Evaluation of the relationship of treatment and vaccination with prognosis in patients with a diagnosis of COVID-19

PURPOSE

Coronavirus disease 2019 (COVID-19) has affected millions of people worldwide and caused mortality. Many factors have been reported to affect the prognosis of COVID-19. In this study, we aimed to investigate the effects of drug therapy and vaccination on prognosis in patients hospitalized with a COVID-19 diagnosis.

METHODS

In this single-center, cross-sectional study, data were retrospectively collected from patients receiving inpatient treatment at a university hospital with a diagnosis of COVID-19 between January 1, 2020, and April 30, 2022. The patients' demographic and clinical characteristics were recorded. The Chi-square, Cox and logistic regression was performed, P < 0.05 was considered statistically significant.

RESULTS

Total 1723 patients (50.1% were men, mean age: 60.6 ± 16.90) who had not been vaccinated rate was 27.0% (> 3 doses: 45.7%). Mortality rate was 17.0%. Increasing age, male, a high Charlson Comorbidity Index (CCI), and no vaccination significantly increased mortality (P < 0.05). The mortality rate was significantly lower in the chloroquine treatment group than in the other treatment groups. Increasing age, male, and a high CCI were determined to be factors that significantly increased the length of hospital stay (LOHS). LOHS found to be significantly lower in the favipiravir or chloroquine groups compared to the remaining treatment groups (P < 0.001). Both mortality and the LOHS significantly differed according to AST, d-dimer, ferritin, and GFR.

CONCLUSION

This study primarily investigated the effect of treatment and vaccination on the prognosis of COVID-19. This was determined to be prepared for another potential pandemic that may arise due to COVID-19.

Brain abscess incidence and microbial etiology in Turkey: a nationwide cross-sectional study

OBJECTIVE

Brain abscess, a localized purulent central nervous system infection, arises from a variety of microorganisms. Expedited diagnosis and formulation of effective treatment strategies are crucial for mitigating mortality risks in patients with brain abscesses. A nuanced understanding of potential microbial agents is pivotal for the development of empirical antibiotic therapies. This study aimed to explore the incidence and microbial etiology of brain abscesses.

PATIENTS AND METHODS

This study is a nationwide cross-sectional analysis of patients diagnosed with brain abscesses in Turkey, employing the ICD 10 diagnosis code from January 1, 2015, to December 31, 2021. Data pertaining to age, sex, comorbidities, and microorganisms isolated from central nervous system samples were meticulously recorded and analyzed.

RESULTS

This study included 11,536 patients diagnosed with brain abscesses. The incidence fluctuated between 0.98 and 3.68 during the review decrease post-2017, with a notable increase in male patients during time. Diabetes constituted 56.5% of the patients. The predominant isolated pathogens were Staphylococcus (37.6%), Streptococci (13.3%), and Klebsiella spp. (7.8%), Escherichia coli (6.4%), and Candida species (6.1%).

CONCLUSIONS

The incidence of brain abscesses is decreasing in Turkey. Although staphylococci remain the most isolated agents, the frequent occurrence of Gram-negative bacteria and Candida species warrants consideration during empirical antibiotic selection.

Evaluation of clinical and laboratory characteristics and factors affecting mortality in 500 hospitalized COVID-19 patients: A retrospective study

OBJECTIVES

To evaluate the clinical and laboratory characteristics of COVID-19 patients admitted to Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey, and to determine the factors affecting mortality.

METHODS

A total of 500 patients who were diagnosed with COVID-19 between 19th of March and 30th of September 2020 in Afyonkarahisar Health Sciences University, Faculty of Medicine, Pandemic Service, Afyonkarahisar, Turkey, were retrospectively investigated for this study. These individuals' prognoses, demographic, clinical, laboratory, and radiological information were examined and recorded retrospectively. Comparisons were carried out between the characteristics of patients with a prognosis of death and those who recovered.

RESULTS

Of the 500 definite COVID-19 cases included in the study, 53.8% were male and the mean age was 57.6±15.1 (18-88 years). The most common comorbidities were hypertension and diabetes mellitus. A total of 45 (9%) patients developed mortality. Factors such as advanced age, male gender, shortness of breath, fever at admission, comorbid conditions such as hypertension, diabetes mellitus, cardiovascular diseases, lymphopenia, high C-reactive protein, high D-dimer, and high ferritin in the laboratory were found to be important risk factors for mortality. Treatments such as hydroxychloroquine, favipiravir, and lopinavir/ritonavir were not found to have lower mortality rates than one another.

CONCLUSION

Considering these elements when assessing patients and adjusting the course of treatment according to the recommendations of the most recent guidelines may lower mortality.

The effect of lymphocyte blood levels on mortality of COVID-19 patients under intensive care unit follow-up

OBJECTIVE

Lymphocytes are the most important cells in defending the human body against viral pathogens. In this study, we aimed at investigating the relationship between lymphocyte blood levels and patient survival in COVID-19 patients hospitalized in the intensive care unit.

PATIENTS AND METHODS

We retrospectively evaluated patients hospitalized with COVID-19 pneumonia in the intensive care unit. Patients were divided into two groups in terms of blood lymphocyte levels; increased lymphocyte and decreased lymphocyte groups on the 5th day of hospitalization. Mortality rates were compared between groups.

RESULTS

Two groups were similar in terms of laboratory tests and comorbidities. Overall survival was 63.8% (n=102) in patients with increased lymphocytes and 33.2% (n=68) in patients with decreased lymphocytes. Mortality rates were significantly higher in decreased lymphocyte group than in increased lymphocyte group (p=0.003).

CONCLUSIONS

Our study reveals that mortality is higher in patients with a lower lymphocyte count on the 5th day compared to the day of hospitalization.

Investigation of the Characteristics of Crimean Congo Hemorrhagic Fever Cases Reported in Afyonkarahisar Province

OBJECTIVE

Crimean Congo Hemorrhagic Fever (CCHF); fever, widespread pain in the body, deterioration in liver function tests; it is a tick-borne viral infectious disease that can cause bleeding and death in the skin, mucous membranes, and sometimes internal organs. In this study, we retrospectively evaluated the clinical, laboratory, and epidemiological characteristics of CCHF cases diagnosed in Afyonkarahisar.

METHODS

Demographic and clinical characteristics, laboratory findings, treatments, and prognoses of patients diagnosed with CCHF in Afyonkarahisar were retrospectively analyzed.

RESULTS

In Afyonkarahisar, it was determined that 35 case reports were made between 2002 and November 2019, the date when the CCHF was first seen in Turkey. A history of tick attachment was detected in 31 subjects. Tick arrest cases were most common in June (12 cases; 34.3%) and July (9 cases; 2.9%). There was a history of living in rural areas in twenty-seven (77.1%) patients, close contact with animals in 12 patients, and a history of contact with animal blood in 4 patients. All the 35 cases that followed resulted in healing and no mortality was observed.

CONCLUSION

CCHF is an endemic disease that still maintains its importance in our country. The most important factor in the control with the disease is to prevent virus contact to prevent transmission. People living in endemic areas should be informed about the precautions to be taken against tick bites, and awareness should be raised by providing education about the disease.

Neurological symptoms and findings in COVID-19: a prospective clinical study

OBJECTIVE

We sought to evaluate neurologic symptoms and findings in patients with COVID-19 infection hospitalized in a ward and intensive care unit (ICU).

METHODS

This study was designed as a prospective study. Hospitalized COVID-19 rRt-PCR positive patients in the ward and ICU were included in the study. A 54-item questionnaire was used to evaluate the patients. Patients were examined within 3 hours of hospitalization.

RESULTS

A total of 379 patients were included in the study. The mean age of the patients was 56.1 ± 17.8. 89 of the patients were in intensive care. At least one general symptom was recorded in 95.5% of patients. The most common neurologic symptoms were myalgia (48.5%), headache (39.6%), anosmia (34.8%), and dysgeusia (34%). Neurological symptoms in ICU patients were higher than in the ward. 53.6% of patients had comorbidities.

DISCUSSION

This study indicated that the prevalence of neurological symptoms was very high in patients with COVID-19. The percentage of neurological symptoms and findings was higher in patients hospitalized in ICU.

[Evaluation of Healthcare Professionals in Contact with Patients Diagnosed with COVID-19 Detected Outside of the Pandemic Service in our Hospital]

The "Coronavirus Disease 19 (COVID-19)" caused by "Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)" is still active all over the world as a pandemia. It is reported that at least 7000 health care workers (HCW) had lost their lives due to COVID-19 from the beginning of the pandemia till September 2020 in the world. In our country between the dates, March 11, 2020 which the first case was reported, and September 1, 2020, the date which our study has been finalized, 7428 HCW were infected by SARS-CoV-2, and 52 of them were deceased. In this study, it was aimed to evaluate the contact and illness of healthcare workers working outside of the pandemic clinics in our hospital and to examine the possible transmission routes and disease prognoses. Healthcare workers who were working outside the pandemic service between March 11, 2020 and September 1, 2020 and who had a definite diagnosis of COVID-19 and all hospital staff who had contacted with these people, and HCW who had contact with patients diagnosed with COVID-19 while receiving inpatient treatment in services other than the pandemic service was evaluated and classified as low, medium and high risk according to the risk scoring defined in the published "Ministry of Health COVID-19 Guidelines". Healthcare workers who were evaluated as contacted were questioned in detail regarding the use of personal protective equipment (PPE) at the time of contact, especially suitability of the masks, contact time and shape and all the data were recorded. A total of 53 index cases (40 HCW and 13 inpatients diagnosed as COVID-19) were detected during the study period. The number of HCW contacted with these index cases was 672. In our study, we examined the data of 40 index cases and 672 contacted HCW (total of 712 HCW). Only 3 of 40 index cases (7.5%) had hospital-acquired COVID-19 infection, the other 37 cases were infected by community sources. COVID-19 was not detected in 94.2% of the contacted HCW during the follow-up while 5.8% of them had positive PCR test results. Considering the possible way of contamination among the contacted HCW who developed COVID-19 during the follow-up period, it was determined that 13.1% of the cases were a result of taken care of patients, 86.9% of the cases were a result of being in hospital social environments (drinking tea, smoking, eating, chatting in the same room without personal precautions) and in the days after the contact, it was in the form of contact with healthcare personnel diagnosed with COVID-19. When the contacted HCW were questioned about using proper masks at the time of contact, we determined that 93.3% of them used masks during patient caring procedures, however, only 48.9% used masks when they were in social areas (p<0.001). Healthcare workers face an unprecedented risk of occupational disease and death due to the COVID-19 pandemic. However, it is also observed that prolonged pandemia period caused health workers to disregard rigorous infection control precautions in social areas of hospitals which they follow inpatient care although this has shown to be the most common way of contamination. Commonly performed in-service training and causing awareness in all areas of the hospital about following infection control precautions and PPE usage and checking the process regularly are the most important ways to prevent HCW from being affected by COVID-19.

Changes in antimicrobial resistance and outcomes of health care-associated infections

To describe the change in the epidemiology of health care-associated infections (HAI), resistance and predictors of fatality we conducted a nationwide study in 24 hospitals between 2015 and 2018. The 30-day fatality rate was 22% in 2015 and increased to 25% in 2018. In BSI, a significant increasing trend was observed for Candida and Enterococcus. The highest rate of 30-day fatality was detected among the patients with pneumonia (32%). In pneumonia, Pseudomonas infections increased in 2018. Colistin resistance increased and significantly associated with 30-day fatality in Pseudomonas infections. Among S. aureus methicillin, resistance increased from 31 to 41%.

Morphological, histological and molecular investigations on canine uterine tissue after ovariectomy

In the present study, we investigated the course of atrophy in canine uterine tissue and the expression of estrogen receptors (ER) and progesterone receptors (PR) within 6 months after ovariectomy (OE). In nine primipar bitches of different breeds, bilateral OE and removal of one horn was performed. Six months after surgery, the remaining uterine tissue was removed. The tissue was examined for signs of inflammation and proliferation, and for expression of ER, PR and Ki67 by means of immunohistochemistry (IHC); furthermore transcription of vascular endothelial growth factor (VEGF), transforming growth factor-ß (TGF-ß), epithelial growth factor (EGF), platelet activating factor (PAF), tumor necrosis factor α (TNFα), and their specific receptors was determined by means of RT-qPCR. Serum concentrations of estrogen and progesterone were measured immediately before the first and second operation. Six month after OE, no inflammation was seen in any uterine tissue, the thickness of the stump was decreased in most bitches. Protein expression of Ki67 revealed high individual differences after the second operation. Concentration of both hormones was not significantly changed, the estrogen concentration always revealed high individual differences. The expression of ER was significantly decreased in stromal and smooth muscle cells of the uterine tissue (p < 0.01), and the expression of PR in stromal cells only (p < 0.05). The gene expression of growth factors did not change significantly between first and second operation. We conclude that complete atrophy did not occur within 6 months after OE, instead, a high percentage of uterine cells still expressed ER and PR, rendering the stump susceptible to hormone treatments.

Plexiform neurofibroma during and after pregnancy

Neurofibromatosis is a genetic disease that affects multiple organ systems, and has a wide range of clinical features. Neurofibromatosis in pregnancy is encountered with a frequency of 1:2434 to 1:18,500 deliveries. Plexiform neurofibromas are rare subcutaneous nodules or amorphous overgrowth of subcutaneous tissues, which may affect the underlying bone, and produce deformities. We present a patient with a giant plexiform neurofibroma of the thigh which got larger in pregnancy, and shrunk a bit in the postpartum period.