Outcomes of High-Dose Vitamin C Therapy on Patients Diagnosed with COVID-19 Associated ARDS in Intensive Care Units: Multi-Center Retrospective Study

Background and Aim: The new type of Severe Acute Respiratory Syndrome Coronavirus 2 (Coronavirus 2019-COVID-19) infection is the largest pandemic in the last decade. Acute respiratory distress syndrome is the complication with the highest mortality rate of this infection and there is no adequate treatment with proven efficacy to reduce mortality. This multi-center, retrospective study aimed to determine the effect of high-dose vitamin C on survival and other endpoints in invasively ventilated ARDS patients. Method(s): This multi-center, observational retrospective cohort study was performed at five ICU centers between March 2020 and July 2020. Patients with ARDS due to COVID-19 who required IMV were included. High-dose vitamin C group was defined as patients who were treated with vitamin C over 200 mg/kg for four days. Patients who were not given vitamin C treatment were defined as the control group by using propensity score match analysis, as well. The groups were compared about the effects of high-dose vitamin C treatment on ICU mortality. Result(s): A total of 86 patients with a mean age of 67.85 +/- 10.38 were included in the study. 72.1% of the patients were male. Forty-two (49%) patients were in the high dose vitamin C group, and 44 (51%) were in the control group. The mean PaO2/FiO2 at the time of admission to the ICU was 128.27+/-58.69 mmHg (133.63+/-56.51 mmHg in the control group, 122.36+/-61.18 mmHg in the study group, p=0.389). The mortality rate of high dose vitamin C group was lower than the control group (73.8% vs. 90.9%, p = 0.037,respectively). Conclusion(s): As an adjunctive therapy in invasively ventilated patients with COVID-19-associated ARDS, high doses of vitamin C may reduce mortality and development of organ damage. Prospective, randomized controlled studies with larger numbers of patients are needed to confirm these findings.Copyright © 2023, Society of Turkish Intensivists. All rights reserved.

Current Threat in COVID-19. Asymptomatic Carriers

BACKGROUND/AIM: Asymptomatic infections are not low in their inability to spread the virus and have no special clinical signs. Consequently, the detection of asymptomatic infections is the central issue for early prevention and control of the coronavirus disease-2019 (COVID-19) around the world. This study aimed to assess the demographic, clinical, and laboratory findings of symptomatic and asymptomatic patients with a diagnosis of COVID-19. MATERIALS AND METHODS: In this retrospective single-center study, 165 laboratory-confirmed COVID-19 patients who were asymptomatic or symptomatic and followed up at home or in the hospital between March 15, 2020, and May 23, 2020, were included. RESULTS: Among all 165 patients, 21 (12.7%) were asymptomatic and 144 (87.2%) were symptomatic. The median age of the symptomatic patients was higher than the asymptomatic patients, and there were no asymptomatic patients over 65 years older. Twenty-one patients were asymptomatic at admission, but four of them (19%) developed symptoms in the follow-up. Although the white blood cell (WBC) and lymphocyte counts were within the normal range for all patients, the asymptomatic patients had a significantly higher WBC and lymphocyte count than the symptomatic patients. The symptomatic patients had higher median C-reactive protein levels than the asymptomatic patients. For the typical CT findings for COVID-19, there were fewer in the asymptomatic infections (12 cases, 57.1%) than those in the symptomatic infections (103 cases, 71.5%). There were 17 (10%) patients in need of intensive care and the mortality rate was 6.1%. CONCLUSION: Asymptomatic infections spread silently in COVID-19. More importance should be given to the identification and quarantine of asymptomatic patients to eliminate COVID-19 transmission and to allow for the early diagnosis of pre-symptomatic patients.

Polypharmacy frequency: the relationship between polypharmacy and mortality in COVID-19 (+) older adults

Objective: This study aims to determine the relationship between polypharmacy and Coronavirus disease-2019 (COVID-19) (+) related mortality. Materials and Methods: All older adults >60 years old who had positive COVID-19 polymerase chain reaction tests were included in the study, designed retrospectively. Polypharmacy was defined as drug use of five or more.

Covid-19 pandemic estimated end date in turkey

Objective: Since the New Coronavirus Disease (COVID-19) can also be spread by asymptomatic individuals, identifying asymptomatic carriers is critical in the fight against the COVID-19 pandemic. We aimed to describe the COVID-19 poly-merase chain reaction (PCR) test positivity rate sent before the operation / interventional procedure in asymptomatic individuals and determine an estimated time for the pandemic’s decay time. Methods: All the patients over the age of 18 who were obtained the COVID-19 PCR test before the operation or interven-tional procedure between July 1 and October 31, 2020 were included. The patients were divided into two groups according to the periods when the peak was experienced or not. Results: 1070 patients were included in the study. PCR positivity was detected in 55 (5.14%) of the patients. The mean case incidence rate was 0.76% (2/263) in the months when the study was conducted, and there was no COVID-19 peak, and 6.57% (53/807) in the months when the peak was observed. These rates were taken as a reference for the months with and without a peak. The time to reach 67%, which is accepted as the herd immunity limit, was calculated by adding 6.57% to the months corresponding to peak periods with 20-day periods starting from April 1, and the rate of 0.76% to the other months. Since there were two peaks after April 2020, the mass immunity rate reached until today has been calculated. If the COVID-19 peak would not happen since this date, the possible pandemic attenuation time was predicted as March 2022, and if only one peak would happen, then predicted as May 2021. Conclusion: The incidence fluctuates with the restrictions, the risk of re-infection, the virus being open to new mutations, and the initiation of vaccination programs make it difficult to predict the pandemic attenuation time.

Evaluation of the relationship between anxiety and nutritional habits in Turkish patients with multiple sclerosis during the Covid-19 outbreak

Objective The Coronavirus disease 2019 is a global public health problem that has led to psychological disorders (depression, anxiety, etc.), especially in fragile individuals such as those affected by multiple sclerosis. This study investigated the relationship between anxiety and nutritional habits during the Coronavirus disease 2019 outbreak in multiple sclerosis patients. Methods This cross-sectional study was an online survey of multiple sclerosis patients living in Turkey. The total sample consisted of 294 multiple sclerosis patients. A questionnaire containing general demographic data, the Beck Anxiety Inventory, and nutritional attitudes and habits was applied to multiple sclerosis patients. Results Moderate or severe anxiety scores were found in 42.2% of multiple sclerosis patients. Weight gain was reported in 40.5% of them during the outbreak. A statistically significant difference was found in the distribution of individuals' Beck Anxiety Inventory scores for consumption of nuts/seeds, rice/pasta, cake/cookies, and water. A 1-unit increase in Beck Anxiety Inventory scores led to a 1.04 times increased consumption of bread and rice/pasta and a 1.05 times increased consumption of cake/cookies either before or after controlling for potential confounders. A 1-unit increase in Beck Anxiety Inventory scores led to a 1.06 times decreased consumption of water and a 1.04 times decreased consumption of meat and poultry, fruit (fresh), and rice/pasta, either before or after controlling for potential confounders. Conclusion During the Coronavirus disease 2019 outbreak, anxiety led to changes in multiple sclerosis patients' nutritional habits and food preferences. The continuous surveillance of psychological consequences and nutritional counseling during outbreaks should become routine as part of preparedness efforts worldwide.