Biruni Index as a Novel Diagnostic Tool for the Early Prediction of Mortality in Critical Patients With COVID-19: A Cohort Study.

BACKGROUND: The aim of this study was to find out the potential risk factors associated with mortality in severe coronavirus disease 2019 (COVID-19) patients hospitalized due to viral bronchopneumonia, and to establish a novel COVID-19 mortality index for daily use. METHODS: The study included 431 quantitative real-time polymerase chain reaction (qRT-PCR)-confirmed COVID-19-positive patients admitted to the intensive care unit in a tertiary care hospital. Patients were divided into training and validation cohorts at random (n= 285 and n= 130, respectively). Biruni Index was developed by multivariate logistic regression analysis for predicting COVID-19-related mortality. RESULTS: In univariate logistic regression analysis, age, systolic and diastolic blood pressures, respiratory and pulse rates per minute, D-dimer, pH, urea, ferritin, and lactate dehydrogenase levels at first admission were statistically significant factors for the prediction of mortality in the training cohort. By using multivariate logistic regression analysis, all of these statistically significant parameters were used to produce Biruni Index. Statistically significant differences in Biruni Index were observed between ex and non-ex groups in both training and validation cohorts (P < 0.001 for both comparisons). Areas under receiver operating characteristic (ROC) curve for Biruni Index were 0.901 (95CI%: 0.864-0.938, P < 0.001) and 0.860 (95CI%: 0.795-0.926, P < 0.001) in training and validation cohorts, respectively. CONCLUSION: As a pioneering clinical study, Biruni Index may be a useful diagnostic tool for clinicians to predict the mortality in critically ill patients with COVID-19 hospitalized due to severe viral bronchopneumonia. However, Biruni Index should be validated with larger series of multicenter prospective clinical studies.

Biruni Index as a Novel Diagnostic Tool for the Early Prediction of Mortality in Critical Patients With COVID-19: A Cohort Study

Background: The aim of this study was to find out the potential risk factors associated with mortality in severe coronavirus disease 2019 (COVID-19) patients hospitalized due to viral bronchopneumonia, and to establish a novel COVID-19 mortality index for daily use. Methods: The study included 431 quantitative real-time polymerase chain reaction (qRT-PCR)-confirmed COVID-19-positive patients admitted to the intensive care unit in a tertiary care hospital. Patients were divided into training and validation cohorts at random (n= 285 and n= 130, respectively). Biruni Index was developed by multivariate logistic regression analysis for predicting COVID-19-related mortality. Results: In univariate logistic regression analysis, age, systolic and diastolic blood pressures, respiratory and pulse rates per minute, D-dimer, pH, urea, ferritin, and lactate dehydrogenase levels at first admission were statistically significant factors for the prediction of mortality in the training cohort. By using multivariate logistic regression analysis, all of these statistically significant parameters were used to produce Biruni Index. Statistically significant differences in Biruni Index were observed between ex and non-ex groups in both training and validation cohorts (P < 0.001 for both comparisons). Areas under receiver operating characteristic (ROC) curve for Biruni Index were 0.901 (95CI%: 0.864-0.938, P < 0.001) and 0.860 (95CI%: 0.795-0.926, P < 0.001) in training and validation cohorts, respectively. Conclusion: As a pioneering clinical study, Biruni Index may be a useful diagnostic tool for clinicians to predict the mortality in critically ill patients with COVID-19 hospitalized due to severe viral bronchopneumonia. However, Biruni Index should be validated with larger series of multicenter prospective clinical studies.

Comparison of Cytokine Hemadsorption as an Immunomodulator Therapy in COVID-19 Patients with and without Bacterial Sepsis.

BACKGROUND: In this retrospective study, we aimed to compare the laboratory and clinical results of cytokine hem-adsorption as an immunomodulation therapy in COVID-19 ICU patients with or without sepsis. METHODS: The levels of PCT, CRP, and ferritin were determined as indicators of infection/sepsis; the levels of in-terleukins (IL-6, IL-8 and IL-10, and TNF-α) were determined as indicators of cytokine storm were compared. APACHE score, SOFA score, and mortality rates were compared for the progression of the disease in 23 COVID-19 patients. RESULTS: The therapy was generally successful in reducing the levels of IL-6, IL-8, IL-10, and TNF-α but the levels measured after the procedure did not differ among the patients with or without sepsis, suggesting that the presence of sepsis did not affect the efficacy and function of the cytokine hemadsorption procedure in COVID-19 patients. All parameters were reduced after the procedure except the levels of PCT and ferritin and mortality rates of patients diagnosed with sepsis. The level of PCT was significantly higher in these patients compared with the patients without sepsis while the ferritin and mortality did not show any significant difference between the two groups, suggesting that the cytokine hemadsorption may be safe in the treatment of critical COVID-19 patients. CONCLUSIONS: As a result, the progression of sepsis in COVID-19 may be avoided with cytokine hemadsorption applied as an immunomodulator therapy. However, this therapy should be further explored and validated prior to its introduction to everyday clinical practice when the epidemic conditions end.

Messenger ribonucleic acid vaccine-associated immune thrombocytopenia: A rare complication of vaccine.

Coronavirus disease-2019 continues to have a serious impact in countries with the effect of new variant viruses emerging with mutations. While the effectiveness and protection of the vaccine have been determined all over the world, some vaccine-related side effects can be detected in the form of cases. In our case, the patient was admitted to the emergency department of our hospital with complaints of weakness and progressive rash on his legs. Diffuse petechiae purpura on the legs of the patient was observed and complete blood count revealed thrombocytopenia. Peripheral blood smear supported the blood count test results with thrombocytopenia, secondary causes of thrombocytopenia were excluded, and the patient was diagnosed with vaccine-induced immune thrombocytopenia.

Angioedema after favipiravir treatment: Two cases.

Drug-induced angioedema often affects elderly patients with chronic drug use. Proper diagnosis and prompt with effective treatment reduce mortality. With the increasing use of favipiravir, many side effects, especially increased alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels due to liver toxicity, and also skin lesions are reported. First patient oral favipiravir treatment on the second day was admitted to the hospital with rash and swelling on the eyelids. Second patient suffered from significant swelling on the upper lip and displayed angioedema. In this cases, angioedema findings regressed after rapid diagnosis and parenterally administered antihistamine and steroid treatment. Although there is no effective drug therapy in the treatment of COVID-19, favipiravir is also included in the treatment protocols in many countries. Clinicians should be careful about the side effects and possible skin manifestations, especially including angioedema, related to the use of favipiravir.

COVID-19 seroconversion in the aircrew from Turkey.

BACKGROUND: Pneumonia due to Severe Acute Respiratory Syndrome 2 (SARS-CoV-2) is spreading rapidly all over the world and air travel is the leading transmission route of the virus among countries. The aim of the study is to determine the frequency of SARS-CoV-2 Immunoglobulin G (IgG) antibodies in aircrew, to determine occupational exposure, and to understand the spread of immunity in social groups. METHOD: The study was designed as a cross-sectional retrospective study. SARS-CoV-2 IgG levels were measured in patients who applied to between December 1, 2020 and January 13, 2021. Coronavirus disease-2019 (COVID-19) Reverse transcription polymerase chain reaction (RT-PCR) positivity was investigated before December 1, 2020. RESULTS: The patients were divided into three groups according to their jobs such as 313 aircrew; 451 healthcare workers; 4258 other patients. The PCR positivity rate was found to be 39% in the aircrew group, 32% in the healthcare workers and %20 other patient group (p < 0.001). The IgG antibody positivity rate was 46% in the aircrew, 41% in healthcare workers, and 35.3% in the other patient group (p < 0.001).The group with the highest IgG antibody titer is in the aircrew; there was a significant difference between the groups (p < 0.001). CONCLUSIONS: In our study, it was observed that aircrew, similar to healthcare workers, are at serious risk against SARS-CoV-2. In this process, it is suggested that the vaccination processes included repeated doses of aircrew should be accelerated and protective measures and equipment should be increased in terms of reinfection.

Most notable 100 articles of COVID-19: an Altmetric study based on bibliometric analysis.

OBJECTIVE: The purpose of this study is to guide researchers in the COVID-19 pandemic by evaluating the 100 most cited articles of COVID-19 in terms of bibliometric analysis, Altmetric scores, and dimension badges. METHODS: "COVID-19" was entered as the search term in Thomson Reuter's Web of Science database. The 100 most cited articles (T100) were analyzed bibliometrically. Altmetric attention scores (AASs) and dimension badge scores of the articles were evaluated. RESULTS: T100 articles were published from January to September 2020. The average citation of the top 100 articles on COVID-19 was 320 ± 344.3 (143-2676). The language of all articles was English. The average Altmetric value of T100 is 3246 ± 3795 (85-16,548) and the mean dimension badge value was 670 ± 541.6 (176-4232). Epidemiological features (n = 22) and treatment (n = 21) were at the top of the main topics of T100 articles. CONCLUSION: The more citations an article is made, the more it indicates the contribution of that article to science. However, the number of citations is not always the only indicator of article quality. The existence of methods that measure the impact of the article outside the academia to measure the value of the article arises more in an issue that affects the whole world, such as the COVID-19 pandemic.