The prognostic significance of erythrocyte sedimentation rate in COVID-19

SUMMARY OBJECTIVE: There are limited data about the significance of erythrocyte sedimentation rate as a single prognostic parameter for the prognosis and mortality of COVID-19. This study aimed to investigate the diagnostic utility of erythrocyte sedimentation rate as a prognostic factor for the disease severity and mortality in patients with COVID-19. METHODS: A total of 148 consecutive patients with a confirmed diagnosis of COVID-19 and hospitalized at the intensive care unit or non-the intensive care unit were included in the study. The patients were allocated to groups as severe/critical disease versus nonsevere disease and survivors and nonsurvivors. The prognostic role and predictable values of erythrocyte sedimentation rate were analyzed. RESULTS: Erythrocyte sedimentation rate was found to be higher among patients with severe/critical disease compared to those with nonsevere disease (p<0.001) and among nonsurvivors compared to survivors (p<0.001). The logistic regression analysis showed that erythrocyte sedimentation rate was an independent parameter for predicting disease severity and mortality. The role of erythrocyte sedimentation rate in the assessment of severity and mortality in patients with COVID-19 was analyzed using the receiver operating characteristic curve and was found to be significant in both. The analyses suggested that the optimum erythrocyte sedimentation rate cutoff point for disease severity and mortality were 52.5 mm/h with 65.5% sensitivity and 76.3% specificity and 56.5 mm/h with 66.7% sensitivity and 72.5% specificity. CONCLUSION: Our results suggest that erythrocyte sedimentation rate was an independent prognostic factor for severity and mortality in patients with COVID-19.

The effectiveness of dexamethasone on the prognosis of dialysis patients with severe COVID-19

SUMMARY OBJECTIVE: This study aimed to investigate the effectiveness of dexamethasone in dialysis patients with COVID-19 and whether it predicts mortality. METHODS: This is a comparative cross-sectional study of 113 consecutive patients with COVID-19 with severe pneumonia signs. The patients were divided into two groups according to the use of dexamethasone treatment: group 1 (n=45) included patients who were treated with dexamethasone and group 2 (n=68) who did not receive dexamethasone. RESULTS: The mean age of both groups was 67.0±10.6 and 67.2±13.0 years, respectively (p=0.947). With respect to demographic and laboratory findings, there were no significant differences between the two groups (p>0.05). The hospitalization time of patients in group 1 was longer than that in group 2 (11 [7-17] days vs. 8 [5.3-14] days, p=0.093]. The 28-day survival rate was 54.2% in the group receiving dexamethasone treatment and 79.5% in the group not receiving dexamethasone treatment (p=0.440). CONCLUSION: Dexamethasone did not reduce mortality rates and the requirement for intensive care unit in dialysis patients with COVID-19. Larger prospective randomized clinical trials are required to associate personalized medicine with the corticosteroid treatment to select suitable patients who are more likely to show a benefit.

Evaluation of cardiac parameters between survivors and nonsurvivors of COVID-19 patients

SUMMARY OBJECTIVE: The present study compares the cardiac parameters of the survivor and nonsurvivor patients with COVID-19 infection. METHODS: This study was conducted in 379 patients diagnosed with COVID-19 disease. Information of 21 nonsurvivor and 358 survivor patients with COVID-19 was obtained from the hospital information management system and analyzed retrospectively. Relationship between cardiac parameters in patients categorized into the mortal and immortal groups was investigated. RESULTS: Of the total 379 patients involved in this study, 155 (40.9%) were females and 224 (59.1%) were males. No statistically significant difference in mortality was found between females and males (p=0.249). The total median age was 70, the median age in the nonsurvivor group was 74 (35-89), and it was 69.5 (18-96) in the survivor group (p=0.249). The median values of high-sensitivity troponin (hs-Tn), creatine kinase MB form, and especially myoglobin in the survivor and nonsurvivor groups were 25/64.9 (p=0.028), 18/23 (p=0.02), and 105.5/322.4 (p<0.001), and the difference was statistically significant. Comparing mortality, while there was 1 (0.7%) nonsurvivor out of 134 patients in the service unit, there were 20 (8.2%) nonsurvivors out of 245 patients in the intensive care unit. This difference was statistically significant (p=0.003). The cutoff value of myoglobin, which may pose a risk of mortality, was found to be 191.4 µg/L, while it was 45.7 ng/l for hs-Tn and 60.1 U/L for creatine kinase MB. CONCLUSIONS: Advanced age and increased levels of high-sensitivity troponin, creatine kinase MB, and myoglobin were found to be associated with mortality.

Evaluation of coagulation parameters: Coronavirus disease 2019 (COVID-19) between survivors and nonsurvivors

SUMMARY OBJECTIVE: This study aims to investigate and compare the coagulation parameters of coronavirus disease 2019 (COVID-19) patients with mortal and nonmortal conditions. METHODS: In this study, 511 patients diagnosed with COVID-19 were included. Information about 31 deceased and 480 recovered COVID-19 patients was obtained from the hospital information management system and analyzed retrospectively. Whether there was a correlation between coagulation parameters between the mortal and nonmortal patients was analyzed. Descriptive analyses on general characteristics of the study population were performed. Visual (probability plots and histograms) and analytical methods (Kolmogorov-Smirnov and Shapiro-Wilk test) were used to test the normal distribution. Analyses were performed using the SPSS statistical software package. RESULTS: Out of 511 patients, 219 (42.9%) were females and 292 (57.1%) were males. There was no statistically significant difference between males and females in terms of mortality (p=0.521). In total, the median age was 67 (22). The median age was 74 (13) in the nonsurvivor group and 67 (22) in the survivor group, and the difference was statistically significant (p=0.007). The D-dimer, prothrombin time, international normalized ratio, neutrophil, and lymphocyte median age values with p-values, in the recovered and deceased patient groups were: 1070 (2129), 1990 (7513) μg FEU/L, p=0.005; 12.6 (2.10), 13.3 (2.1), p=0.014; 1.17 (0.21), 1.22 (0.19), p=0.028; 5.51 (6.15), 8.54 (7.05), p=0.001; and 0.99 (0.96), 0.64 (0.84), p=0.037, respectively, with statistically significant differences. CONCLUSIONS: As a result of this study, D-dimer, prothrombin time, and international normalized ratio increase were found to be associated with mortality. These parameters need to be closely monitored during the patient follow-up.

Association of ABO blood group and age with COVID-19 positive test

ABSTRACT OBJECTIVE: The aim of this study is to evaluate the relation between the coronavirus (SARS-CoV-2) disease (COVID-19) and blood groups and the Rh factor. METHOD: A total of 313 patients hospitalized in the Internal Medicine clinic, at the intensive care unit (ICU) were included in the study. The cases were divided into two groups: those who were COVID-19 positive and those negative, detected with real-time reverse transcription polymerase chain reaction testing. The demographic, clinical, ABO blood groups, and Rh factor data of the cases were obtained from the hospital records retrospectively. RESULTS: The mean age of COVID-19 positive (+) cases was 57.74±16 years and of COVID-19 negative (-) cases, 66.41±15 years. The difference was significant (p<0.001); there was no difference between the two groups in terms of sex (p=0.634). When age was categorically separated in COVID-19 (+) cases, χ2 was extremely significant. Among the ABO blood groups of COVID-19 (+) and (-) cases, χ2 was 4.975 (p=0.174). In the logistic regression, it was 4.1 (p=0.011) in the O blood group. COVID-19 positive test was determined as 13, 4, and 4 times higher in the 31-40, 41-50, and 51-60 age groups, respectively (p=0.001, p=0.010, p=0.003). CONCLUSION: The incidence of COVID-19 has increased in the younger population and in the O blood group. Our findings support that, in this population, the ABO blood groups can contribute to the early detection of COVID-19.

Correlation between venous blood gas indices and radiological involvements of COVID-19 patients at first admission to emergency department

SUMMARY The purpose of this study was to investigate the relation between venous blood gas and chest computerized tomography findings and the clinical conditions of COVID-19 pneumonia. METHODS: A total of 309 patients admitted to the emergency department and subsequently confirmed COVID-19 cases was examined. Patients with pneumonia symptoms, chest computerized tomography scan, venous blood gas findings, and confirmed COVID-19 on reverse transcription-polymerase chain reaction (PCR) were consecutively enrolled. Multiple linear regression was used to predict computerized tomography and blood gas findings by clinical/laboratory data. RESULTS: The median age of patients was 51 (interquartile range 39-66), and 51.5% were male. The mortality rate at the end of follow-up was 18.8%. With respect to survival status of patients pCO2 and HCO3 levels and total computerized tomography score values were found to be higher in the surviving patients (p<0.001 and p=0.003, respectively), whereas pH and lactate levels were higher in patients who died (p=0.022 and p=0.001, respectively). With logistic regression analysis, total tomography score was found to be significantly effective on mortality (p<0.001). The diffuse and random involvement of the lungs had a significant effect on mortality (p<0.001, 95%CI 3.853-38.769, OR 12.222 and p=0.027; 95%CI 1.155-11.640, OR 3.667, respectively). With linear regression analysis, the effect of pH and lactate results were found to have a positive effect on total tomography score (p=0.003 and p<0.001, respectively), whereas pCO2 was found to have a negative effect (p=0.029). CONCLUSION: There was correlation between venous blood gas indices and radiologic scores in COVID-19 patients. Venous blood gas taken in emergency department can be a fast, applicable, minor-invasive, and complementary test in terms of diagnosing COVID-19 pneumonia and predicting the prognosis of disease.

Is the COVID-19 disease associated with de novo nephritic syndrome?

SUMMARY INTRODUCTION: This study aims to determine the incidence of de novo nephritic syndrome (NS) in COVID-19 patients and identify its associated factors. METHODS: All ward patients with COVID-19 pneumonia were investigated. After determining the inclusion and exclusion criteria, the study population was identified. The urine dipstick test and urine protein creatinine ratio (UPCR) measurements were performed. Patients with de novo NS findings, nasopharyngeal swab, and urine RT-PCR tests were performed simultaneously RESULTS: This descriptive cross-sectional study was conducted with 21 patients with COVID-19. The mean age of the patients was 42.2±8.8 years, and 71.4% of them were male. The mean duration of follow-up was 28.4±9.3 days. The urine RT-PCR test was positive in one patient (4.8%). Improvements were observed in hematuria by 71.4%, and proteinuria by 85.7% at the end of the follow-up. A significant decrease in the measured UPCR was found in comparison to the baseline(P=0.000). Also, improvements were recorded in the complete blood counts, inflammatory parameters, ferritin, and coagulation tests, compared to the baseline. There was a positive correlation between baseline UPCR and ferritin, and a negative correlation between baseline UPCR and sodium values CONCLUSION: COVID-19-induced de novo nephritic syndrome may occur mainly due to tubulointerstitial involvement and often results in spontaneous remission. However, why these findings were not present in all patients who had no comorbidities is not clear.

RESUMO INTRODUÇÃO: Este estudo tem como objetivo determinar a incidência da síndrome nefrítica de novo (SN) em pacientes com COVID-19 e identificar os fatores associados. MÉTODOS: Todos os pacientes da enfermaria com pneumonia por COVID-19 foram investigados. Após a determinação dos critérios de inclusão e exclusão, a população do estudo foi identificada. Foram realizadas medições do teste da vareta da urina e da razão da creatinina das proteínas na urina (UPCR). RESULTADOS: Este estudo transversal descritivo foi realizado com 21 pacientes com COVID-19. A idade média dos pacientes foi de 42,2±8,8 anos e 71,4% dos pacientes eram do sexo masculino. A duração média do seguimento foi de 28,4±9,3 dias. O teste de RT-PCR na urina foi positivo em um paciente (4,8%). Houve melhorias observadas na hematúria em 71,4% e na proteinúria em 85,7% no final do acompanhamento. E uma diminuição significativa na UPCR medida em comparação à linha de base (p=0,000). Além disso, foram registradas melhorias nas contagens sanguíneas completas, nos parâmetros inflamatórios, nos testes de ferritina e de coagulação, comparados aos valores basais. Houve correlação positiva entre UPCR basal e ferritina, e correlação negativa entre os valores basais de UPCR e sódio. CONCLUSÃO: A síndrome nefrítica de novo induzida por COVID-19 pode ocorrer principalmente devido ao envolvimento túbulo-intersticial e frequentemente resulta em remissão espontânea. No entanto, a questão de por que esses achados não se apresentaram em todos os pacientes que não apresentavam condição comórbida não é clara.

Effect of COVID-19 on platelet count and its indices

SUMMARY BACKGROUND Easily accessible, inexpensive, and widely used laboratory tests that demonstrate the severity of COVID-19 are important. Therefore, in this study, we aimed to investigate the relationship between mortality in COVID-19 and platelet count, Mean Platelet Volume (MPV), and platelet distribution width. METHODS In total, 215 COVID-19 patients were included in this study. The patients were divided into two groups. Patients with room air oxygen saturation < 90% were considered as severe COVID-19, and patients with ≥90% were considered moderate COVID-19. Patient medical records and the electronic patient data monitoring system were examined retrospectively. Analyses were performed using the SPSS statistical software. A p-value <0.05 was considered significant. RESULTS The patients' mean age was 64,32 ± 16,07 years. According to oxygen saturation, 81 patients had moderate and 134 had severe COVID-19. Our findings revealed that oxygen saturation at admission and the MPV difference between the first and third days of hospitalization were significant parameters in COVID-19 patients for predicting mortality. While mortality was 8.4 times higher in patients who had oxygen saturation under 90 % at hospital admission, 1 unit increase in MPV increased mortality 1.76 times. CONCLUSION In addition to the lung capacity of patients, the mean platelet volume may be used as an auxiliary test in predicting the mortality in COVID-19 patients.

RESUMO OBJETIVO Testes laboratoriais de fácil acesso, baixo custo e amplamente utilizados capazes de demonstrar a gravidade da COVID-19 são importantes. Portanto, neste estudo, o nosso objetivo foi investigar a relação entre a mortalidade na COVID-19 e a contagem de plaquetas, volume plaquetário médio (VMP) e largura de distribuição de plaquetas. MÉTODOS No total, 215 pacientes com COVID-19 foram incluídos no estudo. Os pacientes foram divididos em dois grupos. Pacientes com saturação de oxigênio < 90% em ar ambiente foram considerados casos graves de COVID-19 e pacientes com valores ≥90% foram considerados casos moderados. Os registros médicos dos pacientes e o sistema eletrônico de monitoramento de dados de pacientes foram analisados retrospectivamente. As análises foram realizadas utilizando o software estatístico SPSS. Um valor de p <0,05 foi considerado significativo. RESULTADOS A média de idade dos pacientes foi de 64,32 ± 16,07 anos. Com base na saturação de oxigênio, 81 pacientes eram casos moderados e 134 tinham COVID-19 grave. Nosso estudo revelou que a saturação de oxigênio no momento da internação e a diferença nos valores de VPM entre o primeiro e terceiro dia de internação foram parâmetros significativos para predizer mortalidade de pacientes com COVID-19. A mortalidade foi 8,4 vezes maior nos pacientes com saturação abaixo de 90% no momento da internação, mas um aumento de apenas 1 unidade no valor de VPM aumentou a mortalidade 1,76 vezes. CONCLUSÃO Além da capacidade pulmonar dos pacientes, o volume plaquetário médio pode ser utilizado como um teste auxiliar para prever a mortalidade de pacientes com COVID-19.

Can the neutrophil/lymphocyte ratio (NLR) have a role in the diagnosis of coronavirus 2019 disease (COVID-19)?

SUMMARY OBJECTIVE The present study aimed to investigate the role of neutrophil/lymphocyte ratio (NLR), an inflammation marker, complete blood count, and biochemical parameters in the diagnosis of COVID-19. METHODS A total of 80 patients who had been hospitalized in the internal medicine clinic were enrolled in the study. The cases were allocated into two groups, i.e., COVID (+) and (-), based on real-time reverse transcription-polymerase chain reaction. The demographic, clinical, and laboratory [NLR, platelet/lymphocyte ratio (PLR), complete blood count, biochemistry, and serology] data of the patients were retrospectively obtained from the hospital data management system. RESULTS NLR and fever levels were found to be higher in COVID-19 (+) cases (P=0.021, P=0.001, respectively). There was no difference between males and females with regard to COVID-19 positivity (P=0.527). Total bilirubin levels were found to be lower in COVID-19 (+) cases (P=0.040). When the ROC analysis was carried out for NLR in COVID-19 (+) cases, the AUC value was found to be 0.660 (P=0.021), sensitivity as 69.01 %, specificity as 65.40 %, LR+: 1.98 and LR- : 0.48, PPV: 80.43, and NPV: 50.00, when the NLR was ≥2.4. The risk of COVID-19 was found to be 20.3-fold greater when NLR was ≥ 2.4 in the logistic regression (P=0.007). CONCLUSION NLR is an independent predictor for the diagnosis of COVID-19. We also found that fever and total bilirubin measurements could be useful for the diagnosis of COVID-19 in this population.

RESUMO OBJETIVO O objetivo do presente estudo foi investigar o papel da razão neutrófilos/linfócitos (RNL), um marcador de inflamação, hemograma completo e parâmetros bioquímicos no diagnóstico de COVID-19. MÉTODOS Um total de 80 pacientes internados na clínica médica foram incluídos no estudo. Os casos foram alocados em dois grupos, COVID (+) e (-), de acordo com a reação em cadeia da polimerase com transcrição reversa em tempo real. Os dados demográficos, clínicos e laboratoriais [NLR, relação plaquetas / linfócitos (PLR), hemograma completo, bioquímica e sorologia]) dos pacientes foram obtidos retrospectivamente no sistema de gerenciamento de dados hospitalares. RESULTADOS Os níveis de NLR e febre foram maiores nos casos de COVID-19 (+) (P = 0,021, P = 0,001,respectivamente). Não houve diferença entre homens e mulheres em relação à positividade para COVID-19 (P = 0,527). Os níveis totais de bilirrubina foram menores nos casos de COVID-19 (+) (P = 0,040). Quando a análise ROC foi realizada para NLR nos casos COVID-19 (+), o valor da AUC foi de 0,660 (P = 0,021), sensibilidade 69,01%, especificidade 65,40%, LR +: 1,98 e LR-: 0,48 , PPV: 80,43 e NPV: 50,00 quando o NLR era> 2,4. The risk of COVID-19 was found to be 20.3-fold greater when NLR was ≥ 2.4 in the logistic regression (P=0.007). CONCLUSÃO NLR é um preditor independente para o diagnóstico de COVID-19. Também concluímos que aferições de febre e bilirrubina total podem ser úteis para o diagnóstico de COVID-19 nesta população.

Investigation of the frequency of COVID-19 in patients treated with intravesical BCG

SUMMARY INTRODUCTION In this retrospective study, we aimed to investigate the frequency of COVID-19 in patients with and without BCG application due to bladder tumors. METHODS The presence of COVID-19 was investigated in 167 patients with BCG and 167 without bladder cancer. All patients were compatible with COVID-19 infection. Patients with RT-PCR positive for SARS-CoV-2 and/or Chest CT positive for viral pneumonia between March and May 2020 were included in the study. RESULTS A total of 334 patients were included in the study. The mean age of the 167 patients in the study group was 71.1±14.2 1 (min. 38.0- max. 98.0 years), 141 (84.4%) were male. The mean age of the 167 patients in the control group was 70.5±13.8 years (min. 41.0- max. 96.0 years), and 149 were male (p> 0.05). COVID-19 was detected in 5 patients in the BCG group and in 4 patients in the control group (P> 0.05). CONCLUSION Intravesical BCG administration does not decrease the frequency of COVID-19 infection.

RESUMO INTRODUÇÃO Neste estudo retrospectivo, objetivou-se investigar a frequência de COVID-19 em pacientes com e sem aplicação de BCG por tumor de bexiga. MÉTODOS A presença de COVID-19 foi investigada em 167 pacientes com BCG e 167 sem câncer de bexiga. Todos os pacientes compatíveis para infecção por COVID-19. Resumidamente, os pacientes foram incluídos no estudo com RT-PCR positivo para Sars-CoV-2 e/ou TC de tórax positivo para pneumonia viral entre março e maio de 2020. RESULTADOS Um total de 334 pacientes foi incluído no estudo. A idade média dos 167 pacientes no grupo de estudo foi de 71,1±14,2 1 (min. 38,0 - máx. 98,0 anos), 141 (84,4%) eram do sexo masculino; 167 pacientes do grupo controle tinham idade média de 70,5±13,8 (min. 41,0 - máx. 96,0 anos) e 149 eram do sexo masculino (p>0,05). A COVID-19 foi detectada em cinco pacientes no grupo BCG e em um no grupo controle (p>0,05). CONCLUSÃO A administração intravesical de BCG não diminui a frequência da infecção por COVID-19.

Impact of antihypertensive agents on clinical course and in-hospital mortality: analysis of 169 hypertensive patients hospitalized for COVID-19

SUMMARY OBJECTIVE Coronavirus disease 2019 (COVID-19) is an emerging health threat caused by a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). Previous studies have noted hypertension is associated with increased mortality due to COVID-19; however, it is not clear whether the increased risk is due to hypertension itself or antihypertensive agents. We aimed to evaluate the impact of antihypertensive agents on the clinical outcomes of hypertensive patients with COVID-19. METHODS Our study included 169 consecutive hypertensive patients hospitalized due to COVID-19 between March 20 and April 10, 2020. The demographic characteristics, clinical data, and type of antihypertensive agents being used were reviewed. RESULTS The mean age of patients was 65.8±11.7 years.30 patients(17.7%) died during hospitalization. A total of 142 patients(84%) were using angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs), 91 (53.8%) were using diuretics, 69 (40.8%) were using calcium channel blockers (CCBs), 66 (39.1%) were using beta-blockers, 12 (7.1%) were using alpha-blockers, and 5 (2.9%) were using mineralocorticoid receptor antagonists (MRAs). There was no significant difference between survivors and non-survivors based on the type of antihypertensive agents being used. Binary logistic regression analysis showed that the type of the antihypertensive agent being used had no effect on mortality [OR=0.527 (0.130-2.138), p=0.370 for ACEIs/ARBs; OR=0.731 (0.296-1.808), p=0.498 for CCBs; OR=0.673 (0.254-1.782), p=0.425 for diuretics; OR=1.846 (0.688-4.950), p=0.223 for beta-blockers; OR=0.389 (0.089-1.695), p=0.208 for alpha-blockers; and OR=1.372 (0.107-17.639), p=0.808 for MRAs]. CONCLUSION The type of antihypertensive agent being used had no effect on the clinical course and mortality in hypertensive patients with COVID-19. The use of these agents should be maintained for the treatment of hypertension during hospitalization.

RESUMO OBJETIVO A doença de coronavírus 2019 (COVID-19) é uma ameaça emergente à saúde causada por um novo coronavírus denominado síndrome respiratória aguda grave coronavírus 2 (Sars-COV-2). Estudos anteriores observaram que a hipertensão está associada a um aumento da mortalidade devido ao COVID-19, no entanto, não está claro se o aumento do risco pertence à própria hipertensão ou a agentes anti-hipertensivos. Nosso objetivo foi avaliar o impacto de agentes anti-hipertensivos nos resultados clínicos em pacientes hipertensos com COVID-19. MÉTODOS Nosso estudo incluiu 169 hipertensos consecutivos internados por COVID-19 entre 20 de março e 10 de abril de 2020. As características demográficas, dados clínicos e o tipo de anti-hipertensivos em uso foram revistos. RESULTADOS A idade média dos pacientes foi de 65,8±11,7 anos. Trinta pacientes (17,7%) faleceram durante a internação. Cento e quarenta e dois pacientes (84%) usavam inibidores da enzima de conversão da angiotensina (ACEIs) ou bloqueadores dos receptores da angiotensina II (ARBs), 91 (53,8%) usavam diuréticos, 69 (40,8%) usavam bloqueadores dos canais de cálcio (CCBs), 66 (39,1%) usavam betabloqueadores, 12 (7,1%) usavam bloqueadores alpha e cinco (2,9%) usavam antagonistas dos receptores de mineralocorticoides (MRAs). Não houve diferença significativa entre sobreviventes e não sobreviventes com base no tipo de agentes anti-hipertensivos em uso. A análise de regressão logística binária mostrou que o tipo de agente anti-hipertensivo utilizado não teve efeito na mortalidade (OR=0,527 (0,130-2,138), p=0,370 para ACEIs/ARB; OR=0,731 (0,296-1,808), p=0,498 para CCBs; OR=0,673 (0,254-1,782), p=0,425 para diuréticos; OR=1,846 (0,688-4,950), p=0,223 para bloqueadores beta; OR=0,389 (0,089-1,695), p=0,208 para bloqueadores alpha e OR=1,372 (0,107-17,639), p=0,808 para MRAs). CONCLUSÃO O tipo de agente anti-hipertensivo utilizado não teve efeito no curso clínico e na mortalidade em pacientes hipertensos com COVID-19. O uso desses agentes deve ser mantido no tratamento da hipertensão durante a hospitalização.

The effects of favipiravir on hematological parameters of covid-19 patients

SUMMARY INTRODUCTION This study aims to evaluate changes in hematological parameters after the follow-up of patients who received treatment with favipiravir due to COVID-19 infections. METHODS Sixty-two cases receiving favipiravir treatment for at least five days due to COVID-19 infection were evaluated retrospectively. Parameters including age, gender, nasopharyngeal swab positivity, and chronic diseases were analyzed. Hematologic parameters were analyzed before and after the treatment. RESULTS The mean age of the patients receiving treatment with favipiravir was 63.7±12.3 years. Nasopharyngeal swab positivity was detected in 67.7%. The most common comorbid conditions detected in patients were hypertension in 25 cases (40.3%) and diabetes in 16 cases (25.8%). In the statistical analysis of the hematological parameters before and after treatment with favipiravir, WBC, PT-PTT-INR levels were found to be unaffected; the mean RBC was found to have decreased from 4.33 ± 0.58 M/uL to 4.16 ± 0.54 M/uL (p:0.003); the median hemoglobin level was found to have decreased from 12.3 g/dl to 11.9 g/dl (p:0.041); the hematocrit level decreased from 38.1% ± 4.8 to 36.9% ± 4.2 (p:0.026); the median neutrophil count decreased from 4.57 K/uL to 3.85 K/uL (p:0.001); the mean lymphocyte count increased from 1.22 ± 0.53 K/uL to 1.84 ± 1.19 K/uL (p:0.000); and the mean platelet count increased from 244.1 ± 85.1 K/uL to 281.9 ± 103.3 K/uL (p:0.005). CONCLUSION We concluded that the pathological effect of treatment with favipiravir on the hematologic system was the suppression in the erythrocyte series, and there were no adverse effects in other hematologic parameters.

RESUMO INTRODUÇÃO Este estudo tem como objetivo avaliar as alterações nos parâmetros hematológicos após o acompanhamento de pacientes que receberam tratamento com favipiravir devido à infecção por Covid-19. MÉTODOS Sessenta e dois casos em tratamento com favipiravir por pelo menos cinco dias devido à infecção por Covid-19 foram avaliados retrospectivamente. Parâmetros como idade, sexo, positividade do swab nasofaríngeo e doenças crônicas foram analisados. Os parâmetros hematológicos foram analisados antes e após o tratamento. RESULTADOS A idade média dos pacientes que receberam tratamento com favipiravir foi de 63,7±12,3 anos. A positividade do swab nasofaríngeo foi detectada em 67,7%. As condições comórbidas mais comuns detectadas nos pacientes foram hipertensão em 25 casos (40,3%) e diabetes em 16 casos (25,8%). Na análise estatística dos parâmetros hematológicos antes e após o tratamento com favipiravir, os níveis de leucócitos, PT-PTT-INR não foram afetados. Verificou-se que o RBC médio diminuiu de 4,33±0,58 M/uL para 4,16±0,54 M/uL (p=0,003); o nível médio de hemoglobina foi reduzido de 12,3 g/dl para 11,9 g/dl (p=0,041); o nível de hematócrito diminuiu de 38,1%±4,8 para 36,9%±4,2 (p=0,026); a contagem mediana de neutrófilos diminuiu de 4,57 K/uL para 3,85 K/uL (p=0,001); a contagem média de linfócitos aumentou de 1,22±0,53 K/uL para 1,84±1,19 K/uL (p=0,000); a contagem média de plaquetas aumentou de 244,1±85,1 K/uL para 281,9±103,3 K/uL (p=0,005). CONCLUSÃO Concluiu-se que o efeito patológico do tratamento com favipiravir no sistema hematológico foi a supressão na série eritrocitária e que não houve efeitos adversos em outros parâmetros hematológicos.

Neutrophil count to albumin ratio as a new predictor of mortality in patients with COVID-19 infection

SUMMARY BACKGROUND Coronavirus Disease 2019 is an acute inflammatory respiratory disease. It causes many changes in hemogram parameters. Low albumin levels are associated with mortality risk in hospitalized patients. The aim of the present study is to reveal the place of neutrophil count to albumin ratio in predicting mortality in patients with COVID-19. METHODS 144 patients, 65 females and 79 males, were included in the study. Patients were divided into 2 groups. Group 1 was the non-severe group (n:85), and Group 2 was severe (n:59). Demographic data, neutrophil, lymphocyte and platelet counts, albumin and C-reactive protein (CRP) levels were recorded. Neutrophil count to albumin ratio (NAR) was calculated by dividing the absolute neutrophil counts by the albumin levels. The NAR and levels of the two groups were then compared. RESULTS There were no significant differences in gender and platelet count (201 vs. 211 K/mL) between the groups (p>0,05). Ages (62.0 ± 14.3 vs 68.6 ± 12.2 years), albumin (33.1 vs 29.9 gr/L), CRP (33 vs 113 mg/l), neutrophil count (4 vs 7.24 K/mL), WBC counts (6.70 vs 8.50 K/mL), NAR values (113.5 vs 267.2) and number of Death (5 vs 33) were found to be statistically higher (p <0.001) in Group 2 than in Group 1. The NAR value of 201.5 showed mortality in all patients with COVID-19 to have 71.1% sensitivity and 71.7% specificity (AUC:0.736, 95% CI: 0.641-0.832, p<0.001) CONCLUSION The present study showed that NAR levels can be a cheap and simple marker for predicting mortality in patients with COVID-19.

RESUMO ANTECEDENTES A doença de coronavírus 2019 é uma doença respiratória inflamatória aguda. Causa muitas alterações nos parâmetros do hemograma. Baixos níveis de albumina estão associados ao risco de mortalidade em pacientes hospitalizados. O objetivo do presente estudo é revelar o local da razão entre contagem de neutrófilos e albumina na predição de mortalidade em pacientes com COVID-19. MÉTODOS Cento e quarenta e quatro pacientes do sexo feminino e 79 do sexo masculino foram incluídos no estudo. Os pacientes foram divididos em dois grupos: Grupo 1 não grave (n: 85), Grupo 2 grave (n: 59). Dados demográficos, contagem de neutrófilos, linfócitos e plaquetas, níveis de albumina e proteína C reativa (PCR) foram registrados. A razão de contagem de neutrófilos para albumina (NAR) foi calculada dividindo-se as contagens absolutas de neutrófilos pelos níveis de albumina. O NAR e os níveis dos dois grupos foram comparados. RESULTADOS Não houve diferenças significativas no sexo e na contagem de plaquetas (201 vs 211 K/mL) entre os grupos (p>0,05). Idade (62,0±14,3 vs 68,6±12,2 anos), albumina (33,1 vs 29,9 gr/L), PCR (33 vs 113 mg/l), contagem de neutrófilos (4 vs 7,24 K/mL), contagem de leucócitos (6,70 vs 8,50 K/mL), valores de NAR (113,5 vs 267,2) e número de óbitos (5 vs 33) foram estatisticamente maiores (p<0,001) no Grupo 2 que no Grupo 1. O valor NAR de 201,5 mostrou mortalidade em todos os pacientes com COVID-19 com sensibilidade de 71,1% e especificidade de 71,7% (AUC: 0,736, IC 95%: 0,641-0,832, p<0,001). CONCLUSÃO O presente estudo mostrou que os níveis de NAR podem ser um marcador barato e simples para predizer mortalidade em pacientes com COVID-19.

The effect of abo and rh blood group antigens on admission to intensive care unit and mortality in patients with COVID-19 infection

SUMMARY AIM The aim of this study is to analyze the prognostic significance of ABO and Rh blood group antigens along with various parameters in patients followed-up with the diagnosis of COVID-19. METHODS We evaluated 397 patients who were follow-up and treated due to COVID-19 infections. The ages, genders, chronic diseases, ABO and Rh blood group antigens, admission rates to Intensive Care Units (ICU), and mortality rates of the patients were analyzed. FINDINGS The mean age of the 397 patients with COVID-19 was 47±17 years. In the blood group analysis of the patients, A Rh-positive (A +) was the most frequently seen blood type (176 patients, 44.3%) followed by O Rh-positive (0 +) (109 patients, 27,5%); 38 patients were Rh negative (Rh -) (9,6%). 53 of the patients (13,4%) were followed in ICU and 29 patients died (7,3%). Neither mortality nor admission to ICU was seen for Rh - group. The comparison of Rh groups concerning the need for ICU admission revealed a significantly high rate of ICU admission in the Rh + group (p=0,011), while no significant relationship was found between mortality and Rh antigen (p=0,069). CONCLUSION The most frequently seen blood type among COVID-19 patients was A +. The Rh + blood group was found in all cases who were admitted to ICU and had a death outcome. The Rh + blood group was found in a significantly high number of patients who were admitted to ICU, while no significant relationship was found between mortality and Rh blood group.

RESUMO OBJETIVO O objetivo deste estudo é analisar o significado prognóstico dos antígenos do grupo sanguíneo ABO e Rh, juntamente com vários parâmetros em pacientes acompanhados com o diagnóstico de COVID-19. MÉTODOS Foram avaliados 397 pacientes que foram acompanhados e tratados devido à infecção por COVID-19. Foram analisadas as idades, gêneros, doenças crônicas, antígenos do grupo sanguíneo ABO e Rh, taxas de internação em unidades de terapia intensiva (UTI) e taxas de mortalidade dos pacientes. A idade média de 397 pacientes com COVID foi de 47 ± 17 anos. Na análise do grupo sanguíneo dos pacientes, A Rh positivo (A +) foi o tipo sanguíneo mais frequentemente observado (176 dos pacientes, 44,3%), seguido pelo O Rh positivo (0 +) (109 dos pacientes, 27,5%) 38 dos pacientes eram Rh negativos (Rh -) (9,6%). 53 dos pacientes (13,4%) foram acompanhados em UTI e 29 faleceram (7,3%). Não houve mortalidade nem admissão na UTI para o grupo Rh. A comparação dos grupos Rh quanto à necessidade de admissão na UTI revelou uma taxa significativamente alta de admissão na UTI no grupo Rh + (p = 0,011), enquanto não foi encontrada relação significativa entre mortalidade e antígeno Rh (p = 0,069). CONCLUSÃO O tipo sanguíneo mais frequentemente observado foi o A + entre os pacientes com COVID-19. O grupo sanguíneo Rh + foi encontrado em todos os casos admitidos na UTI e com evolução mortal. O grupo sanguíneo Rh + foi encontrado em um número significativamente alto de pacientes internados na UTI, enquanto nenhuma relação significativa foi encontrada entre a mortalidade e o grupo sanguíneo Rh.

Atherosclerosis in geriatric patients known to be healthy

Background: The aim of the present study is to determine the presence of atherosclerosis in geriatric patients who are known to be healthy and examine sociodemographic and laboratory parameters affecting the presence of atherosclerosis.Method: 90 healthy volunteers including 66(73.3%) non-geriatric ones and 24(26.7%) geriatric ones were included in the study. It was analyzed whether there was a correlation between the two groups in terms of the parameters of gender, age average, alcohol consumption, smoking, carotid intima-media thickness (CA-IMT), and pulse wave velocity (PWV). Sociodemographic and laboratory parameters of the volunteers with and without atherosclerosis in the geriatric group were examined. Results: Among geriatric volunteers (Group 1), 13(54.2%) were male; whereas, among non-geriatric volunteers (Group 2), 41(62.1%) were male. CA-IMT was determined to be higher in Group 1 (averagely 0.80±0.12 mm) than Group 2 (averagely 0.62±0.14 mm) (p:<0.001). PWV was significantly higher in Group 1 (averagely 10.32±1.44 m/s) than Group 2 (6.26±1.09 m/s) (p:<0.001). After PWV or CA-IMT examination, atherosclerosis findings were determined in 12 healthy geriatric volunteers (50%) in Group 1.Conclusion: It should be remembered that even though atherosclerosis can be frequently observed in geriatric individuals who are known to be healthy, it may also go unnoticed. Determination of atherosclerosis with noninvasive methods will be helpful in preventing complications that might be caused by atherosclerosis.

In-hospital and post discharge mortality in patients hospitalized for warfarin overdose

Background: This study aimed to examine the in-hospital and post-discharge mortality rates in patients followed up for warfarin overdose in the cardiology clinic and the factors affecting the mortality.Methods: This study included patients receiving warfarin treatment for atrial fibrillation (AF) and prosthetic heart valve and those hospitalized when warfarin overdose. Furthermore, 48 patients with and without hemorrhagic complications were detected. The causes and rates of mortality of the patients during hospitalization and post discharge were monitored during a mean follow-up of three years.Results: The mean age of 48 patients (32 [66.17%] women) hospitalized for warfarin overdose was 77±10 years. The mean hospitalization period of the patients was 5±4 days, 2±1 day in 11 patients without hemorrhage (22.9%), and 6±3 days in 37 patients with hemorrhage (77.1%). Moreover, 38 patients were receiving warfarin for AF (79.2%) and 10 patients for prosthetic heart valve (20.8%). The mean INR value before hospitalization in patients hospitalized for warfarin was 6.67±2.4, hemoglobin was 10.6±2.3, hematocrit was 33.1±7.5, platelet count was 225±64, and creatinine was 0.9±0.3. In the statistical analysis of 11 patients (22.9%) without hemorrhage and 37 patients (77.1%) hospitalized because of hemorrhage who were being followed up for warfarin overdose, hemoglobin, hematocrit, and platelet count and INR level were considerably low and high in patients with hemorrhage, respectively (Table 2). Figure 1 shows the causes of hemorrhage detected in the patients. On mortality examination, five patients (10.4%) were found to be dead.Conclusions: Being unable to obtain the target INR level or warfarin overdose may lead to serious problem in patients using oral anticoagulants. Whether hemorrhage is observed in patients hospitalized because of warfarin overdose, close monitoring of the patient’s clinical and laboratory parameters is absolutely necessary.

The prevalence of obesity and the factors affecting obesity in the students of secondary education

Background: Childhood obesity has reached alarming dimensions all around the world. In this study, our objective is to determine the prevalence of childhood obesity in the secondary education as well as genetic, cultural and environmental factors giving rise to obesity, nutritional habits, family history and activity status.Methods: The research was performed on 750 students aged between 14-18. Body Mass Index (BMI= weight/height2 (kg/m²)) and Relative Body Mass Index (Rel BMI)  values of each child were calculated by making use of their height and weight measurements. An evaluation was made through the use of a questionnaire form consisting of 46 questions that questioned the family history, nutritional habits and activity status of the children at issue.Results: About 41.7% of 750 children incorporated into the study were female, whereas 58.2% of them were male. The age distribution was between the age range, 14-18. According to BMI values, 12.3% of the children were overweight, while 4% of them were obese. According to Relative BMI values, on the other hand, 10.4% of the children were overweight, whereas 12.9% of them were obese. When the children’s nutritional habits, activity status and family history were evaluated, we ascertained that doing physical exercises irregularly, consuming pastry foods at home and the presence of obesity history within the family had all led to the development of obesity as well as being overweight (p <0.05).Conclusions: In these research subjects comprising children of secondary education, we showed that the nutritional habits, cultural nutritional differences and the insufficiency in physical activities as well as the genetic susceptibility in children could be the determinants in obesity development.

QT dispersion in irritable bowel syndrome

Background: The pathogenesis of irritable bowel syndrome (IBS) has not been fully elucidated. The gastrointestinal tract have a well-differentiated intrinsic nervous system and also this system is connected with nervous system. The symptoms of IBS are related with autonomic nervous system (ANS). It was also possible to see cardiovascular symptoms due to this link. This link can influence QT dispersion (QTd). The aim of this case control study is to show the cardiac effects of IBS by changes in QTd.Methods: There were 56 newly diagnosed patients with IBS and 60 control subjects were included in this study. IBS was diagnosed using the new Roma IV Criterias. Standard 12-lead electrocardiogram (ECG) were taken in both two groups. QTd and corrected QTd (QTcd), QT max, QT min, QT avarage, Corrected QT (QTc) min, QTc max, QTc avarage values were calculated with Bazzet Formula from rest ECGs.Results: There were 56 newly diagnosed patients with IBS and 60 control subjects were included in the study (p:0.94). The mean age of the patients and control patients were 51.75±10.41 years and 48.41±9.72 (p: 0.53) years, respectively. QTd and corrected QTd (QTcd), QT max, QT min, QT mean, Corrected QT (QTc) min, QTc max, QTc mean values were calculated. QTd and QTcd values were found to be significantly higher in the patients with IBS (40.2±7.18; 34.1±6.18 / 52±9.8; 50.6±7.61 Msec, respectively). It is concluded that, QTd (p: 0.022) and QTcd (p: 0.032) were significantly incresased in the IBS.Conclusions: Activation of ANS in the patients with IBS can affect QT period in ECG.

Frequency of cardiovascular diseases in the patients with restless legs syndrome

Background: Restless Legs Syndrome (RLS) is a sensory-motor neurological disease characterized by discomfort, unpleasant sensations, an urge to move the legs. There are a lot of studies showing the association between Restless Legs Syndrome (RLS), Cardiovascular Diseases (CVD), Hypertension (HT) and Body Mass Index (BMI). The potential underlying mechanism of an increased risk of CVD in RLS is not clear but may involve hypertension, as Periodic Limb Movements during Sleep (PLMS) were shown to be related to blood pressure increases. These studies were inconsistent. The aim of this case control study was to show the prevalence of CVD in the patients with RLS compared with a control group.Methods: A total of 37 newly diagnosed patients with RLS (group 1) who were applied to neurology polyclinic of Sakarya University Hospital between March 2016 and May 2017 and 37 control subjects (group 2) were included in this case control study. RLS was diagnosed using the criteria of the International RLS Study Group. Both groups were screened for HT, dyslipidemia, coronary artery diseases, atrial fibrillation. 24hour Ambulatory Blood Pressure Monitoring (ABPM) were enrolled for both groups. Interventricular septum was measured with echocardiography by cardiologist for diagnosis of left ventricular hypertrophy.Results: There were no significant differences in sex (p:0.11) and age (p:0.33) between the two groups. Hypertension (p:0.001) and non-dipper hypertension (p:0.004), BMI (p:0.004), left ventricular hypertrophy (p:0,002) were found statistically significantly higher than the control group. There were no differences in atrial fibrillation (p:1) and hyperlipidemia (p:0.69) between two groups.Conclusions: Patients with RLS should be followed closely for cardiovascular diseases.