Letter to the Editor The successful management of an elderly Covid-19 infected patient by plasmapheresis Dear Editor, Coronavirus disease 2019 (COVID-19) is a pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China since December 2019. The epidemic spread rapidly worldwide, became a global threat and was characterized as a pandemic on March 11, 2020 by World Health Organization (WHO) [1]. It is not just a viral pneumonia, it can also cause a multisystemic disorder called COVID-19 immune syndrome [2]. In severe COVID-19 patients it was reported that the pro-inflammatory cytokins, mainly IL-6, IL-10, TNF-α were significantly increased around 7-14 days after onset, named as cytokine storm, which is also associated with the aggravation of disease and higher mortality [3,4]. Furthermore, most of these patients have already been in an induced-hypercoagulable state and predisposed to thrombosis. Currently, there isn't any specific effective and approved antiviral treatment for COVID-19 [5]. There aren't sufficient randomized controlled trials and so strong recommendations for the management of COVID-19 even from the international societies [2]. For better results and lower mortality rates, clinicians must both control the viral replication and also optimize the immun response. Plasmapheresis can take place successfully in the management of these patients with the use of anticoagulants and removal of both the inflammatory molecules and high molecular weight viscous components [6]. We want to emphasize the role of plasmapheresis by a critically ill Covid-19 patient whose clinical status worsen despite antiviral and tocilizumab treatments and who was successfully managed via performing plasmapheresis. A 65 year old female patient complaining of cough, myalgia and fatigue was admitted to our clinic who had a history of contact with a confirmed Covid-19 case. She had 3 comorbities: asthma, hypertension and type 2 Diabetes Mellitus. Her SARS-CoV-2 PCR test resulted negative, but her chest computed thomography(CT) revealed two small ground glass opacities in both lungs, which indicated COVID-19 pneumonia. According to our national Covid-19 treatment guidelines provided by the Ministry of Health, she was given hydroxychloroquine, azitromycine and oseltamivir. During hospital follow up, her maximum body temperature was 37.8 • C; all other vital signs were normal. Laboratory findings are summarized in Table 1. She completed the treatment schedule and was discharged from hospital after 5 days. On 10th day of the symptom onset she was readmitted to hospital with fever, cough, sputum and shortness of breath. Her fever was 38.5 • C, hearth rate was 118beats/min, respiratory rate was 26/min, blood pressure was 156/84 mmHg and oxygen saturation was 88 % at room air with intermittent prone positioning. Her thorax CT revealed bilateral multiple ground glass infiltrations (Fig. 1). Favipravir, enoxaparine prophylaxis, ceftriaxone and oxygen supplementation of 3 L/min were initiated. Laborat...
Both sedation-types for performing EBUS-TBNA showed similar diagnostic value and complication rates in our study. Propofol with midazolam application requires with an accompanying anaesthesiologist, therefore, it increases cost. EBUS-TBNA procedures had been performed in safe with no decrease in diagnostic yield under moderate sedation.
suMMArY Look closer to welders' lungIntroduction: Welding produces miscellaneous gases and particles that has various impact on respiratory system and long term exposure may result "welders'lung". The aim of this study is to describe the radiological findings of welders' and make an awereness for welders radilogical findings.
OBJECTIVE: This study aimed to evaluate the SARS-CoV-2 immunoglobulin G (IgG) levels after 6 months of polymerase chain reaction (PCR) negative but assumed to be COVID-19 positive cases to investigate the relationship between IgG levels and thoracic computed tomography (CT) findings. METHODS: This was a single-center study that included patients whose PCR test results were negative at least three times using nasopharyngeal swabs but had clinical findings of COVID-19 and thoracic CT findings compatible with viral pneumonia. Six months after discharge, the IgG antibodies were analyzed. The cutoff value for negative and positive serology was defined as <1.4 (index S/C) and ≥1.4 (index S/C), respectively. In addition, the patients were categorized according to their thoracic CT findings as high (typical) and low (atypical). Also, the patients were grouped into classes as <5% lung involvement versus ≥5% lung involvement. RESULTS: The patients' mean age was 49.78±12.96 years. PCR was negative, but patients with COVID-19 symptoms who had SARS-CoV-2 IgG positive were 81.9% (n=95). The antibody titer and lung involvement ≥5% were statistically significantly higher in SARS-CoV-2 IgG positive cases (p<0.001 and p=0.021). Age and chest CT findings were the risk factors for lung involvement (OR=1. 08, p<0.001 and OR=2.19, p=0.010, respectively). CONCLUSION: This study is valuable because increasing severity (≥5%) of lung involvement appears to be associated with high and persistent IgG antibody titers. In probable cases of COVID-19, even if the PCR test is negative, high IgG titers 6 months after discharge can predict the rate of lung parenchymal involvement.
The aim of this study was to assess clinical findings, radiological data, pulmonary functions and physical capacity change over time and to investigate factors associated with radiological abnormalities after coronavirus disease 2019 (COVID-19) in non-comorbid patients. This prospective cohort study was conducted between April 2020 and June 2020. A total of 62 symptomatic in non-comorbid patients with COVID-19 pneumonia were included in the study. At baseline and the 2nd, 5th and 12th months, patients were scheduled for follow-up. Males represented 51.6% of the participants and overall mean age was 51.60 ± 12.45 years. The percentage of patients with radiological abnormalities at 2 months was significantly higher than at 5 months (P < .001). At 12 months, dyspnea frequency (P = .008), 6-minute walk test (6MWT) distance (P = .045), BORG-dyspnea (P < .001) and BORG-fatigue (P < .001) scores was significantly lower, while median SpO2 after 6MWT (P < .001) was significantly higher compared to results at 2 months. The presence of radiological abnormalities at 2 months was associated with the following values measured at 5 months: advanced age (P = .006), lung involvement at baseline (P = .046), low forced expiratory volume in 1 second (P = .018) and low forced vital capacity (P = .006). Even in COVID-19 patients without comorbidities, control computed tomography at 2 months and pulmonary rehabilitation may be beneficial, especially in COVID-19 patients with advanced age and greater baseline lung involvement.
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