The COVID-19 pandemic continues its effects worldwide. In addition, the investigation of the clinical prognostic risk factors and the treatment options for the disease continue. Coenzyme Q10 is an ...important antioxidant that plays a role in membrane stability, energy conversion and ATP production. In the literature, studies showing the relationship of coenzyme Q10 level with disease course and survival in critical COVID-19 patients are very limited. In our study, it is aimed to examine the clinical effects of coenzyme Q10 level in COVID-19 patients in intensive care.
After Ethics Committee Approval, COVID positive and suspected patients over 18 years of age who were admitted to the Hacettepe University Anesthesiology and Reanimation Intensive Care Unit between 1st January 2021 and 1st January 2022 were included in the study. Patients were divided into two groups as positive and negative. Criteria for the COVID-19 negative group; consecutive 4 negative PCR of the patient and the symptoms during hospitalization such as respiratory failure, general conditional disorder and gastrointestinal symptos could be explained by another clinical condition. Demographic data, comorbidities, admission symptoms, COVID-19 PCR results, APACHE-II and SOFA scores, length of stay, laboratory results, coenzyme Q10 levels, mechanical ventilation and vasopressor requirement and mortality of the patients were recorded prospectively. The relationship between coenzyme Q10 level with clinical findings, in-hospital morbidity and mortality was analyzed by statistical methods.
Positive group has 96 and negative group has 62 patients. When factors related to coenzyme Q10 level at hospitalization were investigated, it was observed that the median coenzyme Q10 level was significantly higher in women than in men (1.28 and 1.18, p = 0.035). Malignancy (p = 0.008), neurological disease (p = 0.038), and malnutrition (p = 0.001) were associated with low coenzyme Q10 levels. No correlation was found between coenzyme Q10 level and vasopressor therapy, mechanical ventilation, RRT, and mortality. In addition, the presence of malnutrition was shown to increase the risk of mortality in the ICU 3-fold (HR: 3, 95% CI: 1.6–5.4, p < 0.001). In our study, no demographic and clinical factors related to coenzyme Q10 levels were found between the COVID positive and negative groups.
It has been shown that plasma coenzyme Q10 level alone cannot be a factor predicting mortality and morbidity in this patient group. However, it should be kept in mind that low coenzyme Q10 level is an important component of malnutrition and malnutrition may be a significant risk factor for mortality.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Comparative validation and clinical performance data are essential for the reliable interpretation of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) antibody test results. This study ...aimed to assess the performance of six SARS-CoV-2 IgG immunoassays in the context of different disease severities. Four automated chemiluminescence immunoassays (Access Beckman Coulter, Architect Abbott, Atellica-IM Siemens, and Elecsys Roche) as well as two ELISA assays (SARS-CoV-2 IgG-S1-based and NCP IgG Euroimmun) were evaluated using samples from 143 patients as well as 50 pre-pandemic control serum samples. Accuracy and precision tests were performed for validation purposes. Overall sensitivity ranged between 73.38–88.65% and was higher in spike protein-based assays, while the specificity was ≥98% in all immunoassays. The clinical performance of the immunoassays differed depending on disease severity and target antigen. For instance, the IgG response was lower for samples taken <20 days post-symptom onset (87.30%) compared with those taken ≥20 days post-symptom onset (94.80%). Moreover, moderate disease levels led to the highest levels of IgG. Higher levels of antibodies were detected in the clinically moderate disease group. In asymptomatic and mild groups, more antibody positivity was detected with spike protein-based assays. All the assays tested could be used to detect SARS-CoV-2 IgG. However, spike-based assays revealed relatively higher sensitivity rates than nucleoprotein-based assays, particularly in cases of asymptomatic and mild disease.
It is still not fully understood how to predict the future prognosis of patients at the diagnosis coronavirus disease 2019 (COVID‐19) due to the wide clinical range of the disease. We aimed to ...evaluate whether severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) viral load could predict the clinical course of pediatric patients. This study was conducted retrospectively with medical records of pediatric patients who were tested for SARS‐CoV2 between April 12 and October 25, 2020 in the University of Health Sciences, Ankara Educating and Training Hospital and Hacettepe University Faculty of Medicine. We evaluated 518 pediatric patients diagnosed with COVID‐19 and classified according to severity as asymptomatic (16.2%), mild (59.6%), moderate (20.2%), and critical/severe (3.9%) cases. We analyzed patients in four groups in terms of ages: <4, 5‐9, 10–14, and 15–17 years. There was no statistically significant difference in terms of ∆Ct value among age groups, different gender and the existence of underlying diseases in each disease course. The ∆Ct values were relatively lower in the first 2 days of symptoms than after days in all groups. Our study has indicated that children with COVID‐19 have similar amount of viral load in all disease courses irrespective of the age and underlying disease. It should be taken into account that, regardless of the severity of the disease, pediatric patients may have a role in the transmission chain.
Research Highlights
Children with COVID‐19 can carry similar amount of viral load in all disease courses irrespective of the age and underlying disease.
The viral load has no prediction utility in terms of the clinical course of children with COVID‐19.
Regardless of the severity of the disease, pediatric patients may have a role in the transmission chain.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
We aimed to evaluate the seroconversion rates after two doses of inactive COVID‐19 vaccine (CoronaVac) and the benefit of a third dose mRNA vaccine booster in patients with cancer receiving active ...treatment. Patients with solid tumors receiving active treatment (n = 101) and patients with no‐cancer (n = 48) as the control group were included in the study. All the patients and controls had received two doses of CoronaVac and a third booster dose of the mRNA vaccine (Bnt162b2). Anti‐SARS‐CoV‐2 Spike Receptor Binding Domain IgG antibody levels after the second and third dose were measured with quantitative ELISA. The median age of the patients was 66 (IQR 60‐71). 79% of the patients were receiving chemotherapy, and 21% were receiving immunotherapy at the time of vaccination. Antibody levels measured after two doses of CoronaVac were significantly lower in patients with cancer than in the control group (median 0 μg/ml IQR 0‐1.17 μg/ml vs median 0.91 μg/ml IQR 0‐2.24 μg/ml, respectively, P = .002). Seropositivity rates were 46.5% in patients with cancer and 72.9% in the control group (P = .002). Antibody measurement was performed in 26 patients after the third dose. Seroconversion rate increased from 46.5% to 88.5% (P < .001), and the antibody titers significantly increased with the third‐dose booster (median 0 μg/ml IQR 0‐1.17 μg/ml after two doses vs 12.6 μg/ml IQR 1.8‐69.1 μg/ml after third booster dose, P < .001). Immunogenicity of CoronaVac is low in patients with cancer receiving active treatment, and administering a third dose of an mRNA vaccine is effective in terms of improving seroconversion rates.
What's new?
The existing data on the efficacy of inactive COVID‐19 vaccines and the benefit of heterologous boosters remains limited in patients with cancer, who may be immunocompromised by cancer itself or anti‐cancer treatments. This study shows that the immunogenicity of two doses of inactive COVID‐19 vaccine is lower in patients with cancer receiving active treatment compared with controls. Administering a third booster dose of an mRNA vaccine significantly improves seroconversion rates in these patients. The results could be important for clinical practice considering the limited access to mRNA vaccines in several parts of the world.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Background
We aimed to compare the clinical findings of human bocavirus (HBoV) and human metapneumovirus (HMPV) infections, and to analyze the effects of coinfections on clinical features and disease ...severity in children with HBoV and HMPV infections.
Methods
Data were collected from 125 children with lower respiratory tract infections due to HBoV or HMPV, detected from nasal swap by real‐time polymerase chain reaction (PCR) during the period from January, 2013 to December, 2017. In total, there were 101 HBoV (group 1) and 23 HMPV (group 2) infections in our data. The patients were further divided into four subgroups according to the coinfection status: HoBV only (subgroup 1, n = 41), HMPV only (subgroup 2, n = 19), HBoV and coinfection with other respiratory viruses (subgroup 3, n = 60), and HMPV and coinfection with other respiratory viruses (subgroup 4, n = 4).
Results
The majority (88.8%) of the patients were aged 5 years or younger. Coinfections with other respiratory viruses were significantly more common in group 1 (P = 0.001). Among patients who had nosocomial pneumonia, patients with HBoV infections had significantly longer mean length of hospital stay (LOS) than those with HMPV infections (P = 0.032). The hospitalization and antibiotic requirements were significantly higher in subgroup 1 than subgroup 3 (P = 0.005, 0.039, resp.) According to the logistic regression analyses, the LOS increased by 21.7 times with HBoV infections (P = 0.006).
Conclusions
Human bocavirus and HMPV infections are serious pathogens mostly seen in children and usually requiring hospitalization regardless of co‐infection status. The HBoV infections caused longer LOS than the HMPV infections in patients with nosocomial infections.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Severity of disease caused by influenza virus and the influencing factors that may be different. Moreover, the disease course actually may not be determined specifically in children because of lower ...seroprotection rates of children. Herein, the results clinic and outcome data of children with influenza from Turkey were reported. We present here the results from 2013 to 2017. Nasopharyngeal swab samples of the children with influenza were investigated via multiplex polymerase chain reaction. A total of 348 children were diagnosed with influenza; 143 (41.1%) were influenza A, 85 (24.4%) were influenza B, and 120 (34.5%) were mixt infection with other respiratory viruses. Fifty‐four percent of children admitted to intensive care unit (ICU) were under 2 years of age (p = .001). Having an underlying disease was detected as the main predictor for both hospitalization and ICU stay according to multiple logistic regression analysis (odds ratio OR, 11.784: 95% confidence interval CI, 5.212–26.643; p = .001 and OR, 4.972: 95% CI, 2.331–10.605; p = .001, respectively). Neurological symptoms most frequently seen in cases who died (44.4%; p = .02). Lymphopenia was relatively higher (55.6%) and thrombocytopenia was most frequently seen in cases who died (77.8%) with a significant ratio (p = .001). Underlying diseases was found a risk factor for influenza being hospitalized and being admitted to ICU. Children under 2 years of age and with underlying diseases should be vaccinated particularly in countries where the influenza vaccination is still not routinely implemented in the immunization schedule.
Highlights Underlying diseases is a risk factor for influenza to be hospitalized and admitted to ICU. Influenza vaccination is of great importance to prevent life‐threatening complications of influenza, particularly in children require ICU admission. The possibility to reduce the outpatient visit number by vaccination has a great impact on disease burden in addition to the underestimated crucial social benefits, as well.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Epstein-Barr Virus-Associated Smooth Muscle Tumor (EBV-SMT) is a rare tumor with a higher rate of occurrence in unusual locations in the setting of immunodeficiency. In this study, we evaluated a ...cohort of ordinary leiomyosarcomas (LMS) for the presence of EBV and described the clinicopathological features deviating from routinely diagnosed cases of EBV-SMT.
The sections of tissue microarrays including 93 classical LMS occurring in various locations were hybridized with EBER and stained for LMP1 antibody using the Leica Bond Autostainer. EBV real-time PCR assay was performed in 2 EBER-positive cases.
Among the 93 LMS cases, 2 non-uterine cases (2.2%) were positive for EBER and negative for LMP1, and were referred to as `EBV-positive LMS`. Both were females in their 6th decade without immunosuppression. EBV real-time PCR assay revealed the presence of EBV in one of the cases. Tumors were located in the pancreas and chest wall. Morphologically, tumors were rather myxoid, multinodular, and composed of long fascicles of spindle cells with intermediate- to high-grade features. High mitotic activity and focal necrosis were present, whereas no accompanying lymphocytes were detected. One of the patients developed metastatic disease after 3 years.
EBV-positive LMS occurring in immunocompetent patients has features distinct from classical EBV-SMT seen in immunosuppressed patients.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Background
Non‐tuberculous mycobacteria (NTM) can cause chronic lung infection particularly in patients who have structural lung disease such as cystic fibrosis (CF). We evaluated the incidence and ...management of NTM infections in patients with CF in our center.
Methods
A retrospective cohort study was carried out on CF patients having at least one positive NTM isolate between 2012 and 2020.
Results
Ten patients (2.1%) had at least one positive NTM culture from respiratory samples. All of them were vaccinated with Bacille Calmette–Guérin (BCG) vaccine, which is in the national vaccination program in our country. Eight patients had the Mycobacterium abscessus complex, one had Mycobacterium avium, and one had Mycobacterium szulgai growth in their respiratory samples. Three patients had transient NTM infection, two had persistent, and five had active NTM infection (NTM pulmonary disease). Patients with NTM pulmonary disease received antibiogram‐directed antimycobacterial therapy. In patients with NTM pulmonary disease, the median ppFEV1 and BMI decreased by 17% and 1%, respectively, at the time of the first NTM isolation when compared with the values one year before the first NTM isolation. Culture conversion was not seen in any patient infected with Mycobacteriunm abscessus complex.
Conclusions
The NTM infection incidence is lower in our country than in those countries where the BCG vaccine is not routinely applied. The BCG vaccine may be a protective factor for NTM infection. Further studies are needed about the prevalence of NTM infections, facilitating and protective factors, and appropriate management of NTM infections in patients with CF.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
We present demographic, clinical, laboratory characteristics and outcomes of the patients with solid malignancies and novel coronavirus disease (COVID‐19) collected from the National COVID‐19 ...Registry of Turkey. A total of 1523 patients with a current or past diagnosis of solid tumors and diagnosed with COVID‐19 (confirmed with PCR) between 11 March and 20 May 2020 were included. The primary outcome was 30‐day mortality. Median age was 61 (range: 18‐94), and 752 (49%) were male. The most common types of cancers were breast (19.8%), prostate (10.9%) and colorectal cancer (10.8%). 65% of the patients had at least one comorbidity. At least one COVID‐19‐directed therapy was given in 73% of the patients.. Hospitalization rate of the patients was 56.6% and intensive care unit admission rate was 11.4%. Seventy‐seven (5.1%) patients died within 30 days of diagnosis. The first multivariate model which included only the demographic and clinical characteristics showed older age, male gender and presence of diabetes and receipt of cytotoxic therapy to be associated with increased 30‐day mortality, while breast and prostate cancer diagnoses were associated with lower 30‐day mortality. In the second set, we further included laboratory parameters. The presence of leukocytosis (OR 6.7, 95% CI 3.3‐13.7, P < .001), lymphocytopenia (OR 3,1, 95% CI 1,6‐6,1, P = .001) and thrombocytopenia (OR 3,4 95% CI 1,5‐8,1, P = .005) were found to be associated with increased 30‐day mortality. Relatively lower mortality compared to Western countries and China mainly results from differences in baseline risk factors but may also implicate the importance of intensive supportive care.
What's new?
Patients with cancer represent a vulnerable population to COVID‐19 due to the immune‐suppressive effect of the treatment and disease itself, their older age, and the frequent presence of comorbid diseases. In this cohort analysis of 1523 patients with solid tumors diagnosed with COVID‐19, the 30‐day mortality rate was found to be 5.1%. Cancer type, older age, male gender, diabetes, and cytotoxic treatment within 4 weeks were significant clinical predictors of increased mortality. The relatively lower mortality compared with Western countries and China mainly results from differences in baseline risk factors, but may also implicate the importance of intensive supportive care.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Background
Respiratory viruses (RVs) are frequently present in the airways of patients with cystic fibrosis (CF) during pulmonary exacerbations (PEx).
Method and Objectives
This prospective, ...longitudinal study was performed to examine the role of RVs in acute exacerbations in children with CF. Sputum samples or additional midturbinate swabs were tested from all children using a polymerase chain reaction panel. The primary aims of the study were to determine the prevalence and etiologic role of RVs in exacerbations of CF and to compare changes with RV‐positive and RV‐negative infections. The secondary aims were to determine the predictive factors for RV‐related exacerbations.
Results
From 50 patients with PEx, 23 (48.9%) sputum samples were virus‐positive. With a combination of sputum and swab, viral positivity increased to 56%. The virus‐positive group presented more frequently with hypoxia (oxygen saturation <93%) than the virus‐negative group (P = .048). Virus‐positive exacerbations were not associated with an increase in colonization rates or greater lung function decline over 12 months.
Conclusions
RVs frequently present during PEx of CF. However, predicting viral infections is difficult in this group. Only the presence of hypoxia may raise the suspicion of an accompanying viral agent. The combination of sputum and nasal swab samples increases the diagnostic yield in viral infections of CF. Despite their high frequency, the presence of RVs had no impact on clinical outcomes, such as a decline in lung function and increased colonization rates.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
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