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Aim: The aim of the study is to classify patients infected with Covid-19 in our population according to the radiological consensus defined by Radiology Society of North America (RSNA) and American College of Radiology (ACR) and to show the relationship of the patients with clinical-laboratory findings. Material and Methods: 127 cases (74 males, 53 females; age range 19-92 years) who applied to Ankara City Hospital with symptoms such as fever, cough and respiratory distress and whose laboratory findings were compatible with Covid-19 were included in our study. The thorax computed tomography (CT) findings of the cases were classified according to the RSNA criteria and their relationship with clinical-laboratory data was statistically evaluated. Results: 47.2% of them had fever, 62.2% cough, 22 dyspnea, 4.7% diarrhea and 28.3% fatigue-malaise symptoms. When the thorax CT findings were evaluated, 55% of the patients had a typical appearance, 21% intermediate appearance, 11% atypical appearance and 13% negative appearance. Conclusion: It is obvious that thoracic CT examination has many advantages in evaluating Covid-19 pneumonia. However, it was concluded that more observations should be made in order to classify the findings better and to reveal their relationship with clinical-laboratory findings.

Purpose: This study aims to evaluate the correlations between the severity of the disease and serum steroid levels by analyzing the serum steroid levels in COVID-19 patients with different levels of disease progression and the control group.Methods: Morning plasma Aldosterone, 11-deoxycortisol, Androstenedione, 17- hydroxyprogesterone, Dihydrotestosterone (DHT), Dihydroepiandrostenedion (DHEA), Corticosterone, Dihydroepiandrostenedion sulfate (DHEAS), Estrone, 11- deoxycorticosterone, Cortisol, Corticosterone, Androsterone, Pregnenolone, 17- hydroxypregnenolone levels were measured in 153 consecutive patients were grouped as mild, moderate, and severe based on the WHO COVID-19 disease severity classification and the control group. Steroid hormone levels were analyzed at once with a liquid chromatography-tandem mass spectrometric method (LC-MS/MS). Results: In our study, all of the steroids except DHT and DHEAS were statistically significantly higher in the patients’ group than in the control group (p>0.001). Also, DHEA was an independent predictor of the disease severity with COVID-19Conclusions: Our study reveals that altered steroid hormone levels have a negative impact on COVID-19 prognosis by simultaneous measurement of steroid hormones levels with LC-MS/MS. Also, adrenal insufficiency due to COVID-19 is an endocrinological pathology that should be followed up.

Objectives: The aim of this study was to share the results, follow-up, and treatment characteristics of our pregnant women who were followed-up with anti-Toxoplasma gondii Immunoglobulin (Ig) M positivity during pregnancy. Methods: Anti-T. gondii IgM- and IgG-positive pregnant women were evaluated between 2014-2018. Demographic characteristics, treatment, and information about pregnancy were obtained from the electronic database. Pregnant women were divided into three groups; primary infection, no infection, and suspected infection in pregnancy. Primary and suspected infection in pregnancy were followed up congenital toxoplasmosis risky pregnancy. Fetal ultrasonography (USG), T. gondii DNA polymerase chain reaction (PCR) result in amniotic fluid were recorded. Results: Twenty-four pregnant women with a mean age of 27.9 years were followed up. IgG avidity results were low in 37.5% (n = 9), intermediate avidity in 8.3% (n = 2), and high avidity in 54.2% (n = 13) of pregnant women. Eleven (45.9%) pregnant women had congenital toxoplasmosis risky pregnancy. Fetal USG was performed on ten pregnant women, and no signs of congenital toxoplasmosis were found. Amniocentesis was performed in 72.7% (n = 8) of the participants, and the amniotic fluid T. gondii DNA-PCR result was negative in all of them. Ten (90.9%) pregnancies resulted in mature birth and one (9.1%) resulted in miscarriage. Conclusions: Anti-T. gondii IgM positivity is an indication of acute infection. But IgM can persist for years, and be false-positive in pregnancy. Therefore, additional tests are required, and leading to emotional distress and unnecessary interventions in pregnacy women. These results can aid in developing an approach to screening and diagnosis of T. gondii infection in pregnancy.

Introduction: Candidemia causes high mortality and is occuring at increasing rate in intensive care units (ICUs). (1,3)- β-D-glucan (BDG) testing is recommended in neutropenic patients. However the usefulness of BDG in ICUs is unclear. Methodology: This study was conducted to compare the diagnostic value of Candida score (CS), colonization index (CI), serum BDG detection, and routine laboratory parameters in ICU patients. Characteristics and laboratory data of 83 patients (15 patients with candidemia and 68 patients without candidemia) were evaluated. Results: Median serum BDG was significantly higher in the candidemia group (129 pg/mL vs. 36 pg/mL, p < 0.001). BDG assay with standard cut-off value ≥ of 80 pg/mL had 93.33% sensitivity and 64.18% specificity (Areas under the ROC curve (AUC): 0.788). This study concluded that the optimal cut-off value for BDG assay was 112 pg/mL with sensitivity of 86.67% and specificity of 82.09% (AUC: 0.844). C-reactive protein (CRP) with optimal cut-off value ≥ 85 mg/L and BDG ≥ 80 pg/mL had the highest AUC (0.862, 95% CI: 0.768 - 0.928) with sensitivity 93.33% and specificity 79.1%. Conclusions: Predicting candidemia is essential in critically ill patients who are at high risk and have high mortality rates. The results of this study suggest that BDG testing is useful for predicting candidemia in ICU. However, BDG combined with CRP may be a stronger predictor for candidemia.

Background: Infections of cardiovascular implantable electronic devices (CIED) are mainly due to Gram-positive bacteria (GPB). Data about Gram-negative bacteria CIED (GNB-CIED) infections are limited. This study aimed to investigate risk factors, clinical and diagnostic characteristics, and outcome of patients with GNB-CIED. Methods: A multicentre, international, retrospective, case-control-control study was performed on patients undergoing CIED implantation from 2015 to 2019 in 17 centres across Europe. For each patient diagnosed with GNB-CIED, one matching control with GPB-CIED infection and two matching controls without infection were selected. Results: A total of 236 patients were enrolled: 59 with GNB-CIED infection, 59 with GPB-CIED infection and 118 without infection. No between-group differences were found regarding clinical presentation, diagnostic and therapeutic management. A trend toward a higher rate of fluorodeoxyglucose positron emission computed tomography (FDG PET/CT) positivity was observed among patients with GNB than in those with GPB-CIED infection (85.7% vs. 66.7%; P = 0.208). Risk factors for GNB-CIED infection were Charlson Comorbidity Index Score (relative risk reduction, RRR = 1.211; P = 0.011), obesity (RRR = 5.122; P = 0.008), ventricular-pacing ventricular-sensing inhibited-response pacemaker implantation (RRR = 3.027; P = 0.006) and right subclavian vein site of implantation (RRR = 5.014; P = 0.004). At 180-day survival analysis, GNB-CIED infection was associated with increased mortality risk (HR = 1.842; P = 0.067). Conclusions: Obesity, high number of comorbidities and right subclavian vein implantation site were associated with increased risk of GNB-CIED infection. A prompt therapeutic intervention that may be guided using FDG PET/CT is suggested in patients with GNB-CIED infection, considering the poorer outcome observed in this group.

Introduction: We evaluated neutralizing antibody and anti-spike antibody (anti-S) response against omicron variant in solid organ (SOT) or hematopoietic stem cell (HSTC) receivers after third dose of BNT162b2 (BNT) or CoronaVac (CV) following two doses of CV. Methods: In total, 95 participants who underwent SOT (n=62; 44 liver, 18 kidney) or HSCT (n=27; 5 allogeneic, 22 autologous) were included from five centers in Turkey. The median time between third doses and serum sampling was 154 days. The vaccine-induced antibody responses of both neutralizing antibodies and Anti-Spike antibodies were assessed by plaque neutralizing assay and immunoassay. Results: Neutralizing antibody and anti-spike IgG levels were significantly higher in transplant patients receiving BNT compared to those receiving CV (GMT:26.76 vs 10.89; p=0.03 and 2116 Au/ml vs 172.1 Au/ml; pConclusion: This study highlights the superiority of BNT responses against omicron as a third dose among transplant recipients after two doses of CV. Lack of neutralizing antibody against omicron after CV in liver transplant recipients should be taken into consideration particularly in countries where inactivated vaccines are available in addition to mRNA vaccines.

Aim Chest computed tomography (CT) imaging plays a diagnostic and prognostic role in Coronavirus disease 2019 (COVID‐19) patients. This study aimed to investigate and compare predictive capacity of main pulmonary artery diameter (MPA), ascending aorta diameter (AAo), and MPA‐to‐AAo ratio to determine in‐hospital mortality in COVID‐19 patients. Materials and methods This retrospective study included 255 hospitalized severe or critical COVID‐19 patients. MPA was measured at the level of pulmonary artery bifurcation perpendicular to the direction of the vessel through transverse axial images and AAo was measured by using the same CT slice at its maximal diameter. MPA‐to‐AAo ratio was calculated by division of MPA to AAo. Results Multivariate logistic regression model yielded MPA ≥29.15 mm (OR: 4.95, 95% CI: 2.01–12.2, p = 0.001), MPA (OR: 1.28, 95% CI: 1.13–1.46, p

OBJECTIVE: Cytokine storm with elevated levels of multiple proinflammatory cytokines and inflammatory system activation underlie the pathogenesis of coronavirus disease 2019 (COVID-19). In this study, we aimed to investigate whether increased interleukin (IL)-6 levels can predict right ventricular (RV) systolic impairment in patients hospitalized with COVID-19. METHODS: This prospective, observational study included 100 consecutive patients hospitalized with mild and moderate COVID-19. All the patients underwent chest computerized tomography, detailed laboratory tests including IL-6, and two dimensional (2D) transthoracic echocardiography (TTE) with assessment of 2D conventional and Doppler echocardiography parameters and RV systolic functions. RESULTS: After the elimination of six patients with exclusion criteria, the remaining patients were classified into two groups, namely normal RV systolic functions (n=60) and impaired RV systolic functions (n=34). IL-6 levels were significantly higher in patients with impaired RV systolic functions than in those with normal RV systolic functions (20.3, 4.6, p

The development of candidemia is a highly fatal condition in severe COVID-19 infection.This study aimed to develop a candidemia prediction score in COVID-19 patient based on the patient's clinical characteristics, and healthcare-related factors during intensive care units (ICU) follow-up.Severe COVID-19 patients hospitalised in ICU in Ankara City Hospital during the one-year period (August 15, 2020, and August 15, 2021) were included. After univariate analysis, multivariate analysis was applied using variable selection approach to investigate the effects of variables together and to create a score model for candidemia. Statistically significant factors were included in the development process of candida prediction score.Of 1305 COVID-19 ICU patients, 139 had a candidemia episode. According to the final model, four variables, presence of central venous catheter (CVC) (OR 19.07, CI 8.12-44.8, p .0001), multifocal colonisation (OR 2.28, CI 1.39-3.72, p 0.001), length of ICU stays ≥14 days (OR 3.62, CI 2.42-5.44, p .0001) and corticosteroids (OR 0.51, CI 0.34-0.76, p 0.0011) were the only statistically significant independent risk factors for candidemia. Score model was demonstrated by a nomogram, and the risk for candidemia was calculated to be high in patients who scored ≥56 points by using the criteria [CVC = 51, multifocal colonisation = 14, prolonged hospitalisation = 23, no steroid use = 12 points]. The AUC of the score is 0.84 (CI 0.81-0.87).We developed and validated an easy-to-use clinical prediction score for candidemia in severe COVID-19 infection. In COVID-19 ICU patients, the risk of candidemia is high if one of the other risk factors is present together with CVC.

Background CoronaVac, an inactivated whole-virion SARS-CoV-2 vaccine, has been shown to be well tolerated with a good safety profile in individuals aged 18 years and older in phase 1/2 trials, and provided a good humoral response against SARS-CoV-2. We present the interim efficacy and safety results of a phase 3 clinical trial of CoronaVac in Turkey. Methods This was a double-blind, randomised, placebo-controlled phase 3 trial. Volunteers aged 18-59 years with no history of COVID-19 and with negative PCR and antibody test results for SARS-CoV-2 were enrolled at 24 centres in Turkey. Exclusion criteria included (but were not limited to) immunosuppressive therapy (including steroids) within the past 6 months, bleeding disorders, asplenia, and receipt of any blood products or immunoglobulins within the past 3 months. The K1 cohort consisted of health-care workers (randomised in a 1:1 ratio), and individuals other than health-care workers were also recruited into the K2 cohort (randomised in a 2:1 ratio) using an interactive web response system. The study vaccine was 3 mu g inactivated SARS-CoV-2 virion adsorbed to aluminium hydroxide in a 0.5 mL aqueous suspension. Participants received either vaccine or placebo (consisting of all vaccine components except inactivated virus) intramuscularly on days 0 and 14. The primary efficacy outcome was the prevention of PCR-confirmed symptomatic COVID-19 at least 14 days after the second dose in the per protocol population. Safety analyses were done in the intention-to-treat population. This study is registered with ClinicalTrials.gov (NCT04582344) and is active but no longer recruiting. Findings Among 11 303 volunteers screened between Sept 14, 2020, and Jan 5, 2021, 10 218 were randomly allocated. After exclusion of four participants from the vaccine group because of protocol deviations, the intention-to-treat group consisted of 10 214 participants (6646 [65.1%] in the vaccine group and 3568 [34.9%] in the placebo group) and the per protocol group consisted of 10 029 participants (6559 [65.4%] and 3470 [34.6%]) who received two doses of vaccine or placebo. During a median follow-up period of 43 days (IQR 36-48), nine cases of PCR-confirmed symptomatic COVID-19 were reported in the vaccine group (31.7 cases [14.6-59.3] per 1000 person-years) and 32 cases were reported in the placebo group (192.3 cases [135.7-261.1] per 1000 person-years) 14 days or more after the second dose, yielding a vaccine efficacy of 83.5% (95% CI 65.4-92.1; p, TUSEB, We are grateful to all participants who volunteered to be part of this study and to all members of the clinical research teams of the participating sites. We thank TUSEB for funding the study and Omega-CRO for the statistical analyses and production of figures, and providing the study protocol. We also thank the members of the data and safety monitoring board for their contributions in the safe execution of this study.

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.

Objectives:Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is isolated as the cause of coronavirus disease-2019 (COVİD-19). Middle ear and mastoid air cells are covered with the airway mucosa. In COVİD-19, an involvement occurs in the airway mucosa; however, although the involvement of eustachian tube covered with this mucosa, middle ear, and mastoid is not known, there can be an intervention. The aim of the study is to investigate the findings of temporal tomography and evaluate the middle ear and mastoid in COVİD-19.Materials and Methods:A retrospective observational study was planned. Patients with a positive polymerase chain reaction (PCR) test for SARS-CoV-2 and diagnosed with COVİD-19 were included in the study. COVİD-19 patients, who had temporal bone tomography scans (CT), were evaluated. One hundred twenty-nine COVİD-19 patients with positive PCR, who also had temporal bone scans, were included in the study. A grading system was used to evaluate the effusion in the middle ear and mastoid cells. According to this grading system, left and right middle ear and mastoid were evaluated separately. In the grading system, the scores were evaluated as 0=no effusion, 1=partial effusion, and 2=100% effusion. The maximum score was accepted as 8. Bilateral tympanic membranes of all the patients were normal.Results:Involvement was observed in three patients. Bilateral partial effusion and middle ear involvement were observed in two patients. In one patient, bilateral partial mastoid and unilateral partial middle ear involvement was detected. Temporal CTs of other patients were normal.Conclusion:No specific finding was found regarding temporal bone involvement from the temporal CT. Three patients had effusion in the middle ear and mastoid. SARS-CoV-2 generally does not affect the temporal bone; however, it rarely causes effusion in the mastoid and middle ear.

Thiol-disulphide homeostasis (TDH) is a new parameter indicating oxidative stress that plays a role in the pathogenesis of various clinical disorders. Our study planned to investigate TDH in COVID-19 patients. Age and gender-matched healthy subjects (n = 70) and COVID-19 patients (n = 144) were included in the study. In addition to the routine laboratory parameters of the groups, their native thiol (NT), total thiol (TT) and disulphide levels were measured. Primarily, we compared COVID-19 patients to the healthy control group for inflammatory parameters, NT, TT and disulphide levels. Then, COVID-19 patients were divided into two groups according to the severity of the disease as mild to moderate and severe COVID-19, and the three groups were compared with each other. Predictive value of thiol parameters in the diagnosis of COVID-19 and in the determining its severity, and its correlation with presence and duration of symptoms were investigated. Severe COVID-19 patients had lower NT and TT levels compared with healthy controls and mild to moderate patients (P < 0.001 for both). The results of ROC analysis show that the greatest AUC was IL-6 and NT (AUC = 0.97, AUC = 0.96, respectively) between control and COVID-19 patients, while it was CRP and NT (AUC = 0.85, AUC = 0.83) between mild to moderate and severe patients. A negative correlation was found between duration of symptoms of dyspnoea, cough, fever, and sore throat and NT (r = −0.45, P = 0.017, r = −0.418, P < 0.001, r = −0.131, P = 0.084, r = −0.452, P = 0.040, respectively). NT and TT levels have a strong predictive value in the diagnosis of COVID-19 and in determining disease severity. Our results support that changing TDH parameters appears to have an important role in disease pathogenesis and it can be used in clinical management of patients., Graphical abstract Image 1

Background In this study, we aimed to compare the intensive care unit (ICU) admission rate of hospitalized mild/moderate COVID-19 patients treated with hydroxychloroquine (HCQ), favipiravir, and HCQ plus favipiravir. Methods Single center retrospective designed observational study conducted in Ankara City Hospital. Patients who were hospitalized between March 15, 2020 and June 1, 2020 in COVID-19 inpatient clinics with laboratory confirmed diagnosis of COVID-19 were included in the study. An inverse probability of treatment weighting (IPTW) for multiple treatment groups approach was used to balance the differences in several variables on admission. Results Among 2441 patients hospitalized with diagnosis of COVID-19 during the study period, 824 were eligible for the analysis. Median age of patients was 42 (18−93 years). Among all, 347 (43.2%) of the patients had mild disease, 470 (56.8%) had pneumonia. Propensity scores ranged from 0.1841 to 0.9381 in the HCQ group, from 0.03643 to 0.29885 in the favipiravir group, and from 0.03542 to 0.56184 in the HCQ plus favipiravir group. After IPTW for multiple treatment groups was applied, all the covariates in the planned propensity score had weighted standardized effect sizes below 10% which were ranged from 0.005 to 0.092. Multivariate analysis of treatment effect (adjusted effect of treatment) was indicated that there is no statistically significant difference between HCQ, favipiravir, and HCQ plus favipiravir treatment. After using combination of SMOTE and Bootstrap resampling approach, we found no statistically significant difference between HCQ and HCQ plus favipiravir groups in terms of ICU admission. However, compared with the HCQ group, ICU admission rate was statistically significantly higher in the favipiravir group. We obtained the similar results after the sensitivity analysis. Conclusions HCQ with or without favipiravir treatment is associated with reduced risk of ICU admission compared to favipiravir alone in mild to moderate COVID-19 adult patients.

Background Vitamin D is recognized to be an immune regulator. Also, it is known to have antiviral effects by several mechanisms, including reducing inflammatory cytokines. Objectives To examine the 25-hydroxyvitamin D (25(OH)D) status for assessing the severity of COVID-19. Methods This study consisted of 596 patients confirmed as SARS-CoV-2 infection and 59 healthy individuals. The cases separated into non-severe group, severe survival, and severe non-survival group. 25(OH)D and other laboratory parameters were evaluated retrospectively. Results In all COVID-19 groups 25(OH)D levels were low compared to controls (p Conclusions 25(OH)D deficiency was observed among patients with COVID-19. Declined steadily 25(OH)D levels make a huge contribution to the scale of the progression of the disease. Correlations support that 25(OH)D may be a substantial tool for utilizing the severity of the disease and estimating the survival. Also, supplementation of 25(OH)D might slow down the course of the COVID-19.

Introduction: Worldwide influenza vaccination rates remain low despite guideline recommendations to support vaccinations. It is important to identify attitudes, barriers and motivating factors influencing patients’ vaccination behaviours. We aimed to evaluate the knowledge, attitudes and factors influencing the vaccination behaviours against influenza and sources of information used by patients about influenza vaccine. Materials and Methods: This was a cross-sectional, self administered questionnaire-based study of 229 patients who visited infectious diseases and clinical microbiology outpatient clinic between December 2018 and February 2019. The questionnaire consisted of 39 items in 5 sections: Demographic data (8), questions about influenza vaccine (9), vaccination history (2), factors influencing vaccination behaviours (18) and sources of information used by patients about influenza vaccination (2). Results: Vaccinated group had a higher education level compared to the unvaccinated group, and the difference was statistically significant (p= 0.007). Vaccination against any diseases in adulthood was also statistically higher in the influenza-vaccinated group (p= 0.000). Other features were similar in both groups. The percentage of correct answers to proposals were similar and high between the two groups. Correct answers given to “People with chronic illness should have a flu vaccine” was statistically higher in the vaccinated group (80.5% vs. 61.8%, p= 0.004). Regular annual vaccination rate was only 10.3% in the vaccinated group. The most common motivating factor in vaccination was doctor’s advice (54.5%). The most common barrier against influenza vaccination was the idea that they did not need vaccination (51.3%). The information source affecting the patients mostly was the doctors in both vaccinated and unvaccinated groups. Conclusion: In order to increase the knowledge level and vaccination rates, doctors should be informed rigorously about advising influenza vaccine to patients, especially high risk groups. Education and advice from healthcare professionals about vaccine is crucial for increasing vaccination rate.

Purpose SARS-CoV-2 virus dynamics in different hosts and different samples and their relationship with disease severity have not been clearly revealed. The aim of this study is to evaluate the viral loads of 6 different sample types (nasopharyngeal/oropharyngeal combined, oral cavity, saliva, rectal, urine, and blood) of patients with different ages and clinics, to reveal the relationship between disease course and SARS-CoV-2 viral load, and differences in viral loads of asymptomatic and symptomatic patients. Methods Nasopharyngeal/oropharyngeal, oral cavity, saliva, rectal, urine, and blood samples are collected from patients who were hospitalized with diagnosis of COVID-19 on admission. Laboratory analysis were carried out at Public Health Institute of Turkey Virology Reference and Research Laboratory. Results A total of 360 samples from 60 patients were obtained on admission. Fifteen (25%) of the patients were asymptomatic while 45 (75%) were symptomatic. A significant difference was found between mean ages of asymptomatic vs symptomatic patients (26.4 and 36.4, respectively, p = 0.0248). No PCR positivity were found in blood. Only one asymptomatic patient had positive PCR result for urine sample. Viral loads of asymptomatic patients were found to be significantly higher (p = 0.0141) when compared with symptomatic patients. Viral load had a significant negative trend with increasing age. A significant decrease in viral load was observed with increasing disease severity. Conclusion In conclusion, this study demonstrates that asymptomatic patients have higher SARSCoV-2 viral loads than symptomatic patients and unlike in the few study in the literature, a significant decrease in viral load of nasopharyngeal/oropharyngeal samples was observed with increasing disease severity. Factors associated with poor prognosis are found to be significantly correlated with low viral load.

Objectives: It has been not yet fully understood whether chronic liver diseases may be considered as risk factors for critical course of Coronavirus disease-2019 (COVID-19) Considering the importance of managing with COVID-19, we aimed to investigate the impact of the COVID-19 pandemic on treatment, follow-up and behavioral characteristics of chronic viral hepatitis (CVH) patients Materials and Methods: Patients followed-up in our clinic with diagnosis of chronic hepatitis B or C were screened retrospectively and a total 213 adults included in the study We performed a telephone survey with patients Results: The mean age of participants was 49 9±13 4 years Of the participants, 62% were male Totally 75 (35 2%) patients disrupted their follow-up visits due to COVID-19 pandemic The only risk factor for disruption in follow-up was found as anxiety The vast majority of CVH patients paid attention to prevention measures for COVID-19 Conclusion: We can say that CVH patients' awareness about COVID-19 and application of control measures were well enough Continuity of treatment can be provided in patients with chronic illness during crisis period with informing patients in a way not to cause anxiety and efficient implementations in healthcare system

Introduction There is no published study regarding the effects of preventive measures on coronavirus disease 2019 (COVID-19) frequency in renal transplantation recipients. The aim of this study is to reveal the preventive measures taken by renal transplant recipients during the COVID-19 pandemic and whether these measures influence the prevalence of the disease. Materials and Methods After detecting the first COVID-19 case in Turkey, we briefed all of our renal transplant recipients on preventive measures regarding COVID-19. Two months afterward, a questionnaire was prepared regarding the preventive measures practiced by renal transplant recipients, and patients were asked whether they had any COVID-19 symptoms or had received a COVID-19 diagnosis. Results Among 132 patients, 68 were surveyed through telephone calls. During this time, 95.5% of patients were in isolation at home except for when seeing to their essential needs. Two (2.9%) patients were hospitalized due to increases in creatinine level and urinary tract infection. All patients have worn masks when going out and stated that they washed their hands more frequently. There was a decrease in the frequency of hospital controls in 79.4% of patients. Although 2 (2.9%) patients had complaints of dysuria and fever, they did not apply to the hospital because they thought hospitals carried risk during the pandemic. One patient had a cough with fever and was admitted to the hospital with suspicion of COVID-19 but tested negative. Discussion It was determined that renal transplant recipients in our study population meticulously complied with preventive measures and increased the use of masks and hand hygiene practices. As a result, none were infected with severe acute respiratory syndrome coronavirus 2., Highlights • Transplant recipients are thought to have higher mortality and morbidity for COVID-19. • We found that 95.5% of renal transplant recipients complied with the isolation rules. • They complied with preventive measures, increasing the use of masks and hand hygiene practices. • None of the renal transplant recipients were infected with SARS-CoV-2.

Introduction: The Standardized Infection Ratio (SIR) is a statistic used to track healthcare associated infections over time, at a national or facility level. SIR gives clearer data due to patient and institutional characteristics. It makes it possible to fairly compare hospital performance because the data are risk-adjusted. The aim of our study is to evaluate SIR and cumulative attributable difference (CAD) and to compare for national data. Materials and Methods: The study was conducted in Atatürk Training and Research Hospital reanimation 1 and 2, coronary, cardiovascular surgery, internal medicine-neurology and general surgery intensive care units (ICU). Based on total data reported at national level, stratified calculations based on type of institution and intensive care unit (ICU) type ventilator-associated pneumonia, central line-associated bloodstream infection and catheter-associated urinary tract infection rates calculated, and SIR and CAD were calculated by SIR-matic, which was organized by the Department of Infectious Diseases, General Directorate of Public Health of the Turkish Ministry of Health. Results: According to the infection rate and SIR value for ventilator-associated pneumonia, our ventilator-associated pneumonia rate in all ICUs, the ventilator utilization rate of coronary, internal medicine-neurology and general surgery ICUs is above the Turkey’ average, and in all ICUs except coronary and general surgery ICU, SIR values for ventilator-associated pneumonia were found to be statistically significant > 1.00. According to the infection rate and SIR values for catheter-associated urinary tract infection, our rates were high in ICUs, while SIR value was calculated equal to 1.00. There was no more infection than predicted on an institution basis. When the CAD values were examined, it was found that the unit-based cardiovascular surgery and general surgery ICUs had less infection than expected within one year. According to the infection rate and SIR values for central line-associated bloodstream infection, the rates in our ICUs are higher than the national average. Conclusion: As a result of the study, infection rates and SIR values were higher in most intensive care units than national values. SIR values were found to be more reliable in infection monitoring.

Critically ill COVID-19 patients have a high risk for the development of candidemia due to being exposed to both well-defined classical risk factors and COVID-19-specific risk factors in ICU.In this study, we investigated the incidence of candidemia in critically COVID-19 patients, and the independent risk factors for candidemia.COVID-19 patients hospitalised in ICU during 1-year period (August 2020 to August 2021) were included. Clinical and laboratory characteristics of all COVID-19 patients, applied treatments, and invasive procedures that may predispose to candidemia were recorded.Of 1229 COVID-19 patients, 63 developed candidemia. Candidemia incidence rate was 4.4 episodes per 1000 ICU days. The most common species was Candida albicans (52.3%). Only 37 patients (58.7%) received antifungal therapy. The presence of central venous catheter (OR 4.7, 95% CI 1.8-12.2, p .005), multifocal candida colonisation (OR 2.7, 95% CI 1.4-5.2, p .005), a prolonged ICU stay (≥14 days) (OR 1.9, 95% CI 1.08-3-37, p .05), the absence of chronic lung disease (OR 0.4, 95% CI 0.1-0.9, p .05) and the absence of corticosteroid use (OR 0.3, 95% CI 0.14-0.52, p .0001) were significantly associated with candidemia.Our study filled the knowledge gap in the literature about the impact of COVID-19-associated risk factors for the development of candidemia. The classical risk factors for candidemia had a significant effect on candidemia, and contrary to expectations, corticosteroids had a protective effect against the development of candidemia. The results of these studies showing interesting effects of corticosteroids in critically ill COVID-19 patients should be confirmed by further studies.

The COVID-19 pandemic has created a major alteration in the medical literature including the sepsis discussion. From the outset of the pandemic, various reports have indicated that although there are some unique features pertinent to COVID-19, many of its acute manifestations are similar to sepsis caused by other pathogens. As a consequence, the old definitions now require consideration of this new etiologic agent, namely SARS-CoV-2. Although the pathogenesis of COVID-19 has not been fully explained, the data obtained so far in hospitalized patients has revealed that serum cytokine and chemokine levels are high in severe COVID-19 patients, similar to those found with sepsis. COVID-19 may involve multiple organ systems. In addition to the lungs, the virus has been isolated from blood, urine, faeces, liver, and gallbladder. Results from autopsy series in COVID-19 patients have demonstrated a wide range of findings, including vascular involvement, congestion, consolidation, and hemorrhage as well as diffuse alveolar damage in lung tissue consistent with acute respiratory distress syndrome (ARDS). The presence of viral cytopathic-like changes, infiltration of inflammatory cells (mononuclear cells and macrophages), and viral particles in histopathological samples are considered a consequence of both direct viral infection and immune hyperactivation. Thromboembolism and hyper-coagulopathy are other components in the pathogenesis of severe COVID-19. Although the pathogenesis of hypercoagulability is not fully understood, it has been pointed out that all three components of Virchow’s triad (endothelial injury, stasis, and hypercoagulable state) play a major role in contributing to clot formation in severe COVID-19 infection. In severe COVID-19 cases, laboratory parameters such as hematological findings, coagulation tests, liver function tests, D-dimer, ferritin, and acute phase reactants such as CRP show marked alterations, which are suggestive of a cytokine storm. Another key element of COVID-19 pathogenesis in severe cases is its similarity or association with hemophagocytic lymphohistiocytosis (HLH). SARS-CoV-2 induced cytokine storm has significant clinical and laboratory findings overlapping with HLH. Viral sepsis has some similarities but also some differences when compared to bacterial sepsis. In bacterial sepsis, systemic inflammation affecting multiple organs is more dominant than in COVID-19 sepsis. While bacterial sepsis causes an early and sudden onset clinical deterioration, viral diseases may exhibit a relatively late onset and chronic course. Consideration of severe COVID-19 disease as a sepsis syndrome has relevance and may assist in terms of determining treatments that will modulate the immune response, limit intrinsic damage to tissue and organs, and potentially improve outcome.

Increasing rates of extended-spectrum beta-lactamase (ESBL) producing E. coli and K. pneumoniae over time made empirical treatment complicated. Knowing local antimicrobial resistance patterns of common pathogens can make it easier to decide on empirical antibiotics. We aimed to investigate the prevalence and risk factors of ESBL positivity of E. coli and K. pneumoniae strains in uncomplicated and complicated pyelonephritis acquired in community and healthcare associations and to evaluate the appropriateness of empirical treatment. Adult patients hospitalized with diagnosis of community-acquired or healthcare-associated uncomplicated/complicated pyelonephritis initiated empirical antimicrobial therapy were included in the study. Appropriateness of empirical treatment at 48-72 h based on culture results and treatment modifications were evaluated. A total of 369 uncomplicated (94) and complicated (275) episodes of pyelonephritis were evaluated. The most common agents were E. coli (71.0%) and K. pneumoniae (17.7%), and the ESBL-production rate was 64.4%, and higher in healthcare-associated pyelonephritis (P 0.013). Being of healthcare-associated infection, previous antibiotic use, and presence of urinary catheters were independent risk factors for ESBL-producing E. coli and K. pneumoniae (P 0.009, 0.001, and 0.024, respectively). The treatment inappropriateness was mostly associated with use of ceftriaxone (56.3%) (P 0.001). Treatment has escalated in 41.5% of ceftriaxone-initiated patients, in only 8.8% and 9.5% ertapenem and piperacillin-tazobactam-initiated patients, respectively. ESBL-production rates are quite high even in community-acquired infections. The use of broad-spectrum antibiotics covering ESBL-producing pathogens to increase the appropriateness of empirical treatment and then narrowing treatment based on culture results appears a better and life-saving choice.

Post recovery manifestations have become another concern in patients who have recovered from coronavirus disease 2019 (COVID‐19). Numerous reports have shown that COVID‐19 has a variety of long‐term effects on almost all systems including respiratory, cardiovascular, gastrointestinal, neurological, psychiatric, and dermatological systems. We aimed to investigate the prevalence and characteristics of the post‐COVID syndrome among COVID‐19 survivors and to determine the factors associated with persistent symptoms. This prospective study enrolled in patients with COVID‐19 followed in hospital or outpatient clinics in Ankara City Hospital. We performed a special questionnaire to inquire about the presence of persistent symptoms beyond 12 weeks from the first diagnosis. Demographic data, comorbid diseases, characteristics of acute COVID‐19, presence of persistent symptoms by systems, and knowledge about outpatient clinic visits after recovery were assessed. Of a total of 1007 participants, 39.0% had at least one comorbidity, and 47.5% had persistent symptoms. Fatigue/easy fatigability, myalgia, and loss of weight were the most frequent persistent symptoms (overall 29.3%) followed by respiratory symptoms (25.4%). A total of 235 participants had visited outpatient clinics due to several reasons during the post‐COVID‐19 period, and 17 of them were hospitalized. Severe acute COVID‐19, hospitalization, and presence of comorbidity were independent factors for the development of persistent symptoms. Fully understanding the spectrum of the post‐COVID syndrome is essential for appropriate management of all its long‐term effects. Our study once again underlined the fact that the prevalence of post‐COVID syndrome is higher than expected and concerns many systems, and a multidisciplinary follow‐up should be provided to COVID‐19 survivors in the post recovery period., Highlights COVID‐19 has a variety of long‐term effects on almost all systems.Respiratory, cardiovascular, gastrointestinal, neurological, psychiatric, and dermatological systems are affected in different degree.We detected the prevalence of the post?COVID syndrome among COVID‐19 survivors as 47.5% on 1007 participant.Fatigue/easy fatigability, myalgia, and loss of weight were the most frequent persistent symptoms (overall 29.3%), and followed by respiratory symptoms (25.4%).Severe acute COVID‐19, hospitalization, and presence of comorbidity were independent factors for the development of persistent symptoms.