Comparison of renal cell cancer surgery during Covid-19 pandemic with prepandemic period, Turkey multicenter study (preprint)

Aim: COVID-19 pandemic changed the priorities in medical field. Many elective surgeries for renal cell cancers (RCC) have been postponed. In this study, we aimed to examine the effects of the COVID-19 pandemic on the surgical treatment of RCC in Turkey. Methods 457 patients that underwent surgery for kidney tumor in the 2-year period between March 1, 2019 and February 28, 2021 in 9 centers in Turkey were analyzed retrospectively. Results The number of surgical treatments for RCC during the COVID-19 pandemic has decreased significantly compared to the same period before COVID-19. No significant differences were found between the two periods in terms of admission symptoms (p=0.32). However, while the rate of application due to hematuria was 6.1% in the pre-COVID-19 period, it was 13.1% during the COVID-19 period. Despite not being significant, this difference was still proportional. Two study periods differed significantly in terms of the rate of metastatic RCC detected in preoperative imaging (13.1% vs 6.1%, during COVID-19 and pre-COVID-19, respectively) (p=0.01). Moreover, the study periods differed significantly in terms of time between imaging and operation (55.98±51.02 vs 40.30±34.9 days, during COVID-19 and pre-COVID-19, respectively) (p=0.01). However, there was no significant difference between the two periods in terms of tumor size, type of surgery, and pathological stage (p>0.05). Conclusion There was a significant decrease in the number of RCC-related surgeries over 1-year period during the pandemic. However, the rate of surgery for metastatic disease increased. Covid-19 is a pandemic that continues to affect the whole world. Oncological diseases are negative affected in this process in terms of early diagnosis and treatment.

Effect of the COVID-19 Pandemic on Radical Prostatectomy: A Turkish Multicenter Study.

OBJECTIVE: The present study examines the effects of the coronavirus disease 2019 pandemic on radical prostatectomy performed as part of localized prostate cancer treatment in Turkey. MATERIAL AND METHODS: A retrospective analysis was made of the data of 176 patients from 8 centers in Turkey who underwent radical prostatectomy due to localized prostate cancer over the 2 years spanning March 1, 2019, to February 28, 2021. Within this timeframe, March 1, 2019, to February 28, 2020, was denoted the 1-year pre-coronavirus disease 2019 period, while March 1, 2020, to February 28, 2021, was denoted the 1-year coronavirus disease 2019 period. An analysis was made of whether there was a difference in the number of radical prostatectomies performed for prostate cancer, the time from biopsy to operation, and the biopsy and radical prostatectomy pathology between the 2 periods. RESULTS: It was found that the number of radical prostatectomies performed for localized prostate cancer during the coronavirus disease 2019 pandemic was statistically and highly significantly fewer than in the pre-coronavirus disease 2019 period (P <.001). The patients diagnosed with Gleason 3+3 (low risk) prostate cancer were statistically significantly fewer in number in the coronavirus disease 2019 period (P <.001). The pathological Gleason score was upgrading than the biopsy Gleason score in all patients who underwent in both periods (P <.001). When the periods were compared, the pathological involvement determined by lymph node dissection performed during radical prostatectomy was found to be decreased in the coronavirus disease 2019 period, although the difference was not statistically significant (P =.051). CONCLUSION: As with many diseases, the diagnosis and treatment of prostate cancer have been adversely affected by the coronavirus disease 2019 pandemic.

Eosinophilic lymph node abscesses following a COVID-19 vaccination: A case report.

In this paper, we reported a 37-year-old man who developed several lymphadenopathies after using the second dose of Pfizer-BioNtech vaccination against SARS-CoV-2. The excisional lymph node biopsy showed eosinophil-rich inflammation with micro-abscesses. Although eosinophilic dermatosis and eosinophilic myocarditis have been described previously following COVID-19 vaccinations, eosinophilic lymph node abscess was not reported in the literature. In our case, all lesions were completely recovered with steroid treatment. The patient has been doing well and no recurrence has been observed for six months.

Effects of the COVID-19 Pandemic on Bladder Cancer Diagnosis and Treatment Processes;A Turkish Multicenter Study

Objective: The coronavirus disease-2019 (COVID-19) pandemic effect diagnosis and treatment of certain conditions, including bladder cancer (BC). This study aimed to evaluate the effects of the COVID-19 pandemic on BC diagnosis and treatment. Materials and Methods: Following the approval of the ethics committee for the study, data of 869 patients who underwent surgery for BC in the 2-year period between March 1, 2019 and February 28, 2021 were analyzed retrospectively. The number of surgeries performed for BC, the time elapsed between symptoms and diagnosis, the treatments performed, and the operative pathologies were compared before and during the COVID-19 pandemic. Results: During the COVID-19 period, there was a decrease in the total number of BC surgeries compared to the pre-COVID-19 period (p=0.004). It was observed that this decrease was due to a decrease in patients newly diagnosed with BC (p=0.001) as well as the decrease in the number of primary transurethral resection for bladder tumor procedures performed. There was no difference in the tumor stages of the patients at diagnosis (p=0.9). Intracavitary Bacillus Calmette-Guérin therapy use in high-risk non-muscle invasive bladder cancers (NMIBC) patients also decreased (p=0.008) during the pandemic period. It was observed that the time between symptom and diagnosis was longer in MIBC than in NIMBC during both periods (p<0.001). Conclusion: Diagnosis and treatment of BC have been adversely affected by the ongoing COVID-19 pandemic. The decrease in the number of new diagnoses may not reflect a true decrease in BC incidence, meaning that BC cases that arose during the pandemic are likely to be diagnosed at a more advanced stage.

Tocilizumab treatment in severe COVID-19: a multicenter retrospective study with matched controls.

Coronavirus disease-2019 (COVID-19) associated pneumonia may progress into acute respiratory distress syndrome (ARDS). Some patients develop features of macrophage activation syndrome (MAS). Elevated levels of IL-6 were reported to be associated with severe disease, and anti-IL-6R tocilizumab has been shown to be effective in some patients. This retrospective multicenter case-control study aimed to evaluate the efficacy of tocilizumab in hospitalized COVID-19 patients, who received standard of care with or without tocilizumab. Primary outcome was the progression to intubation or death. PSMATCH (SAS) procedure was used to achieve exact propensity score (PS) matching. Data from 1289 patients were collected, and study population was reduced to 1073 based on inclusion-exclusion criteria. The composite outcome was observed more frequently in tocilizumab-users, but there was a significant imbalance between arms in all critical parameters. Primary analyses were carried out in 348 patients (174 in each arm) after exact PS matching according to gender, ferritin, and procalcitonin. Logistic regression models revealed that tocilizumab significantly reduced the intubation or death (OR 0.40, p = 0.0017). When intubation is considered alone, tocilizumab-users had > 60% reduction in odds of intubation. Multiple imputation approach, which increased the size of the matched patients up to 506, provided no significant difference between arms despite a similar trend for intubation alone group. Analysis of this retrospective cohort showed more frequent intubation or death in tocilizumab-users, but PS-matched analyses revealed significant results for supporting tocilizumab use overall in a subset of patients matched according to gender, ferritin and procalcitonin levels.

Olfactory and Gustatory Dysfunctions in COVID-19 Patients: From a Different Perspective.

PURPOSE: The prevalence of sensory disorders (smell and/or taste) in affected patients has shown a high variability of 5% to 98% during the COVID-19 outbreak, depending on the methodology, country, and study. Loss of smell and taste occurring in COVID-19 cases are now recognized by the international scientific community as being among the main symptoms of the disease. This study investigates loss of smell and taste in outpatients and hospitalized patients with laboratory-confirmed COVID-19 infection. METHODS: Enrolled in the study were patients with a positive PCR test for COVID-19. Excluded were patients with chronic rhinosinusitis, nasal polyposis, common cold, influenza, and olfactory/gustatory dysfunction predating the pandemic. Patients were asked about changes in their sense of smell and taste by structured questionnaire. Their status was classified according to severity of the symptoms. RESULTS: A total of 217 patients were included in the study, of whom 129 received outpatient treatment, whereas 88 were hospitalized; mean age was 41.74 years (range18-76), 59.4% were male. At evaluation for olfactory dysfunction, 53.9% of the patients were found to be normal, whereas 33.2% were anosmic. No gustatory dysfunction was found in 49.8% of patients, whereas in those with loss of taste, the most commonly recorded symptom was ageusia. Anosmia was significantly more common in outpatients (P = 0.038). Presentation of chemosensorial symptoms in women was higher than in men (P = 0.009). No correlation was found between olfactory and gustatory dysfunction and age (P = 0.178). CONCLUSIONS: About one-half of our patients presented olfactory and/or gustatory deficits, and loss of smell was more common in mild cases. It should be considered; a sudden, severe, and isolated loss of smell and/or taste may also be present in COVID-19 patients who are otherwise asymptomatic. We suggest that identification of persons with these signs and early isolation could prevent spread of the disease in the community.

A single center cohort of 40 severe COVID-19 patients who were treated with convalescent plasma

Background/aim: A SARS-Cov2 infection which was first arised from Wuhan in December 2019 and named as COVID-19. Still there lacks either a specific treatment or a vaccine to treat COVID-19. Convalescent plasma (CP) was previously used successfully to treat SARS-CoV-1 and MERS infections. Health authority in Turkey has published a guideline to integrate this promising option in the treatment process of patients who are prone to high risk of developing severe COVID 19. Materials and Methods: Forty consecutive patients who had received CP at our center were included in the study. Demographics, COVID-19 specific parameters, biomarkers to detect the severity of COVID-19 infection and outcome variables were collected retrospectively. The correlation between outcome variables and the independent predictors of the outcome were reported. Results: Median age of the patients was 57.5 and 72.5% were male. At least one COVID-19 PCR test was confirmed to be positive in 75% of patients. Remaining 25% had a Chest-CT which was reported to be compatible with an ongoing COVID-19. All patients (100%) were classified as having severe COVID-19 infection. Over a half of the patients harbored an oxygen saturation of less than 90 despite of a continuous 5 L/min support of O2. 82.5% of the patients had a need for mechanical ventilation and 45.5% had a need for invasive mechanical ventilation. Nine out of 10 patients who have received CP outside ICU have totally recovered from COVID-19 at a median of 9 days, and a half of the patients who needed invasive mechanical ventilation were successfully free of mechanical ventilation support and managed to recover from COVID-19. Conclusion: According to the results of this study, CP is an efficient conjunct to conventional therapy against COVID-19 with a favorable safety profile.