Examining graphic drawing skills for a socioscientific problem situation: The SIR model Covid-19 example

The aim of the study is to examine the graphing skills of prospective elementary mathematics teachers for a socioscientific problem situation related to Covid-19. The research is a qualitative research and was carried out with the case study method.The participants consisted of 43 prospective elementary mathematics teachers studying in the third year of a state university in Turkey. Typical case sampling, one of the purposive sampling methods, was used to determine the participants. In the research, an open-ended question that requires drawing three graphs with vital aspects based on a socio-scientific situation-based scenario was used as a data collection tool. Data analysis consists of two stages. First, the graphs drawn by the prospective elementary mathematics teachers were scored with the descriptive analysis method.Then, the errors in the graphics drawn using the content analysis method were grouped and determined. When the data were analyzed, it was observed that a significant portion of prospective elementary mathematics teachers had deficiencies in their ability to draw graphs about the problem situation in the context of Covid-19. For this reason, when teaching graphics, drawing activities that require more context-based qualitative understanding or technology-assisted teaching applications can be used. © 2022 University of Helsinki. All rights reserved.

Effects of the Beach Chair Position on Respiratory Function in Covid-19 Patients

Introduction: Whether beach chair position can improve pulmonary compliance in mechanically ventilated subjects with Coronavirus disease 2019 (COVID-19) is unclear. This study aimed to investigate the impact of beach chair position on pulmonary compliance and oxygenation in mechanically ventilated patients with COVID-19. Material(s) and Method(s): Forty-four COVID-19 subjects admitted to intensive care unit (ICU) of our institute who receive invasive mechanical ventilation were enrolled in this observational study. Patients were initially placed in supine position. Following a couple of hours patients were then placed in beach-chair position (head of bed elevated to 30 degrees) at least 16 hours a day. Data from mechanical ventilator was recorded hourly in each position. Total compliance was defined as tidal volume (VT, milliliters) divided by the difference between plateau pressure (cm H2O) and positive end-expiratory pressure (PEEP, cm H2O) Blood gas analysis was performed bi-hourly. Mean values were taken for statistical analysis. The difference in lung compliance, airway resistance, and blood gas analysis between supine and beach chair position was the primary outcome measure of this study. Result(s): Positioning patients form supine to beach-chair led to a significant improvement in lung compliance (29.68+/-10.42 ml/cm H2O vs. 33.96+/-11.71 ml/cm H2O, p<0.001), reduction in airway resistance (17.51+/-8.44 H2O/L/sc vs. 16.73+/-8.06 H2O/L/sc, p<0.001) and led to a significant decline in plateau pressure (30.82+/-5.94 cm H2O vs. 29.98+/-5.68 cm H2O, p=0.001). Moreover a significant improvement in PaO2 was observed following positioning from supine to beach-chair (67.93+/-20.29 mm Hg vs. 87.83+/-27.33 mm Hg, p<0.001). Conclusion(s): Compared to supine position, beach chair positioning improves lung compliance and oxygenation in COVID-19 patients with acute respiratory distress syndrome (ARDS) who receive invasive mechanical ventilation. Copyright © 2022 A. CARBONE Editore. All rights reserved.

Utility of Bronchoalveolar Lavage (BAL) Cytology in SARS-CoV-2 Patients: A Review of Clinical and Cytologic Findings with Cost Analysis

Background: Bronchoalveolar lavage (BAL) cytology is a commonly used test in hospitalized patients with SARS-CoV-2 and its demand has dramatically increased in large medical centers. Currently, there are no standard guidelines for using BAL cytology in SARS-CoV-2. Findings such as lymphocytosis, giant cells, hyaline membranes, and intranuclear inclusions have been reported in BALs from patients with SARS-CoV-2 with varying frequencies. The aim of our study is to evaluate the frequency of these reported morphologic findings and to assess the utility and cost-effectiveness of BAL in the management of SARS-CoV-2 patients. Design: We performed a retrospective review of all BAL specimens from patients with positive SARS-CoV-2 nasopharyngeal PCR at our tertiary care medical center between March 2020 and February 2021. Chart review was performed for clinical findings and microbial culture data. BAL Papanicolaou stained thin prep, as well as special stains (PAS, Fite & GMS) on each case, were reviewed by a board-certified cytopathologist. Billing data was acquired from the laboratory manager. Results: A total of 37 patients were included ranging in age from 27-84 years (median: 58 years). Their clinical findings are summarized in Table 1. The majority of the BALs showed no specific findings that would help guide or alter the clinical management. 12 cases(33%) showed no significant cytologic findings, 16(43%) showed a relative increase in neutrophils, 7(19%) a relative increase in lymphocytes including one with markedly activated forms, and 4(11%) showed non-specific pneumocyte hyperplasia. PAS+ hyaline membranes, giant cells, intranuclear inclusions, and necrotic debris were each seen in 3% of cases. Special stains were negative for microorganisms in all cases. The cost of BAL thin prep and special stains (professional+techinal components) at our institution was $295 and $265, respectively. The total cost of BAL/patient was $1090 (295+265x3) and the overall cost for 37 patients was $40330. Conclusions: In the majority of the cases, BAL specimens from patients with SARS-CoV-2 showed non-specific findings such as a relative increase in neutrophils and lymphocytes, and pneumocyte hyperplasia. More specific morphologic findings such as intranuclear inclusions, PAS+ hyaline membranes, and activated lymphocytosis are only seen in rare instances. Overall, the use of BAL cytology in SARS-CoV-2 is time-consuming, not cost-effective, and does not help guide or alter patient management significantly.

COVID-19 Cases Admitted to Hospital for Other Reasons

Introduction: As the pandemic continues, SARS-CoV-2 infection has inevitably been detected in patients hospitalized for other reasons. Detection of SARS-CoV-2 infected cases after hospitalization may lead to delay in taking appropriate infection control measures. Materials and Methods: The present study retrospectively scanned all electronic and hard copy records of the cases presented to the hospital and hospitalized for other reasons and then diagnosed as COV1D-19 in Suleyman Demirel University Faculty of Medicine, Research and Training Hospital between 01 April 2020 and 31 December 2020. Results: Accordingly, 22 cases were decided as community-acquired, 3 cases as probable community-acquired, 5 cases as hospital-acquired, and 4 cases as probable hospital-acquired. The reason for sampling for SARS-CoV-2 was determined as having symptoms compatible with COVID-19 in 23 (67.6%) of 34 cases, preoperative screening of COVID-19 infection in 9 (26.5%), and high risky contact in 2 cases (5.9%). Considering contact histories epidemiologically, it was thought that transmission occurred to 8 healthcare staff from 2 cases, and to other patients or relatives from 8 cases, but sequence analysis could not be performed. Conclusion: The high number of hospitalized patients diagnosed as COVID-19 creates a significant burden on the healthcare system in terms of infrastructure and management capacity. It is recommended that patients and healthcare professionals be screened widely and thoroughly, especially in conditions where COVID-19 cases are detected in non-COVID-1 9 units. This kind of screening will allow the potential outbreak to be controlled.

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.

Investigation of the clinical course and severity of COVID-19 infection in immunocompromised patients

Introduction: Immunocompromised patients, SARS-CoV-2 infection might have a more severe course and may cause pneumonia quicker, compared to normal hosts. The presence of comorbid diseases increases this risk even further. In our study, we aimed to determine the clinical course and severity of COVID-19 in immunocompromised patients. Materials and method: Our study was carried out between 01 April 2020 and 01 October 2020 in 4 centers as a retrospective case-control study. Firstly, COVID-19 positive patients with previous immunosuppressive disorder diagnosis or patients who use immunosuppressive medicines for any reason were enrolled in the case group. COVID-19 rtRT-PCR positive patients who have no previous immunosuppressive disorder diagnosis and who are not on any immunosuppressive medicines were enrolled in the control group. Definitive statistical analysis was conducted for all of the researched variables. Results: 156 immunocompromised patients with COVID-19 diagnosis were enrolled in the case group of patients and 312 non-immunocompromised patients with COVID-19 diagnosis were enrolled in the control groups. In immunocompromised patients, CMI scores, the prevalence of hypertension, respiratory rate/minute, shortness of breath, and weakness were high and complaints about fever were low. In these patients, CRP, D-dimer, ferritin, and troponin values were high at statistically significant levels and lymphocyte values were low. The need for intensive care for immunocompromised patients was 2.93 times more and nosocomial infections and thrombotic complications occurred more frequently. Mortality was 3.57 times higher in immunocompromised patients. Conclusion: SARS-CoV-2 has a more severe course in immunocompromised patients. However, when evaluating these patients, whether or not the underlying diseases are under control should be evaluated and thrombotic complications and nosocomial infections should be taken into account. © 2021 A. CARBONE Editore. All rights reserved.

Severity and reversibility of smell-taste dysfunction in COVID-19 patients

Background: In SARS-COV-2 disease, anosmia and dysgeusia are symptoms that are usually detected together. In our study, it was aimed to investigate the impairments in the sense of smell and taste in our COVID-19 patients and to determine the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the parameters accompanying this impairment. Methods: The study was conducted retrospectively in patients with positive COVID-19 rtRT-PCR test, whose complaints of smell-taste dysfunction were questioned in 6 centers. Result: 8238 patients questioned for the impaired sense of smell and taste were included in our study. 1756 (21.3%) patients had smell-taste dysfunction. Smell dysfunction started 2.9±2.3 days after the onset of COVID-19 specific symptoms and continued for 9.4±2.7 days. There was a positive correlation between the disturbance of smell and taste and the complaints of fever, sore throat, myalgia, weakness, headache, and negative correlation the complaints of cough. 218 (12.4%) of the patients with smell-taste dysfunction stated that this complaint negatively affected their quality of life. Conclusion: Smell-taste dysfunction is more common, especially with the symptoms of upper respiratory tract infection of COVID-19, and has a positive correlation with fever, sore throat, myalgia, weakness, and headache, affects the quality of life of patients and improves in about 10-14 days. © 2021 A. CARBONE Editore. All rights reserved.

A Comparative analysis of the health care financing models in the context of financing sources and health coverage: Covid-19 experience

The primary aim of this study is comparing health financing models in the context of coverage and financing during the pandemic. Because the financing of the healthcare services and population coverage for healthcare services are the main factors affecting the performance of the entire health system including the provision and accessibility of basic health services. Especially between-country differences in the process of combating the pandemic point out the necessity of comparing countries' health systems according to the financing model they adopted. In this regard this study compares three basic models-the Bismarck model, the Beveridge model and the Private Health Insurance model-by using country-specific data such as population coverage for healthcare services, share of the public and out-of-pocket payments in the health expenditures, the measures on financing of the healthcare services and health coverage during the pandemic. © Peter Lang GmbH Internationaler Verlag der Wissenschaften Berlin 2021 All rights reserved.

An investigation of the geometric thinking levels of middle school mathematics preservice teachers according to solo taxonomy: "Social distance problems"

The aim of this study is to examine the geometric thinking levels of middle school mathematics preservice teachers regarding the problem situations regarding the concept of social distance according to the SOLO taxonomy. The research was conducted using the special case method, one of the qualitative research methods. The working group, studying at a state university in Turkey in middle school mathematics teaching department consists of 80 preservice teachers. While determining the participants, purposeful sampling method was used because the preservice teachers who took "Basics of Mathematics II" and "Special Teaching Methods II" courses were selected. In the study, semi-structured interviews were conducted with 15 preservice teachers since it was aimed to examine remarkable situations from the answers given to open-ended questions. Descriptive analysis technique was used while analyzing the data. Most of the answers given in the study were found to be below the relational geometric thinking level. As a result, it was determined that most of the answers given reflected quantitative learning. In line with this result obtained in the study, it is suggested that open-ended questions about life should be included frequently in teaching in order to reach the relational and extended abstract level answers that reflect qualitative learning. © 2021, Ozgen Korkmaz. All rights reserved.

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.

COVID-19: is it Airborne?

Mask, social distancing, and hygiene are followed as primary precautions in order to be protected from the SARS-CoV-2 infection. At the beginning of the pandemic, the virus was considered to be transmitted by droplets and aerosols during medical procedures generating aerosolization. However, case clusters published later on proved that the virus was also transmitted by aerosols in indoors and in settings with bad ventilation. This study aimed to discuss the experimental and epidemiological data supporting aerosol transmission of SARS-CoV-2.

Effectiveness of favipiravir prior to admission to the intensive care unit in COVID-19 pneumonia

After emerging in Wuhan city in December 2019, the coronavirus disease 2019 (COVID-19) rapidly spread throughout China. Although high rates of hospitalization are seen with COVID-19, no specific treatment has been reported, and the choice of antiviral therapies is limited. Favipiravir, approved in Japan for influenza, is one of the drugs that targets RNA-dependent RNA polymerase (RdRP). It significantly decreases the duration of fever, cough dyspnea, and the need of oxygen therapy or noninvasive mechanical ventilation, especially in moderate COVID-19 cases. In the current paper we presented four cases with worsening clinical conditions and the development of hypoxia who were treated with Favipiravir before being admitted to the intensive care unit, and who recovered from the disease.

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.