Evaluation of the effect of the COVID-19 pandemic on mucormycosis studies with bibliometric analysis.

BACKGROUND: Coronavirus disease 2019 (COVID-19)-associated mucormycosis (CAM) is a relatively new concept in the literature that emerged during the pandemic. Bibliometric analysis is a type of analysis that uses mathematical and statistical methods to study the formal properties of knowledge areas. This study aimed to reveal the main themes, conceptual structures, and trends of bibliometric studies on mucormycosis in 2 different periods, pre-and during the pandemic. METHODS: This study consisted of 2 periods: pre-COVID-19 and COVID-19. Articles were collected from the Web of Science (WOS) Core Collection database. We provided AND and OR connectors for the keyword query and selected studies based on relevant keywords. Collected data were classified based on their publication date and examined using the R programming language (Version 4.0.3) package Bibliometrix and SciMAT Software. RESULTS: A total of 1261 articles were investigated, and performance and information structure analyses were conducted. Based on Bradford's law, the Journal of Fungi was the top-ranked journal in both periods. Cureus and mycoses were placed 2nd and 3rd in the second period. India is the largest contributor. In performance analysis, conceptual structures such as Rhizopus oryzae, epidemiology, diagnosis, management, treatment, and outcomes were at the forefront of mucormycosis publications during the COVID-19 period. CONCLUSIONS: Research trends have shifted to the clinical treatment and management of COVID-19. Therefore, pathogenesis, diagnosis, follow-up, and treatment strategies for CAM should be developed in the future.

The impact of COVID-19 pandemic on sleep quality in healthcare workers in Turkey.

Background: The COVID-19 pandemic has caused serious concerns and psychological distress globally. Healthcare workers remain one of the most affected groups due to life threatening risks in addition to increased working hours and labor intensity. All these factors may affect sleep quality of this population. The aim of this study is to evaluate the sleep behaviors of healthcare professionals working in secondary and tertiary hospitals in a large population in Turkey and to show how sleep quality is affected during the pandemic process using the easily applicable Jenkins Sleep Scale (JSS). The population of this cross-sectional descriptive study consists of two pandemic hospitals determined in Kahramanmaras province. In our questionnaire, we asked subjective sleep quality, sleep time, time to fall asleep, total sleep time, and medication use. We also used JSS Turkish version (JSS-TR) to assess sleep quality and the Epworth Sleepiness Scale (ESS) for increased daytime sleepiness. Results: Healthcare workers who participated in our survey reported that they started to go to bed later, fell asleep later (mean: 41.75 ± 35.35 min), their total sleep time (mean: 6.67 ± 1.88 h) was shortened, and they needed medication to sleep more (5.7%) after the COVID-19 pandemic. During the COVID-19 pandemic, bedtime behavior after 24:00 decreased from 80.1 to 43.9% of those who previously went to bed before 24:00. For those who went to bed after 24:00 before, it increased from 19.9 to 56.1%. In addition, sleep quality as assessed by subjective and JSS significantly deteriorated after the COVID-19 pandemic. Excessive daytime sleepiness increased. Those with ESS > 10 before and after COVID-19 were 3.9% and 14.1%, respectively (p < 0.001). Conclusions: The COVID-19 pandemic has significantly adversely affected the sleep behavior and sleep quality of healthcare professionals. The JSS is an easily applicable scale for assessing sleep quality in large population studies.

Comparison of SARS-CoV-2 Antibodies and Six Immunoassays in Pediatric and Adult Patients 12 Weeks After COVID-19.

Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific humoral immune persistence has been proposed to be affected by patients' characteristics. Moreover, available conflicting assay results are needed to be settled through comparative research with defined clinical specimens. Methods This prospective study investigated SARS-CoV-2-specific antibodies among 43 adults and 34 children at a mean of 12 weeks after the onset of COVID-19 symptoms using six serological assays and compared their performance. We used two Euroimmun (Euroimmun, Luebeck, Germany), two automated Roche Elecsys (Basel, Switzerland), and two rapid immuno-chromatographic Ecotest (Matrix Diagnostics, Assure Tech. (Hangzhou) Co., L, China) assays to investigate SARS-CoV-2 antibodies. Results The findings showed that the Roche Elecsys anti-S total test yielded the best positivity/sensitivity (children 94.1% and adults 93.0%; p = 0.877) while five immunoglobulin IgG targeting assays had similar positivity/sensitivity between children (88.2% to 94.1%) and adults (88.4% to 93.0%) (p > 0.05). Although IgM positivity was relatively low (p < 0.001), it was found in the majority of our pediatric and adult patients (67.6% and 86.0%, respectively; p = 0.098). SARS-CoV-2 S IgG titers were found to be higher among males in pediatric and adult groups compared to females (p = 0.027 and p = 0.041, respectively). Furthermore, we observed significantly higher antibody titers among pneumonia patients (p = 0.001). Conclusion Overall, we concluded SARS-CoV-2 antibody persistence over an average of 12 weeks after the onset of COVID-19 symptoms. While automated Roche Elecsys total antibody assays yielded the best sensitivity (> 90%) and five assays targeting IgG had acceptable performance. Patients with pneumonia and males have higher antibody titers. The effect of antibody persistence on re-infections should be monitored in longitudinal studies.

Nosocomial Infections in Non-COVID-19 Pediatric Patients Prior to and During the Pandemic in a Pediatric Intensive Care Unit.

BACKGROUND: Nosocomial infections are a global threat to human health worldwide. AIM: This study aimed to investigate the change of nosocomial infection factors in equivalent historical periods in pediatric patients without COVID-19 before and during the pandemic in the pediatric intensive care unit. METHOD: The study was planned retrospectively. Data on hospital infection rates, incidence densities, invasive device-associated infections, infectious agents, comorbid diseases, and invasive procedures in non-COVID-19 pediatric patients were obtained from the medical records for the periods of April-September 2019 and April-September 2020 in the pediatric intensive care unit. Hand hygiene compliance rates of healthcare workers were evaluated. RESULTS: Prior to the pandemic, the number of patients was 332, comprising 2,377 patient days with a nosocomial infection rate of 5.12, and an incidence density of 7.15. During the pandemic, the number of patients was 221, comprising 2,260 patient days with a nosocomial infection rate of 4.52, and incidence density of 4.43. Prior to the pandemic, there were 28.80% cases of Klebsiella pneumoniae, 23.81% of Pseudomonas aeruginosa, 9.52% of Enterococcus faecium, and 4.76% of Enterococcus faecalis. During the pandemic, there were decreased 14.29% cases of Klebsiella pneumoniae while Pseudomonas aeruginosa, Enterococcus faecium, and Enterococcus faecalis was not seen. Prior to the pandemic, the hand hygiene compliance rate was 94.83%, and during the pandemic, it was found to be 99.44%. CONCLUSION: This study showed that the spread of bacteria such as Klebsiella pneumoniae, Pseudomonas aeruginosa, vancomycin-resistant enterococci, and Stenotrophomonas maltophilia, which are a major public health threat, can be decreased by applying simple standard methods.

Nine-month course of SARS-CoV-2 antibodies in individuals with COVID-19 infection.

BACKGROUND: The continual course of the pandemic points to the importance of studies on the rate and durability of protective immunity after infection or vaccination. AIMS: In this study, we aimed to monitor anti-nucleocapsid (N) and anti-spike (S) antibodies against SARS-CoV-2 nearly 9 months duration after infection. METHODS: Anti-nucleocapsid (N) (at 11-15-20-29-38 weeks) and anti-spike antibodies (at 11 and 38 weeks) against SARS-CoV-2 were monitored during 38 weeks after the initial symptoms of COVID-19. RESULTS: Of 37 cases between 18 and 57 years old, 54% were women. The findings showed that anti-N antibodies decreased significantly after the 15th week (between 15 and 20 weeks, p = 0.016; 20-29 weeks, p = 0.0009; and 29-38 weeks, p = 0.049). At the 38th week, mean antibody levels decreased 35% compared to the 11th week, and 8% of the cases turned negative results. Anti-N antibody average level was 56.48 on the 11th week (the cut-off index threshold ≥ 1). It was estimated statistically that it would decrease to an average of 20.48 in weeks 53-62. In females, average antibody levels of all measurements were lower than males (p > 0.05). Anti-S antibody levels 14% increased at 38th week compared to 11th week (quantitative positivity threshold ≥ 0.8 U/ml), and no cases were negative at 38th week. CONCLUSIONS: Patients had ≥ 90% positivity after at least 9 months of symptoms, both anti-N and anti-S antibodies. In all samples, both anti-N and anti-S antibody levels were lower in females. The findings suggest that the quantitative values of anti-S antibodies remained high for at least 9 months and could provide protection.

Modified Lung Ultrasound Score in Evaluating the Severity of Covid-19 Pneumonia.

Severe acute respiratory syndrome coronavirus 2 causes coronavirus disease 2019 (Covid-19), which has been declared as a pandemic by the World Health Organization. The aim of the study described here was to determine the severity of pneumonia and the clinical parameters related to a modified lung ultrasound score (mLUS) in patients with COVID-19 pneumonia. The study included 44 patients with proven COVID-19 pneumonia. Patients were divided into three groups on the basis of pneumonia severity: mild/moderate pneumonia (group I), severe pneumonia (group II) and critically ill patients (group III). It was determined that mLUS values in groups I-III were 6.51 ± 4.12, 23.5 ± 5.9 and 24.7 ± 3.9, respectively. mLUS values were significantly higher in group II and III patients than in group I patients. There was a positive relationship between mLUS and age and N-terminal pro-brain natriuretic peptide level and a negative relationship with PaO2/FiO2 (p = 0.032, ß = 0.275 vs. p = 0.012, ß = 0.315 vs. p = 0.001, ß = -0.520, respectively). In patients with COVID-19 pneumonia, mLUS increases significantly with the severity of the disease.

Is there a link between pre-existing antibodies acquired due to childhood vaccinations or past infections and COVID-19? A case control study.

BACKGROUND: There is growing evidence indicating that children are less affected from COVID-19. Some authors speculate that childhood vaccinations may provide some cross-protection against COVID-19. In this study, our aim was to compare the circulating antibody titers for multiple childhood vaccine antigens, as an indicator of the state of immune memory between patients with COVID-19 and healthy controls, with a specific aim to identify the association between disease severity and antibody titrations which may indicate a protective function related to vaccine or disease induced memory. METHODS: This study is a case-control study including 53 patients with COVID-19 and 40 healthy volunteers. COVID-19 severity was divided into three groups: asymptomatic, mild and severe. We measured the same set of antibody titers for vaccine antigens, and a set of biochemical and infection markers, in both the case and control groups. RESULTS: Rubella (p = 0.003), pneumococcus (p = 0.002), and Bordetella pertussis (p < 0.0001) titers were found to be significantly lower in the case group than the control group. There was a significant decline in pneumococcus titers with severity of disease (p = 0.021) and a significant association with disease severity for Bordetella pertussis titers (p = 0.014) among COVID patients. Levels of AST, procalcitonin, ferritin and D-dimer significantly increased with the disease severity. DISCUSSION: Our study supports the hypothesis that pre-existing immune memory, as monitored using circulating antibodies, acquired from childhood vaccinations, or past infections confer some protection against COVID-19. Randomized controlled studies are needed to support a definitive conclusion.

Treatment of Crimean-Congo Haemorrhagic Fever by Favipiravir in a Patient with Novel Coronavirus Co-Infection.

INTRODUCTION: Crimean-Congo haemorrhagic fever (CCHF) is a lethal zoonotic disease caused by an RNA virus that is a member of the Nairovirus genus in the Bunyaviridae family from the arbovirus group. CCHF is transmitted by Hyalomma ticks through direct contact with the blood and other bodily fluids of patients or infected animals. CASE DESCRIPTION: A 65-year-old man was admitted to the emergency unit with dry cough, myalgia and fever. He was treated with favipiravir. He had disseminated intravascular coagulopathy with thrombocytopenia in the setting of COVID-19 infection. He tested positive for both COVID-19 and CCHF. By the end of the fifth day of treatment, his laboratory parameters and clinical symptoms had normalized. CONCLUSION: Favipiravir is currently on the market for treating COVID-19 infection worldwide. It has also been used to treat CCHF in laboratory animals. To the best of our knowledge this is the first report of CCHF successfully treated with favipiravir, which could be a key drug for treating human CCHF. LEARNING POINTS: Clinicians should be alert for concomitant viral infections such as Crimean-Congo haemorrhagic fever, which share similar clinical and laboratory findings to COVID-19.The effectiveness of favipiravir for viral infections other than influenza and COVID-19, such as Crimean-Congo haemorrhagic fever, should be elucidated.

Diagnostic performance of low-dose chest CT to detect COVID-19: A Turkish population study.

PURPOSE: We aimed to evaluate the diagnostic performance of low-dose chest computed tomography (CT) in patients under investigation for coronavirus disease 2019 (COVID-19). METHODS: This retrospective study included 330 patients suspected of having COVID-19 from March 15 to April 16, 2020. We examined 306 patients upon initial presentation using both CT and real-time reverse-transcriptase polymerase-chain-reaction (rRT-PCR). The diagnostic performance of CT was calculated using rRT-PCR as a reference. Clinical and laboratory data, CT characteristics, and lesion distribution were assessed for patients with a confirmed diagnosis via rRT-PCR. RESULTS: A total of 250 patients were finally diagnosed with COVID-19. Clinical and laboratory findings included myalgia or fatigue (76%), fever (64.8%), dry cough (60.8%), elevated levels of C-reactive protein (86.4%), procalcitonin (62%), and D-dimer (58.2%), increased neutrophil-lymphocyte ratio (NLR) (54.8%), and lymphopenia (34%). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the initial CT scan were 90.4% (95% IC, 86%-93%), 64.2% (95% IC, 50%-76%), 91.8% (95% IC, 88%-94%), and 60% (95% IC, 49%-69%), respectively. The percentage of patients diagnosed on the initial rRT-PCR test was 51.6% (n=129). Most frequent CT characteristics of COVID-19 in the subgroup of rRT-PCR-positive patients were multiple lesion (97.4%, n=220), followed by bilateral involvement (88.5%, n=200), peripheral distribution (74.3%, n=168), ground-glass opacity (GGO) (69.2%, n=157), subpleural curvilinear opacity (41.6%, n=104), and mixed GGOs (27.6%, n=67). CONCLUSION: rRT-PCR may produce initial false negative results. For this reason, typical CT findings for COVID-19 should be known especially by radiologists. We suggest that patients with typical CT findings but negative rRT-PCR results should be isolated, and rRT-PCR should be repeated to avoid misdiagnosis.

YouTube as a source of information on COVID-19 and rheumatic disease link.

INTRODUCTION/OBJECTIVES: The current 2019 novel coronavirus outbreak is continuing to spread rapidly despite all efforts. Patients with rheumatic disease may have higher levels of anxiety due to their disease characteristics and medications. The web-based platforms are widely used sources for gaining medical information. YouTube presents a wide range of medical information, but there are concerns on its quality. Therefore, we aimed to evaluate the quality of the YouTube videos about COVID-19 and rheumatic diseases link. METHOD: This is a descriptive study. A total of 360 videos listed by the YouTube search engine (www.youtube.com) in response to six search terms were evaluated. The Global Quality Scale (GQS) was performed to evaluate video quality. Three groups were formed according to GQS scores: high quality, moderate quality, and low quality. Video parameters were compared between these groups. RESULTS: After the exclusion criteria, 46 videos were reviewed. Of the videos, 41.4% (n = 19) were of high-quality group, 21.7% (n = 10) were moderate-quality group, and 36.9% (n = 17) were of low-quality group. Significant difference was detected between the quality groups in terms of views per day (p = 0.004). No significant difference was detected in comments per day (p = 0.139) and like ratio (p = 0.232). CONCLUSIONS: Besides high-quality videos, there were substantially low-quality videos that could cause misleading information to spread rapidly during the pandemic. Videos from trustworthy sources such as universities, academics, and physicians should be kept in the foreground.Key Points•Web-based platforms have become an important source of health-related information. One of the most important online sources is YouTube because it is easy accessible and free.•Of the videos evaluating the link between COVID-19 and rheumatic diseases, 41.4% (n = 19) were of high quality.•The main sources of high-quality videos were academics/universities and physicians.•The most frequently discussed topics in videos were the place of hydroxychloroquine in the treatment of COVID-19 and whether to continue the use of existing rheumatological drugs.