NO CSF BIOMARKER EVIDENCE OF PERSISTING CNS INFECTION AFTER SARS-CoV-2 INFECTION

Background: Neurocognitive symptoms are common in acute as well as convalescent (post-acute sequelae of COVID-19 [PASC]) COVID-19, but mechanisms of CNS pathogenesis are unclear. The aim of this study was to investigate cerebrospinal fluid (CSF) biomarker evidence of CNS infection, immune activation and neuronal injury in convalescent compared with acute infection. Method(s): We included 68 (35% female) patients >=18 years with CSF sampled during acute (46), 3-6 months after (22) SARS-CoV-2 infection or both (17), and 20 (70% female) healthy controls from longitudinal studies. The 22 patients sampled only at 3-6 months were recruited in a PASC protocol. CSF N-Ag was analyzed using an ultrasensitive antigen capture immunoassay platform (S-PLEX SARS-CoV-2 N Kit, Meso Scale Diagnostics, LLC. Rockville, MD). Additional analyses included CSF beta2-microglobulin (beta2M)], IFN-gamma, IL-6, TNF-alpha neurofilament light (NfL), and total and phosphorylated tau. Log-transformed CSF biomarkers were compared using ANOVA (Tukey post-hoc test). Result(s): Patients sampled during acute infection had moderate (27) or severe (19) COVID-19. In patients sampled at 3-6 months, corresponding initial severity was 10 (mild), 14 (moderate), and 15 (severe). At 3-6 months, 31/39 patients reported neurocognitive symptoms;8/17 patients also sampled during acute infection reported full recovery after 3-6 months. CSF biomarker results are shown in Figure 1. SARS-CoV-2 RNA was universally undetectable. N-Ag was detectable only during acute infection (32/35) but was undetectable in all follow up and control samples. Significantly higher CSF concentrations of beta2M (p< 0.0001), IFN-gamma (p=0.02), IL-6 (p< 0.0001) and NfL (p=0.04) were seen in acute compared to post-infection. Compared to controls, beta2M (p< .0001), IL-6 (p< 0.0001) and NfL (p=0.005) were significantly higher in acute infection. No biomarker differences were seen post-infection compared with controls. No differences were seen in CSF GFAp, t-tau or p-tau. Conclusion(s): We found no evidence of residual infection (RNA, N-Ag), inflammation (beta2M, IL-6, IFN-gamma, TNF-alpha), astrocyte activity (GFAp) or neuronal injury (NfL, tau) 3-6 months after initial COVID-19, while significantly higher concentrations of several markers were found during acute infection, suggesting that PASC may be a consequence of earlier injury rather than active CNS damage. CSF beta2M, IL-6, IFN-gamma and NfL were significantly lower after 3-6 months than during acute COVID-19 and not different from healthy controls. (Figure Presented).

Intra-BRICS Trade: A Panel Data Analysis with Structural Breaks

This article attempts to examine the recent developments that have amplified the consequences of uncertainty regarding trade between Brazil, Russia, India, China, and South Africa (BRICS) countries under global economic turmoil such as occurred in the 2008 financial crisis and trade wars sparked by the USA and the COVID-19 pandemic. These events severely affected intraBRICS trade and investment. For this purpose, we employed the Westerlund and Edgerton cointegration approach to check for cointegration under structural breaks and the procedure for the asymmetric Granger non-causality test to assess the causal relationship between the custom tariff and export variables of BRICS countries with regard to the panel data methodology for the 2000-2020 period using annual data. The empirical results for cointegration indicate the presence of a long-term relationship;in other words, they are seen to move together under investigation. The estimated breakpoints correspond with 2008 and the ongoing financial turmoil and with the 2018-2020 period and the rising trade disputes between USA and China. In addition, the Granger non-causality test provides enough evidence to show opposite directions (signs) for the causal links between the variables that run from tariffs to exports for BRICS countries.

A Comprehensive Review of Cyber Security Vulnerabilities, Threats, Attacks, and Solutions

Internet usage has grown exponentially, with individuals and companies performing multiple daily transactions in cyberspace rather than in the real world. The coronavirus (COVID-19) pandemic has accelerated this process. As a result of the widespread usage of the digital environment, traditional crimes have also shifted to the digital space. Emerging technologies such as cloud computing, the Internet of Things (IoT), social media, wireless communication, and cryptocurrencies are raising security concerns in cyberspace. Recently, cyber criminals have started to use cyber attacks as a service to automate attacks and leverage their impact. Attackers exploit vulnerabilities that exist in hardware, software, and communication layers. Various types of cyber attacks include distributed denial of service (DDoS), phishing, man-in-the-middle, password, remote, privilege escalation, and malware. Due to new-generation attacks and evasion techniques, traditional protection systems such as firewalls, intrusion detection systems, antivirus software, access control lists, etc., are no longer effective in detecting these sophisticated attacks. Therefore, there is an urgent need to find innovative and more feasible solutions to prevent cyber attacks. The paper first extensively explains the main reasons for cyber attacks. Then, it reviews the most recent attacks, attack patterns, and detection techniques. Thirdly, the article discusses contemporary technical and nontechnical solutions for recognizing attacks in advance. Using trending technologies such as machine learning, deep learning, cloud platforms, big data, and blockchain can be a promising solution for current and future cyber attacks. These technological solutions may assist in detecting malware, intrusion detection, spam identification, DNS attack classification, fraud detection, recognizing hidden channels, and distinguishing advanced persistent threats. However, some promising solutions, especially machine learning and deep learning, are not resistant to evasion techniques, which must be considered when proposing solutions against intelligent cyber attacks. © 2023 by the authors.

Comparison of clinical categories, blood biomarkers and cycle threshold value in COVID-19

Aim: The aim of this study is to investigate whether the viral load of SARS-CoV-2 is an important factor in predicting disease severity and its relationship with clinical and biochemical parameters. Material(s) and Method(s): In this cross-sectional retrospective study, 85 patients who were found to be positive for SARS-CoV-2 PCR at Balikesir University Health Practice and Research Hospital were evaluated. RT-PCR (CT) values, laboratory values and demographic and clinical data of the patients at the first admission to the hospital were obtained from the electronic environment and compared. Result(s): In our study, no significant relationship was found between baseline values and severity of clinical stages in adults with COVID-19. No correlation was found between the gender, vital status, hospitalization or admission to the intensive care unit, presence of comorbidity, degree of disease according to the thorax CT image and mean CT values of the participants included in the study (p>0.05). Discussion(s): More prospective studies and additional data are needed to determine whether CT values can benefit clinicians in clinical and patient management decisions.Copyright © 2023, Derman Medical Publishing. All rights reserved.

Impact of the lockdown in the pandemic period on admissions due to non-COVID-19 pneumonia: A retrospective, cohort study Lockdown on non-COVID pneumonia in pandemic

Aim: The pandemic period has led to social and individual behavioral changes all over the world. In this study, the differences in the admissions of non-coronavirus disease 2019 (non-COVID-19) community-acquired pneumonia cases during the pandemic lockdown period in Turkey were analyzed. Material(s) and Method(s): Patients with suspected COVID-19 and under the age of 18 were excluded, and non-COVID-19, hospitalized community-acquired pneumonia cases were included in this retrospective, cohort study. The analyzes were carried out by creating two groups as before the pandemic (March-May 2019) and the lockdown period of the pandemic (March-May 2020). The number of admissions and mortality rates were taken into consideration as primary outcomes. Result(s): There were 178 cases in the 2019 group and 63 cases in the 2020 group. Gender and age distribution were similar in these two groups. While the rate of intensive care hospitalization was high in the 2020 group, mortality was low (14.3% vs 19.1%);but these differences were not statistically significant. In addition, bilateral infiltration rates were significantly higher in the 2019 group (80.9% vs. 22.2%;p<0.001). Discussion(s): The low number of admissions during the lockdown period shows that there is awareness of the pandemic in society. Again, it can be said that this closure process plays a role in reducing the transmission of infectious diseases such as pneumonia.Copyright © 2022, Derman Medical Publishing. All rights reserved.

Respiratory functions in the follow-up of children with COVID-19 infection

Introduction or Background: The long-term effects of COVID-19 infection on the respiratory system in children are not yet known. Aims and Objectives: To determine the long-term effects of COVID-19 infection on the respiratory system of children by evaluating pulmonary function tests. Method(s): In this multicenter study, COVID-19 PCR positive children(>=6years) were evaluated prospectively with pulmonary function tests(spirometry, plethysmography and CO diffusion) at 3rd and 6th months follow-up. The results were evaluated retrospectively based on clinical symptoms, physical examination findings, radiological and laboratory tests of the patients in the acute phase of the infection. Result(s): At 3rd month evaluation of 270 COVID-19 PCR positive pediatric patients, mean FEV1 96.85+/-16.84%,FVC 96.06+/-16.84% were found;at 6th month, mean FEV1 100,03+/-15.98%,FVC 100.62+/-16.87. At the 3rd month, statistically significant differences were found between FEV1<80%(n:28),FEV1>80%(n:242) groups due to the presence of additional diseases(p<0.001),having respiratory(p=0.006) and cardiovascular(p=0.004) system pathological examination findings, interlobular septal thickening(p=0.020) on thorax CT, high level of CRP(p=0.032),IL6(p=0.048),ferritin(p=0,020) during the infection period. Having COVID-19 pneumonia was found to be non-effective on spirometric test results. No difference was found between the 3rd and 6th month spirometry results of the same patient. Conclusion(s): After recovery of COVID-19 infection, children who have additional diseases, and pathological examination and radiological findings during the infection period, may have functional respiratory changes;so they should be monitored with pulmonary function tests.

Study of bacteria isolated from COVID-19 and non-COVID-19 intensive care units and determination of their antibiotic susceptibility profiles

Nosocomial infections occur 48-72 hours after hospitalization, especially caused by bacteria, and pose a high risk for patients in intensive care units (ICUs), including COVID-ICUs. This study aimed to reveal bacteria distribution and antibiotic susceptibility profiles isolated from various clinical samples of non-COVID-ICU and COVID-ICU patients. We included in this study bacterial strains isolated from ICUs patients in Kastamonu Training and Research Hospital between March 2020 and October 2020. We identified the strains using the Vitek 2 compact automated system (BioMerieux, France) and standard microbiological methods. Using the Vitek 2 automated system, we analyzed antibiotic susceptibility tests and interpreted the results based on the European Committee for Antimicrobial Susceptibility Tests (EUCAST) guideline. There were 302 patients in the non-COVID-ICUs and 440 patients in the COVID-ICUs. We isolated a total of 470 strains, 370 from non-COVID-ICUs and 100 from COVID-ICUs. Acinetobacter spp. was the most frequently isolated strains for both ICUs. Acinetobacter spp. isolated from non-COVID-ICUs had higher resistance rates to meropenem (p= 0.043), ceftazidime (p= 0.014), and levofloxacin (p<0.001) antibiotics than strains from COVID-ICUs. Antibiotic susceptibility profiles of other strains were similar for both ICUs. As a result, the incidence of nosocomial infections in COVID-ICU patients was lower than in non-COVID-ICU patients. Health personnel working in COVID-ICUs may have played an important role in this, as they were more careful about using personal protective equipment and complying with hygiene rules. However, antibiotic resistance continues to be a serious problem in ICUs, including COVID-ICUs. Copyright © 2022 Ondokuz Mayis Universitesi. All rights reserved.

Posterior Reversible Encephalopathy Syndrome in Covid 19 Disease: A Rare Case

Covid-19 disease can have many neurological complications, posterior reversible encephalopathy being one of them. A 42-year-old female patient was admitted to the emergency department on the 4th day of PCR test positivity with decreased consciousness. Patient with a Glasgow coma score of 6 (E1M3V2). The patient's vital signs were stable and there was no abnormality in his laboratory. No pathology was found in the brain tomography to explain the loss of consciousness. In MRI evaluation, the patient was diagnosed with Posterior reversible encephalopathy syndrome (PRES) according to radiological and clinical information. The standard Covid-19 treatment added to the antiedema treatment was applied to the patient. Brain MRI was repeated four days later and previous MRI findings showed regression. The patient was discharged to the ward with stable neurological status on the 22nd day of hospitalization. PRES is a rare but serious complication in Covid-19. Especially in the Covid-19 intensive care unit, intubation and sedation suppress the clinical picture, and the difficulty in getting patients on magnetic resonance imaging can complicate the diagnosis. Therefore, PRES should be kept in mind in the presence of neurological symptoms such as encephalitis, meningitis, encephalopathy and cerebrovascular disease.

Impact of the lockdown in the pandemic period on admissions due to non-COVID-19 pneumonia: A retrospective, cohort study

Aim: The pandemic period has led to social and individual behavioral changes all over the world. In this study, the differences in the admissions of non-coronavirus disease 2019 (non-COVID-19) community-acquired pneumonia cases during the pandemic lockdown period in Turkey were analyzed.Material and Methods: Patients with suspected COVID-19 and under the age of 18 were excluded, and non-COVID-19, hospitalized community-acquired pneumonia cases were included in this retrospective, cohort study. The analyzes were carried out by creating two groups as before the pandemic (March-May 2019) and the lockdown period of the pandemic (March-May 2020). The number of admissions and mortality rates were taken into consideration as primary outcomes.Results: There were 178 cases in the 2019 group and 63 cases in the 2020 group. Gender and age distribution were similar in these two groups. While the rate of intensive care hospitalization was high in the 2020 group, mortality was low (14.3% vs 19.1%);but these differences were not statistically significant. In addition, bilateral infiltration rates were significantly higher in the 2019 group (80.9% vs. 22.2%;p<0.001).Discussion: The low number of admissions during the lockdown period shows that there is awareness of the pandemic in society. Again, it can be said that this closure process plays a role in reducing the transmission of infectious diseases such as pneumonia.

A novel combined index of D-dimer, fibrinogen, albumin, and platelet (FDAPR) as mortality predictor of COVID-19.

Background: In coronavirus disease 2019 (COVID-19) caused by SARSCoV2 viruses, coagulation abnormalities are strongly correlated between disease severity and mortality risk. Aims: The aim was to search for new indices to determine mortality risk. Fibrinogen times D-dimer to albumin times platelet ratio calculated with the formula (FDAPR index: ((Fibrinogen × D-dimer)/(Albumin × Platelet)) investigated as a mortality marker in COVID-19 patients. The hospitalization data of 1124 patients were analyzed from the electronic archive system. Hemogram, coagulation, and inflammatory markers were investigated in the study group. Materials and Methods: All statistical analyses like the student t-test, Mann-Whitney U, Kaplan-Meier, and Cox hazard ratio, were performed with the SPSS 22.0 program. Results: Prothrombin time was prolonged significantly in patients (P < 0.05) compared to healthy subjects (n = 30). D-dimer and fibrinogen were high, and albumin and platelet counts were low in COVID-19 patients (all, P < 0.001). When the data of 224 non-survivors and 900 survived patients were compared, D-dimer and fibrinogen were higher, and albumin and platelet lower (all, P < 0.001) compared to mild and severe patients. At the cut-off value of 0.49, the FDAPR index was performed with 89.1% sensitivity and 88.6% specificity. FDAPR index had the highest mortality predictive power (P < 0.01; HR = 5.366; 95% CI; 1.729-16.654). Conclusions: This study revealed that the FDAPR index could be used as a mortality marker of COVID-19 disease.

POTENTIAL PREDICTORS of OUTCOME for ANAKINRA TREATMENT in COVID-19 PATIENTS with MACROPHAGE ACTIVATION SYNDROME

Background: A hyperinfammatory response compatible with features of macrophage activation syndrome (MAS) contributes to this worse outcome in patients with Coronavirus Disease 2019 (COVID-19). Glucocorticoids have become the standard of care for those requiring oxygen support or mechanical ventilation. More targeted anti-infammatory treatments with tocilizumab and anakinra have also been shown to be effective. Objectives: More studies are being awaited to clarify the features of patients who would beneft more, and we investigated the characteristics of the surviving and dead patients who received anakinra. Methods: The records of hospitalized adult patients between March 2020 and May 2021 in a tertiary referral center were evaluated. Diagnosis of COVID-19-re-lated MAS was based on the expert opinion and preliminary criteria developed by our group that patients with a score of ≥45 were accepted COVID-19-related MAS.1 Patients who received anakinra constituted the study group. Anakinra dose was determined according to the clinical and infammatory parameters;and doses varied between daily 100-300 mg SC to 400-800 mg IV. Laboratory data of surviving and died patients were comparatively analyzed by using the ANCOVA method on the relevant days (baseline, anakinra-onset day, frst response to anakinra treatment, and discharge or death). The temporal variation (drug onset day-frst response day, drug onset day-discharge, or death day) was evaluated using the ANOVA method. A 50% reduction of CRP compared to the anakinra start day was accepted as the frst response to the treatment. Results: Out of 1080 hospitalized patients, 218 (151 male, 67 female, mean age 60.0±14.1) who received anakinra were identifed. Among them, 125 (57.3%) patients were followed in the ward, 21 (9.6%) did not need oxygen treatment during the hospitalization;69 (31.6%) patients were followed at ICU, 40 of them were intubated, 30 (13.7%) died in ICU. Anakinra had been started in a mean of 4.8 days of hospitalization. Twenty had tocilizumab initially and then received anak-inra because of ongoing infammatory parameters. The majority (83.5%) received steroid treatment (79.5% methylprednisolone, 5% of dexamethasone), and 6 received one IV pulse 250 mg of methylprednisolone;36 (16.5%) were followed before September 2020 and received anakinra without steroids because of the standard of care at that period. Only CRP was different between the alive and dead patients for the baseline parameters (p=0.05). On the frst day of drug treatment, CRP and procalcitonin values were signifcantly higher in dead patients (Table 1). A 50% decrease in CRP level was achieved in 3.1 days in survivors and 4.7 days in dead patients. D-dimer (p=0.018), CRP (p=0.006), LDH (p=0.003), procalcitonin (p=0.005), creatinine kinase (p=0.001), and fbrinogen levels (p=0.05) were significantly different between the surviving and dead patients when the measurements between the frst drug administration day and response day were compared. Neu-trophil, lymphocyte count, ferritin, D-dimer, CRP, LDH, AST, procalcitonin, creati-nine kinase, and fbrinogen levels were signifcantly different between the patients when the parameters between the frst drug administration day and discharge/death day were compared. Dead patients had higher CRP values and they did not show a continuing CRP decrease with the steroids and anakinra (Figure 1). Conclusion: Retrospective analysis of 218 patients suggests that starting anakinra earlier in hospitalized patients may provide better results, and a decrease in CRP, ferritin, D-dimer values, as well as an increase in lymphocyte count, are associated with favorable outcomes. Increasing values of D-dimer and troponin during treatment are associated with worse outcomes, possibly indicating cardiovascular and thrombotic pathologies not responding to anakinra. Changes in the CRP values are found to help monitor the response to anakinra. Other infammatory pathways could be targeted in those who are not responding to appropriate doses of anakinra within 5 days.

Stability analysis and numerical simulation of dynamic and fractional SEIRD models for spread of nCOVID-19 in Turkey

There are various mathematical models that have been designed for forecasting the future behavior of coronavirus spreading, which helps to rapidly control the process while there is no treatment and vaccines. The main aim of this study is to describe COVID-19 dynamics in Turkey by using a Susceptible-Exposed-Infected-Recovered-Deceased (SEIRD) model. For this purpose, a new SEIRD model of nCOVID-19 and its fractional-order version are designed. The basic reproduction number is calculated with the generation operator method. All possible equilibria of the dynamic model are investigated in terms of the basic reproduction number. Further, stability conditions are obtained through the Routh-Hurwitz and Lyapunov stability theories. Finally, some numerical simulations of the dynamic system and its fractional version are given based on the data from the number of nCOVID-19 cases in Turkey. These results provide to implicate the theoretical findings corresponding to the model. © 2022 World Scientific Publishing Company.

Sentiment Analysis of Elon Musk’s Twitter Data Using LSTM and ANFIS-SVM

Social media plays a huge role spreading words to millions and influencing their opinions. Twitter is one of the most essential platform that reach over 300 million active users and 500 million tweets per day, it plays a significant role spreading the word around the world,. These tweets covers a various subjects from personal conversations to globally important topics such as updates about Covid19 and macroeconomic subjects. Especially in financial matters, it is a very common situation that business owners, even politicians report the news on Twitter first. The Tesla’s and SpaceX’s CEO and owner Elon Musk’s tweets had a huge impact on coin market or even stock exchanges. Although many accused him of market manipulation his tweets impact cannot be underestimated. In 2020 and 2021 there are various tweets that strike the stock market instantly both in the positive and negative direction. This study aims to predict the direction of his tweets and perform a sentiment analysis using both Long-Short Term Memory (LSTM) and Adaptive Neuro Fuzzy Interface Systems (ANFIS)-SVM(Support Vector Machines) models. The dataset is obtained by using Twitter API which spans a time horizon of 5 years. In order to compare the results under same conditions same preprocessing steps are performed for both models. According to the results, LSTM performs a superior performance with its 72.2% accuracy against ANFIS-SVM model with 74.1%. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Rethinking Principles of School Mathematics during the COVID-19 Pandemic: A Multiple-Case Study on Higher Education Courses Related to Teaching Mathematics

The study was carried out with prospective teachers (PTs) in Primary School Teaching Program in a private university (n=43) and Middle School Mathematics Teaching program in a public university (n=46). In this paper, multiple-case study was adopted to explore PTs' opinions and to reveal the differences between two universities in terms of taking a mathematics education course through online teaching when the COVID-19 pandemic was very first appeared. The content of the course was based on the principles of school mathematics which were put forth by National Council of Teachers of Mathematics [NCTM]. Hence, the principles were used as the themes in the data analysis. For this purpose, a survey was used to explore the advantages and the challenges faced in online teaching from the PTs' perspective. The analysis of the data showed that the PTs at both universities had both positive and opposing views towards online mathematics education course as mandated by the pandemic. Besides, the technology principle in NCTM was found to be a principle in which the other principles were organized and applied according to it. PTs' reflections on the learning and teaching principles in practice were at the forefront. The reflections regarding the assessment and the equity principle were not among the principles that were frequently mentioned. Discussion on and suggestions for overcoming the challenges were elaborated on.

Evaluation of Covid-19 cases that applied to the hospital at the first peak of the pandemic

Early diagnosis in COVID-19 is essential in terms of treatment and prevention of contagiousness. In this study, we aimed to find an alternative diagnosis method by using fewer laboratory parameters in the early diagnosis of COVID-19 disease by creating a fast, easily accessible, costeffective index and has a diagnostic accuracy rate of over 90%. All patients over the age of 18 who applied to Hitit University Erol Olcok Training and Research Hospital Emergency COVID Outpatient Clinic with a pre-diagnosis of COVID-19 between March and April 2020 were evaluated retrospectively. Patients were divided into two groups as COVID-19 positive and COVID-19 negative. It was aimed to create a HITIT-19 index by evaluating the cases according to the clinical and laboratory results. Between March and April 2020 (in the first peak of the pandemic), 1586 patients were applied to the Emergency COVID-19 outpatient clinic with a pre-diagnosis of COVID-19. According to COVID- 19 RT-PCR, card test, and CT involvement, 285 (13%) patients were diagnosed with COVID-19. PCR was positive in 285 (18%) of 1586 patients, and PCR was negative in 1301 (82%). While 153 (53.7%) of the patients diagnosed with COVID-19 were male and the median age was 45 (28-62.75), 883 (55.7%) of the patients not diagnosed with COVID-19 were male, and the median age was 43 (31-65). Hypertension (HT) was the most common underlying disease in 10.5% of patients applied to the emergency room with a diagnosis of COVID-19, while 38.9% dyspnea and 35.1% fever were the most common symptoms. While 76% of Plaquenil and 58% azithromycin were the most frequently started treatments, 31.4% (28.4% of them were hospitalized in the service, 3% in the intensive care unit) of them hospitalized. It was to create a HITIT-19 index that is fast, easily accessible, cost-effective, and has a diagnostic accuracy rate of over 90% by using laboratory tests. However, we could not achieve this goal due to the low accuracy of the diagnostic tests and the lack of significant change in the laboratory levels of the patients at admission. Considering that the pandemic is continuing rapidly, there is still a need to develop practical diagnostic methods that are easier and cheaper in diagnosis. In this sense, we believe that our study will be a guiding study for other studies that will be designed for diagnostic index studies.

Post-hoc comparison tests for odds ratios

The null hypothesis of homogeneity of odds ratio across the strata for a 2x2 tables is tested by several tests. When the null hypothesis is rejected, it means that at least one of the odds ratios significantly differs from others. Post-hoc tests are used after the null hypothesis of equality of groups is rejected Those tests aim to reveal the true differences between groups. In this paper, we propose three post-hoc tests that control family-wise type-I error. The first and second approaches are based on the difference between the two odds ratios. The third approach uses the modification of the Breslow-Day test. These tests provide the homogeneous groups by their odds ratios and enables to calculate the common odds ratio. The suggested tests are applied to several COVID-19 data sets and the results are discussed. The proposed methods can also be used to compare different risk factors on a certain event or outcome.

Investigation of hematological and inflammatory parameters in covid-19 infection

BACKGROUND AND AIM: In this study, we aimed to examine the changes in Neutrophil/Lymphocyte ratio (NLR), C-Reactive Protein (CRP), Ferritin, Lactate Dehydrogenase (LDH), D-Dimer and Systemic immune inflammation index (SII) parameters according to age and gender in patients with COVID-19 infection. METHODS: A total of 322 inpatients (Female: 180, Male: 142) who applied to Lokman Hekim University Ankara Hospital between March 2019 and August 2021 and had positive PCR tests were included in the study. The patients were divided into five age groups (1st group: 1-17 years;2nd group: 18-30 years;3rd group: 31-45 years;4th group: 46-60 years;5th group: 61-92 years). Laboratory results and demographic findings of PCR-positive patients were reviewed retrospectively. WBC, NLR, CRP, Ferritin, LDH, D-Dimer, SII values of the patients included in the study were examined in the study. RESULTS: When NLR, CRP, Ferritin, LDH, D-Dimer parameters were evaluated according to age groups, there was a significant difference (p<0.05). When the first and 2nd groups were compared, there was a significant difference in the D-dimer level. When the first and 3rd groups were compared, there was a significant difference in LDH, WBC, CRP levels. When the first and 4th groups were compared, there was a significant difference in the CRP levels. When the first and 5th groups were evaluated, a significant difference was observed in the levels of Ferritin, NLR, and CRP (p<0.05). When the correlations of NLR, CRP, Ferritin, LDH, D-Dimer values with respect to age were examined, CRP, LDH and Ferritin levels showed a moderate correlation (r=0.557, r=0.408, r=0.400, respectively);No correlation was observed in NLR, D-Dimer and WBC values. When evaluated according to gender, infection-related parameters (CRP, NLR, WBC and Ferritin) were found to be higher in males (p<0.05). When SII values were evaluated according to age and gender, no significant difference was observed (p>0.05). CONCLUSIONS: Since inflammatory and prognostic markers vary in patients with COVID-19 infection, we think that it would be useful to evaluate WBC, NLR, CRP, Ferritin, LDH, D-Dimer parameters and demographic data together for the follow-up of infection.

Fetal Effects of COVID-19 Infection: Targeted Metabolomic profiling of cord blood

Objective: The impact of maternal COVID-19 infection on fetal health remains to be determined. Using targeted metabolomic analysis of newborn umbilical cord blood, we aimed to evaluate the biological consequences of maternal infection on the fetus and develop metabolite biomarkers for the identification of newborn intrauterine exposure. Study Design: Cord blood serum samples from 23 COVID-19 cases (mother infected/ newborn negative) and 23 gestational age-matched controls were analyzed using nuclear magnetic spectroscopy and direct injection liquid chromatography mass spectrometry-mass spectrometry. Logistic regression models were developed using metabolites to predict intrauterine exposure with Area under the Receiver Operating Characteristics curve [AUC (95% CI)], sensitivity, and specificity. Metabolite set enrichment analysis was used to evaluate altered biochemical pathways to highlight biological mechanisms of COVID-19 intrauterine exposure. Results: There were no significant differences in gestational age at delivery between groups (p >0.05). All neonates tested negative for COVID-19 infection. Significant concentration differences (p-value < 0.05 or -log10=1.301) were observed in 19 metabolites between groups. The top metabolite model [cortisol and Ceramide (d18:1/20:0)] achieved an AUC (95% CI) = 0.839 (0.722 - 0.956) with a sensitivity of 91% and specificity of 69% (Table 1). Enrichment analysis revealed significantly (p< 0.05) altered metabolic pathway of steroidogenesis and gluconeogenesis (Figure 1). Cortisol is the stress hormone that increases glucose production through gluconeogenesis resulting in higher oxidative metabolism and energy generation. Ceramides are known to have anti-inflammatory properties. Elevated hypoxanthine has also been correlated with tissue hypoxia and inflammation. Conclusion: We found evidence of intrauterine stress, altered energy metabolism and inflammation in fetal life in cases of maternal COVID-19 infection but ultimately negative newborn culture. Elucidation of long-term consequences is imperative considering the large number of exposures in the population. [Formula presented] [Formula presented]