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Introduction and aim. This study aimed to compare the hospitalization rate, mortality rate and morbidity status of patients hospitalized with stroke and diabetic ketoacidosis (DKA) before and during the COVID-19 pandemic. Material and methods. The data of 2522 patients who applied to the emergency department (ED) before and during the pandemic were evaluated. A Poisson regression analysis was used to examine the number of presentations between two different periods. Results. Stroke cases during the pandemic era were compared to those during the pre-pandemic period, and it was shown that the mortality rate for stroke patients during the pandemic period was much higher. Treatment-related ED presentations decreased significantly during the pandemic period, particularly among patients aged 75-84 years. Rates of ED presentation decreased by 84 percent (IRR: 0.14, 95 percent CI: 0.03-0.59) in those with DKA and by 37 percent (IRR: 0.67, 95 percent CI: 0.53-0.75) in those with stroke during the pandemic period. Conclusion. Conclusion: Stroke and DKA admissions decreased during the pandemic, but the rate of stroke mortality increased statistically 3.375 times. Getting emergency medical care increases their chances of survival. Even in a COVID-19 outbreak, treatment is critical. © 2022 Publishing Office of the University of Rzeszow. All Rights Reserved.
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BackgroundIn COVID-19 severe disease course such as need of intensive care unit (ICU) as well as development of mortality is mainly due to cytokine storm.ObjectivesIn this study, we aimed to evaluate the high dose intravenous anakinra treatment response and outcome in patients with severe and critical COVID-19 compared to standard of care.MethodsThis retrospective observational study was carried out at a tertiary referral center. The study population consisted of two groups as follows;the patients receiving high dose intravenous anakinra (anakinra group) between 01.09.2021 and 01.02.2022 and the patients treated with standard of care (SoC, control group) as historical control group who were hospitalized between 01.07.2021 and 01.09.2021.ResultsAfter the propensity score 1:1 matching 79 patients in anakinra and 79 patients in SoC matched and included into the analysis. Mean±SD patient age was 67.4±16.7 and 67.1±16.3 years in anakinra and SoC group, respectively (p=0.9). Male gender was 38 (48.7 %) in anakinra and 36 (46.2 %) SoC (p=0.8). Overall, ICU admission was in 14.1 % (n=11) and 30.8 % (n=24) (p=0.013;OR: 6.2), intubation in 12.8 % (n=10) and 16.7 % (n=13) patients (p=0.5), 14.1 % (n=11) and 32.1 % (n=25) patients died in anakinra and control group, respectively (p=0.008;OR: 7.1)ConclusionIn our study mortality was lower in patients receiving anakinra compared to SoC. Intravenous high dose anakinra is safe and effective treatment in patients with severe and critical COVID-19.Table 1.Baseline clinical and laboratory features of patients receiving standard of care (SoC) and Anakinra before and after propensity score (PS) matchingBefore PS matchingAfter PS matchingVariablesAnakinra (n=148)SoC (n=114)p value (OR)Anakinra (n=78)SoC (n=78)p value (OR)Age (years) (mean±SD)66.8±1763.1±170.0967.4±16.767.1±16.30.9Gender, male (n, %)78 (52.7)45 (39.5)0.033 (4.5)38 (48.7)36 (46.2)0.8Duration of hospitalization (days) (median, IQR)11 (12)9 (7.3)0.027.5 (9)11 (8)0.01Comorbidities (n, %) Diabetes mellitus41/146 (28.1)39 (34.2)0.318 (23)31 (39.7)0.025 (5) Hypertension84/143 (58.7)64 (56)0.730 (61.5)50 (64)0.7 Coronary heart disease27/143 (19)24 (21)0.718 (23)20 (25.6)0.7 Heart failure18/143 (12.6)23 (20)0.114 (18)20 (25.6)0.24 Chronic renal failure31 (21)6 (5.3)<0.001 (13.06)15 (19)6 (7.7)0.035 (4.5) Chronic obstructive lung disease23/144 (16)19 (16.7)0.914 (18)15 (19)0.8 Dementia15/117 (12.8)2 (1.8)0.001 (10.4)3/61 (5)2 (2.6)0.5 Malignancy16/146 (11)8 (7)0.39 (11.5)6 (7.7)0.4 Immunosuppressive usage18/146 (12.3)2 (1.8)0.001 (10.08)5 (6.5)2 (2.6)0.2Disease severity (n, %) NIH score 3 (severe)57 (38.5)68 (59.6)0.001 (11.5)48 (61.5)44 (56.4)0.5 NIH score 4 (critical)91 (61.5)46 (40.4)30 (38.5)34 (43.6) mcHIS score (mean±SD)3.4±1.22.64±1.5<0.0012.9±13.1±1.30.2PS: Propensity score, SoC: Standard of care, OR: Odds ratio, SD: Standard deviation, IQR: Interquartile range, mcHIS: Modified Covid hyperinflammatory syndrome score, NIH: National Institute Health, ALT: Alanin aminotransferase, AST: Aspartate aminotransferaseTable 2.Outcomes of patients receiving SoC and Anakinra before and after PS matchingBefore PS matchingAfter PS matchingVariables (n, %)Anakinra (n=148)SoC (n=114)p value (OR)Anakinra (n=78)SoC (n=78)p value (OR)Pneumothorax3/134 (2.2)00.25*2/73 (2.7)00.5*Myocardial infarction3/132 (2.3)6 (5.3)0.32/72 (2.8)2/56 (3.6)1Pulmonary embolism4/134 (3)11 (9.6)0.034 (4.8)*3/73 (4.1)7 (9)0.3*Intensive care unit60 (40.5)25 (22)0.001 (10.2)11 (14.1)24 (30.8)0.013 (6.2)Intubation54 (36.5)13 (11.4)<0.001 (21.3)10 (12.8)13 (16.7)0.5Mortality56 (37.8)27 (23.7)0.015 (5.96)11 (14.1)25 (32.1)0.008 (7.1)PS: Propensity score, SoC: Standard of care, OR: Odds ratioREFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.
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INTRODUCTION: Early and effective laboratory parameters are required to determine the prognosis of COVID-19. In this study, our aim was to investigate the relationship between the D-dimer levels of patients with COVID-19 and their in-hospital mortality status. MATERIAL AND METHODS: This retrospective observational study was conducted with patients diagnosed with COVID-19 in the emergency department of a tertiary hospital between January 1, 2022, and June 1, 2022. Patients with a negative reverse transcription-polymerase chain reaction test result and those with unavailable D-dimer records were not included in the study. RESULTS: The population of this study consisted of 517 patients, 241 women and 276 men. The mean age of the patients was 72.4 years. The patients were divided into two groups as survivors and non-survivors. There were 320 patients in the survivor group and 197 in the non-survivor group. As a result of the statistical analysis, D-dimer was found to be statistically significant in predicting in-hospital mortality in patients with COVID-19 (p < 0.001). CONCLUSIONS: In this study, it was concluded that COVID-19 cases with high D-dimer levels had a higher in-hospital mortality rate. In addition, it was observed that patients admitted to the intensive care unit had higher D-dimer levels than those that did not require intensive care. Copyright © 2022 Via Medica.
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Several scoring systems are used to predict critical care requirements in coronavirus disease 2019 (COVID-19) patients. This study aims to determine the relationship between the hemoglobin, albumin, lymphocyte, and platelet (HALP) scores and in-hospital mortality for COVID-19 patients who visited the emergency department (ED). This retrospective study included patients over 18 years of age. Data were scanned into a digital information system of the hospital. The area under the receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to measure each discriminant cutoff value to predict mortality. A total of 458 patients were included in this study. The mean age of the patients was 72 years, and 216 (47.2%) patients were women. ROC analysis was performed to examine the predictive power of the HALP score in predicting mortality in COVID-19 patients, with an AUC of 0.720 (95% confidence interval: 0.676-0.761), a Youden index of 0.357, and a p value of 0.001. As a result of the statistical analysis, it was determined that the HALP score was statistically significant in the prediction of mortality in COVID-19 patients (p < 0.001). In this study, we found that the HALP score could be a good predictor of in-hospital mortality among COVID-19 patients. Copyright © 2023 The Author(s).
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The elderly or geriatric patients represent a significant portion of emergency department (ED) admissions. Factors affecting poor outcome in these patients suspected or diagnosed with sepsis include shock, hyperlactatemia, and organ failure. Atypical presentations should be emphasized in the training of triage and ED personnel due to difficulties and pitfalls in diagnostic processes for sepsis. The vital organ functions of the elderly, who are among the highest risk groups in the management of sepsis, may deteriorate rapidly with very few precursors, and aggressive methods should be used rapidly when necessary. Interactions of drug doses in the elderly, problems in excretion and differences in metabolism should be considered in treatment regimens. Healthcare workers should try to eliminate colonization risks such as vascular catheterization, unnecessary vascular access and urinary catheters should be removed.In the long term after recovery from sepsis, heart failure, peripheral vascular disease, dementia, and diabetes are the most common entities recorded in the literature. This review was intended to provide an overview of the overall management and give some practical tips for this fragile group of patients in the post-pandemic era.
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Objective: To evaluate the impact of coronavirus disease-2019 (COVID-19) lockdown on the sexual lives of couples who live in Turkiye. Material(s) and Method(s): One hundred ninety-three sexually active participants. While sexual functions were evaluated with the international erectile function index-15 in men and the female sexual function index in women, Hamilton anxiety scale (HAM) was used to measure anxiety level. Married people filled out the Marriage adjustment test (MAT) questionnaire. The effects of the quarantine period on the relationship were evaluated with a questionnaire created specifically for this study. Result(s): Sexual improvement and worsening were observed in 8.8%, and 15%, respectively. It did not change for 76.2%. Sexually deteriorated subjects had a higher HAM score (p=0.003). The MAT score was lower in sexually deteriorated subjects (p=0.004). The rate of sexual worsening was higher in women than in men (28.6% vs. 12%, p=0.02). Women's HAM scores were higher (p=0.002). The MAT score was also found to be higher in women (p=0.0037). 58% of sexually deteriorated participants did not feel safe at home during the COVID-19 period, whereas all of those sexually improved participants felt safe at home. Conclusion(s): During the COVID-19 lockdown period, sexual deterioration was detected in 15% of sexually active people. This worsening was associated with the HAM score. Additionally, it was revealed that feeling safe at home is related to sexual life. While the relationship between sexually worsening and the MAT score was significant in men, it was revealed that the level of anxiety in women affected sexual life more significantly. © Copyright 2022 by the Association of Urological Surgery / Journal of Urological Surgery published by Galenos Publishing House.
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Background: The physical activity of university students is restricted during the pandemic, changes in education and training, and uncertainties during the pandemic caused their social lives to change completely. Aim: This study aims to determine the relationship between the depression, anxiety, and stress, and positivity attitudes of university students during the Covid-19 (coronavirus disease-2019) outbreak and their attitudes and behaviors toward the pandemic. Subjects and Methods: This cross-sectional study was conducted online among university students, n = 2153 from April 30, 2020 to May 10, 2020. Data were collected with the Positivity Scale and the Depression Anxiety Stress Scale. Results: The proportion of those with moderate and above depression, anxiety, and stress symptoms in the study group, respectively, were 40.6%, 24.6%, and 22.5%. The risk ratio of these symptoms is higher among those with lower positive attitudes (OR [odds ratio] = 0.804, 0.897, 0.895, respectively), being women (OR = 1.446, 1.666, 1.471), who are concerned with the transmission of the Covid-19 (OR = 1.144, 1.374, 1.201), who believe their intra-family relations (OR = 1.886, 1.728, 2.083) and education (OR = 1.680, 1.682, 2.132) are negatively affected, and those who are more worried about life after the pandemic. Conclusion: Compared with the pre-pandemic period, the frequency of university students showing symptoms of depression increased, and there was no significant change in anxiety and stress levels.
Subject(s)
COVID-19 , Anxiety/epidemiology , Anxiety/etiology , COVID-19/epidemiology , Cross-Sectional Studies , Depression/epidemiology , Depression/etiology , Female , Humans , Male , Mental Health , Pandemics , SARS-CoV-2 , Stress, Psychological/epidemiology , Students , UniversitiesABSTRACT
Background: Several predictive factors were described in COVID-19 during the pandemic, however there is limited data in severe/critically ill patients (pts) with COVID-19 who received biologic therapies including anakinra. Objectives: We aimed to evaluate the predictive factors of mortality in pts with severe and critically ill COVID-19 who received anakinra. Methods: Diagnosis of COVID-19 was confrmed by PCR and/or typical CT fnd-ings. Severe and critically ill pts according to NIH severity scale who received anakinra in the ward were evaluated retrospectively (1). Laboratory values at admission, highest levels and the last day of hospitalization were recorded. COVID hyperinfammatory syndrome score (cHIS) was calculated according to the highest levels of laboratory results (2). All pts received background steroid therapy with 80 mg methylprednisolone (or its equivalent). Anakinra was started in pts who did not respond to steroid therapy at least two days or concomitantly with steroids in pts with higher risk and/or critical illness at admission. Average starting dose of anakinra was 600 mg/day intravenously and increased gradually to 1600 mg/day if necessary. Results: Data of 148 pts (53 % male) were analyzed. Of those 57 pts (38.5 %) severe, 91 pts (61.5 %) had critical disease. Overall, 56 pts (37.8 %) died during the follow-up and intensive care unit admission was in 60 pts (40.5 %) and intubation in 54 pts (54.5 %). Diabetes mellitus was in 28 %, hypertension in 59 %, coronary heart disease in 19 %, heart failure in 12.6 %, chronic kidney failure in 21 %, chronic obstructive pulmonary disease in 16 %, dementia in 12.8 %, malignancy in 11 % and rheumatic disease in 5.6 % of pts. Only dementia signifcantly differed between pts had mortality and had not (p=0.005 OR:9.8). In univariable analysis;patient age, neutrophil to lymphocyte ratio (NLR), mean cHIS scores were higher in pts had mortality. Higher baseline, maximum and last values of CRP, LDH, ferritin, D-dimer levels were observed in pts had mortality. Mortality was also higher in pts with critically ill compared to severe disease In multivariate analysis;higher age (p=0.01 OR:1.05 CI: 1.01-1.09), cHIS score (p=0.002 OR:2.6 CI:1.4-4.9), critical illness compared to severe disease (p=0.02 OR:14 CI:1.6-122) were associated with mortality. In ROC analysis;cut-of values for cHIS score (3.5), NLR (7.1), CRP (160.5 mg/L), LDH (581 U/L), ferritin (771 ng/mL), D-dimer (7.56 mcg/mL) with 72/72, 69/70, 70/69, 72/75, 70/72, 70/73.4 sensitivity/specifcity were calculated, respectively. Conclusion: In our study mortality was developed in third of anakinra receiving pts. Mortality was independently associated with advanced age, critical illness and higher cHIS score refecting higher infammatory burden. Furthermore, highest levels of CRP, LDH, ferritin, D-dimer and higher cHIS score predict higher mortality in pts receiving anakinra. It is important to identify the pts with higher mortality risk to improve outcome.
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In this paper, two different airflow ducts were designed to improve the cooling performance of the semi-trailers cabin that was frequently used for transporting frozen and fresh products or for the delivery of the COVID-19 vaccine packs. The airflow analysis was achieved by using the three-dimensional transient computational fluid dynamics method and also an experimental study including temperature measurements was performed for getting reference data to compare the numerical results. The detailed airflow and temperature analyses in the semi-trailers cabin were presented and discussed. It is observed that the developed innovative airflow channels not only provide the desired uniform temperature distribution inside the cabin but also significantly reduce the time interval to reach the required mean cooling temperature. The total cooling time from 303 K (30 degrees C) to 253 K (-20 degrees C) in the cabin had been reduced to 50% compared to the one without using the airflow duct. The presented experimental and numerical results can be used as a reference for further similar studies.
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Aim: The coronavirus disease-2019 (COVID-19) pandemic has caused a worldwide public health emergency, especially affecting people with chronic illnesses including lysosomal storage disorders (LSDs). The unfavorable conditions due to COVID-19 have mostly affected people with chronic conditions, in terms of disease vulnerability and access to health-care. In the present study, we aimed to assess the problems the patients with LSDs on enzyme replacement therapy (ERT) have encountered during the pandemic, and their level of anxiety. Parental evaluation has also been made for pediatric patients. Materials and Methods: A total of 19 participants were recruited. A semi-structured interview was structured to evaluate the effects of the COVID-19 pandemic on ERT. The Turkish version of "Hospital Anxiety and Depression scale" (HADS) for adult patients and parents were used to evaluate anxiety. Patients between ages 8-17 completed the child version of the Revised Child Anxiety and Depression scale (RCADS). Results: The study was completed by 19 patients, and 13 parents. Five patients (26%) admitted temporary disruption of treatment, of which the most common reason was the fear of getting infected. Eighty-nine percent of all participants were willing to receive treatment at home. Only one adult patient revealed to feel anxiety (16%). While among parents evaluated with HADS, 7/13 had scores that indicated depression and anxiety, 3/4 pediatric patients had RCADS scores indicative of anxiety and depression. Conclusion: The problems LSD patients have been facing during the pandemic, should be identified along with their attitudes regarding ERT in order to maintain the sustainability of their treatment. The psychological health of these patients should also be identified and supported, to provide optimal care to patients.
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'Social distance', which is the most important health precaution taken to minimize the transmission risk of Covid-19 pandemic, whose impact on our social life and institutional structures is expected to continue unpredictably, has completely disrupted the dynamics of social life. In this context, many sectors, especially education and training services, which can only be delivered in an organic social context, have had to undergo a rapid formation process through new building dynamics apart from their traditional structural elements. Leading to a crisis in education systems, the pandemic required the urgent development of new education policies, and the prevention of disruption in education through the use of the most widely available technological opportunities available locally. Our study aims to analyze the transformative effect of the 'artificial techno-social network' as the new education and training method during the pandemic period on the education paradigm. In addition, the possibilities and problems presented by the new technological equipment (some AI-based) some of which were already in use to supplement education before the pandemic will be discussed in terms of the right to education. The 'distance education' or 'online education' practices, which can be described as the digital presentation.