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1. The clinical features, treatment and prognosis of neutropenic fever and Coronavirus disease 2019 results of the multicentre teos study

Author: Dilşah Başkol Elik, Şafak Kaya, Sevil Alkan, Tuna Demirdal, Alper Sener, Selçuk Kaya, Özlem Güzel Tunçcan, Bircan Kayaaslan, Rahmet Güner, Fatma Eser, Hasip Kahraman, Serhat Birengel, Elif Mukime Sarıcaoğlu, Esma Eroğlu, Fatma Çölkesen, Erman Öztürk, Hande Berk Cam, Çiğdem Mermutluoğlu, Şafak Özer Balin, Gülden Sincan, Nilgün Altın, Uluhan Sili, Bedia Mutay Suntur, Tuğba Arslan Gülen, Burak Deveci, Rabin Saba, Şaban İncecik, Gülden Eser Karlıdağ, Elif Hakko, Damla Akdağ, Hüseyin Aytaç Erdem, Hilal Sipahi, Candan Çicek, Mehmet Sezai Taşbakan, Meltem Taşbakan, Hüsnü Pullukçu, Tansu Yamazhan, Bilgin Arda, Sercan Ulusoy, and Oguz Resat Sipahi
Subjects: Medicine, Science
Abstract: Abstract This multicentre (22 centres in Turkey) retrospective cohort study aimed to assess the clinical outcomes of patients with neutropenic fever and SARS-CoV-2 positivity. Study period was 15 March 2020–15 August 2021. A total of 170 cases (58 female, aged 59 ± 15.5 years) that fulfilled the inclusion criteria were included in the study. One-month mortality rate (OMM) was 44.8%. The logistic regression analysis showed the following significant variables for the mentioned dependent variables: (i) achieving PCR negativity: receiving a maximum of 5 days of favipiravir (p = 0.005, OR 5.166, 95% CI 1.639–16.280); (ii) need for ICU: receiving glycopeptide therapy at any time during the COVID-19/FEN episode (p = 0.001, OR 6.566, 95% CI 2.137–20.172), the need for mechanical ventilation (p
Published: 2024
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2. Early empiric antibiotic use in COVID-19 patients: results from the international VIRUS registry

Author: Uluhan Sili, Aysun Tekin, Huseyin Bilgin, Syed Anjum Khan, Juan Pablo Domecq, Girish Vadgaonkar, Smitha S. Segu, Puneet Rijhwani, Umamaheswara Raju, Krishna Mohan Surapaneni, Igor Zabolotskikh, Dina Gomaa, Valerie M. Goodspeed, and Pinar Ay
Subjects: COVID-19, Pandemic, Empiric antibiotic treatment, Antimicrobial stewardship, Antibiotic resistance, Bacterial co-infection, Infectious and parasitic diseases, RC109-216
Abstract: Objectives: COVID-19 escalated inappropriate antibiotic use. We determined the distribution of pathogens causing community-acquired co-infections, the rate, and factors associated with early empiric antibiotic (EEAB) treatment among hospitalized COVID-19 patients. Methods: The Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS) COVID-19 Registry including 68,428 patients from 28 countries enrolled between January 2020 and October 2021 were screened. After exclusions, 7830 patients were included in the analysis. Azithromycin and/or other antibiotic treatment given within the first 3 days of hospitalization was investigated. Univariate and multivariate analyses were performed to determine factors associated with EEAB use. Results: The majority (6214, 79.4%) of patients received EEAB, with azithromycin combination being the most frequent (3146, 40.2%). As the pandemic advanced, the proportion of patients receiving EEAB regressed from 84.4% (786/931) in January-March 2020 to 65.2% (30/46) in April-June 2021 (P < 0.001). Beta-lactams, especially ceftriaxone was the most commonly used antibiotic. Staphylococcus aureus was the most commonly isolated pathogen. Multivariate analysis showed geographical location and pandemic timeline as the strongest independent predictors of EEAB use. Conclusions: EEAB administration decreased as pandemic advanced, which may be the result of intensified antimicrobial stewardship efforts. Our study provides worldwide goals for antimicrobial stewardship programs in the post-COVID-19 era.
Published: 2024
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3. Age, successive waves, immunization, and mortality in elderly COVID-19 hematological patients: EPICOVIDEHA findings

Author: Giuseppe Rossi, Jon Salmanton-García, Chiara Cattaneo, Francesco Marchesi, Julio Dávila-Valls, Sonia Martín-Pérez, Federico Itri, Alberto López-García, Andreas Glenthøj, Maria Gomes da Silva, Caroline Besson, Monia Marchetti, Barbora Weinbergerová, Ozren Jaksic, Moraima Jiménez, Yavuz M. Bilgin, Jaap Van Doesum, Francesca Farina, Pavel Žák, Luisa Verga, Graham P. Collins, Valentina Bonuomo, Jens Van Praet, Marcio Nucci, Stef Meers, Ildefonso Espigado, Nicola S. Fracchiolla, Toni Valković, Christian Bjørn Poulsen, Natasha Čolović, Giulia Dragonetti, Marie-Pierre Ledoux, Carlo Tascini, Caterina Buquicchio, Ola Blennow, Francesco Passamonti, Marina Machado, Jorge Labrador, Rafael F. Duarte, Martin Schönlein, Lucia Prezioso, Iker Falces-Romero, Austin Kulasekararaj, Carolina Garcia-Vidal, Noemí Fernández, Ghaith Abu-Zeinah, Irati Ormazabal-Vélez, Tatjana Adžić-Vukičević, Klára Piukovics, Igor Stoma, Annarosa Cuccaro, Gabriele Magliano, Tomáš Szotkowski, Tomás-José González-López, Shaimaa El-Ashwah, Rui Bergantim, Uluhan Sili, Johan Maertens, Fatih Demirkan, Cristina De Ramón, Verena Petzer, Maria Ilaria Del Principe, Milan Navrátil, Michelina Dargenio, Guldane Cengiz Seval, Michail Samarkos, Zdeněk Ráčil, László Imre Pinczés, Tobias Lahmer, Alessandro Busca, Gustavo-Adolfo Méndez, Antonio Vena, Monika M. Biernat, Maria Merelli, Maria Calbacho, Aleksandra Barać, Martina Bavastro, Alessandro Limongelli, Osman Ilhan, Dominik Wolf, Gökçe Melis Çolak, Ramón García-Sanz, Ziad Emarah, Bojana Mišković, Stefanie K. Gräfe, Miloš Mladenović, Tommaso Francesco Aiello, Lucía Núñez-Martín-Buitrago, Anna Nordlander, Elena Arellano, Giovanni Paolo Maria Zambrotta, Emanuele Ammatuna, Alba Cabirta, Maria Vittoria Sacchi, Raquel Nunes Rodrigues, Ditte Stampe Hersby, Michaela Hanakova, Laman Rahimli, Raul Cordoba, Oliver A. Cornely, Livio Pagano, Joyce MARQUES DE ALMEIDA, José-Ángel HERNÁNDEZ-RIVAS, Anna GUIDETTI, Olimpia FINIZIO, Zlate STOJANOSKI, Milche CVETANOSKI, Joseph MELETIADIS, Nick DE JONGE, Darko ANTIĆ, Natasha ALI, Maria Chiara TISI, Laura SERRANO, Gaëtan PLANTEFEVE, Nina KHANNA, Martin HOENIGL, Martin ČERŇAN, Carolina MIRANDA-CASTILLO, María FERNÁNDEZ-GALÁN, Alexandra SERRIS, Nurettin ERBEN, Rémy DULÉRY, Avinash AUJAYEB, Mario Virgilio PAPA, Jan NOVÁK, Mario DELIA, Giuseppe SAPIENZA, Florian REIZINE, Ali S. OMRANI, Roberta DI BLASI, Sylvain LAMURE, Ľuboš DRGOŇA, Nicola COPPOLA, Josip BATINIĆ, Murtadha AL-KHABORI, José-María RIBERA-SANTA SUSANA, Monica PIEDIMONTE, Jorge LOUREIRO-AMIGO, Guillemette FOUQUET, Rita FAZZI, François DANION, Jörg SCHUBERT, Baerbel HOELL-NEUGEBAUER, Nathan C. BAHR, Ayel Omar YAHIA, Ana TORRES-ATIENZA, Ikhwan RINALDI, Marina POPOVA, Hans-Beier OMMEN, Maria Enza MITRA, Malgorzata MIKULSKA, Ira LACEJ, Sofya KHOSTELIDI, Sein WIN, Donald VINH, Modar SALEH, Juergen PRATTES, Pavel JINDRA, Fabio GUOLO, Roberta DELLA PEPA, Ekaterina CHELYSHEVA, Przemyslaw ZDZIARSKI, Vivien WAI-MAN, Andrés SOTO-SILVA, Hans Martin ORTH, Sandra MALAK, Lisset LORENZO DE LA PEÑA, Martin KOLDITZ, Chi Shan KHO, Christopher H. HEATH, Ana GROH, Eleni GAVRIILAKI, Monica FUNG, Matthias EGGER, Elizabeth DE KORT, Erik DE CABO, Tania CUSHION, Fazle Rabbi CHOWDHURY, M. Mansour CEESAY, Mathias BREHON, Gina VARRICCHIO, Agostino TAFURI, María-Josefa JIMÉNEZ-LORENZO, Nikolai KLIMKO, Panagiotis TSIRIGOTIS, Anastasia ANTONIADOU, and Maria VEHRESCHILD
Subjects: Elderly, SARS-CoV-2, Hematological malignancy, High-risk patient, COVID-19, Infectious and parasitic diseases, RC109-216
Abstract: Objectives: Elderly patients with hematologic malignancies face the highest risk of severe COVID-19 outcomes. The infection's impact on different age groups remains unstudied in detail. Methods: We analyzed elderly patients (age groups: 65-70, 71-75, 76-80, and >80 years old) with hematologic malignancies included in the EPICOVIDEHA registry between January 2020 and July 2022. Univariable and multivariable Cox regression models were conducted to identify factors influencing death in COVID-19 patients with hematological malignancy. Results: The study included data from 3,603 elderly patients (aged 65 or older) with hematological malignancy, with a majority being male (58.1%) and a significant proportion having comorbidities. The patients were divided into four age groups, and the analysis assessed COVID-19 outcomes, vaccination status, and other variables in relation to age and pandemic waves. The 90-day survival rate for patients with COVID-19 was 71.2%, with significant differences between groups. The pandemic waves had varying impacts, with the first wave affecting patients over 80 years old, the second being more severe in 65-70, and the third being the least severe in all age groups. Factors contributing to 90-day mortality included age, comorbidities, lymphopenia, active malignancy, acute leukemia, less than three vaccine doses, severe COVID-19, and using only corticosteroids as treatment. Conclusion: These data underscore the heterogeneity of elderly hematological patients, highlight the different impacts of COVID-19 waves and the pivotal importance of vaccination, and may help in planning future healthcare efforts.
Published: 2023
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4. Decoding the historical tale: COVID-19 impact on haematological malignancy patients—EPICOVIDEHA insights from 2020 to 2022Research in context

Author: Jon Salmanton-García, Francesco Marchesi, Francesca Farina, Barbora Weinbergerová, Federico Itri, Julio Dávila-Valls, Sonia Martín-Pérez, Andreas Glenthøj, Ditte Stampe Hersby, Maria Gomes da Silva, Raquel Nunes Rodrigues, Alberto López-García, Raúl Córdoba, Yavuz M. Bilgin, Iker Falces-Romero, Shaimaa El-Ashwah, Ziad Emarah, Caroline Besson, Milena Kohn, Jaap Van Doesum, Emanuele Ammatuna, Monia Marchetti, Jorge Labrador, Giovanni Paolo Maria Zambrotta, Luisa Verga, Ozren Jaksic, Marcio Nucci, Klára Piukovics, Alba Cabirta-Touzón, Moraima Jiménez, Elena Arellano, Ildefonso Espigado, Ola Blennow, Anna Nordlander, Stef Meers, Jens van Praet, Tommaso Francesco Aiello, Carolina Garcia-Vidal, Nicola Fracchiolla, Mariarita Sciumè, Guldane Cengiz Seval, Pavel Žák, Caterina Buquicchio, Carlo Tascini, Stefanie K. Gräfe, Martin Schönlein, Tatjana Adžić-Vukičević, Valentina Bonuomo, Chiara Cattaneo, Summiya Nizamuddin, Martin Čerňan, Gaëtan Plantefeve, Romane Prin, Tomas Szotkovski, Graham P. Collins, Michelina Dargenio, Verena Petzer, Dominik Wolf, Natasha Čolović, Lucia Prezioso, Toni Valković, Francesco Passamonti, Gustavo-Adolfo Méndez, Uluhan Sili, Antonio Vena, Martina Bavastro, Alessandro Limongelli, Rafael F. Duarte, Marie-Pierre Ledoux, Milche Cvetanoski, Zlate Stojanoski, Marina Machado, Josip Batinić, Gabriele Magliano, Monika M. Biernat, Nikola Pantić, Christian Bjørn Poulsen, Annarosa Cuccaro, Maria Ilaria Del Principe, Austin Kulasekararaj, Irati Ormazabal-Vélez, Alessandro Busca, Fatih Demirkan, Marriyam Ijaz, Nikolai Klimko, Igor Stoma, Sofya Khostelidi, Noemí Fernández, Ali S. Omrani, Rui Bergantim, Nick De Jonge, Guillemette Fouquet, Milan Navrátil, Ghaith Abu-Zeinah, Michail Samarkos, Johan Maertens, Cristina De Ramón, Anna Guidetti, Ferenc Magyari, Tomás José González-López, Tobias Lahmer, Olimpia Finizio, Natasha Ali, László Imre Pinczés, Esperanza Lavilla-Rubira, Alessandra Romano, Maria Merelli, Mario Delia, Maria Calbacho, Joseph Meletiadis, Darko Antić, José-Ángel Hernández-Rivas, Joyce Marques de Almeida, Murtadha Al-Khabori, Martin Hoenigl, Maria Chiara Tisi, Nina Khanna, Aleksandra Barać, Noha Eisa, Roberta Di Blasi, Raphaël Liévin, Carolina Miranda-Castillo, Nathan C. Bahr, Sylvain Lamure, Mario Virgilio Papa, Ayel Yahya, Avinash Aujayeb, Jan Novák, Nurettin Erben, María Fernández-Galán, José-María Ribera-Santa Susana, Ikhwan Rinaldi, Rita Fazzi, Monica Piedimonte, Rémy Duléry, Yung Gonzaga, Andrés Soto-Silva, Giuseppe Sapienza, Alexandra Serris, Ľuboš Drgoňa, Ana Groh, Laura Serrano, Eleni Gavriilaki, Athanasios Tragiannidis, Juergen Prattes, Nicola Coppola, Vladimir Otašević, Miloš Mladenović, Mirjana Mitrović, Bojana Mišković, Pavel Jindra, Sofia Zompi, Maria Vittoria Sacchi, Carolin Krekeler, Maria Stefania Infante, Daniel García-Bordallo, Gökçe Melis Çolak, Jiří Mayer, Marietta Nygaard, Michaela Hanáková, Zdeněk Ráčil, Matteo Bonanni, Philipp Koehler, Laman Rahimli, Oliver A. Cornely, Livio Pagano, Francisco Javier Martín-Vallejo, Przemyslaw Zdziarski, Hossein Zarrinfer, Jana Wittig, Sein Win, Vivien Wai-Man, Benjamín Víšek, Donald C. Vinh, Maria Vehreschild, Gina Varricchio, Panagiotis Tsirigotis, Ana Torres-Tienza, Alina Daniela Tanase, Agostino Tafuri, Maria Stamouli, Jiří Sramek, Carole Soussain, Ayten Shirinova, Jörg Schubert, Enrico Schalk, Mohammad Reza Salehi, Modar Saleh, Giorgio Rosati, Elisa Roldán, Florian Reizine, Mayara Rêgo, Isabel Regalado-Artamendi, Marina Popova, Fernando Pinto, Laure Philippe, Hans Martin Orth, Hans-Beier Ommen, Aleš Obr, Lucía Núñez-Martín-Buitrago, Nicolas Noël, Julia Neuhann, Gianpaolo Nadali, Julia A. Nacov, Ana M. Munhoz Alburquerque, Maria Enza Mitra, Malgorzata Mikulska, Sibylle Mellinghoff, Ben Mechtel, Juan-Alberto Martín-González, Sandra Malak, Jorge Loureiro-Amigo, Lisset Lorenzo De La Peña, Giulia Liberti, Marianne Landau, Ira Lacej, Martin Kolditz, Chi Shan Kho, Reham Abdelaziz Khedr, Meinolf Karthaus, Linda Katharina Karlsson, María-Josefa Jiménez-Lorenzo, Macarena Izuzquiza, Baerbel Hoell-Neugebauer, Raoul Herbrecht, Christopher H. Heath, Fabio Guolo, Jan Grothe, Antonio Giordano, Sergey Gerasymchuk, Ramón García-Sanz, Nicole García-Poutón, Vaneuza Araújo Moreira Funke, Monica Fung, Charlotte Flasshove, Luana Fianchi, Jenna Essame, Matthias Egger, Bernard Drenou, Giulia Dragonetti, Maximilian Desole, Roberta Della Pepa, Bénédicte Deau Fischer, Elizabeth De Kort, Erik De Cabo, François Danion, Etienne Daguindau, Tania Cushion, Louise Cremer, Marianna Criscuolo, Gregorio Cordini, Antonella Cingolani, Fabio Ciceri, Fazle Rabbi Chowdhury, Ekaterina Chelysheva, Adrien Chauchet, Louis Yi Ann Chai, M. Mansour Ceesay, Elena Busch, Mathias Brehon, Davimar M.M. Borducchi, Stephen Booth, Serge Bologna, Caroline Berg Venemyr, Rebeca Bailén-Almorox, Anastasia Antoniadou, Amalia N. Anastasopoulou, and Fevzi Altuntaş
Subjects: Vaccination, ICU, COVID-19, Haematological malignancy, Immunosuppression, Medicine (General), R5-920
Abstract: Summary: Background: The COVID-19 pandemic heightened risks for individuals with hematological malignancies due to compromised immune systems, leading to more severe outcomes and increased mortality. While interventions like vaccines, targeted antivirals, and monoclonal antibodies have been effective for the general population, their benefits for these patients may not be as pronounced. Methods: The EPICOVIDEHA registry (National Clinical Trials Identifier, NCT04733729) gathers COVID-19 data from hematological malignancy patients since the pandemic's start worldwide. It spans various global locations, allowing comprehensive analysis over the first three years (2020–2022). Findings: The EPICOVIDEHA registry collected data from January 2020 to December 2022, involving 8767 COVID-19 cases in hematological malignancy patients from 152 centers across 41 countries, with 42% being female. Over this period, there was a significant reduction in critical infections and an overall decrease in mortality from 29% to 4%. However, hospitalization, particularly in the ICU, remained associated with higher mortality rates. Factors contributing to increased mortality included age, multiple comorbidities, active malignancy at COVID-19 onset, pulmonary symptoms, and hospitalization. On the positive side, vaccination with one to two doses or three or more doses, as well as encountering COVID-19 in 2022, were associated with improved survival. Interpretation: Patients with hematological malignancies still face elevated risks, despite reductions in critical infections and overall mortality rates over time. Hospitalization, especially in ICUs, remains a significant concern. The study underscores the importance of vaccination and the timing of COVID-19 exposure in 2022 for enhanced survival in this patient group. Ongoing monitoring and targeted interventions are essential to support this vulnerable population, emphasizing the critical role of timely diagnosis and prompt treatment in preventing severe COVID-19 cases. Funding: Not applicable.
Published: 2024
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5. Dexamethasone treatment for COVID-19 is related to increased mortality in hematologic malignancy patients: results from the EPICOVIDEHA Registry

Author: Tommaso Francesco Aiello, Jon Salmanton-Garcia, Francesco Marchesi, Barbora Weinbergerova, Andreas Glenthoj, Jens Van Praet, Francesca Farina, Julio Davila-Valls, Sonia Martin-Perez, Shaimaa El-Ashwah, Martin Schonlein, Iker Falces-Romero, Jorge Labrador, Uluhan Sili, Caterina Buquicchio, Antonio Vena, Gaetan Plantefeve, Verena Petzer, Monika M. Biernat, Tobias Lahmer, Ildefonso Espigado, Jaap Van Doesum, Ola Blennow, Klara Piukovics, Carlo Tascini, Michail Samarkos, Yavuz M. Bilgin, Luana Fianchi, Federico Itri, Toni Valković, Nicola S. Fracchiolla, Michelina Dargenio, Moraima Jimenez, Ferenc Magyari, Alberto Lopez-Garcia, Lucia Prezioso, Natasha Čolović, Evgenii Shumilov, Ghaith Abu-Zeinah, Carolin Krekeler, Esperanza Lavilla-Rubira, Mario Virgilio Papa, Tomas Jose Gonzalez-Lopez, Laszlo Imre Pinczes, Fatih Demirkan, Natasha Ali, Caroline Besson, Guillemette Fouquet, Alessandra Romano, Jose-Angel Hernandez-Rivas, Maria Ilaria Del Principe, Avinash Aujayeb, Maria Merelli, Sylvain Lamure, Joyce Marques De Almeida, Maria Gomes Da Silva, Noha Eisa, Joseph Meletiadis, Ikhwan Rinaldi, Olimpia Finizio, Ozren Jaksic, Mario Delia, Summiya Nizamuddin, Monia Marchetti, Marriyam Ijaz, Marina Machado, Rebeca Bailen-Almorox, Martin Čerňan, Nicola Coppola, Eleni Gavriilaki, Chiara Cattaneo, Ana Groh, Zlate Stojanoski, Nurettin Erben, Nicola Pantic, Gustavo-Adolfo Mendez, Roberta Di Blasi, Stef Meers, Cristina De Ramon, Nathan C. Bahr, Ziad Emarah, Gina Varricchio, Milche Cvetanoski, Ramon Garcia-Sanz, Mirjana Mitrovic, Raphael Lievin, Michaela Hanakova, Zdeněk Račil, Maria Vehreschild, Athanasios Tragiannidis, Raquel Nunes Rodrigues, Daniel Garcia-Bordallo, Raul Cordoba, Alba Cabirta, Anna Nordlander, Emanuele Ammatuna, Elena Arellano, Dominik Wolf, Romane Prin, Alessandro Limongelli, Martina Bavastro, Gokce Melis Colak, Stefanie Grafe, Ditte Stampe Hersby, Laman Rahimli, Oliver A. Cornely, Carolina Garcia-Vidal, Livio Pagano, and EPICOVIDEHA study group
Subjects: Diseases of the blood and blood-forming organs, RC633-647.5
Published: 2024
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6. P1521: IMPROVED CLINICAL OUTCOME OF COVID-19 IN HAEMATOLOGIC MALIGNANCY PATIENTS RECEIVING A FOURTH DOSE OF ANTI-SARS-COV-2 VACCINE: AN EPICOVIDEHA REPORT

Author: Jon Salmanton-García, Francesco Marchesi, Andreas Glenthøj, Yavuz M. Bilgin, Jens VAN Praet, Julio Dávila-Valls, Sonia Martín-Pérez, Jorge Labrador, Jaap Van Doesum, Iker Falces-Romero, Francesca Farina, Martin Schönlein, Caroline Besson, Verena Petzer, Ildefonso Espigado, Michelina Dargenio, Avinash Aujayeb, Uluhan Sili, Laura Serrano, Laszlo Imre Pinczes, Nick de Jonge, Andrés Soto-Silva, Caterina Buquicchio, Lucia Prezioso, Monia Marchetti, Stef Meers, Alessandro Busca, Paolo Corradini, Martin Hoenigl, Philipp Koehler, Laman Rahimli, Gökçe Melis Çolak, Elena Arellano, Dominik Wolf, Stefanie Gräfe, Emanuele Ammatuna, Caroline Berg Venemyr, Oliver A. Cornely, and Livio Pagano
Subjects: Diseases of the blood and blood-forming organs, RC633-647.5
Published: 2023
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7. Nirmatrelvir/ritonavir in COVID-19 patients with haematological malignancies: a report from the EPICOVIDEHA registryResearch in context

Author: Jon Salmanton-García, Francesco Marchesi, Maria Gomes da Silva, Francesca Farina, Julio Dávila-Valls, Yavuz M. Bilgin, Andreas Glenthøj, Iker Falces-Romero, Jaap Van Doesum, Jorge Labrador, Caterina Buquicchio, Shaimaa El-Ashwah, Verena Petzer, Jens Van Praet, Martin Schönlein, Michelina Dargenio, Gustavo-Adolfo Méndez, Stef Meers, Federico Itri, Antonio Giordano, László Imre Pinczés, Ildefonso Espigado, Zlate Stojanoski, Alberto López-García, Lucia Prezioso, Ozren Jaksic, Antonio Vena, Nicola S. Fracchiolla, Tomás José González-López, Natasa Colović, Mario Delia, Barbora Weinbergerová, Monia Marchetti, Joyce Marques de Almeida, Olimpia Finizio, Caroline Besson, Monika M. Biernat, Toni Valković, Tobias Lahmer, Annarosa Cuccaro, Irati Ormazabal-Vélez, Josip Batinić, Noemí Fernández, Nick De Jonge, Carlo Tascini, Amalia N. Anastasopoulou, Rémy Duléry, Maria Ilaria Del Principe, Gaëtan Plantefeve, Mario Virgilio Papa, Marcio Nucci, Moraima Jiménez, Avinash Aujayeb, José-Ángel Hernández-Rivas, Maria Merelli, Chiara Cattaneo, Ola Blennow, Anna Nordlander, Alba Cabirta, Gina Varricchio, Maria Vittoria Sacchi, Raul Cordoba, Elena Arellano, Stefanie K. Gräfe, Dominik Wolf, Ziad Emarah, Emanuele Ammatuna, Ditte Stampe Hersby, Sonia Martín-Pérez, Raquel Nunes Rodrigues, Laman Rahimli, Livio Pagano, Oliver A. Cornely, Klára Piukovics, Cristina De Ramón, François Danion, Ayel Yahya, Anna Guidetti, Carolina Garcia-Vidal, Uluhan Sili, Joseph Meletiadis, Elizabeth De Kort, Luisa Verga, Laura Serrano, Nurettin Erben, Roberta Di Blasi, Athanasios Tragiannidis, José-María Ribera-Santa Susana, Hans-Beier Ommen, Alessandro Busca, Nicola Coppola, Rui Bergantim, Giulia Dragonetti, Marianna Criscuolo, Luana Fianchi, Matteo Bonanni, Andrés Soto-Silva, Malgorzata Mikulska, Marina Machado, Chi Shan Kho, Nazia Hassan, Eleni Gavriilaki, Gregorio Cordini, Louis Yi Ann Chi, Matthias Eggerer, Martin Hoenigl, Juergen Prattes, María-Josefa Jiménez-Lorenzo, Sofia Zompi, Giovanni Paolo Maria Zambrotta, Gökçe Melis Çolak, Nicole García-Poutón, Tommaso Francesco Aiello, Romane Prin, Maria Stamouli, and Michail Samarkos
Subjects: Nirmatrelvir, SARS-CoV-2, Haematology, Malignancy, COVID-19, Medicine (General), R5-920
Abstract: Summary: Background: Nirmatrelvir/ritonavir treatment decreases the hospitalisation rate in immunocompetent patients with COVID-19, but data on efficacy in patients with haematological malignancy are scarce. Here, we describe the outcome of nirmatrelvir/ritonavir treatment in a large cohort of the latter patients. Methods: This is a retrospective cohort study from the multicentre EPICOVIDEHA registry (NCT04733729) on patients with haematological malignancy, who were diagnosed with COVID-19 between January and September 2022. Patients receiving nirmatrelvir/ritonavir were compared to those who did not. A logistic regression was run to determine factors associated with nirmatrelvir/ritonavir administration in our sample. Mortality between treatment groups was assessed with Kaplan–Meier survival plots after matching all the patients with a propensity score. Additionally, a Cox regression was modelled to detect factors associated with mortality in patients receiving nirmatrelvir/ritonavir. Findings: A total of 1859 patients were analysed, 117 (6%) were treated with nirmatrelvir/ritonavir, 1742 (94%) were treated otherwise. Of 117 patients receiving nirmatrelvir/ritonavir, 80% had received ≥1 anti-SARS-CoV-2 vaccine dose before COVID-19 onset, 13% of which received a 2nd vaccine booster. 5% were admitted to ICU. Nirmatrelvir/ritonavir treatment was associated with the presence of extrapulmonary symptoms at COVID-19 onset, for example anosmia, fever, rhinitis, or sinusitis (aOR 2.509, 95%CI 1.448–4.347) and 2nd vaccine booster (aOR 3.624, 95%CI 1.619–8.109). Chronic pulmonary disease (aOR 0.261, 95%CI 0.093–0.732) and obesity (aOR 0.105, 95%CI 0.014–0.776) were not associated with nirmatrelvir/ritonavir use. After propensity score matching, day-30 mortality rate in patients treated with nirmatrelvir/ritonavir was 2%, significantly lower than in patients with SARS-CoV-2 directed treatment other than nirmatrelvir/ritonavir (11%, p = 0.036). No factor was observed explaining the mortality difference in patients after nirmatrelvir/ritonavir administration. Interpretation: Haematological malignancy patients were more likely to receive nirmatrelvir/ritonavir when reporting extrapulmonary symptoms or 2nd vaccine booster at COVID-19 onset, as opposed to chronic pulmonary disease and obesity. The mortality rate in patients treated with nirmatrelvir/ritonavir was lower than in patients with targeted drugs other than nirmatrelvir/ritonavir. Funding: EPICOVIDEHA has received funds from Optics COMMIT (COVID-19 Unmet Medical Needs and Associated Research Extension) COVID-19 RFP program by GILEAD Science, United States (Project 2020-8223).
Published: 2023
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8. COVID-19 infection in adult patients with hematological malignancies: a European Hematology Association Survey (EPICOVIDEHA)

Author: Livio Pagano, Jon Salmanton-García, Francesco Marchesi, Alessandro Busca, Paolo Corradini, Martin Hoenigl, Nikolai Klimko, Philipp Koehler, Antonio Pagliuca, Francesco Passamonti, Luisa Verga, Benjamin Víšek, Osman Ilhan, Gianpaolo Nadali, Barbora Weinbergerová, Raúl Córdoba-Mascuñano, Monia Marchetti, Graham P. Collins, Francesca Farina, Chiara Cattaneo, Alba Cabirta, Maria Gomes-Silva, Federico Itri, Jaap van Doesum, Marie-Pierre Ledoux, Martin Čerňan, Ozren Jakšić, Rafael F. Duarte, Gabriele Magliano, Ali S. Omrani, Nicola S. Fracchiolla, Austin Kulasekararaj, Toni Valković, Christian Bjørn Poulsen, Marina Machado, Andreas Glenthøj, Igor Stoma, Zdeněk Ráčil, Klára Piukovics, Milan Navrátil, Ziad Emarah, Uluhan Sili, Johan Maertens, Ola Blennow, Rui Bergantim, Carolina García-Vidal, Lucia Prezioso, Anna Guidetti, Maria Ilaria del Principe, Marina Popova, Nick de Jonge, Irati Ormazabal-Vélez, Noemí Fernández, Iker Falces-Romero, Annarosa Cuccaro, Stef Meers, Caterina Buquicchio, Darko Antić, Murtadha Al-Khabori, Ramón García-Sanz, Monika M. Biernat, Maria Chiara Tisi, Ertan Sal, Laman Rahimli, Natasa Čolović, Martin Schönlein, Maria Calbacho, Carlo Tascini, Carolina Miranda-Castillo, Nina Khanna, Gustavo-Adolfo Méndez, Verena Petzer, Jan Novák, Caroline Besson, Rémy Duléry, Sylvain Lamure, Marcio Nucci, Giovanni Zambrotta, Pavel Žák, Guldane Cengiz Seval, Valentina Bonuomo, Jiří Mayer, Alberto López-García, Maria Vittoria Sacchi, Stephen Booth, Fabio Ciceri, Margherita Oberti, Marco Salvini, Macarena Izuzquiza, Raquel Nunes-Rodrigues, Emanuele Ammatuna, Aleš Obr, Raoul Herbrecht, Lucía Núñez-Martín-Buitrago, Valentina Mancini, Hawraa Shwaylia, Mariarita Sciumè, Jenna Essame, Marietta Nygaard, Josip Batinić, Yung Gonzaga, Isabel Regalado-Artamendi, Linda Katharina Karlsson, Maryia Shapetska, Michaela Hanakova, Shaimaa El-Ashwah, Zita Borbényi, Gökçe Melis Çolak, Anna Nordlander, Giulia Dragonetti, Alessio Maria Edoardo Maraglino, Amelia Rinaldi, Cristina De Ramón-Sánchez, Oliver A. Cornely, and EPICOVIDEHA working group
Subjects: COVID-19, Pandemic, Hematological malignancies, Epidemiology, EHA, Diseases of the blood and blood-forming organs, RC633-647.5, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract: Abstract Background Patients with hematological malignancies (HM) are at high risk of mortality from SARS-CoV-2 disease 2019 (COVID-19). A better understanding of risk factors for adverse outcomes may improve clinical management in these patients. We therefore studied baseline characteristics of HM patients developing COVID-19 and analyzed predictors of mortality. Methods The survey was supported by the Scientific Working Group Infection in Hematology of the European Hematology Association (EHA). Eligible for the analysis were adult patients with HM and laboratory-confirmed COVID-19 observed between March and December 2020. Results The study sample includes 3801 cases, represented by lymphoproliferative (mainly non-Hodgkin lymphoma n = 1084, myeloma n = 684 and chronic lymphoid leukemia n = 474) and myeloproliferative malignancies (mainly acute myeloid leukemia n = 497 and myelodysplastic syndromes n = 279). Severe/critical COVID-19 was observed in 63.8% of patients (n = 2425). Overall, 2778 (73.1%) of the patients were hospitalized, 689 (18.1%) of whom were admitted to intensive care units (ICUs). Overall, 1185 patients (31.2%) died. The primary cause of death was COVID-19 in 688 patients (58.1%), HM in 173 patients (14.6%), and a combination of both COVID-19 and progressing HM in 155 patients (13.1%). Highest mortality was observed in acute myeloid leukemia (199/497, 40%) and myelodysplastic syndromes (118/279, 42.3%). The mortality rate significantly decreased between the first COVID-19 wave (March–May 2020) and the second wave (October–December 2020) (581/1427, 40.7% vs. 439/1773, 24.8%, p value
Published: 2021
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9. Improved Clinical Outcome of COVID-19 in Hematologic Malignancy Patients Receiving a Fourth Dose of Anti-SARS-CoV-2 Vaccine: An EPICOVIDEHA Report

Author: Jon Salmanton-García, Francesco Marchesi, Andreas Glenthøj, Yavuz M. Bilgin, Jens van Praet, Julio Dávila-Valls, Sonia Martín-Pérez, Jorge Labrador, Jaap van Doesum, Iker Falces-Romero, Francesca Farina, Martin Schönlein, Mathilde Chanut, Verena Petzer, Ildefonso Espigado, Michelina Dargenio, Avinash Aujayeb, Uluhan Sili, Laura Serrano, László Imre Pinczés, Nick de Jonge, Andrés Soto-Silva, Caterina Buquicchio, Lucia Prezioso, Monia Marchetti, Stef Meers, Alessandro Busca, Paolo Corradini, Martin Hoenigl, Philipp Koehler, Laman Rahimli, Gökçe Melis Çolak, Elena Arellano, Dominik Wolf, Stefanie Gräfe, Emanuele Ammatuna, Caroline Berg Venemyr, Oliver A. Cornely, and Livio Pagano
Subjects: Diseases of the blood and blood-forming organs, RC633-647.5
Published: 2022
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10. B-cell malignancies treated with targeted drugs and SARS-CoV-2 infection: A European Hematology Association Survey (EPICOVIDEHA)

Author: Maria Stefania Infante, Jon Salmanton-García, Ana Fernández-Cruz, Francesco Marchesi, Ozren Jaksic, Barbora Weinbergerová, Caroline Besson, Rafael F. Duarte, Federico Itri, Toni Valković, Tomáš Szotkovski, Alessandro Busca, Anna Guidetti, Andreas Glenthøj, Graham P. Collins, Valentina Bonuomo, Uluhan Sili, Guldane Cengiz Seval, Marina Machado, Raul Cordoba, Ola Blennow, Ghaith Abu-Zeinah, Sylvain Lamure, Austin Kulasekararaj, Iker Falces-Romero, Chiara Cattaneo, Jaap Van Doesum, Klára Piukovics, Ali S. Omrani, Gabriele Magliano, Marie-Pierre Ledoux, Cristina de Ramon, Alba Cabirta, Luisa Verga, Alberto López-García, Maria Gomes Da Silva, Zlate Stojanoski, Stef Meers, Tobias Lahmer, Sonia Martín-Pérez, Julio Dávila-Vals, Jens Van Praet, Michail Samarkos, Yavuz M. Bilgin, Linda Katharina Karlsson, Josip Batinić, Anna Nordlander, Martin Schönlein, Martin Hoenigl, Zdeněk Ráčil, Miloš Mladenović, Michaela Hanakova, Giovanni Paolo Maria Zambrotta, Nick De Jonge, Tatjana Adžić-Vukičević, Raquel Nunes-Rodrigues, Lucia Prezioso, Milan Navrátil, Monia Marchetti, Annarosa Cuccaro, Maria Calbacho, Antonio Giordano, Oliver A. Cornely, José-Ángel Hernández-Rivas, and Livio Pagano
Subjects: SARS-CoV-2, targeted drugs, infection risk, immune system COVID19, lymphoproliferative diseases (LPD), chronic lymphocytic leukemia (CLL), Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract: Patients with lymphoproliferative diseases (LPD) are vulnerable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Here, we describe and analyze the outcome of 366 adult patients with chronic lymphocytic leukemia (CLL) or non-Hodgkin Lymphoma (NHL) treated with targeted drugs and laboratory-confirmed COVID-19 diagnosed between February 2020 and January 2022. Median follow-up was 70.5 days (IQR 0-609). Most used targeted drugs were Bruton-kinase inhibitors (BKIs) (N= 201, 55%), anti-CD20 other than rituximab (N=61, 16%), BCL2 inhibitors (N=33, 9%) and lenalidomide (N=28, 8%).Only 16.2% of the patients were vaccinated with 2 or more doses of vaccine at the onset of COVID-19. Mortality was 24% (89/366) on day 30 and 36%(134/366) on the last day of follow-up. Age >75 years (p
Published: 2022
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11. An international observational study to assess the impact of the Omicron variant emergence on the clinical epidemiology of COVID-19 in hospitalised patients

Author: Bronner P Gonçalves, Matthew Hall, Waasila Jassat, Valeria Balan, Srinivas Murthy, Christiana Kartsonaki, Malcolm G Semple, Amanda Rojek, Joaquín Baruch, Luis Felipe Reyes, Abhishek Dasgupta, Jake Dunning, Barbara Wanjiru Citarella, Mark Pritchard, Alejandro Martín-Quiros, Uluhan Sili, J Kenneth Baillie, Diptesh Aryal, Yaseen Arabi, Aasiyah Rashan, Andrea Angheben, Janice Caoili, François Martin Carrier, Ewen M Harrison, Joan Gómez-Junyent, Claudia Figueiredo-Mello, James Joshua Douglas, Mohd Basri Mat Nor, Yock Ping Chow, Xin Ci Wong, Silvia Bertagnolio, Soe Soe Thwin, Anca Streinu-Cercel, Leonardo Salazar, Asgar Rishu, Rajavardhan Rangappa, David SY Ong, Madiha Hashmi, Gail Carson, Janet Diaz, Rob Fowler, Moritz UG Kraemer, Evert-Jan Wils, Peter Horby, Laura Merson, Piero L Olliaro, and ISARIC Clinical Characterisation Group
Subjects: COVID-19, Omicron, fatality, emergence, epidemiology, symptoms, Medicine, Science, Biology (General), QH301-705.5
Abstract: Background: Whilst timely clinical characterisation of infections caused by novel SARS-CoV-2 variants is necessary for evidence-based policy response, individual-level data on infecting variants are typically only available for a minority of patients and settings. Methods: Here, we propose an innovative approach to study changes in COVID-19 hospital presentation and outcomes after the Omicron variant emergence using publicly available population-level data on variant relative frequency to infer SARS-CoV-2 variants likely responsible for clinical cases. We apply this method to data collected by a large international clinical consortium before and after the emergence of the Omicron variant in different countries. Results: Our analysis, that includes more than 100,000 patients from 28 countries, suggests that in many settings patients hospitalised with Omicron variant infection less often presented with commonly reported symptoms compared to patients infected with pre-Omicron variants. Patients with COVID-19 admitted to hospital after Omicron variant emergence had lower mortality compared to patients admitted during the period when Omicron variant was responsible for only a minority of infections (odds ratio in a mixed-effects logistic regression adjusted for likely confounders, 0.67 [95% confidence interval 0.61–0.75]). Qualitatively similar findings were observed in sensitivity analyses with different assumptions on population-level Omicron variant relative frequencies, and in analyses using available individual-level data on infecting variant for a subset of the study population. Conclusions: Although clinical studies with matching viral genomic information should remain a priority, our approach combining publicly available data on variant frequency and a multi-country clinical characterisation dataset with more than 100,000 records allowed analysis of data from a wide range of settings and novel insights on real-world heterogeneity of COVID-19 presentation and clinical outcome. Funding: Bronner P. Gonçalves, Peter Horby, Gail Carson, Piero L. Olliaro, Valeria Balan, Barbara Wanjiru Citarella, and research costs were supported by the UK Foreign, Commonwealth and Development Office (FCDO) and Wellcome [215091/Z/18/Z, 222410/Z/21/Z, 225288/Z/22/Z]; and Janice Caoili and Madiha Hashmi were supported by the UK FCDO and Wellcome [222048/Z/20/Z]. Peter Horby, Gail Carson, Piero L. Olliaro, Kalynn Kennon and Joaquin Baruch were supported by the Bill & Melinda Gates Foundation [OPP1209135]; Laura Merson was supported by University of Oxford’s COVID-19 Research Response Fund - with thanks to its donors for their philanthropic support. Matthew Hall was supported by a Li Ka Shing Foundation award to Christophe Fraser. Moritz U.G. Kraemer was supported by the Branco Weiss Fellowship, Google.org, the Oxford Martin School, the Rockefeller Foundation, and the European Union Horizon 2020 project MOOD (#874850). The contents of this publication are the sole responsibility of the authors and do not necessarily reflect the views of the European Commission. Contributions from Srinivas Murthy, Asgar Rishu, Rob Fowler, James Joshua Douglas, François Martin Carrier were supported by CIHR Coronavirus Rapid Research Funding Opportunity OV2170359 and coordinated out of Sunnybrook Research Institute. Contributions from Evert-Jan Wils and David S.Y. Ong were supported by a grant from foundation Bevordering Onderzoek Franciscus; and Andrea Angheben by the Italian Ministry of Health “Fondi Ricerca corrente–L1P6” to IRCCS Ospedale Sacro Cuore–Don Calabria. The data contributions of J.Kenneth Baillie, Malcolm G. Semple, and Ewen M. Harrison were supported by grants from the National Institute for Health Research (NIHR; award CO-CIN-01), the Medical Research Council (MRC; grant MC_PC_19059), and by the NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections at University of Liverpool in partnership with Public Health England (PHE) (award 200907), NIHR HPRU in Respiratory Infections at Imperial College London with PHE (award 200927), Liverpool Experimental Cancer Medicine Centre (grant C18616/A25153), NIHR Biomedical Research Centre at Imperial College London (award IS-BRC-1215-20013), and NIHR Clinical Research Network providing infrastructure support. All funders of the ISARIC Clinical Characterisation Group are listed in the appendix.
Published: 2022
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12. Neurologic Manifestations of Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Hospitalized Patients During the First Year of the COVID-19 Pandemic

Author: Anna M. Cervantes-Arslanian, MD, Chakradhar Venkata, MD, Pria Anand, MD, Joseph D. Burns, MD, Charlene J. Ong, MD, Allison M. LeMahieu, MS, Phillip J. Schulte, PhD, Tarun D. Singh, MD, Alejandro A. Rabinstein, MD, Neha Deo, BS, Vikas Bansal, MBBS, MPH, Karen Boman, BS, Juan Pablo Domecq Garces, MD, Donna Lee Armaignac, PhD, APRN, Amy B. Christie, MD, Roman R. Melamed, MD, Yasir Tarabichi, MD, MSCR, Sreekanth R. Cheruku, MD, MPH, Ashish K. Khanna, MD, FCCP, FCCM, FASA, Joshua L. Denson, MD, MS, Valerie M. Banner-Goodspeed, MPH, Harry L. Anderson, III, MD, FACS, FICS, FCCM, FCCP, FAIM, Ognjen Gajic, MD, MS, Vishakha K. Kumar, MD, MBA, Allan Walkey, MD, Rahul Kashyap, MD, MBA, on behalf of the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 Registry Investigator Group, Jean-Baptiste Mesland, Pierre Henin, Hélène Petre, Isabelle Buelens, Anne-Catherine Gerard, Philippe Clevenbergh, Rolando Claure-Del Granado, Jose A. Mercado, Esdenka Vega-Terrazas, Maria F. Iturricha-Caceres, Ruben Garza, Eric Chu, Victoria Chan, Oscar Y Gavidia, Felipe Pachon, Yeimy A Sanchez, Danijel knežević, Mohamed El Kassas, Mohamed Badr, Ahmed Tawheed, Hend Yahia, Dimitrios Kantas, Vasileios Koulouras, Estela Pineda, Gabina María Reyes Guillen, Helin Archaga Soto, Ana Karen Vallecillo Lizardo, Csaba Kopitkó, Ágnes Bencze, István Méhész, Zsófia Gerendai,, Girish Vadgaonkar, Rekha Ediga, Shilpa Basety, Shwetha Dammareddy, Phani Sreeharsha Kasumalla, Smitha S. Segu, Tuhin Chakraborty, Epcebha Joyce, Sridhar Papani, Mahesh Kamuram, Mradul Kumar Daga, Munisha Agarwal, Ishan Rohtagi, Anusha Cherian, Sreejith Parameswaran, Magesh Parthiban, Phaneendra Doddaga, Neethi Chandra, Puneet Rijhwani, Ashish Jain, Aviral Gupta, Ram Mohan Jaiswal, Ambika Tyagi, Nimish Mathur, Madhav Prabhu, Vishal Jakati, Mukur Petrolwala, Bharat Ladva, Surapaneni Krishna Mohan, Ekambaram Jyothisree, Umamaheswara Raju, Janaki Manduva, Naresh Kolakani, Shreeja Sripathi, Sheetal Chaitanya, Kamlesh Kumar Agrawal, Vijendra Baghel, Kirti Kumar Patel, Nooshin Dalili, Mohsen Nafa, Wataru Matsuda, Reina Suzuki, Michihito Kyo, Shu Tahara, Mineji Hayakawa, Kunihiko Maekawa, Masamitsu Sanui, Sho Horikita, Yuki Itagaki, Akira Kodate, Yuki Takahashi, Koyo Moriki, Takuya Shiga, Yudai Iwasaki, Hidenobu Shigemitsu, Yuka Mishima, Nobuyuki Nosaka, Michio Nagashima, Abdulrahman Al-Fares, Rene Rodriguez-Gutierrez, Jose Gerardo Gonzalez-Gonzalez, Alejandro Salcido-Montenegro, Adrian Camacho-Ortiz, Mariana Janeth Hermosillo Ulloa, Fatimah Hassan-Hanga, Hadiza Galadanci, Abubakar Shehu Gezawa, Halima M. S. Kabara, Taiwo Gboluwaga Amole, Halima Kabir, Dalha Gwarzo Haliru, Abdullahi S Ibrahim, Muhammad Sohaib Asghar, Mashaal Syed, Syed Anosh Ali Naqvi, Igor Borisovich Zabolotskikh,, Konstantin Dmitrievich Zybin, Sergey Vasilevich Sinkov, Tatiana Sergeevna Musaeva, Razan K Alamoudi, Hassan M. AlSharif, Sarah A. Almazwaghi, Mohammed S Elsakran, Mohamed A Aid, Mouaz A Darwich, Omnia M Hagag, Salah A Ali, Alona rocacorba, Kathrine Supeña, Efren Ray Juane, Jenalyn Medina, Jowany Baduria, Marwa Ridha Amer, Mohammed Abdullah, Bawazeer, Talal I. Dahhan, Eiad Kseibi, Abid Shahzad Butt, Syed Moazzum Khurshid, Muath Rabee, Mohammed Abujazar, Razan Alghunaim, Maal Abualkhair, Abeer Turki AlFirm, Yaseen M Arabi, Sheryl Ann Abdukahil, Mohammed A Almazyad, Mohammed I Alarifi, Jara M Macarambon, Ahmad Abdullah Bukhari, Hussain A. Albahrani, Kazi N Asfina, Kaltham M Aldossary, Marija Zdravkovic, Zoran Todorovic, Viseslav Popadic, Slobodan Klasnja, Ana Andrijevic, Srdjan Gavrilovic, Vladimir Carapic, Bojan Kovacevic, Jovana Bojicic, Stevanovic Predrag, Dejan S Stojakov, Duska K Ignjatovic, Suzana C Bojic, Marina M Bobos, Irina B Nenadic, Milica S Zaric, Marko D Djuric, Vladimir R Djukic, Santiago Y. Teruel, Belen C. Martin, Uluhan Sili, Huseyin Bilgin, Pinar Ay, Varsha P Gharpure, Usman Raheemi, Kenneth W. Dodd, Nicholas Goodmanson, Kathleen Hesse, Paige Bird, Chauncey Weinert, Nathan Schoenrade, Abdulrahman Altaher, Esmael Mayar, Matthew Aronson, Tyler Cooper, Monica Logan, Brianna Miner, Gisele Papo, Eric M. Siegal, Phyllis Runningen, Suzanne Barry, Christopher Woll, Gregory Wu, Erin Carrole, Kathryn Burke, Mustafa Mohammed, Roman R. Melamed, David M. Tierney, Love A. Patel, Vino S. Raj, Barite U. Dawud, Narayana Mazumder, Abbey Sidebottom, Alena M. Guenther, Benjamin D. Krehbiel, Nova J. Schmitz, Stacy L. Jepsen, Lynn Sipsey, Anna Schulte, Whitney Wunderlich, Cecely Hoyt, Abhijit A Raval, Andrea Franks, Katherine Irby, Ronald C. Sanders, Jr., Glenda Hefley, Jennifer M. Jarvis, Anmol Kharbanda, Sunil Jhajhria, Zachary Fyffe, Stephen Capizzi, Bethany Alicie, Martha Green, Lori Crockarell, Amelia Drennan, Kathleen Dubuque, Tonya Fambrough, Nikole Gasaway, Briana Krantz, Peiman Nebi, Jan Orga, Margaret Serfass, Alina Simion, Kimberly Warren, Cassie Wheeler, CJ Woolman, Amy B. Christie, Dennis W. Ashley, Rajani Adiga, Andrew S. Moyer, George M. Verghese, Andrea Sikora Newsome, Christy C. Forehand, Rebecca Bruning, Timothy W. Jones, Moldovan Sabov, Fatema Zaidi, Fiona Tissavirasingham, Dhatri Malipeddi, Jarrod M Mosier, Karen Lutrick, Beth Salvagio Campbell, Cathleen Wilson, Patrick Rivers, Jonathan Brinks, Mokenge Ndiva Mongoh, Boris Gilson, Donna Lee Armaignac, Don Parris, Maria Pilar Zuniga, Ilea Vargas, Viviana Boronat, Anneka Hutton, Navneet Kaur, Prashank Neupane, Nohemi Sadule-Rios, Lourdes M. Rojas, Aashish Neupane, Priscilla Rivera, Carlos Valle Carlos, Gregory Vincent, Mahesh Amin, Mary E Schelle, Amanda Steadham, Christopher M Howard, Cameron McBride, Jocelyn Abraham, Orlando Garner, Katherine Richards, Keegan Collins, Preethi Antony, Sindhu Mathew, Valerie C. Danesh, Gueorgui Dubrocq, Amber L. Davis, Marissa J Hammers, ill M. McGahey, Amanda C. Farris, Elisa Priest, Robyn Korsmo, Lorie Fares, Kathy Skiles, Susan M. Shor, Kenya Burns, Corrie A Dowell, Gabriela “Hope” Gonzales, Melody Flores, Lindsay Newman, Debora A Wilk, Jason Ettlinger, Jaccallene Bomar, Himani Darji, Alejandro Arroliga, Alejandro C Arroliga, Corrie A. Dowell, Gabriela Hope Conzales, Debora A. Wilk, Paras B. Khandhar, Elizabeth Kring, Valerie M. Banner-Goodspeed, Somnath Bose, Lauren E. Kelly, Melisa Joseph, Marie McGourty, Krystal Capers, Benjamin Hoenig, Maria C. Karamourtopoulos, Anica C. Law, Elias N. Baedorf Kassis, Allan J. Walkey, Sushrut S. Waikar, Michael A. Garcia, Mia Colona, Zoe Kibbelaar, Michael Leong, Daniel Wallman, Kanupriya Soni, Jennifer Maccarone, Joshua Gilman, Ycar Devis, Joseph Chung, Munizay Paracha, David N. Lumelsky, Madeline DiLorenzo, Najla Abdurrahman, Shelsey Johnson, Maj Andrew M. Hersh, CPT Stephanie L Wachs, Brittany S. Swigger, Stephanie L Wachs, Capt Lauren A. Sattler, Capt Michael N. Moulton, Kimberly Zammit, Patrick, J McGrath, William Loeffler, Maya, R. Chilbert, Aaron S. Miller, Edwin L. Anderson, Rosemary Nagy, Ravali R. Inja, Pooja A. Nawathe, Isabel Pedraza, Jennifer Tsing, Karen Carr, Anila Chaudhary, Kathleen Guglielmino, Raghavendra Tirupathi, Alymer Tang, Arshad Safi, Cindy Green, Jackie Newell, Rayan E. Ihle, Shelda A. Martin, Elaine A. Davis, Katja M. Gist, Imran A Sayed, John Brinton, Larisa Strom, Kathleen Chiotos, Allison M. Blatz, Giyoung Lee, Ryan H. Burnett, Guy I. Sydney, Danielle M. Traynor, Karissa Nauert, Annika Gonzalez, Mariel Bagley, Anita Santpurkar, Salim Surani, Joshua White, Aftab Khan, Rahul Dhahwal, Sreekanth Cheruku, Farzin Ahmed, Christopher Deonarine, Ashley Jones, Mohammad-Ali Shaikh, David Preston, Jeanette Chin, Vidula Vachharajani, Abhijit Duggal, Prabalini Rajendram, Omar Mehkri, Siddharth Dugar, Michelle Biehl, Gretchen Sacha, Stuart Houltham, Alexander King, Kiran Ashok, Bryan Poynter, Mary Beukemann, Richard Rice, Susan Gole, Valerie Shaner, Adarsh Conjeevaram, Michelle Ferrari, Narendrakumar Alappan, Steven Minear, Jaime Hernandez-Montfort, Syed Sohaib Nasim, Ravi Sunderkrishnan, Debasis Sahoo, Patrick S. Milligan, Sandeep K. Gupta, Joy M. Koglin, Regina Gibson, Lana Johnson, Felicia Preston, Crimson Scott, Bethany Nungester, Dana D Byrne, Christa A Schorr, Katie Grant, Katherine L Doktor, Maura C Porto, Olga Kaplan, James E. Siegler, III, Brian Schonewald, Ashley Woodford, Alan Tsai, Savina Reid, Kuntal Bhowmick, Saba Daneshpooy, Cyrus Mowdawalla, Trishna Akshay Dave, Wilhemina Kennedy, Connor Crudeli, Christopher Ferry, Long Nguyen, Sneha Modi, Niharika Padala, Pavan Jitendra Patel, Belle Lin, Lena Chatterjee, Jamie Qiuyun, Fan Mandi Liu, Rasagna Kota, Annesha Banerjee, Steven K. Daugherty, Sam Atkinson, Kelly Shrimpton, Sidney Ontai, Brian Contreras, Uzoma Obinwanko, Nneka Amamasi, Amir Sharafi, Sarah Lee, Zahia Esber, Chetna Jinjvadia, Raquel R Bartz, Vijay Krishnamoorthy, Bryan Kraft, Aaron Pulsipher, Eugene Friedman, Sachin Mehta, Margit Kaufman, Gregg Lobel, Nisha Gandhi, Amr Abdelaty, Elizabeth Shaji, Kiana Lim, Juan Marte, Dani Ashley Sosa, David P. Yamane, Ivy Benjenk, Nivedita Prasanna, Nicholas Perkins, Prera J. Roth, Banu Sivaraj, Haley Fulton, Madison G Herin, Marissa Crum, Morgan E. Fretwell, Emily-Rose Zhou, Christine Waller, Kara Kallies, Jonean Thorsen, Alec Fitzsimmons, Haley Olsen, Heda R. Dapul, Sourabh Verma, Alan Salas, Ariel Daube, Michelle Korn, Michelle Ramirez, Logi Rajagopalan, Laura Santos, Héctor Collazo Santiago, Ricardo Alan Hernandez, Norma Smalls, Asher G Bercow, Mark Shlomovich, Christine Crandall, Sasko Stojanovski, Kristin Johnson, Kelly Michienzi, Steven Q. Davis, Valentina Jovic, Max Masuda, Amanda Hayes, Katharine Nault, Michael Smith, William Snow, Riley Liptak, Hannah Durant, Valerie Pendleton, Alay Nanavati, Risa Mrozowsk, Namrata Nag, Jeff Brauer, Ashwin Dharmadhikari, Sahib Singh, Franco Laghi, Ghania Naeem, Andrew Wang, Kevin Bliden, Amit Rout, Jaime Barnes, Martin Gesheff, Asha Thomas, Melbin Thomas, Alicia R. Liendo, Jovan Milosavljevic, Kenan Abbasi, Nicholas B. Burley, Nicole Rapista, Samuel Amankwah, Sanjay K Poude, Saroj Timilsina, Sauradeep Sarkar, Oluwasayo Akinyosoye, Shashi K. Yalamanchili, Sheena Moorthy, Sonia Sugumar, Jonathan Ford, Martin C. Taylor, Charlotte Dunderdale, Alyssa Henshaw, Mary K. Brunk, Jessica Hagy, Shehryar Masood, Sushrutha Sridhar, Yuk Ming Liu, Sarah Zavala, Esther Shim, Ronald A. Reilkoff, Julia A. Heneghan, Sarah Eichen, Lexie Goertzen, Scott Rajala, Ghislaine Feussom, Ben Tang, Christine C. Junia, Robert Lichtenberg, Hasrat Sidhu, Diana Espinoza, Shelden Rodrigues, Maria Jose Zabala, Daniela Goyes, Ammu Susheela, Buddhi Hatharaliyadda, Naveen Rameshkumar, Amulya Kasireddy, Genessis Maldonado, Lisseth Beltran, Akshata Chaugule, Hassan Khan, Namrata Patil, Ruhi Patil, Rodrigo Cartin-Ceba, Ayan Sen, Fahimeh Talaei, Rahul Kashyap, Juan Pablo Domecq, Ognjen Gajic, Vikas Bansal, Aysun Tekin, Amos Lal, John C. O’Horo, Neha N. Deo, Mayank Sharma, Shahraz Qamar, Romil Singh, Diana J. Valencia Morales, Abigail T. La Nou, Marija Bogojevic, Simon Zec, Devang Sanghavi, Pramod Guru, Pablo Moreno Franco, Karthik Gnanapandithan, Hollie Saunders, Zachary Fleissner, Juan Garcia, Alejandra Yu Lee Mateus, Siva Naga Yarrarapu, Nirmaljot Kaur, Abhisekh Giri, Mohammed Mustafa Hasan, Ashrita Donepudi, Syed Anjum Khan, Nitesh Kumar Jain, Thoyaja Koritala, Alexander Bastidas, Gabriela Orellana, Adriana Briceno Bierwirth, Eliana Milazzo, Juan Guillermo Sierra, Thao Dang, Rahul S Nanchal, Paul A Bergl, Jennifer L Peterson, Jessica Timmer, Kimberly Welker, Travis Yamanaka, Nicholas A. Barreras, Michael Markos, Anita Fareeduddin, Rohan Mehta, Chakradhar Venkata, Miriam Engemann, Annamarie Mantese, Yasir Tarabichi, Adam Perzynski, Christine Wang, Dhatri Kotekal, Adriana C Briceno Bierwirth, Gabriela M Orellana, Gerardo Catalasan, Shohana Ahmed, Carlos F Matute, Ahmad Hamdan, Ivania Salinas, Genesis Del Nogal, Angel Tejada, Anna Eschler, Mary Hejna, Emily Lewandowski, Kristen Kusmierski, Clare Martin, Jen-Ting Chen, Aluko Hope, Zoe Tsagaris, Elise Ruen, Aram Hambardzumyan, Nasar A Siddiqi, Lesly Jurado, Lindsey Tincher, Carolyn Brown, Prithvi Sendi, Meghana Nadiger, Balagangadhar Totapally, Bhagat S. Aulakh, Sandeep Tripathi, Jennifer A. Bandy, Lisa M. Kreps, Dawn R. Bollinger, Neha Gupta, Brent R Brown, Tracy L Jones, Kassidy Malone, Lauren A Sinko, Amy B Harrell, Shonda C Ayers, Lisa M Settle, Taylor J Sears, Roger Scott Stienecker, Andre G. Melendez, Tressa A. Brunner, Sue M Budzon, Jessica L. Heffernan, Janelle M. Souder, Tracy L. Miller, Andrea G. Maisonneuve, Roberta E. Redfern, Jessica Shoemaker, Jennifer Micham, Lynn Kenney, Gabriel Naimy, Victoria Schauf, Sara Utley, Holly Balcer, Kerry P. J. Pulver, Jennifer Yehle, Alicia Weeks, Terra Inman, Majdi Hamarshi, Jeannette Ploetz, Nick Bennett, Kyle Klindworth, Moustafa Younis, Adham Mohamed, Brian L. Delmonaco, Anthony Franklin, Mitchell Heath, Diane Barkas, Antonia L. Vilella, Sara B. Kutner, Kacie Clark, Danielle Moore, Shina Menon, John K McGuire, Deana Rich, Harry L. Anderson, III, Dixy Rajkumar, Ali Abunayla, Jerrilyn Heiter, Howard A. Zaren, Stephanie J. Smith, Grant C. Lewis, Lauren Seames, Cheryl Farlow, Judy Miller, Gloria Broadstreet, John Lin, Cindy Terrill, Brock Montgomery, Sydney Reyes, Summer Reyes, Alex Plattner, Anthony Martinez, Micheal Allison, Aniket Mittal, Rafael Ruiz, Aleta Skaanland, Robert Ross, Umang Patel, Jordesha Hodge, Krunal Kumar Patel, Shivani Dalal, Himanshu Kavani, Sam Joseph, Michael A. Bernstein, Ian K. Goff, Matthew Naftilan, Amal Mathew, Deborah Williams, Sue Murdock, Maryanne Ducey, Kerianne Nelson, Jason Block, James Mitchel, Connor G O’Brien, Sylvan Cox, William Marx, Ioana Amzuta, Asad J. Choudhry, Mohammad T. Azam, Kristina L Carter, Michael A Olmos, Brittany M Parker, Julio Quintanilla, Tara A Craig, Brendon J Clough, Jeffrey T Jameson, Utpal S. Bhalala, Joshua Kuehne, Melinda Garcia, Morgan Beebe, Heather Herrera, Chris Fiack, Stephanie Guo, May Vawer, Beth Blackburn, Caleb Darby, Kristy Page, Amanda Brown, Jessie McAbee, Katherine A. Belden, Michael Baram, Devin M. Weber, Rosalie DePaola, Yuwei Xia, Hudson Carter, Aaron Tolley, Mary Barletta, Mark Steele, Laurie Kemble, Joshua L. Denson, A. Scott Gillet, Margo Brown, Rachael Stevens, Andrew Wetherbie, Kevin Tea, Mathew Moore, Abdurrahman Husain, Atul Malhotra, Qais Zawaydeh, Benjamin J Sines, Thomas J Bice, Emily A. Vail, Susannah Nicholson, Rachelle B. Jonas, AnnaRose E. Dement, William Tang, Mark DeRosa, Robert E. Villarreal, Rajany V. Dy, Alfredo Iardino, Jill Sharma, Richard Czieki, Julia Christopher, Ryan Lacey, Marwan Mashina, Kushal Patel, Erica C. Bjornstad, Nancy M. Tofil, Scott House, Isabella Aldana, Nikhil K. Meena, Jose D. Caceres, Nikhil K Meena, Sarenthia M. Epps, Harmeen Goraya, Kelsey R. Besett, Ryan James, Lana Y. Abusalem, Akash K. Patel, Lana S Hasan, Dina Gomaa, Michael Goodman, Devin Wakefield, Anthony Spuzzillo, John O. Shinn II, Robert MacLaren, Azra Bihorac, Tezcan Ozrazgat Baslanti, George Omalay, Haleh Hashemighouchani, Julie S. Cupka, Matthew M Ruppert, Patrick W. McGonagill, Colette Galet, Janice Hubbard, David Wang, Lauren Allan, Aditya Badheka, Madhuradhar Chegondi, Usman Nazir, Garrett Rampon, Jake Riggle, Nathan Dismang, Vicki Montgomery, Janice Sullivan, Sarah Morris, Jennifer Nason, Ozan Akca, Rainer Lenhardt, Rodrigo S. Cavallazzi, Ann Jerde, Alexa Black, Allison Polidori, Haily Griffey, Justin Winkler, Thomas Brenzel, Roger A. Alvarez, Amarilys Alarcon-Calderon, Marie Anne Sosa, Sunita K. Mahabir, Mausam J. Patel, Pauline Park, Andrew Admon, Sinan Hanna, Rishi Chanderraj, Maria Pliakas, Ann Wolski, Jennifer Cirino, Dima Dandachi, Hariharan Regunath, Maraya N. Camazine, Grant. E. Geiger, Abdoulie O. Njai, Baraa M. Saad, Faraaz Ali Shah, Byron Chuan, Sagar L. Rawal, Manal Piracha, Joseph E. Tonna, Nicholas M. Levin, Kayte Suslavich, Rachel Tsolinas, Zachary T. Fica, Chloe R. Skidmore, Renee D. Stapleton, Anne E. Dixon, Olivia Johnson, Sara S. Ardren, Stephanie Burns, Anna Raymond, Erika Gonyaw, Kevin Hodgdon, Chloe Housenger, Benjamin Lin, Karen McQuesten, Heidi Pecott-Grimm, Julie Sweet, Sebastian Ventrone, Nita Khandelwal, T. Eoin West, Ellen S. Caldwell, Lara Lovelace-Macon, Navya Garimella, Denisse B. Dow, Sreekanth R. Cheruku, Catherine Chen, Murtaza Akhter, Rania Abdul Rahman, Mary Mulrow, Erin M. Wilfong, Kelsi Vela, Ashish K. Khanna, Lynne Harris, Bruce Cusson, Jacob Fowler, David Vaneenenaam, Glen McKinney, Imoh Udoh, Kathleen Johnson, Patrick G. Lyons, Andrew P Michelson, Sara S. Haluf, Lauren M. Lynch, Nguyet M. Nguyen, Aaron Steinberg, Nicholas Braus, Vishwanath Pattan, Jessica Papke, Ismail Jimada, Nida Mhid, Samuel Chakola, Kevin Sheth, Abdalla Ammar, Mahmoud Ammar, Victor Torres Lopez, Charles Dela Cruz,, Akhil Khosla, and Samir Gautam
Subjects: Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: OBJECTIVES:. To describe the prevalence, associated risk factors, and outcomes of serious neurologic manifestations (encephalopathy, stroke, seizure, and meningitis/encephalitis) among patients hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. DESIGN:. Prospective observational study. SETTING:. One hundred seventy-nine hospitals in 24 countries within the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study COVID-19 Registry. PATIENTS:. Hospitalized adults with laboratory-confirmed SARS-CoV-2 infection. INTERVENTIONS:. None. RESULTS:. Of 16,225 patients enrolled in the registry with hospital discharge status available, 2,092 (12.9%) developed serious neurologic manifestations including 1,656 (10.2%) with encephalopathy at admission, 331 (2.0%) with stroke, 243 (1.5%) with seizure, and 73 (0.5%) with meningitis/encephalitis at admission or during hospitalization. Patients with serious neurologic manifestations of COVID-19 were older with median (interquartile range) age 72 years (61.0–81.0 yr) versus 61 years (48.0–72.0 yr) and had higher prevalence of chronic medical conditions, including vascular risk factors. Adjusting for age, sex, and time since the onset of the pandemic, serious neurologic manifestations were associated with more severe disease (odds ratio [OR], 1.49; p < 0.001) as defined by the World Health Organization ordinal disease severity scale for COVID-19 infection. Patients with neurologic manifestations were more likely to be admitted to the ICU (OR, 1.45; p < 0.001) and require critical care interventions (extracorporeal membrane oxygenation: OR, 1.78; p = 0.009 and renal replacement therapy: OR, 1.99; p < 0.001). Hospital, ICU, and 28-day mortality for patients with neurologic manifestations was higher (OR, 1.51, 1.37, and 1.58; p < 0.001), and patients had fewer ICU-free, hospital-free, and ventilator-free days (estimated difference in days, –0.84, –1.34, and –0.84; p < 0.001). CONCLUSIONS:. Encephalopathy at admission is common in hospitalized patients with SARS-CoV-2 infection and is associated with worse outcomes. While serious neurologic manifestations including stroke, seizure, and meningitis/encephalitis were less common, all were associated with increased ICU support utilization, more severe disease, and worse outcomes.
Published: 2022
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13. Hospital Variation in Management and Outcomes of Acute Respiratory Distress Syndrome Due to COVID-19

Author: Shelsey W. Johnson, MD, Michael A. Garcia, MD, Emily K. Q. Sisson, MA, Christopher R. Sheldrick, PhD, Vishakha K. Kumar, MD, MBA, Karen Boman, BA, Scott Bolesta, PharmD, Vikas Bansal, MBBS, MPH, Amos Lal, MBBS, J. P. Domecq, MD, MS, Roman R. Melamed, MD, Amy B. Christie, MD, Abdurrahman Husain, MD, Santiago Yus, MBBS, Ognjen Gajic, MD, MSc, Rahul Kashyap, MBBS, MBA, Allan J. Walkey, MD, MSc, from the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 Registry Investigator Group, Oscar Y. Gavidia, Felipe Pachon, Yeimy A. Sanchez, Mohamed El Kassas, Mohamed Badr, Ahmed Tawheed, Hend Yahia, Wataru Matsuda, Reina Suzuki, Masamitsu Sanui, Sho Horikita, Yuki Itagaki, Akira Kodate, Yuki Takahashi, Koyo Moriki, Muhammad Sohaib, Asghar, Mashaal Syed, Syed Anosh, Ali Naqvi, Borisovich Zabolotskikh, Konstantin Dmitrievich Zybin, Sergey Vasilevich Sinkov, Tatiana Sergeevna Musaeva, Mohammed A. Almazyad, Mohammed I. Alarifi, Jara M. Macarambon, Ahmad Abdullah Bukhari, Hussain A. Albahrani, Kazi N. Asfina, Kaltham M. Aldossary, Marija Zdravkovic, Zoran Todorovic, Viseslav Popadic, Slobodan Klasnja, Predrag D. Stevanovic, Dejan S. Stojakov, Duska K. Ignjatovic, Suzana C. Bojic, Marina M. Bobos, Irina B. Nenadic, Milica S. Zaric, Marko D. Djuric, Vladimir R. Djukic, Santiago Yus, Belen C. Martin, Uluhan Sili, Huseyin Bilgin, Pinar Ay, Roman R. Melamed, David M. Tierney, Love A. Patel, Vino S. Raj, Barite U. Dawud, Narayana Mazumder, Abbey Sidebottom, Alena M. Guenther, Benjamin D. Krehbiel, Nova J. Schmitz, Stacy L. Jepsen, Lynn Sipsey, Anna Schulte, Whitney Wunderlich, Cecely Hoyt, Kenneth W. Dodd, Nicholas Goodmanson, Kathleen Hesse, Paige Bird, Chauncey Weinert, Nathan Schoenrade, Abdulrahman Altaher, Esmael Mayar, Matthew Aronson, Tyler Cooper, Monica Logan, Brianna Miner, Gisele Papo, Abdulrahman Al-Fares, Anmol Kharbanda, Sunil Jhajhria, Zachary Fyffe, Amy B. Christie, Dennis W. Ashley, Rajani Adiga, Andrea Sikora Newsome, Christy C. Forehand, Rebecca Bruning, Timothy W. Jones, Moldovan Sabov, Fatema Zaidi, Fiona Tissavirasingham, Dhatri Malipeddi, Valerie M. Banner-Goodspeed, Somnath Bose, Lauren E. Kelly, Melisa Joseph, Marie McGourty, Krystal Capers, Benjamin Hoenig, Maria C. Karamourtopoulos, Anica C. Law, Elias N. Baedorf Kassis, Allan J. Walkey, Sushrut S. Waikar, Michael A. Garcia, Mia Colona, Zoe Kibbelaar, Michael Leong, Daniel Wallman, Kanupriya Soni, Jennifer Maccarone, Joshua Gilman, Ycar Devis, Joseph Chung, Munizay Paracha, David N. Lumelsky, Madeline DiLorenzo, Najla Abdurrahman, Shelsey Johnson, Kimberly Zammit, Patrick J. McGrath, William Loeffler, Maya R. Chilbert, Jean-Baptiste Mesland, Pierre Henin, Hélène Petre, Isabelle Buelens, Anne-Catherine Gerard, Rayan E. Ihle, Shelda A. Martin, Elaine A. Davis, Salim Surani, Joshua White, Aftab Khan, Rahul Dhahwal, Sreekanth Cheruku, Farzin Ahmed, Christopher Deonarine, Ashley Jones, Mohammad-Ali Shaikh, David Preston, Jeanette Chin, Steven K. Daugherty, Sam Atkinson, Kelly Shrimpton, Raquel R. Bartz, Vijay Krishnamoorthy, Bryan Kraft, Aaron Pulsipher, Eugene Friedman, Sachin Mehta, David P. Yamane, Ivy Benjenk, Nivedita Prasanna, Katharine Nault, Ronald A. Reilkoff, Julia A. Heneghan, Sarah Eichen, Lexie Goertzen, Scott Rajala, Ghislaine Feussom, Ben Tang, Mayo Clinic Arizona, Rodrigo Cartin-Ceba, Ayan Sen, Amanda Palacios, Giyth M. Mahdi, Rahul Kashyap, Ognjen Gajic, Vikas Bansal, Aysun Tekin, Amos Lal, John C. O’Horo, Neha N. Deo, Mayank Sharma, Shahraz Qamar, Juan Pablo Domecq, Romil Singh, Alex Niven, Mayo Clinic, Eau Claire, Abigail T. La Nou, Marija Bogojevic, Barbara Mullen, Devang Sanghavi, Pramod Guru, Pablo Moreno Franco, Karthik Gnanapandithan, Hollie Saunders, Zachary Fleissner, Juan Garcia, Alejandra Yu Lee Mateus, Siva Naga Yarrarapu, Nirmaljot Kaur, Abhisekh Giri, Syed Anjum Khan, Nitesh Kumar Jain, Thoyaja Koritala, Chakradhar Venkata, Miriam Engemann, Annamarie Mantese, Yasir Tarabichi, Adam Perzynski, Christine Wang, Dhatri Kotekal, Bhagat S. Aulakh, Sandeep Tripathi, Jennifer A. Bandy, Lisa M. Kreps, Dawn R. Bollinger, Roger Scott Stienecker, Andre G. Melendez, Tressa A. Brunner, Sue M. Budzon, Jessica L. Heffernan, Janelle M. Souder, Tracy L. Miller, Andrea G. Maisonneuve, Antonia L. Vilella, Sara B. Kutner, Kacie Clark, Danielle Moore, Harry L. Anderson, III, Dixy Rajkumar, Ali Abunayla, Jerrilyn Heiter, Howard A. Zaren, Stephanie J. Smith, Grant C. Lewis, Lauren Seames, Cheryl Farlow, Judy Miller, Gloria Broadstreet, Anthony Martinez, Micheal Allison, Aniket Mittal, Rafael Ruiz, Aleta Skaanland, Robert Ross, Neha Gupta, Tracy L. Jones, Shonda C. Ayers, Amy B. Harrell, Dr. Brent R. Brown, Abdurrahman Husain, Atul Malhotra, Qais Zawaydeh, Dragana Markotić, Ivana Bošnjak, Emily A. Vail, Susannah Nicholson, Rachelle B. Jonas, AnnaRose E. Dement, William Tang, Mark DeRosa, Robert E. Villarreal, Patrick W. McGonagill, Colette Galet, Janice Hubbard, David Wang, Lauren Allan, Aditya Badheka, Madhuradhar Chegondi, Roger A. Alvarez, Amarilys Alarcon-Calderon, Marie Anne Sosa, Sunita K. Mahabir, Mausam J. Patel, Faraaz Ali Shah, Byron Chuan, Sagar L. Rawal, Manal Piracha, Joseph E. Tonna, Nicholas M. Levin, Kayte Suslavich, Rachel Tsolinas, Zachary T. Fica, Chloe R. Skidmore, Renee D. Stapleton, Anne E. Dixon, Olivia Johnson, Sara S. Ardren, Stephanie Burns, Anna Raymond, Erika Gonyaw, Kevin Hodgdon, Chloe Housenger, Benjamin Lin, Karen McQuesten, Heidi Pecott-Grimm, Julie Sweet, Sebastian Ventrone, Murtaza Akhter, Rania Abdul Rahman, Mary Mulrow, Ashish K. Khanna, Lynne Harris, Bruce Cusson, Jacob Fowler, David Vaneenenaam, Glen McKinney, Imoh Udoh, Kathleen Johnson, Vishwanath Pattan, Jessica Papke, Ismail Jimada, Nida Mhid, and Samuel Chakola
Subjects: Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: OBJECTIVES:. To describe hospital variation in use of “guideline-based care” for acute respiratory distress syndrome (ARDS) due to COVID-19. DESIGN:. Retrospective, observational study. SETTING:. The Society of Critical Care Medicine’s Discovery Viral Infection and RESPIRATORY ILLNESS UNIVERSAL STUDY COVID-19 REGISTRY. PATIENTS:. Adult patients with ARDS due to COVID-19 between February 15, 2020, and April 12, 2021. INTERVENTIONS:. Hospital-level use of “guideline-based care” for ARDS including low-tidal-volume ventilation, plateau pressure less than 30 cm H2O, and prone ventilation for a Pao2/Fio2 ratio less than 100. MEASUREMENTS AND MAIN RESULTS:. Among 1,495 adults with COVID-19 ARDS receiving care across 42 hospitals, 50.4% ever received care consistent with ARDS clinical practice guidelines. After adjusting for patient demographics and severity of illness, hospital characteristics, and pandemic timing, hospital of admission contributed to 14% of the risk-adjusted variation in “guideline-based care.” A patient treated at a randomly selected hospital with higher use of guideline-based care had a median odds ratio of 2.0 (95% CI, 1.1–3.4) for receipt of “guideline-based care” compared with a patient receiving treatment at a randomly selected hospital with low use of recommended therapies. Median-adjusted inhospital mortality was 53% (interquartile range, 47–62%), with a nonsignificantly decreased risk of mortality for patients admitted to hospitals in the highest use “guideline-based care” quartile (49%) compared with the lowest use quartile (60%) (odds ratio, 0.7; 95% CI, 0.3–1.9; p = 0.49). CONCLUSIONS:. During the first year of the COVID-19 pandemic, only half of patients received “guideline-based care” for ARDS management, with wide practice variation across hospitals. Strategies that improve adherence to recommended ARDS management strategies are needed.
Published: 2022
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14. Variation in Use of Repurposed Medications Among Patients With Coronavirus Disease 2019. From The Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study: Coronavirus Disease 2019 Registry Investigator Group

Author: Michael A. Garcia, MD, Shelsey W. Johnson, MD, Nicholas A. Bosch, MD, MSc, Emily K. Sisson, MA, Christopher R. Sheldrick, PhD, Vishakha K. Kumar, MD, MBA, Karen Boman, BS, Scott Bolesta, PharmD, Vikas Bansal, MBBS, MPH, Neha Deo, BS, J. P. Domecq, MD, Amos Lal, MD, Amy B. Christie, MD, Valerie M. Banner-Goodspeed, MPH, Devang Sanghavi, MD, MHA, Girish Vadgaonkar, MBBS, Ognjen Gajic, MD, MSc, Rahul Kashyap, MBBS, MBA, Allan J. Walkey, MD, MSc, for the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study Investigators, Jean-Baptiste Mesland, Pierre Henin, Hélène Petre, Isabelle Buelens, Anne-Catherine Gerard, Philippe Clevenbergh, Dragana Markotić, Ivana Bošnjak, Ruben Garza, Eric Chu, Victoria Chan, Oscar Y Gavidia, Felipe Pachon, Yeimy A Sanchez, Mohamed El Kassas, Mohamed Badr, Ahmed Tawheed, Hend Yahia, Jose Luis Ramos Coello, Guillermo Perez, Ana Karen Vallecillo Lizardo, Gabina María Reyes Guillen, Helin Archaga Soto, Smitha S. Segu, Tuhin Chakraborty, Epcebha Joyce, Girish Vadgaonkar, Rekha Ediga, Shilpa Basety, Shwetha Dammareddy, Phani Sreeharsha Kasumalla, Umamaheswara Raju, Janaki Manduva, Naresh Kolakani, Shreeja Sripathi, Sheetal Chaitanya, Mradul Kumar Daga, Munisha Agarwal, Ishan Rohtagi, Sridhar Papani, Mahesh Kamuram, Kamlesh Kumar Agrawal, Vijendra Baghel, Kirti Kumar Patel, Surapaneni Krishna Mohan, Ekambaram Jyothisree, Wataru Matsuda, Reina Suzuki, Michihito Kyo, Yuki Itagaki, Akira Kodate, Yuki Takahashi, Koyo Moriki, Fatimah Hassan-Hanga, Hadiza Galadanci, Abubakar Shehu Gezawa, Halima M. S. Kabara, Taiwo Gboluwaga Amole, Halima Kabir, Dalha Gwarzo Haliru, Abdullahi S Ibrahim, Muhammad Sohaib Asghar, Mashaal Syed, Syed Anosh Ali Naqvi, Igor Borisovich Zabolotskikh, Konstantin Dmitrievich Zybin, Sergey Vasilevich Sinkov, Tatiana Sergeevna Musaeva, Mohammed A Almazyad, Mohammed I Alarifi, Jara M Macarambon, Ahmad Abdullah Bukhari, Hussain A. Albahrani, Kazi N Asfina, Kaltham M Aldossary, Marija Zdravkovic, Zoran Todorovic, Viseslav Popadic, Slobodan Klasnja, Bojan Kovacevic, Jovana Bojicic, Predrag D Stevanovic, Dejan S Stojakov, Duska K Ignjatovic, Suzana C Bojic, Marina M Bobos, Irina B Nenadic, Milica S Zaric, Marko D Djuric, Vladimir R Djukic, Santiago Y. Teruel, Belen C. Martin, Uluhan Sili, Huseyin Bilgin, Pinar Ay, Abhijit A Raval, Andrea Franks, Anmol Kharbanda, Sunil Jhajhria, Zachary Fyffe, Stephen Capizzi, Bethany Alicie, Martha Green, Lori Crockarell, Amelia Drennan, Kathleen Dubuque, Tonya Fambrough, Nikole Gasaway, Briana Krantz, Peiman Nebi, Jan Orga, Margaret Serfass, Alina Simion, Kimberly Warren, Cassie Wheeler, CJ Woolman, Amy B. Christie, Dennis W. Ashley, Rajani Adiga, Andrew S. Moyer, George M. Verghese, Andrea Sikora Newsome, Christy C. Forehand, Rebecca Bruning, Timothy W. Jones, Moldovan Sabov, Fatema Zaidi, Fiona Tissavirasingham, Dhatri Malipeddi, Donna Lee Armaignac, Don Parris, Maria Pilar Zuniga, Ilea Vargas, Viviana Boronat, Anneka Hutton, Navneet Kaur, Prashank Neupane, Nohemi Sadule-Rios, Lourdes M. Rojas, Aashish Neupane, Priscilla Rivera, Carlos Valle Carlos, Gregory Vincent, Valerie M. Banner-Goodspeed, Somnath Bose, Lauren E. Kelly, Melisa Joseph, Marie McGourty, Krystal Capers, Benjamin Hoenig, Maria C. Karamourtopoulos, Anica C. Law, Elias N. Baedorf Kassis, Allan J. Walkey, Sushrut S. Waikar, Michael A. Garcia, Mia Colona, Zoe Kibbelaar, Michael Leong, Daniel Wallman, Kanupriya Soni, Jennifer Maccarone, Joshua Gilman, Ycar Devis, Joseph Chung, Munizay Paracha, David N. Lumelsky, Madeline DiLorenzo, Najla Abdurrahman, Shelsey Johnson, Kimberly Zammit, Patrick, J McGrath, William Loeffler, Maya, R Chilbert, Raghavendra Tirupathi, Alymer Tang, Arshad Safi, Cindy Green, Jackie Newell, Katja M. Gist, Imran A Sayed, John Brinton, Larisa Strom, Steven K. Daugherty, Sam Atkinson, Kelly Shrimpton, David P. Yamane, Ivy Benjenk, Nivedita Prasanna, Norma Smalls, Michael Smith, William Snow, Riley Liptak, Hannah Durant, Valerie Pendleton, Alay Nanavati, Risa Mrozowsk, Yuk Ming Liu, Sarah Zavala, Esther Shim, Ronald A. Reilkoff, Julia A. Heneghan, Sarah Eichen, Lexie Goertzen, Scott Rajala, Ghislaine Feussom, Ben Tang, Christine C. Junia, Robert Lichtenberg, Hasrat Sidhu, Diana Espinoza, Shelden Rodrigues, Maria Jose Zabala, Daniela Goyes, Ammu Susheela, Buddhi Hatharaliyadda, Naveen Rameshkumar, Amulya Kasireddy, Genessis Maldonado, Lisseth Beltran, Akshata Chaugule, Hassan Khan, Rodrigo Cartin-Ceba, Ayan Sen, Amanda Palacios, Giyth M. Mahdi, Rahul Kashyap, Ognjen Gajic, Vikas Bansal, Aysun Tekin, Amos Lal, John C. O’Horo, Neha N. Deo, Mayank Sharma, Shahraz Qamar, Juan Pablo Domecq, Romil Singh, Alex Niven, Abigail La Nou, Marija Bogojevic, Barbara Mullen, Devang Sanghavi, Pablo Moreno Franco, Pramod Guru, Karthik Gnanapandithan, Hollie Saunders, Zachary Fleissner, Juan Garcia, Alejandra Yu, Lee Mateus, Siva Naga Yarrarapu, Nirmaljot Kaur, Abhisekh Giri, Syed Anjum Khan, Nitesh Kumar Jain, Thoyaja Koritala, Jessica Timmer, Kimberly Welker, Chakradhar Venkata, Miriam Engemann, Annamarie Mantese, Anna Eschler, Mary Hejna, Emily Lewandowski, Kristen Kusmierski, Clare Martin, Bhagat S. Aulakh, Sandeep Tripathi, Jennifer A. Bandy, Lisa M. Kreps, Dawn R. Bollinger, Roger Scott Stienecker, Andre G. Melendez, Tressa A. Brunner, Sue M Budzon, Jessica L. Heffernan, Janelle M. Souder, Tracy L. Miller, Andrea G. Maisonneuve, Brian L. Delmonaco, Anthony Franklin, Mitchell Heath, Antonia L. Vilella, Sara B. Kutner, Kacie Clark, Danielle Moore, Harry L. Anderson, III, Dixy Rajkumar, Ali Abunayla, Jerrilyn Heiter, Howard A. Zaren, Stephanie J. Smith, Grant C. Lewis, Lauren Seames, Cheryl Farlow, Judy Miller, Gloria Broadstreet, Anthony Martinez, Micheal Allison, Aniket Mittal, Rafael Ruiz, Aleta Skaanland, Robert Ross, Paul K Mohabir, Connor G O’Brien, Komal Dasani, Neha Gupta, Tracy L Jones, Shonda C Ayers, Amy B Harrell, Brent R Brown, Megan Edwards, Caleb Darby, Kristy Page, Amanda Brown, Jessie McAbee, Katherine A. Belden, Michael Baram, Devin M. Weber, Rosalie DePaola, Yuwei Xia, Hudson Carter, Aaron Tolley, Mary Barletta, Mary Ferranti, Benjamin J Sines, Thomas J Bice, Patrick W. McGonagill, Colette Galet, Janice Hubbard, David Wang, Lauren Allan, Aditya Badheka, Madhuradhar Chegondi, Usman Nazir, Garrett Rampon, Jake Riggle, Nathan Dismang, Roger A. Alvarez, Amarilys Alarcon-Calderon, Marie Anne Sosa, Sunita K. Mahabir, Mausam J. Patel, Dima Dandachi, Hariharan Regunath, Maraya N. Camazine, Grant. E. Geiger, Abdoulie O. Njai, Baraa M. Saad, Renee D. Stapleton, Anne E. Dixon, Olivia Johnson, Sara S. Ardren, Stephanie Burns, Anna Raymond, Erika Gonyaw, Kevin Hodgdon, Chloe Housenger, Benjamin Lin, Karen McQuesten, Heidi Pecott-Grimm, Julie Sweet, Sebastian Ventrone, Ashish K. Khanna, Lynne Harris, Bruce Cusson, Jacob Fowler, David Vaneenenaam, Glen McKinney, Imoh Udoh, Kathleen Johnson, Vishwanath Pattan, Jessica Papke, Ismail Jimada, Nida Mhid, Samuel Chakola, Kevin Sheth, Abdalla Ammar, Mahmoud Ammar, Victor Torres Lopez, Charles Dela Cruz, Akhil Khosla, and Samir Gautam
Subjects: Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: IMPORTANCE:. At the start of the coronavirus disease 2019 pandemic, medications repurposed for management of coronavirus disease 2019 were used in the absence of clinical trial evidence. OBJECTIVES:. To describe the variation and evolution in use of repurposed medications for coronavirus disease 2019. DESIGN, SETTING, AND PARTICIPANTS:. Observational cohort study of adults hospitalized with coronavirus disease 2019 between February 15, 2020, and April 12, 2021, across 76 United States and international hospitals within the Society of Critical Care Medicine’s Discovery Viral Infection and Respiratory Illness Universal Study coronavirus disease 2019 registry. MAIN OUTCOMES AND MEASURES:. Hospital variation was quantified using multivariable adjusted random effects logistic regression models and unsupervised clustering. Repurposed medications included antivirals, corticosteroids, hydroxychloroquine, immunomodulators, and therapeutic dose anticoagulants. RESULTS:. Among 7,069 adults hospitalized with coronavirus disease 2019, 1,979 (28%) received antivirals, 2,876 (41%) received corticosteroids, 1,779 (25%) received hydroxychloroquine, 620 (9%) received immunomodulators, and 2,154 (31%) received therapeutic dose anticoagulants. Contribution of hospital site to risk-adjusted variation was 46% for antivirals, 30% for corticosteroids, 48% for hydroxychloroquine, 46% for immunomodulators, and 52% for therapeutic dose anticoagulants. Compared with the early pandemic, the later pandemic practice phenotypes converged with increased use of antivirals (odds ratio, 3.14; 95% CI, 2.40–4.10) and corticosteroids (odds ratio, 5.43; 95% CI, 4.23–6.97), with decreased use of hydroxychloroquine (odds ratio, 0.02; 95% CI, 0.01–0.04) and immunomodulators (odds ratio, 0.49; 95% CI, 0.34–0.70). There was no clinically significant change in the use of therapeutic dose anticoagulants (odds ratio, 1.01; 95% CI, 1.01–1.02). There were no differences in risk-adjusted mortality between hospitals with high rates of repurposed medication use compared with hospitals with low rates of use. CONCLUSIONS AND RELEVANCE:. Hospital variation in the use of repurposed medications varied widely across hospitals early in the pandemic and later converged with the emergence of randomized clinical trials. Platforms developed for rapid activation and enrollment in clinical trials of repurposed medications are needed prior to the next pandemic to expedite effective, evidence-based practice.
Published: 2021
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15. Risk Factors for Critical Coronavirus Disease 2019 and Mortality in Hospitalized Young Adults: An Analysis of the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS) Coronavirus Disease 2019 Registry

Author: Sandeep Tripathi, MD, MS, Imran A. Sayed, MD, Heda Dapul, MD, Jeremy S. McGarvey, MS, Jennifer A. Bandy, RN, Karen Boman, BS, Vishakha K. Kumar, MD, MBA, Vikas Bansal, MBBS, MPH, Lynn Retford, CAE, Sreekanth Cheruku, MD, MPH, Margit Kaufman, MD, FASA, Smith F. Heavner, MS, RN, Valerie C. Danesh, PhD, RN, Catherine A. St. Hill, DVM, PhD, Ashish K. Khanna, MD, Utpal Bhalala, MD, Rahul Kashyap, MBBS, MBA, Ognjen Gajic, MD, MS, Allan J. Walkey, MD, MS, Katja M. Gist, DO, MSc, for The Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 Registry Investigator Group, Jean-Baptiste Mesland, Pierre Henin, Hélène Petre, Isabelle Buelens, Anne-Catherine Gerard, Philippe Clevenbergh, Rolando Claure-Del Granado, Jose A. Mercado, Esdenka Vega-Terrazas, Maria F. Iturricha-Caceres, Ruben Garza, Eric Chu, Victoria Chan, Oscar Y Gavidia, Felipe Pachon, Yeimy A Sanchez, Mohamed El Kassas, Mohamed Badr, Ahmed Tawheed, Hend Yahia, Sierra-Hoffman, Fernando Valerio, Oscar Diaz, Jose Luis Ramos Coello, Guillermo Perez, Ana Karen Vallecillo Lizardo, Gabina María Reyes Guillen, Helin Archaga Soto, Mradul Kumar Daga, Munisha Agarwal, Ishan Rohtagi, Anusha Cherian, Sreejith Parameswaran, Magesh Parthiban, Menu Priya A., Girish Vadgaonkar, Rekha Ediga, Shilpa Basety, Shwetha Dammareddy, Phani Sreeharsha Kasumalla, Sridhar Papani, Mahesh Kamuram, Smitha S. Segu, Tuhin Chakraborty, Epcebha Joyce, Umamaheswara Raju, Janaki Manduva, Naresh Kolakani, Shreeja Sripathi, Sheetal Chaitanya, Surapaneni Krishna Mohan, Ekambaram Jyothisree, Kamlesh Kumar Agrawal, Vijendra Baghel, Kirti Kumar Patel, Nooshin Dalili, Mohsen Nafa, Sandeep Tripathi, Yuki Itagaki, Akira Kodate, Reina Suzuki, Yuki Takahashi, Koyo Moriki, Michihito Kyo, Masamitsu Sanui, Sho Horikita, Wataru Matsuda, Shu Tahara, Mineji Hayakawa, Kunihiko Maekawa, Takuya Shiga, Yudai Iwasaki, Abdulrahman AlFares, Rene Rodriguez-Gutierrez, Jose Gerardo Gonzalez-Gonzalez, Alejandro Salcido-Montenegro, Adrian Camacho-Ortiz, Fatimah Hassan-Hanga, Hadiza Galadanci, Abubakar Shehu Gezawa, Halima M. S. Kabara, Taiwo Gboluwaga Amole, Halima Kabir, Dalha Gwarzo, Haliru, Abdullahi S Ibrahim, Muhammad Sohaib Asghar, Mashaal Syed, Syed Anosh Ali Naqvi, Igor Borisovich Zabolotskikh, Konstantin Dmitrievich Zybin, Sergey Vasilevich Sinkov, Tatiana Sergeevna Musaeva, Marwa Ridha Amer, Mohammed Abdullah Bawazeer, Talal I. Dahhan, Eiad Kseibi, Abid Shahzad Butt, Syed Moazzum Khurshid, Muath Rabee, Mohammed Abujazar, Razan Alghunaim, Maal Abualkhair, Abeer Turki AlFirm, Razan K Alamoudi, Hassan M. AlSharif, Sarah A. Almazwaghi, Mohammed S Elsakran, Mohamed A Aid, Mouaz A Darwich, Omnia M Hagag, Salah A Ali, Alona rocacorba, Kathrine Supeña, Efren Ray Juane, Jenalyn Medina, Jowany Baduria, Mohammed A Almazyad, Mohammed I Alarifi, Jara M Macarambon, Ahmad Abdullah Bukhari, Hussain A. Albahrani, Kazi N Asfina, Kaltham M Aldossary, Predrag D Stevanovic, Dejan S Stojakov, Duska K Ignjatovic, Suzana C Bojic, Marina M Bobos, Irina B Nenadic, Milica S Zaric, Marko D Djuric, Vladimir R Djukic, Bojan Kovacevic, Jovana Bojicic, Marija Zdravkovic, Zoran Todorovic, Viseslav Popadic, Slobodan Klasnja, Santiago Y. Teruel, Belen C. Martin, Himat Sulaimonov, Firuza Khudonazarova, Nabi Bakhtibekov, Nekruz Jamshedov, Uluhan Sili, Huseyin Bilgin, Pinar Ay, Varsha P Gharpure, Usman Raheemi, Kenneth W. Dodd, Nicholas Goodmanson, Kathleen Hesse, Paige Bird, Chauncey Weinert, Nathan Schoenrade, Abdulrahman Altaher, Esmael Mayar, Matthew Aronson, Tyler Cooper, Monica Logan, Brianna Miner, Gisele Papo, Eric M. Siegal, Phyllis Runningen, Catherine A. St. Hill, Roman R. Melamed, David M. Tierney, Love A. Patel, Vino S. Raj, Barite U. Dawud, Narayana Mazumder, Abbey Sidebottom, Alena M. Guenther, Benjamin D. Krehbiel, Nova J. Schmitz, Stacy L. Jepsen, Abhijit A Raval, Andrea Franks, Katherine Irby, Ronald C. Sanders, Jr., Glenda Hefley, Anmol Kharbanda, Sunil Jhajhria, Zachary Fyffe, Stephen Capizzi, Bethany Alicie, Martha Green, Lori Crockarell, Amelia Drennan, Kathleen Dubuque, Tonya Fambrough, Nikole Gasaway, Briana Krantz, Peiman Nebi, Jan Orga, Margaret Serfass, Alina Simion, Kimberly Warren, Cassie Wheeler, CJ Woolman, Andrew S. Moyer, George M. Verghese, Andrea Sikora Newsome, Christy C. Forehand, Rebecca Bruning, Timothy W. Jones, Moldovan Sabov, Fatema Zaidi, Fiona Tissavirasingham, Dhatri Malipeddi, Jarrod M Mosier, Karen Lutrick, Beth Salvagio Campbell, Cathleen Wilson, Patrick Rivers, Jonathan Brinks, Mokenge Ndiva Mongoh, Boris Gilson, Donna Lee Armaignac, Don Parris, Maria Pilar Zuniga, Ilea Vargas, Viviana Boronat, Anneka Hutton, Navneet Kaur, Prashank Neupane, Nohemi Sadule-Rios, Lourdes M. Rojas, Aashish Neupane, Priscilla Rivera, Carlos Valle Carlos, Gregory Vincent, Mahesh Amin, Mary E Schelle, Amanda Steadham, Christopher M Howard, Cameron McBride, Jocelyn Abraham, Orlando Garner, Katherine Richards, Keegan Collins, Preethi Antony, Sindhu Mathew, Valerie C. Danesh, Gueorgui Dubrocq, Amber L. Davis, Marissa J Hammers, ill M. McGahey, Amanda C. Farris, Elisa Priest, Robyn Korsmo, Lorie Fares, Kathy Skiles, Susan M. Shor, Kenya Burns, Corrie A Dowell, Melody Flores, Lindsay Newman, Debora A Wilk, Jason Ettlinger, Jaccallene Bomar, Himani Darji, Alejandro Arroliga, Alejandro C Arroliga, Corrie A. Dowell, Gabriela Hope Conzales, Debora A. Wilk, Paras B. Khandhar, Elizabeth Kring, Valerie M. Banner-Goodspeed, Somnath Bose, Lauren E. Kelly, Melisa Joseph, Marie McGourty, Krystal Capers, Benjamin Hoenig, Maria C. Karamourtopoulos, Anica C. Law, Elias N. Baedorf Kassis, Allan J. Walkey, Sushrut S. Waikar, Michael A. Garcia, Mia Colona, Zoe Kibbelaar, Michael Leong, Daniel Wallman, Kanupriya Soni, Jennifer Maccarone, Joshua Gilman, Ycar Devis, Joseph Chung, Munizay Paracha, David N. Lumelsky, Madeline DiLorenzo, Najla Abdurrahman, Shelsey Johnson, Andrew M. Hersh, Stephanie L Wachs, Brittany S. Swigger, Lauren A. Sattler, Michael N. Moulton, Kimberly Zammit, J Patrick, William McGrath, Maya Loeffler, R Chilbert, Aaron S. Miller, Edwin L. Anderson, Rosemary Nagy, Ravali R. Inja, Raghavendra Tirupathi, Alymer Tang, Arshad Safi, Cindy Green, Jackie Newell, Rayan E. Ihle, Shelda A. Martin, Elaine A. Davis, Katja M. Gist, Imran A Sayed, John Brinton, Larisa Strom, Kathleen Chiotos, Allison M. Blatz, Giyoung Lee, Ryan H. Burnett, Guy I. Sydney, Danielle M. Traynor, Karissa Nauert, Annika Gonzalez, Mariel Bagley, Anita Santpurkar, Salim Surani, Joshua White, Aftab Khan, Rahul Dhahwal, Sreekanth Cheruku, Farzin Ahmed, Christopher Deonarine, Ashley Jones, Mohammad-Ali Shaikh, David Preston, Jeanette Chin, Vidula Vachharajani, Abhijit Duggal, Prabalini Rajendram, Omar Mehkri, Siddharth Dugar, Michelle Biehl, Gretchen Sacha, Stuart Houltham, Alexander King, Kiran Ashok, Bryan Poynter, Mary Beukemann, Richard Rice, Susan Gole, Valerie Shaner, Adarsh Conjeevaram, Michelle Ferrari, Narendrakumar Alappan, Steven Minear, Jaime Hernandez-Montfort, Syed Sohaib Nasim, Ravi Sunderkrishnan, Debasis Sahoo, Patrick S. Milligan, Sandeep K. Gupta, Joy M. Koglin, Regina Gibson, Lana Johnson, Felicia Preston, Crimson Scott, Bethany Nungester, Steven K. Daugherty, Sam Atkinson, Kelly Shrimpton, Sidney Ontai, Brian Contreras, Uzoma Obinwanko, Nneka Amamasi, Amir Sharafi, Sarah Lee, Zahia Esber, Chetna Jinjvadia, Kimberly Welker, Francis M. Maguire, Jessica Timmer, Raquel R Bartz, Vijay Krishnamoorthy, Bryan Kraft, Aaron Pulsipher, Eugene Friedman, Sachin Mehta, Margit Kaufman, Gregg Lobel, Nisha Gandhi, Amr Abdelaty, Elizabeth Shaji, Kiana Lim, Juan Marte, Dani Ashley Sosa, David P. Yamane, Ivy Benjenk, Nivedita Prasanna, Smith F. Heavner-Sullivan, Prera J. Roth, Banu Sivaraj, Haley Fulton, Madison G Herin, Marissa Crum, Morgan E. Fretwell, Emily-Rose Zhou, Christine Waller, Kara Kallies, Jonean Thorsen, Alec Fitzsimmons, Haley Olsen, Heda R. Dapul, Sourabh Verma, Alan Salas, Ariel Daube, Michelle Korn, Michelle Ramirez, Logi Rajagopalan, Laura Santos, Orma Smalls, Atul Malhotra, Abdurrahman Husain, Qais Zawaydeh, J.H. Steuernagle, Steven Q. Davis, Valentina Jovic, Max Masuda, Amanda Hayes, Katharine Nault, Michael Smith, William Snow, Riley Liptak, Hannah Durant, Valerie Pendleton, Alay Nanavati, Risa Mrozowsk, LiManoj K Gupta, Franscene E. Oulds, Akshay Nandavar, Yuk Ming Liu, Sarah Zavala, Esther Shim, Ronald A. Reilkoff, Julia A. Heneghan, Sarah Eichen, Lexie Goertzen, Scott Rajala, Ghislaine Feussom, Ben Tang, Christine C. Junia, Robert Lichtenberg, Hasrat Sidhu, Diana Espinoza, Shelden Rodrigues, Maria Jose Zabala, Daniela Goyes, Ammu Susheela, Buddhi Hatharaliyadda, Naveen Rameshkumar, Amulya Kasireddy, Genessis Maldonado, Lisseth Beltran, Akshata Chaugule, Hassan Khan, Namrata Patil, Ruhi Patil, Rodrigo Cartin-Ceba, Ayan Sen, Amanda Palacios, Giyth M. Mahdi, Rahul Kashyap, Ognjen Gajic, Vikas Bansal, Aysun Tekin, Amos Lal, John C. O’Horo, Neha N. Deo, Mayank Sharma, Shahraz Qamar, Cory J. Kudrna, Juan Pablo Domecq Garces, Abigail T. La Nou, Marija Bogojevic, Devang Sanghavi, Pramod Guru, Karthik Gnanapandithan, Hollie Saunders, Zachary Fleissner, Juan Garcia, Alejandra Yu Lee Mateus, Siva Naga Yarrarapu, Syed Anjum Khan, Juan Pablo Domecq, Nitesh Kumar Jain, Thoyaja Koritala, Alexander Bastidas, Gabriela Orellana, Adriana Briceno Bierwirth, Eliana Milazzo, Juan Guillermo Sierra, Thao Dang, Amy B. Christie, Dennis W. Ashley, Rajani Adiga, Rahul S Nanchal, Paul A Bergl, Jennifer L Peterson, Travis Yamanaka, Nicholas A. Barreras, Michael Markos, Anita Fareeduddin, Rohan Mehta, Chakradhar Venkata, Miriam Engemann, Annamarie Mantese, Yasir Tarabichi, Adam Perzynski, Christine Wang, Dhatri Kotekal, Adriana C Briceno Bierwirth, Gabriela M Orellana, Gerardo Catalasan, Shohana Ahmed, Carlos F Matute, Ahmad Hamdan, Ivania Salinas, Genesis Del Nogal, Angel Tejada, Anna Eschler, Mary Hejna, Emily Lewandowski, Kristen Kusmierski, Clare Martin, Jen-Ting Chen, Aluko Hope, Zoe Tsagaris, Elise Ruen, Aram Hambardzumyan, Prithvi Sendi, Meghana Nadiger, Balagangadhar Totapally, Bhagat S. Aulakh, Jennifer A. Bandy, Lisa M. Kreps, Dawn R. Bollinger, Roger Scott Stienecker, Andre G. Melendez, Tressa A. Brunner, Sue M Budzon, Jessica L. Heffernan, Janelle M. Souder, Tracy L. Miller, Andrea G. Maisonneuve, Roberta E. Redfern, Jessica Shoemaker, Jennifer Micham, Lynn Kenney, Gabriel Naimy, Sara Utley, Holly Balcer, Kerry P. J. Pulver, Jennifer Yehle, Alicia Weeks, Terra Inman, Brian L. Delmonaco, Anthony Franklin, Mitchell Heath, Antonia L. Vilella, Sara B. Kutner, Kacie Clark, Danielle Moore, Shina Menon, John K McGuire, Deana Rich, Harry L. Anderson, III, Dixy Rajkumar, Ali Abunayla, Jerrilyn Heiter, Howard A. Zaren, Stephanie J. Smith, Grant C. Lewis, Lauren Seames, Cheryl Farlow, Judy Miller, Gloria Broadstreet, John Lin, Cindy Terrill, Brock Montgomery, Sydney Reyes, Summer Reyes, Alex Plattner, Anthony Martinez, Micheal Allison, Aniket Mittal, Rafael Ruiz, Aleta Skaanland, Robert Ross, Umang Patel, Jordesha Hodge, KrunalKumar Patel, Shivani Dalal, Himanshu Kavani, Sam Joseph, Michael A. Bernstein, Ian K. Goff, Matthew Naftilan, Amal Mathew, Deborah Williams, Sue Murdock, Maryanne Ducey, Kerianne Nelson, Paul K Mohabir, Connor G O’Brien, Komal Dasani, William Marx, Ioana Amzuta, Asad J. Choudhry, Mohammad T. Azam, Kristina L Carter, Michael A Olmos, Brittany M Parker, Julio Quintanilla, Tara A Craig, Brendon J Clough, Jeffrey T Jameson, Neha Gupta, Tracy L Jones, Shonda C Ayers, Amy B Harrell, Dr.Brent R Brown, Utpal S. Bhalala, Joshua Kuehne, Melinda Garcia, Morgan Beebe, Heather Herrera, Chris Fiack, Stephanie Guo, May Vawer, Beth Blackburn, Megan Edwards, Caleb Darby, Kristy Page, Amanda Brown, Jessie McAbee, Katherine A. Belden, Michael Baram, Devin M. Weber, Rosalie DePaola, Yuwei Xia, Hudson Carter, Aaron Tolley, Mark Steele, Laurie Kemble, Joshua L. Denson, A. Scott Gillet, Margo Brown, Rachael Stevens, Andrew Wetherbie, Kevin Tea, Mathew Moore, Benjamin J Sines, Thomas J Bice, Emily A. Vail, Susannah Nicholson, Rachelle B. Jonas, AnnaRose E. Dement, William Tang, Mark DeRosa, Robert E. Villarreal, Rajany V. Dy, Alfredo Iardino, Jill Sharma, Richard Czieki, Julia Christopher, Ryan Lacey, Marwan Mashina, Kushal Patel, Erica C. Bjornstad, Nancy M. Tofil, Scott House, Isabella Aldana, Nikhil K. Meena, Jose D. Caceres, Nikhil K Meena, Sarenthia M. Epps, Harmeen Goraya, Kelsey R. Besett, Ryan James, Lana Y. Abusalem, Akash K. Patel, Lana S Hasan, Dina Gomaa, Michael Goodman, Devin Wakefield, Anthony Spuzzillo, John O. Shinn, II, Azra Bihorac, Tezcan Ozrazgat Baslanti, George Omalay, Haleh Hashemighouchani, Julie S. Cupka, Matthew M Ruppert, Patrick W. McGonagill, Colette Galet, Janice Hubbard, David Wang, Lauren Allan, Aditya Badheka, Madhuradhar Chegondi, Usman Nazir, Garrett Rampon, Jake Riggle, Nathan Dismang, Vicki Montgomery, Janice Sullivan, Sarah Morris, Jennifer Nason, Roger A. Alvarez, Amarilys Alarcon-Calderon, Marie Anne Sosa, Sunita K. Mahabir, Mausam J. Patel, Pauline Park, Andrew Admon, Sinan Hanna, Rishi Chanderraj, Maria Pliakas, Ann Wolski, Jennifer Cirino, Dima Dandachi, Hariharan Regunath, Maraya N. Camazine, Grant. E. Geiger, Abdoulie O. Njai, Baraa M. Saad, Faraaz Ali Shah, Byron Chuan, Sagar L. Rawal, Manal Piracha, Joseph E. Tonna, Nicholas M. Levin, Kayte Suslavich, Rachel Tsolinas, Zachary T. Fica, Chloe R. Skidmore, Renee D. Stapleton, Anne E. Dixon, Olivia Johnson, Sara S. Ardren, Stephanie Burns, Anna Raymond, Erika Gonyaw, Kevin Hodgdon, Chloe Housenger, Benjamin Lin, Karen McQuesten, Heidi Pecott-Grimm, Julie Sweet, Sebastian Ventrone, Nita Khandelwal, T. Eoin West, Ellen S. Caldwell, Lara Lovelace-Macon, Navya Garimella, Denisse B. Dow, Murtaza Akhter, Rania Abdul Rahman, Mary Mulrow, Erin M. Wilfong, Kelsi Vela, Ashish K. Khanna, Lynne Harris, Bruce Cusson, Jacob Fowler, David Vaneenenaam, Glen McKinney, Imoh Udoh, Kathleen Johnson, Patrick G. Lyons, Andrew P Michelson, Sara S. Haluf, Lauren M. Lynch, Nguyet M. Nguyen, Aaron Steinberg, Nicholas Braus, Vishwanath Pattan, Jessica Papke, Ismail Jimada, Nida Mhid, and Samuel Chakola
Subjects: Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: IMPORTANCE:. Even with its proclivity for older age, coronavirus disease 2019 has been shown to affect all age groups. However, there remains a lack of research focused primarily on the young adult population. OBJECTIVES:. To describe the epidemiology and outcomes of coronavirus disease 2019 and identify the risk factors associated with critical illness and mortality in hospitalized young adults. DESIGN, SETTINGS, AND PARTICIPANTS:. A retrospective cohort study of the Society of Critical Care Medicine’s Viral Infection and Respiratory Illness Universal Study registry. Patients 18–40 years old, hospitalized from coronavirus disease 2019 from March 2020 to April 2021, were included in the analysis. MAIN OUTCOMES AND MEASURES:. Critical illness was defined as a composite of mortality and 21 predefined interventions and complications. Multivariable logistic regression was used to assess associations with critical illness and mortality. RESULTS:. Data from 4,005 patients (152 centers, 19 countries, 18.6% non-U.S. patients) were analyzed. The median age was 32 years (interquartile range, 27–37 yr); 51% were female, 29.4% Hispanic, and 42.9% had obesity. Most patients (63.2%) had comorbidities, the most common being hypertension (14.5%) and diabetes (13.7%). Hospital and ICU mortality were 3.2% (129/4,005) and 8.3% (109/1,313), respectively. Critical illness occurred in 25% (n = 996), and 34.3% (n = 1,376) were admitted to the ICU. Older age (p = 0.03), male sex (adjusted odds ratio, 1.83 [95% CI, 1.2–2.6]), and obesity (adjusted odds ratio, 1.6 [95% CI, 1.1–2.4]) were associated with hospital mortality. In addition to the above factors, the presence of any comorbidity was associated with critical illness from coronavirus disease 2019. Multiple sensitivity analyses, including analysis with U.S. patients only and patients admitted to high-volume sites, showed similar risk factors. CONCLUSIONS:. Among hospitalized young adults, obese males with comorbidities are at higher risk of developing critical illness or dying from coronavirus disease 2019.
Published: 2021
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16. The Association of Thyroid Hormone Changes with Inflammatory Status and Prognosis in COVID-19

Author: Ceyda Dincer Yazan, Can Ilgin, Onur Elbasan, Tugce Apaydin, Saida Dashdamirova, Tayfun Yigit, Uluhan Sili, Aysegul Karahasan Yagci, Onder Sirikci, Goncagul Haklar, and Hulya Gozu
Subjects: Diseases of the endocrine glands. Clinical endocrinology, RC648-665
Abstract: Background. COVID-19 infection may have multiorgan effects in addition to effects on the lungs and immune system. Recently, studies have found thyroid function abnormalities in COVID-19 cases which were interpreted as euthyroid sick syndrome (ESS) or destructive thyroiditis. Therefore, in this study, we aimed to evaluate the thyroid function status and thyroid autoimmunity in COVID-19 patients. Material and Method. 205 patients were included. The medical history and laboratory parameters at admission were collected from medical records. Serum thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), thyroid peroxidase antibody, and thyroglobulin antibody were measured, and patients were classified according to thyroid function status. Results. 34.1% of the patients were euthyroid. Length of hospitalization (p
Published: 2021
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17. Successful treatment of an invasive fungal infection caused by Talaromyces sp. with voriconazole

Author: Uluhan Sili, Huseyin Bilgin, Rikesh Masania, Emel Eryuksel, Nuri Cagatay Cimsit, Gulcicek Ayranci, Malcolm Richardson, and Volkan Korten
Subjects: Invasive fungal infection, Rheumatoid arthritis, Mold infection, Voriconazole, Medicine (General), R5-920, Biology (General), QH301-705.5
Abstract: Invasive fungal infections (IFI) are on the rise due to increasing numbers of immunosuppressed and critically ill patients. A malignant-looking pulmonary nodule in an immunosuppressed patient may indeed be caused by a fungal organism. We report a patient, who was eventually diagnosed with an IFI caused by an agent of hyalohyphomycosis, Talaromyces sp. determined via molecular methods and succesfully treated with voriconazole.
Published: 2015
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18. Compliance of Healthcare Workers with Hand Hygiene Practices in Neonatal and Pediatric Intensive Care Units: Overt Observation

Author: Ayşe Karaaslan, Eda Kepenekli Kadayifci, Serkan Atıcı, Uluhan Sili, Ahmet Soysal, Gülcan Çulha, Yasemin Pekru, and Mustafa Bakır
Subjects: Infectious and parasitic diseases, RC109-216
Abstract: Background. The objective of this study was to assess the compliance of hand hygiene (HH) of healthcare workers (HCWs) in the neonatal and pediatric intensive care unit in a tertiary university hospital in Istanbul. Methods. An observational study was conducted on the compliance of HH for the five World Health Organization (WHO) indications. HCWs were observed during routine patient care in day shift. The authors also measured the technique of HH through hand washing or hand hygiene with alcohol-based disinfectant. Results. A total of 704 HH opportunities were identified during the observation period. Overall compliance was 37.0% (261/704). Compliance differed by role: nurses (41.4%) and doctors (31.9%) [P=0.02, OR: 1.504, CI 95%: 1.058–2.137]. HCWs were more likely to use soap and water (63.6%) compared to waterless-alcohol-based hand hygiene (36.3%) [P
Published: 2014
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19. Admission Code Status and End-of-life Care for Hospitalized Patients With COVID-19

Author: Whitney A Kiker, Si Cheng, Lauren R Pollack, Claire J Creutzfeldt, Erin K Kross, J Randall Curtis, Katherine A Belden, Roman Melamed, Donna Lee Armaignac, Smith F Heavner, Amy B Christie, Valerie M Banner-Goodspeed, Ashish K Khanna, Uluhan Sili, Harry L Anderson, Vishakha Kumar, Allan Walkey, Rahul Kashyap, Ognjen Gajic, Juan Pablo Domecq, Nita Khandelwal, and Kiker W. A. , Cheng S., Pollack L. R. , Creutzfeldt C. J. , Kross E. K. , Curtis J. R. , Belden K. A. , Melamed R., Armaignac D. L. , Heavner S. F. , et al.
Subjects: Male, Anesteziyoloji ve Ağrı Tıbbı, Nursing, CLINICAL NEUROLOGY, Sağlık Bilimleri, Clinical Medicine (MED), Nöroloji (klinik), Nöroloji, Anesthesiology, Surgery Medicine Sciences, Health Sciences, Humans, Klinik Tıp (MED), Pandemics, General Nursing, Resuscitation Orders, Retrospective Studies, COVID, Terminal Care, HEMŞİRELİK, KLİNİK NÖROLOJİ, Internal Medicine Sciences, Klinik Tıp, Genel Hemşirelik, ANESTEZİYOLOJİ, COVID-19, Dahili Tıp Bilimleri, CLINICAL MEDICINE, Tıp, Cross-Sectional Studies, Anesthesiology and Pain Medicine, Anesteziyoloji, Neurology, Cerrahi Tıp Bilimleri, End of life, Palliative care, Medicine, Neurology (clinical), Hemşirelik
Abstract: © 2022 American Academy of Hospice and Palliative MedicineContext: The COVID-19 pandemic has highlighted variability in intensity of care. We aimed to characterize intensity of care among hospitalized patients with COVID-19. Objectives: Examine the prevalence and predictors of admission code status, palliative care consultation, comfort-measures-only orders, and cardiopulmonary resuscitation (CPR) among patients hospitalized with COVID-19. Methods: This cross-sectional study examined data from an international registry of hospitalized patients with COVID-19. A proportional odds model evaluated predictors of more aggressive code status (i.e., Full Code) vs. less (i.e., Do Not Resuscitate, DNR). Among decedents, logistic regression was used to identify predictors of palliative care consultation, comfort measures only, and CPR at time of death. Results: We included 29,923 patients across 179 sites. Among those with admission code status documented, Full Code was selected by 90% (n = 15,273). Adjusting for site, Full Code was more likely for patients who were of Black or Asian race (ORs 1.82, 95% CIs 1.5–2.19; 1.78, 1.15–3.09 respectively, relative to White race), Hispanic ethnicity (OR 1.89, CI 1.35–2.32), and male sex (OR 1.16, CI 1.0–1.33). Of the 4951 decedents, 29% received palliative care consultation, 59% transitioned to comfort measures only, and 29% received CPR, with non-White racial and ethnic groups less likely to receive comfort measures only and more likely to receive CPR. Conclusion: In this international cohort of patients with COVID-19, Full Code was the initial code status in the majority, and more likely among patients who were Black or Asian race, Hispanic ethnicity or male. These results provide direction for future studies to improve these disparities in care.
Published: 2022

20. Effect of video camera monitoring feedback on hand hygiene compliance in neonatal intensive care unit, an interventional study

Author: Huseyin Bilgin, Uluhan Sili, Nazli Pazar, Isil Kucuker, Eda Kepenekli, Meral Agirman Yanar, Asli Memisoglu, Eren Ozek, Neill KJ Adhikari, Ruxandra Pinto, Volkan Korten, and Bilgin H., SİLİ U., Pazar N., Kucuker I., Kepenekli E., Yanar M. A., MEMİŞOĞLU A., ÖZEK E., Adhikari N. K., Pinto R., et al.
Subjects: Social Sciences and Humanities, Social Sciences (SOC), Hawthorne effect, Family Medicine, Epidemiology, SOCIAL SCIENCES, GENERAL, SAĞLIK BAKIM BİLİMLERİ VE HİZMETLERİ, Hospital acquired infections, Life Sciences (LIFE), Aile Hekimliği, Glove use, Sağlık Bilimleri, Clinical Medicine (MED), IMMUNOLOGY, Sağlık Politikaları, Sociology, Video camera footage, Yaşam Bilimleri, Health Sciences, Epidemiyoloji, Sosyal ve Beşeri Bilimler, Klinik Tıp (MED), Sosyoloji, Halk, Çevre ve İş Sağlığı, PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH, Internal Medicine Sciences, Klinik Tıp, İmmünoloji, Temel Bilimler, Health Policy, Public Health, Environmental and Occupational Health, Life Sciences, Dahili Tıp Bilimleri, INFECTIOUS DISEASES, Sosyal Bilimler Genel, CLINICAL MEDICINE, KAMU, ÇEVRE VE İŞ SAĞLIĞI, HEALTH CARE SCIENCES & SERVICES, Tıp, Bulaşıcı hastalıklar, Yaşam Bilimleri (LIFE), BULAŞICI HASTALIKLAR, Medicine, Sosyal Bilimler (SOC), Natural Sciences
Abstract: Background: The purpose of this study was to determine whether use of a video camera surveillance system for hand hygiene (HH) monitoring, video-based education, and feedback could improve the HH compliance in a neonatal intensive care unit (NICU). Methods and materials: This was an interventional before-after trial conducted in a level-III NICU between July 2019 and June 2020. HH compliance was measured using randomly selected video-camera footage in the baseline, intervention, and maintenance periods. After the baseline, an intervention consisting of feedback and education with video scenarios was implemented. The primary outcome was change in HH compliance. The compliance rates were analyzed as an interrupted time series (ITS) with a segmented regression model adjusted for autocorrelation for each study period. Results: We identified a total of 8335 HH indications. There were non significant increases in the total compliance rate (9.0%, 95% CI -2% to 20%) at the time of intervention and in the compliance rate after intervention (0.26%, 95% CI -0.31% to 0.84%) per day. The hand hygiene compliance before patient contact significantly increased (19.8%, 95% CI, 4.8%-34.8%). Incorrect glove use improved non-significantly with the intervention (-3.4%, 95% CI -13.4% to 6.7%). Conclusion: In this study of HH monitoring using video-camera footage combined with an intervention including feedback and education, there were inconsistent improvements in HH compliance. However, these improvements were not sustained in the long term. Frequent feedback and education may be required to sustain high compliance.
Published: 2023

21. Molnupiravir Compared to Nirmatrelvir/Ritonavir for COVID-19 in High-Risk Patients with Haematological Malignancy in Europe. A Matched-Paired Analysis from the Epicovideha Registry

Author: Jon Salmanton-Garcia, Francesco Marchesi, Philipp Koehler, Barbora Weinbergerova, Natasa Čolovic, Iker Falces-Romero, Caterina Buquicchio, Francesca Farina, Jens Van Praet, Monika M. Biernat, Federico Itri, Lucia Prezioso, Carlo Tascini, Antonio Vena, Alessandra Romano, Mario Delia, Julio Davila-Valls, Sonia Martín-Pérez, Esperanza Lavilla-Rubira, Tatjana N. Adzic, Daniel Garcia-Bordado, Alberto Lopez-Garcia, Mariana Criscuolo, Verena Petzer, Nicola S. Fracchiolla, Ildefonso Espigado, Uluhan Sili, Stef Meers, Nurettin Erben, Chiara Cattaneo, Athanasios Tragiannidis, Eleni Gavriilaki, Martin Schönlein, Mirjana Mitrovic, Nikola Pantic, Maria Merelli, Jorge Labrador, Jose Angel Hernández-Rivas, Andreas Glenthoj, Guillemette Fouquet, Maria Ilaria del Principe, Michelina Dargenio, Maria Calbacho, Caroline Besson, Milena Kohn, Stefanie K. Grafe, Ditte Stampe Hersby, Elena Arellano, Gökçe Melis Çolak, Dominik Wolf, Monia Marchetti, Anna Nordlander, Ola Blennow, Raul Cordoba, Bojana Miskovic, Miloš Mladenovic, Martina Bavastro, Alessandro LIMONGELLI, Laman Rahimli, Livio Pagano, and Oliver A. Cornely
Published: 2023

22. Guideline adherence and survival of patients with candidaemia in Europe: results from the ECMM Candida III multinational European observational cohort study

Author: Martin Hoenigl, Jon Salmanton-García, Matthias Egger, Jean-Pierre Gangneux, Tihana Bicanic, Sevtap Arikan-Akdagli, Ana Alastruey-Izquierdo, Nikolai Klimko, Aleksandra Barac, Volkan Özenci, Eelco F J Meijer, Nina Khanna, Matteo Bassetti, Riina Rautemaa-Richardson, Katrien Lagrou, Kai-Manuel Adam, Emin Halis Akalin, Murat Akova, Valentina Arsic Arsenijevic, Avinash Aujayeb, Ola Blennow, Stéphane Bretagne, François Danion, Blandine Denis, Nick Alexander de Jonge, Guillaume Desoubeaux, Lubos Drgona, Nurettin Erben, Andrea Gori, Julio García Rodríguez, Carolina Garcia-Vidal, Daniele Roberto Giacobbe, Anna L Goodman, Petr Hamal, Helena Hammarström, Cristina Toscano, Fanny Lanternier, Cornelia Lass-Flörl, Deborah E A Lockhart, Thomas Longval, Laura Loughlin, Tadeja Matos, Malgorzata Mikulska, Manjusha Narayanan, Sonia Martín-Pérez, Juergen Prattes, Benedict Rogers, Laman Rahimli, Maite Ruiz, Emmanuel Roilides, Michael Samarkos, Ulrike Scharmann, Uluhan Sili, Oguz Resat Sipahi, Alena Sivakova, Joerg Steinmann, Janina Trauth, Ozge Turhan, Jens Van Praet, Antonio Vena, P Lewis White, Birgit Willinger, Anna Maria Tortorano, Maiken C Arendrup, Philipp Koehler, Oliver A Cornely, Mario Tumbarello, Alida Fe Talento, Alba C Ruiz, Zdenek Racil, Igor Stoma, Maria Calbacho, Eric Van Wijngaerden, Júlia Henriques, Harriett Jordan, Valentina Ferroni, Ozlem Koyuncu Ozyurt, Christopher Milacek, Robert Krause, Christoph Zurl, Matthijs Backx, Ang Li, Raphael Seufert, Rok Tomazin, Yael Blankenheim, Julio Dávila-Valls, Paloma García-Clemente, Tomas Freiberger, Jochem Buil, Jacques F Meis, Deniz Akyol, Hélène Guegan, Clare Logan, Medical University of Graz, University of Cologne, Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), CHU Pontchaillou [Rennes], Scynexis, Hoenigl M., Salmanton-García J., Egger M., Gangneux J., Bicanic T., Arikan-Akdagli S., Alastruey-Izquierdo A., Klimko N., Barac A., Özenci V., et al., and Hematology
Subjects: MESH: Humans, İmmünoloji, Temel Bilimler, Settore MED/42 - Igiene Generale e Applicata, Medizin, Life Sciences, Life Sciences (LIFE), MESH: Adult, INFECTIOUS DISEASES, Sağlık Bilimleri, MESH: Antifungal Agents, MESH: Candidemia, IMMUNOLOGY, Bulaşıcı hastalıklar, Yaşam Bilimleri (LIFE), BULAŞICI HASTALIKLAR, MESH: Candida, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Yaşam Bilimleri, Health Sciences, MESH: Guideline Adherence, MESH: Europe, Natural Sciences, MESH: Cohort Studies
Abstract: Background: The European Confederation of Medical Mycology (ECMM) collected data on epidemiology, risk factors, treatment, and outcomes of patients with culture-proven candidaemia across Europe to assess how adherence to guideline recommendations is associated with outcomes. Methods: In this observational cohort study, 64 participating hospitals located in 20 European countries, with the number of eligible hospitals per country determined by population size, included the first ten consecutive adults with culture-proven candidaemia after July 1, 2018, and entered data into the ECMM Candida Registry (FungiScope CandiReg). We assessed ECMM Quality of Clinical Candidaemia Management (EQUAL Candida) scores reflecting adherence to recommendations of the European Society of Clinical Microbiology and Infectious Diseases and the Infectious Diseases Society of America guidelines. Findings: 632 patients with candidaemia were included from 64 institutions. Overall 90-day mortality was 43% (265/617), and increasing age, intensive care unit admission, point increases in the Charlson comorbidity index score, and Candida tropicalis as causative pathogen were independent baseline predictors of mortality in Cox regression analysis. EQUAL Candida score remained an independent predictor of mortality in the multivariable Cox regression analyses after adjusting for the baseline predictors, even after restricting the analysis to patients who survived for more than 7 days after diagnosis (adjusted hazard ratio 1·08 [95% CI 1·04–1·11; p
Published: 2023

23. Peripheral innate and adaptive immune cells during <scp>COVID</scp> ‐19: Functional neutrophils, pro‐inflammatory monocytes, and half‐dead lymphocytes

Author: İlhan Ocak, Serpil Görçin, Nadir Alpay, Alaattin Yildiz, Emel Eksioglu-Demiralp, Dilek Bakan, Uluhan Sili, Servet Alan, Rayfe Yürekli, Eksioglu-Demiralp, Emel, Alan, Servet, Sili, Uluhan, Bakan, Dilek, Ocak, Ilhan, Yurekli, Rayfe, Alpay, Nadir, Gorcin, Serpil, and Yildiz, Alaattin
Subjects: CD4-Positive T-Lymphocytes, EXPRESSION, caspase-3, Histology, Neutrophils, CD3, CD8-Positive T-Lymphocytes, CD16, Monocytes, Pathology and Forensic Medicine, Immune system, immunophenotyping, Increased lymphocyte apoptosis, Humans, oxidative burst, Innate immune system, biology, SARS-CoV-2, INDUCTION, apoptosis, COVID-19, CD28, Cell Biology, Flow Cytometry, Acquired immune system, Respiratory burst, Apoptosis, Immunology, biology.protein, NK CELLS, ACUTE RESPIRATORY SYNDROME, CD8, RESPONSES
Abstract: SUMMARYA better understanding of the innate and adaptive cells in the COVID-19 disease caused by the SARS-CoV-2 coronavirus is a necessity for the development of effective treatment methods and vaccines. We studied phenotypic features of innate and adaptive immune cells, oxidative burst, phagocytosis and apoptosis. One hundred and three patients with COVID-19 grouped according to their clinical features as mild (35%), moderate (40.8%), and severe (24.3%) were included in the study. Monocytes from all COVID-19 patients were CD16+ pro-inflammatory monocytes. Neutrophils were mature and functional. No defect has been found in ROS production of monocytes and neutrophils as well as no defect in their apoptosis. As bridging cells of the innate and adaptive immune system; the percentage of NK cells was in normal range whereas the percentages of CD3-CD8+CD56+ innate lymphoid and CD3+CD56+ NK like T cells were found to be high in the severe cases of COVID-19. Although absolute numbers of all lymphocyte subsets were low and showed a tendency for a gradual decrease in accord with the disease progression, in all COVID-19 patients, the lymphocyte subset with the most decreased absolute number was B lymphocytes, followed by CD4 + T cells in the severe cases. The percentages of suppressive, CD3+CD4-CD8-; HLA-DR+CD3+ and CD28-CD8+ cells were found to be significantly increased. Importantly, we demonstrated spontaneous caspase-3 activation and increased lymphocyte apoptosis. Altogether our data suggest that SARS-CoV-2 primarily affects lymphocytes not innate cells. So that, it may interrupt the cross-talk between adaptive and innate immune systems.
Published: 2021

24. Frequency and associated factors for carbapenem-non-susceptible Bacteroides fragilis group bacteria colonization in hospitalized patients: Case control study in a university hospital in Turkey

Author: Volkan Korten, Öncü Akgül, Hüseyin Bilgin, Gülşen Altınkanat Gelmez, Güner Söyletir, Elvan Sayın, Uluhan Sili, Ayşe Özaydın, Nurver Ulger Toprak, Toprak, Nurver Ulger, Akgul, Oncu, Bilgin, Huseyin, Ozaydin, Ayse Nilufer, Gelmez, Gulsen Altinkanat, Sayin, Elvan, Sili, Uluhan, Korten, Volkan, and Soyletir, Guner
Subjects: Adult, 0301 basic medicine, Microbiology (medical), medicine.medical_specialty, Carbapenem, Turkey, Carbapenem resistance, medicine.drug_class, 030106 microbiology, Antibiotics, Microbial Sensitivity Tests, medicine.disease_cause, Meropenem, beta-Lactamases, Bacteroides fragilis, Hospitals, University, EMERGENCE, 03 medical and health sciences, 0302 clinical medicine, Intensive care, Internal medicine, Drug Resistance, Bacterial, Bacteroides fragilis group, medicine, Humans, 030212 general & internal medicine, ANTIMICROBIAL RESISTANCE, biology, Pseudomonas aeruginosa, business.industry, STRAINS, Bacteroides Infections, Parabacteroides, biology.organism_classification, Anti-Bacterial Agents, Acinetobacter baumannii, Metallo-beta-lactamase. cfiA gene, Carbapenems, Risk factors, Case-Control Studies, business, medicine.drug
Abstract: Purpuse The carbapenem-resistant Bacteroides fragilis group (CR-BFG) bacteria have been reported in several countries recently with increasing global attention. The high incidence of CR-BFG isolated from our hospitalized patients has become an important problem. Therefore, we aimed to determine the frequency and associated factors for intestinal colonization by carbapenem-non-susceptible BFG (CNS-BFG) among adult patients hospitalized at intensive care units, neurosurgery and internal medicine wards in our hospital. Methods Rectal swabs (n = 1200), collected from 766 patients between February 2014 and March 2015, were inoculated onto kanamycin-vancomycin-leaked blood agar containing 0.125 mg/L meropenem. The isolates were identified by MALDI-TOF MS. Susceptibility testing was performed by agar dilution method. The carbapenemase gene (cfiA) was detected by PCR. Logistic regression analysis was used to evaluate the associated factors for intestinal colonization by CNS-BFG. Results A total 180 non-duplicate BFG isolates were obtained from 164 patients. Ten different species, including Parabacteroides distasonis (n = 46, 25.6%), and Bacteroides fragilis (n = 30; 16.6%), were identified. Twenty-five percent of the isolates were non-susceptible to meropenem (MIC >2 mg/L). The highest prevalence of meropenem resistant strains (MIC >8 mg/L) was detected among B. fragilis (n = 12), followed by Parabacteroides spp. (n = 4). All but one B. fragilis strains were cfiA gene positive. Hospital admission, increasing Charlson score, use of antibiotics; including carbapenems in past three months, colonization with other accompanying carbapenem-resistant Gram negative bacteria (Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa), and having undergone surgical operations were significantly associated with RCS- BFG colonization. Conclusions The high carriage rate of CNS-BFG in hospitalized patients may lead to worse clinical outcomes, such as serious infections and mortality, and deserves attention.
Published: 2021

25. Simultaneous Onset of Haematological Malignancy and COVID: An Epicovideha Survey

Author: Chiara Cattaneo, Jon Salmanton-García, Francesco Marchesi, Shaimaa El-Ashwah, Federico Itri, Barbora Weinbergerová, Maria Gomes Da Silva, Michelina Dargenio, Julio Dávila-Valls, Sonia Martín-Pérez, Francesca Farina, Jaap Van Doesum, Toni Valković, Caroline Besson, Christian Bjørn Poulsen, Alberto López-García, Pavel Žák, Martin Schönlein, Klára Piukovics, Ozren Jaksic, Alba Cabirta, Natasha Ali, Uluhan Sili, Nicola Fracchiolla, Giulia Dragonetti, Tatjana Adžić-Vukičević, Monia Marchetti, Marina Machado, Andreas Glenthøj, Olimpia Finizio, Fatih Demirkan, Ola Blennow, Maria Chiara Tisi, Ali S. Omrani, Milan Navrátil, Zdeněk Ráčil, Jan Novák, Gabriele Magliano, Moraima Jiménez, Carolina Garcia-Vidal, Nurettin Erben, Maria Ilaria Del Principe, Caterina Buquicchio, Rui Bergantim, Josip Batinić, Murtadha Al-Khabori, Luisa Verga, Tomáš Szotkowski, Michail Samarkos, Irati Ormazabal-Vélez, Stef Meers, Johan Maertens, László Imre Pinczés, Martin Hoenigl, Ľuboš Drgoňa, Annarosa Cuccaro, Yavuz M. Bilgin, Avinash Aujayeb, Laman Rahimli, Stefanie Gräfe, Mariarita Sciumè, Miloš Mladenović, Gökçe Melis Çolak, Maria Vittoria Sacchi, Anna Nordlander, Caroline Berg Venemyr, Michaela Hanáková, Nicole García-Poutón, Ziad Emarah, Giovanni Paolo Maria Zambrotta, Raquel Nunes Rodrigues, Raul Cordoba, Gustavo-Adolfo Méndez, Monika M. Biernat, Oliver A. Cornely, Livio Pagano, Institut Català de la Salut, [Cattaneo C] Hematology Unit, ASST-Spedali Civili, Brescia, Italy. [Salmanton-García J] University of Cologne, Faculty of Medicine, University Hospital Cologne, Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany. University of Cologne, Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany. [Marchesi F] Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy. [El-Ashwah S] Oncology Center, Mansoura University, Mansoura, Egypt. [Itri F] San Luigi Gonzaga Hospital, Orbassano, Italy. [Weinbergerová B] Masaryk University and University Hospital Brno—Department of Internal Medicine, Hematology and Oncology, Brno, Czech Republic. [Cabirta A] Servei d’Hematologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Experimental Hematology, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain. Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain. [Jiménez M] Servei d’Hematologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain, Vall d'Hebron Barcelona Hospital Campus, Cattaneo C., Salmanton-García J., Marchesi F., El-Ashwah S., Itri F., Weinbergerová B., Gomes Da Silva M., Dargenio M., Dávila-Valls J., Martín-Pérez S., et al., Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, EPICOVIDEHA has received funds from Optics COMMITTM (COVID-19 Unmet Medical Needs and Associated Research Extension) COVID-19 RFP program by GILEAD Science, United States (Project 2020-8223)., and HAL UVSQ, Équipe
Subjects: Internal Diseases, Cancer Research, Sağlık Bilimleri, Other subheadings::Other subheadings::/drug therapy [Other subheadings], İç Hastalıkları, Clinical Medicine (MED), RECOMMENDATIONS, Sang - Càncer - Tractament, BİYOKİMYA VE MOLEKÜLER BİYOLOJİ, INFECTION, virosis::infecciones por virus ARN::infecciones por Nidovirales::infecciones por Coronaviridae::infecciones por Coronavirus [ENFERMEDADES], haematological malignancy onset, Klinik Tıp (MED), 03.02. Klinikai orvostan, Klinik Tıp, treatment, Temel Bilimler, COVID-19, outcome, prognostic factors, Life Sciences, Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections [DISEASES], Onkoloji, Tıp, MOLECULAR BIOLOGY & GENETICS, Oncology, Medicine, ONKOLOJİ, Natural Sciences, BIOCHEMISTRY & MOLECULAR BIOLOGY, Life Sciences & Biomedicine, Sitogenetik, Life Sciences (LIFE), Otros calificadores::Otros calificadores::/farmacoterapia [Otros calificadores], [SDV.CAN]Life Sciences [q-bio]/Cancer, Molecular Biology and Genetics, PANEL, [SDV.CAN] Life Sciences [q-bio]/Cancer, Yaşam Bilimleri, Health Sciences, Cytogenetic, neoplasias::neoplasias por localización::neoplasias hematológicas [ENFERMEDADES], Moleküler Biyoloji ve Genetik, ACUTE LYMPHOBLASTIC-LEUKEMIA, Internal Medicine Sciences, Science & Technology, diagnóstico::pronóstico::resultado del tratamiento [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS], Dahili Tıp Bilimleri, CLINICAL MEDICINE, Neoplasms::Neoplasms by Site::Hematologic Neoplasms [DISEASES], Diagnosis::Prognosis::Treatment Outcome [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT], Settore MED/15, Settore MED/15 - MALATTIE DEL SANGUE, Sang - Càncer - Diagnòstic, Yaşam Bilimleri (LIFE), Avaluació de resultats (Assistència sanitària), COVID-19 (Malaltia) - Diagnòstic, Kanser Araştırmaları
Abstract: Simple Summary Patients with simultaneous diagnosis of haematological malignancies (HM) and COVID-19 are an even greater challenge for hematologists. To better clarify their outcome, we describe the clinical features and outcome of a cohort of 450 patients with simultaneous diagnosis of HM and COVID-19 registered in the EPICOVIDEHA registry between March 2020 to February 2022. Overall, 343 (76.2%) patients received treatment for HM, and an overall response rate was observed in 140 (40.8%) patients after the first line of treatment. Thirty-day mortality was significantly higher in patients not receiving HM treatment (42.1%) than in those receiving treatment (27.4%, p = 0.004). Statistical analysis showed that, together with age, severe/critical COVID-19, >= 2 comorbidities, lack of HM treatment was an independent risk factors for mortality. These observations suggest the importance of HM treatment in these patients; therefore, it should be delivered as soon as possible for patients requiring immediate therapy. Background: The outcome of patients with simultaneous diagnosis of haematological malignancies (HM) and COVID-19 is unknown and there are no specific treatment guidelines. Methods: We describe the clinical features and outcome of a cohort of 450 patients with simultaneous diagnosis of HM and COVID-19 registered in the EPICOVIDEHA registry between March 2020 to February 2022. Results: Acute leukaemia and lymphoma were the most frequent HM (35.8% and 35.1%, respectively). Overall, 343 (76.2%) patients received treatment for HM, which was delayed for longer than one month since diagnosis in 57 (16.6%). An overall response rate was observed in 140 (40.8%) patients after the first line of treatment. After a median follow-up of 35 days, overall mortality was 177/450 (39.3%); 30-day mortality was significantly higher in patients not receiving HM treatment (42.1%) than in those receiving treatment (27.4%, p = 0.004), either before and/or after COVID-19, or compared to patients receiving HM treatment at least after COVID-19 (15.2%, p < 0.001). Age, severe/critical COVID-19, >= 2 comorbidities, and lack of HM treatment were independent risk factors for mortality, whereas a lymphocyte count >500/mcl at COVID-19 onset was protective. Conclusions: HM treatment should be delivered as soon as possible for patients with simultaneous diagnosis of COVID-19 and HM requiring immediate therapy.
Published: 2022

26. Türkiye'de Bir Yenidoğan Yoğun Bakım Ünitesinde Sağlık Hizmetlerine Bağlı Enfeksiyonların Özellikleri

Author: Akan YAMAN, Aslı MEMİŞOĞLU, Yasemin MASAL, Uluhan SİLİ, Ahmet SOYSAL, Hülya Selva BİLGEN, Volkan KORTEN, and Eren ÖZEK
Subjects: General Medicine
Abstract: Giriş: Sağlık hizmeti ile ilişkili enfeksiyonlar (SHİE), yenidoğan yoğun bakım ünitelerinde (YYBU) neonatal mortalite, morbidite ve sağlık bakım maliyetini artıran risklerden biridir. SHİE'lerin özellikleri farklı bölgelerde ve zaman içinde önemli ölçüde farklılık gösterdiğinden, sürekli SHİE sürveyansı, enfeksiyon kontrolü için SHİE oranlarını ve sağlık bakımıyla ilişkili patojenleri belirlemek açısından önemlidir. Gereç ve Yöntemler: Türkiye'de üçüncü basamak bir referans merkezindeki SHİE'nin özelliklerini incelemeyi amaçladık. 2011-2013 yılları arasında YYBU'ye kabul edilen tüm yenidoğanlar bu çalışmaya dahil edildi. SHİE ile ilgili bilgiler “Ulusal Hastane Enfeksiyon Gözetim Ağı” ve Hastalık Kontrol ve Önleme Merkezleri(CDC)’nin standartlarına göre toplanmıştır. Bulgular: Toplam yatan hasta sayısı 1030 idi. Bunların% 29'unda SHİE gelişti. SHİE'nin genel oranı ve yoğunluğu sırasıyla% 29.0 ve% 24.0 idi. Kan dolaşımı enfeksiyonları, SHİE 'lerin% 36.4'ü idi. En sık izole edilen mikro-organizmalar koagülaz negatif Staphylococci ve Klebsiella pneumonia idi. Ortalama metisilin direnci % 87, ESBL oranı% 79 ve VRE oranı % 40 idi. Sonuçlar: Bu çalışma, SHİE 'nin YYBU'de hala ciddi bir sorun teşkil ettiğini belirlemiştir. Sağlık bakımıyla ilişkili patojenler hakkında zamanında ve doğru epidemiyolojik bilgilerin mevcudiyeti, enfeksiyon kontrolü ve uygun ampirik antibiyotik seçimi için gereklidir.
Published: 2022

27. The effect of immunization with inactivated SARS-CoV-2 vaccine (CoronaVac) and/or SARS-CoV-2 infection on antibody levels, plasmablasts, long-lived-plasma-cells, and IFN-gamma release by natural killer cells

Author: Huseyin Bilgin, Marisa Marku, Sultan Seval Yilmaz, Aysegul Karahasan Yagci, Uluhan Sili, Baris Can, Rabia Can Sarinoglu, Lutfiye Mulazimoglu Durmusoglu, Goncagul Haklar, Onder Sirikci, Emel Eksioglu Demiralp, and Bilgin H., Marku M., Yilmaz S. S., Karahasan Yagci A., Sili U., Can B., Can Sarinoglu R., Mulazimoglu Durmusoglu L., Haklar G., Sirikci O., et al.
Subjects: COVID-19 Vaccines, Plasma Cells, Immunology, Life Sciences (LIFE), Antibodies, Viral, Sağlık Bilimleri, Medical Ecology and Hydroclimatology, Clinical Medicine (MED), Genel İmmünoloji ve Mikrobiyoloji, IFN-gamma, Interferon-gamma, Tıbbi Ekoloji ve Hidroklimatoloji, Araştırma ve Teori, Yaşam Bilimleri, Health Sciences, İncelemeler ve Referanslar (tıbbi), Humans, Klinik Tıp (MED), TIP, ARAŞTIRMA VE DENEYSEL, Internal Medicine Sciences, General Veterinary, İmmünoloji, Klinik Tıp, Research and Theory, General Immunology and Microbiology, SARS-CoV-2, Temel Bilimler, SARS-CoV-2 infection, Vaccination, Public Health, Environmental and Occupational Health, Anti-spike antibody, Life Sciences, COVID-19, Dahili Tıp Bilimleri, CLINICAL MEDICINE, Tıp, Killer Cells, Natural, Infectious Diseases, Yaşam Bilimleri (LIFE), MEDICINE, RESEARCH & EXPERIMENTAL, Reviews and References (medical), Molecular Medicine, Medicine, CoronaVac, Whole virion inactivated vaccine, Natural Sciences
Abstract: Objectives: We evaluated the antibody response, natural killer cell response and B cell phenotypes in healthcare workers (HCW) who are vaccinated with two doses of CoronaVac with or without documented SARS-CoV-2 infection and unvaccinated HCWs with SARS-CoV-2 infection. Methods: HCWs were divided into four groups: vaccine only (VO), vaccine after SARS-CoV-2 infection (VAI), SARS-CoV-2 infection only (IO), and SARS-CoV-2 infection after vaccine (IAV). Anti-SARS-CoV-2 spike protein (Anti-S) antibodies were measured by Elecsys Anti–SARS–CoV–2 S ELISA kit. Memory B cells (CD19+ CD27+ ), plasmablast B cells (CD19+ CD138+ ) and long-lived plasma cells (LLPC; CD138+ CD19- ) were measured by flow cytometry in 74 patients. Interferon gamma (IFN-c) release by natural killer (NK) cells were measured by NKVue Test (NKMAX, Republic of Korea) in 76 patients. RT-PCR was performed with Bio-speedy COVID-19 qPCR detection kit, Version 2 (Bioexen LTD, Istanbul, Turkey). Results: The Anti-S antibodies were detectable in all HCWs (n: 224). The median Anti-S titers (BAU/mL) was significantly higher in VAI (620 25–75% 373–1341) compared to VO (136, 25–75% 85–283) and IO (111, 25–75% 54–413, p < 0.01). VAI group had significantly lower percentage of plasmablasts (2.9; 0– 8.7) compared to VO (6.8; 3.5–12.0) and IO (9.9; 4.7–47.5, p < 0.01) (n:74). Percentage of LLPCs in groups VO, VAI and IO was similar. There was no difference of IFN-c levels between the study groups (n: 76). Conclusion: The antibody response was similar between uninfected vaccinated HCWs and unvaccinated HCWs who had natural infection. HCWs who had two doses of CoronaVac either before or after the natural SARS-CoV-2 infection elicited significantly higher antibody responses compared to uninfected vaccinated HCWs. The lower percentages of plasmablasts in the VAI group may indicate their migration to lymph nodes and initiation of the germinal center reaction phase. IFN-c response did not differ among the groups.
Published: 2022

28. Tuberculosis and COVID-19: An overlapping situation during pandemic

Author: Emel Eryuksel, Uluhan Sili, Sehnaz Olgun Yildizeli, Aysegul Yagci, Rabia Can Sarınoğlu, Cagatay Cimsit, Sarinoglu, Rabia Can, Sili, Uluhan, Eryuksel, Emel, Yildizeli, Sehnaz Olgun, Cimsit, Cagatay, and Yagci, Aysegul Karahasan
Subjects: Adult, Male, Pediatrics, medicine.medical_specialty, COVID-19 Vaccines, Tuberculosis, Pneumonia, Viral, Real-Time Polymerase Chain Reaction, COVID-19, PCR, COVID 19 infection, SARS-CoV-2, Mycobacterium tuberculosis, medicine.disease_cause, Microbiology, Betacoronavirus, 03 medical and health sciences, COVID-19 Testing, 0302 clinical medicine, Tuberculosis diagnosis, Virology, Pandemic, medicine, Humans, 030212 general & internal medicine, Pandemics, Aged, Coronavirus, biology, Clinical Laboratory Techniques, Coinfection, business.industry, Public health, Incidence (epidemiology), HIV, General Medicine, medicine.disease, biology.organism_classification, Infectious Diseases, 030228 respiratory system, Female, Parasitology, Coronavirus Infections, Tomography, X-Ray Computed, business
Abstract: Introduction: The novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the coronavirus disease 2019 (COVID-19). First COVID-19 case was detected in March, 10, 2020 in Turkey and as of May, 18, 2020 148,067 cases have been identified and 4096 citizens have died. Tuberculosis (TB) is a worldwide public health concern, incidence of tuberculosis (per 100,000 people) in Turkey was reported at 14, 1 in 2018. During pandemic COVID-19 was the main concern in every clinic and as we discuss here overlapping respiratory diseases may result in delaying of the diagnosis and treatment. Methodology: There were 4605 respiratory samples examined between March 23 and May 18 for COVID-19 and 185 samples for Mycobacterium tuberculosis in our laboratory. The Xpert Ultra assay was performed for the diagnosis of pulmonary tuberculosis; SARS-CoV-2 RNA was determined by real-time PCR (RT-PCR) analysis in combined nasopharyngeal and deep oropharyngeal swabs of suspected cases of COVID-19. Results: Both of SARS-CoV-2 and M. tuberculosis tests were requested on the clinical and radiological grounds in 30 patients. Here we discussed 2 patients who were both COVID-19 and TB positive. One patient already diagnosed with tuberculosis become COVID-19 positive during hospitalization and another patient suspected and treated for COVID-19 received the final diagnosis of pulmonary TB and Human Immunodeficiency Virus infection. Conclusions: We want to emphasize that while considering COVID-19 primarily during these pandemic days, we should not forget one of the “great imitators”, tuberculosis within differential diagnoses.
Published: 2020

29. Guideline Adherence Predicts Survival of Candidemia in Europe: Results from the ECMM Candida III Multinational European Study

Author: Martin Hoenigl, Jon Salmanton-Garcia, Matthias Egger, Jean-Pierre Gangneux, Tihana Bicanic, Sevtap Arikan-Akdagli, Ana Alastruey-Izquierdo, Nikolai Klimko, Aleksandra Barac, Volkan Özenci, Eelco F. J. Meijer, Nina Khanna, Matteo Bassetti, Riina Rautemaa-Richardson, Katrien Lagrou, Kai-Manuel Adam, Emin Halis Akalın, Murat Akova, Valentina Arsic-Arsenijevic, Avinash Aujayeb, Ola Blennow, Stephane Bretagne, François Danion, Blandine Denis, Nick Alexander de Jonge, Guillaume Desoubeaux, Lubos Drgona, Nurettin Erben, Andrea Gori, Julio García Rodríguez, Carolina Garcia-Vidal, Daniele Roberto Giacobbe, Anna L. Goodman, Petr Hamal, Helena Hammarström, Christina Toscano, Fanny Lanternier, Cornelia Lass-Flörl, Deborah E. A. Lockhart, Thomas Longval, Laura Loughlin, Tadeja Matos, Malgorzata Mikulska, Manjusha Narayanan, Sonia Martín-Pérez, Juergen Prattes, Benedict Rogers, Laman Rahimli, Maite Ruiz, Emmanuel Roilides, Michael Samarkos, Ulrike Scharmann, Uluhan Sili, Oguz Resat Sipahi, Alena Siváková, Joerg Steinmann, Janina Trauth, Özge Turhan, Jens Van Praet, Antonio Vena, Lewis White, Birgit Willinger, Anna Maria Tortorano, Maiken C. Arendrup, Philipp Koehler, Oliver A. Cornely, and ECMM Candida III Study Group
Published: 2022

30. Pharmacokinetic characterization of favipiravir in patients with COVID-19

Author: Rezzan Gülhan, Emel Eryüksel, Medine Gülçebi İdriz Oğlu, Yekta Çulpan, Aylin Toplu, Derya Kocakaya, Elif Tigen, Buket Ertürk Şengel, Uluhan Sili, Şehnaz Olgun Yıldızeli, Mehmet Baran Balcan, Abdullah Elçi, Cenk Bulut, Atila Karaalp, Hasan Raci Yananlı, Abdullah Emre Güner, Mustafa Hatipoğlu, Sait Karakurt, Volkan Korten, Neville Ratnaraj, Philip Patsalos, Pınar Ay, Filiz Onat, and Acibadem University Dspace
Subjects: Pharmacology, Adult, Male, therapeutic drug monitoring, favipiravir, Amides, Antiviral Agents, COVID-19 Drug Treatment, Treatment Outcome, Pyrazines, Humans, Pharmacology (medical), Female, pharmacokinetics, COVID
Abstract: This prospective observational study describes the pharmacokinetic characteristics of favipiravir in adult patients hospitalized for mild to moderate COVID-19 with a positive RT-PCR test. Favipiravir was administered for 5 days, with a loading dose of 3200 mg and a maintenance dose of 1200 mg/day. Serial blood samples were collected on Day 2 and Day 4 of the therapy. Laboratory findings of the patients (n = 21) and in-hospital mortality were recorded. Favipiravir concentrations exhibited substantial variability and a significant decrease during the treatment of COVID-19. The median favipiravir trough concentration (C0-trough) on Day 2 was 21.26 (interquartile range {[}IQR], 8.37-30.78) mu g/mL, whereas it decreased significantly to 1.61 (IQR, 0.00-6.41) mu g/mL on Day 4, the area under the concentration-time curve decreased by 68.5\%. Day 2 C0-trough of female patients was higher than male patients. Our findings indicate that favipiravir concentrations show significant variability during the treatment of COVID-19 and therapeutic drug monitoring may be necessary to maintain targeted concentrations.
Published: 2021

31. Impact of tocilizumab on clinical outcomes in severe covid-19 patients and risk of secondary infection: A case-control study

Author: Serra Ozel, Zekaver Odabasi, Mehtap Aydin, Uluhan Sili, Can Ilgin, Fethi Gül, Ismail Cinel, Volkan Korten, Buket Erturk Sengel, Luftiye Nilsun Altunal, Elif Tukenmez Tigen, Feyyaz Kabadayi, Sengel, Buket Erturk, Ozel, Serra, Gul, Fethi, Ilgin, Can, Tigen, Elif Tukenmez, Altunal, Luftiye Nilsun, Kabadayi, Feyyaz, Sili, Uluhan, Aydin, Mehtap, Odabasi, Zekaver, Cinel, Ismail, and Korten, Volkan
Subjects: Mechanical ventilation, IL-6, medicine.medical_specialty, COVID-19,IL-6,SARS-CoV-2,Tocilizumab, Coronavirus disease 2019 (COVID-19), SARS-CoV-2, business.industry, medicine.medical_treatment, Secondary infection, Case-control study, COVID-19, Tocilizumab, EFFICACY, RHEUMATOID-ARTHRITIS, Tıp, chemistry.chemical_compound, chemistry, Internal medicine, Propensity score matching, Cohort, medicine, Medicine, In patient, business
Abstract: Objective: This study aimed to identify the effect of tocilizumab (TCZ) on clinical outcomes in severe COVID-19 patients. Material and Methods: We included hospitalized COVID-19 patients with an initial WHO scale ≥4. We matched the patients with baseline characteristics by using propensity scores. Then, we selected patients with C-reactive protein levels above 30 and showing an upward trend. We assessed the effect of TCZ in patients on clinical outcomes by using Mann – Whitney U and Chi-square tests. Results: Of 200 patients who had an initial WHO scale ≥ 4, 42 (21%) were given TCZ in addition to standard of care (SOC). Twentyfive patients (50%) needed mechanical ventilation (MV) in the TCZ group, compared with 35 (21%) of 158 patients with SOC (p
Published: 2021

32. Lentiviral vector-based SARS-CoV-2 pseudovirus enables analysis of neutralizing activity in COVID-19 convalescent plasma

Author: Zeynep Sena Karahan, Uluhan Sili, Merkaya Aras, Nesrin Özören, Elif Celik, Safa Baris, Ozge Tatli, Gozde Turkoz, Canan Eren, Ilke Suder, Baris Can Mandaci, Baran Dingiloglu, Tolga Sutlu, Gizem Dinler Doganay, Huseyin Bilginer, Cevriye Pamukcu, and Ebru Zeynep Ergun
Subjects: biology, Chemistry, Myeloma protein, medicine.drug_class, Monoclonal antibody, Virology, Neutralization, Virus, Viral vector, Titer, Immune system, biology.protein, medicine, Antibody
Abstract: As the COVID-19 pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) continues to spread around the globe, effective vaccination protocols are under deployment. Alternatively, the use of convalescent plasma (CP) therapy relies on the transfer of the immunoglobulin repertoire of a donor that has recovered from the disease as a means of passive vaccination. While the lack of an effective antiviral treatment inadvertently increases the interest in CP products, initial clinical evaluation on COVID-19 patients revealed that critical factors determining the outcome of CP therapy need to be defined clearly if clinical efficacy is to be expected. Measurement of neutralizing activity against SARS-CoV-2 using wildtype virus presents a reliable functional assay but the availability of suitable BSL3 facilities for virus culture restricts its applicability. Instead, the use of pseudovirus particles containing elements from the SARS-CoV-2 virus is widely applied to determine the activity of CP or other neutralizing agents such as monoclonal antibodies.In this study, we present our approach to optimize GFP-encoding lentiviral particles pseudotyped with the SARS-CoV-2 Spike and Membrane proteins for use in neutralization assays. Our results show the feasibility of pseudovirus production using a C-terminal truncated Spike protein which is greatly enhanced by the incorporation of the D614G mutation. Moreover, we report that the use of Sodium Butyrate during lentiviral vector production dramatically increases pseudovirus titers. Analysis of CP neutralizing activity against particles pseudotyped with wildtype or D614G mutant Spike protein in the presence or absence the M protein revealed differential activity in CP samples that did not necessarily correlate with the amount of anti-SARS-CoV-2 antibodies.Our results indicate that the extent of neutralizing activity in CP samples depends on the quality rather than the quantity of the humoral immune responses and varies greatly between donors. Functional screening of neutralizing activity using pseudovirus-based neutralization assays must be accepted as a critical tool for choosing CP donors if clinical efficacy is to be maximized.
Published: 2020

33. Needles in a haystack: Extremely rare invasive fungal infections reported in FungiScopeⓇ—Global Registry for Emerging Fungal Infections

Author: Shruti Malik, Barbara Graf, Anupma Jyoti Kindo, Michele I. Morris, Carol A. Kauffman, Hamid Badali, Frédéric Janvier, Barbara D. Alexander, Lóránt Hatvani, Iker Falces-Romero, George Richard Thompson, Thomas P. Weber, Aamer Ikram, Georg Haerter, Mathias W. Pletz, Arunaloke Chakrabarti, Monica A. Slavin, Alessandro C. Pasqualotto, María Almagro-Molto, Sibylle C. Mellinghoff, Martha Avilés-Robles, Michaela Lackner, Mario Fernández-Ruiz, Melina Heinemann, Miguel Ángel Benítez-Peñuela, Lisa Meintker, Aleksandra Barac, Olaf Penack, Diana L. Pakstis, Zdeněk Ráčil, Nicolas Pichon, John W. Baddley, Jin Yu, Raoul Herbrecht, Martin Hoenigl, Jesús García-Martínez, Paul R. Ingram, Robert Krause, Cornelia Lass-Flörl, Shariq Haider, Barbora Weinbergerova, Carlos Seas, Jeffrey D. Jenks, Simone Cesaro, Vanda Chrenková, Luis Figueira, Donald C. Sheppard, Guillaume Desoubeaux, Galina Klyasova, Seda Yilmaz-Semerci, Vincent Marconi, Gloria M. González, Philipp Koehler, Donald C. Vinh, Eduardo Álvarez-Duarte, Atul Patel, Damien Dupont, José Yesid Rodríguez, Kenji Uno, Sanjay Mehta, Nicole Desbois-Nogard, Sandra Gräber, Jagdish Chander, Rodrigo Martino, Kathleen M. Mullane, Andrea Mocná, Yohann Le Govic, Mihai Mareș, Hilmar Wisplinghoff, Serkan Atıcı, Patricia Cornejo-Juárez, Jose A. Vazquez, Uluhan Sili, Jon Salmanton-García, Oliver A. Cornely, Nikolai Klimko, Sharon C.-A. Chen, Danila Seidel, Pamela Hartman, Me Linh Luong, Julio García-Rodríguez, Deniz Yilmaz-Karapinar, Groupe d'Étude des Interactions Hôte-Pathogène (GEIHP), and Université d'Angers (UA)
Subjects: 0301 basic medicine, Microbiology (medical), Mucorales, Fusariosis, medicine.medical_specialty, [SDV]Life Sciences [q-bio], 030106 microbiology, Eurotiales, yeast, invasive fungal infection, Malignancy, 03 medical and health sciences, 0302 clinical medicine, Epidemiology, medicine, 030212 general & internal medicine, ComputingMilieux_MISCELLANEOUS, invasive fungal infection, mold, yeast, Acute leukemia, biology, business.industry, Mortality rate, mold, Mucormycosis, medicine.disease, biology.organism_classification, Dermatology, 3. Good health, Infectious Diseases, business
Abstract: Objectives Emerging invasive fungal infections (IFI) have become a notable challenge. Apart from the more frequently described fusariosis, lomentosporiosis, mucormycosis, scedosporiosis, and certain dematiaceae or yeasts, little is known about extremely rare IFI. Methods Extremely rare IFI collected in the FungiScopeⓇ registry were grouped as Dematiaceae, Hypocreales, Saccharomycetales, Eurotiales, Dermatomycetes, Agaricales, and Mucorales. Results Between 2003 and June 2019, 186 extremely rare IFI were documented in FungiScopeⓇ. Dematiaceae (35.5%), Hypocreales (23.1%), Mucorales (11.8%), and Saccharomycetales (11.3%) caused most IFI. Most patients had an underlying malignancy (38.7%) with acute leukemia accounting for 50% of cancers. Dissemination was observed in 26.9% of the patients. Complete or partial clinical response rate was 68.3%, being highest in Eurotiales (82.4%) and in Agaricales (80.0%). Overall mortality rate was 29.3%, ranging from 11.8% in Eurotiales to 50.0% in Mucorales. Conclusions Physicians are confronted with a complex variety of fungal pathogens, for which treatment recommendations are lacking and successful outcome might be incidental. Through an international consortium of physicians and scientists, these cases of extremely rare IFI can be collected to further investigate their epidemiology and eventually identify effective treatment regimens.
Published: 2020

34. Factors associated with progression to critical illness in 28 days among COVID-19 patients: results from a tertiary care hospital in Istanbul, Turkey

Author: Dilek Yagci Caglayik, Haner Direskeneli, Baran Balcan, Zekaver Odabasi, Pinar Ay, Beliz Bilgili, Lutfiye Mulazimoglu Durmusoglu, Aysegul Yagci, Volkan Korten, Derya Kocakaya, Rabia Can Sarınoğlu, Uluhan Sili, Ismail Cinel, Emel Eryuksel, Elif Tukenmez Tigen, Sehnaz Olgun Yildizeli, Fethi Gül, Hüseyin Bilgin, Ahmet Topuzoğlu, Sait Karakurt, and Buket Erturk Sengel
Subjects: Mechanical ventilation, medicine.medical_specialty, business.industry, Proportional hazards model, medicine.medical_treatment, Vital signs, Hydroxychloroquine, medicine.disease, Comorbidity, Procalcitonin, Internal medicine, Cohort, medicine, business, Prospective cohort study, medicine.drug
Abstract: BackgroundCoronavirus disease 2019 (COVID-19) quickly spread worldwide to become a pandemic. This study aimed to define the predictors of critical illness development within 28 days postadmission.MethodsWe conducted a prospective cohort study including 477 PCR-positive COVID-19 patients admitted to a tertiary care hospital in Istanbul from March 12 to May 12, 2020. The development of critical illness, e.g., invasive mechanical ventilation and/or death, was followed for a period of 28 days postadmission. Demographic characteristics, number of comorbidities, illness severity at admission defined by the WHO scale, vital signs, laboratory findings and period of admission to the hospital were independent variables. Cox proportional hazards analysis was performed, and the C-index was calculated.ResultsThe median (IQR) age of the cohort was 55.0 (44.0-67.0) years, and 50.1% were male. The most common presenting symptoms were cough, dyspnea and fatigue. Overall, 65.2% of the patients had at least one comorbidity. Hydroxychloroquine was given to 99.2% of the patients. Critical illness developed in 45 (9.4%; 95% CI: 7.0%-12.4%) patients. In the multivariable analysis, age (HR: 1.05, pConclusionsAge, comorbidity number, WHO scale, LDH and procalcitonin were independently associated with critical illness development. Mortality from COVID-19 seems to be decreasing as the pandemic advances.summaryWe analyzed 477 confirmed COVID-19 patients for the development of critical illness, e.g., invasive mechanical ventilation and/or death within 28 days postadmission. Age, comorbidity number, WHO scale, LDH and procalcitonin were independently associated with critical illness development.
Published: 2020

35. Untreated herpes simplex virus encephalitis without a fatal outcome

Author: Uluhan Sili, Mehmet Sar, Abdurrahman Kaya, Sibel Yıldız Kaya, Gökhan Aygün, Zehra Durak Sahin, and Ahmet Furkan Kurt
Subjects: 0301 basic medicine, Adult, medicine.medical_specialty, Fatal outcome, Neurology, Delayed Diagnosis, Acyclovir, Herpesvirus 1, Human, Antiviral Agents, Temporal lobe, 03 medical and health sciences, Cellular and Molecular Neuroscience, 0302 clinical medicine, Herpes virus, Virology, medicine, Humans, medicine.diagnostic_test, business.industry, Herpes simplex virus encephalitis, Magnetic resonance imaging, medicine.disease, Magnetic Resonance Imaging, Temporal Lobe, 030104 developmental biology, Treatment Outcome, Female, Neurology (clinical), Encephalitis, Herpes Simplex, business, 030217 neurology & neurosurgery, Encephalitis
Abstract: Herpes simplex virus encephalitis (HSE) is the most common sporadic fatal encephalitis. Although timely administered acyclovir treatment decreases mortality, neuropsychiatric sequelae is still common among survivors. Magnetic resonance imaging is frequently utilized for the diagnosis of HSE, which typically involves temporal lobe(s) and can be mixed with brain tumors involving the same area. Here, we report a case of HSE, who received acyclovir with a delay of 90 days because of presumptive tumor diagnosis and survived with minimal sequelae.
Published: 2020

36. Chronic Hepatitis C Prevalence, Genotype Distribution and Treatment Responses at Marmara University Pendik Training and Research Hospital Between 2014-2018

Author: Rabia Can Sarinoğlu, Tugce Basari, Elif Tukenmez Tigen, Volkan Korten, Betül Ertürk Şengel, Barış Can, and Uluhan Sili
Subjects: General Engineering
Published: 2020

37. Assessment of Transmitted HIV-1 Drug Resistance Mutations Using Ultra- Deep Pyrosequencing in a Turkish Cohort

Author: Uluhan Sili, Ufuk Hasdemir, Volkan Korten, Güner Söyletir, Burak Aksu, and Aysun Tekin
Subjects: Adult, Male, 0301 basic medicine, medicine.medical_specialty, Genotype, Turkey, 030106 microbiology, Human immunodeficiency virus (HIV), HIV Infections, Viral quasispecies, Drug resistance, medicine.disease_cause, Young Adult, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Virology, Internal medicine, Drug Resistance, Viral, Prevalence, medicine, Humans, 030212 general & internal medicine, Aged, Aged, 80 and over, Reverse-transcriptase inhibitor, business.industry, High-Throughput Nucleotide Sequencing, Sequence Analysis, DNA, Middle Aged, Infectious Diseases, chemistry, Rilpivirine, Mutation, Cohort, HIV-1, Pyrosequencing, Female, business, medicine.drug
Abstract: Background:Antiretroviral treatment (ART) reduces morbidity and mortality caused by human immunodeficiency virus (HIV) infection; however, the emergence of drug-resistant strains poses an important obstacle to treatment success. Using conventional sequencing methods to determine antiretroviral resistance, mutations present in ≥20% of quasispecies can be identified, but drug-resistant minority variants can lead to virologic failure.Objective:We aimed to assess transmitted drug resistance mutations (TDRMs) within minority variants using ultra-deep pyrosequencing (UDPS).Method:Treatment-naive adult patients were included in this observational study. Surveillance TDRMs were classified as ≥20% or at minority variant level (≥2% – Results:Thirty-six patients were analyzed. Any TDRM at ≥20% level was detected in 8.3% of the patients (n=3). This prevalence increased to 30.6% (n=11) with the inclusion of minority variants. All non-nucleoside reverse transcriptase inhibitor and protease inhibitor-related TDRMs were within minority variants. The genotypic sensitivity score of rilpivirine-based regimens was considerably diminished when minority variants were included in the PDRM analysis.Conclusion:UDPS was used for the first time to assess TDRM in a Turkish HIV cohort and uncovered several mutations hidden within minority variants. UDPS may be preferred to detect PDRMs for avoiding virologic failure with rilpivirine-based ART regimens.
Published: 2018

38. 150: ASSOCIATION OF LATITUDE AND ALTITUDE WITH COVID-19 SYMPTOMS: SCCM DISCOVERY VIRUS REGISTRY ANALYSIS

Author: Aysun Tekin, Shahraz Qamar, Vikas Bansal, Romil Singh, Mayank Sharma, Marija Bogojevic, Neha Deo, Allison LeMahieu, Andrew Hanson, Phillip Schulte, Amy Christie, Uluhan Sili, Harry Anderson, Vishakha Kumar, Allan Walkey, Ognjen Gajic, Juan Pablo Domecq Garces, and Rahul Kashyap
Subjects: Critical Care and Intensive Care Medicine
Published: 2021

39. COVID-19 Infection in Vaccinated Adult Patients with Hematological Malignancies. Preliminary Results from Epicovideha (Epidemiology of COVID-19 infection in patients with hematological malignancies: A European Haematology Association Survey)

Author: Francesco Passamonti, Nikolay Klimko, Andreas Glenthoej, Livio Pagano, Caterina Buquicchio, Paolo Corradini, Jon Salmanton-García, Alessandro Busca, Uluhan Sili, Malgorzata Mikulska, Giulia Dragonetti, Antonio Pagliuca, Francesco Marchesi, Philipp Kohler, Barbora Weinbergerova, Alberto Lopez-Garcia, Oliver A. Cornely, and Martin Hoenigl
Subjects: 0303 health sciences, medicine.medical_specialty, Hematology, Adult patients, Coronavirus disease 2019 (COVID-19), business.industry, Immunology, education, Cell Biology, Biochemistry, 3. Good health, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Epidemiology, 642.Chronic Lymphocytic Leukemia: Clinical and Epidemiological, Medicine, In patient, business, health care economics and organizations, 030304 developmental biology, 030215 immunology
Abstract: Introduction Coronavirus disease 2019 (COVID-19) is a life-threatening condition of high relevance for co-morbid patients, such as those with baseline hematological malignancies (HM). One year after the diagnosis of the first COVID-19 case, at the end of 2020, the first vaccines against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were administered to the population, starting with individuals at highest risk of infection. EPICOVIDEHA aims to describe the epidemiology, vaccination strategies and mortality rates from HM patients at risk. Methods We collected clinical and epidemiological data from patients with laboratory-based diagnosis of SARS-CoV-2 infection after partial or complete vaccination. The study was sponsored by the European Hematology Association - Infectious Diseases Working Party. Patients were registered in the EPICOVIDEHA online survey between January 1, 2021 and July 31, 2021 from Europe and United States. Data captured included underlying conditions prior to SARS-CoV-2, HM status and management prior to SARS-CoV-2, SARS-CoV-2 vaccination and infection details and mortality. The survey will continue until December 31, 2021. Results Overall, 40 patients have been so far registered, 24 male and 16 females, the vast majority of them aged over 50 years (N=38, 95%). Three quarters of patients were affected by lymphoproliferative malignancies (chronic lymphoid leukemia [CLL] N=14 and non-Hodgkin lymphoma [NHL] and multiple myeloma [MM] N=8, each), followed by myelodysplastic syndrome (MDS) (N=4), acute myeloid leukemia (AML) (N=2) and others (chronic myeloid leukemia [CML], acute lymphoid leukemia [ALL], polycythemia vera [PV] and aggressive mastocytosis one of each). Thirty-one patients (77.5%) were receiving active treatment for underlying HM at the time of SARS-CoV-2 infection, with 16 of them being on chemotherapy in the month prior to infection. All patients were vaccinated with a median time from vaccine to SARS-CoV-2 infection of 45.5 days (IRQ 19-67.5). Twenty-nine patients received a mRNA vaccine (BioNTech/Pfizer N=28, Moderna COVE N=1), whereas the remaining 11 an inactivated vaccine (Sinovac CoronaVac N=6) and vector-based vaccine (AstraZeneca Oxford N=5). Twenty-three patients were completely vaccinated, of which 22 (97.5%) patients were immunized (a minimum of 15 days following second dose). On the contrary, among 17 patients partially vaccinated, none was immunized. In 9 cases, viral genomes were analyzed (English variant N=7, South Africa variant N=1, Indian variant N=1). Overall, 25/40 patients presented with a severe/critical infection (62.5%), 13 of which (52%) were fully vaccinated and immunized, whereas only 15 (37.5%) were asymptomatic or mildly symptomatic. Twenty-seven (92.5%) patients were admitted to hospital, 5/27 (18.5%) to ICU, all requiring mechanical ventilation. After a follow-up of 30 day from SARS-CoV-2 infection, 8 patients died (20%), with 7/8 deaths (87.5%) attributable to SARS-CoV-2. There was no difference in overall survival between those patients that received 2 doses of vaccine or 1 dose (figure 1a), as well as no difference being observed between patients with and without lymphoproliferative malignancies (figure 1b), patients that receiving/not receiving active treatment in the last month (figure 1c), or the type of vaccine injected (figure 1d). Conclusions Our survey, involving over 150 Hematology Departments around the world, provides some preliminary insights. The majority of patients who do not respond to vaccination are patients with lymphoproliferative diseases, as can also be observed for other types of vaccination (e.g., flu-vaccination). Dramatically the mortality observed in all patients, although lower than that observed in the pre-vaccination period which in our experience was around 31%, still remains high (20%). Recruitment to this survey continues, and we hope that with larger numbers of cases, more definitive conclusions can be drawn to develop strategies to keep these complex patients safe. Figure 1 Figure 1. Disclosures Lopez-Garcia: Celgene: Other: Speaker Honoraria; Abbvie: Other: Speaker Honoraria, Advisor, Travel and accommodation grants; Janssen: Other: Speaker Honoraria, Advisor, Travel and accommodation grants, Research Funding; Roche: Other: Speaker Honoraria, Travel and accommodation grants; Novonordisk: Other: Speaker Honoraria; Fresenius: Other: Speaker Honoraria. Glenthoej: Novo Nordisk: Honoraria; Agios: Consultancy, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees; bluebird bio: Consultancy, Membership on an entity's Board of Directors or advisory committees; Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees; Alexion: Research Funding. Mikulska: Biotest: Speakers Bureau; Janssen: Speakers Bureau; MSD: Speakers Bureau; Gilead: Speakers Bureau; Pfizer: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Busca: Gilead Sciences: Other: Lecture Honoraria; Merck: Other: Lecture Honoraria; Pfizer Pharmaceuticals: Other: Lecture Honoraria; Basilea: Other: Lecture Honoraria; Biotest: Other: Lecture Honoraria; Jazz Pharmaceuticals: Other: Lecture Honoraria; Takeda: Membership on an entity's Board of Directors or advisory committees. Corradini: KiowaKirin; Incyte; Daiichi Sankyo; Janssen; F. Hoffman-La Roche; Kite; Servier: Consultancy; AbbVie, ADC Theraputics, Amgen, Celgene, Daiichi Sankyo, Gilead/Kite, GSK, Incyte, Janssen, KyowaKirin, Nerviano Medical Science, Novartis, Roche, Sanofi, Takeda: Honoraria; AbbVie, ADC Theraputics, Amgen, Celgene, Daiichi Sankyo, Gilead/Kite, GSK, Incyte, Janssen, KyowaKirin, Nerviano Medical Science, Novartis, Roche, Sanofi, Takeda: Consultancy; Amgen; Takeda; AbbVie: Consultancy, Honoraria, Other: Travel and accommodations; Novartis; Gilead; Celgene: Consultancy, Other: Travel and accommodations; BMS: Other: Travel and accommodation; Sanofi: Consultancy, Honoraria; Incyte: Consultancy; Novartis, Janssen, Celgene, BMS, Takeda, Gilead/Kite, Amgen, AbbVie: Other: travel and accomodations. Hoenigl: Gilead, Pfizer, Astellas, Scynexis, and NIH: Research Funding. Klimko: Gilead Science, MSD, Pfizer: Membership on an entity's Board of Directors or advisory committees; Gilead Sciences, MSD, Pfizer Pharmaceuticals, and Astellas Pharma: Speakers Bureau. Pagliuca: Gentium/Jazz Pharmaceuticals: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Gilead, Pfizer, and MSD: Research Funding. Passamonti: Celgene: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; AbbVie: Speakers Bureau; BMS: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Janssen: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Köhler: German Federal Ministry of Research and Education and the State of North Rhine-Westphalia, Germany: Other: Support; Miltenyi Biotec GmbH, Bergisch Gladbach, Germany, and the Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany: Other: Non-financial grants; Akademie für Infektionsmedizin e.V., Ambu GmbH, Astellas Pharma, European Confederation of Medical Mycology, Gilead Sciences, GPR Academy Ruesselsheim, MSD Sharp & Dohme GmbH, Noxxon N.V., and University Hospital, LMU Munich: Consultancy, Honoraria. Cornely: Amplyx, Basilea, BMBF, Cidara, DZIF, EU-DG RTD (101037867), F2G, Gilead, Matinas, MedPace, MSD, Mundipharma, Octapharma, Pfizer, Scynexis: Other: Grants or Contracts. Pagano: Gilead Science, MSD, Pfizer, Basilea, Janssen, Novartis, Jazz Pharmaceutical, Cidara: Membership on an entity's Board of Directors or advisory committees; Gilead Sciences, MSD, Pfizer Pharmaceuticals, Astellas Pharma: Speakers Bureau; Menarini: Consultancy.
Published: 2021

40. Herpes Simplex Virus Encephalitis in Geriatric Patients

Author: Asli Tufan, Mustafa Emir Tavsanli, and Uluhan Sili
Subjects: Geriatrics, medicine.medical_specialty, Pediatrics, Neurology, business.industry, Herpes simplex virus encephalitis, medicine.disease, medicine.disease_cause, Rheumatology, 03 medical and health sciences, 0302 clinical medicine, Herpes simplex virus, Infectious disease (medical specialty), Internal medicine, Immunology, Epidemiology, medicine, 030212 general & internal medicine, Geriatrics and Gerontology, business, 030217 neurology & neurosurgery, Encephalitis
Abstract: Herpes simplex virus encephalitis (HSVE) is a rare, devastating infectious disease of the brain. We reviewed published case series to determine whether epidemiology, clinical characteristics, and prognosis of HSVE differed in geriatric patients. Geriatric patients have a higher incidence of HSVE and a worse prognosis than the rest of the adult population. The gold standard to confirm HSVE diagnosis is to demonstrate HSV DNA in cerebrospinal fluid using polymerase chain reaction. Antiviral treatment with acyclovir prevents HSVE-related morbidity and mortality if started on time. Diagnosis and treatment of HSVE pose specific challenges due to comorbidities and medical conditions presenting with similar signs and symptoms commonly encountered in geriatric medicine. Thus, timely empirical treatment and confirmation of diagnosis in this patient population relies largely on astuteness of the clinician.
Published: 2017

41. Chronic Viral Hepatitis in Human Immunodeficiency Virus-infected Patients

Author: Uluhan Sili, Volkan Korten, and Aysun Tekin
Subjects: Tenofovir, business.industry, Hepatitis C virus, Human immunodeficiency virus (HIV), Hepatitis C, Hepatitis B, medicine.disease, medicine.disease_cause, Virology, Liver disease, Chronic hepatitis, Medicine, business, Viral hepatitis, medicine.drug
Abstract: Insan bagisiklik yetmezlik virusu ile enfekte hastalarda kronik hepatit B virusu (HBV) ve hepatit C virusu (HCV) enfeksiyonlari da arastirilmalidir. Bu hastalarda kronik viral hepatitler daha hizli ilerler ve siroz daha cabuk gelisir. Tani konulduktan sonra kronik viral hepatitler icin etkin tedavi verilebilir. HBV’nin replikasyonunu tenofovir iceren anti-retroviral tedaviler ile baskilamak mumkundur. Dogrudan etkili antiviral ilaclarin gelistirilmesiyle HCV enfeksiyonunun sagaltimi mumkun hale gelmistir. Anahtar Kelimeler: Insan bagisiklik yetmezlik virusu, kronik hepatit B, kronik hepatit C, ko-enfeksiyon Infectious diseases physicians taking care of human immunodeficiency virus-infected patients should investigate for the presence of chronic hepatitis caused by hepatitis B and hepatitis C virus infections. This is important as chronic viral hepatitis progresses more rapidly to end-stage liver disease in human immunodeficiency virus-infected patients. Once diagnosed, there are effective drugs for the treatment chronic viral hepatitis. Tenofovir containing anti-retroviral therapy effectively suppresses hepatitis B replication. Hepatitis C cure can be achieved with directly acting antiviral agents.
Published: 2016

42. A qualitative study of hand hygiene compliance among health care workers in intensive care units

Author: Ayşe Gülsen Teker, Pinar Tepe, Seyhan Hıdıroğlu, Ayşen Sürmen, Pinar Ay, Melda Karavuş, Volkan Korten, Uluhan Sili, Ay, Pinar, Teker, Ayse Gulsen, Hidiroglu, Seyhan, Tepe, Pinar, Surmen, Aysen, Sili, Uluhan, Korten, Volkan, and Karavus, Melda
Subjects: Adult, Male, Attitude of Health Personnel, media_common.quotation_subject, INFECTION-CONTROL, qualitative study, Microbiology, intensive care unit, Group cohesiveness, Nursing, Hygiene, Virology, Intensive care, Health care, Humans, Hand Hygiene, Safety culture, media_common, Cross Infection, Infection Control, business.industry, Theory of planned behavior, General Medicine, Middle Aged, FRAMEWORK, Focus group, Personnel, Hospital, Intensive Care Units, Infectious Diseases, healthcare-associated infections, SAFETY, Parasitology, Female, Guideline Adherence, Psychology, business, Qualitative research, Hand hygiene compliance
Abstract: Introduction: Studies indicate that adherence to hand hygiene guidelines is at suboptimal levels. We aimed to explore the reasons for poor hand hygiene compliance. Methodology: A qualitative study based on the Theory of Planned Behavior as a framework in explaining compliance, consisting four focus group discussions and six in-depth interviews. Results: Participants mostly practiced hand hygiene depending on the sense of "dirtiness" and "cleanliness". Some of the participants indicated that on-job training delivered by the infection control team changed their perception of "emotionally" based hand hygiene to "indication" based. Direct observations and individual feedback on one-to-one basis were the core of this training. There was low social cohesiveness and a deep polarization between the professional groups that led one group accusing the other for not being compliant. Conclusions: The infection control team should continue delivering one-to-one trainings based on observation and immediate feedback. But there is need to base this training model on a structured behavioral modification program and test its efficacy through a quasi-experimental design. Increasing social cohesiveness and transforming the blaming culture to a collaborative safety culture is also crucial to improve compliance. High workload, problems related to work-flow and turnover should be addressed.
Published: 2018

43. Hand hygiene knowledge, perception and practice of healthcare workers in a Turkish university hospital intensive care unit

Author: Pinar Ay, Seyhan Hıdıroğlu, Hüseyin Bilgin, Uluhan Sili, Volkan Korten, Sili, Uluhan, Ay, Pinar, Bilgin, Huseyin, Hidiroglu, Seyhan, and Korten, Volkan
Subjects: Adult, Male, medicine.medical_specialty, Health Knowledge, Attitudes, Practice, Turkey, Turkish, media_common.quotation_subject, Health Personnel, Psychological intervention, 010501 environmental sciences, intensive care unit, 01 natural sciences, Microbiology, law.invention, Hospitals, University, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Professional Competence, law, Hygiene, Virology, Perception, Surveys and Questionnaires, Health care, medicine, quantitative study, Humans, Hand Hygiene, 030212 general & internal medicine, 0105 earth and related environmental sciences, media_common, business.industry, General Medicine, Training methods, University hospital, Intensive care unit, language.human_language, Intensive Care Units, Infectious Diseases, Cross-Sectional Studies, healthcare-associated infections, Family medicine, language, Parasitology, Female, business, Hand hygiene compliance
Abstract: Introduction: While improvement of hand hygiene (HH) compliance is considered as the best approach to reduce healthcare-associated infections, the instructional interventions in HH among healthcare workers of intensive care unit (ICU) of our hospital was not successful enough. The following study was conducted to evaluate HH knowledge, perception, practice and effectiveness of the trainings among healthcare workers of ICU in our hospital. Methodology: A cross-sectional study was conducted in the ICU containing 8 medical and 16 surgical beds with 284 filled questionnaires about HH knowledge and 1187 observed opportunities for HH compliance. Results: Overall observed HH compliance rate was 40.6%; lowest compliance was 21.7% for “before clean/aseptic procedure” indication and highest compliance was 68.6% for “after touching a patient” indication. Although > 90% healthcare workers correctly identified the World Health Organization’s five indications for HH, 82 – 85% failed to recognize non-indications, i.e. when it was not necessary to perform HH. Our study showed that 15.1% of healthcare workers neither received nor felt the need for HH training. Conclusions: Despite regular HH trainings, healthcare workers could not differentiate when HH was not required which suggested failure to understand HH rationale. This may explain poor HH compliance rates. A systematic study is needed in order to find out the reasons behind of this noncompliance and improve HH training methods for educating healthcare workers.
Published: 2018

44. HCV-specific lymphocyte responses in individuals with positive anti-HCV but negative HCV-RNA

Author: Selda Aydin, Recep Öztürk, Ali Mert, Abdurrahman Kaya, Nur Hondur, Resat Ozaras, Fehmi Tabak, and Uluhan Sili
Subjects: Adult, Male, T-lymphocyte, Enzyme-Linked Immunospot Assay, Hepatitis C virus, Lymphocyte, medicine.disease_cause, Asymptomatic, Young Adult, chemistry.chemical_compound, Virology, medicine, Humans, Spontaneous Recovery, Lymphocytes, Aged, Hepatitis, biology, Diagnostic Tests, Routine, business.industry, Ribavirin, ELISPOT, virus diseases, False-Positive Serology, T lymphocyte, Hepatitis C Antibodies, Middle Aged, medicine.disease, Hepatitis C, digestive system diseases, Elispot, Infectious Diseases, medicine.anatomical_structure, chemistry, HCV, Immunology, biology.protein, RNA, Viral, Female, Antibody, medicine.symptom, business
Abstract: WOS: 000354124400016 PubMed ID: 25959163 Background: Hepatitis C virus (HCV) status cannot be reliably predicted in anti-HCV positive/HCV-RNA negative individuals who may either have recovered spontaneously or have a false-positive test due to antibody cross-reaction. Investigating T lymphocyte responses in individuals with different HCV status may help understand the cellular immune mechanisms underlying spontaneous recovery, treatment response, and chronicity. Objective: We aimed to determine whether anti-HCV positive, HCV-RNA negative individuals are truly spontaneous recoverers from acute HCV infection. Study design: We used enzyme-linked immunosorbent spot (ELISPOT) assay to compare HCV-specific lymphocyte response among anti-HCV positive/HCV-RNA negative individuals, patients with sustained virological response to interferon-gamma/ribavirin treatment, and patients with chronic HCV infection. Results: We found that 83% of anti-HCV positive/HCV-RNA negative individuals without a past medical history of acute icteric hepatitis had an HCV-specific T lymphocyte response in peripheral blood. Lymphocyte responses in these individuals were similar in magnitude to treatment responders unlike patients with chronic HCV whose virus-directed immunity was significantly suppressed. Conclusions: Detection of HCV-specific T lymphocyte responses using ELISPOT is a feasible method to ascertain past asymptomatic acute HCV infection. Office of Scientific Research Projects, Istanbul University [BYPS-1-26/31012007] This study is funded in part by the Office of Scientific Research Projects, Istanbul University (no: BYPS-1-26/31012007).
Published: 2015

45. Successful treatment of an invasive fungal infection caused by Talaromyces sp. with voriconazole

Author: Gulcicek Ayranci, Emel Eryuksel, Nuri Cagatay Cimsit, Uluhan Sili, Hüseyin Bilgin, Malcolm Richardson, Rikesh Masania, Volkan Korten, Sili, Uluhan, Bilgin, Huseyin, Masania, Rikesh, Eryuksel, Emel, Cimsit, Nun I. Cagatay, Ayranci, Gulcicek, Richardson, Malcolm, and Korten, Volkan
Subjects: Voriconazole, lcsh:R5-920, IDENTIFICATION, business.industry, Critically ill, Mold infection, Case Report, medicine.disease, Microbiology, Invasive fungal infection, Infectious Diseases, lcsh:Biology (General), Rheumatoid arthritis, Pulmonary nodule, medicine, Talaromyces sp, lcsh:Medicine (General), business, lcsh:QH301-705.5, Hyalohyphomycosis, medicine.drug
Abstract: Invasive fungal infections (lFl) are on the rise due to increasing numbers of immunosuppressed and critically ill patients. A malignant-looking pulmonary nodule in an immunosuppressed patient may indeed be caused by a fungal organism. We report a patient, who was eventually diagnosed with an IFI caused by an agent of hyalohyphomycosis, Talaromyces sp determined via molecular methods and succesfully treated with voriconazole. (C) 2015 The Authors, International Society for Human and Animal Mycology Published by Elsevier B.V.
Published: 2015

46. Nocardia Brain Abscess in a Patient with Chronic Lymphocytic Leukemia

Author: Mehmet Yasar Kaynar, Fehmi Tabak, Ali Mert, Recep Öztürk, Zehra Isik Hasiloglu, Resat Ozaras, Bilgul Mete, Ersin Vanli, Ayse Nur Hondur, Uluhan Sili, and Nese Saltoglu
Subjects: Microbiology (medical), Pathology, medicine.medical_specialty, Infectious Diseases, biology, business.industry, Chronic lymphocytic leukemia, medicine, Nocardia, medicine.disease, business, biology.organism_classification, Brain abscess
Published: 2010

47. Accelerated Production of Antigen-specific T Cells for Preclinical and Clinical Applications Using Gas-permeable Rapid Expansion Cultureware (G-Rex)

Author: John R. Wilson, Gianpietro Dotti, Uluhan Sili, Minhtran C. Ngo, Cliona M. Rooney, Hao Liu, Ulrike Gerdemann, Ann M. Leen, Helen E. Heslop, Juan F. Vera, and Lara J. Brenner
Subjects: Cancer Research, Time Factors, medicine.medical_treatment, Immunology, Cell Culture Techniques, Biology, Immunotherapy, Adoptive, Article, Cell therapy, Antigen, Cell Line, Tumor, medicine, Humans, Immunology and Allergy, Cytotoxic T cell, Lymphocyte Count, Antigens, Bioprocess, Cell Proliferation, Pharmacology, Cell growth, Reproducibility of Results, Immunotherapy, Cell biology, CTL, Cell culture, K562 Cells, T-Lymphocytes, Cytotoxic
Abstract: The clinical manufacture of antigen-specific cytotoxic T lymphocytes (CTLs) for adoptive immunotherapy is limited by the complexity and time required to produce large numbers with the desired function and specificity. The culture conditions required are rigorous, and in some cases only achieved in 2-cm wells in which cell growth is limited by gas exchange, nutrients, and waste accumulation. Bioreactors developed to overcome these issues tend to be complex, expensive, and not always conducive to CTL growth. We observed that antigen-specific CTLs undergo 7 to 10 divisions poststimulation. However, the expected CTL numbers were achieved only in the first week of culture. By recreating the culture conditions present during this first week-low frequency of antigen-specific T cells and high frequency of feeder cells-we were able to increase CTL expansion to expected levels that could be sustained for several weeks without affecting phenotype or function. However, the number of 24-well plates needed was excessive and cultures required frequent media changes, increasing complexity and manufacturing costs. Therefore, we evaluated novel gas-permeable culture devices (G-Rex) with a silicone membrane at the base allowing gas exchange to occur uninhibited by the depth of the medium above. This system effectively supports the expansion of CTL and actually increases output by up to 20-fold while decreasing the required technician time. Importantly, this amplified cell expansion is not because of more cell divisions but because of reduced cell death. This bioprocess optimization increased T-cell output while decreasing the complexity and cost of CTL manufacture, making cell therapy more accessible.
Published: 2010

48. Comparison of cellular immunity in patients with chronic hepatitis B, inactive hepatitis B surface antigen carriers and spontaneously recovered individuals

Author: Ferhat, Arslan, Ali, Mert, Uluhan, Sili, Fehmi, Tabak, Recep, Öztürk, and Resat, Ozaras
Subjects: Adult, Male, Immunity, Cellular, Interferon-gamma, Hepatitis B Surface Antigens, Hepatitis B, Chronic, T-Lymphocytes, Carrier State, Humans, Female, Middle Aged
Abstract: Different clinical outcomes of acute HBV infection have been partially explained by individual differences in immune response. In this study we investigated interferon gamma (IFN-γ) secretion of peripheral blood mononuclear cells (PBMC) in vitro against specific (Hepatitis B core antigen; recombinant HB-cAg) and non-specific (CMV, EBV, Influenza peptide pool; CTL CEF peptide pool "plus") antigens using enzyme linked immunospot (ELISPOT) assay in 7 patients with chronic hepatitis B (CHB group), 8 inactive carriers Of HBV (carrier group) and 8 subjects who spontaneously recovered from acute HBV infection as detected by anti-HBs positivity (immune group). Phytohemaglutinin served as the positive test control. Response against recombinant HBcAg was 88±135, 50±110, 105±150 spot forming cell (SFC)/10(5) PBMC, in CHB, carrier and immune groups, respectively. HBcAg-specific T-cell response was slightly higher in the immune group; however, statistically there was no significant difference between the groups. Assessment of cellular immunity by IFN-γ ELISPOT was not sufficient to explain the various outcomes of HBV infection such as resolution, chronicity and carriership.
Published: 2015

49. An Outbreak With Colistin- and Carbapenem-Resistant Klebsiella pneumoniae in an Intensive Care Unit

Author: Gulsen Altinkanat, Beliz Bilgili, Volkan Korten, Pinar Ay, Aysun Tekin, Husniye Karadag, Ismail Cinel, Mustafa Kemal Arslantas, Güner Söyletir, Uluhan Sili, and Fethi Gül
Subjects: medicine.medical_specialty, Carbapenem resistant Klebsiella pneumoniae, business.industry, Outbreak, Intensive care unit, law.invention, Infectious Diseases, Oncology, law, Emergency medicine, medicine, Colistin, business, medicine.drug
Published: 2015

50. Monoculture-derived T lymphocytes specific for multiple viruses expand and produce clinically relevant effects in immunocompromised individuals

Author: Catherine M. Bollard, Robert A. Krance, Uluhan Sili, Chung Che Chang, G. Doug Myers, Ann M. Leen, Kathryn S. Leung, Cliona M. Rooney, Helen E. Heslop, Adrian P. Gee, Malcolm K. Brenner, M. Helen Huls, Heidi L. Weiss, George Carrum, and Jeffrey J. Molldrem
Subjects: Adult, CD4-Positive T-Lymphocytes, Male, Herpesvirus 4, Human, Adoptive cell transfer, Adolescent, T-Lymphocytes, Cell Culture Techniques, Cytomegalovirus, CD8-Positive T-Lymphocytes, Biology, medicine.disease_cause, General Biochemistry, Genetics and Molecular Biology, Virus, Adenoviridae, Immunophenotyping, Immunity, medicine, Humans, Cytotoxic T cell, Child, Cells, Cultured, General Medicine, T lymphocyte, Middle Aged, Virology, CTL, Immune System Diseases, Child, Preschool, Immunology, Female, CD8
Abstract: Immunocompromised individuals are at high risk for life-threatening diseases, especially those caused by cytomegalovirus (CMV), Epstein-Barr virus (EBV) and adenovirus. Conventional therapeutics are primarily active only against CMV, and resistance is frequent. Adoptive transfer of polyclonal cytotoxic T lymphocytes (CTLs) specific for CMV or EBV seems promising, but it is unclear whether this strategy can be extended to adenovirus, which comprises many serotypes. In addition, the preparation of a specific CTL line for each virus in every eligible individual would be impractical. Here we describe genetic modification of antigen-presenting cell lines to facilitate the production of CD4(+) and CD8(+) T lymphocytes specific for CMV, EBV and several serotypes of adenovirus from a single cell culture. When administered to immunocompromised individuals, the single T lymphocyte line expands into multiple discrete virus-specific populations that supply clinically measurable antiviral activity. Monoculture-derived multispecific CTL infusion could provide a safe and efficient means to restore virus-specific immunity in the immunocompromised host.
Published: 2006

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