The impact of Coronavirus disease 2019 (COVID-19) on urinalysis parameters.

BACKGROUND: Creatinine elevation and changes in urinalyse parameters may be seen due to acute kidney injury during COVID-19. In the present study, we aimed to investigate the changes in urinalysis of COVID-19 patients with normal kidney function. METHODS: The data of COVID-19 patients with normal renal functions were retrospectively analyzed. Urinalysis parameters of these patients were recorded. The patients were divided into three groups as mild, moderate and severe with respect to the clinical course of the disease. It was examined whether the urine analysis values in the groups were different from normal reference values and whether these values were different between the groups. In addition, possible relationship between the urinalysis parameters and the clinical severity of the disease was investigated. RESULTS: There are three groups; mild (N.=40), moderate (N.=38) and severe (N.=42). Mean age were significantly higher in the severe group, while gender distribution of the groups was similar (P=0.033, P=0.091) Creatinine values of all patients were normal. There were 6.7% glucose positivity, 13.4% protein positivity, 5.8% urobilinogen positivity and 7.5% ketone positivity in urine dipstick analysis and these changes were all significantly higher than the reference values (P=0.008, P<0.0001, P=0.016, P=0.016). Pyuria and hematuria were detected in 8.3% and 9.2%, respectively. The urinalysis parameters and urine microscopy findings were not affected by the severity of the disease. CONCLUSIONS: Glycosuria, proteinuria, pyuria and hematuria may occur during COVID-19 disease, regardless of comorbidity and renal dysfunction. However, these urine parameters were not correlated with the severity of the disease.

Diagnostic performance of low-dose chest CT to detect COVID-19: A Turkish population study.

PURPOSE: We aimed to evaluate the diagnostic performance of low-dose chest computed tomography (CT) in patients under investigation for coronavirus disease 2019 (COVID-19). METHODS: This retrospective study included 330 patients suspected of having COVID-19 from March 15 to April 16, 2020. We examined 306 patients upon initial presentation using both CT and real-time reverse-transcriptase polymerase-chain-reaction (rRT-PCR). The diagnostic performance of CT was calculated using rRT-PCR as a reference. Clinical and laboratory data, CT characteristics, and lesion distribution were assessed for patients with a confirmed diagnosis via rRT-PCR. RESULTS: A total of 250 patients were finally diagnosed with COVID-19. Clinical and laboratory findings included myalgia or fatigue (76%), fever (64.8%), dry cough (60.8%), elevated levels of C-reactive protein (86.4%), procalcitonin (62%), and D-dimer (58.2%), increased neutrophil-lymphocyte ratio (NLR) (54.8%), and lymphopenia (34%). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the initial CT scan were 90.4% (95% IC, 86%-93%), 64.2% (95% IC, 50%-76%), 91.8% (95% IC, 88%-94%), and 60% (95% IC, 49%-69%), respectively. The percentage of patients diagnosed on the initial rRT-PCR test was 51.6% (n=129). Most frequent CT characteristics of COVID-19 in the subgroup of rRT-PCR-positive patients were multiple lesion (97.4%, n=220), followed by bilateral involvement (88.5%, n=200), peripheral distribution (74.3%, n=168), ground-glass opacity (GGO) (69.2%, n=157), subpleural curvilinear opacity (41.6%, n=104), and mixed GGOs (27.6%, n=67). CONCLUSION: rRT-PCR may produce initial false negative results. For this reason, typical CT findings for COVID-19 should be known especially by radiologists. We suggest that patients with typical CT findings but negative rRT-PCR results should be isolated, and rRT-PCR should be repeated to avoid misdiagnosis.

Evaluation of DNA damage using 3 comet assay parameters in workers occupationally exposed to lead.

The aim of this study was to investigate the association between DNA damage and blood lead levels in individuals occupationally exposed to lead. To evaluate this association, 61 workers exposed to lead were monitored in terms of DNA damage in blood lymphocytes. The levels of DNA damage were measured according to 3 comet assay parameters, including tail intensity (TI), tail moment (TM), and DNA tail (DNAt). A statistically significant positive correlation was found between the lead levels and TI, TM, and DNAt (p < .01). Smoking had independent effects on DNA damage. A statistically significant difference was observed between smokers and nonsmokers in regards to DNA damage parameters (p < .05). In addition, the lead and DNA damage levels in smokers were found to be significantly higher than the levels observed in nonsmoking workers (p < . 05). Our results show that exposure to lead induces genotoxic effects in peripheral lymphocytes, as measured by comet assays.

[Fatal sino-orbital aspergillosis in an immunocompetent case]. / Immün kompetan bir olguda fatal seyirli sino-orbital aspergilloz.

The paranasal sinus infections caused by Aspergillus spp. are usually presented clinically with mild symptoms, however they may lead to invasive disease and mortality especially in immunocompromised individuals. In this report a fatal case of sino-orbital aspergillosis developed in an immunocompetent patient has been presented. Seventy-four years old female patient was admitted to the hospital with the complaints of fever and progressively increasing headache that continued for 15 days. Due to the development of nausea, vomiting, loss of consciousness and stiff neck in the following days, cerebrospinal fluid (CSF) sample was obtained. Direct microscopic examination of the Gram and acidfast staining of the CSF sample revealed no microorganisms, no growth was detected in CSF culture and PCR amplification was negative for Herpes simplex virus and Mycobacterium tuberculosis. Since no response was achieved by empirical ceftriaxone, ampicillin and conventional anti-tuberculosis treatment and tachypnea, proptosis and progressive respiratory failure developed in the patient, she was transferred to the intensive care unit. The radiological examination revealed soft tissue lesion filling the sphenoid sinus, extending to the nasal cavity and suprasellar cistern, destruction of bones, dilated orbital vein, cavernous sinus thrombosis and infarction on left cerebral peduncule. Patient was operated and pus and fungus ball were aspirated from the openings of both sphenoid sinuses. Gomori methenamine silver, periodic acid-Schiff and haematoxylin-eosine staining of the operational material exhibited dichotomously branching hyphae. The patient was diagnosed as invasive sino-orbital aspergillosis based on the clinical, radiological and histopathological findings. Despite antifungal therapy and surgical debridement, the patient died. It should always be kept in mind that aspergillosis can develop in immuncompetent individuals. Delay in diagnosis and treatment may lead to fatality. Thus multidiciplinary approach is necessary for early diagnosis and successful treatment of aspergillus infections.

The first Crimean-Congo hemorrhagic fever case in the winter season from Turkey.

Turkey is one of the countries in which Crimean-Congo hemorrhagic fever is frequently seen and most of the cases are reported between April and August. We describe the first case of Crimean-Congo hemorrhagic fever in the winter season, when Hyalomma tick activity is absent, from Turkey.

The efficacy of ribavirin in the treatment of Crimean-Congo hemorrhagic fever in Eastern Black Sea region in Turkey.

BACKGROUND: The efficiency of ribavirin for treatment of Crimean-Congo hemorrhagic fever (CCHF) is unknown. In the literature, prospective randomized studies investigating the efficacy of ribavirin are not found. OBJECTIVES: To investigate the efficacy of ribavirin in treatment of patients with CCHF. STUDY DESIGN: In this prospective randomized cohort study 136 cases were included between June 2004 and August 2007. The diagnosis was confirmed in the CCHF reference laboratory of Refik Saydam National Hygiene Central Institute of the Turkish Ministry of Health. Patients either received ribavirin plus supportive treatment (Group A) (n=64) or only supportive treatment (Group B) (n=72). For the evaluation of efficacy of ribavirin, various parameters were compared between Group A and Group B. RESULTS: As well as the similarity of demographic features between the two groups, there were no statistical differences in incubation time; hospitalization time; patients requiring platelet replacement therapy; the time taken for platelet levels to return to normal levels and mortality. In Group B, the rate of tick contact was higher (p=0.03). In Group A, leukocyte levels took longer to return to the normal levels (p=0.02). CONCLUSION: In our study, there was no positive effect determined on clinical or laboratory parameters in CCHF patients treated with ribavirin, also it was observed that leukocyte levels took longer to return to normal (p=0.02) and, while not statistically significant, the longer period of hospitalization (p=0.09) needed was observed as a negative effect. Because of these reasons, it is thought that the use of ribavirin makes no significant contribution to the prognosis of the CCHF disease.