Clinical characteristics and outcomes of nosocomial COVID-19 in Turkey:A retrospective multicenter study

Objective:To identify the clinical characteristics and outcomes of hospital-acquired SARS-CoV-2 infection during the vaccination period nationwide in Turkey.Methods:COVID-19 patients followed in the pandemic services across Turkey between January 1,2021,and March 31,2022 were investigated retrospectively.Nosocomial COVID-19 was defined as a patient neither diagnosed with COVID-19 nor suspected COVID-19 at the hospital admission and was confirmed COVID-19≥5 days after hospital admission.The primary outcome of this study was in-hospital mortality;demographic features and vaccination status was compared between survivors and non-survivors.Results:During the study period,15573 COVID-19 patients were followed in 18 centers and 543(3.5%)patients were nosocomial COVID-19.Most patients with nosocomial COVID-19(80.4%)were transferred from medical wards.162(29.8%)of the patients with nosocomial COVID-19 admitted to the intensive care unit due to disease severity and 138(25.4%)of the patients died during hospital stay.Advanced age(≥65 years)and number of comorbid diseases(≥2)was found to be associated with mortality in nosocomial COVID-19(OR 1.74,95%CI 1.11-2.74 and OR 1.60,95%CI 1.02-2.56,respectively).Vaccination was associated with survival in nosocomial COVID-19(OR 0.25,95%CI 0.16-0.38).Conclusions:Patients with nosocomial COVID-19 had increased admission to intensive care units and higher mortality rate.Vaccination can decrease the in-hospital mortality rate.

Risk factors and clinical responses of pneumonia patients with colistin-resistant Acinetobacter baumannii-calcoaceticus

BACKGROUND Nosocomial infections with carbapenem-resistant Acinetobacter baumanniicalcoaceticus complex(ABC)strains are great problem for intensive care units.ABC strains can develop resistance to all the antibiotics available.Carbapenem resistance is common and colistin resistance is rare in our country.Knowing the risk factors for colistin resistance is important since colistin seems to be the only remaining therapeutic option for the patients with pneumonia due to extensively drug resistant ABC for our country.AIM To investigate the comparison of clinical responses and outcomes between pneumonia patients with colistin-susceptible and-resistant Acinetobacter sp.Strains.METHODS During the study period,108 patients with pneumonia due to colistin-susceptible strains and 16 patients with colistin-resistant strains were included retrospectively.Continuous variables were compared with the Mann-Whitney U test,and categorical variables were compared using Pearson’s chi-square test or Fisher’s Exact chi-square test for two groups.A binary logistic regression model was developed to identify the potential independent factors associated with colistin resistance in patients with colistin-resistant strains.RESULTS High Acute Physiology and Chronic Health Evaluation II scores(OR=1.9,95%CI:1.4-2.7;P<0.001)and prior receipt of teicoplanin(OR=8.1,95%CI:1.0-63.3;P=0.045)were found to be independent risk factors for infection with colistin-resistant Acinetobacter sp.Different combinations of antibiotics including colistin,meropenem,ampicillin/sulbactam,amikacin and trimethoprim/sulfamethoxazole were used for the treatment of patients with colistin-resistant strains.Although the median duration of microbiological cure(P<0.001)was longer in the colistin-resistant group,clinical(P=0.703),laboratory(P=0.277),radiological(P=0.551),microbiological response(P=1.000)and infection related mortality rates(P=0.603)did not differ between the two groups.Among the patients with infections due to colistin-resistant strains,seven were treated with antibiotic combinations that included sulbactam.Clinical(6/7)and microbiological(5/7)response rates were quite high in these patients.CONCLUSION The optimal therapy regimen is unclear for colistin-resistant Acinetobacter sp.infections.Although combinations with sulbactam seems to be more effective in our study patients,data supporting the usefulness of combinations with sulbactam is very limited.

Knowledge and attitudes of orthopedic surgeons regarding prosthesis joint infection

BACKGROUND Periprosthetic joint infection(PJI)is a critical complication after joint arthroplasty and is accompanied by increasing rates of morbidity and mortality.Several studies have aimed at preventing PJI.AIM To research the knowledge level and attitudes of orthopedic surgeons,who play a key role in both preventing and managing PJI.METHODS We conducted a web-based survey to evaluate orthopedic surgeons'knowledge level and attitudes regarding PJI.The Likert scale survey utilized consisted of 30 questions which were prepared based on the"Proceedings of the International Consensus on Periprosthetic Joint Infection".RESULTS A total of 264 surgeons participated in the survey.Their average age was 44.8,and 173 participants(65.5%)had more than 10 years of experience.No statistically significant relationship was found between the PJI knowledge of the surgeons and their years of experience.However,participants who worked in training and research hospitals demonstrated higher levels of knowledge than the ones in the state hospitals.It was also noticed that surgeons'knowledge concerning the duration of antibiotic therapy and urinary infections was not consistent with their attitudes.CONCLUSION Even though orthopedic surgeons have adequate knowledge about preventing and managing PJI,their attitudes might contradict their knowledge.Future studies are required to examine the causes and solutions of the contradictions between orthopedic surgeons'knowledge and attitudes.

Effect of vaccination status on CORADS and computed tomography severity score in hospitalized COVID-19 patients:A retrospective study

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic is continuing.The disease most commonly affects the lungs.Since the beginning of the pandemic thorax computed tomography(CT)has been an indispensable imaging method for diagnosis and follow-up.The disease is tried to be controlled with vaccines.Vaccination reduces the possibility of a severe course of the disease.AIM The aim of this study is to investigate whether the vaccination status of patients hospitalized due to COVID-19 has an effect on the CT severity score(CT-SS)and CORADS score obtained during hospitalization.METHODS The files of patients hospitalized between April 1,2021 and April 1,2022 due to COVID-19 were retrospectively reviewed.A total of 224 patients who were older than 18 years of age,whose vaccination status was accessible,whose severe acute respiratory syndrome coronavirus 2 polymerase chain reaction result was positive,and who had a Thorax CT scan during hospitalization were included in the study.RESULTS Among the patients included in the study,52.2%were female and the mean age was 61.85 years.The patients applied to the hospital on the average 7th day of their complaints.While 63 patients were unvaccinated(Group 1),20 were vaccinated with a single dose of CoronaVac(Group 2),24 with a single dose of BioNTech(Group 3),38 with 2 doses of CoronaVac(Group 4),40 with 2 doses of BioNTech(Group 5),and 39 with 3 doses of vaccine(2 doses of CoronaVac followed by a single dose of BioNTech,Group 6).CT-SS ranged from 5 to 23,with a mean of 12.17.RESULTS CT-SS mean of the groups were determined as 14.17,13.35,11.58,10.87,11.28,10.85,respectively.Accordingly,as a result of the comparisons between the groups,the CT-SS levels of the unvaccinated patients found to be significantly higher than the other groups.As the vaccination rates increased,the rate of typical COVID-19 findings on CT was found to be significantly lower.CONCLUSION Increased vaccination rates in COVID-19 patients reduce the probability of typical COVID-19 symptoms in the lungs.It also reduces the risk of severe disease and decreases CT Severity Scores.This may lead to a loss of importance of Thorax CT in the diagnosis of COVID-19 pneumonia as the end of the pandemic approaches.

Clinical importance of serum procalcitonin in ulcerative colitis patients

We have read with interest the recently published article entitled "Clinical significance of serum procalcitonin in patients with ulcerative colitis" by Koido et al. They aimed to investigate the association of procalcitonin with ulcerative colitis(UC) activity. They concluded that elevated procalcitonin levels were significantly correlated with UC activity. We would like to thank the authors for their comprehensive contribution.

Evaluation of a New Real-time PCR Assay for Detection of Mycoplasma Pneumoniae in Clinical Specimens

Objective To establish and evaluate a real-time PCR assay to detect Mycoplasma pneumoniae （M.pneumoniae） in clinical specimens. Methods By analysing the whole pl gene sequence of 60 M.pneurnoniae clinical isolates in Beijing of China, an optimized real-time PCR assay （MpP1） using pl gene conserved region was designed. The specificity and sensitivity of this assay were evaluated and compared with other two reported assays （RepMpl and Mp181） using 40 positive and 100 negative clinical specimens. Results The detection limit of the new assay was 8.1 fg （about 1-3CFU） M.pneumoniae DNA. The sensitivity of MpP1, RepMpl, and Mp181 assays appeared to be 100%, 100%, and 85%, respectively. Conclusion MpP1 assay is suitable for the detection of M.pneumoniae in Chinese clinical specimens.

Diagnostic and prognostic significance of the lymphocyte/C-reactive protein ratio,neutrophil/lymphocyte ratio,and D-dimer values in patients with COVID-19

In this study,our aim was to examine the diagnostic and prognostic significance of lymphocyte/C-reactiveprotein ratio(LCR),neutrophil/lymphocyte ratio(NLR)and D-dimer parameters in COVID-19 infection.The LCR,NLR,neutrophil count,mean platelet volume(MPV),C-reactive protein(CRP),and D-dimer parameters wereevaluated retrospectively.This was a retrospective cohort study with 1000 COVID-19 positive and 1000 healthycontrol groups,all over the age of 18 years.Odds ratio(OR)and 95%confidence interval(CI)values were calculatedfor each parameter found to be statistically significant in the univariate and multivariate logistic regression models.Herein,127(12.7%)of the COVID-19^(+)patients,whose data was included in this study,died.The neutrophil,MPV,CRP,D-dimer,and NLR values were higher in the COVID-19^(+)/deceased group than in the COVID-19^(+)/alive andcontrol groups(p<0.001,p<0.001,p<0.001,p<0.001,p<0.001).The lymphocyte and LCR values were lower inthe COVID-19^(+)/deceased group than in the COVID-19^(+)/alive and control groups(p<0.001,p<0.001).Variableswith statistically significance in predicting COVID-19 infection were lymphocyte,LCR,D-dimer,NLR,CRP,MPV,PLT,and neutrophil values.Statistically significant variables in predicting mortality due to COVID-19 were LCR,CRP,NLR,lymphocyte,D-dimer,neutrophil,and MPV values.A low LCR and high NLR are associated with thepresence,prognosis,and mortality due to COVID-19.LCR and NLR parameters can thus be used in clinicalmonitoring to reduce morbidity and mortality rates.

Gastrointestinal Anthrax:A Case and Review of Literature

Anthrax which is caused by Bacillus anthracis is typically a disease of herbivores. Spores existing in the skin, meat, hair or mouth and nose of animals are transmitted to humans through contact with a break in the skin, consumption of infected meat or inhalation of spores [1]. Infected uncooked or insufficiently cooked meats cause oropharyngeal and gastrointestinal system (GIS) anthrax. When this infected materials swallowed anthrax spores may cause lesions from the oral cavity to the caecum. The diagnosis of gastrointestinal system (GIS) anthrax is difficult due to insidious clinical progression of the disease and difficulty in the isolation of agent pathogen. Releated symptoms of GIS anthrax are sore throat, neck swelling, diffuculty swallowing, stomach pain, anoreksia, bloody diarrhea, nause, bloody vomiting and fever. Supportive and antibiotic treatments are required. Benzylpenicillin, rifampicin, clindamycin, chloramphenicol, imipenem/cilastatin, or vancomycin can be use for treatment, ciprofloxacin or doxycycline may be added to this treat- ment for serious cases. To emphasize the necessity of taking precautions, an oropharyngeal and intestinal anthrax case due to consumption of infected and insufficiently cooked meat is presented below.

Infectious causes of fever of unknown origin in developing countries: An international ID-IRI study

Background:Fever of unknown origin(FUO)in developing countries is an important dilemma and further research is needed to elucidate the infectious causes of FUO.Methods:A multi-center study for infectious causes of FUO in lower middle-income countries(LMIC)and lowincome countries(LIC)was conducted between January 1,2018 and January 1,2023.In total,15 participating centers from seven different countries provided the data,which were collected through the Infectious DiseasesInternational Research Initiative platform.Only adult patients with confirmed infection as the cause of FUO were included in the study.The severity parameters were quick Sequential Organ Failure Assessment(qSOFA)≥2,intensive care unit(ICU)admission,vasopressor use,and invasive mechanical ventilation(IMV).Results:A total of 160 patients with infectious FUO were included in the study.Overall,148(92.5%)patients had community-acquired infections and 12(7.5%)had hospital-acquired infections.The most common infectious syndromes were tuberculosis(TB)(n=27,16.9%),infective endocarditis(n=25,15.6%),malaria(n=21,13.1%),brucellosis(n=15,9.4%),and typhoid fever(n=9,5.6%).Plasmodium falciparum,Mycobacterium tuberculosis,Brucellae,Staphylococcus aureus,Salmonella typhi,and Rickettsiae were the leading infectious agents in this study.A total of 56(35.0%)cases had invasive procedures for diagnosis.The mean qSOFA score was 0.76±0.94{median(interquartile range[IQR]):0(0–1)}.ICU admission(n=26,16.2%),vasopressor use(n=14,8.8%),and IMV(n=10,6.3%)were not rare.Overall,38(23.8%)patients had at least one of the severity parameters.The mortality rate was 15(9.4%),and the mortality was attributable to the infection causing FUO in 12(7.5%)patients.Conclusions:In LMIC and LIC,tuberculosis and cardiac infections were the most severe and the leading infections causing FUO.

Adverse effects of oral antiviral therapy in chronic hepatitis B

Oral nucleoside/nucleotide analogues(NAs) are currently the backbone of chronic hepatitis B(CHB) infection treatment. They are generally well-tolerated by patients and safe to use. To date, a significant number of patients have been treated with NAs. Safety data has accumulated over the years. The aim of this article is to review and update the adverse effects of oral NAs. NAs can cause class adverse effects(i.e., myopathy, neuropathy, lactic acidosis) and dissimilar adverse effects. All NAs carry a "Black Box" warning because of the potential risk for mitochondrial dysfunction. However, these adverse effects are rarely reported. The majority of cases are associated with lamivudine and telbivudine. Adefovir can lead to dose- and time-dependent nephrotoxicity, even at low doses. Tenofovir has significant renal and bone toxicity in patients with human immunodeficiency virus(HIV) infection. However, bone and renal toxicity in patients with CHB are not as prominent as in HIV infection. Entecavir and lamivudine are not generally associated with renal adverse events. Entecavir has been claimed to increase the risk of lactic acidosis in decompensated liver disease and high Model for End-Stage Liver Disease scores. However, current studies reported that entecavir could be safely used in decompensated cirrhosis. An increase in fetal adverse events has not been reported with lamivudine, telbivudine and tenofovir use in pregnant women, while there is no adequate data regarding entecavir and adefovir. Further long-term experience is required to highlight the adverse effects of NAs, especially in special patient populations, including pregnant women, elderly and patients with renal impairment.

Relationship between cytokine gene polymorphisms and chronic hepatitis B virus infection

Hepatitis B virus(HBV)infection is still a public health problem worldwide,being endemic in some parts of the world.It can lead to serious liver diseases such as chronic hepatitis,cirrhosis,and hepatocellular cancer.The differences in host immune response can be one of the reasons for the various clinical presentations of HBV infection.Polymorphisms of genes encoding the proinflammatory and antiinflammatory cytokines,which are responsible for regulation of the immune response,can affect the clinical presentation of the infection.Particularly,the polymorphisms of the genes encoding cytokines such as interleukin(IL)-1,IL-6,IL-8,IL-10,IL-18,IL-28B,interferon-γ,tumor necrosis factor-α,tumor growth factor-β1,and regulatory molecules like vitamin D receptor and chemokine receptor 5 can be responsible for different clinical presentations of HBV infections.The genomic information about cytokines and other mediators can be important for determining high-risk people for developing chronic hepatitis or hepatocellular cancer and may be used to plan treatment and preventive approaches for these people.In this review,the current knowledge in the literature on the association between cytokine/regulatory molecule gene polymorphisms and clinical course of chronic HBV infec-tion is summarized,and the clinical implementations and future prospects regarding this knowledge are discussed.

Choice of drugs in the treatment of chronic hepatitis B in pregnancy

The selection of antiviral drugs for chronic hepatitis B(CHB) treatment in pregnancy is very difficult since none of the drugs have been approved for use in pregnancy.Transmission from mother to newborn remains the most frequent route of infection in mothers with high viral load and positive hepatitis B e antigen status,even with the use of appropriate prophylaxis with hepatitis B virus(HBV) immunoglobulin and HBV vaccination.We read from the article written by Yi et al that lamivudine treatment in early pregnancy was safe and effective.However,we could not understand why adefovir dipivoxil(ADV) was used in three pregnancy cases,since ADV has been classified as pregnancy category C.In pregnancy,telbivudine or tenofovir should be selected when the treatment of CHB is necessary,since these drugs have been classified as Food and Drug Administration pregnancy risk category B.

Treatment of chronic hepatitis B patients with tyrosinemethionine-aspartate-aspartate mutations

Lamivudine is an antiviral used for the treatment of chronic hepatitis B. Several studies have reported various mutations that are induced by lamivudine therapy. These mutations in the tyrosine-methionineaspartate-aspartate(YMDD) motif are necessary and sufficient to confer high-level lamivudine resistance. During treatment with lamivudine, mutations develop in the YMDD motif of the hepatitis B virus(HBV) polymerase gene and lamivudine cannot prevent the replication of the mutant form. The virulence strain of developed mutation in the polymerase gene is lower than the original virus and they are susceptible to treatment with some other nucleoside analogs except lamivudine. Entecavir and tenofovir are potent HBV inhibitors and they can be confidently used as first line monotherapies. We read the article written by Tan et al that lamivudine therapy improved the clinical course in HBV patients with natural YMDD mutations. We think that lamivudine use for this patient group is not appropriate. These patients should use YMDD mutant form-effective drugs such as adefovir, tenofovir.

Distribution of hepatitis B virus genotypes in patients with chronic hepatitis B in Turkey

AIM: Hepatitis B virus (HBV) strains isolated worldwide has been classified into eight genomic groups deduced from genome comparisons and designated as genotypes A to H. We aimed to investigate prevalence of HBV genotypes and subtypes in Turkey.METHODS: A total of 88 chronic hepatitis B (CHB) patients from 15 hospitals throughout the country were included.Patients who were HBsAg positive in serum at least for 6 mo, who had HBV-DNA in serum and elevation of ALT levels more than two times upper limit of normal, and who had percutaneous liver biopsy within 6 mo were included. Genotyping of HBV was done by restriction fragment length polymorphism (RFLP). The patients received subcutaneous 9 MU interferon-α 2a thrice a week for a period of 6 mo.RESULTS: Genotype D was detected in 78 of 88 (88.7%)patients, however, genotyping failed in two patients (2.3%),while no product was obtained in eight (9.0%) patients.Regarding subtypes, D2 was more prevalent (67 patients between 78% and 85.9%) followed by subtype D2+deletion (seven patients of 78 or 8.9%), subtype D1 (three patients of 78% or 3.9%) and subtype D3 (one patient of 78% or 1.3%). Thirty-three patients (37.5%) were HBeAg positive compared to 55 (62.5%) anti-HBe positive patients. The endpoint for the viral response of HBeAg positive patients was 27.2%, while it was found 52.7% in HBeAg negative patients (P＜0.05). Long-term persistent viral response was 29.5% for all patients.CONCLUSION: This multi-center study indicates that the predominant genotype with CHB patients in Turkey like in other Mediterranean countries is genotype D.

Does physical therapy and rehabilitation improve outcomes for diabetic foot ulcers?

One of the most common and serious complications of diabetes mellitus is ulceration of the foot. Among persons with diabetes, 12%-25% will present to a healthcare institution for a foot disorder during their lifespan. Despite currently available medical and surgical treatments, these are still the most common diabetes-related cause of hospitalization and of lower extremity amputations. Thus, many adjunctive and complementary treatments have been developed in an attempt to improve outcomes. We herein review the available literature on the effectiveness of several treatments, including superficial and deep heaters, electro-therapy procedures, prophylactic methods, exercise and shoe modifications, on diabetic foot wounds. Overall, although physical therapy modalities seem to be useful in the treatment of diabetic foot wounds, further randomized clinical studies are required.

Outcome of patients with severe COVID-19 pneumonia treated with high-dose corticosteroid pulse therapy:A retrospective study

Objective:To assess the effectiveness of high-dose corticosteroid pulse therapy and evaluate possible factors associated with 28-day mortality in hospitalised patients with severe COVID-19 pneumonia.Methods:We conducted a single-centre retrospective cohort study on hospitalised patients with clinical,epidemiological,and/or radiologically confirmed and suspected COVID-19 at Bitlis Tatvan State Hospital in Turkey between December 1,2020 and June 1,2021.All data of the study participants were recorded,and all patients received intravenous high-dose corticosteroid pulse therapy.The Ordinal Scale for Clinical Improvement(OSCI),Charlson Comorbidity Index and Total Severity Score were calculated.Univariate and multivariate Cox regression models were performed to evaluate the clinical and laboratory parameters that may affect the 28-day mortality.Results:A total of 126 patients were included in the analysis.The 28-day mortality rate of the patients was 22.2%.Laboratory and clinical improvement were observed in 77.8%(98/126)of patients after high-dose corticosteroid pulse therapy.There was a statistically significant difference between the survivors and non-survivors in terms of age,platelet count,neutrophil/lymphocyte ratio,and OSCI,Charlson Comorbidity Index,and Total Severity Score(P<0.001).Multivariate Cox regression analysis revealed that age[HR 1.047(95%CI 1.01-1.08)],use of prophylactic anticoagulation[HR 0.838(95%CI 0.79-0.89)],and bacterial co-infection[HR 3.966(95%CI 1.40-11.21)]were significant determinants of mortality.Early C-reactive protein(CRP)response,decreased oxygen requirement,and improving respiratory rate/OSCI scores after administration of high-dose corticosteroid pulse therapy could contribute to clinical improvement.Conclusions:CRP response,needed oxygen and OSCI scores can be used as prognostic factors to select patients who will benefit from high-dose corticosteroid pulse therapy.

The predictors of long-COVID in the cohort of Turkish Thoracic Society-TURCOVID multicenter registry:One year follow-up results

Objective:To evaluate long-term effects of COVID-19,and to determine the risk factors in long-COVID in a cohort of the Turkish Thoracic Society(TTS)-TURCOVID multicenter registry.Methods:Thirteen centers participated with 831 patients;504 patients were enrolled after exclusions.The study was designed in three-steps:(1)Phone questionnaire;(2)retrospective evaluation of the medical records;(3)face-to-face visit.Results:In the first step,93.5%of the patients were hospitalized;61.7%had a history of pneumonia at the time of diagnosis.A total of 27.1%reported clinical symptoms at the end of the first year.Dyspnea(17.00%),fatigue(6.30%),and weakness(5.00%)were the most prevalent long-term symptoms.The incidence of long-term symptoms was increased by 2.91 fold(95%CI 1.04-8.13,P=0.041)in the presence of chronic obstructive pulmonary disease and by 1.84 fold(95%CI 1.10-3.10,P=0.021)in the presence of pneumonia at initial diagnosis,3.92 fold(95%CI 2.29-6.72,P=0.001)of dyspnea and 1.69 fold(95%CI 1.02-2.80,P=0.040)fatigue persists in the early-post-treatment period and 2.88 fold(95%CI 1.52-5.46,P=0.001)in the presence of emergency service admission in the post COVID period.In step 2,retrospective analysis of 231 patients revealed that 1.4%of the chest X-rays had not significantly improved at the end of the first year,while computed tomography(CT)scan detected fibrosis in 3.4%.In step 3,138(27.4%)patients admitted to face-to-face visit at the end of first year;at least one symptom persisted in 49.27%patients.The most common symptoms were dyspnea(27.60%),psychiatric symptoms(18.10%),and fatigue(17.40%).Thorax CT revealed fibrosis in 2.4%patients.Conclusions:COVID-19 symptoms can last for extended lengths of time,and severity of the disease as well as the presence of comorbidities might contribute to increased risk.Long-term clinical issues should be regularly evaluated after COVID-19.

COVID-19 and the liver:A brief and core review

Coronavirus disease 2019 has a wide range of clinical spectrum from asymptomatic infection to severe infection resulting in death within a short time.Currently,it is known that severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)does not only cause a respiratory tract infection but a more complicated disease that can lead to multiple system involvement including the liver.Herein,we evaluate the epidemiology,the impact of liver injury/dysfunction on disease prognosis,the pathophysiological mechanisms and management of liver injury.More than one-fourth of the patients have abnormal liver function tests,mostly a mild-to-moderate liver dysfunction.Liver injury is significantly associated with a poor clinical outcome.Direct cytotoxic effect of SARS-CoV-2,the immune response(“cytokine storm”),the complications related to the disease,and drugs used in the treatments are the pathophysiological mechanisms responsible for liver injury.However,the exact mechanism is not yet clearly explained.The binding of SARS-CoV-2 to the angiotensin-converting enzyme 2 receptors and entering the hepatocyte and cholangiocytes can cause cytotoxic effects on the liver.Excessive immune response has an important role in disease progression and causes acute respiratory distress syndrome and multiorgan failures accompanied by liver injury.Treatment drugs,particularly lopinavir/ritonavir,remdesivir and antibiotics are a frequent reason for liver injury.The possible reasons should be meticulously investigated and resolved.

Post-discharge mortality in the first wave of COVID-19 in Turkey

Objective:To determine post-discharge mortality and associated factors of the first-wave multicenter Turkish Thoracic Society(TTD)-TURCOVID study.Methods:In this retrospective cohort study,we analyzed the data of 18 of 26 centers included in the first TTD-TURCOVID study,and 1112 cases diagnosed with COVID-19 between 11 March and 31 July 2020 participated in the study.All causes of death after COVID-19 discharge were recorded.Results:The mean age of the patients was(51.07±16.93)years,with 57.6%male patients.In the cohort group,89.1%of COVID-19 treatment locations were hospital wards,3.6%were intensive care units(ICUs),and 7.2%were community outpatients.In the longterm follow-up,the in-hospital mortality rate was 3.6%(95%CI 2.6-4.8),the post-discharge mortality rate was 2.8%(95%CI 1.9-3.9),and the total mortality was 6.3%(95%CI 5.0-7.8).After discharge,63.3%of mortality overall occurred during the first six months.Mortality rates in post-discharge follow-ups were 12.7%(95%CI 8.0-30.6)in cancer patients,10.8%(95%CI 6.3-22.9)in chronic obstructive pulmonary disease patients,11.1%(95%CI 4.4-22.7)in heart failure patients,7.8(95%CI 3.8-14.3)in atherosclerotic heart disease patients,and 2.3%(95%CI 0.8-5.6)in diabetes mellitus patients.In smokers/ex-smokers,the all-mortality rates were higher than in non-smokers.Conclusions:This multicenter study showed that patients over 65 years of age,males,former/active smoker,ICU stay,lung,heart disease,and malignancy should be followed up for at least the first six months after discharge due to COVID-19.

Use of entecavir in hepatitis B virus reactivation of a patient with non-Hodgkin's lymphoma

We read with interest the case report by Liu et al and the correspondence by Tuna et al regarding this case. Liu et al described hepatitis B virus(HBV) reactivation in a patient with non-Hodgkin's lymphomaafter withdrawal of lamivudine prophylaxis. When HBV reactivation was observed three months after lamivudine withdrawal, entecavir 0.5 mg daily was started. HBV DNA level was moderately elevated(104 copies/m L) at that time. So, we could not understand why a potent antiviral like entecavir was required for this case. In addition to this, entecavir must be used at a dose of 1 mg in patients with prior prophylactic treatment with lamivudine. As stated by Tuna et al duration of lamivudine prophylaxis in this case might be insufficient and HBV reactivation might have occured for this reason. So, we suppose that resolution of HBV reactivation might also be achieved with lamivudine instead of entecavir in this case.