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Thiol-disulphide homeostasis (TDH) is a new parameter indicating oxidative stress that plays a role in the pathogenesis of various clinical disorders. Our study planned to investigate TDH in COVID-19 patients. Age and gender-matched healthy subjects (n = 70) and COVID-19 patients (n = 144) were included in the study. In addition to the routine laboratory parameters of the groups, their native thiol (NT), total thiol (TT) and disulphide levels were measured. Primarily, we compared COVID-19 patients to the healthy control group for inflammatory parameters, NT, TT and disulphide levels. Then, COVID-19 patients were divided into two groups according to the severity of the disease as mild to moderate and severe COVID-19, and the three groups were compared with each other. Predictive value of thiol parameters in the diagnosis of COVID-19 and in the determining its severity, and its correlation with presence and duration of symptoms were investigated. Severe COVID-19 patients had lower NT and TT levels compared with healthy controls and mild to moderate patients (P < 0.001 for both). The results of ROC analysis show that the greatest AUC was IL-6 and NT (AUC = 0.97, AUC = 0.96, respectively) between control and COVID-19 patients, while it was CRP and NT (AUC = 0.85, AUC = 0.83) between mild to moderate and severe patients. A negative correlation was found between duration of symptoms of dyspnoea, cough, fever, and sore throat and NT (r = −0.45, P = 0.017, r = −0.418, P < 0.001, r = −0.131, P = 0.084, r = −0.452, P = 0.040, respectively). NT and TT levels have a strong predictive value in the diagnosis of COVID-19 and in determining disease severity. Our results support that changing TDH parameters appears to have an important role in disease pathogenesis and it can be used in clinical management of patients., Graphical abstract Image 1

Highlights • In the literature, the additional contribution of a second PCR test to the diagnosis is unknown. • Performing a second nasopharyngeal test causes the excessive use of tests and personal protective equipment, the loss of labor and time, and can be costly. • A second PCR test was performed in 91.6% the patients whose first tests were negative. Of them, only 6.6% were detected positive. • The strategy of using the second nasopharyngeal PCR test to confirm or exclude the diagnosis should be reconsidered, because its additional contribution to the first test is very low., Objective The World Health Organization (WHO) recommends performing a second test in patients with a high suspicion of novel coronavirus disease (COVID-19) whose first PCR test is negative. However, the additional contribution of the second PCR test to the diagnosis is unknown. Patients and methods In this study, we aimed to investigate the contribution of second SARS-CoV-2 PCR to diagnosis in patients with a suspicion of COVID-19 whose initial test was negative. Results A total of 1449 patients were hospitalized in infectious disease clinics with the suspicion of COVID-19 infection during the study period. We performed the second PCR test (697 nasopharyngeal sample, 5 tracheal aspirate) in 702/766 (91.6%) patients whose first tests were negative and only 6.6% (46) of them were positive. Conclusions The strategy of using the second nasopharyngeal PCR test to confirm or exclude the diagnosis seems to cause the loss of labor and time, and is costly, because its additional contribution to the first test is very low.

Crimean Congo hemorrhagic fever (CCHF) is a fatal disease with a mortality rate of 5-30%. CCHF can be asymptomatic or it may progress with bleeding and cause mortality.To evaluate relation of viral load with mortality, clinical and laboratory findings in CCHF.A total of 126 CCHF patients were included. Serum samples obtained from all patients on admission for measurement of viral load.In our study, mortality rate was 11.1%. The most important prognostic factor was viral load. Mean viral load was 8.3×10(7)copy/ml and 4.6×10(9)copy/ml in survived and dead patients, respectively (p0.005). Probability of survival is found to be significantly reduced where AST1130U/l, ALT490U/l, CPK505U/l, LDH980U/l, platelet count23×10(3)/l, creatinine1.4mg/dl, INR1.3, d-dimer7100ng/dl, and viral load1.03×10(8)copy/ml. Patients with 10(8)copy/ml or higher viral load had diarrhea, headache, unconsciousness, bleeding, and seizure significantly more frequently (p0.05). WBC, hemoglobin, platelet counts were significantly lower whereas AST, ALT, CPK, LDH, creatinine levels, PT and aPTT time, d-dimer levels, and INR were found to be significantly higher in these group.There are several severity criteria for prognosis of CCHF. In addition to these parameters, we introduce creatinine as a predictive factor for prognosis. Our study, which has the largest number of patients among studies that evaluate viral load on CCHF shows that viral load is the most effective parameter on mortality.

Crimean Congo hemorrhagic fever is a fatal systemic viral infection which is an important health problem in Turkey. Since it leads to diffuse endothelial damage, many complications can be seen during the course of the disease. We report here an atypical presentation of CCHF with acute acalculous cholecystitis and intraabdominal abscess.