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BACKGROUND AND AIM: Atypical pneumonia involves viral and some bacterial microorganisms in etiology. As Coronavirus 2019 (COVID-19) is newly identified, the differences between coronavirus and other microorganisms causing atypical pneumonia have not been fully expressed yet. We aimed to make a clinical comparison of cases with COVID-19 and atypical pneumonia. METHODS: "Non-COVID-19 atypical pneumonia" (non-COVID) group included patients with both radiological and clinical confirmation of atypical pneumonia by radiologists and clinicians. Patients with a positive polymerase chain reaction test formed "COVID-19 pneumonia" (COVID) group. Demographics, radiological, laboratory, and clinical features were recorded retrospectively. RESULTS: A total of 177 patients (46 non-COVID and 131 COVID) were included. The mean age of the COVID group was significantly lower (p=0.040). Ground-glass density and peripheral involvement were more common in thoracic computed tomography of patients with COVID-19 (p=0.017 and p=0.019). Fever and fatigue in COVID (p<0.001 and p=0.040) and shortness of breath and gastrointestinal complaints in non-COVID group were significantly higher as presenting symptoms (p<0.001 and p=0.031). In biochemical tests, impairment in liver function tests in COVID-19 (p<0.001), impairment in kidney function tests, increased C-reactive protein (CRP) and procalcitonin (PCT) in non-COVID-19 patients were more common (p=0.003, p=0.042, and p=0.023, respectively). Serum PCT, CRP, and lymphocyte levels were significantly lower in cases with COVID-19 (p<0.001, p=0.048, and p=0.016). There was no significant difference in the prognosis of both groups (p=0.556). CONCLUSIONS: With COVID-19 pandemic, there has been an increase in atypical pneumonia cases in which viral strains play a role. Symptomatic, laboratory, and radiological differences between two groups detected in our study may help in differential diagnosis especially in winter when atypical pneumonia is more common.
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Background and aims: Ocrelizumab is a humanized monoclonal antibody effective against CD20 positive B cells, approved by the FDA in 2017 to treat RRMS and PPMS. Despite these clinical studies, real-life data on ocrelizumab are limited. Methods: We conducted a retrospective single-center study in Turkey. We obtained medical record data of patients who received at least one infusion of ocrelizumab and were followed for one year before and after treatment initiation. Results: 240 MS patients were included in our study (58.75%) RRMS, (21.25%) SPMS, and (20%) PPMS). Median follow-up was14 months (range, 4-42). 92% of all patients received another DMT or immunosuppressant (98.58% of RRMS, 100% of SPMS, 64.58% of PPMS) prior to treatment with ocrelizumab. ARR before and after initiation of ocrelizumab for both the RRMS and SPMS groups (RRMS, 0.8 vs. 0.1;SPMS, 0.44 vs. 0.04). The most common reason for switching to ocrelizumab was clinical and/or radiological activity. NEDA status at year one was achieved in 88.54% of the RRMS population, and disability progression was found at 12.77% in the same MS subtype. Despite premedication (97.91%), infusion-related reactions were reported in (15.41%). The most common infection in our study was COVID-19 infection (18.33%), followed by urinary and upper respiratory tract infections. Conclusion: According to the first real-world preliminary study in the Turkish MS population using ocrelizumab, it is a well-tolerated, safe, and effective treatment agent in suppressing disease activity in both RRMS and progressive MS forms.
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The unprecedented COVID-19 crisis apparently has questioned our systems' survivability nationally or even in a global context. The pandemic has proven the indispensable role of international shipping in our societies’ sustainability. Still, one of the main challenges for the shipping industry is to secure the supply of competent seafarers. Typically, Maritime Education and Training Institutions' (METIs’) core mission revolves around keeping such demand supplied, however in restrictive situations, METIs' capability to achieve their mission is still questionable. During the pandemic restrictions, METIs are likely exposed to many uncertainties that directly threaten their role and may lead to hazardous consequences. In such scenarios, many questions arise to challenge whether the institution/organizational levels of control are sufficient or additional barriers to keep the risk as low as reasonably practicable are needed. Consequently, this research investigates the possible threats exposed to METIs under such conditions, the potential consequences if they lose control of their operations, and the required barriers to prevent, detect, or protect the METIs from such a failure. To achieve this aim, a survey was designed to capture the expertise of a group of Maritime Education and Training (MET) experts. The survey responses have been quantified and statistically analysed to comprehensively identify these risk factors, their contribution, and their effectiveness. © 2021 21st Annual General Assembly, IAMU AGA 2021 - Proceedings of the International Association of Maritime Universities ,IAMU Conference. All rights reserved.
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Introduction: Severe acute respiratory syndrome coronavirus-2 (SARSCoV- 2) is the virus that causes coronavirus disease 2019 (COVID-19), first reported from the Wuhan city of China in December 2019, affected all the world in a few months and became a global health emergency of primary international concern and was announced a pandemic by the World Health Organisation. Although the disease is showing a milder course in children, vaccination of this age group may be important due to increased number of the multisystem inflammatory syndrome (MIS-C) and vaccines role in prevention of the spread of infection in children who have had asymptomatic disease. As vaccine refusal and hesitancy are increasing around the world, a new problem has emerged for children with pediatric rheumatic diseases who are already prone to infection. Objectives: This study aimed to investigate the parental acceptance of COVID-19 vaccination for children with chronic rheumatic diseases when the vaccine is approved in childhood and to evaluate the background characteristics of willingness to get COVID-19 vaccine. Methods: The study included an analysis of a cross-sectional online questionnaire to the parents of the patients diagnosed with a chronic rheumatic disease at the Pediatric Rheumatology Outpatient Clinic of Istanbul Faculty of Medicine. A message containing a link to the actual questionnaire was sent to their phones simultaneously which covers their view for the SARS CoV-2 infection, sociodemographic data, thoughts about the vaccine, their child's behavior during the pandemic related to the disease, and completed by selfresponse method. Clinical information was accessed from the medical records of the patients. Results: The prevalence of parents' acceptance of COVID-19 vaccination for their children was 39.5% (30/76). The proportion of parents who were hesitant about the vaccination of their children was 47.4%. Whereas, the rates of acceptance of the vaccine by mothers and fathers themselves were 48.7% and 52.6%, respectively. Factors for vaccine referral were side effects (47.4%), limited information about the vaccine (45.2%) and possible ineteraction of the vaccines with the medications of the patients (40.2%). Parents were able to give multiple answers to this question. There was no significant relationship between the parents' educational status and their acceptance of the vaccine (respectively p=0.09, p=0.10) Conclusion: Children can serve as a reservoir that will undermine efforts to end the pandemic. While the vaccines have yet no approval for children <18 years, vaccinating children against the COVID-19 virus will contribute to the pandemic control, and the recovery of the global economy. The preliminary results of this survey targeting parents may be guide for physicians while promoting vaccination in the near future.
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Background: Drugs with the potential to prolong QT are used in the treatment of coronavirus 19 (COVID-19) pneumonia. We have developed a telemedicine-based corrected QT (QTc) follow-up algorithm that allows early rule out for follow up. Aims: In this study, we investigated the availability and safety of the algorithm. Study design: Retrospective cohort Methods: Consecutive patients;administered hydroxychloroquine (HCQ) for COVID-19 pneumonia were enrolled into digital ECG recording program which includes QTc follow-up algorithm. Results: Patients were classified into three groups as those, excluded promptly from the QTc follow-up based on two consecutive ECG findings (early rule out, n = 92) and those, for whom the follow-up was continued (n = 12) and usual care group (n = 68). Of note, 237 ECG tracings were performed in our algorithm population contrary to standard practice of daily recommended ECG monitoring which could have yielded 975 ECG tracings along with accompanied risks of exposure. This way;we ended in 738 (75.7%) fewer ECG tracings. Sustained ventricular arrhythmia or sudden cardiac death was not observed in the entire patient population. Conclusions: It is safe to rely on telemedicine-based early rule out algorithm in COVID-19 patients, receiving hydroxychloroquine treatment. This algorithm abolished the need for further ECG in majority of patients without increased risk during follow up. These algorithms can significantly reduce the healthcare worker exposures by eliminating the need for ECG follow-up promptly.
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BACKGROUND: The pandemic of the new type of corona virus infection 2019 [Covid-19] also affect people with Multiple Sclerosis (pwMS). Currently, the accumulating information on the effects of the infection regarding the demographic and clinical characteristics of the disease, as well as outcomes within different DMTs¸ enable us to have better practices on the management of the Covid-19 infection in pwMS. OBJECTIVE: To investigate the incidence of coronavirus disease 2019 (Covid-19) and to reveal the relationship between the demographic-clinical and therapeutic features and the outcome of Covid-19 infection in a multi-center national cohort of pwMS. METHODS: The Turkish Neurological Society-MS Study Group in association with the Italian MuSC-19 Study Group initiated this study. A web-based electronic Case Report Form (eCRF) of Study-MuSC-19 were used to collect the data. The demographic data and MS histories of the patients were obtained from the file tracking forms of the relevant clinics. RESULTS: 309 MS patients with confirmed Covid-19 infection were included in this study. Two hundred nineteen (219) were females (70.9%). The mean age was 36.9, ranging from 18 to 66, 194 of them (62.8%) were under 40. The clinical phenotype was relapsing-remitting in 277 (89.6%) and progressive in 32 (10.4%). Disease duration ranged from 0.2 years to 31.4 years. The median EDSS was 1.5, ranging from 0 to 8.5. The EDSS score was<= 1 in 134 (43%) of the patients. 91.6% of the patients were on a DMT, Fingolimod was the most frequently used drug (22.0%), followed by Interferon (20.1%). The comorbidity rate is 11.7%. We were not able to detect any significant association of DMTs with Covid-19 severity. CONCLUSION: The Turkish MS-Covid-19 cohort had confirmed that pwMS are not at risk of having a more severe COVID-19 outcome irrespective of the DMT that they are treated. In addition, due to being a younger population with less comorbidities most had a mild disease further highlight that the only associated risk factors for having a moderate to severe COVID-19 course are similar with the general population such as having comorbid conditions and being older.
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COVID-19 , Multiple Sclerosis , Adult , Cohort Studies , Female , Fingolimod Hydrochloride , Humans , SARS-CoV-2ABSTRACT
Background and Aim: Experimental Hydroxychloroquine (HCQ)/Azithromycin (AZT) combination treatment is a widely accepted experimental treatment for COVID-19 and concerns stated about the potential lethal ventricular arrhythmias (VA). Corrected QT, Tpeak-Tend interval (Tp-e) and QT dispersion have been accepted as novel markers for the assessment of myocardial repolarization and VA. We aimed to evaluate the effects of HCQ±AZT treatment on ECG repolarization parameters among patients treated for COVID-19 and their association with the with poor prognos. Methods: All consecutive adult patients diagnosed with COVID-19 and hospitalized for treatment with HKK± AZT in participating centers were evaluated. Exclusion criteria: structural heart disease, Class I/III antiarrhythmic use, complete-bundle-branch-block, high-grade-AV-block, non-sinus rhythms and acute coronary syndrome in follow-up. Bazett qtc corrected tpte "Poor clinical outcome (PCO)" is defined as a combined definition for any of the following clinical features as in hospital death/>7 days of hospitalization/endotracheal entubation and/or ICU stay. Results: Of 312 cases, 296 patients (153 females, 56±21 years) were included for analysis. 136 patients also received AZT in addition to HCQ (46% of population, male%:female% 48.5:44 p=0.44). Mean follow up time was 8±5 days (Min-Max 1-35 days). In hospital death was observed in 14 patients (4.7%, 78±17 years) and all were due to multi-organ failure in intensive care unit. PCO occurred in 88 patients (29.7%, mean±SD 64±20 years which was significantly older, p<0.001). Female mortality rate=5.2% while male=4.2% non significant trend for females p=0.7. No lethal VA or any dysrhythmic death was observed in the follow up. QT/QTc intervals and QTdisp were significantly prolonged at the end of the treatment protocol with HCQ±AZT (mean±SD ms change from baseline to the end of the protocol in both sexes = QTc 422±30 to 431±32, p<0.001, QT dispersion-C median ± SEM ms 26±1.4 to 27±1.5 p=). 7.4% (17 cases) >50 ms Delta QTc and. TpTe, TpTe-c, QTd, QTdc and TpTe/QT parameters did not significantly prolong throughout the protocol. However, delta QTc was found to be correlated with and delta QTc >50 ms significantly predicts PCO [(OR 3.8 (95% CI 1.2-12) (p=0.02)]. Presence of prolonged long QT features on ECG at the end of the protocol (p=0.04) and QTdc >50 ms (p=0.04) were significantly associated with PCO. Conclusions: HCQ/AZT treatment prolongs QTc interval while seemingly exerting no profound effects on surface ECG repolarization parameters. This might be hypothesized as one of the reasons of observed low dysrhythmic events in our cohort of COVID-19 patients. More homogenous transmural repolarization prolongation without evident dispersion of repolarization on human myocardium obsrerved in our cohort with the HCQ use might be protective against the expected deleterious effects of ordinary QT prolonging drugs.