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Letter Medical Education During the Covid-19 Pandemic: Experience From a Newly Established Medical School(Springer india, 2020) Tulek, Necla; Gonullu, Ugur[No Abstract Available]Article Citation - Scopus: 1Impact of the COVID-19 Pandemic on Diabetic Foot Patients A Shift in the Infectious Agent Profile Toward Nonfermentative(Amer Podiatric Med Assoc, 2024) Acar, Ali; Saltoglu, Nese; Tulek, Necla; Turha, Ozge; Nazliserin, Elif; Yapar, Derya; Kaya, Sibel Dogan; Turhan, Özge; Serin, Elif Nazlı; Saltoğglu, NesşeBackground: Diabetes foot infection is a very important public health problem that causes serious health problems, mortality, and high health expenditures, and is one of the most important complications of diabetes mellitus. There are concerns that approaches such as limited personal visits to doctors, avoidance of hospitals, and restrictions on nonemergency surgical procedures during the coronavirus disease of 2019 pandemic pose a threat to those with diabetic foot problems, including diabetic foot ulcers (DFUs), ischemia, and infection, resulting in increased limb loss and mortality. Methods: This multicenter, retrospective, cross-sectional study was conducted in 14 tertiary care hospitals from various regions of Turkey. A total of 1,394 patient records were evaluated, 794 of which were between January 1, 2019, and January 30, 2020 (prepandemic [Pre-P]), and 605 of which were between February 1, 2020, and February 28, 2021 (pandemic period [PP]). Results: During the PP, diabetic foot patient follow-up decreased by 23.8%. In addition, the number of hospitalizations attributable to DFU has decreased significantly during the PP (P = .035). There was no difference between the groups regarding patient demographics, medical history, DFU severity, biochemical and radiologic findings, or comorbidities, but the mean duration of diabetes mellitus years was longer in patients in the Pre-P than in those in the PP (15.1 years versus 13.7 years). There was no difference between the two groups in terms of major complications such as limb loss and mortality, but infection recurrence was higher in the PP than in the Pre-P (12.9% versus 11.4%; P < .05). The prevalence of nonfermentative gram-negative bacteria as causative agents in DFU infections increased during the PP. In particular, the prevalence of carbapenem-resistant Pseudomonas spp. increased statistically during the PP. Conclusions: The rapid adaptation to the pandemic with the measures and changes developed by the multidisciplinary diabetic foot care committees may be the reasons why there was no increase in complications because of DFU during the pandemic in Turkey.Article Citation - WoS: 11Citation - Scopus: 11Impact of Vaccination on the Presence and Severity of Symptoms in Hospitalized Patients With an Infection of the Omicron Variant (b.1.1.529) of the Sars-Cov (subvariant Ba.1)(Elsevier Sci Ltd, 2023) Beraud, Guillaume; Bouetard, Laura; Civljak, Rok; Michon, Jocelyn; Tulek, Necla; Lejeune, Sophie; Epaulard, OlivierObjectives: The emergence of SARS-CoV-2 variants raised questions about the extent to which vaccines designed in 2020 have remained effective. We aimed to assess whether vaccine status was associated with the severity of Omicron SARS-CoV-2 infection in hospitalized patients.Methods: We conducted an international, multi-centric, retrospective study in 14 centres (Bulgaria, Croatia, France, and Turkey). We collected data on patients hospitalized for >= 24 hours between 1 December 2021 and 3 March 2022 with PCR-confirmed infection at a time of exclusive Omicron circu-lation and hospitalization related or not related to the infection. Patients who had received prophylaxis by monoclonal antibodies were excluded. Patients were considered fully vaccinated if they had received at least two injections of either mRNA and/or ChAdOx1-S or one injection of Ad26.CoV2-S vaccines. Results: Among 1215 patients (median age, 73.0 years; interquartile range, 57.0-84.0; 51.3% men), 746 (61.4%) were fully vaccinated. In multivariate analysis, being vaccinated was associated with lower 28 -day mortality (Odds Ratio [95% Confidence Interval] (OR [95CI]) = 0.50 [0.32-0.77]), intensive care unit admission (OR [95CI] = 0.40 [0.26-0.62]), and oxygen requirement (OR [95CI] = 0.34 [0.25-0.46]), independent of age and comorbidities. When co-analysing these patients with Omicron infection with 948 patients with Delta infection from a study we recently conducted, Omicron infection was associated with lower 28-day mortality (OR [95CI] = 0.53 [0.37-0.76]), intensive care unit admission (OR [95CI] = 0.19 [0.12-0.28]), and oxygen requirements (OR [95CI] = 0.50 [0.38-0.67]), independent of age, comorbidities, and vaccination status.Discussion: Originally designed vaccines have remained effective on the severity of Omicron SARS-CoV-2 infection. Omicron is associated with a lower risk of severe forms, independent of vaccination and pa-tient characteristics. Guillaume Beraud, Clin Microbiol Infect 2023;29:642 (c) 2022 The Author(s). Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).Article Citation - WoS: 1Retrospective Evaluation of Potential Rabies Exposure Cases Over Nine Years: Single-Center Experience(Bilimsel Tip Yayinevi, 2024) Demircan, Serife Altun; Kilic, Esra Kaya; Tulek, Necla; Kinikli, Sami; Bulut, CemalIntroduction: T & uuml;rkiye is the only European country where suspected rabies exposure from animal contact is a significant public health concern. In this study, we evaluate cases investigated in our vaccination center, where individuals with suspected rabies exposure have been seeking consultation for many years. The evaluation encompasses demographic characteristics, distribution by years and seasons, the type of animal involved in the contact, the prevalence of stray animals, and the rabies vaccination status of owned animals. Materials and Methods: The study involves cases reported to the Public Health Center from those who sought consultation at our center between January 1, 2011, and December 31, 2019. Demographic characteristics, distribution by years and seasons, the type of animal involved in the contact, the prevalence of stray animals, and the rabies vaccination status of owned animals were retrospectively evaluated. Results: Over the nine years, there were a total of 39.731 cases, resulting in an average of 4414 cases per year. Of these cases, 61% were male, and 68.83% were between the ages of 15 and 64. The most cases occurred in summer and autumn. Of the suspected rabies contacts, 69% involved dogs, and 83.4% of these dogs were unowned. Forty-one point eight percent of the owned dogs were vaccinated. Eighty-nine point six percent of the cats were unowned, and the rate of vaccination among the owned cats was 28.2%. Over the years, there has been a decrease in the use of the 10 -day observation approach, while an increase in the administration of rabies vaccine and/or immunoglobulin has been observed. Conclusion: Seventy percent of all risky rabies contacts involve dogs, with a high rate of 84% of these dogs being unowned. To mitigate contact involving the risk of rabies, addressing the uncontrolled reproduction of stray animals, particularly dogs, and ensuring control and vaccination of the existing animal population appear to be primary measures. Improving the vaccination rate of owned animals, currently at only 30-40%, can prevent people from encountering risky rabies contacts, thereby potentially reducing the need for rabies prophylaxis significantly.Article Investigation of Tetanus Seropositivity Levels in Adult Patients with Rabies Risk Exposure Admitted To a Hospital in Ankara(J Infection Developing Countries, 2025) Gurkaynak, Pinar; Demircan, Serife A.; Tulek, Necla; Kinikli, Sami; Erdinc, Fatma S.; Tuncer, GunayIntroduction: This study aimed to assess tetanus seropositivity levels among adult patients admitted to a tertiary care hospital following rabies risk exposure, and to explore potential factors influencing their immunological status. Methodology: This cross-sectional descriptive epidemiological study included 182 adult individuals (68 females and 114 males) who presented to the hospital following rabies risk exposure. The demographic data was collected during a face-to-face interview, and the tetanus antibody concentrations were assessed using a micro-enzyme-linked immunosorbent assay (ELISA) kit. Serum antibody levels of >= 0.1 IU/mL were defined as "seropositive", while values below this threshold were considered "seronegative". Results: Seropositivity was identified in 81.9% of the patients. There was a significant decline in antibody levels with age (p < 0.001). The Spearman correlation analysis showed a moderately significant negative correlation between age and antibody titers (r = - 0.404, p < 0.001). In addition, there were significantly higher tetanus antibody levels in patients from urban areas, those vaccinated during pregnancy, and those vaccinated within the past 10 years (p = 0.025, 0.036, and 0.013, respectively). Conclusions: Overall, the results highlight a reduction in tetanus antibody levels with age, emphasizing the importance of receiving a booster dose every 10 years. In addition, rabies risk exposure, particularly in older adults, presents a valuable opportunity to administer tetanus vaccination.Editorial Photo Quiz; Anthrax or Orf?(Doc design informatics Co Ltd, 2019) Tulek, Necla; Kilic, Esra Kaya; Ertem, GunayTuncer; Yuksekkaya, Esra[No Abstract Available]Article The Effect Of Constructivist Training On The Rate Of Catheter-Associated Urinary Tract Infections in The Intensive Care Unit(Anestezi Dergisi, 2025) Yarimoglu, Saliha; Erdinç, Fatma Şebnem; Kaymak, Çetin; Tulek, Eren, N.; Basa̧r, Hulya; Tuncer-Ertem, Günay,; Kinikli, Sami; Tulek, Necla; Ertem, Gunay TuncerObjective: Catheter-associated urinary tract infections (CA-UTIs) are common healthcare-associated infections. Constructivist training is based on integrating new knowledge with previously learned knowledge. The aim of this study was to evaluate the effects of constructivist training on the rate of CA-UTIs in the Anesthesia and Reanimation Intensive Care Units (ARICU). Methods: This study was a retrospective-prospective intervention study. Over the period of one month, a total of 62 healthcare staff (seven doctors, 38 nurses, and 17 cleaning staff) working in ARICUs were organized into groups of 4-5 people and received forty-five minutes of constructivist training on preventing CA-UTI. Personnel from each of three ICUs participated in the same number of training sessions. Comparisons were made of the rates of CA-UTI and catheter use in the six-month periods before and after the training. A 4-item questionnaire was administered to the study participants six months after completion of the training. Results: The catheter-associated urinary tract infection rates before and after training were observed to be 8.3 and 8.7 per 1000 catheter days, respectively in ARICU-1, 7.0 and 8.1 per 1000 catheter days in ARICU-2, and 7.3 and 9.9 per 1000 catheter days in ARICU-3. No statistically significant difference was observed in the CA-UTI rate in each unit after constructivist training compared to the pre-training period. The intervention of constructivist training alone did not reduce the CA-UTI rates in the ICUs. According to the results of the survey conducted six months later, 92% of the nurses and 88% of the cleaning staff stated that constructivist training had positive effects. Conclusion: The intervention of constructivisit training alone did not reduce the rates of CA-UTIs in the ARICUs, but an increase was observed in the awareness of ICU nurses and cleaning staff. © 2025 Elsevier B.V., All rights reserved.Article Citation - WoS: 4Citation - Scopus: 3Management of Chronic Hepatitis B in Special Patient Groups: a Consensus Report of the Study Group for Viral Hepatitis of the Turkish Society of Clinical Microbiology and Infectious Diseases-2023(Doc design informatics Co Ltd, 2023) Tekin, Sueda; Karakecili, Faruk; Binay, Umut Devrim; Celik, Ilhami; Tulek, Necla; Tutuncue, Ediz; Demirturk, Nese; Tütüncü, Ediz; Yılmaz, EmelTurkish Society of Clinical Microbiology and Infectious Diseases Viral Hepatitis Working Group updated the consensus report on the management of chronic hepatitis B (CHB) in private hosts and special situations. Relevant literature and international guidelines are reviewed, and agreed recommendations are presented at the end of each chapter. In the report, treatment of hepatitis B virus (HBV) and human immunodeficiency virus (HIV) coinfection, management of HBV and hepatitis C virus (HCV) coinfection, management of CHB in severe COVID-19 patients, non-transplant immunocompromised patients.Conference Object Evaluation of Infectious Diseases in Pregnant Women(Aves, 2020) Ozsoy, Metin; Tulek, Necla; Kinikli, Sami; Erdinc, Fatma Sebnem; Ataman-Hatipoglu, Cigdem; Tuncer-Ertem, Gunay; Cesur, SalihObjective: In this study, we aimed to investigate the infections and their clinical outcomes in pregnant women who were hospitalized with a diagnosis of any infectious disease. Methods: Distribution of bacterial and viral infections in 60 pregnant women who were hospitalized due to any infectious disease between years 2015 and 2018 during a three-year period were evaluated retrospectively. Results: Urinary tract infections (65%) and gastroenteritis (8.3%) were the most common bacterial infections, and human immunodefficiency virus (HIV) infection and chickenpox were most common viral infections. All patients were followed at the inpatient clinic except two patients who had hospitalized in intensive care unit due to influenza and Listeria meningitis. An HIV-positive pregnant woman received zidovudin intrapartum and was followed up later. All the other infections recovered without complications. Conclusions: Urinary tract infection was the most common infectious disease among pregnant women. The necessity of hospitalization due to community-acquired but avoidable and vaccine-preventable diseases verified that informing pregnant women about the prevention of infections and screening them before pregnancy against vaccine-preventable diseases.Article An Evaluation of Flipped Classroom-Based Anatomy Teaching in Medical Students(Springer London Ltd, 2026) Sever, Sinem Nur; Tulek, Necla; Oktem, Hale; Jamil, YusufIntroductionAnatomy education forms a cornerstone of medical curricula, integrating theoretical knowledge with practical understanding. The flipped classroom model, an innovative and interactive pedagogical strategy, has gained increasing attention for promoting active learning, engagement, and long-term knowledge retention. This study aimed to evaluate the impact of the flipped classroom model on learning performance, student engagement, and perceptions of digital learning tools in anatomy education.MethodsA total of 194 second- and third-year medical students participated during the 2024-2025 academic year (94 second-year and 100 third-year students). Flipped classroom sessions focused on the cerebral hemispheres (second year) and the pelvis and perineum (third year). Preparatory materials were provided via Moodle at least 15 days before the sessions. Student performance was assessed through a 20-question formative quiz graded out of 10 marks and related items in the final committee examination. Post-session perceptions were gathered using a 14-item Likert-scale questionnaire. Statistical analyses were performed using the Mann-Whitney U and Wilcoxon Signed-Rank tests.ResultsAverage quiz scores were 8.4 for second-year and 8.3 for third-year students, while committee exam accuracy was 78% and 70.06%, respectively. Over 75% of students reported that the flipped classroom enhanced their understanding and engagement. Significant differences were observed between year groups in enjoyment (p = 0.004) and perceived support for independent learning (p = 0.004). More than 70% agreed that digital anatomy resources improved comprehension and confidence.ConclusionThe flipped classroom model enhances engagement, independent learning, and comprehension in anatomy education. This digitally supported, student-centred approach promotes deeper cognitive involvement and supports the integration of hybrid learning models into future curricula.
