Evaluation of post-vaccination antibody response of biochemical analysis in SARS-CoV-2 inactivated vaccine strategy

Introduction: The importance of academic equipment in biochemical and microbiological evaluations of SARS-CoV-2 is increased. In this context, different techniques have been developed in the diagnosis and treatment of COVID-19 disease as qRT-PCR, rapid antigen tests and vaccine technology. The first known example of vaccine technology is the CoronaVac (Sinovac, China) inactivated vaccine throughout pandemic. In the presented study, the sensitivity of CoronaVac in the community would be positively increased and this data would be strengthened. In addition, antibody sensitivity of the CoronaVac between two doses, as well as the hemogram and biochemical analyzes were evaluated. The focus will be on increasing the sensitivity of the society to the vaccine. Materials and methods: The immunoglobulin, biochemical analyzes, hemogram, and iron-iron binding capacities were evaluated after vaccinated person in a vaccine administration center in Istanbul, Türkiye. Results: RBDIgG level was significantly higher after second dose (p<0.05). Mon#, Bas#, IMG#, Mon, Hgb, MCH, MCHC, RDWCV, RDWSD, and PDW levels were higher at 28th day. RBDIgG, Fe, WBC, Neu#, Lym#, Eos#, and PLT levels were higher at 42nd day. All other parameter means were higher at 56th day. RBDIgG, Fe, WBC, RDWCV, RDWSD and PDW differences between 28th and 42nd days were significant (p<0.05). RBDIgG, HCT, MCV, MCH, MCHC, and RDWCV differences between 28th and 56th days were statistically significant (p<0.05). RBDIgG, MCV and MCH differences between 42nd and 56th days were statistically significant (p<0.05). Discussion and conclusion: The 60 volunteers in our study were laboratory, emergency service staffes and hospital personnel working at high risk of COVID-19. There was no differentiation in blood values related to the vaccine. It has been shown as an example of the phase-1 and the side effects of the CoronaVac, were also evaluated, and all our volunteers were followed for 60 days, and no possible serious side effects were observed. In groups with statistical significance in blood results, a vaccine related observation is not clearly revealed. We see that CoronaVac vaccine offers a positive confidence interval in antibody responses after the 2nd dose. These data are great importance in terms of better monitoring of the data by the anti-vaccine groups in Türkiye. It is beneficial to remove the vaccine mistrust against the anti-vaccination and pave the way for social immunization. This study contributes to the accuracy of the ministry and the vaccination strategy implemented in Türkiye. The result of this study provides preliminary information for the studies that will result from the application of the 3rd and 4th dose of vaccines.

Investigation of respiratory tract coinfections in Coronavirus disease 2019 infected and suspected cases.

OBJECTIVE: The aim of our study is to determine the risk of coinfection with COVID-19 due to the high prevalence of viral agents in Istanbul in autumn (September, October, and November) and winter (December and January) and to investigate the effects of age, gender, season and clinical features on the development of coinfection with COVID-19. METHODS: In the routine studies of our hospital, COVID-19, reverse transcriptase polymerase chain reaction (RTA kit, Turkiye) and Multiplex PCR Bio-Fire (Bio Merieux Company, France) methods were studied from the nasopharyngeal swab sample and the data were recorded. A total of 400 people with a mean age (7.91±17.80) were included in the study by retrospective scanning. RESULTS: Considering the virus distribution, Respiratory syncytial virus (RSV), COVID-19, rhino/entero virus did not show a significant difference in autumn and winter, while H. metapneumovirus, adeno virus, influenza A significantly higher rates were observed in winter months. Parainfluenza (1, 2, 3, 4) and Corona OC43 were detected at a higher rate in autumn compared to other viruses. Double and triple coinfection rates with other viral agents were high for 2 years and younger. CONCLUSION: The risk of coinfection of COVID-19 with influenza A, RSV, parainfluenza, and rhino/entero virus was found to be higher than other viral agents. Especially in winter, the risk of coinfection with influenza A and COVID-19 increases. In terms of treatment management, coinfection should be investigated in risky patients and influenza a vaccine should be offered to risky groups.

Evaluation of the effect of hyperchloremia on the prognosis and mortality of medical intensive care patients: a single-center study.

BACKGROUND: While chloride (Cl) is the most abundant anion in the serum, it is unfortunately one of the most commonly disregarded laboratory test results routinely drawn upon admission into the medical intensive care unit (MICU). We aimed to investigate the relation between in-hospital mortality, different pathologies requiring admission to the MICU, serum Cl levels, and other biochemical tests in a tertiary center. METHODS: The prospective study included data from 373 patients admitted to the ICU of a tertiary care center between 2017 and 2019. Data of patients under 18, pregnant patients or patients who were in the MICU for under 48 h were excluded. Comorbidity status, complete blood count, biochemistry tests, and blood gas analysis results of all patients included in the study were collected and recorded. Univariate and multivariate analyses were performed with the obtained data. RESULTS: : Of the patients included in the study, 158 (42.4%) were discharged, and 215 (57.6%) died. In the receiver operator characteristics curve analysis performed to determine the discriminating power of Cl levels with a cut-off value of >98 mEq/L in relation to mortality, its sensitivity was found to be 84% and specificity 60%. According to Kaplan-Meier analysis results, mortality rate was higher (60% vs 46%) and survival time was lower (19.0 ± 1.46 vs. 23.0 ± 4.36 days; p = 0.035) in the patient group with high Cl levels compared to the patient group with normal or low Cl levels. In the Cox regression analysis, it was found that the survival time of the patients hospitalized in the MICU was associated with the variables of Cl, presence of cancer diagnosis and pCO2 (hazard ratio: 1.030 (1.008-1.049), 2.260(1.451-3.500), and 1.020 (1.003-1.029); p < 0.05, respectively). DISCUSSION: Mortality in MICU patients were found to increase in association with higher Cl levels at admission, presence of cancer disease, and higher pCO2 levels. In addition, it should not be ignored that there may be an important relationship between renal failure and hyperchloremia in MICU patients.

Factors affecting post-operative complications and mortality in surgical patients with and without COVID-19.

OBJECTIVE: The objective of the study was to evaluate the effect of COVID-19 on the outcomes of surgical patients and the factors associated with postoperative complications and mortality. METHODS: The study included hospitalized patients with similar demographic and clinical features, who underwent similar surgical operations with a positive polymerase chain reaction test for SARS CoV-2 before or within days following the surgery (COVID-19 group) and a control group was formed of patients who tested negative for COVID-19. The two groups were compared in terms of demographic, clinical, and laboratory data, the presence of pneumonia, complications, and 30-day post-operative mortality. RESULTS: The diagnosis for COVID-19 increased the risk of complications and mortality. Age, CRP, D-dimer, ASA Grade 3-4, > 2 comorbidities, and pneumonia were determined to be factors increasing the risk of complications. Age, CRP, > 2 comorbidities, emergency operations, and pneumonia were determined to increase the risk of mortality. CONCLUSION: As patients with peri/post-operative COVID-19 positivity might be at increased risk of postoperative complications and mortality, emergency surgery in infected cases should be delayed in appropriate cases.

OBJETIVO: Nos propusimos evaluar el efecto de la COVID-19 en los resultados de los pacientes quirúrgicos y los factores relacionados con las complicaciones postoperatorias y la mortalidad. MÉTODOS: Se incluyeron los pacientes hospitalizados sometidos a operaciones quirúrgicas similares con características demográficas y clínicas similares con una prueba de reacción en cadena de la polimerasa positiva para el CoV-2 del SARS antes/en los días siguientes a la cirugía (grupo COVID-19) y los controles negativos. Los dos grupos se compararon en términos demográficos, clínicos y de laboratorio de la presencia de neumonía, las complicaciones y la mortalidad a los 30 días del postoperatorio. RESULTADOS: El diagnóstico de COVID-19 aumentó el riesgo de complicaciones y mortalidad. La edad, la CRP, el Dímero D, el grado 3-4 de la ASA, tener más de 2 comorbilidades y neumonía se relacionaron con un mayor riesgo de complicaciones. Mientras que la edad, la PCR, tener más de dos comorbilidades, las operaciones de urgencia y la neumonía se relacionaron con un mayor riesgo de mortalidad. CONCLUSIONES: Los pacientes con COVID-19 pre/postoperatorio podrían tener un mayor riesgo de complicaciones postoperatorias y de mortalidad, por lo que las cirugías de urgencia en casos infectados podrían retrasarse en los casos adecuados.

The association between QT interval changes and the treatment protocols of COVID-19 patients.

OBJECTIVE: This study aimed to investigate the QT, QTc, and QTc dispersion changes that may occur with the use of hydroxychloroquine (HCQ), favipiravir, and moxifloxacin in combination or alone in COVID 19 patients. METHODS: This study was retrospectively conducted on 193 inpatients diagnosed with COVID-19. We divided the patients into four separate groups due to their medications as, group-1: favipiravir, group-2: favipiravir + HCQ, group-3: favipiravir + moxifloxacin, and group-4: favipiravir + moxifloxacin + HCQ. We recorded their pre and post-treatment QT parameters of each group and evaluated the changes of these parameters with the SPSS statistical program. RESULTS: The mean age of the patients was 63.1±17.7. In group 1 and 2, although there were slight changes in QT parameters, these results were not statistically significant. In group 3, significant increases in QT and QTc dispersion occurred (p=0.005 and p=0.018). In the 4th group where the triple therapy was applied, there was a significant increase only in the QTc values (p=0.027). When we compared the changes of QT parameters for each group, a significant difference was found in ΔQTc dispersion, and post hoc analysis showed that it was due to changes in the third group (p=0.047). CONCLUSION: We thought that, if there is a COVID-19 infection with an additional bacterial infection, and if there is a need of using moxifloxacin alone or together with HCQ, additional risk factors that may cause QT interval prolongation should be reviewed and ECG monitoring of the patients should be performed during the treatment period.

What Should Be Design, Organization and Role of Pandemic Hospitals in COVID-19 Infection?

INTRODUCTION: The aim of this study was to evaluate the physical structure, design, management, and organization of two emergency hospitals built in Istanbul within 45 days in the COVID-19 pandemic and the role played by these hospitals during the pandemic. A further aim was to determine the advantages and disadvantages of the emergency hospitals by comparing them with similar organizational models in other countries. METHODS: The pandemic hospitals established for the COVID-19 pandemic in Istanbul were investigated in a multi-faceted manner. The parameters investigated were physical structure, bed, and intensive care capacity, mechanics and infrastructure, medical equipment, personnel, organizational structures and management, and the medical services provided by both emergency hospitals during the outbreak. RESULTS: The pandemic hospitals were built on an open area of 125.000 m2 as a hospital building of 75.150 m2. Each hospital has a total bed capacity of 1008, with 576 being clinical and 432 being intensive care beds. The management of the pandemic hospitals is connected to two different hospital management structures, which are experienced in disasters and have all kinds of training, research clinics and academic personnel in this regard. CONCLUSION: The healthcare services provided by both the pandemic hospitals fulfilled the purpose of those hospitals during the pandemic. As it is most likely that the world will face other serious disasters and epidemics in the future, the construction of multi-purpose and permanent emergency hospitals instead of emergency temporary hospitals would be more advantageous in terms of economy, medical service, and environment.

Evaluation of patients with COVID-19 and the United Kingdom mutations in a training and research hospital in Istanbul.

OBJECTIVE: This study aims to evaluate the patient clinics by studying Variant of Concern (VOC) Polymerase Chain Reaction (PCR) on conventional PCR-positive samples in a training and research hospital COVID test center in Istanbul. METHODS: The study is a descriptive type and VOC PCR from all samples (from a total of 1300 samples) which detected positive by conventional PCR in a training and research hospital COVID test center between February 2 and 9, 2021. The United Kingdom mutation (VOC 202012/01, B.1.1.7) has been studied. Clinics parameters of the patients were evaluated from Public Health Management System (HSYS) records. The statistical significance was taken as p<0.05 in the analysis. RESULTS: Within the scope of the research, 1300 PCR-positive COVID-19 patients were evaluated. VOC mutation was positive in 26.1% of all patients (339 persons), and 5.8% of patients (75 persons) were hospitalized. While 3.2% (11 persons) of those with VOC positivity were hospitalized, 6.7% (64 persons) of VOC negatives were hospitalized (p=0.020). About 18.2% of hospitalized VOC positives (two persons) and 23.4% of VOC negatives (15 persons) are in intensive care. CONCLUSION: When VOC mutation was examined in all admitted and hospitalized patients, it was detected that VOC mutation was less frequent in hospitalized patients. No relationship between hospitalization and intensive care stay and VOC mutation was detected. It is recommended to determine with studies the contagiousness of patients with VOC mutations.

ICU admission rates in Istanbul following the addition of favipiravir to the national COVID-19 treatment protocol.

OBJECTIVE: The objective of this study was to understand the observational relationship between adoption of favipiravir into the national COVID-19 treatment protocol and intensive care unit (ICU) admission rates in Istanbul due to COVID-19. METHODS: Data were harvested from the "Public Health Management System-HSYS," which collate centrally the records of all known cases of COVID-19. The total number of cases, numbers admitted to ICU, and number undergoing intubation were compared between 2 time periods: 11th of March, the date on which the first case in Turkey was confirmed, to 30th of March; and March 30, to 10th of April, 5 days after Favipiravir was introduced into the treatment algorithm when, the records were examined. RESULTS: The percentage of patients requiring ICU admission diminished from 24% to 12%, whilst the percentage intubated fell from 77% to 66%. These differences were both statistically significant. CONCLUSION: The addition of favipiravir to the national COVID-19 treatment protocol may explain this rapid decrease in the rate of ICU admissions and intubation.

Evaluation of patients with COVID-19 diagnosis for chronic diseases.

AIM: COVID-19 is one of the most consequential pandemic in world history. Chronic diseases, which are risk factors that increase the case fatality rates, have been the leading cause of death all over the world. This study was aimed at detecting coexisting chronic diseases in patients hospitalized with a diagnosis of COVID-19. MATERIAL AND METHOD: The study was carried out with data from 229 patients in an intensive care unit, from June 1st through June 30th. 2020. The inclusion criteria of the study was as follows: (1) having a COVID-19 diagnosis confirmed by PCR test; (2) being hospitalized in the relevant intensive care unit within the dates of the study; and (3) having their data accessible through the hospital automation system. Through literature; chronic diseases of the patients and their effects on the COVID-19 process were evaluated. Statistical analyzes were performed using the Statistical Package for Social Sciences (SPSS) version 24.0 (IBM Corp.; Armonk, NY, USA). RESULTS: The average age of the patients studied were 61.4 years. While the average symptom duration was 8.2 days; total hospitalization period was 13.1 days. The average length of stay of patients (n = 75) who were sent to intensive care unit was 10.1. The most common chronic disease among patients was hypertension with 47.2%. This was followed by diabetes mellitus (32.8%) and heart disease (27.5%), respectively. In the population studied, cough (59.4%), fever (58.5%) and shortness of breath (45.9%) were found to be the most common symptoms. Leukopenia, impairments in liver and muscle enzymes, abnormal C-reactive protein, ferritin and d-dimer levels were the important biochemical tests. CONCLUSION: Particular attention should be paid to the elderly COVID-19 patients with chronic diseases, especially DM, HT and cancer.

The urine foaming test in COVID-19 as a useful tool in diagnosis, prognosis and follow-up: Preliminary results.

OBJECTIVE: We aimed to develop a simple, rapid urine test based on the level of foaming that occurs in the urine sample due to the excretion of peptide structures containing amino acids specific to the antigenic structure of COVID-19. In this study, we present the preliminary results of the first clinical study with a newly developed urine foaming test (UFT). METHODS: This study was conducted in a tertiary hospital in Istanbul. After obtaining the approval of the ethics committee, urine samples were taken from three groups of patients whose informed consent was obtained. The groups were created according to the COVID-19 Diagnostic Guide of Ministry of Health: A: outpatients with suspected COVID-19, B: inpatients for follow-up and treatment, C: patients treated in intensive care unit (ICU). Also, 30 healthy volunteers were included as the control group D. Urine samples taken from all groups were delivered to the laboratory. 2.5 ml urine sample was added to the test tube and shaken for 15 seconds and the level of foam formed was visually evaluated according to the color scale. Other data of the patients were obtained from the hospital information management system and the physician caring for the patient. The clinical status, PCR test results, computed tomography (CT), if any, laboratory tests, and UFT results were compared and the level of statistical significance was expressed as p≤0.05 in the 95% confidence intervals (CI). Performance characteristics, such as sensitivity, specificity, positive and negative predictive value of the UFT, were statistically calculated according to the RT-PCR result and/or CT. RESULTS: A statistically significant difference was observed between UFT distributions of the control, outpatient, inpatient and ICU patients (p=0.0001). The results of UFT orange and red in inpatients and ICU patients were statistically significantly higher than in the control and outpatient groups. The diagnostic accuracy of UFT was detected in all group, the pooled sensitivity was 92% (95% CI: 87-95%) and specificity was 89% (95% CI: 80-98%). CONCLUSION: Our preliminary results suggest that the UFT is useful, particularly in predicting the clinical severity of COVID-19. The UFT could be recommended as a point of care test, rapid and non-invasive method in the diagnosis and follow-up of COVID-19.