An Important Clinical Condition in Differential Diagnosis of Coronavirus Disease 2019: Crack Lung.

Crack cocaine has been associated with a variety of pulmonary manifestations. We report a 44-year-old man been diagnosed with severe acute respiratory syndrome coronavirus 2 infection, presenting shortness of breath, non-productive cough, chest pain, headache, dizziness, and fever lasting for 2 days. At first, all findings of our patient called for an impression of coronavirus disease 2019. During admission, he presented with acute respiratory symptoms, patchy ground-glass opacities, and laboratory abnormalities, such as elevated acute phase response and lymphopenia. After, the presence of transient lung infiltrations in the follow-up triggered the cause for a re-evaluation of the diagnosis of coronavirus disease 2019. After a detailed inquiry, it was revealed that he had had a history of intense inhaled cocaine use 2 days before hospitalization. We speculate that the crack lung should also be considered in the differential diagnosis in patients with suspected coronavirus disease 2019 pneumonia.

Management of Polydrug-Resistant Tuberculosis.

Background and Objectives: There is a lack of information regarding the effective duration of treatment necessary to prevent the development of acquired resistance when fluoroquinolones (FQ), and/or pyrazinamide (Z) resistance has occurred in patients with polydrug-resistant tuberculosis and isoniazid resistance. The management of these kinds of patients should be carried out in experienced centers according to drug susceptibility test results, clinical status of the patient and the extensity of the disease. Materials and Methods: We evaluated treatment regimens, treatment outcomes, and drug adverse effects in seven patients with polydrug-resistant tuberculosis, including those with Z and/or FQ resistance in a retrospective analysis Results: Regarding the patients with polydrug-resistant tuberculosis in addition to isoniazid (H) resistance, three had Z, two had FQ, and the remaining two had both Z and FQ resistance. In the intensive phase of the treatment, the patients were given at least four drugs according to drug susceptibility tests, and at least three drugs in the continuation phase. The duration of treatment was 9-12 months. Two of the patients were foreign nationals, and could not be followed up with due to returning to their home countries. Regarding the remaining five patients, three of them were terminated as they completed treatment, and two as cured. No recurrence was observed in the first year of the treatment. The most common, and serious drug side effect was seen for amikacin. Conclusions: In patients with polydrug-resistant TB, if Z and/or FQ resistance is detected in addition to H resistance, the treatment of these patients should be conducted on a case-by-case basis, taking into account the patient's resistance pattern, clinical condition, and disease prognosis. Close monitoring of the side effects will increase the success rate of the treatment.

Comparison of Pneumonia Severity Indices, qCSI, 4C-Mortality Score and qSOFA in Predicting Mortality in Hospitalized Patients with COVID-19 Pneumonia.

This is a retrospective and observational study on 1511 patients with SARS-CoV-2, who were diagnosed with COVID-19 by real-time PCR testing and hospitalized due to COVID-19 pneumonia. 1511 patients, 879 male (58.17%) and 632 female (41.83%) with a mean age of 60.1 ± 14.7 were included in the study. Survivors and non-survivors groups were statistically compared with respect to survival, discharge, ICU admission and in-hospital death. Although gender was not statistically significant different between two groups, 80 (60.15%) of the patients who died were male. Mean age was 72.8 ± 11.8 in non-survivors vs. 59.9 ± 14.7 in survivors (p < 0.001). Overall in-hospital mortality was found to be 8.8% (133/1511 cases), and overall ICU admission was 10.85% (164/1511 cases). The PSI/PORT score of the non-survivors group was higher than that of the survivors group (144.38 ± 28.64 versus 67.17 ± 25.63, p < 0.001). The PSI/PORT yielding the highest performance was the best predictor for in-hospital mortality, since it incorporates the factors as advanced age and comorbidity (AUROC 0.971; % 95 CI 0.961−0.981). The use of A-DROP may also be preferred as an easier alternative to PSI/PORT, which is a time-consuming evaluation although it is more comprehensive.

Changing characteristics of cancer patients during the COVID-19 pandemic.

INTRODUCTION: Cancer patients are more sensitive to infections, and, compared to other patients, may have more serious outcomes. Thus, cancer patients are a high-risk group in the COVID-19 pandemic. The aim of this study was to evaluate how cancer patients are affected by COVID-19 infection; the prevalence, and factors affecting mortality. METHODOLOGY: This single-centre, retrospective study included cancer patients under follow-up treatment at our hospital with a laboratory-confirmed diagnosis of COVID-19. Demographic and clinical data were obtained from electronic medical records. The effects of tumour subtype and patient demographic data on COVID-19 prevalence and mortality were analyzed using univariate and multivariate models. RESULTS: Evaluation was made of 217 cancer patients, comprising140 (64.5%) males and 77 (35.5%) females with a mean age of 62.05 ± 12.95 years. Mortality was seen in 84 (38.7%) patients. Disease grade, chemotherapy within the last 3 months and CT findings were determined to be related to mortality. In logistic regression analysis, the most important factors affecting survival were determined to be severe lung involvement (p < 0.001) and hematological malignancy. CONCLUSIONS: It is clear that cancer patients are at greater risk from COVID-19 infection than individuals without a malignant disease. The results showed that cancer patients with different tumour types had different levels of sensitivity to COVID-19. It is clear that with ongoing viral mutations, the duration of the pandemic is unknown. Therefore, the continuation of cancer screening and cancer treatments should not be interrupted.