Role of Vitamin D, ACE2 and the Proteases as TMPRSS2 and Furin on SARS-CoV-2 Pathogenesis and COVID-19 Severity.

BACKGROUND: COVID-19, the 21st century pandemic disease caused by SARS-CoV-2, has shown a wide clinical spectrum ranging from asymptomatic to deadly serious pneumonia. OBJECTIVE: In our study, the relationship between the pathogenesis and clinical severity of COVID-19 and vitamin D, ACE2, Furin and TMPRSS2 was investigated. METHODS: Serum 25(OH)D, 1,25(OH)2D and ACE2 protein were measured in 85 COVID-19 cases, divided into 5 groups, according to disease severity, from asymptomatic to severe and including a healthy control group. Expression levels of ACE2, VDR, TMPRSS2 and Furin mRNAs in PBMC were also measured. The relationship of the parameters within each group, the severity of the disease and the effect on the patients' fate were investigated. RESULTS: Statistically significant differences were found between the severity of COVID-19 and all study parameters, except for serum 25(OH)D. A strong negative correlation was found between serum ACE2 protein, 1,25(OH)2D, and ACE2 mRNA, and disease severity, length of hospital stay and death/survival rate. Vitamin D deficiency increased the death risk by 5.6-fold (95% CI 0.75-41.47), and the levels of 1,25(OH)2D lower than 1 ng/mL increased the risk of death by 3.8-fold (95% CI 1.07-13.30). CONCLUSION: This study suggests that vitamin D supplementation could be beneficial in the treatment and/or prevention of COVID-19.

Could tear be an alternative specimen for SARS-CoV-2 detection?

Objectives For a definitive diagnosis of COVID-19, respiratory tract samples are evaluated by Polymerase Chain Reaction (PCR). In our study, PCR using a tear sample was used to diagnose COVID-19, and it was questioned whether it was a screening method. Unlike the general practice, Schirmer strips were used instead of a swab for tear sample collection in this study. In addition, the diagnostic values of serum Procalcitonin (PCT), C-Reactive Protein (CRP), and Neutrophil (NEU) count in predicting COVID-19 disease from tears were also questioned. Methods A total of 94 patients who were positive for COVID-19 by PCR test were included in this study. Tear samples were obtained from patients with Schirmer strips, commonly used in eye examination, and studied with the PCR technique. CRP, PCT value, and NEU count were also compared between the positive and negative groups of the PCR. The obtained data were analyzed using the R Studio software, and the results were considered statistically significant for pResults Of these patients, 61 (64.9%) tear PCR was negative, and 33 (35.1%) tear PCR was positive. The mean age was 61.72 +/- 17.62 years. The patients were divided into two groups: tear PCR positive and negative. There was no significant age difference between these groups. As a result of ROC Analysis;When serum PCT, CRP, and NEU % values were examined in predicting COVID-19 disease from tears, it was seen that CRP (p=0.027) and especially PCT (p=0.003) values of patients with PCR-positive were significantly higher. Conclusions PCR study on tears collected with Schirmer strips is a different and non-invasive method, but it was concluded that the proposed method could not be used as a screening test. In addition, significantly higher serum PCT values were found in patients with COVID-19 positivity in tears (p<0.05).

Evaluation of the relationship between progression and SARS-CoV-2 viral load in COVID-19 cases in Ankara, Turkey.

INTRODUCTION: Patients infected with SARS-CoV-2 may present with varying clinical pictures. This study aimed to examine the relationship between viral load cycle threshold value, clinical prognosis and other laboratory parameters in initial swab samples on the day of hospitalization. METHODOLOGY: This retrospective and cross-sectional study included 112 patients, who were diagnosed with SARS-CoV-2 via the Bio-Rad CFX96 TouchTM system. Cycle threshold values for the RdRp gene obtained from reverse transcriptase polymerase chain reaction positive patients were recorded. RESULTS: The mean age of the 112 patients was 47.57 ± 17 years. No relationship was found in symptoms, pneumonia, oxygen need, follow-up in intensive care unit, and mortality between patient groups with cycle threshold values of < 30 and ≥ 30. Frequencies of thrombocytopenia (50%) and elevated LDH levels were higher in patients with cycle threshold values of ≥ 30 (p = 0.02 and p = 0.04, respectively). There was a weak but significant correlation between cycle threshold values and CRP levels (Pearson's r = 0.207, p = 0.029). CONCLUSIONS: Symptoms or clinical prognosis were not significantly related to the SARS-CoV-2 viral load levels tested at admission or for the first time within the scope of this study. Thrombocytopenia and elevated LDH rates were higher in patients with cycle threshold values of ≥ 30. A weak but significant correlation was found between the viral load and CRP levels. Large-scale studies are needed to further elucidate this subject matter.

Investigation of Viral Load Cycle Threshold Values in Patients with SARS-CoV-2 Associated Pneumonia with Real-Time PCR Method.

INTRODUCTION: In this study, we aimed investigate the relationship of SARS-CoV-2 viral load cycle threshold (Ct) values with pneumonia. METHODOLOGY: A total of 158 patients in whom SARS-CoV-2 was confirmed in upper respiratory tract (URT) samples with molecular method and who had computed tomography (CT) of the chest, between April 2020 and June 2020 were included in this retrospective cross-sectional study. RESULTS: Mean age of 158 PCR positive patients was 45.22 ± 17.89 and 60.8% of them were male. Pneumonia was detected in 40.5% of the patients on their chest CT. A weak but significant correlation was found between SARS-CoV-2 Ct value detected with PCR in analysis of oropharyngeal/ nasopharyngeal (OP/NP) samples and chest CT score (Pearson's r: 0.197, p = 0.01). No correlation was found between the first detected viral load Ct value and age, gender and mortality. There was no significant correlation between chest CT score and mortality. While the areas remaining under ROC curve for Ct value in analysis of OP/NP samples in prediction of chest CT score ≥ 1, ≥ 5 and ≥ 10 were 0.564, 0.640 and 0.703 respectively. CONCLUSIONS: We found that the amount of SARS-CoV-2 viral load (inverse relationship with Ct) detected in OP/NP samples of patients with COVID-19 pneumonia did not reflect the increasing severity of pulmonary lesions on chest CT. Although primary target of SARS-CoV-2 is all epithelial cells of the respiratory tract we believe studies comparing viral loads in lower respiratory tract samples are needed to determine the severity of pulmonary disease.

Relationship between chest computed tomography findings and clinical conditions of coronavirus disease (COVID-19): A multicentre experience.

AIMS: This study aimed to investigate the clinical and chest computed tomography (CT) features associated with clinical parameters for coronavirus disease (COVID-19) in the capital of Turkey, Ankara. MATERIALS AND METHODS: Epidemiological, clinical features, laboratory findings and radiological characteristics of 1563 hospitalised patients with COVID-19 in Ankara were collected, reviewed and analysed in this study. The risk factors associated with disease severity were investigated. RESULTS: Non-severe (1214; 77.7%) and severe cases (349; 22.3%) were enrolled in the study. Compared with the non-severe group, the severe group were significantly older and had more comorbidities (ie, hypertension, diabetes mellitus, cardiovascular disease and chronic kidney disease). Smoking was more common in the severe group. Severe patients had higher respiratory rates and higher incidences of cough and dyspnoea compared with non-severe patients. Compared with the non-severe patients, the severe patients had increased C-reactive protein (CRP), procalcitonin, neutrophil to lymphocyte ratio (NLR) and CRP/albumin ratio and decreased albumin. The occurrence rates of consolidation, subpleural sparing, crazy-paving pattern, cavity, halo sign, reversed halo sign, air bronchogram, pleural thickening, micronodule, subpleural curvilinear line and multilobar and bilateral involvement in the CT finding of the severe patients were significantly higher than those of the non-severe patients. CONCLUSIONS: Many factors are related to the severity of COVID-19, which can help clinicians judge the severity of the patient and evaluate the prognosis. This cohort study revealed that male sex, age (≥55 years), patients with any comorbidities, especially those with cardiovascular disease, dyspnoea, increased CRP, D-dimer and NLR, and decreased lymphocyte count and CT findings of consolidation and multilobar involvement were predictors of severe COVID-19.

The Effect of Helicobacter pylori on the Presentation and Clinical Course of Coronavirus Disease 2019 Infection.

OBJECTIVES: Novel coronavirus 2019 (corona virus disease 2019 [COVID-19]) binds angiotensin-converting enzyme-2 (ACE-2) receptors to enter the cell. These receptors are widely expressed in the intestine, and COVID-19 may cause gastrointestinal symptoms via these receptors during the course of the disease. Helicobacter pylori is known to increase the expression of ACE-2 receptors in the gastrointestinal tract. The aim of this study was to investigate the effects of H pylori on the presentation and clinical course of COVID-19 infections. METHODS: This study was carried out from June 1 to July 20, 2020. Patients diagnosed with COVID-19 infections by PCR tests were included in the study. Antigen screening tests were performed on stool samples to determine the presence of H pylori. All patients were evaluated for manifestations of COVID-19 infection, severity of the course, hospitalized days because of the virus and outcome of the disease process. RESULTS: Of 108 COVID-19 positive patients evaluated, 31 with a mean age of 49.54 ±â€Š17.94 years were H pylori-positive (8 girls [25.8%]) and 77 with a mean age of 47.85 ±â€Š20.51 years; (31 girls [40.3%]) were H pylori-negative. Abdominal pain (19.4% vs 2.6%) and diarrhea (32.3% vs 9.1%) were significantly higher in patients with H pylori than those without (P = 0.007 and P = 0.006, respectively). There was no statistically significant difference between H pylori positivity and the number of hospitalized days, the severity of the course of COVID-19 infection, or the outcome of the disease (P > 0.05). CONCLUSION: Our results revealed that the findings of abdominal pain and diarrhea strongly correlated with the presence of H pylori in COVID-19 patients.

Could serum albumin value and thrombocyte/lymphocyte ratio be an important prognostic factor in determining the severity of COVID 19?

Background and aim: Creating potential clinical markers for risk assessment in patients with COVID-19 continues to be an area of interest. In this study, we aimed to evaluate whether serum albumin level and thrombocyte/lymphocyte ratio are related to the severity of the disease. Materials and methods: The patients were divided into two groups according to the severity of disease. Demographic data, serum albumin value, lymphocyte count, TLO-1 values (thrombocyte/lymphocyte ratio-1), the highest thrombocyte count during hospitalization, TLO-2 (thrombocyte/lymphocyte ratio-2) values formed by the highest thrombocyte count, were recorded. Results: There was no statistically significant differences (P > 0.05) in terms of sex, thrombocyte count at the time of admission, and highest thrombocyte count during hospital follow-up. There were statistically significant differences in terms of age, comorbidity, lymphocyte value at the time of hospitalization, lymphocyte count during hospital follow-up, TLO 1, TLO 2, and serum albumin values between the groups. The ICU group were found to be older, had higher rates of comorbidity, lower lymphocyte values, higher TLO 1-2, and lower serum albumin levels (P < 0.05). Conclusion: TLO-2 ratio above 260 and lymphocyte level below 1 103 cells/µL, would be a predictor of further intensive care unit need.