Gastrointestinal and Liver Manifestations in Children with COVID-19 and Their Relationship to Clinical Course.

OBJECTIVE: Coronavirus disease 2019 is a major health problem in all age groups. Although most clinical symptoms are respiratory, gastrointestinal symptoms are often reported. This is a major concern for children and has limited research coverage. In this study, we evaluated the frequencies of gastrointestinal symptoms and liver biochemical findings in children with coronavirus disease 2019 and their relationship with clinical course and length of hospital stay. MATERIALS AND METHODS: Demographic data, clinical, and laboratory findings of children with Coronavirus disease 2019 who were followed up by the Department of Pediatric Infectious Diseases between March 2020 and August 2020 were recorded. They were classified accord- ing to age groups as <5 years, 5-10 years, and >10 years. Laboratory findings were analyzed according to age groups. Demographic, clinical, and laboratory findings were compared in both situations, the presence of gastrointestinal symptoms and the presence of elevated liver enzymes. It was considered statistically significant if it was <.05. RESULTS: A total of 294 patients (median age 10 years [14 days to 18 years]) were enrolled in this study. Although fever is the most common symptom of coronavirus disease 2019, 15.6% of patients presented with acute gastroenteritis. Most patients with liver involvement (n = 130, 44.2%) were under 5 years of age (n = 74, 56.9%, P <.001). The patterns of abnormal liver test results were cholestatic (71.5%), hepatocellular (18.4%), and mixed (10%) types. Severe or mas- sive elevation of aminotransferase or liver failure was not observed. No statistically significant difference was noted in outcomes, including length of stay, for patients with gastrointestinal symptoms (P = .178) or liver involvement (P = .146). CONCLUSION: The presence of gastrointestinal symptoms or elevated liver enzymes does not affect the course of the disease in children with coronavirus disease 2019.

Reduced Monocyte Subsets, Their HLA-DR Expressions, and Relations to Acute Phase Reactants in Severe COVID-19 Cases.

Monocytes are one of the principal immune defense cells that encounter infectious agents. However, an essential role of monocytes has been shown in the spread of viruses throughout the human body. Considering this dilemma, this study aimed to evaluate monocyte subsets and Human Leukocyte Antigen-DR isotype (HLA-DR) expressions in clinical coronavirus disease 2019 (COVID-19) cases. This prospective, multicenter, case-control study was conducted with COVID-19 patients and healthy controls. The patient group was divided into two subgroups according to disease severity (severe and non-severe). Three monocyte subsets (classical, CL; intermediate, INT; non-classical, NC) were analyzed with flow cytometry upon the patients' hospital admission. A total of 42 patients with COVID-19 and 30 controls participated in this study. The patients' conditions were either severe (n = 23) or non-severe (n = 19). All patients' monocyte and HLA-DR expressions were decreased compared with the controls (p < 0.05). Per disease severity, all monocyte subsets were not significant with disease severity; however, the HLA-DR expressions of CL monocytes (p = 0.002) and INT monocytes (p = 0.025) were more decreased in the severe patient group. In patients with various clinical features, NC monocytes were more affected. Based on these results, NC monocytes were more decreased in acute COVID-19 cases, though related various clinics decreased all monocyte subsets in these patients. Decreased monocyte HLA expressions may be a sign of immune suppression in severe patients, even when the percentage of monocyte levels has not decreased yet.

Clinical and Laboratory Characteristics of COVID-19 Cases Followed in Selcuk University Faculty of Medicine

Objective: Understanding the natural course of COVID-19 and determining its clinical findings are essential for early diagnosis and treatment. In this study, we aimed to investigate clinical and laboratory characteristics of cases followed with a diagnosis of COVID-19 in Selcuk University Faculty of Medicine Department of Infectious Diseases and Clinical Microbiology. Methods: Among patients followed with a diagnosis of possible/definitive COVID-19, those with a positive SARS-CoV-2 RT-PCR test were evaluated retrospectively in terms of their clinical, laboratory and thorax computed tomography (CT) data. Results: Among 407 patients followed with a diagnosis of possible/definitive COVID-19, 149 (36.6%) were SARS-CoV-2 RT-PCR test-positive. 82 (55%) of the patients were female and 67 (45%) were male. Mean age was 49.3 +/- 7.6 years. 11 (7.4%) were health care workers. While the most common symptom was cough with 46.3%, fever was observed in 29.5%, sore throat in 27.5% and malaise in 26.8% of the patients. 94 (63.1%) of the patients had underlying diseases. Hypertension and diabetes mellitus were the most common underlying disease. Laboratory findings were leukopenia in 12 (8.1%), lymphopenia in 34 (22.8%), thrombocytopenia in 24 (16.1%), elevated D-dimer levels in 43 (28.9%), elevated lactate dehydrogenase levels in 73 (49%), and elevated C-reactive protein (CRP) levels in 45 (30.2%) patients. While 71 (47.6%) of the patients had normal thorax CT, 43 (28.9%) had mild pneumonia, and 35 (23.5%) moderate pneumonia. D-dimer and CRP levels were higher in those with pneumonia than those without pneumonia (p=0.001 and p=0.001, respectively). As the pneumonia level increased, the increase of D-dimer and CRP levels became evident (p=0.003 and p=0.001, respectively). Conclusions: The clinical course of COVID-19 patients varies. It is noteworthy that there is a positive correlation between the severity of pneumonia and the increase in D-dimer and CRP levels in COVID-19.