EVALUATION OF THE EFFECT OF THE COVID-19 PANDEMIC ON THE TREATMENT OF RADIATION ONCOLOGY PATIENTS

Background: Patients undergoing cancer treatment and people with a history of cancer constitute a high-risk patient group in the COVID-19 pandemic. In this study, we aimed to evaluate the life effect of the COVID-19 pandemic on the treatment processes of cancer patients receiving radiotherapy at our hospital's Radiation Oncology Clinic. Methods: Sociodemographic data, COVID-19 pandemic awareness, vaccination and disease transmission of the Radiation Oncology Clinic's patients were administered with a written questionnaire that includes the effects of the pandemic on the treatment between 1st and 30th June of 2021. Results: 7 (13.2%) of the patients had COVID-19 infection during the treatment processes, the in-home index was 4 (57%) due to contact with the case (p<0.001). 4 of the patients (7.5%) stated that they had experienced disruptions in their treatment processes caused by the health institution and 4 of the patients (7.5%) stated that they had experienced disruptions in their treatment processes caused by personal anxiety and anxiety during the pandemic process. 8 patients (15%) stated that they had concerns that they would receive incomplete treatment due to the pandemic process, while one patient (1.9%) stated that they had received psychological support and psychiatric medication due to this anxiety and fear. 9 patients (17%) stated that the covid-19 pandemic had a negative effect on oncological disease treatment processes. Conclusion: It is important that the treatment and follow-up of cancer patients, who are a at-risk group for COVID-19 infection, should continue without interruption, accompanied by up-to-date national and international guidelines.

EVALUATION OF THE EFFECTS OF MRNA AND INACTIVE COVID VACCINE APPLICATIONS ON THE CLINICAL COURSE OF COVID 19 PATIENTS

Objective: As of December 2021, two types of vaccines are applied in our country: inactive Coronavac and BNT162b2 mRNA vaccine. In this study, it was aimed to compare the rates of Covid-19 disease infection, pneumonia development rates and hospitalization requirement of individuals vaccinated with different vaccines. Materials and methods: Individuals at least one dose vaccinated with Coronavac inactive or mRNA active were compared for the evaluation of oxygen saturation values, SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR) results for the development of pneumonia, and hospitalization. Results: 71 individuals vaccinated with mRNA vaccine and 145 individuals vaccinated with inactive Coronavac vaccine, a total of 216 individuals were evaluated. There was no significant difference between the two groups in terms of the presence of fever complaints and Sars-CoV-2 Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) positivity rates. 5.6% (n=4) of the individuals vaccinated with the mRNA vaccine had pneumonic infiltration on non-contrast computed tomography (CT) images of the thorax, while 2.8% (n=2) required hospitalization. 17.9% (n=4) of the individuals vaccinated with inactive Coronavac vaccine had pneumonic infiltration on non-contrast thoracic CT images, while 11.7% (n=17) had hospitalization requirement. Conclusion: There are currently no studies in the literature comparing the effectiveness of an inactive vaccine and an mRNA vaccine. In our study, we concluded that even if people vaccinated with the mRNA vaccine were infected with Sars-CoV-2, the pneumonic involvement and hospitalization requirements for thoracic CT were lower compared to those without the vaccine and those vaccinated with the inactive Coronavac vaccine.

The effect of risk factors on the clinical course and treatment of older patients with coronavirus disease 2019

Introduction: Coronavirus disease 2019 (COVID-19) is known to have higher morbidity and mortality rates, parallel to the increased risk factors in the elderly. We aimed to define the risk factors related to mortality and morbidity in older patients hospitalized with COVID-19 disease in this study. Materials and Methods: This retrospective cross-sectional study included patients aged ≥65 years who were hospitalized with a confirmed diagnosis of COVID-19. We analyzed their demographic data, clinical findings, comorbidities, laboratory and radiologic findings, treatment protocols, and outcomes. Results: A total of 58 patients were included in the study. A total of eight (13.8%) patients died during the clinical follow-up and treatment, and 50 (86.2%) patients were discharged. The most common comorbidities among all patients were hypertension (HT) (69%) and diabetes mellitus (39.7%). The most common symptoms include fever (51.7%), cough (44.8%), and dyspnea (43.1%), and the most common neurologic findings were headache (27.6%) and impaired consciousness (27.6%). Intensive care unit admission was significantly higher among patients with comorbidities of HT, cerebrovascular disease, atrial fibrillation (AF), and chronic obstructive pulmonary disease. The rate of death was significantly higher in patients with a history of smoking, cerebrovascular disease, AF, and HT. Although there was a statistically significant positive correlation between the death rate and leukocyte, neutrophil, C-reactive protein, lactate dehydrogenase, D-dimer, interleukin-6, and procalcitonin levels, a negative correlation was observed in lymphocyte levels. Conclusion: Age-related comorbid conditions, especially HT, cerebrovascular disease, and AF, caused increased morbidity and mortality rates in older patients with COVID-19.

Gastrointestinal Symptoms in Patients with COVID-19: A Single-Center Experience

Objective: Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus, the first cases of which were reported in Wuhan, China in December 2019. The disease often presents with major respiratory symptoms. In addition, gastrointestinal (GI) symptoms are observed. They may be the first or even the only symptoms of the disease. The aim of this study is to demonstrate the presentation of GI symptoms and their relationship to other symptoms, the clinical course and prognosis of patients with COVID-19. Methods: Included in this study were patients over 18 years of age who had been hospitalised for treatment in clinics and intensive care units due to COVID-19 between March and June 2020. The symptoms reported by the patients at the time of admission and the data collected as a result of the clinical follow-up were evaluated. Results: Out of the 1,045 patients with COVID-19, 140 patients (13.4%) had GI symptoms. The complaints of these 140 patients were nausea (53.6%), vomiting (32.1%), abdominal pain (11.4%), diarrhea (45.7%), anorexia (43.6%) and loss of taste (5.6%). In 3.2% of the patients, only GI symptoms were present, without any respiratory symptoms. Conclusion: Gastrointestinal symptoms were present at the time of admission in 13.4% of the patients with COVID-19. The most common GI symptom in the patients was nausea. Length of stay in hospital and mortality rate were higher in patients with only GI symptoms. Therefore, GI symptoms should be considered in patients with suspected COVID-19.

Effects of high dose vitamin C administration in COVID-19 patients

Aim: There is currently no pharmacotherapy with for the treatment of COVID-19. We aimed to investigate the effects of early and high-dose vitamin C (VC) therapy in hospitalized patients with COVID-19. Materials and Methods: We included patients (n=139) who received high-dose VC supplement to the standard treatment protocol into group 1 (n=58), and only those who received a standard treatment protocol into group 2 (n=81). The patients' requirement for supplemental oxygen therapy, requirement for intensive care treatment and survival rates was investigated retrospectively. Furthermore, the changes in white blood cell, C-reactive protein (CRP), procalcitonin, D-Dimer, renal function tests, ferritin, and interleukin 6 values during hospitalization were evaluated.

A Tertiary Care Hospital Experience During the COVID-19 Pandemic

Introduction: Early detection of the severity of COVID-19 disease is important for patient prognosis and effective use of hospital capac- ity. Early detection of critical patients and providing supportive treatment is the main goal of disease management. In this study, we evaluated demographic, clinical, laboratory and radiological findings in COVID-19 patients and aimed to find risk factors associated with poor prognosis. Materials and Methods: A total of 579 cases hospitalized with the diagnosis of COVID-19 were evaluated retrospectively. The diagnosis of COVID-19 was confirmed by polymerase chain reaction (PCR) positivity or typical clinical, laboratory and radiological findings. The study population was divided into groups according to the World Health Organization (WHO) COVID-19 disease severity classification. Significant risk factors associated with severe disease and mortality were investigated by comparing the demographic, clinical, labora- tory and radiological data of these groups. Results: Mean age of the 579 cases was 54 +/- 18.25, and 321 of them (55.4%) were male. Severe disease was detected in 131 (22.6%) patients and mortality rate was %8.29. The most common comorbidities were hypertension (31.8%), diabetes mellitus (18.5%) and coronary artery disease (17.8%), respectively. The most common symptoms at the time of admission to the hospital were cough (40.7%), fever (38 degrees C;33.6%) and shortness of breath (26.3%). Age, coronary artery disease and shortness of breath, neutrophil count, urea, CRP, ferritin, Pro-BNP, fibronogen, IL-6 values were found to be predictive variables for severe disease. Age, presence of shortness of breath, urea, ferritin and Pro-BNP values were found to be independent predictive variables for severe disease, and the cut-off points were calculated for these variables (age 59.5, urea 33.5 mg/dL, ferritin 50.8 mu g/L and Pro-BNP 881 pg/mL). Conclusion: Some predictive factors were demonstrated to detect severe disease in COVID-19 patients. It is important to predict poor prognosis based on these factors. It provides early detection of critical patients and it will be a guide for reducing mortality rates in these patients with effective treatment.

Comparison of textbook versus 3d animation versus cadaveric training video in teaching laparoscopic rectal surgery: A prospective randomized clinical trial from tertiary care center

Purpose/Background: Digital 3D animation and cadaveric videos have been increasingly used in surgical education and provide tremendous opportunity to develop new surgical educational tools, particularly during this Coronavirus-19 pandemic period. This prospective, randomized, blinded study is designed to compare the educational effectiveness of various educational tools including a surgical textbook, animation, and cadaveric videos in laparoscopic rectal surgery. Methods/Interventions: Initially, an electronic questionnaire assessing the knowledge about laparoscopic rectal surgery was created and validated. Exploratory and confirmatory factor analysis were utilized to test the structure validity of the questionnaire. After the questionnaire was sent to the graduates completing the general surgery residency program in Turkey, the volunteers were then randomized into four groups based on the study material including a textbook, 3D animation, cadaveric video, and both 3D animation + cadaveric video. Demographics, colorectal cancer surgery case volume, and pre-educational scores among the randomized groups were comparable. A step-by-step educational 3D animation and cadaveric video were prepared in order to teach the technical steps of laparoscopic rectal surgery. Volunteers in four groups were given 2 weeks to review their educational material. After the 2-weeks of the study period, the volunteers were asked to answers the same electronic questionnaire imported in the edited live laparoscopic rectal surgery. Pre- and post-educational assessment of the questionnaire among the groups were performed and compared. Results/Outcome(s): A total of 168 volunteers completed the preeducational questionnaire and were randomized into four groups. Preeducational assessment scores were similar among the groups (p>0.05). Of 168 volunteers, 130 (77.3%) responded to the post-educational questionnaire after completing the two-weeks of education. Post-educational assessment scores are significantly higher in the 3D animation - cadaveric video group (p< 0.01), animation group (p< 0.01) and cadaveric group (p<0.01) compared to the textbook group. Moreover, Post-educational assessment scores are significantly highest in the 3D animation - cadaveric video group and also higher than the animation group(p<0.01). Each groups' post-educational scores were significantly higher compared to the pre-educational scores except for the textbook group(Figure). Conclusions/Discussion: Our prospective, randomized, blinded study demonstrates that 3D animation- cadaveric group, animation group, and cadaveric video group are superior to a surgical textbook in teaching laparoscopic rectal cancer surgery. The employment implementation of 3D animation and cadaveric video components leads to effective training and can theoretically facilitate the learning process.

Comparison of base excess approach versus stewart’s physicochemical method for the evaluation of metabolic acid-base disturbances in critically ill patients infected with SARS-CoV-2

Objective: Complex metabolic acid-base disturbances can be seen in critically ill patients infected with the SARS-CoV-2 virus. For arterial blood gas (ABG) analysis, base excess (BE) approach enables limited evaluation of the etiological factors. The Stewart’s physicochemical approach, on the other hand, may not reveal etiological agents adequately. In this study, we aimed to compare BE approach versus physicochemical method for the evaluation of metabolic acid-base disturbances in critically ill patients infected with SARS-CoV-2. Method: Between March 2020 and May 2020, ABG analysis results of a total of 113 patients (71 males, 42 females) infected with SARS-CoV-2 and hospitalized in the adult intensive care units were retrospectively analyzed. The patients were divided into groups according to the BE approach and evaluated for physicochemical components. The ABG and some electrolyte values were compared among groups. Results: The most common acidotic components according to the Stewart’s method were hyperphosphatemia (84.9%), but low strong ion difference (SID) acidosis (62.2%) in patients with metabolic acidosis according to the BE approach. Low SID acidosis (50%) and hyperphosphatemia (30.9%) in patients with normal BE and hyperphosphatemia (77.7%) in patients with metabolic alkalosis according to the BE approach were observed. In patients with metabolic acidosis according to BE approach, 71.6% of the patients had hypoalbuminemia and 24.5% of the cases had high SID alkalosis among the Stewart’s alkalosis components. Strong ion gap (SIG) acidosis was seen in 11.1% and low SID acidosis was seen in 11.1% in patients with metabolic acidosis according to the BE approach. Conclusion: Physiochemical approach seems to provide additional information regarding the etiological factors and unravel the invisible part of the iceberg for the evaluation of metabolic acid-base disturbances in critically ill patients infected with the SARS-CoV-2 virus.

The effect of hydroxychloroquine and azithromycin on the QTc interval in patients with Covid-19

Background and Aim: The exact treatment method of Covid-19 has not been found so far. However, some small-scale studies have shown the potential benefit of hydroxychloroquine/chloroquine (hydroxychloroquine treatment in our country) and azithromycin in Covid-19 treatment. It is known that these drugs (alone or combined use) may increase the risk of malignant arrhythmia such as torsades de pointes (polymorphic ventricular tachycardia) with prolonged QT interval. There is no data showing the effect of Favipiravir on cardiac arrhythmia. In this study, we aimed to investigate the effect of hydroxychloroquine and azithromycin on the QTc interval in patient with Covid-19. Methods: Patients who hospitalized in our center between March and May 2020 for Covid-19 and treated with recommendations of Republic of Turkey Ministry of Health SARS-CoV-2 guide included in our study. The data of 142 consecutive patients who received hydroxychloroquine and/or azithromycin treatment were retrospectively analyzed and the QTc interval in ECG was calculated with the Bazzet formula. Patients who were already using hydroxychloroquine (i.e. because of autoimmune disease etc), hypersensitivity to hydroxychloroquine and/or azithromycin and patients who use drugs other than hydroxychloroquine and/or azithromycin that can prolong the QT interval were excluded. Patients with baseline QTc 500 milliseconds (msec) or longer were also excluded from the study. According to the protocol, ECG was performed all patients before treatment, and ECG controls were performed on the 1st, 3rd and 5th days of the treatment. Results: The mean age of the study population was 46.9±17.3. A total of 142 patients (50.7% male and 49.3% female), received hydroxychloroquine therapy, 36 patients (25%) received hydroxychloroquine monotherapy, while 106 patients (75%) received hydroxychloroquine and azithromycin combination therapy (Table 1). Majority of the patients were in sinus rhythm (%95,1) with mean baseline heart rate of 81.9±14.7 beats per minute. Mean baseline QTc values of 142 patients were 417.3±24 msec, ranging between 356-486 msec. There were no significant differences between the baseline, 1st, 3rd and 5th day's QTc values of two groups. (p>0.05). When each groups were evaluated for QTc prolongation during the therapy period, it was observed that the baseline QTc interval was significantly prolonged with treatment in both the hydroxychloroquine group and the hydroxychloroquine + azithromycin group (Table 2) (p<0.05). There were no patients required discontinuation of these medications, no malign arrhythmia and no arrhythmogenic deaths due to QTc prolongation (Table 3). Conclusions: Although treatment-related QTc prolongation is observed in our study population, no malignant arrhythmia was observed. Close monitoring of the treatment process by cardiologist and the predetermination of patients with long onset QTc distances are considered to be the most important factor in the safe management of the treatment.

How did covid-19 pandemic affect the older patients? Comparison of clinical features in older versus younger patients

Íntroduction: COVID-19 infection may be atypically presented in the older adults with a poor prognosis. In this study, we aimed to investigate the clinical and laboratory differences of COVID-19 course in older patients. Materials and Method: The demographic, clinical, laboratory and radiological data of the patients hospitalized with COVID-19 infection were compiled retrospectively. A randomized control group was created from younger patients. Chest tomography of the patients were examined and scored. Results: Data of 100 older and 127 younger patients with COVID-19 infection, and 80 non-COVID older patients were evaluated retrospectively. While the mean CRP, fibrinogen, procalcitonin, urea, LDH, INR, PT, Troponin-I, CK-MB and total radiological lung score were significantly higher in older patients;the mean hemoglobin, hematocrit and d-dimer were significantly higher in younger patients. Lymphopeniawasmore common and themortality ratewas higher in the older adults. Lymphopenia, presence of comorbidity, being over the age of 75, and radiological lung involvement were identified as mortality risk factors in older patients. The cut-off values for mortality were as follows;age≥77 years, lymphocyte#≤ 700x103 cells/µL, CRP≥108.71 mg/L, d-dimer≥2.25 mg/L, fibrinogen≥383 mg/L, INR≥1.05, PT ≥12.5 seconds, aPTT≥31 seconds, Troponin-I≥19.1 pg/mL, total lung score≥6 points. COVID-19 did not increase mortality much more than other hospital-requiring clinical events in older adults (17% vs 26.25%). Conclusion: The older adults require special attention in COVID-19 pandemic. Those with comorbidities, lymphopenia, high d-dimer levels, and extensive lung involvement in the initial tomography should be followed-up closely.

A new COVID-19 prediction scoring model for in-hospital mortality: experiences from Turkey, single center retrospective cohort analysis.

OBJECTIVE: Although many studies reported prognostic factors proceeding to severity of COVID-19 patients, in none of the article a prediction scoring model has been proposed. In this article a new prediction tool is presented in combination of Turkish experience during pandemic. MATERIALS AND METHODS: Laboratory and clinical data of 397 over 798 confirmed COVID-19 patients from Gülhane Training and Research Hospital electronic medical record system were included into this retrospective cohort study between the dates of 23 March to 18 May 2020. Patient demographics, peripheral venous blood parameters, symptoms at admission, in hospital mortality data were collected. Non-survivor and survivor patients were compared to find out a prediction scoring model for mortality. RESULTS: There was 34 [8.56% (95% CI:0.06-0.11)] mortality during study period. Mean age of patients was 57.1±16.7 years. Older age, comorbid diseases, symptoms, such as fever, dyspnea, fatigue and gastrointestinal and WBC, neutrophil, lymphocyte count, C-reactive protein, neutrophil-to-lymphocyte ratio of patients in non-survivors were significantly higher. Univariate analysis demonstrated that OR for prognostic nutritional index (PNI) tertile 1 was 18.57 (95% CI: 4.39-78.65, p<0.05) compared to tertile 2. Performance statistics of prediction scoring method showed 98% positive predictive value for criteria 1. CONCLUSIONS: It is crucial to constitute prognostic clinical and laboratory parameters for faster delineation of patients who are prone to worse prognosis. Suggested prediction scoring method may guide healthcare professional to discriminate severe COVID-19 patients and provide prompt intensive therapies which is highly important due to rapid progression leading to mortality.

Normal chest ct prevalence in coronavirus disease 2019 (covid-19) patients: A report of 791 cases

Introduction: In this study, we aimed to better understand the role of chest CT as an initial workup tool among all COVID-19 patients admitted to a tertiary hospital. Materials and Methods: We retrospectively evaluated the data of patients that were suspected for COVID-19. All patients who had both noncontrast chest CT scan with RT-PCR test results included in the study. Symptomatic patients were divided into four groups according to time between the onset of symptoms and chest CT;4 days, 5-8 days, 9-13 days, and 14 days. Chest CT findings according to symptom status, duration, and RT-PCR positivity were evaluated. Results: Data for a total of 791 patients were evaluated. The mean patient age was 51.7 19.7 years. 459 (58%) patients were male, and 332 (42%) were female. 55.1% of patients had positive and 44.9% negative RT-PCR tests. Typical, indeterminate, atypical and negative chest CT findings were seen in 241 (30.5%), 131 (16.6%), 154 (19.5%), and 265 (33.5%) patients, respectively. Among 355 patients with negative RT-PCR results, 152 (42.8%) had typical or indeterminate chest CT findings. Asymptomatic patients had a 91.9% of RT-PCR positivity. Only 123 (61.5%) patients had typical or indeterminate CT findings among symptomatic and RT-PCR positive cohort. Conclusion: The greatest value of our study is in demonstrating the value of chest CT in both patients that had symptoms but had negative RT-PCR test results and insignificance of chest CT in asymptomatic but had suspected contact with COVID-19 patients.