ABSTRACT
Objective: This study is intended to evaluate the mental health statuses of hematological cancer (HC) inpatients diagnosed during the COVID-19 pandemic compared to the statuses of patients diagnosed with HC before the pandemic. Method(s): A cross-sectional survey collected the mental health measurements of 77 inpatients with HC between March and May 2021 in Ankara, Turkey. The levels of depression, generalized anxiety, distress, sleep disorder, health anxiety, trait anxiety, corona phobia, and resilience in HC patients newly diagnosed during the pandemic (n=38) and before the pandemic (n=39) were compared. We then explored the relationships between predictive factors and cancer patients' mental health statuses. Result(s): Compared to HC patients diagnosed before the pandemic, depression (63.2% vs. 35.9%, p=0.017) and sleep disorder (67.8% vs. 38.5, p=0.016) were significantly higher, while comparison, generalized anxiety (57.9% vs. 38.5%, p=0.088) and distress (60.5% vs. 38.5%, p=0.053) were higher in a non-significant trend in patients newly diagnosed with HC during the pandemic. In contrast, health anxiety was more common in patients diagnosed before the pandemic (53.8% vs. 31.6%, p=0.048). Among the newly diagnosed patients, women had more generalized anxiety symptoms than men (76.5% vs. 42.9%, p=0.037). Being newly diagnosed increased the risk of more severe symptoms of depression (odds ratio [OR]: 3.178, p=0.036) and sleep disorders (OR: 4.73, p=0.018) but lowered the risk of health anxiety (OR: 0.14, p=0.003). Conclusion(s): Our data indicate that patients with HC are vulnerable to mental health problems during the COVID-19 pandemic. This vulnerability is higher in newly diagnosed HC patients than in patients diagnosed before the pandemic. Copyright © Telif Hakki 2023 Gazi Universitesi Tip Fakultesi - Makale.
ABSTRACT
Examination of global epidemics in history shows that, despite destructive consequences, each epidemic offers a change-transformation opportunity. Since the beginning of humanity, global epidemics have had heavy, lasting and profound economic and social impacts. Despite all these difficulties and transformations, humanity's unlimited resilience and ability to adapt is extraordinary, and various examples and evidence in history testify to this. Considering the other epidemics examined in the study, besides Covid-19, common features were observed in the context of international trade and economic results. If the leading economies can reduce their disagreements to some extent, agreements and solutions that will allow the continuation of the global economy and international trade even under the most difficult conditions will be reached. At the beginning of these solutions, it may be possible for every nation to secure its own agricultural production and food sovereignty.
ABSTRACT
Background: Zinc is an important component of the immune system with T lymphocyte activation. It inhibits viral replication by mechanisms such as viral RNA synthesis and topoisomerase enzyme inhibition (1, 2). The aim of this study is to examine the prognostic value of serum zinc level at ICU admission. Method: After ethics committee approval, patients with PCR or antibody (+) followed in the ICU between April 2020 and April 2021 were prospectively included in the study. Serum zinc levels were taken from the patients on admission to the ICU along with other tests. Student-t test, chi-square, Man Whitney U and binary logistic regression test used for statistical analyses. Results: 123 of 214 patients were included in the study (female: 46 (37.4%)). 86 of the patients had low zinc levels and 43 of them had mortality. Mechanical ventilation requirement and the length of stay in the ICU were found to be statistically significant in patients with low zinc levels (<70 μg/dL). In the logistic regression analysis, gender, APACHE-II, CRP, BUN, and zinc/LDH values (respectively;β: 1.393, p: 0.024, β: 0.095, p: 0.035, β: 0.065, p: 0. 02, β: 0.041, p: 0.017, β: -9.549, p: 0.021) were found to be independent variables in predicting mortality. Conclusion: We think that the Zinc/LDH ratio can be used as a prognostic factor in SARS CoV-2 patients admitted to the ICU.
ABSTRACT
Background: Since, the thyroid gland is affected both due to the cytokine storm and via angiotensinconverting enzyme-2 receptors, changes in thyroid functions can be among the prognostic factors of COVID-19 patients (1,2). The aim of this study is to evaluate the prognostic significance of thyroid functions at COVID-ICU admission. Method: After ethical approval, PCR (+) COVID-19 patients followed in the ICU between March 2020 and April 2021 were retrospectively screened. Patients with previous thyroid disease were excluded from the study. Free triiodothyronine (fT3 free thyroxine (fT4 and thyroid-stimulating hormone (TSH) levels at ICU admission were evaluated. Mann Whitney U, Spearman correlation, binary logistic, and linear regression tests were used for statistical analysis. Results: A total of 131 patients (46 female, 85 male) were included in the study (Fig 1). The the 90- day mortality rate was 46%. There was no statistically significant relationship between thyroid function levels and mortality. Significant correlations were found between age, APACHE II, fT3, C-reactive protein and duration of ICU (r:0,236, p:0,002;r:0,262, p:0,004;r:-0,271, p:0,011;r:0,277, p:0,001 respectively) and hospital stay (r:0,193, p:0,027;r:0,177, p:0,054;r:-0,326, p:0,002;r:0,198, p:0,023, respectively). Linear regression analysis revealed fT3 as the only independent predictor for ICU (β:- 0,259, p:0,036) and hospital stay (β:-2,138, p:0,036). Conclusion: Free triiodothyronine levels at ICU admission can predict the length of ICU and hospital stay in COVID-19 patients. (Table Presented).
ABSTRACT
Background: Klinefelter syndrome (KS) is characterized by XXY karyotype and hypercoagulopathy. We aim to present a patient with KS diagnosed with COVID-19 infection with a history of pulmonary thromboembolism (PTE) and heparin allergy. Case Report: A 49-year-old male patient with KS presented with respiratory distress. He had diabetes mellitus, previous PTE history, heparin allergy. He used warfarin routinely. He was diagnosed with Covid-19 pneumonia (PCR test positive) and favipiravir treatment was started. On the third day, his respiratory distress worsened with hemoptysis. He was admitted to ICU, due to his comorbidities. Chest computed tomography was compatible with Covid-19 pneumonia and there was no PTE (Figure 1). His SpO2 was 88% with a 4L/min nasal oxygen. Prone positioning, continuous positive airway pressure, and dexamethasone treatment was given. As hemoptysis and oxygen need decreased, he was transferred to the service on the 8th ICU day. Discussion: We assumed that the presence of KS and PTE history in our patient might further increase the COVID-19 associated coagulopathy. The patient's heparin allergy made our treatment difficult. Despite all of this, the patient had good prognosis with COVID-19. X-chromosome has been postulated to have protective properties on COVID pneumonia via different immunological mechanisms (1). To the best of our knowledge, there is no previous report about KS diagnosed with COVID- 19. This may be due to the protection of excess X-chromosomes. Conclusion: In some COVID-19 cases, there may be extra conditions that are detrimental (previous PTE history and heparin allergy) or beneficial (extra X-chromosome) for the treatment. COVID-19 treatment should be individualized. (Figure Presented).
ABSTRACT
Background: Social isolation due to COVID-19 may aggravate psychiatric symptoms (1). We aim to present a suicide attempt as a result of isolation due to COVID-19 pneumonia in a severely depressed patient. Case Report: A 63-year-old man with a medical history of depression, presented with a 3-day history of weakness, fever, and cough. After a positive COVID-19 PCR result, treatment with favipiravir was initiated and he was sent to isolation at home. Direct contact between the family and the patient was purposely minimal;visitors were prohibited. On isolation day 7, he attempted suicide by jumping out of the second floor. His computed tomography revealed multiple rib fractures, left hemopneumothorax, head injury, bladder laceration, and pelvic fracture with active bleeding (Figure1). He was transferred to the ICU. A chest tube was inserted. His psychiatric history was obtained after extubation, he had an anxious period with insomnia after a traffic accident in 2017 and received psychiatric support for a long time. He was transferred to the ward after 5 days of ICU stay. Discussion: Posttraumatic stress disorder (PTSD) is characterized by nightmares and flashbacks of past traumatic events, avoidance of reminders of the trauma, and sleep disturbance (2). This novel, potentially deadly virus may frighten itself, as well as relieve feelings of fear, helplessness, and loneliness from previous bad experiences. All of these feelings can be aggravated by fever, dyspnea, and weakness, together with isolation from the family. Conclusion: Healthcare professionals treating patients during the COVID-19 pandemia should be aware of their patient's history of depression, anxiety, insomnia, and/or distress. Scoring systems to identify patients with high-risk psychological burdens should be urgently established. (Figure Presented).