Disease management in a patient diagnosed with COVID-19 disease during induction intravesical BCG therapy: A case report and review of the literature.

OBJECTIVE: To discuss the patient diagnosed with COVID-19 disease while receiving intravesical induction bacillus Calmette-Guérin (BCG) treatment for non-muscle-invasive bladder cancer, its management in the light of the literature. PATIENT AND METHODS: A 52-year-old male patient, who received intravesical BCG treatment for high-grade pT1 papillary urothelial carcinoma, presented 12 h after taking the fourth dose of induction therapy 38.2° fever and chills. The patient's reverse transcriptase-polymerase chain reaction test was positive, and Thorax CT imaging showed a few ground-glass pneumonic infiltrations in bilateral lung bases consistent with COVID-19 disease. RESULTS: Although international urology associations have current recommendations regarding the pandemic process, only one study has made specific recommendations regarding the patient group diagnosed with COVID-19 while receiving intravesical BCG treatment. According to this recommendation, we interrupted our patient's BCG treatment for 3 weeks and then completed the treatment for 6 weeks. A maintenance treatment not exceeding 1 year was planned. CONCLUSION: This group of patients' recommendation is to delay BCG therapy for at least 3 weeks after initial symptoms to allow for complete recovery. Although the administration schedule varies, maintenance therapy is recommended for no more than 1 year.

Is there an association between urine biochemical parameters on admission and the severity OF COVID-19?

AIM: To determine the importance of urinary biochemical parameters on the severity of coronavirus disease-2019 (COVID-19). METHODS: One hundred and thirty-three patients who were diagnosed with COVID-19 were retrospectively included. Groups were formed according to the severity of their disease (moderate [n = 85], severe [n = 29] and critical = [n = 19]), and an additional control group was created from healthy individuals (n = 50). We investigated the correlation between urine biochemical parameters and the severity of the disease. RESULTS: Erythrocyturia, proteinuria and glucosuria rates were significantly higher in patients than in the controls. In patients, the median urine specific gravity (SG) was lower (P < .001), and the median potential of hydrogen (pH) value was higher compared with the controls (P < .001). In correlation analyses, there were strong positive correlations between disease severity and age (r = 0.545, P < .001), RR (r = 0.838, P < .001) and proteinuria (r = 0.462, P < .001), while there was a strong negative correlation with SpO2 (r = -0.839, P = .001). On multivariate analysis, age (OR: 1.06, 95% CI 1.03-1.10, P = .035), respiratory rate ≥30 breaths/min (OR: 4.72, 95% CI 1.26-6.24, P < .0031), SpO2  ≤ 93% (OR: 3.82, 95% CI 1.18-5.82, P = .001) and proteinuria (OR: 1.13, 95%CI 1.02-2.1, P = .023) were independent predictive factors for disease severity. CONCLUSION: Proteinuria in routine urine analysis, which is one of the parameters that can be easily applied in the application, may be related to the severity of the COVID-19 disease.

Predictive values of blood urea nitrogen/creatinine ratio and other routine blood parameters on disease severity and survival of COVID-19 patients.

We aimed to examine independent predictive factors for the severity and survival of COVID-19 disease, from routine blood parameters, especially the blood urea nitrogen (BUN)/creatinine (Cr) ratio. A total of 139 patients with COVID-19 were investigated at Siirt State Hospital. According to the disease severity, the patients were categorized as three groups (moderate: 85, severe: 54, and critical: 20). Then, patients were divided into two groups: nonsevere (moderate) and severe (severe and critical). Demographic, clinical data, and routine blood parameters were analyzed. In multivariate model adjusted for potential confounders BUN/Cr ratio (odds ratio [OR] = 1.70; 95% confidence interval [CI]: 1.20-2.40; P = .002) and neutrophil to lymphocyte ratio (NLR) (OR = 2.21; 95% CI: 1.20-4.30; P < .001) were independent predictive factors for disease severity. In multivariate Cox proportional hazard model BUN/Cr ratio (hazard ratio [HR] = 1.02; 95% CI: 1.01-1.05; P = .030), and NLR (HR = 1.17; 95% CI: 1.06-1.30; P = .020) were independent predictors for survival of COVID-19 disease. The optimal thresholds of the BUN/Cr ratio at 33.5 and 51.7 had the superior possibility for severe disease and mortality, area under the curve (AUC) were 0.98 and 0.95, respectively. The optimal thresholds of NLR at 3.27 and 5.72 had a superior possibility for severe disease and mortality, AUC were 0.87 and 0.85, respectively. BUN/Cr and NLR are independent predictors for COVID-19 patient severity and survival. Routine evaluation of BUN/Cr and NLR can help identify high-risk cases with COVID-19.

Could flank pain be an indicator of COVID-19 infection?

Background: We describe the incidental detection of patients infiltrates due to COVID-19 in lung basal sections in patients undergoing abdominal computed tomography (CT) with flank pain attending the urology outpatient clinic during the current pandemic. Methods: We retrospectively analysed 276 patients admitted to the Siirt Training and Research Hospital Urology outpatients clinic between 15 March 2020 and 9 August 2020 with a complaint of flank pain and undergoing non-contrast abdominal CT. A total of 10 patients with COVID-19 compatible findings in CT were defined as the study group. A control group was formed from 10 patients with only urological pathologies (kidney stones, ureteral stones, and hydronephrosis) without a COVID-19 compatible appearance on CT. Results: Ten (3.6 %) patients were identified with COVID-19 and pneumonic infiltrations in the basal regions of the lungs; diagnosis was made by cross-sectional abdominal CT. The visual analog scale (VAS) score of flank pain was significantly higher in the control group (p<0.001); these subjects had urological pathology and no evidence of COVID-19 in the basal regions of the lungs on abdominal CT. There were no signs of COVID-19 disease detected during the admissions procedure in the urology outpatient clinic, including fever, cough, and shortness of breath. Conclusion: During the COVID-19 pandemic, it is important to consider a diagnosis of COVID_19 in patients reporting non-severe flank pain if no urological pathology is evident on abdominal CT scans.

Flank Pain as a Symptom of COVID-19.

The COVID-19 disease is spreading rapidly worldwide, and no vaccine or very effective drug has been found yet. However, the transmission rate of the disease can be reduced by taking precautions. Therefore, it is essential to detect the patients early to prevent the spread of the disease.1,2 We report a case of 26-year-old male patient who was admitted to our urology outpatient clinic with the complaint of flank pain and had incidental findings of COVID-19 in the lung bases on abdominal CT.