DISCUSSION
All people of all age groups may be infected with SARS-CoV-2. Age was one of the risk factors rapidly and lead to death especially in elderly people and in patients with chronic diseases (8). The infection of COVID-19 can affect both men and women. However, its incidence and severity is higher in males than in females.
A study of 138 hospitalized patients with COVID-19 showed that the median age was 56 years and 75 (54.3%) were male while 63 (45.7%) were female (9). Almost half (46.4%) of patients had an underlying health condition in a retrospective analysis (n=138) of patients with COVID-19 (9).
According to the National Health Commission of China (NHC), approximately 80% of deaths were reported among patients over 60 years of age while 75% had previous health problems including diabetes and cardiovascular disease (10).
No specific consensus on patient hospitalization or discharge has been reached for infection with COVID-19. Studies show that around 14% of those infected with COVID-19 have a serious illness and 6% of those infected are critically ill so 20% of all cases need to be seriously hospitalized (11).
Hospitalization is recommended for patients over 50 years of age and all age groups with positive CT findings (12).
In our study the female-male ratio and the rate of comorbid diseases were similar to the literature. Cardiovascular diseases, chronic lung diseases and DM were the most common accompanying diseases. Our average age was 47.98 ± 14.81 years of age. Mortality has not been observed in our patients due to mild to moderate cases and younger patients. The patients %70 were given treatment at home. The fact that we have a younger population compared to China and the USA explains this situation.
The most COVID-19 cases (> 70%) show ground glass opacities with consolidation and interstitial and/or interlobular septal thickening in Thorax CT (13). COVID-19 predominant CT findings are bilateral, peripheral and basal predominant ground-glass opacity, consolidation, or both (14). Air bubble signs and nodules are rare findings (15, 16). In 3%-13% of COVID-19 pneumonia patients. nodules were identified (17, 18), which was lower than that seen in other types of viral pneumonia (19).
All but one of the patients had at least one ground glass or consolidation on their CT scans. Nodular infiltration has been observed in one patient. Ground-glass opacity. with or without consolidation is the main feature of the disease.
The most common symptoms were fever (98%) followed by cough (76%) with more than half (55%) of patients developing dyspnea in a study (n=41) conducted by Huang et al. in patients with confirmed COVID-19 infection (20).
In a large study (n=1.099) from China. Guan et al. reported that 67.8% of COVID-19 patients had cough while 33% had sputum production and 18.7% had shortness of breath (21). In a retrospective study (n=138) of hospitalized COVID-19 patients. 10% of patients reported nausea and diarrhea (9).
A variety of studies have recorded a wide incidence rate of asymptomatic infections ranging from 1.6 to 56.6% (22-28). Asymptomatic patients typically experience none of the aforementioned clinical signs and/or symptoms. according to these studies. Furthermore, this subgroup of patients has few to no radiological imaging anomalies. While some with asymptomatic infection may develop into symptomatic cases, most progress is without clinical deterioration. The most common symptoms recorded in our research were cough, shortness of breath, weakness, myalgia and diarrhea. Seven percent of our patients were initially asymptomatic.
It has been accepted that smoking raises the risk of viral infections and influenza. Similar knowledge has been accepted for the COVID-19 pandemic. Smoking has been reported to be correlated with the incidence of the disease and the seriousness of the clinical course (29). Of our patients 20.6 per cent (n: 65) have been smoked.
No drugs for effective treatment of COVID-19 have been approved to date (30, 31). Treatment is tailored to the severity of the condition and individual heterogeneity.
Updated periodically from the beginning of the pandemic in our country, according to T.C. The Scientific Advisory Board of the Ministry of Health Adult Patient Management Guidelines, if there are no contraindications, hydroxychloroquine and/ or favipravir treatment is recommended for patients with COVID-19. 58.7% of our patients received favipiravir, 24.8% received hydroxychloroquine and 16.5% received favipiravir and hydroxychloroquine. The symptoms of patients who received dual therapy at the beginning of treatment were observed to continue in the first month. This situation can be explained by the fact that these patients are heavier than other patients at the time of diagnosis and require more hospitalization.
Long COVID is the name used by patients to identify symptoms of COVID-19 that persist after acute illness (32). The working definitions of ’post-acute’ (symptoms after 3-4 weeks) and ’chronic’ (symptoms after 12 weeks) COVID-19 have not yet been officially confirmed (33, 34).
People with long COVID experience a confounding variety of recurrent and fluctuating symptoms, including cough, dyspnea, fever, sore throat, chest pain, palpitations, cognitive deficiencies, myalgia, neurological symptoms, skin rashes, and diarrhea. [33, 35-39); some of which also have persistent or intermittent low oxygen saturation (40).
In our study, cough, dyspnea, weakness and myalgia were the most common in the first month. It was determined that the symptoms had persisted in patients who had been hospitalized, had dual therapy, had comorbid diseases and had more common pathologies in their pulmonary imagings.
Also, all patients who started corticosteroid therapy at the beginning had at least one symptom in the first month. Corticosteroid therapy was thought to be related to the initiation of patients with severity pneumonia.
The cause of persistent symptoms is unknown, but it probably involves several different mechanisms of disease, including an inflammatory reaction with a vasculitic component (41).
Recent studies estimated that 10–20% of people are still ill after 3 weeks and 1–3% are still severely ill after 12 weeks (34, 42).
In individuals with conditions such as asthma, diabetes and autoimmune disorders, mainstream medical opinion considers them more common (though they are also known to occur in those with no pre-existing conditions) (35, 36, 42, 43), in those who have been admitted to hospital (36, 37, 42).
This study found that 87.4% reported persistence with at least 1 symptom, particularly fatigue and dyspnea, in patients who had recovered from COVID-19 (36).
They subsequently complained of a relapse of chronic symptoms, in particular myalgia, extreme weakness, fever, dyspnea, tightness of the chest, tachycardia, headaches and anxiety (44).
Interestingly few of them show biological anomalies (no lymphocytopenia or elevated C-reactive protein in particular) and in rare cases, chest computed tomographic scan traces of infection (44). COVID-19 laboratory markers are not specific and are of minimal clinical benefit (12).
Lymphocytopenia and an increase in CRP values are the most commonly reported laboratory anomalies in the literature (45, 46).
In our study, when the laboratory values of individuals whose symptoms continued after 1 month were examined both the initial and 1 month later D-dimer and CRP values were found to be higher for those with symptoms.
D-dimer levels are commonly increased in patients infected with COVID-19. Significantly higher levels are found in those with critical illness and can be used as a prognostic marker for in hospital mortality (47).