ABSTRACT
Objective: Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus, the first cases of which were reported in Wuhan, China in December 2019. The disease often presents with major respiratory symptoms. In addition, gastrointestinal (GI) symptoms are observed. They may be the first or even the only symptoms of the disease. The aim of this study is to demonstrate the presentation of GI symptoms and their relationship to other symptoms, the clinical course and prognosis of patients with COVID-19. Methods: Included in this study were patients over 18 years of age who had been hospitalised for treatment in clinics and intensive care units due to COVID-19 between March and June 2020. The symptoms reported by the patients at the time of admission and the data collected as a result of the clinical follow-up were evaluated. Results: Out of the 1,045 patients with COVID-19, 140 patients (13.4%) had GI symptoms. The complaints of these 140 patients were nausea (53.6%), vomiting (32.1%), abdominal pain (11.4%), diarrhea (45.7%), anorexia (43.6%) and loss of taste (5.6%). In 3.2% of the patients, only GI symptoms were present, without any respiratory symptoms. Conclusion: Gastrointestinal symptoms were present at the time of admission in 13.4% of the patients with COVID-19. The most common GI symptom in the patients was nausea. Length of stay in hospital and mortality rate were higher in patients with only GI symptoms. Therefore, GI symptoms should be considered in patients with suspected COVID-19.
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Aim: There is currently no pharmacotherapy with for the treatment of COVID-19. We aimed to investigate the effects of early and high-dose vitamin C (VC) therapy in hospitalized patients with COVID-19. Materials and Methods: We included patients (n=139) who received high-dose VC supplement to the standard treatment protocol into group 1 (n=58), and only those who received a standard treatment protocol into group 2 (n=81). The patients' requirement for supplemental oxygen therapy, requirement for intensive care treatment and survival rates was investigated retrospectively. Furthermore, the changes in white blood cell, C-reactive protein (CRP), procalcitonin, D-Dimer, renal function tests, ferritin, and interleukin 6 values during hospitalization were evaluated.
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Objective: Complex metabolic acid-base disturbances can be seen in critically ill patients infected with the SARS-CoV-2 virus. For arterial blood gas (ABG) analysis, base excess (BE) approach enables limited evaluation of the etiological factors. The Stewart’s physicochemical approach, on the other hand, may not reveal etiological agents adequately. In this study, we aimed to compare BE approach versus physicochemical method for the evaluation of metabolic acid-base disturbances in critically ill patients infected with SARS-CoV-2. Method: Between March 2020 and May 2020, ABG analysis results of a total of 113 patients (71 males, 42 females) infected with SARS-CoV-2 and hospitalized in the adult intensive care units were retrospectively analyzed. The patients were divided into groups according to the BE approach and evaluated for physicochemical components. The ABG and some electrolyte values were compared among groups. Results: The most common acidotic components according to the Stewart’s method were hyperphosphatemia (84.9%), but low strong ion difference (SID) acidosis (62.2%) in patients with metabolic acidosis according to the BE approach. Low SID acidosis (50%) and hyperphosphatemia (30.9%) in patients with normal BE and hyperphosphatemia (77.7%) in patients with metabolic alkalosis according to the BE approach were observed. In patients with metabolic acidosis according to BE approach, 71.6% of the patients had hypoalbuminemia and 24.5% of the cases had high SID alkalosis among the Stewart’s alkalosis components. Strong ion gap (SIG) acidosis was seen in 11.1% and low SID acidosis was seen in 11.1% in patients with metabolic acidosis according to the BE approach. Conclusion: Physiochemical approach seems to provide additional information regarding the etiological factors and unravel the invisible part of the iceberg for the evaluation of metabolic acid-base disturbances in critically ill patients infected with the SARS-CoV-2 virus.
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Background and Aim: The exact treatment method of Covid-19 has not been found so far. However, some small-scale studies have shown the potential benefit of hydroxychloroquine/chloroquine (hydroxychloroquine treatment in our country) and azithromycin in Covid-19 treatment. It is known that these drugs (alone or combined use) may increase the risk of malignant arrhythmia such as torsades de pointes (polymorphic ventricular tachycardia) with prolonged QT interval. There is no data showing the effect of Favipiravir on cardiac arrhythmia. In this study, we aimed to investigate the effect of hydroxychloroquine and azithromycin on the QTc interval in patient with Covid-19. Methods: Patients who hospitalized in our center between March and May 2020 for Covid-19 and treated with recommendations of Republic of Turkey Ministry of Health SARS-CoV-2 guide included in our study. The data of 142 consecutive patients who received hydroxychloroquine and/or azithromycin treatment were retrospectively analyzed and the QTc interval in ECG was calculated with the Bazzet formula. Patients who were already using hydroxychloroquine (i.e. because of autoimmune disease etc), hypersensitivity to hydroxychloroquine and/or azithromycin and patients who use drugs other than hydroxychloroquine and/or azithromycin that can prolong the QT interval were excluded. Patients with baseline QTc 500 milliseconds (msec) or longer were also excluded from the study. According to the protocol, ECG was performed all patients before treatment, and ECG controls were performed on the 1st, 3rd and 5th days of the treatment. Results: The mean age of the study population was 46.9±17.3. A total of 142 patients (50.7% male and 49.3% female), received hydroxychloroquine therapy, 36 patients (25%) received hydroxychloroquine monotherapy, while 106 patients (75%) received hydroxychloroquine and azithromycin combination therapy (Table 1). Majority of the patients were in sinus rhythm (%95,1) with mean baseline heart rate of 81.9±14.7 beats per minute. Mean baseline QTc values of 142 patients were 417.3±24 msec, ranging between 356-486 msec. There were no significant differences between the baseline, 1st, 3rd and 5th day's QTc values of two groups. (p>0.05). When each groups were evaluated for QTc prolongation during the therapy period, it was observed that the baseline QTc interval was significantly prolonged with treatment in both the hydroxychloroquine group and the hydroxychloroquine + azithromycin group (Table 2) (p<0.05). There were no patients required discontinuation of these medications, no malign arrhythmia and no arrhythmogenic deaths due to QTc prolongation (Table 3). Conclusions: Although treatment-related QTc prolongation is observed in our study population, no malignant arrhythmia was observed. Close monitoring of the treatment process by cardiologist and the predetermination of patients with long onset QTc distances are considered to be the most important factor in the safe management of the treatment.
ABSTRACT
Íntroduction: COVID-19 infection may be atypically presented in the older adults with a poor prognosis. In this study, we aimed to investigate the clinical and laboratory differences of COVID-19 course in older patients. Materials and Method: The demographic, clinical, laboratory and radiological data of the patients hospitalized with COVID-19 infection were compiled retrospectively. A randomized control group was created from younger patients. Chest tomography of the patients were examined and scored. Results: Data of 100 older and 127 younger patients with COVID-19 infection, and 80 non-COVID older patients were evaluated retrospectively. While the mean CRP, fibrinogen, procalcitonin, urea, LDH, INR, PT, Troponin-I, CK-MB and total radiological lung score were significantly higher in older patients;the mean hemoglobin, hematocrit and d-dimer were significantly higher in younger patients. Lymphopeniawasmore common and themortality ratewas higher in the older adults. Lymphopenia, presence of comorbidity, being over the age of 75, and radiological lung involvement were identified as mortality risk factors in older patients. The cut-off values for mortality were as follows;age≥77 years, lymphocyte#≤ 700x103 cells/µL, CRP≥108.71 mg/L, d-dimer≥2.25 mg/L, fibrinogen≥383 mg/L, INR≥1.05, PT ≥12.5 seconds, aPTT≥31 seconds, Troponin-I≥19.1 pg/mL, total lung score≥6 points. COVID-19 did not increase mortality much more than other hospital-requiring clinical events in older adults (17% vs 26.25%). Conclusion: The older adults require special attention in COVID-19 pandemic. Those with comorbidities, lymphopenia, high d-dimer levels, and extensive lung involvement in the initial tomography should be followed-up closely.