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 taste and smell disorders in pediatric COVID-19 Cases

SUMMARY OBJECTIVE: Pediatric coronavirus disease 2019 (COVID-19) cases have a high risk of contagiousness, as they usually progress with asymptomatic or mild respiratory symptoms. Disorder in taste and/or smell has rarely been reported in pediatric cases. In our study, early diagnosis and isolation measures were emphasized by evaluating the clinical, laboratory, and radiological imaging findings of pediatric COVID-19 cases presenting with symptoms of taste and/or smell disorder. METHODS: Seven cases aged 0-18 years were included in the study. The severe acute respiratory syndrome coronavirus-2 polymerase chain reaction test was performed for the seven cases presented with taste and/or smell disorders. Clinical findings, laboratory tests, and radiological imaging of all the cases were evaluated on the day of admission and on the fifth day. RESULTS: Seven (5.7%) of 122 pediatric COVID-19 cases had disorder in taste and/or smell. In two cases, pneumonia findings were detected in thorax computed tomography imaging. It was observed that all the patients fully recovered at the latest on the 21st day. In the cranial diffusion magnetic resonance imaging of a case, diffusion restriction was detected in the corpus callosum splenium. CONCLUSION: Although less common than adults, children with COVID-19 may also have taste and smell disorders, and this may be accompanied by central nervous system imaging findings.

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.

Comparison of saliva and oro-nasopharyngeal swab sample in the molecular diagnosis of COVID-19

SUMMARY BACKGROUND Healthcare personnel are at risk of becoming infected while taking upper and/or lower respiratory tract specimens. Therefore, there is a need for sampling methods that do not risk infecting them. In this study, we aimed to compare the saliva and Oro-Nasopharyngeal Swab (ONS) sampling methods. METHODS Patients were divided into three groups. Group 1 included patients whose diagnosis of COVID-19 was confirmed by polymerase chain reaction (PCR). Group 2 included patients with COVID-19 compatible findings in lung computed tomography (CT), but with a negative PCR. Group 3 included patients who presented to the emergency department with COVID-19 compatible complaints but had normal CT. Saliva and ONS samples were taken on the third day of hospitalization in groups 1 and 2, whereas in group 3, they were taken at the time of admission to the hospital. RESULTS A total of 64 patients were included in the study. The average age was 51.04 ± 17.9 years, and 37 (57.8%) were male. SARS-CoV-2 was detected in 27 (42.2%) patients' saliva samples. While the sensitivity and positive predictive value of saliva samples were 85.2%, specificity and negative predictive value were 89.2%. The value of kappa was in substantial agreement (0.744), and it was found statistically significant (<0.001). CONCLUSIONS Saliva samples can be used instead of ONS samples in detecting SARS-CoV-2. Investigating SARS-CoV-2 with saliva is cheaper, easier for the patient and overall, and, most importantly, it poses much less risk of SARS-CoV-2 contamination to healthcare personnel.

RESUMO OBJETIVO Funcionários da saúde correm risco de infecção ao coletar amostras do trato superior e/ou inferior. Portanto, existe a necessidade de métodos de coleta de amostras que não representem um risco de infecção. Neste estudo, nosso objetivo foi comparar as métodos de coleta de saliva e swab de naso e orofaringe (ONS). MÉTODOS Os pacientes foram divididos em três grupos. O Grupo 1 incluiu pacientes cujo diagnóstico de COVID-19 foi confirmado por reação em cadeia da polimerase (PCR). O Grupo 2 incluiu pacientes com achados compatíveis com COVID-19 em exames de tomografia computadorizada (TC), mas com PCR negativo. O Grupo 3 incluiu pacientes que compareceram ao departamento de emergência com queixas compatíveis com COVID-19, mas TC normal. Amostras de saliva e ONS foram coletadas no terceiro dia de internação, nos Grupos 1 e 2, já no Grupo 3, foram coletadas no momento da internação. RESULTADOS Um total de 64 pacientes foram incluídos no estudo. A média de idade foi de 51,04 ± 17,9 anos, e 37 (57,8%) eram do sexo masculino. SARS-CoV-2 foi detectado em 27 (42,2%) amostras de saliva dos pacientes. A sensibilidade e valor preditivo positivo foi de 85,2% nas amostras de saliva, já a especificidade e o valor preditivo negativo foi 89,2%. O valor de Kappa estava substancialmente de acordo (0,744) e era estatisticamente significante (<0,001). CONCLUSÃO Amostras de saliva podem ser usada em vez de ONS na detecção de SARS-CoV-2. O uso de amostras de saliva para detecção de SARS-CoV-2 é mais barato, mais fácil para o paciente e em geral e, mais importante, representa um risco muito menor de contaminação de SARS-CoV-2 para os profissionais da saúde.