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    Altered cardiac autonomic function after recovery from COVID-19
    (Wiley, 2022) Kurtoglu, Ertugrul; Afsin, Abdulmecit; Aktas, Ibrahim; Akturk, Erdal; Kutlusoy, Ergun; Cagasar, Ozlem
    Background Autonomic dysfunction may occur during the acute phase of COVID-19. Heart rate variability (HRV) is a useful tool for the assessment of cardiac sympathetic and parasympathetic balance. We aimed to evaluate cardiac autonomic function by using HRV in subjects after recovery from COVID-19 who had previously symptomatic and were followed outpatiently. Methods The study group composed of 50 subjects with a confirmed history of COVID-19 and the control group composed of 50 healthy subjects without a history of COVID-19 and vaccination. All the study participants underwent 2-dimensional, pulsed- and tissue-Doppler echocardiographic examinations and 24-hour Holter monitoring for HRV analysis. Results Time domain parameters of SDNN, SDANN, SDNNi, RMSSD, pNN50, and HRV triangular index were all decreased in the study group when compared with the control group. Frequency domain parameters of TP, VLF, LF, HF, and HFnu were also decreased in the study group in comparison with the control group. LFnu was similar between groups. Nonlinear parameters of HRV including alpha(1) and alpha(2) decreased in the study group. By contrast, Lmax, Lmean, DET, REC, and Shannon entropy increased in the study population. Approximate and sample entropies also enhanced in the study group. Conclusions The present study showed that all three domain HRV significantly altered in patients after recovery from COVID-19 indicating some degree of dysfunction in cardiac autonomic nervous system. HRV may be a useful tool for the detection of preclinical autonomic dysfunction in this group of patients.
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    Differential diagnosis of COVID-19 pneumonia from acute heart failure in pandemic: Importance of radiological and laboratory findings
    (Turkish Assoc Tuberculosis & Thorax, 2021) Kasapogu, Umut Sabri; Gok, Abdullah; Delen, Leman Acun; Sayan, Hasan; Kacmaz, Osman; Cagasar, Ozlem; Karaca, Rukan
    Introduction: COVID-19 pneumonia typically presents with high fever, cough, and shortness of breath and on thorax computed tomography (CT) peripheral ground glass opacities help the diagnosis. Although typical imaging findings for COVID-19 pneumonia are specified in thorax CT, these findings can confused with other diseases. The aim of this study is to investigate the roles of radiological imaging and laboratory findings in the differential diagnosis of COVID-19 pneumonia and acute heart failure (AHF). Materials and Methods: In the present study, 74 patients who admitted to the emergency department with respiratory distress during the pandemic period and received a diagnosis of COVID-19 pneumonia and AHF were included. Laboratory data and radiological findings of the patients, at the time of admission, were evaluated. Results: On admission, there was no difference in age, gender between two groups. However, COVID-19 exposure history was found significantly higher in COVID-19 pneumonia patients group (p< 0.001). Fever, cough, and fatigue were found significantly higher in the COVID-19 pneumonia patients group (p< 0.001). There was difference of lesions distribution between the two groups, centrally distributed lesions were found significantly higher in acute heart failure patients (p< 0.001). Pleural effusion and cardiomegaly were found significantly higher in AHF patients (p< 0.001, p< 0.001). Counts of the white blood cells and lymphocytes were found significantly lower in COVID-19 pneumonia patients 0.003, p= 0.009). COVID-19 pneumonia patients had significantly higher levels of CRP ferritin, LDH and CK compared with AHF patients (p< 0.001, p< 0.001, p= 0.002, p= 0.013). However the level of NT-proBNP was found significantly higher in the AHF patients group (p< 0.001). Conclusion: We believe that laboratory data and thorax CT findings can provide beneficial clinical information in differentiating COVID-19 pneumonia from AHF during the pandemic.
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    EFFECTS OF HYDROXYCHLOROQUINE PLUS FAVIPIRAVIR TREATMENT ON THE CLINICAL COURSE AND BIOMARKERS IN HOSPITALIZED COVID-19 PATIENTS WITH PNEUMONIA
    (Sestre Milosrdnice Univ Hospital, 2022) Delen, Leman Acun; Gok, Abdullah; Kasapoglu, Umut Sabri; Cagasar, Ozlem; Gok, Zarife; Berber, Nurcan; Derya, Serdar
    Background: The novel coronavirus disease 2019 (COVID-19) has a broad spectrum of clin-ical manifestations, the most common serious clinical manifestation of the coronavirus infection being pneumo-nia. Unfortunately, the optimal treatment approach is still uncertain. However, many studies have been conducted on the effectiveness of several medications in the treatment of COVID-19 infection. The aim of this study was to evaluate the effectiveness of the hydroxychloroquine (HCQ) + favipiravir (FAV) treatment regimen and HCQ alone by comparing the patient's clinical response and laboratory results on the fifth day of treatment in patients hospitalized due to COVID-19 infection.Patients and methods: This retrospective cohort study was conducted in Malatya Training and Research Hospital between March 2020 and July 2020. The study included 69 patients with confirmed COVID-19 with pneumonia. The patients were divided into 2 groups, those receiving HCQ alone and those receiving the HCQ + FAV combination.Results: A total of 69 patients were included in the study, and the mean age was 60.09 +/- 15.56 years. A statisti-cally significant decrease was observed in C-reactive protein (CRP) levels, at the end of the fifth day, in patients who received HCQ + FAV treatment (p=0.002), whereas there was no decrease in CRP levels in patients who received HCQ treatment alone. In addition, an increase in lymphocyte count and a better fever response was observed at the end of the fifth day in patients who received HCQ + FAV (p=0.008). However, there was no statistical difference between both treatment regimens in terms of hospital stay and treatment results (p=0.008, p=0.744, p=0.517).Conclusion: Although the combination of HCQ + FAV treatment was observed to be effective on CRP levels and fever response in patients with COVID-19 pneumonia, there was no difference in terms of hospital stay and discharge.
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    Efficacy of tocilizumab therapy in severe COVID-19 pneumonia patients and determination of the prognostic factors affecting 30 days mortality
    (Marmara Univ, Fac Medicine, 2022) Delen, Leman; Kasapoglu, Umut Sabri; Gok, Abdullah; Cagasar, Ozlem; Tetik, Bora; Oksuz, Ersoy
    Objective: In coronavirus disease - 19 (COVID-19) patients, cytokine storm develops due to the increase of pro-inflammatory cytokines. Tocilizumab (TU.), has been used in the treatment of COVID-19 patients and successful results have been obtained. The aim of this study was to determine the efficacy of TCZ and also investigate the prognostic factors affecting the success of treatment and mortality in COVID-19 patients treated with TCZ. Patients and Methods: Between March 2020 and August 2021, a total of 326 confirmed severe COVID-19 pneumonia patients, treated in the intensive care unit, were included in the study. Results: The mean age of the patients was 63.02 +/- 11.58 years, and 203 (62.3%) of the patients were male. Patients treated with TCZ had a longer survival time compared with the standard therapy (p=0.012). It was found that type of respiratory support (HR:2.19, CI:1.10-4.36, p=0.025) and hyperlactatemia on the day of TCZ therapy admission (HR:2.93 CI:1.53-5.64, p=0.001) were the significant and independent prognostic factors of survival in severe COVID-19 pneumonia patients treated with TCZ. Conclusion: Tocilizumab therapy improved 30-days survival in critically ill COVID-19 pneumonia patients. Also, among the patients with TCZ, types of respiratory support and hyperlactatemia on the day of TCZ admission were the independent prognostic factors.
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    The Impact of COVID-19 on Conjunctival Flora
    (Taylor & Francis Inc, 2021) Gunduz, Ayten; Ozturk, Emrah; Cagasar, Ozlem
    Purpose: This study aims to evaluate the effect of coronavirus disease 2019 (COVID-19) on conjunctival flora in patients hospitalized with COVID-19. Methods: This prospective, controlled study was conducted between June 2020 and December 2020. The study group consisted of 45 confirmed COVID-19 patients and 43 control subjects. The collected samples were inoculated into the Thioglycollate broth media without delay. The samples with growth were then passed on eosin methylene blue agar, sabouraud dextrose agar, chocolate agar, and 5% sheep blood agar solid media. Results: The mean age of the COVID-19 patients was 64.24 +/- 15.4 years, and the control subjects were 59.72 +/- 11.4 years. The culture positivity of conjunctiva samples in COVID-19 patients (95.6%) was statistically significantly higher than control subjects (76.7%) (p = .024). Coagulase-negative staphylococcus and Staphylococcus aureus' positivity was significantly higher in COVID-19 patients than control subjects (p < .05). Conclusion: Patients with COVID-19 demonstrate significantly higher culture positivity on conjunctival flora than the control subjects.
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    Peripheral Blood Smear Findings of COVID-19 Patients Provide Information about the Severity of the Disease and the Duration of Hospital Stay
    (Mattioli 1885, 2021) Berber, Ilhami; Cagasar, Ozlem; Sarici, Ahmet; Berber, Nurcan Kirici; Aydogdu, Ismet; Ulutas, Ozkan; Yildirim, Asli
    Background: Data about the morphological changes in peripheral blood smears during COVID-19 infection and their clinical severity association are limited. We aimed to examine the characteristics of the cells detected in the pathological rate and/or appearance and whether these findings are related to the clinical course by evaluating the peripheral blood smear at the time of diagnosis in COVID-19 patients. Methods: Clinical features, laboratory data, peripheral blood smear of fifty patients diagnosed with COVID-19 by PCR was evaluated at diagnosis. Peripheral smear samples of the patients were compared with the age and sex-matched 30 healthy controls. Pictures were taken from the patient's peripheral blood smear. Patients were divided into two groups. Mild and severe stage patient groups were compared in terms of laboratory data and peripheral smear findings. The relationship between the laboratory values of all patients and the duration of hospitalization was analyzed. Results: The number of segmented neutrophils and eosinophils were low, pseudo-Pelger-Huet, pseudo-Pelger-Huet/mature lymphocyte ratio, atypical lymphocytes, monocytes with vacuoles, bands, and pyknotic neutrophils rates were higher in the peripheral blood smear of the patient group (p<0.05). Increased pseudo-Pelger-Huet anomaly, pseudo-Pelger Huet/mature lymphocyte ratio, a decreased number of mature lymphocytes, and eosinophils in peripheral blood smear were observed in the severe stage patients (p<0.05). A negative correlation was observed between hospitalization duration and mature lymphocyte and monocytes with vacuoles rates (p<0.05). Conclusion: A peripheral blood smear is an inexpensive, easily performed, and rapid test. Increased Pseudo-Pelger-Huet anomaly/mature lymphocyte rate suggests a severe stage disease, while high initial mature lymphocyte and monocytes with vacuoles rates at the time of diagnosis may be an indicator of shortened duration of hospitalization.