Current COVID - 19 Informations

.: PREFACE
ÖN SÖZ
PREFACE
Prof. Dr. Duran CANATANa, Prof. Dr. Şefik Ş. ALKANb
aAntalya Genetik Hastalıklar Değerlendirme Merkezi, Antalya, Türkiye
bEmekli Bağışıklık Bilimcisi, Basel, İsviçre
Article Language: TR
Türkiye Klinikleri tarafından COVID-19 konusunda birçok yayın yapıldı. Ancak, şimdiye dek görülmemiş hızla ilerleyen bir konuda yeni derlemelere büyük gereksinim vardır. Biz bu kitapta COVID -19'a neden olan SARS-CoV-2 virüsünün kalıtsal (genom) yapısını, mikroRNA'lar ile etkileşimini, mutasyonlarını, hastalığın tanı yöntemlerini, aşılama ve bağışıklık yanıtlarını, bireylerin hastalığa kalıtsal yatkınlığını ve son olarak da yapay zekânın COVID-19'daki yerini inceleyen değerli bilim insanlarımızın görüşlerine yer verdik.

Aslında koronavirüsler 1920'lerden beri biliniyordu ama alçak sesle konuşulduğu için birkaç bilimcinin dışında kimsenin dikkatini çekmemişti. Derken 2003'de SARS, 2012'de MERS gibi ölümcül üst solunum yolu hastalıkları yapan koronavirüsler ortaya çıktı. Gene birkaç bilimci dışında dünyada fazla yankı uyandırmadı. Ama, 2020'nin başlarında COVID-19 hastalığı ortaya çıkınca herkes kulak kesildi. O gün bugün SARS-CoV-2 ile savaşıyor ve salgınlar tarihinden ders almadığımız için büyük bedeller ödüyoruz. Korkarız, mini-canlıları, onların evrimleşme kurallarını bilmedikçe ve toplumsal yaşamımızı ona göre düzenlemedikçe durumumuz hep böyle olacak gibi...

Bu kitaptaki COVID-19 bölümleri söyle özetlenebilir; Genetik (kalıtım) bölümünde; korona virüs ailesi ve genetik yapısı ele alınmıştır. Koronavirüsler, Nidovirales takımında Coronaviridae ailesinde yer alan yaklaşık 80-160 nm büyüklüğünde, zarflı, sarmal kapsidli, tek iplikçikli RNA virüsleridir. Alfakoronavirüs (α-CoV), Betakoronavirüs (β-CoV), Deltakoronavirüs (δ-CoV) ve Gamakoronavirüs (γ-CoV) olmak üzere dört cins içermektedir. Koronavirüsler, dört ana yapısal proteini; diken (Spike, S), zar (membran, M), zarf glikoproteinleri (E) ve nükleokapsid (N) fosfoproteinlerine sahiptir. SARS-CoV-2, tek sarmallı, pozitif polariteli, 29.8-29.9 nükleotidlik tek bir parçadan oluşan RNA genomuna sahip, bilinen en büyük ikinci RNA virüsüdür.

Değişimler (Mutasyonlar) bölümünde, SARS-CoV-2'nin değişim düzeneğini (mutasyon mekanizmasını) uğradığı seçilim baskısı sonucu oluşan değişkeleri (varyantları), bunların aşılara ve salgının seyrindeki etkisi anlatılıyor. Virüsler diğer üreyen canlılara kıyasla çok daha hızlı evrim geçirirler. Bunun sebebi temel olarak yoğun sayıları, kısa ve hızlı üreme döngüleri ve değişim (mutasyon) oranlarının yüksek oluşudur.

MikroRNA'lar bölümünde, COVID-19 hastalığının oluşumunda (patogenezinde) mikroRNA'ların rolü anlatılmaktadır. Günümüzde, COVID-19 hastalığında oluşan aşırı sitokin üretimi ve organ hasarını önlemek amacıyla, mezenkimal kök hücre kaynaklı, içeriğine özel mikroRNA'ların da eklendiği hücre dışı kesecikler ile ilgili çalışmalar yürütülmektedir.

Günümüzde SARS-CoV-2'nin tanısında en geçerli yöntem olarak hâlâ gerçek zamanlı tersine transkriptaz polimeraz zincir tepkimesi (RT-PCR) kullanılmaktadır. Bu süreçte birçok yeni an tijen ve antikor saptayıcı testler geliştirilmiştir. Ancak bunların kullanımları kısıtlıdır. SARSCoV-2'nin yeni değişiklikleri (varyantları) tanımlanırken, kullanılmakta olan testlerin yeni değişkenler açısından değerlendirilmesi ve yeniden yapılandırılması büyük önem taşımaktadır. COVID-19 küresel salgını başlayalı bir yıl geçti ama COVID-19 bağışıklığı üzerine söylenen ya da yazılanlar hâlâ sıklıkla değişmektedir. Bunun nedeni çeşitli insan kümelerinin bağışıklık yanıtlarının bireyselliği ve karmaşıklığıdır. Bu bölümde bağışıklığın COVID-19'a karşı aldığı çoğu zaman doğru ama kimi zaman yanlış davranışlar hakkındaki bilimsel bilgiler derlenmiştir. Bunu yaparken K. Popper'in şu sözlerinin kulağımızda olması gerekliliği vurgulanmıştır: ''En güvenilir bilgi, bilimsel bilgidir, ancak onda da yanılmalar olabilir''.

COVID-19 küresel salgınında yüksek ölüm oranı ve hızlı yayılma nedeni ile acilen etkili bir aşıya gereksinim duyulmuştur. Aşı geliştirme çalışmaları, araştırma, hayvan deneyleri ve insanlarda güvenlik için yapılan 3 evre (faz) çalışmaları genelde 10-15 yıl sürmesine karşın, COVID-19 için Dünya Sağlık Örgütü tüm ülkelere çok hızlı aşı üretimi için onay vermiştir. Aşılamanın temel amacı, toplum bağışıklığı yaratarak hastalık bulaşmasını önlemektir. Bunun için toplumun en az %70'inin SARS-CoV-2 ile aşılanması gerekir.

COVID-19'a karşı en hızlı geliştirilen mRNA aşıları bölümünde aşı tipleri ve etki mekanizmaları incelenerek, SARS-CoV-2'nin kalıtsal (genomik) yapısındaki proteinleri şifreleyen mRNA aşılarına eklenen lipidler, nanoparçacıklar irdelenmiş ve geliştirilen/geliştirilmekte olan yeni mRNA aşıları hakkında güncel bilgiler verilmiştir.

Bireylerin COVID-19'a karşı risk durumları ele alınmış, bu konuda yapılan risk analizi yöntemleri ayrıca değerlendirilmiştir. Başka bir bölümde, birçok genetik hastalıklarda bireylerin COVID-19 durumu ele alınmıştır.

Kitabın son bölümde, yapay zekânın tıp alanında kullanım serüveni sunulduktan sonra, yapay zekâ işlem basamaklarının (algoritmalarının) COVID-19 salgını ile ilgili nasıl ve ne amaçla kullanıldıklarına dair yapılan çalışmalar hakkında geniş bilgiler verilmiştir. Yapay zekâ tabanlı çözümlerin pratikte kullanılabilmesi için uyarlanabilir ve ölçeklenebilir bir yazılım sisteminin gerekliliği ortadadır. Bu nedenle, sunulan çalışmada yapay zekâ sistemlerinin gerçek zamanlı olarak uygulanabilmesi için bir yazılım mimarisi önerilmiştir. Bu sistem, COVID-19 ve gelecekte karşılaşılabilecek benzer durumlarda da uyarlanıp kullanılabilecek bir mimari olarak değerlendirilebilir.

Kimi okuyucunun hemen dikkatini çekmiştir; burada elimizden geldiğince Türkçe kullanmaya özen gösterdik. (Pandemi= küresel salgın; spike= diken, başak; vektor= yöney; membran füzyonu= zarla kaynaşması; pozisyon= konum; sekonder sturuktur= ikincil yapı vb.) Herkesin bir dil alışkanlığı vardır ve alışkanlığı bırakmanın ne denli güç olduğunu kendimizden biliyoruz. Buna karşın, eleştirel düşünebilmenin en iyi ana dilde yapabildiğini çok iyi bilen Atatürk'ün izinde gitmenin yararına inanıyoruz. Anadile sadık kalmanın; her şeyimizi borçlu olduğumuz halkımızla sağlıklı ve anlamlı ilişki kurabilmenin tek yolu olduğunu düşünüyoruz. Bu bakımdan bağışıklık ve aşılama bölümlerine, genel okuyucunun bile anlayacağı dille yazılmış bir deneme gözüyle bakabilirsiniz. Şunu da ekleyelim: Düzetmenleriniz (editörleriniz) hem bu iki bölüm hem de tüm kitap için sayısız kere, çeşitli sözlüklere başvurdular.

Bu kitabın yazılmasına fırsat veren Türkiye Klinikleri baş editörüne, yardımcı olan yazı ekibine, değerli çalışmaları ve yazıları ile katkıda bulunan değerli bilim insanlarımıza teşekkürü borç biliriz.

Kitabın COVID-19 ile ''savaşan'' tüm sağlıkçılara ve araştırmacılara yararlı olmasını dileriz.

Prof. Dr. Duran CANATAN
Editör

Prof. Dr. Ş. Şanal ALKAN
Editör
Although Türkiye Klinikleri have had several publications on COVID-19, there is a great need for new reviews on a subject that is advancing at an unprecedented speed. In this book, we have compiled the opinions of our valuable scientists who examine the following topics; the hereditary (genome) structure of the SARS-CoV-2 virus that causes COVID-19, its interaction with microRNAs, its mutations, diagnostic methods of the disease, vaccination methods and immune responses, the hereditary susceptibility of individuals to the disease and finally, the place of artificial intelligence in COVID-19.

The coronaviruses have been known since the 1920s, but they did not attract much attention except a few scientists because they were speaking in a low voice. Then, they caused deadly upper respiratory diseases such as SARS in 2003 and as MERS in 2012. Again, it did not have much repercussions in the world, except for a few scientists. But since the emergence of COVID-19 in early 2020, the whole world talk about it. Today we are at war with SARS-CoV-2 virus, but unfortunately, we are paying a great price for not learning from the long history of the epidemics. As long as we do not understand the microorganisms and in particular evolutionary roles of viruses and organize our social life accordingly, we are afraid that this suffering will stop quickly...

The chapters in this book can be summarized as follows; In the genetics section; the genetic structure corona virus family is discussed. Coronaviruses belonging to the Coronaviridae family are enveloped, helical capsid, single-stranded RNA viruses of approximately 80-160 nm in size. It consists of four types such as Alfacoronavirus (α-CoV), Betacoronavirus (β-CoV), Deltacoronavirus (δ-CoV) and Gamacoronavirus (γ-CoV). Coronaviruses have four major structural proteins spike (S), membrane (M), envelope glycoproteins (E), and nucleocapsid (N) phosphoproteins. SARS-CoV-2 is the second largest known RNA virus with a single-stranded, positivepolarity RNA genome consisting of a single segment of 29.8-29.9 nucleotides.

In the mutations section, the variants of SARS-CoV-2 resulting from the selection pressure and the effects of these variants on vaccines and the course of the epidemic are explained. Viruses evolve much faster than any other microorganisms due to their vastly large numbers, short and rapid replication cycles, and high mutation rates.

The microRNAs section the role of microRNAs in the pathogenesis of COVID-19 disease is described. Studies are described on extracellular vesicles originating from mesenchymal stem cells, in which special microRNAs are added, in order to prevent excessive cytokine production and organ damage in COVID-19.

Today, real-time reverse transcriptase polymerase chain reaction (RT-PCR) is still used as the most valid method in the diagnosis of SARS-CoV-2 infection. In due time, many new antigen and antibody detection tests have been developed. However, their use is limited. As new variants of SARS-CoV-2 emerges, it is important to re-evaluate existing tests.

It has been over a year since the COVID-19 pandemic started, but the knowledge on the immune response to COVID-19 is still frequently changing. This is due to the individuality and complexity of the immune responses of the various human beings. In this section, available information on the mostly correct but sometimes wrong behavior of immune system against COVID-19 has been compiled. While doing this, we tried to keep in mind the following words of K. Popper; "Our best knowledge is scientific knowledge and that is fallible too''.

Due to the high mortality rate and rapid spread of COVID-19, an effective vaccine was urgently needed. Although usual vaccine development studies, research, animal experiments and 3 phase studies in humans usually take 10-15 years, the WHO has encouraged and approved rapid vaccine development for COVID-19. The main purpose of vaccination is to prevent disease transmission by creating herd immunity. For this, at least 70% of the population needs be vaccinated with SARS-CoV-2.

In the section of the mRNA vaccines against COVID-19, the types of vaccines and their mechanisms of action are examined, and updated information about the lipids and nanoparticles used in the mRNA vaccines were given. Also, the new mRNA vaccines that are being developed have been summarized. The risks of the individuals against COVID-19 mutants have been discussed.

In another section, COVID-19 status of individuals in many genetic diseases is discussed.

In the last section of the book, after the adventure of the use of artificial intelligence in the field of medicine, extensive information is given about the studies on how and for what purpose artificial intelligence algorithms are used in relation to the COVID-19 outbreak. It is obvious that an adaptable and scalable software system is required for the practical use of AI-based solutions. For this reason, a software architecture is proposed to apply artificial intelligence systems in real time. This system can be considered as an architecture that can be adapted and used in COVID19 and similar situations that may occur in the future.

As some of the readers may have noticed immediately, in this book we have tried to use Turkish words as much as possible. Understandably, everyone prefers to use a favored adapted foreign word to explain complex scientific matters because it is much easier. Also, we know how difficult it is to change our ''habits'' from our personal experiences. However, we believe that it is beneficial to follow Atatürk, who knew very well that critical thinking is best done in the mother tongue. In addition, we think that as health professionals, staying true to the mother tongue is the only way to establish a healthy and meaningful relationship with our people, to whom we owe everything. In this respect, you can consider the immunization and vaccination sections in this book as an essay written in Turkish that even the general reader can understand.

We would like to thank the chief editor of Türkiye Klinikleri and writing team and our dear scientist colleagues for their valuable contributions for this book.

We also hope that the book will be beneficial to all those healthcare professionals and researchers who are "fighting" against COVID-19.

Prof. Dr. Duran CANATAN
Editor

Prof. Dr. Şefik Şanal ALKAN
Editor

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30.03.2014

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Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

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