Here, we discussed a 22-year-old pregnant woman (gestational age: 32 weeks) infected with COVID-19 who presented with fever (39.1°C) and respiratory symptoms. Thoracic computed tomography could not be obtained due to pregnancy. PCR testing was positive. The patient was treated with supportive care and anti-viral and anti-inflammatory agents; however, general health status deteriorated and patient was admitted to intensive care unit on day 3. After admission to COVID-19 ICU, clinical picture was rapidly worsened with development of respiratory failure and acute respiratory distress syndrome (ARDS). Thus, "extracorporeal cytokine hemoadsorption" (CytoSorb®, Cytosorbents Corporation, Monmouth Junction, NJ, USA) was planned and performed with regular intervals in order to remove inflammatory cytokines from circulation and to relieve systemic inflammatory response. The fever response and CRP elevation were controlled by hemoadsorption and cytokine filter performed in alternate days. On day 7 of ICU admission, it was decided to terminate pregnancy due to worsening hypoxemia and a healthy, premature infant was born. On day 2 after cesarean section, the patient was intubated and mechanical ventilation support was initiated. However, the patient showed an increasingly complicated clinical course and died on day 22 after ICU admission. It is seen that COVID-19 positivity carries an important risk for both mother and fetus, particularly in those at advanced stages of gestation, by physiological changes in the mother during pregnancy. We believe that, in the treatment of COVID-19 and its complications during pregnancy, cytokine filter treatment can give time to patient for hemodynamic and metabolic stabilization.

Objective: After onset of coronavirus disease (COVID-19), the risk for exposure or having the disease is increased among healthcare providers involved in the treatment of the disease. There are reports of healthcare providers died due to COVID-19 disease who became ill during work. This resulted in psychological distress in healthcare providers. In this study, we aimed to investigate anxiety in healthcare providers working at intensive care units, considered as an area at highest risk, and to confirm social psychological factors among healthcare providers working in hospitals. Materials and Methods: The study included 106 healthcare providers working in intensive care unit who accepted participation to the survey. The healthcare providers responded to survey were stratified into 2 groups as those working in pandemic intensive care unit (pandemic group; n=55) and those working in remaining intensive care units (others; n=51). The relationship between sociodemographic characteristics and levels of anxiety and depression was evaluated using State-Trait Anxiety Inventory. Results: In our study, it was found that STAI anxiety scores were higher in healthcare providers working in pandemic intensive care unit during COVID-19 outbreak (p<0.05). In the pandemic group, anxiety scores were significantly higher in male healthcare providers when compared to female healthcare providers (p>0.05). However, it was seen that healthcare providers with work experience of 1-10 years had higher mean anxiety level in STAI-II scale. It was also seen that anxiety score was significantly higher in those with work experience of 1-10 years when compared to those work experience of 11-20 years or ≥21 years (p<0.05). Work setting, male gender, experience of intensive care and concerns about outbreak were identified as factors associated to anxiety. Conclusion: Our study showed that STAI anxiety scores were higher in healthcare providers working in pandemic ICU during COVID-19 outbreak. The COVID-19 period has led psychological problems in healthcare providers working in ICU. It is important to provide psychological support and information, and to monitor psychological status in healthcare providers.

Coronavirus disease 2019 (COVID-19) is a rapidly spreading deadly respiratory disease that emerged in the city of Wuhan in December 2019. As a result of its rapid and widespread transmission, the WHO declared a pandemic on March 11, 2020 and studies evaluating mortality and prognosis in COVID-19 gained importance. The aim of this study was to determine the factors affecting the survival of COVID-19 patients followed up in a tertiary intensive care unit (ICU) and undergoing chest computed tomography (CT) scoring. This retrospective cross-sectional study was conducted with the approval of Uşak University Medical Faculty Ethics Committee between July and September 2020. It included 187 symptomatic patients (67 females, 120 males) with suspected COVID-19 who underwent chest CT scans in the ICU. Demographics, acute physiology and chronic health evaluation (APACHE II), chest CT scores, COVID-19 real-time polymerase chain reaction (RT PCR) results, and laboratory parameters were recorded. SPSS 15.0 for Windows was used for the data analysis. The ages of the patients ranged from 18 to 94 and the mean age was 68.0 ± 13.9 years. The COVID-19 RT PCR test was positive in 86 (46.0%) patients and 110 patients (58.8%) died during the follow-up. ICU stay (P = .024) and total invasive mechanical ventilation time (P < .001) were longer and blood urea nitrogen (BUN) was higher (P < .001) in the nonsurvivors. Patients with an APACHE II score of 23 and above had a 1.12-fold higher mortality rate (95% CI 0.061-0.263). There was no significant difference in total chest CT score between the survivors and nonsurvivors (P = .210). Chest CT score was not significantly associated with mortality in COVID-19 patients. Our idea that COVID-19 will cause greater mortality in patients with severe chest CT findings has changed. More studies on COVID-19 are needed to reveal the markers that affect prognosis and mortality in this period when new variants are affecting the world.Abbreviations: APACHE = acute physiology and chronic health evaluation, BUN = blood urea nitrogen, COVID-19 = coronavirus disease 2019, CT = computed tomography, ICU = intensive care unit, MV = mechanical ventilation, RT PCR = real-time polymerase chain reaction, SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2, WHO = World Health Organization.

Aim: In patients with Coronavirus disease 2019 (COVID-19) infection, a situation called cytokine storm and an increase in proinflammatory cytokines such as interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-1 (IL-1) in the blood has been observed and it has been found that this is clinically related to the development of severe disease. Therefore, tocilizumab (TCZ) therapy that blocks IL-6 will reduce the immunological response and thus potentially harm caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The aim of this study is to determine the effect of TCZ treatment on length of hospital stay, need for invasive mechanical ventilation and mortality in COVID-19 patients followed in the tertiary intensive care unit.Material and Method: This retrospective cross-sectional study was conducted among patients hospitalized with the diagnosis of COVID-19 pneumonia between 01.09.2020 and 01.01.21 in intensive care units. Data were analyzed and evaluated separately in patients who received and did not receive TCZ treatment. Patients older than 18 years of age, who were hospitalized for at least 24 hours with the diagnosis of COVID-19 pneumonia and needed ≥36 hours of oxygen therapy, were not referred to another health center, were included in this study. Pregnant and lactating women were not included in the study. Patients with missing at least one data in the parameters to be evaluated were excluded from the study. Patients treated with an IL-6 inhibitor other than TCZ were excluded.Results: After excluding patients who did not meet the inclusion criteria, 565 patients were included in the study. It was found that patients who received TCZ treatment after propensity score matching (PSM) had a significantly higher mean age (P&lt;0.001) and lower obesity rates (P=0.002). There was no significant difference between the patients who received and did not receive TCZ treatment in terms of mechanical ventilation need, length of hospital stay and mortality (P=0.505, P=0.661, P=0.834).Conclusion: As a result of our research, it was seen that TCZ treatment did not affect the need for invasive mechanical ventilation, hospital and intensive care unit stay, and mortality.

Novel coronavirus disease-2019 (COVID-19) has affected millions of individuals within in a short period of time, resulting in hundreds of thousands of deaths, and has led to a crisis worldwide. A 22-year-old pregnant woman (32 weeks of gestation) was admitted to our clinic with a suspicion of COVID-19. Initially, radiological evaluation using computed tomography (CT) imaging was unable to be performed, as the patient refused imaging study; however, we were able to obtain CT following emergency cesarean section. On CT scan, pulmonary lesions were predominant at the lower zones and progressed to confluent bilateral consolidation with pneumomediastinum, confirming COVID-19 pneumonia and pneumomediastinum complications. In conclusion, although rare, spontaneous pneumomediastinum should be considered in COVID-19 infection.