Real-life evaluation of incidence and clinical outcomes of COVID-19 among healthcare workers during pre-vaccination and post-vaccination periods: A cross-sectional impact study.

INTRODUCTION: We aimed to evaluate the prevalence and clinical outcomes of COVID-19 in healthcare workers (HCWs) in the pre-vaccination and post-vaccination periods. In addition, we determined factors associated with the development of COVID-19 after vaccination. METHODOLOGY: In this analytical cross-sectional epidemiological study, HCWs who were vaccinated between January 14, 2021, and March 21, 2021, were included. HCWs were followed up for 105 days after the 2 doses of CoronaVac. Pre-vaccination and post-vaccination periods were compared. RESULTS: A total of 1,000 HCWs were included, 576 patients (57.6%) were male, and the mean age was 33.2 ± 9.6 years. In the last 3 months during the pre-vaccination period, 187 patients had COVID-19, and the cumulative incidence of COVID-19 was 18.7%. Six of these patients were hospitalized. Severe disease was observed in three patients. In the first 3 months post-vaccination period, COVID-19 was detected in 50 patients, and the cumulative incidence of the disease was determined to be 6.1%. Hospitalization and severe disease were not detected. Age (p = 0.29), sex (OR = 1.5, p = 0.16), smoking (OR = 1.29, p = 0.43), and underlying diseases (OR = 1.6, p = 0.26) were not associated with post-vaccination COVID-19. A history of COVID-19 significantly reduced the likelihood of the development of post-vaccination COVID-19 in multivariate analysis (p = 0.002, OR = 0.16, 95% CI = 0.05-0.51). CONCLUSIONS: CoronaVac significantly reduces the risk of SARS-CoV-2 infection and alleviates the severity of COVID-19 in the early period. Additionally, HCWs who have been infected and vaccinated with CoronaVac are less likely to be reinfected with COVID-19.

Evaluation of clinical outcomes of vaccinated and unvaccinated patients with hospitalization for COVID-19.

We aimed to compare vaccinated and unvaccinated patients hospitalized with COVID-19 in terms of disease severity, need for intensive care unit (ICU) admission, and death. In addition, we determined the factors affecting the COVID-19 severity in vaccinated patients. Patients aged 18-65 years who were hospitalized for COVID-19 between September and December 2021 were retrospectively analyzed in three groups: unvaccinated, partially vaccinated, and fully vaccinated.A total of 854 patients were included. Mean age was 47.9 ± 10.6 years, 474 patients (55.5%) were male. Of these, 230 patients (26.9%) were fully vaccinated, 97 (11.3%) were partially vaccinated, and 527 (61.7%) were unvaccinated. Of the fully vaccinated patients, 67% (n = 153) were vaccinated with CoronaVac and 33% (n = 77) were vaccinated with Pfizer-BioNTech. All patients (n = 97) with a single dose were vaccinated with Pfizer-BioNTech. One hundred thirteen (13.2%) patients were transferred to ICU. A hundred (11.7%) patients were intubated and 77 (9.0%) patients died. Advanced age (P = 0.028, 95% CI = 1.00-1.07, OR = 1.038) and higher Charlson Comorbidity Index (CCI) (P < 0.001, 95% CI = 1.20-1.69, OR = 1.425) were associated with increased mortality, while being fully vaccinated (P = 0.008, 95% CI = 0.23-0.80, OR = 0.435) was associated with survival in multivariate analysis. Full dose vaccination reduced the need for ICU admission by 49.7% (95% CI = 17-70) and mortality by 56.5% (95% CI = 20-77). When the fully vaccinated group was evaluated, we found that death was observed more frequent in patients with CCI>3 (19.1 vs 5.8%, P < 0.01, OR = 3.7). Therefore, the booster vaccine especially in individuals with comorbidities should not be delayed, since the survival expectation is low in patients with a high comorbidity index.

The Effect of Host miRNAs on Prognosis in COVID-19: miRNA-155 May Promote Severity via Targeting Suppressor of Cytokine Signaling 1 (SOCS1) Gene.

The epigenetic features contribute to variations in host susceptibility to SARS-CoV-2 infection and severity of symptoms. This study aimed to evaluate the relationship between the relative expression of microRNAs (miRNAs) and the severity of the disease in COVID-19 patients. The miRNA profiles were monitored during the different stages of the disease course using reverse transcription-quantitative polymerase chain reaction (RT-qPCR). The expression levels of the selected 11 miRNAs were measured in the blood samples collected from 73 patients (moderate, n = 37; severe, n = 25; critically ill, n = 11, a total of 219 longitudinal samples) on hospitalization day and days 7 and 21. Expression changes were expressed as "fold change" compared to healthy controls (n = 10). Our study found that several miRNAs differed according to disease severity, with the miR-155-5p the most strongly upregulated (p = 0.0001). A statistically significant negative correlation was observed between the expression of miR-155-5p and its target gene, the suppressor of cytokine signaling 1 (SOCS1). The relative expression of miR-155-5p was significantly increased and SOCS1 was significantly decreased with the disease progression (r = -0.805 p = 0.0001, r = -0.940 p = 0.0001, r = -0.933 p = 0.0001 for admission, day 7, and day 21, respectively). The overexpression of miR-155-5p has significantly increased inflammatory cytokine production and promoted COVID-19 progression. We speculated that microRNA-155 facilitates immune inflammation via targeting SOCS1, thus establishing its association with disease prognosis.

Respiratory viral infections in otherwise healthy humans with inherited IRF7 deficiency.

Autosomal recessive IRF7 deficiency was previously reported in three patients with single critical influenza or COVID-19 pneumonia episodes. The patients' fibroblasts and plasmacytoid dendritic cells produced no detectable type I and III IFNs, except IFN-ß. Having discovered four new patients, we describe the genetic, immunological, and clinical features of seven IRF7-deficient patients from six families and five ancestries. Five were homozygous and two were compound heterozygous for IRF7 variants. Patients typically had one episode of pulmonary viral disease. Age at onset was surprisingly broad, from 6 mo to 50 yr (mean age 29 yr). The respiratory viruses implicated included SARS-CoV-2, influenza virus, respiratory syncytial virus, and adenovirus. Serological analyses indicated previous infections with many common viruses. Cellular analyses revealed strong antiviral immunity and expanded populations of influenza- and SARS-CoV-2-specific memory CD4+ and CD8+ T cells. IRF7-deficient individuals are prone to viral infections of the respiratory tract but are otherwise healthy, potentially due to residual IFN-ß and compensatory adaptive immunity.

Comparison of Pneumonia Severity Indices, qCSI, 4C-Mortality Score and qSOFA in Predicting Mortality in Hospitalized Patients with COVID-19 Pneumonia.

This is a retrospective and observational study on 1511 patients with SARS-CoV-2, who were diagnosed with COVID-19 by real-time PCR testing and hospitalized due to COVID-19 pneumonia. 1511 patients, 879 male (58.17%) and 632 female (41.83%) with a mean age of 60.1 ± 14.7 were included in the study. Survivors and non-survivors groups were statistically compared with respect to survival, discharge, ICU admission and in-hospital death. Although gender was not statistically significant different between two groups, 80 (60.15%) of the patients who died were male. Mean age was 72.8 ± 11.8 in non-survivors vs. 59.9 ± 14.7 in survivors (p < 0.001). Overall in-hospital mortality was found to be 8.8% (133/1511 cases), and overall ICU admission was 10.85% (164/1511 cases). The PSI/PORT score of the non-survivors group was higher than that of the survivors group (144.38 ± 28.64 versus 67.17 ± 25.63, p < 0.001). The PSI/PORT yielding the highest performance was the best predictor for in-hospital mortality, since it incorporates the factors as advanced age and comorbidity (AUROC 0.971; % 95 CI 0.961-0.981). The use of A-DROP may also be preferred as an easier alternative to PSI/PORT, which is a time-consuming evaluation although it is more comprehensive.

Risk factors and the impact of vaccination on mortality in COVID-19 patients.

INTRODUCTION: The novel coronavirus disease (COVID-19) pandemic has had a profound global impact economically, socially, and in many other areas. As vaccines are developed and introduced, their effect on the disease on both, the global and individual scale is a subject of intense curiosity. This study aimed to evaluate the relationship between risk factors for hospitalization, disease severity, and vaccination status in COVID-19 inpatients in a pandemic hospital. METHODOLOGY: Patients hospitalized for COVID-19 between June and September 2021 were retrospectively analyzed in three groups: unvaccinated, incompletely vaccinated, and fully vaccinated. Disease severity was classified as moderate, severe, or critical according to World Health Organization criteria, and mortality risk factors and the prognostic effect of vaccination were analyzed. RESULTS: The study included 486 patients, 228 women (46.9 %) and 258 men (53.1 %), with a mean age of 55.4 ± 16.5 years. Of these, 264 patients (54.3 %) were unvaccinated, 147 (30.2 %) were incompletely vaccinated, and 75 (15.4 %) were fully vaccinated. Older age, higher Charlson Comorbidity Index, greater disease severity, and being unvaccinated or incompletely vaccinated were associated with higher mortality. CONCLUSIONS: The results of our study indicate that age, disease severity, comorbidities, and vaccination status were factors affecting COVID-19 mortality. Our findings support that full vaccination reduces COVID-19 -related mortality rates, disease severity, and length of hospital stay. However, large-scale studies with larger patient populations are needed (Tab. 2, Ref. 22).

In-vitro cytokine production and nasopharyngeal microbiota composition in the early stage of COVID-19 infection.

BACKGROUND: To determine and compare nasopharyngeal microbiota (NM) composition, in vitro basal (Nil tube), provoked (Mitogen tube) production of cytokines at the early stage of COVID-19. METHODS: This cross-sectional study included 4 age and sex-matched study groups; group 1 (recovered COVID-19) (n = 26), group 2 (mild COVID-19) (n = 24), group 3 (severe COVID-19) (n = 25), and group 4 (healthy controls) (n = 25). The study parameters obtained from the COVID-19 (group 2, and 3) at the early phase of hospital admission. RESULTS: The results from the reaserch deoicted that the Mean ± SD age was 53.09 ± 14.51 years. Some of the in vitro cytokines production was significantly different between the study groups. Some of the findinggs on cytokines depicted a significant differences between study groups were interleukin (IL)-1ß Nil, IL-1ß Mitogen, and their subtraction (i.e Mitogen-Nil). Regarding IL-10, and IL-17a levels, Mitogen, and Mitogen-Nil tube production levels were significantly different between the groups. Surprisingly, most of these measures were lowest in the severe COVID-19 patients' group. Using discriminant analysis effect size (LEfSe), Taxa of NM with significant abundance was determined. About 20 taxa with an LDA score > 4 were identified as candidate biomarkers. Some of these taxa showed a significant correlation with IL-1ß and IL-10 Mitogen and Mitogen- Nil levels (R > 0.3 or < -0.3, p < 0.05). CONCLUSIONS: The findings of this perticular study regarting the early stage of COVID-19 showed that in vitro cytokines production, studies might be more useful than the ordinary cytokines' blood level measurement. Besides, the study identified some NM species that could be candidate biomarkers in managing this infection. However, further detailed studies are needed in these fields.

Comparison of systemic immune-inflammation index (SII), early warning score (ANDC) and prognostic nutritional index (PNI) in hospitalized patients with malignancy, and their influence on mortality from COVID-19.

INTRODUCTION: We evaluated several biological indicators based on inflammation and/or nutritional status, such as systemic immune-inflammation index (SII), early warning score (ANDC) and prognostic nutritional index (PNI) in hospitalized COVID-19 patients with and without malignancies for a prognostic significance. METHODOLOGY: This is a retrospective and observational study on 186 patients with SARS-CoV-2, who were diagnosed with COVID-19 by real-time PCR testing and hospitalized due to COVID-19 pneumonia. 75 patients had various malignancies, and the rest (111), having a similar age and comorbidity profile based on propensity score matching, had no malignancy. RESULTS: None of the measures as neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, monocyte to lymphocyte ratio, SII, PNI or ANDC was found to be significantly different between two groups. Odds ratio for the mortality, OR 2.39 (%95 CI 1.80-3.16) was found to be significantly higher for the malignancy group, even though the duration of hospitalization was statistically similar for both groups. PNI was found to be significantly lower for deceased patients compared with survivors in the malignancy group. Contrarily, ANDC was found to be significantly higher for deceased patients in the malignancy group. CONCLUSIONS: PNI and ANDC have independent predictive power on determining the in-hospital death in COVID-19 malignancy cases. It is suggested that ANDC seems to be a more sensitive score than SII in COVID-19 cases with malignancies.

Investigation of SARS-CoV-2 in tear and conjunctival secretions of hospitalized patients with clinically-confirmed COVID-19 pneumonia.

BACKGROUND: The aim of this study was to demonstrate the presence of the virus in tear and conjunctival secretions of clinically-confirmed COVID-19 pneumonia patients. METHODS: This prospective study was conducted at Bakirkoy Dr. Sadi Konuk Training and Research Hospital (2020/190). Nasopharyngeal and ocular samples were obtained by swab technique and investigated by RT-PCR. RESULTS: A total of 83 patients were included. The mean age was 61.88 ± 16.04 years. 28.92% of the patients had mild, 65.06% moderate and 6.02% severe pneumonia radiologically. RT-PCR was positive in 31 (37.35%) patients in the first nasopharyngeal swabs and in 19 (22.89%) in the second swabs. 17 of 19 patients had positive both first and second nasopharyngeal swabs; only the second swabs of two patients were positive. The first conjunctival swabs RT-PCR were positive in 5 out of 83 clinically-confirmed patients or 33 laboratory-confirmed patients (rates: 6.02% and 15.15%). There were no positives detected in the second conjunctival swabs. CONCLUSIONS: SARS-CoV-2 can be detected in the conjunctival swabs of patients with COVID-19 pneumonia.

The Importance of Healthcare Workers to Comply with Infection Prevention and Control Instructions During COVID-19 Outbreak-A Survey Study

Objective: Taking precations to prevent contamination and developing prevention programs play a key role in the outbreak. For this purpose, the use of personal protective equipment (PPE) of healthcare workers (HCWs) and their compliance with hand hygiene were investigated in the current Coronavirus disease-19 (COVID-19) outbreak. Methods: In study, 117 HCW, who were diagnosed with COVID-19 between 11 March and 18 May 2020, and 117 HCW, who did not meet the case definition, 234 HCW were included in the study, A survey consisting of 28 questions was applied to obtain the research data. The survey consisted of multiple choice questions and was prepared by the researchers using the knowledge of the literature. Results: It was determined that 65.8% of the participants were women, 41.9% were nurses, 82.1% did not have additional diseases and 62.8% did not smoke. Positivity was significantly higher in young patients aged 20-30 (p=0.05). In the use of PPE, the use of gloves as "always recommended" was found higher in infected HCW with 77.8% (p=0.012). The use of overalls/ gowns was found to be statistically significantly lower in infected healthcare workers (p=0.01). In terms of the hand hygiene application variable after touching the patient between the groups, compliance was found to be low in healthcare workers diagnosed with COVID-19 (p=0.005). Conclusion: It was observed that the risks of healthcare workers getting COVID-19 decreased significantly if the infection control measures were followed. It is thought that it would be beneficial to investigate new methods to ensure that protective measures are fully implemented by HCW. (English) [ABSTRACT FROM AUTHOR] Amaç: Salgın sürecinde sağlık çalışanlarında (SÇ) bulaşmayı önlemek açısından önlemlerin alınması ve önleme programlarının geliştirilmesi anahtar role sahiptir. Bu amaçla, halen yaşanmakta olan Koronavirüs hastalığı-19 (COVÍD-19) salgınında, SÇ'nin kişisel koruyucu ekipmanları (KKE) kullanımı ve el hijyenine uyumu araştırılmıştır. Yöntemler: Çalışmamızda 11 Mart-18 Mayıs 2020 tarihleri arasında laboratuvar tarafından doğrulanmış COVÍD-19 tanısı alan 117 sağlık çalışanı ile olası olgu tanımını karşılamayan 117 sağlık çalışanı olmak üzere 234 sağlık çalışanı çalışmaya dahil edildi. Araştırma verilerini elde etmek için 28 sorudan oluşan anket uygulanmıştır. Anket, çoktan seçmeli sorulardan oluşmuş ve araştırmacılar tarafından literatür bilgisinden yararlanılarak hazırlanmıştır. Bulgular: Katılımcıların %65,8'inin kadın, %41,9'unun hemşire olduğu, %82,1'inin ek hastalığının olmadığı, %62,8'inin sigara kullanmadığı saptanmıştır. Yirmi-30 yaş arası genç hastalarda pozitiflik anlamlı oranda yüksek saptanmıştır (p=0,05). KKE "her zaman önerildiği gibi" şeklinde eldiven kullanımı %77,8 ile enfekte SÇ'lerde daha yüksek bulunmuştur (p=0,012). Özellikle tulum/önlük kullanımı enfekte SÇ'lerinde istatistiksel açıdan anlamlı olarak düşük saptanmıştır (p=0,01). Gruplar arasında hastaya dokunduktan sonra el hijyeni uygulama değişkeni açısından COVÍD-19 tanılı SÇ'lerinde uyumun düşük olduğu saptanmıştır (p=0,005). Sonuç: Enfeksiyon kontrol önlemlerine uyulduğu takdirde SÇ'lerin COVÍD-19'a yakalanma risklerinin anlamlı olarak düştüğü gözlenmiştir. Buna rağmen, COVÍD-19 pandemisi sürecinde, SÇ'lerin KKE kullanımındaki eksikliklerini görmek, KKE protokollerini iyileştirmek ve eğitimlerini yenilikçi yöntemler kullanarak geliştirmek için detaylı araştırmalara ihtiyaç vardır. (Turkish) [ABSTRACT FROM AUTHOR] Copyright of Bezmialem Science is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Immune Thrombocytopenia in a Very Elderly Patient With Covid-19.

Immune thrombocytopenia (ITP) is an autoimmune disorder characterized by a decreased number of platelets and mucocutaneous bleeding. Many viruses have been identified as triggers of the autoimmune process, including human immunodeficiency virus (HIV), hepatitis C virus (HCV), Epstein-Barr virus (EBV), cytomegalovirus (CMV), parvovirus, rubella, and measles. Association with the new severe acute respiratory syndrome coronavirus, SARS-CoV-2 infection (Covid-19 infection) has been rarely reported. Here, we report the oldest case of ITP patient triggered by the novel coronavirus infection. He showed inadequate response to IVIG but responded to corticosteroids with no severe adverse events. Further studies are warranted to determine the optimal therapeutic strategies for ITP with the Covid-19 infection.