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Background and Aim: The new type of Severe Acute Respiratory Syndrome Coronavirus 2 (Coronavirus 2019-COVID-19) infection is the largest pandemic in the last decade. Acute respiratory distress syndrome is the complication with the highest mortality rate of this infection and there is no adequate treatment with proven efficacy to reduce mortality. This multi-center, retrospective study aimed to determine the effect of high-dose vitamin C on survival and other endpoints in invasively ventilated ARDS patients. Method(s): This multi-center, observational retrospective cohort study was performed at five ICU centers between March 2020 and July 2020. Patients with ARDS due to COVID-19 who required IMV were included. High-dose vitamin C group was defined as patients who were treated with vitamin C over 200 mg/kg for four days. Patients who were not given vitamin C treatment were defined as the control group by using propensity score match analysis, as well. The groups were compared about the effects of high-dose vitamin C treatment on ICU mortality. Result(s): A total of 86 patients with a mean age of 67.85 +/- 10.38 were included in the study. 72.1% of the patients were male. Forty-two (49%) patients were in the high dose vitamin C group, and 44 (51%) were in the control group. The mean PaO2/FiO2 at the time of admission to the ICU was 128.27+/-58.69 mmHg (133.63+/-56.51 mmHg in the control group, 122.36+/-61.18 mmHg in the study group, p=0.389). The mortality rate of high dose vitamin C group was lower than the control group (73.8% vs. 90.9%, p = 0.037,respectively). Conclusion(s): As an adjunctive therapy in invasively ventilated patients with COVID-19-associated ARDS, high doses of vitamin C may reduce mortality and development of organ damage. Prospective, randomized controlled studies with larger numbers of patients are needed to confirm these findings.Copyright © 2023, Society of Turkish Intensivists. All rights reserved.
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Introduction: Treatment adherence is crucial for the success of Growth Hormone (GH) therapy. Non-adherence rates have varied over a wide range from 5% to 80% in the literature. Several factors may have an impact on treatment adherence. Besides, with the COVID-19 pandemic that affected the whole world, there were problems with the hospital admission and routine controls of the patients who used GH treatment. Objective(s): The survey's primary objective is to investigate adherence to treatment in patients with GH. The survey will also investigate potential problems in GH treatment during the pandemic. Material(s) and Method(s): The survey was sent to pediatric endocrinologists. Patient data, diagnosis, history of pituitary surgery, current GH doses, duration of GH therapy, who administers the therapy (mother and father, patient), duration of missed doses, reasons for missed doses as well as problems associated with GH therapy, and missed dose data in the recent year (after the onset of the pandemic) and causes were asked. The treatment adherence category was determined based on missed dose rates over the past month (0 to 5%, full adherence;5.1 to 10% moderate adherence;>10% non-adherence). Result(s): 427 cases from thirteen centers were evaluated. The median age of diagnosis of the cases (56.2% male) was 8.5 (0.13-16) years. GH treatment indications were isolated GH deficiency (61.4%), multiple pituitary hormone deficiency (14%), Turner syndrome (7.5%), idiopathic GH deficiency (7.5%), and SGA (2.8%), and other (6.8%). GH therapy was administered by 70% parents and 30% patients. Mean daily dose was 32.3 mcg/kg, the annual growth rate was 7.52+/-2.7 cm. GH adherence rate was good (70.3%), moderate (14.7%), and poor (15%), respectively. The reasons for non-adherence were mainly due to forgetting, being tired, inability to access medication, and pen problems. It was noteworthy that the COVID-19 pandemic had a negative effect on adherence in 22%. The problem with an appointment, taking the medication, and anxiety about going to the hospital were the main reasons. There was no difference between genders in the adherence rate. Non-adherence to GH treatment decreased statistically when the patient administered the treatment, increased age, the duration of the treatment, and COVID-19 pandemia. A non-statistical decrease was found in the annual growth rate as the skip rate increased. Conclusion(s): During the COVID-19 pandemic, poor adherence was found to be 15%, and the duration of hormone use and advanced age are important factors. The pandemic period negatively affected compliance.
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In this study, it was aimed to evaluate the relationship between the clinical course of the disease and hematological data, serum 25-hydroxyvitamin D (25 (OH) D), iron (Fe), free iron-binding capacity (UIBC), and D-dimer levels in calves with diarrhea in the neonatal period. Within the scope of the study, 10 healthy calves (group-I) and 30 diarrheal calves in the neonatal period of different races, ages and genders were used. Calves with diarrhea were divided into mild (group-II, n=10), moderate (group-III, n=10) and severe (group-IV, n=10) groups. Blood samples were taken from calves in all groups at once. Hematological analyzes were performed using a veterinary-specific hematology analyzer device. In serum samples, 25 (OH) D3, Fe and UIBC levels were determined with an autoanalyzer, and D-dimer levels were determined with an automatic immunoassay analyzer. In the hematological analysis, an increase was observed in the number of LYMs (lymphocytes) in group-II (5.04±1.3) and III (5.2±3.3) compared to group-I (4.47±1.2), and a decrease was observed in group IV (2.76±0.9) (P<0.05). Fe levels in group-II (59±56), group III (56±52) and group IV (72±63) were found to be decreased compared to group-I (131±66) (P<0.05). It was determined that the 25 (OH) D3 level of group IV (13.4±8.5) was higher than that of group-I (6.12±2.73) (P<0.05). D-dimer levels of group-III (1.15±1.13) and group-IV (0.96±0.88) were found to be higher than group-I (0.10±1.46) (P<0.05).
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Introduction: The Coronavirus disease-2019 (COVID-19) pandemic that started over two years ago has led to high mortality and morbidity. Vaccine studies have been initiated worldwide to end the pandemic, and the CoronaVac (R) vaccine was first administered to healthcare workers at high risk of COVID-19 in Turkey. In our study, we aimed to investigate serum antibody levels after vaccination. Materials and Methods: Volunteer healthcare workers without COVID-19 disease who received two doses of CoronaVac (R) vaccine 28 days apart and were at least 14 days after the last dose of vaccine were included in this study. Assessment of antibodies against Severe acute respiratory syndrome-Coronavirus-2 (SARS-CoV-2) in blood samples from participants was performed using the Elecsys (R) anti-SARS-CoV-2 electrochemiluminescence immunoassay. Samples with a cut-off index (COI) (COI;signal sample/cut-off) <1.0 were considered negative;whereas samples with COI >= 1.0 were deemed positive. Results: A total of 269 healthcare workers, 168 women (62.5%), were included in our study. The mean age of the participants was 37.7 +/- 8.6 (minimum-maximum: 21-62). Antibody levels were positive in 188 (69.9%) of the participants. The median antibody level was 9.2 COI (interquartile ranges=3-34.7). In terms of mean age, the mean age of participants with negative antibodies was higher with a statistically significant difference (p=0.001). The antibody positivity rate of women was higher than that of men (p<0.001). No statistically significant association was found between the time elapsed after vaccination, presence of comorbidities, development of post-vaccine side effects, and antibody levels. It was found that one or more side effects developed in 45.7% of the participants after vaccination. Conclusion: Our study showed that seropositivity developed significantly in healthcare workers after the CoronaVac (R) vaccine. It emphasizes the importance of maintaining infection prevention and control measures and administering the SARS-CoV-2 vaccine for healthcare workers at high risk.
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BACKGROUND: Healthcare workers (HCWs) have an increased risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection due to occupational exposure. Strict measures generally focus on the patient-to-HCW contacts. However, interactions between the HCWs also pose a high risk for SARS-CoV-2 exposure. AIMS: This study was aimed to investigate the effect of social contacts on the level of SARS-CoV-2 exposure risk among workers by broadening the current risk assessment algorithm. METHODS: Contact tracing records of the workers in a large university hospital between 19th March and 31st December 2020 were analysed. Multivariate conditional logistic regression models were estimated to evaluate factors associated with high-risk exposure for contacts among workers. RESULTS: Of the 329 exposed clusters, 260 (79%) were HCW-to-HCW contacted clusters. High-risk exposure was higher in the HCW-to-HCW contacts (44%), when compared to the patient-to-HCW contacts (5%) (P < 0.001). A total of 1827 HCWs contacted a laboratory-confirmed COVID-19-positive co-worker. Among the HCW-to-HCW contacts, high-risk exposure was higher in the support staff (49%, P < 0.001), in non-patient care settings (47%, P < 0.001) and in the social contacts (57%, P < 0.001). Social contacts between workers increased the high-risk exposure (adjusted odds ratio: 3.50, 95% confidence interval 2.62-4.69) in multivariate analysis. CONCLUSIONS: A significant association between social contacts among workers and high-risk exposure of SARS-CoV-2 was observed. The results of the study emphasize the need for policies regarding the improved protection of HCWs in social settings in addition to patient care services.
Subject(s)
COVID-19 , Occupational Exposure , Health Personnel , Humans , Occupational Exposure/adverse effects , Risk Assessment , SARS-CoV-2ABSTRACT
Research on pharmacological therapies for the treatment and prevention of Coronavirus Disease 2019 (COVID-19) is limited in patients with Type 2 Diabetes Mellitus (T2DM). In this case, diabetes management of a 51-year-old male patient who was followed up and treated with COVID-19 diagnosis in the pandemic clinic is presented. While metformin (2000 mg/day) oral therapy was continued, insulin glargine U100 (IGlar100) was added to the treatment subcutaneously. In addition, enoxaparin, hydroxychloroquine, azithromycin were started to be administered to the patient. During follow-up, respiratory distress and tachypnea (26 breaths/min), high fever (38.3oC), increased CRP (42 mg/dL), and decreased oxygen saturation (91%) were detected. Favipiravir was added to the treatment, and metformin was stopped due to possible lactic acidosis risk. IGlar300 treatment with more potency effect and lower risk of hypoglycaemia was initiated while IGlar100 was discontinued. In the follow-ups, titration was provided with IGlar300 to keep fasting blood glucose between 100-140 mg/dL and postprandial one between 140-180 mg/dL. In the treatment for this purpose, a maximum of 34 units/day insulin was needed. Capillary blood sugar monitoring was revised every 12 hours and then once a day. As the infection was brought under control, the required dose of IGlar300 decreased to 14 units/day. After diabetes training with a video phonecall, he was discharged with metformin and IGlar300. IGlar300 may be effective against diabetes in the COVID-19 pandemic. In addition, a significant contribution can be made both to the treatment safety of the patient in a glycemic sense and to the safety of contamination by reduced contact of health care professionals.
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Recent data show that no age group is excluded from the possibility of SARS-CoV-2 infection. However, it is more likely to affect the elderly with comorbidities such as cardiovascular and pulmonary diseases, diabetes, and hypertension that can lead to the progression of COVID-19. Dyslipidemia is often found with these comorbid diseases. According to recent findings, lipoproteins, and particularly high- density lipoprotein cholesterol (HDL-C), may play a role in regulating the entry of the SARS-CoV-2 virus into the host cell. In fact, HDL-C has many beneficial properties, including anti-inflammatory, anti-oxidative, anti-thrombotic, anti-infectious, anti-apoptotic, intercellular communication, and pro-vasodilator capacities. HDL-C has an affinity for binding and neutralization of the pathogen. The link between COVID-19 and lipid-dependent pathologies has not yet been fully understood. We draw attention to the molecules and functions involved in HDL-C. Because many therapeutic compounds that regulate HDL-C functions and metabolism can be used in the treatment of COVID-19 recently.
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Viruses invade cells to reproduce, and they require an iron-filled cell for efficient reproduction. Together with other viruses, the coronavirus disease-2019 (COVID-19) virus can alter the expression of proteins involved in iron homeostasis. For example, in COVID-19 patients, an increase in pro-inflammatory cytokines such as interleukin-6 may stimulate the synthesis of hepcidin, the regulatory hormone of iron metabolism, thereby suppressing ferroportin-mediated cellular iron export. Increased serum levels of ferritin in COVID-19 virus infection is associated with a poor prognosis and may be partly due to the virus itself. Some viruses selectively infect iron acceptor cells (e.g. macrophages) by binding to transferrin receptor 1 during cell entry. Moreover, human airway secretions in the major route of entry of COVID-19 include transferrin and lactoferrin, and this glycoproteins can bind iron and maintain a chemically inert form. Understanding how iron metabolism and viral infection interact in the COVID-19 outbreak may suggest new ways to control the disease.
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COVID-19 is characterized by an abnormal inflammatory response associated with endothelial dysfunction and microvascular complications. Unfortunately, no specific treatment for the disease and its life-threatening complications is available as of now. Ozone (O3) gas is a molecule consisting of three oxygen atoms in a dynamically unstable structure due to the presence of mesomeric states. Although O3 can have dangerous effects, it can have many therapeutic effects due to hormesis. The direct effect of ozone may be the direct inactivation of COVID-19, stimulation of oxygen metabolism, and activation of the immune system. Fortunately, COVID-19 contains sulfur-bound proteins that can be easily damaged through ozone oxidation. This structural content can be crucial to the antiviral effect because ozone can easily break down the double bonds in sulfur protein structures through a reaction called ozonolysis. Therefore, medical ozone can help reduce pneumonia, slow viral replication, regulate lung circulation and oxygenation, and prevent microvascular thrombosis. Ozone therapy can be considered as a cost-effective and easy-to-administer adjunct therapy while awaiting the development of a specific drug or vaccine for COVID-19. Furthermore, a growing number of studies have shown that ozone can be used as an adjuvant therapy for COVID-19.