Antibody responses to COVID-19 vaccines in older adults.

Because of the senescence of the immune system, antibody response to the COVID-19 vaccines may differ from older to younger adults. The study aim compares the titers of SARS-CoV-2 IgG antibody of patients ≥60 years who received three doses of CoronaVac vaccine and those who received two doses of CoronaVac+1 dose of Pfizer-BioNTech after 1 month of the last vaccination. Patients ≥60 years who received the CoronaVac vaccine between March 1, 2021, and April 30, 2021, who did not have COVID-19 disease before the first dose of vaccination and were negative for COVID-19 antibodies, whose antibodies were tested before the third dose of vaccination, and who did not have any COVID-19 disease during the follow-up were included. The demographic characteristics and comorbidities of patients were recorded. An immunofluorescence assay (IFA) fast test and a chemiluminescent microparticle immunoassay (Abbott) were used to measure SARS-CoV-2 quantitative antibody levels at the first month after the third-dose vaccine. Totally 81 patients, 41 patients in third dose of the CoronaVac group (female:male 18:23, mean age 69.4 ± 8.5), and 40 patients in third dose of the Pfizer-BioNTech group (female:male 15:25, mean age 69.9 ± 9.1) were included. The patients' comorbidities in the groups were similar. The titers of IgG antibodies to SARS-CoV-2 measured according to both IFA and Abbott Kit at first month the third dose vaccination was significantly higher in the Pfizer-BioNTech group (p ≥ 0.001, p = 0.012, respectively). The results report that the formed immunity in the first month after the two doses of CoronaVac+1 dose Pfizer-BioNTech vaccine was higher than three doses of CoronaVac vaccine in older adults.

Measurement of antibody levels in patients with COVID-19 over time by immunofluorescence assay: a longitudinal observational study.

BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic, antibody screening is a critical tool to assess anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunity. We examined variation in antibody titers associated with age and sex among patients with confirmed COVID-19. METHODS: Blood IgG levels were tested in 1081 patients with positive SARS-CoV-2 quantitative reverse transcription polymerase chain reaction (RT-qPCR) tests between 1 September and 31 December 2020. Patients who did not experience reinfection were identified. Serum IgG levels were measured by immunofluorescence assay. Antibody positivity and antibody titers were analyzed according to time since infection, sex, and age. RESULTS: The mean (standard deviation) age was 41.2 (14.2) years and 41.2% of patients were women. The lowest antibody positivity rate between the first and ninth month post-infection was detected in the sixth month. The lowest antibody titers among patients aged 20 to 80 years occurred in those aged 30 to 39 years. The IgG titer was positively correlated with age in years (r = 0.125) and decades (r = 0.126). CONCLUSIONS: Six months after infection, anti-SARS-CoV-2 antibody titers increased. Anti-SARS-CoV-2 antibody titers also increased with age. Immunity and pathogenicity should be investigated in addition to antibody positivity rates and antibody titers.

The Diagnostic and Predictive Roles of Neutrophil-Lymphocyte Ratio for Severity of Disease in COVID-19 Patients.

BACKGROUND: Neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), and platelet-lymphocyte ratio (PLR) are inflammation markers in inflammatory, cardiovascular, and malignant diseases and are important to assess prognosis. The aim of the study is to show the correlation between the inflammation markers of NLR, LMR, and PLR identified in total blood count of patients with Coronavirus disease 2019 (COVID-19) with the disease severity. METHODS: A total of 409 patients attending hospital with clinical symptoms of COVID-19 and with positive quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) test were divided into two groups as 61 severe patients and 348 non-severe patients. The levels of inflammation markers NLR, LMR, PLR, and c-reactive protein (CRP) were assessed. RESULTS: The mean age of 409 patients was 49.9 ± 18.3 years and 48.7% of all patients were female. In the severe patient group, NLR 8.94 ± 13.24, LMR 2.24 ± 1.46, and PLR 248 ± 254 were identified. NLR exhibited the largest area under the curve at 0.698, with the highest specificity (67%) and sensitivity (67.3%) among the other inflammation markers such as LMR and PLR. Consistent with the severity of disease in severe COVID-19 patients, NLR, PLR, CRP and other inflammation markers increase, while LMR is observed to reduce. CONCLUSIONS: NLR and PLR, calculated with the simple, cheap, and easily accessible hemogram test requested for diagnosis and follow-up of COVID-19 disease, were correlated with the total score for radiological findings and duration of hospitalization, and we observed NLR and LMR may predict disease severity.

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.

Does the COVID-19 seroconversion in older adults resemble the young?

High antibody titers have been found to correlate with the severity of coronavirus disease 2019 (COVID-19) disease. Therefore, antibody titers may be higher in older adults, whose disease is known to have a more severe course than younger ones. This study aimed to compare the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) antibody level in the reverse transcription-polymerase chain reaction (RT-PCR) to test positive older adults with young. Patients aged ≥18 with positive RT-PCR and checked serum IgG antibodies between November 1, 2020 and January 13, 2021 were included. The IgG antibody levels and the time between RT-PCR positivity with the antibody levels were recorded. A total of 1071 patients were divided into two groups as Group 1 <60 years old (n = 902) and Group 2 ≥60 years old (n = 169). The SARS-CoV-2 IgG antibody titers were higher in Group 2 (p = 0.001). This height was present in the first 3 months after positive RT-PCR. While the antibody titers were compared by dividing Group 2 into the three groups according to age ranges (60-69, 70-79, and ≥80 years), the antibody titer was higher in ≥80 years patients (p = 0.044). High COVID-19 IgG antibody levels may be associated with the severity of the disease. Also, the humoral immunity advantage was seen in the first 3 months in the older patients, which suggests that older adults with COVID-19 may develop reinfection in the long term.

Determining host factors contributing to disease severity in a family cluster of 29 hospitalized SARS-CoV-2 patients: Could genetic factors be relevant in the clinical course of COVID-19?

In this study, we report a large family cluster consisting of 29 genetically related patients hospitalized with coronavirus disease-2019 (COVID-19). We sought to determine the clinical characteristics relevant to the clinical course of COVID-19 by comparing the family cluster to unrelated patients with SARS-CoV-2 infection so that the presence of potential determinants of disease severity, other than traditional risk factors previously reported, could be investigated. Twenty-nine patient files were investigated in group 1 and group 2 was created with 52 consecutive patients with COVID-19 having age and gender compatibility. The virus was detected for diagnosis. The clinical, laboratory and imaging features of all patients were retrospectively screened. Disease course was assessed using records regarding outcome from patient files retrospectively. Groups were compared with respect to baseline characteristics, disease severity on presentation, and disease course. There was no difference between the two groups in terms of comorbidity and smoking history. In terms of inhospital treatment, use differed not significantly between two groups. We found that all 29 patients in the group 1 had severe pneumonia, 18 patients had severe pneumonia. Hospitalization rates, length of hospital stay, and transferred to intensive care unit were found to be statistically significantly higher in the group 1. In the present study, COVID-19 cases in the large family cluster were shown to have more severe disease and worse clinical course compared with consecutive patients with COVID-19 presenting to the same time. We believe further studies into potential genetic mechanisms of host susceptibility to COVID-19 should include such family clusters.

The relationship between positivity for COVID-19 RT-PCR and symptoms, clinical findings, and mortality in Turkey.

Introduction: This study aimed to assess the correlation between nucleic acid amplification test (real-time reverse transcription-polymerase chain reaction, RT-PCR) positivity of patients presenting with suspected COVID-19 and pneumonic infiltration consistent with COVID-19-specific pneumonia diagnosis on thoracic computed tomography (CT), with symptoms, laboratory findings, and clinical progression.Methods: The study included 286 patients (female:male 131:155; mean age, 53.3 ± 17.9 years) who were divided into two groups according to their RT-PCR test results. The symptoms, laboratory examinations, clinical findings, and thoracic CT imaging of the patients were evaluated.Results: While the physical examination, comorbidities, and total CT scores were similar between the groups, taste/smell abnormalities were observed more frequently in the PCR-positive group. The use of moxifloxacin, lopinavir/ritonavir, and tocilizumab was higher in the PCR-positive group (p = 0.016, p < 0.001, and p = 0.002, respectively). The duration of hospitalization, intensive care requirement, and mortality rate of the studied groups did not differ between the groups.Conclusions: Among patients presenting with suspected COVID-19 and pneumonic infiltration consistent with COVID-19 on thoracic CT, the symptoms, physical examination, total CT scores, duration of hospitalization, intensive care requirement, and mortality rate were similar between RT-PCR-positive and RT-PCR-negative patients. However, PCR-positive patients appeared to require more specific treatments.

Tocilizumab challenge: A series of cytokine storm therapy experiences in hospitalized COVID-19 pneumonia patients.

To recognize the period of exaggerated cytokine response in patients with coronavirus disease 2019 (COVID-19) pneumonia, and to describe the clinical outcomes of using tocilizumab as a treatment option. The data of 12 adult COVID-19 pneumonia patients who were followed in the inpatient clinics of Biruni University Medical Faculty Hospital (Istanbul, Turkey) were retrospectively analyzed. Diagnostic tests, laboratory examinations, clinical findings, and computed tomography of the thorax imaging results were evaluated. A dramatic laboratory and clinical improvement was observed in 83% (10 out of 12) of patients after tocilizumab. In 17% (2 out of 12) of our patients, short-term ventilator support was required in the intensive care unit. The longest hospital stay was 18 days. However, in the end, all of our patients were discharged home with good health. Although arterial oxygen saturations (87.58 ± 3.12%) dropped in room air in the pre-tocilizumab period, post-tocilizumab they normalized in all patients (94.42 ± 1%). None of them had fever after tocilizumab treatment and the levels of C-reactive protein (13.08 ± 12.89) were almost within normal limits. Eosinophil values were quite low at the time of diagnosis (10 ± 17.06), but increased significantly post-tocilizumab (155.33 ± 192.69). There is currently no proven treatment for COVID-19 induced by novel coronavirus SARS-CoV-2. Based on our experience with twelve adult COVID-19 pneumonia patients, we can say that tocilizumab, an IL-6 inhibitor, is more beneficial in preventing the damage caused by excessive cytokine response in the body if administered at the right time and provides clinical and radiological recovery.

Case Report: A COVID-19 Patient Presenting with Mild Rhabdomyolysis.

The news was reported from the Wuhan region of China about a novel corona virus in the end of 2019. After spreading around the world, a pandemic was declared by the WHO. Depending on the different involvement of the disease, the most common symptoms are fever, cough, and dyspnea. However, some indeterminate symptoms that make diagnosis difficult, such as myalgia and fatigue, can also be seen alone, without the typical clinical picture. We describe a patient with COVID-19 pneumonia, the only complaint of which is myalgia, and the first diagnosis is mild rhabdomyolysis. The patient had no evidence or history other than viral infection that could explain muscle pain and also increased level of muscle enzymes. When mild rhabdomyolysis lack of myoglobinuria and complications was diagnosed, treatment-related rhabdomyolysis was also avoided as no treatment related to COVID-19 was initiated yet. Apart from the typical symptoms leading to the typical diagnosis of COVID-19 at the first admission, SARS-CoV-2 related with rhabdomyolysis should also be kept in mind.

Effect of oral l-Glutamine supplementation on Covid-19 treatment.

OBJECTIVES: The aim of this study is to investigate the effect of oral l-Glutamine supplementation on hospitalization time, need for intensive care unit and Coronavirus Disease-19 (Covid-19) mortality. METHODS: The study included 30 Covid-19 patients using l-Glutamine and 30 Covid-19 patients who did not use l-Glutamine with similar age, gender and clinical status. Diagnostic tests, laboratory examinations, clinical findings and computed thorax tomography imaging of the patients were evaluated. RESULTS: Hospitalization time was 10.4 ± 1.9 days in Covid-19 without L-Glutamine group and 8.9 ± 1.8 days in Covid-19 with L-Glutamine group (p = 0.005). In Covid-19 without the L-Glutamine group, four patients require the ICU though no one in the other group required that (p = 0.038). Only one mortality was observed in Covid-19 without the L-Glutamine group (p = 0.999). CONCLUSIONS: Nutritional supplements such as L-Glutamine boost immune system especially by inhibition of inflammatory responses. Our results suggest adding enteral L-glutamine to the normal nutrition in the early period of Covid-19 infection may lead to a shortened hospital stay and lead to less need for ICU. Larger-scale studies are needed to evaluate the effect of adding enteral L-Glutamine to the currently used treatments in the infectious diseases especially like Covid-19.