected Patients with Genotype 4 in Real-life Practice: A Multicentre Experience 奥姆比他韦/帕利他韦/利托那韦+利巴韦林联合治疗基因4型丙型肝炎病毒感染患者的现实实践:多中心经验
Pub Date : 2019-10-07 DOI: 10.36519/idcm.2019.19014
B. Aygen, N. Demirtürk, Orhan Yıldız, I. Çelik, Deniz Kamalak, G. Ersöz, A. Batırel, B. Ormen, F. Karakeçili, P. Korkmaz, N. Tuna, A. Şener, R. Çetinkaya, Emine Türkoğlu, Güliz Evik, N. Türker, U. Binay, E. Yenilmez, G. Zararsiz
Objective: Objective: Ombitasvir/paritaprevir/ritonavir (OMV/PTV/r) + ribavirin (RBV) combination improved the efficacy, safety, and tolerability of the treatment of chronic hepatitis C virus (HCV) genotype 4 infection. We described the effectiveness and safety of OMV/PTV/r + RBV therapy in patients with genotype 4 infection. Materials and Methods: In this prospective cohort study, HCV genotype 4-infected patients treated with OMV/PTV/r + RBV (n=55) who were registered in a national database were included. Study patients were treatment-naïve or interferon plus RBV-experienced with or without compensated cirrhosis. Demographic, clinical and virological data were analyzed. Details of clinical and laboratory adverse events (AEs) were recorded. Results: The mean age of the patients was 55.2, and 52.7% were male. The majority of patients were non-cirrhotic (81.8%), and 69.1% were treatment-naïve. The HCV RNA level was below 800.000 IU/mL in 16 of the cases. Seventy-eight percent of the patients had an underlying disease. SVR12 rate was 98% in all patients. One patient had virological failure. HCV RNA was undetectable at treatment week 4 in 77.6%, at treatment week 8 in 100%, and at end of treatment in 98%. The SVR12 rates were 100% and 88.9% for those without or with compensated cirrhosis (p= 0.176). Rates of AEs and AEsassociated treatment discontinuation were 69.1% and 3.6% in the patients, respectively. Conclusion: The OBV/PTV/r + RBV combination was found to have high efficacy and safety profile in the patients with chronic HCV genotype 4 infection. This work is licensed under a Creative Commons Attribution-Non Commercial 4.0 International License. 98 Treatment of Chronic HCV Genotype 4 Infection Aygen et al. INTRODUCTION A bout 170-200 million people are known to be infected with the hepatitis C virus (HCV) worldwide. Chronic hepatitis C (CHC) infection carries risks of hepatic fibrosis, cirrhosis, portal hypertension, liver failure, and hepatocellular carcinoma (HCC) (1-4). Chronic HCV infection is an important health problem in Turkey (5-10). In Turkey, among HCV infections, genotype 1b was reported to be the most common one (90%), while types 2, 3, and 4 exist, with lower prevalence. However, recently, there has been an increase in HCV genotype 4 infections in Turkey (9-13). Two studies from Kayseri reported an unusually high proportion of genotype 4 infections reaching up to 35% among the patients, who were admitted to the hospitals for treatment of CHC (14, 15). This high proportion was significantly higher than the average prevalence of 1.4% reported for type 4 HCV infections in Turkey (15). It was shown recently that Kayseri genotype 4 isolates were closely related to subtype 4d sequences (13, 16). There are several different treatment approaches for HCV genotype 4 infection. By the combination therapy of pegylated interferon (PegINF) and ribavirin (RBV), the sustained virological response (SVR) rate was 60% in patients infected with HCV g
目的:目的:Ombitasvir/paritaprevir/ritonavir (OMV/PTV/r) +利巴韦林(RBV)联合治疗慢性丙型肝炎病毒(HCV)基因4型感染的疗效、安全性和耐受性提高。我们描述了OMV/PTV/r + RBV治疗基因4型感染患者的有效性和安全性。材料和方法:在这项前瞻性队列研究中,纳入了在国家数据库中登记的接受OMV/PTV/r + RBV治疗的HCV基因型4感染患者(n=55)。研究患者为treatment-naïve或干扰素+ rbv,伴有或不伴有代偿性肝硬化。对人口学、临床和病毒学资料进行分析。详细记录临床和实验室不良事件(ae)。结果:患者平均年龄为55.2岁,男性占52.7%。大多数患者为非肝硬化(81.8%),69.1%为treatment-naïve。16例HCV RNA水平低于800.000 IU/mL。78%的患者有潜在疾病。所有患者的SVR12率为98%。一名患者出现病毒学失败。77.6%的患者在治疗第4周检测不到HCV RNA, 100%的患者在治疗第8周检测不到,98%的患者在治疗结束时检测不到HCV RNA。无代偿性肝硬化或代偿性肝硬化患者的SVR12率分别为100%和88.9% (p= 0.176)。ae和aesa相关治疗的停药率分别为69.1%和3.6%。结论:OBV/PTV/r + RBV联合治疗慢性HCV基因型4感染患者具有较高的疗效和安全性。本作品采用知识共享署名-非商业4.0国际许可协议授权。全世界已知约有1.7 -2亿人感染丙型肝炎病毒(HCV)。慢性丙型肝炎(CHC)感染有肝纤维化、肝硬化、门脉高压、肝功能衰竭和肝细胞癌(HCC)的风险(1-4)。慢性丙型肝炎病毒感染是土耳其的一个重要健康问题(5-10)。在土耳其,在HCV感染中,基因1b型报告为最常见的一种(90%),而2、3和4型也存在,患病率较低。然而,最近,土耳其的HCV基因型4感染有所增加(9-13)。来自开塞利的两项研究报告称,在因CHC入院治疗的患者中,基因4型感染的比例异常高,高达35%(14,15)。这一高比例显著高于土耳其报告的4型HCV感染的平均患病率1.4%(15)。最近有研究表明,Kayseri基因型4分离株与4d亚型序列密切相关(13,16)。HCV基因型4感染有几种不同的治疗方法。通过聚乙二醇化干扰素(PegINF)和利巴韦林(RBV)联合治疗,HCV基因型4感染患者的持续病毒学应答(SVR)率为60%(17)。第一代蛋白酶抑制剂联合PegINF和RBV在HCV基因型4感染患者中的应答率较低,而且这些方案的特点是安全性较差,这影响了对PegINF为基础的治疗的依从性(7,11,12)。新型无if的第二代直接作用抗病毒药物(DAAs)由ombitasvir (OBV)/paritaprevir (PTV)/ritonavir (r)±dasabuvir (DSV)±RBV组成,提高了治疗慢性HCV感染的疗效、安全性和耐受性。该组合不仅对基因1型有效,对基因4型也有效。基因4型感染患者推荐采用OBV/PTV/r + RBV联合治疗,在临床和实际试验中也导致了较高的SVR率(18-22)。其中三种药物针对HCV病毒生命周期的不同阶段。其中两种为蛋白酶抑制剂:OBV抑制参与病毒组装的病毒NS5A磷酸化蛋白,PTV抑制参与蛋白水解加工的病毒NS3-4A丝氨酸蛋白酶。此外,利托那韦增强了PTV的药代动力学特性,通过改善药物暴露增加了它们的可用性(23)。我们的目的是在实际临床实践中评估OMV/ PTV/r + RBV联合治疗基因4型感染患者的有效性和安全性。研究对象为年龄大于18岁、慢性HCV基因型4感染、treatment-naïve或既往接受过PegINF/RBV治疗、慢性肝炎或代偿性肝硬化的患者。排除基因型非4型HCV感染、Child-Pugh B级或C级失代偿性肝硬化、HCC证据、根据制造商推荐的禁忌用药、当前妊娠、哺乳期和血小板计数<25.000/mm3的患者。
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引用次数: 2
The Knowledge, Attitudes and Beliefs of the Healthcare Workers about Influenza Infection and Vaccination at a Public Hospital in Turkey 土耳其一家公立医院医护人员对流感感染和疫苗接种的知识、态度和信念
Pub Date : 2019-10-07 DOI: 10.36519/idcm.2019.19013
Ezgi Gulten, Deniz Ozer Turk, A. Erol, C. Ozel
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引用次数: 3
期刊
European Journal of Clinical Microbiology and Infectious Diseases
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