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The new Coronavirus SARS-CoV-2 (COVID-19) epidemic continues to affect the world. It is emphasized that COVID-19 is more severe in patients with solid organ transplantation, and the risk of mortality may be higher than in the normal population. Herein, with the first time, we described a COVID-19 pneumoniae kidney recipient case treated with sirolimus. A 49-year-old male patient had kidney transplantation 13 years ago. He was used prednisolone and sirolimus. His main complaints were fever (38.3°C) and weakness. Atypical pneumoniae was diagnosed with thorax computed tomography. The respiratory specimen of the patient was positive with COVID-19 by PCR test. Sirolimus was stopped due to the immunosuppressive effect, and the treatment switched to low dose everolimus. Also, hydroxychloroquine, oseltamivir and azithromycin triple therapy was started for five days. The patient was discharged with healing on the seventh day.

Amaç: Bu çalışmada merkezimizde yatarak tedavi edilmiş hastaların klinik özellikleri ve başvuru semptomları ile prognozları arasındaki ilişkinin ortaya konulması amaçlanmıştır. Materyal ve Metot: Mart 2020- Ocak 2021 arasında Sakarya Üniversitesi Eğitim ve Araştırma Hastanesi’nde servis ve yoğun bakımlarda COVID-19 tanısıyla takip edilen 499 hasta çalışmaya dahil edildi. Hastaların klinik ve demografik verileri hasta dosyaları ve hastane otomasyon sisteminden elde edildi. Elde edilen veriler istatistiksel olarak değerlendirildi.Bulgular: 499 hastanın 171’i serviste, 328’i yoğun bakımda takip edilmiştir. 230 hastanın takibi ölümle sonuçlanırken 269 hasta taburcu edilmiştir. Komorbid hastalıklar mortal grupta anlamlı ölçüde daha sık rastlanmıştır (p0,05).Sonuç: Başvuru esnasında nefes darlığı şikayeti olan hastaların klinik seyrinin daha şiddetli olabileceği ve bu hastaların daha yakından takip edilmesi gerektiği sonucuna varılmıştır., Objective: In this study, it was aimed to reveal the relationship between the clinical features, presenting symptoms, and prognosis of COVID-19 patients who were hospitalized in our center.Materials and Methods: 499 patients with the diagnosis of COVID-19 followed in the service and intensive care units of Sakarya University Training and Research Hospital between March 2020 and January 2021 were included in the study. The clinical and demographical data of the patients were obtained from the patient files and hospital automation system. The obtained data were analyzed statistically.Results: Of 499 patients, 171 were followed up in the ward and 328 in the intensive care unit. Follow-up of 230 patients resulted in death, while 269 patients were discharged. Comorbid diseases were found to be more frequently seen in the mortal group (p0.05).Conclusion: It was concluded that the clinical course of patients with dyspnea at admission may be more severe and these patients should be followed more closely.

Dünyada ilk SARS-CoV-2 enfeksiyonunun görülmesinden bu yana yapılan araştırmalar, bu enfeksiyonun pulmoner tutulumların yanında ekstrapulmoner tutulumlara da yol açtığını göstermiştir. COVID-19 hastalığı olan kişilerde; pankreas tutulumu olduğunda, akut hiperglisemik krizlere, diyabetik ketoasidoza (DKA) ve hiperosmolar hiperglisemik duruma (HHD), diyabetin ciddi akut metabolik komplikasyonlarına; renal tutulum gerçekleştiğinde ise akut böbrek hasarına ve elektrolit bozukluklarına yol açabildiği saptanmıştır. Bu yazıda; pulmoner tutulum belirtileri olmayan, hipernatremi ve hiperosmolar hiperglisemik durum ile prezente olan COVID-19 olgusu sunulmuştur., Researches since the first SARS-CoV-2 infection in the world have shown that this infection causes extrapulmonary involvement as well as pulmonary involvement.. In people with COVID-19 disease; when pancreatic involvement occurs, acute hyperglycemic crises, diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS), severe acute metabolic complications of diabetes; when renal involvement occurs, it has been found that it can lead to acute kidney damage and electrolyte disturbances. In this article; a COVID-19 case without signs of pulmonary involvement who presented with hypernatremia and hyperosmolar hyperglycemic state is presented.

Objective: In this study, we aimed to determine the factors that contribute to the early determination of mortality risk in patients hospitalized with COVID-19.Methods: We included 941 adult inpatients (474 male [50.4%], mean age, 53.5±17.0. The patients were divided into two groups: the discharge group and the death group. Epidemiological data, medical history, underlying comorbidities, laboratory findings, chest computed tomographic scans, real-time reverse transcription-polymerase chain reaction detection results, and survival data were obtained with retrospective recordings on admission and follow-up. The statistical relationship between survival data and parameters was analyzed. A mathematical model was created from the data of both groups.Results: While 863 patients survived, 78 were non-survivors. During the study period, the preliminary case fatality rate of the inpatients was 8.3%. The mean age of the non-survivors was 71.7±11.2 SD ( P 1000 ng/ml), high C-reactive protein (CRP), CK-MB, and LDH, and low lymphocyte count were associated with poor prognosis.Conclusion: According to week 1 data of patients with COVID-19, advanced age, hypertension, d-dimer, CRP, CK-MB, high LDH, and low lymphocyte were associated with poor prognosis. We believe that this model will be useful in predicting patient mortality., Amaç: Bu çalışmada COVID-19 tanısıyla hastaneye yatırılan hastalarda mortalite riskinin erken dönemde belirlenmesine katkıda bulunan faktörleri belirlemeyi amaçladık.Yöntem: Hastanede yatan 941 COVID-19 tanılı erişkin hasta (474 erkek [% 50.4], yaş ortalaması 53.5 ± 17 çalışmaya dahil edildi. Hastalar taburcu edilenler ve mortal seyredenler olarak iki gruba ayrıldı. Epidemiyolojik veriler, tıbbi öykü, altta yatan komorbiditeler, laboratuvar sonuçları, akciğer bilgisayarlı tomografi görüntüleri, PCR sonuçları, sağkalım verileri, başvuru ve takipte geriye dönük olarak kaydedildi. Sağkalım verileri ile parametreler arasındaki istatistiksel ilişki incelendi.Her iki grup verilerinden matematiksel bir model oluşturuldu. Bulgular: 863 hasta hayatta kalırken, 78 hasta mortal seyretti. Çalışma süresi boyunca, yatan hastaların ilk vaka ölüm oranı % 8.3 idi. Mortal grupta hastaların ortalama yaşı 71.7 ± 11.2 SD idi (P 1000 ng / ml), yüksek C-reaktif protein (CRP), CK-MB ve LDH ve düşük lenfosit sayısının kötü prognozla ilişkili olduğunu gösterdi.Sonuç: COVID-19 hastalarının 1. hafta verilerine göre ileri yaş, hipertansiyon, yüksek D-Dimer, CRP, CK-MB, LDH ve düşük lenfosit kötü prognozla ilişkilendirildi. Bu modelin hasta ölümlerini tahmin etmede faydalı olacağına inanıyoruz.

Although various treatment methods are used with current information in COVID-19 patients, there is no proven cure and the researchs for effective treatment continues worldwide. It has been shown that the effect of the inflammatory storm in the pathogenesis of COVID-19 causes gas exchange dysfunction between the alveoli and blood vessels, which subsequently leads to pulmonary fibrosis and organ failure. Interleukin-6 (IL-6) plays a key role in this pathogenesis. Tocilizumab (TCZ) is a recombinant human monoclonal antibody that acts as an IL-6 receptor antagonist. There are studies on tocilizumab treatment showing that it significantly reduces the cytokine storm in which IL-6 plays an important role and the infiltration of inflammatory cells into the lung. In this article; a case of liver toxicity developed after tocilizumab treatment, who was followed up in the intensive care unit due to severe COVID-19 disease, is presented., COVID-19 hastalarında mevcut bilgilerle çeşitli tedavi yöntemleri uygulansa da, kanıtlanmış kesin bir tedavisi bulunmamakta ve dünya çapında etkin tedavi arayışı devam etmektedir. COVID-19 patogenezinde inflamatuar fırtınanın yarattığı etkinin alveol ile kan damarları arasındaki gaz değişim disfonksiyonuna neden olduğu, sonrasında pulmoner fibrozis ve organ yetmezliğine yol açtığı gösterilmiştir. İnterlökin-6 (IL-6) bu patogenezde anahtar role sahiptir. Tosilizumab (TCZ), IL-6 reseptör antagonisti olarak işlev gören, rekombinant insan monoklonal antikorudur. Tosilizumab tedavisinin; IL-6’nın anahtar rol oynadığı sitokin fırtınasını ve inflamatuar hücrelerin akciğere infiltrasyonunu önemli ölçüde azalttığına dair çalışmalar mevcuttur. Bu yazıda; ağır seyirli COVID-19 hastalığından dolayı yoğun bakım ünitesinde takip edilen, tosilizumab tedavisi sonrasında gelişen karaciğer toksisitesi olgusu sunulmuştur.

Clinical spectrum of COVID-19 disease; it ranges from asymptomatic infection to severe disease with hypoxaemic respiratory failure, septic shock and multi-organ dysfunction requiring invasive mechanical ventilation and other organ support in intensive care units. The presence of hypercoagulation, which is characterized by micro and macro vascular thrombotic angiopathy, has been shown to serious and critical conditions in COVID-19 patients. In this case; lower extremity ischemia due to acute femoral artery occlusion during follow-up in the intensive care unit due to severe COVID-19 disease is presented., COVID-19 hastalığının klinik spektrumu; asemptomatik enfeksiyondan yoğun bakım ünitelerinde invazif mekanik ventilasyon ve diğer organ desteği gerektiren hipoksemik solunum yetmezliği, septik şok ve çoklu organ disfonksiyonu ile seyreden şiddetli hastalığa kadar uzanır. COVID-19 hastalarında gelişen ciddi ve kritik tablolara mikro ve makro vasküler trombotik anjiyopati ile karakterize olan hiperkoagülasyon durumunun varlığı gösterilmiştir. Bu olguda; ağır seyirli COVID-19 hastalığından dolayı yoğun bakım ünitesinde takip edilen, takibi sırasında akut femoral arter tıkanıklığı sonucunda gelişen alt ekstremite iskemisi sunulmuştur.

Objectives. In this study, we investigated the relationship between the rate of increase in troponinI levels and in-hospital cardiovascular endpoints (outcomes) in patients with ST-elevation myocardial infarction (STEMI). Methods. Eighty-four patients with acute STEMI who received thrombolytic treatment or who underwent primary percutaneous coronary intervention (PCI) were enrolled. After admission to hospital, delta troponinI levels, which were determinedby serial measurements after 2, 4, and 6h of admission, and in-hospital major cardiovascular events were evaluated. Results. There were 35(41.7%) patients in the thrombolytic group and 49(58.3%) patients in the primary PCI group. As major cardiovascular endpoints, death from cardiovascular events was seen in 7(8.3%) patients, stroke/transient ischemic attack in 2(2.4%), recurrent ischemia in 5(6%), arrhythmia in 8(9.5%), and urgent revascularization was performed in 5(6%) cases. In patients with arrhythmia, ventricular fibrillation was seen in 3(3.6%) patients, atrial fibrillation in 3(3.6%), and ventricular tachycardia in 2(2.4%) patients. The ventricular septal defect was observed only in 1(1.2%) patient as a mechanical complication, and the patient underwent urgent surgery. The analysis of all patients and sub-groups of thrombolytic and primary PCI patients revealed no statistically significant difference between delta troponinI levels at time intervals of (02), (04), and (06)h and in-hospital major cardiovascular endpoints (p0.05). Conclusion. The analysis of delta troponinI levels is not a predicting factor of in-hospital endpoints (outcomes) in patients with STEMI treated by thrombolytic therapy or primary PCI. Randomized controlled studies with a larger study population are needed on this subject.

Objectives. In this study, we investigated the relationship between the rate of increase in troponinI levels and in-hospital cardiovascular endpoints (outcomes) in patients with ST-elevation myocardial infarction (STEMI). Methods. Eighty-four patients with acute STEMI who received thrombolytic treatment or who underwent primary percutaneous coronary intervention (PCI) were enrolled. After admission to hospital, delta troponinI levels, which were determinedby serial measurements after 2, 4, and 6h of admission, and in-hospital major cardiovascular events were evaluated. Results. There were 35(41.7%) patients in the thrombolytic group and 49(58.3%) patients in the primary PCI group. As major cardiovascular endpoints, death from cardiovascular events was seen in 7(8.3%) patients, stroke/transient ischemic attack in 2(2.4%), recurrent ischemia in 5(6%), arrhythmia in 8(9.5%), and urgent revascularization was performed in 5(6%) cases. In patients with arrhythmia, ventricular fibrillation was seen in 3(3.6%) patients, atrial fibrillation in 3(3.6%), and ventricular tachycardia in 2(2.4%) patients. The ventricular septal defect was observed only in 1(1.2%) patient as a mechanical complication, and the patient underwent urgent surgery. The analysis of all patients and sub-groups of thrombolytic and primary PCI patients revealed no statistically significant difference between delta troponinI levels at time intervals of (02), (04), and (06)h and in-hospital major cardiovascular endpoints (p0.05). Conclusion. The analysis of delta troponinI levels is not a predicting factor of in-hospital endpoints (outcomes) in patients with STEMI treated by thrombolytic therapy or primary PCI. Randomized controlled studies with a larger study population are needed on this subject.