Cardiac findings and short-term outcomes of multisystem inflammatory syndrome associated with COVID-19 single center experiences from turkiye

Background and Aim: Multi-system inflammatory syndrome in chil-dren (MISC) associated with COVID-19 has been described as a potentially life-threatening disease. In this study, we aimed to evaluate cardiovascular findings in children diagnosed with MISC at initial presentation and follow up. Method(s): Between November 2020 and November 2021, 35 children diagnosed with MISC based on WHO criteria were evaluated in this retrospective study.Cardiac markers, electrocardi-ography and echocardiography were performed in all cases at pre-sentation. Cardiac evaluation were repeated at the mean of 10th week after discharge(range:5 to 33weeks). Result(s): At this period, 633 children had positive PCR test of Covid-19. The freguency of MISC was 5.5% in our cohort. The median age was 9 years at diagnosis. Comorbid diseases were found in 20% cases, but none had preexisting heart disease. All patients had high grade fever and laboratory evidence of hyperin-flammation. Most cases had mild form disease, however 12 patients had been hospitalized in ICU median 6 day. 27 cases (77%) had cardiovascular involvement.Kawasaki-like findings were found in 10 patients and 5 cases were presented with shock(Figure-1) Echocardiography;Left ventricular (LV)systolic dysfunction (EFlt;57%) was detected in 11 cases (31.4%) and coronary artery (CA) dilatation(z scoregt;2)was found in five(14.2%) cases. Pericardial effusion was seen in 12 cases. Electrocardiography: Sinus tachycardia was the most common finding. 2 cases had pro-longed QTc interval and four cases had T wave alterations. Four cases had experienced complex ventricular arrhythmia. Cardiac markers:24 cases had high Pro-BNP level. 18 cases also had high Troponin T levels. Pro-BNP and Troponin T levels were not found to be correlated with LVEF. Only one adolescent boy who had severe cardiac dysfunction died during the acute period. Followup:There were two cases with persistent cardiac symptom, but no case had LV systolic dysfunction. The mean PR intervale was significantly lower than initial measurements. The mean of QT and QTc at follow up were not different from basal measurements.The mean LVEF was significantly higher than the initial levels. The basal CA z scores normalized at followup. Conclusion(s): MISC is characterized predominantly by cardio-vascular system involvement, but the children with MISC have good cardiac outcomes at short term follow up.

Resources, stressors and coping strategies of nurses caring for patients with coronavirus from the perspective of Conservation of Resources Theory: A qualitative study

Objectives: To explore the resources, stress factors and coping strategies of nurses, who provide direct care to patients with coronavirus disease. Methods: In this qualitative study, 20 registered nurses were interviewed, who have been working in the pandemic hospitals located in different parts of Turkey for at least two weeks. In-depth interviews were carried out individually and online. Interview data were analyzed with thematic analysis from the perspective of the Conservation of Resources Theory (COR). Results: Three themes emerged from the analysis of the data according to the COR theory. First theme, resources are required to adapt to changing processes and to be motivated to maintain service. Nurses' personal resources were helping patients, professional responsibility, spirituality, hope and conscience. Money, knowledge, and experience were energy resources while being in a well-functioning working team, having a similar fate, and social support were condition resources and the personal protective equipment formed object resources. Second theme, perceived threats to their resources are the main stressors. The final theme is that strategies for coping with identified stressors are reactive rather than proactive. Conclusion: This study contributed to the resources being noticed that nurses had and used during the pandemic, as well as into understanding which resources were under threat and a critical component of the stress process. The findings of the study can be used by psychiatric consultation-liaison nurses to strengthen their resources and support clinical nurses to effectively cope with the negative effects and consequences of the pandemic. © 2022 by Journal of Psychiatric Nursing.

COVID-19 and food security: impact on wheat

The new coronavirus, emerged in Wuhan, China in December 2019, turned into a major global pandemic and has caused many deaths around the world. Covid-19 pandemic has adversely affected every aspect from economy, education to health system. During Covid-19 pandemic, access to foodstuffs has become even more important, and some countries have imposed restrictions on exports of basic food items for fear of food shortages. These restrictions and quotas are feared to disrupt the flows of trade for staple foods such as wheat, corn and rice, which has deepened the concerns for food security. This study was conducted to examine the effects of the Covid-19 pandemic on wheat price, production and trade and to review the policies of wheat exporter countries. According to the results of the study, Covid-19 did not cause fear in wheat markets, and no shortages of wheat are expected in the short term. Although countries have reduced the measures they have taken as of May, uncertainties regarding food safety still persist for the coming years. World economies have shrunk significantly as a result of the drastic measures they have taken against covid-19, which could worsen the situation for low income households.

Two doses of the Pfizer-BioNTech vaccine, two different side effects: Skin and eye.

A 47-year-old male patient presented to our clinic with the complaints of eye pain, reduced vision and redness in the right eye three days after administration of the second dose of the Pfizer-BioNTech vaccine. The patient was diagnosed with uveitis associated with the Pfizer-BioNTech vaccine and inflammatory glaucoma due to the uveitis. In addition, an erythematous, morbilliform rash had developed three days after the first dose of the vaccine. This is the first case report in the literature to show both skin and eye side effects after the Pfizer-BioNTech vaccine.

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

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

The Roles and Responsibilities of School Administrators During the Emergency Remote Teaching Process in Covid-19 Pandemic

When Covid 19 pandemic started, schools in Turkey, as in many parts of the world, were closed and then emergency remote teaching started. The purpose of this study is to explain the roles and responsibilities of school administrators related to emergency remote teaching after schools were closed. In order to reveal the purpose above, this research was carried out in qualitative research design. 105 school administrators from different regions of Turkey and different school levels participated in the study. The data were collected through a Google Drive form with open-ended questions. The collected data were analyzed with content and descriptive analyses. The findings showed that the roles and responsibilities of the school administrators regarding emergency remote teaching included planning the process, starting online classes, opening different social media accounts, managing the online program, solving the adaptation problems of students and teachers, monitoring the actions taken and motivating teachers, students, parents;communication and finally it has been seen that they are in the act of transition to and maintaining digital management. During the Covid 19 pandemic, school administrators have mostly done "communication". There were also changes in the communication styles of school administrators and social media tools were used effectively. The intensive use of technology in this period has caused changes in management processes and managers have mostly talked about digital management and the exhausting aspects of digital management are expressed as well as the facilitating ones. Since emergency remote teaching is not a common case in the K-12 Turkish education system, we hope the results of this study will contribute to a better understanding of the roles and responsibilities of school administrators during such emergency periods.

Qtc interval and electrocardiographic findings of covid-19 patients

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

COVID-19 AND COLORECTAL SURGERY: LESSONS LEARNED FROM FIRST CASES

Objective: This study aimed to examine the preoperative, perioperative, and postoperative colorectal surgery experience during the initial stage of the pandemic outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) later named COVID-19 disease in Turkey and to assess conditions and needs. Material and Method: Seven early cases of colorectal disease patients are described and lessons learned from these cases are reported. All patients' preoperative workup included two nasopharyngeal polymerase chain reaction (PCR) swabs for SARS-CoV-2 taken at a three-day interval preoperatively and a thorax computerized tomography scan taken on a preoperative day. Results: COVID-19 infection occurred before and after surgery despite all measures taken, including isolation. It became complicated to manage surgical complications such as stoma complication, surgical site infection, and small bowel obstruction. Nonetheless, while patients with underlying health conditions have a high mortality rate from COVID-19 infection, no death was observed in this small case series. Conclusion: Medical centers must be well organized to perform colorectal surgery under pandemic conditions. Patients may initially test negative or become positive for COVID-19 at any stage during this disease outbreak. Multidisciplinary teamwork with the infectious disease department and anesthetists can prevent mortality from COVID-19 infection during colorectal surgery and subsequent hospitalization.

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

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

Evaluation of Childhood COVID-19 Cases: A Retrospective Analysis

Objective This study aims to evaluate the demographic, epidemiological, and clinical features of novel coronavirus disease 2019 (COVID-19) cases aged between 0 and 18 years Methods The demographic characteristics of the patients, admission symptoms, contact and travel histories, clinical onset duration, symptoms, treatments, laboratory findings, radiological images, and polymerase chain reaction (PCR) negation times were evaluated in a retrospective manner Thirty-eight children (19 boys and 19 girls) were included in the study Discussion The mean age of the patients was 1036 ± 559 years The average admission times of the patients after the onset of the symptoms was determined as 184 ± 202 days Thirteen (342%) patients were observed as asymptomatic The most common identified symptoms were fever, cough, and fatigue (552, 342, and 132%, respectively) Febrile convulsions, myalgia, dizziness, and diarrhea were the least common symptoms Also, 25-hydroxyvitamin D3 (vitamin D3) levels were low and aspartate aminotransferase (AST) values were higher in the moderate group than the mild group and the relationships were statistically significant (p = 0044and 0027) Ferritin levels of the patients with ground glass opacity (GGO) were found statistically and significantly higher than the patients without GGO (p = 0,031) There was more than one lobe and segment involvement in five patients, the average number of affected lobes and segments was 38 and 88, respectively High-resolution computed tomography of the 24 patients showed that;GGO in five (208%), consolidation + GGO (mixed) in three (125%), consolidation (alone) in one, subpleural linear opacities in three (125%), and pavement stone opacities in one (42%) patient COVID-19, which is seen less frequently in children, may pose a risk in infants and young children Conclusion Especially high ferritin levels may present with lung involvement and low vitamin D levels may worsen the aggravation of the lung involvement There is a great need for further research on this subject. © 2021 Hogrefe Verlag GmbH & Co. KG. All rights reserved.

In silico, 6lu7 protein inhibition using dihydroxy-3-phenyl coumarin derivatives for SARS-CoV-2

The new emerging coronavirus (SARS-CoV-2) has become a global health problem with very rapid transmission from person to person, causing severe acute respiratory problems. In the circumstance, the discovery of vaccines or drugs to eradicate or reduce the impact of the COVID-19 has made it imperative to develop new approaches. In the current situation, many drugs on the drug bank have been researched computationally, and there has not been an emphasis on synthetic effort. We tested 42 coumarin derivatives (1a-14c) containing 14 different substituents, which are secondary metabolites of plants, and the anticoagulant Coumadin (warfarin) drug as a reference by Molecular Docking calculation technique on 6LU7 main protease of the coronavirus. Optimized geometries, electron motions and energy values of all coumarins were also determined using the Density Functional Theory (DFT) method. The drug properties of coumarins were estimated using the ADME-Tox test method. Coumarins formed strong interactions with HIS41, CYS145, and other amino acids in the active site of the main protease. In general, 6,7-dihydroxy-3-phenylcoumarin derivatives gave relatively higher scores, and for all coumarins, biphenyl (for 10a,-8.6 kcal/mol;10b,-8.3 kcal/mol;10c,-7.9 kcal/mol) and 4-trifluoromethylphenyl (for 13a,-8.1 kcal/mol;13b,-8.1 kcal/mol;13c-8.3 kcal/mol) substituted coumarin had the highest score. The coumarins data reported in this study serves as a stepping stone for in vitro and in vivo experimental research for vaccine development purposes. © 2020, Turkish Chemical Society. All rights reserved.