Use of ABO blood groups and co-morbidities as predictors of mortality in COVID-19 patients.

OBJECTIVE: This study aimed to investigate the mortality relationship between COVID-19 and ABO blood groups and comorbid diseases. The aim of this study was to determine whether ABO blood groups and comorbid diseases can be used as a prognostic factor for hospitalization. PATIENTS AND METHODS: This retrospective study included patients aged ≥ 18 years presenting to the adult emergency COVID-19 outpatient clinic. COVID-19 patients were divided into four stages according to their clinical status: mild, moderate, severe, and critical. Those with the comorbid disease were classified as Group I, and those without comorbid disease were classified as Group II. RESULTS: Of the 384 patients included in the study, 190 (49.5%) were male and 194 (50.5%) were female, with a mean age of 47.3 ± 18.4 years. The clinical data of the patients were scanned from the hospital automation system. Although the risk of transmission was higher, especially in people with A blood type, this rate was lower in the O blood group. The clinical course of the disease was more severe and the mortality rates were higher in the AB blood group (p < 0.001). In the hospital, 35 people who were treated for COVID-19 disease died. CONCLUSIONS: Certain ABO blood types and comorbid diseases were important risk factors for COVID-19 and were associated with mortality. We found that some ABO blood groups and comorbid diseases are associated with COVID-19 and may be important risk factors. While the risk of transmission of COVID-19 is high in blood group A, we think that the clinical course of COVID-19 may be more severe and the death rate higher in blood group AB.

A recovery rash: White islands in a sea of red

Introduction People are travelling to regions where Dengue fever is endemic. Physicians should be able to recognize the clinical presentation of this viral infection. Dengue fever is associated with mucocutaneous manifestations such as flushing erythema and maculopapular or morbilliform eruption during the acute phase. However, in rare cases, a rash may occur during the recovery phase and seems to be due to an immune reaction. Case description A 33-year-old woman was evaluated for high fever (T: 39-40degreeC) since 5 days. Her main complaints were headache, muscle pain and dry cough. There were no dyspnea, gastro-intestinal or urinary symptoms. She had no relevant past medical history and was not taking any medication. She returned from a 3-week holiday in Thailand 6 days before. She mentioned mosquito bites during her holiday and did not use repellent or prophylaxis for malaria. On physical examination, temperature was 37.2degreeC, blood pressure 100/50 mmHg, heart rate 61 beats per minute and oxygen saturation 99% while breathing ambient air. Cardio-respiratory auscultation and abdominal examination were normal. She had no skin rash and no arthritis. She did not had signs of throat infection. Neurological examination was normal. The neutrophil count was 590/mm c, lymphocyte count 580/mm, 3 and the platelet count 78.000/mm, 3 . CRP was 1 mg/L. LDH was slightly elevated (267 U/L) and GOT (44 U/L). Urine analysis was negative (44 white blood cells/muL). Blood cultures were taken. Nasopharyngeal swab for SarsCov2 (PCR) was negative. Two tick blood smears at 12 h interval were negative for malaria parasites. Serology for EBV was positive (but with presence of anti EBNA). Serology for CMV was negative for acute infection. The patient was immune for Hepatitis A and negative for Hepatitis B/C, Syphilis and HIV. Chest X-ray was normal and the patient was discharged with a prescription of Paracetamol with a follow-up consultation in 1 week. Five days later, the patient came back to the emergency ward because of a rash that was evolving since 3 days on her legs, arms, thorax and abdomen. The skin rash was not itchy or painful and was characterized by a confluent erythema with several white spots. She mentioned no more fever or muscle pain. Her neutrophil count was 1000/mm c, lymphocyte count 1220/mm, 3 and platelet count 165.000/mm3. There was still no elevation of CRP level. Liver enzymes were higher (GOT 69 U/L, GPT 62 U/L) and LDH 480 U/L. The patient was discharged with no extra measures but a follow-up consultation. Based on the skin manifestation (erythematosus rash with island of sparing), a Dengue infection was suspected. One week later, she was evaluated on the internal medicine consultation. She had no persistent complaints. There was still a skin hyperpigmentation, particularly on the legs and serology for Dengue came back positive. Conclusion(s): When faced with an erythematous or petechial rash with areas of normal skin (isles of white in a sea of red) in a patient with a history of traveling, a Dengue infection should be highly suspected.

Fever and rash: Do not MIS the diagnosis

Case description A 25-year-old patient was admitted for high fever (T: 39degreeC) since 1 week and a generalized maculopapular rash since 3 days. The eruption spread from his legs to his chest but spared his face. There were also papules on his hand palms while his foot soles were deeply erythematous. The patient described a sore throat, dry cough, slight retrosternal discomfort and muscle pain the week before. He also noticed a redness of his eyes since 2 days. There was no recent travelling, sexual intercourse and no animals at home. He was vaccinated against measles and COVID-19. His last proven COVID-19 infection dated from 8 months earlier. He was not taking medication and had no past medical history. Clinically, the patient had a generalized maculopapular eruption, multiple cervical lymphadenopathy, cheilitis, bilateral conjunctivitis and a hepatosplenomegaly. Labs showed a CRP at 312 mg/L, neutrophil count at 13.000/mm c, platelet count at 169.000/mm c, total bilirubin at 1,7 mg/dL (mostly direct), ASAT 100 U/L, ALAT 150 U/L, GGT 202 U/L and LDH 348 U/L. Creatinine level was 1,17 mg/dL. Troponine count was 187ng/L. D-dimers were elevated at 3069 ng/mL and ferritin level was also elevated at 3268 microgramme/L. There was a slight disturbance of INR (1,9). NT-ProBNP level was 1911 pg/mL. Urine analysis was normal and blood cultures were negative. Chest X-ray was negative. Abdominal ultrasound confirmed a hepatosplenomegaly. A transthoracic echocardiography showed an ejection fraction of 51% without signs of pericarditis. Serology for Hepatitis A, C, HIV, CMV, Syphilis, Mycoplasma were negative. The patient was immune for Hepatitis B and measles. PCR for measles was negative. He had already been in contact with Parvovirus B19 (IgG positive) and EBV (IgM and IgG positive with presence of anti EBNA). His serology for COVID-19 was positive with high levels of anti-nucleocapsid and anti-spike S1 antibodies but PCR on nasopharyngeal swab was negative. Autoimmune serology were negative (ANA, ANCA). We suspected the presence of a multisystem inflammatory syndrome of the adult (MIS-A) with cardiac involvement because of the Kawasaki-like dermatological presentation and the high inflammatory levels. We had no proof of a more recent SARS-CoV-2 infection than the infection of 8 months earlier. A cardiac monitoring was proposed and the patient was treated by intravenous immunoglobulin and corticosteroids. His general state improved rapidly and he was discharged after 10 days of hospitalization with a tapering dose of corticosteroid given orally. Conclusion(s): MIS-A is a novel syndrome secondary to SARS-Cov-2 infection, in the beginning mostly described in children (MIS-C) but also described in adults. There is fever, high inflammation, and severe illness with multisystem organ involvement (>=2). Cardiac involvement is present in most of the cases. Serology is often positive but PCR can be negative, suggesting the presence of a dysregulation of the immune system more than an acute infection. The mortality rate is 1-2% so physicians should be able to recognize this disease in order to give the best treatment.

Current status of urological training and differences between institutions

Objectives: Appropriate training of urology residents is important to secure not only high-quality patient care, but also the bright future of our specialty. We aimed to investigate residency training from the perspective of qualification and standardization and to evaluate surgical education, publication output, working conditions, future plans, and overall satisfaction, in a comprehensive way. Methods: We conducted a survey of urology chief residents/recent graduates in Turkey to identify differences between institutions and deficiencies in urology resident training. A total of 155 chief residents/recently graduated specialists were contacted by phone and a survey was completed. Results: The survey response rate was 96.1%. Respondents had high proficiency in endourology (97.3%), similar to Canada and European countries. However, they reported a lack of proficiency in laparoscopy (28.9%) and functional urology (26.2%). Also, no one had completed a robotic procedure as first surgeon. A total of 75.2% respondents had no first author publication, and 10.1% had no first author presentation. There was no significant difference between institution types with or without certification. There was a satisfaction rate of 87.2% among participants. Conclusions: It was observed that qualified and standardized training could has not been achieved and the positive effects of certification have not been seen yet. There is a lack of modernization in all aspects of education, and there is no standardized curriculum addressing academic research. Therefore, there is a risk that future urologists will have insufficient skills. We hope this study serves as a guide for modernization and standardization in urology training. (C) 2021 AEU. Published by Elsevier Espana, S.L.U. All rights reserved.

A Case with Down Syndrome Who Developed Pericardial Tamponade due to COVID-19

Cardiac tamponade is a life-threatening condition that disrupts normal hemodynamics, limits the adequate filling of the heart cavities, and occurs with sudden and/or excessive fluid accumulation in the pericardial cavity. Cardiac tamponade is rare in pediatric patients and requires early diagnosis and urgent intervention. Herein, we present an 11-month-old boy with Down syndrome who developed pericardial tamponade associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and acute respiratory distress syndrome. An 11-month-old boy with Down syndrome was admitted to the pediatric infection service due to cough and respiratory distress. Pericardial effusion was detected in the follow-up of the patient whose SARS-CoV-2 polymerase chain reaction test was positive. Ibuprofen treatment was started for pericardial effusion. During the follow-up, the patient who developed respiratory distress was transferred to the intensive care unit, intubated and mechanically ventilated. In the intensive care unit, the patient developed hypotension and cardiac tamponade. An emergency pericardiocentesis was performed. Despite pericardiocentesis, the patient’s hypotension persisted. The patient died due to acute respiratory distress syndrome. Coexistence of cardiac tamponade and Coronavirus disease-2019 (COVID-19) in children has been rarely reported. We do not have enough knowledge about the course of COVID-19 in patients with Down syndrome. This case is presented in order to ensure the early recognition of similar cases in the SARS-CoV-2 pandemic and to be more careful in ARDS due to COVID-19 infection in patients with Down syndrome. © Telif Hakkı 2021 Çocuk Acil Tıp ve Yoğun Bakım Derneği.

POSSIBLE RELATIONSHIP BETWEEN CORONAVIRUS-2 (SARS-COV-2 ) AND PERIODONTAL DISEASE

Since December 2019, the world has been struggling with a viral infection that had emerged in Wuhan, China, becoming an epidemic spread to many countries over a short time. On March 2020, the World Health Organization (WHO) called it COVID-19 pandemic. Millions of people around the world became infected with the virus and died due to pneumonia or multiple organ disfunction syndromes. COVID-19 is a respiratory tract disease that can be transmitted by droplets, contact, aerosols;when it becomes contagious, it binds to the Angiotension Converting Enzyme II (ACE2) receptors on the surface of the epithelial cells in the respiratory tract. It shows a very high degree of contagiouness and can damage lungs and other organs. Comorbidities such as age, gender, diabetes, obesity, cardiovascular disease and hypertension are risk factors for the complications of COVID-19 infection. They cause a more severe disease in some people. Similar factors are also associated with the periodontal pathogens causing periodontal diseases different from one individual to another.A possible relation between SARS-CoV-2 and bacterial load and the complications it causes may be related to oral health and periodontal diseases. As known, comorbidities caused by risk factors of COVID-19 also cause changes in the oral flora and increase the risk of periodontal disease. Since there are similar risk factors between periodontal diseases and COVID-19, a relation between them appears as possible. It is emphasized that the oral cavity and mucosa may be related to the transmission of SARS-CoV-2.

Orthopaedics and traumatology in COVID-19 pandemic

Objectives: We aimed to convey our pandemic observations and experience as orthopedics and traumatology clinic in the period from the formal declaration of the first case in Turkey to the descending trend of the number of active cases. Materials and Methods: The first Coronovirus disease-2019 (COVID-19) case in Turkey was seen on March 11 and all elective surgeries were postponed as of March 17th. The number of active cases entered a downward trend with the number of patients recovering daily exceeding the number of new cases daily on April 24. The numbers and categories of surgeries performed in our clinic between March 17 and April 24, 2020 were examined and analyzed by comparing to the same period of 2019.

A case of chronic eosinophilic pneumonia confused with covid-19 pneumonia

The etiology of chronic eosinophilic pneumonia (CEP) is not precisely known, although its characteristic features include eosinophilia, involving alveoli or blood;subacute or chronic respiratory and general symptoms;while chest radiological imaging shows peripheral pulmonary infiltrates. Many cases of pneumonia associated with the new coronavirus (2019-nCoV) were detected in Wuhan, China starting in December 2019. HRCT is a highly sensitive and convenient screening tool for 2019-nCoV. The radiological appearance of the new coronavirus pneumonia is not very different from that of the common viral pneumonia, but it has some unique features. It usually manifests with patchy or punctuate opacities resembling ground glass (85.7%), and patchy consolidation (19.0%), and the lesions are mainly located in the subpleural area. Here we present a case of CEP who presented with shortness of breath, cough, fever, and a clinical and radiological picture similar to COVID-19.

Late Breaking Abstract - Impact of an improvised system on preserving oxygen supplies in patients with COVID-19

Background: Patients with coronavirus disease (COVID-19) can develop severe hypoxemia. Meeting the soaring demands of oxygen may be a challenge. Objective: To test the efficacy of an easily handmade system, the double-trunk mask (DTM), in reducing oxygen consumption while maintaining patient's oxygenation level. Methods: Hospitalized adults with COVID-19 and hypoxemia treated with low-flow oxygen therapy we recruited. The standard oxygen delivery system was replaced by the DTM with nasal cannula for 30 minutes with an oxygen output adapted to maintain an identical oxygen saturation by pulse oximetry. The standard oxygen delivery system was then reinstated for 30 minutes. Primary outcome was the absolute change in oxygen flow between the standard delivery systems and the DTM. Secondary outcomes were changes in blood gases, vital parameters and patient comfort. Results: Eleven patients were analyzed (mean age 61 years;27% male). Compared with standard delivery systems, the oxygen output was significantly reduced with the DTM (median, 5 vs 1.5 L/min (95% CI -4 to -1.5, p=0.003)) when oxygen saturation and arterial oxygen tension remained stable. The DTM was also associated with a significant but slight increase in arterial carbon dioxide tension (median, 36 mmHg vs 37 mmHg, p=0.006), and respiratory rate (median, 26 vs 30 breaths/min, p=0.05). Other parameters were unaltered. The DTM was generally judged less comfortable than the baseline oxygen delivery system, especially in patients requiring low oxygen flow at baseline. Conclusions: The DTM is a simple and efficient system to reduce oxygen consumption. This may have clinical implications in places where oxygen supplies are limited.