Baseline serum vitamin A and vitamin C levels and their association with disease severity in COVID-19 patients.

AIM: We aimed to investigate the association between the serum concentrations of Vitamin A and Vitamin C and the severity of the COVID-19.  Methods: Fifty-three consecutive PCR (+) COVID-19 patients admitted to a dedicated ward were enrolled in this study. Blood samples for serum Vitamin A and C measurements were drawn from all participants upon admission. All subjects underwent thoracic CT imaging prior to hospitalization. CT severity score (CT-SS) was then calculated for determining the extent of pulmonary involvement. A group of healthy volunteers, in whom COVID-19 was ruled out, were assigned to the control group (n=26). These groups were compared by demographic features and serum vitamin A and C levels. The relationship between serum concentrations of these vitamins and pre-defined outcome measures, CT-SS and length of hospitalization (LOH), was also assessed.  Results: In COVID-19 patients, serum Vitamin A (ng/ml, 494±96 vs. 698±93; p<0.001) and Vitamin C (ng/ml, 2961 [1991-31718] vs. 3953 [1385-8779]; p=0.007) levels were significantly lower with respect to healthy controls. According to the results of correlation analyses, there was a significant negative association between Vitamin A level and outcome measures (LOH, r=-0.293; p=0.009 and CT-SS, r=-0.289; p=0.010). The negative correlations between Vitamin C level and those measures were even more prominent (LOH, r=-0.478; p<0.001 and CT-SS, r=-0.734: p<0.001). CONCLUSION: COVID-19 patients had lower baseline serum Vitamin A and Vitamin C levels as compared to healthy controls. In subjects with COVID-19, Vitamin A and Vitamin C levels were negatively correlated with CT-SS and LOH.

Increasing modified CHA2DS2-VASc risk score is associated with acute cardiac injury in hospitalised COVID-19 patients.

BACKGROUND: Prediction of hospital mortality in patients with COVID-19 by the CHA2DS2VASc (M-CHA2DS2VASc) has been recently shown. Because COVID-19 patients with acute cardiac injury have higher mortality compared to those without, we assumed that this risk score may also predict acute cardiac injury in these patients. METHODS: In this retrospective, single centre cohort study, we included 352 hospitalised patients with laboratory-confirmed COVID-19 and divided into three groups according to M-CHA2DS2VASc risk score which was created by changing gender criteria of the CHA2DS2VASc from female to male (Group 1, score 0-1 (n = 142); group 2, score 2-3 (n = 138) and group 3, score ≥4 (n = 72)). RESULTS: As the M-CHA2DS2VASc risk score increased, acute cardiac injury was also significantly increased (Group 1, 11.3%; group 2, 48.6%; group 3, 76%; p < 0.001). The higher M-CHA2DS2VASc tertile had higher prevalence of arrhythmias compared to lower tertile. The multivariate logistic regression analysis showed that M-CHA2DS2VASc risk score, admission to intensive care unit and invasive mechanical ventilation were independent predictors of acute cardiac injury (p = 0.001, odds ratio 1.675 per scale for M-CHA2DS2VASc). In receiver operating characteristic analysis, M-CHA2DS2VASc risk score was able to predict acute cardiac injury (Area under the curve value for acute cardiac injury was 0.80; p < 0.001). CONCLUSION: Admission M-CHA2DS2VASc risk score was associated with acute cardiac injury in hospitalised patients with COVID-19.

A novel survival algorithm in COVID-19 intensive care patients: the classification and regression tree (CRT) method.

BACKGROUND/AIM: The present study aimed to create a decision tree for the identification of clinical, laboratory and radiological data of individuals with COVID-19 diagnosis or suspicion of Covid-19 in the Intensive Care Units of a Training and Research Hospital of the Ministry of Health on the European side of the city of Istanbul. MATERIALS AND METHODS: The present study, which had a retrospective and sectional design, covered all the 97 patients treated with Covid-19 diagnosis or suspicion of COVID-19 in the intensive care unit between 12 March and 30 April 2020. In all cases who had symptoms admitted to the COVID-19 clinic, nasal swab samples were taken and thoracic CT was performed when considered necessary by the physician, radiological findings were interpreted, clinical and laboratory data were included to create the decision tree. RESULTS: A total of 61 (21 women, 40 men) of the cases included in the study died, and 36 were discharged with a cure from the intensive care process. By using the decision tree algorithm created in this study, dead cases will be predicted at a rate of 95%, and those who survive will be predicted at a rate of 81%. The overall accuracy rate of the model was found at 90%. CONCLUSIONS: There were no differences in terms of gender between dead and live patients. Those who died were older, had lower MON, MPV, and had higher D-Dimer values than those who survived.

Effect of thermal welding tonsillectomy on emergence agitation.

: This study sought to examine the effect of thermal welding tonsillectomy that reduces pain and length of anesthesia on emergence agitation. A total of 60 patients (age range, 3­6 years) with chronic recurrent tonsillitis with an indication for tonsillectomy were included. Patients were randomly assigned to 2 groups. The control group (the CD group) was composed of patients undergoing cold dissection (CD) tonsillectomy. The study group (TW group) included patients undergoing thermal welding (TW) tonsillectomy. All patients were given sevoflurane as an anesthetic agent. For all patients, anesthesia time, operation time, extubation time, Pediatric Anesthesia Emergence Delirium scale, pain scale, nausea/vomiting score, and delivery time were recorded. The duration of anesthesia, operation, and delivery was significantly lower in the TW group as compared with the CD group (P = 0.000 < 0001). The pain and agitation scores were significantly lower in the TW group as compared with the CD group (P = 0.000 < 0001). We assume that, besides reducing pain and allowing surgery without bleeding, the TW tonsillectomy method diminishes emergence agitation induced by anesthetic agents, such as sevoflurane.