Evaluation of the value of exhaled carbon monoxide in the differentiation of viral and bacterial pneumonia.

Aim: This study compared exhaled carbon monoxide (CO) levels in patients hospitalized for bacterial and COVID-19-related viral community-acquired pneumonia. Materials & methods: The study included a total of 150 patients: 50 patients hospitalized for COVID-19 between February 2021 and March 2022, 50 patients with bacterial community-acquired pneumonia and 50 healthy controls. Results: In comparisons of exhaled CO levels among the groups, there was no significant difference between patients with bacterial pneumonia and controls, whereas patients with COVID-19 pneumonia had significantly higher exhaled CO levels compared with both the bacterial pneumonia and control groups (p < 0.001). Conclusion: Viral agents can directly affect the heme oxygenase system of the lower respiratory tract, leading to greater increases in ferritin and exhaled CO levels compared with bacterial pneumonia.

Infections in the lung tissue cause stress in the body. Several mechanisms are activated in the body to balance this stress. The heme oxygenase system plays a role in suppressing inflammation, and its overactivation can cause an increase in the amount of carbon monoxide (CO) we exhale. This study examined exhaled CO levels in patients with bacterial lung infection and COVID-19 viral lung infection in comparison with the healthy population. We found that patients with COVID-19 lung infection had higher levels of CO in their breath than patients with bacterial lung infection and healthy control subjects. These findings suggest that measurements of exhaled CO levels in people with signs and symptoms of lung infection might be used to differentiate patients with viral and bacterial lung infections.

Comparison of two antifibrotic treatments for lung fibrosis in post-COVID-19 syndrome: A randomized, prospective study.

BACKGROUND: Although pulmonary fibrosis secondary to COVID-19 infection is uncommon, it can lead to problems if not treated effectively in the early period. This study aimed to compare the effects of treatment with nintedanib and pirfenidone in patients with COVID-19-related fibrosis. METHODS: Thirty patients who presented to the post-COVID outpatient clinic between May 2021 and April 2022 with a history of COVID-19 pneumonia and exhibited persistent cough, dyspnea, exertional dyspnea, and low oxygen saturation at least 12 weeks after diagnosis were included. The patients were randomized to receive off-label treatment with nintedanib or pirfenidone and were followed up for 12 weeks. RESULTS: After 12 weeks of treatment, all pulmonary function test (PFT) parameters, 6MWT distance, and oxygen saturation were increased compared to baseline in both the pirfenidone group and nintedanib groups, while heart rate and radiological score levels were decreased (p<0.05 for all). The changes in 6MWT distance and oxygen saturation were significantly greater in the nintedanib group than in the pirfenidone group (p=0.02 and 0.005, respectively). Adverse drug effects were more frequent with nintedanib than pirfenidone, with the most common being diarrhea, nausea, and vomiting. CONCLUSION: In patients with interstitial fibrosis after COVID-19 pneumonia, both nintedanib and pirfenidone were observed to be effective in improving radiological score and PFT parameters. Nintedanib was more effective than pirfenidone in increasing exercise capacity and saturation values but caused more adverse drug effects.

Comparación de dos tratamientos antifibróticos para la fibrosis pulmonar en el síndrome post-COVID-19: un estudio prospectivo aleatorizado Comparison of two antifibrotic treatments for lung fibrosis in post-COVID-19 syndrome: A randomized, prospective study

Introducción: Aunque la fibrosis pulmonar secundaria a la infección por COVID-19 es poco común, puede generar problemas si no se trata de manera efectiva en el período inicial. Este estudio tuvo como objetivo comparar los efectos del tratamiento con nintedanib y pirfenidona en pacientes con fibrosis relacionada con COVID-19. Métodos: Se incluyeron 30 pacientes que acudieron a la consulta externa post-COVID entre mayo de 2021 y abril de 2022 con antecedentes de neumonía por COVID-19 y presentaron tos persistente, disnea, disnea de esfuerzo y baja saturación de oxígeno al menos 12 semanas después del diagnóstico. Los pacientes fueron aleatorizados para recibir un tratamiento no aprobado con nintedanib o pirfenidona y fueron seguidos durante 12 semanas. Resultados: Después de 12 semanas de tratamiento, todos los parámetros de la prueba de función pulmonar (PFT), la distancia de la PM6M y la saturación de oxígeno aumentaron en comparación con los valores basales tanto en el grupo de pirfenidona como en el de nintedanib, mientras que la frecuencia cardíaca y los niveles de puntuación radiológica disminuyeron (p<0,05). para todos). Los cambios en la distancia de la PM6M y la saturación de oxígeno fueron significativamente mayores en el grupo de nintedanib que en el grupo de pirfenidona (p=0,02 y 0,005, respectivamente). Los efectos adversos del fármaco fueron más frecuentes con nintedanib que con pirfenidona, siendo los más frecuentes diarrea, náuseas y vómitos. Conclusión: En pacientes con fibrosis intersticial después de neumonía por COVID-19, se observó que tanto nintedanib como pirfenidona son efectivos para mejorar la puntuación radiológica y los parámetros de PFT. Nintedanib fue más eficaz que la pirfenidona para aumentar la capacidad de ejercicio y los valores de saturación, pero provocó más efectos adversos del fármaco.

Review of Medical Studies on COVID-19 During the Pandemic Period.

Due to the COVID-19 pandemic, both the university hospital and the city hospital have faced a significant patient load in our city. During this period, academic articles were written that contributed significantly to the literature on both hospitals struggling with patient density. In our study, we aimed to compile medical articles about COVID-19 in our city using the Web of Science and PubMed database.

The association of antiviral drugs with COVID-19 morbidity: The retrospective analysis of a nationwide COVID-19 cohort.

Background and objectives: Although several repurposed antiviral drugs have been used for the treatment of COVID-19, only a few such as remdesivir and molnupiravir have shown promising effects. The objectives of our study were to investigate the association of repurposed antiviral drugs with COVID-19 morbidity. Methods: Patients admitted to 26 different hospitals located in 16 different provinces between March 11-July 18, 2020, were enrolled. Case definition was based on WHO criteria. Patients were managed according to the guidelines by Scientific Board of Ministry of Health of Turkey. Primary outcomes were length of hospitalization, intensive care unit (ICU) requirement, and intubation. Results: We retrospectively evaluated 1,472 COVID-19 adult patients; 57.1% were men (mean age = 51.9 ± 17.7years). A total of 210 (14.3%) had severe pneumonia, 115 (7.8%) were admitted to ICUs, and 69 (4.7%) were intubated during hospitalization. The median (interquartile range) of duration of hospitalization, including ICU admission, was 7 (5-12) days. Favipiravir (n = 328), lopinavir/ritonavir (n = 55), and oseltamivir (n = 761) were administered as antiviral agents, and hydroxychloroquine (HCQ, n = 1,382) and azithromycin (n = 738) were used for their immunomodulatory activity. Lopinavir/ritonavir (ß [95% CI]: 4.71 [2.31-7.11]; p = 0.001), favipiravir (ß [95% CI]: 3.55 [2.56-4.55]; p = 0.001) and HCQ (ß [95% CI]: 0.84 [0.02-1.67]; p = 0.046) were associated with increased risk of lengthy hospital stays. Furthermore, favipiravir was associated with increased risks of ICU admission (OR [95% CI]: 3.02 [1.70-5.35]; p = 0.001) and invasive mechanical ventilation requirement (OR [95% CI]: 2.94 [1.28-6.75]; p = 0.011). Conclusion: Our findings demonstrated that antiviral drugs including lopinavir, ritonavir, and favipiravir were associated with negative clinical outcomes such as increased risks for lengthy hospital stay, ICU admission, and invasive mechanical ventilation requirement. Therefore, repurposing such agents without proven clinical evidence might not be the best approach for COVID-19 treatment.

Evaluation of the Relationship between Exhaled CO Levels with Clinical Course and Parenchymal Involvement in COVID-19.

BACKGROUND: COVID-19, caused by the SARS-CoV-2 virus, has infected nearly 270 million people over the past two years. We aimed to determine the exhaled CO levels of patients hospitalized with COVID-19 pneumonia and its correlation with parenchymal involvement. METHODS: Between September 2021 and December 2021, 74 patients who were hospitalized in the infectious diseases service of our hospital and whose delta variant COVID-19 infection was confirmed with real-time PCR method were included in the study. The patients were analyzed in 3 groups: moderate COVID-19 (group 1), severe COVID-19 without macrophage activation syndrome (MAS) (group 2), and severe COVID-19 with MAS (group 3). RESULTS: While it was observed that the exhaled CO levels were higher in patients in Group 3 at the time of hospitalization than in patients in Group 1 and 2, it was determined that no significant difference was observed between the groups at the time of discharge (p < 0.001, 0.213). CT scores obtained at the time of hospitalization were also observed to be statistically significantly higher in patients in Group 3 when compared to patients in Group 1 and 2 (p = 0.002). In the correlation analysis of the exhaled CO levels and the CT scores at the time of hospitalization, a statistically significant positive correlation was observed (r = 0.628, p < 0.001). CONCLUSIONS: In COVID-19, which has a high affinity for lung tissue compared to other known viral lower respiratory tract infections, the exhaled CO level may be a non-invasive parameter that can be used in the evaluation of parenchymal involvement and clinical course.

The association of antiviral drugs with COVID-19 morbidity: The retrospective analysis of a nationwide COVID-19 cohort

Background and objectives Although several repurposed antiviral drugs have been used for the treatment of COVID-19, only a few such as remdesivir and molnupiravir have shown promising effects. The objectives of our study were to investigate the association of repurposed antiviral drugs with COVID-19 morbidity. Methods Patients admitted to 26 different hospitals located in 16 different provinces between March 11–July 18, 2020, were enrolled. Case definition was based on WHO criteria. Patients were managed according to the guidelines by Scientific Board of Ministry of Health of Turkey. Primary outcomes were length of hospitalization, intensive care unit (ICU) requirement, and intubation. Results We retrospectively evaluated 1,472 COVID-19 adult patients;57.1% were men (mean age = 51.9 ± 17.7years). A total of 210 (14.3%) had severe pneumonia, 115 (7.8%) were admitted to ICUs, and 69 (4.7%) were intubated during hospitalization. The median (interquartile range) of duration of hospitalization, including ICU admission, was 7 (5–12) days. Favipiravir (n = 328), lopinavir/ritonavir (n = 55), and oseltamivir (n = 761) were administered as antiviral agents, and hydroxychloroquine (HCQ, n = 1,382) and azithromycin (n = 738) were used for their immunomodulatory activity. Lopinavir/ritonavir (β [95% CI]: 4.71 [2.31–7.11];p = 0.001), favipiravir (β [95% CI]: 3.55 [2.56–4.55];p = 0.001) and HCQ (β [95% CI]: 0.84 [0.02–1.67];p = 0.046) were associated with increased risk of lengthy hospital stays. Furthermore, favipiravir was associated with increased risks of ICU admission (OR [95% CI]: 3.02 [1.70–5.35];p = 0.001) and invasive mechanical ventilation requirement (OR [95% CI]: 2.94 [1.28–6.75];p = 0.011). Conclusion Our findings demonstrated that antiviral drugs including lopinavir, ritonavir, and favipiravir were associated with negative clinical outcomes such as increased risks for lengthy hospital stay, ICU admission, and invasive mechanical ventilation requirement. Therefore, repurposing such agents without proven clinical evidence might not be the best approach for COVID-19 treatment.

When and how important is anti-fibrotic therapy in the post-COVID-19 period?

PURPOSE: In addition to the highly variable clinical presentation of acute COVID-19 infection, it can also cause various post-acute signs and symptoms. In our study, we aimed to examine the efficacy of anti-fibrotic therapy in patients who developed pulmonary fibrosis after COVID-19. METHODS: In total, 15 patients who applied to the Post-Covid Outpatient Clinic between May 2021 and August 2021 and were diagnosed with COVID-19 pneumonia, and whose cough, dyspnea, exertional dyspnea and low saturation continued to be present at least 12 weeks after the diagnosis, were included in the study. Off-label pirfenidone treatment was started according to the radiological findings, pulmonary function test parameters (PFT) and 6-minute walking test (6MWT) results. The patients were followed up for 12 weeks. RESULTS: While all of the FVC, FVC%, FEV1, FEV1%, DLCO%, DLCO/VA%, 6MWT, and room air saturation levels were observed to increase statistically significantly in the patients at the 12th week, it was determined that there was a statistically significant decrease in the pulse level in room air (p = 0.01, 0.01, 0.01, 0.01, 0.004, 0.001, 0.002, 0.001, and 0.002, respectively). In regression analysis based on radiological scoring, it was observed that the DLCO and room air saturation levels at the 12th week of the treatment were statistically significantly higher in patients with lower scores at the beginning (p = 0.04, 0.03). In addition, it was observed that anti-fibrotic treatment, which was started in the earliest period, i.e., 12 weeks after the diagnosis, resulted in an improvement in radiological, PFT and 6MWT parameters. CONCLUSION: Patients who still had dyspnea and low saturation 12 weeks after the diagnosis, defined as chronic COVID-19, should be evaluated for anti-fibrotic therapy after the necessary radiological and PFT evaluation. Early treatment commencement brings about, besides radiological improvement, a better response obtained in PFT and 6MWT (Tab. 2, Fig. 2, Ref. 21).

Evaluation of the Relationship between CRP/Albumin Ratio and Pulmonary Function Parameters in Patients with Post-Acute COVID-19.

BACKGROUND: Novel coronavirus disease 2019 (COVID-19), which has been a global pandemic for nearly 2 years, presents with highly variable clinical manifestations in both the acute and post-acute periods. This study evaluated the relationship between CRP/albumin ratio and pulmonary function at 12 weeks in patients with post-acute COVID-19. METHODS: The study included 157 patients with a previous diagnosis of COVID-19 pneumonia who presented to our outpatient clinic with symptoms of post-acute COVID-19 (12 weeks after first testing positive) between July 2021 and October 2021. Patients who had non-severe pneumonia were included in group 1, severe pneumonia that did not require intensive care in group 2, and severe pneumonia that required intensive care in group 3. RESULTS: At 12 weeks, group 3 had significantly lower percent predicted forced expiratory volume in 1 second (FEV1%), percent predicted forced vital capacity (FVC%), percent predicted diffusing capacity of the lungs for carbon monoxide (DLCO%), and oxygen saturation (SO2) compared to patients in groups 1 and 2 (p = 0.001, 0.04, 0.001, and 0.001, respectively). CRP/albumin ratio was significantly lower in group 2 compared to groups 1 and 3 (p = 0.001). Correlation analysis independent of age and comorbidity showed that CRP/albumin ratio was negatively correlated with SO2, FEV1%, FVC%, and DLCO%. CONCLUSIONS: CRP and albumin levels have prognostic significance during acute COVID-19 infection. The negative correlation between CRP/albumin ratio and respiratory function observed in our study suggest this parameter may be used in the follow-up of patients presenting at 12 weeks with post-acute COVID-19 symptoms.

The role of exhaled nitric oxide (FeNO) in the evaluation of lung parenchymal involvement in COVID-19 patients.

The inflammatory balance is an important factor in the clinical course of COVID-19 (SARS-CoV-2) infection, which has affected over 300 million people globally since its appearance in December 2019. This study aimed to evaluate the correlation between exhaled nitric oxide (FeNO) level and parenchymal involvement in COVID-19. The study included 106 patients with the delta variant of COVID-19 identified by real-time PCR as well as 40 healthy control groups between October 2021 and March 2022. The patients were analyzed in three groups: moderate COVID-19 (group 1), severe COVID-19 without macrophage activation syndrome (MAS) (group 2), and severe COVID-19 with MAS (group 3). FeNO and CT scores were significantly higher in groups 2 and 3 at admission and discharge compared to group 1 (p = 0.001 for all). In addition, CT score at admission and CT score and FeNO level at discharge were higher in group 3 than in group 2 (p = 0.001 for all). It was found that the FeNO levels were higher in Groups 2 and 3 than in the control group (p = 0.001) during the admission. FeNO and CT scores showed strong positive correlation at admission and discharge (r = 0.917, p = 0.001; r = 0.790, p = 0.001). In receiver operating characteristic curve analysis for prediction of MAS, FeNO at a cut-off of 10.5 ppb had 66% sensitivity and 71% specificity. COVID-19 causes more severe lung involvement than other viral lower respiratory tract infections, leading to the frequent use of chest CT in these patients. FeNO assessment is a practical and noninvasive method that may be useful in evaluating for parenchymal infiltration in the diagnosis and follow-up of COVID-19 patients.

High-Frequency Chest Wall Oscillation in Patients with COVID-19: A Pilot Feasibility Study.

OBJECTIVE: Coronavirus 2019 disease presents in a spectrum that can range from mild viral infection to pneu- monia. Common symptoms of coronavirus disease 2019 pneumonia include cough, sputum, and shortness of breath. High-frequency chest wall oscillation is a pulmonary rehabilitation method used for the recovery of pulmonary functions and removal of secretions in the lungs. The aim of the study was to evaluate the efficacy of high-frequency chest wall oscillation on patients with coronavirus disease 2019 pneumonia. MATERIALS AND METHODS: In this study, 100 patients, between 18 and 70 years old, with a positive polymerase chain reaction result for coronavirus disease 2019, were included. Standard medical treatment was applied to all patients. In group rehabilitation, high-frequency chest wall oscillation treatment was applied twice a day for 20 minutes for 5 days. No additional intervention was made to the control group. Pulmonary function tests and oxygenation were evaluated on the first and fifth days. Patients' high-flow oxygen, non-invasive mechani- cal ventilation, and invasive mechanical ventilation needs were evaluated and recorded. RESULTS: Compared with the control group, the forced expiratory volume in 1 second, forced vital capacity, and peak expiratory flow rates were statistically higher in the rehabilitation group on the fifth day (P < .05). On evaluating the oxygenation of patients, the fifth day to first-day oxygen saturation difference was signifi- cantly higher in rehabilitation group than in control group (P < .05). Furthermore, the number of patients who needed non-invasive mechanical ventilation was lower in the rehabilitation group (P < .05). CONCLUSION: This study demonstrated that pulmonary rehabilitation applied with the high-frequency chest wall oscillation device in patients with coronavirus disease 2019 in the early period contributed to the improvement of oxygenation by providing significant improvement as observed in the pulmonary function tests of the patients.

Clinical Predictors of Response to Tocilizumab: A Retrospective Multicenter Study.

OBJECTIVE: A substantial number of patients with coronavirus disease-2019 (COVID-19) demonstrate severe infection. Cytokine storm is an underlying condition that worsens clinical outcomes. As an interleukin-6 receptor antagonist, tocilizumab is a promising treatment option for COVID-19. This study aimed to evaluate the clinical predictors of mortality for critically ill COVID-19 patients receiving tocilizumab therapy. MATERIAL AND METHODS: The retrospective cohort study was conducted in 4 centers' both wards and intensive care units between March 20 and May 20, 2020. Demographic, clinical, and laboratory data were consecutively drawn from medical records. The primary endpoint was in-hospital mortality. RESULTS: In this study, 39 patients (28.2% female) were included, and the mortality rate was 25.6% (n = 10). There was statistically significant difference between survivor and non-survivor groups regarding age (53.0 (46.5-65.0) vs. 75.0 (68.25-81.25), respectively,P = .001), CALL score (8.0 (7.0-10.0) vs. 12.0 (9.75-13.0), P = .001), GRAM score (119.5 (99.5-142.0) vs. 155.0 (129.8-226.0), P = .004), and white blood cell count (k/mL) (5.6 (3.8-8.6) vs. 8.0 (7.6-9.3), P = .003). The patients who were on invasive mechanical ventilation at the time of tocilizumab administration had a higher mortality rate (100% vs. 25.9%, P < .001). Besides, arterial partial pressure of oxygen/ fraction of inspiratory oxygen (PaO2/FiO2) ratio on day 7, but not on days 0, 1, and 3 of tocilizumab therapy, was associated with mortal- ity. C-reactive protein (mg/dL) tended to be lower in the survivor group; however, it was not statistically significant (68.4 (32.7-157.5) vs. 113.5 (77.7-219.0), P = .058). CONCLUSION: This study demonstrated that advanced age, increased leukocyte count, higher CALL and GRAM scores, and the need for invasive mechanical ventilation revealed a worse prognosis after tocilizumab treatment.

Effect of montelukast therapy on clinical course, pulmonary function, and mortality in patients with COVID-19.

The inflammatory/anti-inflammatory balance has an important role in the clinical course of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) infection, which has affected over 200 million people since it first appeared in China in December 2019. This study aimed to determine the effectiveness of montelukast, which has known anti-inflammatory and bronchodilatory effects, in these patients. The prospective randomized controlled study included 180 patients who were hospitalized in the infectious diseases department of our hospital between May and July 2021 and were diagnosed with the delta variant of SARS-CoV-2 by real-time polymerase chain reaction of nasopharyngeal swabs. The patients were divided into three groups and received only standard treatment according to national guidelines (Group 1) or standard treatment plus 10 mg/day montelukast (Group 2) or 20 mg/day montelukast (Group 3). Laboratory parameters and pulmonary function tests (PFTs) at admission and on Day 5 of treatment were compared. Comparison of laboratory parameters on Day 5 showed that Groups 2 and 3 had significantly lower levels of lactate dehydrogenase, fibrinogen, D-dimer, C-reactive protein, and procalcitonin compared with Group 1 (p = 0.04, 0.002, 0.05, 0.03, and 0.04, respectively). In the comparison between Groups 2 and 3, only fibrinogen was significantly lower in Group 3 (p = 0.02). PFT results did not differ between the groups at admission, while on Day 5, only Group 3 showed significant improvements in forced expiratory volume in 1 s, forced vital capacity, and peak expiratory flow 25-75 compared with admission (p = 0.001 for all). Montelukast may be beneficial in COVID-19 patients to maintain the inflammatory/anti-inflammatory balance, prevent respiratory failure through its bronchodilator activity, and reduce mortality.

Evaluation of 3-month follow-up of patients with postacute COVID-19 syndrome.

In addition to the highly variable clinical presentation of acute COVID-19 infection, it can also cause various postacute signs and symptoms. This study aimed to evaluate patients with postacute COVID-19 over 12 weeks of follow-up. The study included 151 patients who were diagnosed with COVID-19 by real-time polymerase chain reaction of a nasopharyngeal swab 1 month earlier, had radiologic findings consistent with COVID-19 pneumonia, and presented to the post-COVID-19 outpatient clinic between May and August 2021. The patients were divided into three groups based on COVID-19 severity: nonsevere pneumonia (Group 1), severe pneumonia (Group 2), and severe pneumonia requiring intensive care (Group 3). Evaluation of laboratory parameters at 4 and 12 weeks showed that Group 3 had a higher lactose dehydrogenase (LDH) level and a lower mean platelet volume than the other groups at both time points (p = 0.001 for all). Group 3 also had lower percent predicted forced vital capacity (FVC%), percent predicted forced expiration volume in 1 s (FEV1%), and percent predicted diffusion capacity of the lungs for carbon monoxide divided by alveolar volume (DLCO/VA%) compared to Groups 1 and 2 at Week 4 (p = 0.001, 0.004, 0.001, respectively) and compared to Group 1 at 12 weeks (p = 0.002, 0.03, 0.001, respectively). Patients with persistent dyspnea at 12 weeks had significantly lower FEV1%, FVC%, DLCO/VA%, and saturation levels in room air and significantly higher LDH, pro-BNP, D-dimer, and heart rate compared to those without dyspnea (p = 0.001 for all). Although the lungs are most commonly affected after COVID-19 infection, vascular and endothelial damage also causes multisystem involvement. Our study indicates that laboratory values, radiological signs, and pulmonary functional capacity improved in most patients after 12 weeks of follow-up.

Evaluation of the relationship between macrophage migration inhibitory factor level and clinical course in patients with COVID-19 pneumonia.

The COVID-19 pandemic, which has ravaged our world for more than a year, still shapes our agenda with a scale of intensity that fluctuates over time. In our study, we aimed to determine the correlation between serum migration inhibitory factor (MIF) level and disease severity in COVID-19 with different prognoses. Between 15 October 2020 and 20 January 2021, 110 patients over the age of 18 who were diagnosed with COVID-19 and 40 volunteer healthcare personnel were included in our study. MIF levels were measured by enzyme-linked immunosorbent assay. In the comparison of serum MIF values in the patient and control group, it was observed that the MIF level was significantly higher in patients with both moderate and severe COVID-19 levels compared to the control group (p = 0.001, 0.001). In the comparison of serum MIF values of moderate to severe COVID-19 patients, it was observed that MIF level was higher in severe patients (p = 0.001). In the receiver operating characteristic curve analysis performed to differentiate between severe and moderate COVID-19 patients with MIF levels, the area under the curve was observed as 0.78. When the cutoff value of the MIF level was taken as 4.455 ng/ml, the sensitivity was 83% and the specificity was 62%. Failure to adequately balance the pro-inflammatory cytokines synthesized in COVID-19 with anti-inflammatory effect is the most important reason for the aggravation of the disease course. Playing a role in pro-inflammatory cytokine synthesis, MIF can provide important information about the disease prognosis in the early period.

Evaluation of the relationship between pentraxin 3 (PTX3) rs2305619 (281A/G) and rs1840680 (1449A/G) polymorphisms and the clinical course of COVID-19.

Macrophage activation syndrome (MAS) is one of the main causes of morbidity and mortality in patients with coronavirus disease 2019 (COVID-19). This study aimed to investigate the relationship between the pentraxin 3 (PTX3) gene polymorphisms rs2305619 (281A/G) and rs1840680 (1449A/G) and the development of MAS in patients with COVID-19. The study included a total of 94 patients aged 18-45 who were diagnosed as having COVID-19 between June and December 2020. PTX3 281A/G and 1449A/G polymorphism frequencies were evaluated. PTX3 281A/G allele and genotype frequencies did not deviate from Hardy-Weinberg (HW) equilibrium in the MAS or non-MAS group (χ2 : 0.049, df: 2, p = 0.976, χ2 : 0.430, df: 2, p = 0.806). PTX3 1449A/G allele and genotype frequencies deviated significantly from HW equilibrium in the non-MAS group (χ2 : 6.794, df: 2, p = 0.033) but not in the MAS group (χ2 : 2.256, df: 2, p = 0.324). The AG genotype was significantly more frequent in the non-MAS group, while the AA genotype was significantly more frequent in the MAS group (χ2 : 11.099, df: 2, p= 0.004). Analysis of the PTX3 1449A/G polymorphism showed that individuals with the GG genotype had higher serum PTX3 levels than those with the AA and AG genotypes (p = 0.001 for both). Analysis of the PTX3 1449A/G polymorphism in patients with COVID-19 showed that those with the AG genotype were relatively more protected from MAS compared with individuals with the AA genotype. In addition, lower serum PTX3 levels are observed in patients carrying the A allele.

Is endogenous carboxyhaemoglobin level a useful biomarker of clinical course and prognosis in COVID-19 patients?

OBJECTIVE: SARS-CoV-2 has caused nearly 4 million confirmed cases of COVID-19 worldwide in the approximately 4 months since it emerged in Wuhan, China in December 2019. Comorbidities increase morbidity and mortality in COVID-19, and many laboratory parameters have been associated with mortality. The aim of the present study was to identify the relationship between endogenous carboxyhaemoglobin (COHb) level and the clinical course and prognosis of COVID-19. METHODS: The study included 48 non-smokers or ex-smokers aged 18 years or older who presented to the emergency department, were diagnosed with COVID-19 by real-time PCR analysis of nasopharyngeal swab sample and were treated in the pulmonary diseases ward of the Atatürk University hospital after 24 March 2020 and 15 April 2020. The patients' laboratory parameters and demographic data were analysed retrospectively. RESULTS: Prothrombin time and C-reactive protein (CRP), troponin-I, and D-dimer levels decreased in COVID-19 patients during follow-up (P = .024, P = .001, P = .001, P = .001), while PaO2 /FiO2 ratio and COHb increased (P = .002, P = .001). COHb level at admission was significantly lower in patients who developed macrophage activation syndrome (MAS), acute respiratory distress syndrome (ARDS), and those who died compared with the other patients (P = .002, P = .001). COHb level on day 5 of treatment was significantly higher in patients with ARDS and patients who died (P = .001, P = .001). Significant correlations were detected between COHb level and CRP (r=-0.425, P = .001), ferritin (r = -.395, P = .001) and PaO2 /FiO2 ratio (r = .431, P = .001). CONCLUSIONS: COHb level may be an easily accessible biomarker that guides early follow-up and treatment planning to avoid ARDS, MAS and mortality in COVID-19.

Evaluation of the relationship between KIM-1 and suPAR levels and clinical severity in COVID-19 patients: A different perspective on suPAR.

Coronavirus disease 2019 (COVID-19) is one of the most pressing health problems of this century, but our knowledge of the disease is still limited. In this study, we aimed to examine serum-soluble urokinase plasminogen activator receptor (suPAR) and kidney injury molecule 1 (KIM-1) levels based on the clinical course of COVID-19. Our study included 102 patients over the age of 18 who were diagnosed as having COVID-19 between September 2020 and December 2020 and a control group of 50 health workers over the age of 18 whose severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) PCR results were negative. KIM-1 was measured by ELISA and suPAR by suPARnostic™ assay. Analysis of previously identified variables of prognostic significance in COVID-19 revealed high neutrophil to lymphocyte ratio, lactose dehydrogenase, prothrombin time, C-reactive protein, PaO2 /FiO2 , D-dimer, ferritin, and fibrinogen levels in patients with severe disease (p < 0.05 for all). KIM-1 and suPAR levels were significantly higher in COVID-19 patients compared to the control group (p = 0.001 for all). KIM-1 level was higher in severe patients compared to moderate patients (p = 0.001), while suPAR level was lower (p = 0.001). KIM-1, which is believed to play an important role in the endocytosis of SARS-CoV-2, was elevated in patients with severe COVID-19 and may be a therapeutic target in the future. SuPAR may have a role in defense mechanism and fibrinolysis, and low levels in severe patients may be associated with poor prognosis in the early period.

Evaluation of the relationship between TREM-1/TREM-2 ratio and clinical course in COVID-19 pneumonia.

OBJECTIVE: The inflammatory/anti-inflammatory balance has an important role in the clinical course of SARS-CoV-2 infection (COVID-19), which has affected over 100 million people since it first appeared in China in December 2019. The aim of this study was to investigate the relationship between triggering receptor expressed on myeloid cells (TREM)-1/TREM-2 ratio and COVID-19 severity. METHODS: A total of 171 individuals were included in the study: 121 patients who were admitted to the chest diseases department and intensive care unit of our hospital and diagnosed with COVID-19 by real-time PCR of nasopharyngeal swab samples from December 2020 to March 2021 and a control group consisting of 50 asymptomatic health workers in our hospital who had negative real-time PCR results during routine COVID-19 screening. RESULTS: TREM-1 level was significantly higher in patients with severe disease compared with the moderate and control groups (P = .003, P = .001). TREM-2 levels did not differ significantly in moderate and severe patients (P = .36) but were significantly higher in both patient groups compared with the control group (P = .001 for both). TREM-1/TREM-2 ratio was significantly higher in the severe patient group than in the moderate and control groups (P = .001 for both). In receiver operating characteristic curve analysis of TREM-1/TREM-2 ratio in patients with moderate and severe COVID-19, the area under the curve was 0.723. Using a cut-off value of 0.125 for TREM-1/TREM-2 ratio in the Youden index calculation, the sensitivity was 60% and specificity was 71%. CONCLUSION: Experience with the positive effects of medical treatments to restore inflammatory balance in the course of COVID-19 is steadily increasing. TREM-1 and TREM-2 have an important role in inflammation and may serve as biomarkers and therapeutic targets in the early treatment and follow-up of COVID-19.