Factors affecting disease severity of multisystem inflammatory syndrome in children

Purpose: Multisystem inflammatory syndrome that occurs after SARS-Cov-2 infection with fever, cardiogenic shock and hyperinflammation in children, can be life threatening. In this study, it was aimed to investigate the effects of the complaint and duration at diagnosis on the severity of multisystem inflammatory syndrome in children. Materials and methods: The medical records of 99 pediatric patients, who were diagnosed multisystem inflammatory syndrome between September 2020 and August 2021 according to Centers for Disease Control and Prevention, were evaluated retrospectively. Demographic features, initial findings, and admission time of patients were noted. Patients were categorized according to intensive care necessity. Results: The median age of the patients was 10 (2-18) and 62 (62.6%) of patients were male. The median duration before admission was 4 (1-10) days. All patients has fever, 81.8% had gastrointestinal and 75.8% had cardiovascular involvement at admission. The patients (56.6%) who were accepted as severe and moderate MIS-C required intensive care. Prolonged fever, delayed admission, cardiovascular involvement, high inflammatory markers, lymphopenia and thrombocytopenia were found to key parameters determining the need for intensive care. Conclusion: Multisystem inflammatory syndrome in children is a new disease characterized by fever, signs of inflammation and organ dysfunction associated with SARS-CoV-2 infection. Delayed admission, high cardiac and inflammatory markers at diagnosis increase the need for intensive care. © 2022, Pamukkale University. All rights reserved.

Comparison of the pregnant and non-pregnant women of reproductive age hospitalized due to COVID-19 infection

COVID-19 affects pregnant women more severely than nonpregnant women of reproductive age. However, the rate of critical illness and fatality reported in other studies varied in a wide range in both groups. The study aims to investigate the clinical outcomes of COVID-19 in the pregnant and nonpregnant matched control patients admitted to the hospital. Pregnant and nonpregnant patients of reproductive age (18-45 years) infected with COVID-19 who were admitted to Ondokuz Mayis University Hospital, Samsun, Turkey, from March 11 to December 11, 2020, were enrolled in the study. The clinical, radiological, and laboratory data of the patients were analyzed retrospectively. A total of 153 patients were investigated;123 were nonpregnant, and 30 were pregnant. Emergency delivery occurred in 5 (17%) pregnant women due to acute respiratory failure associated with COVID-19 and 1 (3%) pregnant woman due to obstetric reasons. Four premature births, one perinatal death, and no stillbirth or miscarriage were reported. The rate of admission to the intensive care unit (ICU) [7/30 (23.3%) vs 3/123 (2.4%), p<0.001] and the need for invasive mechanical ventilation (IMV) [5/30 (17.0%) vs 2/123 (1.6%), p=0.003] were significantly higher in pregnant than in non-pregnant patients. However, hospital length of stay (HLOS) and mortality did not differ between groups: HLOS was median 4 vs 5 days, p=0.68, and the mortality rate was 1/123 (0.8%) vs 0/30 (0%), p=0.62 in nonpregnant and pregnant patients respectively. We observed that COVID-19 has a more severe course in pregnant women versus the nonpregnant control group, but no difference was noted in terms of hospital length of stay and mortality. The overall case fatality rate of COVID-19 in hospitalized pregnant or nonpregnant women of reproductive age was found to be much lower than the general hospitalized population worldwide. Copyright © 2022 Ondokuz Mayis Universitesi. All rights reserved.

ACUTE STROKE MANAGEMENT DURING COVID-19 PANDEMIC

INTRODUCTION: In the coronavirus disease 2019 (COVID-19) pandemic, there may be a decrease in the number of acute stroke intervention and acute treatment, and delays in treatment periods. In this study, it was aimed to compare the clinical features of patients presenting with acute stroke during the COVID-19 pandemic and in the pre-pandemic period. METHODS: Patients hospitalized with the diagnosis of cerebrovascular disease (CVD) between January 01, 2019 and May 31, 2021 were included in the study. Demographic characteristics and stroke risk factors of the patients were recorded. Stroke type and ischemic disease subtypes were determined, and patients' admission National Institutes of Health Stroke Scale (NIHSS) score, symptom-door time, door-consultation time, door-to-door Needle time and door-groin puncture time, intravenous tissue type plasminogen activator (IV tPA) and endovascular thrombectomy (EVT) applications were recorded. Discharge modified Rankin Scale (mRS) and NIHSS scores and mortality rates were evaluated. Patients hospitalized in two separate periods of 14 months each were compared by dividing them into pre-pandemic and pandemic periods. RESULTS: Before COVID-19, 316 patients (female 45.25%, age: 66.75±13.68 years) and during the pandemic period 341 (female 41.94%, age: 68.34±13.55 years) patients were included in the study. During the pandemic period, an increase in the number of hemorrhagic CVD and transient ischemic attacks, a decrease in the number of ischemic stroke and cerebral venous thrombosis (CVT) hospitalizations, a decrease in cardioembolic strokes and an increase in lacuner ischemic CVD subtypes were observed (p<0.01). The number of large vessel atherosclerosis, IV tPA and EVT were found to be similar before and after the pandemic. In the pandemic period, although it did not reach statistical significance compared to the pre-pandemic period, prolongation was recorded in the symptom-door, door-consultation, door-needle and door-groin puncture times (p>0.05). The COVID-19 test was positive after hospitalization in 5 (1.8%) patients with ischemic stroke hospitalized during the pandemic period. During the pandemic period, admission NIHSS, discharge NIHSS and mRS scores and mortality rates were found to be significantly higher between hemorrhagic and ischemic stroke patients (p<0.01). DISCUSSION AND CONCLUSION: The COVID-19 pandemic adversely affects the management of acute stroke. The duration of acute stroke treatment is delayed due to pre-hospital and in-hospital reasons. With the heavy burden of stroke during the pandemic period, poor clinical outcome and high mortality are observed.

The Effects of the Hybrid Telerehabilitation Exercise Program in Inactive University Students during COVID-19 Pandemic - A Randomized Controlled Study

Background/Aim The need for alternative methods to prevent physical inactivity and related problems is increasing day by day due to the prevalence of physical inactivity among university students, especially in the pandemic. This study aimed to investigate the effects of a hybrid telerehabilitation exercise program on the physical inactivity, poor sleep quality and physio-mental negativities caused by the pandemic in university students. Materials and Methods The study was completed with sixty-three physically inactive students with poor sleep quality, divided into two groups. The physiotherapist made all assessments at baseline and after the 6-week for both groups. Assessments consisted of Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), Short Form-12 (SF-12), and International Physical Activity Questionnaire-Short Form (IPAQ-SF). While no exercise program was applied to the control group, one session synchronous exercise training and one session control education were given to the exercise group. After two synchronous training sessions, the exercise group asynchronously continued the exercise program including indoor walking, flexibility and strengthening exercises for 6 weeks. Results According to inter-groups analysis, PSQI (p=0.026), BDI (p=0.037), SF-12 Mental (p=0.007), and IPAQ-sitting (p=0.003) of the exercise group had significant differences compared to the control. Also, the exercise group's PSQI, BDI, SF-12, and IPAQ-sitting time were p<0.001, while no change was observed in the control group in the within-group analysis (p>0.05). Conclusion Hybrid telerehabilitation exercise programs are a valuable, simple, and practical tool to improve sleep quality, prevent inactivity, develop and protect mental health among university students. Encouraging physically inactive people to engage in such methods may be one of the primary preventive approach to prevent the future negative consequences.

Acceptability of virtual exercise program in healthy adolescents

Introduction: After the Covid 19 pandemic, telerehabilitation has become part of regular practice in pediatric rehabilitation. Despite the availability of studies exploring the feasibility of telerehabilitation in the pediatric population, studies measuring acceptability of telerehabilitation are limited. The aim of this study is to examine the acceptability of virtual exercise program in healthy adolescence. Methods: A virtual exercise program was implemented with 13 health adolescents aged 9-14 years old (n = 9 girls, n = 3 boys). Each session lasted 30-40 minutes and was implemented once a week for 6 weeks. After completion of the program, a semi-structure interview was conducted with each adolescent. Thematic analyses of interviews were done by two reviewers. Results: Result revealed seven themes. The adolescents perceived that exercise program improved their lifestyle (e.g. regularly exercise habit), social skills (e.g, peer interaction), and emotions (e.g. feeling happier, more energetic), yet busy schedule of daily routine (e.g. homework), technical issues (e.g. lack of internet connection during a trip, adjustment of camera while exercising), intensity of the exercise program (e.g. being tired after exercises) were some barriers to participation. On the other hand, the virtual nature of telerehabilitation was expressed as an advantage allowing adolescents to participate in the exercise program after school time. Conclusion: This study showed that virtual exercise programs may benefit adolescents from variance angles, yet there are some issues to be addressed to improve the implementation. Future studies should focus on the improvement of acceptability of telerehabilitation not only in the healthy population but also in children and adolescents with disabilities.

Transient Sinus Bradycardia in Children with Multisystem Inflammatory Syndrome Associated with COVID-19

Objective: Multisystem inflammatory syndrome in children (MIS-C) may cause cardiovascular involvement and dysrhythmia. Although a variety of arrhythmias may be seen, sinus bradycardia was rarely reported. The aim of this study is to determine the frequency and clinical course of bradycardia in children with MIS-C. Material and Methods: Medical records of patients who were diag-nosed with MIS-C between August 2020 and March 2021 were retro-spectively evaluated. MIS-C diagnosis was made according to US Cen-ters for Disease Control and Prevention (CDC) criteria. All patients who had sinus bradycardia were included in the study. Results: Transient sinus bradycardia was observed in 7 of 40 (17.5%) patients (2 girls, 5 boys) with MIS-C. The median age was 10.8 years (range, 5.4-13.8 years). All patients were initially treated with intravenous immu-noglobulin (IVIG) and six out of the seven patients also received intravenous methylprednisolone (MPZ). Sinus bradycardia developed a median of four days (range, 2-6 days) after MIS-C diagnosis and continued for a median of four days (range, 2-6 days). In six of the seven patients, bra-dycardia was detected a median of 42 hours (range, 11-74 hours) after MPZ treatment and resolved a median of 36 hours (range, 20-50 hours) after tapering MPZ dosage. Electrocardiogram (ECG) of patients showed sinus bradycardia. All patients were asymptomatic and awake when bra-dycardia was observed. No patients had any underlying structural heart defect or electrolyte abnormalities. Bradycardia episodes resolved without any specific intervention. Conclusion: Sinus bradycardia may occur due to the cardiac involvement of MIS-C itself or as a possible side effect of MPZ therapy, which can resolve without any specific treatment.

The association between prognosis and sarcopenia assessed by psoas muscle measurements in elderly male patients with covid-19

Introduction: Sarcopenia, which is defined as a generalized loss of skeletal muscle mass and function, is an important clinical condition, especially among elderly patients with comorbidities. This study assesses the association between prognosis and sarcopenia assessed by psoas muscle measurements in elderly male patients with coronavirus disease 2019. Materials and Methods: This study included 130 consecutive elderly male patients hospitalized with coronavirus disease 2019. The participants were followed until their time of discharge or death. The psoas muscle cross-sectional area, psoas density, and psoas muscle index measurements were performed based on a single-axial computed tomography section at the L2 vertebral corpus. The outcome measurements of the patients were determined as intensive care unit admission and mortality. Results: During the clinical course of these patients, 29.2% (38) were transferred to the intensive care unit, and 13.1% (17) died. The interclass correlation coefficients for the psoas muscle cross-sectional area and density were 0.91 and 0.93, respectively, between observers. Low psoas muscle index is significantly associated with mortality (p = 0.001), and the probability of mortality increases approximately 5–30 times as the psoas muscle index decreases. No factors were identified as being significantly associated with intensive care unit admission. Conclusion: In elderly male patients who are hospitalized due to coronavirus disease 2019, an assessment of the psoas muscle may provide additional information on the prognosis of the disease. © 2021, Geriatrics Society. All rights reserved.

New chalcone derivatives as effective against SARS-CoV-2 agent.

AIMS: Flavonoids and related compounds, such as quercetin-based antiviral drug Gene-Eden-VIR/Novirin, inhibit the protease of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The alkylated chalcones isolated from Angelica keiskei inhibit SARS-CoV proteases. In this study, we aimed to compare the anti-SARS CoV-2 activities of both newly synthesized chalcone derivatives and these two drugs. METHODS: Determination of the potent antiviral activity of newly synthesized chalcone derivatives against SARS-CoV-2 by calculating the RT-PCR cycling threshold (Ct ) values. RESULTS: Antiviral activities of the compounds varied because of being dose dependent. Compound 6, 7, 9, and 16 were highly effective against SARS-CoV-2 at the concentration of 1.60 µg/mL. Structure-based virtual screening was carried out against the most important druggable SARS-CoV-2 targets, viral RNA-dependent RNA polymerase, to identify putative inhibitors that could facilitate the development of potential anti-coronavirus disease-2019 drug candidates. CONCLUSIONS: Computational analyses identified eight compounds inhibiting each target, with binding affinity scores ranging from -4.370 to -2.748 kcal/mol along with their toxicological, ADME, and drug-like properties.

Acute kidney injury in hospitalized COVID-19 patients: A multicentre study by Turkish society of nephrology

BACKGROUND AND AIMS: Acute kidney injury (AKI) is common in coronavirus disease-2019 (COVID-19) and the severity of AKI is linked to adverse outcomes. In this study, we investigated the factors associated with in-hospital outcomes among hospitalized patients with COVID-19 and AKI. METHOD: In this multicenter retrospective observational study, we evaluated the characteristics and in-hospital renal and patient outcomes of 578 patients with confirmed COVID-19 and AKI. Data were collected from 34 hospitals in Turkey from March 11 to June 30, 2020. AKI definition and staging were based on the Kidney Disease Improving Global Outcomes criteria. Patients with end-stage kidney disease or with a kidney transplant were excluded. Renal outcomes were identified only in discharged patients. RESULTS: The median age of the patients was 69 years, and 60.9% were males. The most frequent comorbid conditions were hypertension (70.5%), diabetes mellitus (43.8%), and chronic kidney disease (41.5%). The proportions of AKI stages 1, 2, and 3 were 54.0%, 24.7%, and 21.3%, respectively. 291 patients (50.3%) were admitted to the intensive care unit. Renal improvement was complete in 80.7% and partial in 17% of the patients who were discharged. Renal outcomes were worse in patients with AKI stage 3 or baseline CKD. The overall in-hospital mortality in patients with AKI was 38.9%. By multivariate Cox regression analysis, age (hazard ratio [HR] [95% confidence interval (95%CI)]: 1.01 [1.0-1.03], p = 0.035], male gender (HR [95%CI]: 1.47 [1.04-2.09], p = 0.029), diabetes mellitus (HR [95%CI]: 1.51 [1.06-2.17], p = 0.022) and cerebrovascular disease (HR [95%CI]: 1.82 [1.08-3.07], p = 0.023), serum lactate dehydrogenase (greater than two-fold increase) (HR [95%CI]: 1.55 [1.05-2.30], p = 0.027) and AKI stage 2 (HR [95%CI]: 1.98 [1.25-3.14], p = 0.003) and stage 3 (HR [95%CI]: 2.25 [1.44-3.51], p = 0.0001) were independent predictors of in-hospital mortality. The in-hospital mortality rates across AKI stages by age, gender, and diabetes mellitus were shown in the Figure. CONCLUSION: Advanced-stage AKI is associated with extremely high mortality among hospitalized COVID-19 patients. Age, male gender, comorbidities, which are risk factors for mortality in patients with COVID-19 in the general population, are also related to in-hospital mortality in patients with AKI. Renal problems continue in a significant portion of the patients who were discharged.

Exercise Program for Covid-19 Survivors: A Telerehabilitation Framework

Coronavirus disease (COVID-19) is a serious acute respiratory syndrome that has been recognized as a pandemic disease caused by Coronavirus 2 (SARS-CoV-2). The complications related to coronavirus itself, physically inactive period due to symptoms of disease and lockdown may also influence the functional capacities of COVID-19 survivors negatively. It may lead to obstructions in engaging with previous activities of daily living. As a physiotherapy intervention, exercise treatment is one of the novel approaches to support these individuals after the COVID-19 treatment. However, there is limited access to physiotherapy and rehabilitation services during pandemic conditions because of lockdown, especially for infected patients. For increasing accessibility to physiotherapy and rehabilitation care, the World Confederation of Physical Therapy has published a report advising the home-based exercise interventions via Telerehabilitation. Up to date, there is no published framework for structured exercise programs for this population, yet. Since the individual differences in functional levels and possible differences in the severity of coronavirus infection, the physiotherapy, and rehabilitation exercise program should be structured individually for COVID-19 survivors. This document suggests a framework for physical therapists to put into practice an exercise training via telerehabilitation in COVID-19 survivors. The proposed framework has consisted of determination of eligible and risky COVID-19 patients for intervention, physiotherapy assessment tools, 6-week exercise prescription based on FIIT-VP principle (frequency, intensity, time, type, volume, and progression) and criteria for ending exercise.

Thromboembolic complications in Takotsubo Syndrome during Covid-19 outbreak. A review with case report

New coronavirus (COVID-19) outbreak, which started in Wuhan, China and spread rapidly all over the world, has become the most important cause of the emotional distress for susceptible people. Because the people also remained in fear and anxiety during the period when the elderly population in the whole country was desperate due to the COVID-19 outbreak and was asked to stay at home in fear of death. In addition, the fact that the patients were hospitalized together with COVID-19 patients caused his psychological distress to be experienced even more. Takotsubo Syndrome (TTS) is known as a distress-induced transient left ventricular dysfunction. In our patient with TTS, it was found that a new apical thrombus, which was not seen in the left ventricle, was seen in previous echo and computerized tomographic investigation, and that it was a source of thromboemboli, by stress triggering neurocardiac reactions. While under the medical treatment of viral pneumonia, under the Coronavirus transmission measures, thrombus in the LV was removed by being taken to the emergency open heart surgery. Our case is the first patient in the literature where a new thrombus developed in the LV and splenic infarction in TTS triggered by the pandemic. In this article;We have presented the experience of TTS triggered by pandemic, etiopathogenesis of left ventricular thrombus, open heart surgery indications when COVID-19 is suspected, coronavirus transmission measures in the surgical approach, the postoperative treatment and literature is reviewed.