{"id":6261,"date":"2023-10-18T18:03:25","date_gmt":"2023-10-18T15:03:25","guid":{"rendered":"https:\/\/www.klimik.org.tr\/koronavirus\/?p=6261"},"modified":"2023-10-20T15:56:20","modified_gmt":"2023-10-20T12:56:20","slug":"covid-19-guncel-durum-ve-gelismeler-3-ekim-2023-web-konferansindan-aklimizda-kalanlar","status":"publish","type":"post","link":"https:\/\/www.klimik.org.tr\/koronavirus\/covid-19-guncel-durum-ve-gelismeler-3-ekim-2023-web-konferansindan-aklimizda-kalanlar\/","title":{"rendered":"COVID-19 G\u00fcncel Durum ve Geli\u015fmeler: 3 Ekim 2023 Web Konferans\u0131ndan Akl\u0131m\u0131zda Kalanlar"},"content":{"rendered":"<p><span style=\"color: #800000;\"><strong><em>COVID-19\u2019un Epidemiyoloji ve SARS-CoV-2 Varyantlar\u0131 <\/em><\/strong><\/span><\/p>\n<ul>\n<li>Pandeminin d\u00f6rd\u00fcnc\u00fc y\u0131l\u0131 biterken COVID-19 halen \u00f6ng\u00f6r\u00fclebilir bir s\u0131kl\u0131kta seyretmemekte, mevsimsel \u00f6zellik g\u00f6stermemekte, endemik olarak devam etmekte ve gripten daha fazla hastane yat\u0131\u015f\u0131 ve \u00f6l\u00fcme neden olmaktad\u0131r (1,2). COVID-19\u2019a ba\u011fl\u0131 hastane yat\u0131\u015flar\u0131nda 2023 yaz aylar\u0131na g\u00f6re \u015fu anda \u00e7ok belirgin art\u0131\u015flar vard\u0131r (3).<\/li>\n<li>SARS-Cov-2 pandeminin ba\u015flang\u0131c\u0131ndan itibaren gerek do\u011fas\u0131 gerek toplumda geli\u015fmi\u015f ba\u011f\u0131\u015f\u0131kl\u0131k gerekse uygulanan baz\u0131 tedaviler nedeniyle s\u00fcrekli mutasyonlarla evrimine devam etmektedir. Ger\u00e7ek zamanl\u0131 olarak izleyebildi\u011fimiz bu evrim, \u00e7ok say\u0131da varyant\u0131n ortaya \u00e7\u0131kmas\u0131na, bu da pandeminin devam\u0131na ve her bask\u0131n varyantla t\u00fcm d\u00fcnyay\u0131 etkileyen yeni bir COVID-19 dalgas\u0131n\u0131n geli\u015fmesine neden olmu\u015ftur. \u015eu ana kadar tan\u0131mlanm\u0131\u015f varyantlar aras\u0131nda en \u00f6nemlileri pandeminin ilk y\u0131l\u0131n\u0131n sonuna do\u011fru ayr\u0131lmaya ba\u015flayan alfa ve beta, 2021 y\u0131l\u0131n\u0131n ba\u015f\u0131nda ortaya \u00e7\u0131kan delta ve sonunda ortaya \u00e7\u0131kan omikron varyantlar\u0131d\u0131r. 2022 y\u0131l\u0131ndan itibaren omikron varyant\u0131n\u0131n rekombinantlar\u0131 olu\u015fmaya ba\u015flam\u0131\u015f, XBB olarak isimlendirilen alt tipler ortaya \u00e7\u0131km\u0131\u015f ve h\u0131zla t\u00fcm d\u00fcnyada bask\u0131n hale gelmi\u015ftir. G\u00fcn\u00fcm\u00fczde XBB 1.9.2 ya da EG.5.1 olarak adland\u0131r\u0131lan ve halk aras\u0131nda Eris olarak bilinen varyant t\u00fcm d\u00fcnyada bask\u0131n varyant olarak dola\u015f\u0131m\u0131n\u0131 s\u00fcrd\u00fcrmektedir.\u00a0 G\u00fcn\u00fcm\u00fczde dola\u015f\u0131mda olan varyantlarda y\u00fczey antijenini kodlayan S geninde g\u00f6r\u00fclen F456L mutasyonu a\u015f\u0131 etkinli\u011fini azaltabilme ve ba\u011f\u0131\u015f\u0131kl\u0131k sisteminden ka\u00e7abilme potansiyeli nedeni ile dikkat \u00e7ekicidir.\u00a0 D\u00fcnyada, SARS-CoV-2 su\u015flar\u0131 aras\u0131ndaki g\u00fcncel varyant da\u011f\u0131l\u0131m\u0131 \u015fu \u015fekildedir: XBB.19.2 (EG.5.1, Eris) %43, XBB.2.3 %15, XBB.1.5 %14, XBB.1.9.1 %13, XBB.1.16 %12 (1, 2, 3).<\/li>\n<li>T\u00fcrkiye\u2019ye ait varyant da\u011f\u0131l\u0131m\u0131na a\u00e7\u0131k veri tabanlar\u0131ndan ula\u015fmak m\u00fcmk\u00fcn de\u011fildir.<\/li>\n<\/ul>\n<p><span style=\"color: #800000;\"><strong><em>COVID-19\u2019un \u00d6nlenmesi \u00a0<\/em><\/strong><\/span><\/p>\n<ul>\n<li>COVID-19 hastalar\u0131n\u0131n izolasyonu: \u0130zolasyon s\u00fcresi, asemptomatik olgularda 5 g\u00fcn, hafif-orta seyirli olgularda 10 g\u00fcn, ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 bask\u0131lanm\u0131\u015f veya a\u011f\u0131r COVID-19 nedeniyle int\u00fcbe edilmi\u015f hastalarda 20 g\u00fcnd\u00fcr. Semptomlar\u0131 d\u00fczelmi\u015f hastalarda 5. g\u00fcnden sonra h\u0131zl\u0131 antijen testinin sonucuna g\u00f6re izolasyon kald\u0131r\u0131labilir. Ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 bask\u0131lanm\u0131\u015flarda izolasyonun kald\u0131r\u0131lmas\u0131 i\u00e7in 24 saat ara ile iki kez test (PCR testi veya antijen testi) negatifli\u011fi g\u00f6r\u00fclmesi, pozitifli\u011fin bir aydan uzun s\u00fcrd\u00fc\u011f\u00fc olgulardaysa genomik s\u00fcrveyans ve virus k\u00fclt\u00fcr\u00fc yap\u0131lmas\u0131 \u00f6nerilmektedir. \u0130zolasyonun kald\u0131r\u0131labilmesi i\u00e7in hastan\u0131n iyile\u015fmekte olmas\u0131 ve en az 24 saattir ate\u015finin olmamas\u0131 gerekmektedir. Test y\u00f6ntemi olarak h\u0131zl\u0131 antijen veya PCR testleri kullan\u0131labilir. PCR testinin duyarl\u0131l\u0131\u011f\u0131, antijen testine g\u00f6re daha y\u00fcksek olmakla birlikte bula\u015ft\u0131r\u0131c\u0131l\u0131k a\u00e7\u0131s\u0131ndan antijen testi sonu\u00e7lar\u0131na g\u00f6re de\u011ferlendirme yap\u0131labilece\u011fi belirtilmektedir. Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131\u2019n\u0131n 14 Ocak 2022 tarihli \u201cG\u00fcncel d\u00f6nemde COVID-19 ili\u015fkili izolasyon ve karantina uygulamalar\u0131\u201d rehberinde COVID-19 olgular\u0131 i\u00e7in 7 g\u00fcn izolasyon \u00f6nerilmektedir. Bu d\u00f6k\u00fcman\u0131n yay\u0131nland\u0131\u011f\u0131 tarihten sonra d\u00fcnyada izolasyon s\u00fcreleri konusunda g\u00fcncellemeler olmu\u015f ancak bu bilgiler Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 d\u00f6k\u00fcmanlar\u0131na hen\u00fcz yans\u0131mam\u0131\u015ft\u0131r (4, 5)<\/li>\n<li>Maske kullan\u0131m\u0131: Toplumda; nezle, grip benzeri hastal\u0131\u011f\u0131, SARS-CoV-2 antijen veya PCR testi pozitifli\u011fi ve COVID-19 hastas\u0131yla yak\u0131n zamanda temas\u0131 ve a\u011f\u0131r COVID-19 a\u00e7\u0131s\u0131ndan y\u00fcksek riskte (&gt;65 ya\u015f, ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 bask\u0131lanm\u0131\u015flar ve \u00e7oklu komorbiditesi olanlar) olanlar, kapal\u0131\/iyi havaland\u0131r\u0131lmayan ortamlarda bulunanlar\u0131n maske takmas\u0131 \u00f6nerilir. \u00d6zellikle hastal\u0131\u011f\u0131n insidensinin artt\u0131\u011f\u0131 durumlarda, toplumda kalabal\u0131k her ortamda toplumda maske tak\u0131lmas\u0131 yararl\u0131d\u0131r. Hastanelerde, toplumda yayg\u0131n SARS-CoV-2 bula\u015fmas\u0131 s\u00f6z konusuysa, hastaneye giren herkesin (\u00e7al\u0131\u015fanlar, hastalar, ziyaret\u00e7iler dahil) ve t\u00fcm hastane ortamlar\u0131nda (t\u00fcm klinik alanlar ve ortak kullan\u0131m alanlar\u0131 dahil) cerrahi maske takmas\u0131 gerekmektedir. Toplumda SARS-CoV-2 bula\u015fmas\u0131n\u0131n sporadik oldu\u011fu durumlarda, hastanelerde sadece klinik alanlarda cerrahi bir maske tak\u0131lmas\u0131 yeterlidir. \u00d6zellikle ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 bask\u0131lanm\u0131\u015f hastalar\u0131n izlendi\u011fi polikliniklerde ve yatt\u0131\u011f\u0131 servislerde, hastalarda COVID-19 olup olmamas\u0131ndan ba\u011f\u0131ms\u0131z olarak- cerrahi maske her zaman tak\u0131lmal\u0131d\u0131r. COVID-19 hastalar\u0131n\u0131n izlendi\u011fi serviste \u00e7al\u0131\u015fanlar -COVID-19 hastas\u0131n\u0131n odas\u0131na girmedi\u011fi s\u00fcrece- cerrahi maske takabilir ancak hasta odas\u0131na girerken N95\/FFP2\/FFP3 maske tak\u0131lmal\u0131d\u0131r. COVID-19 nedeniyle solunum deste\u011fi uygulanan (non-invazif destek veya ent\u00fcbasyon) hasta oldu\u011fu durumda yo\u011fun bak\u0131m \u00fcnitesinde \u00e7al\u0131\u015fanlar N95\/FFP2\/ FFP3 maske takmal\u0131d\u0131r (5, 6).<\/li>\n<\/ul>\n<p><span style=\"color: #800000;\"><strong><em>COVID-19 A\u015f\u0131lar\u0131 (7, 8, 9)<\/em><\/strong><\/span><\/p>\n<ul>\n<li>COVID-19 a\u015f\u0131lama \u00f6nerileri, kitle ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131n\u0131n y\u00fcksek, test olanaklar\u0131n\u0131n geni\u015f ve tedavide etkili ila\u00e7lara ula\u015f\u0131labilen g\u00fcn\u00fcm\u00fcz ko\u015fullar\u0131 g\u00f6zetilerek yap\u0131lmaktad\u0131r. DS\u00d6 COVID-19\u2019un gelece\u011fi i\u00e7in, yeni varyantlar\u0131n genellikle a\u011f\u0131r hastal\u0131k yapmad\u0131\u011f\u0131, ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131n azald\u0131\u011f\u0131 ki\u015filerde ve d\u00f6nemlerde olgu say\u0131lar\u0131n\u0131n artt\u0131\u011f\u0131, a\u015f\u0131lar\u0131n g\u00fcncellenerek y\u00fcksek riskli ki\u015filer i\u00e7in belli aral\u0131klarla hat\u0131rlatma dozlar\u0131n\u0131n uyguland\u0131\u011f\u0131 senaryoyu en olas\u0131 senaryo olarak g\u00f6rmekte ve bilimsel \u00f6nerilerini bu senaryoya g\u00f6re yapmaktad\u0131r.<\/li>\n<li>DS\u00d6\u2019n\u00fcn g\u00fcncelledi\u011fi COVID-19 a\u015f\u0131lama \u00f6nerilerinde, \u201cY\u00fcksek \u00d6ncelikli Gruplar\u201d ( &gt;50 ya\u015f (en riskli &gt;75 ya\u015f), birden fazla ciddi komorbiditesi (diabetes mellitus veya kalp hastal\u0131klar\u0131 gibi) veya ciddi obezitesi olan (VK\u0130&gt;40) gen\u00e7 eri\u015fkinler (18-49 ya\u015f), &gt;6 ay \u00e7ocuklar dahil t\u00fcm ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 bask\u0131lanm\u0131\u015flar (HIV\u2019le ya\u015fayan bireyler, solid organ veya kemik ili\u011fi al\u0131c\u0131lar\u0131 vb.), gebeler, hastalarla yak\u0131n temasta olan sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131) i\u00e7in \u00a0primer ba\u011f\u0131\u015f\u0131klama ve ilk hat\u0131rlatma dozunu takiben yeni varyantlar\u0131 i\u00e7eren\u00a0 a\u015f\u0131larla da\u00a0 hat\u0131rlatma dozlar\u0131 \u00f6nerilirken; \u201cOrta \u00d6ncelikli Gruplar\u201d (komorbiditesi olmayan &lt;50 ya\u015f eri\u015fkinler, ciddi obezitesi veya a\u011f\u0131r COVID-19 riskini art\u0131ran komorbiditesi olan &gt;6 ay-17 ya\u015f \u00e7ocuklar) i\u00e7inse primer a\u015f\u0131 \u015femas\u0131 ve bir hat\u0131rlatma dozu \u00f6nerilmektedir. \u00a0\u201cD\u00fc\u015f\u00fck \u00d6ncelikli Gruplar\u201d ( &gt;6 ay-17 ya\u015f sa\u011fl\u0131kl\u0131 \u00e7ocuklar) i\u00e7in primer \u015fema ve hat\u0131rlatma dozu yap\u0131p yapmama karar\u0131n\u0131n ise \u00fclkelerin ko\u015fullar\u0131na ve hastal\u0131k y\u00fcklerine g\u00f6re verilebilece\u011fi belirtilmi\u015ftir.<\/li>\n<li>DS\u00d6 2023 sonbahar\u0131nda kullan\u0131lacak COVID-19 a\u015f\u0131s\u0131 i\u00e7in, orijinal virus antijen\/RNA kodunun \u00e7\u0131kart\u0131lmas\u0131 ve yerine Omikronun alt varyantlar\u0131ndan XBB 1.5 su\u015funu i\u00e7eren tekli a\u015f\u0131 haz\u0131rlanmas\u0131n\u0131 \u00f6nermi\u015ftir. Yap\u0131lan n\u00f6tralizasyon \u00e7al\u0131\u015fmalar\u0131 XBB 1.5 i\u00e7eren a\u015f\u0131lar\u0131n halen dola\u015fmakta olan yeni varyantlara (EG.5 veya Eris, BA 2.86) etkili antikor \u00fcretimini sa\u011flayaca\u011f\u0131n\u0131 g\u00f6stermektedir. 1.5 i\u00e7eren tekli mRNA a\u015f\u0131lar\u0131 \u00fcretilmi\u015f, onaylanm\u0131\u015f ve Eyl\u00fcl 2023\u2019ten itibaren bir\u00e7ok y\u00fcksek gelirli \u00fclkede kullan\u0131ma girmi\u015ftir.<\/li>\n<li>Yeni g\u00fcncellenmi\u015f COVID-19 a\u015f\u0131lar\u0131na ula\u015f\u0131lamayan \u00fclkelerde; eski a\u015f\u0131lar\u0131n y\u00fcksek riskli gruplarda ve primer a\u015f\u0131lama i\u00e7in ve ilk hat\u0131rlatma dozu olarak halen kullan\u0131labilece\u011fi d\u00fc\u015f\u00fcn\u00fclmektedir. \u00d6zellikle ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 bask\u0131lanm\u0131\u015f ki\u015filere, ileri ya\u015fta (&gt;75) olup altta yatan ciddi hastal\u0131\u011f\u0131 olanlara son a\u015f\u0131lar\u0131ndan veya COVID-19 hastal\u0131\u011f\u0131ndan 6-12 ay sonra orijinal su\u015fu i\u00e7eren a\u015f\u0131yla hat\u0131rlatma yap\u0131labilir. Bu ki\u015filerde a\u015f\u0131lama karar\u0131 hekime dan\u0131\u015f\u0131larak bireysel olarak verilmelidir. Bu risk gruplar\u0131 d\u0131\u015f\u0131nda kalan ve primer a\u015f\u0131lama \u015femas\u0131n\u0131 mRNA a\u015f\u0131lar\u0131 ile tamamlam\u0131\u015f olan ki\u015filere orijinal su\u015f i\u00e7eren a\u015f\u0131lar ile hat\u0131rlatma dozu yap\u0131lmas\u0131, a\u015f\u0131 etkinli\u011findeki azalma ve hastal\u0131k seyrine s\u0131n\u0131rl\u0131 etkileri nedeniyle \u00f6nerilmemektedir.<\/li>\n<\/ul>\n<p><span style=\"color: #800000;\"><strong><em>COVID-19 Tedavisi<\/em><\/strong><\/span><\/p>\n<ul>\n<li>A\u015f\u0131lama ve\/veya hastal\u0131\u011f\u0131 ge\u00e7irerek geli\u015fmi\u015f ba\u011f\u0131\u015f\u0131kl\u0131k COVID-19\u2019lu hastalarda \u00f6l\u00fcm oran\u0131n\u0131, t\u00fcm hasta gruplar\u0131nda ortalama %0.6-1\u2019den, %0.06-0.1\u2019e, hastaneye yat\u0131r\u0131lmas\u0131 gereken hastalardaysa %15.1\u2019den (Delta) %4.9\u2019a d\u00fc\u015f\u00fcrm\u00fc\u015ft\u00fcr. Ayn\u0131 nedenle COVID-19 nedeniyle hastaneye yat\u0131\u015f oranlar\u0131 da belirgin olarak d\u00fc\u015fm\u00fc\u015ft\u00fcr (2). Ancak belli risk gruplar\u0131 halen COVID-19 nedeniyle hastaneye yatmakta ve hayat\u0131n\u0131 kaybetmektedir. G\u00fcn\u00fcm\u00fczde COVID-19 nedeniyle hastaneye yat\u0131r\u0131lmas\u0131 gerekenler veya hayat\u0131n\u0131 kaybedenler genellikle ya\u015fl\u0131lar (&gt;65 ya\u015f), \u22653 komorbiditesi olanlar veya ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 bask\u0131lanm\u0131\u015f konaklard\u0131r (10, 11).<\/li>\n<li>COVID-19\u2019un tedavisinde, hastal\u0131\u011f\u0131n farkl\u0131 evrelerinde, farkl\u0131 patolojik s\u00fcre\u00e7lere etkili, farkl\u0131 ila\u00e7lar\u0131n kullan\u0131lmas\u0131 gerekmektedir. Hastal\u0131\u011f\u0131n erken evrelerinde (ilk 5-7 g\u00fcn) ve hafif hastal\u0131k tablosunda virusun \u00e7o\u011falmas\u0131n\u0131 engelleyecek antiviral tedaviler \u00f6nerilirken; ilerleyen g\u00fcnlerde geli\u015fmi\u015f a\u011f\u0131r hastal\u0131kta a\u015f\u0131r\u0131 inflamatuar ve dengesiz imm\u00fcnolojik yan\u0131t\u0131 ve bunlar\u0131n tetikledi\u011fi koag\u00fclasyonu hedefleyen kortikosteroidler, antisitokinler ve antikoag\u00fclan ajanlar\u0131n kullan\u0131m\u0131 \u00f6nerilmektedir.<\/li>\n<li>COVID-19 tedavisi i\u00e7in onaylanm\u0131\u015f \u00fc\u00e7 adet antiviral bulunmaktad\u0131r; bunlar nirmatrelvir\/ritonavir(r), remdesivir ve molnupiravirdir. Bu antiviral ila\u00e7lar\u0131n hepsinin, a\u011f\u0131r COVID-19 a\u00e7\u0131s\u0131ndan riskli gruplarda ve hastal\u0131\u011f\u0131n erken safhas\u0131nda ba\u015fland\u0131\u011f\u0131nda etkili oldu\u011fu g\u00f6sterilmi\u015ftir. Yap\u0131lan faz \u00e7al\u0131\u015fmalar\u0131nda bu antivirallerin, semptomlar\u0131n ilk 5 g\u00fcn\u00fcnde ba\u015flanmas\u0131 halinde, riskli gruplarda hastane yat\u0131\u015f\u0131 ve \u00f6l\u00fcm\u00fc s\u0131ras\u0131yla %89, %87 (12, 13) oran\u0131nda azaltt\u0131\u011f\u0131 g\u00f6sterilmi\u015ftir. Hastanede yatan a\u011f\u0131r COVID-19 hastalar\u0131ndaysa remdesivirin \u00f6l\u00fcm\u00fc %12-17 oran\u0131nda azaltt\u0131\u011f\u0131 belirlenmi\u015ftir (14, 15).<\/li>\n<li>Faz \u00e7al\u0131\u015fmalar\u0131ndan sonra yap\u0131lm\u0131\u015f \u00e7al\u0131\u015fmalarda da hem nirmatrelvir\/r\u2019nin hem de molnupiravirin ayaktan hastalarda viral klirensi (16) ve iyile\u015fmeyi h\u0131zland\u0131rd\u0131\u011f\u0131 (17) ve \u00f6l\u00fcm\u00fc azaltt\u0131\u011f\u0131 g\u00f6r\u00fclm\u00fc\u015ft\u00fcr (18).<\/li>\n<li>Hen\u00fcz etkili antivirallerin olmad\u0131\u011f\u0131 pandeminin ba\u015f\u0131nda daha s\u0131kl\u0131kla kullan\u0131lm\u0131\u015f olan konvalesan plazman\u0131n (KP)\u2019sa\u00a0, a\u011f\u0131r COVID-19 riski y\u00fcksek \u00a0ayaktan izlenen hastanelerde, \u00f6zellikle semptomlar\u0131n ilk 5 g\u00fcn\u00fcnde ve y\u00fcksek antikor\u00a0 titreli olmas\u0131 halinde hastane yat\u0131\u015f\u0131n\u0131 %56 oran\u0131nda azaltt\u0131\u011f\u0131, a\u011f\u0131r COVID-19 nedeniyle hastanede yatan\u00a0 immunokompetan hastalarda sa\u011f kal\u0131m \u00fczerine olumlu bir etkisinin olmad\u0131\u011f\u0131,\u00a0 ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 bask\u0131lanm\u0131\u015f hastalardaysa\u00a0 \u00f6l\u00fcm\u00fc %37 oran\u0131nda azaltt\u0131\u011f\u0131 g\u00f6sterilmi\u015ftir (19, 20, 21).<\/li>\n<li>Yukar\u0131da belirtilmi\u015f kan\u0131tlara dayanarak, COVID-19 olan ve \u00f6zellikle &gt;65 ya\u015f, ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 bask\u0131lanm\u0131\u015flar ve \u00e7oklu komorbiditesi bulunanlarda olmak \u00fczere a\u011f\u0131r hastal\u0131\u011fa ilerleme riski y\u00fcksek ki\u015filerde \u00f6ncelikle nirmatrelvir\/r ile, yoksa remdesivirle, her ikisi de yoksa molnupiravirle antiviral tedavi ba\u015flanmas\u0131 \u00f6nerilmektedir.<\/li>\n<li>A\u011f\u0131r hastal\u0131\u011fa ilerleme riski y\u00fcksek olan ayaktan izlenen hafif-orta \u015fiddette COVID-19 olan hastalara, di\u011fer tedavi se\u00e7eneklerinin (nirmatrelvir\/ritonavir, remdesivir, molnupiravir ve SARS-CoV-2&#8217;ye \u00f6zg\u00fc monoclonal antikorlar) kullan\u0131lamad\u0131\u011f\u0131 durumlarda, semptom ba\u015flang\u0131c\u0131ndan sonraki ilk 8 g\u00fcn i\u00e7inde olmak \u00fczere y\u00fcksek titreli KP tedavisi verilebilir (22). Ek olarak ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 bask\u0131lanm\u0131\u015f konaklarda, se\u00e7ilmi\u015f hastalarda, hastal\u0131\u011f\u0131n ilerlemi\u015f d\u00f6nemlerinde de KP tedavisi yap\u0131labilir.<\/li>\n<li>Oksijen ihtiyac\u0131 olan a\u011f\u0131r COVID-19 hastalar\u0131nda 10 g\u00fcnl\u00fck 6mg\/g\u00fcn deksametazon tedavisinin mortaliteyi azaltt\u0131\u011f\u0131 bilinmektedir. Ancak daha y\u00fcksek dozlarda (12 mg\/g\u00fcn deksametazon, vb)\u00a0 uygulanan kortikositeroidlerin, sadece nazal oksijen ihtiyac\u0131 olan a\u011f\u0131r COVID-19 hastalar\u0131nda zararl\u0131 oldu\u011fu g\u00f6sterilmi\u015ftir (23). Dakikada 10 litreden fazla oksijenihtiyac\u0131 olan\u00a0 veya NIV veya mekanik ventilasyon uygulanan a\u011f\u0131r COVID-19 hastalar\u0131ndaysa , \u00f6zellikle anti-sitokinlere ula\u015f\u0131lamayan durumlarda 12mg\/g\u00fcn \u00a0deksamteazon veya e\u015fde\u011feri dozlarda di\u011fer kortikosteroidlerin \u00a0yarar\u0131 olabilir, ancak bu \u00f6neriyi destekleyen kan\u0131tlar \u00e7ok g\u00fc\u00e7l\u00fc de\u011fildir (24, 25).<\/li>\n<li>IL-6 inhibit\u00f6rlerinden tosilizumab ve sarilumab (26), janus kinaz inhibit\u00f6rlerinden barisitinib ve tofasitinib (27) ve IL-1 inhibit\u00f6rlerinden anakinra (28) a\u011f\u0131r COVID-19\u2019lu hastalarda mortaliteyi \u00a0yakla\u015f\u0131k %20 oran\u0131nda azaltmaktad\u0131r. Bu nedenle, \u00f6zellikle 6mg\/g\u00fcn deksametazon alt\u0131nda oksijen ihtiyac\u0131 artan hastalarda olmak \u00fczere\u00a0 kortikosteoridlerle kombine edilerek kullan\u0131mlar\u0131 \u00f6nerilmektedir, gere\u011finde bu aajanlar\u0131n iki ayr\u0131 t\u00fcr\u00fc\u00a0 eklenerek \u00fc\u00e7l\u00fc kombinasyon halinde de kullan\u0131labilece\u011fi bildirilmektedir (29).<\/li>\n<li>A\u011f\u0131r COVID-19 nedeniyle serviste yat\u0131r\u0131larak izlenen hastalarda tedavi dozunda, yo\u011fun bak\u0131m \u00fcnitesinde izlenenlerdeyse tedavi dozunda antikoag\u00fclan (\u00f6zellikle d\u00fc\u015f\u00fck molek\u00fcl a\u011f\u0131rl\u0131kl\u0131 heparin) kullan\u0131m\u0131 hem \u00f6l\u00fcm hem de tromboz riskini azaltmaktad\u0131r. Ancak ayaktan izlenen veya taburcu edilmi\u015f hastalarda, tan\u0131mlanm\u0131\u015f bir tromboz olmamas\u0131 halinde antikoag\u00fclan kullan\u0131m\u0131n\u0131n yarar\u0131 g\u00f6sterilmemi\u015f olup, bu ko\u015fullardaki uygulamalar kanama riskinde art\u0131\u015fa yol a\u00e7abilmektedir (30, 31, 32, 33).<\/li>\n<li>Aspirin ve tikagrelor gibi anti-trombosit ajanlar (34, 35), inhaler kortikosteroidler (36, 37), \u00e7inko ve D ve C vitaminleri (38, 39) COVID-19\u2019un tedavisinde rutin olarak \u00f6nerilmemektedir.<\/li>\n<\/ul>\n<p><strong><em>Kaynaklar<\/em><\/strong><\/p>\n<ol>\n<li><a href=\"https:\/\/www.who.int\/publications\/m\/item\/covid-19-epidemiological-update---29-september-2023\">https:\/\/www.who.int\/publications\/m\/item\/covid-19-epidemiological-update&#8212;29-september-2023<\/a>.<\/li>\n<li>Xie Y. JAMA 2023 ;329(19):1697-1699. doi:10.1001\/jama.2023.5348.<\/li>\n<li><a href=\"https:\/\/coronavirus.data.gov.uk\/\">https:\/\/coronavirus.data.gov.uk\/<\/a><\/li>\n<li>https:\/\/covid19.saglik.gov.tr\/Eklenti\/42333\/0\/covid-19gunceldonemdecovid19iliskiliizolasyonvekarintinauygulamalari-2pdf.pdf<\/li>\n<li><a href=\"https:\/\/www.who.int\/news\/item\/13-01-2023-who-updates-covid-19-guidelines-on-masks--treatments-and-patient-care\">https:\/\/www.who.int\/news\/item\/13-01-2023-who-updates-covid-19-guidelines-on-masks&#8211;treatments-and-patient-care<\/a>, <a href=\"https:\/\/www.who.int\/publications\/i\/item\/WHO-2019-nCoV-ipc-guideline-2023.1\">https:\/\/www.who.int\/publications\/i\/item\/WHO-2019-nCoV-ipc-guideline-2023.1<\/a><\/li>\n<li><a href=\"https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/need-extra-precautions\/people-who-are-immunocompromised.html\">https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/need-extra-precautions\/people-who-are-immunocompromised.html<\/a>, <a href=\"https:\/\/www.england.nhs.uk\/long-read\/covid-19-testing-policy-update-changes-to-nhs-use-cases\/\">https:\/\/www.england.nhs.uk\/long-read\/covid-19-testing-policy-update-changes-to-nhs-use-cases\/<\/a><\/li>\n<li>Statement on the antigen composition of COVID-19 vaccines [Internet]. Geneva: World Health Organization (WHO). [cited July 18, 2023]. Available from:<a href=\"https:\/\/www.who.int\/news\/item\/18-05-2023-statement-on-the-antigen-composition-of-covid-19-vaccines\">https:\/\/www.who.int\/news\/item\/18-05-2023-statement-on-the-antigen-composition-of-covid-19-vaccines<\/a><\/li>\n<li>Interim clinical considerations for use of COVID-19 vaccines currently authorized in the United States [Internet]. Atlanta: Centers for Disease Control and Prevention (CDC). [cited September 17, 2023]. Available from:<a href=\"https:\/\/www.cdc.gov\/vaccines\/covid-19\/clinical-considerations\/covid-19-vaccines-us.html\">https:\/\/www.cdc.gov\/vaccines\/covid-19\/clinical-considerations\/covid-19-vaccines-us.html<\/a><\/li>\n<li>WHO SAGE roadmap for prioritizing uses of COVID-19 vaccines [Internet]. Geneva: World Health Organization (WHO). [cited July 18, 2023]. Available from:<a href=\"https:\/\/www.who.int\/publications\/i\/item\/WHO-2019-nCoV-Vaccines-SAGE-Roadmap\">https:\/\/www.who.int\/publications\/i\/item\/WHO-2019-nCoV-Vaccines-SAGE-Roadmap<\/a><\/li>\n<li><a href=\"https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/hcp\/clinical-care\/underlyingconditions\">https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/hcp\/clinical-care\/underlyingconditions<\/a><\/li>\n<li>Adjei S. MMWR, 2022. <a href=\"http:\/\/dx.doi.org\/10.15585\/mmwr.mm7137a4\">http:\/\/dx.doi.org\/10.15585\/mmwr.mm7137a4<\/a><\/li>\n<li>Cao Z. NEJM 2022; DOI: 10.1056\/NEJMoa2208822<\/li>\n<li>Bernal AJ. NEJM 2021; 10.1056\/NEJMoa2116044<\/li>\n<li>Chokkalingam AP. JAMA Network Open. 2022;5(12):e2244505, doi:10.1001\/jamanetworkopen.2022.44505<\/li>\n<li>Amstutz A. Lancet Respir Med 2023; https:\/\/doi.org\/10.1016\/ S2213-2600(22)00528-8).<\/li>\n<li>Schilling WHK. Lancet Infect Dis 2023, 2023; <a href=\"https:\/\/doi.org\/10.1016\/S1473-3099(23)00493-0\">https:\/\/doi.org\/10.1016\/S1473-3099(23)00493-0<\/a>)<\/li>\n<li>Butler C. Lancet 2022; <a href=\"https:\/\/doi.org\/10.1016\/S0140-6736(22)02597-1\">https:\/\/doi.org\/10.1016\/S0140-6736(22)02597-1<\/a>)<\/li>\n<li>Wong CKH Lancet. 2022;400(10359):1213-1222. doi: 10.1016\/S0140-6736(22)01586-0).<\/li>\n<li>Senefeld JW. JAMA Netw Open. 2023;6(1):e2250647<\/li>\n<li>Levine AC. CID 2023;ciad088. DOI: 10.1093\/cid\/ciad088<\/li>\n<li>Mihalek N. Sci Rep. 2023;13(1):12904).<\/li>\n<li><a href=\"https:\/\/www.idsociety.org\/practice-guideline\/covid-19-guideline-treatment-and-management\/#toc-11\">https:\/\/www.idsociety.org\/practice-guideline\/covid-19-guideline-treatment-and-management\/#toc-11<\/a><\/li>\n<li>Recovery Group. 2023;401(10387):1499-1507. doi: 10.1016\/S0140-6736(23)00510-X<\/li>\n<li>Salton F. Eur Respir J. 2023 ;61(4):2201514. doi: 10.1183\/13993003.01514-2022<\/li>\n<li>COVID STEROID 2 Trial Group; JAMA. 2021 Nov 9;326(18):1807-1817. doi: 10.1001\/jama.2021.18295).<\/li>\n<li>Albuquerque Clin Microbiol Infect. 2023;29(1):13-21. doi: 10.1016\/j.cmi.2022.07.008<\/li>\n<li>RECOVERY Collaborative Group. Lancet. 2022;400(10349):359-68<\/li>\n<li>Kyriazopoulou E. Nat Med. 2021;27(10):1752-1760. doi: 10.1038\/s41591-021-01499-z<\/li>\n<li><a href=\"https:\/\/www.who.int\/publications\/i\/item\/WHO-2019-nCoV-clinical-2023.2\">https:\/\/www.who.int\/publications\/i\/item\/WHO-2019-nCoV-clinical-2023.2<\/a>)<\/li>\n<li>ATTACC Investigators. N Engl J Med. 2021 26;385(9):790-802. doi: 10.1056\/NEJMoa2105911<\/li>\n<li>Stone GW. J Am Coll Cardiol. 2023 May 9;81(18):1747-1762. doi: 10.1016\/j.jacc.2023.02.041<\/li>\n<li>Ramacciotti E. 2022 Jan 1;399(10319):50-59. doi: 10.1016\/S0140-6736(21)02392-8.<\/li>\n<li>Wang Ann Intern Med. 2023 Apr;176(4):515-523. doi: 10.7326\/M22-3350.<\/li>\n<li>Fischer AL. Cochrane Database Syst Rev. 2023;7(7):CD015078<\/li>\n<li>Berger JS,. JAMA Netw Open. 2023;6(5):e2314428<\/li>\n<li>Griesel M. Cochrane Database Syst Rev. 2022;3(3):CD015125. doi: 10.1002\/14651858.CD015125<\/li>\n<li>Boulware DR, N Engl J Med. 2023 Sep 21;389(12):1085-1095. doi: 10.1056\/NEJMoa220942<\/li>\n<li>Thomas S. JAMA Netw Open.\u00a02021;4(2):e210369. doi:10.1001\/jamanetworkopen.2021.0369<\/li>\n<li>Ben Abdallah S. CID 2023; <a href=\"https:\/\/doi.org\/10.1093\/cid\/ciac807\">https:\/\/doi.org\/10.1093\/cid\/ciac807<\/a><\/li>\n<\/ol>\n<p><em><strong>Katk\u0131lar\u0131 i\u00e7in Alpay Azap, \u00d6zlem Azap, Mert Ku\u015fkucu ve Serap \u015eim\u015fek-Yavuz&#8217;a te\u015fekk\u00fcr ederiz.<\/strong><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>COVID-19\u2019un Epidemiyoloji ve SARS-CoV-2 Varyantlar\u0131 Pandeminin d\u00f6rd\u00fcnc\u00fc y\u0131l\u0131 biterken COVID-19 halen \u00f6ng\u00f6r\u00fclebilir bir s\u0131kl\u0131kta seyretmemekte, mevsimsel \u00f6zellik g\u00f6stermemekte, endemik olarak devam etmekte ve gripten daha fazla hastane yat\u0131\u015f\u0131 ve \u00f6l\u00fcme neden olmaktad\u0131r (1,2). COVID-19\u2019a ba\u011fl\u0131 hastane yat\u0131\u015flar\u0131nda 2023 yaz aylar\u0131na g\u00f6re \u015fu anda \u00e7ok belirgin art\u0131\u015flar vard\u0131r (3). SARS-Cov-2 pandeminin ba\u015flang\u0131c\u0131ndan itibaren gerek do\u011fas\u0131 gerek toplumda geli\u015fmi\u015f ba\u011f\u0131\u015f\u0131kl\u0131k gerekse uygulanan baz\u0131 tedaviler nedeniyle s\u00fcrekli mutasyonlarla evrimine devam etmektedir. Ger\u00e7ek zamanl\u0131 olarak izleyebildi\u011fimiz bu evrim, \u00e7ok say\u0131da varyant\u0131n ortaya \u00e7\u0131kmas\u0131na, bu da pandeminin devam\u0131na ve her bask\u0131n varyantla t\u00fcm d\u00fcnyay\u0131 etkileyen yeni bir COVID-19 dalgas\u0131n\u0131n geli\u015fmesine neden olmu\u015ftur. \u015eu ana kadar [&hellip;]<\/p>\n","protected":false},"author":4,"featured_media":6262,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[1],"tags":[],"_links":{"self":[{"href":"https:\/\/www.klimik.org.tr\/koronavirus\/wp-json\/wp\/v2\/posts\/6261"}],"collection":[{"href":"https:\/\/www.klimik.org.tr\/koronavirus\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.klimik.org.tr\/koronavirus\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.klimik.org.tr\/koronavirus\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimik.org.tr\/koronavirus\/wp-json\/wp\/v2\/comments?post=6261"}],"version-history":[{"count":2,"href":"https:\/\/www.klimik.org.tr\/koronavirus\/wp-json\/wp\/v2\/posts\/6261\/revisions"}],"predecessor-version":[{"id":6264,"href":"https:\/\/www.klimik.org.tr\/koronavirus\/wp-json\/wp\/v2\/posts\/6261\/revisions\/6264"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.klimik.org.tr\/koronavirus\/wp-json\/wp\/v2\/media\/6262"}],"wp:attachment":[{"href":"https:\/\/www.klimik.org.tr\/koronavirus\/wp-json\/wp\/v2\/media?parent=6261"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimik.org.tr\/koronavirus\/wp-json\/wp\/v2\/categories?post=6261"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimik.org.tr\/koronavirus\/wp-json\/wp\/v2\/tags?post=6261"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}