701
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Lim S, Shin SM, Nam GE, Jung CH, Koo BK. Proper Management of People with Obesity during the COVID-19 Pandemic. J Obes Metab Syndr 2020; 29:84-98. [PMID: 32544885 PMCID: PMC7338495 DOI: 10.7570/jomes20056] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/08/2020] [Accepted: 06/11/2020] [Indexed: 12/15/2022] Open
Abstract
Since December 2019, countries around the world have been struggling with a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Case series have reported that people with obesity experience more severe coronavirus disease 2019 (COVID-19). During the COVID-19 pandemic, people have tended to gain weight because of environmental factors imposed by quarantine policies, such as decreased physical activity and increased consumption of unhealthy food. Mechanisms have been postulated to explain the association between COVID-19 and obesity. COVID-19 aggravates inflammation and hypoxia in people with obesity, which can lead to severe illness and the need for intensive care. The immune system is compromised in people with obesity and COVID-19 affects the immune system, which can lead to complications. Interleukin-6 and other cytokines play an important role in the progression of COVID-19. The inflammatory response, critical illness, and underlying risk factors may all predispose to complications of obesity such as diabetes mellitus and cardiovascular diseases. The common medications used to treat people with obesity, such as glucagon-like peptide-1 analogues, statins, and antiplatelets agents, should be continued because these agents have anti-inflammatory properties and play protective roles against cardiovascular and all-cause mortality. It is also recommended that renin–angiotensin system blockers are not stopped during the COVID-19 pandemic because no definitive data about the harm or benefits of these agents have been reported. During the COVID-19 pandemic, social activities have been discouraged and exercise facilities have been closed. Under these restrictions, tailored lifestyle modifications such as home exercise training and cooking of healthy food are encouraged.
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Affiliation(s)
- Soo Lim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Soo Myoung Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ga Eun Nam
- Department of Family Medicine, Korea University College of Medicine, Seoul, Korea
| | - Chang Hee Jung
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bo Kyung Koo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
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702
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Hu R, Gao H, Huang D, Jiang D, Chen F, Fu B, Yuan X, Li J, Jiang Z. Successful blood glucose management of a severe COVID-19 patient with diabetes: A case report. Medicine (Baltimore) 2020; 99:e20844. [PMID: 32590779 PMCID: PMC7328947 DOI: 10.1097/md.0000000000020844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
RATIONALE Coronavirus disease 2019 (COVID-19) has emerged as a rapidly spreading communicable disease affecting individuals worldwide. Patients with diabetes are more vulnerable to the disease, and the mortality is higher than in those without diabetes. We reported a severe COVID-19 patient with diabetes and shared our experience with blood glucose management. PATIENT CONCERNS A 64-year-old female diabetes patient was admitted to the intensive care unit due to productive coughing for 8 days without any obvious cause. The results of blood gas analysis indicated that the partial pressure of oxygen was 84 mm Hg with oxygen 8 L/min, and the oxygenation index was less than 200 mm Hg. In addition, postprandial blood glucose levels were abnormal (29.9 mmol/L). DIAGNOSES The patient was diagnosed with COVID-19 (severe type) and type 2 diabetes. INTERVENTIONS Comprehensive interventions including establishing a multidisciplinary team, closely monitoring her blood glucose level, an individualized diabetes diet, early activities, psychological care, etc, were performed to control blood glucose while actively treating COVID-19 infection. OUTCOMES After the comprehensive measures, the patient's blood glucose level gradually became stable, and the patient was discharged after 20 days of hospitalization. LESSONS This case indicated that the comprehensive measures performed by a multidisciplinary team achieved good treatment effects on a COVID-19 patient with diabetes. Targeted treatment and nursing methods should be performed based on patients' actual situations in clinical practice.
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Affiliation(s)
- Rujun Hu
- Department of Emergency
- Department of Nursing
| | | | | | | | | | - Bao Fu
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
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703
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Agarwal S, Agarwal SK. Endocrine changes in SARS-CoV-2 patients and lessons from SARS-CoV. Postgrad Med J 2020; 96:412-416. [PMID: 32527756 PMCID: PMC7306278 DOI: 10.1136/postgradmedj-2020-137934] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/16/2020] [Accepted: 05/26/2020] [Indexed: 12/19/2022]
Abstract
Coronavirus infection outbreaks have occurred frequently in the last two decades and have led to significant mortality. Despite the focus on reducing mortality by preventing the spread of the virus, patients have died due to several other complications of the illness. The understanding of pathological mechanisms and their implications is continuously evolving. A number of symptoms occur in these patients due to the involvement of various endocrine glands. These clinical presentations went largely unnoticed during the first outbreak of severe acute respiratory syndrome (SARS) in 2002–2003. A few of these derangements continued during the convalescence phase and sometimes occurred after recovery. Similar pathological and biochemical changes are being reported with the novel coronavirus disease outbreak in 2020. In this review, we focus on these endocrine changes that have been reported in both SARS coronavirus and SARS coronavirus-2. As we battle the pandemic, it becomes imperative to address these underlying endocrine disturbances that are contributing towards or predicting mortality of these patients.
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Affiliation(s)
- Shubham Agarwal
- Department of Internal Medicine, Rosalind Franklin University of Medicine and Science Chicago Medical School, North Chicago, Illinois, USA
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704
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Heaney AI, Griffin GD, Simon EL. Newly diagnosed diabetes and diabetic ketoacidosis precipitated by COVID-19 infection. Am J Emerg Med 2020; 38:2491.e3-2491.e4. [PMID: 32536476 PMCID: PMC7274947 DOI: 10.1016/j.ajem.2020.05.114] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 05/30/2020] [Indexed: 12/16/2022] Open
Affiliation(s)
- Ashley I Heaney
- Cleveland Clinic Akron General, Department of Emergency Medicine, Akron, OH, United States of America; Northeast Ohio Medical University, Rootstown, OH, United States of America
| | - Gregory D Griffin
- Cleveland Clinic Akron General, Department of Emergency Medicine, Akron, OH, United States of America
| | - Erin L Simon
- Cleveland Clinic Akron General, Department of Emergency Medicine, Akron, OH, United States of America; Northeast Ohio Medical University, Rootstown, OH, United States of America.
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705
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Miao Y, Lidove O, Mauhin W. First case of acute pancreatitis related to SARS-CoV-2 infection. Br J Surg 2020; 107:e270. [PMID: 32492174 PMCID: PMC7300914 DOI: 10.1002/bjs.11741] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/11/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Y Miao
- Internal Medicine Department, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - O Lidove
- Internal Medicine Department, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - W Mauhin
- Internal Medicine Department, Diaconesses Croix Saint Simon Hospital, Paris, France
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706
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The immune system and COVID-19: Friend or foe? Life Sci 2020; 256:117900. [PMID: 32502542 PMCID: PMC7266583 DOI: 10.1016/j.lfs.2020.117900] [Citation(s) in RCA: 166] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/30/2020] [Accepted: 05/31/2020] [Indexed: 12/21/2022]
Abstract
AIM Coronavirus disease 2019 (COVID-19) is a novel highly contagious infection caused by SARS-CoV-2, which has been became a global public health challenge. The pathogenesis of this virus is not yet clearly understood, but there is evidence of a hyper-inflammatory immune response in critically ill patients, which leads to acute respiratory distress syndrome (ARDS) and multi-organ failure. MATERIAL AND METHODS A literature review was performed to identify relevant articles on COVID-19 published up to April 30, 2020. The search resulted in 361 total articles. After reviewing the titles and abstracts for inclusion, some irrelevant papers were excluded. Additional relevant articles were identified from a review of citations referenced. KEY FINDINGS SARS-CoV-2, directly and indirectly, affects the immune system and avoids being eliminated in early stages. On the other hand, the secretion of inflammatory cytokines creates critical conditions that lead to multi-organ failure. SIGNIFICANCE The immune system which is affected by the virus tries to respond via a cytokine storm and hyperinflammation, which itself leads to further multi-organ damage and even death.
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707
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Deng M, Jiang L, Ren Y, Liao J. Can We Reduce Mortality of COVID-19 if We do Better in Glucose Control? MEDICINE IN DRUG DISCOVERY 2020; 7:100048. [PMID: 32551437 PMCID: PMC7266598 DOI: 10.1016/j.medidd.2020.100048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/16/2020] [Accepted: 05/19/2020] [Indexed: 02/08/2023] Open
Abstract
The SARS-CoV-2 has infected more than 3 million people and caused more than 240,000 death globally. Among the COVID-19 patients, the prevalence of people with other chronic diseases, such as diabetes, high blood pressure, and coronary heart disease is much higher than others. More strikingly, the survival rate of diabetic patients is also much lower than in non-diabetic patients. In addition to the general damage of high glucose to cells and tissues, a recent discovery that high glucose activates interferon regulatory factor 15 promotes influenza virus -induced cytokine storm. This discovery may shed light on the high incidence of diabetes in COVID-19. Several diabetes prevention strategies together with recent significant data-driven diabetes prediction approaches, which may help COVID-19 treatments, have been proposed. The mortality rate of COVID-19 patients is about 6% worldwide. Out of the ease patients, one third have diabetes, which has significant impact on the disease progress and mortality. If we can prevent and even cure diabetes, the mortality rate will be significantly reduced. We summarize the potential reasons that high glucose increases the damage of human cells and immune system together with the infection of SARS-CoV-2 virus, and give suggestions for prevention and prediction of diabetes in the AI era.
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Affiliation(s)
- Mingyan Deng
- West China-California Center for Predictive Intervention Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ling Jiang
- Biochemistry and Molecular biology Department, School Basic Medical Science, Heilongjiang University of Chinese Medicine, 24 Heping Road, Harbin, 150040, P.R.China
| | - Yan Ren
- Division of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Jiayu Liao
- Department of Bioengineering, College of Engineering, University of California at Riverside, 900 University Avenue, Riverside, CA 92521, United States of America.,West China-California Center for Predictive Intervention Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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708
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Mongioì LM, Barbagallo F, Condorelli RA, Cannarella R, Aversa A, La Vignera S, Calogero AE. Possible long-term endocrine-metabolic complications in COVID-19: lesson from the SARS model. Endocrine 2020; 68:467-470. [PMID: 32488837 PMCID: PMC7266418 DOI: 10.1007/s12020-020-02349-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/12/2020] [Indexed: 12/14/2022]
Abstract
The outbreak of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is centralizing the interest of the scientific world. In the next months, long-term consequences on the endocrine system may arise following COVID-19. In this article, we hypothesized the effects of SARS-CoV-2 taking into account what learned from the severe acute respiratory syndrome coronavirus (SARS-CoV) that caused SARS in 2003.
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Affiliation(s)
- Laura M Mongioì
- Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78, 95123, Catania, Italy
| | - Federica Barbagallo
- Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78, 95123, Catania, Italy
| | - Rosita A Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78, 95123, Catania, Italy
| | - Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78, 95123, Catania, Italy
| | - Antonio Aversa
- Department of Experimental and Clinical Medicine, Magna Graecia University Catanzaro, 88100, Catanzaro, Italy
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78, 95123, Catania, Italy.
| | - Aldo E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78, 95123, Catania, Italy
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709
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Bonny V, Maillard A, Mousseaux C, Plaçais L, Richier Q. [COVID-19: Pathogenesis of a multi-faceted disease]. Rev Med Interne 2020; 41:375-389. [PMID: 32507520 PMCID: PMC7250743 DOI: 10.1016/j.revmed.2020.05.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/13/2020] [Accepted: 05/16/2020] [Indexed: 02/07/2023]
Abstract
SARS-CoV-2 infection, named COVID-19, can lead to a dysregulated immune response and abnormal coagulation responsible for a viral sepsis. In this review, we specify physiopathological mechanisms of each phase of COVID-19 - viral, immune and pro-thrombotic - notably because they involve different treatment. Finally, we specify the physiopathological mechanisms of organ injury.
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Affiliation(s)
- V Bonny
- Interne en DES de pneumologie, Sorbonne-université, France
| | - A Maillard
- Interne en DES de maladies infectieuses, MSc, Université de Paris, France
| | - C Mousseaux
- DES de néphrologie, MSc, Sorbonne-université, France
| | - L Plaçais
- Interne en DES de médecine interne, MSc, Sorbonne-université, France
| | - Q Richier
- Interne en DES de médecine interne Paris, MSc, Université de Paris, France.
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710
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Wang Z, Du Z, Zhu F. Glycosylated hemoglobin is associated with systemic inflammation, hypercoagulability, and prognosis of COVID-19 patients. Diabetes Res Clin Pract 2020; 164:108214. [PMID: 32416121 PMCID: PMC7233217 DOI: 10.1016/j.diabres.2020.108214] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 05/07/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Diabetes is a risk factor for the progression and prognosis of coronavirus disease (COVID-19), but the relationship between glycosylated hemoglobin (HbA1c) level, inflammation, and prognosis of COVID-19 patients has not been explored. METHODS This was a retrospective study of COVID-19 patients who underwent an HbA1c test. Their demographic data, medical history, signs and symptoms of COVID-19, laboratory test results, and final outcomes of COVID-19 treatment were collected and analyzed. RESULTS A total of 132 patients were included and divided into three groups based on their blood glucose status. There were significant differences in SaO2, serum ferritin level, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen (Fbg) level, and IL6 level among the three groups. A pairwise comparison of the groups showed that groups B and C were significantly different from group A in terms of CRP, ESR, and Fbg, IL6, and serum ferritin levels (P < 0.05). Correlation analysis showed that there was a linear negative correlation between SaO2 and HbA1c (r = -0.22, P = 0.01), while there was a linear positive correlation between serum ferritin, CRP, Fbg, and ESR levels and HbA1c (P < 0.05). CONCLUSIONS High HbA1c level is associated with inflammation, hypercoagulability, and low SaO2 in COVID-19 patients, and the mortality rate (27.7%) is higher in patients with diabetes. Determining HbA1c level after hospital admission is thus helpful assessing inflammation, hypercoagulability, and prognosis of COVID-19 patients.
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Affiliation(s)
- Zhenzhou Wang
- Trauma Center, National Center for Trauma Medicine, Key Laboratory of Trauma and Neural Regeneration, Peking University People's Hospital, Beijing 100044, China
| | - Zhe Du
- Trauma Center, National Center for Trauma Medicine, Key Laboratory of Trauma and Neural Regeneration, Peking University People's Hospital, Beijing 100044, China
| | - Fengxue Zhu
- Trauma Center, National Center for Trauma Medicine, Key Laboratory of Trauma and Neural Regeneration, Peking University People's Hospital, Beijing 100044, China.
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711
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Chee YJ, Ng SJH, Yeoh E. Diabetic ketoacidosis precipitated by Covid-19 in a patient with newly diagnosed diabetes mellitus. Diabetes Res Clin Pract 2020; 164:108166. [PMID: 32339533 PMCID: PMC7194589 DOI: 10.1016/j.diabres.2020.108166] [Citation(s) in RCA: 197] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 12/11/2022]
Affiliation(s)
| | | | - Ester Yeoh
- Khoo Teck Puat Hospital, Singapore; Diabetes Centre, Admiralty Medical Centre, Singapore.
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712
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Bornstein SR, Rubino F, Khunti K, Mingrone G, Hopkins D, Birkenfeld AL, Boehm B, Amiel S, Holt RI, Skyler JS, DeVries JH, Renard E, Eckel RH, Zimmet P, Alberti KG, Vidal J, Geloneze B, Chan JC, Ji L, Ludwig B. Practical recommendations for the management of diabetes in patients with COVID-19. Lancet Diabetes Endocrinol 2020; 8:546-550. [PMID: 32334646 PMCID: PMC7180013 DOI: 10.1016/s2213-8587(20)30152-2] [Citation(s) in RCA: 536] [Impact Index Per Article: 134.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/07/2020] [Accepted: 04/13/2020] [Indexed: 12/11/2022]
Abstract
Diabetes is one of the most important comorbidities linked to the severity of all three known human pathogenic coronavirus infections, including severe acute respiratory syndrome coronavirus 2. Patients with diabetes have an increased risk of severe complications including Adult Respiratory Distress Syndrome and multi-organ failure. Depending on the global region, 20-50% of patients in the coronavirus disease 2019 (COVID-19) pandemic had diabetes. Given the importance of the link between COVID-19 and diabetes, we have formed an international panel of experts in the field of diabetes and endocrinology to provide some guidance and practical recommendations for the management of diabetes during the pandemic. We aim to briefly provide insight into potential mechanistic links between the novel coronavirus infection and diabetes, present practical management recommendations, and elaborate on the differential needs of several patient groups.
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Affiliation(s)
- Stefan R Bornstein
- Department of Medicine III, University Hospital Carl Gustav Carus, Dresden, Germany; Paul Langerhans Institute Dresden of the Helmholtz Center Munich, University Hospital Carl Gustav Carus, Dresden, Germany; Department of Diabetes, School of Life Course Science and Medicine, King's College London, London, UK; Department of Endocrinology and Diabetology, University Hospital Zurich, Zurich, Switzerland; Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany.
| | - Francesco Rubino
- Department of Diabetes, School of Life Course Science and Medicine, King's College London, London, UK; Bariatric and Metabolic Surgery, King's College Hospital, London, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Geltrude Mingrone
- Department of Diabetes, School of Life Course Science and Medicine, King's College London, London, UK; Fondazione Policlinico Universitario Agostino Gemelli Istituto Di Ricovero e Cura a Carattere Scientifico, Rome, Italy; Department of Internal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - David Hopkins
- Department of Diabetes, School of Life Course Science and Medicine, King's College London, London, UK; Institute of Diabetes Endocrinology and Obesity, King's Health Partners, London, UK
| | - Andreas L Birkenfeld
- Department of Diabetes, School of Life Course Science and Medicine, King's College London, London, UK; German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany; Department of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, Tübingen, Germany; Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen, Tübingen, Germany
| | - Bernhard Boehm
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
| | - Stephanie Amiel
- Department of Diabetes, School of Life Course Science and Medicine, King's College London, London, UK
| | - Richard Ig Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, UK
| | - Jay S Skyler
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - J Hans DeVries
- Department of Endocrinology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Profil Institute for Metabolic Research, Neuss, Germany
| | - Eric Renard
- Montpellier University Hospital and Institute of Functional Genomics, Centre national de la recherche scientifique, INSERM, University of Montpellier, Montpellier, France
| | - Robert H Eckel
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Paul Zimmet
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Kurt George Alberti
- Division of Diabetes, Endocrinology and Metabolism, Imperial College, London, UK
| | - Josep Vidal
- Centro de Investigación Biomédica en Red en Diabetes y Enfermedades Metabólicas Asociadas, Barcelona, Spain
| | - Bruno Geloneze
- Obesity and Comorbities Research Center, Laboratory of Investigation in Metabolism and Diabetes/Gastrocentro, Universidade de Campinas, Campinas, São Paulo, Brazil
| | - Juliana C Chan
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity and Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Center, Beijing, China
| | - Barbara Ludwig
- Department of Medicine III, University Hospital Carl Gustav Carus, Dresden, Germany; Paul Langerhans Institute Dresden of the Helmholtz Center Munich, University Hospital Carl Gustav Carus, Dresden, Germany; Department of Endocrinology and Diabetology, University Hospital Zurich, Zurich, Switzerland; Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; Deutsche Forschungsgemeinschaft-Center for Regenerative Therapies Dresden, Technische Universität Dresden, Dresden, Germany; German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
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713
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Zhou J, Tan J. Diabetes patients with COVID-19 need better blood glucose management in Wuhan, China. Metabolism 2020; 107:154216. [PMID: 32220612 PMCID: PMC7102634 DOI: 10.1016/j.metabol.2020.154216] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 03/22/2020] [Accepted: 03/23/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Jun Zhou
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jie Tan
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
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714
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Hadi A, Werge M, Kristiansen KT, Pedersen UG, Karstensen JG, Novovic S, Gluud LL. Coronavirus Disease-19 (COVID-19) associated with severe acute pancreatitis: Case report on three family members. Pancreatology 2020; 20:665-667. [PMID: 32387082 PMCID: PMC7199002 DOI: 10.1016/j.pan.2020.04.021] [Citation(s) in RCA: 166] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 04/27/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVES Abdominal pain is one of the known symptoms associated with coronavirus disease 2019. Little is known about the development of acute pancreatitis as a complication of severe acute respiratory syndrome coronavirus 2 infection. This case report describes the presentation of acute pancreatitis in two of three family members with severe COVID-19 infection. METHODS Data were collected from three family members admitted with COVID-19 to the intensive care unit in March 2020. This study was reviewed and approved by the local data and ethics committee (31-1521-253). RESULTS Two of the three family members were diagnosed with acute pancreatitis associated with SARS-CoV-2. Other causes of acute pancreatitis were excluded for both patients (including alcohol, biliary obstruction/gall stones, drugs, trauma, hypertriglyceridemia, hypercalcemia, and hypotension). CONCLUSIONS These cases highlight acute pancreatitis as a complication associated with COVID-19 and underlines the importance of measuring pancreas-specific plasma amylase in patients with COVID-19 and abdominal pain.
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Affiliation(s)
- Amer Hadi
- Pancreatitis Centre East, Gastrounit, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
| | - Mikkel Werge
- Pancreatitis Centre East, Gastrounit, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | | | | | - John Gásdal Karstensen
- Pancreatitis Centre East, Gastrounit, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Srdan Novovic
- Pancreatitis Centre East, Gastrounit, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark.
| | - Lise Lotte Gluud
- Pancreatitis Centre East, Gastrounit, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
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715
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Caruso P, Longo M, Esposito K, Maiorino MI. Type 1 diabetes triggered by covid-19 pandemic: A potential outbreak? Diabetes Res Clin Pract 2020; 164:108219. [PMID: 32442555 PMCID: PMC7237369 DOI: 10.1016/j.diabres.2020.108219] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Paola Caruso
- Department of Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy.
| | - Miriam Longo
- Department of Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy.
| | - Katherine Esposito
- Department of Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy.
| | - Maria Ida Maiorino
- Department of Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy.
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716
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Sharma S, Ray A, Sadasivam B. Metformin in COVID-19: A possible role beyond diabetes. Diabetes Res Clin Pract 2020; 164:108183. [PMID: 32360697 PMCID: PMC7190487 DOI: 10.1016/j.diabres.2020.108183] [Citation(s) in RCA: 133] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 04/24/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Swati Sharma
- Department of Pharmacology, All India Institute of Medical Sciences Bhopal, Madhya Pradesh, India.
| | - Avik Ray
- Department of Pharmacology, All India Institute of Medical Sciences Bhopal, Madhya Pradesh, India
| | - Balakrishnan Sadasivam
- Department of Pharmacology, All India Institute of Medical Sciences Bhopal, Madhya Pradesh, India
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717
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Orioli L, Hermans MP, Thissen JP, Maiter D, Vandeleene B, Yombi JC. COVID-19 in diabetic patients: Related risks and specifics of management. ANNALES D'ENDOCRINOLOGIE 2020; 81:101-109. [PMID: 32413342 PMCID: PMC7217100 DOI: 10.1016/j.ando.2020.05.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/10/2020] [Accepted: 05/10/2020] [Indexed: 01/08/2023]
Abstract
Diabetes is among the most frequently reported comorbidities in patients infected with COVID-19. According to current data, diabetic patients do not appear to be at increased risk of contracting SARS-CoV-2 compared to the general population. On the other hand, diabetes is a risk factor for developing severe and critical forms of COVID-19, the latter requiring admission to an intensive care unit and/or use of invasive mechanical ventilation, with high mortality rates. The characteristics of diabetic patients at risk for developing severe and critical forms of COVID-19, as well as the prognostic impact of diabetes on the course of COVID-19, are under current investigation. Obesity, the main risk factor for incident type 2 diabetes, is more common in patients with critical forms of COVID-19 requiring invasive mechanical ventilation. On the other hand, COVID-19 is usually associated with poor glycemic control and a higher risk of ketoacidosis in diabetic patients. There are currently no recommendations in favour of discontinuing antihypertensive medications that interact with the renin-angiotensin-aldosterone system. Metformin and SGLT2 inhibitors should be discontinued in patients with severe forms of COVID-19 owing to the risks of lactic acidosis and ketoacidosis. Finally, we advise for systematic screening for (pre)diabetes in patients with proven COVID-19 infection.
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MESH Headings
- Acidosis, Lactic/chemically induced
- Acidosis, Lactic/epidemiology
- Acidosis, Lactic/virology
- Betacoronavirus/physiology
- COVID-19
- Comorbidity
- Coronavirus Infections/complications
- Coronavirus Infections/diagnosis
- Coronavirus Infections/epidemiology
- Coronavirus Infections/therapy
- Critical Illness/epidemiology
- Critical Illness/therapy
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/epidemiology
- Diabetes Mellitus, Type 2/therapy
- Diabetic Ketoacidosis/chemically induced
- Diabetic Ketoacidosis/epidemiology
- Diabetic Ketoacidosis/virology
- Humans
- Mass Screening/methods
- Mass Screening/standards
- Metformin/therapeutic use
- Obesity/complications
- Obesity/epidemiology
- Obesity/therapy
- Pandemics
- Pneumonia, Viral/complications
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/epidemiology
- Pneumonia, Viral/therapy
- Prediabetic State/complications
- Prediabetic State/diagnosis
- Prediabetic State/epidemiology
- Prediabetic State/therapy
- Renin-Angiotensin System/physiology
- Risk Factors
- Risk Management
- SARS-CoV-2
- Severity of Illness Index
- Sodium-Glucose Transporter 2 Inhibitors/therapeutic use
- Withholding Treatment
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Affiliation(s)
- Laura Orioli
- Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, avenue Hippocrate 10, 1200 Brussels, Belgium; Department of Endocrinology, Diabetology and Nutrition, IREC, UCLouvain, avenue Hippocrate 55, Brussels, Belgium.
| | - Michel P Hermans
- Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Jean-Paul Thissen
- Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, avenue Hippocrate 10, 1200 Brussels, Belgium; Department of Endocrinology, Diabetology and Nutrition, IREC, UCLouvain, avenue Hippocrate 55, Brussels, Belgium
| | - Dominique Maiter
- Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Bernard Vandeleene
- Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Jean-Cyr Yombi
- Department of internal medicine, Cliniques Universitaires Saint-Luc, avenue Hippocrate 10, 1200 Brussels, Belgium
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718
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Noh J, Chang HH, Jeong IK, Yoon KH. Coronavirus Disease 2019 and Diabetes: The Epidemic and the Korean Diabetes Association Perspective. Diabetes Metab J 2020; 44:372-381. [PMID: 32613777 PMCID: PMC7332333 DOI: 10.4093/dmj.2020.0138] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/23/2020] [Indexed: 01/09/2023] Open
Abstract
Diabetes has been associated with more severe outcomes and higher mortality in coronavirus disease 2019 (COVID-19) patients compare to morbidity and mortality in patients without diabetes. Several mechanisms may play a role in this greater morbidity and mortality, especially uncontrolled hyperglycemia, an impaired immune system, pre-existing proinflammatory states, multiple comorbidities, and dysregulated angiotensin-converting enzyme 2 signaling. Thus, the diabetes medical community emergently needs to know about COVID-19 and its effects on patients with diabetes, as they must take precautions to carefully manage these patients during the COVID-19 pandemic. The Korean Diabetes Association provides some guidance and practical recommendations for the management of diabetes during the pandemic. This report provides insight into the association between diabetes and COVID-19, proper management of diabetes in patients with COVID-19 and an official suggestion by the Korean Diabetes Association for managing the COVID-19 outbreak.
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Affiliation(s)
- Junghyun Noh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Hyun Ha Chang
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - In Kyung Jeong
- Department of Endocrinology and Metabolism, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea.
| | - Kun Ho Yoon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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719
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Drucker DJ. Coronavirus Infections and Type 2 Diabetes-Shared Pathways with Therapeutic Implications. Endocr Rev 2020; 41:5820492. [PMID: 32294179 PMCID: PMC7184382 DOI: 10.1210/endrev/bnaa011] [Citation(s) in RCA: 268] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/14/2020] [Indexed: 02/07/2023]
Abstract
Individuals with diabetes are at increased risk for bacterial, mycotic, parasitic, and viral infections. The severe acute respiratory syndrome (SARS)-CoV-2 (also referred to as COVID-19) coronavirus pandemic highlights the importance of understanding shared disease pathophysiology potentially informing therapeutic choices in individuals with type 2 diabetes (T2D). Two coronavirus receptor proteins, angiotensin-converting enzyme 2 (ACE2) and dipeptidyl peptidase-4 (DPP4) are also established transducers of metabolic signals and pathways regulating inflammation, renal and cardiovascular physiology, and glucose homeostasis. Moreover, glucose-lowering agents such as the DPP4 inhibitors, widely used in subjects with T2D, are known to modify the biological activities of multiple immunomodulatory substrates. Here, we review the basic and clinical science spanning the intersections of diabetes, coronavirus infections, ACE2, and DPP4 biology, highlighting clinical relevance and evolving areas of uncertainty underlying the pathophysiology and treatment of T2D in the context of coronavirus infection.
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Affiliation(s)
- Daniel J Drucker
- From the Lunenfeld-Tanenbaum Research Institute, Department of Medicine, Mt. Sinai Hospital, University of Toronto, Toronto Ontario, Canada
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720
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Cristelo C, Azevedo C, Marques JM, Nunes R, Sarmento B. SARS-CoV-2 and diabetes: New challenges for the disease. Diabetes Res Clin Pract 2020; 164:108228. [PMID: 32446801 PMCID: PMC7242186 DOI: 10.1016/j.diabres.2020.108228] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/06/2020] [Accepted: 05/15/2020] [Indexed: 02/06/2023]
Abstract
A novel small enveloped RNA virus with the typical characteristic of the family to which it belongs, a crown, hence the name coronavirus, appeared in December 2019 in Wuhan, China, and subdued the world to its influence. The particular severity of the disease and higher mortality rates in patients with associated morbidities, including hypertension, obesity and diabetes, increases the concern over the consequences of this pandemic. In this review, the features of SARS-CoV-2 will be addressed, as well as the reasons why it poses a particular challenge to diabetic patients. We will also highlight the recent treatment strategies being explored to control this pandemic. Emerging evidence demonstrates that the correct management of diabetes in those patients infected with SARS-CoV-2 is of utmost importance for the viral disease progression, therefore, the importance of blood glucose control will also be addressed.
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Affiliation(s)
- Cecília Cristelo
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - Cláudia Azevedo
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - Joana Moreira Marques
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal; Faculdade de Farmácia, University of Porto, Porto, Portugal
| | - Rute Nunes
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Bruno Sarmento
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal; CESPU, Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde & Instituto Universitário de Ciências da Saúde, Gandra, Portugal.
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721
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Gupta R, Hussain A, Misra A. Diabetes and COVID-19: evidence, current status and unanswered research questions. Eur J Clin Nutr 2020; 74:864-870. [PMID: 32404898 PMCID: PMC7220586 DOI: 10.1038/s41430-020-0652-1] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 04/23/2020] [Accepted: 04/28/2020] [Indexed: 01/08/2023]
Abstract
Patients with diabetes who get coronavirus disease 2019 (COVID-19) are at risk of a severe disease course and mortality. Several factors especially the impaired immune response, heightened inflammatory response and hypercoagulable state contribute to the increased disease severity. However, there are many contentious issues about which the evidence is rather limited. There are some theoretical concerns about the effects of different anti-hyperglycaemic drugs. Similarly, despite the recognition of angiotensin converting enzyme 2 (ACE2) as the receptor for severe acute respiratory syndrome coronavirus 2 (SARS CoV-2), and the role of ACE2 in lung injury; there are conflicting results with the use of angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB) in these patients. Management of patients with diabetes in times of restrictions on mobility poses some challenges and novel approaches like telemedicine can be useful. There is a need to further study the natural course of COVID-19 in patients with diabetes and to understand the individual, regional and ethnic variations in disease prevalence and course.
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Affiliation(s)
- Ritesh Gupta
- Fortis CDOC Hospital, Chirag Enclave, New Delhi, India
| | - Akhtar Hussain
- Chronic Disease-Diabetes, NORD University, Stjørdal, Norway
- Medicine, Federal University of Ceara (UFC), Ceara, Brazil
| | - Anoop Misra
- Fortis CDOC Hospital, Chirag Enclave, New Delhi, India.
- National Diabetes, Obesity and Cholesterol Foundation, New Delhi, India.
- Diabetes Foundation (India), New Delhi, India.
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722
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Hohes Mortalitätsrisiko bei Diabetespatienten mit COVID-19. INFO DIABETOLOGIE 2020. [PMCID: PMC7302938 DOI: 10.1007/s15034-020-2139-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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723
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Chen Y, Zhao M, Wu Y, Zang S. Epidemiological analysis of the early 38 fatalities in Hubei, China, of the coronavirus disease 2019. J Glob Health 2020; 10:011004. [PMID: 32373340 PMCID: PMC7183246 DOI: 10.7189/jogh.10.011004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Since the emergence of coronavirus disease 2019 (COVID-19) in Hubei province of China by the end of 2019, it has burned its way across the globe, resulting in a still fast-growing death toll that far exceeded those from severe acute respiratory syndrome (SARS) in less than two months. As there is a paucity of evidence on which population is more likely to progress into severe conditions among cases, we looked into the first cluster of death cases, aiming to add to current evidence and reduce panic among the population. METHODS We prospectively collected the demographic and clinical data of the first 38 fatalities whose information was made public by the Health Commission of Hubei province and the official Weibo account of China Central Television news center, starting from 9 January through 24 January 2020. The death cases were described from four aspects (gender and age characteristics, underlying diseases, the time course of death, symptoms at the incipience of illness and hospital admission). RESULTS Among the 38 fatalities, 71.05% were male, and 28.95% were female, with the median age of 70 years (interquartile range (IQR) = 65-81). Persons aged 66-75 made up the largest share. Twenty-five cases had a history of chronic diseases. The median time between the first symptoms and death was 12.50 days (IQR = 10.00-16.25), while the median time between the admission and death was 8.50 (IQR = 5.00-12.00) days. In persons aged over 56 years, the time between the first symptoms and death decreased with age, and so did the time between the admission and death, though the latter increased again in persons aged over 85 years. The major first symptoms included fever (52.63%), cough (31.58%), dyspnea (23.68%), myalgia and fatigue (15.79%). CONCLUSIONS Among the death cases, persons with underlying diseases and aged over 65 made up the majority. The time between the first symptoms and death decreased with the advanced age. In all the age groups, males dominated the fatalities.
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Affiliation(s)
- Yifei Chen
- School of Nursing, China Medical University, Shenyang, Liaoning, China
| | - Meizhen Zhao
- Nursing Department, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yifan Wu
- School of Nursing, China Medical University, Shenyang, Liaoning, China
| | - Shuang Zang
- School of Nursing, China Medical University, Shenyang, Liaoning, China
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724
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Nakhleh A, Shehadeh N. Glycemic control of type 2 diabetic patients with coronavirus disease during hospitalization: a proposal for early insulin therapy. Am J Physiol Endocrinol Metab 2020; 318:E835-E837. [PMID: 32401039 PMCID: PMC7237499 DOI: 10.1152/ajpendo.00163.2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Afif Nakhleh
- Institute of Endocrinology, Diabetes and Metabolism, Rambam Health Care Campus, Haifa, Israel
| | - Naim Shehadeh
- Institute of Endocrinology, Diabetes and Metabolism, Rambam Health Care Campus, Haifa, Israel
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725
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Abstract
Type 2 diabetes mellitus and hypertension are the most common comorbidities in patients with coronavirus infections. Emerging evidence demonstrates an important direct metabolic and endocrine mechanistic link to the viral disease process. Clinicians need to ensure early and thorough metabolic control for all patients affected by COVID-19.
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Affiliation(s)
- Stefan R Bornstein
- Department of Medicine III, University Hospital Carl Gustav Carus, Dresden, Germany.
- Department of Diabetes, School of Life Course Science & Medicine, King's College London, London, UK.
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, University Hospital, Zürich, Switzerland.
| | - Rinkoo Dalan
- Tan Tock Seng Hospital, Department of Endocrinology, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - David Hopkins
- Institute of Diabetes Endocrinology and Obesity, King's Health Partners, London, UK
| | - Geltrude Mingrone
- Department of Diabetes, School of Life Course Science & Medicine, King's College London, London, UK
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Bernhard O Boehm
- Tan Tock Seng Hospital, Department of Endocrinology, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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726
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Venkatakrishnan AJ, Puranik A, Anand A, Zemmour D, Yao X, Wu X, Chilaka R, Murakowski DK, Standish K, Raghunathan B, Wagner T, Garcia-Rivera E, Solomon H, Garg A, Barve R, Anyanwu-Ofili A, Khan N, Soundararajan V. Knowledge synthesis of 100 million biomedical documents augments the deep expression profiling of coronavirus receptors. eLife 2020; 9:58040. [PMID: 32463365 PMCID: PMC7371427 DOI: 10.7554/elife.58040] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 05/27/2020] [Indexed: 12/12/2022] Open
Abstract
The COVID-19 pandemic demands assimilation of all biomedical knowledge to decode mechanisms of pathogenesis. Despite the recent renaissance in neural networks, a platform for the real-time synthesis of the exponentially growing biomedical literature and deep omics insights is unavailable. Here, we present the nferX platform for dynamic inference from over 45 quadrillion possible conceptual associations from unstructured text, and triangulation with insights from single-cell RNA-sequencing, bulk RNA-seq and proteomics from diverse tissue types. A hypothesis-free profiling of ACE2 suggests tongue keratinocytes, olfactory epithelial cells, airway club cells and respiratory ciliated cells as potential reservoirs of the SARS-CoV-2 receptor. We find the gut as the putative hotspot of COVID-19, where a maturation correlated transcriptional signature is shared in small intestine enterocytes among coronavirus receptors (ACE2, DPP4, ANPEP). A holistic data science platform triangulating insights from structured and unstructured data holds potential for accelerating the generation of impactful biological insights and hypotheses.
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Affiliation(s)
| | | | | | | | - Xiang Yao
- Janssen pharmaceutical companies of Johnson & Johnson (J&J), Spring House, United States
| | - Xiaoying Wu
- Janssen pharmaceutical companies of Johnson & Johnson (J&J), Spring House, United States
| | | | | | - Kristopher Standish
- Janssen pharmaceutical companies of Johnson & Johnson (J&J), Spring House, United States
| | | | | | | | | | | | | | - Anuli Anyanwu-Ofili
- Janssen pharmaceutical companies of Johnson & Johnson (J&J), Spring House, United States
| | - Najat Khan
- Janssen pharmaceutical companies of Johnson & Johnson (J&J), Spring House, United States
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727
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Gebhard C, Regitz-Zagrosek V, Neuhauser HK, Morgan R, Klein SL. Impact of sex and gender on COVID-19 outcomes in Europe. Biol Sex Differ 2020; 11:29. [PMID: 32450906 PMCID: PMC7247289 DOI: 10.1186/s13293-020-00304-9] [Citation(s) in RCA: 678] [Impact Index Per Article: 169.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/24/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Emerging evidence from China suggests that coronavirus disease 2019 (COVID-19) is deadlier for infected men than women with a 2.8% fatality rate being reported in Chinese men versus 1.7% in women. Further, sex-disaggregated data for COVID-19 in several European countries show a similar number of cases between the sexes, but more severe outcomes in aged men. Case fatality is highest in men with pre-existing cardiovascular conditions. The mechanisms accounting for the reduced case fatality rate in women are currently unclear but may offer potential to develop novel risk stratification tools and therapeutic options for women and men. CONTENT The present review summarizes latest clinical and epidemiological evidence for gender and sex differences in COVID-19 from Europe and China. We discuss potential sex-specific mechanisms modulating the course of disease, such as hormone-regulated expression of genes encoding for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) entry receptors angiotensin converting enzyme (ACE) 2 receptor and TMPRSS2 as well as sex hormone-driven innate and adaptive immune responses and immunoaging. Finally, we elucidate the impact of gender-specific lifestyle, health behavior, psychological stress, and socioeconomic conditions on COVID-19 and discuss sex specific aspects of antiviral therapies. CONCLUSION The sex and gender disparities observed in COVID-19 vulnerability emphasize the need to better understand the impact of sex and gender on incidence and case fatality of the disease and to tailor treatment according to sex and gender. The ongoing and planned prophylactic and therapeutic treatment studies must include prospective sex- and gender-sensitive analyses.
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Affiliation(s)
- Catherine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland.
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
| | - Vera Regitz-Zagrosek
- University of Zurich, Zurich, Switzerland
- Charité, Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Hannelore K Neuhauser
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
- Robert Koch Institute, Berlin, Germany
| | - Rosemary Morgan
- Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sabra L Klein
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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728
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Baidya A, Singh SK, Bajaj S, Zargar AH, Singh P, Das S, Shankar A. Diabetes and COVID-19: A Review. J ASEAN Fed Endocr Soc 2020; 35:40-48. [PMID: 33442168 PMCID: PMC7784172 DOI: 10.15605/jafes.035.01.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/22/2020] [Indexed: 01/08/2023] Open
Abstract
Coronavirus Disease 2019 (COVID-19) is an emerging disease and since its first identification in Wuhan, China, in December 2019, there has been a rapid increase in cases and deaths across the world. COVID-19 has been shown to have an immense impact in infected persons with diabetes, worsening their outcome, especially in elderly, smokers, obese, those having CVD, CKD, poor glycemic control and long duration of diabetes. In this review we summarize the current understanding of `the impact of COVID-19 on diabetes and discusses the pathophysiological mechanisms and management of diabetes and its complication in this scenario.
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Affiliation(s)
- Arjun Baidya
- Department of Endocrinology, Nil Ratan Sircar Medical College, Kolkata, India
| | | | - Sarita Bajaj
- Department of Medicine, Motilal Nehru Medical College, Allahabad, India
| | - Abdul Hamid Zargar
- Centre for Diabetes and Endocrine Care, National Highway Gulshan Nagar Srinagar, Jammu and Kashmir, India
| | - Parminder Singh
- Department of Endocrinology, Dayanand Medical College and Hospital, Ludhiana, India
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729
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Potier L, Julla JB, Roussel R, Boudou P, Gauthier DC, Ketfi C, Gautier JF. COVID-19 symptoms masking inaugural ketoacidosis of type 1 diabetes. DIABETES & METABOLISM 2020; 47:101162. [PMID: 32447100 PMCID: PMC7240273 DOI: 10.1016/j.diabet.2020.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 12/16/2022]
Affiliation(s)
- L Potier
- Bichat Hospital, AP-HP, Université de Paris, Paris, France.
| | - J B Julla
- Lariboisière Hospital, AP-HP, Université de Paris, Paris, France
| | - R Roussel
- Bichat Hospital, AP-HP, Université de Paris, Paris, France
| | - P Boudou
- Saint-Louis Hospital, AP-HP, Université de Paris, Paris, France
| | - D C Gauthier
- Lariboisière Hospital, AP-HP, Université de Paris, Paris, France
| | - C Ketfi
- Lariboisière Hospital, AP-HP, Université de Paris, Paris, France
| | - J F Gautier
- Lariboisière Hospital, AP-HP, Université de Paris, Paris, France
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730
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Peric S, Stulnig TM. Diabetes and COVID-19 : Disease-Management-People. Wien Klin Wochenschr 2020; 132:356-361. [PMID: 32435867 PMCID: PMC7238399 DOI: 10.1007/s00508-020-01672-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/01/2020] [Indexed: 12/17/2022]
Abstract
The current pandemic of SARS-CoV‑2 coronavirus disease 2019 (COVID-19) is a particular challenge for diabetes patients. Diabetes mellitus predisposes to a particularly severe course of the disease and doubles the COVID-19 mortality risk due to pulmonary and cardiac involvement. In addition, diabetes patients often suffer from comorbidities which further worsen clinical outcomes. Glycemic control during infectious diseases is often suboptimal, and antidiabetic drugs and insulin therapy have to be adapted accordingly. On the other hand, access of diabetes patients to outpatient clinics are limited during the ongoing season urging alternative treatment options, particularly the implementation of novel telemedicine strategies. Hence, the opportunity of the COVID 19 crisis should be taken to make a significant step forward in the care for diabetes patients.
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Affiliation(s)
- Slobodan Peric
- Third Department of Medicine with Metabolic Diseases and Nephrology, Hietzing Hospital with Neurological Center Rosenhuegel, Wolkersbergenstraße 1, 1130, Vienna, Austria
- Karl Landsteiner Institute for Metabolic Diseases and Nephrology, Hietzing Hospital with Neurological Center Rosenhuegel, Vienna, Austria
| | - Thomas M Stulnig
- Third Department of Medicine with Metabolic Diseases and Nephrology, Hietzing Hospital with Neurological Center Rosenhuegel, Wolkersbergenstraße 1, 1130, Vienna, Austria.
- Karl Landsteiner Institute for Metabolic Diseases and Nephrology, Hietzing Hospital with Neurological Center Rosenhuegel, Vienna, Austria.
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731
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Vavougios GD. Letter to the editor: The role of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in developing a COVID-19 comorbidity-based host risk score. Crit Care 2020; 24:242. [PMID: 32430049 PMCID: PMC7236436 DOI: 10.1186/s13054-020-02903-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/16/2020] [Indexed: 01/22/2023] Open
Affiliation(s)
- George D Vavougios
- Department of Neurology, Athens Naval Hospital, 70 Deinokratous Street, 11125, Athens, Greece. .,Department of Respiratory Medicine, University of Thessaly, Larisa, Greece. .,Department of Computer and Electrical Engineering, Volos, Greece.
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732
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The COVID-19 Pandemic during the Time of the Diabetes Pandemic: Likely Fraternal Twins? Pathogens 2020; 9:pathogens9050389. [PMID: 32438687 PMCID: PMC7281197 DOI: 10.3390/pathogens9050389] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/13/2020] [Accepted: 05/16/2020] [Indexed: 02/06/2023] Open
Abstract
An altered immune response to pathogens has been suggested to explain increased susceptibility to infectious diseases in patients with diabetes. Recent evidence has documented several immunometabolic pathways in patients with diabetes directly related to the COVID-19 infection. This also seems to be the case for prediabetic subjects with proinflammatory insulin resistance syndrome accompanied with prothrombotic hyperinsulinemic and dysglycemic states. Patients with frank hyperglycemia, dysglycemia and/or hyperinsulinemia develop systemic immunometabolic inflammation with higher levels of circulating cytokines. This deleterious scenario has been proposed as the underlying mechanism enhancing a cytokine storm-like hyperinflammatory state in diabetics infected with severe COVID-19 triggering multi-organ failure. Compared with moderately affected COVID-19 patients, diabetes was found to be highly prevalent among severely affected patients suggesting that this non-communicable disease should be considered as a risk factor for adverse outcomes. The COVID-19 pandemic mirrors with the diabetes pandemic in many pathobiological aspects. Our interest is to emphasize the ties between the immunoinflammatory mechanisms that underlie the morbidity and lethality when COVID-19 meets diabetes. This review brings attention to two pathologies of highly complex, multifactorial, developmental and environmentally dependent manifestations of critical importance to human survival. Extreme caution should be taken with diabetics with suspected symptoms of COVID-19 infection.
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733
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Jimeno C, Anonuevo-Cruz MC, Uy AB, Bacena AO, Francisco MD, Tiglao-Gica AL, Bruno R, Corpuz DG. UP Philippine General Hospital Division of Endocrinology, Diabetes & Metabolism Consensus Recommendations for In-Patient Management of Diabetes Mellitus among Persons with COVID-19. J ASEAN Fed Endocr Soc 2020; 35:14-25. [PMID: 33442164 PMCID: PMC7784188 DOI: 10.15605/jafes.035.01.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 01/08/2023] Open
Abstract
Diabetes mellitus (DM) is a known risk factor for morbidity and mortality among patients with COVID-19 based on recent studies. While there are many local and international guidelines on inpatient management of diabetes, the complicated pathology of the virus, the use of glucose-elevating drugs such as glucocorticoids, antivirals and even inotropes, and various other unique problems has made the management of in-hospital hyperglycemia among patients with COVID-19 much more difficult than in other infections. The objective of this guidance is to collate and integrate the best available evidence that has been published regarding in-patient management of diabetes among patients with COVID-19. A comprehensive review of literature was done and recommendations have been made through a consensus of expert endocrinologists from the University of the Philippines-Philippine General Hospital (UP-PGH) Division of Endocrinology, Diabetes and Metabolism. These recommendations are evolving as we continue to understand the pathology of the disease and how persons with diabetes are affected by this virus.
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Affiliation(s)
- Cecilia Jimeno
- Division of Endocrinology, Diabetes and Metabolism, University of the Philippines-Philippine General Hospital
| | - Ma Cecille Anonuevo-Cruz
- Division of Endocrinology, Diabetes and Metabolism, University of the Philippines-Philippine General Hospital
| | - Angelique Bea Uy
- Division of Endocrinology, Diabetes and Metabolism, University of the Philippines-Philippine General Hospital
| | - Adrian Oscar Bacena
- Division of Endocrinology, Diabetes and Metabolism, University of the Philippines-Philippine General Hospital
| | - Mark David Francisco
- Division of Endocrinology, Diabetes and Metabolism, University of the Philippines-Philippine General Hospital
| | - Angelique Love Tiglao-Gica
- Division of Endocrinology, Diabetes and Metabolism, University of the Philippines-Philippine General Hospital
| | - Racquel Bruno
- Division of Endocrinology, Diabetes and Metabolism, University of the Philippines-Philippine General Hospital
| | - Diane Grace Corpuz
- Division of Endocrinology, Diabetes and Metabolism, University of the Philippines-Philippine General Hospital
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734
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Preckel B, Schultz MJ, Vlaar AP, Hulst AH, Hermanides J, de Jong MD, Schlack WS, Stevens MF, Weenink RP, Hollmann MW. Update for Anaesthetists on Clinical Features of COVID-19 Patients and Relevant Management. J Clin Med 2020; 9:E1495. [PMID: 32429249 PMCID: PMC7291059 DOI: 10.3390/jcm9051495] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/09/2020] [Accepted: 05/14/2020] [Indexed: 02/07/2023] Open
Abstract
When preparing for the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the coronavirus infection disease (COVID-19) questions arose regarding various aspects concerning the anaesthetist. When reviewing the literature it became obvious that keeping up-to-date with all relevant publications is almost impossible. We searched for and summarised clinically relevant topics that could help making clinical decisions. This is a subjective analysis of literature concerning specific topics raised in our daily practice (e.g., clinical features of COVID-19 patients; ventilation of the critically ill COVID-19 patient; diagnostic of infection with SARS-CoV-2; stability of the virus; Covid-19 in specific patient populations, e.g., paediatrics, immunosuppressed patients, patients with hypertension, diabetes mellitus, kidney or liver disease; co-medication with non-steroidal anti-inflammatory drugs (NSAIDs); antiviral treatment) and we believe that these answers help colleagues in clinical decision-making. With ongoing treatment of severely ill COVID-19 patients other questions will come up. While respective guidelines on these topics will serve clinicians in clinical practice, regularly updating all guidelines concerning COVID-19 will be a necessary, although challenging task in the upcoming weeks and months. All recommendations during the current extremely rapid development of knowledge must be evaluated on a daily basis, as suggestions made today may be out-dated with the new evidence available tomorrow.
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Affiliation(s)
- Benedikt Preckel
- Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (A.H.H.); (W.S.S.); (M.F.S.); (R.P.W.); (M.W.H.)
- Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands; (M.J.S.); (A.P.V.)
| | - Marcus J. Schultz
- Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands; (M.J.S.); (A.P.V.)
- Department of Intensive Care, and Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok 10400, Thailand
- Nuffield Department of Medicine, University of Oxford, Old Road Campus Research Build, Roosevelt Dr, Headington, Oxford OX3 7DQ, UK
| | - Alexander P. Vlaar
- Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands; (M.J.S.); (A.P.V.)
- Department of Intensive Care, and Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands
| | - Abraham H. Hulst
- Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (A.H.H.); (W.S.S.); (M.F.S.); (R.P.W.); (M.W.H.)
| | - Jeroen Hermanides
- Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (A.H.H.); (W.S.S.); (M.F.S.); (R.P.W.); (M.W.H.)
| | - Menno D. de Jong
- Department of Medical Microbiology & Infection prevention, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands;
| | - Wolfgang S. Schlack
- Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (A.H.H.); (W.S.S.); (M.F.S.); (R.P.W.); (M.W.H.)
| | - Markus F. Stevens
- Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (A.H.H.); (W.S.S.); (M.F.S.); (R.P.W.); (M.W.H.)
| | - Robert P. Weenink
- Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (A.H.H.); (W.S.S.); (M.F.S.); (R.P.W.); (M.W.H.)
| | - Markus W. Hollmann
- Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (A.H.H.); (W.S.S.); (M.F.S.); (R.P.W.); (M.W.H.)
- Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands; (M.J.S.); (A.P.V.)
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735
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Kabashneh S, Ali H, Alkassis S. Multi-Organ Failure in a Patient With Diabetes due to COVID-19 With Clear Lungs. Cureus 2020; 12:e8147. [PMID: 32550066 PMCID: PMC7294884 DOI: 10.7759/cureus.8147] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The pandemic of coronavirus disease 2019 has emerged in late 2019 infecting millions of people worldwide. Diabetes mellitus (DM) has been associated with severe illness and mortality mainly due to acute respiratory distress syndrome. We report a case of a middle-aged man with DM and COVID-19 who developed seizure and altered mental status, found to have diabetic ketoacidosis (DKA), acute kidney injury, hypovolemic shock, and hyperammonemia all contributing to metabolic encephalopathy. He was admitted to the ICU and subsequently intubated for airway protection; with appropriate management his condition improved and was successfully extubated. The patient had no lung involvement throughout the illness. We report this case to highlight that COVID-19 can lead to multi-organ failure in patients with DM even in the absence of lung involvement which all physicians should be mindful of.
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Affiliation(s)
- Sohaip Kabashneh
- Internal Medicine, Wayne State University - Detroit Medical Center, Detroit, USA
| | - Hammad Ali
- Internal Medicine, Wayne State University - Detroit Medical Center, Detroit, USA
| | - Samer Alkassis
- Internal Medicine, Wayne State University - Detroit Medical Center, Detroit, USA
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736
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Meireles PA, Bessa F, Gaspar P, Parreira I, Silva VD, Mota C, Alvoeiro L. Acalculous Acute Pancreatitis in a COVID-19 Patient. Eur J Case Rep Intern Med 2020; 7:001710. [PMID: 32523925 PMCID: PMC7279899 DOI: 10.12890/2020_001710] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a multisystemic condition caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with manifestations ranging from mild upper respiratory symptoms to cytokine storm causing acute respiratory distress syndrome. Pancreatic exocrine tissue and endocrine islets both express angiotensin-converting enzyme 2 (ACE2), the proven receptor for SARS-CoV-2 cell internalization. An increase in pancreatic enzymes has been increasingly recognized in patients with COVID-19, but little is known about the real prevalence of acute pancreatitis in this population. We report a case of acute acalculous pancreatitis in a COVID-19 patient.
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Affiliation(s)
- Pedro Antunes Meireles
- Serviço de Medicina 2, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Serviço de Oncologia Médica, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Filipe Bessa
- Serviço de Medicina 2, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Pedro Gaspar
- Serviço de Medicina 2, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Inês Parreira
- Serviço de Medicina 2, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Virgílio Dias Silva
- Serviço de Medicina 2, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Serviço de Medicina Intensiva, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Catarina Mota
- Serviço de Medicina 2, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Lourdes Alvoeiro
- Serviço de Medicina 2, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
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737
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Finucane FM, Davenport C. Coronavirus and Obesity: Could Insulin Resistance Mediate the Severity of Covid-19 Infection? Front Public Health 2020; 8:184. [PMID: 32574288 PMCID: PMC7247836 DOI: 10.3389/fpubh.2020.00184] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/24/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Francis M Finucane
- HRB Clinical Research Facility, National University of Ireland Galway, Galway, Ireland.,Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
| | - Colin Davenport
- HRB Clinical Research Facility, National University of Ireland Galway, Galway, Ireland.,Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
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738
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Sardu C, Gambardella J, Morelli MB, Wang X, Marfella R, Santulli G. Hypertension, Thrombosis, Kidney Failure, and Diabetes: Is COVID-19 an Endothelial Disease? A Comprehensive Evaluation of Clinical and Basic Evidence. J Clin Med 2020; 9:E1417. [PMID: 32403217 PMCID: PMC7290769 DOI: 10.3390/jcm9051417] [Citation(s) in RCA: 342] [Impact Index Per Article: 85.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/02/2020] [Accepted: 05/04/2020] [Indexed: 02/06/2023] Open
Abstract
The symptoms most commonly reported by patients affected by coronavirus disease (COVID-19) include cough, fever, and shortness of breath. However, other major events usually observed in COVID-19 patients (e.g., high blood pressure, arterial and venous thromboembolism, kidney disease, neurologic disorders, and diabetes mellitus) indicate that the virus is targeting the endothelium, one of the largest organs in the human body. Herein, we report a systematic and comprehensive evaluation of both clinical and preclinical evidence supporting the hypothesis that the endothelium is a key target organ in COVID-19, providing a mechanistic rationale behind its systemic manifestations.
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Affiliation(s)
- Celestino Sardu
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy; (C.S.); (R.M.)
- Department of Medical Sciences, International University of Health and Medical Sciences “Saint Camillus”, 00131 Rome, Italy
| | - Jessica Gambardella
- Department of Advanced Biomedical Sciences, International Translational Research and Medical Education Academic Research Unit (ITME), “Federico II” University, 80131 Naples, Italy;
- Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Wilf Family Cardiovascular Research Institute, New York, NY 10461, USA; (M.B.M.); (X.W.)
| | - Marco Bruno Morelli
- Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Wilf Family Cardiovascular Research Institute, New York, NY 10461, USA; (M.B.M.); (X.W.)
- Department of Molecular Pharmacology, Fleischer Institute for Diabetes and Metabolism (FIDAM), Montefiore University Hospital, New York, NY 10461, USA
| | - Xujun Wang
- Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Wilf Family Cardiovascular Research Institute, New York, NY 10461, USA; (M.B.M.); (X.W.)
| | - Raffaele Marfella
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy; (C.S.); (R.M.)
| | - Gaetano Santulli
- Department of Advanced Biomedical Sciences, International Translational Research and Medical Education Academic Research Unit (ITME), “Federico II” University, 80131 Naples, Italy;
- Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Wilf Family Cardiovascular Research Institute, New York, NY 10461, USA; (M.B.M.); (X.W.)
- Department of Molecular Pharmacology, Fleischer Institute for Diabetes and Metabolism (FIDAM), Montefiore University Hospital, New York, NY 10461, USA
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739
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Chen Y, Zhao M, Wu Y, Zang S. Epidemiological analysis of the early 38 fatalities in Hubei, China, of the coronavirus disease 2019. J Glob Health 2020. [PMID: 32373340 PMCID: PMC7183246 DOI: 10.7189/jogh-10-011004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Since the emergence of coronavirus disease 2019 (COVID-19) in Hubei province of China by the end of 2019, it has burned its way across the globe, resulting in a still fast-growing death toll that far exceeded those from severe acute respiratory syndrome (SARS) in less than two months. As there is a paucity of evidence on which population is more likely to progress into severe conditions among cases, we looked into the first cluster of death cases, aiming to add to current evidence and reduce panic among the population. Methods We prospectively collected the demographic and clinical data of the first 38 fatalities whose information was made public by the Health Commission of Hubei province and the official Weibo account of China Central Television news center, starting from 9 January through 24 January 2020. The death cases were described from four aspects (gender and age characteristics, underlying diseases, the time course of death, symptoms at the incipience of illness and hospital admission). Results Among the 38 fatalities, 71.05% were male, and 28.95% were female, with the median age of 70 years (interquartile range (IQR) = 65-81). Persons aged 66-75 made up the largest share. Twenty-five cases had a history of chronic diseases. The median time between the first symptoms and death was 12.50 days (IQR = 10.00-16.25), while the median time between the admission and death was 8.50 (IQR = 5.00-12.00) days. In persons aged over 56 years, the time between the first symptoms and death decreased with age, and so did the time between the admission and death, though the latter increased again in persons aged over 85 years. The major first symptoms included fever (52.63%), cough (31.58%), dyspnea (23.68%), myalgia and fatigue (15.79%). Conclusions Among the death cases, persons with underlying diseases and aged over 65 made up the majority. The time between the first symptoms and death decreased with the advanced age. In all the age groups, males dominated the fatalities.
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Affiliation(s)
- Yifei Chen
- School of Nursing, China Medical University, Shenyang, Liaoning, China
| | - Meizhen Zhao
- Nursing Department, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yifan Wu
- School of Nursing, China Medical University, Shenyang, Liaoning, China
| | - Shuang Zang
- School of Nursing, China Medical University, Shenyang, Liaoning, China
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740
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Liu H, Chen S, Liu M, Nie H, Lu H. Comorbid Chronic Diseases are Strongly Correlated with Disease Severity among COVID-19 Patients: A Systematic Review and Meta-Analysis. Aging Dis 2020; 11:668-678. [PMID: 32489711 PMCID: PMC7220287 DOI: 10.14336/ad.2020.0502] [Citation(s) in RCA: 158] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/02/2020] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has resulted in considerable morbidity and mortality worldwide since December 2019. In order to explore the effects of comorbid chronic diseases on clinical outcomes of COVID-19, a search was conducted in PubMed, Ovid MEDLINE, EMBASE, CDC, and NIH databases to April 25, 2020. A total of 24 peer-reviewed articles, including 10948 COVID-19 cases were selected. We found diabetes was present in 10.0%, coronary artery disease/cardiovascular disease (CAD/CVD) was in 8.0%, and hypertension was in 20.0%, which were much higher than that of chronic pulmonary disease (3.0%). Specifically, preexisting chronic conditions are strongly correlated with disease severity [Odds ratio (OR) 3.50, 95% CI 1.78 to 6.90], and being admitted to intensive care unit (ICU) (OR 3.36, 95% CI 1.67 to 6.76); in addition, compared to COVID-19 patients with no preexisting chronic diseases, COVID-19 patients who present with either diabetes, hypertension, CAD/CVD, or chronic pulmonary disease have a higher risk of developing severe disease, with an OR of 2.61 (95% CI 1.93 to 3.52), 2.84 (95% CI 2.22 to 3.63), 4.18 (95% CI 2.87 to 6.09) and 3.83 (95% CI 2.15 to 6.80), respectively. Surprisingly, we found no correlation between chronic conditions and increased risk of mortality (OR 2.09, 95% CI 0.26 to16.67). Taken together, cardio-metabolic diseases, such as diabetes, hypertension and CAD/CVD were more common than chronic pulmonary disease in COVID-19 patients, however, each comorbid disease was correlated with increased disease severity. After active treatment, increased risk of mortality in patients with preexisting chronic diseases may reduce.
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Affiliation(s)
- Hong Liu
- Department of Nutrition, the Third Xiangya Hospital of Central South University, Changsha, China.
| | - Shiyan Chen
- Department of Endocrinology & Metabolism, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.
| | - Min Liu
- Department of Nutrition, the Third Xiangya Hospital of Central South University, Changsha, China.
| | - Hao Nie
- Department of Geriatrics, the First Affiliated Hospital of Hunan Normal University, Changsha, China.
| | - Hongyun Lu
- Department of Endocrinology & Metabolism, Zhuhai Hospital Affiliated with Jinan University, Zhuhai People’s Hospital, Zhuhai, China.
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741
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Dalan R, Bornstein SR, El-Armouche A, Rodionov RN, Markov A, Wielockx B, Beuschlein F, Boehm BO. The ACE-2 in COVID-19: Foe or Friend? Horm Metab Res 2020; 52:257-263. [PMID: 32340044 PMCID: PMC7339082 DOI: 10.1055/a-1155-0501] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 01/08/2023]
Abstract
COVID-19 is a rapidly spreading outbreak globally. Emerging evidence demonstrates that older individuals and people with underlying metabolic conditions of diabetes mellitus, hypertension, and hyperlipidemia are at higher risk of morbidity and mortality. The SARS-CoV-2 infects humans through the angiotensin converting enzyme (ACE-2) receptor. The ACE-2 receptor is a part of the dual system renin-angiotensin-system (RAS) consisting of ACE-Ang-II-AT1R axis and ACE-2-Ang-(1-7)-Mas axis. In metabolic disorders and with increased age, it is known that there is an upregulation of ACE-Ang-II-AT1R axis with a downregulation of ACE-2-Ang-(1-7)-Mas axis. The activated ACE-Ang-II-AT1R axis leads to pro-inflammatory and pro-fibrotic effects in respiratory system, vascular dysfunction, myocardial fibrosis, nephropathy, and insulin secretory defects with increased insulin resistance. On the other hand, the ACE-2-Ang-(1-7)-Mas axis has anti-inflammatory and antifibrotic effects on the respiratory system and anti-inflammatory, antioxidative stress, and protective effects on vascular function, protects against myocardial fibrosis, nephropathy, pancreatitis, and insulin resistance. In effect, the balance between these two axes may determine the prognosis. The already strained ACE-2-Ang-(1-7)-Mas in metabolic disorders is further stressed due to the use of the ACE-2 by the virus for entry, which affects the prognosis in terms of respiratory compromise. Further evidence needs to be gathered on whether modulation of the renin angiotensin system would be advantageous due to upregulation of Mas activation or harmful due to the concomitant ACE-2 receptor upregulation in the acute management of COVID-19.
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Affiliation(s)
- Rinkoo Dalan
- Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University
Singapore, Singapore
| | - Stefan R. Bornstein
- Lee Kong Chian School of Medicine, Nanyang Technological University
Singapore, Singapore
- Department of Medicine III, University Hospital Carl Gustav Carus,
Dresden, Germany
- Division of Diabetes & Nutritional Sciences, Faculty of Life
Sciences & Medicine, King's College London, London,
UK
- Klinik für Endokrinologie, Diabetologie und Klinische
Ernährung, University Hospital, Zürich,
Switzerland
| | - Ali El-Armouche
- Department of Pharmacology and Toxicology, Medical Faculty Carl Gustav
Carus, Technische Universität Dresden, Dresden, Germany
| | - Roman N Rodionov
- Division of Angiology, Department of Internal Medicine III, University
Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden,
Germany
| | - Alexander Markov
- Department of General Physiology, Saint-Petersburg State University,
Saint-Petersburg, Russia
| | - Ben Wielockx
- Institute of Clinical Chemistry, University Hospital Carl Gustav Carus,
Technische Universität Dresden, Dresden, Germany
| | - Felix Beuschlein
- Klinik für Endokrinologie, Diabetologie und Klinische
Ernährung, University Hospital, Zürich,
Switzerland
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität
München, Munich, Germany
| | - Bernhard O. Boehm
- Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University
Singapore, Singapore
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742
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Jin JM, Bai P, He W, Wu F, Liu XF, Han DM, Liu S, Yang JK. Gender Differences in Patients With COVID-19: Focus on Severity and Mortality. Front Public Health 2020; 8:152. [PMID: 32411652 PMCID: PMC7201103 DOI: 10.3389/fpubh.2020.00152] [Citation(s) in RCA: 1273] [Impact Index Per Article: 318.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/09/2020] [Indexed: 12/16/2022] Open
Abstract
Objective: The recent outbreak of Novel Coronavirus Disease (COVID-19) is reminiscent of the SARS outbreak in 2003. We aim to compare the severity and mortality between male and female patients with COVID-19 or SARS. Study Design and Setting: We extracted the data from: (1) a case series of 43 hospitalized patients we treated, (2) a public data set of the first 37 cases of patients who died of COVID-19 and 1,019 patients who survived in China, and (3) data of 524 patients with SARS, including 139 deaths, from Beijing in early 2003. Results: Older age and a high number of comorbidities were associated with higher severity and mortality in patients with both COVID-19 and SARS. Age was comparable between men and women in all data sets. In the case series, however, men's cases tended to be more serious than women's (P = 0.035). In the public data set, the number of men who died from COVID-19 is 2.4 times that of women (70.3 vs. 29.7%, P = 0.016). In SARS patients, the gender role in mortality was also observed. The percentage of males were higher in the deceased group than in the survived group (P = 0.015). Conclusion: While men and women have the same prevalence, men with COVID-19 are more at risk for worse outcomes and death, independent of age.
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Affiliation(s)
- Jian-Min Jin
- Department of Respiratory and Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Department of Internal Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Peng Bai
- Department of Respiratory and Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Department of Internal Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei He
- Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Fei Wu
- Department of Internal Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao-Fang Liu
- Department of Respiratory and Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - De-Min Han
- Department of Otolaryngology and Head Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Shi Liu
- Department of Internal Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jin-Kui Yang
- Department of Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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743
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Brufsky A. Hyperglycemia, hydroxychloroquine, and the COVID-19 pandemic. J Med Virol 2020; 92:770-775. [PMID: 32293710 PMCID: PMC7262330 DOI: 10.1002/jmv.25887] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 04/12/2020] [Accepted: 04/13/2020] [Indexed: 01/08/2023]
Abstract
Coronavirus disease‐2019 (COVID‐19) infection and its severity can be explained by the concentration of glycosylated severe acute respiratory syndrome‐coronavirus 2 (SARS‐CoV‐2) viral particles in the lung epithelium, the concentration of glycosylated angiotensin‐converting enzyme receptor 2 (ACE2) in the lung epithelium, and the degree and control of the pulmonary immune response to the SARS‐CoV‐2 spike protein at approximately day 8 to 10 after symptom onset, which may be related to both. Binding of ACE2 by SARS‐CoV‐2 in COVID‐19 also suggests that prolonged uncontrolled hyperglycemia, and not just a history of diabetes mellitus, may be important in the pathogenesis of the disease. It is tempting to consider that the same mechanism acts in COVID‐19 as in SARS, where an overactive macrophage M1 inflammatory response, as neutralizing antibodies to the SARS‐CoV‐2 spike protein form at day 7 to 10, results in acute respiratory distress syndrome (ARDS) in susceptible patients. It also allows consideration of agents, such as hydroxychloroquine, which may interfere with this overly brisk macrophage inflammatory response and perhaps influence the course of the disease, in particular, those that blunt but do not completely abrogate the M1 to M2 balance in macrophage polarization, as well as viral load, which in SARS appears to be temporally related to the onset of ARDS. Aberrant glycosylation of SARS‐CoV‐2, ACE2, and various immunoregulatory proteins such as the Fc gamma receptor may impact the severity of COVID‐19 disease. Hyperglycemia, and not simply diabetes, may increase glycosylation of these proteins and lead to more severe COVID‐19 disease. Agents that block glycosylation may blunt the severity of COVID‐19.
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Affiliation(s)
- Adam Brufsky
- UPMC Hillman Cancer Center, Magee Women's Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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744
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Wang X, Fang X, Cai Z, Wu X, Gao X, Min J, Wang F. Comorbid Chronic Diseases and Acute Organ Injuries Are Strongly Correlated with Disease Severity and Mortality among COVID-19 Patients: A Systemic Review and Meta-Analysis. RESEARCH (WASHINGTON, D.C.) 2020; 2020:2402961. [PMID: 32377638 PMCID: PMC7187729 DOI: 10.34133/2020/2402961] [Citation(s) in RCA: 173] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 04/08/2020] [Indexed: 01/08/2023]
Abstract
The recent outbreak of COVID-19 has been rapidly spreading on a global scale. To date, there is no specific vaccine against the causative virus, SARS-CoV-2, nor is there an effective medicine for treating COVID-19, thus raising concerns with respect to the effect of risk factors such as clinical course and pathophysiological parameters on disease severity and outcome in patients with COVID-19. By extracting and analyzing all available published clinical data, we identified several major clinical characteristics associated with increased disease severity and mortality among patients with COVID-19. Specifically, preexisting chronic conditions such as hypertension, cardiovascular disease, chronic kidney disease, and diabetes are strongly associated with an increased risk of developing severe COVID-19; surprisingly, however, we found no correlation between chronic liver disease and increased disease severity. In addition, we found that both acute cardiac injury and acute kidney injury are highly correlated with an increased risk of COVID-19-related mortality. Given the high risk of comorbidity and the high mortality rate associated with tissue damage, organ function should be monitored closely in patients diagnosed with COVID-19, and this approach should be included when establishing new guidelines for managing these high-risk patients. Moreover, additional clinical data are needed in order to determine whether a supportive therapy can help mitigate the development of severe, potentially fatal complications, and further studies are needed to identify the pathophysiology and the mechanism underlying this novel coronavirus-associated infectious disease. Taken together, these findings provide new insights regarding clinical strategies for improving the management and outcome of patients with COVID-19.
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Affiliation(s)
- Xinhui Wang
- The First Affiliated Hospital, School of Public Health, Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Xuexian Fang
- The First Affiliated Hospital, School of Public Health, Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Zhaoxian Cai
- The First Affiliated Hospital, School of Public Health, Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Xiaotian Wu
- The First Affiliated Hospital, School of Public Health, Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Xiaotong Gao
- The First Affiliated Hospital, School of Public Health, Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Junxia Min
- The First Affiliated Hospital, School of Public Health, Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Fudi Wang
- The First Affiliated Hospital, School of Public Health, Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou 310058, China
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745
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Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY 2020. [PMID: 32294485 DOI: 10.1016/j.jaci.2020.04.006.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND In December 2019, the coronavirus disease 2019 (COVID-19) outbreak occurred in Wuhan. Data on the clinical characteristics and outcomes of patients with severe COVID-19 are limited. OBJECTIVE We sought to evaluate the severity on admission, complications, treatment, and outcomes of patients with COVID-19. METHODS Patients with COVID-19 admitted to Tongji Hospital from January 26, 2020, to February 5, 2020, were retrospectively enrolled and followed-up until March 3, 2020. Potential risk factors for severe COVID-19 were analyzed by a multivariable binary logistic model. Cox proportional hazard regression model was used for survival analysis in severe patients. RESULTS We identified 269 (49.1%) of 548 patients as severe cases on admission. Older age, underlying hypertension, high cytokine levels (IL-2R, IL-6, IL-10, and TNF-α), and high lactate dehydrogenase level were significantly associated with severe COVID-19 on admission. The prevalence of asthma in patients with COVID-19 was 0.9%, markedly lower than that in the adult population of Wuhan. The estimated mortality was 1.1% in nonsevere patients and 32.5% in severe cases during the average 32 days of follow-up period. Survival analysis revealed that male sex, older age, leukocytosis, high lactate dehydrogenase level, cardiac injury, hyperglycemia, and high-dose corticosteroid use were associated with death in patients with severe COVID-19. CONCLUSIONS Patients with older age, hypertension, and high lactate dehydrogenase level need careful observation and early intervention to prevent the potential development of severe COVID-19. Severe male patients with heart injury, hyperglycemia, and high-dose corticosteroid use may have a high risk of death.
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Abstract
AIMS We aimed to briefly review the general characteristics of the novel coronavirus (SARS-CoV-2) and provide a better understanding of the coronavirus disease (COVID-19) in people with diabetes, and its management. METHODS We searched for articles in PubMed and Google Scholar databases till 02 April 2020, with the following keywords: "SARS-CoV-2", "COVID-19", "infection", "pathogenesis", "incubation period", "transmission", "clinical features", "diagnosis", "treatment", "diabetes", with interposition of the Boolean operator "AND". RESULTS The clinical spectrum of COVID-19 is heterogeneous, ranging from mild flu-like symptoms to acute respiratory distress syndrome, multiple organ failure and death. Older age, diabetes and other comorbidities are reported as significant predictors of morbidity and mortality. Chronic inflammation, increased coagulation activity, immune response impairment, and potential direct pancreatic damage by SARS-CoV-2 might be among the underlying mechanisms of the association between diabetes and COVID-19. No conclusive evidence exists to support the discontinuation of angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers or thiazolidinediones because of COVID-19 in people with diabetes. Caution should be taken to potential hypoglycemic events with the use of chloroquine in these subjects. Patient tailored therapeutic strategies, rigorous glucose monitoring and careful consideration of drug interactions might reduce adverse outcomes. CONCLUSIONS Suggestions are made on the possible pathophysiological mechanisms of the relationship between diabetes and COVID-19, and its management. No definite conclusions can be made based on current limited evidence. Further research regarding this relationship and its clinical management is warranted.
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Affiliation(s)
- Akhtar Hussain
- Faculty of Health Sciences, Nord University, Bodø 8049, Norway; Faculty of Medicine, Federal University of Ceará (FAMED-UFC), Brazil; International Diabetes Federation (IDF), 166 Chaussee de La Hulpe, B - 1170 Brussels, Belgium; Diabetes Asian Study Group (DASG), Ambwadi, Ahmedabad 380015, Gujarat, India; Centre for Global Health Research, Diabetic Association of Bangladesh, Dhaka 1000, Bangladesh.
| | - Bishwajit Bhowmik
- Centre for Global Health Research, Diabetic Association of Bangladesh, Dhaka 1000, Bangladesh; Institute of Health and Society, Department of Community Medicine and Global Health, University of Oslo (UiO), Oslo 0318, Norway
| | - Nayla Cristina do Vale Moreira
- Faculty of Medicine, Federal University of Ceará (FAMED-UFC), Brazil; Institute of Health and Society, Department of Community Medicine and Global Health, University of Oslo (UiO), Oslo 0318, Norway
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747
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Li G, Hu R, Zhang X. Antihypertensive treatment with ACEI/ARB of patients with COVID-19 complicated by hypertension. Hypertens Res 2020; 43:588-590. [PMID: 32231220 PMCID: PMC7103897 DOI: 10.1038/s41440-020-0433-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 03/04/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Gang Li
- Cardiology Division, Geriatric Institute, Hebei General Hospital, Shijiazhuang, Hebei, China.
| | - Rui Hu
- General Clinical Laboratory, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xuejiao Zhang
- Cardiology Division, Geriatric Institute, Hebei General Hospital, Shijiazhuang, Hebei, China
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748
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Ilias I, Zabuliene L. Hyperglycemia and the novel Covid-19 infection: Possible pathophysiologic mechanisms. Med Hypotheses 2020; 139:109699. [PMID: 32240876 PMCID: PMC7203506 DOI: 10.1016/j.mehy.2020.109699] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 03/25/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Ioannis Ilias
- Endocrine Unit, Elena Venizelou Hospital, Athens GR-11521, Greece.
| | - Lina Zabuliene
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Ciurlionio 21, Vilnius LT-03101, Lithuania.
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749
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Ferrara F, Vitiello A. The impact of COVID-19 in diabetic patient. ARCHIVES OF MEDICINE AND HEALTH SCIENCES 2020. [DOI: 10.4103/amhs.amhs_117_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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750
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Saban-Ruiz J, Ly-Pen D. COVID-19: A Personalized Cardiometabolic Approach for Reducing Complications and Costs. The Role of Aging beyond Topics. J Nutr Health Aging 2020; 24:550-559. [PMID: 32510105 PMCID: PMC7217344 DOI: 10.1007/s12603-020-1385-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/03/2020] [Indexed: 02/07/2023]
Abstract
COVID 19 is much more than an infectious disease by SARS-CoV-2 followed by a disproportionate immune response. An older age, diabetes and history of cardiovascular disease, especially hypertension, but also chronic heart failure and coronary artery disease among others, are between the most important risk factors. In addition, during the hospitalization both hyperglycaemia and heart failure are frequent. Less frequent are acute coronary syndrome, arrhythmias and stroke. Accordingly, not all prolonged stays or even deaths are due directly to SARS-CoV-2. To our knowledge, this is the first review, focusing both on cardiovascular and metabolic aspects of this dreadful disease, in an integrated and personalized way, following the guidelines of the Cardiometabolic Health/Medicine. Therefore, current personalized aspects such as ACEIs and ARBs, the place of statins and the most appropriate management of heart failure in diabetics are analysed. Aging, better than old age, as a dynamic process, is also considered in this review for the first time in the literature, and not only as a risk factor attributed to cardiovascular and non-cardiovascular comorbidities. Immunosenescence is also approached to build healthier elders, so they can resist present and future infectious diseases, and not only in epidemics or pandemics. In addition, to do this we must start knowing the molecular mechanisms that underlying Aging process in general, and immunosenescence in particular. Surprisingly, the endoplasmic reticulum stress and autophagy are implicated in both process. Finally, with a training in all the aspects covered in this review, not only the hospital stay, complications and costs of this frightening disease in high-risk population should be reduced. Likely, this paper will open a gate to the future for open-minded physicians.
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Affiliation(s)
- J Saban-Ruiz
- Prof. Saban-Ruiz, MD, PhD, d-médical Clinic, Madrid, Spain,
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