Evaluation of Clinical Laboratory Findings with Computed Tomography Segmentation-Volume Analysis Results in COVID-19 Patients

Objective: COVID-19 is a disease caused by SARS-COV-2 and early diagnosis and classification of the COVID-19 are critical for the better prognosis. This study aimed to combine laboratory data of COVID-19 patients with Computed Tomography Segmentation-Volume Analysis (CT-SVA). Thus, we hope to contribute to the early diagnosis and classification of the disease. Methods: Patients were divided into two groups according to disease severity as mild/moderate (n=41) and severe/critical (n=42). Some laboratory parameters were recorded and evaluated together with CT-SVA. Results: The results of the study have shown that sodium, C-reactive protein, D-dimer, ferritin, fibrinogen, interleukin 6, procalcitonin, white blood cells, neutrophil, neutrophil-lymphocyte ratio values were significantly higher at first admission in the severe/critical diseased group (p<0.05), while albumin, lymphocyte, and venous blood pH values were significantly lower (p<0.05). CT-SVA results have shown negative correlation with albumin, while having a positive correlation with C-reactive protein, D-dimer, ferritin, fibrinogen, interleukin 6 and procalcitonin. The results of the performed Receiver Operating Characteristics analysis revealed that CT-SVA has a cut-off value of 15.92 with a sensitivity of 87.1% and a specificity of 80.0% in predicting disease severity. Binary logistic regression model has included CT-SVA, D-dimer, ferritin, interleukin 6, and neutrophil-lymphocyte ratio. The model correctly classified 88.1% of cases. CT-SVA, D-dimer, ferritin, interleukin 6, and neutrophil-lymphocyte ratio were detected to be the independent predictors of disease severity. Conclusion: Evaluation of laboratory parameters together with CT-SVA results will help identification of cases with a poor prognosis and accelerate intervention.

The effect of COVID-19 on tourists' attitudes and travel intentions: an empirical study on camping/glamping tourism in Turkey during COVID-19

Purpose - In this study, visitors' attitudes and behavioural intentions towards camping/glamping tourism in Turkey during the pandemic were investigated using the extended theory of planned behaviour (TPB). The model has been extended to include constructs such as risk perception and risk aversion attitudes that stem from COVID-19 to predict visitors' attitudes and behavioural intentions. Design/methodology/approach - The data were collected through an online questionnaire from 432 participants who have experience and interest in camping/glamping tourism in Turkey. The responses were analysed using the structural equation modelling (SEM). Findings - The findings show that besides the basic TPB structures, other added variables also significantly affect visitors' attitudes and intentions. Moreover, it has been observed that the risk perception and risk aversion attitude derived from COVID-19 increase negative emotions in visitors and decreased behavioural intentions. Research limitations/implications - The results of the study are discussed for future research as well as its academic and practical implications. Originality/value - This theoretical expansion is thought to increase the theory's predictive power in predicting visitors' behaviour during the pandemic.

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.

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 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.

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.