Which Body Composition Parameters on Computed Tomography Are More Successful in Predicting the Prognosis of COVID-19 Patients?

OBJECTIVES: The aims of the study are to compare the body composition parameters (BCPs), which have been reported to have a prognostic impact, in COVID-19 patients, and to determine the most influential BCP(s) on the prognosis. METHODS: Unenhanced chest computed tomography examinations of COVID-19 cases were assessed regarding the severity of pneumonia, pectoralis muscle area and density (PMA, PMD), visceral adipose tissue area (VAA), waist circumference, waist to paravertebral muscle circumference ratio, coronary artery calcification severity, and paravertebral muscle area at the T5 vertebral level. A second observer repeated measurements and an intraclass correlation coefficient score were used for interobserver agreement. The relationship between data and patient outcomes (intubation, death) was investigated using multivariable logistic regression analysis. The area under the receiver operating characteristic curve (AUC) was used to evaluate the performance of BCPs in predicting outcomes. RESULTS: A total of 238 (121 males, median age, 48 years [interquartile range, 36-63 years]) consecutive COVID-19 patients with chest computed tomography were investigated. Twenty-four patients (10.08%) were intubated, and 15 patients (6.3%) died during at least 1 month of follow-up. Waist to paravertebral muscle circumference ratio, PMA, PMD, and T5 vertebral level were significantly associated with intubation in the multivariable analysis. Pectoralis muscle density and PMA were significantly associated with death. Pectoralis muscle density showed the highest AUC for the prediction of intubation and death (AUC of 0.814 and 0.871, respectively). There was a good to excellent agreement between observers (intraclass correlation coefficient range, 0.899-0.998). CONCLUSIONS: Pectoralis muscle density is the most influential BCP in predicting intubation and death in COVID-19 patients.

Clinical Outcomes and Independent Risk Factors for 90-Day Mortality in Critically Ill Patients with Respiratory Failure Infected with SARS-CoV-2: A Multicenter Study in Turkish Intensive Care Units.

BACKGROUND: There are limited data on the long-term outcomes of COVID-19 from different parts of the world. AIMS: To determine risk factors of 90-day mortality in critically ill patients in Turkish intensive care units (ICUs), with respiratory failure. STUDY DESIGN: Retrospective, observational cohort. METHODS: Patients with laboratory-confirmed COVID-19 and who had been followed up in the ICUs with respiratory failure for more than 24 hours were included in the study. Their demographics, clinical characteristics, laboratory variables, treatment protocols, and survival data were recorded. RESULTS: A total of 421 patients were included. The median age was 67 (IQR: 57-76) years, and 251 patients (59.6%) were men. The 90-day mortality rate was 55.1%. The factors independently associated with 90-day mortality were invasive mechanical ventilation (IMV) (HR 4.09 [95% CI: [2.20-7.63], P < .001), lactate level >2 mmol/L (2.78 [1.93-4.01], P < .001), age ≥60 years (2.45 [1.48-4.06)], P < .001), cardiac arrhythmia during ICU stay (2.01 [1.27-3.20], P = .003), vasopressor treatment (1.94 [1.32-2.84], P = .001), positive fluid balance of ≥600 mL/day (1.68 [1.21-2.34], P = .002), PaO2/FiO2 ratio of ≤150 mmHg (1.66 [1.18-2.32], P = .003), and ECOG score ≥1 (1.42 [1.00-2.02], P = .050). CONCLUSION: Long-term mortality was high in critically ill patients with COVID-19 hospitalized in intensive care units in Turkey. Invasive mechanical ventilation, lactate level, age, cardiac arrhythmia, vasopressor therapy, positive fluid balance, severe hypoxemia and ECOG score were the independent risk factors for 90-day mortality.

Recurrent and More Severe COVID-19 Infection: Two Elderly Case Reports.

Although the sensitivity of reverse transcriptase-polymerase chain reaction (RT-PCR) is low in the diagnosis of coronavirus disease 2019 (COVID-19), it is the gold standard. Clinical improvement is prioritized in the follow-up of patients with COVID-19 who are followed as possible or definitive cases. Although the priority in the discharge decision is the resolution of complaints, it is also important to see radiological improvement and RT-PCR negativity. A total of 2 of our patients who were hospitalized and treated in our clinic with a diagnosis of COVID-19 were discharged after their complaints were resolved and their treatment was completed. The patients had 2 negative RT-PCR results at discharge. Both of them presented to the hospital with symptoms such as fever, cough, and shortness of breath after the discharge, and both showed positive RT-PCR results. Considering recurrent COVID-19 infection, we aimed to present treatment and the 2 cases we followed.

A Rare Case with Systemic Lupus Erythematosus Manifested by two Different Neurologic Entities; Guillain Barre Syndrome and Posterior Reversible Encephalopathy Syndrome.

Systemic lupus erythematosus (SLE) is an immune-mediated, lifelong disease characterized by quite heterogeneous neuropsychiatric manifestations. Herewith, we report the first rare co-incidental case with posterior reversible encephalopathy syndrome (PRES), Guillain Barre Syndrome (GBS), and (SLE). The coexistence of these neurological conditions in SLE patients could lead to delayed diagnosis and treatment due to this rare coalescence and clinical diversity. Currently, there are no specific, diagnostic radiological or laboratory biomarkers for neurological involvement in SLE. Awareness and, early recognition of neuropsychiatric involvements of the disease are important for timely appropriate treatment. Delayed treatment may cause permanent damage, poor prognosis, long term morbidity, and even death.

Detection of SARS-CoV-2 in the tears and conjunctival secretions of Coronavirus disease 2019 patients.

INTRODUCTION: Current studies suggest that tears and conjunctival secretions may be an important transmission route in coronavirus disease 2019 (COVID-19). The study aims to evaluate the presence of severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) virus in tears and conjunctival secretion of patients with COVID-19. METHODOLOGY: A prospective interventional case series study was performed, and 32 patients with COVID-19 were selected at the Pamukkale University Hospital from 15 to 22 May 2020. The tear and conjunctival samples were collected by a conjunctival swab. Each specimen was sent to the laboratory for reverse transcription-polymerase chain reaction (RT-PCR) analyses. To avoid cross-infection, gloves and personal protective equipment were changed after collecting each sample. RESULTS: 32 patients (18 male, 14 female) with Covid-19 were included in this cross-sectional study. The average age of the patients was 52.81 ± 16.76 years. By the time of the first collection of conjunctival-tear samples, the mean time of the onset of complaints was 6.84 ± 6.81 (1-35) days. Tear-conjunctival samples from 5 patients (16%) without conjunctivitis yielded positive PCR results, 3 of whom had positive and 2 negative nasopharyngeal PCR results. CONCLUSIONS: Five of 32 patients (16 %) without conjunctivitis or any eye symptoms had viral RNA in their tear-conjunctival samples. The possibility of transmission via tears and conjunctival secretions should be recognized even in the absence of conjunctivitis or other ocular manifestations.

The prognostic value of pneumonia severity score and pectoralis muscle Area on chest CT in adult COVID-19 patients.

PURPOSE: To assess the prognostic value of pneumonia severity score (PSS), pectoralis muscle area (PMA), and index (PMI) on chest computed tomography (CT) in adult coronavirus disease 2019 (COVID-19) patients. METHOD: The chest CT images of COVID-19 patients were evaluated for the PSS as the ratio of the volume of involved lung parenchyma to the total lung volume. The cross-sectional areas of the pectoralis muscles (PMA, cm2) were also measured automatically on axial CT images, and PMI was calculated as the following formula: PMI = PMA / patient's height square (m2). The relationship between clinical variables, PSS, PMA, sex-specific PMI values, and patient outcomes (intubation, prolonged hospital stay, and death) were investigated using multivariable logistic regression analysis. All patients were followed for more than a month. RESULTS: One-hundred thirty patients (76 males, 58.46 %) were included in the study. Fifteen patients (11.54 %) were intubated, 24 patients (18.46 %) had prolonged hospital stay, and eight patients (6.15 %) died during follow-up. Patients with comorbidity had a higher mean of PSS (6.3 + 4.5 vs 3.9 + 3.8; p = 0.001). After adjusting the confounders, PSS was an independent predictor of intubation (adjusted Odds Ratio [OR]: 1.73, 95 % CI 1.31-2.28, p < 0.001), prolonged hospital stay (OR: 1.20, 95 % CI 1.09-1.33, p < 0.001), and death (OR: 2.13, 95 % CI 1.1-4.13, p = 0.026. PMI value was a predictor of prolonged hospital stay (OR: 0.83, 95 % CI 0.72-0.96, p = 0.038) and death (OR: 0.53, 95 % CI 0.29-0.96, p = 0.036). Incrementally increasing PMA value was a predictor of prolonged hospital stay (OR: 0.93, 95 % CI 0.89-0.98, p = 0.01) and intubation (OR: 0.98, 95 % CI 0.96-1, p = 0.036). CONCLUSION: PSS, PMA, and PMI values have prognostic value in adult COVID-19 patients and can be easily assessed on chest CT images.

The association between the route of nutrition and serum levels of adipokines in critical illness: a pilot study

Background/aim: Adipokines play an important role in the regulation of metabolism. In critical illness, they alter serum levels and are suspected to worsen clinical outcomes. But the effect of the route of nutrition on adipokines is not known. The purpose of this study was to evaluate the association between the route of nutrition and adipokine levels in critically ill patients. Materials and methods: This prospective study was performed in an intensive care unit (ICU). Patients admitted to the ICU for least 72 h and receiving either enteral nutrition (EN) via tube feeding or parenteral nutrition (PN) were enrolled. Serum was obtained at baseline, 24 h, and 72 h for concentrations of leptin, adiponectin, resistin, glucagon­like peptide 1 (GLP­1), insulin­like growth factors 1 (IGF­1), and ghrelin. Results: A total of 26 patients were included in the study. Thirteen patients received EN and 13 patients received PN. In the PN group, leptin level significantly increased (P = 0.037), adiponectin and ghrelin significantly decreased during follow up (P = 0.037, P = 0.008, respectively). There was no significant change between all adipokines in the EN group and resistin, IGF­1 and GLP­1 in the PN group during follow up. Resistin levels were markedly lower in the EN group at both 24 h (P = 0.015) and 72 h (P = 0.006) while GLP­1 levels were higher in the EN group at baseline, 24 h, and 72 h (P = 0.018, P = 0.005, and P = 0.003, respectively). There were no differences in leptin, adiponectin, IGF­1, and ghrelin levels over time. Conclusion: The delivery of EN in critical illness was associated with decreased resistin levels and increased GLP­1 levels. Thus, the route of nutrition may impact the clinical outcome in critical illness due to adipokines.

Acute Effects of Red Bull Energy Drinks on Atrial Electromechanical Function in Healthy Young Adults.

Energy drinks (EDs) are widely consumed by adolescents and young adults. Almost all kinds of arrhythmias have been reported following EDs consumption, most of which is atrial fibrillation (AF). Atrial conduction time prolongation and heterogeneous sinusal impulses propagation to the atriums are the key electrophysiological mechanisms leading AF. We aimed to evaluate the acute effects of Red Bull ED ingestion on atrial electromechanical conduction times in healthy young adults. After a 12-hour fasting, 54 healthy young adults consumed 330 mL of Red Bull ED. Atrial electromechanical coupling (PA), intra-atrial electromechanical delay (intra-AEMD), and interatrial electromechanical delay (inter-AEMD) were measured at baseline and 2-hour after Red Bull ED ingestion by echocardiographic tissue-Doppler imaging (TDI) method. PA-lateral (49.7 ± 11.2 vs 54.1 ± 11.0 msn, p = 0.001) and PA-septal (40.8 ± 9.1 vs 43.7 ± 10.5 msn, p = 0.032) times were statistically significantly prolonged after Red Bull ED ingestion. There was also a statistically significant increase in the duration of inter-AEMD (14.4 ± 10.6 vs 18.1 ± 8.5 msn, p = 0.010) after ED ingestion. It was showed that even a single can of ED can acutely increase atrial electromechanical conduction times in young adults. These findings may be the cause of ED-associated AF.

Thiamin Status in Adults Receiving Chronic Diuretic Therapy Prior to Admission to a Medical Intensive Care Unit: A Pilot Study.

BACKGROUND: The aim of the study was to determine serum thiamin concentrations in critically ill medical patients who required chronic diuretic drug treatment before admission to a medical intensive care unit (ICU). METHODS: This prospective study was performed in a medical ICU. Subjects who received diuretic drug therapy for at least 6 months prior to ICU admission constituted the diuretic group. The control group was clinically matched adults admitted to the same ICU but without a history of diuretic therapy. RESULTS: A total of 50 subjects were included (25 subjects in each of the diuretic and control groups). In the diuretic group, daily dose of furosemide prior to admission was 40 mg/d (range of 20-160 mg/d). In all subjects, the ICU admission baseline blood thiamin concentrations were 31.2 ± 27.1 ng/mL. In the diuretic group, the baseline whole blood thiamin level was significantly lower compared with levels in the control group (15.5 ± 10.7 vs 46.8 ± 29.5 ng/mL; P < 0.001). On day 2 after entry, thiamin levels remained low (23.2 ± 15.4 ng/mL in the diuretic group vs 49 ± 38 ng/mL in the control group; P = 0.003). Low thiamin levels were found in 96% of patients at baseline and in 72% of patients on the second day in the diuretic group. CONCLUSION: Adults receiving chronic diuretic therapy and then requiring medical ICU care commonly exhibit thiamin depletion on admission to the ICU and during the initial days of ICU care.

Investigation of the effects of major ozone autohemotherapy application on erythrocyte deformability and aggregation.

BACKGROUND: Ozone is used intensively worldwide in treatment and research of various pathologies due to its healing effects. OBJECTIVE: The aim of this study is to investigate the effect of major ozone autohemotherapy on erythrocyte deformability and aggregation. METHODS: 10 and 50µg/ml doses of ozone was applied for 20 minute to venous blood samples obtained from 10 healthy male volunteers. Erythrocyte aggregation, deformability were measured by an ektacytometer. Total oxidant status, total antioxidant status were measured via a commercial kit. The oxidative stress index was calculated. RESULTS: Ozone at 10 and 50µg/ml doses did not alter erythrocyte aggregation. 50µg/ml ozone increased red blood cell (RBC) deformability measured at 0.53 Pa. Compared with the Control value, there was a significant increase in TOS, TAS for the doses of 10 and 50µg/ml. The increase in TAS was found to be more significant at 10µg/ml dose. The most obvious increase in OSI value was observed at 50µg/ml. CONCLUSION: Our results demonstrate that although 10µg/ml ozone has no effect on hemorheology, 50µg/ml ozone concentration has positive effects on RBC deformability, thus circulation at 0.53 Pa corresponding to the shear stress encountered during venous circulation.

Outcomes for haematological cancer patients admitted to an intensive care unit in a university hospital.

BACKGROUND: Haematological cancer (HC) patients are increasingly requiring intensive care (ICUs). The aim of this study was to investigate the outcome of HC patients in our ICU and evaluate 5 days-full support as a breakpoint for patients' re-assessment for support. METHODS: Retrospective study enrolling 112 consecutive HC adults, requiring ICU in January-December 2015. Patients' data were collected from medical records and Infection Control Committee surveillance reports. Logistic regression analysis was performed to identify independent risk factors for ICU mortality. RESULTS: Sixty-one were neutropenic, and 99 (88%) had infection at ICU admission. Acute myeloid leukaemia was diagnosed in 43%. Thirty-five (31%) were hematopoietic stem cell transplant recipients. Only 17 (15%) were in remission. Eighty-nine underwent mechanical ventilation on admission. Fifty-three patients acquired ICU-infection (35 bacteremia) being gram negative bacteria (Klebsiella pneumoniae and non-fermenters) the top pathogens. However, ICU-acquired infection had no impact on mortality. The overall ICU and 1-year survival rate was 27% (30 patients) and 7% (8 patients), respectively. Moreover, only 2/62 patients survived with APACHE II score ≥25. The median time for death was 4 days. APACHE II score ≥25 [OR:35.20], septic shock [OR:8.71] and respiratory failure on admission [OR:10.55] were independent risk factors for mortality in multivariate analysis. APACHE II score ≥25 was a strong indicator for poor outcome (ROC under curve 0.889). CONCLUSIONS: APACHE II score ≥25 and septic shock were criteria of ICU futility. Our findings support the full support of patients for 5 days and the need to implement a therapeutic limitations protocol.

Evaluation of chromosomal DNA damage, cytotoxicity, cytostasis, oxidative DNA damage and their relationship with endocrine hormones in patients with acute organophosphate poisoning.

Pesticides are commonly used compounds in agriculture. Especially, organophosphates (OPs) are among the extensively used pesticides. Therefore, OPs poisoning is common, especially in underdeveloped and developing countries. Primary aim of this study was to research the effects of acute OPs poisoning on genome instability in the individuals' lymphocytes with acute OPs poisoning both by using the cytokinesis-block micronucleus cytome (CBMN-cyt) assay to examine chromosome/genome damage, cell proliferation index and cell death rate and by using the plasma 8-hydroxy-2'-deoxyguanosine (8-OHdG) levels to determine oxidative DNA damage. Secondary aim of this study was also to assess whether a relation exists between endocrine hormones and the genome damage in acute OPs poisoning. In the study, blood samples were analysed of 13 patients before and after treatment admitted to the Department of Intensive Care Unit with acute OPs poisoning and of 13 healthy subjects of similar age and sex. The present study demonstrates that genome damage (micronucleus; MN and nucleoplasmic bridges; NPBs frequencies), apoptotic and necrotic cell frequencies increased in lymphocytes of patients with acute OPs poisoning before treatment and decreased after treatment. The present study also show that CBMN cyt assay parameters and 8-OHdG levels could be affected by some endocrine hormones such as E2, fT3, fT4, GH, IGF-1, FSH, LH, TSH, PRL, but not be related to ACTH and tT levels in acute OPs poisoning. In conclusion, it is believed that this is the first study to evaluate the chromosomal/oxidative DNA damage, cell proliferation, cell death and their associations with endocrine hormones in acute OPs poisoning. These preliminary findings need to be supported by further studies with larger sample sizes.

Increased erythrocyte aggregation and oxidative stress in patients with idiopathic interstitial pneumonia.

BACKGROUND: Hemorheological properties are important determinants of tissue oxygenation. Although hemorheological alterations in various lung diseases have been well-defined, no information is available about the effects of idiopathic interstitial pneumonia (IIP) on hemorheological parameters. OBJECTIVES: The aim of this study was to investigate hemorheological parameters (erythrocyte deformability, aggregation, and plasma viscosity -PV) and associated oxidative stress indices in patients with IIP. METHODS: The study enrolled 31 patients (9 Idiopathic pulmonary fibrosis (IPF), 10 non-specific Interstitial Pneumonia (NSIP), 12 Cryptogenic Organising Pneumonia (COP) and 33 healthy controls. Erythrocyte deformability and aggregation were measured by an ektacytometer. PV was determined by a cone-plate rotational viscometer and oxidative stress via a commercial kit. RESULTS: Erythrocyte aggregation, total oxidant status (TOS) and oxidative stress index (OSI) of IIP patients were higher than controls whereas erythrocyte deformability, PV and total antioxidant status (TAS) were unaltered. CONCLUSIONS: Increment of oxidative stress in IIP seems to depend on enhancement of oxidants, rather than alteration of antioxidants. The issue that, elevated erythrocyte aggregation may further impair tissue oxygenation by disturbing microcirculation in IIP, may be considered in the follow up and development of new treatment protocols for this disease.

Detraining reverses exercise-induced improvement in blood pressure associated with decrements of oxidative stress in various tissues in spontaneously hypertensive rats.

This study aimed to investigate the effects of moderate intensity swimming exercise (10 weeks) followed by detraining (for five and 10 weeks) on oxidative stress levels of heart, lung, kidney, and liver tissues and systolic blood pressure (SBP) of spontaneously hypertensive rats (SHR). SHR and control rats were randomized into sedentary, exercised, detrained (5 weeks) and late-detrained (10 weeks) groups. Corresponding sedentary rats were grouped as time 1-2-3. Exercise of 60 min, 5 days/week/10 weeks was applied. Detraining rats underwent the same training protocol and then discontinued training during next 5, 10 weeks. SBP was measured by tail-cuff method. Tissue total oxidant/antioxidant status was measured using a commercial kit and oxidative stress index (OSI) was calculated. Exercise training slightly decreased tissue OSI of SHR and reduced SBP of both groups. Tissue OSI of SHR were higher than WKY and aging resulted in increment of oxidants in groups. detraining yielded time-dependent increments in oxidative stress of all tissues and SBP of both rat groups. Although short-term cessations may be tolerated, our results emphasize the importance of exercising as a way of life for cardiovascular well-being in hypertensives or in individuals who are genetically under risk of hypertension.

Prognostic value of excision repair cross-complementing gene 1 expression for cisplatin-based chemotherapy in advanced gastric cancer.

BACKGROUND: Association of excision repair cross-complementing gene 1 (ERCC1) expression and treatment response and survival was evaluated in advanced stages of gastric cancer patients who were given different platinum-based chemotherapy. PATIENTS AND METHODS: Forty-one patients with advanced gastric cancer were enrolled into the study from January 2000 to December 2009. ERCC1 expression was evaluated by immunohistochemistry (IHC). RESULTS: Thirteen of the 41 patients (31%) were shown to have ERCC1 positive lesions. Although the clinical benefit from platin based chemotherapy was the same for ERCC1 positive and negative patients, survival times were statistically significantly better in ERCC1 negative gastric cancer patients. CONCLUSION: We suggest that IHC studies for ERCC1 may be useful in prediction of the clinical outcome of advanced gastric cancer patients treated with platin-based chemotherapy.