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J Mov Disord ; 14(2): 119-125, 2021 May.
Article in English | MEDLINE | ID: covidwho-1136663


OBJECTIVE: Telemedicine has rapidly gained momentum in movement disorder neurology during the coronavirus disease (COVID-19) pandemic to preserve clinical care while mitigating the risks of in-person visits. We present data from the rapid implementation of virtual visits in a large, academic, movement disorder practice during the COVID-19 pandemic. METHODS: We describe the strategic shift to virtual visits and retrospectively examine elements that impacted the ability to switch to telemedicine visits using historical prepandemic in-person data as a comparator, including demographics, distance driven, and diagnosis distribution, with an additional focus on patients with deep brain stimulators. RESULTS: A total of 686 telemedicine visits were performed over a five-week period (60% of those previously scheduled for in-office visits). The average age of participants was 65 years, 45% were female, and 73% were Caucasian. Men were more likely to make the transition (p = 0.02). Telemedicine patients lived farther from the clinic than those seen in person (66.47 km vs. 42.16 km, p < 0.001), age was not associated with making the switch, and patient satisfaction did not change. There was a significant shift in the distribution of movement disorder diagnoses seen by telemedicine compared to prepandemic in-person visits (p < 0.001). Patients with deep brain stimulators were more likely to use telemedicine (11.5% vs. 7%, p < 0.001). CONCLUSION: Telemedicine is feasible, viable and relevant in the care of movement disorder patients, although health care disparities appear evident for women and minorities. Patients with deep brain stimulators preferred telemedicine in our study. Further study is warranted to explore these findings.

Int J Clin Pract ; 75(6): e14078, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1069395


AIM: The contribution of micronutrients to the immune system has been known for a long time. This study aimed to investigate the association between the micronutrient levels and hemogram values and prognostic factors of the disease in COVID-19 patients in Ankara City Hospital. MATERIALS AND METHODS: Our study is a descriptive observational study based on a retrospective review of patient files. COVID-19 patients over 18 years of age who were admitted to our hospital between 14 March and 1 June 2020, and with a complete micronutrient profile were included in the study. Age, gender, chronic diseases, micronutrient concentrations in the last 6 months, hemogram data on the day of hospitalization, total length of stay in hospital, and hospitalization to Intensive Care Unit (ICU)-intubation-death status of the patients were obtained from the patient files. RESULTS: A total of 310 patients whose parameters were thoroughly examined were included in our study; 51.9% of them were men and the mean age of all patients was 57.02 ± 18.28 years, and the most common comorbid disease was hypertension. The percentage of patients who were followed in the ICU, were intubated, and died was 34.5%, 13.9%, and 9.4%, respectively. The mean length of hospital stay was 15.87 ± 12.79 days. Low folate, iron, vitamin D, and hemoglobin levels of the patients and high vitamin B12 concentration were more related to poor prognostic factors. The number of white blood cells was significantly higher in patients with a worse prognosis, and the number of lymphocytes was lower in patients with ICU admission but higher in intubated and dead patients. CONCLUSION: Micronutrient and hemogram values, advanced age, being male, and having comorbid diseases were correlated with the poor prognosis of COVID-19 infection. Deficiency of Iron, Folate, and vitamin D should be well-considered in COVID-19. Excessive vitamin B12 and multivitamin supplementation should be avoided by choosing supplement wisely. In addition, attention should be paid to leukocytosis, lymphocyte counts, and anemia during COVID-19 patient follow-up. What's known Some micronutrients have an immunomodulatory and anti-inflammatory effect with antioxidant effects and thus play a protective role in respiratory tract infections as COVID-19. Vitamin D deficiency is found to be associated with poor prognostic factors in COVID-19. Lymphopenia is found to be associated with poor prognostic factors in COVID-19. What's new According to the results obtained from our study, low iron and folate levels should be controlled first in patients diagnosed with COVID-19, low vitamin D levels should also be well-considered, and supplementation should be provided in the case of deficiencies. On the other hand excessive use of vitamin B12 should be avoided. The fact that all micronutrients should be evaluated and managed by choosing wisely rather than a complete multivitamin supplement approach was demonstrated by the differences in the poor prognosis levels of vitamin B12 versus the other micronutrients. In addition, it was found in our study that leukocytosis, lymphocyte counts, and anemia should be taken into consideration together when evaluating hemogram parameters in the follow-up of COVID-19 patients.

COVID-19 , Micronutrients , Adolescent , Adult , Aged , Female , Humans , Infant , Male , Middle Aged , Prognosis , Retrospective Studies , SARS-CoV-2 , Turkey/epidemiology
Environ Res ; 194: 110670, 2021 03.
Article in English | MEDLINE | ID: covidwho-1002512


BACKGROUND: The dynamics of urinary trace elements in patients with COVID-19 still remains to be investigated. METHODS: A retrospective study was performed on a cohort of 138 confirmed COVID-19 patients for their urinary levels of essential and/or toxic metals including chromium, manganese, copper, arsenic, selenium, cadmium, mercury, thallium and lead according to the different disease severity (severe or non-severe) and outcome (recovered or deceased). RESULTS: Urinary concentrations of chromium, manganese, copper, selenium, cadmium, mercury and lead after creatinine adjustment were found to be higher in severe patients than the non-severe cases with COVID-19. And among the severe cases, these elements were also higher in the deceased group than the recovered group. When the weeks of the post-symptom onset were taken in account, the changes of these urinary elements were existed across the clinical course since the disease onset. These urinary elements were found to be mostly positively inter-correlated, and further positively correlated with other laboratory inflammatory parameters including serum cytokines (IL-1B, IL2R, IL6, IL8, IL10, TNFα), ferritin, and neutrophil count and white blood cell count. As a independently predictive factor, urinary creatinine-adjusted copper of ≥25.57 µg/g and ≥99.32 µg/g were associated with significantly increased risk of severe illness and fatal outcome in COVID-19, respectively. CONCLUSIONS: These results suggest abnormities in urinary levels of the trace metals were tightly associated with the severe illness and fatal outcome of COVID-19.

COVID-19 , Selenium , Trace Elements , Cadmium , Copper , Humans , Retrospective Studies , SARS-CoV-2 , Severity of Illness Index