COVID-19 Infection in Children with Leukemia: A Single-center Retrospective Study

Objective: Children were less likely than adults to develop severe illness from coronavirus disease-2019 (COVID-19) infection, whereas children with leukemia had compromised immunity and may be at increased risk of severe COVID-19 infection. The aim of this study is examine the characteristics and outcomes of COVID-19 in children with leukemia.Method: Between March 2020 and February 2021, patients on active leukemia treatment who were diagnosed with severe acute respiratory syndrome coronavirus-2 infection were enrolled in the study. Clinical, laboratory, and radiological characteristics, as well as infection severity and prognosis, were all assessed.Results: The children's median age was 9.6 years, and 66.7 percent of them were male. The majority of patients with COVID-19 infection were in the early stages of leukemia treatment and had severe or critical COVID-19 infection. Six patients were treated for COVID-19. Five patients required oxygen, six were in the intensive care unit, and three were intubated. Twelve patients were fully recovered, and three died. Two of the patients were re-infected with COVID-19. The disease status of re-infected patients was worse than the first infection, and the duration of polymerase chain reaction positivity was much longer.Conclusion: Children with leukemia who have COVID-19 infection may have severe/critical illness. The type and character of primer malignancy, as well as the prognostic factors of COVID-19 infection, may all have an impact on clinical outcomes. It is critical to take the most stringent precautions to prevent infection from spreading to these patients.

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With the Covid-19 pandemic, both schools affiliated with the Ministry of National Education (MoNE) and in higher education institutions have switched to online distance education in Turkiye, as in the rest of the world. One of the most critical factors in the effective and efficient exe-cution of this practice is academic staff readiness for e-learning. By including multiple variables, this study investigates, the e-learning readi-ness of the academic staff teaching at a state university. The study adopts the survey design, and its research group is formed by academic staff working in a state university in the 2019-2020 academic year. 308 out of 576 academic staff working at the university voluntarily participated in the research. The data were obtained though the "Personal Information Form" and the "E-learning Readiness Scale of Academic Staff." The findings show that the level of academic staff readiness for e-learning is at a medium level. Considering the gender variable, male lecturers have a higher self-efficacy in information and communications technologies use and self-confidence in e-learning. Furthermore, the e-learning needs of 24 to 31-year-olds are more compelling than those of 48 and above. Academic staff at the Faculty of Education are more ready to e-learn than those at the Faculty of Literature. It is concluded that academic title and education level do not make any difference in e-learning readiness. In accessing the internet, the self-efficacy perceptions in information and communications technologies use of the academic staff that uses laptop computers are more positive than those who use desktop computers. Those developing their computer and internet use skills with the help of others have stronger e-learning needs than those who developed them through university courses. Various suggestions are made in line with the findings of the research.

Examining the role of cyberloafing, narcissism, locus of control, and social appearance anxiety on the Internet gaming disorder in university students

Individual and multiple games played on the Internet are seen as a popular leisure activity, which is becoming increasingly common among young people. With the Covid 19 pandemic, the interest in Internet games has increased because young people spend more time at home. This has led to an increase in Internet gaming disorder, which is recognized by the American Psychiatric Association and the World Health Organization. When the literature is examined, attention is drawn to the importance of revealing the factors associated with Internet gaming disorder to combat Internet gaming disorder in young people. This research was carried out to reveal the Internet gaming disorder profiles of university students in Turkey and to determine the factors associated with it. In this direction, the structural relationships between cyberloafing, narcissism, locus of control, and social appearance anxiety variables, which are thought to be associated with Internet gaming disorder, were examined. The research data were obtained from 596 university students studying in various cities in Turkey. Research findings show that cyberloafing and locus of control directly affect Internet gaming disorder. Narcissism, on the other hand, has been shown to have a mediating effect on Internet gaming disorder through cyberloafing. It has been determined that Internet gaming disorder affects social appearance anxiety. Research results show that Internet gaming disorder can be reduced by improving internal locus of control and reducing cyberloafing behaviors and narcissism. The results of the research will provide tips to experts on interventions that can be made for students with Internet gaming disorder. In line with the findings obtained from the research, what can be done to combat Internet gaming disorder is discussed. © 2023 Wiley Periodicals LLC.

Relationships between vaccination, age, and mortality in the COVID-19 intensive care patients

Objectives: To investigate the effects of vaccination on age, mortality, and healthcare workers among patients followed in the COVID-19 Intensive Care Unit. Method(s): We examined age, gender, occupation, demographic characteristics, comorbid diseases, hemogram, biochemistry parameters, coagulation tests, morbidity-mortality characteristics of 548 patients in Bozyaka Training and Research Hospital COVID-19 intensive care unit admitted between March and October 2021. In addition, the vaccination status of the patients and the type of vaccination were recorded via the Ministry of Health Vaccine Tracking System (VTS). Within the vaccine follow-up system, patients who received at least 2 doses of vaccine 4 weeks prior to study were considered vaccinated. Result(s): The data of 548 patients in the COVID-19 intensive care unit between March 2021 and October 2021 were analyzed. The mortality rate was 50.7% (n = 278). It was determined that 428 (78.1%) of the patients followed in the COVID-19 intensive care unit were not vaccinated. In terms of age distribution, the number of patients under the age of 65 was 357 (65.1%), while the number of patients aged 65 and over was 191 (34.9%). When mortality rates were compared based on vaccination status, the mortality rate in the unvaccinated group was found to be statistically significantly higher than in the vaccinated group (p < 0.05). Mortality rate in the vaccinated group was 12.5% whereas it was 61.4% in the unvaccinated group. Conclusion(s): Vaccination to protect against SARS-CoV-2 infection reduces intensive care unit admission and reduces mortality rates. Being unvaccinated increases hospitalization and mortality in intensive care units in addition to carrying risks for all age groups. Copyright © 2022 by Prusa Medical Publishing.

PEDIATRIC OPIOID ANALGESIA SELF-INSTRUCTION SYSTEM (PEDOASIS): AN EFFECTIVE EDUCATION TOOL

Background: Many children with cancer, survivors of childhood cancer, and patients with sickle cell disease experience pain, yet receive inadequate pain management due to health care provider lack of knowledge and comfort. Pain management using opioids is a required competency for pediatric hematology/oncology (PHO) fellows, yet knowledge gaps persist. Objectives: Pediatric Opioid Analgesia Self-Instruction System (PedOASIS) is an interactive, case-based education tool for independent learning by post-graduate medical trainees which has undergone pilot testing and validity and reliability testing. The goal of this study was to evaluate its efficacy in increasing PHO fellows' knowledge and comfort with using opioids to manage pain. Design/Method: PHO fellows were recruited from 74 ACGMEaccredited US programs during the 2019-2020 academic year. Participants were randomized to receive access to PedOASIS (intervention) or usual PHO training (control). Participants completed surveys at enrollment, immediately after distribution of the tool, and 6 months later. Surveys assessed subjective comfort with prescribing opioids and objective knowledge, using a version of the questions from the tool. Results: At baseline, mean scores on the 10-question knowledge assessment did not significantly differ by level of training (first year: 5.05, second year 5.74, third/fourth year: 5.58;p = 0.410) or between groups (intervention: 5.38, control: 5.5;p = 0.795). Following intervention, mean score was significantly higher in the intervention group (8.91) vs. controls (5.38;p < .0001). Six months later, scores in both groups decreased but remained significantly higher in the intervention group (6.91) compared to baseline (p = 0.0002) and compared to controls (4.91, p < .0001). Fellows indicated comfort with selecting opioid and starting dose for an opioid-naive patient at baseline but less with rotating opioids. Intervention group reported significant increases in comfort dosing opioids after exposure to the tool (p = 0.022) and in rotating opioids (p = 0.054) following the intervention. Conclusion: Use of PedOASIS was associated with improvement in scores on validated knowledge questions and in comfort using opioids for pain management in PHO fellows exposed to the tool compared to fellows without the tool. These findings suggest that this is a valid, reliable, and effective curricular tool. The use of self-directed learning has been associated with increased knowledge gains when compared to traditional didactic methods. The asynchronous learning structure is useful in the setting of the ongoing SARS-CoV19 pandemic, which has necessitated significant alterations in medical education. Based on these results, we suggest that PedOASIS is an effective and relevant addition to the PHO fellowship curriculum.

WHAT BOTHERED PATIENTS WITH PARKINSON DISEASE DURING THE COVID-19 LOCKDOWN? AN ANALYSIS OF TELEPHONE RECORDS

Introduction: It has been suggested that patients with Parkinson's disease are more susceptible to the negative consequences of restrictions for Coronavirus pandemic regulations. We evaluated whether the lockdown caused a change in the subjective complaints of the Parkinson's disease patients. Material and Methods: Telephone records of the Parkinson's disease patients in the 2.5 months of the lockdown in 2020 were categorized and compared to the records of the same period of 2018 and 2019. Results: In total, 666 complaints/questions were categorized from 625 telephone calls of 391 patients. The percentage of motor-related complaints did not differ significantly across the years. In 2020, calls about administrative issues increased significantly compared to 2018 (OR= 3.7 95% CI:1.5-9.3;p= 0.004) and 2019 (OR= 2.1, 95% CI:1.0-4.5;p= 0.044). Moreover in 2020, the odds of calling due to behavioral/psychotic symptoms increased by at least 3 times compared to 2018 (OR=3.7, 95% CI:1.3-10.8 p= 0.014) and 2019 (OR=3.0, 95% CI:1.2-7.4 p= 0.018). Anxiety was also more frequent but only compared to 2019. Conclusions: The results highlight the necessity of taking urgent action to improve the organizational and psychosocial needs of Parkinson's disease patients in times of humanitarian crises.

Effect of pulsed corticosteroids and tocilizumab on hyperinflammation in COVID-19 patients with acute respiratory distress syndrome

Objective: To compare the efficacy of pulsed-dose corticosteroids (≥250 mg methylprednisolone, 3 days) and tocilizumab in treating COVID-19-related hyperinflammation. Methods: This prospective observational study included RT-PCR positive COVID-19 patients with acute respiratory distress syndrome, who were admitted to the COVID-19 Adult Intensive Care Unit of Prof Dr. Murat Dilmener Emergency Hospital (Istanbul, Turkey) between December 1, 2020 and February 28, 2021. Clinical, laboratory and radiological examinations were used to diagnose COVID-19 associated hyperinflammation. Three cohort groups were formed: the pulsed-dose corticosteroids group (250 mg methylprednisolone for 3 days), the tocilizumab group (8 mg/day single dose or 400 mg/day for 2 days), and the combined group (pulsed-dose corticosteroid+tocilizumab). The difference in mortality rates among the groups was compared primarily. The most common cause(s) of death was determined. Furthermore, adverse events (secondary infection, acute kidney injury, arrhythmia, gastrointestinal system bleeding) for 28 days were recorded. Results: A total of 60 patients were included in this study, with 20 patients in each group. There was no statistically significant difference between the 3 groups in mortality rates (55% in the pulsed corticosteroid group, 60% in the tocilizumab group, 50% in the combined group, χ 2 =0.404, P=0.817). Infectious causes were found to be the most common cause of mortality in all the three groups, and no difference was found between them (χ 2 =0.404, P=0.817). There was also no difference in the development of adverse events such as secondary infection, acute kidney injury, arrhythmia, and gastrointestinal bleeding among the groups (P>0.05). Conclusions: Corticosteroids can be used instead of tocilizumab to treat hyperinflammation in COVID-19 patients with acute respiratory distress syndrome.

The Systematic Effect of Mesenchymal Stem Cell Therapy in Critical COVID-19 Patients: A Prospective Double Controlled Trial.

The aim of this clinical trial was to control the cytokine storm by administering mesenchymal stem cells (MSCs) to critically-ill COVID-19 patients, to evaluate the healing effect, and to systematically investigate how the treatment works. Patients with moderate and critical COVID-19 clinical manifestations were separated as Group 1 (moderate cases, n = 10, treated conventionally), Group 2 (critical cases, n = 10, treated conventionally), and Group 3 (critical cases, n = 10, treated conventionally plus MSCs transplantation therapy of three consecutive doses on treatment days 0, 3, and 6, (as 3 × 106 cells/kg, intravenously). The treatment mechanism of action was investigated with evaluation markers of the cytokine storm, via biochemical parameters, levels of proinflammatory and anti-inflammatory cytokines, analyses of tissue regeneration via the levels of growth factors, apoptosis markers, chemokines, matrix metalloproteinases, and granzyme-B, and by the assessment of the immunomodulatory effects via total oxidant/antioxidant status markers and the levels of lymphocyte subsets. In the assessment of the overall mortality rates of all the cases, six patients in Group-2 and three patients in Group-3 died, and there was no loss in Group-1. Proinflammatory cytokines IFNγ, IL-6, IL-17A, IL-2, IL-12, anti-inflammatory cytokines IL-10, IL-13, IL-1ra, and growth factors TGF-ß, VEGF, KGF, and NGF levels were found to be significant in Group-3. When Group-2 and Group-3 were compared, serum ferritin, fibrinogen and CRP levels in Group-3 had significantly decreased. CD45 +, CD3 +, CD4 +, CD8 +, CD19 +, HLA-DR +, and CD16 + / CD56 + levels were evaluated. In the statistical comparison of the groups, significance was only determined in respect of neutrophils. The results demonstrated the positive systematic and cellular effects of MSCs application on critically ill COVID-19 patients in a versatile way. This effect plays an important role in curing and reducing mortality in critically ill patients.

Mesenchymal stem cells treatment in COVID-19 patient with multi-organ involvement.

The aim of this study is to evaluate the therapeutic effect of mesenchymal stem cells (MSCs) in a severe case of brain and multiple organ involvement in a patient with COVID-19. Here, a 51-year-old male patient with multi-organ involvement due to COVID-19 infection and developing cardiac arrest is presented. MSCs were transplanted to the patient four times systematically and once intrathecally. As a result, the application of MSCs has been found to have a healing effect on organs in this patient with severe COVID-19 infection. In addition, transplantation of MSCs both systematically and intrathecally is considered to be effective in the treatment of the central nervous system (Tab. 2, Fig. 2, Ref. 24). Keywords: mesenchymal stem cell, COVID-19, organ involvement.