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Kaseje N, Ranganathan M, Magadi M, Oria K, Haines A. The effectiveness of rural community health workers in improving health outcomes during the COVID-19 pandemic: a systematic review. Glob Health Action 2024; 17:2292385. [PMID: 38180049 PMCID: PMC10773683 DOI: 10.1080/16549716.2023.2292385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/03/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Rural community health workers [CHWs] play a critical role in improving health outcomes during non-pandemic times, but evidence on their effectiveness during the COVID-19 pandemic is limited. There is a need to focus on rural CHWs and rural health systems as they have limited material and human resources rendering them more vulnerable than urban health systems to severe disruptions during pandemics. OBJECTIVES This systematic review aims to describe and appraise the current evidence on the effectiveness of rural CHWs in improving access to health services and health outcomes during the COVID-19 pandemic in low-and middle-income countries [LMICs]. METHODS We searched electronic databases for articles published from 2020 to 2023 describing rural CHW interventions during the COVID-19 pandemic in LMICs. We extracted data on study characteristics, interventions, outcome measures, and main results. We conducted a narrative synthesis of key results. RESULTS Fifteen studies from 10 countries met our inclusion criteria. Most of the studies were from Asia [10 of 15 studies]. Study designs varied and included descriptive and analytical studies. The evidence suggested that rural CHW interventions led to increased household access to health services and may be effective in improving COVID-19 and non-COVID-19 health outcomes. Overall, however, the quality of evidence was poor due to methodological limitations; 14 of 15 studies had a high risk of bias. CONCLUSION Rural CHWs may have improved access to health services and health outcomes during the COVID-19 pandemic in LMICs but more rigorous studies are needed during future pandemics to evaluate their effectiveness in improving health outcomes in different settings and to assess appropriate support required to ensure their impact at scale.
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Affiliation(s)
- Neema Kaseje
- London School of Hygiene & Tropical Medicine, London, UK
- Department of Research, Surgical Systems Research Group, Kisumu, Kenya
| | | | - Monica Magadi
- Keele School of Medicine, Keele University Staffordshire, Newcastle-under-Lyme, UK
| | - Kevin Oria
- Department of Research, Tropical Institute of Community Health, Kisumu, Kenya
| | - Andy Haines
- London School of Hygiene & Tropical Medicine, London, UK
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Williams BS, Piasecki TM, Fiore MC, Conner KL, Slutske WS. Hospital outcomes for young adults with COVID-19. GLOBAL EPIDEMIOLOGY 2024; 8:100155. [PMID: 39100963 PMCID: PMC11296004 DOI: 10.1016/j.gloepi.2024.100155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 07/02/2024] [Accepted: 07/03/2024] [Indexed: 08/06/2024] Open
Abstract
Background Older adults are at higher risk of severe outcomes from COVID-19 with comorbidities increasing such risk. Much less is known about the outcomes of young adults with COVID-19 despite their having had high infection rates. Objectives Our objective was to determine outcomes of hospitalized young adults with COVID-19 infection including rates of oxygen use, mortality, ICU admission, intubation, duration of hospitalization, and factors associated with adverse outcomes. Study design This retrospective cohort study included EHR data from 21 health systems in the United States on 18-29-year-olds hospitalized with COVID-19 from March 1, 2020 - January 31, 2022. Oxygen need was used to identify symptomatic COVID-19. Rates for mortality, ICU admission, and intubation were calculated for the symptomatic and asymptomatic groups. Effects of demographic and health characteristics on outcomes were assessed as were changes in hospital outcomes over time. Results Our sample included 9871 young adults hospitalized with COVID-19; 35% required oxygen. Of those who required oxygen, 53.5% were female, 23.7% had an anxiety disorder, 2.6% died (n = 89), 27.7% were admitted to the ICU (n = 955), and 15.8% were intubated (n = 547). A past-year history of any cancer was associated with a 2.1 times increased odds of death. Vaccination was associated with a >40% reduction in the odds of ICU admission. Mortality rates did not change significantly across the study period. Conclusions COVID-19 caused significant morbidity and mortality in hospitalized young adults who required oxygen. A cancer history was associated with increased risk of death. Vaccination appeared to have had a protective effect on illness severity.
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Affiliation(s)
- Brian S. Williams
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health
- Division of Hospital Medicine and Complex Care, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health
- Division of Hospital Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health
| | - Thomas M. Piasecki
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health
- Division of General Internal Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health
| | - Michael C. Fiore
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health
- Division of General Internal Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health
| | - Karen L. Conner
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health
- Division of General Internal Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health
| | - Wendy S. Slutske
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health
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3
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Zhao Y, Yao Z, Xu S, Yao L, Yu Z. Glucocorticoid therapy for acute respiratory distress syndrome: Current concepts. JOURNAL OF INTENSIVE MEDICINE 2024; 4:417-432. [PMID: 39310055 PMCID: PMC11411438 DOI: 10.1016/j.jointm.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/30/2024] [Accepted: 02/07/2024] [Indexed: 09/25/2024]
Abstract
Acute respiratory distress syndrome (ARDS), a fatal critical disease, is induced by various insults. ARDS represents a major global public health burden, and the management of ARDS continues to challenge healthcare systems globally, especially during the pandemic of the coronavirus disease 2019 (COVID-19). There remains no confirmed specific pharmacotherapy for ARDS, despite advances in understanding its pathophysiology. Debate continues about the potential role of glucocorticoids (GCs) as a promising ARDS clinical therapy. Questions regarding GC agent, dose, and duration in patients with ARDS need to be answered, because of substantial variations in GC administration regimens across studies. ARDS heterogeneity likely affects the therapeutic actions of exogenous GCs. This review includes progress in determining the GC mechanisms of action and clinical applications in ARDS, especially during the COVID-19 pandemic.
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Affiliation(s)
- Yuanrui Zhao
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Zhun Yao
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Song Xu
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Lan Yao
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Zhui Yu
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
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4
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Bai Z, Wan D, Lan T, Hong W, Dong H, Wei Y, Wei X. Nanoplatform Based Intranasal Vaccines: Current Progress and Clinical Challenges. ACS NANO 2024; 18:24650-24681. [PMID: 39185745 PMCID: PMC11394369 DOI: 10.1021/acsnano.3c10797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
Multiple vaccine platforms have been employed to develop the nasal SARS-CoV-2 vaccines in preclinical studies, and the dominating pipelines are viral vectored as protein-based vaccines. Among them, several viral vectored-based vaccines have entered clinical development. Nevertheless, some unsatisfactory results were reported in these clinical studies. In the face of such urgent situations, it is imperative to rapidly develop the next-generation intranasal COVID-19 vaccine utilizing other technologies. Nanobased intranasal vaccines have emerged as an approach against respiratory infectious diseases. Harnessing the power of nanotechnology, these vaccines offer a noninvasive yet potent defense against pathogens, including the threat of COVID-19. The improvements made in vaccine mucosal delivery technologies based on nanoparticles, such as lipid nanoparticles, polymeric nanoparticles, inorganic nanoparticles etc., not only provide stability and controlled release but also enhance mucosal adhesion, effectively overcoming the limitations of conventional vaccines. Hence, in this review, we overview the evaluation of intranasal vaccine and highlight the current barriers. Next, the modern delivery systems based on nanoplatforms are summarized. The challenges in clinical application of nanoplatform based intranasal vaccine are finally discussed.
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Affiliation(s)
- Ziyi Bai
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 17, Block 3, Southern Renmin Road, Chengdu, Sichuan 610041, P. R. China
| | - Dandan Wan
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 17, Block 3, Southern Renmin Road, Chengdu, Sichuan 610041, P. R. China
| | - Tianxia Lan
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 17, Block 3, Southern Renmin Road, Chengdu, Sichuan 610041, P. R. China
| | - Weiqi Hong
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 17, Block 3, Southern Renmin Road, Chengdu, Sichuan 610041, P. R. China
| | - Haohao Dong
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 17, Block 3, Southern Renmin Road, Chengdu, Sichuan 610041, P. R. China
| | - Yuquan Wei
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 17, Block 3, Southern Renmin Road, Chengdu, Sichuan 610041, P. R. China
| | - Xiawei Wei
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 17, Block 3, Southern Renmin Road, Chengdu, Sichuan 610041, P. R. China
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Luckner KM, Seckel MA. Understanding the Evolving Pathophysiology of Coronavirus Disease 2019 and Adult Nursing Management. Crit Care Nurs Clin North Am 2024; 36:295-321. [PMID: 39069352 DOI: 10.1016/j.cnc.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Coronavirus disease 2019 (COVID-19) was first identified in December 2019 and quickly became a global pandemic. The understanding of the pathophysiology, treatment, and management of the disease has evolved since the beginning of the pandemic in 2020. COVID-19 can be complicated by immune system dysfunction, lung injury with hypoxemia, acute kidney injury, and coagulopathy. The treatment and management of COVID-19 is based on the severity of illness, ranging from asymptomatic to severe and often life-threatening disease. The 3 main recommended medication classes include antivirals, immunomodulators, and anticoagulants. Other supportive therapies include ensuring adequate oxygenation, mechanical ventilation, and prone positioning.
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Moreno-Pérez O, Merino E, Manuel Ramos J, Carlos Rodríguez J, Diaz C, Mas P, Reus S, Sánchez-Martínez R, Boix V, Chico-Sánchez P, Sánchez-Payá J, Portilla J. Valproic acid could help in the fight against COVID-19: A case-control study. Neurologia 2024; 39:549-554. [PMID: 39232592 DOI: 10.1016/j.nrleng.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/22/2022] [Indexed: 09/06/2024] Open
Abstract
OBJECTIVE There is early evidence about Valproic acid (VPA) antiviral effect. Our aim was to investigate the incidence and severity of SARS-CoV-2 infection in VPA users as compared with the general population. MATERIAL AND METHODS A case-control study nested within a cohort, carried out between March 1 and December 17, 2020. Retrospectively, we identified confirmed SARS-CoV-2 infection patients exposed to VPA in our health department (defined as case). We ascertained VPA regimen (all the time (AT) (292 days) or at least 20% of the study period (notAT) (≥58 days) and if VPA levels were in therapeutic range (ATR) (50-100mcg/mL) in the last 24 months. We calculated the cumulative incidence of SARS-CoV-2 infection and hospital admission in the cases, comparing it with the general unexposed VPA population (controls). RESULTS During the study period, 6183 PCR+ were detected among 281,035 inhabitants, of these, 746 were hospitalized. 691 patients were on VPA notAT and 628 (90.1%) AT. The indication for VPA use was epilepsy in 54.9%. The incidence of PCR+ was 1.736% (OR 0.785 (95%CI 0.443-1.390) and 1.910% (OR 0.865 (95%CI 0.488-1.533), on VPA notAT and VPA AT patients, respectively vs. 2.201% in people without VPA regimen. Those patients with VPA ATR had a lower risk of PCR + (OR 0.233 (95%CI 0.057-0.951) notAT; OR 0.218 (95%CI 0.053-0.890) AT). Hospital admission incidence was lower in patient on VPA (OR was 0.543 (95% CI 0.076-3.871). CONCLUSION Patients with VPA within the therapeutic range had a reduction of SARS-Cov-2 infection incidence greater than 75%. There is a downward trend in the risk of COVID-19 admission by SARS-CoV-2 in patients on VPA therapy. These findings warrant further investigation.
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Affiliation(s)
- O Moreno-Pérez
- Endocrinology and Nutrition department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain; Clinical Medicine Department, Miguel Hernández University, Elche, Spain
| | - E Merino
- Unit of Infectious Diseases, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain.
| | - J Manuel Ramos
- Internal Medicine Department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain; Clinical Medicine Department, Miguel Hernández University, Elche, Spain
| | - J Carlos Rodríguez
- Microbiology Department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain; Miguel Hernández University, Elche, Spain
| | - C Diaz
- Neurology Department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain; Clinical Medicine Department, Miguel Hernández University, Elche, Spain
| | - P Mas
- Pharmacy Department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - S Reus
- Unit of Infectious Diseases, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain; Clinical Medicine Department, Miguel Hernández University, Elche, Spain
| | - R Sánchez-Martínez
- Internal Medicine department, Alicante General University Hospital - Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain
| | - V Boix
- Unit of Infectious Diseases, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain; Clinical Medicine Department, Miguel Hernández University, Elche, Spain
| | - P Chico-Sánchez
- Preventive Department, Alicante General University Hospital - Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain
| | - J Sánchez-Payá
- Preventive Department, Alicante General University Hospital - Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain
| | - J Portilla
- Internal Medicine Department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain; Clinical Medicine Department, Miguel Hernández University, Elche, Spain
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7
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Nica S, Nica RI, Nica HA, Miricescu D, Abdelfatah MAAK, Schiopu OM, Nedelcu IC, Cimponeriu DG, Stefani C, Stanescu-Spinu II, Ciornei MC. Characteristics of Patients with Persistent COVID-19 Symptoms and Unscheduled Return Visits to a Centre for COVID-19 Evaluation. Diseases 2024; 12:199. [PMID: 39329868 PMCID: PMC11431115 DOI: 10.3390/diseases12090199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Revised: 08/25/2024] [Accepted: 08/28/2024] [Indexed: 09/28/2024] Open
Abstract
Background: This retrospective study aimed to evaluate the characteristics of patients with long COVID syndrome. Methods: This study included 457 adults who had at least one persistent symptom after COVID-19 infection. Results: The median time interval between the last SARS-CoV-2 infection and emergency room presentation was 3 months. Older patients had comorbidities (61.7 vs. 44.9 years, p < 0.0001), moderate or severe forms of COVID-19 (61.2 vs. 50.9 years, p < 0.0001), and respiratory symptoms (56.1 vs. 52.0 years, p = 0.0027). Non-vaccinated patients were older than vaccinated patients (56.0 vs. 51.5 years, p = 0.0008) and had residual lung abnormalities following COVID-19 infection (51.5% vs. 36.8%, p < 0.003). The time interval between the last SARS-CoV-2 infection and the hospital evaluation was shorter for vaccinated patients (3.2 vs. 3.9 months, p < 0.0001) and those with mild forms (3.3 vs. 4.12 months, p = 0.0001) versus non-vaccinated individuals. After the last SARS-CoV-2 infection, 107 patients developed impaired fasting glucose, impaired glucose tolerance, or diabetes mellitus, being patients with already known chronic diseases (p = 0.0002), or hypertension (p = 0.001). Conclusions: Our study pointed out the heterogeneity of symptoms following COVID-19, and they are associated with age, vaccination status, or severity of SARS-CoV-2 infection.
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Affiliation(s)
- Silvia Nica
- Emergency Discipline, University Hospital of Bucharest, 050098 Bucharest, Romania; (S.N.); (M.C.C.)
- Department of Emergency and First Aid, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Remus Iulian Nica
- Central Military Emergency University Hospital “Dr. Carol Davila”, 010825 Bucharest, Romania; (M.A.A.K.A.); (O.M.S.); (I.C.N.)
- Discipline of General Surgery, Faculty of Midwifery and Nursing, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Horia Alexandru Nica
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania;
| | - Daniela Miricescu
- Discipline of Biochemistry, Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | | | - Oana Maria Schiopu
- Central Military Emergency University Hospital “Dr. Carol Davila”, 010825 Bucharest, Romania; (M.A.A.K.A.); (O.M.S.); (I.C.N.)
| | - Ioan Cristian Nedelcu
- Central Military Emergency University Hospital “Dr. Carol Davila”, 010825 Bucharest, Romania; (M.A.A.K.A.); (O.M.S.); (I.C.N.)
| | | | - Constantin Stefani
- Department I of Family Medicine and Clinical Base, “Dr. Carol Davila” Central Military Emergency University Hospital, 051075 Bucharest, Romania;
| | - Iulia-Ioana Stanescu-Spinu
- Discipline of Physiology, Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd, 050474 Bucharest, Romania;
| | - Mariana Cătălina Ciornei
- Emergency Discipline, University Hospital of Bucharest, 050098 Bucharest, Romania; (S.N.); (M.C.C.)
- Discipline of Physiology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Miner D, Smith K, Wu PT, Price JH, Piscitelli D, Chui K. Pragmatic approach to mobilizing individuals with critical illness due to COVID-19: clinical perspective. Disabil Rehabil 2024; 46:4040-4048. [PMID: 37752855 DOI: 10.1080/09638288.2023.2263370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE To provide pragmatic guidance for acute rehabilitation management and implementation of early mobility for individuals with critical illness due to COVID-19. METHODS Clinical perspective developed through reflective clinical practice and narrative review of best available evidence. RESULTS Current clinical practice guidelines do not provide guidance for implementation of early mobility interventions for individuals with critical illness due to COVID-19 who require enhanced ventilatory support or support of inhaled pulmonary artery vasodilators. Many individuals who may benefit from implementation of early mobility interventions are excluded by strict interpretation of current guidelines. CONCLUSIONS Risk vs benefit of implementing early mobility interventions in individuals with critical illness due to COVID-19 can be mitigated through coordinated efforts of interdisciplinary teams to promote shared decision-making through therapeutic alliances with patients and their families. Clinicians must clearly define the goals of care, understand the limitations of monitoring equipment in the intensive care unit, prepare to titrate levels of oxygen based on an individual's physiologic response to mobility interventions, and help individuals maintain external goal-directed focus of attention to optimize outcomes of early mobility interventions.
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Affiliation(s)
- Daniel Miner
- Department of Physical Therapy, Carilion Clinic, Radford University Carilion, Radford, VA, USA
| | - Kellen Smith
- Department of Physical Therapy, Carilion Clinic, Radford University, Roanoke, VA, USA
| | - Pei-Tzu Wu
- Department of Physical Therapy, Pacific University, Hillsboro, OR, USA
| | - Justin H Price
- Carilion Clinic, VA Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Daniele Piscitelli
- Department of Physical Therapy, University of Connecticut, Storrs, CT, USA
| | - Kevin Chui
- Department of Physical Therapy, Radford University, Radford, VA, USA
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Tanaka A, Wakayama K, Fukuda Y, Ohta S, Homma T, Ando K, Nishihara Y, Nakano R, Zhao J, Suzuki Y, Kyotani Y, Yano H, Kasahara K, Chung KP, Sagara H, Yoshizumi M, Nakahira K. Increased levels of circulating cell-free DNA in COVID-19 patients with respiratory failure. Sci Rep 2024; 14:17399. [PMID: 39075117 PMCID: PMC11286760 DOI: 10.1038/s41598-024-68433-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 07/23/2024] [Indexed: 07/31/2024] Open
Abstract
Cell-free DNA (cfDNA) is released from injured cells and aggravates inflammation. Patients with coronavirus disease (COVID-19) often develop pneumonia and respiratory failure, and require oxygen therapy (OT), including mechanical ventilation (MV). It remains unclear whether cfDNA predicts the risk of receiving OT or MV in COVID-19 patients. Therefore, we hypothesized that circulating cfDNA levels could reflect the severity of respiratory failure and determine a therapeutic approach for oxygenation in patients with COVID-19. We analyzed cfDNA levels in serum samples from 95 hospitalized patients with COVID-19 at Showa University Hospital (Tokyo, Japan). cfDNA levels were assessed by measuring the copy numbers of mitochondrial DNA (mtDNA) and nuclear DNA (nDNA) using quantitative real-time PCR (qPCR). Both cf-nDNA and cf-mtDNA levels were negatively correlated with adjusted SpO2 for FiO2 (SpO2/FiO2 ratio). Elevated cf-nDNA and cf-mtDNA levels were associated with the requirement for OT or MV during patient admission. Multivariate logistic regression analysis revealed that cf-nDNA and cf-mtDNA levels were independent risk factors for OT and MV. These results suggest that both serum cf-nDNA and cf-mtDNA could serve as useful early biomarkers to indicate the necessity of OT or MV in patients with COVID-19.
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Affiliation(s)
- Akihiko Tanaka
- Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Katsuki Wakayama
- Department of Pharmacology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Yosuke Fukuda
- Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Shin Ohta
- Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Tetsuya Homma
- Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Koichi Ando
- Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
- Division of Internal Medicine, Showa University Dental Hospital Medical Clinic, Tokyo, Japan
| | - Yuji Nishihara
- Department of Infectious Diseases, Nara Medical University, Kashihara, Nara, Japan
| | - Ryuichi Nakano
- Department of Microbiology and Infectious Diseases, Nara Medical University, Kashihara, Nara, Japan
| | - Jing Zhao
- Department of Pharmacology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Yuki Suzuki
- Department of Microbiology and Infectious Diseases, Nara Medical University, Kashihara, Nara, Japan
| | - Yoji Kyotani
- Department of Pharmacology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Hisakazu Yano
- Department of Microbiology and Infectious Diseases, Nara Medical University, Kashihara, Nara, Japan
| | - Kei Kasahara
- Department of Infectious Diseases, Nara Medical University, Kashihara, Nara, Japan
| | - Kuei-Pin Chung
- Department of Laboratory Medicine, College of Medicine, National Taiwan University, Taipei, 10051, Taiwan
- Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, 100225, Taiwan
| | - Hironori Sagara
- Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Masanori Yoshizumi
- Department of Pharmacology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Kiichi Nakahira
- Department of Pharmacology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan.
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
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10
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Wynberg E, Han AX, van Willigen HDG, Verveen A, van Pul L, Maurer I, van Leeuwen EM, van den Aardweg JG, de Jong MD, Nieuwkerk P, Prins M, Kootstra NA, de Bree GJ. Inflammatory profiles are associated with long COVID up to 6 months after COVID-19 onset: A prospective cohort study of individuals with mild to critical COVID-19. PLoS One 2024; 19:e0304990. [PMID: 39008486 PMCID: PMC11249251 DOI: 10.1371/journal.pone.0304990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 05/17/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND After initial COVID-19, immune dysregulation may persist and drive post-acute sequelae of COVID-19 (PASC). We described longitudinal trajectories of cytokines in adults up to 6 months following SARS-CoV-2 infection and explored early predictors of PASC. METHODS RECoVERED is a prospective cohort of individuals with laboratory-confirmed SARS-CoV-2 infection between May 2020 and June 2021 in Amsterdam, the Netherlands. Serum was collected at weeks 4, 12 and 24 of follow-up. Monthly symptom questionnaires were completed from month 2 after COVID-19 onset onwards; lung diffusion capacity (DLCO) was tested at 6 months. Cytokine concentrations were analysed by human magnetic Luminex screening assay. We used a linear mixed-effects model to study log-concentrations of cytokines over time, assessing their association with socio-demographic and clinical characteristics that were included in the model as fixed effects. RESULTS 186/349 (53%) participants had ≥2 serum samples and were included in current analyses. Of these, 101/186 (54%: 45/101[45%] female, median age 55 years [IQR = 45-64]) reported PASC at 12 and 24 weeks after COVID-19 onset. We included 37 reference samples (17/37[46%] female, median age 49 years [IQR = 40-56]). In a multivariate model, PASC was associated with raised CRP and abnormal diffusion capacity with raised IL10, IL17, IL6, IP10 and TNFα at 24 weeks. Early (0-4 week) IL-1β and BMI at COVID-19 onset were predictive of PASC at 24 weeks. CONCLUSIONS Our findings indicate that immune dysregulation plays an important role in PASC pathogenesis, especially among individuals with reduced pulmonary function. Early IL-1β shows promise as a predictor of PASC.
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Affiliation(s)
- Elke Wynberg
- Department of Medical Microbiology & Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Alvin X Han
- Department of Medical Microbiology & Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Hugo D G van Willigen
- Department of Medical Microbiology & Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Anouk Verveen
- Department of Medical Psychology, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Lisa van Pul
- Department of Experimental Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Irma Maurer
- Department of Experimental Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Ester M van Leeuwen
- Department of Experimental Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Joost G van den Aardweg
- Department of Pulmonology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Menno D de Jong
- Department of Medical Microbiology & Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Pythia Nieuwkerk
- Department of Medical Psychology, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Maria Prins
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Department of Infectious Diseases, Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Neeltje A Kootstra
- Department of Medical Psychology, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Godelieve J de Bree
- Department of Infectious Diseases, Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
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11
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Saito Z, Kanai O, Okamoto N, Watanabe I, Tsukino M. Efficacy of corticosteroid therapy for oxygen-free coronavirus disease 2019-derived pneumonia. Medicine (Baltimore) 2024; 103:e38932. [PMID: 38996125 PMCID: PMC11245202 DOI: 10.1097/md.0000000000038932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 06/24/2024] [Indexed: 07/14/2024] Open
Abstract
Corticosteroid therapy for oxygen-free coronavirus disease 2019 (COVID-19) is not recommended due to its negative prognostic impact, but the efficacy of corticosteroids when limited to COVID-19 pneumonia is unclear. We aimed to evaluate the efficacy of corticosteroid monotherapy for patients with COVID-19 pneumonia without supplemental oxygen. We retrospectively reviewed patients with oxygen-free COVID-19 pneumonia at our institute between September 2020 and August 2021 and assessed the use of corticosteroids and the timing of initiation. We classified the patients into the following 2 groups: those who were initiated corticosteroids without developing respiratory failure (early steroid group) and those who were not (standard of care [SOC] group). We used inverse probability of treatment weighting (IPW) to balance between the groups. The primary outcome was the incidence of respiratory failure. A total of 144 patient records were reviewed; 63 patients were in the early steroid group and 81 patients were in the SOC group. Of all patients, 14 (22.2%) and 27 (33.3%) patients in the early steroid and SOC group, respectively, required supplemental oxygen (P = .192). After adjusted by the IPW method, 10 (16.0%) and 32 (40.1%) patients in the early steroid and SOC groups, respectively, required supplemental oxygen (P = .004). The logistic regression analysis indicated that early corticosteroid use was significantly associated with a decreased incidence of respiratory failure (odds ratio; 0.17, 95% confidence intervals; 0.06-0.46, P < .001). Corticosteroid monotherapy may suppress the development of exacerbation requiring oxygen supply in patients with oxygen-free COVID-19 pneumonia.
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Affiliation(s)
- Zentaro Saito
- Divison of Respiratory Medicine, Hikone Municipal Hospital, Hikone City, Japan
- Division of Respiratory Medicine, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Osamu Kanai
- Division of Respiratory Medicine, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Natsumi Okamoto
- Divison of Respiratory Medicine, Hikone Municipal Hospital, Hikone City, Japan
| | - Isao Watanabe
- Divison of Respiratory Medicine, Hikone Municipal Hospital, Hikone City, Japan
| | - Mitsuhiro Tsukino
- Divison of Respiratory Medicine, Hikone Municipal Hospital, Hikone City, Japan
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12
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Cai Z, Guo X, Lv X, Wu Y, Niu X, Song L. Patient self-inflicted lung injury associated pneumothorax/pneumomediastinum is a risk factor for worse outcomes of severe COVID-19: a case-control study. Sci Rep 2024; 14:15437. [PMID: 38965293 PMCID: PMC11224394 DOI: 10.1038/s41598-024-66229-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 06/28/2024] [Indexed: 07/06/2024] Open
Abstract
We aimed to determine the clinical characteristics of patient self-inflicted lung injury (P-SILI)-associated pneumothorax/pneumomediastinum, to reveal its risk factors, and to assess its impact on severe COVID-19 cases. In total, 229 patients were included in this case-control study. They were randomly divided into either the case group or the control group as per the inclusion and exclusion criteria. The two groups were further analyzed to reveal the risk factors of spontaneous pneumothorax/pneumomediastinum (SP/P). Finally, risk factors for death were analyzed in the case group and the relationship between death and SP/P was also analyzed among all patients. The mean age of patients was 59.69 ± 17.01 years, most of them were male (74.2%), and 62.0% of them had comorbidities upon admission. A respiratory rate higher than 30 BPM was a risk factor for SP/P (OR 7.186, 95% CI 2.414-21.391, P < 0.001). Patients with delayed intubation due to early application of HFNC or NIV had a higher mortality rate when they developed SP/P (P < 0.05). Additionally, advanced age increased the risk of death (P < 0.05). Finally, SP/P may be a risk factor for death among patients with severe COVID-19 (OR 2.047). P-SILI occurs in severe COVID-19 with acute respiratory failure. It is necessary to identify the risk factors of P-SILI, the indicators of severe P-SILI, and the preventive measures.
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Affiliation(s)
- Zhigui Cai
- Department of Pulmonary and Critical Care Medicine, Xijing Hospital, Air Force Medical University, No. 169, Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Xingxing Guo
- Department of Pulmonary and Critical Care Medicine, Xijing Hospital, Air Force Medical University, No. 169, Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Xing Lv
- Department of Pulmonary and Critical Care Medicine, Xijing Hospital, Air Force Medical University, No. 169, Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Yunfu Wu
- Department of Pulmonary and Critical Care Medicine, Xijing Hospital, Air Force Medical University, No. 169, Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Xiaona Niu
- Department of Cardiology, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Liqiang Song
- Department of Pulmonary and Critical Care Medicine, Xijing Hospital, Air Force Medical University, No. 169, Changle West Road, Xi'an, 710032, Shaanxi, China.
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13
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Hao S, Wei Y, Wang Y, Muhetaer Y, Zhou C, Qiong S, Jiang P, Zhong M. End-expiratory lung volumes as a potential indicator for COVID-19 associated acute respiratory distress syndrome: a retrospective study. BMC Pulm Med 2024; 24:298. [PMID: 38918752 PMCID: PMC11197326 DOI: 10.1186/s12890-024-03118-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/19/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND End-expiratory lung volume (EELV) has been observed to decrease in acute respiratory distress syndrome (ARDS). Yet, research investigating EELV in patients with COVID-19 associated ARDS (CARDS) remains limited. It is unclear whether EELV could serve as a potential metric for monitoring disease progression and identifying patients with ARDS at increased risk of adverse outcomes. STUDY DESIGN AND METHODS This retrospective study included mechanically ventilated patients diagnosed with CARDS during the initial phase of epidemic control in Shanghai. EELV was measured using the nitrogen washout-washin technique within 48 h post-intubation, followed by regular assessments every 3-4 days. Chest CT scans, performed within a 24-hour window around each EELV measurement, were analyzed using AI software. Differences in patient demographics, clinical data, respiratory mechanics, EELV, and chest CT findings were assessed using linear mixed models (LMM). RESULTS Out of the 38 patients enrolled, 26.3% survived until discharge from the ICU. In the survivor group, EELV, EELV/predicted body weight (EELV/PBW) and EELV/predicted functional residual capacity (EELV/preFRC) were significantly higher than those in the non-survivor group (survivor group vs. non-survivor group: EELV: 1455 vs. 1162 ml, P = 0.049; EELV/PBW: 24.1 vs. 18.5 ml/kg, P = 0.011; EELV/preFRC: 0.45 vs. 0.34, P = 0.005). Follow-up assessments showed a sustained elevation of EELV/PBW and EELV/preFRC among the survivors. Additionally, EELV exhibited a positive correlation with total lung volume and residual lung volume, while demonstrating a negative correlation with lesion volume determined through chest CT scans analyzed using AI software. CONCLUSION EELV is a useful indicator for assessing disease severity and monitoring the prognosis of patients with CARDS.
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Affiliation(s)
- Shengyu Hao
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China
| | - Yilin Wei
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, 130 Dong'an Road, Shanghai, China
| | - Yuxian Wang
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China
| | - Yaxiaerjiang Muhetaer
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China
| | - Chujun Zhou
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China
| | - Songjie Qiong
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China
| | - Pan Jiang
- Department of Nutrition, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China.
| | - Ming Zhong
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China.
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14
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Letelier P, Delgado H, Garrido F, Quiñones F, San MA, Hernández L, Garcés P, Guzmán-Oyarzo D, Boguen R, Hernandez A, Medina G, Schwerter P, Guzmán N. Dynamic changes of hematological and hemostatic parameters in COVID-19 hospitalized patients: Potential role as severity biomarkers for the Chilean population. J Med Biochem 2024; 43:556-564. [PMID: 39139154 PMCID: PMC11318854 DOI: 10.5937/jomb0-47588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/29/2023] [Indexed: 08/15/2024] Open
Abstract
Background COVID-19 is still a global health issue, there is limited evidence in South America regarding laboratory biomarkers associated with severe disease. The objective of our study was to identify hematological and hemostatic changes associated with severe COVID-19. Methods A total of 170 hospitalized patients with COVID19 were included in the study, defining their severity according to established criteria. Demographic, clinical, and laboratory (days 1, 3, 7, 15) data were obtained. We performed a statistical analysis, assuming significance with a value of p < 0.05. We analyzed the correlation between severity and biomarkers and established cut-off values for severe patients through ROC curves, estimating Odds Ratio associated with severe disease. Results Day 1 was observed significant differences between moderate vs severe patients for leukocytes (WBC), Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and D-dimer, establishing cut-off points for each of them. The markers we found associated to risk of severe disease were WBC (OR=3.2396; p = 0.0003), NLR (OR=5.7084; p < 0.0001), PLR (OR=4.4094; p < 0.0001), Neutrophil (OR=4.1193; p < 0.0001), D-dimer (OR=2.7827; p = 0.0124). Conclusions The results allow to establish basic laboratory biomarkers associated to severe disease, which could be used as prognostic markers.
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Affiliation(s)
- Pablo Letelier
- Universidad Católica de Temuco, Facultad de Ciencias de la Salud, Departamento de Procesos Diagnósticos y Evaluación, Precision Health Research Laboratory, Temuco, Chile
| | - Hugo Delgado
- Dr. Hernán Henríquez Aravena Hospital, Clinical Laboratory, Temuco, Chile
| | - Felipe Garrido
- Dr. Hernán Henríquez Aravena Hospital, Clinical Laboratory, Temuco, Chile
| | - Francisco Quiñones
- Dr. Hernán Henríquez Aravena Hospital, Clinical Laboratory, Temuco, Chile
| | - Martín Andrés San
- Dr. Hernán Henríquez Aravena Hospital, Clinical Laboratory, Temuco, Chile
| | - Loreto Hernández
- Complejo Asistencial Padre Las Casas, Padre Las Casas, Araucanía, Chile
| | | | - Dina Guzmán-Oyarzo
- Universidad San Sebastián, Facultad de Medicina y Ciencias, School of Medical Technology, Campus Concepción, Concepción, Chile
| | - Rodrigo Boguen
- Universidad Católica de Temuco, Facultad de Ciencias de la Salud, Departamento de Procesos Diagnósticos y Evaluación, Precision Health Research Laboratory, Temuco, Chile
| | - Alfonso Hernandez
- Universidad Católica de Temuco, Facultad de Ciencias de la Salud, Departamento de Procesos Diagnósticos y Evaluación, Precision Health Research Laboratory, Temuco, Chile
| | - Gustavo Medina
- Universidad Católica de Temuco, Facultad de Ciencias de la Salud, Departamento de Procesos Diagnósticos y Evaluación, Precision Health Research Laboratory, Temuco, Chile
| | - Patricia Schwerter
- Universidad Católica de Temuco, Facultad de Ingeniería, Department of Mathematical and Physics Sciences, Temuco, Chile
| | - Neftalí Guzmán
- Universidad Católica de Temuco, Facultad de Ciencias de la Salud, Departamento de Procesos Diagnósticos y Evaluación, Precision Health Research Laboratory, Temuco, Chile
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15
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Vidal C, Nativel M, Puech B, Poirson F, Cally R, Dangers L, Braunberger E, Jabot J, Allou N, Allyn J. Duration of Invasive Mechanical Ventilation before Veno-Venous ExtraCorporeal Membrane Oxygenation for Covid-19 related Acute Respiratory Distress Syndrome: The experience of a tertiary care center. Heliyon 2024; 10:e31811. [PMID: 38882376 PMCID: PMC11176752 DOI: 10.1016/j.heliyon.2024.e31811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 06/18/2024] Open
Abstract
Background Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO) is an efficient ventilatory support in patients with refractory Covid-19-related Acute Respiratory Distress Syndrome (ARDS), however the duration of invasive mechanical ventilation (IMV) before ECMO initiation as a contraindication is still controversial. The aim of this study was to investigate the impact of prolonged IMV prior to VV-ECMO in patients suffering from refractory Covid-19-related ARDS. Methods This single-center retrospective study included all patients treated with VV-ECMO for refractory Covid-19-related ARDS between January 1, 2020 and May 31, 2022. The impact of IMV duration was investigated by comparing patients on VV-ECMO during the 7 days (and 10 days) following IMV with those assisted after 7 days (and 10 days). The primary endpoint was in-hospital mortality. Results Sixty-four patients were hospitalized in the ICU for Covid-19-related refractory ARDS requiring VV-ECMO. Global in-hospital mortality was 55 %. Median duration of IMV was 4 [2; 8] days before VV-ECMO initiation. There was no significant difference in in-hospital mortality between patients assisted with IMV pre-VV-ECMO for a duration of ≤7 days (≤10 days) and those assisted after 7 days (and 10 days) ((p = 0.59 and p = 0.45). Conclusion This study suggests that patients assisted with VV-ECMO after prolonged IMV had the same prognosis than those assisted earlier in refractory Covid-19-related ARDS. Therefore, prolonged mechanical ventilation of more than 7-10 days should not contraindicate VV-ECMO support. An individual approach is necessary to balance the risks and benefits of ECMO in this population.
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Affiliation(s)
- Charles Vidal
- Service de Réanimation polyvalente, Centre Hospitalier Universitaire Felix Guyon Allée des Topazes, 97405, Saint Denis, France
| | - Mathilde Nativel
- Service de Réanimation polyvalente, Centre Hospitalier Universitaire Felix Guyon Allée des Topazes, 97405, Saint Denis, France
| | - Bérénice Puech
- Service de Réanimation polyvalente, Centre Hospitalier Universitaire Felix Guyon Allée des Topazes, 97405, Saint Denis, France
| | - Florent Poirson
- Service de Réanimation polyvalente, Centre Hospitalier Universitaire Felix Guyon Allée des Topazes, 97405, Saint Denis, France
| | - Radj Cally
- Service de Réanimation polyvalente, Centre Hospitalier Universitaire Felix Guyon Allée des Topazes, 97405, Saint Denis, France
| | - Laurence Dangers
- Service de Réanimation polyvalente, Centre Hospitalier Universitaire Felix Guyon Allée des Topazes, 97405, Saint Denis, France
| | - Eric Braunberger
- Service de chirurgie cardio-thoracique et vasculaire, Center Hospitalier Universitaire Felix Guyon Allée des Topazes, 97405, Saint Denis, France
| | - Julien Jabot
- Service de Réanimation polyvalente, Centre Hospitalier Universitaire Felix Guyon Allée des Topazes, 97405, Saint Denis, France
| | - Nicolas Allou
- Service de Réanimation polyvalente, Centre Hospitalier Universitaire Felix Guyon Allée des Topazes, 97405, Saint Denis, France
| | - JérômeM Allyn
- Service de Réanimation polyvalente, Centre Hospitalier Universitaire Felix Guyon Allée des Topazes, 97405, Saint Denis, France
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16
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Nassi-Liberman O, Oberman B, Strahl T, Yosef N, Shlomi D. Association between obstructive sleep apnea (OSA) and COVID-19 severity. J Sleep Res 2024:e14260. [PMID: 38867140 DOI: 10.1111/jsr.14260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/20/2024] [Accepted: 05/24/2024] [Indexed: 06/14/2024]
Abstract
Obstructive sleep apnea and sleep-related hypoxia have been associated with higher rates of hospitalization and mortality among patients with Coronavirus disease 2019 (COVID-19). We further explored the association between obstructive sleep apnea, COVID-19 severity and related mortality. In addition, we examined the effects of clinical and demographic parameters on COVID-19. In this retrospective study, we included adult patients who were diagnosed with COVID-19 prior to the Omicron variant identification. We compared the severity of COVID-19 and mortality with the diagnosis of obstructive sleep apnea. The study population included 44,275 patients who tested positive for COVID-19. Of these, 97% had mild or asymptomatic disease, 1.2% had moderate disease, and 1.8% had severe disease. Obstructive sleep apnea was diagnosed in 980 (2.2%) patients. In a multivariate analysis, obstructive sleep apnea diagnosis increased the risk of severe COVID-19 by 1.6 (95% confidence interval: 1.1-2.4) compared with mild disease. However, no increase in mortality was associated with obstructive sleep apnea. Interestingly, patients with moderate and high socioeconomic status had a 1.6 times higher risk for severe COVID-19 than patients from the low socioeconomic status group (95% confidence interval: 1.2-2.1 and 95% confidence interval: 1.1-2.3, respectively). The risk of dying due to COVID-19 was 1.6 (95% confidence interval: 1.1-2.5) and 3.1 (95% confidence interval: 1.8-5.3) times higher in patients with medium and high socioeconomic status, respectively, compared with patients with low socioeconomic status. Diagnosis of obstructive sleep apnea was found to be an independent risk factor for severe COVID-19. The higher the socioeconomic status, the higher the risk of severe COVID-19 morbidity and mortality.
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Affiliation(s)
| | - Bernice Oberman
- Research Unit, Dan- Petah-Tiqwa District, Clalit Health Services Community Division, Ramat-Gan, Israel
| | - Tamar Strahl
- Research Unit, Dan- Petah-Tiqwa District, Clalit Health Services Community Division, Ramat-Gan, Israel
| | - Noga Yosef
- Research Unit, Dan- Petah-Tiqwa District, Clalit Health Services Community Division, Ramat-Gan, Israel
| | - Dekel Shlomi
- Adelson School of Medicine, Ariel University, Ariel, Israel
- Pulmonary Clinic, Dan- Petah-Tiqwa District, Clalit Health Services Community Division, Ramat-Gan, Israel
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17
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Yang S, Sun Y, Yan C. Recent advances in the use of extracellular vesicles from adipose-derived stem cells for regenerative medical therapeutics. J Nanobiotechnology 2024; 22:316. [PMID: 38844939 PMCID: PMC11157933 DOI: 10.1186/s12951-024-02603-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/28/2024] [Indexed: 06/09/2024] Open
Abstract
Adipose-derived stem cells (ADSCs) are a subset of mesenchymal stem cells (MSCs) isolated from adipose tissue. They possess remarkable properties, including multipotency, self-renewal, and easy clinical availability. ADSCs are also capable of promoting tissue regeneration through the secretion of various cytokines, factors, and extracellular vesicles (EVs). ADSC-derived EVs (ADSC-EVs) act as intercellular signaling mediators that encapsulate a range of biomolecules. These EVs have been found to mediate the therapeutic activities of donor cells by promoting the proliferation and migration of effector cells, facilitating angiogenesis, modulating immunity, and performing other specific functions in different tissues. Compared to the donor cells themselves, ADSC-EVs offer advantages such as fewer safety concerns and more convenient transportation and storage for clinical application. As a result, these EVs have received significant attention as cell-free therapeutic agents with potential future application in regenerative medicine. In this review, we focus on recent research progress regarding regenerative medical use of ADSC-EVs across various medical conditions, including wound healing, chronic limb ischemia, angiogenesis, myocardial infarction, diabetic nephropathy, fat graft survival, bone regeneration, cartilage regeneration, tendinopathy and tendon healing, peripheral nerve regeneration, and acute lung injury, among others. We also discuss the underlying mechanisms responsible for inducing these therapeutic effects. We believe that deciphering the biological properties, therapeutic effects, and underlying mechanisms associated with ADSC-EVs will provide a foundation for developing a novel therapeutic approach in regenerative medicine.
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Affiliation(s)
- Song Yang
- Institute of Life Sciences, Chongqing Medical University, Chongqing, 400016, People's Republic of China.
| | - Yiran Sun
- School of Pharmacy, Chengdu Medical College, Chengdu, 610500, People's Republic of China.
| | - Chenchen Yan
- School of Pharmacy, Chengdu Medical College, Chengdu, 610500, People's Republic of China
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18
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Deng X, Tang K, Wang Z, He S, Luo Z. Impacts of Inflammatory Cytokines Variants on Systemic Inflammatory Profile and COVID-19 Severity. J Epidemiol Glob Health 2024; 14:363-378. [PMID: 38376765 PMCID: PMC11176143 DOI: 10.1007/s44197-024-00204-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 01/30/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Cytokine storm is known to impact the prognosis of coronavirus disease 2019 (COVID-19), since pro-inflammatory cytokine variants are associated with cytokine storm. It is tempting to speculate that pro-inflammatory cytokines variants may impact COVID-19 outcomes by modulating cytokine storm. Here, we verified this hypothesis via a comprehensive analysis. METHODS PubMed, Cochrane Library, Central, CINAHL, and ClinicalTrials.gov were searched until December 15, 2023. Case-control or cohort studies that investigated the impacts of rs1800795 or rs1800629 on COVID-19 susceptibility, severity, mortality, IL-6, TNF-α, or CRP levels were included after an anonymous review by two independent reviewers and consultations of disagreement by a third independent reviewer. RESULTS 47 studies (8305 COVID-19 individuals and 17,846 non-COVID-19 individuals) were analyzed. The rs1800629 A allele (adenine at the -308 position of the promoter was encoded by the A allele) was associated with higher levels of tumor necrosis factor-α (TNF-α) and C-reactive protein (CRP). In contrast, the rs1800795 C allele (cytosine at the -174 position of the promoter was encoded by the C allele) was linked to higher levels of interleukin-6 (IL-6) and CRP. In addition, the A allele of rs1800629 increased the severity and mortality of COVID-19. However, the C allele of rs1800795 only increased COVID-19 susceptibility. CONCLUSIONS rs1800629 and rs1800795 variants of pro-inflammatory cytokines have significant impacts on systemic inflammatory profile and COVID-19 clinical outcomes. rs1800629 may serve as a genetic marker for severe COVID-19.
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Affiliation(s)
- XueJun Deng
- Department of Cardiology, Suining Central Hospital, Suining, 629000, Sichuan, China
| | - Kai Tang
- Department of Cardiology, Suining Central Hospital, Suining, 629000, Sichuan, China
| | - Zhiqiang Wang
- Orthopedic Center 1 Department of Orthopedic Trauma, Suining Central Hospital, Suining, Sichuan, China.
| | - Suyu He
- The Fourth Department of Digestive Disease Center, Suining Central Hospital, Suining, 629000, Sichuan, China.
| | - Zhi Luo
- Department of Cardiology, Suining Central Hospital, Suining, 629000, Sichuan, China.
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Moreno E, Ciordia S, Fátima SM, Jiménez D, Martínez-Sanz J, Vizcarra P, Ron R, Sánchez-Conde M, Bargiela R, Sanchez-Carrillo S, Moreno S, Corrales F, Ferrer M, Serrano-Villar S. Proteomic snapshot of saliva samples predicts new pathways implicated in SARS-CoV-2 pathogenesis. Clin Proteomics 2024; 21:37. [PMID: 38778280 PMCID: PMC11112864 DOI: 10.1186/s12014-024-09482-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 04/15/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Information on the microbiome's human pathways and active members that can affect SARS-CoV-2 susceptibility and pathogenesis in the salivary proteome is very scarce. Here, we studied a unique collection of samples harvested from April to June 2020 from unvaccinated patients. METHODS We compared 10 infected and hospitalized patients with severe (n = 5) and moderate (n = 5) coronavirus disease (COVID-19) with 10 uninfected individuals, including non-COVID-19 but susceptible individuals (n = 5) and non-COVID-19 and nonsusceptible healthcare workers with repeated high-risk exposures (n = 5). RESULTS By performing high-throughput proteomic profiling in saliva samples, we detected 226 unique differentially expressed (DE) human proteins between groups (q-value ≤ 0.05) out of 3376 unambiguously identified proteins (false discovery rate ≤ 1%). Major differences were observed between the non-COVID-19 and nonsusceptible groups. Bioinformatics analysis of DE proteins revealed human proteomic signatures related to inflammatory responses, central cellular processes, and antiviral activity associated with the saliva of SARS-CoV-2-infected patients (p-value ≤ 0.0004). Discriminatory biomarker signatures from human saliva include cystatins, protective molecules present in the oral cavity, calprotectins, involved in cell cycle progression, and histones, related to nucleosome functions. The expression levels of two human proteins related to protein transport in the cytoplasm, DYNC1 (p-value, 0.0021) and MAPRE1 (p-value, 0.047), correlated with angiotensin-converting enzyme 2 (ACE2) plasma activity. Finally, the proteomes of microorganisms present in the saliva samples showed 4 main microbial functional features related to ribosome functioning that were overrepresented in the infected group. CONCLUSION Our study explores potential candidates involved in pathways implicated in SARS-CoV-2 susceptibility, although further studies in larger cohorts will be necessary.
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Affiliation(s)
- Elena Moreno
- Department of Infectious Diseases, Facultad de Medicina, Hospital Universitario Ramón y Cajal, IRYCIS, Carretera de Colmenar Viejo, Km 9.100, 28034, Madrid, Spain.
- CIBERINFEC, Instituto de Salud Carlos III, 28029, Madrid, Spain.
| | - Sergio Ciordia
- Functional Proteomics Laboratory, Centro Nacional de Biotecnología (CNB), CSIC, 28049, Madrid, Spain
| | - Santos Milhano Fátima
- Functional Proteomics Laboratory, Centro Nacional de Biotecnología (CNB), CSIC, 28049, Madrid, Spain
| | - Daniel Jiménez
- Department of Infectious Diseases, Facultad de Medicina, Hospital Universitario Ramón y Cajal, IRYCIS, Carretera de Colmenar Viejo, Km 9.100, 28034, Madrid, Spain
| | - Javier Martínez-Sanz
- Department of Infectious Diseases, Facultad de Medicina, Hospital Universitario Ramón y Cajal, IRYCIS, Carretera de Colmenar Viejo, Km 9.100, 28034, Madrid, Spain
- CIBERINFEC, Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Pilar Vizcarra
- Department of Infectious Diseases, Facultad de Medicina, Hospital Universitario Ramón y Cajal, IRYCIS, Carretera de Colmenar Viejo, Km 9.100, 28034, Madrid, Spain
- CIBERINFEC, Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Raquel Ron
- Department of Infectious Diseases, Facultad de Medicina, Hospital Universitario Ramón y Cajal, IRYCIS, Carretera de Colmenar Viejo, Km 9.100, 28034, Madrid, Spain
- CIBERINFEC, Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Matilde Sánchez-Conde
- Department of Infectious Diseases, Facultad de Medicina, Hospital Universitario Ramón y Cajal, IRYCIS, Carretera de Colmenar Viejo, Km 9.100, 28034, Madrid, Spain
- CIBERINFEC, Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Rafael Bargiela
- Centre for Environmental Biotechnology, School of Natural Sciences, Bangor University, Bangor, LL57 2UW, UK
| | - Sergio Sanchez-Carrillo
- Instituto de Catalisis y Petroleoquimica (ICP), CSIC, 28049, Madrid, Spain
- Centro de Biologia Molecular Severo Ochoa (CBM), CSIC-UAM, 28049, Madrid, Spain
| | - Santiago Moreno
- Department of Infectious Diseases, Facultad de Medicina, Hospital Universitario Ramón y Cajal, IRYCIS, Carretera de Colmenar Viejo, Km 9.100, 28034, Madrid, Spain
- CIBERINFEC, Instituto de Salud Carlos III, 28029, Madrid, Spain
- Facultad de Medicina, Universidad de Alcalá de Henares, 28801, Alcalá de Henares, Madrid, Spain
| | - Fernando Corrales
- Functional Proteomics Laboratory, Centro Nacional de Biotecnología (CNB), CSIC, 28049, Madrid, Spain
| | - Manuel Ferrer
- Instituto de Catalisis y Petroleoquimica (ICP), CSIC, 28049, Madrid, Spain
| | - Sergio Serrano-Villar
- Department of Infectious Diseases, Facultad de Medicina, Hospital Universitario Ramón y Cajal, IRYCIS, Carretera de Colmenar Viejo, Km 9.100, 28034, Madrid, Spain
- CIBERINFEC, Instituto de Salud Carlos III, 28029, Madrid, Spain
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Zhu Y, Cao X, Ying R, Liu K, Chai Y, Luo M, Huang Q, Gao P, Zhang C. Mapping the vast landscape of multisystem complications of COVID-19: Bibliometric analysis. Heliyon 2024; 10:e30760. [PMID: 38765136 PMCID: PMC11098853 DOI: 10.1016/j.heliyon.2024.e30760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 04/16/2024] [Accepted: 05/03/2024] [Indexed: 05/21/2024] Open
Abstract
Background With the rapid global spread of COVID-19, it has become evident that the virus can lead to multisystem complications, leading to a significant increase in related publications. Bibliometrics serves as a valuable tool for identifying highly cited literature and research hotspots within specific areas. Objective The aim of this study is to identify current research hotspots and future trends in COVID-19 complications. Methods The dataset was obtained from the Web of Science Core Collection, covering COVID-19 complications from December 8, 2019, to October 31, 2022. Various aspects, including publication general information, authors, journals, co-cited authors, co-cited references, research hotspots, and future trends, were subjected to analysis. Visual analysis was conducted using VOSviewer, The Online Analysis Platform of Literature Metrology, and Charticulator. Results There were 4597 articles in the study. The top three countries with the most published articles are the USA (n = 1350, 29.4 %), China (n = 765, 16.6 %), and Italy (n = 623, 13.6 %). USA and China have the closest collaborative relationship. The institute with the largest number of publications is Huazhong University of Science and Technology, followed by Harvard Medical School. Nevertheless, half of the top 10 institutes belong to the USA. "Rezaei, Nima" published 13 articles and ranked first, followed by "Yaghi, Shadi" with 12 articles and "Frontera, Jennifer" with 12 articles. The journal with the largest number of publications is "Journal of Clinical Medicine". The top 3 co-cited authors are "Zhou, Fei", "Guan, Wei-Jie", "Huang, Chaolin". The top 3 co-cited references addressed COVID-19's clinical features in China and noticed that COVID-19 patients had a wide range of complications. We also list four research hotspots. Conclusions This study conducted a bibliometric visual analysis of the literature on COVID-19 complications and summarized the current research hotspots. This study may provide valuable insights into the complications of COVID-19.
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Affiliation(s)
- Yi Zhu
- Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiyu Cao
- Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Rongtao Ying
- Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ke Liu
- Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yilu Chai
- Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Maocai Luo
- Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qingsong Huang
- Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Peiyang Gao
- Department of Critical Care Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Chuantao Zhang
- Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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21
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Luo Z, Song X, Huang D, Xiao L, Zou K. Research hotspots and evolving trends of barrier dysfunction in acute lung injury and acute respiratory distress syndrome. Heliyon 2024; 10:e30579. [PMID: 38742065 PMCID: PMC11089360 DOI: 10.1016/j.heliyon.2024.e30579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 04/24/2024] [Accepted: 04/29/2024] [Indexed: 05/16/2024] Open
Abstract
Endothelial and epithelial barrier dysfunction due to increased permeability and heightened inflammatory reactions influences the emergence of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Nevertheless, bibliometric research comparing endothelial and epithelial barriers is limited. Therefore, this bibliometric study analyzed the Web of Science Core Collection (WoSCC) of the Science Citation Index Expanded literature to explore present research priorities and development tendencies within this field. We conducted a comprehensive search (October 18, 2023) on WoSCC from January 1, 2010, to October 18, 2023, focusing on articles related to endothelial and epithelial barriers in ALI and ARDS. Retrieved data were visualized and analyzed using R-bibliometrix, VOS viewer 1.6.19, and CiteSpace 6.2. R4. Functional enrichment analysis of gene targets identified in the keyword list using Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene ontology databases, and based on the STRING database to construct a PPI network to predict core genes. A total of 941 original articles and reviews were identified. The United States had the highest number of publications and citations and the highest H-index and G-index. According to the Collaboration Network Analysis graph, the United States and China had the strongest collaboration. Birukova AA had the most publications and citations among all authors, while eight of the top ten institutions with mediator centrality were located in the United States. The American Journal of Physiology-Lung Cellular and Molecular Physiology was the leading journal and had the most well-established publication on endothelial and epithelial barriers in ALI and ARDS. Bibliometric analysis revealed that the most frequently used keywords were acute lung injury, ARDS, activation, expression, and inflammation. RHOA appeared most frequently among gene-related keywords, and the PI3K-AKT signaling pathway had the highest count in KEGG pathway enrichment. Research on endothelial versus epithelial barriers in ALI and ARDS remains preliminary. This bibliometric study examined cooperative network connections among countries, authors, journals, and network associations in the cited references. Investigation of the functions of the endothelial and epithelial barriers in ALI/ARDS associated with COVID-19 has recently gained significant attention.
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Affiliation(s)
- Zixin Luo
- The First Clinical Medical College, Gannan Medical University, Ganzhou City, Jiangxi Province, 341000, China
| | - Xinyue Song
- The First Clinical Medical College, Gannan Medical University, Ganzhou City, Jiangxi Province, 341000, China
| | - Duoqin Huang
- The First Clinical Medical College, Gannan Medical University, Ganzhou City, Jiangxi Province, 341000, China
| | - Li Xiao
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Gannan Medical University, Ganzhou City, Jiangxi Province, 341000, China
| | - Kang Zou
- Department of Critical Care Medicine, The First Affiliated Hospital of Gannan Medical University, Ganzhou City, Jiangxi Province, 341000, China
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22
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Heredia-Orbegoso O, Vences MA, Failoc-Rojas VE, Fernández-Merjildo D, Lainez-Chacon RH, Villamonte R. Cerebral hemodynamics and optic nerve sheath diameter acquired via neurosonology in critical patients with severe coronavirus disease: experience of a national referral hospital in Peru. Front Neurol 2024; 15:1340749. [PMID: 38765265 PMCID: PMC11099257 DOI: 10.3389/fneur.2024.1340749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/15/2024] [Indexed: 05/21/2024] Open
Abstract
Aim We aimed to describe the neurosonological findings related to cerebral hemodynamics acquired using transcranial Doppler and to determine the frequency of elevated ICP by optic nerve sheath diameter (ONSD) measurement in patients with severe coronavirus disease (COVID-19) hospitalized in the intensive care unit of a national referral hospital in Peru. Methods We included a retrospective cohort of adult patients hospitalized with severe COVID-19 and acute respiratory failure within the first 7 days of mechanical ventilation under deep sedoanalgesia, with or without neuromuscular blockade who underwent ocular ultrasound and transcranial Doppler. We determine the frequency of elevated ICP by measuring the diameter of the optic nerve sheath, choosing as best cut-off value a diameter equal to or >5.8 mm. We also determine the frequency of sonographic patterns obtained by transcranial Doppler. Through insonation of the middle cerebral artery. Likewise, we evaluated the associations of clinical, mechanical ventilator, and arterial blood gas variables with ONSD ≥5.8 mm and pulsatility index (PI) ≥1.1. We also evaluated the associations of hemodynamic findings and ONSD with mortality the effect size was estimated using Poisson regression models with robust variance. Results This study included 142 patients. The mean age was 51.39 ± 13.3 years, and 78.9% of patients were male. Vasopressors were used in 45.1% of patients, and mean arterial pressure was 81.87 ± 10.64 mmHg. The mean partial pressure of carbon dioxide (PaCO2) was elevated (54.08 ± 16.01 mmHg). Elevated intracranial pressure was seen in 83.1% of patients, as estimated based on ONSD ≥5.8 mm. A mortality rate of 16.2% was reported. In the multivariate analysis, age was associated with elevated ONSD (risk ratio [RR] = 1.07). PaCO2 was a protective factor (RR = 0.64) in the cases of PI ≥ 1.1. In the mortality analysis, the mean velocity was a risk factor for mortality (RR = 1.15). Conclusions A high rate of intracranial hypertension was reported, with ONSD measurement being the most reliable method for estimation. The increase in ICP measured by ONSD in patients with severe COVID-19 on mechanical ventilation is not associated to hypercapnia or elevated intrathoracic pressures derived from protective mechanical ventilation.
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Affiliation(s)
- Omar Heredia-Orbegoso
- Centro de Emergencia de Lima Metropolitana, Hospital Nacional Edgardo Rebagliati Martins, Unidad de Cuidados Intensivos, Lima, Peru
| | | | | | | | - Richard H. Lainez-Chacon
- Centro de Emergencia de Lima Metropolitana, Hospital Nacional Edgardo Rebagliati Martins, Unidad de Cuidados Intensivos, Lima, Peru
| | - Renán Villamonte
- Centro de Emergencia de Lima Metropolitana, Hospital Nacional Edgardo Rebagliati Martins, Unidad de Cuidados Intensivos, Lima, Peru
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23
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Snelling PJ, Jones P, Connolly R, Jelic T, Mirsch D, Myslik F, Phillips L, Blecher G. Comparison of lung ultrasound scoring systems for the prognosis of COVID-19 in the emergency department: An international prospective cohort study. Australas J Ultrasound Med 2024; 27:75-88. [PMID: 38784699 PMCID: PMC11109992 DOI: 10.1002/ajum.12364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Purpose The purpose of this study was to evaluate whether the lung ultrasound (LUS) scores applied to an international cohort of patients presenting to the emergency department (ED) with suspected COVID-19, and subsequently admitted with proven disease, could prognosticate clinical outcomes. Methods This was an international, multicentre, prospective, observational cohort study of patients who received LUS and were followed for the composite primary outcome of intubation, intensive care unit (ICU) admission or death. LUS scores were later applied including two 12-zone protocols ('de Alencar score' and 'CLUE score'), a 12-zone protocol with lung and pleural findings ('Ji score') and an 11-zone protocol ('Tung-Chen score'). The primary analysis comprised logistic regression modelling of the composite primary outcome, with the LUS scores analysed individually as predictor variables. Results Between April 2020 to April 2022, 129 patients with COVID-19 had LUS performed according to the protocol and 24 (18.6%) met the composite primary endpoint. No association was seen between the LUS score and the composite primary end point for the de Alencar score [odds ratio (OR) = 1.04; 95% confidence interval (CI): 0.97-1.11; P = 0.29], the CLUE score (OR = 1.03; 95% CI: 0.96-1.10; P = 0.40), the Ji score (OR = 1.02; 95% CI: 0.97-1.07; P = 0.40) or the Tung-Chen score (OR = 1.02; 95% CI: 0.97-1.08). Discussion Compared to these earlier studies performed at the start of the pandemic, the negative outcome of our study could reflect the changing scenario of the COVID-19 pandemic, including patient, disease, and system factors. The analysis suggests that the study may have been underpowered to detect a weaker association between a LUS score and the primary outcome. Conclusion In an international cohort of adult patients presenting to the ED with suspected COVID-19 disease who had LUS performed and were subsequently admitted to hospital, LUS severity scores did not prognosticate the need for invasive ventilation, ICU admission or death.
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Affiliation(s)
- Peter J Snelling
- Department of Emergency MedicineGold Coast University HospitalSouthportQueenslandAustralia
- School of Medicine and DentistryGriffith UniversitySouthportQueenslandAustralia
- Sonography Innovation and Research GroupSouthportQueenslandAustralia
| | - Philip Jones
- Department of Emergency MedicineGold Coast University HospitalSouthportQueenslandAustralia
- School of Medicine and DentistryGriffith UniversitySouthportQueenslandAustralia
- Sonography Innovation and Research GroupSouthportQueenslandAustralia
| | - Rory Connolly
- Department of Emergency MedicineUniversity of OttawaOttawaOntarioCanada
| | - Tomislav Jelic
- Department of Emergency MedicineUniversity of ManitobaWinnipegManitobaCanada
| | - Dan Mirsch
- Department of Emergency MedicineUniversity at BuffaloBuffaloNew YorkUSA
| | - Frank Myslik
- Division of Emergency MedicineWestern UniversityLondonOntarioCanada
| | - Luke Phillips
- Department of Emergency MedicineAlfred HospitalMelbourneVictoriaAustralia
- Department of Epidemiology and Preventative MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Gabriel Blecher
- Emergency Services, Peninsula HealthFrankstonVictoriaAustralia
- Peninsula Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
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24
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Huang J, Su H, Lin J, Zhu F, Jiang X, Pan J. Achalasia Following SARS-CoV-2 Infection: A Case Report and Review of Literature. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024. [PMID: 38657616 DOI: 10.1055/a-2275-2423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
RATIONALE The COVID-19 pandemic caused by the SARS-CoV-2 virus has led to health complications beyond respiratory symptoms, revealing multi-organ involvement, including potential gastrointestinal implications. PATIENT CONCERNS We present a case of a 40-year-old female without any history of achalasia who developed symptoms of the condition following a confirmed SARS-CoV-2 infection. Unusually, multiple esophageal ulcers were identified, which are not typically associated with achalasia. DIAGNOSIS Achalasia and esophageal ulcers were confirmed through a series of examinations, including barium swallow, CT scan, and upper endoscopy. Furthermore, immunohistochemical staining of esophageal biopsy specimens revealed the presence of the SARS-CoV-2 spike protein, suggesting direct viral involvement. INTERVENTIONS The patient was treated with calcium channel blockers and proton pump inhibitors and later underwent a peroral endoscopic myotomy (POEM) procedure following the resolution of her COVID-19 infection. OUTCOME After the POEM procedure, the patient made a good recovery. LESSONS This case underscores the potential for SARS-CoV-2 to trigger gastrointestinal complications and emphasizes the need for ongoing patient management and further research into the long-term implications of COVID-19. Despite the single-case nature of this report, it contributes to the expanding understanding of the diverse and multi-systemic impact of COVID-19.
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Affiliation(s)
- Jianbin Huang
- Department of Gastroenterology, Wenzhou Central Hospital, Wenzhou 325000, China
- Department of Gastroenterology, The Dingli Clinical College of Wenzhou Medical University, Wenzhou 325000, Zhejiang province, China
- Department of Gastroenterology, The Second Affiliated Hospital of Shanghai University, Wenzhou 325000, Zhejiang province, China
| | - Huang Su
- Department of Gastroenterology, Wenzhou Central Hospital, Wenzhou 325000, China
- Department of Gastroenterology, The Dingli Clinical College of Wenzhou Medical University, Wenzhou 325000, Zhejiang province, China
- Department of Gastroenterology, The Second Affiliated Hospital of Shanghai University, Wenzhou 325000, Zhejiang province, China
| | - Jiejun Lin
- Department of Gastroenterology, Wenzhou Central Hospital, Wenzhou 325000, China
- Department of Gastroenterology, The Dingli Clinical College of Wenzhou Medical University, Wenzhou 325000, Zhejiang province, China
- Department of Gastroenterology, The Second Affiliated Hospital of Shanghai University, Wenzhou 325000, Zhejiang province, China
| | - Fangchao Zhu
- Department of Gastroenterology, Wenzhou Central Hospital, Wenzhou 325000, China
- Department of Gastroenterology, The Dingli Clinical College of Wenzhou Medical University, Wenzhou 325000, Zhejiang province, China
- Department of Gastroenterology, The Second Affiliated Hospital of Shanghai University, Wenzhou 325000, Zhejiang province, China
| | - Xiaofen Jiang
- Department of Gastroenterology, Wenzhou Central Hospital, Wenzhou 325000, China
- Department of Gastroenterology, The Dingli Clinical College of Wenzhou Medical University, Wenzhou 325000, Zhejiang province, China
- Department of Gastroenterology, The Second Affiliated Hospital of Shanghai University, Wenzhou 325000, Zhejiang province, China
| | - Jie Pan
- Department of Gastroenterology, Wenzhou Central Hospital, Wenzhou 325000, China
- Department of Gastroenterology, The Dingli Clinical College of Wenzhou Medical University, Wenzhou 325000, Zhejiang province, China
- Department of Gastroenterology, The Second Affiliated Hospital of Shanghai University, Wenzhou 325000, Zhejiang province, China
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Nedeljkovic-Arsenovic O, Ristić A, Đorđević N, Tomić M, Krljanac G, Maksimović R. Cardiac Magnetic Resonance Imaging as a Risk Stratification Tool in COVID-19 Myocarditis. Diagnostics (Basel) 2024; 14:790. [PMID: 38667436 PMCID: PMC11049213 DOI: 10.3390/diagnostics14080790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 02/18/2024] [Accepted: 02/23/2024] [Indexed: 04/28/2024] Open
Abstract
The aim of this retrospective study was to identify myocardial injury after COVID-19 inflammation and explore whether myocardial damage could be a possible cause of the persistent symptoms following COVID-19 infection in previously healthy individuals. This study included 139 patients who were enrolled between January and June 2021, with a mean age of 46.7 ± 15.2 years, of whom 68 were men and 71 were women without known cardiac or pulmonary diseases. All patients underwent clinical work-up, laboratory analysis, cardiac ultrasound, and CMR on a 1.5 T scanner using a recommended protocol for morphological and functional assessment before and after contrast media application with multi-parametric sequences. In 39% of patients, late gadolinium enhancement (LGE) was found as a sign of myocarditis. Fibrinogen was statistically significantly higher in patients with LGE than in those without LGE (4.3 ± 0.23 vs. 3.2 ± 0.14 g/L, p < 0.05, respectively), as well as D-dimer (1.8 ± 0.3 vs. 0.8 ± 0.1 mg/L FEU). Also, troponin was statistically significantly higher in patients with myocardial LGE (13.1 ± 0.4 ng/L) compared to those with normal myocardium (4.9 ± 0.3 ng/L, p < 0.001). We demonstrated chest pain, fatigue, and elevated troponin to be independent predictors for LGE. Septal LGE was shown to be a predictor for arrhythmias. The use of CMR is a potential risk stratification tool in evaluating outcomes following COVID-19 myocarditis.
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Affiliation(s)
- Olga Nedeljkovic-Arsenovic
- Department of Magnetic Resonance Imaging, Centre for Radiology, University Clinical Centre of Serbia, Pasterova 2, 11000 Belgrade, Serbia;
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia;
| | - Arsen Ristić
- Clinic for Cardiology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (A.R.); (N.Đ.); (M.T.)
| | - Nemanja Đorđević
- Clinic for Cardiology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (A.R.); (N.Đ.); (M.T.)
| | - Milenko Tomić
- Clinic for Cardiology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (A.R.); (N.Đ.); (M.T.)
| | - Gordana Krljanac
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia;
- Clinic for Cardiology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (A.R.); (N.Đ.); (M.T.)
| | - Ruzica Maksimović
- Department of Magnetic Resonance Imaging, Centre for Radiology, University Clinical Centre of Serbia, Pasterova 2, 11000 Belgrade, Serbia;
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia;
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26
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Audley G, Raubenheimer P, Symons G, Mendelson M, Meintjes G, Ntusi NAB, Wasserman S, Dlamini S, Dheda K, van Zyl-Smit R, Calligaro G. High-flow nasal oxygen in resource-constrained, non-intensive, high-care wards for COVID-19 acute hypoxaemic respiratory failure: Comparing outcomes of the first v. third waves at a tertiary centre in South Africa. Afr J Thorac Crit Care Med 2024; 30:e1151. [PMID: 38756391 PMCID: PMC11094705 DOI: 10.7196/ajtccm.2024.v30i1.1151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 01/08/2024] [Indexed: 05/18/2024] Open
Abstract
Background High-flow nasal oxygen (HFNO) is an accepted treatment for severe COVID-19-related acute hypoxaemic respiratory failure (AHRF). Objectives To determine whether treatment outcomes at Groote Schuur Hospital, Cape Town, South Africa, during the third COVID-19 wave would be affected by increased institutional experience and capacity for HNFO and more restrictive admission criteria for respiratory high-care wards and intensive care units. Methods We included consecutive patients with COVID-19-related AHRF treated with HFNO during the first and third COVID-19 waves. The primary endpoint was comparison of HFNO failure (composite of the need for intubation or death while on HFNO) between waves. Results A total of 744 patients were included: 343 in the first COVID-19 wave and 401 in the third. Patients treated with HFNO in the first wave were older (median (interquartile range) age 53 (46 - 61) years v. 47 (40 - 56) years; p<0.001), and had higher prevalences of diabetes (46.9% v. 36.9%; p=0.006), hypertension (51.0% v. 35.2%; p<0.001), obesity (33.5% v. 26.2%; p=0.029) and HIV infection (12.5% v. 5.5%; p<0.001). The partial pressure of arterial oxygen to fraction of inspired oxygen (PaO2 /FiO2 ) ratio at HFNO initiation and the ratio of oxygen saturation/FiO2 to respiratory rate within 6 hours (ROX-6 score) after HFNO commencement were lower in the first wave compared with the third (median 57.9 (47.3 - 74.3) mmHg v. 64.3 (51.2 - 79.0) mmHg; p=0.005 and 3.19 (2.37 - 3.77) v. 3.43 (2.93 - 4.00); p<0.001, respectively). The likelihood of HFNO failure (57.1% v. 59.6%; p=0.498) and mortality (46.9% v. 52.1%; p=0.159) did not differ significantly between the first and third waves. Conclusion Despite differences in patient characteristics, circulating viral variant and institutional experience with HFNO, treatment outcomes were very similar in the first and third COVID-19 waves. We conclude that once AHRF is established in COVID-19 pneumonia, the comorbidity profile and HFNO provider experience do not appear to affect outcome. Study synopsis What the study adds. This study adds to the body of evidence demonstrating the utility of high-flow nasal oxygen (HFNO) in avoiding invasive mechanical ventilation (IMV) in patients with severe COVID-19 hypoxaemic respiratory failure, and shows that this utility remained consistent across different waves of the COVID-19 pandemic.Implications of the study. In resource-constrained settings, HFNO is a feasible non-invasive alternative to IMV and can be employed with favourable and consistent outcomes outside traditional critical care wards. It also confirms that the degree of gas exchange abnormality, and not pre-existing patient-related factors, circulating wave variant or provider experience, is the main predictor of HFNO failure.
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Affiliation(s)
- G Audley
- Division of General Internal Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur
Hospital, Cape Town, South Africa
| | - P Raubenheimer
- Division of General Internal Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur
Hospital, Cape Town, South Africa
| | - G Symons
- Division of General Internal Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur
Hospital, Cape Town, South Africa
- Division of Pulmonology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - M Mendelson
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote
Schuur Hospital, Cape Town, South Africa
| | - G Meintjes
- Division of General Internal Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur
Hospital, Cape Town, South Africa
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town,
South Africa
| | - N A B Ntusi
- Division of General Internal Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur
Hospital, Cape Town, South Africa
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town,
South Africa
- South African Medical Research Council/University of Cape Town Extramural Research Unit on the Intersection of Noncommunicable Diseases
and Infectious Diseases, University of Cape Town, South Africa
| | - S Wasserman
- Division of General Internal Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur
Hospital, Cape Town, South Africa
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote
Schuur Hospital, Cape Town, South Africa
| | - S Dlamini
- Division of General Internal Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur
Hospital, Cape Town, South Africa
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote
Schuur Hospital, Cape Town, South Africa
| | - K Dheda
- Division of Pulmonology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
- South African Medical Research Council/University of Cape Town Extramural Research Unit on the Intersection of Noncommunicable Diseases
and Infectious Diseases, University of Cape Town, South Africa
- Faculty of Infectious and Tropical Diseases, Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, UK
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute, University of Cape Town,
South Africa; South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, South Africa
| | - R van Zyl-Smit
- Division of Pulmonology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - G Calligaro
- Division of Pulmonology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute, University of Cape Town,
South Africa; South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, South Africa
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Le M, Khoury L, Lu Y, Prosty C, Cormier M, Cheng MP, Fowler R, Murthy S, Tsang JLY, Ben-Shoshan M, Rahme E, Golchi S, Dendukuri N, Lee TC, Netchiporouk E. COVID-19 Immunologic Antiviral Therapy With Omalizumab (CIAO)-a Randomized Controlled Clinical Trial. Open Forum Infect Dis 2024; 11:ofae102. [PMID: 38560604 PMCID: PMC10977629 DOI: 10.1093/ofid/ofae102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/21/2024] [Indexed: 04/04/2024] Open
Abstract
Background Omalizumab is an anti-immunoglobulin E monoclonal antibody used to treat moderate to severe chronic idiopathic urticaria, asthma, and nasal polyps. Recent research suggested that omalizumab may enhance the innate antiviral response and have anti-inflammatory properties. Objective We aimed to investigate the efficacy and safety of omalizumab in adults hospitalized for coronavirus disease 2019 (COVID-19) pneumonia. Methods This was a phase II randomized, double blind, placebo-controlled trial comparing omalizumab with placebo (in addition to standard of care) in hospitalized patients with COVID-19. The primary endpoint was the composite of mechanical ventilation and/or death at day 14. Secondary endpoints included all-cause mortality at day 28, time to clinical improvement, and duration of hospitalization. Results Of 41 patients recruited, 40 were randomized (20 received the study drug and 20 placebo). The median age of the patients was 74 years and 55.0% were male. Omalizumab was associated with a 92.6% posterior probability of a reduction in mechanical ventilation and death on day 14 with an adjusted odds ratio of 0.11 (95% credible interval 0.002-2.05). Omalizumab was also associated with a 75.9% posterior probability of reduced all-cause mortality on day 28 with an adjusted odds ratio of 0.49 (95% credible interval, 0.06-3.90). No statistically significant differences were found for the time to clinical improvement and duration of hospitalization. Numerically fewer adverse events were reported in the omalizumab group and there were no drug-related serious adverse events. Conclusions These results suggest that omalizumab could prove protective against death and mechanical ventilation in hospitalized patients with COVID-19. This study could also support the development of a phase III trial program investigating the antiviral and anti-inflammatory effect of omalizumab for severe respiratory viral illnesses requiring hospital admission. ClinicalTrials.gov ID: NCT04720612.
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Affiliation(s)
- Michelle Le
- Division of Dermatology, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Lauren Khoury
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Yang Lu
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Connor Prosty
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Maxime Cormier
- Division of Respiratory Medicine, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Mathew P Cheng
- Divisions of Infectious Diseases & Medical Microbiology, McGill University, McGill's Interdisciplinary Initiative in Infection and Immunity, Montreal, QC, Canada
| | - Robert Fowler
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Srinivas Murthy
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer L Y Tsang
- Niagara Health Knowledge Institute, Niagara Health, St. Catharines, ON, Canada
| | - Moshe Ben-Shoshan
- Division of Allergy, Immunology and Dermatology, Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - Elham Rahme
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Shirin Golchi
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Nandini Dendukuri
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Todd C Lee
- Divisions of Infectious Diseases & Medical Microbiology, McGill University, McGill's Interdisciplinary Initiative in Infection and Immunity, Montreal, QC, Canada
| | - Elena Netchiporouk
- Division of Dermatology, Department of Medicine, McGill University, Montreal, QC, Canada
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28
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Eligulashvili A, Gordon M, Lee JS, Lee J, Mehrotra-Varma S, Mehrotra-Varma J, Hsu K, Hilliard I, Lee K, Li A, Essibayi MA, Yee J, Altschul DJ, Eskandar E, Mehler MF, Duong TQ. Long-term outcomes of hospitalized patients with SARS-CoV-2/COVID-19 with and without neurological involvement: 3-year follow-up assessment. PLoS Med 2024; 21:e1004263. [PMID: 38573873 PMCID: PMC10994395 DOI: 10.1371/journal.pmed.1004263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 02/28/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Acute neurological manifestation is a common complication of acute Coronavirus Disease 2019 (COVID-19) disease. This retrospective cohort study investigated the 3-year outcomes of patients with and without significant neurological manifestations during initial COVID-19 hospitalization. METHODS AND FINDINGS Patients hospitalized for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection between 03/01/2020 and 4/16/2020 in the Montefiore Health System in the Bronx, an epicenter of the early pandemic, were included. Follow-up data was captured up to 01/23/2023 (3 years post-COVID-19). This cohort consisted of 414 patients with COVID-19 with significant neurological manifestations and 1,199 propensity-matched patients (for age and COVID-19 severity score) with COVID-19 without neurological manifestations. Neurological involvement during the acute phase included acute stroke, new or recrudescent seizures, anatomic brain lesions, presence of altered mentation with evidence for impaired cognition or arousal, and neuro-COVID-19 complex (headache, anosmia, ageusia, chemesthesis, vertigo, presyncope, paresthesias, cranial nerve abnormalities, ataxia, dysautonomia, and skeletal muscle injury with normal orientation and arousal signs). There were no significant group differences in female sex composition (44.93% versus 48.21%, p = 0.249), ICU and IMV status, white, not Hispanic (6.52% versus 7.84%, p = 0.380), and Hispanic (33.57% versus 38.20%, p = 0.093), except black non-Hispanic (42.51% versus 36.03%, p = 0.019). Primary outcomes were mortality, stroke, heart attack, major adverse cardiovascular events (MACE), reinfection, and hospital readmission post-discharge. Secondary outcomes were neuroimaging findings (hemorrhage, active and prior stroke, mass effect, microhemorrhages, white matter changes, microvascular disease (MVD), and volume loss). More patients in the neurological cohort were discharged to acute rehabilitation (10.39% versus 3.34%, p < 0.001) or skilled nursing facilities (35.75% versus 25.35%, p < 0.001) and fewer to home (50.24% versus 66.64%, p < 0.001) than matched controls. Incidence of readmission for any reason (65.70% versus 60.72%, p = 0.036), stroke (6.28% versus 2.34%, p < 0.001), and MACE (20.53% versus 16.51%, p = 0.032) was higher in the neurological cohort post-discharge. Per Kaplan-Meier univariate survival curve analysis, such patients in the neurological cohort were more likely to die post-discharge compared to controls (hazard ratio: 2.346, (95% confidence interval (CI) [1.586, 3.470]; p < 0.001)). Across both cohorts, the major causes of death post-discharge were heart disease (13.79% neurological, 15.38% control), sepsis (8.63%, 17.58%), influenza and pneumonia (13.79%, 9.89%), COVID-19 (10.34%, 7.69%), and acute respiratory distress syndrome (ARDS) (10.34%, 6.59%). Factors associated with mortality after leaving the hospital involved the neurological cohort (odds ratio (OR): 1.802 (95% CI [1.237, 2.608]; p = 0.002)), discharge disposition (OR: 1.508 (95% CI [1.276, 1.775]; p < 0.001)), congestive heart failure (OR: 2.281 (95% CI [1.429, 3.593]; p < 0.001)), higher COVID-19 severity score (OR: 1.177 (95% CI [1.062, 1.304]; p = 0.002)), and older age (OR: 1.027 (95% CI [1.010, 1.044]; p = 0.002)). There were no group differences in radiological findings, except that the neurological cohort showed significantly more age-adjusted brain volume loss (p = 0.045) than controls. The study's patient cohort was limited to patients infected with COVID-19 during the first wave of the pandemic, when hospitals were overburdened, vaccines were not yet available, and treatments were limited. Patient profiles might differ when interrogating subsequent waves. CONCLUSIONS Patients with COVID-19 with neurological manifestations had worse long-term outcomes compared to matched controls. These findings raise awareness and the need for closer monitoring and timely interventions for patients with COVID-19 with neurological manifestations, as their disease course involving initial neurological manifestations is associated with enhanced morbidity and mortality.
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Affiliation(s)
- Anna Eligulashvili
- Department of Radiology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Moshe Gordon
- Department of Radiology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Jimmy S. Lee
- Department of Radiology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Jeylin Lee
- Department of Radiology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Shiv Mehrotra-Varma
- Department of Radiology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Jai Mehrotra-Varma
- Department of Radiology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Kevin Hsu
- Department of Radiology, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Imanyah Hilliard
- Department of Radiology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Kristen Lee
- Department of Radiology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Arleen Li
- Department of Radiology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Muhammed Amir Essibayi
- Department of Neurological Surgery, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Judy Yee
- Department of Radiology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - David J. Altschul
- Department of Neurological Surgery, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Emad Eskandar
- Department of Neurological Surgery, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Mark F. Mehler
- Department of Neurology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Tim Q. Duong
- Department of Radiology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
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Gray R, Ryan MA, Mehta V. Volume and Practice-Setting Shift of Laryngology Procedures During the COVID-19 Pandemic: A Reg-ENT Database Analysis. OTO Open 2024; 8:e128. [PMID: 38590586 PMCID: PMC11000131 DOI: 10.1002/oto2.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/03/2024] [Indexed: 04/10/2024] Open
Abstract
Objective The onset of the coronavirus disease 2019 (COVID-19) pandemic changed practice patterns throughout medicine. The purpose of this study is to evaluate changes in the volume and location setting of laryngology procedures after the onset of COVID-19. Study Design Retrospective database cohort study. Setting Reg-ENT registry. Methods Retrospective review from 2017 to 2022 of patients who underwent a laryngology procedure identified by procedure code categorized by site of service code-"ambulatory surgical" versus "office" setting. Based on March 2020 as the cutoff point, the procedures were designated as pre-COVID versus COVID time period. Results A total of 5989 patients underwent laryngology procedures. Forty-two percent more procedures were performed in the COVID period (n = 3780) versus pre-COVID (n = 2209). Pre-COVID, the procedure distribution between office and ambulatory surgical setting was 70% (n = 1546) compared with 30% (663). This shifted to 77% (n = 2920) and 23% (n = 860) during COVID, P = .9. The most common diagnoses associated with laryngology procedures during the study period were vocal fold paralysis 47% (n = 2831), dysphonia 33% (n = 1392), and laryngotracheal stenosis 14% (n = 838). These trends remained in both pre-COVID and COVID time periods. After the start of the pandemic, among patients undergoing laryngology procedures, there was a 93% increase (n = 284-549) in the diagnosis of laryngotracheal stenosis, 70% increase (n = 520-882 patients) in dysphonia and 69% increase (n = 1054-1777) in vocal fold paralysis. Conclusion An increase in laryngology procedures performed after the onset of the COVID-19 pandemic was identified with an overall procedural shift to the office-setting.
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Affiliation(s)
- Raluca Gray
- Department of Otolaryngology–Head and Neck SurgeryUniversity of MinnesotaMinneapolisMinnesotaUSA
| | | | - Vikas Mehta
- Department of OtolaryngologyMontefiore Medical Center/Albert Einstein College of MedicineBronxNew YorkUSA
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30
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Kibria MK, Ali MA, Yaseen M, Khan IA, Bhat MA, Islam MA, Mahumud RA, Mollah MNH. Discovery of Bacterial Key Genes from 16S rRNA-Seq Profiles That Are Associated with the Complications of SARS-CoV-2 Infections and Provide Therapeutic Indications. Pharmaceuticals (Basel) 2024; 17:432. [PMID: 38675393 PMCID: PMC11053588 DOI: 10.3390/ph17040432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
SARS-CoV-2 infections, commonly referred to as COVID-19, remain a critical risk to both human life and global economies. Particularly, COVID-19 patients with weak immunity may suffer from different complications due to the bacterial co-infections/super-infections/secondary infections. Therefore, different variants of alternative antibacterial therapeutic agents are required to inhibit those infection-causing drug-resistant pathogenic bacteria. This study attempted to explore these bacterial pathogens and their inhibitors by using integrated statistical and bioinformatics approaches. By analyzing bacterial 16S rRNA sequence profiles, at first, we detected five bacterial genera and taxa (Bacteroides, Parabacteroides, Prevotella Clostridium, Atopobium, and Peptostreptococcus) based on differentially abundant bacteria between SARS-CoV-2 infection and control samples that are significantly enriched in 23 metabolic pathways. A total of 183 bacterial genes were found in the enriched pathways. Then, the top-ranked 10 bacterial genes (accB, ftsB, glyQ, hldD, lpxC, lptD, mlaA, ppsA, ppc, and tamB) were selected as the pathogenic bacterial key genes (bKGs) by their protein-protein interaction (PPI) network analysis. Then, we detected bKG-guided top-ranked eight drug molecules (Bemcentinib, Ledipasvir, Velpatasvir, Tirilazad, Acetyldigitoxin, Entreatinib, Digitoxin, and Elbasvir) by molecular docking. Finally, the binding stability of the top-ranked three drug molecules (Bemcentinib, Ledipasvir, and Velpatasvir) against three receptors (hldD, mlaA, and lptD) was investigated by computing their binding free energies with molecular dynamic (MD) simulation-based MM-PBSA techniques, respectively, and was found to be stable. Therefore, the findings of this study could be useful resources for developing a proper treatment plan against bacterial co-/super-/secondary-infection in SARS-CoV-2 infections.
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Affiliation(s)
- Md. Kaderi Kibria
- Bioinformatics Laboratory, Department of Statistics, University of Rajshahi, Rajshahi 6205, Bangladesh; (M.K.K.); (M.A.A.); (M.A.I.)
- Department of Statistics, Hajee Mohammad Danesh Science and Technology University, Dinajpur 5200, Bangladesh
| | - Md. Ahad Ali
- Bioinformatics Laboratory, Department of Statistics, University of Rajshahi, Rajshahi 6205, Bangladesh; (M.K.K.); (M.A.A.); (M.A.I.)
- Department of Chemistry, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Muhammad Yaseen
- Institute of Chemical Sciences, University of Swat, Main Campus, Charbagh 19130, Pakistan;
| | - Imran Ahmad Khan
- Department of Chemistry, Government College University, Faisalabad 38000, Pakistan;
| | - Mashooq Ahmad Bhat
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh 11421, Saudi Arabia;
| | - Md. Ariful Islam
- Bioinformatics Laboratory, Department of Statistics, University of Rajshahi, Rajshahi 6205, Bangladesh; (M.K.K.); (M.A.A.); (M.A.I.)
| | - Rashidul Alam Mahumud
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia;
| | - Md. Nurul Haque Mollah
- Bioinformatics Laboratory, Department of Statistics, University of Rajshahi, Rajshahi 6205, Bangladesh; (M.K.K.); (M.A.A.); (M.A.I.)
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Hammoudi Halat D, Ayoub Moubareck C. Hospital-acquired and ventilator-associated pneumonia caused by multidrug-resistant Gram-negative pathogens: Understanding epidemiology, resistance patterns, and implications with COVID-19. F1000Res 2024; 12:92. [PMID: 38915769 PMCID: PMC11195619 DOI: 10.12688/f1000research.129080.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2024] [Indexed: 06/26/2024] Open
Abstract
The ongoing spread of antimicrobial resistance has complicated the treatment of bacterial hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). Gram-negative pathogens, especially those with multidrug-resistant profiles, including Escherichia coli, Klebsiella pneumoniae, Enterobacter spp., Pseudomonas aeruginosa, and Acinetobacter spp., are important culprits in this type of infections. Understanding the determinants of resistance in pathogens causing pneumonia is ultimately stressing, especially in the shadows of the COVID-19 pandemic, when bacterial lung infections are considered a top priority that has become urgent to revise. Globally, the increasing prevalence of these pathogens in respiratory samples represents a significant infection challenge, with major limitations of treatment options and poor clinical outcomes. This review will focus on the epidemiology of HAP and VAP and will present the roles and the antimicrobial resistance patterns of implicated multidrug-resistant (MDR) Gram-negative pathogens like carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Pseudomonas aeruginosa (CRPA), carbapenem-resistant Enterobacterales (CRE), as well as colistin-resistant Gram-negative pathogens and extended-spectrum β-lactamase (ESBL)-producing Enterobacterales. While emerging from the COVID-19 pandemic, perspectives and conclusions are drawn from findings of HAP and VAP caused by MDR Gram-negative bacteria in patients with COVID-19.
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32
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Shirvani M, Vaziri S, Akrami MR, Sarmasti A, Hassanpour K, Akrami A. Evaluating the therapeutic effects of isotretinoin on patients with coronavirus disease 2019 (COVID-19): A controlled open-label clinical trial. Heliyon 2024; 10:e26685. [PMID: 38463889 PMCID: PMC10920163 DOI: 10.1016/j.heliyon.2024.e26685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/10/2023] [Accepted: 02/18/2024] [Indexed: 03/12/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19) is still a global health issue with no certain treatment option. So far, various treatments have been suggested among which one can mention isotretinoin. The aim of the present study was to investigate the potential of this medication as a side treatment for COVID-19. This open-label controlled clinical trial with the approval ID of IRCT20190624043993N3 was conducted in Farabi Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. Considering the inclusion and exclusion criteria, 52 patients diagnosed with COVID-19 were enrolled. The control group only received standard of care (SOC) treatment while the intervention arm received 40 mg per day of isotretinoin along with the SOC. The patients were followed until discharge. The results showed no death among the groups. The hospitalization duration in the intervention and SOC groups were 5.1 ± 2.29 and 5.1 ± 3.44 days, respectively with no statistical difference (P = 0.98). Moreover, the SpO2, pulse rate, respiratory rate, and blood pressure also showed no statistical difference neither at admission nor upon discharge (P > 0.05). The laboratory investigations showed that white blood cells, absolute lymphocyte count, hemoglobin value, and platelet count did not differ between the groups at admission or upon discharge (P > 0.05). According to the results, it seems that isotretinoin didn't act as a potent side therapy in patients with COVID-19. However, due to the small sample size, we suggest further investigations.
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Affiliation(s)
- Maria Shirvani
- Department of Infectious Diseases, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Siavash Vaziri
- Department of Infectious Diseases, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Reza Akrami
- Department of Neurosurgery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Azar Sarmasti
- School of Nursing, Shahid Beheshti Medical University, Tehran, Iran
| | - Kamyab Hassanpour
- School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ali Akrami
- Department of Neurosurgery, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Tang N, Yang Y, Xie Y, Yang G, Wang Q, Li C, Liu Z, Huang JA. CD274 (PD-L1) negatively regulates M1 macrophage polarization in ALI/ARDS. Front Immunol 2024; 15:1344805. [PMID: 38440722 PMCID: PMC10909908 DOI: 10.3389/fimmu.2024.1344805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/05/2024] [Indexed: 03/06/2024] Open
Abstract
Background Acute lung injury (ALI)/severe acute respiratory distress syndrome (ARDS) is a serious clinical syndrome characterized by a high mortality rate. The pathophysiological mechanisms underlying ALI/ARDS remain incompletely understood. Considering the crucial role of immune infiltration and macrophage polarization in the pathogenesis of ALI/ARDS, this study aims to identify key genes associated with both ALI/ARDS and M1 macrophage polarization, employing a combination of bioinformatics and experimental approaches. The findings could potentially reveal novel biomarkers for the diagnosis and management of ALI/ARDS. Methods Gene expression profiles relevant to ALI were retrieved from the GEO database to identify co-upregulated differentially expressed genes (DEGs). GO and KEGG analyses facilitated functional annotation and pathway elucidation. PPI networks were constructed to identify hub genes, and differences in immune cell infiltration were subsequently examined. The expression of hub genes in M1 versus M2 macrophages was evaluated using macrophage polarization datasets. The diagnostic utility of CD274 (PD-L1) for ARDS was assessed by receiver operating characteristic (ROC) analysis in a validation dataset. Experimental confirmation was conducted using two LPS-induced M1 macrophage models and an ALI mouse model. The role of CD274 (PD-L1) in M1 macrophage polarization and associated proinflammatory cytokine production was further investigated by siRNA-mediated silencing. Results A total of 99 co-upregulated DEGs were identified in two ALI-linked datasets. Enrichment analysis revealed that these DEGs were mainly involved in immune-inflammatory pathways. The following top 10 hub genes were identified from the PPI network: IL-6, IL-1β, CXCL10, CD274, CCL2, TLR2, CXCL1, CCL3, IFIT1, and IFIT3. Immune infiltration analysis revealed a significantly increased abundance of M1 and M2 macrophages in lung tissue from the ALI group compared to the control group. Subsequent analysis confirmed that CD274 (PD-L1), a key immunological checkpoint molecule, was highly expressed within M1 macrophages. ROC analysis validated CD274 (PD-L1) as a promising biomarker for the diagnosis of ARDS. Both in vitro and in vivo experiments supported the bioinformatics analysis and confirmed that the JAK-STAT3 pathway promotes CD274 (PD-L1) expression on M1 macrophages. Importantly, knockdown of CD274 (PD-L1) expression potentiated M1 macrophage polarization and enhanced proinflammatory cytokines production. Conclusion This study demonstrates a significant correlation between CD274 (PD-L1) and M1 macrophages in ALI/ARDS. CD274 (PD-L1) functions as a negative regulator of M1 polarization and the secretion of proinflammatory cytokines in macrophages. These findings suggest potential new targets for the diagnosis and treatment of ALI/ARDS.
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Affiliation(s)
- Nana Tang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
- Medical Intensive Care Unit, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Yang Yang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Respiratory Diseases, Soochow University, Suzhou, China
| | - Yifei Xie
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Respiratory Diseases, Soochow University, Suzhou, China
| | - Guohui Yang
- Medical Intensive Care Unit, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Qin Wang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Respiratory Diseases, Soochow University, Suzhou, China
| | - Chang Li
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Respiratory Diseases, Soochow University, Suzhou, China
| | - Zeyi Liu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Respiratory Diseases, Soochow University, Suzhou, China
| | - Jian-an Huang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Respiratory Diseases, Soochow University, Suzhou, China
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Lan L, Ni Y, Zhou Y, Fu L, Wu W, Li P, Yu H, Liang G, Luo F. PEEP-Induced Lung Recruitment Maneuver Combined with Prone Position for ARDS: A Single-Center, Prospective, Randomized Clinical Trial. J Clin Med 2024; 13:853. [PMID: 38337547 PMCID: PMC10856548 DOI: 10.3390/jcm13030853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
Background: Prone position (PP) and the positive end-expiratory pressure (PEEP)-induced lung recruitment maneuver (LRM) are both efficient in improving oxygenation and prognosis in patients with ARDS. The synergistic effect of PP combined with PEEP-induced LRM in patients with ARDS remains unclear. We aim to explore the effects of PP combined with PEEP-induced LRM on prognosis in patients with moderate to severe ARDS and the predicting role of lung recruitablity. Methods: Patients with moderate to severe ARDS were consecutively enrolled. The patients were prospectively assigned to either the intervention (PP with PEEP-induced LRM) or control groups (PP). The clinical outcomes, respiratory mechanics, and electric impedance tomography (EIT) monitoring results for the two groups were compared. Lung recruitablity (recruitment-to-inflation ratio: R/I) was measured during the PEEP-induced LRM procedure and was used for predicting the response to LRM. Results: Fifty-eight patients were included in the final analysis, among which 28 patients (48.2%) received PEEP-induced LRM combined with PP. PEEP-induced LRM enhanced the effect of PP by a significant improvement in oxygenation (∆PaO2/FiO2 75.8 mmHg vs. 4.75 mmHg, p < 0.001) and the compliance of respiratory system (∆Crs, 2 mL/cmH2O vs. -1 mL/cmH2O, p = 0.02) among ARDS patients. Based on the EIT measurement, PP combined with PEEP-induced LRM increased the ventilation distribution mainly in the dorsal region (5.0% vs. 2.0%, p = 0.015). The R/I ratio was measured in 28 subjects. The higher R/I ratio was related to greater oxygenation improvement after LRM (Pearson's r = 0.4; p = 0.034). Conclusions: In patients with moderate to severe ARDS, PEEP-induced LRM combined with PP can improve oxygenation and dorsal ventilation distribution. R/I can be useful to predict responses to LRM.
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Affiliation(s)
- Lan Lan
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610064, China; (L.L.); (Y.N.); (Y.Z.); (L.F.); (W.W.); (P.L.); (H.Y.); (G.L.)
- State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu 610064, China
| | - Yuenan Ni
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610064, China; (L.L.); (Y.N.); (Y.Z.); (L.F.); (W.W.); (P.L.); (H.Y.); (G.L.)
- State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu 610064, China
| | - Yubei Zhou
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610064, China; (L.L.); (Y.N.); (Y.Z.); (L.F.); (W.W.); (P.L.); (H.Y.); (G.L.)
- State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu 610064, China
| | - Linxi Fu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610064, China; (L.L.); (Y.N.); (Y.Z.); (L.F.); (W.W.); (P.L.); (H.Y.); (G.L.)
- State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu 610064, China
| | - Wentao Wu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610064, China; (L.L.); (Y.N.); (Y.Z.); (L.F.); (W.W.); (P.L.); (H.Y.); (G.L.)
- State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu 610064, China
| | - Ping Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610064, China; (L.L.); (Y.N.); (Y.Z.); (L.F.); (W.W.); (P.L.); (H.Y.); (G.L.)
- State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu 610064, China
| | - He Yu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610064, China; (L.L.); (Y.N.); (Y.Z.); (L.F.); (W.W.); (P.L.); (H.Y.); (G.L.)
| | - Guopeng Liang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610064, China; (L.L.); (Y.N.); (Y.Z.); (L.F.); (W.W.); (P.L.); (H.Y.); (G.L.)
- State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu 610064, China
| | - Fengming Luo
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610064, China; (L.L.); (Y.N.); (Y.Z.); (L.F.); (W.W.); (P.L.); (H.Y.); (G.L.)
- State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu 610064, China
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Song J, Choi S, Jeong S, Chang JY, Park SJ, Oh YH, Kim JS, Cho Y, Byeon K, Choi JY, Lee S, Park SM. Protective effect of vaccination on the risk of cardiovascular disease after SARS-CoV-2 infection. Clin Res Cardiol 2024; 113:235-245. [PMID: 37522901 DOI: 10.1007/s00392-023-02271-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 07/18/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE This study investigated the incidence of CVDs after COVID-19. METHODS Data for 2,146,130 infected people were collected, including the vaccination status. COVID-19 patients were classified according to the number of the received vaccine doses: no, first, second, and ≥ third. To evaluate the short-term risk of CVDs after infection, adjusted odds ratios (aOR) and 95% confidence intervals (CIs) were calculated by multivariable logistic regression analysis after adjustments for covariates. RESULTS Compared to non-infected people, aORs [95% CIs; p value] for CVDs within a month after infection were 2.80 [2.64-2.97; < 0.001] in overall infected people and 4.62 [4.23-5.05; < 0.001], 4.20 [3.45-5.11; < 0.001], 2.79 [2.55-3.05; < 0.001], and 2.07 [1.91-2.24; < 0.001] in those who were infected after receiving no, first, second, and ≥ third vaccine doses, respectively. Among participants who received second doses of vaccine prior to contracting COVID-19, the aOR in those vaccinated with only the mRNA-based vaccine (BNT162b2 and mRNA-1273; Reference) was lower than those vaccinated with the virus-derived vaccine (ChAdOx1 nCov-19 and AD26.COV2-S; aOR 1.25 [1.06-1.48; < 0.01]). CONCLUSION Although COVID-19 increased the CVD risk, the inverse association in the risk of CVDs according to vaccine doses was significant in a dose-response manner. Our findings suggest that ≥ second doses of the COVID-19 vaccine prevent the risk of CVDs after SARS-CoV-2 infection.
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Affiliation(s)
- Jihun Song
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Republic of Korea
| | - Seulggie Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seogsong Jeong
- Department of Biomedical Informatics, School of Medicine, CHA University, Seongnam, Republic of Korea
| | - Joo Young Chang
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Republic of Korea
| | - Sun Jae Park
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Republic of Korea
| | - Yun Hwan Oh
- Department of Family Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Republic of Korea
| | - Ji Soo Kim
- International Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yoosun Cho
- School of Medicine, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul, Republic of Korea
| | - Kyeonghyang Byeon
- Big Data Department, National Health Insurance Service, Wonju, Republic of Korea
| | - Jun Yong Choi
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seju Lee
- Division of Infectious Diseases, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - Sang Min Park
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Republic of Korea.
- Department of Family Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
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Chu Y, Li M, Sun M, Wang J, Xin W, Xu L. Gene crosstalk between COVID-19 and preeclampsia revealed by blood transcriptome analysis. Front Immunol 2024; 14:1243450. [PMID: 38259479 PMCID: PMC10800816 DOI: 10.3389/fimmu.2023.1243450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 12/14/2023] [Indexed: 01/24/2024] Open
Abstract
Background The extensive spread of coronavirus disease 2019 (COVID-19) has led to a rapid increase in global mortality. Preeclampsia is a commonly observed pregnancy ailment characterized by high maternal morbidity and mortality rates, in addition to the restriction of fetal growth within the uterine environment. Pregnant individuals afflicted with vascular disorders, including preeclampsia, exhibit an increased susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection via mechanisms that have not been fully delineated. Additionally, the intricate molecular mechanisms underlying preeclampsia and COVID-19 have not been fully elucidated. This study aimed to discern commonalities in gene expression, regulators, and pathways shared between COVID-19 and preeclampsia. The objective was to uncover potential insights that could contribute to novel treatment strategies for both COVID-19 and preeclampsia. Method Transcriptomic datasets for COVID-19 peripheral blood (GSE152418) and preeclampsia blood (GSE48424) were initially sourced from the Gene Expression Omnibus (GEO) database. Subsequent to that, we conducted a subanalysis by selecting females from the GSE152418 dataset and employed the "Deseq2" package to identify genes that exhibited differential expression. Simultaneously, the "limma" package was applied to identify differentially expressed genes (DEGs) in the preeclampsia dataset (GSE48424). Following that, an intersection analysis was conducted to identify the common DEGs obtained from both the COVID-19 and preeclampsia datasets. The identified shared DEGs were subsequently utilized for functional enrichment analysis, transcription factor (TF) and microRNAs (miRNA) prediction, pathway analysis, and identification of potential candidate drugs. Finally, to validate the bioinformatics findings, we collected peripheral blood mononuclear cell (PBMC) samples from healthy individuals, COVID-19 patients, and Preeclampsia patients. The abundance of the top 10 Hub genes in both diseases was assessed using real-time quantitative polymerase chain reaction (RT-qPCR). Result A total of 355 overlapping DEGs were identified in both preeclampsia and COVID-19 datasets. Subsequent ontological analysis, encompassing Gene Ontology (GO) functional assessment and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis, revealed a significant association between the two conditions. Protein-protein interactions (PPIs) were constructed using the STRING database. Additionally, the top 10 hub genes (MRPL11, MRPS12, UQCRH, ATP5I, UQCRQ, ATP5D, COX6B1, ATP5O, ATP5H, NDUFA6) were selected based on their ranking scores using the degree algorithm, which considered the shared DEGs. Moreover, transcription factor-gene interactions, protein-drug interactions, co-regulatory networks of DEGs and miRNAs, and protein-drug interactions involving the shared DEGs were also identified in the datasets. Finally, RT-PCR results confirmed that 10 hub genes do exhibit distinct expression profiles in the two diseases. Conclusion This study successfully identified overlapping DEGs, functional pathways, and regulatory elements between COVID-19 and preeclampsia. The findings provide valuable insights into the shared molecular mechanisms and potential therapeutic targets for both diseases. The validation through RT-qPCR further supports the distinct expression profiles of the identified hub genes in COVID-19 and preeclampsia, emphasizing their potential roles as biomarkers or therapeutic targets in these conditions.
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Affiliation(s)
| | | | | | | | | | - Lin Xu
- Department of Obstetrics, the Affiliated Hospital of Qingdao University, Qingdao, China
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Yang B, Pan M, Feng K, Wu X, Yang F, Yang P. Identification of the feature genes involved in cytokine release syndrome in COVID-19. PLoS One 2024; 19:e0296030. [PMID: 38165854 PMCID: PMC10760774 DOI: 10.1371/journal.pone.0296030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/04/2023] [Indexed: 01/04/2024] Open
Abstract
OBJECTIVE Screening of feature genes involved in cytokine release syndrome (CRS) from the coronavirus disease 19 (COVID-19). METHODS The data sets related to COVID-19 were retrieved using Gene Expression Omnibus (GEO) database, the differentially expressed genes (DEGs) related to CRS were analyzed with R software and Venn diagram, and the biological processes and signaling pathways involved in DEGs were analyzed with GO and KEGG enrichment. Core genes were screened using Betweenness and MCC algorithms. GSE164805 and GSE171110 dataset were used to verify the expression level of core genes. Immunoinfiltration analysis was performed by ssGSEA algorithm in the GSVA package. The DrugBank database was used to analyze the feature genes for potential therapeutic drugs. RESULTS This study obtained 6950 DEGs, of which 971 corresponded with CRS disease genes (common genes). GO and KEGG enrichment showed that multiple biological processes and signaling pathways associated with common genes were closely related to the inflammatory response. Furthermore, the analysis revealed that transcription factors that regulate these common genes are also involved in inflammatory response. Betweenness and MCC algorithms were used for common gene screening, yielding seven key genes. GSE164805 and GSE171110 dataset validation revealed significant differences between the COVID-19 and normal controls in four core genes (feature genes), namely IL6R, TLR4, TLR2, and IFNG. The upregulated IL6R, TLR4, and TLR2 genes were mainly involved in the Toll-like receptor signaling pathway of the inflammatory pathway, while the downregulated IFNG genes primarily participated in the necroptosis and JAK-STAT signaling pathways. Moreover, immune infiltration analysis indicated that higher expression of these genes was associated with immune cell infiltration that mediates inflammatory response. In addition, potential therapeutic drugs for these four feature genes were identified via the DrugBank database. CONCLUSION IL6R, TLR4, TLR2, and IFNG may be potential pathogenic genes and therapeutic targets for the CRS associated with COVID-19.
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Affiliation(s)
- Bing Yang
- The Second Affiliated Hospital, Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Meijun Pan
- The Second Affiliated Hospital, Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Kai Feng
- The Second Affiliated Hospital, Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Xue Wu
- The Second Affiliated Hospital, Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Fang Yang
- The Second Affiliated Hospital, Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Peng Yang
- The Second Affiliated Hospital, Guizhou University of Traditional Chinese Medicine, Guiyang, China
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Kyu Oh T, Song IA. Extracorporeal Membrane Oxygenation Support and Critically Ill COVID-19 Patient Outcomes: A Population-Based Cohort Study. ASAIO J 2024; 70:68-74. [PMID: 37788479 DOI: 10.1097/mat.0000000000002065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
We selected critically ill patients with coronavirus disease 2019 (COVID-19) who were receiving extracorporeal membrane oxygenation (ECMO) support and had been transferred to experienced centers. Thus, we aimed to evaluate factors that were associated with receiving ECMO support and factors that were associated with patient mortality. Using data from the National Health Insurance Service and Korea Disease Control and Prevention Agency in South Korea, adult patients admitted to an intensive care unit from October 8, 2020, to December 31, 2021, with a main diagnosis of COVID-19 were included. They were divided into two groups: ECMO group (n = 455) and non-ECMO group (n = 12,648). Receiving ECMO support was less associated with old age [odds ratio (OR), 0.95; 95% confidence interval (CI), 0.94-0.96; p < 0.001], underlying severe disabilities (OR, 0.49; 95% CI, 0.29-0.83; p = 0.008), and booster vaccination status (second: OR, 0.61; 95% CI, 0.39-0.94; p = 0.024; third: OR, 0.40; 95% CI, 0.25-0.65; p < 0.001). In addition, after adjusting for various variables, low mortality in patients with ECMO support was associated with having previously received a second booster vaccination (OR, 0.33; 95% CI, 0.14-0.77; p = 0.010). Vaccination and booster therapy may lower the need for ECMO support and lower mortality among critically ill patients with COVID-19 with ECMO support.
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Affiliation(s)
- Tak Kyu Oh
- From the Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, South Korea
| | - In-Ae Song
- From the Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, South Korea
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Manole C, Dediu-Anghel M, Baroiu L, Ștefanopol IA, Nechifor A, Niculet E, Mihailov R, Moroianu LA, Voinescu DC, Firescu D. Efficiency of continuous positive airway pressure and high-flow nasal oxygen therapy in critically ill patients with COVID-19. J Int Med Res 2024; 52:3000605231222151. [PMID: 38194495 PMCID: PMC10777799 DOI: 10.1177/03000605231222151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/06/2023] [Indexed: 01/11/2024] Open
Abstract
OBJECTIVE Critically ill patients with COVID-19 develop acute respiratory distress syndrome characterized by relatively well-preserved pulmonary compliance but severe hypoxemia. The challenge in managing such patients lies in optimizing oxygenation, which can be achieved through either high oxygen flow or noninvasive mechanical ventilation. This study was performed to compare the efficiency of two methods of noninvasive oxygen therapy: continuous positive airway pressure (CPAP) and high-flow nasal oxygen therapy (HFNO). METHODS This retrospective cohort study involved 668 patients hospitalized in the intensive care unit (ICU) of the "Sf. Apostol Andrei" Emergency Clinical Hospital, Galati, Romania from 1 April 2020 to 31 March 2021 (CPAP, n = 108; HFNO, n = 108). RESULTS Mortality was significantly lower in the CPAP and HFNO groups than in the group of patients who underwent intubation and mechanical ventilation after ICU admission. Mortality in the ICU was not significantly different between the CPAP and HFNO groups. CONCLUSIONS HFNO and CPAP represent efficient alternative therapies for patients with severe COVID-19 whose respiratory treatment has failed. Studies involving larger groups of patients are necessary to establish a personalized, more complex management modality for critically ill patients with COVID-19.
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Affiliation(s)
- Corina Manole
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galat,i, Romania
- Intensive Care Department, “Sfantul Apostol Andrei” Emergency Clinical Hospital, Galati, Romania
| | - Mihaela Dediu-Anghel
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galat,i, Romania
- Intensive Care Department, “Sfantul Apostol Andrei” Emergency Clinical Hospital, Galati, Romania
| | - Liliana Baroiu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galat,i, Romania
- Infectious Diseases Department, “Sf. Cuv. Parascheva” Infectious Diseases Clinical Hospital, Galati, Romania
| | - Ioana Anca Ștefanopol
- Clinical Surgical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galat,i, Romania
- Surgical Department, “Sfantul Ioan” Emergency Clinical Hospital for Children, Galati, Romania
| | - Alexandru Nechifor
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galat,i, Romania
- Multidisciplinary Integrated Center of Dermatological Interface Research Center (MIC-DIR), “Dunărea de Jos” University of Galat,i, Romania
| | - Elena Niculet
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galat,i, Romania
- Pathology Department, “Sfantul Apostol Andrei” Emergency Clinical Hospital, Galati, Romania
| | - Raul Mihailov
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galat,i, Romania
- Surgical Department, “Sfantul Apostol Andrei” Emergency Clinical Hospital, Galati, Romania
| | - Lavinia Alexandra Moroianu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galat,i, Romania
- Psychiatry Department, “Elisabeta Doamna” Psychiatric Clinical Hospital, Galati, Romania
| | - Doina Carina Voinescu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galat,i, Romania
- Medical Department, “Sfantul Apostol Andrei” Emergency County Clinical Hospital, Galati, Romania
| | - Dorel Firescu
- Clinical Surgical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galat,i, Romania
- Surgical Department, “Sfantul Apostol Andrei” Emergency Clinical Hospital, Galati, Romania
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Kurakh AV, Ahii VI, Chopey IV, Hechko MM, Chubirko KI. Characteristics of brain lesions found using MRI imaging in patients with post-COVID with signs of cognitive decline. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2024; 77:383-386. [PMID: 38691776 DOI: 10.36740/wlek202403102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
OBJECTIVE Aim: To describe and evaluate abnormalities of the brain in post-COVID patients with neurologic symptoms and cognitive deficits using MRI imaging of the brain. PATIENTS AND METHODS Materials and Methods: We included 21 patients with a previous positive PCR testing for SARS-CoV-2 and one or more of the following symptoms: memory and cognitive decline, dizziness, anxiety, depression, chronic headaches. All patients had MRI imaging done at onset of symptoms, but after at least 1 year after positive testing for COVID-19 based on the patient's previous medical history. RESULTS Results: All of the patients complained of lack of concentration, forgetfulness, hard to process information. 15 patients suffered from confusion, 10 from anxiety. Of the 21 patients 14 had isolated chronic headaches, 3 had isolated dizziness, 4 patients had both symptoms upon inclusion. All patients underwent MRI imaging as a part of the diagnostic workup and had varying degrees of neurodegeneration. CONCLUSION Conclusions: Our data correlates with existing research and shows tendency for cognitive decline in post-COVID patients. This provides groundwork for further research to determine correlation between acceleration of neurodegeneration and post-COVID.
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Bagnato G, Imbalzano E, Ioppolo C, La Rosa D, Chiappalone M, De Gaetano A, Viapiana V, Irrera N, Nassisi V, Tringali MC, Singh EB, Falcomatà N, Russo V, Neal Roberts W, Di Micco P, Versace AG. Stratification of COVID-19 Patients with Moderate-to-Severe Hypoxemic Respiratory Failure for Response to High-Flow Nasal Cannula: A Retrospective Observational Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:71. [PMID: 38256332 PMCID: PMC10819134 DOI: 10.3390/medicina60010071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/12/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024]
Abstract
Background and Objectives: In patients with COVID-19, high-flow nasal cannula (HFNC) and continuous positive airway pressure (CPAP) are widely applied as initial treatments for moderate-to-severe acute hypoxemic respiratory failure. The aim of the study was to assess which respiratory supports improve 28-day mortality and to identify a predictive index of treatment response. Materials and Methods: This is a single-center retrospective observational study including 159 consecutive adult patients with COVID-19 and moderate-to-severe hypoxemic acute respiratory failure. Results: A total of 159 patients (82 in the CPAP group and 77 in the HFNC group) were included in the study. Mortality within 28 days was significantly lower with HFNC compared to CPAP (16.8% vs. 50%), while ICU admission and tracheal intubation within 28 days were significantly higher with CPAP compared to HFNC treatment (32% vs. 13%). We identified an index for survival in HFNC by including three variables easily available at admission (LDH, age, and respiratory rate) and the PaO2/FiO2 ratio at 48 h. The index showed high discrimination for survival with an AUC of 0.88, a negative predictive value of 86%, and a positive predictive value of 95%. Conclusions: Treatment with HFNC appears to be associated with greater survival and fewer ICU admission than CPAP. LDH, respiratory rate, age, and PaO2/FiO2 at 48 h were independently associated with survival and an index based on these variables allows for the prediction of treatment success and the assessment of patient allocation to the appropriate intensity of care after 48 h. Further research is warranted to determine effects on other outcomes and to assess the performance of the index in larger cohorts.
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Affiliation(s)
- Gianluca Bagnato
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.B.); (E.I.); (C.I.); (D.L.R.); (M.C.); (A.D.G.); (N.I.); (V.N.); (M.C.T.); (E.B.S.); (N.F.); (A.G.V.)
| | - Egidio Imbalzano
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.B.); (E.I.); (C.I.); (D.L.R.); (M.C.); (A.D.G.); (N.I.); (V.N.); (M.C.T.); (E.B.S.); (N.F.); (A.G.V.)
| | - Carmelo Ioppolo
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.B.); (E.I.); (C.I.); (D.L.R.); (M.C.); (A.D.G.); (N.I.); (V.N.); (M.C.T.); (E.B.S.); (N.F.); (A.G.V.)
| | - Daniela La Rosa
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.B.); (E.I.); (C.I.); (D.L.R.); (M.C.); (A.D.G.); (N.I.); (V.N.); (M.C.T.); (E.B.S.); (N.F.); (A.G.V.)
| | - Marianna Chiappalone
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.B.); (E.I.); (C.I.); (D.L.R.); (M.C.); (A.D.G.); (N.I.); (V.N.); (M.C.T.); (E.B.S.); (N.F.); (A.G.V.)
| | - Alberta De Gaetano
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.B.); (E.I.); (C.I.); (D.L.R.); (M.C.); (A.D.G.); (N.I.); (V.N.); (M.C.T.); (E.B.S.); (N.F.); (A.G.V.)
| | - Valeria Viapiana
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.B.); (E.I.); (C.I.); (D.L.R.); (M.C.); (A.D.G.); (N.I.); (V.N.); (M.C.T.); (E.B.S.); (N.F.); (A.G.V.)
| | - Natasha Irrera
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.B.); (E.I.); (C.I.); (D.L.R.); (M.C.); (A.D.G.); (N.I.); (V.N.); (M.C.T.); (E.B.S.); (N.F.); (A.G.V.)
| | - Veronica Nassisi
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.B.); (E.I.); (C.I.); (D.L.R.); (M.C.); (A.D.G.); (N.I.); (V.N.); (M.C.T.); (E.B.S.); (N.F.); (A.G.V.)
| | - Maria Concetta Tringali
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.B.); (E.I.); (C.I.); (D.L.R.); (M.C.); (A.D.G.); (N.I.); (V.N.); (M.C.T.); (E.B.S.); (N.F.); (A.G.V.)
| | - Emanuele Balwinder Singh
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.B.); (E.I.); (C.I.); (D.L.R.); (M.C.); (A.D.G.); (N.I.); (V.N.); (M.C.T.); (E.B.S.); (N.F.); (A.G.V.)
| | - Nicola Falcomatà
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.B.); (E.I.); (C.I.); (D.L.R.); (M.C.); (A.D.G.); (N.I.); (V.N.); (M.C.T.); (E.B.S.); (N.F.); (A.G.V.)
| | - Vincenzo Russo
- Department of Medical Translational Sciences, Division of Cardiology, Monaldi Hospital, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | | | - Pierpaolo Di Micco
- Emergency Department, Rizzoli Hospital, Health Authority NA2, 80122 Napoli, Italy
| | - Antonio Giovanni Versace
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.B.); (E.I.); (C.I.); (D.L.R.); (M.C.); (A.D.G.); (N.I.); (V.N.); (M.C.T.); (E.B.S.); (N.F.); (A.G.V.)
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Kutsuzawa N, Ito Y, Kagawa S, Kohno C, Takiguchi H, Asano K. Dexamethasone restores TNFα-induced epithelial barrier dysfunction in primary rat alveolar epithelial cells. PLoS One 2023; 18:e0295684. [PMID: 38150443 PMCID: PMC10752552 DOI: 10.1371/journal.pone.0295684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 11/27/2023] [Indexed: 12/29/2023] Open
Abstract
Alveolar barrier dysfunction is one of the major pathophysiological changes in acute lung injury (ALI)/acute respiratory distress syndrome (ARDS). In ALI/ARDS, tumor necrosis factor-alpha (TNFα) disrupts the barriers of alveolar epithelium and endothelium. Glucocorticoids (GCs) exert anti-inflammatory effects and ameliorate pulmonary edema in ALI/ARDS. However, the involvement of GCs in the restoration of alveolar epithelial barrier dysfunction has not been extensively studied. Here, we elucidated that dexamethasone (Dex) restored TNFα-induced alveolar epithelial barrier dysfunction in vitro using primary rat alveolar epithelial cells isolated from Sprague-Dawley rats. Moreover, Dex promoted the alveolar epithelial cell barrier integrity by initiating GC receptor-mediated signaling via the downregulation of myosin light chain kinase (MLCK) expression and the dephosphorylation of myosin light chain (MLC) 2. Further investigation revealed that Dex enhanced the expression of zonula occludens-1 (ZO-1), a tight junction-related protein, at intercellular junction sites. These findings suggest that GCs strengthen the integrity of the alveolar epithelial barrier in ALI/ARDS via the GR-MLCK-pMLC2 axis.
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Affiliation(s)
- Naokata Kutsuzawa
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Yoko Ito
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Shizuko Kagawa
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Chinatsu Kohno
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Hiroto Takiguchi
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Koichiro Asano
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
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Yan J, Tang Z, Li Y, Wang H, Hsu JC, Shi M, Fu Z, Ji X, Cai W, Ni D, Qu J. Molybdenum Nanodots for Acute Lung Injury Therapy. ACS NANO 2023; 17:23872-23888. [PMID: 38084420 PMCID: PMC10760930 DOI: 10.1021/acsnano.3c08147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Acute respiratory disease syndrome (ARDS) is a common critical disease with high morbidity and mortality rates, yet specific and effective treatments for it are currently lacking. ARDS was especially apparent and rampant during the COVID-19 pandemic. Excess reactive oxygen species (ROS) production and an uncontrolled inflammatory response play a critical role in the disease progression of ARDS. Herein, we developed molybdenum nanodots (MNDs) as a functional nanomaterial with ultrasmall size, good biocompatibility, and excellent ROS scavenging ability for the treatment of acute lung injury (ALI). MNDs, which were administered intratracheally, significantly ameliorated lung oxidative stress, inflammatory response, protein permeability, and histological severity in ALI mice without inducing any safety issues. Importantly, transcriptomics analysis indicated that MNDs protected lung tissues by inhibiting the activation of the Nod-like receptor protein 3 (NLRP3)-dependent pyroptotic pathway. This work presents a promising therapeutic agent for patients suffering from ARDS.
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Affiliation(s)
- Jiayang Yan
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Shanghai 200025, China
| | - Zhongmin Tang
- Departments of Radiology and Medical Physics, University of Wisconsin, Madison, Wisconsin 53705, United States
| | - Yanan Li
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Shanghai 200025, China
| | - Han Wang
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jessica C Hsu
- Departments of Radiology and Medical Physics, University of Wisconsin, Madison, Wisconsin 53705, United States
| | - Mengmeng Shi
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Shanghai 200025, China
| | - Zi Fu
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Xiuru Ji
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Weibo Cai
- Departments of Radiology and Medical Physics, University of Wisconsin, Madison, Wisconsin 53705, United States
| | - Dalong Ni
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jieming Qu
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Shanghai 200025, China
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Liu X, Xiong W, Ye M, Lu T, Yuan K, Chang S, Han Y, Wang Y, Lu L, Bao Y. Non-coding RNAs expression in SARS-CoV-2 infection: pathogenesis, clinical significance, and therapeutic targets. Signal Transduct Target Ther 2023; 8:441. [PMID: 38057315 PMCID: PMC10700414 DOI: 10.1038/s41392-023-01669-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 09/12/2023] [Accepted: 09/28/2023] [Indexed: 12/08/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has been looming globally for three years, yet the diagnostic and treatment methods for COVID-19 are still undergoing extensive exploration, which holds paramount importance in mitigating future epidemics. Host non-coding RNAs (ncRNAs) display aberrations in the context of COVID-19. Specifically, microRNAs (miRNAs), long non-coding RNAs (lncRNAs), and circular RNAs (circRNAs) exhibit a close association with viral infection and disease progression. In this comprehensive review, an overview was presented of the expression profiles of host ncRNAs following SARS-CoV-2 invasion and of the potential functions in COVID-19 development, encompassing viral invasion, replication, immune response, and multiorgan deficits which include respiratory system, cardiac system, central nervous system, peripheral nervous system as well as long COVID. Furthermore, we provide an overview of several promising host ncRNA biomarkers for diverse clinical scenarios related to COVID-19, such as stratification biomarkers, prognostic biomarkers, and predictive biomarkers for treatment response. In addition, we also discuss the therapeutic potential of ncRNAs for COVID-19, presenting ncRNA-based strategies to facilitate the development of novel treatments. Through an in-depth analysis of the interplay between ncRNA and COVID-19 combined with our bioinformatic analysis, we hope to offer valuable insights into the stratification, prognosis, and treatment of COVID-19.
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Affiliation(s)
- Xiaoxing Liu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 100191, Beijing, China
| | - Wandi Xiong
- Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, 100871, Beijing, China
- Key Laboratory of Tropical Biological Resources of Ministry of Education, School of Pharmaceutical Sciences, Hainan University, 570228, Haikou, China
| | - Maosen Ye
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences & Yunnan Province, KIZ/CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences, 650204, Kunming, Yunnan, China
| | - Tangsheng Lu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, 100191, China
| | - Kai Yuan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 100191, Beijing, China
| | - Suhua Chang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 100191, Beijing, China
| | - Ying Han
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, 100191, China
| | - Yongxiang Wang
- Institute of Brain Science and Brain-inspired Research, Shandong First Medical University & Shandong Academy of Medical Sciences, 250117, Jinan, Shandong, China.
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
| | - Lin Lu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 100191, Beijing, China.
- Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, 100871, Beijing, China.
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, 100191, China.
| | - Yanping Bao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, 100191, China.
- Institute of Brain Science and Brain-inspired Research, Shandong First Medical University & Shandong Academy of Medical Sciences, 250117, Jinan, Shandong, China.
- School of Public Health, Peking University, 100191, Beijing, China.
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Perry A, Wheeler-Martin K, Terlizzi K, Krawczyk N, Jent V, Hasin DS, Neighbors C, Mannes ZL, Doan LV, Pamplin II JR, Townsend TN, Crystal S, Martins SS, Cerdá M. Evaluating chronic pain as a risk factor for COVID-19 complications among New York State Medicaid beneficiaries: a retrospective claims analysis. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:1296-1305. [PMID: 37651585 PMCID: PMC10690846 DOI: 10.1093/pm/pnad121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 08/10/2023] [Accepted: 08/28/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE To assess whether chronic pain increases the risk of COVID-19 complications and whether opioid use disorder (OUD) differentiates this risk among New York State Medicaid beneficiaries. DESIGN, SETTING, AND SUBJECTS This was a retrospective cohort study of New York State Medicaid claims data. We evaluated Medicaid claims from March 2019 through December 2020 to determine whether chronic pain increased the risk of COVID-19 emergency department (ED) visits, hospitalizations, and complications and whether this relationship differed by OUD status. We included beneficiaries 18-64 years of age with 10 months of prior enrollment. Patients with chronic pain were propensity score-matched to those without chronic pain on demographics, utilization, and comorbidities to control for confounders and were stratified by OUD. Complementary log-log regressions estimated hazard ratios (HRs) of COVID-19 ED visits and hospitalizations; logistic regressions estimated odds ratios (ORs) of hospital complications and readmissions within 0-30, 31-60, and 61-90 days. RESULTS Among 773 880 adults, chronic pain was associated with greater hazards of COVID-related ED visits (HR = 1.22 [95% CI: 1.16-1.29]) and hospitalizations (HR = 1.19 [95% CI: 1.12-1.27]). Patients with chronic pain and OUD had even greater hazards of hospitalization (HR = 1.25 [95% CI: 1.07-1.47]) and increased odds of hepatic- and cardiac-related events (OR = 1.74 [95% CI: 1.10-2.74]). CONCLUSIONS Chronic pain increased the risk of COVID-19 ED visits and hospitalizations. Presence of OUD further increased the risk of COVID-19 hospitalizations and the odds of hepatic- and cardiac-related events. Results highlight intersecting risks among a vulnerable population and can inform tailored COVID-19 management.
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Affiliation(s)
- Allison Perry
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, United States
| | - Katherine Wheeler-Martin
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, United States
| | - Kelly Terlizzi
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, United States
| | - Noa Krawczyk
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, United States
| | - Victoria Jent
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, United States
| | - Deborah S Hasin
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY 10032, United States
| | - Charles Neighbors
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, United States
| | - Zachary L Mannes
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY 10032, United States
| | - Lisa V Doan
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Grossman School of Medicine, New York, NY 10016, United States
| | - John R Pamplin II
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, United States
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY 10032, United States
| | - Tarlise N Townsend
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, United States
| | - Stephen Crystal
- Center for Health Services Research, Rutgers Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ 08901, United States
| | - Silvia S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY 10032, United States
| | - Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, United States
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Wei D, Xie Y, Liu X, Chen R, Zhou M, Zhang X, Qu J. Pathogen evolution, prevention/control strategy and clinical features of COVID-19: experiences from China. Front Med 2023; 17:1030-1046. [PMID: 38157194 DOI: 10.1007/s11684-023-1043-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/23/2023] [Indexed: 01/03/2024]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was reported at the end of 2019 as a worldwide health concern causing a pandemic of unusual viral pneumonia and many other organ damages, which was defined by the World Health Organization as coronavirus disease 2019 (COVID-19). The pandemic is considered a significant threat to global public health till now. In this review, we have summarized the lessons learnt during the emergence and spread of SARS-CoV-2, including its prototype and variants. The overall clinical features of variants of concern (VOC), heterogeneity in the clinical manifestations, radiology and pathology of COVID-19 patients are also discussed, along with advances in therapeutic agents.
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Affiliation(s)
- Dong Wei
- Department of Infectious Diseases, Research Laboratory of Clinical Virology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Yusang Xie
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Shanghai, 200025, China
| | - Xuefei Liu
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Shanghai, 200025, China
| | - Rong Chen
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Shanghai, 200025, China
| | - Min Zhou
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Shanghai, 200025, China
| | - Xinxin Zhang
- Department of Infectious Diseases, Research Laboratory of Clinical Virology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jieming Qu
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Shanghai, 200025, China.
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Bertram R, Naumann HT, Bartsch V, Hitzl W, Kinzig M, Haarmeyer GS, Baumgärtel M, Geise A, Muschner D, Nentwich J, John S, Sörgel F, Steinmann J, Höhl R. Clinical and demographic factors affecting trough levels of isavuconazole in critically ill patients with or without COVID-19. Mycoses 2023; 66:1071-1078. [PMID: 37700457 DOI: 10.1111/myc.13653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/23/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND The broad-spectrum antifungal isavuconazole is administered to treat invasive aspergillosis and mucormycosis. OBJECTIVES Isavuconazole plasma concentrations in critically ill ICU patients with or without COVID-19 and invasive fungal infection were determined, and factors for sub-therapeutic drug levels (<1 μg/mL) were evaluated. PATIENTS AND METHODS Isavuconazole plasma levels were measured as part of therapeutic drug monitoring (TDM) in ICUs of a tertiary hospital. Concentrations determined 20-28 h after previous dosing were defined as trough (Cmin ) levels. A total of 160 Cmin levels from 62 patients with invasive fungal infections were analysed, 30 of which suffering from COVID-19. Patient characteristics included into univariable and multivariable analyses were gender, age, COVID-19 status, body mass index (BMI), sepsis-related organ failure (SOFA) score, renal replacement therapy (RRT) and extracorporeal membrane oxygenation (ECMO) requirement. RESULTS The mean Cmin of isavuconazole in all patients was 1.64 μg/mL (interquartile range 0.83-2.24 μg/mL, total range 0.24-5.67 μg/mL). In total, 34.4% of the Cmin values (corresponding to 46.8% of patients) were below a threshold concentration of 1 μg/mL. Drug concentrations between patients with or without COVID-19 did not differ (p = .43). In contrast, levels were significantly lower in patients with female sex (p = .0007), age ≤ 65 years (p = .002), BMI > 25 (p = .006), SOFA score > 12 (p = .026), RRT (p = .017) and ECMO requirement (p = .001). CONCLUSIONS Isavuconazole plasma levels can be negatively affected by patients' risk factors, supportive renal replacement and ECMO therapy. Future prospective studies analysing the relevance of isavuconazole drug levels in ICU patient outcome are urgently needed.
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Affiliation(s)
- Ralph Bertram
- Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Hans-Theodor Naumann
- Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Vanessa Bartsch
- Study Program in Human Medicine, Paracelsus Medical University, Nuremberg, Germany
| | - Wolfgang Hitzl
- Department of Research and Innovation Management, Biostatistics and publication of clinical trial studies, Paracelsus Medical University, Salzburg, Austria
- Department of Ophthalmology and Optometry, Paracelsus Medical University, Salzburg, Austria
- Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Salzburg, Austria
| | - Martina Kinzig
- Institute for Biomedical and Pharmaceutical Research, Nuremberg-Heroldsberg, Germany
| | - Golo-Sung Haarmeyer
- Department for Respiratory Medicine, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Matthias Baumgärtel
- Department for Respiratory Medicine, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Arnim Geise
- Department for Respiratory Medicine, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Dorothea Muschner
- Department for Respiratory Medicine, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Jens Nentwich
- Department of Cardiology, Intensive Care Medicine, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Stefan John
- Department of Cardiology, Intensive Care Medicine, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Fritz Sörgel
- Institute for Biomedical and Pharmaceutical Research, Nuremberg-Heroldsberg, Germany
- Institute of Pharmacology, West German Heart and Vascular Centre, University of Duisburg-Essen, Essen, Germany
| | - Joerg Steinmann
- Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Rainer Höhl
- Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
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Scialò F, Cernera G, Esposito S, Pinchera B, Gentile I, Di Domenico M, Bianco A, Pastore L, Amato F, Castaldo G. The MBL2 genotype relates to COVID-19 severity and may help to select the optimal therapy. Clin Chem Lab Med 2023; 61:2143-2149. [PMID: 37313996 DOI: 10.1515/cclm-2023-0183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/01/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Sars-CoV-2 acute infection is clinically heterogeneous, ranging from asymptomatic cases to patients with a severe, systemic clinical course. Among the involved factors age and preexisting morbidities play a major role; genetic host susceptibility contributes to modulating the clinical expression and outcome of the disease. Mannose-binding lectin is an acute-phase protein that activates the lectin-complement pathway, promotes opsonophagocytosis and modulates inflammation, and is involved in several bacterial and viral infections in humans. Understanding its role in Sars-CoV-2 infection could help select a better therapy. METHODS We studied MBL2 haplotypes in 419 patients with acute COVID-19 in comparison to the general population and related the haplotypes to clinical and laboratory markers of severity. RESULTS We recorded an enhanced frequency of MBL2 null alleles in patients with severe acute COVID-19. The homozygous null genotypes were significantly more frequent in patients with advanced WHO score 4-7 (OR of about 4) and related to more severe inflammation, neutrophilia, and lymphopenia. CONCLUSIONS Subjects with a defective MBL2 genotype (i.e., 0/0) are predisposed to a more severe acute Sars-CoV-2 infection; they may benefit from early replacement therapy with recombinant MBL. Furthermore, a subset of subjects with the A/A MBL genotype develop a relevant increase of serum MBL during the early phases of the disease and develop a more severe pulmonary disease; in these patients, the targeting of the complement may help. Therefore, COVID-19 patients should be tested at hospitalization with serum MBL analysis and MBL2 genotype, to define the optimal therapy.
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Affiliation(s)
- Filippo Scialò
- Dipartimento di Scienze Mediche Traslazionali, Università della Campania "L. Vanvitelli", Naples, Italy
- CEINGE-Biotecnologie Avanzate, scarl, Naples, Italy
| | - Gustavo Cernera
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, Naples, Italy
- CEINGE-Biotecnologie Avanzate, scarl, Naples, Italy
| | | | - Biagio Pinchera
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Ivan Gentile
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Marina Di Domenico
- Dipartimento di Medicina di Precisione, Università della Campania "L. Vanvitelli", Naples, Italy
| | - Andrea Bianco
- Dipartimento di Scienze Mediche Traslazionali, Università della Campania "L. Vanvitelli", Naples, Italy
| | - Lucio Pastore
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, Naples, Italy
- CEINGE-Biotecnologie Avanzate, scarl, Naples, Italy
| | - Felice Amato
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, Naples, Italy
- CEINGE-Biotecnologie Avanzate, scarl, Naples, Italy
| | - Giuseppe Castaldo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, Naples, Italy
- CEINGE-Biotecnologie Avanzate, scarl, Naples, Italy
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Szafran A, Dahms K, Ansems K, Skoetz N, Monsef I, Breuer T, Benstoem C. Early versus late tracheostomy in critically ill COVID-19 patients. Cochrane Database Syst Rev 2023; 11:CD015532. [PMID: 37982427 PMCID: PMC10658650 DOI: 10.1002/14651858.cd015532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
BACKGROUND The role of early tracheostomy as an intervention for critically ill COVID-19 patients is unclear. Previous reports have described prolonged intensive care stays and difficulty weaning from mechanical ventilation in critically ill COVID-19 patients, particularly in those developing acute respiratory distress syndrome. Pre-pandemic evidence on the benefits of early tracheostomy is conflicting but suggests shorter hospital stays and lower mortality rates compared to late tracheostomy. OBJECTIVES To assess the benefits and harms of early tracheostomy compared to late tracheostomy in critically ill COVID-19 patients. SEARCH METHODS We searched the Cochrane COVID-19 Study Register, which comprises CENTRAL, PubMed, Embase, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, and medRxiv, as well as Web of Science (Science Citation Index Expanded and Emerging Sources Citation Index) and WHO COVID-19 Global literature on coronavirus disease to identify completed and ongoing studies without language restrictions. We conducted the searches on 14 June 2022. SELECTION CRITERIA We followed standard Cochrane methodology. We included randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSI) evaluating early tracheostomy compared to late tracheostomy during SARS-CoV-2 infection in critically ill adults irrespective of gender, ethnicity, or setting. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methodology. To assess risk of bias in included studies, we used the Cochrane RoB 2 tool for RCTs and the ROBINS-I tool for NRSIs. We used the GRADE approach to assess the certainty of evidence for outcomes of our prioritized categories: mortality, clinical status, and intensive care unit (ICU) length of stay. As the timing of tracheostomy was very heterogeneous among the included studies, we applied GRADE only to studies that defined early tracheostomy as 10 days or less, which was chosen according to clinical relevance. MAIN RESULTS We included one RCT with 150 participants diagnosed with SARS-CoV-2 infection and 24 NRSIs with 6372 participants diagnosed with SARS-CoV-2 infection. All participants were admitted to the ICU, orally intubated and mechanically ventilated. The RCT was a multicenter, parallel, single-blinded study conducted in Sweden. Of the 24 NRSIs, which were mostly conducted in high- and middle-income countries, eight had a prospective design and 16 a retrospective design. We did not find any ongoing studies. RCT-based evidence We judged risk of bias for the RCT to be of low or some concerns regarding randomization and measurement of the outcome. Early tracheostomy may result in little to no difference in overall mortality (RR 0.82, 95% CI 0.52 to 1.29; RD 67 fewer per 1000, 95% CI 178 fewer to 108 more; 1 study, 150 participants; low-certainty evidence). As an indicator of improvement of clinical status, early tracheostomy may result in little to no difference in duration to liberation from invasive mechanical ventilation (MD 1.50 days fewer, 95%, CI 5.74 days fewer to 2.74 days more; 1 study, 150 participants; low-certainty evidence). As an indicator of worsening clinical status, early tracheostomy may result in little to no difference in the incidence of adverse events of any grade (RR 0.94, 95% CI 0.79 to 1.13; RD 47 fewer per 1000, 95% CI 164 fewer to 102 more; 1 study, 150 participants; low-certainty evidence); little to no difference in the incidence of ventilator-associated pneumonia (RR 1.08, 95% CI 0.23 to 5.20; RD 3 more per 1000, 95% CI 30 fewer to 162 more; 1 study, 150 participants; low-certainty evidence). None of the studies reported need for renal replacement therapy. Early tracheostomy may result in little benefit to no difference in ICU length of stay (MD 0.5 days fewer, 95% CI 5.34 days fewer to 4.34 days more; 1 study, 150 participants; low-certainty evidence). NRSI-based evidence We considered risk of bias for NRSIs to be critical because of possible confounding, study participant enrollment into the studies, intervention classification and potentially systematic errors in the measurement of outcomes. We are uncertain whether early tracheostomy (≤ 10 days) increases or decreases overall mortality (RR 1.47, 95% CI 0.43 to 5.00; RD 143 more per 1000, 95% CI 174 less to 1218 more; I2 = 79%; 2 studies, 719 participants) or duration to liberation from mechanical ventilation (MD 1.98 days fewer, 95% CI 0.16 days fewer to 4.12 more; 1 study, 50 participants), because we graded the certainty of evidence as very low. Three NRSIs reported ICU length of stay for 519 patients with early tracheostomy (≤ 10 days) as a median value, which we could not include in the meta-analyses. We are uncertain whether early tracheostomy (≤ 10 days) increases or decreases the ICU length of stay, because we graded the certainty of evidence as very low. AUTHORS' CONCLUSIONS We found low-certainty evidence that early tracheostomy may result in little to no difference in overall mortality in critically ill COVID-19 patients requiring prolonged mechanical ventilation compared with late tracheostomy. In terms of clinical improvement, early tracheostomy may result in little to no difference in duration to liberation from mechanical ventilation compared with late tracheostomy. We are not certain about the impact of early tracheostomy on clinical worsening in terms of the incidence of adverse events, need for renal replacement therapy, ventilator-associated pneumonia, or the length of stay in the ICU. Future RCTs should provide additional data on the benefits and harms of early tracheostomy for defined main outcomes of COVID-19 research, as well as of comparable diseases, especially for different population subgroups to reduce clinical heterogeneity, and report a longer observation period. Then it would be possible to draw conclusions regarding which patient groups might benefit from early intervention. Furthermore, validated scoring systems for more accurate predictions of the need for prolonged mechanical ventilation should be developed and used in new RCTs to ensure safer indication and patient safety. High-quality (prospectively registered) NRSIs should be conducted in the future to provide valuable answers to clinical questions. This could enable us to draw more reliable conclusions about the potential benefits and harms of early tracheostomy in critically ill COVID-19 patients.
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Affiliation(s)
- Agnieszka Szafran
- Department of Intensive Care Medicine and Intermediate Care, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Karolina Dahms
- Department of Intensive Care Medicine and Intermediate Care, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Kelly Ansems
- Department of Intensive Care Medicine and Intermediate Care, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Nicole Skoetz
- Cochrane Haematology, Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ina Monsef
- Cochrane Haematology, Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Thomas Breuer
- Department of Intensive Care Medicine and Intermediate Care, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Carina Benstoem
- Department of Intensive Care Medicine and Intermediate Care, Medical Faculty, RWTH Aachen University, Aachen, Germany
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Shang W, Qian H, Shen X, Wen Z, Zhang S, Chen D. Human blood metabolites and risk of severe COVID-19: A Mendelian randomization study. Eur J Clin Invest 2023; 53:e14079. [PMID: 37589179 DOI: 10.1111/eci.14079] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/25/2023] [Accepted: 08/01/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Evidence supports the observational associations of human blood metabolites with the risk of severe COVID-19. However, little is known about the potential pathological mechanisms and the analysis of blood metabolites may offer a better understanding of the underlying biological processes. METHODS We applied a two-sample Mendelian randomization (MR) analysis to evaluate relationships between 486 blood metabolites and the risk of severe COVID-19. The inverse-variance weighted (IVW) model was used as the primary two-sample MR analysis method to estimate the causal relationship of the exposure on the outcome. Sensitivity analyses were implemented with Cochran's Q test, MR-Egger intercept test, MR-PRESSO, leave-one-out analysis and the funnel plot. RESULTS Four hunderd and eighty six metabolites were included for MR analysis following rigorous genetic variants selection. After MR analyses and sensitivity analysis filtration, we found weak evidence of an association between 3-hydroxybutyrate (odds ratio [OR] = 1.21, 95% CI, 1.07-1.38, p = .0036) and the risk of severe COVID-19. A series of sensitivity analyses have been carried out to confirm the rigidity of the above results. CONCLUSION This study suggested a causal relationship between 3-hydroxybutyrate and the severity of COVID-19, thus providing novel insights into biomarkers and pathways for COVID-19 prevention and clinical interventions.
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Affiliation(s)
- Weifeng Shang
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hang Qian
- Anhui Medical University, Hefei, China
| | - Xuan Shen
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenliang Wen
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sheng Zhang
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dechang Chen
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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