Telemedicine implementation for management of COVID19 patients at hospital admission: a single center experience

Introduction: Telemedicine has already been used for the patients with respiratory diseases especially at follow up of long term mechanically ventilated patients and tele-pulmonary rehabilitation. Aim(s): To assess the efficacy of telemedicine consultation system in the management of COVID-19 suspected patients at hospital admission. Method(s): To reduce the risk of SARS-CoV-2 contamination among health-care workers, the COVID-19 pandemic control committee of our centre established a tele-medicine consultation group including pulmonologists, radiologists, emergency medicine and infectious disease specialists. Suspected COVID-19 patients were examined in the pandemic outpatient clinic or emergency department at their first admission by a physician. The physician consulted to the tele-consultation group with a structured medical story and test results after the first examination. Result(s): 469 patients were evaluated through teleconsultation, of 58.2 % were pre-diagnosed with COVID-19. SARS-COV-2 PCR resulted positive in 76.3 % of 273 patients with COVID-19 pre-diagnosis. 288 patients were hospitalized, and 0.9 % of discharged patients were re-admitted to the hospital due to deterioration. Main diagnoses were as follows: COVID-19 (n:289, 62 %), Cardiogenic pulmonary edema (n:40, 8.6 %), non-COVID-19 pneumonia (n:44, 9.4 %), COPD exacerbation (n:8, 1.7 %). Consistency rates between pre- and main diagnosis were 87,2 % for COVID-19 and 63,5 % for non-COVID-19 diseases. Discussion(s): The teleconsultation could be considered an effective method for the management of COVID-19 during the admission to hospital with a reduced risk of transmission of SARS-CoV-2 among health-care workers.

Post-COVID-19 Interstitial Lung Disease: a new entity, what do we deal with?

Introduction: In the post-acute phase, COVID-19 survivors may have persistent symptoms, lung function abnormalities and sequela lesions on thorax CT. This new entity is defined as post-COVID Interstitial Lung Disease (ILD) or a residual disease. Aim(s): To investigate the characteristics and clinical significance of post-COVID-19 ILD. Method(s): Patients with persistent respiratory symptoms after recovery were evaluated by a team including two pulmonologists and a radiologist. Pulmonary function tests, 6-minute walking test, thorax HRCT were performed. Post-COVID ILD was defined as presence of all the followings: respiratory symptoms, hypoxemia, restrictive lung functions and interstitial changes on follow-up HRCT. Result(s): A total of 375 post-COVID-19 patients were evaluated on average 91 days after recovery and 262 of them were included. 17.9 % of the patients were non-hospitalized with mild COVID-19;10.8 % of the patients had received high flow nasal oxygen, of 17.5 % had required non-invasive mechanical ventilation, of 8.8 % had been intubated. The most prevalent symptoms were dyspnoea, exercise intolerance and fatigue. The mean mMRC score was 1.82, oxygen saturation was 94.1, 6-minute walking distance was 374 meters. Pulmonary functions (percentage of mean predicted value +/- SD) were as follows;FEV1:79+/-19, FVC: 73+/-19, FEV1/FVC: 87+/-9, DLCO: 64.5+/-21.8. On CT, GGOs, fibrotic bands, and a combination of them were detected. The mean CT score was 13.5. Discussion(s): The presence of symptoms and functional defects in addition to radiological parenchymal lesions requires the definition of this new entity is post-COVID-19 ILD which could be seen even in non-hospitalised patients with mild COVID-19.

Methylprednisolone in the treatment of post-COVID-19 Interstitial Lung Disease (STERCOV-ILD)

Introduction: Post-COVID-19 Interstitial Lung Disease (ILD) is controversial and need for treatment is unclear. Aim(s): To investigate the efficacy of methylprednisolone in the treatment of post-COVID-19 ILD. Method(s): This multicentre, prospective, randomized controlled clinical trial, included post-COVID ILD patients (ClinicalTrials.gov, NCT:04988282). Post-COVID ILD was defined as the presence of respiratory symptoms, hypoxemia, restrictive lung functions and parenchymal infiltrates on thorax HRCT. 262 post-COVID-19 patients were randomly assigned to one of two arms: the steroid group (n:135) or control group (n:127). For 4 weeks, the steroid group received oral methylprednisolone at a dose of 0.5 mg/kg/day (maximum dose: 48 mg/day). At the end of the study, thorax HRCT, 6-minute walking test and lung function tests were re-evaluated. A good response was defined as a mMRC score of 0, a FVC percentage greater than 80% and absence of hypoxemia at rest or during exercise, greater than 90% resolution of lesions on CT. Result(s): Good clinical and functional response rates were higher in steroid group compared to the control group (62.9% vs 33.3%;54.1% vs 33.7%, p<0.001, respectively). Patients with a radiological response in steroid group tend to be higher than control group, but not statistically significant (61.1 % vs 51.1 %, p=0.159). The increase in oxygen saturation, FVC, and 6-minute walking distance were significantly higher in the steroid group compared to the control. Discussion(s): Systemic corticosteroids improves clinical and functional characteristics and increases oxygen saturation, FVC, and exercise capacity in post-COVID ILD patients compared to the natural course of the disease.

Clinical course of Covid-19 cases vaccinated or unvaccinated

The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continues to spread rapidly all over the world and cause deaths. There are vaccines developed for the ongoing pandemic. In our study, we aimed to evaluate the effects of vaccines on the severity and course of the disease in patients diagnosed with Covid-19 and followed up in the hospital. Forty-nine patients with a diagnosis of Covid-19 pneumonia, who were hospitalized and followed up, were evaluated. Patients whose vaccine doses were incomplete were excluded from the study. The mean age of the patients included in the study was 67.85+/-13.14. 27 (55.1%) patients were male. 22 patients (55.1%) had received the Covid-19 vaccine. 15 (30.6%) people were vaccinated with Pfizer/BioNTech, 7 (14.2) people with Sinovac (CoronaVac). When the length of hospitalization, need for intensive care and mortality rates of the vaccinated and unvaccinated patients were compared, the number of days of hospitalization, the need for intensive care and death were significantly less in the vaccinated group. (respectively;p:0.048, p:0.042, p:0.034) Since the SARS-CoV-2 pandemic continues despite all the individual and national measures taken, the most important method of combating the disease is currently seen as vaccination. In our study, we showed that vaccination reduces the mortality of the disease, the need for intensive care, and the length of hospital stay. With these findings, we can predict that the pandemic will be brought under control with the increase in vaccination rates.

Mental health, quality of life, and COVID-19 fear in Turkish healthcare workers practicing in pandemic hospitals

Background: Healthcare workers (HCWs) face work-related psychosocial risks. The ongoing pandemic is causing widespread concern in a variety of ways, including COVID-19 fear and anxiety. Objective(s): We aimed to evaluate mental health, quality of life, COVID-19 fear and related factors in Turkish HCWs practicing in pandemic hospitals. Method(s): The data were collected in 13 provinces between 27 September and 11 November 2021 by researchers from the Early Career Task Force of the Turkish Thoracic Society. The study survey included sociodemographic, health- and work-related characteristics, the General Health Questionnaire-12 (GHQ-12) evaluating mental health, the World Health Organization Quality of Life-BREF (WHOQoL-BREF) questionnaire and the Fear of COVID-19 Scale (FCV-19S). Result(s): Of 1,556 participants, 522 (33.5%) reported a need for mental health support (MHS) in the previous year. The FCV-19S weakly correlated with the GHQ-12 (r=0.234, p<0.001) and WHOQoL-BREF domains (r=-0.245 for physical health, r=-0.182 for psychological health, r=-0.141 for social relationships and r=-0.183 for environmental health domains;p<0.001). The need for MHS was the common significant variable for all scale scores in univariate analyses and multiple linear regression. After multiple linear regression, the FCV-19S score was significantly related to the GHQ-12 and all WHOQoL-BREF domain scores. Conclusion(s): Our results indicate a remarkable level of need for MHS. The need for MHS and COVID-19 fear are related to mental health and quality of life in Turkish HCWs. The self-reported need for MHS may serve as an alarming characteristic for HCWs' psychosocial burden.