Evaluation of the effectiveness and safety of adding ivermectin to treatment in severe COVID-19 patients.

BACKGROUND AND OBJECTIVES: An effective treatment option is not yet available for SARS-CoV2, which causes the COVID-19 pandemic and whose effects are felt more and more every day. Ivermectin is among the drugs whose effectiveness in treatment has been investigated. In this study; it was aimed to investigate the presence of gene mutations that alter ivermectin metabolism and cause toxic effects in patients with severe COVID-19 pneumonia, and to evaluate the effectiveness and safety of ivermectin use in the treatment of patients without mutation. MATERIALS AND METHODS: Patients with severe COVID19 pneumonia were included in the study, which was planned as a prospective, randomized, controlled, single-blind phase 3 study. Two groups, the study group and the control group, took part in the study. Ivermectin 200 mcg/kg/day for 5 days in the form of a solution prepared for enteral use added to the reference treatment protocol -hydroxychloroquine + favipiravir + azithromycin- of patients included in the study group. Patients in the control group were given only reference treatment with 3 other drugs without ivermectin. The presence of mutations was investigated by performing sequence analysis in the mdr1/abcab1 gene with the Sanger method in patients included in the study group according to randomization. Patients with mutations were excluded from the study and ivermectin treatment was not continued. Patients were followed for 5 days after treatment. At the end of the treatment and follow-up period, clinical response and changes in laboratory parameters were evaluated. RESULTS: A total of 66 patients, 36 in the study group and 30 in the control group were included in the study. Mutations affecting ivermectin metabolism was detected in genetic tests of six (16.7%) patients in the study group and they were excluded from the study. At the end of the 5-day follow-up period, the rate of clinical improvement was 73.3% (22/30) in the study group and was 53.3% (16/30) in the control group (p = 0.10). At the end of the study, mortality developed in 6 patients (20%) in the study group and in 9 (30%) patients in the control group (p = 0.37). At the end of the follow-up period, the average peripheral capillary oxygen saturation (SpO2) values of the study and control groups were found to be 93.5 and 93.0%, respectively. Partial pressure of oxygen (PaO2)/FiO2 ratios were determined as 236.3 ± 85.7 and 220.8 ± 127.3 in the study and control groups, respectively. While the blood lymphocyte count was higher in the study group compared to the control group (1698 ± 1438 and 1256 ± 710, respectively) at the end of the follow-up period (p = 0.24); reduction in serum C-reactive protein (CRP), ferritin and D-dimer levels was more pronounced in the study group (p = 0.02, p = 0.005 and p = 0.03, respectively). CONCLUSIONS: According to the findings obtained, ivermectin can provide an increase in clinical recovery, improvement in prognostic laboratory parameters and a decrease in mortality rates even when used in patients with severe COVID-19. Consequently, ivermectin should be considered as an alternative drug that can be used in the treatment of COVID-19 disease or as an additional option to existing protocols.

Evaluation of clinical features and laboratory findings in critical intensive care unit patients with severe coronavirus disease-19 who underwent extracorporeal cytokine adsorption.

AIM: To evaluate the inflammatory parameters and oxygenation in severe coronavirus disease-19 patients who underwent extracorporeal cytokine adsorption (CA). METHODS: Patients who underwent extracorporeal CA for cytokine storm were included in the study. The changes in oxygenation, laboratory parameters, and mortality rates were investigated. RESULTS: Thirty-six patients were included in the study. The hemoglobin, thrombocyte, and C-reactive protein (CRP) decreased, and PaO2 /FiO2 ratio increased (p < 0.001; p < 0.01; p < 0.001; p = 0.04, respectively). Twelve (33.3%) patients received a single session, 24 (66.6%) received 2 or more sessions. CRP and fibrinogen levels decreased, and PaO2 /FIO2 ratio increased in the single session group (p = 0.04; p = 0.04; p = 0.01, respectively). In the multi-session group, the hemoglobin, platelet, procalcitonin, and CRP levels decreased, and PaO2 /FIO2 ratio increased (p < 0.01; p = 0.02; p = 0.02; p < 0.01; p = 0.01, respectively). Day 15, 30, and 90 mortality rates were 61.1%, 83.3%, and 88.9%. CONCLUSION: CA with hemoperfusion reduced CRP and improved oxygenation; however, mortality rates were high.

The Relationship between Mortality and the Modified Nutrition Risk in Critically Ill (mNUTRIC) and Nutritional Risk Screening 2002 (NRS-2002) Scores in the Intensive Care Unit.

OBJECTIVE: To measure the effects on mortality of the Modified Nutrition Risk in Critically Ill (mNUTRIC) and Nutritional Risk Screening 2002 (NRS-2002) scores in critical patients in the Intensive Care Unit (ICU) and to investigate the relationship between macronutrient deficiency and the mNUTRIC and NRS-2002 scores. STUDY DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: The Department of Intensive Care, Burdur Public Hospital, Turkey, between 01st October 2019 and 01st November 2021. METHODOLOGY: The study included 311 patients aged >18 years, treated in the ICU for more than 7 days, and who received more than 48 hours of mechanical ventilation when required. The patients were divided into two groups according to calorie sufficiency as those who received <70% or >70% of the energy calculated for the first 5 days in ICU. RESULTS: Of the 311 patients included in the study, the high nutritional risk was determined in 20.9% according to the NRS-2002, and 62.7% according to the mNUTRIC. In patients classified as having high nutritional risk in nNUTRIC (score ≥5), the in-hospital mortality risk was 3-fold higher (p<0.001), and in patients classified as having high nutritional risk in NRS-2002 (score ≥5), it was 2-fold higher (p=0.002). There was a strong relationship found between a high mNUTRIC score and insufficient calorie intake and there was no relationship between the mNUTRIC score and protein intake (p=0.058). CONCLUSION: While the mNUTRIC score was a significant scoring system to show 28-day in-hospital survival, the efficacy of NRS-2002 in showing mortality could not be demonstrated. KEY WORDS: Intensive care unit, Mortality, mNUTRIC, Nutritional status, NRS-2002.

Magnesemia in COVID-19 ICU patients: the relationship between serum magnesium level and mortality

Objective: This study aimed to investigate the relationship between serum magnesium (Mg) levels at the time of admission and survival in COVID-19 patients followed in the intensive care unit (ICU). Methods: In total, 461 patients over the age of 18 diagnosed with the COVID-19, followed in the COVID-19 ICU of our hospital, were included. Patients whose files could not be accessed were excluded. Data on patients' demographics, clinical features, and laboratory data were compared according to the Mg levels measured during their admission to the ICU. The patients were divided into five groups according to their Mg level: Group 1 (<1.8 mg/dL), Group 2 (1.8-<2 mg/dL), Group 3 (2-<2.2 mg/dL), Group 4 (2.2-<2.4 mg/dL), and Group 5 (>2.4 mg/dL). Results: For patients with Mg value of <2 mg/dL, the proportion of males to females was roughly equal, however, the proportion of males was higher in other groups (p = 0.004). Overall, hypertension was the most common comorbid disease in patients, followed by diabetes mellitus in 32.1%. The latter was observed more frequently in Group 1 (<1.8 mg/dL) compared to the other groups (51.3%, p = 0.008). No significant difference was determined between the groups regarding laboratory values and treatments administered. Requirement of mechanical ventilation was significantly higher in Groups 1 (<1.8 mg/dL) and 5 (>2.4 mg/dL) than in other groups (p = 0.008). However, although mortality was also high in these groups, the difference was not statistically significant (p = 0.067). Conclusion: A correlation between serum Mg levels and mortality was not observed, but mortality and the need for mechanical ventilation were higher in groups with Mg levels <1.8 mg/dL and >2.4 mg/dL compared to other groups. We believe that it is critical to measure serum Mg levels while supporting COVID-19 patients with Mg in the ICU.

Neurological symptoms and findings in COVID-19: a prospective clinical study.

OBJECTIVE: We sought to evaluate neurologic symptoms and findings in patients with COVID-19 infection hospitalized in a ward and intensive care unit (ICU). METHODS: This study was designed as a prospective study. Hospitalized COVID-19 rRt-PCR positive patients in the ward and ICU were included in the study. A 54-item questionnaire was used to evaluate the patients. Patients were examined within 3 hours of hospitalization. RESULTS: A total of 379 patients were included in the study. The mean age of the patients was 56.1 ± 17.8. 89 of the patients were in intensive care. At least one general symptom was recorded in 95.5% of patients. The most common neurologic symptoms were myalgia (48.5%), headache (39.6%), anosmia (34.8%), and dysgeusia (34%). Neurological symptoms in ICU patients were higher than in the ward. 53.6% of patients had comorbidities. DISCUSSION: This study indicated that the prevalence of neurological symptoms was very high in patients with COVID-19. The percentage of neurological symptoms and findings was higher in patients hospitalized in ICU.

Visual and Quantitative Assessment of COVID-19 Pneumonia on Chest CT: The Relationship with Disease Severity and Clinical Findings.

BACKGROUND: Lungs are the primary organ involved in COVID-19, and the severity of pneumonia in COVID-19 patients is an important cause of morbidity and mortality. AIM: We aimed to evaluate the pneumonia severity through the visual and quantitative assessment on chest computed tomography (CT) in patients with coronavirus disease 2019 (COVID-19) and compare the CT findings with clinical and laboratory findings. METHODS: We retrospectively evaluated adult COVID-19 patients who underwent chest CT along with theirclinical scores, laboratory findings, and length of hospital stay. Two independent radiologists visually evaluated the pneumonia severity on chest CT (VSQS). Quantitative CT (QCT) assessment was performed using a free DICOM viewer, and the percentage of the well-aerated lung (%WAL), high-attenuation areas (%HAA) at different threshold values, and mean lung attenuation (MLA) values were calculated. The relationship between CT scores and the clinical, laboratory data, and the length of hospital stay were evaluated in this cross-sectional study. The student's t-test and chi-square test were used to analyze the differences between the variables. The Pearson correlation test analyzed the correlation between the variables. The diagnostic performance of the variables was assessed using the receiver operating characteristic (ROC) analysis. RESULTS: The VSQS and QCT scores were significantly correlated with procalcitonin, d-dimer, ferritin, and C-reactive protein levels. Both VSQ and QCT scores were significantly correlated with the disease severity (p < 0.001). Among the QCT parameters, the %HAA-600 value showed the best correlation with the VSQS (r = 730, p < 0.001). VSQS and QCT scores had high sensitivity and specificity in distinguishing disease severity and predicting prolonged hospitalization. CONCLUSION: The VSQS and QCT scores can help manage the COVID-19 and predict the duration of the hospitalization.

Serum neopterin levels in patients with HBV infection at various stages.

BACKGROUND/AIMS: Neopterin (NPT) level is elevated in a number of situations in which cellular immunity is active. In the present study, levels of serum NPT were measured in patients who were in different phases of hepatitis B virus (HBV) infection in order to determine if the NPT level can be considered a predictor for the stage of this infection. METHODOLOGY: A total of 120 patients were included in the study, patients were divided equally in four groups; each group consisted of 30 patients. Group I were non-replicative HBV carriers, Group II were immune to HBV, Group III were chronically infected with HBV, and the Group IV were healthy controls. Five ml of blood was drawn from each patient and serum NPT levels were measured by the ELISA technique. RESULTS: Mean NPT levels were found to be 14.80 +/-11.20 nmol/L, 19.73 +/- 18.40 nmol/L, 24.73+/-20.77 nmol/L, and 8.66 +/- 10.03 nmol/L in Group I, II, III and Group IV (the control group) respectively. The mean NPT levels were significantly higher in Group I, II and III than in the control group (Group IV) (p = 0.036, p = 0.010 and p = 0.001 respectively). CONCLUSIONS: Serum levels of NPT are elevated in all the patients in Group I, II and Group III as an indicator of cellular immunity which is activated in different levels. However, an increased level of NPT does not seem to be a sufficient indicator in determining the immunopathogenetic stages of this infection.

Anti-HCV positivity in sexual partners and offspring of patient with chronic hepatitis C.

We investigated the seroprevalence of HCV in stable sexual partners and offspring of chronic hepatitis C patients, and aimed to determine the risk factors involved. 191 anti-HCV and HCV RNA positive subjects who coinhabited with their spouse and/or offspring were included. Risk factors of index cases for disease transmission, liver biopsy results, anti-HCV and HCV-RNA in spouses and/or offspring were evaluated. Together with index cases, a total of 404 family members including 174 stable sexual partners and 230 offspring were included. The most common risk factors among index cases were dental procedures (73.8%), history of surgery (64.9%), and blood transfusions (24.1%). Anti-HCV positivity was established in 11 (2.7%) of the total 404 family contacts--6 sexual partners and 5 offspring. HCV seropositivity was significantly higher in the spouses of index cases with severe hepatitis C compared to those with mild to moderate hepatitis C (p=0.008), but there was no statistically significant correlation between the severity of liver disease in index cases and anti-HCV positivity in their offspring. In conclusion, anti-HCV seropositivity in the spouses and children of patients who are HCV-RNA positive HCV carriers does not appear to be higher than the HCV seroprevalence in our country.