Fatal Mucormycosis Infection with Coronavirus Disease 2019 in a Kidney Transplant Patient

Mucormycosis is a life-threatening infection, especially seen in individuals with diabetes mellitus and immunosuppression, in which the vast majority of cases result in death. Early diagnosis is vital for treatment. Coronavirus disease 2019 infection can also lead to the development of mucormycosis infection. Only few cases have been reported in the literature. A 35-year-old kidney transplant patient was hospitalized for coronavirus disease 2019 infection with lung involvement and was further examined upon complaint of headache and visual impairment during follow-up, which was later diagnosed as mucormycosis infection. The patient died despite the initiation of emergent surgical debridement and amphotericin B therapy. © 2023 Turkish Society of Nephrology. All rights reserved.

The relation of hepcidin, vitamin D and inflammatory parameters, and effects on intensive care unit outcome in critically ill COVID-19 patients

Objectives: Aim of this study was to evaluate hepcidin levels and its correlation with inflammatory markers, vitamin D levels as well as its effects on intensive care unit (ICU) mortality in critically ill coronavirus disease-2019 (COVID-19) patients. Materials and Methods: Adult patients those were admitted to pandemic ICU between March 1st, 2021 and May 17th 2021 were prospectively included to the study. Hepcidin levels and inflammatory markers on day 1, 2, 3 and 7, admission vitamin D levels, length of ICU stay and ICU mortality were recorded and analysed. Results: Median age of patients was 60.5 (52.50-71.25) and 20 (66.7%) of them was male. It was observed that hepcidin levels and lymphocyte counts were increased significantly from day 1 to day 7 (p=0.01 and p<0.01, respectively). In contrast, C-reactive protein (CRP) and procalsitonin levels were decreased from day 1 to day 7 (p=0.01 and p<0.01, respectively). In the analysis admission hepcidin levels and inflammatory markers [IL-6 (p=0.61), CRP (p=0.82) and ferritin (p=0.27)], vitamin D (p=0.13) and iron level (p=0.90) was not correlated. There was no correlation between hepcidin levels and ICU mortality (p=0.95). Conclusion: In this study, hepcidin levels were above normal limits in critically ill COVID-19 patients. However, our findings do not support the use of hepcidin, IL6, serum ferritin, and vitamin D levels in predicting COVID-19 mortality.

The efficacy and safety of second allogeneic hematopoietic stem cell transplantation

Background: Second allogeneic hematopoietic cell transplant (sAHCT) might be indicated following a graft failure or disease relapse after the first one;although it might emerge with high rates of morbidities and mortality. Currently, there is a limited number of publications on this matter in the literature, here we aimed to share our sAHCT experience from a single center. Methods: Data from 51 patients who were eligible for sAHCT between 2001 and 2021 was evaluated retrospectively. All data was obtained from the Ankara University Faculty of Medicine, Department of Hematology and Bone Marrow Transplant Unit. Results: 51 patients were included in the present study. Median age at sAHCT was 34 (18- 65) and female/ male ratio 19/ 32 (37.3% / 62.7%). The same donor from the first transplant was eligible for sAHCT for most patients (n= 46, 90.2 %). sAHCT indication was graft failure for 11 patients (21.6 %) whereas 40 (78.4 %) patient went on sAHCT for disease relapse. Patients' diagnoses were as follows: acute myeloid leukemia (n= 26, 50.9 %), acute lymphoblastic leukemia (n=9, 17.6 %), myelodysplastic syndrome (n= 6, 11.8 %), aplastic anemia (n= 6, 11.8 %) and others (CMML, CML, biphenotypic leukemia). Median number of transplanted CD34+ hematopoietic cells was 5.77 x x106/ kg (1.11- 8.29). Stem cell source was either bone marrow (n= 5, 9.8%) or peripheral blood (n= 46, 90.2 %). Myeloablative conditioning regimens were used for most sAHCTs (n= 30, 58.8%). Median overall survival (OS) rates for graft failure and disease relapse groups were 12.8 and 18.7 months, respectively (p= 0.63). During early transplant phase, 20 patients (39.2 %) died due to bone marrow aplasia, transplant failure or other complications. 1 year OS of the entire cohort was 33.3 % whereas 2-y- OS was 21.6% (95% CI= 25-45). 2 patients (3.9 %) died due to COVID19 during transplant process. On univariate analysis, sex, time from the first transplant (<12 months/ ≥12 months), conditioning intensity, sAHCT indication did not statistically significantly influence OS. Multivariate analysis confirmed a lower ECOG score (<2) at sAHCT significantly increased OS (p= 0.001). Conclusions: Based on this single center study, sAHCT is an efficacious treatment modality especially for patients with lower ECOG scores. sAHCT may offer long term survival for both graft failure and disease relapse states.

The Effect of Blood Lactate Level on Mortality in COVID-19 Positive Patients

Aim: We aimed to investigate the relationship between increased lactate values and mortality in COVID-19 patients. Materials and Methods: This study was conducted in a tertiary training and research hospital. According to the order of application, a total of 316 patients over the age of 18 who were admitted to the emergency department (ED) with symptoms of COVID-19 during the two months and whose data could be completely accessed were included in the study retrospectively. Plasma lactate values and mortality within 28 days were determined. Results: The median age of the patients was 69 years. Of the patients, 53.5% were male, 72.2% had comorbidities, and the most common comorbidity was COPD (13.0%). Of the patients, 83.5% were hospitalized. The mean lactate value of the patients was 2.05 +/- 1.45mmol / L. Mortality developed in 14.2% of the patients during the first 28 days. The 28-day mortality was significantly higher in patients with a positive Polymerase Chain Reaction (PCR) (23.8%) than that of negative PCR (8.2%) (p < 0.001). The lactate level was found to be significantly different in both PCR positive and negative groups in which mortality developed within 28 days (p < 0.001;p < 0.001). If the cut-off value of lactate in terms of mortality was 2.45, the sensitivity and specificity were determined as 80.0% and 81.2%, respectively. Conclusion: In patients with COVID-19 infection, the blood lactate level examined at the first admission to ED can be used as a practical screening test to predict mortality.

Qtc interval and electrocardiographic findings of covid-19 patients

Aim: This study aimed to investigate the effectiveness of using the QTc interval and electrocardiographic (ECG) findings to predict 28-day all-cause mortality in patients with COVID-19. Material and Methods: Patients aged 18 or older who visited ED with complaints of fever, cough and shortness of breath were tested using real-time reverse-transcriptase polymerase chain reaction, were imaged with CCT, underwent ECG, and consequently, diagnosed with COVID-19 were included in this study. Results: A total of 276 patients were included in the study. When at least one comorbid disease, reduced oxygen saturation, ECG findings of prolonged QTc interval, ventricular tachycardia/fibrillation, left bundle branch block and ST segment elevation/depression or severe lung involvement (four or five lobes) on CCT scans were detected, patients had a higher 28-day all-cause mortality rate. Compared to surviving individuals, deceased patients had approximately 4.5-fold increased D-dimer levels, and approximately 5-fold increased C-reactive protein and troponin T levels. Among the deceased patients, 40% had sinus tachycardia. Discussion: Usage of comorbidities, ECG, laboratory tests and CCT together is useful for predicting 28-day all-cause mortality rate in patients diagnosed with COVID-19.

Prospective analysis of different oral iron posology on clinical findings and serum iron parameters including hepcidin in patients with iron deficiency anemia

Background: Iron Deficiency Anemia (IDA) is a common health problem in daily clinical practice. A better understanding of iron metabolism in recent years;has created the need for revising treatment regimens in the treatment of IDA. Aims: Based on these data, we aimed to evaluate the effectiveness of oral ferrous sulfate treatment at different doses, and posologies in premenopausal women diagnosed with IDA, and its relationship with hepcidin, treatment compliance, and gastrointestinal side effects in this study. Methods: This is a prospective observational study including premenopausal female patients median age 36 (18-50) diagnosed with IDA. This study was approved by local ethic committe and sponsored by Ankara University School of Medicine Scientific Research Projects(BAP proje number 20L0230012) All patients recieved po ferrous sulfate (FS) 80 mg elemental iron) for three months. Patients were classified into three group according to FS dose: Group 1: 2x1/day;Group 2: 1x1/ day;Group 3: 1x1every other day. At the time of enrollment, thereafter at the second week of FS and at the third month: Hb level, transferrin saturation(%TS), total iron binding capacity were recorded. Blood was drawn and stored at -20 temperature for hepcidin analysis from patiens who signed informed consent. Results: We intent to analyse 50 patients for each group, however as a consequence of COVID-19 pandemic, neither patients could come to hospitals nor we could visit them. The patients in each group, ages and results are shown Table At the end of the second week a significant increase in Hb level was observed (p <0.01) and the mean Hb level increased by 1.38 ± 1.04 and 1.03 ± 0.48 in the first and second groups respectively and ≥ 1 g / dl while in the group given every other day it remained <1 g / dl with an increase of 0.69 ± 0.36. (p = 0.020, p = 0.019, respectively). Comparing the ferritin levels within the three group, it was seen that the ferritin increased significantly in the first group compared to the second and third group (p <0.05). There was no difference between group 2 and group 3 in terms of increase in ferritin level (p> 0.05). The increase in TS% and decrease in total iron binding capacity were similar in all three group at the end of the treatment (p> 0.05). The change between the second week and the initial hepcidin was mostly observed in the second group (p= 0.024) and the change between the three group were similar (p = 0.708). Gastrointestinal side effects were observed more in the first group who received 2∗1 daily than in the second and third group (p <0.05). While a similar increase in appetite and weight was observed in the patients in group 1 and 2 at the end of the treatment (p> 0.05) and there was no increase in appetite and weight in group 3. Summary/Conclusion: Hb level increase at the end of second week was ≥1 g / dl in the first and second group and <1 g / dl in the third treatment group. However, at the end of the treatment third month anemia was significantly improved in all three group and the increase in Hb level was similar. We consider, 1∗1 daily or 1∗1 every other day posology would be more appropriate instead of 2∗1 daily due to the significant gastrointestinal side effects in the first group. In addition, we believe in that, the evaluation of Hb response in the second week is too early to decide treatment outcome due to the slower Hb increase in the other day group and serial Hepcidin measurements will give a better idea to better understand the kinetics.

The anxiety levels of children with cystic fibrosis and healthy children during the COVID-19 pandemic

Objectives: The first case of COVID-19 infection was confirmed in Turkey on March 11, 2020 and the Turkish government ordered a nation-wide school closure and lockdown for people younger than 20 years old by 1st of April. School closure and home confinement might have adverse effects on children's physical and mental health. In this study, we aimed to compare the effect of the COVID-19 pandemic on psychological reactions and coping of CF patients and healthy controls. Methods: 132 CF patients and 135 volunteers, ages 7 years and older, were included in the study. The survey included questions regarding family environment and peer relations, self care during lockdown and psychological reactions to the COVID-19 pandemic. Results: Compared to the patient group, the control group showed more anxiety symptoms, tried to have new hobbies during lockdown and needed more psychological help (Table 1). [Table presented] Conclusion: Surprisingly, symptoms of anxiety were higher in the control group compared to the CF group. CF patients seem to show more resiliance in coping with the outbreak and with school closure than their peers. Also, they reported needing less psychological help (not statistically significant). Since CF patients are already used to wearing face masks and follow infection control measures in their daily lives, these measures may not cause extra anxiety as in their healthy peers. Screening for psychological symptoms should be recommended both for CF patients and healthy children. Children with CF and also healthy children should be screened for anxiety symptoms and appropriate psychological support should be provided to them, if needed.

Lymphocyte/mean platelet volume ratio, a new marker; is it effective in predicting the prognosis of COVID-19 cases?

OBJECTIVES: This study aims to determine the prognostic significance of the lymphocyte/mean platelet volume ratio (LMR) in terms of the clinical course of the disease in patients with COVID-19. METHODS: Patients over 18 who were evaluated for COVID-19 during the period from April 1, to April 30, 2020 were retrospectively scanned. Patients with at least 1 positive PCR test result were as assigned to Group 1 while patients with negative test results were assigned to Group 2. The LMR ratio was calculated by dividing the lymphocyte value by that of MPV. The relationship between LMR, severity of patients' CT findings and 28-day mortality was evaluated. RESULTS: A total of 938 patients were included in the study. It was observed that the lymphocyte and LMR levels were significantly different in those who died within 28 days (p < 0.001, p ≤ 0.001). In the ROC analysis for the LMR level, the area under the curve (AUC) was found to be 0.737 (95% CI 0.639‒0.834). When the cut­off value of LMR was 0.045, the sensitivity was found to be 99.0 % and specificity was 15.2 %. CONCLUSION: LMR can be a guide in multiple cases of care provided to critical patients, as is the case in the COVID-19 pandemic and can be used in recognizing critical patients (Tab. 5, Fig. 1, Ref. 21).