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Søvik S, Bådstøløkken PM, Sørensen V, Myhre PL, Prebensen C, Omland T, Berdal J. A single-centre, prospective cohort study of COVID-19 patients admitted to ICU for mechanical ventilatory support. Acta Anaesthesiol Scand 2021; 65:351-359. [PMID: 33128800 PMCID: PMC7894152 DOI: 10.1111/aas.13726] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/11/2020] [Accepted: 10/09/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Mortality rates in COVID-19 patients in need of mechanical ventilation are high, with wide variations between countries. Most studies were retrospective, and results may not be generalizable due to differences in demographics, healthcare organization and surge capacity. We present a cohort of mechanically ventilated COVID-19 patients from a resource-rich, publicly financed healthcare system. METHODS Prospective study from a tertiary hospital. Consecutive SARS-CoV-2 positive adult patients admitted to the ICU for mechanical ventilation from 10 March 2020 to 04 May 2020 were included. Triage and treatment were protocolized. High-dose dalteparin was adjusted by D-dimer. Demographics, treatments and high-resolution physiological variables were collected. Outcomes were 30-day and hospital mortality. Data are medians (quartiles). RESULTS Of the 1484 persons in the hospital catchment area testing positive for SARS-CoV-2, 201 (13.5%) were hospitalized. Thirty-eight (19%) patients were mechanically ventilated, of whom five (13%) died. Of the 163 patients treated with supplemental oxygen, eight (5%) died. In ventilated patients (75% males, age 61 (53-70) years), severe, moderate and mild ARDS was present in 25%, 70% and 5%. Tidal volume ≤8 mL/kg ideal bodyweight was achieved in 34 (94%) patients. Proning and neuromuscular blockers were used in 19 (54%) and 20 (61%) patients. Duration of ventilation was 12 days (8-23). D-dimer peaked at 3.8 mg/L (2.1-5.3), and maximum dalteparin dose was 15 000 IU/24 h (10 000-15 000). Despite organizational changes, a high degree of adherence to treatment protocols was achieved. CONCLUSION In a prospective cohort study of mechanically ventilated COVID-19 patients treated in a resource-rich, publicly financed healthcare system, mortality was considerably lower than previously reported in retrospective studies.
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Affiliation(s)
- Signe Søvik
- Department of Anaesthesia and Intensive Care Akershus University Hospital Lørenskog Norway
- Institute of Clinical Medicine Faculty of Medicine University of Oslo Oslo Norway
| | - Per M. Bådstøløkken
- Department of Anaesthesia and Intensive Care Akershus University Hospital Lørenskog Norway
| | - Vibecke Sørensen
- Department of Anaesthesia and Intensive Care Akershus University Hospital Lørenskog Norway
| | - Peder Langeland Myhre
- Institute of Clinical Medicine Faculty of Medicine University of Oslo Oslo Norway
- Department of Cardiology Akershus University Hospital Lørenskog Norway
| | - Christian Prebensen
- Institute of Clinical Medicine Faculty of Medicine University of Oslo Oslo Norway
- Department of Infectious Diseases Akershus University Hospital Lørenskog Norway
| | - Torbjørn Omland
- Institute of Clinical Medicine Faculty of Medicine University of Oslo Oslo Norway
- Department of Cardiology Akershus University Hospital Lørenskog Norway
| | - Jan‐Erik Berdal
- Institute of Clinical Medicine Faculty of Medicine University of Oslo Oslo Norway
- Department of Infectious Diseases Akershus University Hospital Lørenskog Norway
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Das K, Agrawal N, Kala M, Khanduri R. Coronavirus Disease 2019 Treatment—T-Cells Hold the Key in Severe Cases. Indian J Med Paediatr Oncol 2021. [DOI: 10.1055/s-0041-1729343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Kunal Das
- Department of Pediatrics, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Nitika Agrawal
- Department of Pediatrics, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Mansi Kala
- Department of Pathology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Rakhee Khanduri
- Department of Pulmonary Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
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Keski H. Hematological and Inflammatory Parameters to Predict the Prognosis in COVID-19. Indian J Hematol Blood Transfus 2021; 37:534-542. [PMID: 33679013 PMCID: PMC7910775 DOI: 10.1007/s12288-021-01407-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 02/09/2021] [Indexed: 02/07/2023] Open
Abstract
We aimed to evaluate the predictive ability of hematological and inflammatory parameters for mortality in COVID-19 patients. This was a retrospective study of hospitalized COVID-19 patients over 18 years old between March 2020 and May 2020. Patients were diagnosed to have COVID-19 based either on chest computed tomography findings or reverse transcriptase-polymerase chain reaction test. Age, gender, chronic medical conditions, and laboratory values including hemogram parameters (white blood cell, neutrophil, lymphocyte, and platelet counts), neutrophil to lymphocyte ratio, D-dimer, ferritin, fibrinogen, C-reactive protein, procalcitonin, prothrombin time, activated partial thromboplastin time and the international normalized ratio were recorded. Overall, we included 302 patients. Of these, 148 patients were male; the male to female ratio was 0.961. The mean age of the entire study cohort was 57.1 ± 17.6 years. The most common chronic medical condition was hypertension (38.1%). Half of the patients received low molecular weight heparin. During the study period, 25 patients (8.2%) died. White blood cell count and neutrophil count were significantly higher, whereas lymphocyte count was significantly lower in the deceased patients. The median neutrophil to lymphocyte ratio was 11.6 in the deceased patients, it was significantly higher than the surviving patients (p < 0.001). The values of C-reactive protein, procalcitonin, D-dimer, and ferritin were significantly higher among the deceased patients. Prothrombin time, activated partial thromboplastin time and the international normalized ratio were significantly longer in the deceased group compared with the surviving group. Logistic regression analysis showed age > 65 years, neutrophil to lymphocyte ratio, activated partial thromboplastin time, and hypertension as the independent predictors of mortality. The rate of abnormal inflammatory and hematologic-coagulation parameters increased with the COVID-19 severity. Age > 65 years, hypertension, activated partial thromboplastin time and neutrophil to lymphocyte ratio were the independent predictors of mortality.
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Affiliation(s)
- Hakan Keski
- Department of Hematology, Umraniye Training and Research Hospital, Elmalıkent Mh. Adem Yavuz Cd. No: 1 Ümraniye, İstanbul, Turkey
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Hendricks CL, Herd C, Nel M, Tintinger G, Pepper MS. The COVID-19 Treatment Landscape: A South African Perspective on a Race Against Time. Front Med (Lausanne) 2021; 8:604087. [PMID: 33681243 PMCID: PMC7933453 DOI: 10.3389/fmed.2021.604087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/21/2021] [Indexed: 12/15/2022] Open
Abstract
The pandemic caused by SARS-CoV-2 has infected more than 94 million people worldwide (as of 17 January 2020). Severe disease is believed to be secondary to the cytokine release syndrome (CRS or "cytokine storm") which causes local tissue damage as well as multi-organ dysfunction and thrombotic complications. Due to the high mortality rates in patients receiving invasive ventilation, practice has changed from "early-intubation" for acute respiratory distress syndrome (ARDS) to a trial of non-invasive ventilation (NIV) or high flow nasal cannula (HFNC) oxygen. Reports indicating the benefit of NIV and HFNC have been encouraging and have led to more than 20,000 such devices being manufactured and ready for roll-out in South Africa (SA) as of July 2020. The need to identify drugs with clear clinical benefits has led to an array of clinical trials, most of which are repurposing drugs for COVID-19. The treatment landscape reflects the need to target both the virus and its effects such as the CRS and thrombotic complications. Conflicting results have the potential to confuse the implementation of coordinated treatment strategies and guidelines. The purpose of this review is to address pertinent areas in the current literature on the available medical treatment options for COVID-19. Remdesivir, tocilizumab, and dexamethasone are some of the treatment options that have shown the most promise, but further randomized trials are required to particularly address timing and dosages to confidently create standardized protocols. For the SA population, two healthcare sectors exist. In the private sector, patients with medical insurance may have greater access to a wider range of treatment options than those in the public sector. The latter serves >80% of the population, and resource constraints require the identification of drugs with the most cost-effective use for the greatest number of affected patients.
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Affiliation(s)
- Candice Laverne Hendricks
- Department of Medical Immunology, Institute for Cellular and Molecular Medicine, University of Pretoria, Pretoria, South Africa
| | - Candice Herd
- Department of Medical Immunology, Institute for Cellular and Molecular Medicine, University of Pretoria, Pretoria, South Africa
| | - Marcel Nel
- Department of Medical Immunology, Institute for Cellular and Molecular Medicine, University of Pretoria, Pretoria, South Africa
| | - Gregory Tintinger
- Department of Internal Medicine, University of Pretoria, Pretoria, South Africa
| | - Michael Sean Pepper
- Department of Medical Immunology, Institute for Cellular and Molecular Medicine, University of Pretoria, Pretoria, South Africa
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Nalugo M, Schulte LJ, Masood MF, Zayed MA. Microvascular Angiopathic Consequences of COVID-19. Front Cardiovasc Med 2021; 8:636843. [PMID: 33604359 PMCID: PMC7884319 DOI: 10.3389/fcvm.2021.636843] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/11/2021] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease-2019 (COVID-19) pandemic has rapidly spread across the world. The disease is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which first appeared in Wuhan, China in December, 2019. Ever increasing data is continuing to emerge about the impact of COVID-19 on cardiovascular tissue and other organ system. Clinical features associated with COVID-19 suggest that endothelial cell dysfunction and microvascular thrombosis are to a large extent contributing to resultant multi-organ complications. This review is aimed at highlighting the critical aspects associated with COVID-19 and its presumed microvascular angiopathic consequences on the cardiovascular system leading to multi-organ dysfunction.
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Affiliation(s)
- Margaret Nalugo
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Linda J. Schulte
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Muhammad F. Masood
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Mohamed A. Zayed
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
- Division of Molecular Cell Biology, Washington University School of Medicine, St. Louis, MO, United States
- Department of Biomedical Engineering, McKelvey School of Engineering, Washington University, St. Louis, MO, United States
- Veterans Affairs St. Louis Health Care System, St. Louis, MO, United States
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56
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de Havenon A, Ney JP, Callaghan B, Delic A, Hohmann S, Shippey E, Esper GJ, Stulberg E, Tirschwell D, Frontera J, Yaghi S, Anadani M, Majersik JJ. Impact of COVID-19 on Outcomes in Ischemic Stroke Patients in the United States. J Stroke Cerebrovasc Dis 2021; 30:105535. [PMID: 33310595 PMCID: PMC7832426 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105535] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Studies have shown worse outcomes in patients with comorbid ischemic stroke (IS) and coronavirus disease 2019 (COVID-19), but have had small sample sizes. METHODS We retrospectively identified patients in the Vizient Clinical Data Base® with IS as a discharge diagnosis. The study outcomes were in-hospital death and favorable discharge (home or acute rehabilitation). In the primary analysis, we compared IS patients with laboratory-confirmed COVID-19 (IS-COVID) discharged April 1-July 31, 2020 to pre-COVID IS patients discharged in 2019 (IS controls). In a secondary analysis, we compared a matched cohort of IS-COVID patients to patients within the IS controls who had pneumonia (IS-PNA), created with inverse-probability-weighting (IPW). RESULTS In the primary analysis, we included 166,586 IS controls and 2086 IS-COVID from 312 hospitals in 46 states. Compared to IS controls, IS-COVID were less likely to have hypertension, dyslipidemia, or be smokers, but more likely to be male, younger, have diabetes, obesity, acute renal failure, acute coronary syndrome, venous thromboembolism, intubation, and comorbid intracerebral or subarachnoid hemorrhage (all p<0.05). Black and Hispanic patients accounted for 21.7% and 7.4% of IS controls, respectively, but 33.7% and 18.5% of IS-COVID (p<0.001). IS-COVID, versus IS controls, were less likely to receive alteplase (1.8% vs 5.6%, p<0.001), mechanical thrombectomy (4.4% vs. 6.7%, p<0.001), to have favorable discharge (33.9% vs. 66.4%, p<0.001), but more likely to die (30.4% vs. 6.5%, p<0.001). In the matched cohort of patients with IS-COVID and IS-PNA, IS-COVID had a higher risk of death (IPW-weighted OR 1.56, 95% CI 1.33-1.82) and lower odds of favorable discharge (IPW-weighted OR 0.63, 95% CI 0.54-0.73). CONCLUSIONS Ischemic stroke patients with COVID-19 are more likely to be male, younger, and Black or Hispanic, with significant increases in morbidity and mortality compared to both ischemic stroke controls from 2019 and to patients with ischemic stroke and pneumonia.
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Affiliation(s)
- Adam de Havenon
- Department of Neurology, University of Utah, 175 N. Medical Dr, Salt Lake City, UT 84132, United States.
| | - John P Ney
- Department of Neurology, Boston University, United States.
| | - Brian Callaghan
- Department of Neurology, University of Michigan, United States.
| | - Alen Delic
- Department of Neurology, University of Utah, 175 N. Medical Dr, Salt Lake City, UT 84132, United States.
| | | | | | | | - Eric Stulberg
- Department of Neurology, University of Utah, 175 N. Medical Dr, Salt Lake City, UT 84132, United States.
| | - David Tirschwell
- Department of Neurology, University of Washington, United States.
| | | | - Shadi Yaghi
- Department of Neurology, New York University, United States.
| | | | - Jennifer J Majersik
- Department of Neurology, University of Utah, 175 N. Medical Dr, Salt Lake City, UT 84132, United States.
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Al-Abbas O, Alshaikhli A, Amran HA. New-Onset Atrial Fibrillation and Multiple Systemic Emboli in a COVID-19 Patient. Cureus 2021; 13:e12917. [PMID: 33654600 PMCID: PMC7906080 DOI: 10.7759/cureus.12917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was declared a pandemic by the World Health Organization in March 2020. Initially, infected patients presented with fever, nonproductive cough, dyspnea, myalgia, shortness of breath, and radiographic evidence of pneumonia. However, others presented with atypical cardiac manifestation. As this disease is new, the full picture of the disease presentation is not fully understood. Since December 2019, many morbidities related to coronavirus disease-2019 (COVID-19) were documented, including vascular complications like venous thromboembolism (VTE), pulmonary embolism (PE), and deep vein thrombosis (DVT) in acutely ill COVID-19 patients. Hereby, we are writing a case of a patient with COVID-19 infection suffering from new-onset atrial fibrillation (AF). It was complicated by multiple arterial embolisms involving different organs despite the use of an intermediate dose of low-molecular-weight heparin (LMWH), and the patient was eventually discharged home on a direct-acting oral anticoagulant (DOAC).
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Affiliation(s)
- Omar Al-Abbas
- Family Medicine Residency Program, Medical Education, Hamad Medical Corporation, Doha, QAT
| | | | - Hashed A Amran
- Family Medicine Residency Program, Medical Education, Hamad Medical Corporation, Doha, QAT
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58
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Shah H, Iyer A, Zaghlol R, Raparla S. Case Report: Multiple Strokes and Digital Ischemia in a Young COVID-19 Patient. Am J Trop Med Hyg 2021; 104:60-62. [PMID: 33205744 PMCID: PMC7790090 DOI: 10.4269/ajtmh.20-1101] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/08/2020] [Indexed: 01/21/2023] Open
Abstract
COVID-19 is an infectious disease caused by SARS-CoV-2. This enveloped RNA coronavirus primarily has tropism for the respiratory tract. However, it has also been shown to have various extrapulmonary manifestations such as pulmonary embolism, ischemic strokes, deep venous thrombosis, or arterial thrombosis. We present a case of a 34-year-old woman who had severe COVID-19 infection with no respiratory symptoms and developed strokes in multiple vascular territories and digital ischemia due to thrombosis formation in the brachial circulation of her arm despite receiving therapeutic anticoagulation.
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Affiliation(s)
- Harsh Shah
- Department of Internal Medicine, Medstar Washington Hospital Center, Georgetown University, Washington, District of Columbia
| | - Aditya Iyer
- Department of Internal Medicine, Medstar Washington Hospital Center, Georgetown University, Washington, District of Columbia
| | - Raja Zaghlol
- Department of Internal Medicine, Medstar Washington Hospital Center, Georgetown University, Washington, District of Columbia
| | - Sandeep Raparla
- Department of Internal Medicine, Medstar Washington Hospital Center, Georgetown University, Washington, District of Columbia
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Peyko V, Ladd H, Cutrona A. The Safe Administration of Remdesivir in a Patient with Acute Kidney Injury Requiring Hemodialysis. Case Rep Infect Dis 2020; 2020:8811798. [PMID: 33425407 PMCID: PMC7771254 DOI: 10.1155/2020/8811798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/02/2020] [Accepted: 12/17/2020] [Indexed: 11/21/2022] Open
Abstract
Remdesivir is a nucleoside analog prodrug with broad-spectrum antiviral activity, including against coronaviruses. This has prioritized the inclusion of remdesivir in coronavirus disease 2019 (COVID-19) clinical trials. The United States Food and Drug Administration has granted emergency use authorization for remdesivir. This emergency use authorization does not recommend the use of remdesivir in patients with estimated glomerular filtration rate (eGFR) less than 30 mL/min unless the benefits outweigh the risks. To date, there are no studies and scant information in the literature evaluating remdesivir utilization in patients with eGFR less than 30 mL/min or receiving hemodialysis. With little utilization data for patients with acute or chronic kidney injury, remdesivir may not be considered, leaving this patient population without the opportunity of a potentially beneficial treatment option. We present a case of one patient with eGFR less than 30 mL/min that required hemodialysis in which remdesivir was safely initiated, with therapy completed without any serious adverse events.
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Affiliation(s)
- Vincent Peyko
- Mercy Health–St Elizabeth Boardman Hospital, Department of Pharmacy, 8401 Market St., Boardman, Youngstown, OH 44512, USA
| | - Helena Ladd
- Mercy Health–St Elizabeth Boardman Hospital, Department of Pharmacy, 8401 Market St., Boardman, Youngstown, OH 44512, USA
| | - Anthony Cutrona
- NEO Infectious Diseases Associates, 540 Parmalee Ave., Ste. 610, Youngstown, OH 44510, USA
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Denas G, Gennaro N, Ferroni E, Fedeli U, Lorenzoni G, Gregori D, Iliceto S, Pengo V. Reduction in all-cause mortality in COVID-19 patients on chronic oral anticoagulation: A population-based propensity score matched study. Int J Cardiol 2020; 329:266-269. [PMID: 33309764 PMCID: PMC7833678 DOI: 10.1016/j.ijcard.2020.12.024] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/08/2020] [Accepted: 12/05/2020] [Indexed: 12/21/2022]
Abstract
Background Coronavirus disease 2019 (COVID-19) global pandemic has strikingly high mortality rate with hypercoagulability state being part of the imputed mechanisms. We aimed to compare the rates of in hospital mortality in propensity score matched cohorts of COVID-19 patients in chronic anticoagulation versus those that were not. Methods In this population-based study in the Veneto Region, we retrospectively reviewed all patients aged 65 years or older, with a laboratory-confirmed COVID-19 diagnosis. We compared, after propensity score matching, those who received chronic anticoagulation for atrial fibrillation with those who did not. Results Overall, 4697 COVID-19 patients fulfilled inclusion criteria, and the propensity score matching yielded 559 patients per arm. All-cause mortality rate ratio was significantly higher among non-anticoagulated patients (32.2% vs 26.5%, p = 0.036). On time to event analysis, all-cause mortality was found lower among anticoagulated patients, although the estimate was not statistically significant. (HR 0.81, 95%CI 0.65–1.01, p = 0.054). Conclusion Among elderly patients with COVID-19, those on chronic oral anticoagulant treatment for atrial fibrillation seem to be at lower risk of all-cause mortality compared to their propensity score matched non-anticoagulated counterpart. This finding needs to be confirmed in further studies.
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Affiliation(s)
- Gentian Denas
- Cardiology Clinic, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University Hospital, Padua, Italy
| | - Nicola Gennaro
- Epidemiological Department (SER), Veneto Region, Padua, Italy
| | - Eliana Ferroni
- Epidemiological Department (SER), Veneto Region, Padua, Italy
| | - Ugo Fedeli
- Epidemiological Department (SER), Veneto Region, Padua, Italy
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University Hospital, Padua, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University Hospital, Padua, Italy
| | - Sabino Iliceto
- Cardiology Clinic, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University Hospital, Padua, Italy
| | - Vittorio Pengo
- Cardiology Clinic, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University Hospital, Padua, Italy.
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Perveen S, Millington KA, Acharya S, Garg A, Boyar V. Neonate born with ischemic limb to a COVID-19 positive mother: management and review of literature. CASE REPORTS IN PERINATAL MEDICINE 2020. [DOI: 10.1515/crpm-2020-0086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
To describe challenges in diagnosis and treatment of congenital neonatal gangrene lesions associated with history of maternal coronavirus disease 2019 (COVID-19) infection.
Case presentation
A preterm neonate was born with upper extremity necrotic lesions and a history of active maternal COVID-19 infection. The etiology of his injury was challenging to deduce, despite extensive hypercoagulability work-up and biopsy of the lesion. Management, including partial forearm salvage and hand amputation is described.
Conclusions
Neonatal gangrene has various etiologies, including compartment syndrome and intrauterine thromboembolic phenomena. Maternal COVID-19 can cause intrauterine thrombotic events and need to be considered in a differential diagnosis.
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Affiliation(s)
- Shahana Perveen
- Division of Neonatal-Perinatal Medicine , Cohen Children’s Medical Center of NY, Donald and Barbara Zucker School of Medicine at Hofstra, Northwell , New York , NY , USA
| | - Karmaine A. Millington
- Department of Pathology and Laboratory Medicine , Cohen Children’s Medical Center of NY/Long Island Jewish Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra, Northwell , New York , NY , USA
| | - Suchitra Acharya
- Pediatrics Hematology Oncology and Stem Cell Transplantation , Cohen Children Medical Center of NY, Donald and Barbara Zucker School of Medicine at Hofstra, Northwell , New York , NY , USA
| | - Amit Garg
- Department of Dermatology , Donald and Barbara Zucker School of Medicine at Hofstra, Northwell , New York , NY , USA
| | - Vita Boyar
- Division of Neonatal-Perinatal Medicine , Cohen Children’s Medical Center of NY, Donald and Barbara Zucker School of Medicine at Hofstra, Northwell , New York , NY , USA
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El Shamy O, Munoz-Casablanca N, Coca S, Sharma S, Lookstein R, Uribarri J. Bilateral Renal Artery Thrombosis in a Patient With COVID-19. Kidney Med 2020; 3:116-119. [PMID: 33200122 PMCID: PMC7654329 DOI: 10.1016/j.xkme.2020.07.010] [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] [Indexed: 01/09/2023] Open
Abstract
Reports of the incidence of acute kidney injury in patients with coronavirus disease 2019 (COVID-19) have varied greatly from 0.5% to as high as 39%, with onset generally within 7 days from time of admission. The nature of the kidney insult is acute tubular necrosis, immune cell infiltration, or rhabdomyolysis, as demonstrated in autopsy reports. Moreover, infection with COVID-19 has been associated with coagulation abnormalities, as well as complement-mediated generalized thrombotic microvascular injury. These patients have been found to have high D-dimer, fibrin degradation product, and fibrinogen values, an elevated international normalized ratio, normal partial thromboplastin time, and normal platelet count values. Renal artery thrombosis is a rare condition, the most common cause of which is atrial fibrillation. However, bilateral completely occlusive renal artery thrombosis is even rarer. We present a case of a patient with COVID-19 on systemic anticoagulation therapy who presented with a serum creatinine level of 6.04 mg/dL requiring the initiation of kidney replacement therapy and was found to have bilateral renal artery thrombosis.
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Affiliation(s)
- Osama El Shamy
- Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Steven Coca
- Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shuchita Sharma
- Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Robert Lookstein
- Division of Interventional Radiology, The Mount Sinai Hospital, New York, NY
| | - Jaime Uribarri
- Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY
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Stratton CW, Tang YW, Lu H. Pathogenesis-directed therapy of 2019 novel coronavirus disease. J Med Virol 2020; 93:1320-1342. [PMID: 33073355 DOI: 10.1002/jmv.26610] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 01/18/2023]
Abstract
The 2019 novel coronavirus disease (COVID-19) now is considered a global public health emergency. One of the unprecedented challenges is defining the optimal therapy for those patients with severe pneumonia and systemic manifestations of COVID-19. The optimal therapy should be largely based on the pathogenesis of infections caused by this novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since the onset of COVID-19, there have been many prepublications and publications reviewing the therapy of COVID-19 as well as many prepublications and publications reviewing the pathogenesis of SARS-CoV-2. However, there have been no comprehensive reviews that link COVID-19 therapies to the pathogenic mechanisms of SARS-CoV-2. To link COVID-19 therapies to pathogenic mechanisms of SARS-CoV-2, we performed a comprehensive search through MEDLINE, PubMed, medRxiv, EMBASE, Scopus, Google Scholar, and Web of Science using the following keywords: COVID-19, SARS-CoV-2, novel 2019 coronavirus, pathology, pathologic, pathogenesis, pathophysiology, coronavirus pneumonia, coronavirus infection, coronavirus pulmonary infection, coronavirus cardiovascular infection, coronavirus gastroenteritis, coronavirus autopsy findings, viral sepsis, endotheliitis, thrombosis, coagulation abnormalities, immunology, humeral immunity, cellular immunity, inflammation, cytokine storm, superantigen, therapy, treatment, therapeutics, immune-based therapeutics, antiviral agents, respiratory therapy, oxygen therapy, anticoagulation therapy, adjuvant therapy, and preventative therapy. Opinions expressed in this review also are based on personal experience as clinicians, authors, peer reviewers, and editors. This narrative review linking COVID-19 therapies with pathogenic mechanisms of SARS-CoV-2 has resulted in six major therapeutic goals for COVID-19 therapy based on the pathogenic mechanisms of SARS-CoV-2. These goals are listed below: 1. The first goal is identifying COVID-19 patients that require both testing and therapy. This is best accomplished with a COVID-19 molecular test from symptomatic patients as well as determining the oxygen saturation in such patients with a pulse oximeter. Whether a symptomatic respiratory illness is COVID-19, influenza, or another respiratory pathogen, an oxygen saturation less than 90% means that the patient requires medical assistance. 2. The second goal is to correct the hypoxia. This goal generally requires hospitalization for oxygen therapy; other respiratory-directed therapies such as prone positioning or mechanical ventilation are often used in the attempt to correct hypoxemia due to COVID-19. 3. The third goal is to reduce the viral load of SARS-CoV-2. Ideally, there would be an oral antiviral agent available such as seen with the use of oseltamivir phosphate for influenza. This oral antiviral agent should be taken early in the course of SARS-CoV-2 infection. Such an oral agent is not available yet. Currently, two options are available for reducing the viral load of SARS-CoV-2. These are post-Covid-19 plasma with a high neutralizing antibody titer against SARS-CoV-2 or intravenous remdesivir; both options require hospitalization. 4. The fourth goal is to identify and address the hyperinflammation phase often seen in hospitalized COVID-19 patients. Currently, fever with an elevated C-reactive protein is useful for diagnosing this hyperinflammation syndrome. Low-dose dexamethasone therapy currently is the best therapeutic approach. 5. The fifth goal is to identify and address the hypercoagulability phase seen in many hospitalized COVID-19 patients. Patients who would benefit from anticoagulation therapy can be identified by a marked increase in d-dimer and prothrombin time with a decrease in fibrinogen. To correct this disseminated intravascular coagulation-like phase, anticoagulation therapy with low molecular weight heparin is preferred. Anticoagulation therapy with unfractionated heparin is preferred in COVID-19 patients with acute kidney injuries. 6. The last goal is prophylaxis for persons who are not yet infected. Potential supplements include vitamin D and zinc. Although the data for such supplements is not extremely strong, it can be argued that almost 50% of the population worldwide has a vitamin D deficiency. Correcting this deficiency would be beneficial regardless of any impact of COVID-19. Similarly, zinc is an important supplement that is important in one's diet regardless of any effect on SARS-CoV-2. As emerging therapies are found to be more effective against the SARS-CoV-2 pathogenic mechanisms identified, they can be substituted for those therapies presented in this review.
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Affiliation(s)
- Charles W Stratton
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yi-Wei Tang
- Danaher Diagnostic Platform/Cepheid, Shanghai, China
| | - Hongzhou Lu
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
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Crisan-Dabija R, Pavel CA, Popa IV, Tarus A, Burlacu A. "A Chain Only as Strong as Its Weakest Link": An Up-to-Date Literature Review on the Bidirectional Interaction of Pulmonary Fibrosis and COVID-19. J Proteome Res 2020; 19:4327-4338. [PMID: 32883081 PMCID: PMC7640958 DOI: 10.1021/acs.jproteome.0c00387] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Indexed: 01/08/2023]
Abstract
The COVID-19 pandemic rapidly became a worldwide healthcare emergency affecting millions of people, with poor outcomes for patients with chronic conditions and enormous pressure on healthcare systems. Pulmonary fibrosis (PF) has been cited as a risk factor for a more severe evolution of COVID-19, primarily because its acute exacerbations are already associated with high mortality. We reviewed the available literature on biochemical, pathophysiological, and pharmacological mechanisms of PF and COVID-19 in an attempt to foresee the particular risk of infection and possible evolution of PF patients if infected with SARS-COV-2. We also analyzed the possible role of medication and risk factors (such as smoking) in the disease's evolution and clinical course. We found out that there is a complexity of interactions between coexisting idiopathic pulmonary fibrosis/interstitial lung disease (ILD) and COVID-19 disease. Also, patients recovering from severe COVID-19 disease are at serious risk of developing PF. Smokers seem to have, in theory, a chance for a better outcome if they develop a severe form of COVID-19 but statistically are at much higher risk of dying if they become critically ill.
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Affiliation(s)
- Radu Crisan-Dabija
- Clinic
of Pulmonary Diseases Iasi, Iasi, Romania
- ‘Grigore
T. Popa’ University of Medicine, Iasi, Romania
| | | | - Iolanda Valentina Popa
- ‘Grigore
T. Popa’ University of Medicine, Iasi, Romania
- Institute
of Gastroenterology and Hepatology, Iasi, Romania
| | - Andrei Tarus
- ‘Grigore
T. Popa’ University of Medicine, Iasi, Romania
- Department
of Cardiovascular Surgery, Cardiovascular
Diseases Institute, Iasi, Romania
| | - Alexandru Burlacu
- ‘Grigore
T. Popa’ University of Medicine, Iasi, Romania
- Department
of Interventional Cardiology, Cardiovascular
Diseases Institute, Iasi Romania
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Keri VC, Hooda A, Kodan P, R L B, Jorwal P, Wig N. Intricate interplay between Covid-19 and cardiovascular diseases. Rev Med Virol 2020; 31:e2188. [PMID: 33128859 DOI: 10.1002/rmv.2188] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/17/2020] [Accepted: 10/19/2020] [Indexed: 02/06/2023]
Abstract
Covid-19 disease can involve any organ system leading to myriad manifestations and complications. Cardiovascular manifestations are being increasingly recognised with the improved understanding of the disease. Acute coronary syndrome, myocarditis, arrhythmias, cardiomyopathy; heart failure and thromboembolic disease have all been described. The elderly and those with prior cardiac diseases are at an increased risk of mortality. Overlapping symptomatology, ability of drugs to cause QTc interval (start of Q wave to the end of T wave) prolongation on electrocardiogram and arrhythmias, potential drug interactions, the need to recognise patients requiring urgent definitive management and provide necessary bedside interventions without increasing the risk of nosocomial spread have made the management challenging. In the background of a pandemic, non-Covid-19 cardiac patients are affected by delayed treatment and nosocomial exposure. Triaging using telemedicine and artificial intelligence along with utilization of bedside rapid diagnostic tests to detect Covid-19 could prove helpful in this aspect.
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Affiliation(s)
- Vishakh C Keri
- Infectious Diseases, Department of Medicine and Microbiology, AIIMS, New Delhi, India
| | - Amit Hooda
- Department of Cardiology, Mount Sinai Hospital, New York, USA
| | - Parul Kodan
- Department of Medicine, Lady Hardinge Medicine College and RML Hospital, New Delhi, India
| | - Brunda R L
- Department of Emergency Medicine, AIIMS, New Delhi, India
| | | | - Naveet Wig
- Department of Medicine, AIIMS, New Delhi, India
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van de Sande D, van Genderen ME, Rosman B, Diether M, Endeman H, van den Akker JPC, Ludwig M, Huiskens J, Gommers D, van Bommel J. Predicting thromboembolic complications in COVID-19 ICU patients using machine learning. J Clin Transl Res 2020; 6:179-186. [PMID: 33501388 PMCID: PMC7821745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/01/2020] [Accepted: 10/05/2020] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic is a challenge for intensive care units (ICU) in part due to the failure to identify risks for patients early and the inability to render an accurate prognosis. Previous reports suggest a strong association between hypercoagulability and poor outcome. Factors related to hemostasis may, therefore, serve as tools to improve the management of COVID-19 patients. AIM The purpose of this report is to develop a model to determine whether it is possible to early identify COVID-19 patients at risk for thromboembolic complications (TCs). METHODS We analyzed electronic health record data of 108 consecutive COVID-19 patients admitted to the adult ICU of the Erasmus University Medical Center between February 27 and May 20, 2020. By training a decision tree classifier on 66% of the available data, a model for the prediction of TCs was developed. RESULTS The median (interquartile range) age was 62 (53-70) years and 73% were male. Forty-three patients (40%) developed a TC during their ICU stay. Mortality was higher for patients in the TCs group compared to the control group (26% vs. 8%, P=0.03). Lactate dehydrogenase, standardized bicarbonate, albumin, and leukocytes were identified by the Decision Tree classifier as the most powerful predictors for TCs 2 days before the onset of the TC, with a sensitivity of 73% and a positive likelihood ratio of 2.7 on the test dataset. CONCLUSIONS Clinically relevant TCs frequently occur in critically ill COVID-19 patients. These can successfully be predicted using a decision tree model. Although this model could be of special importance to aid clinical decision making, its generalizability and clinical impact should be determined in a larger population. RELEVANCE FOR PATIENTS Recently, severe TCs were observed in COVID-19 patients with progressive respiratory failure warranting ICU treatment. Timely identification of patients at risk of developing TCs is critical inasmuch as it would enable clinicians to initiate potentially salvaging therapeutic anticoagulation.
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Affiliation(s)
- Davy van de Sande
- 1Department of Adult Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Michel E. van Genderen
- 1Department of Adult Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands,
Corresponding author: Michel E. van Genderen Department of Adult Intensive Care, Erasmus Medical Center, Room Ne-411, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Babette Rosman
- 1Department of Adult Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Maren Diether
- 1Department of Adult Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands,2Deloitte Netherlands, Analytics and Cognitive, Amsterdam, the Netherlands
| | - Henrik Endeman
- 1Department of Adult Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Martijn Ludwig
- 1Department of Adult Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands,2Deloitte Netherlands, Analytics and Cognitive, Amsterdam, the Netherlands
| | - Joost Huiskens
- 1Department of Adult Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands,3SAS Institute, Health Care Analytics, Huizen, the Netherlands
| | - Diederik Gommers
- 1Department of Adult Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jasper van Bommel
- 1Department of Adult Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands
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Lukaszewicz K, Hillegass E, Puthoff ML, McPhedran AK. Clinical Update for Physical Therapists: Coagulopathy and COVID-19. Phys Ther 2020; 100:2127-2133. [PMID: 32914188 PMCID: PMC7499770 DOI: 10.1093/ptj/pzaa157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2020] [Indexed: 01/06/2023]
Abstract
Physical therapists have a unique role in both prevention of venous thromboembolism (VTE) through the promotion of early mobility and physical activity and diagnosis through discovery of signs and symptoms of VTE. This Perspective updates clinicians on the latest information regarding pathophysiology of coagulopathy associated with COVID-19 and applies VTE clinical practice guidelines to COVID-19 in order to provide guidance on physical therapist management.
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Affiliation(s)
- Kathleen Lukaszewicz
- Department of Physical Therapy, Exercise and Rehabilitation Science, College of Health Sciences, Marquette University, Milwaukee, Wisconsin
| | | | | | - A Kate McPhedran
- Morosky College of Health Professions and Sciences, Gannon University, Erie, Pennsylvania
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Hiffler L, Rakotoambinina B. Selenium and RNA Virus Interactions: Potential Implications for SARS-CoV-2 Infection (COVID-19). Front Nutr 2020; 7:164. [PMID: 33015130 PMCID: PMC7498630 DOI: 10.3389/fnut.2020.00164] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 08/10/2020] [Indexed: 12/13/2022] Open
Abstract
SARS-CoV-2 is an RNA virus responsible for the COVID-19 pandemic that already claimed more than 340,000 lives worldwide as of May 23, 2020, the majority of which are elderly. Selenium (Se), a natural trace element, has a key and complex role in the immune system. It is well-documented that Se deficiency is associated with higher susceptibility to RNA viral infections and more severe disease outcome. In this article, we firstly present evidence on how Se deficiency promotes mutations, replication and virulence of RNA viruses. Next, we review how Se might be beneficial via restoration of host antioxidant capacity, reduction of apoptosis and endothelial cell damages as well as platelet aggregation. It also appears that low Se status is a common finding in conditions considered at risk of severe COVID-19, especially in the elderly. Finally, we present a rationale for Se use at different stages of COVID-19. Se has been overlooked but may have a significant place in COVID-19 spectrum management, particularly in vulnerable elderly, and might represent a game changer in the global response to COVID-19.
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70
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Balgradean M, Cinteza E, Aria LA, Matei RL, Marin L, Moga L, Negritoru SC, Slavulete RE, Stefan MC, Ionescu M. Clinical and Pathogenic Correlations Between SARS-CoV-2 Infection and Hemolytic Uremic Syndrome in Children. MAEDICA 2020; 15:376-380. [PMID: 33312255 PMCID: PMC7726516 DOI: 10.26574/maedica.2020.15.3.376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background The present paper examines the correlations between coronavirus disease (COVID-19) and hemolytic uremic syndrome (HUS) from a clinical and pathophysiological point of view. Method: We describe COVID-19 and HUS by outlining the similarities and differences, detailing each one's pathway into the body, explaining the consequences of the inflammatory response, mainly on multiple organ dysfunction, the foremost complication that can lead to death in both cases. Using reviews from specialized literature and guidelines, we had an approach based on critical interpretive synthesis. Nonetheless, the present article has certain limitations, mainly due to the short period from the emergence of the virus and the everincreasing body of research that have been shedding light each day. Discussion: Both COVID-19 and HUS require binding to a membrane receptor to trigger the pathophysiological mechanism. Despite the evident difference in tropism, both conditions develop with severe endothelial dysfunction, microangiopathy and important inflammatory response, responsible for MODS. The role of the coagulation pathway is more significant in COVID-19 but less in HUS. Excessive complement activation appears to be a determinant of severe prognosis in both diseases. Regarding COVID-19, children have a milder symptomatology than adults, but in some cases the paediatric inflammatory multisystem syndrome (PIMS) is described.
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Affiliation(s)
| | - Eliza Cinteza
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | | | | | - Lavinia Marin
- "Marie Curie" Emergency Children's Hospital, Bucharest, Romania
| | - Lorena Moga
- "Marie Curie" Emergency Children's Hospital, Bucharest, Romania
| | | | | | | | - Marcela Ionescu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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71
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Editorial Comment on "Multisystem Assessment of the Imaging Manifestations of Coagulopathy in Hospitalized Patients With Coronavirus Disease (COVID-19)". AJR Am J Roentgenol 2020; 216:1096-1097. [PMID: 32812792 DOI: 10.2214/ajr.20.24438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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72
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Hiffler L, Rakotoambinina B. Selenium and RNA Virus Interactions: Potential Implications for SARS-CoV-2 Infection (COVID-19). Front Nutr 2020. [PMID: 33015130 DOI: 10.2139/ssrn.3594240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
SARS-CoV-2 is an RNA virus responsible for the COVID-19 pandemic that already claimed more than 340,000 lives worldwide as of May 23, 2020, the majority of which are elderly. Selenium (Se), a natural trace element, has a key and complex role in the immune system. It is well-documented that Se deficiency is associated with higher susceptibility to RNA viral infections and more severe disease outcome. In this article, we firstly present evidence on how Se deficiency promotes mutations, replication and virulence of RNA viruses. Next, we review how Se might be beneficial via restoration of host antioxidant capacity, reduction of apoptosis and endothelial cell damages as well as platelet aggregation. It also appears that low Se status is a common finding in conditions considered at risk of severe COVID-19, especially in the elderly. Finally, we present a rationale for Se use at different stages of COVID-19. Se has been overlooked but may have a significant place in COVID-19 spectrum management, particularly in vulnerable elderly, and might represent a game changer in the global response to COVID-19.
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73
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Hiffler L, Rakotoambinina B. Selenium and RNA Virus Interactions: Potential Implications for SARS-CoV-2 Infection (COVID-19). Front Nutr 2020. [PMID: 33015130 DOI: 10.31219/osf.io/vaqz6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
SARS-CoV-2 is an RNA virus responsible for the COVID-19 pandemic that already claimed more than 340,000 lives worldwide as of May 23, 2020, the majority of which are elderly. Selenium (Se), a natural trace element, has a key and complex role in the immune system. It is well-documented that Se deficiency is associated with higher susceptibility to RNA viral infections and more severe disease outcome. In this article, we firstly present evidence on how Se deficiency promotes mutations, replication and virulence of RNA viruses. Next, we review how Se might be beneficial via restoration of host antioxidant capacity, reduction of apoptosis and endothelial cell damages as well as platelet aggregation. It also appears that low Se status is a common finding in conditions considered at risk of severe COVID-19, especially in the elderly. Finally, we present a rationale for Se use at different stages of COVID-19. Se has been overlooked but may have a significant place in COVID-19 spectrum management, particularly in vulnerable elderly, and might represent a game changer in the global response to COVID-19.
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