Telemedicine implementation for management of COVID19 patients at hospital admission: a single center experience

Introduction: Telemedicine has already been used for the patients with respiratory diseases especially at follow up of long term mechanically ventilated patients and tele-pulmonary rehabilitation. Aim(s): To assess the efficacy of telemedicine consultation system in the management of COVID-19 suspected patients at hospital admission. Method(s): To reduce the risk of SARS-CoV-2 contamination among health-care workers, the COVID-19 pandemic control committee of our centre established a tele-medicine consultation group including pulmonologists, radiologists, emergency medicine and infectious disease specialists. Suspected COVID-19 patients were examined in the pandemic outpatient clinic or emergency department at their first admission by a physician. The physician consulted to the tele-consultation group with a structured medical story and test results after the first examination. Result(s): 469 patients were evaluated through teleconsultation, of 58.2 % were pre-diagnosed with COVID-19. SARS-COV-2 PCR resulted positive in 76.3 % of 273 patients with COVID-19 pre-diagnosis. 288 patients were hospitalized, and 0.9 % of discharged patients were re-admitted to the hospital due to deterioration. Main diagnoses were as follows: COVID-19 (n:289, 62 %), Cardiogenic pulmonary edema (n:40, 8.6 %), non-COVID-19 pneumonia (n:44, 9.4 %), COPD exacerbation (n:8, 1.7 %). Consistency rates between pre- and main diagnosis were 87,2 % for COVID-19 and 63,5 % for non-COVID-19 diseases. Discussion(s): The teleconsultation could be considered an effective method for the management of COVID-19 during the admission to hospital with a reduced risk of transmission of SARS-CoV-2 among health-care workers.

Post-COVID-19 Interstitial Lung Disease: a new entity, what do we deal with?

Introduction: In the post-acute phase, COVID-19 survivors may have persistent symptoms, lung function abnormalities and sequela lesions on thorax CT. This new entity is defined as post-COVID Interstitial Lung Disease (ILD) or a residual disease. Aim(s): To investigate the characteristics and clinical significance of post-COVID-19 ILD. Method(s): Patients with persistent respiratory symptoms after recovery were evaluated by a team including two pulmonologists and a radiologist. Pulmonary function tests, 6-minute walking test, thorax HRCT were performed. Post-COVID ILD was defined as presence of all the followings: respiratory symptoms, hypoxemia, restrictive lung functions and interstitial changes on follow-up HRCT. Result(s): A total of 375 post-COVID-19 patients were evaluated on average 91 days after recovery and 262 of them were included. 17.9 % of the patients were non-hospitalized with mild COVID-19;10.8 % of the patients had received high flow nasal oxygen, of 17.5 % had required non-invasive mechanical ventilation, of 8.8 % had been intubated. The most prevalent symptoms were dyspnoea, exercise intolerance and fatigue. The mean mMRC score was 1.82, oxygen saturation was 94.1, 6-minute walking distance was 374 meters. Pulmonary functions (percentage of mean predicted value +/- SD) were as follows;FEV1:79+/-19, FVC: 73+/-19, FEV1/FVC: 87+/-9, DLCO: 64.5+/-21.8. On CT, GGOs, fibrotic bands, and a combination of them were detected. The mean CT score was 13.5. Discussion(s): The presence of symptoms and functional defects in addition to radiological parenchymal lesions requires the definition of this new entity is post-COVID-19 ILD which could be seen even in non-hospitalised patients with mild COVID-19.

Methylprednisolone in the treatment of post-COVID-19 Interstitial Lung Disease (STERCOV-ILD)

Introduction: Post-COVID-19 Interstitial Lung Disease (ILD) is controversial and need for treatment is unclear. Aim(s): To investigate the efficacy of methylprednisolone in the treatment of post-COVID-19 ILD. Method(s): This multicentre, prospective, randomized controlled clinical trial, included post-COVID ILD patients (ClinicalTrials.gov, NCT:04988282). Post-COVID ILD was defined as the presence of respiratory symptoms, hypoxemia, restrictive lung functions and parenchymal infiltrates on thorax HRCT. 262 post-COVID-19 patients were randomly assigned to one of two arms: the steroid group (n:135) or control group (n:127). For 4 weeks, the steroid group received oral methylprednisolone at a dose of 0.5 mg/kg/day (maximum dose: 48 mg/day). At the end of the study, thorax HRCT, 6-minute walking test and lung function tests were re-evaluated. A good response was defined as a mMRC score of 0, a FVC percentage greater than 80% and absence of hypoxemia at rest or during exercise, greater than 90% resolution of lesions on CT. Result(s): Good clinical and functional response rates were higher in steroid group compared to the control group (62.9% vs 33.3%;54.1% vs 33.7%, p<0.001, respectively). Patients with a radiological response in steroid group tend to be higher than control group, but not statistically significant (61.1 % vs 51.1 %, p=0.159). The increase in oxygen saturation, FVC, and 6-minute walking distance were significantly higher in the steroid group compared to the control. Discussion(s): Systemic corticosteroids improves clinical and functional characteristics and increases oxygen saturation, FVC, and exercise capacity in post-COVID ILD patients compared to the natural course of the disease.

Clinical course of Covid-19 cases vaccinated or unvaccinated

The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continues to spread rapidly all over the world and cause deaths. There are vaccines developed for the ongoing pandemic. In our study, we aimed to evaluate the effects of vaccines on the severity and course of the disease in patients diagnosed with Covid-19 and followed up in the hospital. Forty-nine patients with a diagnosis of Covid-19 pneumonia, who were hospitalized and followed up, were evaluated. Patients whose vaccine doses were incomplete were excluded from the study. The mean age of the patients included in the study was 67.85+/-13.14. 27 (55.1%) patients were male. 22 patients (55.1%) had received the Covid-19 vaccine. 15 (30.6%) people were vaccinated with Pfizer/BioNTech, 7 (14.2) people with Sinovac (CoronaVac). When the length of hospitalization, need for intensive care and mortality rates of the vaccinated and unvaccinated patients were compared, the number of days of hospitalization, the need for intensive care and death were significantly less in the vaccinated group. (respectively;p:0.048, p:0.042, p:0.034) Since the SARS-CoV-2 pandemic continues despite all the individual and national measures taken, the most important method of combating the disease is currently seen as vaccination. In our study, we showed that vaccination reduces the mortality of the disease, the need for intensive care, and the length of hospital stay. With these findings, we can predict that the pandemic will be brought under control with the increase in vaccination rates.

Mental health, quality of life, and COVID-19 fear in Turkish healthcare workers practicing in pandemic hospitals

Background: Healthcare workers (HCWs) face work-related psychosocial risks. The ongoing pandemic is causing widespread concern in a variety of ways, including COVID-19 fear and anxiety. Objective(s): We aimed to evaluate mental health, quality of life, COVID-19 fear and related factors in Turkish HCWs practicing in pandemic hospitals. Method(s): The data were collected in 13 provinces between 27 September and 11 November 2021 by researchers from the Early Career Task Force of the Turkish Thoracic Society. The study survey included sociodemographic, health- and work-related characteristics, the General Health Questionnaire-12 (GHQ-12) evaluating mental health, the World Health Organization Quality of Life-BREF (WHOQoL-BREF) questionnaire and the Fear of COVID-19 Scale (FCV-19S). Result(s): Of 1,556 participants, 522 (33.5%) reported a need for mental health support (MHS) in the previous year. The FCV-19S weakly correlated with the GHQ-12 (r=0.234, p<0.001) and WHOQoL-BREF domains (r=-0.245 for physical health, r=-0.182 for psychological health, r=-0.141 for social relationships and r=-0.183 for environmental health domains;p<0.001). The need for MHS was the common significant variable for all scale scores in univariate analyses and multiple linear regression. After multiple linear regression, the FCV-19S score was significantly related to the GHQ-12 and all WHOQoL-BREF domain scores. Conclusion(s): Our results indicate a remarkable level of need for MHS. The need for MHS and COVID-19 fear are related to mental health and quality of life in Turkish HCWs. The self-reported need for MHS may serve as an alarming characteristic for HCWs' psychosocial burden.

COVID-19: booster(s) vs. hospitalization and Intensive Care Unit admission.

OBJECTIVE: As the pandemic continues, different vaccine protocols have been implemented to maintain the protection of vaccines and to provide protection against new variants. The aim of this study was to assess hospitalized patients' vaccination status and document the efficacy of boosters. PATIENTS AND METHODS: The patients that were hospitalized due to COVID-19 were enrolled from 28 hospitals in Turkey for five months from September 2021. 5,331 confirmed COVID-19 patients from collaborating centers were randomly enrolled to understand/estimate the distribution of vaccination status in hospitalized patients and to compare the efficacy of vaccination/booster protocols. RESULTS: 2,779 men and 2,552 women of which 2,408 (45.2%) were admitted to Intensive Care Units participated in this study. It was found that the highest risk reduction for all age groups was found in groups that received 4 doses. Four doses of vaccination for every 3.7 people under 50 years of age, for every 5.7 people in the 50-64 age group, and for every 4.3 people over 65 years of age will prevent 1 patient from being admitted to intensive care. Regardless of the type of vaccine, it was found that the risk of ICU hospitalization decreased in those who were vaccinated compared to those who were not vaccinated. Regardless of the type of vaccine, the ICU risk was found to decrease 1.25-fold in those who received 1 or 2 doses of vaccine, 1.18-fold in those who received 3 doses, and 3.26-fold in those who received 4 doses. CONCLUSIONS: The results suggested that the addition of a fourth dose is more effective in preventing intensive unit care even in disadvantaged groups.

Effect of the novel type coronavirus on the mental health of patients

BACKGROUND AND AIM: The novel Coronavirus disease (COVID-19) emerged in China in 2019 and significantly affected the entire world. The pandemic and the restrictions led to an increase in the frequency of mental health disorders (i.e., depression and anxiety) and insomnia. The aim of the study was to evaluate mental health disorders in patients who were hospitalized because of COVID-19. The patients were evaluated 6 months after hospital discharge. METHODS: A total of 114 patients who were hospitalized at Ufuk University Hospital with the diagnosis of COVID-19 were consented to participate in the posttreatment questionnaire about demographics and a Depression, Anxiety, and Stress Scale-21. The Pittsburgh Sleep Quality Index was also given to the patients to answer. RESULTS: In our study, anxiety symptoms were detected in 34 (29.8%) individuals, stress symptoms in 9 (7.9%) individuals, and depressive symptoms in 17 (14.9%). When gender, education level, age, and marital status were evaluated, there was no significant relationship observed between depression, anxiety and stress, and sleep disorders. Only those with a history of psychiatric illness had significantly higher levels of anxiety, stress, and depression (p=0.040, p=0.047, and p=0.009, respectively). Sleep quality was poor in 88 (77.2%) patients and good (normal) in 26 (22.8%) patients. CONCLUSIONS: The results show that the sleep quality of the patients deteriorated and the symptoms of stress and anxiety increased during the COVID-19 pandemic period. Patients with a previous history of psychiatric illness were more affected.

How Are Immigrants Advancing on the European Labor Market? The Case of Spain

Introduction: Despite its significance, the research on international migration with a specific focus on the European Union (EU) needs to be strengthened with comprehensive studies, for developing better immigration and integration policies. Considering the amplitude of migration flows in Europe and recent challenges brought by the Covid-19 pandemic crisis, the Brexit decision and humanitarian dimension of the migration phenomena (asylum seekers and refugees), the need for better immigration and integration policies within the host countries' labor markets stands out as a major research direction, especially in case of immigrants looking for better working and living conditions. Aim: This chapter aims to design specific immigration clusters within the main EU-10 destination countries (including Spain, Italy, Belgium, Denmark, Finland, France, UK, Germany, Austria, and Sweden) ( cluster analysis procedure);and to identify feasible ways and specific policies for immigrants' labor market success (spatial analysis and macroeconometric models. Method: The methodological framework consists of two parts: (i) immigration clusters analysis, based on the interlinkages between several fundamental migration coordinates, namely, economic welfare at destination, employment opportunities for the foreign population, migrant integration policies and associated governmental efforts, educational background;and (ii) spatial analysis models, namely spatial lag-autoregressive and spatial error, and other three econometric procedures, respectively, the robust regression, Panel Corrected Standard Errors, and Arellano-Bond Dynamic Generalized Method of Moments. National data compiled for the 10 main EU receiving economies during 2000-2015, with a particular focus on Spain were used. Findings: The impact of the proposed research is reflected through a set of new specific tailored ways, policies and strategies that can be adopted and implemented by the policy-makers across Europe. Our empirical results show that, overall, EU-10 countries still fail to identify immigrants with high levels of education and skills acquired to enhance their potential for labor market integration. Policy-makers should always monitor the specific ways in which migration policies lead to concrete positive labor market outcomes for immigrants and that the tools used for implementing these policies are suitable in achieving predefined migration goals. Therefore, a particular focus should be on developing a new immigration system to select migrants for their skills and high level of human capital, by following the best practices examples of other receiving countries.

OUR EXPERIENCES IN A NEUROSURGICAL OPERATING ROOM DURING THE COVID-19 PANDEMIC

Objective: The COVID-19 pandemic has led to many compulsory alterations at health system. Emergency surgery is an area that is facing the need for many adaptations in health system.We aimed to evaluate the emergency cases accepted the neurosurgery operating room during the pandemic period and to determine the adequacy of the measures we took and if any, our deficiencies. Methods: We examined the 135 patients who were urgently operated in the neurosurgery operating room during the pandemic period (between March 15 and June 1, 2020). Demographic features and the way they applied to our clinic were recorded. Our study includes the results of the PCR tests before and after the surgery, chest x-rays, chest CT findings, laboratory results. The patients were called on the phone and asked whether they were diagnosed with COVID-19 in the postoperative period 1st month. Results: COVID-19 infection was detected in 3 of 135 patients who had an emergency surgery. All three patients with the infection were children. Preoperative PCR tests were carried out in only one of the three positive patients. In the other two patients, postoperative test results were positive. No infection was detected in our anesthesia and surgical personnel in our units period. Conclusion: If we organize our surgery programs with the precautions suggested by the guides, we will ensure the safety of both our patients and healthcare professionals.

Nursing student attitudes toward nursing profession and their state anxiety level during COVID-19 outbreak

Objectives: This study was designed to investigate nursing students' attitudes toward the nursing profession and examine their state anxiety level during the coronavirus 2019 (COVID-19) pandemic. Methods: The population for this descriptive research was Turkish university nursing students. The study sample consisted of 1653 nursing students who participated in the study between April 25 and May 10, 2020. The Attitude Scale for Nursing Profession (ASNP) and the State-Trait Anxiety Inventory (STAI) were used to collect the study data. The Mann-Whitney U test, Kruskal-Wallis test, and the Spearman correlation test were used to evaluate the findings. Results: The mean score of the preference for the nursing profession (PNP) subscale of the ASNP was 51.13 +/- 8.61 and the mean score of the general attitude toward the nursing profession (GATNP) subscale score was 34.82 +/- 2.80. The mean STAI mean score was 43.95 +/- 11.17. There was a weak, negative relationship between the STAI and the PNP (r=-0.279) and the GATNP (r=-0.140) (p<0.05).The 2 most important predictors of state anxiety level were motivation to join the nursing profession and being a female (p<0.01). Conclusion: The students who participated in the study reported a moderate state anxiety level. Mental health assessments of student nurses are recommended, as well as efforts to increase their psychological resilience and ability to cope with stress.

The predictive value of initial ct scan in patients with covid-19

Background: As the pandemic of coronavirus disease 2019 (COVID-19) in Wuhan raised public health concerns, many studies were conducted to reveal the risk factors of the disease and predictive prognostic indicators to plan the treatment strategies and commence therapies earlier. Although specific parameters, including age, gender, chronic diseases, D-dimer, and neutrophil-lymphocyte-ratio play a curial role in COVID-19, the association between mortality and the extent of lung involvement in the initial computerized tomography (CT) scan of patients diagnosed with COVID-19 has not been well documented in the literature. Objectives: We compared two groups (CT-1 and CT-2) in terms of lung involvement in the initial CT of patients admitted to the emergency unit and then hospitallzed with COVID-19. Methods: Using the digital data system of Ízmir Bozyaka Training and Research Hospital, Turkey, subjects diagnosed with COVID-19 in April 2020 were retrospectively screened. For each of the 90 patients, the initial CT scans on admission were evaluated for the extent of lung involvement and classified as CT-1 (≤ 5% of lung involvement, n: 45) and CT-2 (> 5% of lung involvement, n: 45). Results: There was not any statistical significance between two different CT groups regarding mortality and length of stay of patients in hospital with COVID-19 (P = 0.72 and P = 0.51, respectively). Neutrophil counts were found to be statistically significant and higher in CT-2 group than the CT-1 (P = 0.02) group. The length of stay in hospital was correlated with age, neutrophil-lymphocyte ratio (NLR), neutrophils, lymphocyte, and only the correlation between length of stay in hospital and age was significant (P = 0.01). Conclusions: The size of involvement is not a predictive indicator for mortality and length of stay in hospital in patients with COVID-19. © 2021, Kowsar Medical Institute. All rights reserved.

Nutritional habits and emotional eating of adults during social isolation days due to Covid-19 pandemic

Data Collection Sociodemographic Information Form: The form created by the researchers includes data of age, sex, education level, number of households, employment status, body weight and height, sleeprelated changes and their duration, and physical activity status. According to the data obtained on food purchasing and nutritional behaviors in quarantine days, 50.1% of participants stocked food at home. According to BMI groups, a decrease in physical activity was most common among overweight women (76.2%) and healthy weight men (76.9%). Whereas 51.5% of obese women reported involuntary body weight gain, this rate in obese men was 55.4% (Table 4).