Association Between Presence of Bacillus Calmette-Guerin Vaccine Scar and Coronavirus Disease 2019 (preprint)

Objective: Bacillus Calmette-Guerin (BCG) vaccine is administered for protection against tuberculosis and may also have beneficial effects against some viral respiratory tract infections. The low incidence and mortality of coronavirus disease (COVID-19) in countries that have BCG vaccination program is impressive, and some studies have shared contradictory results. In this study, it was aimed to investigate the relationship between BCG vaccination which is confirmed by BCG scar, and the frequency and course of COVID-19. Methods: : Among 490 patients who applied to the outpatient clinic for Pulmonary and Enfectious Diseases between March 2021 and June 2021, 400 patients who accepted to participate in the study were included. After the consent of patients; age, gender, body mass index, comorbidities, smoking, history and the progress of COVID-19 of these patients were investigated; presence and number of BCG scar were recorded by physician. Data from groups with and without COVID-19 history were compared. Results: : Of the 400 patients 228 (57%) were female. Mean age was 39.65 ± 13.53. 188 (47%) patients had a history of COVID-19. There was no relation between presence and number of the BCG scar and COVID-19 related hospitalization and intensive care unit admission. When groups with and without COVID-19 history compared, no statistically significant difference was found with the presence and number of BCG scars (p>0,05). Conclusion: No association was found between the presence or number of BCG scars and the frequency and course of COVID-19 in individuals with BCG vaccination history confirmed by the presence of BCG vaccine scars.

EFFECT OF THE POVIDONE IODINE, HYPERTONIC ALKALINE SOLUTION AND SALINE NASAL LAVAGE ON NASOPHARYNGEAL VIRAL LOAD IN COVID-19 (preprint)

Objective: The causative virus of COVID-19 is SARS-CoV-2. The aim of the present study was to invastigate the in vivo virucidal activity of nasal irrigation with saline, nasal irrigation with Povidone-iodine (PVP-I) 1%, nasal irrigation with hypertonic alkaline and nasal irrigation with PVP-I 1% against SARS CoV- 2. Design: The present study was a prospective randomized clinical trial. Setting: A multicenter study involving tertiary care centers. Participants: The study included adult outpatients whose qualitative SARS-CoV-2 RT-PCR tests in nasopharyngeal swabs were positive. One hundred twenty patients divided into four equal groups. Standard COVID-19 treatment was given to group 1 (n=30), nasal irrigation containing isotonic solution was added to patients’ treatment in group 2 (n=30), nasal irrigation containing 1% PVP solution was added to patients’ treatment in group 3(n=30), and nasal irrigation containing 1% PVP solution and nasal irrigation containing hypertonic alkaline solution was added to patients’ treatment in group 4 (n=30). Main outcome measures: On the first day of diagnosis (day 0), nasopharyngeal swab samples were taken, on the 3rd and 5th days the nasopharyngeal viral load reduction in quantitative RT-PCR tests were calculated. Results: Between the 0-3rd Day and 0-5th days, the nasopharyngeal viral load reduction was significant in all groups (p< .05). In paired comparisons of groups, the nasopharyngeal viral load decrease in group 4 in first 3 days was significantly lower than all groups (p < .05). The nasopharyngeal viral load degrease in groups 3 and 4 in the first 5 days were significantly lower than group 1 (p < .05). Conclussion: This study was reveal that the use of hypertonic alkaline nasal irrigation together with 1% povidone-iodine was more effective in reducing viral load in the early period. The decreased nasopharyngeal viral load may reduce the carriage of infectious SARS-CoV-2 in patients. Our results suggest that 1% povidone-iodine and hypertonic alkaline nasal irrigation may be promising modality to prevent the COVID-19 epidemic.

Acute Kidney Injuries in different stages of COVID-19: An analysis on patients without prior kidney disease (preprint)

BackgroundKidney involvement in COVID-19 may manifest as acute kidney injury (AKI). This study aimed to analyze and compare AKIs in different stages of COVID-19.Methods1056 hospitalized COVID-19 patients were retrospectively evaluated and 383 of them met the inclusion criteria. Eighty-nine patients who developed AKI, but didn’t have prior kidney diseases were involved in the final analysis. Patients were classified into three groups, those who had AKI on admission, those who developed AKI in the first week and those who developed AKI starting from the 7th day. Electrolytes, acid-base status and changes in the inflammatory markers were compared. ResultsAKIs that were seen on hospital admission day were generally transient. Patients who developed AKI after the 7th day had higher peak CRP and D-dimer levels and lower nadir lymphocyte counts (p=0.000, 0.004 and 0.003 respectively). AKI that developed later was more related to immunologic response and had significantly higher mortality, reaching as high as 44% after 7th day. Hematuria and proteinuria (p=0.001; OR: 2.4; 95% CI: 1.4 – 3.8 and p=0.015; OR: 4.34; 95% CI: 1.3 – 14.3 respectively) were more common in patients who died. Hypernatremia (p=0.000, OR: 6.5; 95% CI:3.0 – 13.9) and hyperchloremia (p=0,002, OR:3,8; 95%CI: 1,7 – 8,4) were also observed more often in patients who died.ConclusionsAKI in COVID-19 is not of one kind. When developed, AKI should be evaluated in conjunction with the disease stage and possible etiologies. AKI that develops later has worse prognosis and is more related to electrolyte abnormalities even in patients with normal kidney functions.

Psychiatric morbidity and protracted symptoms in recovered COVID-19 patients (preprint)

We investigated the psychiatric symptomatology and the protracted symptoms in recently recovered COVID-19 patients. This cross-sectional study assessed 284 patients recruited from a tertiary hospital. Patients completed a web-based survey on socio-demographic data, past medical/psychiatric history, and additional information relevant to the outbreak conditions. The psychiatric status was assessed using the Impact of Events Scale-Revised (IES-R), Hospital Anxiety and Depression Scale (HADS), Pittsburgh Sleep Quality Index (PSQI), and MINI suicidality scale. Patients completed a checklist for the acute symptom burden and protracted symptoms that were experienced after the acute infection. After a mean of 50 days following the diagnosis of COVID-19, 98 patients (34.5%) reported clinically significant PTSD, anxiety, and/or depression, with PTSD being the most common condition reported (25.4%). One hundred and eighteen patients (44.3%) reported one or more protracted symptom(s), with fatigue, muscle aches, alteration of smell/taste, headache and difficulty in concentration, being the most common symptoms reported. Predictors of PTSD symptom severity were the female gender, past traumatic events, protracted symptoms, perceived stigmatization, and a negative view on the seriousness of the COVID-19 pandemic. Binary logistic regression analysis showed that PTSD symptom severity was the sole independent predictor of the presence of protracted symptoms. Our results suggest that COVID-19 patients may be prone to substantial psychological distress in the first months after the infection. The protracted symptoms were also frequent in this period, and these were related to the posttraumatic psychiatric morbidity. Both the psychiatric morbidity and the protracted symptoms were independent of the initial infection severity. Further research on the neurobiological commonalities between the protracted symptoms and PTSD in COVID-19 patients is warranted.

Efficacy of Serum Angiotensin II Levels in Prognosis of Patients with COVID-19 (preprint)

Introduction: The SARS-CoV-2 uses angiotensin converting enzyme 2 (ACE2) as a functional receptor to infect the host cell. It is suggested that serum Angiotensin II levels increase due to the weakening of ACE2 activity by the virus and this directly leads to lung damage. We aimed to determine serum Angiotensin II levels in patients with COVID-19 infection and to investigate the effect of these levels on the prognosis of the disease. Methods: Patients over 18 years of age with positive polymerase chain reaction (PCR) tests and lung involvement diagnosed with COVID-19 infection in the emergency department were included in the study. Blood samples were taken from patients three times for Angiotensin II levels. Angiotensin II levels were studied by ELISA method. Angiotensin II levels were compared in terms of ARDS, need for intensive care unit and mortality. Findings: The serum Angiotensin II levels were statistically significantly lower in the patients with COVID-19 compared with the healthy control group (p < 0.001). There was no statistical significance between the serum Angiotensin II levels measured at three different times (p>0.05). The serum Angiotensin II levels of the patients with acute respiratory distress syndrome (ARDS) were found to be statistically significantly lower than those without acute respiratory distress syndrome (ARDS) in three samples collected at different clinical periods (p < 0.05). The Angiotensin II levels of the patients who required admission to the intensive care unit (ICU) at all three times of blood sample collection were found to be statistically significantly lower than those who did not (p<0.05). Although the serum Angiotensin II levels of the patients who died were low, there was no statistically significant difference in mortality at all three times (p>0.05). Interpretation: The serum Angiotensin II levels decrease significantly in patients with COVID-19 and this decrease is correlated with lung damage. Funding: Financial support of the study was provided by the Istanbul University-Cerrahpaşa Rectorate Scientific Research Projects Coordination Unit (No: TSG-2020-34914, Date: Provided by 28.05.2020).Declaration of Interests: The authors declare that there are no conflicts of interest.Ethics Approval Statement: This study was conducted in accordance with the research rules following the principles of the “World Medical Association Declaration of Helsinki” after obtaining the approval of the Clinical Research Ethics Committee of Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine (Date: 13.05.2020).

Kidney function on admission predicts in-hospital mortality in COVID-19 (preprint)

Background Recent data have reinforced the concept of a reciprocal relationship between COVID-19 and kidney function. However, most studies have focused on the effect of COVID-19 on kidney function, whereas data regarding kidney function on the COVID-19 prognosis is scarce. Therefore, in this study, we aimed to investigate the association between eGFR on admission and the mortality rate of COVID-19. Methods We recruited 336 adult consecutive patients (male 57.1%, mean age 55.0 {+/-}15.9) that were hospitalized with the diagnosis of COVID-19 in the tertiary care university hospital. Data were collected from the electronic health records of the hospital. On admission, eGFR was calculated using the CKD-EPI formula. Acute kidney injury was defined according to the KDIGO criteria. Binary logistic regression and Cox regression analyses were used to assess the relationship between eGFR on admission and in-hospital mortality of COVID-19. Results Baseline eGFR was under 60 mL/min/1.73m2 in 61 patients (18.2%). Acute kidney injury occurred in 29.1% of the patients. In-hospital mortality was calculated as 12.8%. Age-adjusted and multivariate logistic regression analysis (p:0.005, odds ratio:0.974, CI:0.956-0.992) showed that baseline eGFR was independently associated with mortality. Additionally, age-adjusted Cox regression analysis revealed a higher mortality rate in patients with an eGFR under 60 mL/min/1.73m2. Conclusions On admission eGFR seems to be a prognostic marker for mortality in patients with COVID-19; We recommend to determine eGFR in all patients on admission and use it as an additional tool for risk stratification. Close follow-up should be warranted in patients with reduced eGFR.