In part 2 of this two-part review article, the extrapulmonary imaging manifestations of coronavirus disease 2019 (COVID-19), as well as the pediatric and pregnancy-related manifestations of the vir...

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Multisystem Imaging Manifestations of COVID-19, Part 2: From Cardiac Complications to Pediatric Manifestations.

Mental and neurological disorders and risk of COVID-19 susceptibility, illness severity and mortality: A systematic review, meta-analysis and call for action.

Accumulating evidence supports the high prevalence of co-infections among Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) patients, and their potential to worsen the clinical outcome of COVID-19. However, there are few data on Southern Hemisphere populations, and most studies to date have investigated a narrow spectrum of viruses using targeted qRT-PCR. Here we assessed respiratory viral co-infections among SARS-CoV-2 patients in Australia, through respiratory virome characterization. Nasopharyngeal swabs of 92 SARS-CoV-2-positive cases were sequenced using pan-viral hybrid-capture and the Twist Respiratory Virus Panel. In total, 8% of cases were co-infected, with rhinovirus (6%) or influenzavirus (2%). Twist capture also achieved near-complete sequencing (> 90% coverage, > tenfold depth) of the SARS-CoV-2 genome in 95% of specimens with Ct < 30. Our results highlight the importance of assessing all pathogens in symptomatic patients, and the dual-functionality of Twist hybrid-capture, for SARS-CoV-2 whole-genome sequencing without amplicon generation and the simultaneous identification of viral co-infections with ease.

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Respiratory viral co-infections among SARS-CoV-2 cases confirmed by virome capture sequencing.

Purpose: This study was undertaken to analyze the extended spectrum of β lactamase (ESBL), metallo β lactamase (MBL) & AmpC production in Pseudomonas aeruginosa in various clinical samples.

Materials & Methods: One hundred four non repetitive clinical specimens were inoculated onto nutrient agar, blood agar and incubated at 37oC overnight. The colonies were tested for oxidase test and other biochemical tests and antibiogram. ESBL screening was done using 3rd generation cephalosporins and confirmatory combined double disc test, imipenem-EDTA double disc synergy test for MBL enzyme and AmpC test using Cefoxitin disc.

Results & Analysis: Out of 104 P.aeruginosa isolates, 42.30% were ESBL producer, 15.38 % MBL producer and none were AmpC producer. Imipenem, Ofloxacin, and aminoglycosides (amikacin (29.8%) tobramycin (29.8%) and netilmycin (13.46%) has got the better antipseudomonal activity in this study. 43 (41.35%) P.aeruginosa was found to be Multi Drug Resistant (MDR).

Conclusion: This study highlights the prevalence of ESBL, MBL and MDR P.aeruginosa. Carbapenems and aminoglycosides are promising drugs with antipseudomonal activity in our study.

Resistance Pattern of Pseudomonas aeruginosa in a Tertiary Care Hospital of Kanchipuram, Tamilnadu, India.

SUMMARY: The aim of the present study was to determine the rate of device-associated infection (DAI) and the change in profiles and antimicrobial resistance patterns of the causative microorganisms in a medical-surgical intensive care unit (ICU), as well as to evaluate the effect of a new nationwide hospital infection control program (NHICP), which has been implemented in Turkey. In this study, 5,772 patients that were hospitalized for a total of 43,658 days acquired 1,321 DAIs, with an overall rate of 30.2z per 1,000 ICU days. Between 2004 (before the NHICP) and 2010, the incidence densities of catheter-associated urinary tract infection (CAUTI) decreased from 10.2 to 5.7 per 1,000 device-days (P o 0.0001), and central venous catheter-associated bloodstream infection (CVC-BSI) decreased from 5.3 to 2.1 per 1,000 device-days (P o 0.0001). However, ventilator-associated pneumonia increased from 27.0 to 31.5 per 1,000 device-days. Multidrug-resistant species rates increased from 5.8z to 76.6z (P o 0.0001) for Acinetobacter spp. and from 6.8z to 53.1z (P o 0.0001) for Pseudomonas aeruginosa. The extended-spectrum b-lactamase-producing Enterobacteriaceae rate increased from 23.1z to 54.2z (P＝ 0.01); the vancomycin-resistance rate among Enterococcus spp. increased from 0z in 2004 to 12.5z in 2010 (P＝ 0.0003). In conclusion, while a significant decrease was achieved in the incidences of CAUTI and CVC-BSI, the NHICP was not completely effective in our ICU. The high incidence of DAI and the increasing prevalence of multidrug-resistant microorganisms indicate that further interventions are urgently needed.

Alterations in bacterial spectrum and increasing resistance rates in isolated microorganisms from device-associated infections in an intensive care unit of a teaching hospital in Istanbul (2004-2010).

Coronavirus disease 2019 (COVID-19) has caused a huge outbreak worldwide. Patients infected with COVID-19 most commonly present with respiratory tract symptoms and pneumonia. Gastrointestinal symptoms can also occur in these patients. Renal involvement presenting as acute renal infarct and/or acute kidney injury has been described in literature; however, these typically occur in patients with severe COVID-19. To the best of our knowledge, there are no reported cases describing abnormal renal imaging findings in a patient with only mild form of COVID-19. We, therefore, report a case of a patient with mild COVID-19 presenting with acute abdominal pain and acute renal infarct.

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Possible radiologic renal signs of COVID-19.

Multi-drug resistant Pseudomonas aeruginosa and Acinetobacter spp. infections are becoming an important problem all throughout the world as well as in our country. In this study, we evaluated the drug resistance rates of P. aeruginosa and Acinetobacter spp. in the intensive care units of Dokuz Eylul University Hospital, Izmir, Turkey. Since by the year 2003, antibiotic consumption is started to be controlled by infectious disease and clinical microbiology specialists according to antibiotic policies ruled by the government, the antibiotic resistance rates were evaluated in two periods (2000-2002 and 2003-2006). Seventynine P. aeruginosa and 89 Acinetobacter spp. isolated during January 2000-December 2002 and 66 P. aeruginosa and 48 Acinetobacter spp. isolated during january 2003-December 2006 were included to the study. All the isolates were from deep tracheal aspirate or bronchoalveolar lavage specimens. Susceptibilities of the isolates against meropenem, imipenem, piperacillin-tazobactam, cefepime, cefotaxime, ceftazidime, tobramycine and ciprofloxacin were determined by E-test (AB Biodisk, Sweden). The results indicated high antibiotic resistance rates. P. aeruginosa resistance rate for ceftazidime was 84%, cefepime 83%, carbapenemes 73%, ciprofloxacine 87% and piperacillin-tazobactam 88% while these rates were 98%, 95.6%, 87%, 100% and 100% for Acinetobacter spp., respectively. The data obtained in this study indicated that there were no decrease in the antibiotic resistance rates after 2003. In the year 2005, "Antibiotic use guideline" established in our hospital let the antibiotics used without infectious disease and clinical microbiology specialists consultation. The high antibiotic resistance rates may be attributed to the application of this antibiotic guideline leading to the uncontrolled use of antibiotics.

[Evaluation of antibiotic resistance patterns of Pseudomonas aeruginosa and Acinetobacter spp. strains isolated from intensive care patients between 2000-2002 and 2003-2006 periods in Dokuz Eylul University Hospital, Izmir]

Background/aim: Coronavirus disease 2019 (COVID-19) is a disease with a high rate of progression to critical illness. However, the predictors of mortality in critically ill patients admitted to the intensive care unit (ICU) are not yet well understood. In this study, we aimed to investigate the risk factors associated with ICU mortality in our hospital. Materials and methods: In this single-centered retrospective study, we enrolled 86 critically ill adult patients with COVID-19 admitted to ICU of Dokuz Eylul University Hospital (Izmir, Turkey) between 18 March 2020 and 31 October 2020. Data on demographic information, preexisting comorbidities, treatments, the laboratory findings at ICU admission, and clinical outcomes were collected. The chest computerized tomography (CT) of the patients were evaluated specifically for COVID-19 and CT score was calculated. Data of the survivors and nonsurvivors were compared with survival analysis to identify risk factors of mortality in the ICU. Results: The mean age of the patients was 71.1 ± 14.1 years. The patients were predominantly male. The most common comorbidity in patients was hypertension. ICU mortality was 62.8%. Being over 60 years old, CT score > 15, acute physiology and chronic health evaluation (APACHE) II score ≥ 15, having dementia, treatment without favipiravir, base excess in blood gas analysis ≤ ­2.0, WBC > 10,000/mm3, D-dimer > 1.6 µg/mL, troponin > 24 ng/L, Na ≥ 145 mmol/L were considered to link with ICU mortality according to Kaplan­Meier curves (log-rank test, p < 0.05). The APACHE II score (HR: 1.055, 95% CI: 1.021­1.090) and chest CT score (HR: 2.411, 95% CI:1.193­4.875) were associated with ICU mortality in the cox proportional-hazard regression model adjusted for age, dementia, favipiravir treatment and troponin. Howewer, no difference was found between survivors and nonsurvivors in terms of intubation timing. Conclusions: COVID-19 patients have a high ICU admission and mortality rate. Studies in the ICU are also crucial in this respect. In our study, we investigated the ICU mortality risk factors of COVID-19 patients. We determined a predictive mortality model consisting of APACHE II score and chest CT score. It was thought that this feasible and practical model would assist in making clinical decisions.

https://journals.tubitak.gov.tr/medical/issues/sag-21-51-4/sag-51-4-9-2101-89.pdf

Risk Factors Associated with Mortality in Intensive Care COVID-19 Patients: the importance of chest CT score and intubation timing as risk factors.

Following the announcement of the first coronavirus disease 2019 (COVID-19) case on 11 March 2020 in Turkey, we aimed to report the coinfection rates, and the clinical, laboratory, radiological distinctive features of viral pneumonia caused by viruses other than severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A cross-sectional study was conducted between 18 and 31 March 2020. COVID-19 suspected cases admitted to pandemic policlinic, who had nasopharyngeal swab specimens tested for both SARS-CoV-2 and other respiratory viral pathogens, were included. Among 112 patients, SARS-CoV-2 was detected in 34 patients (30%). Among the non-SARS-CoV-2 viruses (n = 25, 22%), metapneumovirus (n = 10) was the most frequent agent. There were two coinfections with SARS-CoV-2. Sputum was less in the SARS-CoV-2 group (P = .003). The leukocyte, lymphocyte, and thrombocyte count and C-reactive protein levels were the lowest in the SARS-CoV-2 group (P < .001, P = .04, P < .001, P = .007, respectively). Peripheral involvement (80% vs 20%; P ≤ .001), pure ground-glass opacity (65% vs 33%; P = .04), apicobasal gradient (60% vs 40%; P = .08), involvement of greater than or equal to three lobes (80% vs 40%; odds ratio: 6.0; 95% confidence interval: 1.33-27.05; P = .02), and consolidation with accompanying ground-glass opacity (4% vs 33%; P = .031) were more common in SARS-CoV-2 group. Some clinical, laboratory, and radiological findings may help in the differential diagnosis of non-SARS-CoV-2 viruses from COVID-19. However, coinfections may occur, and a non-SARS-CoV-2 pathogen positivity does not exclude accompanying COVID-19.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/jmv.26410

Clinical and radiological diagnosis of non-SARS-CoV-2 viruses in the era of COVID-19 pandemic.

Purpose: To identify the risk of inducing ocular surface dysplasia following topical administration of 1% voriconazole eye drop.Methods: Fourteen noninflamed healthy eyes of 14 white adult New Zeal...

Oya Özlem Eren Kutsoylu

Papers

Possible radiologic renal signs of COVID-19.

[Evaluation of antibiotic resistance patterns of Pseudomonas aeruginosa and Acinetobacter spp. strains isolated from intensive care patients between 2000-2002 and 2003-2006 periods in Dokuz Eylul University Hospital, Izmir]

Risk Factors Associated with Mortality in Intensive Care COVID-19 Patients: the importance of chest CT score and intubation timing as risk factors.

Clinical and radiological diagnosis of non-SARS-CoV-2 viruses in the era of COVID-19 pandemic.

Topically applied 1% voriconazole induces dysplastic changes on the ocular surface: animal study.