Comparison of anakinra and tocilizumab in management of severe COVID-19: a retrospective cohort study.

BACKGROUND: Studies regarding effectiveness of anakinra and tocilizumab treatments in coronavirus disease 2019 (COVID-19) have contradictory results. Furthermore, there is scarce comparative data regarding superiority of any agent. To further elucidate any superiority between these two agents, we retrospectively investigated and compared outcomes in hospitalized COVID-19 patients of our inpatient cohort who received anakinra or tocilizumab. METHODS: This study was designed as a single-center, retrospective, cross-sectional cohort study. Hospitalized patients with confirmed diagnosis of COVID-19 who had Brescia-COVID respiratory severity scale score ≥3 and hyperinflammation (defined as elevation of C reactive protein ≥50 g/L or ferritin ≥700 ng/mL) and received anakinra or tocilizumab in addition to standard care were enrolled in the study. Length of hospital stay after initiation of antiinflammatory treatment, need for mechanical ventilation, need for intensive care unit admission, mortality were set as primary outcomes and compared between tocilizumab and anakinra recipients after propensity score matching. RESULTS: One hundred and six patients were placed in each group after propensity score matching. In the anakinra group, relative risk reduction for intensive care unit admission was 50% when compared to the tocilizumab group and the number needed to treat to avert an intensive care unit admission was 3 (95% CI, 2-5). In terms of mortality, a 52% relative risk reduction was observed with anakinra treatment and the number needed to treat to avert an intensive care unit admission was 8 (95% CI, 4-50). Significantly more patients were observed to receive glucocorticoids in the anakinra group. DISCUSSION: Anakinra administration in severe COVID-19 patients was significantly associated with better survival and greater clinical improvement compared to the tocilizumab administration in our study. Increased rate of glucocorticoid use in the anakinra group might have contributed to better outcomes.

Investigation of the relation between risk assessment of exposure and nosocomial SARS-CoV-2 transmission in healthcare workers: a prospective single-centre study.

OBJECTIVES: Healthcare workers (HCWs) are among the risk groups for COVID-19. Determining transmission routes and risk levels during healthcare is of great importance in preventing nosocomial outbreaks. This study aimed to investigate the frequency of nosocomial transmission and factors affecting the transmission in HCW. METHODS: HCWs admitted to the infectious diseases outpatient clinic due to contact with a COVID-19 patient and diagnosed with SARS-COV-2 by reverse-transcriptase PCR (RT-PCR) between 20 March 2020 and 30 June 2020 were included in the study. RESULTS: A total of 822 HCWs with 295 low, 284 intermediate and 243 high-risk exposures were included in the study. 27.1% of the HCWs were male, and the median age was 31.9 years (20-62). 89.5% of these patients were directly in charge of patient care. Of the index cases contacted, 72.6% were HCW, and 27.4% were non-HCW patients. Most of the risky exposure (51.7%) occurred in nurses. The occurrence frequency of high-risk exposure was lower in those assigned to direct patient care when compared with the occurrence frequency of moderate-risk or low-risk exposures (76.5%, 94.7, 95.3, respectively p<0.001). In most high-risk exposures (220/253), the index cases were HCWs (p<0.001). Symptoms were detected in 311 of the HCWs (37.8%) during the follow-up. The median time to perform SARS-CoV-2 RT-PCR was 5.3 days (IQR) after the last risky exposure. In multivariate analysis, SARS-CoV-2 RT-PCR positivity was 5.65 times higher in HCWs not directly involved in patient care than HCWs who are not involved in patient care (95% CI 2.437 to 13.111; p<0.001). CONCLUSIONS: This study provides particularly useful information on post-exposure COVID-19 follow-up and management of working schedules and procedures of HCWs.

Effect of deep breathing exercise with Triflo on dyspnoea, anxiety and quality of life in patients receiving covid-19 treatment: A randomized controlled trial.

AIMS AND OBJECTIVES: Determination of the effect of deep breathing exercise applied with Triflo on dyspnoea, anxiety and quality of life in patients who are hospitalized for COVID-19 and have dyspnoea. BACKROUND: COVID-19 is a viral infection that can cause severe pulmonary disease. Deep breathing exercise with Triflo in patients with COVID-19 may contribute to the reduction/elimination of dyspnoea and anxiety, and improvement of respiratory and quality of life. DESIGN: The study was a randomized controlled clinical trial and conducted in accordance with the Consolidated Standards of Reporting Trials (CONSORT) 2010 guidelines. METHODS: The study was conducted in the clinic of COVID-19 of a tertiary hospital. A total of 44 eligible participants were enrolled from January to April 2021. Primary outcomes included oxygen saturation in the blood, respiratory assessment and dyspnoea level. Secondary outcomes included anxiety and quality of life. In the statistical analysis of the data, the independent sample t-test, Wilcoxon test, Mann-Whitney U test and Spearman correlation were used to examine the intervention effect on primary outcomes and secondary outcomes, according to numbers, percentage, mean, standard deviation and conformity to normal distribution. RESULTS: It was determined that the patients in the deep breathing group had a statistically significant shorter hospitalization time (3.04 ± 0.65), higher SpO2  level (97.05 ± 1.46) and higher quality of life (77.82 ± 6.77) compared with the patients in the usual care group (p < 0.05). CONCLUSIONS: Deep breathing exercise with Triflo increases the SpO2  level and quality of life in patients with COVID-19 and contributes to a decrease in dyspnoea and anxiety levels. Moreover, the duration of hospital stay is shortened in patients who are applied deep breathing exercise with Triflo. RELEVANCE TO CLINICAL PRACTICE: With deep breathing exercise applied with Triflo, respiratory rate reaches normal limits in a short time, SpO2  levels increase significantly, and quality of life improves significantly in patients with COVID-19 pneumonia. CLINICAL TRIALS REGISTRATION NUMBER: https://clinicaltrials.gov; NCT04696562.

Development and validation of nomogram to predict severe illness requiring intensive care follow up in hospitalized COVID-19 cases.

BACKGROUND: Early identification of severe COVID-19 patients who will need intensive care unit (ICU) follow-up and providing rapid, aggressive supportive care may reduce mortality and provide optimal use of medical resources. We aimed to develop and validate a nomogram to predict severe COVID-19 cases that would need ICU follow-up based on available and accessible patient values. METHODS: Patients hospitalized with laboratory-confirmed COVID-19 between March 15, 2020, and June 15, 2020, were enrolled in this retrospective study with 35 variables obtained upon admission considered. Univariate and multivariable logistic regression models were constructed to select potential predictive parameters using 1000 bootstrap samples. Afterward, a nomogram was developed with 5 variables selected from multivariable analysis. The nomogram model was evaluated by Area Under the Curve (AUC) and bias-corrected Harrell's C-index with 95% confidence interval, Hosmer-Lemeshow Goodness-of-fit test, and calibration curve analysis. RESULTS: Out of a total of 1022 patients, 686 cases without missing data were used to construct the nomogram. Of the 686, 104 needed ICU follow-up. The final model includes oxygen saturation, CRP, PCT, LDH, troponin as independent factors for the prediction of need for ICU admission. The model has good predictive power with an AUC of 0.93 (0.902-0.950) and a bias-corrected Harrell's C-index of 0.91 (0.899-0.947). Hosmer-Lemeshow test p-value was 0.826 and the model is well-calibrated (p = 0.1703). CONCLUSION: We developed a simple, accessible, easy-to-use nomogram with good distinctive power for severe illness requiring ICU follow-up. Clinicians can easily predict the course of COVID-19 and decide the procedure and facility of further follow-up by using clinical and laboratory values of patients available upon admission.

Effects of COVID-19 Pandemic on Treatment, Follow-up, and Lifestyle and Behavioral Characteristics in People Living with HIV

Objectives: Limited available data currently indicate that the course of Coronavirus disease-2019 (COVID-19) in people living with human immunodeficiency virus (HIV) does not differ from people without HIV. During overstressing circumstances like pandemics, it is important to know how the population, especially special groups, are coping with such a major disaster. Measures and policies which are adopted according to this special patient group can change the quality of care in HIV patients. Health authorities have implemented some policies for elderly and special patient populations. In this study, it was aimed to evaluate the impact of the COVID-19 pandemic on treatment, follow-up and lifestyle and behavioral characteristics of HIV patients. Materials and Methods: A phone survey was applied to all HIV patients who were followed regularly in our center. A total of 100 patients were included. The patients were asked about whether there was a disruption in follow-up and treatment. In addition, patient groups with and without anxiety were compared. Results: Education level was higher and the duration of HIV infection was longer in the patient group with anxiety (p=0.01 and p=0.007, respectively). The groups were compared for follow-up disruption. Disruption of follow-up was more frequent in retired, working and student patients (p=0.01). Eighty-five percent stated that they adopted lifestyle and behavioral changes due to COVID-19. Conclusion: Compliance with measures was sufficient and no patient was infected with the novel coronavirus. The appropriate measures and correct policies implemented by the authorities and patients’ compliance with the protective measures have played a major role in ensuring the continuity of treatment of patients with chronic illnesses like HIV infection.

Characteristics of candidemia in COVID-19 patients; increased incidence, earlier occurrence and higher mortality rates compared to non-COVID-19 patients.

Severe COVID-19 patients in ICU are at high risk for candidemia due to exposure to multiple risk factors for candidemia. We aimed to compare the incidence of candidemia in ICU patients with and without COVID-19, and to investigate epidemiologic and clinical characteristics of candidemia patients and risk factors for mortality in candidemia patients. This retrospective study was conducted in patients followed in the ICUs of Ankara City Hospital for 2 years, divided into pre-pandemic and pandemic periods. The incidence (event per 1000 patient-days) and epidemiology of candidemia, clinical and laboratory characteristics of patients were compared in COVID-19 and non-COVID-19 groups. Candidemia incidence was higher in the COVID-19 group (2.16, 95% CI 1.77-2.60) than the non-COVID-19 group (1.06, 95% CI 0.89-0.125) (p < .001). A total of 236 candidemia episodes (105 in COVID-19 patients and 131 in non-COVID-19 patients) were detected during the study periods. COVID-19 cases had a higher rate of corticosteroid use (63.8% vs. 9.9%, p < .001). Epidemiology of candidemia and antifungal susceptibility were similar. Candidemia developed 2 weeks earlier in COVID-19 groups and resulted in higher mortality (92.5% vs. 79.4%, p .005). One-third of candidemia patients died before receiving any antifungal treatment, and this rate was higher in the COVID-19 group. In multivariate logistic regression analysis, corticosteroid use, presence of sepsis and age older than 65 years were independent risk factors for mortality in candidemia patients. Candidemia with high mortality is a more serious problem for COVID-19 patients due to its increased incidence, earlier occurrence and a higher rate of mortality.

COVID-19 experience of the major pandemic response center in the capital: results of the pandemic's first month in Turkey

Background/aim: The aim of this study is to evaluate the epidemiological and clinical characteristics and parameters that determined the clinical course and prognosis of the COVID-19 patients admitted to Ankara City Hospital during the first month of the pandemic in Turkey. Materials and methods: SARS-CoV-2 PCR positive patients who were hospitalized between March 10 and April 10, 2020 were included. Results: Among 222 patients, mean age was higher in severe acute respiratory illness (SARI)/critical disease group (P < 0.001). Median time from illness onset to admission and presence of comorbidity, especially coronary artery disease and chronic obstructive pulmonary disease, were significantly higher in the SARI/critical disease group (P < 0.05). Cough and fever were the most common symptoms, while anosmia and loss of taste were observed in 8.6% and 7.7% patients, respectively. The mortality rate was 5.4%. A high neutrophil/lymphocyte ratio; low lymphocyte, monocyte, and platelet count; elevated liver enzymes; low GFR; and high levels of muscle enzymes, ferritin, and IL-6 on admission were found to be associated with SARI/critical disease (P < 0.05). Bilateral ground-glass opacity and patchy infiltration were more frequently seen in the SARI/critical disease group (P < 0.001). Patients older than 65 years had an 8-fold increased risk for development of SARI/critical disease. Conclusion: This cohort study regarding COVID-19 cases in Turkey reveals that older age, presence of comorbidity, bilateral infiltration on CT, high neutrophil/lymphocyte ratio, low monocyte and platelet count, elevated liver enzymes, low GFR, high levels of muscle enzymes, and high levels of ferritin and IL-6 on admission are predictors of SARI and severe disease.