{"id":22942,"date":"2021-07-09T09:40:04","date_gmt":"2021-07-09T06:40:04","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=22942"},"modified":"2021-08-29T20:44:07","modified_gmt":"2021-08-29T17:44:07","slug":"turkiyede-koronavirus-covid-19-pandemisinin-sonumlenme-ongorusu","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2021\/07\/09\/turkiyede-koronavirus-covid-19-pandemisinin-sonumlenme-ongorusu\/","title":{"rendered":"T\u00fcrkiye\u2019de Koronavirus (COVID-19) Pandemisinin S\u00f6n\u00fcmlenme \u00d6ng\u00f6r\u00fcs\u00fc"},"content":{"rendered":"<h2><b>G\u0130R\u0130\u015e<\/b><\/h2>\n<p>\u015eiddetli akut solunum yolu sendromu koronavirusu 2 (SARS-CoV-2), Aral\u0131k 2019\u2019da \u00c7in\u2019de ortaya \u00e7\u0131kan, h\u0131zla t\u00fcm d\u00fcnyaya yay\u0131lan yeni bir pandemi etkenidir. \u0130nfeksiyon etkeni asemptomatik ve semptomatik olgular arac\u0131l\u0131\u011f\u0131 ile yay\u0131l\u0131r. COVID-19\u2019un bula\u015ft\u0131r\u0131c\u0131l\u0131k s\u00fcresi kesin olarak bilinmemektedir. Semptomatik d\u00f6nemden 1-2 g\u00fcn \u00f6nce ba\u015flay\u0131p semptomlar\u0131n kaybolmas\u0131yla sona erdi\u011fi d\u00fc\u015f\u00fcn\u00fclmektedir. Temastan semptom ba\u015flang\u0131c\u0131na kadar ge\u00e7en ortalama s\u00fcre 5 g\u00fcnd\u00fcr ve olgular\u0131n %97.5\u2019inde semptomlar ortalama 11.5 g\u00fcn i\u00e7inde ortaya \u00e7\u0131kar (1).<\/p>\n<p>COVID-19 infeksiyonu genellikle ate\u015f, \u00f6ks\u00fcr\u00fck, nefes darl\u0131\u011f\u0131, miyalji ve \/ veya yorgunlukla kendini g\u00f6sterir ve herhangi bir ya\u015f grubunda g\u00f6r\u00fclebilir (2,3). Hastal\u0131k \u00f6zellikle, ileri ya\u015fta ve komorbid hastal\u0131\u011f\u0131 olanlarda yo\u011fun bak\u0131m \u00fcnitesine (YB\u00dc)<span class=\"Apple-converted-space\">\u00a0 <\/span>yat\u0131\u015f gerektiren ilerleyici solunum yetmezli\u011fine neden olabilir (3). Hastanede yatan COVID-19 hastalar\u0131nda hipertansiyon, kardiyovask\u00fcler hastal\u0131k, diyabet, sigara kullan\u0131m\u0131, kronik obstr\u00fcktif akci\u011fer hastal\u0131\u011f\u0131, kronik b\u00f6brek hastal\u0131\u011f\u0131 ve malignitenin yayg\u0131n altta yatan hastal\u0131klar oldu\u011fu g\u00f6sterilmi\u015ftir (4,5).<span class=\"Apple-converted-space\">\u00a0 <\/span>Hastal\u0131\u011f\u0131n mortalite oran\u0131 %2-5 aras\u0131ndad\u0131r (6).<\/p>\n<p>Rehberler COVID-19 pandemisi s\u0131ras\u0131nda, t\u00fcm elektif ameliyatlar\u0131 ve giri\u015fimleri ertelemeyi \u00f6nermektedir (7). Elektif prosed\u00fcrler ertelenmi\u015f olsa bile, hayati ve acil operasyonlar devam etmektedir. T\u00fcrk Jinekolojik Onkoloji Derne\u011fi ve Amerikan Gastrointestinal ve Endoskopik Cerrahlar Derne\u011fi (Society of American Gastrointestinal and Endoscopic Surgeons \u2013 SAGES)<span class=\"Apple-converted-space\">\u00a0 <\/span>dahil olmak \u00fczere Amerika K\u0131lavuzlar\u0131, hastalar\u0131n operasyon \u00f6ncesi semptomlar\u0131na veya temas durumlar\u0131na bak\u0131lmaks\u0131z\u0131n COVID-19 i\u00e7in test yap\u0131lmas\u0131n\u0131 \u00f6nermektedir (8). \u00dclkeler asemptomatik cerrahi adaylar\u0131n\u0131 test etme konusunda maddi ve sosyal \u015fartlar\u0131na g\u00f6re kararlar alm\u0131\u015ft\u0131r. \u00dclkemizde de baz\u0131 giri\u015fimsel i\u015flemler ve operasyonlar i\u00e7in belirlenmi\u015f kurallar \u00e7er\u00e7evesinde operasyon \u00f6ncesi tarama testi yap\u0131lmaktad\u0131r. Asemptomatik birey oran\u0131n\u0131n saptanmas\u0131 elektif operasyonlara ba\u015flanma s\u00fcresini \u00f6n g\u00f6rme, operasyon \u00f6ncesi tarama testlerinin gereklili\u011fini de\u011ferlendirme ve hasta takip stratejileri geli\u015ftirilmesi a\u00e7\u0131lar\u0131ndan da \u00f6nemlidir. Yap\u0131lan \u00e7al\u0131\u015fmalarda, %4 ile %32 aras\u0131nda de\u011fi\u015fen asemptomatik infeksiyon oranlar\u0131 tan\u0131mlam\u0131\u015f olsa da, ger\u00e7ek oranlar ve bu bireylerin bula\u015ft\u0131r\u0131c\u0131 olup olmad\u0131\u011f\u0131 net de\u011fildir (9\u201311). Asemptomatik bireylerin semptomatik olanlarla ayn\u0131 bula\u015f\u0131c\u0131l\u0131\u011fa sahip oldu\u011funu bildiren \u00e7al\u0131\u015fmalar\u0131n yan\u0131 s\u0131ra, bula\u015ft\u0131r\u0131c\u0131l\u0131\u011f\u0131n daha d\u00fc\u015f\u00fck oldu\u011funu savunan \u00e7al\u0131\u015fmalar da bulunmaktad\u0131r (11).<\/p>\n<p>Kitle ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131, bir pop\u00fclasyonda yeterince b\u00fcy\u00fck oranda ba\u011f\u0131\u015f\u0131kl\u0131k sahibi birey bulundu\u011funda, duyarl\u0131 bireylerin infeksiyondan korunmas\u0131n\u0131 ifade eder. A\u015f\u0131lama programlar\u0131 kitle ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 olu\u015fturmay\u0131 ama\u00e7lar. Ba\u011f\u0131\u015f\u0131k birey say\u0131s\u0131 ne kadar fazla ise, hastal\u0131k yay\u0131lamaz ve prevalans\u0131 azal\u0131r. Duyarl\u0131 bireylerin oran\u0131n\u0131n bula\u015fma i\u00e7in gerekli e\u015fi\u011fin alt\u0131na d\u00fc\u015ft\u00fc\u011f\u00fc nokta, kitle ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 e\u015fi\u011fi (R0) olarak bilinir. R0, tamamen duyarl\u0131 bir pop\u00fclasyona giren tek bir bula\u015f\u0131c\u0131 bireyin neden oldu\u011fu ortalama ikincil infeksiyon say\u0131s\u0131n\u0131 ifade eder. Matematiksel olarak, kitle ba\u011f\u0131\u015f\u0131kl\u0131k e\u015fi\u011fi 1 &#8211; 1 \/ R0 ile tan\u0131mlan\u0131r. R0 de\u011feri patojene, patojenin bula\u015fma h\u0131z\u0131na ve pop\u00fclasyonun \u00f6zelliklerine g\u00f6re de\u011fi\u015fir. Bu de\u011fi\u015fkenlik do\u011fas\u0131 gere\u011fi, kitle ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 e\u015fi\u011finin pop\u00fclasyonlar aras\u0131nda de\u011fi\u015fece\u011fi anlam\u0131na gelir. SARS-CoV-2 yay\u0131lmas\u0131n\u0131n ba\u015flang\u0131c\u0131ndan bu yana, \u00e7e\u015fitli \u00e7al\u0131\u015fmalar R0 de\u011ferinin 2 ila 6 aral\u0131\u011f\u0131nda oldu\u011funu bildirmi\u015ftir (12). SARS-CoV-2 i\u00e7in R0 tahmini olarak 3 varsay\u0131ld\u0131\u011f\u0131nda, kitle ba\u011f\u0131\u015f\u0131kl\u0131k e\u015fi\u011fi yakla\u015f\u0131k %67\u2019dir (13,14).<\/p>\n<p>Literat\u00fcrde asemptomatik pozitiflik oranlar\u0131n\u0131 ara\u015ft\u0131ran ve toplum taramalar\u0131 ile salg\u0131n s\u00f6nme zaman\u0131n\u0131 tespitini ama\u00e7layan \u00e7al\u0131\u015fmalar k\u0131s\u0131tl\u0131d\u0131r. T\u00fcrkiye\u2019de 15 Haziran 2020\u2019de ba\u015flanan 81 ilde 150 000 ki\u015fiyle yap\u0131lan antikor testi \u00e7al\u0131\u015fmalar\u0131 kapsam\u0131nda, rastgele test edilen 1000 ki\u015fiden 2.5\u2019inde test sonucunun pozitif \u00e7\u0131kt\u0131\u011f\u0131 a\u00e7\u0131klanm\u0131\u015ft\u0131r. Koruyuculuk ve ta\u015f\u0131y\u0131c\u0131l\u0131\u011f\u0131n y\u00fcksek olmad\u0131\u011f\u0131n\u0131, salg\u0131n s\u00f6nmesini beklemek i\u00e7in %60-65 oran\u0131n\u0131 bulmak gerekti\u011fi vurgulanm\u0131\u015ft\u0131r (15).<\/p>\n<p>Bu \u00e7al\u0131\u015fma ile asemptomatik bireylerde operasyon veya giri\u015fimsel i\u015flem \u00f6ncesi taranan COVID-19 polimeraz zincir reaksiyonu (PZR) test pozitiflik oran\u0131n\u0131 belirlemek ve bu oran\u0131 toplum taramas\u0131 olarak kabul ederek, toplumda rastlant\u0131sal saptanan COVID-19 infeksiyon y\u00fczdesine dikkat \u00e7ekmek ama\u00e7land\u0131. Ayr\u0131ca elde edilen verilerle pandeminin s\u00f6n\u00fcmlenme zaman\u0131 hakk\u0131nda tahmini bir s\u00fcre belirlenmesi hedeflendi.<\/p>\n<h2><b>Y\u00d6NTEM<\/b><\/h2>\n<h3><b>\u00c7al\u0131\u015fma Plan\u0131 ve Hasta Se\u00e7imi<\/b><\/h3>\n<p>\u00c7al\u0131\u015fma Erciyes \u00dcniversitesi Hastaneleri\u2019nde, retrospektif epidemiyolojik \u00e7al\u0131\u015fma olarak planland\u0131. 1 Temmuz &#8211; 31 Ekim 2020 tarihleri aras\u0131nda her hangi bir<span class=\"Apple-converted-space\">\u00a0 <\/span>infeksiyon klini\u011fi olmayan, operasyon ve giri\u015fimsel i\u015flem \u00f6ncesi COVID-19 PZR testi g\u00f6nderilen, 18 ya\u015f \u00fcst\u00fc t\u00fcm hastalar \u00e7al\u0131\u015fmaya dahil edildi. Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 sitesindeki olgu g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131na bak\u0131lmaks\u0131z\u0131n, PZR testi \u00f6nerilen poliklinik ya da klinik hastalar\u0131 \u00e7al\u0131\u015fmaya dahil edildi.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<h3><b>Veri Toplanmas\u0131<span class=\"Apple-converted-space\">\u00a0<\/span><\/b><\/h3>\n<p>Hastalar\u0131n kimlik bilgileri<span class=\"Apple-converted-space\">\u00a0 <\/span>ve preoperatif PZR taramas\u0131 i\u00e7in yap\u0131lacak olan i\u015flem t\u00fcr\u00fc Halk Sa\u011fl\u0131\u011f\u0131 Bilgi Sistemi kay\u0131tlar\u0131ndan elde edildi. Hastalar\u0131n demografik verileri, komorbid hastal\u0131klar\u0131 ve klinik seyirlerine hastane bilgi sisteminden ula\u015f\u0131ld\u0131.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<h3><b>Laboratuvar Prosed\u00fcrleri<\/b><\/h3>\n<p>SARS-CoV-2 testi i\u00e7in kombine bo\u011faz ve burun s\u00fcr\u00fcnt\u00fcs\u00fc \u00f6rnekleri al\u0131nd\u0131. E\u011fitimli personel taraf\u0131ndan nazofaringeyal \/ orofaringeyal s\u00fcr\u00fcnt\u00fcleri al\u0131narak viral ta\u015f\u0131ma besiyeri ile transfer edildi. Bu \u00f6rneklerden SARS \u2013 CoV \u2013 2 RNA\u2019s\u0131, \u00fcreticinin protokollerine g\u00f6re Biospeedy COVID \u2013 19 RT \u2013 PCR kiti (Bioeksen Ar-Ge Teknolojileri Ltd., T\u00fcrkiye Cumhuriyeti Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131, \u0130stanbul, T\u00fcrkiye) kullan\u0131larak belirlendi. T\u00fcm testler Roto \u2013 Gene Platformu (Qiagen, Hilden, Almanya) ile yap\u0131ld\u0131.<\/p>\n<h3><b>PZR Taramas\u0131 Yap\u0131lan Hastalar<\/b><\/h3>\n<p>Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 Rehberi \u00f6nerileri do\u011frultusunda a\u015fa\u011f\u0131daki durumlarda son 14 g\u00fcndeki yeni olgu g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131na bak\u0131lmaks\u0131z\u0131n i\u015flem \u00f6ncesi PZR testi yap\u0131ld\u0131 (16):<\/p>\n<ul>\n<li>Kemoterapi ve radyoterapi uygulanacak hastalar<span class=\"Apple-converted-space\">\u00a0<\/span><\/li>\n<li>Transplantasyon yap\u0131lacak hastalar<span class=\"Apple-converted-space\">\u00a0<\/span><\/li>\n<li>Son 3 ay i\u00e7erisinde &gt;15 mg prednisolon veya e\u015fde\u011feri glukokortikoid ve\/veya imm\u00fcnos\u00fcpresif etkili k\u00fc\u00e7\u00fck molek\u00fcl veya biyolojik ajan kullanacak hastalar<span class=\"Apple-converted-space\">\u00a0<\/span><\/li>\n<li>T\u00fcm cerrahi bran\u015flar\u0131n A grubu operasyonlar\u0131 gereken hastalar<\/li>\n<li>Plastik cerrahinin ve kulak-burun-bo\u011faz b\u00f6l\u00fcmlerinin ba\u015f boyun operasyonu gerektiren hastalar<span class=\"Apple-converted-space\">\u00a0<\/span><\/li>\n<li>Kalp cerrahisinde kardiyopulmoner pompaya girmeyi gerektiren t\u00fcm hastalar<span class=\"Apple-converted-space\">\u00a0<\/span><\/li>\n<li>G\u00f6\u011f\u00fcs cerrahisi gerektiren hastalar<\/li>\n<li>\u00c7ene cerrahisi yap\u0131lacak hastalar<span class=\"Apple-converted-space\">\u00a0<\/span><\/li>\n<li>Hava yolu cerrahisi yap\u0131lacak hastalar<span class=\"Apple-converted-space\">\u00a0<\/span><\/li>\n<li>Kanser cerrahisi yap\u0131lacak hastalar<\/li>\n<li>ASA (American Society of Anesthesiologists) skoru 3 ve \u00fczerinde olan, genel anestezi gerektiren hastalar.<\/li>\n<\/ul>\n<p>Kombine nazal ve bo\u011faz s\u00fcr\u00fcnt\u00fc \u00f6rne\u011finde COVID-19 PZR sonucu pozitif geldi\u011fi d\u00f6nemde, hastanede yatan hastalar infeksiyon hastal\u0131klar\u0131 hekimi taraf\u0131ndan de\u011ferlendirildi ve tedavileri d\u00fczenlendi. Rehber \u00f6nerileri do\u011frultusunda klini\u011fin a\u011f\u0131r seyredece\u011fi d\u00fc\u015f\u00fcn\u00fclen hastalar ya da takipte klinik geli\u015fen, ba\u015fka sebeplerden hastanede yatmas\u0131 gereken hastalar\u0131n yat\u0131r\u0131lmas\u0131na devam edildi. Klinik de\u011ferlendirmeler sonras\u0131 yat\u0131\u015f gerekmeyen hastalar tedavi ve tedbir \u00f6nerileri ile taburcu edildi. Polikliniklerden g\u00f6nderilen \u00f6rneklerde PZR testi pozitif \u00e7\u0131kan hastalar filyasyon ekipleri taraf\u0131ndan de\u011ferlendirilerek tedavileri d\u00fczenlendi.<\/p>\n<p>Temmuz- Ekim 2020 tarihleri aras\u0131nda bak\u0131lan COVID-19 PZR pozitiflik oranlar\u0131n\u0131n genel toplum insidans\u0131n\u0131 yans\u0131tt\u0131\u011f\u0131 ve pozitiflik s\u00fcresinin ortalama 20 g\u00fcn s\u00fcrd\u00fc\u011f\u00fc kabul edilerek, 20\u2019\u015fer g\u00fcnl\u00fck periyotlarda COVID-19 ba\u011f\u0131\u015f\u0131kl\u0131k prevalans\u0131 belirlendi (17,18).<\/p>\n<p>COVID-19\u2019a kar\u015f\u0131 kitle ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131n\u0131n ger\u00e7ekle\u015fmesi i\u00e7in toplumun hastal\u0131\u011fa yakalanma oran\u0131 %67 olarak kabul edildi (14,15). COVID-19 PZR pozitifli\u011finin s\u00fcresi ortalama 20 g\u00fcn olarak istatistiksel hesaplamaya dahil edildi. T\u00fcrkiye\u2019de Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 verilerine g\u00f6re 2020 y\u0131l\u0131nda her biri ortalama 70 g\u00fcn s\u00fcren iki COVID-19 piki ya\u015fand\u0131 (19).<span class=\"Apple-converted-space\">\u00a0 <\/span>COVID-19\u2019a ba\u011fl\u0131 birinci pikin Nisan 2020 olmas\u0131 nedeniyle 20 g\u00fcnl\u00fck periyodlar\u0131n ba\u015flang\u0131\u00e7 tarihi 1 Nisan 2020 olarak kabul edildi. \u00c7al\u0131\u015fmaya al\u0131nan hastalar pikin ya\u015fand\u0131\u011f\u0131 ve ya\u015fanmad\u0131\u011f\u0131 d\u00f6nemlerde olmalar\u0131na g\u00f6re iki gruba ayr\u0131ld\u0131 ve ayr\u0131 ayr\u0131 COVID-19 PZR pozitiflik oranlar\u0131 belirlendi. \u0130leriye d\u00f6n\u00fck olarak 2021 y\u0131l\u0131nda pik ger\u00e7ekle\u015fmeyece\u011fi, bir veya iki pik ger\u00e7ekle\u015fece\u011fi \u00f6ng\u00f6r\u00fclerine g\u00f6re \u00fc\u00e7 farkl\u0131 senaryoda kitle ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131na ula\u015fma s\u00fcreleri hesapland\u0131.<\/p>\n<p>Operasyon ve giri\u015fimsel i\u015flem \u00f6ncesi PZR testi yap\u0131lan, PZR testi pozitif olan veya olmayan hastalar aras\u0131ndaki demografik veriler, uygulanmas\u0131 planlanan i\u015flem ve<span class=\"Apple-converted-space\">\u00a0 <\/span>operasyon t\u00fcr\u00fc, komorbid hastal\u0131klar a\u00e7\u0131s\u0131ndan fark olup olmad\u0131\u011f\u0131 ara\u015ft\u0131r\u0131ld\u0131. Ayr\u0131ca PZR testi pozitif olan hastalarda hastaneye yat\u0131\u015f gereken ve ayaktan takip edilen hastalar aras\u0131nda da ayn\u0131<span class=\"Apple-converted-space\">\u00a0 <\/span>parametreler<span class=\"Apple-converted-space\">\u00a0 <\/span>a\u00e7\u0131s\u0131ndan kar\u015f\u0131la\u015ft\u0131rma yap\u0131ld\u0131.<\/p>\n<h3><b>\u0130statistiksel Analiz<\/b><\/h3>\n<p>Veri normalli\u011fini de\u011ferlendirmek i\u00e7in histogram, Q-Q grafikleri ve Shapiro-Wilk testi kullan\u0131ld\u0131. Varyans homojenli\u011fini test etmek i\u00e7in Levene testi uygulanm\u0131\u015ft\u0131r. Gruplar aras\u0131ndaki farklar\u0131 kar\u015f\u0131la\u015ft\u0131rmak amac\u0131yla s\u00fcrekli de\u011fi\u015fkenler i\u00e7in iki tarafl\u0131 ba\u011f\u0131ms\u0131z \u00f6rneklemler t testi, kategorik de\u011fi\u015fkenler i\u00e7in Pearson ki-kare analizi veya Fisher\u2019s exact testi kullan\u0131ld\u0131. Bu hipotez testlerinin sonu\u00e7lar\u0131 n (%) veya ortalama ve standart sapma olarak \u00f6zetlendi. Analizler TURCOSA (<a href=\"https:\/\/turcosa.com.tr\">Turcosa Analitik \u00c7\u00f6z\u00fcmler Ltd. \u015eti.,T\u00fcrkiye<\/a>) istatistik yaz\u0131l\u0131m\u0131 kullan\u0131larak yap\u0131ld\u0131. %5\u2019in alt\u0131ndaki <em>P<\/em> de\u011feri istatistiksel olarak anlaml\u0131 kabul edildi.<\/p>\n<h2><b>BULGULAR<\/b><\/h2>\n<p>\u00c7al\u0131\u015fmaya bir operasyon veya giri\u015fimsel i\u015flem \u00f6ncesi COVID-19 i\u00e7in PZR testi taramas\u0131 yap\u0131lan 1067 hasta dahil edildi. Hastalar\u0131n 55 (%5.14)\u2019inde PZR pozitifli\u011fi saptand\u0131. PZR pozitif ve negatif olan hastalar\u0131n demografik verileri, operasyon t\u00fcrleri ve komorbiditelerinin kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131 Tablo1\u2019de g\u00f6sterildi. Hastalar\u0131n ya\u015f ortancas\u0131 54.1 (18-94) y\u0131ld\u0131 ve %59.8\u2019i erkekti. PZR<\/p>\n<div id=\"attachment_23404\" style=\"width: 2195px\" class=\"wp-caption alignright\"><a href=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/07\/KD.C34.S2_3704_Tablo1.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-23404\" class=\"wp-image-23404 size-full\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/07\/KD.C34.S2_3704_Tablo1.png\" alt=\"\" width=\"2185\" height=\"1921\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/07\/KD.C34.S2_3704_Tablo1.png 2185w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/07\/KD.C34.S2_3704_Tablo1-296x260.png 296w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/07\/KD.C34.S2_3704_Tablo1-614x540.png 614w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/07\/KD.C34.S2_3704_Tablo1-768x675.png 768w\" sizes=\"auto, (max-width: 2185px) 100vw, 2185px\" \/><\/a><p id=\"caption-attachment-23404\" class=\"wp-caption-text\"><strong>Tablo 1.<\/strong> Hastalar\u0131n Demografik Verileri ve PZR Sonucuna G\u00f6re Kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131<\/p><\/div>\n<p>pozitif ve negatif hastalar aras\u0131nda ya\u015f ve cinsiyet a\u00e7\u0131s\u0131ndan anlaml\u0131 fark izlenmedi. Operasyon t\u00fcrlerine g\u00f6re da\u011f\u0131l\u0131m\u0131 yap\u0131ld\u0131\u011f\u0131nda 767 hastaya (%71.9) operasyon \u00f6ncesi ve 300 hastaya (%28.1) giri\u015fimsel i\u015flem \u00f6ncesi PZR taramas\u0131 yap\u0131lm\u0131\u015ft\u0131. En s\u0131k yap\u0131lan i\u015flemler s\u0131ras\u0131 ile %32.1 A grubu operasyonlar, %17.1 ba\u015f-boyun cerrahisi, %13.9 g\u00f6\u011f\u00fcs cerrahisi ve kalp damar cerrahisi operasyonlar\u0131 idi. PZR pozitif hastalarda giri\u015fimsel i\u015flem \u00f6ncesi testlerin oran\u0131 PZR negatiflere g\u00f6re daha y\u00fcksekti (%47.3\u2019ye %27.1) (p=0.001). Bronkoskopi\/endoskopi \u00f6ncesi test oran\u0131 PZR pozitif hastalarda daha y\u00fcksekti (p&lt;0.001). Bu \u00e7al\u0131\u015fmaya dahil edilen hastalar\u0131n %56.1\u2018inde en az bir kronik hastal\u0131k mevcuttu ve en s\u0131k g\u00f6r\u00fclen komorbid hastal\u0131klar malignite (%28.2), hipertansiyon (%15.7) ve diyabet (%12) idi. Komorbid hastal\u0131k varl\u0131\u011f\u0131 ve hastal\u0131klar\u0131n t\u00fcrlerine g\u00f6re PZR pozitif ve negatif hastalar aras\u0131nda anlaml\u0131 fark izlenmedi.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p>Bu \u00e7al\u0131\u015fmada PZR pozitif saptanan ve izlemeye al\u0131nan 55 hastan\u0131n 22 (%40)\u2019sinde<span class=\"Apple-converted-space\">\u00a0 <\/span>COVID-19 semptomlar\u0131 geli\u015fti ve hastaneye yat\u0131r\u0131larak tedavi edildi. Otuz \u00fc\u00e7 hasta ise tedavi ve evde karantina \u00f6nerileri ile bulunduklar\u0131 kliniklerden taburcu edildi. Hastanede yatan veya evde izolasyon \u00f6nerilen hastalar\u0131n kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131 Tablo 2\u2019de g\u00f6sterildi. Buna g\u00f6re hastanede yatan hastalar\u0131n ya\u015f ortancas\u0131, erkek cinsiyet oran\u0131 ve komorbid hastal\u0131k varl\u0131\u011f\u0131 ayakta takip edilen hastalardan daha y\u00fcksekti. Ancak demografik veriler, komorbid hastal\u0131klar ve operasyon t\u00fcrleri a\u00e7\u0131s\u0131ndan gruplar aras\u0131nda anlaml\u0131 fark izlenmedi (Tablo 2).<\/p>\n<div id=\"attachment_23406\" style=\"width: 2196px\" class=\"wp-caption alignright\"><a href=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/07\/KD.C34.S2_3704_Tablo2.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-23406\" class=\"wp-image-23406 size-full\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/07\/KD.C34.S2_3704_Tablo2.png\" alt=\"\" width=\"2186\" height=\"1779\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/07\/KD.C34.S2_3704_Tablo2.png 2186w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/07\/KD.C34.S2_3704_Tablo2-319x260.png 319w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/07\/KD.C34.S2_3704_Tablo2-664x540.png 664w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/07\/KD.C34.S2_3704_Tablo2-768x625.png 768w\" sizes=\"auto, (max-width: 2186px) 100vw, 2186px\" \/><\/a><p id=\"caption-attachment-23406\" class=\"wp-caption-text\"><strong>Tablo 2.<\/strong> PZR Pozitif Olan Hastalar\u0131n Hastanede Yat\u0131\u015f Durumuna G\u00f6re De\u011fi\u015fkenlerin Kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131<\/p><\/div>\n<div id=\"attachment_23000\" style=\"width: 2192px\" class=\"wp-caption alignright\"><a href=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/06\/kd.2021.3704_Sekil_1.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-23000\" class=\"wp-image-23000 size-full\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/06\/kd.2021.3704_Sekil_1.png\" alt=\"\" width=\"2182\" height=\"2783\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/06\/kd.2021.3704_Sekil_1.png 2182w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/06\/kd.2021.3704_Sekil_1-204x260.png 204w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/06\/kd.2021.3704_Sekil_1-423x540.png 423w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/06\/kd.2021.3704_Sekil_1-768x980.png 768w\" sizes=\"auto, (max-width: 2182px) 100vw, 2182px\" \/><\/a><p id=\"caption-attachment-23000\" class=\"wp-caption-text\"><strong>\u015eekil 1.<\/strong> 2021 y\u0131l\u0131nda COVID-19 piki<\/p><\/div>\n<p>T\u00fcrkiye\u2019de Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 verilerine g\u00f6re Nisan-May\u0131s ve Ekim-Aral\u0131k aylar\u0131nda olmak \u00fczere iki COVID-19 piki ya\u015fand\u0131 ve ortalama 70 g\u00fcn devam etti (19).<span class=\"Apple-converted-space\">\u00a0 <\/span>\u00c7al\u0131\u015fman\u0131n yap\u0131ld\u0131\u011f\u0131 ve COVID-19 piki g\u00f6r\u00fclmeyen aylarda toplam 263 hastaya test yap\u0131ld\u0131 ve 2 (%0.76)<span class=\"Apple-converted-space\">\u00a0 <\/span>hastada pozitif sonu\u00e7 elde edildi ve bu oran pik g\u00f6r\u00fclmeyen aylar i\u00e7in referans olarak al\u0131nd\u0131.<span class=\"Apple-converted-space\">\u00a0 <\/span>COVID-19 piki g\u00f6zlenen aylarda ise olgu insidans oranlar\u0131 ortalamas\u0131 %6.57 (53\/807) bulundu. Benzer \u015fekilde bu oran da pik g\u00f6r\u00fclen aylar i\u00e7in referans olarak al\u0131nd\u0131.<span class=\"Apple-converted-space\">\u00a0 <\/span>T\u00fcrkiye\u2019de COVID-19\u2019a ba\u011fl\u0131 birinci pikin Nisan 2020\u2019de olmas\u0131 nedeniyle 20 g\u00fcnl\u00fck periyotlar\u0131n ba\u015flang\u0131\u00e7 tarihi 1 Nisan 2020 olarak kabul edildi. 1 Nisan\u2019dan itibaren 20 g\u00fcnl\u00fck periyotlarla pik d\u00f6nemlerine denk gelen aylara %6.57 oran\u0131, di\u011fer aylara ise %0.76 oran\u0131 eklenerek, kitle ba\u011f\u0131\u015f\u0131kl\u0131k s\u0131n\u0131r\u0131 olarak kabul edilen %67\u2019ye ula\u015f\u0131lma zaman\u0131 hesapland\u0131 (\u015eekil 1). Nisan 2020\u2019den sonra ortalama 70 g\u00fcn s\u00fcren iki pik ya\u015fand\u0131\u011f\u0131 i\u00e7in g\u00fcn\u00fcm\u00fcze kadar ula\u015f\u0131lan kitle ba\u011f\u0131\u015f\u0131kl\u0131k oran\u0131 hesapland\u0131. Buna g\u00f6re T\u00fcrkiye\u2019de Mart 2021 tarihinde kitle ba\u011f\u0131\u015f\u0131kl\u0131k oran\u0131 %53.58 olarak saptand\u0131. Bu tarihten itibaren hi\u00e7 COVID-19 piki ger\u00e7ekle\u015fmez ise olas\u0131 pandemi s\u00f6n\u00fcmleme zaman\u0131 Mart 2022 veya tek pik ger\u00e7ekle\u015firse May\u0131s 2021 olarak belirlendi (\u015eekil 1). Bir COVID-19 piki ger\u00e7ekle\u015fece\u011fi varsay\u0131m\u0131yla yap\u0131lan sim\u00fclasyonda kitle ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 s\u0131n\u0131r\u0131na ula\u015f\u0131laca\u011f\u0131ndan T\u00fcrkiye\u2019de gelecekte birden fazla COVID-19 piki ya\u015fanma olas\u0131l\u0131\u011f\u0131 olmayaca\u011f\u0131 hesapland\u0131.<\/p>\n<h2><b>\u0130RDELEME<\/b><\/h2>\n<p class=\"p1\">\u00c7al\u0131\u015fmam\u0131za dahil edilen hastalar\u0131n %59.8\u2019inin erkek oldu\u011fu saptand\u0131. Li L.Q. ve arkada\u015flar\u0131n\u0131n (20) yapt\u0131\u011f\u0131 bir meta analize g\u00f6re de cinsiyet da\u011f\u0131l\u0131m\u0131na g\u00f6re erkeklerin olgu grubunun %60\u2019\u0131n\u0131 olu\u015fturdu\u011fu bildirildi. MERS ve SARS\u2019da da erkeklerde infeksiyon oran\u0131n\u0131n daha fazla oldu\u011funu bildiren \u00e7al\u0131\u015fmalar mevcuttur (21,22). Kad\u0131nlar\u0131n viral infeksiyonlara kar\u015f\u0131 duyarl\u0131l\u0131\u011f\u0131n\u0131n az olmas\u0131n\u0131n, do\u011fal ve kazan\u0131lm\u0131\u015f ba\u011f\u0131\u015f\u0131kl\u0131kta \u00f6nemli bir rol oynayan X kromozomu ve cinsiyet hormonlar\u0131n\u0131n etkisine ba\u011fl\u0131 oldu\u011fu savunulmaktad\u0131r (23). Ayr\u0131ca erkekler koronavirusun kolayca ba\u011fland\u0131\u011f\u0131 ACE2 resept\u00f6r\u00fcn\u00fcn y\u00fcksek ekspresyonu nedeniyle daha d\u00fc\u015f\u00fck dirence sahiptir (24).<\/p>\n<p class=\"p1\">Bu \u00e7al\u0131\u015fmaya dahil edilen hastalar\u0131n %56.1 \u2018inde en az bir kronik hastal\u0131k ve COVID-19 PZR pozitifli\u011fi saptanan 55 hastan\u0131n %49.1 \u2018inde en az bir kronik hastal\u0131k mevcuttu. Emami ve arkada\u015flar\u0131n\u0131n 76 993 olgu say\u0131l\u0131 \u00e7al\u0131\u015fmas\u0131nda, en yayg\u0131n komorbiditeler hipertansiyon, kardiyovask\u00fcler hastal\u0131k, sigara ve diyabet olarak bildirilmi\u015ftir (4).<span class=\"Apple-converted-space\">\u00a0 <\/span>Benzer \u015fekilde Yang ve arkada\u015flar\u0131n\u0131n \u00e7al\u0131\u015fmas\u0131nda da (5)<span class=\"Apple-converted-space\">\u00a0 <\/span>en s\u0131k hipertansiyon (%21.1), diyabet (%9.7), kardiyovask\u00fcler hastal\u0131k (%8.4 ) ve solunum sistemi hastal\u0131\u011f\u0131 (%1.5) s\u0131kl\u0131kla bildirilen komorbid durumlard\u0131r. Bu \u00e7al\u0131\u015fmada PZR taramas\u0131 yap\u0131lan b\u00fct\u00fcn hasta grubunda ve PZR pozitifli\u011fi saptanan hasta grubunda en s\u0131k bildirilen komorbid hastal\u0131k malignitelerdi. \u00c7al\u0131\u015fmam\u0131zda malignite oran\u0131n\u0131n daha fazla \u00e7\u0131kmas\u0131n\u0131n sebebinin, pandemi s\u00fcrecinde elektif cerrahilerden \u00e7ok acil ve kanser cerrahilerine \u00f6ncelik verilmesinden kaynaklanabilece\u011fi d\u00fc\u015f\u00fcn\u00fcld\u00fc.<\/p>\n<p class=\"p1\">\u00c7al\u0131\u015fmam\u0131zda 55 asemptomatik hastan\u0131n 22 (%40)\u2019sinin semptomatik hale geldikleri i\u00e7in hastanede yat\u0131r\u0131larak tedavi edilme gereksinimi olmu\u015ftur. \u00c7in\u2019den asemptomatik infeksiyonlar\u0131 uygun bir \u015fekilde tan\u0131mlayan ve bir grup enfekte ki\u015fiyi izleyen yak\u0131n tarihli bir \u00e7al\u0131\u015fmada, hi\u00e7bir zaman semptom geli\u015ftirmeyen enfekte ki\u015filerin oran\u0131n\u0131n %23 oldu\u011fu bildirilmi\u015ftir (25). \u00c7al\u0131\u015fmam\u0131zda asemptomatik bireylerin oran\u0131 %5.5 olarak hesaplanm\u0131\u015ft\u0131r.<span class=\"Apple-converted-space\">\u00a0 <\/span>\u00dc\u00e7 \u00fclkeden (\u00c7in, Amerika ve \u0130talya ) 599 COVID-19 vakas\u0131 ve 9297 temasl\u0131 be\u015f \u00e7al\u0131\u015fman\u0131n d\u00e2hil edildi\u011fi bir meta analizde, asemptomatik olgular\u0131n oran\u0131n\u0131n %6-41 aras\u0131nda de\u011fi\u015fti\u011fi ve asemptomatik olgular\u0131n oran\u0131n\u0131n genel olarak %16 oldu\u011fu bildirilmi\u015fti (26). Genel olarak asemptomatik infeksiyonlar\u0131n, alt hastal\u0131\u011f\u0131 olmayan gen\u00e7 ve orta ya\u015fl\u0131 bireylerde daha yayg\u0131n oldu\u011funu bildirilmi\u015ftir. Bizim \u00e7al\u0131\u015fmam\u0131zda da PZR pozitif olgular\u0131n ya\u015f ortalamas\u0131 58.1 y\u0131l olup, beklenen ya\u015f ortalamas\u0131ndan y\u00fcksek \u00e7\u0131km\u0131\u015ft\u0131r. Bu durum, pandemi d\u00f6neminde elektif cerrahilerin ertelenmesine ve hastanede yatan hastalar\u0131n daha \u00e7ok ileri ya\u015fta ve komorbiditesi olan hastalar olmas\u0131na ba\u011flanm\u0131\u015ft\u0131r. Dolay\u0131s\u0131 ile elde edilen y\u00fczde t\u00fcm toplumu yans\u0131tmak konusunda s\u0131n\u0131rl\u0131 kalacakt\u0131r.<\/p>\n<p class=\"p1\">Literat\u00fcrde operasyon \u00f6ncesi PZR pozitiflik oranlar\u0131n\u0131 ara\u015ft\u0131ran \u00e7al\u0131\u015fmalar k\u0131s\u0131tl\u0131d\u0131r. Tanacan ve arkada\u015flar\u0131n\u0131n<span class=\"Apple-converted-space\">\u00a0 <\/span>(27) Ankara \u015eehir Hastanesinde 15 Nisan -5 Haziran 2020 tarihleri aras\u0131nda yapt\u0131\u011f\u0131 prospektif kohort \u00e7al\u0131\u015fmas\u0131nda, 206 asemptomatik gebe hastaya preoperatif SARS-CoV-2 testi yap\u0131ld\u0131\u011f\u0131nda pozitiflik oran\u0131 %1.4 olarak bildirilmi\u015ftir. Newham \u00dcniversitesinde yap\u0131lan retrospektif bir \u00e7al\u0131\u015fmada, 22 Nisan-5 May\u0131s 2020 tarihleri aras\u0131 180 gebeye 2 hafta ara ile PZR testi yap\u0131ld\u0131\u011f\u0131nda 7 olguda (%3.9) SARS-CoV-2 test pozitifli\u011fi saptand\u0131\u011f\u0131, 6\u2019s\u0131n\u0131n (%3.3) asemptomatik oldu\u011fu bildirilmi\u015ftir (28). New York\u2019da bir Ortopedi Hastanesinde 99 hasta ile yap\u0131lan prospektif kohort \u00e7al\u0131\u015fmada 5-24 Nisan 2020 tarihleri aras\u0131nda ortopedik cerrahiler \u00f6ncesi t\u00fcm hastalardan PZR \u00f6rne\u011fi al\u0131nm\u0131\u015f ve %12.1 test pozitifli\u011fi saptanm\u0131\u015ft\u0131r. Testi pozitif hastalar\u0131n y\u00fczde %58.3\u2018\u00fcn\u00fcn asemptomatik oldu\u011fu bildirilmi\u015ftir (29). \u00c7al\u0131\u015fmam\u0131zda asemptomatik COVID-19 hasta insidans\u0131 %5.14 idi. \u00c7al\u0131\u015fman\u0131n yap\u0131ld\u0131\u011f\u0131 ve COVID-19 piki g\u00f6r\u00fclmeyen aylarda insidans %0.76 iken pik g\u00f6r\u00fclen aylarda insidans<span class=\"Apple-converted-space\">\u00a0 <\/span>%6.57 bulundu. Literat\u00fcrdeki benzer \u00e7al\u0131\u015fmalara g\u00f6re asemptomatik COVID-19 olgusu insidans\u0131m\u0131z daha fazla olup, \u00f6rneklem say\u0131lar\u0131n\u0131n da b\u00fcy\u00fck olmas\u0131 nedeni ile sonu\u00e7lar\u0131n g\u00fcvenilir oldu\u011fu d\u00fc\u015f\u00fcn\u00fclmektedir.<\/p>\n<p class=\"p1\">SARS-CoV-2 RNA, solunum yolu \u00f6rneklerinde semptom ba\u015flang\u0131c\u0131ndan 1-2 g\u00fcn \u00f6nce qRT-PCR ile tan\u0131mlanm\u0131\u015ft\u0131r ve pozitifli\u011fin orta \u015fiddette seyreden olgularda 7-12 g\u00fcn, a\u011f\u0131r seyreden olgulardaysa 2 haftaya kadar devam etti\u011fi g\u00f6sterilmi\u015ftir (30,31). Farkl\u0131 hasta \u00f6rnekleri ile viral yay\u0131l\u0131m s\u00fcresi \u00fczerine yap\u0131lan \u00e7al\u0131\u015fmalar aras\u0131nda en uzun s\u00fcre 60 g\u00fcn, en k\u0131sa s\u00fcre 3 g\u00fcn olarak bildirilmi\u015ftir<span class=\"Apple-converted-space\">\u00a0 <\/span>(32). Hastaneye yatan hastalarda solunum yollar\u0131ndan izole edilen PZR pozitiflik s\u00fcresi alt\u0131 haftaya kadar uzayabilmektedir. Bu s\u00fcre hastal\u0131\u011f\u0131n seyri, hastan\u0131n ya\u015f\u0131, komorbid hastal\u0131klar\u0131, imm\u00fcnosupresyon gibi durumlarda uzayabilmektedir. Literat\u00fcrdeki veriler do\u011frultusunda viral yay\u0131l\u0131m\u0131n s\u00fcresi ortalama 20 g\u00fcn olarak belirlenmi\u015ftir (17,18).<\/p>\n<p>Geni\u015f bir hasta grubunda, titiz bir ara\u015ft\u0131rma ve planlamayla yap\u0131lmas\u0131na ra\u011fmen \u00e7al\u0131\u015fman\u0131n baz\u0131<span class=\"Apple-converted-space\">\u00a0 <\/span>k\u0131s\u0131tl\u0131l\u0131klar\u0131 vard\u0131r;<\/p>\n<ol>\n<li>Demografik veriler: Retrospektif olarak yap\u0131lan bu \u00e7al\u0131\u015fmaya dahil edilen kat\u0131l\u0131mc\u0131lar\u0131n, ya\u015f ve cinsiyet da\u011f\u0131l\u0131mlar\u0131, PZR testi yap\u0131ld\u0131\u011f\u0131 d\u00f6nemde alt hastal\u0131klar\u0131n\u0131n tan\u0131 ve tedavisi amac\u0131yla hastane ve di\u011fer sosyal ortamlara daha s\u0131k temas etmeleri gibi nedenlerle toplumu temsil eden ideal bir \u00f6rneklem grubu olmamalar\u0131.<\/li>\n<li>COVID-19 insidans\u0131n\u0131n dalgalanmas\u0131: Bu \u00e7al\u0131\u015fmada 2020 y\u0131l\u0131nda ger\u00e7ekle\u015fen insidans dikkate al\u0131narak analizler yap\u0131lm\u0131\u015f olup 2021 y\u0131l\u0131nda, pandeminin kontrol alt\u0131na al\u0131nmas\u0131 amac\u0131yla al\u0131nacak \u00f6nlemlerin seviyesi ve s\u00fcresi gibi fakt\u00f6rlere ba\u011fl\u0131 olarak COVID-19 insidans\u0131n\u0131n \u00f6ng\u00f6r\u00fclemeyen art\u0131\u015flar veya azal\u0131\u015flarla seyredebilecek olmas\u0131.<span class=\"Apple-converted-space\">\u00a0<\/span><\/li>\n<li>COVID-19 re-infeksiyon riski: Literat\u00fcrde COVID-19 ge\u00e7iren hastalarda re-infeksiyonla ilgili olgu bildirimleri d\u0131\u015f\u0131nda yeterli veri yoktur (33,34). Bu olgu sunumlar\u0131 ise hastal\u0131\u011f\u0131 semptomatik ge\u00e7iren hastalarla ilgilidir ve asemptomatik olgularda re-infeksiyon olas\u0131l\u0131\u011f\u0131 bilinmemektedir. COVID-19 infeksiyonunun humoral veya h\u00fccresel ba\u011f\u0131\u015f\u0131kl\u0131k oranlar\u0131 ve olu\u015fan ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131n s\u00fcresi ile ilgili veriler de k\u0131s\u0131tl\u0131d\u0131r. Bu \u00e7al\u0131\u015fmada COVID-19 ge\u00e7iren her olguda uzun s\u00fcreli bir do\u011fal ba\u011f\u0131\u015f\u0131kl\u0131k olu\u015faca\u011f\u0131 ve re-infeksiyon geli\u015fmeyece\u011fi ya da ihmal edilebilir d\u00fczeylerde d\u00fc\u015f\u00fck olaca\u011f\u0131 varsay\u0131m\u0131yla analizler yap\u0131lm\u0131\u015ft\u0131r.<\/li>\n<li>COVID-19 mutasyonlar\u0131: D\u00fcnya genelinde saptanan mutasyonlar \u015fimdilik do\u011fal infeksiyon ya da a\u015f\u0131yla edinilen ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131n yitirilmesine neden olmasa da gelecekte COVID-19, influenza viruslar\u0131nda oldu\u011fu gibi kitle ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 kazan\u0131m\u0131 sadece o y\u0131lla s\u0131n\u0131rl\u0131 olan, mevsimsel bir hastal\u0131\u011fa d\u00f6n\u00fc\u015fme olas\u0131l\u0131\u011f\u0131.<\/li>\n<li>COVID-19 a\u015f\u0131lama programlar\u0131: COVID-19\u2019a kar\u015f\u0131 geli\u015ftirilen veya geli\u015ftirilecek olan a\u015f\u0131lar; bu farkl\u0131 a\u015f\u0131lar\u0131n ba\u011f\u0131\u015f\u0131klama oranlar\u0131; a\u015f\u0131lama programlar\u0131n\u0131n h\u0131z\u0131 ve a\u015f\u0131lama oran\u0131, COVID-19 pandemisinin s\u00f6n\u00fcmlenme zaman\u0131nda b\u00fcy\u00fck de\u011fi\u015fikliklere neden olabilece\u011fi de ak\u0131lda tutulmal\u0131d\u0131r.<\/li>\n<\/ol>\n<p>Sonu\u00e7 olarak, T\u00fcrkiye\u2019de Mart 2021 tarihinde COVID-19 kitle ba\u011f\u0131\u015f\u0131kl\u0131k oran\u0131 %53.58 olarak hesapland\u0131. Mart 2021 tarihinden sonra<span class=\"Apple-converted-space\">\u00a0 <\/span>COVID-19 piki ya\u015fan\u0131rsa May\u0131s 2021, pik ya\u015fanmaz ise Mart 2022\u2019de<span class=\"Apple-converted-space\">\u00a0 <\/span>s\u00f6n\u00fcmlenece\u011fi varsay\u0131ld\u0131. \u00c7al\u0131\u015fmam\u0131z tahmini bir pandemi s\u00f6n\u00fcmleme zaman\u0131 verilse de, \u00e7al\u0131\u015fmaya dahil edilen hastalar\u0131n ileri ya\u015f grubunda olmas\u0131,<span class=\"Apple-converted-space\">\u00a0 <\/span>al\u0131nan \u00f6nlemler ve k\u0131s\u0131tlamalarla insidans\u0131n dalgalanmas\u0131, re-infeksiyon riski, virusun yeni mutasyonlara a\u00e7\u0131k olmas\u0131 ve a\u015f\u0131lama programlar\u0131n\u0131n ba\u015flamas\u0131 gibi nedenlerle pandemi s\u00f6n\u00fcmleme zaman\u0131n\u0131n tahmini g\u00fc\u00e7le\u015fmektedir.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>G\u0130R\u0130\u015e \u015eiddetli akut solunum yolu sendromu koronavirusu 2 (SARS-CoV-2), Aral\u0131k 2019\u2019da \u00c7in\u2019de ortaya \u00e7\u0131kan, h\u0131zla t\u00fcm d\u00fcnyaya yay\u0131lan yeni bir pandemi etkenidir. \u0130nfeksiyon etkeni asemptomatik ve semptomatik olgular arac\u0131l\u0131\u011f\u0131 ile yay\u0131l\u0131r. COVID-19\u2019un bula\u015ft\u0131r\u0131c\u0131l\u0131k s\u00fcresi kesin olarak bilinmemektedir. Semptomatik d\u00f6nemden 1-2 g\u00fcn \u00f6nce ba\u015flay\u0131p semptomlar\u0131n kaybolmas\u0131yla sona erdi\u011fi d\u00fc\u015f\u00fcn\u00fclmektedir. Temastan semptom ba\u015flang\u0131c\u0131na kadar ge\u00e7en ortalama s\u00fcre [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":23551,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5129],"tags":[5199,5174,5200,5189],"class_list":["post-22942","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ozgun-arastirma","tag-asemptomatik","tag-covid-19","tag-kitle-bagisikligi","tag-sars-cov-2"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/22942","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/comments?post=22942"}],"version-history":[{"count":5,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/22942\/revisions"}],"predecessor-version":[{"id":23031,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/22942\/revisions\/23031"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media\/23551"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=22942"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=22942"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=22942"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}