Proposal to protect patients and healthcare professionals undergoing elective surgery during COVID-19 outbreak

BackgroundThe aim of this study was to investigate the reliability of COVID-19 Reporting and Data System (CO-RADS) scale on chest computerized tomography (CT) in addition to the reverse transcriptase-polymerase chain reaction (RT-PCR) test in diagnosis of COVID-19 on patients who will undergo elective surgery to protect patients and healthcare professionals during the intense pandemic period and the correlation between CO-RADS scale and Total Severity Score (TSS). During the intensive pandemic until normalization, 253 patients aged ≥ 18 years who underwent elective surgery with two negative RT-PCR results within the last 5 days and CO-RADS scale ≤ 3 on chest CT were included in the study. Demographic characteristics, American Society of Anesthesiologists classification, type of anesthesia and surgery, department of clinic, chest CT findings, scale of CO-RADS and TSS on CT, patients' postoperative hospital stay, follow-up time, and vital status (whether or not COVID-19 disease) at the hospital and discharge information were collected for each patient.ResultsThe most frequently calculated CO-RADS score was found to be 1 (73.1%). It was followed by scale of CO-RADS 2 (20.9%). Regarding TSS, the most common TSS for the right and left lungs was 0 (91.7% and 92.5%, respectively). COVID-19 was not detected in any of the patients who were hospitalized for an average of 4.9 ± 6.4 days and followed-up for an average of 14.3 ± 8.2 days. It was observed that the CO-RADS score and TSS were positively and moderately correlated with each other (p < 0.001).ConclusionIt was concluded that in early diagnostic of COVID-19, chest CT scans serve like a complementary diagnostic method in addition to RT-PCR testing to keep safe both the patients and health professionals and the scale of CO-RADS and TSS on CT are valuable in correlation with each other.

Evaluation of Anxiety, Depression, and Insomnia Levels of Healthcare Professionals after Inactive COVID-19 Vaccination (CoronaVac)

Objective: The aim of this study was to examine changes in the levels of depression, anxiety, and insomnia after inactive COVID-19 vaccination among healthcare professionals working actively during the COVID-19 pandemic. Methods: This cross-sectional study was conducted from January 1, 2021, to June 30, 2021, using an online survey across frontline healthcare professionals in Turkey. The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scale were used to evaluate the mental health of the participants, and the Insomnia Severity Index-7 (ISI-7) was used to evaluate their sleep problems. The data obtained from two different periods, pre-vaccination and post-vaccination, were examined. Results: The study included 416 healthcare professionals. The frequency of depression, anxiety, and insomnia was 27.9%, 31.5%, and 41.1%, respectively, in the pre-vaccination period, and there was a decrease in these rates (22.8%, 21.9%, and 34.1%, respectively) in the post-vaccination period. The differences between the two periods were also statistically significant for the PHQ-9 (p=0.000), GAD-7 (p=0.002), and ISI-7 (p=0.038) scores. We determined that the presence of long weekly working hours, being female, living alone, and presence of psychiatric disease were effective in the development of depression and anxiety. Conclusion: Among frontline healthcare professionals, depression, anxiety, and insomnia symptoms and the frequency of the diagnosis of these clinical conditions increased due to the COVID-19 pandemic. However, after the start of the immunization process, the frequency of these mental disorders and the anxiety levels of the healthcare professionals significantly decreased. (English) [ FROM AUTHOR] Amaç: COVID-19 pandemi sürecinde ön saflarda görev yapan sağlık çalışanlarının inaktif COVID-19 aşısı sonrasındaki depresyon, anksiyete ve insomnia düzeylerindeki değişimleri incelemek. Gereç ve Yöntem: Bu kesitsel çalışma, 1 Ocak--30 Haziran 2021 tarihleri arasında Türkiye'de ön saflarda yer alan sağlık profesyonellerini değerlendirmek için çevrimiçi bir anket kullanılarak yürütülmüştür. Katılımcıların mental sağlığını değerlendirmek için Patient Health Questionnaire- 9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7) ölçekleri kullanıldı. Uyku problemlerini değerlendirmek için Insomnia Severity Index-7 (ISI-7) kullanıldı. Çalışmada aşılama öncesi (AÖ) ve sonrası (AS) olmak üzere iki ayrı döneme dair veriler incelendi. Bulgular: Çalışmaya 416 sağlık çalışanı dahil edildi. AÖ dönemde depresyon, anksiyete ve insomnia sıklığı sırasıyla;%27.9, %31.5 ve %41.1 şeklindeydi. Bu oranlarda AS dönemde azalma olup;%22.8, %21.9 ve %34.1 şeklinde olduğu görüldü. Dönemler arasındaki bu farklar PHQ-9 (p=0.000), GAD-7 (p=0.002) ve ISI-7 (p=0.038) için istatistiksel olarak da anlamlıydı. Çalışmamızda yüksek haftalık çalışma saatleri, kadın cinsiyet, tek başına yaşam ve psikiyatrik hastalık varlığı faktörlerinin depresyon ve anksiyete gelişiminde etkili olduğunu tespit ettik. Sonuç: Ön saflardaki sağlık çalışanlarında depresyon, anksiyete ve insomnia semptomları ve bu kinik tablolara tanı konma sıklığının COVID- 19 pandemisine bağlı olarak arttığı görülmektedir. Ancak bağışıklama süreci başladıktan sonra bu mental bozuklukların sıklığı ve sağlık çalışanlarının endişe düzeyleri belirgin bir şekilde azalma göstermiştir. (Turkish) [ FROM AUTHOR] Copyright of Southern Clinics of Istanbul Eurasia is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Clinical Features and Laboratory Findings of COVID-19 in Children: A Tertiary Center Experience

Objective: Despite increasing data on Coronavirus Disease 2019 (COVID-19) in adults, the data in pediatric patients are still limited. The aim of our study is to evaluate the clinical features and laboratory findings of our confirmed pediatric COVID-19 cases. Methods: This retrospective descriptive study was conducted in one of the largest COVID-19 treatment centers in Ístanbul, Turkey. Four hundred and fifty-six cases confirmed using reverse transcriptase-polymerase chain reaction (RT-PCR) were included in the study. One hundred inpatients and 356 outpatients were treated. Patients were classified according to the disease severity as asymptomatic, mild, moderate and severe. Results: The number of asymptomatic, mild, moderate or severe cases were 199 (43.6%), 194 (42.5%), 33 (7.2%) and 30 (6.6%) respectively. Most of the hospitalized patients younger than 5 years old had the mild disease (67.7%), whereas most of the patients over 15 years of age had severe disease (54.2%). Lymphopenia and high ferritin levels at admission were more common in severe cases (p<0.05). Also, multiple regression analysis revealed that high ferritin and D-dimer levels were found to prolong hospital stay (p=0.000;R2=0.404). Conclusion: Age, lymphocyte count, ferritin and D-dimer levels can be used to estimate the disease severity for COVID-19 infection in children. (English) [ FROM AUTHOR] Amaç: Erişkinlerde Coronavirus Hastalığı 2019 (COVID-19) hakkında artan verilere rağmen, pediatrik hastalardaki veriler hala sınırlıdır. Çalışmamızın amacı, doğrulanmış pediatrik COVID-19 olgularımızın klinik özelliklerini ve laboratuvar bulgularını değerlendirmektir. Gereç ve Yöntem: Bu geriye dönük çalışma, Türkiye'deki en büyük COVID-19 tedavi merkezlerinden birinde yapıldı. Çalışmaya ters transkriptaz polimeraz zincir reaksiyonu (RT-PCR) kullanılarak doğrulanan 456 olgu dahil edildi.Yüz hasta yatarak, 356 hasta ayakta tedavi edildi. Hastalar hastalık şiddetine göre asemptomatik, hafif, orta ve şiddetli olarak sınıflandırıldı. Bulgular: Asemptomatik, hafif, orta ve ağır vaka sayısı sırasıyla 199 (%43.6), 194 (%42.5), 33 (%7.2) ve 30 (%6.6) idi. Hastanede yatan beş yaş altı hastaların çoğu hafif (%67.7) iken, 15 yaş üstü hastaların çoğu ağır hastalığa (%54.2) sahipti. Başvuru anında lenfopeni ve yüksek ferritin düzeyleri ağır olgularda daha yaygındı (p<0.05). Ayrıca çoklu regresyon analizi, yüksek ferritin ve D-dimer düzeylerinin hastanede yatış süresini artırdığını ortaya koydu (p=0.000;R2=0.404). Sonuç: Çocuklarda COVID-19 enfeksiyonu için hastalık şiddetini tahmin etmek için yaş, lenfosit sayısı, ferritin ve D-dimer seviyeleri kullanılabilir. (Turkish) [ FROM AUTHOR] Copyright of Southern Clinics of Istanbul Eurasia is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Management of Children with Severe COVID-19 in a Pediatrics Unit in Istanbul: A Retrospective Study

Objective: SARS-CoV-2 is a probable causative agent of severe disease both in children and adults. In this study, we aimed to evaluate the management of hospitalized severe pediatric COVID-19 patients. Methods: Data on the management of 21 children under the age of 18 who were hospitalized with severe COVID-19 between March 2020 and May 2020 were included in this study. Results: A total of 1109 patients, including 888 outpatients and 221 inpatients, were included in this study. 91 (41.1%) of the 221 hospitalized children were PCR positive for SARS-CoV-2. 21 (23%) of 91 COVID-19 patients were considered severe COVID-19. 10 (47.6%) were females and 11 (52.4%) were males, with a mean±standard deviation (SD) age of 14.4±2.7 years (range;9 years-17.6 years). The most prevalent symptoms at admission were fever (80.9%), cough (76.1%), shortness of breath (23.8%) and myalgia (23.8%). 4 (19%) of 21 patients had underlying diseases. 19 (90.4%) patients were in close contact with confirmed cases in the family. All patients had typical findings on lung computed tomography (CT) and the major CT abnormalities observed were ground-glass opacities. Two patients who needed respiratory support received favipiravir treatment. The mean hospital stay was 7.34±2.65 (5-16) days. Clinical improvement was achieved in all patients. Conclusion: The clinical course of COVID-19 in children is milder and has a better prognosis than adults, but it should be kept in mind that severe cases are defined in the pediatric patient group and these patients should be followed closely. (English) [ FROM AUTHOR] Amaç: SARS-CoV-2, hem çocuklarda hem de yetişkinlerde ciddi hastalığın olası bir etkenidir. Bu çalışmada, hastanede yatan ağır çocuk COVID-19 hastalarının yönetimini değerlendirmeyi amaçladık. Gereç ve Yöntem: Mart 2020 ile Mayıs 2020 tarihleri arasında 18 yaş altı ağır COVID-19'lu hastanede yatan 21 çocuğun yönetimine ilişkin veriler bu çalışmaya dahil edildi. Bulgular: Bu çalışmada 888 ayaktan ve 221 yatan hasta olmak üzere toplam 1109 hasta toplandı. Hastanede yatan 221 çocuğun 91'i (%41.1) SARS-CoV-2 için PCR pozitifti. Doksan bir COVID-19 hastasının 21'i (%23) şiddetli COVID-19 olarak kabul edildi. Onu (%47.6) kız, 11'i (%52.4) erkek olup, yaşları ortalama±standart sapma (SS) 14.4±2.7 yıl (aralık;9 yıl-17.6 yıl) olarak saptandı. En sık başvuru semptomları ateş (%80.9), öksürük (%76.1), nefes darlığı (%23.8) ve miyalji (%23.8) idi. Yirmi bir hastanın dördünde (%19) altta yatan hastalık vardı. On dokuz (%90.4) hasta ailede doğrulanmış olgularla yakın temas halindeydi. Tüm hastalarda tipik olarak akciğer bilgisayarlı tomografi (BT) bulguları vardı ve başlıca gözlenen BT anormallikleri buzlu cam opasiteleriydi. Solunum desteğine ihtiyaç duyan iki hasta favipiravir tedavisi aldı. Ortalama hastanede kalış süresi 7.34±2.65 (5-16) gündü. Tüm hastalarda klinik iyileşme sağlandı. Sonuç: Çocuklarda COVID-19'un yetişkinlere göre klinik seyri daha hafiftir ve daha iyi prognozu vardır ancak çocuk hasta grubunda ciddi olgular tanımlandığı ve bu hastaların yakından takip edilmesi gerektiği akılda tutulmalıdır. (Turkish) [ FROM AUTHOR] Copyright of Southern Clinics of Istanbul Eurasia is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Relationship of chest computed tomography score with disease severity and laboratory values in children with COVID-19.

AIM: Although chest computed tomography (CT) score has been well evaluated in adult coronavirus disease (COVID-19), its use in paediatric cases is insufficiently studied. Our aim is to evaluate the relationship of chest CT score with disease severity and laboratory parameters. METHODS: Seventy-six paediatric patients with confirmed COVID-19 and chest CT evaluation on admission have been included in this study. Chest CT score was calculated for each of the five lobes considering the extent of anatomical involvement, as follows: 0: 0%; 1: <5%; 2: 5%-25%; 3: 26%-50%; 4: 51%-75% and 5: >75%. The resulting total CT score was the sum of each individual lobar score; the range was between 0 and 25. RESULTS: Total chest CT score was found to be positively correlated with alanine aminotransferase and d-dimer, and negatively correlated with lymphocyte count. In receiver operating characteristic analysis, total chest CT score had area under the curve 0.99 (95% confidence interval, 0.98-1.00) at cut-off 2 with 95% sensitivity and 96% specificity for the severe disease. Furthermore, in-depth analysis of lobar CT scores showed a correlation between left upper lobe with lymphocyte count, left lower lobe with d-dimer, right middle and lower lobes with alanine aminotransferase and right upper lobe with leukocyte count. CONCLUSIONS: There is a significant relationship between chest CT score and COVID-19 severity and laboratory findings in children. This suggests that chest CT scores can be used to assess the severity of the disease and can play an important role in paediatric clinical practice.

Coinfection in SARS-CoV-2 Infected Children Patients.

INTRODUCTION: The aim of this study is to determine the coinfections with other respiratory pathogens in SARS-CoV-2 infected children patients in a pediatric unit in Istanbul. METHODOLOGY: This retrospective descriptive study was conducted in a 1000-bedded tertiary education and research hospital in Istanbul. All children hospitalized with the diagnosis of SARS-CoV-2 infection had been investigated for respiratory agents in nasopharyngeal secretions. Laboratory confirmation of SARS-CoV-2 and the other respiratory pathogens were performed using reverse transcriptase-polymerase chain reaction (RT-PCR). RESULTS: A total of 209 hospitalized children with suspected SARS-CoV-2 infection between March 2020-May 2020 were enrolled in this study. Among 209 children, 93 (44.5%) were RT-PCR positive for SARS-CoV-2 infection, and 116 (55.5%) were RT-PCR negative. The most common clinical symptoms in all children with SARS-CoV-2 infection were fever (68.8%) and cough (57.0%). The other clinical symptoms in decreasing rates were headache (10.8%), myalgia (5.4%), sore throat (3.2%), shortness of breath (3.2%), diarrhea (2.2%) and abdominal pain in one child. In 7 (7.5%) patients with SARS-CoV-2 infection, coinfection was detected. Two were with rhinovirus/enterovirus, two were with Coronavirus NL63, one was with adenovirus, and one was with Mycoplasma pneumoniae. In one patient, two additional respiratory agents (rhinovirus/enterovirus and adenovirus) were detected. There was a significantly longer hospital stay in patients with coinfection (p = 0.028). CONCLUSIONS: Although the coinfection rate was low in SARS-CoV-2 infected patients in our study, we found coinfection as a risk factor for length of hospital stay in the coinfected patient group.

Pulse steroid treatment for hospitalized adults with COVID-19

Background/aim: High-dose steroid has been shown to reduce the mortality rate in Corona virus disease 2019 (COVID-19) patients who need oxygen support. Here, we evaluated the effectiveness of pulse-steroid in case of unresponsiveness to treatment with high dose steroid. Materials and methods: The study is a retrospective controlled trial. We divided the patients in 3 groups: standard-care therapy alone, high-dose steroid treatment (6 mg/day dexamethasone equivalent), and pulse-steroid treatment (250 mg/day methyl-prednisolone). One hundred and fifty patients were enrolled in each group. All patients were hospitalized and needed oxygen support. We matched the patients according to disease severity at the onset of hypoxia, weight of co-morbidities, age, and sex. We then compared 3 groups in terms of mortality, length of hospitalization, need for intensive care unit (ICU) admission and mechanical ventilation (MV), length of stay in ICU, and duration of MV. Results: The pulse-steroid group had shorter ICU stay. The median ICU stay was 9.0 (CI 95% 6.0­12.0) days in standard-care group, 8.0 (CI 95% 5.0­13.0) days in high-dose steroid group and 4.5(CI %95 3.0­8.0) days in pulse-steroid group. Moreover, although patients in pulse-steroid group were initially unresponsive to high dose steroid therapy, they achieved similar results compared to the high-dose steroid group in other outcomes except for length of hospital stay. Conclusion: Pulse-steroid treatment would be an option for COVID-19 patients who do not respond to the initial high-dose steroid treatment.

Comparison of Laboratory and Radiological Findings of Pregnant and Non-Pregnant Women with Covid-19.

OBJECTIVE: Covid-19 became a pandemic, and researchers have not been able to establish a treatment algorithm. The pregnant population is also another concern for health care professionals. There are physiological changes related to pregnancy that result in different laboratory levels, radiological findings and disease progression. The goal of the present article is to determine whether the laboratory results and radiological findings were different in non-pregnant women (NPWs) of reproductive age and pregnant women (PWs) diagnosed with the Covid-19 infection. METHODS: Out of 34 patients, 15 (44.11%) PWs and 19 (55.8%) NPWs were included in the study. Age, comorbidities, complaints, vitals, respiratory rates, computed tomography (CT) findings and stages, as well as laboratory parameters, were recorded from the hospital database. RESULTS: The mean age of the PWs was of 27.6 ± 0.99 years, and that of the NPWs was of 37.63 ± 2.00; when age was compared between the groups, a statistically significant difference (p = 0.001) was found. The mean systolic blood pressure of the PWs was of 116.53 ± 11.35, and that of the NPWs was of 125.53 ± 13.00, and their difference was statistically significant (p = 0.05). The difference in the minimum respiratory rates of the patients was also statistically significant (p = 0.05). The platelet levels observed among the PWs with Covid-19 were lower than those of the NPWs (185.40 ± 39.09 × 109/mcL and 232.00 ± 71.04 × 109/mcL respectively; p = 0.05). The mean D-dimer value of the PWs was lower in comparison to that of the NPWs (p < 0.05). CONCLUSION: The laboratory findings and imaging studies may differ between pregnant and non-pregnant populations. It is important to properly interpret these studies. Future studies with a higher number of patients are required to confirm these preliminary data.

Acute Limb Ischemia in Hospitalized COVID-19 Patients.

BACKGROUND: COVID-19 is a multisystemic disorder. Hematologic and cardiovascular involvement of COVID-19 causes thromboembolic events across multiple organs which mainly manifest as venous thromboembolism, and rarely, peripheral arterial thromboembolic events. In-situ thrombosis of a healthy, non-atherosclerotic native artery is rare, and COVID-19 has been reported to be a cause of this phenomenon. We aimed to report our institutional experience with COVID-19 patients who developed acute limb ischemia (ALI) during hospitalization or after discharge. METHODS: This was a single-center cross-sectional study. Records of all patients ≥18 years of age admitted to a tertiary center with a confirmed diagnosis of COVID-19 infection between September 1 and December 31, 2020 were retrospectively examined. Data regarding patient demographics, co-morbidities and outcomes were collected. Patients were followed-up during index hospitalization and for 30 days postdischarge. Acute limb ischemia was diagnosed by means of duplex ultrasound and computed tomography angiography in the presence of a clinical suspicion. RESULTS: A total of 681 consecutive patients (38.5% women) were hospitalized with a confirmed diagnosis of COVID-19 during the study period. Median age was 63 years (IQR, 52-74). In-hospital mortality occurred in 94 (13.8%) patients. Ninety (13.2%) patients required intensive care unit admission at some point of their hospital stay. Six (0.9%) patients (one woman) with a median age of 62 years experienced ALI (IQR, 59-64.3). All patients were receiving low molecular weight heparin when they developed ALI. The median of duration between COVID-19 diagnosis and ALI symptom onset was 13 days (IQR, 11.3-14). Three patients underwent emergent surgical thrombectomy combined with systemic anticoagulation, and 3 received systemic anticoagulation alone. Two patients with ALI did not survive to hospital discharge. Among survivors, 1 patient underwent bilateral major amputations, and another underwent a minor amputation within 1 month of hospital discharge. Symptoms of ALI completely resolved in 2 patients without sequelae. CONCLUSIONS: COVID-19 is a multisystemic disorder with involvement of hematologic and cardiovascular systems. Despite widespread use of thromboprophylaxis, hospitalized patients with COVID-19 are at increased risk of ALI, and subsequent limb loss or even death.

COVID-19 patients in the operating room: a concise review of existing literature.

A novel Coronavirus was identified in late 2019 as the cause of COVID-19 disease which is highly contagious. SARS-CoV-2 is a single-stranded RNA, enveloped virus from the beta Coronavirus family. Intraoperative management of patients with COVID-19 is a high-risk procedure. An international attention has raised to develop recommendations for the management strategies. This review article was designed to synthesize the existing evidence and experience related to intraoperative management of COVID-19. This review provides a summary of clinical guidance and addresses six domains: principles of intraoperative monitoring, airway management and related difficulties, ventilation, type of anesthesia, medications and side effects, and intraoperative fluid management.

The Psychological Impact of COVID-19 Disease is more Severe on Intensive Care Unit Healthcare Providers: A Cross-sectional Study.

OBJECTIVE: : Fear, anxiety, depression and sleep deprivation are common mental health disorders in COVID-19 disease. We aimed to analyse the risk for healthcare providers during COVID-19 pandemic in a university hospital. METHODS: Anesthesiologists, nurses and nurse anesthetists were invited to fill out the survey. The survey was consist of questions from ''The Fear of COVID-19 Scale'', ''Patient Health Questionnaire'' and ''Pittsburgh Sleep Quality Index'' (PSQI). Each question was worth a point. RESULTS: The data of 208 participants were analyzed. Mean age was 29 ± 7.748 years, 72.1% were male, 67.3% were nurses, 62% were working in intensive care units, 38% were in hospital wards, 62% of all participants were living alone. Moderate depression was the most frequently detected outcome (n = 90, 43.3%). Mean The Fear of COVID-19 Scale for all participants was 18.56 ± 7.731. The mean PSQI of patients was 6.18 ± 4.356 with a 45.7% rate of poor sleep quality. PSQI was found significantly higher in nurses (7.1 ± 4.7, p = 0.000). Nurses were the group with the highest deterioration in sleep quality (53.6%, p = 0.003). The rate of moderate-to-severe depressive symptoms was significantly higher in intensive care unit nurses and physicians (p = 0.018). PSQI score was found significantly higher in intensive care unit nurses and physicians than hospital ward co-workers (7.02 ± 4.59 vs. 4.81 ± 3.57 respectively, p = 0.001). A significant positive correlation was observed between PSQI and The Fear of COVID-19 Scale total score in all patients (p < 0.005). CONCLUSION: Depression, anxiety, fear and sleep disorders may occur in healthcare workers during COVID-19 outbreak. Intensive care unit nurses were at highest risk.