Introduction. The coronavirus disease 2019 (COVID-19), that is caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), has spread rapidly worldwide since December 2019. The SARS-CoV-2 virus has a great affinity for the angiotensin-converting enzyme-2 (ACE-2) receptor, which is an essential element of the renin-angiotensin system (RAS). This study is aimed at assessing the impact of the angiotensin-converting enzyme (ACE) gene insertion (I)/deletion (D) polymorphisms, on the susceptibility and clinical outcomes of the COVID-19 immunoinflammatory syndrome. Patients and Methods. A total of 112 patients diagnosed with COVID-19 between 1 and 15 May 2020 were enrolled in the study. ACE gene allele frequencies were compared to the previously reported Turkish population comprised of 300 people. Results. The most common genotype in the patients and control group was DI with 53% and II with 42%, respectively. The difference in the presence of the D allele between the patient and control groups was statistically significant (67% vs. 42%, respectively, ). Severe pneumonia was observed more in patients with DI allele (31%) than DD (8%) and II (0%) ( ). The mortality rate, time to defervescence, and the hospitalization duration were not different between the genotype groups. Conclusion. Genotype DI of ACE I/D polymorphism is associated with the infectious rate particularly severe pneumonia in this study conducted in the Turkish population. Therefore, ACE D/I polymorphism could affect the clinical course of COVID-19.

Background/aim: Despite the fact that the COVID-19 pandemic has been going on for over 5 months, there is yet to be a standard management policy for all patients including those with mild-to-moderate cases. We evaluated the role of early hospitalization in combination with early antiviral therapy with COVID-19 patients in a tertiary care university hospital. Materials and methods: This was a prospective, observational, single-center study on probable/confirmed COVID-19 patients hospitalized in a tertiary care hospital on COVID-19 wards between March 20 and April 30, 2020. The demographic, laboratory, and clinical data were collected. Results: We included 174 consecutive probable/confirmed COVID-19 adult patients hospitalized in the Internal Medicine wards of the University Adult Hospital between March 20 and April 30, 2020. The median age was 45.5 (19-92) years and 91 patients (52.3%) were male. One hundred and twenty (69%) were confirmed microbiologically, 41 (23.5%) were radiologically diagnosed, and 13 (7.5%) were clinically suspected (negative microbiological and radiological findings compatible with COVID-19); 35 (20.1%) had mild, 107 (61.5%) moderate disease, and 32 (18.4%) had severe pneumonia. Out of 171 cases, 130 (74.3%) showed pneumonia; 80 were typical, and 50 showed indeterminate infiltration for COVID-19. Patients were admitted within a median of 3 days (0-14 days) after symptoms appear. The median duration of hospitalization was 4 days (0-28 days). In this case series, 13.2% patients were treated with hydroxychloroquine alone, 64.9% with hydroxychloroquine plus azithromycin, and 18.4% with regimens including favipiravir. A total of 15 patients (8.5%) were transferred to the ICU. Four patients died (2.2%). Conclusion: In our series, 174 patients were admitted to the hospital wards for COVID-19, 69% were confirmed with PCR and/or antibody test. At the time of admission, nearly one fifth of the patients had severe diseases. Of the patients, 95.4% received hydroxychloroquine alone or in combination. The overall case fatality rate was 2.2%.

Objective On 30 January 2020, WHO declared that coronavirus disease 2019 (COVID-19) outbreak has met the criteria for a Public Health Emergency of International Concern. Here, we report the clinical features and outcome of the first two cases of COVID-19 in a university hospital in Turkey, who were housemate internists. Case Presentation Our first patient was a 28-year-old female who works as a resident in the Internal Medicine Department of a 1200-bed, tertiary care University Hospital. Her initial symptom was fatigue. She developed dry cough, nausea, and myalgia. She had no fever, no shortness of breath, or any other complaints. As the 2019-nCoV PCR test was positive, oral hydroxychloroquine and azithromycin were commenced. After the positive PCR test of the first patient, we screened 85 subjects who had unprotected exposure to her; most of them were her colleagues and other healthcare workers. Test results of all but one were negative. The only person with a positive test result was the 35-year-old female who was the housemate and also a colleague of the first patient. Discussion These two cases showed us the desperate situation of COVID-19. To fight an infectious disease that had a high transmission rate, it is important to the infection chain between source and vulnerable subject and transmission route. Unfortunately, to find all infected sources is not possible every time, due to asymptomatic or mild cases, or with low sensitivity diagnostic tests. So, we need to do vigorous isolation precautions and to test more people to end up this pandemic.

We investigated the influence of a local guideline on the quality of febrile neutropenia (FN) management and the applicability of a computerized decision support system (CDSS) using real-life data. The study included 227 FN patients between April 2016 and January 2019. The primary outcome measure was the achievement of a 20% increase in the rate of appropriate empirical treatment of FN in bacteremic patients. The compatibility of the CDSS (the development of which was completed in November 2021) with local protocols was tested using standard patient scenarios and empirical antibiotic recommendations for bacteremic FN patients. In total, 91 patients were evaluated before (P1: between April 2016 and May 2017) and 136 after (P2: between May 2017 and January 2019) the guideline’s release (May 2017). The demographic characteristics were similar. Appropriate empirical antibacterial treatment was achieved in 58.3% of P1 and 88.1% of P2 patients (p = 0.006). The need for escalation of antibacterial treatment was significantly lower in P2 (49.5% vs. 35.3%; p = 0.03). In P2, the performance of the CDSS and consulting physicians was similar (CDSS 88.8% vs. physician 88.83%; p = 1) regarding appropriate empirical antibacterial treatment. The introduction of the local guideline improved the appropriateness of initial empirical treatment and reduced escalation rates in FN patients. The high rate of compliance of the CDSS with the local guideline-based decisions in P2 highlights the usefulness of the CDSS for these patients.

A 74-year-old female from a rural district in Central Anatolia, Turkey, was admitted with persisting fever, malaise, cough, and vomiting. There is no abnormal finding on physical examination. There was no petechiae, purpura, ecchymosis, or bleeding in organ systems at any time. Laboratory findings showed increased D-dimer level and acute inflammation biomarkers such as C-reactive protein, ferritin, and thrombocytopenia with prolonged prothrombin time. Since the patient applied with clinic features indicating a viral infection and on a pandemic period, firstly, we focused on coronavirus disease 2019 (COVID-19 )disease. However, the probability was reduced with negative chest imaging and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse-transcription polymerase chain reaction (RT-PCR) results. Any patient admitting with symptoms indicative of COVID-19 disease during the pandemic era should also be evaluated for other infections, especially endemic zoonotic infections such as brucellosis, Crimean-Congo hemorrhagic fever (CCHF), Q fever. In this case, serologic tests were all negative (Leptospira Toxoplasma, Cytomegalovirus (CMV), Epstein-Barr virus (EBV), Rubella, Brucella, Coxiella, Hepatitis B, Hepatitis C). The patient was found to be IgM and RNA positive for the CCHF virus by ELISA and polymerase chain reaction (PCR) methods, respectively. In endemic areas, CCHF is one of the diseases which should be considered in the differential diagnosis. In addition, it is essential to accurately identify CCHF infection using proper medical tests to prevent misdiagnosis amid this COVID-19 pandemic. Hence, we need to keep an eye on the cases that come from endemic rural areas in the Central Anatolia region of Turkey. Herein, we present a case of CCHF patients initilally evaluated to have COVID-19.

Background/aim: We aimed to analyze the usefulness of such a reserved area for the admission of the patients' symptoms suggesting COVID-19 and compare the demographic and clinical characteristics of the patients with COVID-19 and without COVID-19 who were admitted to C1 during the first month of the COVID-19 outbreak in our hospital. Materials and methods: A new area was set up in Hacettepe University Adult Hospital to limit the contact of COVID-19 suspicious patients with other patients, which was named as COVID-19 First Evaluation Outpatient Clinic (C1). C1 had eight isolation rooms and two sampling rooms for SARS-CoV-2 polymerase-chain-reaction (PCR). All rooms were negative-pressurized. Patients who had symptoms that were compatible with COVID-19 were referred to C1 from pretriage areas. All staff received training for the appropriate use of personal protective equipment and were visited daily by the Infection Prevention and Control team. Results: One hundred and ninety-eight (29.4%) of 673 patients who were admitted to C1were diagnosed with COVID-19 between March 20, 2020, and April 19, 2020. SARS-CoV-2 PCR was positive in 142 out of 673 patients. Chest computerized tomography (CT) was performed in 421 patients and COVID-19 was diagnosed in 56 of them based on CT findings despite negative PCR. Four hundred and ninety-three patients were tested for other viral and bacterial infections with multiplex real-time reverse-transcriptase PCR (RT-PCR). Blood tests that included complete blood count, renal and liver functions, d-dimer levels, ferritin, C-reactive protein, and procalcitonin were performed in 593 patients. Only one out of 44 healthcare workers who worked at C1 was infected by SARS-CoV-2. Conclusion: A well-planned outpatient care area and teamwork including internal medicine, microbiology, and radiology specialists under the supervision of infectious diseases specialists allowed adequate management of the mild-to-moderate patients with suspicion of COVID-19.