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Item Comparison of the clinical course of COVID-19 infection in sickle cell disease patients with healthcare professionals(2021) Boga, Can; Asma, Suheyl; Leblebisatan, Goksel; Sen, Nazan; Tombak, Anil; Demiroglu, Yusuf Ziya; Yeral, Mahmut; Akin, Sule; Yesilagac, Hasan; Habesoglu, Mehmet Ali; Aribogan, Anis; Kasar, Mutlu; Korur, Asli; Ozdogu, Hakan; 0000-0002-9866-2197; 34032899; AAZ-9711-2021; AAY-2668-2021It is highly expected that COVID-19 infection will have devastating consequences in sickle cell disease (SCD) patients due to endothelial activation and decreased tissue and organ reserve as a result of microvascular ischemia and continuous inflammation. In this study, we aimed to compare the clinical course of COVID-19 in adult SCD patients under the organ injury mitigation and clinical care improvement program (BASCARE) with healthcare professionals without significant comorbid conditions. The study was planned as a retrospective, multicenter and cross-sectional study. Thirty-nine SCD patients, ages 18 to 64 years, and 121 healthcare professionals, ages 21 to 53, were included in the study. The data were collected from the Electronic Health Recording System of PRANA, where SCD patients under the BASCARE program had been registered. The data of other patients were collected from the Electronic Hospital Data Recording System and patient files. In the SCD group, the crude incidence of COVID-19 was 9%, while in healthcare professionals at the same period was 23%. Among the symptoms, besides fever, loss of smell and taste were more prominent in the SCD group than in healthcare professionals. There was a significant difference between the two groups in terms of development of pneumonia, hospitalization, and need for intubation (43 vs 5%, P < 0.00001; 26 vs 7%, P = 0.002; and 10 vs 1%, P = 0.002, respectively). Prophylactic low molecular weight heparin and salicylate were used more in the SCD group than in healthcare professionals group (41 vs 9% and 28 vs 1%; P < 0.0001 for both). The 3-month mortality rate was demonstrated as 5% in the SCD group, while 0 in the healthcare professionals group. One patient in the SCD group became continously dependent on respiratory support. The cause of death was acute chest syndrome in the first case, hepatic necrosis and multi-organ failure in the second case. In conclusion, these observations supported the expectation that the course of COVID-19 in SCD patients will get worse. The BASCARE program applied in SCD patients could not change the poor outcome.Item Factors Affecting Mortality In Geriatric Patients Diagnosed With Community-Acquired Pneumonia Treated In Intensive Care Units(2021) Bozkurt Yilmaz, Hatice Eylul; Unsal, Zuhal Ekici; Habesoglu, Mehmet Ali; Kara, Sibel; Sen, NazanIntroduction: The aim of this study was to determine the factors affecting mortality in elderly patients with community-acquired pneumonia who were receiving intensive care unit. Materials and Methods: The study was retrospective, cross-sectional, and descriptive. The medical records of patients over 65 years of age who were admitted to the intensive care unit with a diagnosis of community-acquired pneumonia between January 1, 2013 and February 29, 2020 were reviewed. The factors associated with mortality in the patients who had died were examined. Results: A total of 208 patients with a mean age of 75.11 +/- 5.59 years, 78 of whom were women (37.5%), were included in the study. During the follow-up 35 (16.82%) of 208 patients had died from pneumonia or complications due to pneumonia. According to multiple linear regression analysis, the following parameters were found to be predictors of mortality: Charlson comorbidity index value (odds ratio: 1.44, 95% confidence interval: 1.132-1.1841, p=0.003), chronic obstructive pulmonary disease (odds ratio: 0.292, 95% confidence interval: 0.094-1.149, p=0.038), congestive heart failure (odds ratio: 0.199, 95% confidence interval: 0.051-0.782, p=0.021), saturation value in arterial blood gas (odds ratio: 0.569, 95% confidence interval: 0.804-0.939, p<0.001), intubation duration (odds ratio: 3.476, 95% confidence interval: 1.880-6.425, p<0.001), hypertension (odds ratio: 3.449, 95% confidence interval: 0.941-12.649, p=0.042), and the presence of diabetes mellitus (odds ratio: 3.116, 95% confidence interval: 2.673-59.021, p=0.046). Conclusion: Community-acquired pneumonia requiring intensive care unit is a clinical condition with high mortality in the elderly patient population. The presence of comorbid diseases and prolonged intubation time may be associated with higher mortality.Item A Patient with Suspected Myocarditis Associated with Legionnaires' Disease: A Case Report and Review of the Literature(2017) Erdogan, Haluk; Eldem, Halil Olcay; 0000-0002-9033-4236; O-2247-2015; AAE-6201-2021Legionnaires' disease (LD) is a systemic infectious disease caused by Legionella species. It mainly presents with lung involvement. Herein, we present a case with suspected myocarditis associated with LD and review of the relevant literature. An 81-year-old male tourist patient with high fever, cough, imbalance while walking, and confusion presented to the emergency department. The patient was diagnosed with LD based on increased density in the left lower zone on chest x-ray and a positive Legionella urine antigen test. He was administered a combination of claritromycin and levofloxacine on the day of admission. The diagnosis of acute myocarditis was made after worsening of the cardiac functions, ST elevation and troponin I positivity. The patient's symptoms regressed with antibiotic therapy and the patient was transferred to his home country by ambulance plane ten days after admission. A search of PubMed and Web of Science using the keywords "Legionella and myocarditis" revealed 15 case reports, nine of which were in English and were reviewed. There were three female and six male patients with a mean age of 44 years (range: 32-56 years). Seven were diagnosed with LD by urine antigen testing, one by serological testing and culture, and one by direct fluorescent-antibody staining and culture. Myocarditis was diagnosed by biopsy in two patients and by clinical and laboratory findings in the rest. Myocarditis without existing pneumonia was detected in one case. Electrocardiography abnormalities such as atrial flutter, atrioventricular block, torsade de pointes, sinus tachycardia, QT prolongation, ST elevation, and T wave inversion were detected in seven patients. Ventricle dysfunction on echocardiography and cardiac marker abnormality were detected in all but one of the patients (not tested in one patient). Antimicrobial monotherapy was chosen for three of the cases. One patient died due to myocarditis. In conclusion, myocarditis may develop rarely during the course of LD. Clinical suspicion is essential for the diagnosis. Early diagnosis and appropriate treatment may be life-saving.