Evaluation of the Relationship Between Disease Severity and Viral Cycle Threshold Value in COVID-19 Patients

Objective: There is a positive and significant relationship between severity and viral load in some viral diseases. Studies on the relationship between SARS-CoV-2 viral load at diagnosis and severity of coronavirus disease-2019 (COVID-19) have yielded conflicting results. Therefore, we aimed to evaluate the relationship between viral load and the clinical status of patients with COVID-19.Methods: Data of the patients diagnosed with COVID-19 and admitted to our center between May 01 and June 31, 2020, were retrospectively reviewed. The patients were divided into two groups according to their clinical character-istics as mild-moderate and severe. The demographic, laboratory, clinical, and radiological data were retrieved from electronic folders.Results: The entire cohort included 285 patients;254 had a mild-moderate clinical course, and 31 had a severe course. Statistical analyses revealed that SARS-CoV-2 viral load was not associated with symptom duration and clinical status (p>0.05). According to multivariate logistic regression analysis, only ferritin, C-reactive protein, and lactate dehydro-genase elevations were positively correlated with severe clinical course. (p<0.05).Conclusion: We do not recommend using viral load to predict disease severity in COVID-19. We also found that only ferritin, C-reactive protein, and lactate dehydrogenase accompanied severe clinical course. Keywords: cycle threshold, COVID-19, clinical severity

Online Education Experiences of Veterinary Medicine Students and Effect on Students' Burnout

In Turkey, when the first case of COVID-19 was announced, the following day education was suspended and later it was transformed into the online model. In such a brief period, students were expected to adapt to the online education system in terms of both technologically and mentally. An online survey was applied to students of a veterinary medicine faculty (n = 288) to identify students' online education experiences, the effect of living condi-tions and year of study on students' online education experiences and bur-nout scores, as well as the relationship between students' online education experiences and burnout components and the determinants of students' self-evaluation of their academic progress. Burnout scores of the students were assessed by the Maslach Burnout Inventory-Student Scale, which was adapted to Turkish language. Students living in remote areas, living in crowded environments, and students who lost motivation as a result of missing practical courses were found to have negative experiences. When students had negative experiences, emotional exhaustion and depersona-lization scores increased and personal accomplishment scores decreased. Students with high weighted grade point average, high emotional exha-ustion, high personal accomplishment, and low depersonalization scores rated their academic progress high. Reconstructing the online education model is vital for veterinary medicine faculties for an effective learning, considering vulnerable students' needs as well as providing students with adequate practical courses. This reconstruction would help to reduce the burnout scores of students.

Evaluation of the Relationship Between Disease Severity and Viral Cycle Threshold Value in COVID-19 Patients

Objective: There is a positive and significant relationship between severity and viral load in some viral diseases. Studies on the relationship between SARS-CoV-2 viral load at diagnosis and severity of coronavirus disease-2019 (COVID-19) have yielded conflicting results. Therefore, we aimed to evaluate the relationship between viral load and the clinical status of patients with COVID-19. Method(s): Data of the patients diagnosed with COVID-19 and admitted to our center between May 01 and June 31, 2020, were retrospectively reviewed. The patients were divided into two groups according to their clinical characteristics as mild-moderate and severe. The demographic, laboratory, clinical, and radiological data were retrieved from electronic folders. Result(s): The entire cohort included 285 patients;254 had a mild-moderate clinical course, and 31 had a severe course. Statistical analyses revealed that SARS-CoV-2 viral load was not associated with symptom duration and clinical status (p>0.05). According to multivariate logistic regression analysis, only ferritin, C-reactive protein, and lactate dehydro-genase elevations were positively correlated with severe clinical course. (p<0.05). Conclusion(s): We do not recommend using viral load to predict disease severity in COVID-19. We also found that only ferritin, C-reactive protein, and lactate dehydrogenase accompanied severe clinical course. Copyright © 2022, DOC Design and Informatics Co. Ltd.. All rights reserved.

Learner autonomy and learning strategy use before and during the COVID-19 pandemic

This study aims to explore the autonomy level and use of language learning strategies in a preparatory school of a state university before and during the COVID-19 pandemic. One hundred fifty-five preparatory school students from a state university participated in the research. For the data collection, Oxford's Language Learning Strategy (LLS) and a learner autonomy questionnaire developed by Zhang and Li were used. Means, standard deviation, t-test, and Pearson's r-correlation were used to analyze the data. The results showed that while participants' level of learner autonomy before the pandemic was high, during the pandemic it was moderate. Additionally, the results from the LLS questionnaires showed that students used a moderate proportion of language learning strategies before and after the pandemic. Finally, the correlation analysis used to determine the relationship between the level of learner autonomy and LLS use before and during the COVID-19 pandemic indicated that there is a positive and linear relationship between the level of learner autonomy and LLS use.

The efficacy and safety of second allogeneic hematopoietic stem cell transplantation

Background: Second allogeneic hematopoietic cell transplant (sAHCT) might be indicated following a graft failure or disease relapse after the first one;although it might emerge with high rates of morbidities and mortality. Currently, there is a limited number of publications on this matter in the literature, here we aimed to share our sAHCT experience from a single center. Methods: Data from 51 patients who were eligible for sAHCT between 2001 and 2021 was evaluated retrospectively. All data was obtained from the Ankara University Faculty of Medicine, Department of Hematology and Bone Marrow Transplant Unit. Results: 51 patients were included in the present study. Median age at sAHCT was 34 (18- 65) and female/ male ratio 19/ 32 (37.3% / 62.7%). The same donor from the first transplant was eligible for sAHCT for most patients (n= 46, 90.2 %). sAHCT indication was graft failure for 11 patients (21.6 %) whereas 40 (78.4 %) patient went on sAHCT for disease relapse. Patients' diagnoses were as follows: acute myeloid leukemia (n= 26, 50.9 %), acute lymphoblastic leukemia (n=9, 17.6 %), myelodysplastic syndrome (n= 6, 11.8 %), aplastic anemia (n= 6, 11.8 %) and others (CMML, CML, biphenotypic leukemia). Median number of transplanted CD34+ hematopoietic cells was 5.77 x x106/ kg (1.11- 8.29). Stem cell source was either bone marrow (n= 5, 9.8%) or peripheral blood (n= 46, 90.2 %). Myeloablative conditioning regimens were used for most sAHCTs (n= 30, 58.8%). Median overall survival (OS) rates for graft failure and disease relapse groups were 12.8 and 18.7 months, respectively (p= 0.63). During early transplant phase, 20 patients (39.2 %) died due to bone marrow aplasia, transplant failure or other complications. 1 year OS of the entire cohort was 33.3 % whereas 2-y- OS was 21.6% (95% CI= 25-45). 2 patients (3.9 %) died due to COVID19 during transplant process. On univariate analysis, sex, time from the first transplant (<12 months/ ≥12 months), conditioning intensity, sAHCT indication did not statistically significantly influence OS. Multivariate analysis confirmed a lower ECOG score (<2) at sAHCT significantly increased OS (p= 0.001). Conclusions: Based on this single center study, sAHCT is an efficacious treatment modality especially for patients with lower ECOG scores. sAHCT may offer long term survival for both graft failure and disease relapse states.

RESPONSE AND VACCINATION STATUS OR LACK OF IMMUNOPARESIS ARE ASSOCIATED WITH BETTER OUTCOME FOLLOWING COVID-19 INFECTION AMONG PATIENTS DIAGNOSED WITH MULTIPLE MYELOMA: A SINGLE CENTER EXPERIENCE ON 110 PATIENTS

Introduction: Patients with multiple myeloma (MM) have an inherently compromised humoral and cellular immunity predisposing to Covid-19 infection. Factors associated with increased risk of adverse COVID-19 outcome is unclear. The aim of our retrospective analysis was to evaluate COVID-19 infection outcome among our myeloma patients and to define the possible prognostic parameters. Patients And Methods: Between March 2020- February 2022, 10 myeloma patients were diagnosed with COVID infection confirmed by PCR test and computer tomography (CT). The severity of SARS-CoV-2 infection was classified according to WHO definition as: mild: symptomatic without pneumonia or hypoxia;moderate: with or without signs of pneumonia with SpO2 >90% on room air;severe disease: with symptoms of pneumonia and respiratory rate> 30/min, severe respiratory distress or SpO2 <90% on room air. Critical disease: with acute respiratory distress syndrome (ARDS), sepsis and septic shock. In addition, CALL (comorbidity-age-lymphocyte count-lactate dehydrogenase) score was used. All patients were given supportive care including heparin and 0.4 gr/kg/day intravenous immunoglobulin for those presenting with immunoparesis regardless of IgG treshold of 4.0 gr/L. Convalescent or monoclonal plasma was not used. All anti-myeloma treatments were discontinued until full recovery. Results: Baseline characteristics of our patients are summarized in Table 1. The median age at onset of COVID-19 was 62 years. Three patients were therapy naive, two newly diagnosed MM and one with smoldering MM. At the time point of COVID-19 diagnosis, eight patients were being followed without treatment. Twenty patients were followed out-patient without any treatment and with full recovery. Eighteen (16%) patients were admitted to ICU and 13 (12%) required invasive mechanic ventilation. Two patients received hydroxychloroquine, 68 received favipiravir, one patient received anakinra and two patients received tocilizumab. Full recovery from COVID-19 infection with regression of clinic symptoms and achievement of PCR negativity of COVID-19 was observed in 93 (84.5%) patients and 17 (15.5%) patients died due to severe COVID-19 pneumonia with respiratory and multi-organ failure. No death due to thromboembolic event was observed. As expected, high CALL risk score (HR:0.17 (95% CI: 0.06-0.48) and higher COVID severity grade (HR:0.26 (95% CI: 0.07- 0.97) were detrimental. Age did not have an impact. However response <VGPR (HR: 3.1 (95% CI: 1.0-9.6);p=0.04) or immunoparesis (HR: 6.59 (95% CI: 1.44-30.1);p=0.01) were correlated (Kappa CE: 0.212, p=0.03) and associated with worse COVID-19 outcome (Figure 1-2-3). In MVA with age, response, Call score, vaccine, immunoparesis entered in the model only immunoparesis was significant (HR: 6.5, p=0.016). Mortality prior to introduction of vaccines reduced to 3.6 % compared with 11.8 % at the pre-vaccine period. There was a trend to increase in Covid infection incidence recently due to the Omicron variant. Conclusion: Among 110 MM patients, the mortality rate is less than the one reported by IMS during the beginning of the pandemic. In our experience COVID-19 infection severity and mortality decreases with anti-Covid vaccination, response ≥VGPR or lack of immunoparesis. Importantly, MM patients with COVID-19 infection need close monitoring for severe COVID-19-related complications, and correction of humoral immunity may be life-saving. .

Outcome of COVID-19 infection among myeloma patients on lenalidomide maintenance

Introduction: Maintenance with lenalidomide after high dose melphalan consolidation is known to extend progression free survival (PFS) in multiple myeloma (MM) patients [1]. Lenalidomide may induce neutropenia and lymphopenia, exposing patients to infections. On the other hand, there have been small case series and brief reports suggesting IMIDs might protect from severe Covid-19 [2] [3]. Here, we resumed our set of MM patients who were diagnosed with Covid-19 infection and compared outcomes based on continuous lenalidomide maintenance. Patients and Methods: 45 MM patients were diagnosed with Covid- 19 in our department between March 2010- December 2020. Here we will be reporting the data of those on lenalidomide (n= 14) and not receiving Lenalidomide maintenance(n:15). Results were compared on Lenalidomide but no Covid-19 (Table 1). All statistical analyses were performed via SPSS statistics version 20.0 software. Results: Table 1 summarizes patient demographics and essential laboratory data: Infection fatality rate for lenalidomide maintenance and no lenalidomide groups were 27.5 % and 33.3 %, relatively. Recovery rates were 71.5 % and 66.7 %, relatively. Both these results were in favor of lenalidomide maintenance. Conclusion: Although cytopenias and immunoparesis may develop during continuous maintenance, lenalidomide seems to be safe and has effects in favor of less severe Covid-19 forms and mortality among MM patients. Based on our experience we do not recommend discontinuation during the pandemic.

Awareness and precaution attitude of dentists as regards to risks associated with exposure to COVID-19

Objective: Dentists need a high level of awareness to limit the spread of COVID-19 (Coronavirus disease 2019). This study aimed to evaluate the level of awareness and attitude regarding the risk associated with dental procedures among dentists. Material and Methods: An online questionnaire was submitted to dentists between April-May 2020. The questionnaire form included questions related to demographic data, the transmission characterization of SARS-CoV-2, and treatment of COVID-19 patients. Data were analyzed using IBM SPSS V23 and chi-square test (p ≤ 0.05). Results: A total of 3825 participants (29.1± 7.6 years) were included. In COVID-19, the riskiest dental branch in terms of the risk of contamination through saliva was considered to be Periodontics (32.2%), while the least risky branch was Orthodontics (0.2%). Specific dental treatment procedures considered at high risk of contamination were tooth preparation (69.4%), scaling and root planing (63.5%), filling (53.4%), and pulpectomy (40.5%). The parameters of the study that differed according to gender and professional status were the viability of the virus, the risk assessment, saliva contamination risk, and aerosol-generating activities for COVID-19 (p < 0.05). Conclusion: Dentists were aware of the risk assessment and extra precautionary methods. However, they had limited knowledge about the viability of the virus. Dentists should be aware of recommended approaches and update their knowledge about COVID-19 to limit the spread of the disease. Since dentistry is an area suitable for the transmission of the COVID-19, the fact that dentists have information about the viability of this virus will be lifesaving in clinical applications. © 2021, Universidade Estadual Paulista, Institute of Science and Technology of Sao Jose dos Campos. All rights reserved.