Association of Vitamin D and Secondary Infection in COVID-19

Introduction: Vitamin D plays a role in the modulation of cytokine release, inflammation, innate and adaptive immunity. It has been frequently discussed that the hyperinflammatory response that causes acute respiratory distress syndrome or other organ damage due to SARS-CoV-2 at the beginning of the pandemic can be modulated by the adequacy of vitamin D. The relationship of vitamin D with many conditions such as mortality, number of intensive care unit stays, disease severity, and organ damage has been investigated, but the information on its effect on secondary infections that occur during the course of the disease is limited. In this study, it was aimed to reveal the relationship of vitamin D with secondary infections that occur during the course of COVID-19 disease. Materials and Methods: Medical records of patients hospitalized in the COVID-19 pandemic service with the diagnosis of COVID-19 were evaluated retrospectively. Results: One hundred eighty-one patients were included in the study. The mean of 25(OH) vitamin D was found to be 18.76 +/- 9.82 ng/mL. When 25-hydroxy vitamin D was compared with gender, disease severity, mortality, need for mechanical ventilation and presence of symptoms, no statistically significant difference was found (p> 0.05). The medical data of the patients during their hospitalization were analyzed and secondary infection was detected in 14.9% (n= 27). When 25-hydroxy vitamin D and the presence of secondary infection were compared, the 25(OH)D vitamin level of those with secondary infection was found to be low and this was found to be statistically significant (p= 0.016). As a result of the evaluation made by ROC analysis, 25-hydroxy vitamin D was found to have a diagnostic value in predicting positive culture results in COVID-19 patients (AUC= 0.771, 95% Confidence Interval= 0.612-0.810, p= 0.003, p< 0.05). Conclusion: While vitamin D continues to be an important topic of discussion in COVID-19 disease due to its effects on the immune system, it should not be forgotten that low vitamin D increases the risk of secondary infection developing in the course of COVID-19 and this may have an impact on prognosis.

Association of Vitamin D and Secondary Infection in COVID-19.

Introduction: Vitamin D plays a role in the modulation of cytokine release, inflammation, innate and adaptive immunity. It has been frequently discussed that the hyperinflammatory response that causes acute respiratory distress syndrome or other organ damage due to SARS-CoV-2 at the beginning of the pandemic can be modulated by the adequacy of vitamin D. The relationship of vitamin D with many conditions such as mortality, number of intensive care unit stays, disease severity, and organ damage has been investigated, but the information on its effect on secondary infections that occur during the course of the disease is limited. In this study, it was aimed to reveal the relationship of vitamin D with secondary infections that occur during the course of COVID-19 disease. Material(s) and Method(s): Medical records of patients hospitalized in the COVID-19 pandemic service with the diagnosis of COVID-19 were evaluated retrospectively. Result(s): One hundred eighty-one patients were included in the study. The mean of 25(OH) vitamin D was found to be 18.76 +/- 9.82 ng/mL. When 25-hydroxy vitamin D was compared with gender, disease severity, mortality, need for mechanical ventilation and presence of symptoms, no statistically significant difference was found (p> 0.05). The medical data of the patients during their hospitalization were analyzed and secondary infection was detected in 14.9% (n= 27). When 25-hydroxy vitamin D and the presence of secondary infection were compared, the 25(OH)D vitamin level of those with secondary infection was found to be low and this was found to be statistically significant (p= 0.016). As a result of the evaluation made by ROC analysis, 25-hydroxy vitamin D was found to have a diagnostic value in predicting positive culture results in COVID-19 patients (AUC= 0.771, 95% Confidence Interval= 0.612-0.810, p= 0.003, p< 0.05). Conclusion(s): While vitamin D continues to be an important topic of discussion in COVID-19 disease due to its effects on the immune system, it should not be forgotten that low vitamin D increases the risk of secondary infection developing in the course of COVID-19 and this may have an impact on prognosis.Copyright © 2022 Bilimsel Tip Yayinevi. All rights reserved.

Pre-Endoscopic viral screening of children during the Covid-19 pandemic

Aim: Transmission of SARS-CoV-2 infection can easily occur through direct or close contact with infected people, just as with other infectious diseases. Therefore, it is important to detect it prior to the intervention for protecting the health of both the healthcare worker and the patient. In the study, it was aimed to determine the seropositivity rates of acute respiratory syndrome coronavirus 2, hepatitis A, hepatitis B, hepatitis C virus and human immune deficiency virus infections among children who underwent gastrointestinal endoscopy. Material(s) and Method(s): The study was conducted at the Department of Pediatric Gastroenterology of the Karabuk University in Turkey from December 2020 to December of 2021. A total of 175 children were included in the study. The study was divided into three age groups as follows: 1-6 years old, 7-12 years old and 13-18 years old. All children were screened for acute respiratory syndrome coronavirus 2, hepatitis A, hepatitis B, hepatitis C virus and human immune deficiency virus infections. Result(s): The median age was 12.5 years (1-18). The seroprevalence of acute respiratory syndrome coronavirus 2, Anti-HAV IgM, Anti-HAV IgG, HBsAg, Anti-HBs, Anti-HCV, Anti-HIV and were detected 0.57%, 0.57%, 42.8%, 0%, 58.8%, 1.1% and 0 % respectively. The seroprevalence of Anti-HAV IgG was significantly higher in children aged 1-6 years than in the group aged 13-18 years (95.7 vs 25.2: chi2=48.1, p=0.001). Discussion(s): Although seroprevalence rates prior to endoscopy were low in this study, viral screening, except for hepatitis A infection, is essential for the safety of both patients and healthcare.Copyright © 2022, Derman Medical Publishing. All rights reserved.

Analysis of the spillover effects between green economy, clean and dirty cryptocurrencies

Cryptocurrencies have been widely used as financial instruments over the past decade. Given the development of the cryptocurrency market and the increasing awareness of greener and more energy-efficient tokens, their connection to the green economy has become a popular topic for understanding economic and policy issues. However, the literature still lacks clear evidence on how cryptocurrencies interact with green economy indicators. Therefore, this study examines the correlations and spillover relationships between green economy indices, five black cryptocurrencies, and five clean cryptocurrencies for the U.S., Euro, and Asian markets. To this end, it applies the novel quantile spillover index approach of Ando et al. (2018) to daily data from November 9, 2017, to April 4, 2022. The empirical results show that the overall linkage is stronger for green economy indices and clean cryptocurrencies than for dirty cryptocurrencies. Moreover, green economy indices show net receiving behavior, while cryptocurrencies' results differ across variables, quantiles, and time. In addition, a notable point for clean cryptocurrencies is 2020, which was the start of the COVID-19 pandemic. The overall spillover effect is very high for all quantiles for the three markets, especially for Asia. This outcome signifies the safe harbor property for diversification purposes of the green economy. The results presented in this study are important for investors, regulators and, policymakers, cryptocurrency founders as they seek to be financially integrated and develop a more sustainable business. © 2023

Association of Vitamin D and Secondary Infection in COVID-19

Introduction: Vitamin D plays a role in the modulation of cytokine release, inflammation, innate and adaptive immunity. It has been frequently discussed that the hyperinflammatory response that causes acute respiratory distress syndrome or other organ damage due to SARS-CoV-2 at the beginning of the pandemic can be modulated by the adequacy of vitamin D. The relationship of vitamin D with many conditions such as mortality, number of intensive care unit stays, disease severity, and organ damage has been investigated, but the information on its effect on secondary infections that occur during the course of the disease is limited. In this study, it was aimed to reveal the relationship of vitamin D with secondary infections that occur during the course of COVID-19 disease. Materials and Methods: Medical records of patients hospitalized in the COVID-19 pandemic service with the diagnosis of COVID-19 were evaluated retrospectively. Results: One hundred eighty-one patients were included in the study. The mean of 25(OH) vitamin D was found to be 18.76 ± 9.82 ng/mL. When 25-hydroxy vitamin D was compared with gender, disease severity, mortality, need for mechanical ventilation and presence of symptoms, no statistically significant difference was found (p> 0.05). The medical data of the patients during their hospitalization were analyzed and secondary infection was detected in 14.9% (n= 27). When 25-hydroxy vitamin D and the presence of secondary infection were compared, the 25(OH)D vitamin level of those with secondary infection was found to be low and this was found to be statistically significant (p= 0.016). As a result of the evaluation made by ROC analysis, 25-hydroxy vitamin D was found to have a diagnostic value in predicting positive culture results in COVID-19 patients (AUC= 0.771, 95% Confidence Interval= 0.612-0.810, p= 0.003, p< 0.05). Conclusion: While vitamin D continues to be an important topic of discussion in COVID-19 disease due to its effects on the immune system, it should not be forgotten that low vitamin D increases the risk of secondary infection developing in the course of COVID-19 and this may have an impact on prognosis.

Investigation of COVID-19 exposure, risk category and subsequent clinical picture and prognosis in healthcare professionals: early pandemic experience

Aim: Healthcare workers are the most risky group in terms of Coronavirus disease 2019 (COVID-19) transmission. The aim of this study was to reveal the relationships related to the departments in which contact healthcare workers work, personal protective equipment (PPE) use status, risk category, clinical picture and prognosis in follow-up. Materials and Methods: Healthcare workers who had contact with COVID-19 cases in our hospital between March 23, 2020 and June 1, 2020 were included in the study. The healthcare workers included in the study were divided into 3 groups according to their main departments and evaluated. In addition, healthcare workers included in the study were divided into groups and evaluated according to PPE use and risk categories, regardless of the departments they work in.

Pre-Endoscopic viral screening of children during the Covid-19 pandemic

Aim: Transmission of SARS-CoV-2 infection can easily occur through direct or close contact with infected people, just as with other infectious diseases. Therefore, it is important to detect it prior to the intervention for protecting the health of both the healthcare worker and the patient. In the study, it was aimed to determine the seroposidvity rates of acute respiratory syndrome coronavirus 2, hepatitis A, hepatitis 8, hepatitis C virus and human immune deficiency virus infections among children who underwent gastrointestinal endoscopy. Material and Methods: The study was conducted at the Department of Pediatric Gastroenterology of the Karabuk University in Turkey from December 2020 to December of 2021. A total of 175 children were included in the study. The study was divided into three age groups as follows: 1-6 years old, 7-12 years old and 13-18 years old. All children were screened for acute respiratory syndrome coronavirus 2. hepatitis A, hepatitis B, hepatitis C virus and human immune deficiency virus infections. Results: The median age was 12.5 years (1-18). The seroprevalence of acute respiratory syndrome coronavirus 2, Anti-HAV IgM, Anti-HAV IgG, HBsAg, AntiHBs, Anti-HCV, Anti-HIV and were detected 0.57%, 0.57%, 42.8%, 0%, 58.8%. 1.1% and 0 % respectively. The seroprevalence of Anti-HAV IgG was significantly higher in children aged 1-6 years than in the group aged 13-18 years (95.7 vs 25.2: x2=48.1, p=0.001). Discussion: Although seroprevalence rates prior to endoscopy were low in this study, viral screening, except for hepatitis A infection, is essential for the safety of both patients and healthcare.

Are we aware of COVID-19-related acute kidney injury in intensive care units?

OBJECTIVE: Coronavirus disease-19 (COVID-19) primarily affects the respiratory system. In some cases, the heart, kidney, liver, circulatory system, and nervous system are also affected. COVID-19-related acute kidney injury (AKI) occurs in more than 20% of hospitalized patients and more than 50% of patients in the intensive care unit (ICU). In this study, we aimed to review the prevalence of COVID-19-related acute kidney injury, risk factors, hospital and ICU length of stay, the need for renal replacement therapy. We also examined the effect of AKI on mortality in patients in the ICU that we treated during a 1-year period. PATIENTS AND METHODS: The files of patients with COVID-19 (n=220) who were treated in our ICU between March 21st, 2020, and June 1st, 2021, were analyzed retrospectively. Demographic data of the patients, laboratory data, and treatments were examined. Patients were divided into two groups, group I patients without AKI and, group II patients with AKI. The patients with AKI were evaluated according to the theKidney Disease Improving Global Outcomes (KDIGO) classification and were graded. RESULTS: Of the 220 patients included in the study, 89 were female and 131 were male. The mean age of patients with AKI (70.92±11.28 years) was statistically significantly higher than among those without AKI (58.87±13.63 years) (p<0.001). In patients with AKI, ICU length of stay, Acute Physiology and Chronic Health Evaluation (APACHE) II scores, initial lactate levels, need for mechanical ventilation, duration of mechanical ventilation, and secondary infection rates were found to be statistically significantly higher. Discharge rates from the ICU in patients without AKI were statistically higher (75.3% vs. 26.6%), and mortality rates were significantly higher in patients with AKI (67.8% vs. 14.3%). CONCLUSIONS: Various studies conducted have shown that patients with COVID-19 are at risk for AKI, and this is closely related to age, sex, and disease severity. The presence of AKI in patients with COVID-19 increases mortality, and this is more evident in patients hospitalized in the ICU. In our study, the prevalence of AKI was higher in older patients with high APACHE II scores and initial lactate levels. Comorbidities such as hypertension, chronic kidney disease, and coronary artery disease in patients with AKI were higher than in those without AKI.

Evaluation of Worry and Anxiety in the Postpandemic Normalization Process in Operating Room Staff

Objective: The COVID-19 pandemic, which is a rapidly spreading infection, has caused serious stress and anxiety in people, primarily healthcare workers. In our study, we aimed to determine the anxiety of loss of professional skills that may be caused by staying away from operations for a long time due to the pandemic in operating room workers and the reasons that may cause anxiety caused by working under the threat of coronavirus infection during the normalization process. Methods: The population of this cross-sectional study consists of doctors, nurses, technicians, and auxiliary personnel working in the operating room of our hospital. Sociodemographic form, health histories, Worry and Anxiety Questionaire (WAQ) and occupational skill loss anxiety questionnaire were applied to the researchers. Results: Worry and Anxiety (WA) scores and occupational anxiety scores of female healthcare workers were found to be statistically significantly higher than males. It was determined that the WA scores of the anesthesia assistants and operating room nurses were statistically significantly higher than the scores of the surgeons and assistants. It was determined that the WA scores of the participants with chronic disease were statistically significantly higher than those without chronic disease. Conclusion: Psychological support should be continued for health workers who work under intense working conditions and high risk, especially for health workers on the front line, and their family members when necessary. It has been determined that anesthetists and health workers who have previously had psychological disorders and chronic diseases carry a high risk of worry and anxiety, and psychological support should be prioritized. © 2022 Anestezi Dergisi. All rights reserved.

Local and Systemic Adverse Effects of CoronaVac Vaccine in Risk Groups: Prospective, Cross-Sectional Study

Objective: Coronavirus disease-2019 (COVID-19) infection progresses as an asymptomatic disease in some cases, whereas as a symptomatic disease and fatal in other cases. Due to its high spread, vaccines have been produced in many countries to control the infection. We aimed to evaluate local and allergic adverse effects of the CoronaVac vaccine in the risk group such as healthcare workers, individuals over 65 years of age, individuals who had COVID-19 infection. Material and Methods: A total of 189 healthcare workers and 122 individuals over the age of 65 who received the 2nd dose of CoronaVac vaccine 20 days ago were included in the study. Allergic, systemic and local symptoms were evaluted through a questionnaire which included 50 questions. Results: The most common local symptom was pain at the injection site (48.6%) and the most common systemic skin symptom after vaccination is pruritus outside the injection site (2.3%). There was a significant increase in symptoms of pruritus outside the injection site, rash outside the injection site, maculopapular rash, swelling around the eyelids, lips, or mouth, pale, sweaty, cold skin (vasovagal reflex) fever, chills, shortness of breath in participants who had COVID-19 infection (p<0.05). Symptoms of swelling around the eyelids, lips, and mouth, urticarial lesions outside the injection site were found to be significantly increase in indivuduals with a positive allergy history (p<0.05). Conclusion: Our study determined that the inactivated CoronaVac vaccine is safe in terms of serious adverse reactions in risk group. Therefore, CoronaVac vaccine has also adverse effect profile like other vaccines.

The Use of Health Institutions by Patients in the "Normalization" Process of the COVID-19 Pandemic and its Relationship with Health Literacy

Introduction: The aim of this study was to evaluate the behaviors of patients applying to the outpatient triage of a university hospital during the restriction period and normalization process and to use health institutions and to examine the relationship of these behaviors with health literacy. Materials and Methods: In this cross-sectional analytical study, 116 patients who applied to the outpatient triage of a university hospital between August and September 2020, who did not have communication problems at age 18 and over and who agreed to participate in the study, formed the research group. Participants were given the "Health Institution Usage Characteristics Survey" and the "Turkish Health Literacy Scale (TSOY-32)" for the evaluation of health literacy in order to determine the characteristics of the use of health institutions. Descriptive statistics included numbers, percentages, averages, standard deviations, lowest and highest values. In cases where the two groups were compared, T-test in independent groups in parametric conditions, Mann-Whitney U test in non-parametric conditions, Oneway ANOVA test in parametric conditions, Kruskal Wallis test in non-parametric conditions were applied. The McNemar Bowker test was used to evaluate dependent groups with multiple categorical variables. p< 0.05 was considered statistically significant. Results: The overall TSOY-32 index score average of the research group was 33.38 +/- 8.38 (lowest 14.58, highest 50.00). Of the participants, 20.7% were inadequate, 31.0% had limited-problem, 31.0% were adequate and 17.2% had excellent health literacy. The average TSOY-32 index score of the participants who stated that the current application complaint started during the epidemic restrictions and postponed their application was found to be significantly higher than those who stated that the application complaint was an emergency and those who indicated that it was a chronic condition (respectively p= 0.024, p= 0.043 and p= 0.024). Conclusion: In this study, it was concluded that people with high levels of health literacy were less likely to apply to health institutions. Low health literacy can lead to increased unnecessary hospital admissions, failure to observe preventive measures, lack of contact and further spread of the disease. The importance of health literacy should be taken into account in order to combat the pandemic and the aim should be to raise the level of health literacy.

Evaluation of iron status in COVID-19 pneumonia

Introduction: In late 2019, a new coronavirus disease was detected in Wuhan, China and called COVID-19. Iron metabolism is one of the topics have to be investigated for the development of therapeutic strategies for COVID-19. The aim of this study is to assess changes in traditional biochemical iron status indicators during COVID-19 pneumonia. Materials and methods: A case-control study. Case group was defined as COVID-19 pneumonia with polymerase chain reaction (PCR)-confirmed and the control group consisted of patients with non-COVID-19 pneumonia with culture confirmed. Biomarkers of anemia and iron metabolism, C-reactive protein (CRP), procalcitonin were analyzed. Demographic features, thorax tomography findings, oxygen saturation, development of acute respiratory distress syndrome (ARDS), intensive care unit admission, duration of hospitalization, discharge status (event free survival or death) were evaluated. Results: 205 hospitalized patients with pneumonia were analyzed retrospectively. COVID-19 group was significantly younger than control group. 23 of 106 patients had critical COVID-19 infection. Comorbidity frequency and mortality rate of patients with COVID-19 pneumonia were significantly higher. Hemoglobin (Hb), reticulocyte hemoglobin equivalent (RET-He), iron, transferin saturation (TSAT), CRP, procalcitonin (PCT) and oxygen saturation (SpO2) were significantly lower. Hb, RET-He, iron, TSAT levels significantly correlated to lung aeration loss, hospitalization day and inflamatory markers in COVID-19 pneumonia. Conclusions: The patients with COVID-19 pneumonia had lower iron parameters even they were young. Low RET-He, iron, TSAT may effect the lung aeration loss related to paranchimal infiltrations and mortality of the patients with COVID-19 pneumonia. Our data indicates that iron deficiency parameters associated with longer hospital stays, lower oxygenation, higher CRP and procalsitonin. © 2021 A. CARBONE Editore. All rights reserved.

Investigation of the frequency of adverse effects in patients treated with favipiravir as sars-cov-2 treatment

Objective: For 2019 and 2020, SARS-CoV-2 has been a sensational virus. Unfortunately, a treatment agent specific for SARS-CoV-2 has not been developed yet. Favipiravir is one of the antiviral agents used experimentally in the treatment of SARS-CoV-2. This study aimed to determine the frequency of side effects seen in patients hospitalized in our hospital and received favipiravir at any stage of their treatment. Methods: Our study is a retrospective observational study. Definite and probable COVID-19 cases hospitalized in our hospital between March 23, 2020, May 31, 2020 were determined, and those receiving favipiravir as initial or secondary therapy were included in the study. The demographic data, laboratory tests, observed side effects of the patients were recorded and analyzed statistically. Results: A total of 134 patients, 37.3% using favipiravir at the beginning and 62.7% as secondary, were included in the study. The mean age of the patients was 66.8±15.7 years. 38.1% (n=51) of the group were female. Side effects were detected in 17 (13%) patients in the whole group. Hepatotoxicity (4.5%), increased serum uric acid (4.5%), nephrotoxicity (1.5%), gastro-intestinal side effects (1.5%), cardiac side effects (0.7%) were detected. There was no statistically significant difference in terms of adverse events between the patients who received favipiravir initially or later on disease course. Conclusions: Although some results support the short-term safety of favipiravir, more studies are needed for its long-term effects. Studies on hyperuricemia, QTc prolongation, use in pregnancy, use during lactation and use in children are insuf-ficient. Therefore, although Favipiravir appears to be a good alternative in the treatment of COVID-19, it should be used carefully because the data on its safety is still insufficient.

New-onset or Exacerbated Occupational Hand Eczema among Healthcare Workers During the COVID-19 Pandemic: A Growing Health Problem

Hand hygiene is one of the cornerstones in ensuring effective infection control during the Coronavirus disease 2019 (COVID-19) outbreak. We aimed to investigate the prevalence of new-onset occupational HE during the COVID-19 outbreak in healthcare workers (HCWs) and the clinical course, clinical features, and risk factors of occupational hand eczema (HE). A total of 159 volunteer HCWs (female: n=112;male: n=47, mean age=35.55+/-7.03 years) working in a pandemic hospital were included. Participants were questioned in terms of daily hand hygiene, use of gloves, and signs and symptoms associated with HE before and during the COVID-19 pandemic. HCWs were divided into two groups classified as non-COVID and COVID, according to the unit they worked in. In our study, 55 participants reported new-onset signs and/or symptoms associated with HE during the COVID-19 pandemic. 59 participants described an increase in signs and/or symptoms associated with HE. The presence of newly-formed or increased signs and/or symptoms associated with HE was found to be 71.7%. A significant increase in dryness, itching, pain/burning, erythema, and scaling was observed (P<0.05). No difference was found between the COVID and non-COVID groups in terms of newly formed and/or increased signs and symptoms (P>0.05). The study included a limited number of participants, and the participants self-reported the signs and symptoms associated with HE. During the COVID-19 period, there has been a significant increase in the signs and symptoms of occupational HE as a result of increased hand hygiene practices in HCWs.

Early-Responding Civil Society and a Late Coming State: Findings from Turkey during the Pandemic

By building on available literature and interview notes with the NGOs working mainly on refugees and irregular migrants, this study examines the experiences of civil society in Turkey in the first 6 months of the COVID-19 pandemic. One of the main findings is that NGOs responded quite early and with agility to the sufferings of people before the state entered into the field and implemented its own rules and methods to deal with the crisis. The study also reveals that the pandemic affected the focus of the NGOs, their services, finances, and working methods in the field. The organizations we examined adapted to a new online working environment which increased demand for their services and aggravated difficulties in assuring clients access to needed healthcare services. The study finds that relations with the local and central governments remain difficult, and during the pandemic, the NGOs were compelled to act very cautiously. While suffering from their society's political polarization, they report that xenophobia continues to rise and has been worsened by the impact of the pandemic. © 2021 Erhan Doǧan and H Deniz Genç, published by De Gruyter, Berlin/Boston.