EFFECTS OF HYDROXYCHLOROQUINE PLUS FAVIPIRAVIR TREATMENT ON THE CLINICAL COURSE AND BIOMARKERS IN HOSPITALIZED COVID-19 PATIENTS WITH PNEUMONIA.

Background: The novel coronavirus disease 2019 (COVID-19) has a broad spectrum of clinical manifestations, the most common serious clinical manifestation of the coronavirus infection being pneumonia. Unfortunately, the optimal treatment approach is still uncertain. However, many studies have been conducted on the effectiveness of several medications in the treatment of COVID-19 infection. The aim of this study was to evaluate the effectiveness of the hydroxychloroquine (HCQ) + favipiravir (FAV) treatment regimen and HCQ alone by comparing the patient's clinical response and laboratory results on the fifth day of treatment in patients hospitalized due to COVID-19 infection. Patients and methods: This retrospective cohort study was conducted in Malatya Training and Research Hospital between March 2020 and July 2020. The study included 69 patients with confirmed COVID-19 with pneumonia. The patients were divided into 2 groups, those receiving HCQ alone and those receiving the HCQ + FAV combination. Results: A total of 69 patients were included in the study, and the mean age was 60.09±15.56 years. A statistically significant decrease was observed in C-reactive protein (CRP) levels, at the end of the fifth day, in patients who received HCQ + FAV treatment (p=0.002), whereas there was no decrease in CRP levels in patients who received HCQ treatment alone. In addition, an increase in lymphocyte count and a better fever response was observed at the end of the fifth day in patients who received HCQ + FAV (p=0.008). However, there was no statistical difference between both treatment regimens in terms of hospital stay and treatment results (p=0.008, p=0.744, p=0.517). Conclusion: Although the combination of HCQ + FAV treatment was observed to be effective on CRP levels and fever response in patients with COVID-19 pneumonia, there was no difference in terms of hospital stay and discharge.

Altered cardiac autonomic function after recovery from COVID-19.

BACKGROUND: Autonomic dysfunction may occur during the acute phase of COVID-19. Heart rate variability (HRV) is a useful tool for the assessment of cardiac sympathetic and parasympathetic balance. We aimed to evaluate cardiac autonomic function by using HRV in subjects after recovery from COVID-19 who had previously symptomatic and were followed outpatiently. METHODS: The study group composed of 50 subjects with a confirmed history of COVID-19 and the control group composed of 50 healthy subjects without a history of COVID-19 and vaccination. All the study participants underwent 2-dimensional, pulsed- and tissue-Doppler echocardiographic examinations and 24-hour Holter monitoring for HRV analysis. RESULTS: Time domain parameters of SDNN, SDANN, SDNNi, RMSSD, pNN50, and HRV triangular index were all decreased in the study group when compared with the control group. Frequency domain parameters of TP, VLF, LF, HF, and HFnu were also decreased in the study group in comparison with the control group. LFnu was similar between groups. Nonlinear parameters of HRV including α1 and α2 decreased in the study group. By contrast, Lmax, Lmean, DET, REC, and Shannon entropy increased in the study population. Approximate and sample entropies also enhanced in the study group. CONCLUSIONS: The present study showed that all three domain HRV significantly altered in patients after recovery from COVID-19 indicating some degree of dysfunction in cardiac autonomic nervous system. HRV may be a useful tool for the detection of preclinical autonomic dysfunction in this group of patients.

Differential diagnosis of COVID-19 pneumonia from acute heart failure in pandemic: Importance of radiological and laboratory findings.

INTRODUCTION: COVID-19 pneumonia typically presents with high fever, cough, and shortness of breath and on thorax computed tomography (CT) peripheral ground glass opacities help the diagnosis. Although typical imaging findings for COVID-19 pneumonia are specified in thorax CT, these findings can be confused with other diseases. The aim of this study is to investigate the roles of radiological imaging and laboratory findings in the differential diagnosis of COVID-19 pneumonia and acute heart failure (AHF). MATERIALS AND METHODS: In the present study, 74 patients who admitted to the emergency department with respiratory distress during the pandemic period and received a diagnosis of COVID-19 pneumonia and AHF were included. Laboratory data and radiological findings of the patients, at the time of admission, were evaluated. RESULT: On admission, there was no difference in age, gender between two groups. However, COVID-19 exposure history was found significantly higher in COVID-19 pneumonia patients group (p<0.001). Fever, cough, and fatigue were found significantly higher in the COVID-19 pneumonia patients group (p<0.001). There was difference of lesions distribution between the two groups, centrally distributed lesions were found significantly higher in acute heart failure patients (p<0.001). Pleural effusion and cardiomegaly were found significantly higher in AHF patients (p<0.001, p<0.001). Counts of the white blood cells and lymphocytes were found significantly lower in COVID-19 pneumonia patients (p= 0.003, p= 0.009). COVID-19 pneumonia patients had significantly higher levels of CRP, ferritin, LDH and CK compared with AHF patients (p<0.001, p<0.001, p= 0.002, p= 0.013). However the level of NT-proBNP was found significantly higher in the AHF patients group (p<0.001). CONCLUSIONS: We believe that laboratory data and thorax CT findings can provide beneficial clinical information in differentiating COVID-19 pneumonia from AHF during the pandemic.

The Impact of COVID-19 on Conjunctival Flora.

Purpose: This study aims to evaluate the effect of coronavirus disease 2019 (COVID-19) on conjunctival flora in patients hospitalized with COVID-19.Methods: This prospective, controlled study was conducted between June 2020 and December 2020. The study group consisted of 45 confirmed COVID-19 patients and 43 control subjects. The collected samples were inoculated into the Thioglycollate broth media without delay. The samples with growth were then passed on eosin methylene blue agar, sabouraud dextrose agar, chocolate agar, and 5% sheep blood agar solid media.Results: The mean age of the COVID-19 patients was 64.24 ± 15.4 years, and the control subjects were 59.72 ± 11.4 years. The culture positivity of conjunctiva samples in COVID-19 patients (95.6%) was statistically significantly higher than control subjects (76.7%) (p = .024). Coagulase-negative staphylococcus and Staphylococcus aureus' positivity was significantly higher in COVID-19 patients than control subjects (p < .05).Conclusion: Patients with COVID-19 demonstrate significantly higher culture positivity on conjunctival flora than the control subjects.

Peripheral Blood Smear Findings of COVID-19 Patients Provide Information about the Severity of the Disease and the Duration of Hospital Stay.

BACKGROUND: Data about the morphological changes in peripheral blood smears during COVID-19 infection and their clinical severity association are limited. We aimed to examine the characteristics of the cells detected in the pathological rate and/or appearance and whether these findings are related to the clinical course by evaluating the peripheral blood smear at the time of diagnosis in COVID-19 patients. METHODS: Clinical features, laboratory data, peripheral blood smear of fifty patients diagnosed with COVID-19 by PCR was evaluated at diagnosis. Peripheral smear samples of the patients were compared with the age and sex-matched 30 healthy controls. Pictures were taken from the patient's peripheral blood smear. Patients were divided into two groups. Mild and severe stage patient groups were compared in terms of laboratory data and peripheral smear findings. The relationship between the laboratory values of all patients and the duration of hospitalization was analyzed. RESULTS: The number of segmented neutrophils and eosinophils were low, pseudo-Pelger-Huet, pseudo-Pelger-Huet/mature lymphocyte ratio, atypical lymphocytes, monocytes with vacuoles, bands, and pyknotic neutrophils rates were higher in the peripheral blood smear of the patient group (p <0.05). Increased pseudo-Pelger-Huet anomaly, pseudo-Pelger Huet/mature lymphocyte ratio, a decreased number of mature lymphocytes, and eosinophils in peripheral blood smear were observed in the severe stage patients (p <0.05). A negative correlation was observed between hospitalization duration and mature lymphocyte and monocytes with vacuoles rates (p <0.05). CONCLUSION: A peripheral blood smear is an inexpensive, easily performed, and rapid test. Increased Pseudo-Pelger-Huet anomaly/mature lymphocyte rate suggests a severe stage disease, while high initial mature lymphocyte and monocytes with vacuoles rates at the time of diagnosis may be an indicator of shortened duration of hospitalization.

[Two cases of tick-borne tularemia in Yozgat province, Turkey]. / Yozgat Ilinde Kene Kaynakli Iki Tularemi Olgusu.

Tularemia which has a worldwide distribution, is a zoonotic infection caused by Francisella tularensis. F.tularensis can infect a wide range of animals and can be transmitted to humans in a variety of ways, the most common being by the bite of an infected arthropod vector (usually tick) in the USA and Europe. The clinical presentations have been classically divided into ulceroglandular, glandular, oculoglandular, pharyngeal, respiratory, and typhoidal tularemia depending on the route of transmission. Arthropod-borne infection generally leads to the ulceroglandular form of tularemia. In Turkey, oropharyngeal form which is related to the consumption of contaminated water, is the most common presentation of tularemia. In this report, two cases of ulceroglandular tularemia which developed as a consequence of tick bite in Yozgat province have been presented. A 33-year-old female patient was admitted to the hospital with a tender lump on the right axilla. Empiric antibiotic treatment with amoxicillin clavulanate did not lead to an improvement in the painful axillary mass. She reported a tick bite on her right shoulder before development of fever, chills and regional tender lump. On physical examination, hyperemia was seen on the shoulder, with enlarged tender right axillary lymph node. The clinical diagnosis of suspected ulceroglandular tularemia was confirmed by the seroconversion (1/160 and 1/1280 titers in acute and convelescent sera, respectively) with microagglutination test (MAT) and F.tularensis DNA positivity in lymph node aspirate by polymerase chain reaction. The agent was identified as F.tularensis subsp. holarctica based on the results of amplification of target RD1 gene. Second case, a 18-year-old male, was admitted to our hospital with a-week history of sudden onset of fever, headache, generalized aches, vomiting, nause, and tender lump on the left axilla. On physical examination, an inflammatory eschar was seen on his scalp with enlarged cervical lymph node on left side. The tick, which has removed from the scalp lesion by the patient himself was identified as Dermacentor spp. The suspected diagnosis of ulceroglandular tularemia was confirmed by 1/2560 titer positivity obtained with MAT. Gentamicin (5 mg/kg/day, PO) was initiated for the treatment of both patients, however, LAP did persist in both of them requiring abscess drainage and prolonged treatment with gentamicin following a 14-day course of ciprofloxacin (1500 mg/day, PO). LAP decreased after medical treatment and repetitive drainage procedures. The patients recovered completely without sequela. These cases, to the best of our knowledge, who were the first confirmed tick-borne tularemia cases in our country, were presented to call attention to a different mode of transmission for F.tularensis.