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OBJECTIVE: The present study aimed to evaluate and compare the use of 2 different high-dose methylprednisolone posology in treat-ing severe coronavirus disease 2019 pneumonia regarding mortality and recovery time between themselves and against steroidal/ non-steroidal treatment. MATERIAL AND METHODS: Severe coronavirus disease 2019 patients followed up between March 2020 and January 2021 were included. The steroid-free treatment protocol was applied before August 2020 (non-pulse group) and a treatment algorithm containing normal and high doses of methylprednisolone was applied after August 2020 (pulse group). Patients with clinical deterioration under the normal dose of methylprednisolone were administered 250 mg or 1000 mg of methylprednisolone for 3 days. We compared the pulse and non-pulse groups, in addition to pulse subgroups with each other, for clinical outcomes. RESULT(S): A total of 138 patients were included, including 36 patients in the non-pulse group and 102 in the pulse group. In the pulse group, 70 patients received 1000 mg/day and 32 received 250 mg/day of high-dose methylprednisolone therapy. In the comparison of pulse and non-pulse patient groups, mortality rate was lower in the pulse group (P <.001), and the time to discharge without oxygen support was shorter. Although the patients in the 250 mg subgroup were older, there was no difference between the 250 mg and 1000 mg subgroups in terms of end of oxygen requirement, discharge with oxygen support, and mortality. In addition, the required time to reach the oxygen-free period in patients discharged without oxygen support was similar in the 2 subgroups, and the majority of patients in both subgroups reached the oxygen-free period on the 20th day after initiating methylprednisolone. CONCLUSION(S): Since there was no difference in clinical improvement between the use of 250 mg or 1000 mg methylprednisolone in patients with severe coronavirus disease 2019 infection, 1000 mg methylprednisolone was not required.Copyright © 2023, AVES. All rights reserved.
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OBJECTIVE: As the pandemic continues, different vaccine protocols have been implemented to maintain the protection of vaccines and to provide protection against new variants. The aim of this study was to assess hospitalized patients' vaccination status and document the efficacy of boosters. PATIENTS AND METHODS: The patients that were hospitalized due to COVID-19 were enrolled from 28 hospitals in Turkey for five months from September 2021. 5,331 confirmed COVID-19 patients from collaborating centers were randomly enrolled to understand/estimate the distribution of vaccination status in hospitalized patients and to compare the efficacy of vaccination/booster protocols. RESULTS: 2,779 men and 2,552 women of which 2,408 (45.2%) were admitted to Intensive Care Units participated in this study. It was found that the highest risk reduction for all age groups was found in groups that received 4 doses. Four doses of vaccination for every 3.7 people under 50 years of age, for every 5.7 people in the 50-64 age group, and for every 4.3 people over 65 years of age will prevent 1 patient from being admitted to intensive care. Regardless of the type of vaccine, it was found that the risk of ICU hospitalization decreased in those who were vaccinated compared to those who were not vaccinated. Regardless of the type of vaccine, the ICU risk was found to decrease 1.25-fold in those who received 1 or 2 doses of vaccine, 1.18-fold in those who received 3 doses, and 3.26-fold in those who received 4 doses. CONCLUSIONS: The results suggested that the addition of a fourth dose is more effective in preventing intensive unit care even in disadvantaged groups.
Subject(s)
COVID-19 , Male , Humans , Female , Aged , COVID-19/epidemiology , COVID-19/prevention & control , Hospitalization , Intensive Care Units , Hospitals , Critical CareABSTRACT
Objectives: Clinical features and risk factors are highly variable for Coronavirus disease-2019 (COVID-19). Researchers investigate for the prediction of people who have high risk of developing severe illness and dying. The aim of this study is to examine the effect of obesity on the course of COVID-19. Materials and Methods: Patients with laboratory confirmed COVID-19 were retrospectively screened between March 11 and April 30. Anthropometric measures including standing height and body weight were measured at admission. Body mass index (BMI) was calculated and patients were classified into three groups as BMI< 25, BMI 25-29.99, and BMI30 according to the guidelines for the diagnosis and treatment of obesity in Turkey.
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Objective: Early diagnosis is important for severe diseases in COVID-19. Monocyte/high dansity lipoprotein ratio (MHR) is a new prognostic marker indicating inflammation. We aimed to investigate the relationship between MHR and diseases severity in COVID-19. Methods: Patients with laboratory confirmed COVID-19, were retrospectively analyzed. Clinical symptoms, signs and laboratory data on the first day of hospitalization were obtained from medical records of hospital. The clinical data of 301 patients were included in study. Cases were diagnosed on the basis of interim guidance of World Health Organization (WHO). Patients were classified into two groups as non-severe COVID-19 and severe COVID-19. MHR were calculated with laboratory data on the first day of hospitalization. The relationship between MHR level and COVID-19 severity was evaluated. Statistical analysis of the data was performed by using SPSS 25 (SPSS Inc., Chicago, IL, USA) package program. Statistical significance level was accepted as p<0.05. Results: One hundred ninety-six patients (65.1 %) had non-severe COVID-19,105 patients (34.9 %) had severe COVID-19. In our study, it was found that the mean age was higher in severe patients and comorbid diseases were more common. Although monocyte count values were not statistically significantly different, MHR was significantly higher in severe COVID-19 than non-severe COVID-19. Conclusions: Monocytes are very important to cytokine storm in COVID-19. Dyslipidemia can occur in viral infection because of inflammation. MHR can be used as an inflammatory marker in COVID-19.
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Objective: The coronavirus disease 2019 (COVID-19) has placed huge strains on medical systems. Therefore, it is essential to determine the predictors of the long hospital stay. We sought to investigate whether alterations in left ventricular (LV) geometry in COVID-19 patients are associated with the length of stay (LoS) and a long hospital stay. Materials and Methods: 108 consecutive hospitalized COVID-19 patients were incorporated in the study and 89 patients remained for statistical analysis. All participants underwent standard two-dimensional (2D) and Doppler echocardiographic examinations. Patients were classified according to LV geometry characteristics namely normal geometry (NG), concentric remodeling, concentric hypertrophy and eccentric hypertrophy. Results: Multiple binary logistic regression model adjusted for clinical and laboratory variables yielded significant and independent association of LV mass index (LVMI) (OR: 1.12, 95% CI: 1.06-1.19, p<0.001), 10 g/m(2) increase in LVMI (OR: 3.63, 95% CI: 2.00-6.59, p<0.001), LV geometry patterns (OR: 2.92, 95% CI: 1.46-5.34, p=0.002), and altered geometric patterns compared to NG (OR: 3.97, 95% CI: 1.08-14.5, p=0.037) with long hospital stay. Correlation analysis of LVMI and LoS demonstrated significant and moderate correlation (rho=0.58, p<0.001). Conclusion: LVMI and LV geometric patterns independently predict long hospital stays in COVID-19 patients. The significant correlation between LoS and LVMI underlies the significance of LV geometry in this infection.
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Objective: Multisystem inflammatory syndrome in children (MIS-C) is a recently described condition associated with COVID-19. Shock and systemic inflammation usually responds to supportive care and immunomodulatory treatments. Extracorporeal life support (ECLS) is rarely needed. Methods: MIS-C case requiring E-CPR Results: A 5 year old girl with MIS-C presented with fever, maculopapular rash, abdominal pain. Parental Covid- 19 infection was 6 weeks ago. She was in hypotensive shock with poor perfusion and acute kidney injury .Laboratory values given in table. Echocardiography was reported as normal. She was supported with mechanical ventilation, antibiotics, vasoactive/inotropic infusions. Clinical response to IVIG, pulse steroids and trial of coupled plasma filtration and adsorption (CPFA) and renal replacement therapy was not satisfactory. She developed cardiac arrest within 24 hours of admission due to pulseless ventricular tachycardia without major electrolyte abnormality. E-CPR was initiated via central cannulation with good flows (87ml/kg/minute). Anakinra was added. ECLS improved her hemodynamics but neurological examination remained poor. Brain death was declared on day 7. After decannulation, her organ functions were stable and imaging studies confirmed no flow. She was not eligible for organ donation due to COVID status. Conclusions: MIS-C may have a fulminant course despite extensive supportive therapy and immunomodulation. Our case may be the first reporting ventricular arrythmias in this disease entity.
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Background: Vitamin D is recognized to be an immune regulator. Also, it is known to have antiviral effects by several mechanisms, including reducing inflammatory cytokines. Objectives: To examine the 25-hydroxyvitamin D (25(OH) D) status for assessing the severity of COVID-19. Methods: This study consisted of 596 patients confirmed as SARS-CoV-2 infection and 59 healthy individuals. The cases separated into non-severe group, severe survival, and severe non-survival group. 25(OH)D and other laboratory parameters were evaluated retrospectively. Results: In all COVID-19 groups 25(OH)D levels were low compared to controls (p<0.05). 25(OH)D concentrations were lowest in patients in severe non-survival groups than those in other SARS-CoV-2 infection groups (p<0.05). Multivariate regression analysis exhibited that decreasing 25(OH)D was associated with an increased likelihood of non-severe, severe survival and severe non-survival disease. There were significant associations between 25(OH)D and certain inflammatory and hemostatic parameters (p<0.05, for all). Conclusions: 25(OH)D deficiency was observed among patients with COVID-19. Declined steadily 25(OH)D levels make a huge contribution to the scale of the progression of the disease. Correlations support that 25(OH)D may be a substantial tool for utilizing the severity of the disease and estimating the survival. Also, supplementation of 25(OH)D might slow down the course of the COVID-19.
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Background and Aim: The inflammatory response plays a critical role in coronavirus disease 2019 (COVID-19) and inflammatory cytokine storm increases the severity of COVID-19. Epicardial adipose tissue serves as a source of inflammatory cytokines and mediators. This study aimed to investigate the association between epicardial fat volume (EFV), inflammatory biomarkers and clinical severity of COVID-19. Methods: This retrospective study included 101 patients hospitalized with COVID-19 between March 11 and April 21, 2020. Laboratory findings, treatment and complications were recorded. The serum inflammatory biomarkers including C-reactive protein (CRP), interleukin-6 (IL-6), procalcitonin (PCT) and ferritin levels were measured. Computed tomographic images were analyzed and semi-automated measurements for EFV were obtained. The primary composite endpoint was admission to intensive care unit (ICU) or death. Results: The primary composite endpoint occurred in 25.1% (n=26) of patients (mean age 64.8±14.8 years, 14 male). A total of 10 patients died (mean age 71.9±14.3, 6 male). EFV (115.1±44.0 cm3 vs 94.3±45.5 cm3, respectively, p=0.037), CRP, PCT, ferritin and IL-6 levels were significantly higher in ICU patients. Moreover, a positive correlation between EFV and CRP (r=0.494, p<0.001), PCT (r=.287, p=0.005), ferritin (r=0.265, p=0.01) and IL-6 (r=0.311, p=0.005) was determined. At receiver operating characteristic analysis, patients with EFV >102 cm3 were more likely to have severe complications. Conclusions: Epicardial fat volume and the serum levels of CRP, IL-6, PCT and ferritin can effectively assess disease severity and predict outcome in patients with COVID-19.