MUSCULOSKELETAL DISORDERS DURING COVID-19 INFECTION: A SURVEY OF HEALTHCARE WORKERS

BackgroundCOVID-19 infection has revealed a considerable number of extra-pulmonary manifestations, especially rheumatological. The detection of these manifestations, which herald the infection, is of great value in the early diagnosis of the disease, especially in health care workers (HCWs) who are at considerable risk of infection. Although myalgia is a common clinical feature of COVID-19, other musculoskeletal disorders (MSDs) have been rarely described.ObjectivesTo describe MSDs during SARS-COV2 infection in HCWs.MethodsProspective descriptive study conducted at the department of occupational pathology and fitness for work of Charles Nicolle Hospital in Tunis, having included the HCWs affected by COVID-19 during the period from 01 September 2020 to 28 February 2021. Data collection was carried out by regular telephone follow-up during the containment period using a pre-established form.ResultsDuring the study period, 656 HCWs were infected with SARS COV 2, of whom 134 (20.4%) had at least one musculoskeletal event. The mean age was 42±9 years with a sex ratio (M/F) of 0.2. The most represented occupational category was nurses (33.6%) followed by health technicians (23.1%). The median professional length of service was 12 [7;20] years. The presence of comorbidity was noted in 58.2% of HCWs. A pre-existing osteoarticular disease was found in 8.2% of cases. Obesity was noted in 25.4% of the population. Active smoking was reported by 14.3% of respondents. A known vitamin D deficiency was noted in 16.5% of patients. Spinal pain was the most reported MSD, present in 87.3% of cases. Low back pain was the most frequent spinal pain (56.7%) followed by back pain (37.4%) and neck pain (5.9%). MSDs of the lower limbs were found in 12.7% of patients. They were represented by gonalgia in 11.9% of cases, ankle pain in 5.2% of cases and hip pain in 4.3% of cases. MSDs of the upper limbs were described by 7.5% of the patients, 92.5% of whom presented with shoulder pain. The median duration of MSDs during COVID-19 was 5 [3;8] days. These manifestations were persistent on return to work in 21.1% of cases.ConclusionKnowledge of the frequency and consequences of musculoskeletal manifestations related to COVID-19 infection is of great importance, particularly in HCWs, in order to optimise management and ensure a rapid return to work.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

RETROSPECTIVE STUDY OF VITAMIN D DEFICIENCY IN RHEUMATOLOGIC PATIENTS DURING THE COVID-19 PANDEMIC IN POLAND

BackgroundBefore the COVID-19 pandemic it was estimated that nearly 70% of the population is deficient in vitamin D - 25(OH)D <20ng/ml in Poland [1]. The percentage was expected to increase due to indoor isolation during the COVID-19 pandemic. Vitamin D has a positive effect on the condition of the bones, affects the course of autoimmune diseases, the course of neurological diseases, in type 2 diabetes, vitamin D supplementation improves glucose tolerance and reduces insulin resistance [2,3,4].ObjectivesThe aim of the retrospective study was to determine what percentage of rheumatology clinic patients suffer from vitamin D deficiency and whether this condition is effectively treated.MethodsIn January 2023, a retrospective analysis of the documentation of 172 patients treated at the Rheumatology Outpatient Clinic in Bełżyce (Poland) in 2022 was conducted.ResultsResults: The mean age of the 172 patients whose documentation was analyzed was 60.43 years (min 19, max 88). There were 132 women (76.8%) and 40 men (23.2%) in this group. The mean concentration of vitamin D was 25.57ng/ml±SD11.9 (min 5.7, max 75, Me 22.8). Vitamin D deficiency was found in 44% (serum concentration <20mg/ml), suboptimal concentration (20-30ng/ml) in 31%, optimal concentration (30-50ng/ml) in 21%, and high concentration (>50ng/ml) ml) in 4%. All those with a deficit or deficiency (75 people) were prescribed cholecalciferol in a dose of 20,000 units orally, 1 capsule twice a week after breakfast for 2 months [5]. Patients with optimal vitamin D levels were advised to take a dose of 2,000 units per day. Among the patients with deficit or deficiency, 48 people came for a follow-up visit to check the level of vitamin D (64% of the group with too low vitamin D concentration;28% of the entire group whose documentation was analyzed). In the follow-up examination, the mean concentration of vitamin D was 37.14±9.8ng/ml (min 28, max 84, Me 35.3). Therefore, a statistically significant increase in the concentration of vitamin D in the blood was noted (p<0.05). In the group of people who came for the follow-up examination, there were 35 women, whose mean age was 60.7 years and 13 men (mean age 68.2 years).Conclusion:1. During the COVID-19 pandemic in the group of outpatient rheumatology patients, 75% had a deficiency or suboptimal level of vitamin D.2. Treatment with cholecalciferol in a dose of 20,000 IU twice a week orally for 2 months is effective treatment of vitamin D deficiency.3. Too low percentage of patients diagnosed with vitamin D deficiency come for visits and check-ups.References[1]Hilger J., Friedel A., Herr R.. A systematic review of vitamin D status in populations worldwide. Br J Nutr. 2013;9: 1023.[2]Karczmarewicz E., Czekuć-Kryskiewicz E., Płudowski P. Effect of vitamin D status on pharmacological treatment efficiency-impact on cost- effective management in medicine. Dermatoendocrinology, 2013;5: 299-304.[3]Zhu J., Bing C., Wilding J.P.H. Vitamin d receptor ligands attenuate the inflammatory profile of IL-1β-stimulated human white preadipocytes via modulating the NF-κB and unfolded protein response pathways Biochemical and Biophysical Research Communications 2-18, 503: 1049-1056.[4]Luan W., Hammond L.A. Vuillermot S. Maternal vitamin d prevents abnormal dopaminergic development and function in a mouse model of prenatal immune activation. Scientific Reports 2018;8 (1) article numer 9741.[5]Płudowski P., Karczmarewicz E. i wsp. Witamina D: Rekomendacje dawkowania w populacji osób zdrowych oraz w grupach ryzyka deficytów.Wytyczne dla Europy Środkowej 2013 r. Standardy Medyczne/Pediatria 2013, 10, 573-578 (in Polish).Acknowledgements:NIL.Disclosure of InterestsNone Declared.

TESTING A NEW FATIGUE CHECKLIST IN SLE PATIENTS FOR EVERYDAY CLINICAL PRACTICE - AN INTERIM ANALYSIS

BackgroundFatigue is a difficult subject for both physicians and patients. It is barely addressed during consultations and can therefore burden patient-physician-relations. To improve communication regarding fatigue, we developed a checklist that includes suggestions for evaluating possible causes for fatigue. In this analysis, we describe our study population and report first results 3 and 6 months after using the checklist.ObjectivesThe aims of our study are to validate the use of our newly developed fatigue checklist and to demonstrate that addressing fatigue in daily clinical practice and offering possible interventions can improve fatigue.MethodsWe recruited n=110 SLE patients with fatigue from our university hospital-based lupus reference centre in Duesseldorf. Fatigue was measured using the FSS (Fatigue Severity Scale). Our checklist included signs of depression and anxiety using the PHQ-4 (Patient Health Questionnaire), BMI (body mass index), physical activity, anemia, hypothyroidism and vitamin D deficiency. For each applicable cause, we listed possible interventions for free selection by the treating physician, such as replacement therapy (vitamin D, vitamin B12, iron, folic acid, erythropoietin), physical activity programs and psychosomatic consultations that were discussed with the patients. We re-evaluated our patients after 3 (T1) and 6 months (T2).ResultsBaseline characteristics of patients are summarized in Table 1.Table 1.BMI=body mass index, TSH=thyroidea stimulating hormone, PHQ4=patient health questionnaire (cut-off >3 points), HAQ=health assessment questionnaire, IMET= Index for measuring restrictions on social participation (higher scores point towards more restrictions on social participation), FSS=fatigue severity scale (≥4 points equal severe fatigue)N = 110n (%)Mean (SD)Age (years)49.0 (12.34)Female sex99.0 (90.0)BMI (kg/m2)25.9 (5.55)Disease duration (years)19.1 (10.05)TSH (µIU/ml)1.5 (1.05)25-OH-Vitamin D (ng/ml)39.5 (15.35)Haemoglobin (g/dl)13.0 (1.64)Sports activities>4h/week6.0 (5.5)2-4h/week18.0 (16.4)1-2h/week16.0 (14.5)<1h/week28.0 (25.5)No sport42.0 (38.2)Depression (PHQ4 score)2.3 (1.63)Anxiety (PHQ4 score)2.0 (1.71)Functional status (HAQ score)0.8 (0.49)Participation (IMET score)2.8 (2.31)Fatigue (FSS score)5.3 (1.35)After 3 and 6 months, we re-evaluated 83 patients and saw a significant reduction in fatigue measured by the FSS score (T1: mean difference estimate 0.367 and p-value <0.001;T2: mean difference estimate 0.305;p-value <0.005).Figure 1.Comparing FSS-Scores from T0, T1 and T2[Figure omitted. See PDF]ConclusionThe preliminary analysis of our study shows for the first time that incorporation of a checklist procedure into the management of patients with fatigue may improve short-term outcome after 3 and 6 months of observation. The improvement of symptoms documented in our study occurred even though the suggested exercise program and psychosomatic counseling sessions were not available for use during the current observation period because of the COVID-19 pandemic. At present, the mechanisms behind the observed effect remain unclear. Our ongoing analysis will clarify whether an additional effect on fatigue will occur after all suggested interventions resulting from the use of the checklist have been executed. Finally, it will demonstrate whether the incorporation of our checklist into routine clinical practice is capable to reduce fatigue over a prolonged time period.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

Case–control study of serum vitamin D concentrations in hospitalised patients with COVID-19 and hospitalised controls suffering with respiratory tract infections of differing aetiology

This study explored the prevalence of low serum vitamin D in patients admitted with acute respiratory tract infections (ARTIs) such as COVID-19. This study investigated whether patients with COVID-19 had lower serum vitamin D compared with patients with ARTIs of other aetiology. A case–control study was performed with cases of COVID-19 and controls of non-COVID-19 ARTIs. Patients were enrolled from a single general medical ward in a secondary care hospital between 15 April 2020 and 15 May 2020. Exclusion criteria were an oxygen requirement of >8 L/min. Data collected included serum 25-hydroxyvitamin D concentration, venous plasma glucose concentration and heamoglobin A1c. Outcomes measured were length of hospital stay, deaths, the need for high dependency and intensive care unit involvement. A total of 60 patients of five ethnic groups were enrolled, 85% (n=46) were of White-British ethnicity. The data analysis is based on these 46 patients of which 24 were non-COVID-19 patients with ARTI and 22 were patients with COVID-19. Overall, 80% of the study population had a serum vitamin D concentration below 50 nmol/L with median concentrations of 30 nmol/L and 35 nmol/L for patients with COVID-19 and non-COVID-19 ARTIs respectively. A Mann-Whitney sign-ranked test with respect to serum vitamin D concentration found no statistically significant difference between cases and controls, p=0.09. There was no significant difference in the length of stay, body mass index and rates of various comorbidities such as diabetes mellitus (DM), hypertension and lung disease in both study groups. However, DM was found to be associated with lower serum vitamin D concentrations. The results of this study support published literature showing an association between low serum vitamin D and ARTIs including COVID-19. However, this study did not identify patients with COVID-19 to have a statistically significant lower serum vitamin D concentration than non-COVID-19 patients with ARTI.

INSUFFICIENT VITAMIN D LEVELS IN PATIENTS WITH HEART FAILURE

Chronic heart failure despite the development of new treatment methods, remains the most common and prognostic adverse complication of all cardiovascular diseases. Studies conducted in different countries over the past decades have convincingly proved that vitamin D deficiency is one of the important factors in the development of CCC diseases. Vitamin D (VDR) receptors were detected in more than 40 target tissues, including cardiomyocytes, smooth muscle and endothelial vascular cells and have convincingly proved, that eliminating vitamin D deficiency improves blood pressure in hypertension and also reduces myocardial hypertrophy. The above studies also confirmed the effect of vitamin D on the development of prediabetes, diabetes, metabolic disorders. The effect of vitamin D on the prevention of atherosclerosis has also been confirmed. One of the mechanisms for the development of atherosclerosis is currently considered an inflammatory process. The effect of vitamin D on the course of inflammatory processes in the body was clearly manifested during the pandemic caused by the new coronavirus infection COVID-19. There was a clear correlation between vitamin D levels and the severity of infection. In severe COVID-19, as a rule, either a deficiency or a lack of vitamin D in the body was determined. In addition, low vitamin D levels increase the risk of developing severe forms of coronary heart disease. The study involved 30 patients <n = 30>diagnosed with heart failure(I-III NYHA) In 12 < 40%> patients out of 30, vitamin D levels were below 20.0 ng/mL, consistent with this vitamin deficiency. In 14 < 46,67%>the level of vitamin D in the blood was between 20.0 ng/mL and 30.0 ng/mL and this corresponded about the lack of vitamin D. Only 4 < 13,33%> patients has level of vitamin D in reference values and this was due to the use vitamin D due to comorbid pathology: thyroid disease, autoimmune diseases or previously identified vitamin D hypovitaminosis. Vitamin D partially enters the body with food mainly found in animal productsliver, milk, eggs, butter, etc and is formed in the skin under the influence of ultraviolet rays. However, patients with CHF often have concomitant diseases:kidney disease, diabetes, disorders and others, forcing them to adhere to a strict diet poor in vitamin D. Also, due to CHF, these patients mainly lead a sedentary lifestyle, and, as a result, receive little ultraviolet rays. This explains the frequently detected deficiency and deficiency of vitamin D in patients with CHF, if, they do not receive drugs that compensate for its deficiency.

High-Dose Vitamin D For The Treatment Of COVID-19

IntroductionThe aim of this EUnetHTA (European Network for Health Technology Assessment) Rolling Collaborative Review on high dose vitamin D for the treatment of COVID-19 was to inform health policy at an early stage in the life cycle of therapies and to monitor ongoing studies in the format of a Living Document.MethodsThe systematic literature search was conducted in Medline, Pubmed, medRxiv, bioRxiv, arXivso, Cochrane COVID-19 Study Register, ClinicalTrials.gov, ISRCTN Registry, EU Clinical Trials Register. The first search was done in January 2021, and the last in November 2021. English and German randomized controlled studies (RCTs) investigating treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected individuals with high dose vitamin D2, D3 or their metabolites were included if examining mortality, length of hospital stay, viral burden, clinical progression, hospitalization rates, intensive care unit (ICU) admission, mechanical ventilation, quality of life or adverse events. Two reviewers independently screened search results and assessed risk of bias and certainty of evidence. One reviewer extracted study data, checked by another.ResultsOf the nine RCTs published to date, two investigate calcifediol, one calcitriol and six vitamin D3. All used different dosing regimens. Disease severity and proportion of vitamin D deficiency varied between studies. Calcifediol treated patients in one study required significantly less ICU admissions than untreated patients. Vitamin D3 in another study led to significantly more SARS-CoV-2 PCR-negative patients before day 21 than placebo. There were no other significant differences between groups. Twenty-five RCTs are ongoing, five of them with over 1,000 patients.ConclusionsThe current evidence is heterogenous regarding form and dosage of vitamin D, baseline disease severity and baseline vitamin D deficiency. There is currently no standardized/recommended level of what constitutes a (beneficial) "high dose”. Most results did not show significant differences between vitamin D treated groups and no vitamin D / placebo groups. Many of the studies are very small and certainty of evidence is predominantly low or very low.

Vitamin D in defense against the terrorism of coronavirus disease 2019: A meta-analysis

Background: Coronavirus disease 2019 (COVID-19) pandemic was also spread during winter time in December from Wuhan the city of China to worldwide. Various studies conducted throughout the world have indicated the possible relationship between Vitamin D and COVID-19 infection. Aim: This narrative review is designed to support Vitamin D role and its efficacy in managing COVID-19 menace. Materials and Methods: Latest 50 articles for Vitamin D, and COVID-19 relationship and management were scrutinized to summarize this article from data bases of PubMed and Google scholar in English language. Diagrams were created by biorender.com to summarize pictorial relations. Conclusions: Higher mortality is associated with countries of high-level Vitamin D deficiencies. Many studies have found a significant relation between Vitamin D deficiency and COVID-19 complications and related comorbidities. It is highly supported by many literature to recommend daily dose of Vitamin D3 10,000 IU/day for a few weeks to rapidly increase 25-hydroxyvitamin D levels above 40–60 ng/mL, in population at higher risk.

Association between vitamin D deficiency and extended duration of COVID-19 symptoms

Introduction and ObjectivesVitamin D (VD) is involved in immunity and inflammation through mechanisms such as renin inhibition and inflammatory cytokine reduction. There is already evidence to suggest that VDD may increase COVID-19 infection susceptibility, however research assessing the impact of VDD on COVID-19 symptom duration is limited. The aim of this research was to determine whether VDD is a significant independent risk factor for extended durations of COVID-19 symptoms.MethodsThe study included 392 healthcare workers who isolated due to COVID-19 symptoms during the first wave of the pandemic (12th to 22nd May 2020) as part of the convalescent immunity (COCO) study. Data on 8 symptom types and duration of symptoms were collected, including patients’ demographics and co-morbidities. Anti-SARS-Cov-2 antibodies were measured using a combined IgG, IgA and IgM ELISA (The Binding Site). Vitamin D status was determined by measurement of serum 25(OH)D3 using the AB SCIEX Triple Quad 4500 mass spectrometry system. VDD was defined as serum 25(OH)D3 <30 nmol/L.ResultsThrough univariate analysis of VDD and non-VDD staff, we initially showed VDD to be significantly associated with longer durations of body aches (median 7 days, IQR 5–14 vs. median 5 days, IQR 3–7.5;p=0.0075) and fatigue (median 12 days, IQR 7–14 vs. median 7 days, IQR 4–14;p=0.0127). VDD did not influence the duration of the other 6 symptoms analysed, such as cough and fever. Using binary logistic regression models, we confirm that VDD is a significant independent risk factor for extended durations of fatigue (OR 2.089, 95% CI 1.087–4.011;p=0.027) and body aches (OR 3.069, 95% CI 1.538–6.124;p=0.001). Additionally, VDD staff experienced a significantly greater quantity of symptoms compared to non-VDD staff (median 5, IQR 4–7 versus median 4, IQR 3–6;p=0.0030).ConclusionsThis is one of the first studies to investigate the influence of VDD on COVID-19 symptom duration. Our results indicate that VDD is a significant independent risk factor for a longer duration of body aches and fatigue. Larger studies are required to confirm these results and determine if VD supplementation could shorten symptoms.

Vitamin D to prevent COVID-19 or other acute respiratory infections: phase 3 randomised controlled trial (CORONAVIT)

IntroductionVitamin D deficiency associates with susceptibility to COVID-19 and other acute respiratory infections (ARI).ObjectiveTo determine whether a ‘test-and-treat’ approach to vitamin D replacement in the general population reduces incidence of COVID-19 or other ARI.MethodsWe randomly assigned 6200 UK adults to receive an offer of a postal vitamin D test with postal provision of a 6-month supply of higher-dose vitamin D (3200 IU/d, n=1550) or lower-dose vitamin D (800 IU/d, n=1550) to those with 25(OH)D <75 nmol/L vs no offer of vitamin D testing or supplementation (n=3100). The primary outcome was the proportion of participants experiencing at least one test- or doctor-confirmed ARI of any cause at 6 months. Secondary outcomes included incidence of COVID-19.Results2958/3100 adults randomised to intervention accepted the offer of testing, of whom 2690 (90.9%) had 25(OH)D <75 nmol/L and received vitamin D supplements (1356 higher-dose, 1334 lower-dose). 72 adults in the higher-dose offer group, 86 in the lower-dose offer group and 132 in the no offer group experienced at least one ARI of any cause during follow-up (odds ratio [OR] for higher-dose vs. no offer 1.05, 95% CI 0.78–1.40;OR for lower-dose vs. no offer 1.27, 0.96–1.68). COVID-19 was diagnosed in 32 adults in the higher-dose offer group, 48 in the lower-dose offer group and 68 in the no offer group (OR for higher-dose vs. no offer 0.90, 0.59–1.37;OR for lower-dose vs. no offer 1.37, 0.94–1.99).ConclusionsIn adults with a high baseline prevalence of vitamin D insufficiency, a test-and-treat approach to vitamin D replacement did not reduce risk of all-cause ARI or COVID-19.Please refer to page A209 for declarations of interest related to this .

Vitamin D supplementation and immune-related markers: an update from nutrigenetic and nutrigenomic studies

Vitamin D is both a nutrient and a neurologic hormone that plays a critical role in modulating immune responses. While low levels of vitamin D are associated with increased susceptibility to infections and immune-related disorders, vitamin D supplementation has demonstrated immunomodulatory effects that can be protective against various diseases and infections. Vitamin D receptor is expressed in immune cells that have the ability to synthesise the active vitamin D metabolite. Thus, vitamin D acts in an autocrine manner in a local immunologic milieu in fighting against infections. Nutrigenetics and nutrigenomics are the new disciplines of nutritional science that explore the interaction between nutrients and genes using distinct approaches to decipher the mechanisms by which nutrients can influence disease development. Though molecular and observational studies have proved the immunomodulatory effects of vitamin D, only very few studies have documented the molecular insights of vitamin D supplementation. Until recently, researchers have investigated only a few selected genes involved in the vitamin D metabolic pathway that may influence the response to vitamin D supplementation and possibly disease risk. This review summarises the impact of vitamin D supplementation on immune markers from nutrigenetics and nutrigenomics perspective based on evidence collected through a structured search using PubMed, EMBASE, Science Direct and Web of Science. The research gaps and shortcomings from the existing data and future research direction of vitamin D supplementation on various immune-related disorders are discussed.

Can vitamin D protect against covid-19?

Two new trials find no effect, but aren’t the final word

Seven days in medicine: 27 July to 2 August 2022

Both studies, published as preprints, ruled out the likelihood of recent or prior SARS-CoV-2 infection as a direct cause for the acute hepatitis.1 (Full story doi:10.1136/bmj.o1876) Vitamin D Supplements “don’t reduce fractures in healthy elderly” Vitamin D supplementation did not result in a significantly lower risk of fractures than placebo in generally healthy middle aged and older adults who were not recruited on the basis of vitamin D deficiency, low bone mass, or osteoporosis, in a study reported in the New England Journal of Medicine.1 The 25 871 participants were followed for five years, and the researchers found no difference in the number of fractures in people taking vitamin D and those taking placebo. [...]of ambulance workers see deaths linked to delays A third of ambulance workers have been involved in cases where a patient’s death was linked to delays in receiving treatment, a poll by the GMB union found. Eye care guidance NICE rapid recommendation on eye condition treatment In final draft guidance the National Institute for Health and Care Excellence recommended brolucizumab (also known as Beovu and manufactured by Novartis) as an option for treating visual impairment due to diabetic macular oedema in adults, the main cause in the UK of sight loss in people with diabetes.

THE ABILITIES OF VITAMIN AND MINERAL SUPPLEMENTS DURING THE COVID-19 PANDEMIC

The insufficient provision of micronutrients (vitamins A, D, E, C, and B-group, the minerals zinc, iron, selenium, magnesium, copper, and phosphorus) weakens the immune response, which can increase the risk of infection, contribute to disease severity and COVID-19 complications. The population of Russia, both adults and children, has deficiencies of multiple micronutrients (vitamins D, B-group, calcium, magnesium, zinc, and iodine), their simultaneous deficiency is experienced by about one third of the surveyed population. The micronutrients in the body are interconnected to form metabolic networks. A lack of one or more vitamins can disrupt the conversion of other vitamins to their biologically active forms, causing a functional vitamin deficiency. The percentage of vitamins and minerals in the diet of the population is a modifiable risk factor for infectious diseases. This implies replenishing the insufficient dietary intake of micronutrients not only to cover the needs of the body, but also to achieve their optimal provision. We are not dealing with therapy with and use of vitamins in pharmacological dosages. The intake of multivitamins provides protection against COVID-19, a decrease in the severity of the disease, a reduction in the manifestations of post-COVID sequels, and an increase in the efficiency of vaccination. Optimization of the vitamin status in all population groups through the intake of vitamin and mineral supplements (VMS) containing a complete set of vitamins and immunotropic elements is an underestimated important preventive factor in protecting from viral infections. Conclusion: The relevance of taking VMS in pregnancy and lactation during the pandemic is becoming even more important. During the pandemic, the use of VMS by pregnant and lactating women will not only improve their own micronutrient status and subsequently optimize the percentage of vitamins and minerals in breast milk, and thus the micronutrient status of the baby, but will also contribute to the body's resistance to disease.

Demonstrating New-onset orWorsened Sudomotor Function post COVID-19

Objective: Identify if SARS-CoV-2 virus is triggering and/or worsening dysautonomia by reviewing the function of autonomic patients pre-COVID-19 and post-COVID-19 infection, as well as new onset autonomic patients post-COVID-19 infection. Background: Autonomic dysfunction may be part of acute and long COVID-19 infection. Design/Methods: Six participants were enrolled and divided into two groups. The first group of 4 volunteers reported worsened autonomic symptoms post-COVID-19 infection. These individuals had first autonomic test prior to COVID-19 pandemic outbreak (July 2019- December 2019). Autonomic function testing was repeated in these participants, 6 months to 1- year post-COVID-19 infection (June, 2021). The second group of 2 volunteers reported newonset autonomic symptoms post-COVID-19 infection and were tested March-May, 2021. All participants were screened for known causes of autonomic dysfunction and had normal neurophysiological studies (EMG/NCS), no hypertension/hyperlipidemia or thyroid dysfunction, no diabetes/prediabetes, no vitamin deficiencies, no history of HIV, hepatitis, or syphilis, no prior radiation or chemical exposure and no evidence of monoclonal gammopathy, or autoimmune condition. Participants were diagnosed with COVID-19 via PCR testing, and tested again via SARS-CoV-2 capsid-antibody test. Results: All volunteers were female (age: 21-37y) and endorsed orthostatic intolerance. Gastrointestinal symptoms (5/6), new-onset paresthesias, drier skin (3/6), and sexual dysfunction (2/6) were reported. Dysgeusia reported in 50%, but was not demonstrated on neurological examination. Parasympathetic autonomic function remained stable 6-months to 1- year post-COVID-19 infection and not demonstrated in participants with new-onset symptoms. Sympathetic-adrenergic dysfunction as new-onset orthostatic hypotension and abnormalities on blood-pressure response to Valsalva was found in 50% of participants. Sympathetic cholinergic (sudomotor) dysfunction was demonstrated in ALL participants. Worsened, or new-onset, sudomotor dysfunction was demonstrated in those with mild or normal sudomotor function on pre-COVID-19 autonomic testing Conclusions: Sudomotor dysfunction was demonstrated as worsened or new-sequelae to COVID-19 infection. COVID-19 may be responsible for new-onset or worsened small-fiber neuropathy in this sample.

The Relationship Between COVID-19 Infection and Vitamin D Levels

Aim: Vitamin D has many known benefits. One of them is that it is immunomodulator. It is also protective against upper respiratory tract infections. It was aimed to examine vitamin D levels in Covid 19 patients, who can cause multi-organ failure and death from asymptomatic infection. Materials and Methods: 580 patients with positive Real Time-Polymerase Chain Reaction (RT-PCR, PCR) test registered in our family medicine system were scanned from the national health data system and 91 patients whose vitamin D levels were checked recently were included in the research group. In addition, 91 people with negative PCR tests with the same characteristics were taken as the control group. Their vitamin D levels were taken from the national health data system. Results: The average age of the Covid 19 patient group was 53, while the control group was 55 years, it was observed 39.60% of the participants were male and 60.40% were female. Vitamin D levels of positive patients, 69.20% (<20 ng / mL) deficiency, 23.10% (20-30 ng / mL) insufficiency, 7.70% (30-149 ng/mL) was found to be optimal and the average vitamin D is 17.61 ng / ml. The vitamin D levels of the control group were found to be 58.20% deficiency, 24.20% insufficiency, 17.60% (30-149) optimal, and the average was 20.75 ng / ml. Conclusion: Vitamin D deficiency is more common in Covid 19 patients, and the average of vitamin D is generally lower in Covid 19 patients. Vitamin D supplementation is important in our fight against Covid 19.Alternate :Amaç: D vitamininin bilinen birçok faydası vardır. Bunlardan biri de immunmodülatör olmasıdır. Ayrıca üst solunum yolu enfeksiyonlarına karşı koruyucudur. Asemptomatik enfeksiyondan çoklu organ yetmezliğine ve ölüme neden olabilen Covid 19 hastalarında D vitamini düzeylerinin incelenmesi amaçlandı. Gereç ve Yöntem: Aile hekimliği sistemimize kayıtlı Real Time-Polymerase Chain Reaction (RT-PCR, PCR) testi pozitif olan 580 hasta ulusal sağlık veri sisteminden taranmış ve D vitamini düzeyi yakın zamanda kontrol edilen 91 hasta araştırma grubuna dahil edilmiştir. Ayrıca aynı özelliklere sahip PCR testi negatif olan 91 kişi kontrol grubu olarak alındı. D vitamini seviyeleri ulusal sağlık veri sisteminden alınmıştır. Bulgular: Covid 19 hasta grubunun yaş ortalaması 53 yıl, kontrol grubu 55 yıl iken, katılımcıların %39.60'ının erkek, %60,40'ının kadın olduğu gözlendi. Pozitif hastaların D vitamini düzeyleri, %69.20 (<20 ng/mL) eksikliği, %23.10 (20-30 ng/ml) yetersizliği, %7.70 (30-149 ng/mL) optimal ve ortalama D vitamini olarak bulundu. 17.61 ng / ml'dir. Kontrol grubunun D vitamini düzeyleri %58.20 eksiklik, %24,2 yetersizlik, %17.60 (30-149) optimal ve ortalama 20.75 ng/ml olarak bulundu. Sonuç: Covid 19 hastalarında D vitamini eksikliği daha fazla görülmektedir ve genel olarak Covid 19 hastalarında D vitamini ortalaması da daha düşüktür. Covid 19 ile mücadelemizde D vitamini takviyesi önemlidir. Anahtar Kelimeler: Covid-19, D vitamini, bağışıklık, düzeyi

COVID‐19 mortality and its predictors in the elderly: A systematic review

Background and AimsOlder people have higher rates of comorbidities and may experience more severe inflammatory responses;therefore, are at higher risk of death. Herein, we aimed to systematically review the mortality in coronavirus disease 2019 (COVID‐19) patients and its predictors in this age group.MethodsWe searched PubMed, Web of Science, and Science Direct using relevant keywords. Retrieved records underwent a two‐step screening process consisting of title/ and full‐text screenings to identify the eligible studies.ResultsSummarizing findings of 35 studies demonstrated that older patients have higher mortality rates compared to the younger population. A review of articles revealed that increasing age, body mass index, a male gender, dementia, impairment or dependency in daily activities, presence of consolidations on chest X‐ray, hypoxemic respiratory failure, and lower oxygen saturation at admission were risk factors for death. High d‐dimer levels, 25‐hydroxy vitamin D serum deficiencies, high C‐reactive protein (≥5 mg/L) levels plus any other abnormalities of lymphocyte, higher blood urea nitrogen or lactate dehydrogenase, and higher platelet count were predictors of poor prognosis and mortality in the elderly. Studies have also shown that previous treatment with renin–angiotensin–aldosterone system inhibitors, pharmacological treatments of respiratory disorders, antibiotics, corticosteroids, vitamin K antagonist, antihistamines, azithromycin, Itolizumab (an anti‐CD6 monoclonal antibody) in combination with other antivirals reduces COVID‐19 worsening and mortality. Vaccination against seasonal influenza might also reduce COVID‐19 mortality.ConclusionOverall, a critical consideration is necessary for the care and management of COVID‐19 in the aged population considering the drastic contrasts in manifestation and prognosis compared to other age groups. Mortality from COVID‐19 is independently associated with the patient's age. Elderly patients with COVID‐19 are more vulnerable to poor outcomes. Thus, strict preventive measures, timely diagnosis, and aggressive therapeutic/nontherapeutic care are of great importance to reduce acute respiratory distress syndrome and severe complications in older people.

Vitamin D Insufficiency in Disease Severity and Prognosis of the Patients with SARS Corona Virus-2 Infection Role of Vitamin D in COVID-19

The global crisis caused by the SARS Corona virus-2 infection is continuing through 2021, with more than 3.5 million deaths. Several risk factors for this virus’s severity and death were documented, including diabetes, hypertension, and ischemic heart disease. To evaluate the relation between serum vitamin D3 level, the disease severity, and prognosis of the patients with SARS Corona virus-2 infection. Patients with COVID-19 were evaluated for serum vitamin D levels and laboratory data. Correlation between vitamin D levels and laboratory data with disease severity and prognosis was assessed. Cox and logistic regression tests, as well as ROC curves, were used for data analysis. Ninety-eight patients with Corona virus-2 disease (COVID-19), which consisted of sixty patients with moderate COVID-19 in the general wards, and thirty-eight patients with severe COVID-19 in the intensive care unit (ICU), were evaluated. The mean age in the general wards was lower than in ICU (60.96±14.86 compared to 67.94±16.46, P=0.001), and the mean serum vitamin D level in the patients admitted in the general wards was higher than in the ICU (31 ng/mL compared to 20.57 ng/mL, P=0.003). Furthermore, vitamin D deficiency (25 (OH) D <25 ng/ml) significantly increased the risk of severe disease. (odds ratio=2.91, P=0.019) and mortality (odds ratio=3.64, P=0.026). Vitamin D deficiency is a risk factor for disease severity and poor prognosis in COVID-19. Vitamin D levels of 25 ng/mL can be used as a cut-off value for predicting severity and prognosis.