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COVİD-19 PANDEMİSİNİN KARDİYOVASKÜLER ETKİLERİ

Yıl 2021, Cilt: 28 Sayı: COVİD-19 ÖZEL SAYI, 229 - 233, 01.05.2021
https://doi.org/10.17343/sdutfd.915484

Öz

Koronavirüs hastalığı-2019 (COVID-19), DSÖ tarafından Mart 2020 de Pandemi olarak kabul edildi ve etken “Ciddi Akut Solunumsal Sendrom-Koronavirüs-2” (SARS-CoV-2) olarak isimlendirildi. SARS-CoV2 enfeksiyonu, anjiyotensin dönüştürücü enzim 2'nin (ACE2) virüs yüzeyine diken proteinlerle bağlanmasıyla hücreye penetre olmaktadır. Çalışmalarda COVID-19 enfeksiyonuna, kardiyovasküler hastalıkların sıklıkla eşlik ettiği ve kötü prognozla ilişkili olduğu gösterilmiştir. COVİD-19 enfeksiyonu miyokardit, kalp yetmezliği, akut koroner sendromlar, aritmi, kardiyojenik şok gibi bazı kardiyovasküler komplikasyonlara neden olabilir. Bu olumsuz kardiyovasküler komplikasyonlar, ACE2 yolu ile doğrudan miyokardiyal hasar veya SARS CoV-2'nin dolaylı kardiyak etkileri nedeniyle ortaya çıkar. Özellikle hiperenflamasyona bağlı olarak gelişen sitokin fırtınası kalp hasarından sorumlu olabilir. COVID-19 ile enfekte olmuş hastaların % 25'inden fazlası miyokardiyal hasara sahiptir. Bu nedenle, COVID-19 ile enfekte olan hastalar, hastanede kaldıkları süre boyunca, mutlaka miyokardiyal hasar açısından değerlendirilmelidir.

Destekleyen Kurum

YOK

Proje Numarası

YOK

Kaynakça

  • Referans 1. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA 2020 Feb 7.2. Referans 2. Fehr AR, Perlman S. Coronaviruses: an overview of their replication and pathogenesis. Methods in Molecular Biology. 2015;1282:1-23
  • Referans 3.Zhu N, Zhang D, Wang W, Li X, Song J, Yang B, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl j Med. 2020;382:727-33
  • Referans 4. Andersen KG, Rambaut A, Lipkin WI, Holmes EC, Garry RF. The proximal origin of SARS-CoV-2. Nat Med 2020 Mar 17.
  • Referans 5. Lauer SA, Grantz KH, Bi Q, Jones FK, Zheng Q, Meredith HR, et al. The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application. Ann Intern Med 2020 Mar 10.
  • Referans 6. Clerkin Kj, Fried jA, Raikhelkar j, Sayer G, Griffen MJ, Masoumi A, et al. Coronavirus Disease 2019 (COVID-19) and Cardiovascular Disease Circulation. 2020; 10.1161.
  • Referans 7. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020 Feb 28.
  • Referans 8. Li B, Yang J, Zhao F, Zhi L, Wang X, Liu L, et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol 2020 Mar 11.
  • Referans 9. Guo T, Fan Y, Chen M, Wu X, Zhang L, He T, et al. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). jAMA Cardiol. 2020.
  • Referans 10. Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F, et al. Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. jAMA Cardiol. 2020.
  • Referans 11. Zhou F, Yu T, Du R, Fun G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult in patients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395:1054-62.
  • Referans 12. Han Y. Initial COVID-19 affecting cardiac patients in China, European Heart journal, ehaa257 .
  • Referans 13. Driggin E, Madhavan MV, Bikdeli B, Chuich T, Laracy J, Bondi-Zoccai G, et al. Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the Coronavirus Disease 2019 (COVID-19) Pandemic. Journal of the American College of Cardiology (2020).
  • Referans 14. Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. j Thromb Haemost. 2020;18:844-7.
  • Referans 15. Vallance P, Collier j, Bhagat K. Infection, inflammation, and infarction: does acute endothelial dysfunction provide a link? Lancet. 1997;349:1391-2.
  • Referans 16. Huang C, Wang Y, Li X, Ren L, Zhou J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395: 497-506.
  • Referans 17. Alhawassi TM, Krass I, Pont LG. Prevalence, prescribing and barriers to effective management of hypertension in older populations:a narrative review. J Pharm Policy Pract 2015;8:24.
  • Referans 18. Hamming I, Timens W, Bulthuis ML, Lely AT, Navis G, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. The journal of Pathology. 2004;203:631-7.
  • Referans 19. Crackower MA, Sarao R, Oudit GY, Yagil C, Kozieradzki I, Scanga ES, et al. Angiotensin-converting enzyme 2 is an essential regulator of heart function. Nature. 2002;417:822-8.
  • Referans 20. Vaduganathan M, Vardeny O, Michel T, Mc-Murray jjV, Pfeffer MA, Solomon SD. Renin-angiotensin-aldosterone system inhibitors in patients with Covid-19. N Engl j Med. 2020.
  • Referans 21. Li XC, Zhang J, Zhuo JL. The vasoprotective axes of the renin-angiotensin system: Physiological relevance and therapeutic implications in cardiovascular, hypertensive and kidney diseases. Pharmacol Res 2017;125:21–38
  • Referans 22. Hamming I, Timens W, Bulthuis ML, Lely AT, Navis G, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol 2004;203:631–7.
  • Referans 23. Ferrario CM, Jessup J, Chappell MC, Averill DB, Brosnihan KB, Tallant EA, et al. Effect of angiotensin-converting enzyme inhibition and angiotensin II receptor blockers on cardiac angiotensin-converting enzyme 2. Circulation 2005;111:2605–10.
  • Referans 24. Ocaranza MP, Godoy I, Jalil JE, Varas M, Collantes P, Pinto M, et al. Enalapril attenuates downregulation of Angiotensin-converting enzyme 2 in the late phase of ventricular dysfunction in myocardial infarcted rat. Hypertension 2006;48:572–8.
  • Referans 25. Ishiyama Y, Gallagher PE, Averill DB, Tallant EA, Brosnihan KB, Ferrario CM. Upregulation of angiotensin-converting enzyme 2 after myocardial infarction by blockade of angiotensin II receptors. Hypertension 2004;43:970–6.
  • Referans 26. Henry C, Zaizafoun M, Stock E, Ghamande S, Arroliga AC, White HD. Impact of angiotensin-converting enzyme inhibitors and statins on viral pneumonia. Proc (Bayl Univ Med Cent) 2018;31:419–23.
  • Referans 27. Simone G. Position Statement of the ESC Council on Hypertension on ACE-Inhibitors and Angiotensin Receptor Blockers. 2020 March.
  • Referans 28. Tang N, Li D, Wang X, Sun z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. j Thromb Haemost. 2020;18:844-7.
  • Referans 29. Corrales-Medina VF, Alvarez KN, Weissfeld LA, Angus CD, Chirinos AJ, Chang HCC, et al. Association between hospitalization for pneumonia and subsequent risk of cardiovascular disease. jAMA. 2015;313:264-74.
  • Referans 30. Udell JA, Zawi R, Bhatt DL, Jahromi KM, Gaughran F, Phroumtikul A, et al. Association between influenza vaccination and cardiovascular outcomes in high-risk patients: a metaanalysis. jAMA. 2013;310:1711-20.
  • Referans 31. Vallance P, Collier j, Bhagat K. Infection, inflammation,and infarction: does acute endothelial dysfunction pro-vide a link? Lancet. 1997;349:1391-2.
  • Referans 32. Chapman AR, Shah AS, Lee KK, Anand A, Francis O, Adamson P, et al. Long-Term Outcomes in Patients With Type 2 Myocardial Infarction and Myocardial Injury. Circulation. 2018;137:1236-45.
  • Referans 33. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020:S0140-6736;30566-3.
  • Referans 34. Zanuzzi JL. Troponin and BNP Use in COVID-19 American College of Cardiology.. Accessed Mar 23, 2020.
  • Referans 35. Choudry FA, Hamshere MS, Rathod SK, Akhtar MM, Archbold RA, Guttman PO, et al. J Am Coll Cardiol. 2020 Sep 8;76(10):1168-1176.
  • Referans 36. Care I, Frankie C, Wong A, Lam Y. Impact of Coronavirus Disease 2019 (COVID-19) Outbreak on ST-Segment-Elevation Myocardial Infarction Care in Hong Kong, China. 2020; 2019(April):2019-2021.
  • Referans 37. Zeng J, Huang J, Pan L. How to balance acute myocardial infarction and COVID-19: the protocols from Sichuan Provincial People’s Hospital. Intensive Care Med. 2020:10-12.
  • Referans 38. Arentz M, Yim E, Klaff L, Lokhandwala S, Riedo FX, Chong M, et al. Characteristics and Outcomes of 21 Critically Ill Patients With COVID-19 in Washington State. JAMA 2020 Mar 19.
  • Referans 39. Buzon J, Roignot O, Lemoine S, Perez P, Kimmoun A, Levy B, et al. Takotsubo Cardiomyopathy Triggered by Influenza A Virus. Intern Med 2015;54:2017–9.
  • Referans 40. Zhu Z. Comparison of clinical and imaging features between patients with heart failure and new coronavirus pneumonia during the epidemic. Chinese Journal of Cardiovascular Disease, 2020, 48
  • Referans 41. Bajwa EK, Januzzi JL, Gong MN, Thompson BT, Christiani DC. Prognostic value of plasma N-terminal probrain natriuretic peptide levels in the acute respiratory distress syndrome. Crit Care Med 2008;36:2322–7.
  • Referans 42. Repessé X, Charron C, Vieillard-Baron A. Acute cor pulmonale in ARDS: rationale for protecting the right ventricle. Chest 2015;147:259–65.
  • Referans 43. Channappanavar R, Perlman S. Pathogenic human koronavirüs infections: causes and consequences of cytokine storm and immunopathology. Semin Immunopathol 2017;39:529–39.
  • Referans 44. Zeng JH, Liu Y, Yuan J, Wang F, Wu W, Li XJ, et al. First Case of COVID-19 Infection with Fulminant Myocarditis Complication: Case Report and Insights. Preprints Mar 11, 2020.
  • Referans 45. Frederich MG, Sechtem U, Schulz-Menger J, Holmvang G, Alakije P, Cooper TL, et al. Cardiovascular magnetic resonance in myocarditis. J Am Coll Cardiol. 2009;53(17): 1475-87.
  • Referans 46. Cooper LT Jr. Myocarditis. N Engl J Med.2009;360(15):1526-38.

CARDIOVASCULAR EFFECTS OF COVID-19 PANDEMIA

Yıl 2021, Cilt: 28 Sayı: COVİD-19 ÖZEL SAYI, 229 - 233, 01.05.2021
https://doi.org/10.17343/sdutfd.915484

Öz

The coronavirus disease-2019 (COVID-19) has rapidly developed into a global pneumonia pandemic. SARS-CoV2 infection is occurred by attaching angiotensin converting enzyme 2 (ACE2)with spike proteins on the surface of virus. Cardiovascular diseases is most common comorbidity of COVID-19 patients and is closely related to poor prognosis. COVİD-19 infection may cause a some of cardiovascular complications such as myocardit, heart failure, acute coronary syndroms, arrhythmia, cardiojenic shock. These unfavourable cardiovascular complications occur due to the direct myocardial injury by ACE2 pathway or indirect cardiac effects of SARS CoV-2. Especially, Cytokine storm that develops especially due to hyper-inflammation may be responsible for cardiac damage. More than 25% of COVID-19 infected patient have myocardial injury .Thus, COVID-19 infected patients must be followed for myocardial injury during the hospital stay.

Proje Numarası

YOK

Kaynakça

  • Referans 1. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA 2020 Feb 7.2. Referans 2. Fehr AR, Perlman S. Coronaviruses: an overview of their replication and pathogenesis. Methods in Molecular Biology. 2015;1282:1-23
  • Referans 3.Zhu N, Zhang D, Wang W, Li X, Song J, Yang B, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl j Med. 2020;382:727-33
  • Referans 4. Andersen KG, Rambaut A, Lipkin WI, Holmes EC, Garry RF. The proximal origin of SARS-CoV-2. Nat Med 2020 Mar 17.
  • Referans 5. Lauer SA, Grantz KH, Bi Q, Jones FK, Zheng Q, Meredith HR, et al. The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application. Ann Intern Med 2020 Mar 10.
  • Referans 6. Clerkin Kj, Fried jA, Raikhelkar j, Sayer G, Griffen MJ, Masoumi A, et al. Coronavirus Disease 2019 (COVID-19) and Cardiovascular Disease Circulation. 2020; 10.1161.
  • Referans 7. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020 Feb 28.
  • Referans 8. Li B, Yang J, Zhao F, Zhi L, Wang X, Liu L, et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol 2020 Mar 11.
  • Referans 9. Guo T, Fan Y, Chen M, Wu X, Zhang L, He T, et al. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). jAMA Cardiol. 2020.
  • Referans 10. Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F, et al. Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. jAMA Cardiol. 2020.
  • Referans 11. Zhou F, Yu T, Du R, Fun G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult in patients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395:1054-62.
  • Referans 12. Han Y. Initial COVID-19 affecting cardiac patients in China, European Heart journal, ehaa257 .
  • Referans 13. Driggin E, Madhavan MV, Bikdeli B, Chuich T, Laracy J, Bondi-Zoccai G, et al. Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the Coronavirus Disease 2019 (COVID-19) Pandemic. Journal of the American College of Cardiology (2020).
  • Referans 14. Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. j Thromb Haemost. 2020;18:844-7.
  • Referans 15. Vallance P, Collier j, Bhagat K. Infection, inflammation, and infarction: does acute endothelial dysfunction provide a link? Lancet. 1997;349:1391-2.
  • Referans 16. Huang C, Wang Y, Li X, Ren L, Zhou J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395: 497-506.
  • Referans 17. Alhawassi TM, Krass I, Pont LG. Prevalence, prescribing and barriers to effective management of hypertension in older populations:a narrative review. J Pharm Policy Pract 2015;8:24.
  • Referans 18. Hamming I, Timens W, Bulthuis ML, Lely AT, Navis G, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. The journal of Pathology. 2004;203:631-7.
  • Referans 19. Crackower MA, Sarao R, Oudit GY, Yagil C, Kozieradzki I, Scanga ES, et al. Angiotensin-converting enzyme 2 is an essential regulator of heart function. Nature. 2002;417:822-8.
  • Referans 20. Vaduganathan M, Vardeny O, Michel T, Mc-Murray jjV, Pfeffer MA, Solomon SD. Renin-angiotensin-aldosterone system inhibitors in patients with Covid-19. N Engl j Med. 2020.
  • Referans 21. Li XC, Zhang J, Zhuo JL. The vasoprotective axes of the renin-angiotensin system: Physiological relevance and therapeutic implications in cardiovascular, hypertensive and kidney diseases. Pharmacol Res 2017;125:21–38
  • Referans 22. Hamming I, Timens W, Bulthuis ML, Lely AT, Navis G, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol 2004;203:631–7.
  • Referans 23. Ferrario CM, Jessup J, Chappell MC, Averill DB, Brosnihan KB, Tallant EA, et al. Effect of angiotensin-converting enzyme inhibition and angiotensin II receptor blockers on cardiac angiotensin-converting enzyme 2. Circulation 2005;111:2605–10.
  • Referans 24. Ocaranza MP, Godoy I, Jalil JE, Varas M, Collantes P, Pinto M, et al. Enalapril attenuates downregulation of Angiotensin-converting enzyme 2 in the late phase of ventricular dysfunction in myocardial infarcted rat. Hypertension 2006;48:572–8.
  • Referans 25. Ishiyama Y, Gallagher PE, Averill DB, Tallant EA, Brosnihan KB, Ferrario CM. Upregulation of angiotensin-converting enzyme 2 after myocardial infarction by blockade of angiotensin II receptors. Hypertension 2004;43:970–6.
  • Referans 26. Henry C, Zaizafoun M, Stock E, Ghamande S, Arroliga AC, White HD. Impact of angiotensin-converting enzyme inhibitors and statins on viral pneumonia. Proc (Bayl Univ Med Cent) 2018;31:419–23.
  • Referans 27. Simone G. Position Statement of the ESC Council on Hypertension on ACE-Inhibitors and Angiotensin Receptor Blockers. 2020 March.
  • Referans 28. Tang N, Li D, Wang X, Sun z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. j Thromb Haemost. 2020;18:844-7.
  • Referans 29. Corrales-Medina VF, Alvarez KN, Weissfeld LA, Angus CD, Chirinos AJ, Chang HCC, et al. Association between hospitalization for pneumonia and subsequent risk of cardiovascular disease. jAMA. 2015;313:264-74.
  • Referans 30. Udell JA, Zawi R, Bhatt DL, Jahromi KM, Gaughran F, Phroumtikul A, et al. Association between influenza vaccination and cardiovascular outcomes in high-risk patients: a metaanalysis. jAMA. 2013;310:1711-20.
  • Referans 31. Vallance P, Collier j, Bhagat K. Infection, inflammation,and infarction: does acute endothelial dysfunction pro-vide a link? Lancet. 1997;349:1391-2.
  • Referans 32. Chapman AR, Shah AS, Lee KK, Anand A, Francis O, Adamson P, et al. Long-Term Outcomes in Patients With Type 2 Myocardial Infarction and Myocardial Injury. Circulation. 2018;137:1236-45.
  • Referans 33. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020:S0140-6736;30566-3.
  • Referans 34. Zanuzzi JL. Troponin and BNP Use in COVID-19 American College of Cardiology.. Accessed Mar 23, 2020.
  • Referans 35. Choudry FA, Hamshere MS, Rathod SK, Akhtar MM, Archbold RA, Guttman PO, et al. J Am Coll Cardiol. 2020 Sep 8;76(10):1168-1176.
  • Referans 36. Care I, Frankie C, Wong A, Lam Y. Impact of Coronavirus Disease 2019 (COVID-19) Outbreak on ST-Segment-Elevation Myocardial Infarction Care in Hong Kong, China. 2020; 2019(April):2019-2021.
  • Referans 37. Zeng J, Huang J, Pan L. How to balance acute myocardial infarction and COVID-19: the protocols from Sichuan Provincial People’s Hospital. Intensive Care Med. 2020:10-12.
  • Referans 38. Arentz M, Yim E, Klaff L, Lokhandwala S, Riedo FX, Chong M, et al. Characteristics and Outcomes of 21 Critically Ill Patients With COVID-19 in Washington State. JAMA 2020 Mar 19.
  • Referans 39. Buzon J, Roignot O, Lemoine S, Perez P, Kimmoun A, Levy B, et al. Takotsubo Cardiomyopathy Triggered by Influenza A Virus. Intern Med 2015;54:2017–9.
  • Referans 40. Zhu Z. Comparison of clinical and imaging features between patients with heart failure and new coronavirus pneumonia during the epidemic. Chinese Journal of Cardiovascular Disease, 2020, 48
  • Referans 41. Bajwa EK, Januzzi JL, Gong MN, Thompson BT, Christiani DC. Prognostic value of plasma N-terminal probrain natriuretic peptide levels in the acute respiratory distress syndrome. Crit Care Med 2008;36:2322–7.
  • Referans 42. Repessé X, Charron C, Vieillard-Baron A. Acute cor pulmonale in ARDS: rationale for protecting the right ventricle. Chest 2015;147:259–65.
  • Referans 43. Channappanavar R, Perlman S. Pathogenic human koronavirüs infections: causes and consequences of cytokine storm and immunopathology. Semin Immunopathol 2017;39:529–39.
  • Referans 44. Zeng JH, Liu Y, Yuan J, Wang F, Wu W, Li XJ, et al. First Case of COVID-19 Infection with Fulminant Myocarditis Complication: Case Report and Insights. Preprints Mar 11, 2020.
  • Referans 45. Frederich MG, Sechtem U, Schulz-Menger J, Holmvang G, Alakije P, Cooper TL, et al. Cardiovascular magnetic resonance in myocarditis. J Am Coll Cardiol. 2009;53(17): 1475-87.
  • Referans 46. Cooper LT Jr. Myocarditis. N Engl J Med.2009;360(15):1526-38.
Toplam 45 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Derlemeler
Yazarlar

Mustafa Karabacak 0000-0001-6879-5522

Proje Numarası YOK
Yayımlanma Tarihi 1 Mayıs 2021
Gönderilme Tarihi 14 Nisan 2021
Kabul Tarihi 18 Nisan 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 28 Sayı: COVİD-19 ÖZEL SAYI

Kaynak Göster

Vancouver Karabacak M. COVİD-19 PANDEMİSİNİN KARDİYOVASKÜLER ETKİLERİ. SDÜ Tıp Fak Derg. 2021;28(COVİD-19 ÖZEL SAYI):229-33.

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