Increased Mortality with Co-existence of Crimean-Congo Hemorrhagic Fever and COVID-19

Crimean-Congo hemorrhagic fever (CCHF) is an acute viral disease with fever and bleeding caused by a tick-borne virus belonging to the Bunyaviridae family. Coronavirus disease-2019 (COVID-19) is a novel disease caused by Severe Acute Respiratory Syndrome Coronavirus Type 2, which can lead to acute respiratory distress syndrome (ARDS). Here, we present a case with CCHF and COVID-19 co-infection to draw attention to the increased mortality in co-infection cases. A 77-year-old female patient with known hypertension was admitted to the emergency department with complaints of fever, nausea, vomiting, diarrhea, and myalgia for two days. There was no history of tick bite or contact with a patient with COVID-19. Current anamnesis and clinical and laboratory findings pre-diagnose the patient with CCHF, hemolytic uremic syndrome, and thrombotic thrombocytopenic purpura, leading to a ward admission. Crimean-Congo hemorrhagic fever was diagnosed after receiving a positive CCHF immunoglobulin M (indirect fluorescent antibody) result. A nasopharyngeal swab sample for COVID-19 real-time polymerase time reaction was sent due to a continuous fever and the development of shortness of breath on day three of hospitalization, which revealed positive results;thus, the patient was started on favipiravir treatment. The patient was transferred to the intensive care unit on day four due to increased oxygen demand and ARDS diagnosis. The patient died due to respiratory failure on the seventh day of hospitalization. COVID-19-related ARDS that overlapped on top of CCHF caused her to develop a cytokine storm and died despite her clinical parameter improvement due to CCHF. Crimean-Congo hemorrhagic fever and COVID-19 symptoms or findings can be confused because of their similarities, but the possibility of being seen together should not be overlooked. Concurrently, some similarities in the pathogenesis of these two diseases suggest that co-infection may worsen the clinical course;hence, new studies are needed on this subject.

Outcomes of High-Dose Vitamin C Therapy on Patients Diagnosed with COVID-19 Associated ARDS in Intensive Care Units: Multi-Center Retrospective Study

Background and Aim: The new type of Severe Acute Respiratory Syndrome Coronavirus 2 (Coronavirus 2019-COVID-19) infection is the largest pandemic in the last decade. Acute respiratory distress syndrome is the complication with the highest mortality rate of this infection and there is no adequate treatment with proven efficacy to reduce mortality. This multi-center, retrospective study aimed to determine the effect of high-dose vitamin C on survival and other endpoints in invasively ventilated ARDS patients. Method(s): This multi-center, observational retrospective cohort study was performed at five ICU centers between March 2020 and July 2020. Patients with ARDS due to COVID-19 who required IMV were included. High-dose vitamin C group was defined as patients who were treated with vitamin C over 200 mg/kg for four days. Patients who were not given vitamin C treatment were defined as the control group by using propensity score match analysis, as well. The groups were compared about the effects of high-dose vitamin C treatment on ICU mortality. Result(s): A total of 86 patients with a mean age of 67.85 +/- 10.38 were included in the study. 72.1% of the patients were male. Forty-two (49%) patients were in the high dose vitamin C group, and 44 (51%) were in the control group. The mean PaO2/FiO2 at the time of admission to the ICU was 128.27+/-58.69 mmHg (133.63+/-56.51 mmHg in the control group, 122.36+/-61.18 mmHg in the study group, p=0.389). The mortality rate of high dose vitamin C group was lower than the control group (73.8% vs. 90.9%, p = 0.037,respectively). Conclusion(s): As an adjunctive therapy in invasively ventilated patients with COVID-19-associated ARDS, high doses of vitamin C may reduce mortality and development of organ damage. Prospective, randomized controlled studies with larger numbers of patients are needed to confirm these findings.Copyright © 2023, Society of Turkish Intensivists. All rights reserved.

The effect of oral corticosteroid treatment on clinical course, hospitalization and mortality in COVID-19 patients

Introduction: It has been reported that short-term and lowdose intravenous corticosteroids prevent the progression of the disease and reduce mortality during the hyperinflammation period caused by the virus in COVID-19 disease. The aim of our study is to evaluate the clinical course, hospital readmission and mortality rates of patients with mild to moderate COVID- 19 pneumonia, who do not need oxygen and for whom we started outpatient corticosteroid treatment. Materials and Methods: Patients over the age of 18 who applied to our hospital with the diagnosis of mild-to-moderate COVID-19 pneumonia and were treated with outpatient oral systemic corticosteroid were included in the study. Inclusion criteria were pneumonia finding consistent with mild to moderate COVID-19 involvement in lung computerized tomography, seven days or more from symptom onset, and oxygen saturation of 93 and above. The patients were given dexamethasone 8 milligrams (mg) methylprednisolone 32 mg, methylprednisolone 40 mg as oral systemic corticosteroid. Results: The mean age of the patients was 49.2 +or- 12, and 60% of them were male. The median steroid duration was 6.76 +or- 2.35 days. Due to ongoing symptoms, 56% of the patients were admitted to the hospital again, 12% were hospitalized due to clinical and laboratory deterioration, the intensive care hospitalization rate was 3% and the mortality rate was 2% (2/100). Conclusion: As a result, the effectiveness of oral corticosteroids on mortality and morbidity has not been demonstrated in mild to moderate COVID-19 pneumonia. Well-designed randomized controlled studies are needed on this subject.

Inflammatory rheumatic diseases developed after COVID-19 vaccination: presentation of a case series and review of the literature.

OBJECTIVE: An increasing number of new on-set autoimmune-inflammatory rheumatic diseases (AIRD) after COVID-19 vaccination has begun to be reported in the literature. In this article, we present our patients with new-onset AIRD after vaccination for COVID-19 and review the literature on the subject. PATIENTS AND METHODS: We investigated the clinical characteristics and laboratory parameters of previously described "newly developed AIRD in individuals recently vaccinated for COVID-19", in 22 cases vaccinated with one of the COVID-19 vaccines (BNT162b2 or CoronaVac) approved in our country. RESULTS: We collected 22 cases (14 female, 63.6%) that developed an AIRD after COVID-19 vaccination. Mean age was 53±14.4 (24-87) years. The interval between the last dose of vaccination and the development of the first complaint was 23.9±19.5 (4-90) days. CoronaVac was administered to four patients, and the BNT162b2 to 18 patients. AIRD-related symptoms developed in 12 patients after the first dose, in 8 patients after the second dose, and in two patients after the third dose. Twelve out of the 22 (54.5%) cases were diagnosed with rheumatoid arthritis, two with SLE, and the remaining eight patients each with leukocytoclastic vasculitis, Sjogren's syndrome, psoriatic arthritis, ankylosing spondylitis, systemic sclerosis, mixed connective tissue disease, eosinophilic granulomatosis with polyangiitis, and inflammatory myositis, respectively. Six patients had a history of documented antecedent COVID-19 infection. CONCLUSIONS: Autoimmune/inflammatory rheumatic diseases may develop after COVID-19 vaccinations. In the era of the COVID-19 pandemic, vaccination should be questioned carefully in newly diagnosed AIRD patients.

The role of Diabetes mellitus in the progression and prognosis of COVID-19

Objective: The COVID-19 pandemic, caused by SARSCoV-2 of Coronaviruses types, is a highly infectious disease caused by SARS-CoV-2, which first appeared in China. The presence of comorbid diseases, especially diabetes, and advanced age are determinants of the mortality and morbidity of the disease. In this study, it was aimed to examine the possible role of Diabetes mellitus (DM) in the course of the novel coronavirus disease (COVID-19). Methods: In this study, the data of 81 patients who applied to Ankara Polatlı Duatepe State Hospital between January 01 and May 05, 2021 and were confirmed to have COVID-19 and were hospitalized in the COVID-19 service for 5 to 20 days were analyzed. 39 female and 42 male patients were included in the study and the patients were divided into three groups. COVID-19 group (n=26;10 female, 16 male), COVID-19+DM group (n=28;13 female, 15 male), and COVID-19+hypertension (HT) group (n=27;16 female, 11 male). Demographic, clinical, radiological and laboratory records of the patients were reviewed retrospectively. Results: There was a statistically significant difference between the groups when they matched for age and gender (p<0.05). The mean age of the COVID-19+DM and COVID-19+HT groups was higher than the COVID-19 group (p<0.05). COVID-19 group 55.96±15.545 years, COVID-19+DM 68.29±12.849 years, COVID-19+HT 71.48±11.416 years. Only 32 patients had positive PCR tests, and the rate was 39.5%. The number of patients with CT is 69, and the rate is 85.2%. The number of CT-positive patients is 56 and the positivity rate is 81%. The PCR test positivity rate is lower than the CT positivity rate. The serum fasting blood glucose (FBG) and C-reactive protein (CRP) levels were significantly higher in the COVID-19+DM group when compared to the COVID-19 group and COVID-19+HT group (p<0.05). The serum sodium (Na) and chlorine (Cl) levels were significantly lower in the COVID-19+DM group when compared to the COVID-19 group and COVID-19+HT group (p<0.05). The serum creatinine and phosphorus (P) levels were significantly higher in the COVID-19+DM group when compared to the COVID-19 group (p<0.05).The serum hemoglobin (HGB) and hematocrit (HCT) levels were considerably higher in the COVID-19 group compared to the COVID-19+DM group (p<0.05). Conclusion: When all the data we obtained in our study are evaluated;we determined that the comorbidity effect of DM is important in the clinical course of patients infected with the SARS-CoV-2 virus. We think that SARSCoV-2 pneumonia patients with diabetes may be more severe than those without diabetes in terms of organ damage, and inflammatory variables, and are more likely to evolve to a worse prognosis, regardless of whether the additional comorbidities were present or not. © 2022,Turk Hijyen ve Deneysel Biyoloji Dergisi. All Rights Reserved.

Efficacy of anticytokine treatments added to corticosteroids in patients with COVID-19-associated pneumonia and hyperinflammation: a single center experience.

OBJECTIVE: Pneumonia and hyperinflammatory state related to COVID-19 infection are fatal clinical conditions without definite treatment modalities. Interleukin-6 and Interleukin-1 targeted therapies have been proposed as treatment options. This study was conducted to investigate the efficacy of anakinra and tocilizumab added to corticosteroids in patients with COVID-19-associated pneumonia and hyper-inflammatory syndrome in our tertiary clinical center. PATIENTS AND METHODS: Patients with COVID-19-associated pneumonia and hyperinflammatory state who did not respond to initial treatments, including corticosteroids, were included in the study. The patients' electronic records were reviewed retrospectively and recorded according to a standardized data table. Univariate and multivariate regression analyses were used to identify risk factors associated with intubation. RESULTS: 388 patients were included in the study. 197 patients were intubated and most of them died (n=194/197, 98%). 67 patients received tocilizumab, and 97 patients received anakinra. Anakinra [OR: 0.440, 95% CI=0.244-0.794, p=0.006] and tocilizumab [OR: 0.491, 95% CI=0.256-0.943, p=0.033] were both associated with a decreased risk for intubation. However, having a neutrophil/lymphocyte ratio ≥ 10 [OR: 2.035, 95% CI=1.143-3.623, p=0.016], serum lactate dehydrogenase (LDH) level ≥ 400 [OR: 3.160, 95% CI=1.937-5.156, p<0.001] and age ≥ 50 [OR: 4.048, 95% CI=2.037-8.043, p < 0.001] was associated with an increased risk for intubation. CONCLUSIONS: Both anakinra and tocilizumab, added to initial standard COVID-19 treatments (including glucocorticoids) reduced the need for intubation in patients with COVID-19-associated severe pneumonia and hyperinflammatory syndrome. Given the high mortality rate of intubated patients with COVID-19, both treatments may have added benefits on mortality.

Determination of Depression, Anxiety and Stress in Pregnancy During the COVID-19 Pandemic

Objective: This study aims to determine the depression, anxiety and stress in pregnant women during the 2019 Coronavirus Disease (COVID-19) pandemic. Materials and Methods: The sample of this descriptive study consisted of 203 pregnant women reached over online between May 15 and June 1, 2020. To collect data in the study, the 'Personal Information Form', 'COVID-19 PandemicRelated Information Form' and 'Depression, Anxiety, Stress Scale-21 (DASS-21)' were used. Results: In our study, it was determined that 81.7% of the pregnant women experienced anxiety, 56.1% depression and 24.1% stress, according to the median values obtained from DASS-21. The median values of anxiety and stress of unemployed women were higher than those of working women and the difference between them was statistically significant (p=0.011;p=0.023). The differences between social media use (p=0.044;p=0.048;p=0.015), thinking that they are positive for COVID-19 (p=0.009;p=0.014;p=0.001), thoughts about the end of the COVID-19 pandemic (p=0.001;p=0.001;p=0.001), worrying about their own health and the fetus (p=0.001;p=0.001;p=0.001), and experiencing abnormal physical symptoms (p=0.001;p=0.001;p=0.001) had statistically significant effects on the anxiety, depression and stress subscale median values of pregnant women. Conclusion: Pregnant women were found to experience depression and anxiety during the COVID-19 pandemic. It is considered that knowing the negative psychosocial reactions experienced by pregnant women during the COVID-19 pandemic and taking protective measures will contribute to improving the health outcomes of the mother and the fetus.

The Importance of the Collaboration Between Communication Studies and Psychology: An Interdisciplinary Analysis in the Context of the COVID-19 Pandemic

Communication studies and the discipline of psychology have a major role in the analysis of the social and physical conditions that we experience and in evaluating the effects of these conditions. The interaction of these two disciplines has progressed further with the advancement and widespread use of communication technology and has constituted a multidimensional research tradition. Such an interdisciplinary approach has vital contributions to scientific studies. This study aims to emphasize the importance of the collaboration of communication studies and psychology by revealing the role of this interdisciplinary approach in the possible solution of the problems highlighted by the pandemic. For this purpose, research areas that need the collaboration of these two disciplines and new research questions for future studies have been identified and analysed by scanning the literature on the problems stood out during pandemic. In this study, it has been determined that this interdisciplinary approach can have important scientific contributions while handling a) the solutions of environmental problems faced globally, b) the effects of the pandemic on human psychology, c) the impacts of the pandemic on the breach of online privacy and surveillance practices, and d) the difficulties experienced in the development of positive health behaviours during the pandemic. It is hoped that the formulated research questions can lead the way for future studies and contribute to the post-pandemic period as well as the pandemic period.

Examination of social workers' attitudes towards sustainable development and environment in the focus of the COVID-19 pandemic

Purpose: The purpose of this paper is to assess the views of social workers concerning theoretical and practical courses covering their professional responsibilities, focussing on sustainable development and the natural environment. It also investigates the impact on their attitudes towards sustainable development referencing their adoption of ecocentric or anthropocentric attitudes during the COVID-19 pandemic. Design/methodology/approach: This study used a structural equation model to answer six research questions, while the descriptive statistics answered one of the research questions through an online survey conducted with 315 social workers. Findings: This study demonstrated the need to consider attitudes to sustainable development focussing on the ecocentric and anthropocentric attitudes, as well as the current COVID-19 global pandemic. Originality/value: This study is the first initiative to examine attitudes towards sustainable development and the natural environment from a social work perspective focussed on the COVID-19 pandemic. In addition, it is the first to emphasise the responsibilities of social workers in relation to micro, meso and macro level interventions during and after the global pandemic. © 2021, Emerald Publishing Limited.

Chloroquine and hydroxychloroquine in treatment of COVID-19 disease

The use of chloroquine and its derivatives as an anti-viral agent is supported by pre-clinical in-vitro studies and its clinical safety is known in the term of its other indications. But there is insufficient clinical data to support its use in critically ill patients with The noval corona virus disease 2019 (COVID-19). Nevertheless, it is recommended that these drugs, which are supported by the urgency of the COVID-19 pandemic in many national guidelines and consensus reports, including our country, should be applied in accordance with the guidelines.