The Relationship Between Functional Status and Fatigue After COVID-19 Infection

Introduction: After COVID-19 infection, symptoms last for weeks or months. In this study, it was aimed to examine the relationship between functional status and fatigue and the associated factors in patients with COVID-19. Method(s): Patients with COVID-19 infection who applied to 13 centers were included into the study according to the inclusion criteria. Age, gender, height, body weight, body mass index (BMI), marital status, smoking status and amount, presence, duration of chronic disease, Charlson comorbidity index, regular exercise habit, time of diagnosis with COVID-19, presence of hospitalization,length of hospital stay, intubation status, home oxygen therapy need, participation in PR program, presence of dyspnea, cough, sputum, mMRC score, post-COVID functional status scale, fatigue severity scale, EQ-5D-5L Questionnaire scores were recorded. Result(s): Of the 1095 patients, 603 (55%) were male and 492 (45%) were female. Their mean age was 50+/-14 years. The most common chronic lung disease was COPD (11%), while 266 patients (29%) had non-pulmonary systemic disease. The median time of COVID-19 diagonosis was 5 months ago with 47% hospitalization rate. The median value of post-COVID functional status scale was 1 (0:4), and fatigue severity scale score was 4.4 (1:7). There was a significant correlation between post-COVID functional status and fatigue severity scale (r=0.43, p <0.01). Conclusion(s): Functional status and fatigue were found to be related primarily to quality of life and then patients' age, BMI, presence of chronic and systemic lung disease, regular exercise habits before COVID-19, hospitalization and its duration, home oxygen therapy and symptoms.

Should Anticoagulant Drugs Be Advised in Every Future Pandemic Guideline?Ourcovid-19 Comparative Analysis

Background: Covid-19 is a viral disease that has been declared a pandemic by the World Health Organization.[ 1,2]. The most frequent complication has been reported to be sepsis[3]. Disseminated intravascular coagulation (DIC) has been observed in majority of mortalities.[4,5].While Disseminated Intravascular Coagulation is widely used to describe sepsis associated coagulopathy, ISTH has recently started using Sepsis Associated Coagulopathy in its definition. SIC is actually considered the early stage of DIC, and research has found that anticoagulant treatment is effective in patients meeting SIC criteria.[6,7]. Anticoagulant treatment has been shown to be beneficial in patients who do not exhibit clinical DIC, but meet SIC criteria. (Figure 1). Contemporary guidelines recommend anticoagulant treatment. Method(s): The patient groups, who were followed up with Covid-19 in Necmettin Erbakan University hospital, with and without anticoagulant treatment, will be analyzed retrospectively and comparative. Result(s): This study assessed the data of 2028 patients diagnosed with COVID-19 and subsequently given (Group1 (n=1008)) or not given (Group2 (n=1020)) anticoagulant treatment. The demographic characteristics displayed on the table exhibited similarities;D-dimer, SOFA and SIC scores demonstrated significant changes. (Table 1).Patients who developed DVT, arterial embolism and pulmonary embolism were included in the THROMBOSIS'' study. While group 1 had a thrombosis development rate of 5.15% (n=52), this rate was 19.21% (n=196) in group2.THROMBOSIS patients in group1 and 2 demonstrated a mortality rate of 38.46%(n=20) and 65.5% (n=128), respectively (p<0.001).THROMBOSIS patients in group1 and 2 were divided into subgroups according to SIC scores and their mortality rates were analyzed with respect to SICDIC scores;significant results were observed (SIC>5 was accepted as DIC).Patients who receive anticoagulant treatment subsequent to COVID-19 diagnosis have reduced disposition to thrombosis. According to SIC-DIC scores obtained through SOFA scores and clinical parameters, patients who reach DIC levels (SIC>5) have an increased rate of mortality. (Table 2).However, in group 2 patients who were diagnosed with COVID-19 and not given anticoagulant treatment due to no recommendation in prior guidelines, the mortality rate was high with every SIC score. Patients with a SIC score of 4 had a substantially high mortality rate;this is probably due to not receiving anticoagulants because DIC had not manifested.It was observed that compared to group 1, patients in group 2 who had not yet reached a DIC score, but had a SIC score of 4, had mortality rates reduced by 97% with anticoagulant treatment (p<0.001). According to SIC-DIC scores obtained through SOFA scores and clinical parameters, patients who reach DIC levels (SIC>5) have an increased rate of mortality (Tables 2 and 3). According to SIC-DIC scores obtained through SOFA scores and clinical parameters, patients who reach DIC Conclusion(s): Through our findings, we wanted to describe when COVID-19 patients who are hospitalized should receive anticoagulant treatment. Patients should be monitored with respect to their SIC scores, and clinicians should consider anticoagulant administration as it can potentially decrease mortality rate, regardless of DIC development.

The association of neutrophil/lymphocyte ratio, lymphocyte/monocyte ratio, platelet/lymphocyte ratio and hematological parameters with severity and prognosis in hospitalized patients with COVID-19

Objective: To investigate neutrophil/lymphocyte (NLR), lymphocyte/monocyte (LMR), platelet/lymphocyte (PLR) ratios, and the value of these parameters in determining disease severity and progression in hospitalized COVID19 patients. Materials and Methods: Study was conducted retrospectively with 182 in-patients and 91 controls due to COVID19 between April-September 2020 in the chest diseases clinic. Hematological parameters and rates were compared with controls' parameters. Correlations and differences between hematological parameters and other parameters were investigated.

Abnormal pupillary light reflex responses in post-COVID-19 patients

Purpose: Neurological manifestations involving the central, peripheral, and autonomic nervous system have been reported in the acute phase of coronavirus disease 2019 (COVID-19) and have been shown to persist in a proportion of patients after recovery. In this cross-sectional study, we assessed pupillary light reflex responses using dynamic pupillometry in patients after COVID-19. Methods: Thirty patients recovered from COVID-19 and 25 healthy control participants were studied using an infrared dynamic pupillometry system (MonPack One;Metrovision, France) to quantify pupillary responses to white light stimulation (light intensity 100 cd/m2, on/off time 200/3300 ms) (Figure 1). A questionnaire in accord with the long-COVID guideline developed by the National Institute for Health and Care Excellence (NICE) was used to identify persisting symptoms more than 4 weeks. Patients with diabetes mellitus or any other systemic disease that might cause autonomic dysfunction were excluded. Results: Post-COVID-19 patients and control participants were matched for age (P=0.179) and gender (P=0.522). The mean time after the diagnosis of COVID-19 was 3.6 ± 1.6 months. There was no significant difference in the initial pupil diameter, amplitude and velocity of pupil contraction, and latency, duration and velocity of pupil dilation, but the latency of pupil contraction was increased (P <0.001) and the duration of pupil contraction was reduced (P=0.029) in post-COVID-19 patients compared to healthy controls. Amongst patients with COVID-19, 16/30 (53%) had at least one persisting neurological symptom beyond 4 weeks after infection. Compared to controls, the latency of pupil contraction was increased in both subgroups of patients with (P=0.014) and without (P <0.001) persisting neurological symptoms. However, the duration of contraction was reduced only in the subgroup of subjects with neurological symptoms (P=0.025). NICE questionnaire score correlated with the duration of contraction (p=-0.366;P=0.030), the latency of dilation (p=-0.411;P=0.024), and the duration of dilation (p=0.381;P=0.038). Conclusions: Dynamic pupillometry demonstrates significant alterations in pupillary light responses in post-COVID-19 patients, particularly those with persisting neurological symptoms.

Comparison of Clinical and Laboratory Findings and Computed Tomography Findings of SARS-CoV-2 Infected Patients Followed-up in a Tertiary University Hospital

Introduction: The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection is a pandemic, a major global health concern. In this study, it was aimed to compare the clinical, laboratory and computed tomography (CT) findings of patients with SARS-CoV-2 infection followed up in our hospital. Materials and Methods: In this study, reverse transcriptase-polymerase chain reaction (RT-PCR) positive patients hospitalized between 01.03.2020-31.05.2020 were retrospectively analyzed. Computed tomography images of the patients were grouped as typical, indeterminate, atypical, and no pneumonia based on the Radiological Society of North America. After recording patient information on SPSS, clinical and laboratory findings of the patients were analyzed by comparing them to CT findings. Results: Among 237 RT-PCR positive patients, 104 (43.9%) were female and 133 (56.1%) were male. The mean age of the patients was 50.46 +/- 17.26 (18-92) years and the mean symptom onset time of the patients was 3.75 +/- 2.72 (median: 3) days. Eighty-seven of the patients (36.7%) had contact stories. Twenty-three (9.7%) patients were healthcare professionals. Of the patients, 49.8% had a comorbid disease. The most common referral complaint was cough with 66.7%. The most common treatment that patients received was hydroxychloroquine (96.2%). Anemia was detected in 61 (25.7%) patients, leukopenia in 104 (43.9%), lymphopenia in 25 (10.5%) and thrombocytopenia in 14 (5.9%). High rates were detected for C-reactive protein (CRP) in 221 (84%) patients, ferritin in 190 (80.2%) patients, D-dimer in 144 (60.8%) patients, fibrinogen in 147 (62%) patients and sedimentation (SED) in 172 (72.6%) patients. Headache was detected higher in patients with typical pneumonia findings in thorax CT (p=0.006). A statistically significant difference wasn't detected between other symptoms and CT findings. Leukocyte and neutrophil counts, SED, CRP, ferritin, D-dimer, fibrinogen, aspartate aminotransferase, and lactate dehydrogenase (p=0.001) levels were observed to be higher in patients with typical pneumonia findings on thorax CT. Conclusion: Some laboratory parameters, especially acute phase reactants, were found to be higher in patients with typical pneumonia on thorax CT compared to patients without pneumonia. In this viral infection, patients should be evaluated together with clinical, laboratory and CT findings.