Sleep disturbances in children with cystic fibrosis and primary ciliary dyskinesia at the beginning and in the first year of COVID-19 pandemic

Introduction: During the COVID-19 pandemic, the lifestyle and sleep habits of children with chronic lung disease have changed. Aims and objectives: To evaluate the differences in sleep habits in the first year of the pandemic in children with cystic fibrosis (CF) and primary ciliary dyskinesia (PCD). Method(s): Primary caregivers of children with CF and PCD aged 3-16 years who were evaluated for sleep habits at the beginning of the pandemic were re-evaluated at the end of the first year of the pandemic. The Sleep Disturbance Scale for Children (SDSC) was used and questions were asked about sleep habits and weight changes during the first year of the pandemic. Result(s): Primary caregivers of 31 children with CF and 14 children with PCD were included in the study. The median age of the children were 10.0 (7.5-12.0) years, 42.2% of the children were female. The mean BMI of children with CF was 15.8+/-1.8, and 20.0+/-3.5 in children with PCD (p:0.001). The mean daily screen time was 2h (1-3) at the beginning and 5h (4-6) in the first year of the pandemic among children with CF, 2h (1-2.2) at the beginning and 5h (4.7-6) in the first year of the pandemic among children with PCD (p<0.001, p:0.001, respectively). There were no differences in terms of disorders of initiating and maintaining sleep, sleep breathing disorders, disorders of arousal, sleep-wake transition disorders, disorders of excessive somnolence, sleep hyperhidrosis scores between two groups during first year of pandemic. Conclusion(s): While daily screen time increased in children with CF and PCD, sleep disturbances and changes in daily habits continued in the first year of the pandemic.

Respiratory functions in the follow-up of children with COVID-19 infection

Introduction or Background: The long-term effects of COVID-19 infection on the respiratory system in children are not yet known. Aims and Objectives: To determine the long-term effects of COVID-19 infection on the respiratory system of children by evaluating pulmonary function tests. Method(s): In this multicenter study, COVID-19 PCR positive children(>=6years) were evaluated prospectively with pulmonary function tests(spirometry, plethysmography and CO diffusion) at 3rd and 6th months follow-up. The results were evaluated retrospectively based on clinical symptoms, physical examination findings, radiological and laboratory tests of the patients in the acute phase of the infection. Result(s): At 3rd month evaluation of 270 COVID-19 PCR positive pediatric patients, mean FEV1 96.85+/-16.84%,FVC 96.06+/-16.84% were found;at 6th month, mean FEV1 100,03+/-15.98%,FVC 100.62+/-16.87. At the 3rd month, statistically significant differences were found between FEV1<80%(n:28),FEV1>80%(n:242) groups due to the presence of additional diseases(p<0.001),having respiratory(p=0.006) and cardiovascular(p=0.004) system pathological examination findings, interlobular septal thickening(p=0.020) on thorax CT, high level of CRP(p=0.032),IL6(p=0.048),ferritin(p=0,020) during the infection period. Having COVID-19 pneumonia was found to be non-effective on spirometric test results. No difference was found between the 3rd and 6th month spirometry results of the same patient. Conclusion(s): After recovery of COVID-19 infection, children who have additional diseases, and pathological examination and radiological findings during the infection period, may have functional respiratory changes;so they should be monitored with pulmonary function tests.

A general evaluation on current global threat of coronavirus (COVID-19) immuno responsibilities

Covid-19 SARS-CoV-2 (severe acute respiratory syndrome-coronavirus-2) is a new type of coronavirus known as an infectious upper respiratory tract infection disease. The coronavirus, which poses a great threat to human health worldwide, emerged in Wuhan, China in December 2019. The most important reason for coronavirus epidemics to become a pandemic that the disease was easily transmitted by droplets in close proximity with infected people. The disease spread rapidly all over the world within a few months and it was declared a worldwide epidemic by the World Health Organization in March 2020. It poses a risk for severe diseases such as hypertension, diabetes, cardiovascular disease, cancer, chronic lung disease and chronic kidney disease in the advanced age group. Considering the mortality rates to date, great efforts have been made both worldwide and in our country to manufacture successful drugs and vaccines against Covid-19 infection. The main purpose of this review is to assist in an immune response and preventive work for Covid-19, thanks to the available information about the coronavirus epidemic that deeply affects humanity and the diseases it causes.

Determinants of clinical course and mortality in COVID- 19 patients with hematological disorders: real life data from a single center

Objectives: Patients with hematological disorders are often immunosuppressive due to underlying diseases, immunosuppressive therapies or cytotoxic chemotherapeutics. In the case of coronavirus disease 2019 (COVID- 19), they are at high risk of poor prognosis. Therefore, the present study aimed to evaluate the determinants of clinical course and mortality in COVID-19 patients with hematological disorders. Methods: Sixty-two hospitalized patients older than 18 years with documented COVID-19 and hematological disorders were included in the study. The clinical and laboratory data of the patients were recorded. Age, gender, overall follow-up time, duration of hospitalization, neutropenia, D-dimer levels, disease status, presence of underlying diseases, prior autologous and allogeneic stem cell transplant, immunosuppressive drug use, chemotherapy within 28 days, pneumonia, secondary bacterial infection, intubation, survival and mortality of the patients were evaluated. Results: Twenty-eight (45.2%) of 62 patients died due to COVID-19 and its complications. It was observed that presence of pneumonia, secondary bacterial infection, intubation, neutropenia developed after the diagnosis of COVID-19, and elevated D-dimer levels were associated with significant mortality. A D-dimer level of > 1.2 μg/dL was found to be associated with 5.02 fold increase in the risk of death, with 60.7% sensitivity and 76.5% specificity. Presence of rheumatologic diseases also affected survival negatively. Conclusions: D-dimer levels have high predictive value for mortality. Considering the identified risk factors, it can be concluded that broad spectrum antibiotics can be administered earlier for prevention of high mortality rates in COVID-19 patients with underlying hematological disorders. These observations can give confidence to clinicians that delivery of effective anticancer regimens should continue during this difficult pandemic

Effects of the COVID-19 Pandemic on Students, Teachers, and Parents According to School Counselors' Perceptions

This study examines the positive and negative effects of the COVID-19 pandemic and distance education practices on students, teachers, and parents from the perspective of school counselors. This research was carried out within the scope of phenomenology design, a qualitative research method. The data were obtained via purposive sampling through online interviews conducted with 55 public school counselors at the end of the fall semester of the 2020-2021 academic year in Turkey. Content analysis was utilized to analyze the obtained data. The school counselors expressed that the pandemic had positive and negative relational, individual/psychological, and academic effects on students;positive and negative effects on the application of education and personal lives of teachers;and positive and negative effects on the parent???child???education relationship and the personal lives of parents. The results are discussed in relation to the relevant literature and recommendations are made.

Parkinson's Disease and the COVID-19 Pandemic: Do Quarantine Affect the Motor and Non-Motor Symptoms of Patients with and without Deep Brain Stimulation?

Aim: Patients with chronic diseases were forced into lockdown due to the coronavirus disease-2019 pandemic. Extended quarantine could lead to physical inactivity and psychiatric problems. We investigated the effects of quarantine and social isolation during the pandemic on the motor and non-motor symptoms (NMS) of Parkinson's disease (PD) patients with and without deep brain stimulation (DBS). Methods: This study included 168 patients with PD who were in quarantine for 2 months (between April 1, 2020 and May 31, 2020). Eighty-three patients had undergone bilateral subthalamic DBS surgery. A questionnaire with three parts was administered via phone: 1) motor symptoms, 2) NMS, and 3) the reasons for impairment. Results: Of the patients, 54.7% reported impairment in at least one motor symptom and 58.9% reported impairment in at least one NMS. Increased tremors, difficulty with turning in bed, and insomnia were significantly more pronounced in patients without DBS. Patients with DBS complained less of being bored due to staying at home and had less deterioration due to lack of exercise and slower disease progression. Conclusion: Half of the symptoms of patients with PD worsened during quarantine, but patients with DBS tolerated the lockdown better. Telemedicine and online physiotherapy programs should be recommended to prevent rapid disease progression.

Serological exposure in Bactrian and dromedary camels in Kazakhstan to a MERS or MERS-like coronavirus.

Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is a camel-borne zoonotic virus endemic across Eastern Africa and the Middle East, with evidence of circulation in Bangladesh and Mongolia. To determine if MERS-CoV was present in Kazakhstan, in 2017-2018, we collected swabs and sera from Bactrian camels (n = 3124) and dromedary (n = 5083). The total seropositivity was 0.54% in Bactrian camels and 0.24% in dromedaries; however, we did not detect MERS-CoV RNA in swab samples. There was no difference in the probability of infection between species or sex, but younger camels had a higher probability of being seropositive, suggesting a recent introduction of the virus to Kazakhstan. The infection of both camel species indicates that they both may play a role as natural reservoirs. These results reinforce the need for continual surveillance, especially at the camel-human interface to understand the risk of zoonotic exposure.

Epicardial fat volume predicts clinical severity of COVID-19

Background and Aim: The inflammatory response plays a critical role in coronavirus disease 2019 (COVID-19) and inflammatory cytokine storm increases the severity of COVID-19. Epicardial adipose tissue serves as a source of inflammatory cytokines and mediators. This study aimed to investigate the association between epicardial fat volume (EFV), inflammatory biomarkers and clinical severity of COVID-19. Methods: This retrospective study included 101 patients hospitalized with COVID-19 between March 11 and April 21, 2020. Laboratory findings, treatment and complications were recorded. The serum inflammatory biomarkers including C-reactive protein (CRP), interleukin-6 (IL-6), procalcitonin (PCT) and ferritin levels were measured. Computed tomographic images were analyzed and semi-automated measurements for EFV were obtained. The primary composite endpoint was admission to intensive care unit (ICU) or death. Results: The primary composite endpoint occurred in 25.1% (n=26) of patients (mean age 64.8±14.8 years, 14 male). A total of 10 patients died (mean age 71.9±14.3, 6 male). EFV (115.1±44.0 cm3 vs 94.3±45.5 cm3, respectively, p=0.037), CRP, PCT, ferritin and IL-6 levels were significantly higher in ICU patients. Moreover, a positive correlation between EFV and CRP (r=0.494, p<0.001), PCT (r=.287, p=0.005), ferritin (r=0.265, p=0.01) and IL-6 (r=0.311, p=0.005) was determined. At receiver operating characteristic analysis, patients with EFV >102 cm3 were more likely to have severe complications. Conclusions: Epicardial fat volume and the serum levels of CRP, IL-6, PCT and ferritin can effectively assess disease severity and predict outcome in patients with COVID-19.

The management of acute coronary syndrome patients in COVID-19 pandemic

Background and Aim: Acute coronary syndromes (ACS) are the diseases that requires emergent therapies and if not applicable most of these patients have high morbidity and mortality. Therefore, the management of these syndromes is very well-defined. However, the management of them during an infectious outbreak can be changed to reduce the contamination and thus to protect healthcare providers and other individuals. Nowadays, there is a Coronavirus (COVID-19) pandemic all over the world including Turkey and this pandemic affects lots of people, especially immunocompromised and elderly individuals. We aimed to report an algorithm about the management of ACS patients during COVID-19 pandemic. Methods: According to this algorithm patients who admitted to the emergency department and diagnosed to have ACS divide into two groups within the scope of COVID-19 outbreak. At first group, patients with suspected or confirmed COVID-19 cases are included. At second group unsuspected cases that do not have the signs and symptoms of COVID-19 infection was included.If the patient has STEMI and includes in the first group, thrombolytic therapy (Actilyse 100 and 50 mg) is preferred at first. If the patient has NSTEMI and includes within the first group, the treatment decision is made according to the risk category of the patients. Results: This algorithm was applied on a total of 47 patients who were hospitalized between 12 March 2020 to 31 March 2020 with the diagnosis of ACS. Among 47 ACS patients, 32 had STEMI (16 inferior, 14 anterior and 2 posterior MI, mean age: 52.8±19 years, male/female: 26/6, hypertension (HT) prevalance 53%, diabetes mellitus (DM) prevalance 18%) and 15 had NSTEMI (mean age: 63.0±16 years, male/female: 12/3, HT prevalance 66%, DM prevalance 26%). All STEMI was type I MI. 31 STEMI and 14 NSTEMI patients were included into group 2 patients and treated within our routine procedure protocol. All STEMI patients except one who was referred to cardiovascular surgery due to the LAD rupture were treated with PCI. On the other hand, 14 NSTEMI patients were treated with PCI and one patient was treated with medical therapy. 1 STEMI and 1 NSTEMI patients were included into group 1 because of the suspected COVID-19 infection. Conclusions: The management of ACS patients during pandemics have to be well-planned and organised to protect both of health care workers and other individuals interested with the patients. Thrombolytic therapy is the first option for eligible STEMI patients. However, NSTEMI patients have to be categorised based on their risk and then the management strategy should be determined. CTA is also important for medium and low risk NSTEMI patients to decide the invasive therapy before discharge from the hospital. An isolation catheter room and isolation room in ICU with negative pressure is a requisite for follow-up of these patients and must be included into these management algorithm.