Successful Treatment of COVID-19-Related Immune- Complex Glomerulonephritis, Case Report.

Acute kidney injury (AKI) , proteinuria in the nephrotic or subnephrotic range and hematuria might be seen in patients with coronavirus disease 2019 (COVID-19) infection. In this case study we present a 59 years old manwho was diagnosed with immune-complex glomerulonephritis after development of rapidly progressive kidney failure accompanied by pulmonary hemorrhage, 2 months after COVID-19 infection. The patient was hospitalised with the diagnosis of acute kidney injury and nephrotic syndrome. Hemodialysis was performed due to uremic symptoms. Cyclophosphamide, methylprednisolone and plasmapheresis were started. Pathologic examination of kidney biopsy revealed features compatible with immune complex-related acute glomerulonephritis. Cyclophosphamide and plasmapheresis were discontinued , and treatment with 1 mg/kg/day methylprednisolone was continued. Immune-complex glomerulonephritis can be seen following COVID-19 infection. It is important to diagnose this disease entity as soon as possible . Steroidtherapy and other supportive modalities might be sufficient in the treatment.  DOI: 10.52547/ijkd.6527.

Anxiety and Sleep Quality Levels of Emergency Medical Personnel and Factors Affecting Them During the Coronavirus Disease-2019 Pandemic

Objective: The study was conducted to determine the anxiety and sleep quality levels of emergency medical service personnel as well as factors affecting them during the Coronavirus disease-2019 (COVID-19) pandemic. Materials and Methods: This descriptive study included 247 medical professionals working in emergency medical services. Results: The mean age of the medical personnel was 32.62±7.36 years, of whom 54.3% were females, 49.8% were married, 89.9% were university graduates and 47.8% nurse. Of the medical staff, 21.9% had mild anxiety, 15.8% had moderate anxiety, and 33.2% had high anxiety. Pittsburgh sleep quality index scores of all participants were >5. A strong and positive relationship (p<0.001) was found between the anxiety level (19.24±15.67) and sleep quality (14.39±3.13) of participants. The study revealed that healthcare personnel who worked 24 hour shifts, smoked and/or drank alcohol, had a psychological disorder, and lacked adequate protective equipment had high anxiety scores and poor sleep quality. Moreover, healthcare professionals who experienced problems with childcare, thought that working conditions affect their children negatively, and were afraid of COVID-19 transmission to themselves and their families had high anxiety scores and poor sleep quality. Conclusion: During the pandemic, monitoring the emergency medical personnels' health and work is important to determine their levels of anxiety and sleep quality and to provide necessary psychological support. Amaç: Bu çalışma, Koronavirüs hastalığı-2019 (COVID-19) pandemi döneminde acil servis çalışanlarının anksiyete ve uyku kalitesi düzeyleri ile etkileyen faktörleri belirlemek amacıyla yapılmıştır. Gereç ve Yöntem: Tanımlayıcı tipte olan bu araştırma acil servislerde çalışan 247 sağlık personeli ile yapılmıştır. Bulgular: Yaş ortalamaları 32,62±7,36 olan sağlık personellerinin %54,3'ü (n=134) kadın, %49,8'i (n=123) evli, %89,9'u (n=222) üniversite mezunu ve %47,8'i (n=118) hemşire idi. Sağlık personelinin %21,9'u hafif, %15,8'i orta ve %33,2'si yüksek anksiyete düzeyine sahipti. Katılımcıların tamamının Pittsburgh uyku kalitesi indeks puanı 5'in üzerinde idi. Katılımcıların anksiyete düzeyi (19,24±15,67) ile uyku kalitesi (14,39±3,13) arasında kuvvetli ve pozitif yönde ilişki saptandı. Çalışmada;24 saatlik vardiyalar halinde çalışan, sigara ve/veya alkol kullanan, psikolojik bir hastalığı olan ve yeterli koruyucu ekipmana sahip olmadığını belirten sağlık personellerinin anksiyete puanlarının yüksek, uyku kalitelerinin kötü olduğu saptandı. Ek olarak, çocuklarının bakımı ile ilgili sorun yaşayan, çalışma şartlarının çocuklarını olumsuz etkilediğini düşünen, kendisine ve ailesine COVID-19 bulaşmasından korkan sağlık personellerinin anksiyete puanları yüksek, uyku kaliteleri kötü idi. Sonuç: Pandemi döneminde sağlık personellerinin çalışma şeklinin yeniden gözden geçirilmesi, anksiyete ve uyku kalitelerinin belirlenerek gerekli psikolojik desteğin sağlanması önemlidir.

The atherogenic index of plasma as a predictor of mortality in patients with COVID-19.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has become a global health threat, and thus, an early and effective set of predictors is needed to manage the course of the disease. OBJECTIVES: We aim to determine the effect of SARS-CoV-2 on lipid profile and to evaluate whether the atherogenic index of plasma (AIP) could be used to predict in-hospital mortality in COVID-19 patients. METHODS: In this retrospective chart review study, a total of 139 confirmed COVID-19 patients, whose diagnoses are confirmed by PCR and computerized tomography results, are enrolled. The study population is divided into two groups: the deceased patient group and the survivor group. For each patient, fasting total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and the triglyceride values are obtained from the laboratory tests required at the admission to hospital. Finally, the AIP is calculated as the base 10 logarithm of the triglyceride to HDL-C ratio. Distributional normality of the data is checked and depending on the normality of the data, either T test or Mann Whithey U test is employed to compare the two aforementioned study groups. RESULTS: Mean age of the study population is 49.2 ± 20.8 and 61.2% (n = 85) is male. Out of the 139 patients 26 have deceased and the remaining 113 patients survived the disease. Mean age of the deceased patients was 71.8*8.9 and mean age of the survivor patients is 44.0*19.2 (p < 0.001). The deceased group had more patients with hypertension (50.0% vs. 23.0, p = 0.006), diabetes mellitus (35.6% vs. 10.6%, p = 0.002), cardiovascular diseases (23.1% vs. 4.4%, p = 0.001), chronic renal insufficiency (11.5% vs. 0.9%, p = 0.003) and atrial fibrillation (7.7% vs 0%, p = 0.003). The AIP values in the deceased group are found to be statistically higher (p < 0.001) than the survivor group. As a measure of mortality, the area under the operating characteristic curve for the AIP is calculated as 0.850 (95% confidence interval: 0.772-0.928) along with the optimal cut-off value of 0.6285 (78.6% sensitivity and 80.5% specificity). Furthermore, the AIP value is observed to be elevated in patients with pneumonia, intubation history, and intensive care admission during hospital stay (p = 0.002, p < 0.001 and p < 0.001, respectively). Finally, compared to the survivor group, total cholesterol, HDL-C, LDL-C values are lower (p = 0.004, p < 0.001 and p < 0.001, respectively) and triglyceride levels are higher (p < 0.001) in deceased patients. CONCLUSION: In this study, we show that the AIP levels higher than 0.6285 can predict in-hospital mortality for COVID-19 patients. Moreover, the AIP emerges as a good candidate to be used as an early biomarker to predict pneumonia, intubation and intensive care need. Hence, regular check of the AIP levels in COVID-19 patients can improve management of these patients and prevent deterioration of the disease.