Novel optical coherence tomography findings in a patient with methanol toxicity: a case report.

We report a case of acute methanol toxicity with unique optical coherence tomography findings. A 56-year-old man was referred to our ophthalmology clinic with a history of handmade vodka consumption and vision loss. On ophthalmologic examination, his vision was 20/100 in his right eye and 20/200 in his left eye. Bilateral mild optic disk hyperemia was detected on fundus examination. Because of the severity of systemic symptoms in such cases, it is very difficult to include optical coherence tomography in the ophthalmologic examination. However, we managed to perform optical coherence tomography and recorded shallow subretinal fluid and a prominent middle limiting membrane sign as acute retinal structural changes in the patient. The patient was treated with hemodialysis, intravenous ethanol, and sodium bicarbonate. On the fourth day of treatment, visual acuity improved to 20/20 in both eyes. In addition, the prominent middle limiting membrane sign and subretinal fluid disappeared. In this unusual case, retinal pigment epithelium damage and retinal ischemia may have contributed to the prominent middle limiting membrane and subretinal fluid, which are novel optical coherence tomography findings of methanol toxicity.

Choroidal structural changes in patients with early diabetic nephropathy.

PURPOSE: To determine alterations of the choroidal thickness (CT) and the choroidal vascularity index (CVI) in patients with glomerular hyperfiltration, a marker of early diabetic nephropathy (DN). METHODS: Twenty-two patients with type 2 diabetes (T2D) with glomerular hyperfiltration (early DN group) and 28 patients with T2D without DN (NDN group) were included in the study. Patients with diabetic retinopathy were excluded. Parameters including subfoveal CT, the subfoveal choroidal vascularity index (CVI), and total CVI were measured using spectral-domain enhanced depth imaging optical coherence tomography method. RESULTS: The early DN group included 22 patients and the NDN group comprised 28 patients. The groups were similar in terms of age and sex (p>0.05). The CT values were statistically significantly lower in the early DN group than in the NDN group (p < 0.001). There was no significant difference between the early DN group and the NDN group in terms of total and subfoveal CVI (p>0.05). CONCLUSION: The choroidal thickness decreased in patients with T2D with glomerular hyperfiltration, but there were no differences in CVI when they were compared with patients with T2D without DN.

Messenger ribonucleic acid vaccine-associated immune thrombocytopenia: A rare complication of vaccine.

Coronavirus disease-2019 continues to have a serious impact in countries with the effect of new variant viruses emerging with mutations. While the effectiveness and protection of the vaccine have been determined all over the world, some vaccine-related side effects can be detected in the form of cases. In our case, the patient was admitted to the emergency department of our hospital with complaints of weakness and progressive rash on his legs. Diffuse petechiae purpura on the legs of the patient was observed and complete blood count revealed thrombocytopenia. Peripheral blood smear supported the blood count test results with thrombocytopenia, secondary causes of thrombocytopenia were excluded, and the patient was diagnosed with vaccine-induced immune thrombocytopenia.

Can the Reduction of Cytokines Stop the Progression of Sepsis?

Objective In this study, we aimed to analyze the laboratory and clinical results of cytokine hemadsorption as an immunomodulation therapy in ICU patients diagnosed with sepsis or septic shock. Methods The levels of procalcitonin (PCT) and C-reactive protein (CRP), determined to be indicators of infection/sepsis, and the levels of interleukins (IL-6, IL-8, and IL-10) and tumor necrosis factor α (TNFα), deemed as indicators of the cytokine storm, were compared among 32 patients before and after the hemadsorption procedure. Results The hemadsorption significantly reduced the levels of IL-6, IL-8, IL-10, TNFα, PCT, CRP, Acute Physiology and Chronic Health Evaluation (APACHE) scores, mortality rate, and Sequential Organ Failure Assessment (SOFA) scores (p<0.05). APACHE scores and the mean predicted mortality rate (PMR) of the non-survivors measured before the procedure was significantly higher than those of survivors (p=0.002 for both). IL-10, APACHE scores, and the mortality rates determined before the hemadsorption procedure were deemed significant parameters to predict the mortality among all ICU patients (p<0.05). IL-10 levels ≤125.3 ng/L, APACHE score >30, and PMR >70.33 were significantly associated with the mortality rates of all patients, indicating that these three parameters determined before the hemadsorption may be good predictors of mortality among ICU patients with sepsis. Conclusion The progression of sepsis in ICU patients may be prevented with cytokine hemadsorption applied as an immunomodulator therapy.

Kidney tissue elastography and interstitial fibrosis observed in kidney biopsy.

INTRODUCTION: Kidney interstitial fibrosis is an important risk factor for the progression of chronic kidney disease. Kidney elastography is a noninvasive imaging modality that might be used to assess tissue fibrosis. In this study, we aimed to investigate the relationship between tissue stiffness detected in kidney elastography and interstitial fibrosis observed in kidney biopsy. MATERIALS AND METHODS: Patients who were hospitalized in a tertiary care university hospital with a kidney biopsy indication were included in this study. In all patients, the transverse and sagittal elastography measurements were made using a sonoelastography device before the biopsy. The total histological score was calculated. RESULTS: Fifty-seven native kidney patients with proteinuria were included in the study. Patients were divided into two groups according to the presence (n = 6) and absence of fibrosis (n = 51) as detected by kidney biopsy. A significant correlation was found between the presence of fibrosis detected by biopsy and elastography outcomes (p = .046, r = .192). A significant correlation was found between the urea and creatinine levels and transverse elastography measurements (p = .036, r = .240). No correlation was observed between the transverse elastography measurements and total histological score consisting of glomerular, vascular, and tubular scores (r = .006, p = .967). CONCLUSION: The findings of our study suggest a significant relationship between the elastography measurements and interstitial fibrosis. Because of the high negative predictive value (91%), we suggest that elastography should mainly be used as an exclusion test for the presence of fibrosis. We also believe that elastography may be useful to evaluate the fibrosis status in kidney diseases.

Measurement of antibody levels in patients with COVID-19 over time by immunofluorescence assay: a longitudinal observational study.

BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic, antibody screening is a critical tool to assess anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunity. We examined variation in antibody titers associated with age and sex among patients with confirmed COVID-19. METHODS: Blood IgG levels were tested in 1081 patients with positive SARS-CoV-2 quantitative reverse transcription polymerase chain reaction (RT-qPCR) tests between 1 September and 31 December 2020. Patients who did not experience reinfection were identified. Serum IgG levels were measured by immunofluorescence assay. Antibody positivity and antibody titers were analyzed according to time since infection, sex, and age. RESULTS: The mean (standard deviation) age was 41.2 (14.2) years and 41.2% of patients were women. The lowest antibody positivity rate between the first and ninth month post-infection was detected in the sixth month. The lowest antibody titers among patients aged 20 to 80 years occurred in those aged 30 to 39 years. The IgG titer was positively correlated with age in years (r = 0.125) and decades (r = 0.126). CONCLUSIONS: Six months after infection, anti-SARS-CoV-2 antibody titers increased. Anti-SARS-CoV-2 antibody titers also increased with age. Immunity and pathogenicity should be investigated in addition to antibody positivity rates and antibody titers.

Angioedema after favipiravir treatment: Two cases.

Drug-induced angioedema often affects elderly patients with chronic drug use. Proper diagnosis and prompt with effective treatment reduce mortality. With the increasing use of favipiravir, many side effects, especially increased alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels due to liver toxicity, and also skin lesions are reported. First patient oral favipiravir treatment on the second day was admitted to the hospital with rash and swelling on the eyelids. Second patient suffered from significant swelling on the upper lip and displayed angioedema. In this cases, angioedema findings regressed after rapid diagnosis and parenterally administered antihistamine and steroid treatment. Although there is no effective drug therapy in the treatment of COVID-19, favipiravir is also included in the treatment protocols in many countries. Clinicians should be careful about the side effects and possible skin manifestations, especially including angioedema, related to the use of favipiravir.

Relationship between Antibody Levels and SARS-Cov-2 Reinfection.

OBJECTIVE: In this period when mutant strains are increasing all over the world, studies on how much humoral immunity will protect against the Severe Acute Respiratory Syndrome 2 (SARS-CoV-2) are quite limited. The aim of our study is to investigate the positivity and antibody levels of the COVID-19 reverse transcription polymerase chain reaction (RT-PCR) test, the frequency of SARS-CoV-2 re-infection, and the protective antibody level against re-infection. METHODS: Patients who were positive for COVID-19 IgG antibody between 1 July and 31 August were included in our study. The COVID-19 RT-PCR test positivity, age, gender and comorbidities of these patients were recorded before this date. The COVID-19 RT-PCR test positivity of these patients was followed from the National COVID-19 Database between September 1, 2020 and February 28, 2021. RESULTS: 1665 patients (female: male 683: 982, mean age 40.6±13.4 years). Among all patients, 14 patients had reinfection and the frequency of reinfection was 0.8%. It was observed that the frequency of reinfection was more frequent in patients with PCR negative (p<0.001). The IgG cut-off value causing reinfection was found to be 11.9 (AUC: 0.844, 79.2% sensitivity, 78.6% specificity) (p<0.001). CONCLUSION: Humoral antibodies against SARS-CoV-2 were protective against COVID-19 reinfection, 0.8% of the patients had reinfection and the resultant reinfection was mostly seen in PCR negative patients who were asymptomatic.

COVID-19 seroconversion in the aircrew from Turkey.

BACKGROUND: Pneumonia due to Severe Acute Respiratory Syndrome 2 (SARS-CoV-2) is spreading rapidly all over the world and air travel is the leading transmission route of the virus among countries. The aim of the study is to determine the frequency of SARS-CoV-2 Immunoglobulin G (IgG) antibodies in aircrew, to determine occupational exposure, and to understand the spread of immunity in social groups. METHOD: The study was designed as a cross-sectional retrospective study. SARS-CoV-2 IgG levels were measured in patients who applied to between December 1, 2020 and January 13, 2021. Coronavirus disease-2019 (COVID-19) Reverse transcription polymerase chain reaction (RT-PCR) positivity was investigated before December 1, 2020. RESULTS: The patients were divided into three groups according to their jobs such as 313 aircrew; 451 healthcare workers; 4258 other patients. The PCR positivity rate was found to be 39% in the aircrew group, 32% in the healthcare workers and %20 other patient group (p < 0.001). The IgG antibody positivity rate was 46% in the aircrew, 41% in healthcare workers, and 35.3% in the other patient group (p < 0.001).The group with the highest IgG antibody titer is in the aircrew; there was a significant difference between the groups (p < 0.001). CONCLUSIONS: In our study, it was observed that aircrew, similar to healthcare workers, are at serious risk against SARS-CoV-2. In this process, it is suggested that the vaccination processes included repeated doses of aircrew should be accelerated and protective measures and equipment should be increased in terms of reinfection.

Mad Honey Poisoning Case Series Presenting With ECG Findings Including Atrioventricular Complete Block and Symptomatic Hypotension.

Plants belonging to the Ericaceae family, which grow endemically in some parts of the world, contain grayanotoxin, which causes fatal bradyarrhythmia and circulatory collapse. Mad honey, which comes from plants with grayanotoxin, has various uses, namely, as an aphrodisiac, as an alternative therapy for GI disorders such as peptic ulcer, dyspepsia, and gastritis, and as a treatment for hypertension. However, GI, neurological and cardiac side effects may arise from its ingestion due to the grayanotoxin contained by this type of honey. Cardiac rhythm disturbances, sinus bradycardia, and other life-threatening side effects can occur, especially atrioventricular (AV) block and nodal rhythms. In this article, we present five honey poisoning cases involving adults who were admitted to our ED. Notably, one of the patients was unresponsive to atropine, so a temporary pacemaker was inserted, after which the patient was moved to the coronary ICU. Meanwhile, the cardiac rhythm of the other cases returned to normal in the follow-up after atropine administration.

Does the COVID-19 seroconversion in older adults resemble the young?

High antibody titers have been found to correlate with the severity of coronavirus disease 2019 (COVID-19) disease. Therefore, antibody titers may be higher in older adults, whose disease is known to have a more severe course than younger ones. This study aimed to compare the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) antibody level in the reverse transcription-polymerase chain reaction (RT-PCR) to test positive older adults with young. Patients aged ≥18 with positive RT-PCR and checked serum IgG antibodies between November 1, 2020 and January 13, 2021 were included. The IgG antibody levels and the time between RT-PCR positivity with the antibody levels were recorded. A total of 1071 patients were divided into two groups as Group 1 <60 years old (n = 902) and Group 2 ≥60 years old (n = 169). The SARS-CoV-2 IgG antibody titers were higher in Group 2 (p = 0.001). This height was present in the first 3 months after positive RT-PCR. While the antibody titers were compared by dividing Group 2 into the three groups according to age ranges (60-69, 70-79, and ≥80 years), the antibody titer was higher in ≥80 years patients (p = 0.044). High COVID-19 IgG antibody levels may be associated with the severity of the disease. Also, the humoral immunity advantage was seen in the first 3 months in the older patients, which suggests that older adults with COVID-19 may develop reinfection in the long term.

Massive pulmonary embolism presenting with hemoptysis and S1Q3T3 ECG findings.

BACKGROUND: Venous thromboembolism clinically presenting with a deep vein thrombosis or pulmonary embolism is among the most commonly seen cardiovascular syndromes. The aim of this case presentation is to emphasise the typical electrocardiographic findings that are detected with massive pulmonary embolism along with the electrocardiographic S1Q3 and S1Q3T3 accompanied by T negativity at the D3 derivation based on prevalent T negativity. CASE PRESENTATION: We present the case of an adult male who presented with a massive pulmonary embolism that was associated with tachycardia, haemoptysis and typical S1Q3T3 electrocardiographic findings. Tomographic findings showed filling defects in the two main pulmonary artery lumens, which were found to be compatible with a massive embolism. Intravenous heparin was injected (5000 IU), and low molecule weight heparin (LMWH) treatment was initiated. After two days of observation and treatment in the coronary intensive care unit, the patient was discharged for outpatient care. DISCUSSION: Massive pulmonary embolism is an urgent life-threatening clinical situation that is frequently confused with acute ST elevation myocardial infarction. The definitive diagnosis of massive pulmonary embolism was made with a computed tomography pulmonary angiogram. Electrocardiographic findings and hypoxic hypercarbia in the blood gas analysis are typical. Early diagnosis with laboratory and imaging investigations is vital in the treatment and prognosis of pulmonary embolism. CONCLUSIONS: Ventricular overload signs accompanied by ST segment elevation in electrocardiography and S1Q3 and prevalent T negativity are crucial features in terms of distinguishing between pulmonary embolism and myocardial infarction and selecting effective treatments for patients admitted to the emergency department.

The relationship between positivity for COVID-19 RT-PCR and symptoms, clinical findings, and mortality in Turkey.

Introduction: This study aimed to assess the correlation between nucleic acid amplification test (real-time reverse transcription-polymerase chain reaction, RT-PCR) positivity of patients presenting with suspected COVID-19 and pneumonic infiltration consistent with COVID-19-specific pneumonia diagnosis on thoracic computed tomography (CT), with symptoms, laboratory findings, and clinical progression.Methods: The study included 286 patients (female:male 131:155; mean age, 53.3 ± 17.9 years) who were divided into two groups according to their RT-PCR test results. The symptoms, laboratory examinations, clinical findings, and thoracic CT imaging of the patients were evaluated.Results: While the physical examination, comorbidities, and total CT scores were similar between the groups, taste/smell abnormalities were observed more frequently in the PCR-positive group. The use of moxifloxacin, lopinavir/ritonavir, and tocilizumab was higher in the PCR-positive group (p = 0.016, p < 0.001, and p = 0.002, respectively). The duration of hospitalization, intensive care requirement, and mortality rate of the studied groups did not differ between the groups.Conclusions: Among patients presenting with suspected COVID-19 and pneumonic infiltration consistent with COVID-19 on thoracic CT, the symptoms, physical examination, total CT scores, duration of hospitalization, intensive care requirement, and mortality rate were similar between RT-PCR-positive and RT-PCR-negative patients. However, PCR-positive patients appeared to require more specific treatments.

Most notable 100 articles of COVID-19: an Altmetric study based on bibliometric analysis.

OBJECTIVE: The purpose of this study is to guide researchers in the COVID-19 pandemic by evaluating the 100 most cited articles of COVID-19 in terms of bibliometric analysis, Altmetric scores, and dimension badges. METHODS: "COVID-19" was entered as the search term in Thomson Reuter's Web of Science database. The 100 most cited articles (T100) were analyzed bibliometrically. Altmetric attention scores (AASs) and dimension badge scores of the articles were evaluated. RESULTS: T100 articles were published from January to September 2020. The average citation of the top 100 articles on COVID-19 was 320 ± 344.3 (143-2676). The language of all articles was English. The average Altmetric value of T100 is 3246 ± 3795 (85-16,548) and the mean dimension badge value was 670 ± 541.6 (176-4232). Epidemiological features (n = 22) and treatment (n = 21) were at the top of the main topics of T100 articles. CONCLUSION: The more citations an article is made, the more it indicates the contribution of that article to science. However, the number of citations is not always the only indicator of article quality. The existence of methods that measure the impact of the article outside the academia to measure the value of the article arises more in an issue that affects the whole world, such as the COVID-19 pandemic.

Determining host factors contributing to disease severity in a family cluster of 29 hospitalized SARS-CoV-2 patients: Could genetic factors be relevant in the clinical course of COVID-19?

In this study, we report a large family cluster consisting of 29 genetically related patients hospitalized with coronavirus disease-2019 (COVID-19). We sought to determine the clinical characteristics relevant to the clinical course of COVID-19 by comparing the family cluster to unrelated patients with SARS-CoV-2 infection so that the presence of potential determinants of disease severity, other than traditional risk factors previously reported, could be investigated. Twenty-nine patient files were investigated in group 1 and group 2 was created with 52 consecutive patients with COVID-19 having age and gender compatibility. The virus was detected for diagnosis. The clinical, laboratory and imaging features of all patients were retrospectively screened. Disease course was assessed using records regarding outcome from patient files retrospectively. Groups were compared with respect to baseline characteristics, disease severity on presentation, and disease course. There was no difference between the two groups in terms of comorbidity and smoking history. In terms of inhospital treatment, use differed not significantly between two groups. We found that all 29 patients in the group 1 had severe pneumonia, 18 patients had severe pneumonia. Hospitalization rates, length of hospital stay, and transferred to intensive care unit were found to be statistically significantly higher in the group 1. In the present study, COVID-19 cases in the large family cluster were shown to have more severe disease and worse clinical course compared with consecutive patients with COVID-19 presenting to the same time. We believe further studies into potential genetic mechanisms of host susceptibility to COVID-19 should include such family clusters.

Effect of oral l-Glutamine supplementation on Covid-19 treatment.

OBJECTIVES: The aim of this study is to investigate the effect of oral l-Glutamine supplementation on hospitalization time, need for intensive care unit and Coronavirus Disease-19 (Covid-19) mortality. METHODS: The study included 30 Covid-19 patients using l-Glutamine and 30 Covid-19 patients who did not use l-Glutamine with similar age, gender and clinical status. Diagnostic tests, laboratory examinations, clinical findings and computed thorax tomography imaging of the patients were evaluated. RESULTS: Hospitalization time was 10.4 ± 1.9 days in Covid-19 without L-Glutamine group and 8.9 ± 1.8 days in Covid-19 with L-Glutamine group (p = 0.005). In Covid-19 without the L-Glutamine group, four patients require the ICU though no one in the other group required that (p = 0.038). Only one mortality was observed in Covid-19 without the L-Glutamine group (p = 0.999). CONCLUSIONS: Nutritional supplements such as L-Glutamine boost immune system especially by inhibition of inflammatory responses. Our results suggest adding enteral L-glutamine to the normal nutrition in the early period of Covid-19 infection may lead to a shortened hospital stay and lead to less need for ICU. Larger-scale studies are needed to evaluate the effect of adding enteral L-Glutamine to the currently used treatments in the infectious diseases especially like Covid-19.

Tocilizumab challenge: A series of cytokine storm therapy experiences in hospitalized COVID-19 pneumonia patients.

To recognize the period of exaggerated cytokine response in patients with coronavirus disease 2019 (COVID-19) pneumonia, and to describe the clinical outcomes of using tocilizumab as a treatment option. The data of 12 adult COVID-19 pneumonia patients who were followed in the inpatient clinics of Biruni University Medical Faculty Hospital (Istanbul, Turkey) were retrospectively analyzed. Diagnostic tests, laboratory examinations, clinical findings, and computed tomography of the thorax imaging results were evaluated. A dramatic laboratory and clinical improvement was observed in 83% (10 out of 12) of patients after tocilizumab. In 17% (2 out of 12) of our patients, short-term ventilator support was required in the intensive care unit. The longest hospital stay was 18 days. However, in the end, all of our patients were discharged home with good health. Although arterial oxygen saturations (87.58 ± 3.12%) dropped in room air in the pre-tocilizumab period, post-tocilizumab they normalized in all patients (94.42 ± 1%). None of them had fever after tocilizumab treatment and the levels of C-reactive protein (13.08 ± 12.89) were almost within normal limits. Eosinophil values were quite low at the time of diagnosis (10 ± 17.06), but increased significantly post-tocilizumab (155.33 ± 192.69). There is currently no proven treatment for COVID-19 induced by novel coronavirus SARS-CoV-2. Based on our experience with twelve adult COVID-19 pneumonia patients, we can say that tocilizumab, an IL-6 inhibitor, is more beneficial in preventing the damage caused by excessive cytokine response in the body if administered at the right time and provides clinical and radiological recovery.

Case Report: A COVID-19 Patient Presenting with Mild Rhabdomyolysis.

The news was reported from the Wuhan region of China about a novel corona virus in the end of 2019. After spreading around the world, a pandemic was declared by the WHO. Depending on the different involvement of the disease, the most common symptoms are fever, cough, and dyspnea. However, some indeterminate symptoms that make diagnosis difficult, such as myalgia and fatigue, can also be seen alone, without the typical clinical picture. We describe a patient with COVID-19 pneumonia, the only complaint of which is myalgia, and the first diagnosis is mild rhabdomyolysis. The patient had no evidence or history other than viral infection that could explain muscle pain and also increased level of muscle enzymes. When mild rhabdomyolysis lack of myoglobinuria and complications was diagnosed, treatment-related rhabdomyolysis was also avoided as no treatment related to COVID-19 was initiated yet. Apart from the typical symptoms leading to the typical diagnosis of COVID-19 at the first admission, SARS-CoV-2 related with rhabdomyolysis should also be kept in mind.