Neurological Symptoms Common in Covid-19 Patients: A Retrospective Observational Study

In December 2019, a novel coronavirus outbreak spread rapidly all over the world. The virus is known to be neuroinvasive, but much is still unknown. In this study, we aimed to pres-ent the main neurologic symptoms in patients who were diagnosed with coronavirus disease 2019 (COVID-19). The study was conducted retrospectively by phoning 156 patients in Turkey diagnosed with COVID-19 through real-time polymerase chain reaction;only 100 patients could be reached. Data about their demographics, initial symptoms, neurological symptoms, and sleeping habits were collected. During the disease process, 66% had at least one neurological symptom, 55% had central nervous system symptoms, 42% had peripheral nervous system symptoms, and 64% had sleep disturbances and myalgia. Impaired consciousness, smell and taste impairments, and sleep disturbances were significantly higher in patients with positive chest computed tomography imaging (p < 0.05). Neurological symptoms were observed in COVID-19, as in other coronaviruses. Headache in particular was the most common symptom in our population. In patients with respiratory system findings, the detec-tion of certain neurological symptoms such as smell-taste impairments, impaired consciousness, and sleep disorders were more common. We concluded that COVID-19 patients should be approached in a more holistic way, taking the nervous system into account.Copyright © 2022, Dr. Mladen Stojanovic University Hospital. All rights reserved.

Hypersentivity reactions to COVID-19 vaccines: a case of Eosinophilic pneumonia following Sinovac/CoronaVac vaccination.

SUMMARY: Hypersensitivity reactions has been reported with COVID-19 vaccines. Acute eosinophilic pneumonia has not been reported yet after Sinovac/CoronaVac vaccine. A 73-year-old woman presented with maculopapular rash, cough and dyspnea following Sinovac/CoronaVac injection. The complete blood count (CBC) indicated eosinophilia and further evaluation of the eosinophilia with CT and bronchoscopy confirmed a diagnosis of acute eosinophilic pneumonia. After methylprednisolone therapy, her rash resolved with marked improvement of the dyspnea. She is still on treatment and on the follow up period, we plan to continue steroid treatment at least 3 months.

Do disasters trigger protests? A conceptual view of the connection between disasters, injustice, and protests—The case of COVID-19

People around the globe are affected by disasters far beyond the disaster properties. Given that certain social groups are affected disproportionately, disasters need to be considered as political events which may cause political actions. Therefore, we aim to discuss, from a social psychological perspective, how and why protests might occur during or after a disaster. We argue for an elaborated model of collective action participation suggesting that disasters enhance the predictors of protest mobilization and participation though emerged or enhanced social injustice. We also suggest that disaster properties can be used to delegitimise protests and social movements, limiting the mobilization and collective resilience during and after a disaster. Finally, we discuss the gaps in current research and emphasize the need for more attention to the disaster-protest link as we can expect more disasters due to climate crisis, likely to lead to more protests and political collective action. Copyright © 2022 Vestergren, Uysal and Tekin.

Association of hematological indices with neurological symptoms in COVID 19 patients

Purpose: The aim of this study was to compare the neurological involvement in Coronavirus 19 (COVID-19) patients with laboratory findings with these cost-free, practical tests. Materials and Methods: Of the 170 patients diagnosed COVID-19, 103 patients could be reached by phone, and neurological symptoms were recorded as three categories. Laboratory tests of the patients and 103 controls whose real-time polymerase chain reaction (RT-PCR) test negative without any chronic disease history and drug use were obtained from the hospital software. Results: White blood cell, neutrophil, lymphocyte, eosinophil, basophil, platelet were lower, monocyte to lymphocyte ratio and platelet to lymphocyte ratio higher in patients than controls. In the group with central nervous system findings, red blood cell and hematocrit counts, in the group with peripheral nervous system findings, lymphocyte and platelet counts and with sleep disturbances and muscle pain group eosinophil counts were lower in patients than those without. Conclusion: COVID-19 patients with neurological symptoms have some hematological abnormalities. The presence of certain hematological findings may be a clue to the emergence of neurological symptoms, and early detection and correction of these hematological abnormalities may be the solution to prevent the development of neurological symptoms in COVID-19.

Maternal and perinatal outcomes of SARS-CoV-2 infection in unvaccinated pregnancies during Delta and Omicron waves.

OBJECTIVE: There is little evidence related to the effects of the Omicron severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant on pregnancy outcomes, particularly in unvaccinated women. This study aimed to compare pregnancy outcomes of unvaccinated women infected with SARS-CoV-2 during the pre-Delta, Delta and Omicron waves. METHODS: This was a retrospective cohort study conducted at two tertiary care facilities: Sancaktepe Training and Research Hospital, Istanbul, Turkey, and St George's University Hospitals NHS Foundation Trust, London, UK. Included were women who tested positive for SARS-CoV-2 by real-time reverse-transcription polymerase chain reaction (RT-PCR) during pregnancy, between 1 April 2020 and 14 February 2022. The cohort was divided into three periods according to the date of their positive RT-PCR test: (i) pre-Delta (1 April 2020 to 8 June 2021 in Turkey, and 1 April 2020 to 31 July 2021 in the UK), (ii) Delta (9 June 2021 to 27 December 2021 in Turkey, and 1 August 2021 to 27 December 2021 in the UK) and (iii) Omicron (after 27 December 2021 in both Turkey and the UK). Baseline data collected included maternal age, parity, body mass index, gestational age at diagnosis and comorbidities. The primary outcome was the need for oxygen supplementation, classified as oxygen support via nasal cannula or breather mask, non-invasive mechanical ventilation with continuous positive airway pressure (CPAP) or high-flow oxygen, mechanical ventilation with intubation, or extracorporeal membrane oxygenation (ECMO). Inferences were made after balancing of confounders, using an evolutionary search algorithm. Selected confounders were maternal age, body mass index and gestational age at diagnosis of infection. RESULTS: During the study period, 1286 unvaccinated pregnant women with RT-PCR-proven SARS-CoV-2 infection were identified, comprising 870 cases during the pre-Delta period, 339 during the Delta wave and 77 during the Omicron wave. In the confounder-balanced cohort, infection during the Delta wave vs during the pre-Delta period was associated with increased need for nasal oxygen support (risk ratio (RR), 2.53 (95% CI, 1.75-3.65); P < 0.001), CPAP or high-flow oxygen (RR, 2.50 (95% CI, 1.37-4.56); P = 0.002), mechanical ventilation (RR, 4.20 (95% CI, 1.60-11.0); P = 0.003) and ECMO (RR, 11.0 (95% CI, 1.43-84.7); P = 0.021). The maternal mortality rate was 3.6-fold higher during the Delta wave compared to the pre-Delta period (5.3% vs 1.5%, P = 0.010). Infection during the Omicron wave was associated with a similar need for nasal oxygen support (RR, 0.62 (95% CI, 0.25-1.55); P = 0.251), CPAP or high-flow oxygen (RR, 1.07 (95% CI, 0.36-3.12); P = 0.906) and mechanical ventilation (RR, 0.44 (95% CI, 0.06-3.45); P = 0.438) with that in the pre-Delta period. The maternal mortality rate was similar during the Omicron wave and the pre-Delta period (1.3% vs 1.3%, P = 0.999). The need for nasal oxygen support during the Omicron wave was significantly lower compared to the Delta wave (RR, 0.26 (95% CI, 0.11-0.64); P = 0.003). Perinatal outcomes were available for a subset of the confounder-balanced cohort. Preterm birth before 34 weeks' gestation was significantly increased during the Delta wave compared with the pre-Delta period (15.4% vs 4.9%, P < 0.001). CONCLUSIONS: Among unvaccinated pregnant women, SARS-CoV-2 infection during the Delta wave, in comparison to the pre-Delta period, was associated with increased requirement for oxygen support (including ECMO) and higher maternal mortality. Disease severity and pregnancy complications were similar between the Omicron wave and pre-Delta period. SARS-CoV-2 infection of unvaccinated pregnant women carries considerable risks of morbidity and mortality regardless of variant, and vaccination remains key. Miscommunication of the risks of Omicron infection may impact adversely vaccination uptake among pregnant women, who are at increased risk of complications related to SARS-CoV-2. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

COVID-19: risk factors increasing disease and scoring

Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). It became a major global health threat in a short time after being declared by the World Health Organization (WHO) as a pandemic on March 11, 2020. Viral, environmental, and host factors play a role in the course of COVID-19. The disease is more common in the elderly, men, and people with diabetes mellitus, hypertension, cardiovascular disease, chronic renal disease, and malignancy. While some risk scores are used to predict ICU admission and mortality, they are not specific to COVID-19. Identifying high-risk individuals and preventing their infection can reduce mortality in the disease.

The impact of COVID-19 on traumatic hand injuries: A Turkish survey

Aim: Our aim in the study is to perform a comparative analysis of traumatic hand injuries during the quarantine period of the COVID-19 pandemic with data of the previous year and to research the effect of quarantine on hand injuries. Material and Methods: We retrospectively analyzed patients who presented to the emergency department with traumatic hand injuries between 16.03.2020 and 01.06.2020 and within the same period of 2019. Patients' age, gender, injury mechanism, length of hospitalization, ethnic origin, presence of major and digital nerve injuries, presence of bone injury, emergency or elective surgery data were recorded. The data were analyzed statistically in comparison with the previous year. Results: A total of 301 patients participated in the study. There were 117 patients in 2020, and 184 patients in 2019. When patients of both years were examined in terms of age, gender and length of hospitalization, there was no statistically significant difference between the patients who were operated for hand injuries between 2020 and 2019 (p 0.05). When patients who were operated due to hand injuries were examined in terms of differences in ethnic origin, operation under emergency conditions and accompanying bone injury between both groups, a statistically significant difference was found between them (p<0.05). Discussion: A decrease was observed in the number of traumatic hand injuries admitted to the emergency department during the COVID-19 pandemic;however, there were no changes in etiology. These reference data can help healthcare systems prepare for future outbreaks and similar restrictions.

Immature platelet fraction: Is a novel early predictive marker for disease severity in patients with Covid-19 pneumonia?

Objectives: In many diseases, immature platelet fraction (IPF%) is related to coagulopathy and poor outcome. This study aimed to investigate the predictive value of IPF% for the severity of pneumonia in patients with Coronavirus Disease 2019 (COVID-19). Methods: A total of 154 patients with COVID-19 infections were included. The patients were divided into two groups according to the severity of pneumonia (severe and nonsevere) regarding their oxygen demand. Results: Given laboratory parameters, themedian IPF% was significantly higher in the severe group (11.9 vs. 3.9%, p<0.001). Mean platelet volume (p<0.001), platelet-large cell ratio (p=0.001), platelet distribution width (p=0.001),D-Dimer (p<0.001), INR (p=0.003), and aPTT (p=0.007) were also found to be significantly higher in the severe group.Moreover, IPF (p=0.014, Odds ratio = 2.000, 95%CI: 1.149-3.482) was an independent predictor for the severity. The curve value from receiver operating characteristics was 0.879 (p<0.001, 95%CI: 0.784-0.943) for determining the severity of pneumonia. IPF% had a sensitivity and specificity value of 69.5 and 92.4% to detect the disease's severity. Conclusions: IPF% is an independent predictor for the severity of COVID-19 pneumonia. Assessment of IPF% may both help to early determine high-risk patients with COVID-19 and to alert the physicians.

The effectiveness of hydroxychloroquine versus vydroxychloroquine plus Lopinavir/ritonavir therapy in SARSCoV- 2 Pneumonia

Introduction: There is no specific antiviral treatment with proven efficacy and safety in the management of Coronavirus disease-2019 (COVID-19). We aimed to compare the effectiveness of hydroxychloroquine (HQ) monotherapy and HQ-lopinavir/ritonavir (Lpv/r) combined therapy in patients with laboratory-confirmed COVID-19 and to determine the independent factors predicting mortality. Materials and Methods: Retrospective observational multi-centered cohort study. Results: In total, 151 patients (mean age 61±17 years, 66% male) with COVID-19 pneumonia were included: 68 patients received combination therapy, i.e., Lpv/r in addition to HQ, and 83 patients received only HQ. The patients in both groups were similar regarding the majority of baseline variables except for white blood cell count, procalcitonin, lactate dehydrogenase levels, intensive care unit (ICU) admission rates, which were significantly higher, and decreased oxygen saturation in the combination group. The mean duration of symptoms and hospital stay were 5.6±2.3 days and 12.7±9.4 days, respectively. Nearly 43% (n=65) of patients were admitted to the ICU. Patients in the HQ monotherapy group had a shorter stay in hospital than those in the combination group (10 vs. 16 days, p<0.005). The primary end points were 14- and 28-day mortality. Neither treatment group revealed significant differences with respect to 14-day and 28-day survival before and after propensity score matching. Age, hypertension, diabetes mellitus, chronic obstructive pulmonary disease, the Charlson Comorbidity Index (CCI), and ICU stay length were variable predictors of 14-day mortality, while CCI [Hazard ratio (HR) 95% confidence interval (CI): 0.85 (0.43-0.9)] and ICU stay length [HR (95% CI): 1.5 (1.39-1.76)] were the independent predictors of 28-day mortality. Conclusion: Combination therapy with Lpv/r and HQ did not provide any benefit compared with HQ monotherapy. Charlson Comorbidity Index and ICU stay were independent predictors of 28-day mortality.

Chronic hepatitis c in the pandemic

Corona virus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, affected all the world and has been a major cause for significant morbidity and mortality. COVID-19 represents with pulmonary manifestations, but in more than half of the cases, other organs, especially hepatic involvement, are observed. Chronic hepatitis C (CHC) is an important public health problem worldwide. Sustained virological response (SVR) can be achieved and HCV-related mortality and morbidity can be prevented with direct-acting antiviral agents (DAAs), which have been used in recent years. However, if CHC is not diagnosed, it can cause cirrhosis and liver cancer. Since the diagnosis and treatment of these patients require follow-up, they are among the most affected chronic diseases during the pandemic. It does not seem possible to predict when the COVID-19 outbreak will end. Diagnosis and treatment need of CHC patients should be met in special areas where protection measures are taken in health institutions. In patients who undergo DAA treatment, the follow-up should be carried out by health institutions that do not provide pandemic services, and if necessary, telemedicine should be used. © 2021, DOC Design and Informatics Co. Ltd.. All rights reserved.

Investigation of healthcare workers attitudes and practices towards the COVID-19 pandemic

Objective: To evaluate the behaviors and attitudes of healthcare workers toward COVID-19. Methods: A total of 280 healthcare workers (172 females and 108 males) answered an online questionnaire about the biosafety procedures for and their attitudes about COVID-19. The average age of participants was 33.57 ± 7.78. The data were analyzed using descriptive statistical methods and the chi-square test. Results: The study sample consisted of 39.5% medical doctors, 32.1% dentists, 14.3% nurses, 4.6% technicians, 2.9% physiotherapists, 3.6% secretaries, and 3.2% auxiliary staff. Of these healthcare workers, 151 (53.9%) had children. A great majority of the participants (91.8%) stated that they were afraid of being infected with the COVID-19 virus. There was no significant difference by gender, but the difference between having a child (95.4%) and not having a child (87.6%) was statistically significant (p=0.042). A little more than half (54.3%) of the participants answered yes to the question of whether they quarantined themselves, and this was found to be significantly higher in those who had children (42.4%) than those who did not (33.3%)(p=0.001). The precautions worn by healthcare workers while working were as follows: masks (89.3%), gloves (80.1%), N95/FFP2 masks (17.4%), face protective shields (39.1%), glasses (28.5%), and bonnets (33.1%). Sources of information for health workers about COVID-19 included the websites or social media accounts of professional organizations such as the Ministry of Health, the Association of Dentists, and the World Health Organization (82.2%);published scientific articles (47.3%);and social media accounts like Instagram and Twitter (48%). Conclusions: While healthcare workers responded well to the standard measures and attitudes they have to protect themselves against COVID-19 contamination, their practice on the extra measures they can take should be improved. In addition to personal protective equipment, efforts should be made to protect the immunity and mental health of healthcare workers.