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1.
Exp Gerontol ; 170: 111998, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2086199

ABSTRACT

PURPOSE: While the definitive diagnosis of COVID-19 relies on PCR confirmation of the virus, the sensitivity of this technique is limited. The clinicians had to go on with the clinical diagnosis of COVID-19 in selected cases. We aimed to compare PCR-positive and PCR-negative patients diagnosed as COVID-19 with a specific focus on older adults. METHODS: We studied 601 hospitalized adults. The demographics, co-morbidities, triage clinical, laboratory characteristics, and outcomes were noted. Differences between the PCR (+) and (-) cases were analyzed. An additional specific analysis focusing on older adults (≥65 years) (n = 184) was performed. RESULTS: The PCR confirmation was present in 359 (59.7 %). There was not any difference in terms of age, sex, travel/contact history, hospitalization duration, ICU need, the time between first symptom/hospitalization to ICU need, ICU days, or survival between PCR-positive and negative cases in the total study group and older adults subgroup. The only symptoms that were different in prevalence between PCR-confirmed and unconfirmed cases were fever (73.3 % vs. 64 %, p = 0.02) and fatigue/myalgia (91.1 % vs. 79.3 %, p = 0.001). Bilateral diffuse pneumonia was also more prevalent in PCR-confirmed cases (20 % vs. 13.3 %, p = 0.03). In older adults, the PCR (-) cases had more prevalent dyspnea (72.2 % vs. 51.4 %, p = 0.004), less prevalent fatigue/myalgia (70.9 % vs. 88.6 %, p = 0.002). CONCLUSION: The PCR (+) and (-) cases displayed very similar disease phenotypes, courses, and outcomes with few differences between each other. The presence of some worse laboratory findings may indicate a worse immune protective response in PCR (-) cases.


Subject(s)
COVID-19 , Pneumonia , Humans , COVID-19/diagnosis , SARS-CoV-2 , Myalgia , Hospitalization , Polymerase Chain Reaction , Outcome Assessment, Health Care , Fatigue
2.
Front Immunol ; 13: 954391, 2022.
Article in English | MEDLINE | ID: covidwho-2039677

ABSTRACT

Erroneous immune responses in COVID-19 could have detrimental effects, which makes investigation of immune network underlying COVID-19 pathogenesis a requisite. This study aimed to investigate COVID-19 related alterations within the frame of innate and adaptive immunity. Thirty-four patients clinically diagnosed with mild, moderate and severe COVID-19 disease were enrolled in this study. Decreased ILC1 and increased ILC2 subsets were detected in mild and moderate patients compared to healthy controls. NK cell subsets and cytotoxic capacity of NK cells were decreased in severe patients. Moreover, CD3+ T cells were reduced in severe patients and a negative correlation was found between CD3+ T cells and D-dimer levels. Likewise, moderate and severe patients showed diminished CD3+CD8+ T cells. Unlike T and NK cells, plasmablast and plasma cells were elevated in patients and IgG and IgA levels were particularly increased in severe patients. Severe patients also showed elevated serum levels of pro-inflammatory cytokines such as TNF-α, IL-6 and IL-8, reduced intracellular IFN-γ and increased intracellular IL-10 levels. Our findings emphasize that SARS-CoV-2 infection significantly alters immune responses and innate and acquired immunity are differentially modulated in line with the clinical severity of the disease. Elevation of IL-10 levels in NK cells and reduction of CD3+ and CD8+ T cells in severe patients might be considered as a protective response against the harmful effect of cytokine storm seen in COVID-19.


Subject(s)
COVID-19 , CD8-Positive T-Lymphocytes/metabolism , Cytokines/metabolism , Humans , Immunity, Innate , Immunoglobulin A/metabolism , Immunoglobulin G/metabolism , Interleukin-10/metabolism , Interleukin-6/metabolism , Interleukin-8/metabolism , Killer Cells, Natural , SARS-CoV-2 , Tumor Necrosis Factor-alpha/metabolism
3.
Exp Gerontol ; 167: 111907, 2022 10 01.
Article in English | MEDLINE | ID: covidwho-2031280

ABSTRACT

BACKGROUND: While there are substantial reports on the acute phase of Covid-19, the data on post-Covid phase are limited. AIM: To report the data on older post-Covid patients comparatively with the young adults. STUDY DESIGN: Retrospective, single-center study in post-Covid outpatient clinic. Clinical characteristics, laboratory examination, chest imagings were examined. RESULTS: 665 patients were included (median age, 46; 53 %, male; 10.5 %, aged ≥65). We assessed patients at 47th day (median) after recovery. 43.6 % were suffering from one or more ongoing symptomatology. The prevalence of symptoms or physical examination findings were not different between older and younger groups. Most prevalent ongoing symptom was dyspnea (14.3 % and 11.8 % older and younger group, respectively). Most common laboratory abnormality was high pro-BNP (12.2 %, in both age groups). Despite there was no differences regarding imaging findings at acute-phase, there were higher rates of control imaging abnormalities in older subgroup (35.7 % vs 19.4 %; p = 0.006). On admission 28.4 % younger patients had normal imaging, of whom 12.4 % developed some form of sequela; however, in older group, 40.0 % had normal imaging, of whom 25.0 % developed sequela. CONCLUSION: Complaints related to Covid-19 persisted in about half of the patients at about 1.5 months after Covid. More than 1/3 older post-Covid patients displayed pulmonary sequela in the post-acute period which was more prevalent than those in younger adults. Hence, compared to the younger counterparts, the clinicians should be alert in follow-up of older adults for subsequent pulmonary sequela, even among those that had normal imaging finding on initial presentation.


Subject(s)
COVID-19 , Aged , Female , Humans , Lung/diagnostic imaging , Male , Retrospective Studies , SARS-CoV-2
4.
Can J Microbiol ; 68(8): 543-550, 2022 Aug 01.
Article in English | MEDLINE | ID: covidwho-1950269

ABSTRACT

Our aim was to analyze severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific antibody level kinetics after coronavirus disease 2019 (COVID-19) infection and determine the efficiency of vaccination on SARS-CoV-2-specific antibody levels. The study included 50 SARS-CoV-2 infected and 70 uninfected cases. Levels of SARS-CoV-2-specific IgG nucleocapsid protein (IgG-NP), IgG spike protein (IgG-SP), IgM nucleocapsid protein (IgM-NP), and IgA spike protein (IgA-SP) antibodies were evaluated by an enzyme-linked immunosorbent assay in sera obtained at baseline, 1st, 3rd, and 6th month follow-up visits for infected cases and at postvaccination visits for all cases. In symptomatic cases (n = 50), IgG-SP levels were decreased in 6 months compared with baseline, while IgA-SP levels were significantly increased. IgG-NP levels were significantly decreased in symptomatic cases at the 6-month visit. After vaccination, IgG-SP levels were increased in symptomatic cases compared with prevaccination levels. Among subjects vaccinated with CoronaVac (the Sinovac COVID-19 vaccine), infected cases had approximately double the IgG-SP level of uninfected cases. SARS-CoV-2-specific antibody levels were higher at the baseline in symptomatic cases. Nevertheless, all infected cases showed significantly reduced IgG-SP levels at the 6th month. Vaccination effectively increased IgG-SP levels.


Subject(s)
COVID-19 Vaccines , COVID-19 , Immunity, Humoral , Antibodies, Viral , COVID-19/prevention & control , COVID-19 Vaccines/immunology , Humans , Immunoglobulin A , Immunoglobulin G , Immunoglobulin M , Nucleocapsid Proteins , SARS-CoV-2 , Spike Glycoprotein, Coronavirus , Vaccination
5.
SSRN; 2022.
Preprint in English | SSRN | ID: ppcovidwho-337923

ABSTRACT

Background: Hyperinflammation with features of cytokine storm developing in 2nd week of COVID-19 contributes to the worse outcome. Because of relatively milder inflammatory findings compared to other cytokine storms, available criteria for classification of hemophagocytic lymphohistiocytosis or macrophage activation syndrome (MAS) could not be helpful. Methods: Discovery cohort included symptomatic COVID-19 patients, who were followed at hospital during the initial wave. Replication cohort consisted of hospitalized patients from a later period, and all required oxygen support and received glucocorticoids. Diagnosis of MAS was made by an expert panel and the majority received tocilizumab or anakinra. Daily clinical and laboratory data were recorded, and data of treatment start day were compared with the 5-6th day data of non-MAS group. Receiver operating characteristics (ROC) and values maximising the sensitivity and specificity of each parameter were calculated to determine criteria items. Findings: 685 patients were analysed in the discovery and 156 in the replication cohorts;of whom 150 and 61 received the treatment for MAS, respectively. Mortality rate was higher in the patients with MAS in the discovery cohort (23·3%) compared to the rate of non-MAS (3·7%) patients;and it was much lower in the replication cohort for both groups. The new 12-item criteria were developed to define COVID-19-associated pulmonary MAS (pMAS) early, and the score of 35 provided 85·3% sensitivity and 81.7% specificity. The same criteria gave 90·0% sensitivity for the diagnosis of pMAS in the replication cohort, but much lower specificity scores were observed, due to the control group including milder cases of MAS. Interpretation: The new set of criteria is expected to help define patients with COVID-19 associated pMAS with a reasonable sensitivity and specificity and enable us to start treatments as early as possible.

6.
Int Urol Nephrol ; 54(5): 1097-1104, 2022 May.
Article in English | MEDLINE | ID: covidwho-1782900

ABSTRACT

BACKGROUND: Acute kidney injury (AKI) in COVID-19 patients is associated with poor prognosis. However, the incidence, risk factors and potential outcomes of AKI in hospitalized patients are not well studied. MATERIALS AND METHODS:  This is a retrospective cohort study conducted in two major university hospitals. Electronic health records of the patients, 18 years or older, hospitalized between 13 April and 1 June 2020 with confirmed COVID-19 were reviewed. We described the incidence and the risk factors for AKI development in COVID-19 patients. Furthermore, we investigated the effects of AKI on the length of hospital and intensive care unit (ICU) stay, the admission rates to ICU, the percentage of patients with cytokine storm and in-hospital mortality rate. RESULTS: Among 770 hospitalized patients included in this study, 92 (11.9%) patients developed AKI. The length of hospitalized days (16 vs 9.9, p < 0.001) and days spent in the hospital until ICU admission (3.5 vs. 2.5, p = 0.003) were higher in the AKI group compared to patients without AKI. In addition, ICU admission rates were also significantly higher in patients with AKI (63% vs. 20.7%, p < 0.001). The percentage of patients with AKI who developed cytokine storm was significantly higher than patients without AKI (25.9% vs. 14%, p = 0.009). Furthermore, the in-hospital mortality rate was significantly higher in patients with AKI (47.2% vs. 4.7%, p < 0.001). CONCLUSIONS: AKI is common in hospitalized COVID-19 patients. Furthermore, we show that AKI increases the admission rates to ICU and in-hospital mortality. Our findings suggest that AKI should be effectively managed to prevent the adverse outcomes in COVID-19 patients.


Subject(s)
Acute Kidney Injury , COVID-19 , Acute Kidney Injury/epidemiology , Acute Kidney Injury/etiology , COVID-19/complications , Cytokine Release Syndrome , Hospital Mortality , Humans , Intensive Care Units , Retrospective Studies , Risk Factors
7.
Turk J Gastroenterol ; 33(3): 196-204, 2022 03.
Article in English | MEDLINE | ID: covidwho-1786213

ABSTRACT

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 virus was found to have effects not only in the lungs but also in many different organs. We aimed to evaluate the management of our patients with inflammatory bowel disease in this pandemic, the incidence of coronavirus disease 2019 in terms of clinical, medical treatment, and features of inflammatory bowel disease, and to investigate the effects of the severe acute respiratory syndrome coronavirus 2 on this particular group of patients. METHODS: During the coronavirus disease 2019 pandemic, 207 patients who had inflammatory bowel disease for at least 6 months were questioned for coronavirus disease 2019 at their outpatient clinic admissions, and their medical records were evaluated prospectively. RESULTS: Of the 207 patients, 146 had Crohn's disease. The mean disease duration was determined as 118.15 ± 72.85 months. Of the patients, 127 (61.4%) were using mesalazine, 110 (53.1%) azathioprine, and 148 (71.5%) biological agents. It was found that 66 (31.9%) patients changed their medications during the coronavirus disease 2019 pandemic. As a medication change, anti-Tumor Necrosis Factor (TNF) dose was observed to be omitted most frequently at a rate of 80%. Diarrhea was present in 20.8%, abdominal pain in 20.3%, nausea in 10.6%, anorexia in 13.5%, and weight loss in 15.9% of the patients. Twelve (5.79%) patients were diagnosed with coronavirus disease 2019. Lung involvement was present in 11 (91.7%) of the patients diagnosed with coronavirus disease 2019. Of the patients diagnosed and not diagnosed with coronavirus disease 2019, 75% vs. 71.6% were using biological agents (P = .80), respectively. Half of the patients diagnosed with coronavirus disease 2019 were active in terms of inflammatory bowel disease at the time of diagnosis, and 2 of these patients were severely active. CONCLUSION: The incidence of coronavirus disease 2019 infection in patients with inflammatory bowel disease was not different from the general population during the severe acute respiratory syndrome coronavirus 2 pandemic. Coronavirus disease 2019 infection does not progress with poor prognosis in patients with inflammatory bowel disease who receive immunosuppressive therapy including biological agents.


Subject(s)
COVID-19 , Inflammatory Bowel Diseases , Biological Factors/therapeutic use , COVID-19/complications , COVID-19/epidemiology , Chronic Disease , Humans , Inflammatory Bowel Diseases/complications , Inflammatory Bowel Diseases/drug therapy , Inflammatory Bowel Diseases/epidemiology , Risk Factors , SARS-CoV-2
8.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-311343

ABSTRACT

Background: Throughout the pandemic, physicians working at the frontlines have embarked on various quests to protect themselves, and many physicians preferred the use of hydroxychloroquine (HQN) as a prophylactic agent. This study aimed to investigate the reasons leading physicians to use HQN and the effects of HQN use on physicians. Methods: : This study is a cross-sectional study with a target population of physicians working in pandemic hospitals in Ístanbul, Turkey. We have recruited the participants from seven different hospitals via an invitation email between May 14 and June 13, 2020. An online questionnaire, including 57 questions in total, was sent to each physician. Results: A total of 148 (26%) physicians used hydroxychloroquine for prevention. Older physicians and ones who have a story of exposure to COVID-19 patients without any protection used more prophylactic HQN. Hydroxychloroquine did not differ statistically in terms of being infected among the exposed physicians (p=0.52). Nineteen (13%) physicians using hydroxychloroquine developed side effects related to the drug. Diarrhea and nausea were the most common. Conclusion: Prophylactic HQN use was more common among the physicians older than 40 years and who had higher exposure rates to a COVID-19 patient without any protection. The physicians working at the frontlines had the highest rate of infection. Hydroxychloroquine was not effective in the prophylaxis of COVID-19 among the exposed physicians.

9.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-316822

ABSTRACT

Objective: Older adults have been continuously reported to be at higher risk for adverse outcomes of Covid-19. We aimed to describe clinical characteristics and early outcomes of the older Covid-19 patients hospitalized in our center comparatively with the younger patients, and also to analyze the triage factors that were related to the in-hospital mortality of older adults. Design: Retrospective;observational study Setting: Istanbul Faculty of Medicine hospital, Turkey Participants: 362 hospitalized patients with laboratory-confirmed Covid-19 from March 11 to May 11, 2020. Measurements: The demographic information;associated comorbidities;presenting clinical, laboratory, radiological characteristics on admission and outcomes from the electronic medical records were analyzed comparatively between the younger (<65 years) and older (≥65 years) adults. Factors associated with in-hospital mortality of the older adults were analyzed by multivariate regression analyses. Results: : The median age was 56 years (interquartile range [IQR], 46-67), and 224 (61.9%) were male. There were 104 (28.7%) patients ≥65 years of age. More than half of the patients (58%) had one or more chronic comorbidity. The three most common presenting symptoms in the older patients were fatigue/myalgia (89.4%), dry cough (72.1%), and fever (63.5%). Cough and fever were significantly less prevalent in older adults compared to younger patients (p=0.001 and 0.008, respectively). Clinically severe pneumonia was present in 31.5% of the study population being more common in older adults (49% vs. 24.4%) (p<0.001). The laboratory parameters that were significantly different between the older and younger adults were as follows: the older patients had significantly higher CRP, D-dimer, TnT, pro-BNP, procalcitonin levels, higher prevalence of lymphopenia, neutrophilia, increased creatinine, and lower hemoglobin, ALT, albumin level (p<0.05). In the radiological evaluation, more than half of the patients (54.6%) had moderate-severe pneumonia, which was more prevalent in older patients (66% vs. 50%) (p=0.006). The adverse outcomes were significantly more prevalent in older adults compared to the younger patients (ICU admission, 28.8% vs. 8.9%;mortality, 23.1% vs. 4.3%, p<0.001). Among the triage evaluation parameters, the only factor associated with higher mortality was the presence of clinically severe pneumonia on admission (Odds Ratio=12.3, 95% confidence interval=2.7-55.5, p=0.001). Conclusion: Older patients presented with more prevalent chronic comorbidities, less prevalent symptomatology but more severe respiratory signs and laboratory abnormalities than the younger patients. Among the triage assessment factors, the clinical evaluation of pulmonary involvement came in front to help clinicians to stratify the patients for mortality risk.

10.
COVID-19 NEDEN&Iacute ; YLE HASTANEYE YATIRILMIŞ 504 HASTANIN ÖZELL&Iacute;KLER&Iacute; VE MORTAL&Iacute;TE AÇISINDAN R&Iacute;SK FAKTÖRLER&Iacute;.; 85(1):1-8, 2022.
Article in English | Academic Search Complete | ID: covidwho-1663005

ABSTRACT

Objective: In this study, we aimed to analyze the demographic characteristics, symptoms, and comorbidities of 504 patients hospitalized for COVID-19. We also sought to describe the relationship between these features and intensive care unit (ICU) admission and mortality. Materials and Methods: This study is a descriptive study involving 504 COVID-19 patients hospitalized between 16.03.2020 and 07.05.2020 at Istanbul Universitys’ Istanbul Faculty of Medicine Hospital. Information about the patients was obtained from the hospital automation system and evaluated retrospectively. Results: The average age of the 504 patients was 56±15.14, and 59.1% of them were male. The proportion of the patients admitted into ICU 11.9% and for 8.52% of them the disease resulted in death. Real time polymerase chain reaction (RT-PCR) test results were positive for 60.5% of the patients. The median time spent in the hospital was eight days. Fifty six percent of the patients had at least one accompanying comorbid disease, with hypertension (39.3%) and diabetes (20.8%) being the most common. Being 65 years old or older (p<0.001), days spent in the hospital (p<0.001), presence of at least one comorbidity (p=0.009), hypertension (p=0.003), coronary artery disease (p=0.004), congestive heart failure (p=0.005) and dyspnea (p<0.001) were all factors found in those admitted to ICU. Conclusion: COVID-19 infection leading to high morbidity-mortality rates and an increased requirement for ICU admission is mainly seen among older patients and those who have dyspnea. During the process of analyzing patients suspected of COVID-19 who are admitted to hospital, it is crucial to consider both the patient’s age and any respiratory symptoms. Such a clinical evaluation is crucial for a better understanding of the course of the disease. (English) [ FROM AUTHOR] Amaç: Bu araştırmada, COVID-19 nedeniyle tedavi almak üzere hastaneye yatırılan 504 hastanın demografik özellikleri, semptomları ve komorbiditeleri incelenerek;bu özelliklerin yoğun bakım ünitesine yatış ve mortalite ile ilişkisini ortaya koymak amaçlanmıştır. Gereç ve Yöntem: Bu araştırma, 16.03.2020-07.05.2020 tarihleri arasında COVID-19 tedavisi almak üzere Ístanbul Üniversitesi Ístanbul Tıp Fakültesi Hastanesi’ne yatırılan 504 hastanın dahil edildiği tanımlayıcı tipte bir araştırmadır. Hastalara ait bilgiler hastane otomasyon sisteminden alınarak retrospektif olarak değerlendirilmiştir. Bulgular: Beşyüz dört hastanın yaş ortalaması 56±15,14 yıl, hastaların %59,1’i erkekti. Yoğun bakım ünitesine yatışı olan hastaların oranı %11,9;ölen hastaların oranı %8,52 idi. Hastaların %60,5’inin test sonucu pozitifti. Hastanede kalınan sürenin ortancası sekiz gündü. Hastaların %56’sının en az bir komorbid hastalığı vardı;hipertansiyon (%39,3) ve diyabet (%20,8) en sık eşlik eden komorbiditelerdi. Altmış beş yaş ve üzeri olmak (p<0,001), hastanede kalınan gün sayısı (p<0,001), en az bir komorbidite varlığı (p=0,009), hipertansiyon (p=0,003), koroner arter hastalığı (p=0,004), konjestif kalp yetmezliği (p=0,005) ve dispne (p<0,001), yoğun bakıma yatış ile ilişkili bulunmuştur. Sonuç: Yüksek morbidite-mortalite oranlarına ve yoğun bakım ünitesine yatış ihtiyacının artmasına neden COVID-19, özellikle yaşlı hastalarda ve dispnesi olan hastalarda daha yüksek mortalite oranlarına neden olmaktadır. Hastaneye başvuran COVID-19 şüpheli hastalar değerlendirilirken özellikle hastanın yaşı ve solunum sistemi semptomları göz önünde bulundurularak klinik değerlendirilmesinin yapılması hastalığın seyri açısından önem taşımaktadır. (Turkish) [ FROM AUTHOR] Copyright of Istanbul Tip Fakültesi Dergisi is the property of Istanbul Tip Fakultesi Dergisi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

11.
Asthma Allergy Immunology / Astim Allerji Immunoloji ; 19(3):174-182, 2021.
Article in English | Academic Search Complete | ID: covidwho-1592071

ABSTRACT

Objective: The clinical features of COVID-19 range from asymptomatic disease to severe pneumonia or even death. Therefore, many researchers have investigated the factors that could affect the severity of COVID-19. We aimed to assess the impact of aero-allergen sensitization and allergic diseases on the severity of COVID-19. Materials and Methods: We included 60 adult patients with symptomatic COVID-19 and allocated them into two groups equal in number as having severe and non-severe COVID-19. We evaluated the demographic features and allergic diseases in addition to clinical, laboratory and radiological findings of COVID-19. Skin prick tests (SPTs) with common aero-allergens, serum total IgE levels and blood eosinophil counts were evaluated 3 months after the patient's recovery from COVID-19. Results: The mean age of the patients was 52 ± 11 years and 73.3% of the patients were male. There was no significant difference between the two groups in terms of age, gender, smoking habits, obesity and comorbidities. Although the frequency of sensitization to aeroallergens and the allergic diseases were similar, the history of allergic diseases in the family was higher in the severe group (p<0.001). The polysensitization in SPTs was associated with the presence of a cytokine storm during the infection (p=0.02). Total IgE levels and blood eosinophil counts were not significantly different between the two groups. Conclusion: The presence of atopy or allergic diseases does not seem to be related to the severity of COVID-19. However, polysensitization and a family history of allergic diseases are more prominent in those having a cytokine storm and severe COVID-19, respectively. [ FROM AUTHOR] Copyright of Asthma Allergy Immunology / Astim Allerji Immunoloji is the property of Turkish National Society of Allergy & Clinical Immunology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

12.
Curr Med Sci ; 41(6): 1075-1080, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1482282

ABSTRACT

OBJECTIVE: Corona Virus Disease-2019 (COVID-19) has been among the major infectious events of the century. In today's literature where COVID-19 and host factor effects are frequently examined, we aimed to examine another factor: Circadian Clock Protein PERIOD 3 (PER3). There is a significant correlation between PER3 gene polymorphism and circadian rhythm disturbances and immune system dysregulation. METHODS: In our study, we recruited 200 patients diagnosed with COVID-19 in our hospital between April-June 2020, and 100 volunteers without known comorbidities to create a healthy control group. After comparing the initial gene polymorphisms of the patients with healthy controls, three separate clinical subgroups were formed. Gene polymorphism distribution and statistical significance were examined in the formed patient groups. RESULTS: No significant difference was found between the patient group and the healthy controls (P>0.05, for all). When patients were divided into two separate clinical subgroups as exitus/alive according to their last condition during their 28-day follow-up, the 4R/5R genotype was significantly more common in patients with a mortal course (P=0.007). The PER3 4R/5R genotype was found at a significantly higher rate in the group of patients with the need for intensive care (P=0.034). CONCLUSION: The 4R/5R genotype may be associated with the need for intensive care and mortality in COVID-19 patients. These important results will be a guide for future studies.


Subject(s)
COVID-19/genetics , Pandemics , Period Circadian Proteins/genetics , SARS-CoV-2 , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , Case-Control Studies , Female , Genotype , Humans , Male , Middle Aged , Minisatellite Repeats , Patient Acuity , Polymorphism, Genetic , Turkey/epidemiology , Young Adult
13.
Pathog Glob Health ; 116(3): 178-184, 2022 05.
Article in English | MEDLINE | ID: covidwho-1437790

ABSTRACT

For COVID-19 (Coronavirus Disease-2019) cases, detecting host-based factors that predispose to infection is a very important research area. In this study, the aim is to investigate the MBL2 and NOS3 gene polymorphisms in COVID-19 patients with lung involvement, whose first nasopharyngeal PCR results were negative. Seventy-nine patients diagnosed with COVID-19 between April-June 2020 who were admitted to a university hospital, and 100 healthy controls were included. In the first statistical analysis performed between PCR-positive, CT-negative and PCR-negative, CT-positive patients; the AB of MBL2 genotype was significantly higher in the first group (p = 0.049). The B allele was also significantly higher in the same subgroup (p = 0.001). The absence of the AB genotype was found to increase the risk of CT positivity by 6.9 times. The AB genotype of MBL2 was higher in healthy controls (p = 0.006). The absence of the AB genotype was found to increase the risk of CT positivity; also, it can be used for early detection and isolation of patients with typical lung involvement who had enough viral loads, but whose initial PCR results were negative.


Subject(s)
COVID-19 , Mannose-Binding Lectin , COVID-19/diagnosis , Genetic Predisposition to Disease , Genotype , Humans , Mannose-Binding Lectin/genetics , Nitric Oxide Synthase Type III/genetics , Polymerase Chain Reaction/methods
14.
Immunity ; 54(6): 1186-1199.e7, 2021 06 08.
Article in English | MEDLINE | ID: covidwho-1207036

ABSTRACT

A cardinal feature of COVID-19 is lung inflammation and respiratory failure. In a prospective multi-country cohort of COVID-19 patients, we found that increased Notch4 expression on circulating regulatory T (Treg) cells was associated with disease severity, predicted mortality, and declined upon recovery. Deletion of Notch4 in Treg cells or therapy with anti-Notch4 antibodies in conventional and humanized mice normalized the dysregulated innate immunity and rescued disease morbidity and mortality induced by a synthetic analog of viral RNA or by influenza H1N1 virus. Mechanistically, Notch4 suppressed the induction by interleukin-18 of amphiregulin, a cytokine necessary for tissue repair. Protection by Notch4 inhibition was recapitulated by therapy with Amphiregulin and, reciprocally, abrogated by its antagonism. Amphiregulin declined in COVID-19 subjects as a function of disease severity and Notch4 expression. Thus, Notch4 expression on Treg cells dynamically restrains amphiregulin-dependent tissue repair to promote severe lung inflammation, with therapeutic implications for COVID-19 and related infections.


Subject(s)
Host-Pathogen Interactions , Immunity, Cellular , Pneumonia, Viral/etiology , Pneumonia, Viral/metabolism , Receptor, Notch4/metabolism , Signal Transduction , T-Lymphocytes, Regulatory/immunology , T-Lymphocytes, Regulatory/metabolism , Amphiregulin/pharmacology , Animals , Biomarkers , Cytokines/metabolism , Disease Models, Animal , Disease Susceptibility , Host-Pathogen Interactions/immunology , Humans , Immunohistochemistry , Immunomodulation/drug effects , Inflammation Mediators/metabolism , Influenza A virus/physiology , Lung/immunology , Lung/metabolism , Lung/pathology , Lung/virology , Mice , Mice, Transgenic , Pneumonia, Viral/pathology , Receptor, Notch4/antagonists & inhibitors , Receptor, Notch4/genetics , Severity of Illness Index
15.
Infect Genet Evol ; 89: 104717, 2021 04.
Article in English | MEDLINE | ID: covidwho-1051857

ABSTRACT

BACKGROUND/OBJECTIVES: COVID-19 followed a mortal course in some young patients without any underlying factors, however, it followed a very benign course in some very older individuals with multiple comorbidities. These observations question if some genetic factors may be related to the vulnerability and poor prognosis of the disease. In this study, we aimed to investigate whether MBL2 gene B variant at codon 54 (rs1800450) were related to the variabilities in clinical course of this infection. METHODS: 284 PCR-confirmed COVID-19 patients and 100 healthy controls were included in the study. COVID-19 patients were subdivided according to the clinical features and clinical characteristics were analyzed. DNAs of all patients and controls were examined for the codon 54 A/B (gly54asp: rs1800450) variation in exon 1 of the MBL2 gene. RESULTS: In univariate analysis, BB genotype of MBL2 gene was more common among COVID-19 cases compared with controls (10.9% vs 1.0%, respectively; OR = 12.1, 95%CI = 1.6-90.1, p = 0.001). Multivariate analyses, adjusted for age, sex and MBL genetic variants, revealed that when compared with the COVID-19 patients that had AA genotype (reference), the patients that had BB or AB genotypes suffered from a higher risk for severe disease (for BB genotype, odds ratio (OR) = 5.3, p < 0.001; for AB genotype, OR = 2.9, p = 0.001) and for ICU need (for BB genotype, OR = 19.6, p < 0.001; for AB genotype, OR = 6.9, p = 0.001). On the other hand, there was not any significant difference between the genotype variants in terms of mortality at 28 days or development of secondary bacterial infection. CONCLUSION: The B variants of MBL2 gene at codon 54, which were associated with lower MBL2 levels, were related to a higher risk for a more severe clinical course of COVID-19 infection in some respects. Our findings may have potential future implications, e.g. for use of MBL protein as potential therapeutics or prioritize the individuals with B variants during vaccination strategies.


Subject(s)
COVID-19/genetics , COVID-19/pathology , Mannose-Binding Lectin/genetics , Mutation, Missense , Adult , Aged , Aged, 80 and over , COVID-19/virology , Case-Control Studies , Comorbidity , Female , Genetic Predisposition to Disease , Humans , Male , Mannose-Binding Lectin/metabolism , Middle Aged , Protein Interaction Maps , SARS-CoV-2/isolation & purification , Severity of Illness Index , Young Adult
16.
Am J Med Sci ; 361(5): 591-597, 2021 05.
Article in English | MEDLINE | ID: covidwho-973807

ABSTRACT

BACKGROUND: The information on electrocardiographic features of patients with coronavirus disease 2019 (COVID-19) is limited. Our aim was to determine if baseline electrocardiographic features of hospitalized COVID-19 patients are associated with markers of myocardial injury and clinical outcomes. METHODS: In this retrospective, single center cohort study, we included 223 hospitalized patients with laboratory-confirmed COVID-19. Clinical, electrocardiographic and laboratory data were collected and analyzed. Primary composite endpoint of mortality, need for invasive mechanical ventilation, or admission to the intensive care unit was assessed. RESULTS: Forty patients (17.9%) reached the primary composite endpoint. Patients with the primary composite endpoint were more likely to have wide QRS complex (>120 ms) and lateral ST-T segment abnormality. The multivariable Cox regression showed increasing odds of the primary composite endpoint associated with acute respiratory distress syndrome (odds ratio 7.76, 95% CI 2.67-22.59; p < 0.001), acute cardiac injury (odds ratio 3.14, 95% CI 1.26-7.99; p = 0.016), high flow oxygen therapy (odds ratio 2.43, 95% CI 1.05-5.62; p = 0.037) and QRS duration longer than >120 ms (odds ratio 3.62, 95% CI 1.39-9.380; p = 0.008) Patients with a wide QRS complex (>120 ms) had significantly higher median level of troponin T and pro-BNP than those without it. Patients with abnormality of lateral ST-T segment had significantly higher median level of troponin T and pro-BNP than patients without. CONCLUSIONS: The presence of QRS duration longer than 120 ms and lateral ST-T segment abnormality were associated with worse clinical outcomes and higher levels of myocardial injury biomarkers.


Subject(s)
COVID-19 , Electrocardiography , Heart Injuries , Natriuretic Peptide, Brain/blood , Respiration, Artificial , SARS-CoV-2/metabolism , Troponin T/blood , Acute Disease , Adult , Aged , Biomarkers , COVID-19/blood , COVID-19/mortality , COVID-19/physiopathology , COVID-19/therapy , Disease-Free Survival , Female , Heart/physiopathology , Heart Injuries/blood , Heart Injuries/mortality , Heart Injuries/physiopathology , Heart Injuries/therapy , Humans , Male , Middle Aged , Retrospective Studies , Survival Rate
17.
Cardiovasc J Afr ; 32(2): 79-86, 2021.
Article in English | MEDLINE | ID: covidwho-916532

ABSTRACT

AIM: The purpose of this article was to report the low rates of intensive care unit admission and mortality in intermediate- and high-risk COVID-19 patients, and to share our clinical approach with other colleagues. In addition, we sought to reveal the relationship between myocardial injury and clinical outcomes such as death, intensive care unit uptake and hospital stay, and the relationship between inflammatory parameters and cardiac biomarkers in a cardiovascular perspective. METHODS: Patients admitted to the emergency department in the Department of Internal Medicine, Faculty of Medicine, Istanbul University, with laboratory or clinically and radiologically confirmed COVID-19 were included in this retrospective cross-sectional study, which was conducted from 11 March to 10 April 2020. The demographic (age and gender) and clinical (symptoms, co-morbidities, treatments, complications and outcomes) characteristics, laboratory findings, and results of cardiac examinations (cardiac biomarkers and electrocardiography) of patients during hospitalisation were collected from their medical records by two investigators. Data were analysed using SPSS version 25.0 (IBM). A two-sided p < 0.05 was considered statistically significant. Analysis began on 11 April 2020. RESULTS: Mortality and intensive care unit admission rates were statistically significantly higher in patients with cardiac injury than in those without. There was a positive correlation between levels of high-sensitivity TNT and fibrinogen, D-dimer, ferritin, procalcitonin and C-reactive protein (r = 0.24, p < 0.01; r = 0.37, p < 0.01; r = 0.25, p < 0.01, r = 0.34, p < 0.01; r = 0.31, p < 0.01). CONCLUSIONS: The first general data of our 309 patients regarding low mortality and intensive care admission rates, and particular treatment algorithms specific to our centre should be helpful in determining better treatment strategies in the future. Our study emphasises the importance and frequency of cardiovascular outcomes, and the significance of some cardiac biomarkers in predicting COVID-19 prognosis.


Subject(s)
COVID-19/mortality , Cardiovascular System/virology , Critical Care , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/diagnosis , COVID-19/virology , Cross-Sectional Studies , Hospitalization/statistics & numerical data , Humans , Intensive Care Units , Length of Stay/statistics & numerical data , Middle Aged , Retrospective Studies
18.
Angiology ; 72(2): 187-193, 2021 02.
Article in English | MEDLINE | ID: covidwho-792871

ABSTRACT

Thrombotic and embolic complications in the cardiovascular system are evident and associated with worse prognosis in coronavirus disease 2019 (COVID-19) patients. Endothelial-specific molecule 1 (endocan) plays a role in vascular pathology. We hypothesized serum endocan levels on admission are associated with primary composite end point (mortality and intensive care unit hospitalization) in COVID-19 patients. Patients (n = 80) with laboratory, clinical, and radiological confirmed COVID-19 were included in this cross-sectional study. Ten milliliter of peripheral venous blood were drawn within 24 hours of admission to estimate serum endocan levels. Data were analyzed using SPSS version 26.0 (IBM). Patients with the primary composite end point had significantly higher serum endocan levels than patients without (852.2 ± 522.7 vs 550.2 ± 440.8 ng/L, respectively; P < .01). In the logistic regression analysis, only increased serum endocan levels and increase in age were independent predictors of the primary composite end point (P < .05). In the receiver operating characteristics curve analysis, we found that a serum endocan level of 276.4 ng/L had a 97% sensitivity and 85% specificity for prediction of the primary composite end point. Baseline serum endocan levels may prove useful as a prognostic factor in patients hospitalized for COVID-19.


Subject(s)
COVID-19/blood , COVID-19/mortality , Neoplasm Proteins/blood , Proteoglycans/blood , Adult , Aged , Cross-Sectional Studies , Female , Hospitalization , Humans , Intensive Care Units , Male , Middle Aged , Pilot Projects , Prognosis , Retrospective Studies
19.
Ann Hepatol ; 19(6): 614-621, 2020.
Article in English | MEDLINE | ID: covidwho-753947

ABSTRACT

INTRODUCTION: COVID-19 caused by the SARS-CoV-2 continues to spread rapidly across the world. In our study, we aim to investigate the relationship between the liver enzymes on admission (AST, ALT, ALP, GGT) and severity of COVID-19. We evaluated course of disease, hospital stay, liver damage and mortality. MATERIALS AND METHODS: Our study included 614 patients who were hospitalized with the diagnosis of COVID-19 between 03.16.20 and 05.12.20. Patients with liver disease, hematological and solid organ malignancy with liver metastases were excluded, resulting in 554 patients who met our inclusion criteria. We retrospectively evaluated liver transaminase levels, AST/ALT ratio, cholestatic enzyme levels and R ratio during hospital admission and these were compared in terms of morbidity, mortality and clinical course. RESULTS: Mean age of 554 subjects were 66.21±15.45 years, 328 (59.2%) were men. The mean values of liver enzymes on admission were AST (36.2±33.6U/L), ALT (34.01±49.34U/L), ALP (78.8±46.86U/L), GGT (46.25±60.05U/L). Mortality rate and need for intensive care unit were statistically significant in subjects that had high ALT-AST levels during their admission to the hospital (p=0.001). According to the ROC analysis AST/ALT ratio was a good marker of mortality risk (AUC=0.713: p=0.001) and expected probability of intensive care unit admission (AUC=0.636: p=0.001). R ratio, which was used to evaluate prognosis, showed a poor prognosis rate of 26.5% in the cholestatic injury group, 36.1% in the mixed pattern group and 30% in the hepato-cellular injury group (p 0.001). CONCLUSIONS: ALT-AST elevation and AST/ALT ratio >1 was associated with more severe course and increased mortality in COVID-19.


Subject(s)
Alanine Transaminase/metabolism , Aspartate Aminotransferases/metabolism , Betacoronavirus , Coronavirus Infections/enzymology , Coronavirus Infections/mortality , Liver Diseases/virology , Pneumonia, Viral/enzymology , Pneumonia, Viral/mortality , Adult , Aged , COVID-19 , Coronavirus Infections/complications , Female , Hospitalization , Humans , Liver Diseases/diagnosis , Liver Diseases/mortality , Liver Function Tests , Male , Middle Aged , Pandemics , Pneumonia, Viral/complications , Prognosis , Retrospective Studies , SARS-CoV-2 , Sensitivity and Specificity , Survival Rate , Turkey
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