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.

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.

Specialty-Training Program During COVID-19 Pandemic: A Single Center Survey on over 300 Trainees and Trainers

Objective: COVID-19 pandemic caused significant modifications in education of trainees who are in medical speciality training programs. Limiting the number of residents in the clinics, cancelling elective surgical procedures, stopping face to face practical education, and transforming theoretical education into distance learning platforms resulted in alterations in the curriculum. Limited number of studies in the literature surveyed the impact of the COVID-19 pandemic on specialty training in various medical disciplines. Methods: We addressed to assess the situation of trainees' education using an online questionnaire from the trainees' and directors' perspective during the pandemic. The survey platform SurveyMonkey® was used to distribute the survey and to collect responses. We generated a list of multiple-choice questions about how social distancing affected the delivery of medical education, potential compromise in core training and difficulties in conducting clinical research for the thesis. Results: A total of 364 trainees among 552 (65.9%) under training at our university hospital and 90% of the directors (37 of 41) responded the survey. Almost 78 percent of the trainees claimed that they have been negatively affected during the pandemic. Although majority of the trainees (60.3%) reported that extension of their education program is not necessary, most of the program directors were in tendency of extending the duration of the speciality training period. The participants predominantly considered that online training would keep on being a part of the training program after the pandemic. Conclusion: Education programs are negatively affected during pandemics. However, authorities should manage this deficiency by a new perspective since present trainees are familiar to use technology-driven virtual sources for their education. After the pandemic, computer-assisted online learning and webbased programs should be integrated into educational curriculum. (English) [ FROM AUTHOR] Amaç: COVID-19 pandemisi tıpta uzmanlık eğitimi alan uzmanlık öğrencilerinin eğitim programında belirgin değişikliklere neden olmuştur. Kliniklerde asistan sayıları azaltılmış, elektif ameliyatlar ertelenmiş, yüz yüze pratik eğitim sonlandırılmış ve teorik eğitim uzaktan eğitime dönüştürülerek müfredat düzenlenmiştir. COVID-19 pandemisinin farklı tıp dsiplinlerinde uzmanlık eğitimini nasıl etkilediğine ait çalışma sayısı sınırlıdır. Yöntemler: Pandemi döneminde eğitimin sorgulanması için uzmanlık öğrencilerine ve anabilim dalı başkanlarına yönelik "online" bir anket hazırlanmıştır. Anket "SurveyMonkey®" programında hazırlanmış ve dağıtılmıştır. Sosyal mesafe kurallarının tıp eğitimini nasıl etkilediği, çekirdek eğitim müfredatının nasıl yürütüldüğü, tez çalışmalarının ve klinik araştırmaların durumunu sorgulayan çoktan seçmeli sorular hazırlanmıştır. Sonuçlar: Üniversite hastanemizde eğitim alan toplam 552 uzmanlık öğrencisinden 364'ü (%65.9) ve anabilim dalı başkanlarının %90'ı (41'den 37'si) anketi cevaplandırmıştır. Uzmanlık öğrencilerinin %78'si pandeminin eğitimlerini olumsuz yönde etkilediğini bildirmiş, ancak, çoğunluk (%60.3) uzmanlık eğitim süresinin uzamasını istememiştir. Tersine, anabilim dalı başkanlarının çoğunluğu sürenin uzatılması gerektiğini bildirmiştir. Katılımcıların çoğu uzaktan "online" eğitimin pandemiden sonra da eğitim programına dahil edilmesi gerektiğini bildirmiştir. Tartışma: Pandemi döneminde eğitim olumsuz etkilenmiştir. Ancak, eğitim sorumluları günümüz uzmanlık öğrencilerinin teknolojinin kullanıldığı uzaktan eğitim modellerine daha yatkın olmalarından yararlanarak, eğitim sistemlerini yeni bir bakış açısı ile güncellemelidir. Pandemi sonrasında, bilgisayar temelli eğitim kaynakları uzmanlık eğitim müfredatına yerleştirilmelidir. (Turkish) [ FROM AUTHOR] Copyright of Gazi Medical Journal is the property of Gazi Medical Journal 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 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 . (Copyright applies to all s.)

The factors predicting pneumonia in COVID-19 patients: preliminary results from a university hospital in Turkey

Background/aim: Pneumonia is the most serious clinical presentation of COVID-19. This study aimed to determine the demographic, clinical, and laboratory findings that can properly predict COVID-19 pneumonia. Materials and methods: This study was conducted in the Gazi University hospital. All hospitalized patients with confirmed and suspected SARS-CoV-2 infection between 16 March 2020 and 30 April 2020 were analyzed retrospectively. COVID-19 patients were separated into two groups, pneumonia and nonpneumonia, and then compared to determine predicting factors for COVID-19 pneumonia. Variables that had a P-value of less than 0.20 and were not correlated with each other were included in the logistic regression model. Results: Of the 247 patients included in the study 58% were female, and the median age was 40. COVID-19 was confirmed in 70.9% of these patients. Among the confirmed COVID-19 cases, 21.4% had pneumonia. In the multivariate analysis male sex (P = 0.028), hypertension (P = 0.022), and shortness of breath on hospital admission (P = 0.025) were significant factors predicting COVID-19 pneumonia. Conclusion: Shortness of breath, male sex, and hypertension were significant for predicting COVID-19 pneumonia on admission. Patients with these factors should be evaluated more carefully for diagnostic procedures, such as thorax CT.