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Mohd Fuad SH, Juliana N, Mohd Azmi NAS, Mohd Fahmi Teng NI, Azmani S, Abu IF, Das S. Circadian Disruption and Occupational Toxicants Exposure Affecting the Immunity of Shift Workers During SARS CoV-2 Pandemic. Front Public Health 2022; 10:829013. [PMID: 35392476 PMCID: PMC8980348 DOI: 10.3389/fpubh.2022.829013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
In several regions of the world, the recent Coronavirus Disease-2019 (COVID-19) pandemic outbreak increased morbidity and mortality. The pandemic situation disrupted many workers' previously established lifestyles. The main aim of the present review was to describe the circadian disruption and occupational toxicant exposure affecting the immunity of shift workers during the SARS CoV-2 pandemic. We retrieved pertinent published literature from the Google Scholar, PubMed, and Scopus databases. In the present review, we discuss the circadian rhythm involving the hypothalamic-pituitary-adrenal (HPA) axis at the molecular level, its disruption, occupational toxicant exposure causing immunomodulatory effects, and the role of immunity during the SARS CoV-2 pandemic. The severity of the progression of the viral infection depends on multiple factors affecting immunity. Hence, shift workers may need to be aware of those factors such as circadian rhythm disruption as well as occupational toxicant exposure. The timing of shift workers' energy intake is also important concerning the shift of the workers. The information in the present review may be important for all workers who are at risk during the pandemic. In the absence of any published literature related to association of circadian rhythm disruption with occupational toxicant exposure, the present review may have greater importance.
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Affiliation(s)
- Siti Hanisah Mohd Fuad
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai, Malaysia
| | - Norsham Juliana
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai, Malaysia
| | | | | | - Sahar Azmani
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai, Malaysia
| | - Izuddin Fahmy Abu
- Institute of Medical Science Technology, Universiti Kuala Lumpur, Kajang, Malaysia
| | - Srijit Das
- Department of Human & Clinical Anatomy, College of Medicine and Health Sciences, Muscat, Oman
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Naito K, Narita T, Murata Y, Morimura N. Risk factors associated with hospital transfer among mild or asymptomatic COVID-19 patients in isolation facilities in Tokyo: a case-control study. IJID REGIONS (ONLINE) 2022; 2:8-15. [PMID: 35721433 PMCID: PMC8595257 DOI: 10.1016/j.ijregi.2021.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/02/2021] [Accepted: 11/02/2021] [Indexed: 12/15/2022]
Abstract
Facility-based isolation for COVID-19 in Tokyo involved remote health observation. This study was conducted in a prehospital setting using multivariable analysis. Older age, male sex, and higher BMI were associated with transfers to hospital. Comorbidities, such as bronchial asthma, increased the risk for hospital transfer. Some patients requiring urgent oxygenation showed few signs of dyspnea (silent hypoxia).
Objectives The Tokyo Metropolitan Government has been implementing facility-based isolation of asymptomatic/mild coronavirus disease (COVID-19) patients to facilitate timely hospital referral. However, there are only a few published studies in prehospital settings, and the factors associated with hospital transfer are unclear. Our study identified the factors associated with COVID-19 deterioration in a prehospital setting. Methods This case-control study assessed the risk factors for hospital transfer from isolation facilities and the need for ambulance transport due to deterioration among COVID-19 patients, using multivariate logistic regression analysis. Results In total, 10 590 patients (median age 34 years), with male predominance (61.1%), were included. 367 (3.5%) were transferred to hospital, of whom 44 (12.0%) required ambulance transport. Hypertension, diabetes, and bronchial asthma were prevalent in 704 (6.6%), 195 (1.8%), and 305 (2.9%) patients, respectively. After adjustment, older age, male sex, higher body mass index (BMI), and comorbidities (including diabetes, inflammatory bowel disease, and bronchial asthma) were associated with hospital transfer. Older age, male sex, and higher BMI significantly increased the risk of transfer by ambulance. Conclusions Our results may be beneficial for the development of intervention measures for probable future COVID-19 waves.
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Affiliation(s)
- Keisuke Naito
- Bureau of Social Welfare and Public Health, Tokyo Metropolitan Government, 8-1 Nishi-Shinjuku 2-chome, Shinjuku-ku, Tokyo, Japan
- Corresponding author: Keisuke Naito. Bureau of Social Welfare and Public Health, Tokyo Metropolitan Government, 8-1 Nishi-Shinjuku 2-chome, Shinjuku-ku, Tokyo, Japan.
| | - Tomoyo Narita
- Bureau of Social Welfare and Public Health, Tokyo Metropolitan Government, 8-1 Nishi-Shinjuku 2-chome, Shinjuku-ku, Tokyo, Japan
| | - Yukari Murata
- Tokyo Metropolitan Institute of Public Health, 3-24-1 Hyakunin-cho, Shinjuku-ku, Tokyo, Japan
| | - Naoto Morimura
- Department of Emergency Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-Ku, Tokyo, Japan
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Critical Care in SARS-CoV-2 Infected Pregnant Women: A Prospective Multicenter Study. Biomedicines 2022; 10:biomedicines10020475. [PMID: 35203683 PMCID: PMC8962376 DOI: 10.3390/biomedicines10020475] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/13/2022] [Accepted: 02/15/2022] [Indexed: 02/01/2023] Open
Abstract
Evidence suggests that pregnant women are at a higher risk of complications compared to the general population when infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the reasons that lead them to need intensive care are not clear. This is a prospective multicenter study of SARS-CoV-2 positive pregnant women, registered by the Spanish Obstetric Emergency Group, with the objective to define the characteristics of the mothers who were admitted to the Intensive Care Unit (ICU) and to investigate the causes and risk factors for ICU admission. A total of 1347 infected pregnant women were registered and analyzed, of whom, 35 (2.6%) were admitted to the ICU. No differences in maternal characteristics or comorbidities were observed between ICU and non-ICU patients, except for in vitro fertilization and multiple pregnancies. The main causes of admission to the ICU were non-obstetric causes (worsening of the maternal condition and respiratory failure due to SARS-CoV-2 pneumonia, 40%) and a combination of coronavirus disease 2019 (COVID-19) symptoms and obstetrical complications (31.4%). The multivariable logistic analysis confirmed a higher risk of ICU admission when pre-eclampsia or hemorrhagic events coexist with pneumonia. The incidence of thromboembolic events and disseminated intravascular coagulation were also significantly higher among patients admitted to the ICU. Therefore, surveillance and rapid intervention should be intensified in SARS-CoV-2 infected pregnant women with the mentioned risk factors and complications. Emphasis should always be placed on anticoagulant therapy in these patients due to the increased thromboembolic risk, C-section surgery and immobilization in the ICU.
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He C, Liu C, Yang J, Tan H, Ding X, Gao X, Yang Y, Shen Y, Xiang H, Ke J, Yuan F, Chen R, Cheng R, Lv H, Li P, Zhang L, Huang L. Prognostic significance of day‐by‐day in‐hospital blood pressure variability in COVID‐19 patients with hypertension. J Clin Hypertens (Greenwich) 2022; 24:224-233. [PMID: 35293689 PMCID: PMC8925012 DOI: 10.1111/jch.14437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/25/2021] [Accepted: 12/27/2021] [Indexed: 01/02/2023]
Abstract
Hypertension is the most common comorbidity in patients with coronavirus disease 2019 (COVID‐19) and increases in‐hospital mortality. Day‐by‐day blood pressure (BP) variability (BPV) is associated with clinical outcomes in hypertensive patients. However, little information is available on the association of BPV with the outcomes of COVID‐19 patients with hypertension. This study aimed to demonstrate whether day‐by‐day in‐hospital BPV had prognostic significance in these patients. The authors included 702 COVID‐19 patients with hypertension from Huoshenshan Hospital (Wuhan, China), who underwent valid in‐hospital BP measurements on at least seven consecutive days. Day‐by‐day BPV was assessed by standard deviation (SD), coefficient of variation (CV), and variation independent of mean (VIM). Overall, patients with severe COVID‐19 and non‐survivors had higher BPV than moderate cases and survivors, respectively. Additionally, higher BPV was correlated with greater age and higher levels of C‐reactive protein, procalcitonin, high‐sensitive cardiac troponin I, and B‐type natriuretic peptide. In multivariable Cox regression, SD of systolic BP (SBP) was predictive of mortality [hazard ratio (HR) 1.17, 95% confidence interval (CI) 1.05–1.30] as well as acute respiratory distress syndrome (ARDS) (HR 1.09, 95% CI 1.01–1.16). Similar trends were observed for CV and VIM of SBP, but not indices of diastolic BP variability. The authors demonstrated that day‐by‐day in‐hospital SBP variability can independently predict mortality and ARDS in COVID‐19 patients with hypertension. And high BPV might be correlated with severe inflammation and myocardial injury. Further studies are needed to clarify whether early reduction of BPV will improve the prognosis of these patients.
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Affiliation(s)
- Chunyan He
- Institute of Cardiovascular Diseases of PLA the Second Affiliated Hospital, Army Medical University Chongqing China
| | - Chuan Liu
- Institute of Cardiovascular Diseases of PLA the Second Affiliated Hospital, Army Medical University Chongqing China
| | - Jie Yang
- Institute of Cardiovascular Diseases of PLA the Second Affiliated Hospital, Army Medical University Chongqing China
| | - Hu Tan
- Institute of Cardiovascular Diseases of PLA the Second Affiliated Hospital, Army Medical University Chongqing China
- Department of Infectious Diseases Huoshenshan Hospital Wuhan China
| | - Xiaohan Ding
- Department of Infectious Diseases Huoshenshan Hospital Wuhan China
- Department of Health Care and Geriatrics the 940th Hospital of Joint Logistics Support Force of PLA Lanzhou China
| | - Xubin Gao
- Institute of Cardiovascular Diseases of PLA the Second Affiliated Hospital, Army Medical University Chongqing China
| | - Yuanqi Yang
- Institute of Cardiovascular Diseases of PLA the Second Affiliated Hospital, Army Medical University Chongqing China
| | - Yang Shen
- Institute of Cardiovascular Diseases of PLA the Second Affiliated Hospital, Army Medical University Chongqing China
| | - Hedong Xiang
- Institute of Cardiovascular Diseases of PLA the Second Affiliated Hospital, Army Medical University Chongqing China
| | - Jingbin Ke
- Institute of Cardiovascular Diseases of PLA the Second Affiliated Hospital, Army Medical University Chongqing China
| | - Fangzhengyuan Yuan
- Institute of Cardiovascular Diseases of PLA the Second Affiliated Hospital, Army Medical University Chongqing China
| | - Renzheng Chen
- Institute of Cardiovascular Diseases of PLA the Second Affiliated Hospital, Army Medical University Chongqing China
| | - Ran Cheng
- Institute of Cardiovascular Diseases of PLA the Second Affiliated Hospital, Army Medical University Chongqing China
| | - Hailin Lv
- Institute of Cardiovascular Diseases of PLA the Second Affiliated Hospital, Army Medical University Chongqing China
| | - Ping Li
- Institute of Cardiovascular Diseases of PLA the Second Affiliated Hospital, Army Medical University Chongqing China
- Department of Infectious Diseases Huoshenshan Hospital Wuhan China
| | - Limin Zhang
- Institute of Cardiovascular Diseases of PLA the Second Affiliated Hospital, Army Medical University Chongqing China
- Department of Infectious Diseases Huoshenshan Hospital Wuhan China
| | - Lan Huang
- Institute of Cardiovascular Diseases of PLA the Second Affiliated Hospital, Army Medical University Chongqing China
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Oh SM, Nair S, Casler A, Nguyen D, Forero JP, Joco C, Kubert J, Esses D, Adams D, Jariwala S, Leff J. A prospective observational study evaluating the use of remote patient monitoring in ED discharged COVID-19 patients in NYC. Am J Emerg Med 2022; 55:64-71. [PMID: 35279578 PMCID: PMC8868022 DOI: 10.1016/j.ajem.2022.02.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/26/2022] [Accepted: 02/16/2022] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES We investigated whether continuous remote patient monitoring (RPM) could significantly reduce return Emergency Department (ED) revisits among coronavirus disease 2019 (COVID-19) patients discharged from the emergency Department. MATERIALS AND METHODS A prospective observational study was conducted from a total of 2833 COVID-19 diagnosed patients who presented to the Montefiore Medical Center ED between September 2020-March 2021. Study patients were remotely monitored through a digital platform that was supervised 24/7 by licensed healthcare professionals. Age and time-period matched controls were randomly sampled through retrospective review. The primary outcome was ED revisit rates among the two groups. RESULTS In our study, 150 patients enrolled in the RPM program and 150 controls were sampled for a total of 300 patients. Overall, 59.1% of the patients identified as Hispanic/Latino. The RPM group had higher body mass index (BMI) (29 (25-35) vs. 27 (25-31) p-value 0.020) and rates of hypertension (50.7% (76) vs. 35.8% (54) p-value 0.009). There were no statistically significant differences in rates of ED revisit between the RPM group (8% (12)) and control group (9.3% (14)) (OR: 0.863; 95% CI:0.413-1. 803; p- 0.695). DISCUSSION AND CONCLUSION Our study explored the impact of continuous monitoring versus intermittent monitoring for reducing ED revisits in a largely underrepresented population of the Bronx. Our study demonstrated that continuous remote patient monitoring showed no significant difference in preventing ED revisits compared to non-standardized intermittent monitoring. However, potential other acute care settings where RPM may be useful for identifying high-risk patients for early interventions warrant further study.
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Heinert SW, Riggs R, Prendergast H. Emergency Department Management of Hypertension in the Context of COVID-19. Curr Hypertens Rep 2022; 24:37-43. [PMID: 35076879 PMCID: PMC8787746 DOI: 10.1007/s11906-022-01169-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 02/06/2023]
Abstract
Purpose of Review This review describes the relationship between COVID-19 and hypertension (HTN), and considerations for emergency medicine providers in the management of hypertensive patients during the COVID-19 pandemic. Recent Findings Hypertensive patients with COVID-19 have a higher risk of severe disease/complications, hospitalizations, intensive care unit (ICU) admissions, and mortality than non-hypertensive patients. Studies have also shown the importance of consideration of various demographic factors (such as older age) and socioeconomic factors that may confound these relationships. Despite concerns at the start of the pandemic that RAAS inhibiting antihypertension medications may contribute to worsened outcomes in COVID-19 patients, subsequent research has shown that use of ACEi/ARBs is associated with neutral or even improved COVID-19 outcomes. Socioeconomic factors must also be considered including patients’ potential delay of health care due to fear of contracting COVID-19, loss of health insurance, and barriers to accessing primary care appointments for post-ED follow-up care. Summary While there is mixed evidence on biological considerations for HTN care during the COVID-19 pandemic, the pandemic has undoubtedly been a major stressor and barrier to effective chronic disease management. Emergency medicine and other providers should consider this when evaluating acute care patients with a history of HTN or newly elevated blood pressure.
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Affiliation(s)
- Sara W Heinert
- Department of Emergency Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
| | - Renee Riggs
- Department of Emergency Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Heather Prendergast
- Department of Emergency Medicine, University of Illinois at Chicago, Chicago, IL, USA
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Self medication practices and its determinants in health care professionals during the coronavirus disease-2019 pandemic: cross-sectional study. Int J Clin Pharm 2022; 44:507-516. [PMID: 35022953 PMCID: PMC8754192 DOI: 10.1007/s11096-021-01374-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/23/2021] [Indexed: 12/12/2022]
Abstract
Background The exposure of health care professionals (HCP) to patients with coronavirus disease-2019 (COVID-19) in the course of performing their professional duties may expose them to contracting the virus. This may likely increase their tendency to self-medicate for prevention or treatment of perceived infection. Aim This study determined the prevalence of COVID-19 related self-medication and its determinants among HCPs in three tertiary hospitals in Southern Nigeria. Method This was a cross-sectional study that enrolled 669 adult HCPs from three tertiary hospitals in three Southern Nigerian States using a non-probability convenience sampling method. A structured self-administered questionnaire was used for data collection. Data entry and analysis were done using IBM SPSS version 22. Results The mean age of the respondents was 35.6 ± 8.7 years. Two hundred and forty-three respondents (36.3%) reported having practiced COVID-19 related self-medication. The commonly used medications were ivermectin, azithromycin, vitamin C, chloroquine and zinc. Factors associated with self-medication were older age (p = < 0.0001), being pharmacist (p = 0.03), higher income (p = < 0.0001), previous COVID-19 testing (p < 0.001). Predictors of self medication were > 44 years (Adjusted Odd Ratio[AOR]:2.77,95% Confidence Interval [CI]: 1.62–4.75, p = < 0.0001), previous COVID-19 testing (AOR = 2.68, 95% CI: 1.82–3.94, p = < 0.0001). Conclusion About one-third of HCPs practiced COVID-19 related self-medication. HCPs that are often assumed to be health literate may not necessarily practice safe health behavior. Regular health education of the HCPs on implications of self-medications is highly recommended. There should also be formulation and effective implementation of policies that regulate purchase of medications.
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Putri IRR, Surismanto F, Sugiarto S, Ridwan ES. Factor Related the Use of Respiratory Supports among COVID-19 Patients in Sardjito Hospital Yogyakarta: A Cross-sectional Study. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: In patients with coronavirus disease-19 (COVID-19), respiratory failure is a serious condition that requires immediate respiratory supports. Various clinical conditions can be determinant factors to the need for used of ventilators.
AIM: The aim of the study was to determine factor related to the used of ventilators among COVID-19 patients transferred to intensive care unit Sardjito Hospital.
METHODS: Using a cross-sectional design, a total of 171 of 300 medical records selected in accordance to the inclusion criteria. Association of each clinical characteristics and outcome variable used contingency coefficient and Spearman rank tests, while multivariate logistic regression model was performed for hypothesis testing. The area under curve (AUC) was test to determine model fit of the logistic approach.
RESULTS: There was a significant correlation between age (p = 0.004), blood sugar levels (p < 0.001), and oxygen saturation (p < 0.001), and the used of ventilator. Patients with hypoxia and severe hypoxia had odds of using ventilation supports 5 times and 114 times (OR = 5.623) and (OR = 114.3). The AUC test indicated that null hypothesis was rejected.
CONCLUSION: The clinical characteristics were associated with age, blood sugar levels, and oxygen saturation. Patients with COVID-19 who admitted to hospital with hypoxia and severe hypoxia increased the odds of the use ventilators.
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Patil S, Toshniwal S, Acharya A, Narwade G. Role of “Ferritin” in COVID-19 pneumonia: Sensitive marker of inflammation, predictor of mechanical ventilation, and early marker of post-COVID-lung fibrosis – A prospective, observational, and interventional study in a tertiary care setting in India. MULLER JOURNAL OF MEDICAL SCIENCES AND RESEARCH 2022. [DOI: 10.4103/mjmsr.mjmsr_19_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Martínez-Urbistondo M, Moreno-Torres V, Mora-Vargas A, Expósito-Palomo E, Castejón-Díaz R, Daimiel L, Ramos-Lopez O, San-Cristóbal R, Vargas JA, Martínez JA. Interaction of ACEI antihypertensive agent's administration with the inflammatory status at admission concerning COVID-19 clinical stay outcomes. Vascul Pharmacol 2022; 143:106955. [PMID: 35065299 PMCID: PMC8769875 DOI: 10.1016/j.vph.2022.106955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 12/08/2021] [Accepted: 01/16/2022] [Indexed: 12/14/2022]
Abstract
Interactions between anti-hypertensive agents (ACEI), comorbidities, inflammation, and stress status may impact hospital stay duration in COVID-19 patients. This retrospective study analyzed epidemiological data, comorbidities, metabolic/inflammatory markers, and clinical information from 165 SARS-CoV-2 positive patients. In a multiple linear regression model, an IL-6 higher than 100 mg/L, glucose at admission (baseline levels at the hospital entry), and the interaction between ACEI administration and LDH predicted the days of hospital admission (P < 0.001). In conclusion, hypertensive patients suffering more severe inflammatory condition assessed by LDH levels clinically benefited more and reduced the hospital stay when prescribed ACEI agents than those with lower systemic baseline inflammation at admission.
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Patil S, Gondhali G, Acharya A. "Serial ferritin titer" monitoring in COVID-19 pneumonia: valuable inflammatory marker in assessment of severity and predicting early lung fibrosis - prospective, multicentric, observational, and interventional study in tertiary care setting in India. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2022; 34:75. [PMID: 36254195 PMCID: PMC9556145 DOI: 10.1186/s43162-022-00163-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 08/10/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction The COVID-19 pneumonia is a heterogeneous disease with variable effect on lung parenchyma, airways, and vasculature leading to long-term effects on lung functions. Materials and methods Multicentric, prospective, observational, and interventional study conducted during July 2020 to May 2021, in the MIMSR Medical College and Venkatesh Hospital Latur India, included 1000 COVID-19 cases confirmed with RT-PCR. All cases were assessed with lung involvement documented and categorized on HRCT thorax, oxygen saturation, inflammatory marker, ferritin at entry point, and follow-up during hospitalization. Age, gender, comorbidity, and use of BIPAP/NIV and outcome as with or without lung fibrosis as per CT severity were key observations. CT severity scoring is done as per universally accepted standard scoring tool as score < 7 as mild, 7–14 as moderate, and score > 15 as severe affection of the lung. Statistical analysis is done by using chi-square test. Observations and analysis In study of 1000 COVID-19 pneumonia cases, age (< 50 and > 50 years) and gender (male versus female) have significant association with ferritin in predicting severity of COVID-19 pneumonia (p < 0.00001) and (p < 0.010), respectively. CT severity score at entry point with ferritin level has significant correlation in severity scores < 8, 8–15, and > 15 documented in normal and abnormal ferritin level as in 190/110, 90/210, and 40/360, respectively (p < 0.00001). Ferritin level has significant association with duration of illness, i.e., DOI < 7 days, 8–15 days, and > 15 days of onset of symptoms documented normal and abnormal ferritin levels in 30/310, 160/300, and 130/70 cases, respectively (p < 0.00001). Comorbidity as diabetes mellitus, hypertension, COPD, IHD, and obesity has significant association in COVID-19 cases with normal and abnormal ferritin level respectively (p < 0.00001). Ferritin level has significant association with oxygen saturation in COVID-19 pneumonia cases; cases with oxygen saturation > 90%, 75–90%, and < 75% are observed as normal and abnormal ferritin level in 110/100, 150/340, and 60/240 cases, respectively (p < 0.00001). BIPAP/NIV requirement during the course of COVID-19 pneumonia in critical care setting has significant association with ferritin level; cases received BIPAP/NIV during hospitalization were documented normal and abnormal ferritin level in 155/445 and 165/235 cases, respectively (p < 0.00001). Timing of BIPAP/NIV requirement during course of COVID-19 pneumonia in critical care setting has significant association with ferritin level; cases received BIPAP/NIV at entry point < 1 day, 3–7 days, and after 7 days of hospitalization were documented significance in fourfold raised ferritin level in 110/70, 150/160, and 30/80 cases, respectively (p < 0.00001). Follow-up of ferritin titer during hospitalization as compared to entry point abnormal ferritin has significant association in post-COVID lung fibrosis (p < 0.00001). Follow-up of ferritin titer during hospitalization as compared to entry point normal ferritin has significant association in post-COVID lung fibrosis (p < 0.00001). Conclusion Ferritin is easily available, sensitive and reliable, cost-effective, and universally acceptable inflammatory marker in COVID-19 pandemic. Ferritin has very crucial role in COVID-19 pneumonia in predicting severity of illness and assessing response to treatment during hospitalization. Follow-up of ferritin titer during hospitalization and at discharge can be used as early predictor of post-COVID lung fibrosis.
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Affiliation(s)
- Shital Patil
- grid.415674.50000 0004 1766 7426Pulmonary Medicine, MIMSR Medical College, Latur, India
| | - Gajanan Gondhali
- grid.415674.50000 0004 1766 7426Internal Medicine, MIMSR Medical College, Latur, India
| | - Abhijit Acharya
- grid.415674.50000 0004 1766 7426Department of Pathology, MIMSR Medical College, Latur, India
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Reyes C, Pistillo A, Fernández-Bertolín S, Recalde M, Roel E, Puente D, Sena AG, Blacketer C, Lai L, Alshammari TM, Ahmed WUR, Alser O, Alghoul H, Areia C, Dawoud D, Prats-Uribe A, Valveny N, de Maeztu G, Sorlí Redó L, Martinez Roldan J, Lopez Montesinos I, Schilling LM, Golozar A, Reich C, Posada JD, Shah N, You SC, Lynch KE, DuVall SL, Matheny ME, Nyberg F, Ostropolets A, Hripcsak G, Rijnbeek PR, Suchard MA, Ryan P, Kostka K, Duarte-Salles T. Characteristics and outcomes of patients with COVID-19 with and without prevalent hypertension: a multinational cohort study. BMJ Open 2021; 11:e057632. [PMID: 34937726 PMCID: PMC8704062 DOI: 10.1136/bmjopen-2021-057632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/09/2021] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To characterise patients with and without prevalent hypertension and COVID-19 and to assess adverse outcomes in both inpatients and outpatients. DESIGN AND SETTING This is a retrospective cohort study using 15 healthcare databases (primary and secondary electronic healthcare records, insurance and national claims data) from the USA, Europe and South Korea, standardised to the Observational Medical Outcomes Partnership common data model. Data were gathered from 1 March to 31 October 2020. PARTICIPANTS Two non-mutually exclusive cohorts were defined: (1) individuals diagnosed with COVID-19 (diagnosed cohort) and (2) individuals hospitalised with COVID-19 (hospitalised cohort), and stratified by hypertension status. Follow-up was from COVID-19 diagnosis/hospitalisation to death, end of the study period or 30 days. OUTCOMES Demographics, comorbidities and 30-day outcomes (hospitalisation and death for the 'diagnosed' cohort and adverse events and death for the 'hospitalised' cohort) were reported. RESULTS We identified 2 851 035 diagnosed and 563 708 hospitalised patients with COVID-19. Hypertension was more prevalent in the latter (ranging across databases from 17.4% (95% CI 17.2 to 17.6) to 61.4% (95% CI 61.0 to 61.8) and from 25.6% (95% CI 24.6 to 26.6) to 85.9% (95% CI 85.2 to 86.6)). Patients in both cohorts with hypertension were predominantly >50 years old and female. Patients with hypertension were frequently diagnosed with obesity, heart disease, dyslipidaemia and diabetes. Compared with patients without hypertension, patients with hypertension in the COVID-19 diagnosed cohort had more hospitalisations (ranging from 1.3% (95% CI 0.4 to 2.2) to 41.1% (95% CI 39.5 to 42.7) vs from 1.4% (95% CI 0.9 to 1.9) to 15.9% (95% CI 14.9 to 16.9)) and increased mortality (ranging from 0.3% (95% CI 0.1 to 0.5) to 18.5% (95% CI 15.7 to 21.3) vs from 0.2% (95% CI 0.2 to 0.2) to 11.8% (95% CI 10.8 to 12.8)). Patients in the COVID-19 hospitalised cohort with hypertension were more likely to have acute respiratory distress syndrome (ranging from 0.1% (95% CI 0.0 to 0.2) to 65.6% (95% CI 62.5 to 68.7) vs from 0.1% (95% CI 0.0 to 0.2) to 54.7% (95% CI 50.5 to 58.9)), arrhythmia (ranging from 0.5% (95% CI 0.3 to 0.7) to 45.8% (95% CI 42.6 to 49.0) vs from 0.4% (95% CI 0.3 to 0.5) to 36.8% (95% CI 32.7 to 40.9)) and increased mortality (ranging from 1.8% (95% CI 0.4 to 3.2) to 25.1% (95% CI 23.0 to 27.2) vs from 0.7% (95% CI 0.5 to 0.9) to 10.9% (95% CI 10.4 to 11.4)) than patients without hypertension. CONCLUSIONS COVID-19 patients with hypertension were more likely to suffer severe outcomes, hospitalisations and deaths compared with those without hypertension.
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Affiliation(s)
- Carlen Reyes
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Andrea Pistillo
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Sergio Fernández-Bertolín
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Martina Recalde
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Elena Roel
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Diana Puente
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Anthony G Sena
- Janssen Research and Development Titusville, Titusville, New Jersey, USA
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Clair Blacketer
- Janssen Research and Development Titusville, Titusville, New Jersey, USA
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Lana Lai
- School of Medical Sciences, The University of Manchester, Manchester, UK
| | | | - Waheed-Ui-Rahman Ahmed
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Center, Oxford, UK
- College of Medicine and Health, University of Exeter, St Luke's Campus, Exeter, UK
| | - Osaid Alser
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Heba Alghoul
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Carlos Areia
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Dalia Dawoud
- National Institute for Health and Care Excellence (NICE), London, UK
- Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Albert Prats-Uribe
- Center for Statistics in Medicine, NDORMS, University of Oxford, Botnar Research Center, Nuffield Orthopaedic Center, Oxford, UK
| | | | | | - Luisa Sorlí Redó
- Universitat Autonoma de Barcelona, Barcelona, Spain
- Department of Infectious Diseases, Hospital del Mar, Institut Hospital del Mar d'Investigació Mèdica (IMIM), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Jordi Martinez Roldan
- Director of Innovation and Digital Transformation, Hospital del Mar, Barcelona, Spain
| | - Inmaculada Lopez Montesinos
- Department of Infectious Diseases, Hospital del Mar, Institut Hospital del Mar d'Investigació Mèdica (IMIM), Barcelona, Spain
| | - Lisa M Schilling
- University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Asieh Golozar
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | | | - Jose D Posada
- Stanford University School of Medicine, Stanford, California, USA
| | - Nigam Shah
- Stanford University School of Medicine, Stanford, California, USA
| | - Seng Chan You
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
| | - Kristine E Lynch
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Department of Internal Medicine, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Scott L DuVall
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Department of Internal Medicine, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Michael E Matheny
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Department of Internal Medicine, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Ostropolets
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, USA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, USA
- Medical Informatics Services, New York-Presbyterial Hospital, New York, NY, USA
| | - Peter R Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marc A Suchard
- Department of Biostatistics, Fielding School of Publich Health, University of California, Los Angeles, California, USA
| | - Patrick Ryan
- Janssen Research and Development Titusville, Titusville, New Jersey, USA
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, USA
| | - Kristin Kostka
- Real-World Solutions, IQVIA, Cambridge, Massachusetts, USA
- The OHDSI Center at the Roux Institute, Northeastern University, Portland, ME, USA
| | - Talita Duarte-Salles
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
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Lara OD, Smith M, Wang Y, O'Cearbhaill RE, Blank SV, Kolev V, Carr C, Knisely A, McEachron J, Gabor L, Chapman-Davis E, Cohen S, Fehniger J, Lee YC, Isani S, Liu M, Wright JD, Pothuri B. COVID-19 outcomes of patients with gynecologic cancer in New York City: An updated analysis from the initial surge of the pandemic. Gynecol Oncol 2021; 164:304-310. [PMID: 34922769 PMCID: PMC8648583 DOI: 10.1016/j.ygyno.2021.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/16/2021] [Accepted: 12/01/2021] [Indexed: 12/12/2022]
Abstract
Background Despite significant increase in COVID-19 publications, characterization of COVID-19 infection in patients with gynecologic cancer remains limited. Here we present an update of COVID-19 outcomes among people with gynecologic cancer in New York City (NYC) during the initial surge of severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019 [COVID-19]). Methods Data were abstracted from gynecologic oncology patients with COVID-19 infection among 8 NYC area hospital systems between March and June 2020. Multivariable logistic regression was utilized to estimate associations between factors and COVID-19 related hospitalization and mortality. Results Of 193 patients with gynecologic cancer and COVID-19, the median age at diagnosis was 65.0 years (interquartile range (IQR), 53.0–73.0 years). One hundred six of the 193 patients (54.9%) required hospitalization; among the hospitalized patients, 13 (12.3%) required invasive mechanical ventilation, 39 (36.8%) required ICU admission. Half of the cohort (49.2%) had not received anti-cancer treatment prior to COVID-19 diagnosis. No patients requiring mechanical ventilation survived. Thirty-four of 193 (17.6%) patients died of COVID-19 complications. In multivariable analysis, hospitalization was associated with an age ≥ 65 years (odds ratio [OR] 2.12, 95% confidence interval [CI] 1.11, 4.07), Black race (OR 2.53, CI 1.24, 5.32), performance status ≥2 (OR 3.67, CI 1.25, 13.55) and ≥ 3 comorbidities (OR 2.00, CI 1.05, 3.84). Only former or current history of smoking (OR 2.75, CI 1.21, 6.22) was associated with death due to COVID-19 in multivariable analysis. Administration of cytotoxic chemotherapy within 90 days of COVID-19 diagnosis was not predictive of COVID-19 hospitalization (OR 0.83, CI 0.41, 1.68) or mortality (OR 1.56, CI 0.67, 3.53). Conclusions The case fatality rate among patients with gynecologic malignancy with COVID-19 infection was 17.6%. Cancer-directed therapy was not associated with an increased risk of mortality related to COVID-19 infection.
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Affiliation(s)
- Olivia D Lara
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, NY, United States of America
| | - Maria Smith
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, NY, United States of America
| | - Yuyan Wang
- Department of Population Health, NYU Langone Health, New York, NY, United States of America
| | - Roisin E O'Cearbhaill
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, United States of America
| | - Stephanie V Blank
- Department of Obstetrics, Gynecologic and Reproductive Science, Division of Gynecologic Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Valentin Kolev
- Department of Obstetrics, Gynecologic and Reproductive Science, Division of Gynecologic Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Caitlin Carr
- Department of Obstetrics, Gynecologic and Reproductive Science, Division of Gynecologic Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Anne Knisely
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Jennifer McEachron
- Department of Obstetrics and Gynecology, State University of New York Downstate Medical Center, Brooklyn, NY, United States of America
| | - Lisa Gabor
- Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Eloise Chapman-Davis
- Department of Obstetrics & Gynecology, Cornell University, New York, NY, United States of America
| | - Seth Cohen
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, United States of America
| | - Julia Fehniger
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, NY, United States of America
| | - Yi-Chun Lee
- Department of Obstetrics and Gynecology, State University of New York Downstate Medical Center, Brooklyn, NY, United States of America
| | - Sara Isani
- Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Mengling Liu
- Department of Population Health, NYU Langone Health, New York, NY, United States of America; Department of Environmental Medicine, NYU Langone Health, New York, NY, United States of America
| | - Jason D Wright
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Bhavana Pothuri
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, NY, United States of America.
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Alroomi M, Rajan R, Omar AA, Alsaber A, Pan J, Fatemi M, Zhanna KD, Aboelhassan W, Almutairi F, Alotaibi N, Saleh MA, AlNasrallah N, Al‐Bader B, Malhas H, Ramadhan M, Abdullah M, Abdelnaby H. Ferritin level: A predictor of severity and mortality in hospitalized COVID-19 patients. Immun Inflamm Dis 2021; 9:1648-1655. [PMID: 34438471 PMCID: PMC8589386 DOI: 10.1002/iid3.517] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/10/2021] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION This study aims to investigate in-hоsрitаl mоrtаlity in severe асute resрirаtоry syndrоme соrоnаvirus 2 раtients strаtified by serum ferritin levels. METHODS Patients were stratified based on ferritin levels (ferritin levels ≤ 1000 or >1000). RESULTS Approximately 89% (118) of the patients with ferritin levels > 1000 had pneumonia, and 51% (67) had hypertension. Fever (97, 73.5%) and shortness of breath (80, 61%) were two major symptoms among the patients in this group. Logistic regression analysis indicated that ferritin level (odds ratio [OR] = 0.36, 95% confidence interval [CI] = 0.21-0.62; p < .001), male sex (OR = 2.63, 95% CI = 1.43-5.06; p = .003), hypertension (OR = 4.16, 95% CI = 2.42-7.36; p < .001) and pneumonia (OR = 8.48, 95% CI = 3.02-35.45; p < .001) had significance in predicting in-hospital mortality. Additionally, the Cox proportional hazards analysis and Kaplan-Meier survival probability plot showed a higher mortality rate among patients with ferritin levels > 1000. CONCLUSION In this study, higher levels of serum ferritin were found to be an independent predictor of in-hоsрitаl mоrtаlity.
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Affiliation(s)
- Moudhi Alroomi
- Department of Infectious DiseasesInfectious Diseases Hospital, Shuwaikh Medical AreaKuwait CityKuwait
| | - Rajesh Rajan
- Department of CardiologySabah Al Ahmad Cardiac Centre, Al Amiri HospitalKuwait CitySharqKuwait
| | | | - Ahmad Alsaber
- Department of Mathematics and StatisticsUniversity of StrathclydeGlasgowUnited Kingdom
| | - Jiazhu Pan
- Department of Mathematics and StatisticsUniversity of StrathclydeGlasgowUnited Kingdom
| | - Mina Fatemi
- Public Health and Commissioning ManagerNottinghamshire County CouncilNottinghamUnited Kingdom
| | - Kobalava D. Zhanna
- Department of Internal Medicine with the Subspecialty of Cardiology and Functional Diagnostics Named after V.S. MoiseevPeoples' Friendship University of Russia (RUDN University)MoscowRussian Federation
| | - Wael Aboelhassan
- Division of Gastroenterology, Department of MedicineJaber Al Ahmed HospitalSouth SurraKuwait
| | | | | | | | | | | | - Haya Malhas
- Department of Emergency MedicineMubarak Al‐Kabeer HospitalJabriyaKuwait
| | - Maryam Ramadhan
- Department of Obstetrics and GynaecologyMaternity Hospital, Shuwaikh Medical AreaKuwait CityKuwait
| | - Mohammed Abdullah
- Department of Infectious DiseasesInfectious Diseases Hospital, Shuwaikh Medical AreaKuwait CityKuwait
| | - Hassan Abdelnaby
- Department of Endemic and Infectious Diseases, Faculty of MedicineSuez Canal UniversityIsmailiaEgypt
- Division of Gastroenterology, Department of MedicineAl Sabah Hospital, Shuwaikh Medical AreaKuwait CityKuwait
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Wang IE, Cooper G, Mousa SA. Diagnostic Approaches for COVID-19 and Its Associated Complications. Diagnostics (Basel) 2021; 11:2071. [PMID: 34829418 PMCID: PMC8619505 DOI: 10.3390/diagnostics11112071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 12/23/2022] Open
Abstract
With almost 4 million deaths worldwide from the COVID-19 pandemic, the efficient and accurate diagnosis and identification of COVID-19-related complications are more important than ever. Scales such as the pneumonia severity index, or CURB-65, help doctors determine who should be admitted to the hospital or the intensive care unit. To properly treat and manage admitted patients, standardized sampling protocols and methods are required for COVID-19 patients. Using PubMed, relevant articles since March 2020 on COVID-19 diagnosis and its complications were analyzed. Patients with COVID-19 had elevated D-dimer, thrombomodulin, and initial factor V elevation followed by decreased factor V and factor VII and elevated IL-6, lactate dehydrogenase, and c-reactive protein, which indicated coagulopathy and possible cytokine storm. Patients with hypertension, newly diagnosed diabetes, obesity, or advanced age were at increased risk for mortality. Elevated BUN, AST, and ALT in severe COVID-19 patients was associated with acute kidney injury or other organ damage. The gold standard for screening COVID-19 is reverse transcriptase polymerase chain reaction (RT-PCR) using sputum, oropharyngeal, or nasopharyngeal routes. However, due to the low turnover rate and limited testing capacity of RT-PCR, alternative diagnostic tools such as CT-scan and serological testing (IgM and IgG) can be considered in conjunction with symptom monitoring. Advancements in CRISPR technology have also allowed the use of alternative COVID-19 testing, but unfortunately, these technologies are still under FDA review and cannot be used in patients. Nonetheless, increased turnover rates and testing capacity allow for a bright future in COVID-19 diagnosis.
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Affiliation(s)
| | | | - Shaker A. Mousa
- The Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, 1 Discovery Drive, Rensselaer, NY 12144, USA; (I.E.W.); (G.C.)
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Moftakhar L, Piraee E, Mohammadi Abnavi M, Moftakhar P, Azarbakhsh H, Valipour A. Epidemiological Features and Predictors of Mortality in Patients with COVID-19 with and without Underlying Hypertension. Int J Hypertens 2021; 2021:7427500. [PMID: 34676114 PMCID: PMC8526257 DOI: 10.1155/2021/7427500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 09/03/2021] [Accepted: 09/12/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUNDS Individuals with hypertension are at higher risk of COVID-19 infection and related mortality. This study was carried out to assess the epidemiological features and predictors of mortality in patients with COVID-19 with hypertension. METHODS In this retrospective study, the epidemiological characteristics of two groups of patients with COVID-19 with hypertension (1927) and without hypertension (39030) were compared. Chi-square test was applied to evaluate the differences between qualitative variables in two study groups. Logistic regression was also used to determine predictors of mortality in patients with COVID-19 and in patients with COVID-19 with hypertension. RESULTS The prevalence of hypertension in patients with COVID-19 was 4.7%, and 24.37% of COVID-19 related deaths occurred in these individuals. The average age of hypertension and nonhypertension patients was 61 and 37 years, respectively. Fever, cough, headache, anorexia, fatigue, and comorbid diseases, such as cardiovascular disease, chronic lung and kidney disease, diabetes, immunodeficiency disease, and thyroid disease, were significantly more frequent in people with hypertension than those without hypertension. The chances of mortality in patient with COVID-19 were 1.8 times higher in individuals with dyspnea, 1.25 in individuals with fever, 1.33 in individuals with cough, 3.6 in patients with hypertension, 2.21 in diabetics, and 2.2 in individuals with cardiovascular disease. Also, individuals with COVID-19 with hypertension that had dyspnea, immunodeficiency, and cardiovascular disease were at higher risk of mortality. CONCLUSION Hypertension is a serious threat to patients with COVID-19. Therefore, in order to control these patients more precisely and reduce mortality in them, it is extremely important to develop prevention and treatment strategies.
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Affiliation(s)
- Leila Moftakhar
- Abadan University of Medical Sciences, Abadan, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Elahe Piraee
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Parisa Moftakhar
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | | | - Aliasghar Valipour
- Department of Public Health, Abadan Faculty of Medical Sciences, Abadan, Iran
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Lami F, Elfadul M, Rashak HA, Al Nsour M, Akhtar H, Khader YS, Hussein AM, Naciri M, Samy S, Ghaleb Y, Taha HA, Aljanabe AH, Ali NA, Zayer RH, Ikram A, Rahman FU, Khan MM, Adam R, Ahmed AY, Afifi S. Risk Factors of COVID-19 Critical Outcomes in the Eastern Mediterranean Region: A Multicountry Retrospective Study . JMIR Public Health Surveill 2021; 8:e32831. [PMID: 34736222 PMCID: PMC8929409 DOI: 10.2196/32831] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The establishment of empirical evidence in the Eastern Mediterranean Region (EMR) necessitates the implementation of wide-scale studies to describe the demographic, clinical features, and severity profile of COVID-19 patients. OBJECTIVE This study aimed to assess the patterns of COVID-19 severity and mortality in seven countries and to determine the risk factors of COVID-19 severity and mortality. METHODS This multi-country study was based on a retrospective review of medical records of hospitalized patients confirmed to have COVID-19. This study included data from Iraq, Pakistan, Sudan, Somalia, Morocco, Egypt, and Yemen. All demographic and clinical data were extracted from hospital records (paper files) by trained data collectors. RESULTS A total of 4141 patients were included in this study from seven countries. Comorbidities were reported by nearly half of the patients, with hypertension (HT) (24.7%) and diabetes (22.7%) being the most common. Older age, diabetes mellitus, hypertension, and heart diseases were significantly associated with COVID-19 severity and mortality. Ever smoking and renal diseases were significantly associated with severity but not mortality, while male gender, respiratory diseases, and malignancy were significantly associated with mortality but not severity. CONCLUSIONS The study confirmed the role of comorbidities and demographic features on the severity and mortality of COVID-19. Understanding the contributing factors ensures attentive care and informs clinical management of patients with poorer prognoses in the early stages of diseases.
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Affiliation(s)
- Faris Lami
- University of Baghdad, Department of Community and Family Medicine, Baghdad, IQ
| | - Maisa Elfadul
- University of Medical Sciences amd Technology ,Sudan, Federal Minstry of Health, Airport avenue,, Khartoum, SD
| | | | - Mohannad Al Nsour
- Global Health Development (GHD), The Eastern Mediterranean Public Health Network (EMPHNET), Amman, JO
| | - Hashaam Akhtar
- Yusra Institute of Pharmaceutical Sciences, Yusra Medical and Dental Collage, Islamabad, PK
| | - Yousef S Khader
- Department of Community Medicine, Public Health and Family Medicine/ Faculty of Medicine, Jordan University of Science & Technology, Amman, JO
| | | | - Mariam Naciri
- Research Center Biotechnology, Biodiversity and Environment (BIOBIO), Laboratory of Biodiversity, Ecology and Genome, Biology Department, Faculty of Sciences, Mohammed V University, Rabat, MA
| | - Sahar Samy
- Communicable disease control department - Preventive Sector, Ministry of Health and Population, Cairo, EG
| | - Yasser Ghaleb
- Ministry of Public Health and Population, Yemen Field Epidemiology Training Program, Sana'a, YE
| | - Hana Ahmad Taha
- Global Health Development (GHD)
- Eastern Mediterranean Public Health Network, Health Protection and Promotion, Amman, JO
| | | | | | - Raheem Hussein Zayer
- Al-Rusafa Health Directorate, Public Health Department, Ministry of Health, Baghdad, IQ
| | | | - Fazal Ur Rahman
- Medical Unit 1 Benazir Bhutto Hospital, Rawalpindi Medical University, Rawalpindi, PK
| | | | - Reema Adam
- Federal Ministry of Health, Directorate of Emergency and Humantarian actions, Khartoum, SD
| | | | - Salma Afifi
- Ministry of Health and Population, Cairo, EG
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Treskova-Schwarzbach M, Haas L, Reda S, Pilic A, Borodova A, Karimi K, Koch J, Nygren T, Scholz S, Schönfeld V, Vygen-Bonnet S, Wichmann O, Harder T. Pre-existing health conditions and severe COVID-19 outcomes: an umbrella review approach and meta-analysis of global evidence. BMC Med 2021; 19:212. [PMID: 34446016 PMCID: PMC8390115 DOI: 10.1186/s12916-021-02058-6] [Citation(s) in RCA: 102] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 07/08/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND This study applies an umbrella review approach to summarise the global evidence on the risk of severe COVID-19 outcomes in patients with pre-existing health conditions. METHODS Systematic reviews (SRs) were identified in PubMed, Embase/Medline and seven pre-print servers until December 11, 2020. Due to the absence of age-adjusted risk effects stratified by geographical regions, a re-analysis of the evidence was conducted. Primary studies were extracted from SRs and evaluated for inclusion in the re-analysis. Studies were included if they reported risk estimates (odds ratio (OR), hazard ratio (HR), relative risk (RR)) for hospitalisation, intensive care unit admission, intubation or death. Estimated associations were extracted from the primary studies for reported pre-existing conditions. Meta-analyses were performed stratified for each outcome by regions of the World Health Organization. The evidence certainty was assessed using GRADE. Registration number CRD42020215846. RESULTS In total, 160 primary studies from 120 SRs contributed 464 estimates for 42 pre-existing conditions. Most studies were conducted in North America, European, and Western Pacific regions. Evidence from Africa, South/Latin America, and the Eastern Mediterranean region was scarce. No evidence was available from the South-East Asia region. Diabetes (HR range 1.2-2.0 (CI range 1.1-2.8)), obesity (OR range 1.5-1.75 (CI range 1.1-2.3)), heart failure (HR range 1.3-3.3 (CI range 0.9-8.2)), COPD (HR range 1.12-2.2 (CI range 1.1-3.2)) and dementia (HR range 1.4-7.7 (CI range 1.2-39.6)) were associated with fatal COVID-19 in different regions, although the estimates varied. Evidence from Europe and North America showed that liver cirrhosis (OR range 3.2-5.9 (CI range 0.9-27.7)) and active cancer (OR range 1.6-4.7 (CI range 0.5-14.9)) were also associated with increased risk of death. Association between HIV and undesirable COVID-19 outcomes showed regional heterogeneity, with an increased risk of death in Africa (HR 1.7 (CI 1.3-2.2)). GRADE certainty was moderate to high for most associations. CONCLUSION Risk of undesirable COVID-19 health outcomes is consistently increased in certain patient subgroups across geographical regions, showing high variability in others. The results can be used to inform COVID-19 vaccine prioritisation or other intervention strategies.
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Affiliation(s)
| | - Laura Haas
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Sarah Reda
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Antonia Pilic
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Anna Borodova
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Kasra Karimi
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Judith Koch
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Teresa Nygren
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Stefan Scholz
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Viktoria Schönfeld
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Sabine Vygen-Bonnet
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Ole Wichmann
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Thomas Harder
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
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Chen L, Chen J, Wu Y, Zhong J, Zhou F, Liu Y, Xu A, Li J, Cai H. Clinical Characteristics and Outcomes of Hypertensive Patients Infected with COVID-19: A Retrospective Study. Int J Gen Med 2021; 14:4619-4628. [PMID: 34429644 PMCID: PMC8380129 DOI: 10.2147/ijgm.s324077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/11/2021] [Indexed: 12/21/2022] Open
Abstract
Background Hypertension has been reported as the most prevalent comorbidity in patients with coronavirus disease 2019 (COVID-19). This retrospective study aims to compare the clinical characteristics and outcomes in COVID-19 patients with or without hypertension. Methods A total of 944 hospitalized patients with laboratory-confirmed COVID-19 were included from January to March 2020. Information from the medical record, including clinical features, radiographic and laboratory results, complications, treatments, and clinical outcomes, were extracted for the analysis. Results A total of 311 (32.94%) patients had comorbidity with hypertension. In COVID-19 patients with hypertension, the coexistence of type 2 diabetes (56.06% vs 43.94%), coronary heart disease (65.71% vs 34.29%), poststroke syndrome (68.75% vs 31.25%) and chronic kidney diseases (77.78% vs 22.22%) was significantly higher, while the coexistence of hepatitis B infection (13.04% vs 86.96%) was significantly lower than in COVID-19 patients without hypertension. Computed tomography (CT) chest scans show that COVID-19 patients with hypertension have higher rates of pleural effusion than those without hypertension (56.60% vs 43.40%). In addition, the levels of blood glucose [5.80 (IQR, 5.05–7.50) vs 5.39 (IQR, 4.81–6.60)], erythrocyte sedimentation rate (ESR) [28 (IQR, 17.1–55.6) vs 21.8 (IQR, 11.5–44.1), P=0.008], C-reactive protein (CRP) [17.92 (IQR, 3.11–46.6) vs 3.15 (IQR, 3.11–23.4), P=0.013] and serum amyloid A (SAA) [99.28 (IQR, 8.85–300) vs 15.97 (IQR, 5.97–236.1), P=0.005] in COVID-19 patients with hypertension were significantly higher than in patients without hypertension. Conclusion It is common for patients with COVID-19 to have the coexistence of hypertension, type 2 diabetes, coronary heart disease and so on, which may exacerbate the severity of COVID-19. Therefore, optimal management of hypertension and other comorbidities is essential for better clinical outcomes.
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Affiliation(s)
- Liqin Chen
- The Second Affiliated Hospital (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, People's Republic of China
| | - Jiankun Chen
- The Second Affiliated Hospital (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, People's Republic of China.,Guangzhou Key Laboratory of Traditional Chinese Medicine for Prevention and Treatment of Emerging Infectious Diseases, Guangzhou, 510006, Guangdong, People's Republic of China
| | - Yuwan Wu
- The Second Affiliated Hospital (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, People's Republic of China
| | - Jinyao Zhong
- The Second Affiliated Hospital (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, People's Republic of China
| | - Fuzhen Zhou
- The Second Affiliated Hospital (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, People's Republic of China
| | - Yuntao Liu
- The Second Affiliated Hospital (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, People's Republic of China.,Guangzhou Key Laboratory of Traditional Chinese Medicine for Prevention and Treatment of Emerging Infectious Diseases, Guangzhou, 510006, Guangdong, People's Republic of China
| | - Aiting Xu
- The People's Hospital of Yangjiang, Yangjiang, 529500, Guangdong, People's Republic of China
| | - Jiqiang Li
- The Second Affiliated Hospital (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, People's Republic of China.,Guangzhou Key Laboratory of Traditional Chinese Medicine for Prevention and Treatment of Emerging Infectious Diseases, Guangzhou, 510006, Guangdong, People's Republic of China
| | - Huayang Cai
- The Second Affiliated Hospital (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, People's Republic of China
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Hakim A, Hasan MM, Hasan M, Lokman SM, Azim KF, Raihan T, Chowdhury PA, Azad AK. Major Insights in Dynamics of Host Response to SARS-CoV-2: Impacts and Challenges. Front Microbiol 2021; 12:637554. [PMID: 34512561 PMCID: PMC8424194 DOI: 10.3389/fmicb.2021.637554] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 07/28/2021] [Indexed: 01/08/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19), a pandemic declared by the World Health Organization on March 11, 2020, is caused by the infection of highly transmissible species of a novel coronavirus called severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). As of July 25, 2021, there are 194,372,584 cases and 4,167,937 deaths with high variability in clinical manifestations, disease burden, and post-disease complications among different people around the globe. Overall, COVID-19 is manifested as mild to moderate in almost 90% of the cases and only the rest 10% of the cases need hospitalization. However, patients with older age and those having different comorbidities have made worst the pandemic scenario. The variability of pathological consequences and clinical manifestations of COVID-19 is associated with differential host-SARS-CoV-2 interactions, which are influenced by the factors that originated from the SARS-CoV-2 and the host. These factors usually include the genomic attributes and virulent factors of the SARS-CoV-2, the burden of coinfection with other viruses and bacteria, age and gender of the individuals, different comorbidities, immune suppressions/deficiency, genotypes of major histocompatibility complex, and blood group antigens and antibodies. We herein retrieved and reviewed literatures from PubMed, Scopus, and Google relevant to clinical complications and pathogenesis of COVID-19 among people of different age, sex, and geographical locations; genomic characteristics of SARS-CoV-2 including its variants, host response under different variables, and comorbidities to summarize the dynamics of the host response to SARS-CoV-2 infection; and host response toward approved vaccines and treatment strategies against COVID-19. After reviewing a large number of published articles covering different aspects of host response to SARS-CoV-2, it is clear that one aspect from one region is not working with the scenario same to others, as studies have been done separately with a very small number of cases from a particular area/region of a country. Importantly, to combat such a pandemic as COVID-19, a conclusive understanding of the disease dynamics is required. This review emphasizes on the identification of the factors influencing the dynamics of host responses to SARS-CoV-2 and offers a future perspective to explore the molecular insights of COVID-19.
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Affiliation(s)
- Al Hakim
- Department of Genetic Engineering and Biotechnology, School of Life Sciences, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Md. Mahbub Hasan
- Department of Genetic Engineering and Biotechnology, Faculty of Biological Sciences, University of Chittagong, Chittagong, Bangladesh
- Institute of Pharmaceutical Science, School of Cancer and Pharmaceutical Sciences, King’s College London, Franklin-Wilkins Building, London, United Kingdom
| | - Mahmudul Hasan
- Department of Pharmaceutical and Industrial Biotechnology, Sylhet Agricultural University, Sylhet, Bangladesh
| | - Syed Mohammad Lokman
- Department of Genetic Engineering and Biotechnology, Faculty of Biological Sciences, University of Chittagong, Chittagong, Bangladesh
| | - Kazi Faizul Azim
- Department of Microbial Biotechnology, Faculty of Biotechnology and Genetic Engineering, Sylhet Agricultural University, Sylhet, Bangladesh
| | - Topu Raihan
- Department of Genetic Engineering and Biotechnology, School of Life Sciences, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | | | - Abul Kalam Azad
- Department of Genetic Engineering and Biotechnology, School of Life Sciences, Shahjalal University of Science and Technology, Sylhet, Bangladesh
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Dejani NN, Elshabrawy HA, Bezerra Filho CDSM, de Sousa DP. Anticoronavirus and Immunomodulatory Phenolic Compounds: Opportunities and Pharmacotherapeutic Perspectives. Biomolecules 2021; 11:biom11081254. [PMID: 34439920 PMCID: PMC8394099 DOI: 10.3390/biom11081254] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 08/14/2021] [Accepted: 08/15/2021] [Indexed: 02/06/2023] Open
Abstract
In 2019, COVID-19 emerged as a severe respiratory disease that is caused by the novel coronavirus, Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). The disease has been associated with high mortality rate, especially in patients with comorbidities such as diabetes, cardiovascular and kidney diseases. This could be attributed to dysregulated immune responses and severe systemic inflammation in COVID-19 patients. The use of effective antiviral drugs against SARS-CoV-2 and modulation of the immune responses could be a potential therapeutic strategy for COVID-19. Studies have shown that natural phenolic compounds have several pharmacological properties, including anticoronavirus and immunomodulatory activities. Therefore, this review discusses the dual action of these natural products from the perspective of applicability at COVID-19.
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Affiliation(s)
- Naiara Naiana Dejani
- Department of Physiology and Pathology, Federal University of Paraíba, João Pessoa 58051-900, Brazil;
| | - Hatem A. Elshabrawy
- Department of Molecular and Cellular Biology, College of Osteopathic Medicine, Sam Houston State University, Conroe, TX 77304, USA;
| | - Carlos da Silva Maia Bezerra Filho
- Department of Pharmaceutical Sciences, Federal University of Paraíba, João Pessoa 58051-900, Brazil;
- Postgraduate Program in Bioactive Natural and Synthetic Products, Federal University of Paraíba, João Pessoa 58051-900, Brazil
| | - Damião Pergentino de Sousa
- Department of Pharmaceutical Sciences, Federal University of Paraíba, João Pessoa 58051-900, Brazil;
- Postgraduate Program in Bioactive Natural and Synthetic Products, Federal University of Paraíba, João Pessoa 58051-900, Brazil
- Correspondence: ; Tel.: +55-83-3216-7347
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Lami F, Elfadul M, Rashak H, Al Nsour M, Akhtar H, Khader Y, Hussein AM, Naciri M, Samy S, Ghaleb Y, Taha H, Hussein A, Ali NA, Hussein R, Ikram A, Rahman FU, Khan MM, Adam R, Ahmed AY, Afifi S. Risk Factors of COVID-19 Critical Outcomes in the Eastern Mediterranean Region: Multicountry Retrospective Study (Preprint).. [DOI: 10.2196/preprints.32831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND
The establishment of empirical evidence in the Eastern Mediterranean Region necessitates the implementation of wide-scale studies to describe the demographic, clinical features, and severity profile of patients with COVID-19.
OBJECTIVE
This study aims to assess the patterns of COVID-19 severity and mortality in seven countries, and to determine the risk factors of COVID-19 severity and mortality.
METHODS
This multicountry study was based on a retrospective review of medical records of hospitalized patients confirmed to have COVID-19. This study includes data from Iraq, Pakistan, Sudan, Somalia, Morocco, Egypt, and Yemen. All demographic and clinical data were extracted from hospital records (paper files) by trained data collectors.
RESULTS
A total of 4141 patients were included in this study from seven countries. Comorbidities were reported by nearly half of the patients, with hypertension (n=1021, 24.7%) and diabetes (n=939, 22.7%) being the most common. Older age, diabetes mellitus, hypertension, and heart diseases were significantly associated with COVID-19 severity and mortality. Ever smoking and renal diseases were significantly associated with severity but not mortality, while male gender, respiratory diseases, and malignancy were significantly associated with mortality but not severity.
CONCLUSIONS
The study confirms the role of comorbidities and demographic features on the severity and mortality of COVID-19. Understanding the contributing factors ensures attentive care and informs clinical management of patients with poorer prognoses in the early stages of diseases.
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Portacci A, Carpagnano GE, Tummolo MG, Santomasi C, Palma L, Fasano D, Resta E, Lozupone M, Solfrizzi V, Panza F, Resta O. COVID-19 Clinical Phenotypes and Short-term Outcomes: Differences Between the First and the Second Wave of Pandemic in Italy. Expert Rev Respir Med 2021; 15:1619-1625. [PMID: 34311634 PMCID: PMC8436419 DOI: 10.1080/17476348.2021.1960824] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Objectives: There are no comparative studies between patients belonging to the first and second waves of the SARS-CoV-2 pandemic, the virus triggering coronavirus disease 2019 (COVID-19). In this retrospective observational study, we analyzed the clinical characteristics and the short-term outcomes of two groups of laboratory-confirmed COVID-19 patients with moderate-to-severe acute respiratory distress syndrome (ARDS) belonging to two different waves of the pandemic. Methods: We analyzed 97 consecutive patients from 11 March 2020 to 31 May 2020 and 52 consecutive patients from 28 August 2020 to 15 October 2020. Results: Patients belonging to the second wave were younger, had a lower number of concomitant chronic conditions (multimorbidity), and had a milder clinical phenotype. Medical treatments and respiratory support use have changed during the COVID-19 pandemic, based on different laboratory results and disease clinical features. Patients in the second wave had better short-term clinical outcomes, with lower death rates and more step-down transfers to a general ward. Conclusion: The present findings show a clear phenotypic difference in patients hospitalized at different stages of the COVID-19 pandemic in Italy. These results can help to stratify clinical risk and to better tailor medical treatments and respiratory support for patients with ARDS and COVID-19 pneumonia.
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Affiliation(s)
- Andrea Portacci
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari, "Aldo Moro", Bari
| | - Giovanna Elisiana Carpagnano
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari, "Aldo Moro", Bari
| | - Maria Grazia Tummolo
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari, "Aldo Moro", Bari
| | - Carla Santomasi
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari, "Aldo Moro", Bari
| | - Lavinia Palma
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari, "Aldo Moro", Bari
| | - Domenico Fasano
- Medical Clinic "C. Frugoni" and Geriatric Medicine Unit, University of Bari "Aldo Moro", Bari
| | - Emanuela Resta
- Translational Medicine and Health System Management, University of Foggia, Foggia, Italy
| | - Madia Lozupone
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Vincenzo Solfrizzi
- Medical Clinic "C. Frugoni" and Geriatric Medicine Unit, University of Bari "Aldo Moro", Bari
| | - Francesco Panza
- Population Health Unit, "Salus in Apulia Study", National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy
| | - Onofrio Resta
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari, "Aldo Moro", Bari
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Cai CZ, Lin YL, Hu ZJ, Wong LP. Psychological and mental health impacts of COVID-19 pandemic on healthcare workers in China: A review. World J Psychiatry 2021; 11:337-346. [PMID: 34327126 PMCID: PMC8311517 DOI: 10.5498/wjp.v11.i7.337] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/13/2021] [Accepted: 06/23/2021] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease-19 (COVID-19) pandemic has put healthcare workers in an unprecedented situation, increasing their psychological and mental health distress. Much research has focused on the issues surrounding anxiety, depression, and stress among healthcare workers. The consequences of mental health problems on healthcare workers’ physical health, health-compromising behaviours, suicide ideation, family relationships, and job satisfaction during the COVID-19 pandemic are not well studied. Enhanced psychological stress has known effects on an individual’s physical health. In healthcare workers with pre-existing comorbidities, psychological stressors may exacerbate their current health problems. Healthcare professionals are known to have a high risk of substance use, hence they may be at risk of development of substance use addiction or vulnerable to addiction relapse. Frontline COVID-19 healthcare workers are being pushed above and beyond their limits, possibly resulting in suicidal tendencies. Furthermore, the burden of high workload and burnout may also have serious manifestations in relationships with family and an intention to quit their jobs. Future studies should explore the above-mentioned deleterious consequences to provide insight into the development of mental healthcare strategies to combat the psychological impact of COVID-19 on healthcare workers during the COVID-19 emergency. It is imperative to employ strategies to care for and policies to protect the psychological well-being of healthcare workers.
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Affiliation(s)
- Carla Zi Cai
- Department of Epidemiology and Heath Statistics, School of Public Health, Fujian Medical University, Fuzhou 350122, Fujian Province, China
| | - Yu-Lan Lin
- Department of Epidemiology and Heath Statistics, School of Public Health, Fujian Medical University, Fuzhou 350122, Fujian Province, China
| | - Zhi-Jian Hu
- Department of Epidemiology and Heath Statistics, School of Public Health, Fujian Medical University, Fuzhou 350122, Fujian Province, China
| | - Li Ping Wong
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
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Lu X, Zhang Y, Li H, Jin Y, Zhao L, Wang X. Nicotine prevents in vivo Aβ toxicity in Caenorhabditis elegans via SKN-1. Neurosci Lett 2021; 761:136114. [PMID: 34274434 DOI: 10.1016/j.neulet.2021.136114] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/05/2021] [Accepted: 07/12/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Nicotine, a main active compound in tobacco, has been shown to attenuate amyloid-β (Aβ) mediated neurotoxicity. However, the detailed underlying mechanisms remains to be elucidated. In this study, nematode Caenorhabditis elegans (C. elegans) had been chosen as the model animal for dissecting the role of nicotine in the prevention of Aβ-induced toxicity in vivo. METHODS CL2120 and CL4176 transgenic worms of Alzheimer's disease (AD) models were treated with different concentrations of nicotine, and worm paralysis was monitored. Next, the effects of nicotine on Aβ deposits, Aβ oligomers, reactive oxygen species (ROS) and the oxidative stress resistance in worms were measured. Moreover, the pathway responsible for nicotine alleviating Aβ-induced toxicity in vivo was explored by observing the oxidative stress resistance of skn-1 or daf-16 mutants in the presence of nicotine. Furthermore, the worm paralysis and Aβ deposits were further checked in CL4176 worms with skn-1 RNA interference under the condition of nicotine. RESULTS Nicotine (5 μM) attenuated AD-like symptoms of worm paralysis in CL2120 and CL4176 transgenic C. elegans. Nicotine did not inhibit Aβ aggregation in vitro, however it suppressed Aβ deposits and reduced the Aβ oligomers to alleviate the toxicity induced by Aβ overexpression in C. elegans. Although nicotine did not possess apparent intrinsic anti-oxidative activity, it decreased in vivo reactive oxygen species (ROS). Nicotine enhanced the oxidative stress resistance of C. elegans, which was mediated by SKN-1 but not DAF-16 signaling. Furthermore, skn-1 RNAi abrogated the effect of nicotine reducing Aβ deposits in vivo and completely blocked nicotine preventing Aβ induced worm paralysis. CONCLUSIONS Nicotine reduces Aβ oligomer formation and alleviates Aβ-induced paralysis of C. elegans, which is mediated by SKN-1 signaling.
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Affiliation(s)
- Xiaoda Lu
- College of Life Science and Technology, Changchun University of Science and Technology, Changchun 130022, China
| | - Yue Zhang
- College of Life Science and Technology, Changchun University of Science and Technology, Changchun 130022, China
| | - Hongyuan Li
- Laboratory of Chemical Biology, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, Jilin 130022, China
| | - Yushan Jin
- Department of Immunology and Department of Cell & Systems Biology, University of Toronto, Toronto, Canada
| | - Lihui Zhao
- College of Life Science and Technology, Changchun University of Science and Technology, Changchun 130022, China.
| | - Xiaohui Wang
- Laboratory of Chemical Biology, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, Jilin 130022, China; Department of Applied Chemistry and Engineering, University of Science and Technology of China, Hefei 230026, China.
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Sarjerao Shirkande A, Abhijeet Shirkande A. Ayurvedic evaluation and treatment of Covid 19: A Case Report. J Ayurveda Integr Med 2021; 13:100489. [PMID: 34276164 PMCID: PMC8277552 DOI: 10.1016/j.jaim.2021.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 03/16/2021] [Accepted: 07/04/2021] [Indexed: 11/28/2022] Open
Abstract
COVID-19 patients, with underlying comorbidities are observed to develop complications. Studies have shown that hypertension (one of the comorbidities) is a risk factor for patients with severe COVID-19. There have been more patients with hypertension among those who have died than among survivors. There is no proven treatment of COVID-19 as of now. Ministry of AYUSH, Government of India, has permitted use of traditional systems of medicine for treating mild to moderate cases of COVID-19. In line with this, there are few case reports which show promising results for treatment of COVID-19 with Ayurveda treatment module. These treatment reports highlight subdued COVID-19 infection without developing serious complications. Case in the paper is of a young hypertensive female patient with fever, weakness, anosmia, tastelessness and severe myalgia who was diagnosed with COVID-19. Ayurvedic assessment for this was Kaphavataj jwara. The patient sought Ayurvedic treatment. She was advised with treatment module including medicines, diet and behavioral interventions. Though patient was having comorbid hypertension with major COVID-19 symptoms, tested negative and recovered with exclusive Ayurvedic treatment. The patient was recovered both physically as well as psychologically with no post COVID-19 complications so far. Ayurvedic treatment module appears to be safe and efficacious with early recovery and better outcomes.
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Hyoju SK, Baral B, Jha PK. Central catecholaminergic blockade with clonidine prevent SARS-CoV-2 complication: A case series. IDCases 2021; 25:e01219. [PMID: 34249614 PMCID: PMC8258028 DOI: 10.1016/j.idcr.2021.e01219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/05/2021] [Accepted: 07/05/2021] [Indexed: 02/06/2023] Open
Abstract
SAR-CoV-2 infection lead to sympathetic overactivity. People with co morbid condition due to pre-sympathetic overactivity, there will be always possible of worse outcome. FDA-approved drug clonidine reduces sympathetic activity during COVID-19 infection and prevent complication and death. Clonidine should be considered early in incremental fashion to mitigate SAR-CoV-2 related complication. This is the first case series demonstrating the effectiveness of early use of clonidine in COVID-19.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a life-threating viral infection that is highly transmissible and be lethal. Although many patients with mild symptoms recover, an acute form of the infection is characterized by rapidly evolving respiratory failure, an acute inflammatory response, organ failure, and death. Herein, we describe the use of clonidine to modulate the acute inflammatory consequences of this infection in three cases. The patients were three men between 40–50 years from Kathmandu valley, during the peak of COVID-19 (September 2020- January 2021). All three patients presented with typical COVID-19 symptoms (daily fever, loss of smell and taste, excessive fatigue, cough) and had pneumonia with typical finding in CT Scan of chest. Patient 1was able to maintain adequate oxygenation despite having pneumonia, managed at home by regular self-monitoring of vitals and treatment with oral clonidine whereas patient 2 and 3 developed significant pneumonia and had difficult in maintaining oxygenation hence admitted in hospital and treated with clonidine and supplemental oxygen. All three patients recovered completely. In this limited report, we proposed several mechanisms by which clonidine may be useful in managing rapidly evolving SARS-CoV-2 infection based on the rationale that early clonidine administration can intervene in the catecholaminergic response that characterizes rapid clinical deterioration including presumptive cytokine storm that occurs in COVID-19 infection in vulnerable populations.
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Affiliation(s)
- Sanjiv K Hyoju
- Bhomi Hospital and Institute of Medical Sciences, Banepa, Nepal
| | - Bidur Baral
- Critical Care and Anesthesiology, Bir Hospital, Nepal
| | - Prabin K Jha
- Anesthesiology Department, Koshi Zonal Hospital, Nepal
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78
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Sonmez A, Demirci I, Haymana C, Tasci I, Dagdelen S, Salman S, Ata N, Sahin I, Emral R, Cakal E, Atmaca A, Sahin M, Celik O, Demir T, Ertugrul D, Unluturk U, Caglayan M, Satman I. Clinical characteristics and outcomes of COVID-19 in patients with type 2 diabetes in Turkey: A nationwide study (TurCoviDia). J Diabetes 2021; 13:585-595. [PMID: 33655669 PMCID: PMC8013711 DOI: 10.1111/1753-0407.13171] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 02/22/2021] [Accepted: 02/26/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has been reported to be associated with a more severe course in patients with type 2 diabetes mellitus (T2DM). However, severe adverse outcomes are not recorded in all patients. In this study, we assessed disease outcomes in patients with and without T2DM hospitalized for COVID-19. METHODS A nationwide retrospective cohort of patients with T2DM hospitalized with confirmed COVID-19 infection from 11 March to 30 May 2020 in the Turkish Ministry of Health database was investigated. Multivariate modeling was used to assess the independent predictors of demographic and clinical characteristics with mortality, length of hospital stay, and intensive care unit (ICU) admission and/or mechanical ventilation. RESULTS A total of 18 426 inpatients (median age [interquartile range, IQR]: 61 [17] years; males: 43.3%) were investigated. Patients with T2DM (n = 9213) were compared with a group without diabetes (n = 9213) that were matched using the propensity scores for age and gender. Compared with the group without T2DM, 30-day mortality following hospitalization was higher in patients with T2DM (13.6% vs 8.7%; hazard ratio 1.75; 95% CI, 1.58-1.93; P < .001). The independent associates of mortality were older age, male gender, obesity, insulin treatment, low lymphocyte count, and pulmonary involvement on admission. Older age, low lymphocyte values, and pulmonary involvement at baseline were independently associated with longer hospital stay and/or ICU admission. CONCLUSIONS The current study from the Turkish national health care database showed that patients with T2DM hospitalized for COVID-19 are at increased risk of mortality, longer hospital stay, and ICU admission.
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Affiliation(s)
- Alper Sonmez
- Department of Endocrinology and MetabolismUniversity of Health Sciences Turkey, Gulhane Faculty of Medicine and Gulhane Training and Research HospitalAnkaraTurkey
| | - Ibrahim Demirci
- Department of Endocrinology and MetabolismUniversity of Health Sciences Turkey, Gulhane Training and Research HospitalAnkaraTurkey
| | - Cem Haymana
- Department of Endocrinology and MetabolismUniversity of Health Sciences Turkey, Gulhane Training and Research HospitalAnkaraTurkey
| | - Ilker Tasci
- Department of Internal MedicineUniversity of Health Sciences Turkey, Gulhane Faculty of Medicine and Gulhane Training and Research HospitalAnkaraTurkey
| | - Selcuk Dagdelen
- Department of Endocrinology and Metabolism, Faculty of MedicineHacettepe UniversityAnkaraTurkey
| | - Serpil Salman
- Department of Endocrinology and MetabolismMedica ClinicIstanbulTurkey
| | - Naim Ata
- Department of Strategy DevelopmentRepublic of Turkey, Ministry of HealthAnkaraTurkey
| | - Ibrahim Sahin
- Department of Endocrinology and Metabolism, Faculty of MedicineMalatya İnönü UniversityMalatyaTurkey
| | - Rifat Emral
- Department of Endocrinology and Metabolism, Faculty of MedicineAnkara UniversityAnkaraTurkey
| | - Erman Cakal
- Department of Endocrinology and Metabolism, Faculty of MedicineUniversity of Health Sciences Turkey, Diskapi Yildirim Beyazit Training and Research HospitalAnkaraTurkey
| | - Aysegul Atmaca
- Department of Endocrinology and Metabolism, Faculty of MedicineSamsun 19 Mayis UniversitySamsunTurkey
| | - Mustafa Sahin
- Department of Endocrinology and Metabolism, Faculty of MedicineAnkara UniversityAnkaraTurkey
| | - Osman Celik
- Public Hospitals General DirectorateRepublic of Turkey, Ministry of HealthAnkaraTurkey
| | - Tevfik Demir
- Department of Endocrinology and Metabolism, Faculty of MedicineDokuz Eylul UniversityAnkaraTurkey
| | - Derun Ertugrul
- Department of Endocrinology and Metabolism, Faculty of MedicineUniversity of Health Sciences Turkey, Kecioren Training and Research HospitalAnkaraTurkey
| | - Ugur Unluturk
- Department of Endocrinology and Metabolism, Faculty of MedicineHacettepe UniversityAnkaraTurkey
| | | | - Ilhan Satman
- Department of Endocrinology and Metabolism, Faculty of MedicineIstanbul UniversityIstanbulTurkey
- Turkish Institute of Public Health and Chronic DiseasesIstanbulTurkey
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79
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Lindner TH. Neues zu Hypertonie und Diabetes. DER DIABETOLOGE 2021. [PMCID: PMC8246430 DOI: 10.1007/s11428-021-00785-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Hypertonie und Diabetes treten oft gemeinsam auf und erhöhen die kardiovaskuläre Mortalität. Beide Erkrankungen sind bei COVID-19-Patienten (COVID-19: „coronavirus disease 2019“) mit schweren Verläufen gehäuft anzutreffen. Hinsichtlich der Kausalität für COVID-19 ist die Datenlage widersprüchlich. Sicher ist ein Surrogateffekt, da meiste ältere COVID-19-Patienten einen schweren Verlauf aufgrund der Vorschäden aufweisen. Hemmer des Renin-Angiotensin-Aldosteron-Systems (RAAS-Blocker) erhöhen nicht die Wahrscheinlichkeit der positiven SARS-CoV-2-Testung (SARS-CoV-2: „severe acute respiratory syndrome coronavirus 2“). Sie haben keinen Einfluss auf die Schwere des Verlaufs und die Mortalität und sollten daher unter COVID-19 nicht pausiert/abgesetzt werden. Die renale Denervierung erfreut sich einer Renaissance, nachdem sich die Studiendesigns und Technologien stark weiterentwickelt haben. Bei den SGLT-2-Hemmern (SGLT-2: „sodium glucose linked transporter 2“) ist der Wissenszuwachs enorm. In den ersten beiden großen randomisierten kontrollierten Studien mit primären renalen Endpunkten verzögerten sie die Progression der chronischen Niereninsuffizienz (CKD) bis zum Dialysebeginn deutlich um zusätzliche ca. 12–13 Jahre. Sie sind prinzipiell bei Typ‑2- sowie Typ-1-Diabetes und auch bei herzinsuffizienten Patienten mit und ohne Diabetes einsetzbar und reduzieren den systolischen Blutdruck. Der nichtsteroidale Mineralokortikoidrezeptorantagonist (MRA) Finerenon wirkt bei Typ‑2-Diabetes reno- und kardioprotektiv bezüglich kardiovaskulärer Mortalität und Niereninsuffizienz. Wie bei den klassischen MRA kann es auch hier zur Hyperkaliämie in höheren CKD-Bereichen kommen. Größere Vergleichsstudien zu den klassischen MRA liegen nicht vor. Die Zulassung in Deutschland steht noch aus.
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Affiliation(s)
- Tom H. Lindner
- Fachbereich Nephrologie, Klinik und Poliklinik für Endokrinologie, Nephrologie, Rheumatologie (III), Universitätsklinikum Leipzig – AöR, Liebigstraße 20, 04103 Leipzig, Deutschland
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80
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Lee AC, Li WT, Apostol L, Ma J, Taub PR, Chang EY, Rajasekaran M, Ongkeko WM. Cardiovascular, cerebrovascular, and renal co-morbidities in COVID-19 patients: A systematic-review and meta-analysis. Comput Struct Biotechnol J 2021; 19:3755-3764. [PMID: 34221254 PMCID: PMC8238636 DOI: 10.1016/j.csbj.2021.06.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/22/2021] [Accepted: 06/22/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND COVID-19 has infected over 35 million people worldwide and led to over 1 million deaths. Several risk factors that increase COVID-19 severity have emerged, including age and a history of cardiovascular disease, hypertension, or kidney disease. However, a number of outstanding questions persist, including whether the above comorbidities correlate with increased mortality from COVID-19 or whether age is a significant confounding variable that accounts for the observed relationship between COVID-19 severity and other comorbidities. METHODS AND FINDINGS We conducted a systematic review and meta-analysis of studies documenting COVID-19 patients with hypertension, cardiovascular disease, cerebrovascular disease, or chronic kidney disease. We classified COVID-19 cases into severe/non-severe or deceased/surviving and calculated the odds ratio (OR) for each of the four comorbidities in these cohorts. 36 studies, comprising 22,573 patients, are included in our meta-analysis. We found that hypertension is the most prevalent comorbidity in deceased COVID-19 patients (55.4%; CI: 49.4-61.3%), followed by cardiovascular disease (30.7%; CI: 22.6-38.8%), cerebrovascular disease (13.4%; CI: 9.12-19.2%), then chronic kidney disease (9.05%; CI: 5.57-15.0%). The risk of death is also significantly higher for patients with these comorbidities, with the greatest risk factor being chronic kidney disease (OR: 8.86; CI: 5.27-14.89), followed by cardiovascular disease (OR: 6.87; CI: 5.56-8.50), hypertension (OR: 4.87; CI: 4.19-5.66), and cerebrovascular disease (OR: 4.28; CI: 2.86-6.41). These risks are significantly higher than previously reported, while correlations between comorbidities and COVID-19 severity are similar to previously reported figures. Using meta-regression analysis with age as a moderating variable, we observed that age contributes to the observed risks but does not explain them fully. CONCLUSIONS In this meta-analysis, we observed that cardiovascular, cerebrovascular, and kidney-related comorbidities in COVID-19 significantly contributes to greater risk of mortality and increased disease severity. We also demonstrated that age may not be a confounder to these associations.
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Affiliation(s)
- Abby C. Lee
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, UC San Diego School of Medicine, San Diego, CA 92093, USA
- Research Service, VA San Diego Healthcare System, San Diego, La Jolla, CA 92093, USA
| | - Wei Tse Li
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, UC San Diego School of Medicine, San Diego, CA 92093, USA
- Research Service, VA San Diego Healthcare System, San Diego, La Jolla, CA 92093, USA
| | - Lauren Apostol
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, UC San Diego School of Medicine, San Diego, CA 92093, USA
- Research Service, VA San Diego Healthcare System, San Diego, La Jolla, CA 92093, USA
| | - Jiayan Ma
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, UC San Diego School of Medicine, San Diego, CA 92093, USA
- Research Service, VA San Diego Healthcare System, San Diego, La Jolla, CA 92093, USA
| | - Pam R. Taub
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, CA, USA
| | - Eric Y. Chang
- Department of Radiology, University of California, San Diego, CA 92093, USA
- Radiology Service, VA San Diego Healthcare System, San Diego 92161, USA
| | - Mahadevan Rajasekaran
- Department of Urology, University of California San Diego, La Jolla, CA 92093, USA
- Urology Service, VA San Diego Healthcare System, San Diego, CA 92161, USA
| | - Weg M. Ongkeko
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, UC San Diego School of Medicine, San Diego, CA 92093, USA
- Research Service, VA San Diego Healthcare System, San Diego, La Jolla, CA 92093, USA
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81
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Giri A, Srinivasan A, Sundar IK. COVID-19: Sleep, Circadian Rhythms and Immunity - Repurposing Drugs and Chronotherapeutics for SARS-CoV-2. Front Neurosci 2021; 15:674204. [PMID: 34220430 PMCID: PMC8249936 DOI: 10.3389/fnins.2021.674204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/05/2021] [Indexed: 01/08/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has affected nearly 28 million people in the United States and has caused more than five hundred thousand deaths as of February 21, 2021. As the novel coronavirus continues to take its toll in the United States and all across the globe, particularly among the elderly (>65 years), clinicians and translational researchers are taking a closer look at the nexus of sleep, circadian rhythms and immunity that may contribute toward a more severe coronavirus disease-19 (COVID-19). SARS-CoV-2-induced multi-organ failure affects both central and peripheral organs, causing increased mortality in the elderly. However, whether differences in sleep, circadian rhythms, and immunity between older and younger individuals contribute to the age-related differences in systemic dysregulation of target organs observed in SARS-CoV-2 infection remain largely unknown. Current literature demonstrates the emerging role of sleep, circadian rhythms, and immunity in the development of chronic pulmonary diseases and respiratory infections in human and mouse models. The exact mechanism underlying acute respiratory distress syndrome (ARDS) and other cardiopulmonary complications in elderly patients in combination with associated comorbidities remain unclear. Nevertheless, understanding the critical role of sleep, circadian clock dysfunction in target organs, and immune status of patients with SARS-CoV-2 may provide novel insights into possible therapies. Chronotherapy is an emerging concept that is gaining attention in sleep medicine. Accumulating evidence suggests that nearly half of all physiological functions follow a strict daily rhythm. However, healthcare professionals rarely take implementing timed-administration of drugs into consideration. In this review, we summarize recent findings directly relating to the contributing roles of sleep, circadian rhythms and immune response in modulating infectious disease processes, and integrate chronotherapy in the discussion of the potential drugs that can be repurposed to improve the treatment and management of COVID-19.
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Affiliation(s)
| | | | - Isaac Kirubakaran Sundar
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, United States
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82
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The COVID-19 Vaccine Preference for Youngsters Using PROMETHEE-II in the IFSS Environment. Symmetry (Basel) 2021. [DOI: 10.3390/sym13061030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Extensive decision-making during the vaccine preparation period is unpredictable. An account of the severity of the disease, the younger people with COVID-19 comorbidities and other chronic diseases are also at a higher risk of the COVID-19 pandemic. In this research article, the preference ranking structure for the COVID-19 vaccine is recommended for young people who have been exposed to the effects of certain chronic diseases. Multiple Criteria Decision-Making (MCDM) approach effectively handles this vague information. Furthermore, with the support of the Intuitionistic Fuzzy Soft Set (IFSS), the entries under the new extension of the Preference Ranking Organization Method for Enrichment Evaluation-II (PROMETHEE-II) is suggested for Preference Ranking Structure. The concept of intuitionistic fuzzy soft sets is parametric in nature. IFSS suggests how to exploit an intuitionistic ambiguous input from a decision-maker to make up for any shortcomings in the information provided by the decider. The weight of the inputs is calculated under the Intuitionistic Fuzzy Weighted Average (IFWA) operator, the Simply Weighted Intuitionistic Fuzzy Average (SWIFA) operator, and the Simply Intuitionistic Fuzzy Average (SIFA) operator. An Extended PROMETHEE-based ranking, outranking approach is used, and the resultant are recommended under the lexicographic order. Its sustainability and feasibility are explored for three distinct priority structures and the possibilities of the approach. To demonstrate the all-encompassing intuitionistic fuzzy PROMETHEE approach, a practical application regarding COVID-19 severity in patients is given, and then it is compared to other existing approaches to further explain its feasibility, and the sensitivity of the preference structure is examined according to the criteria.
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83
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Trump S, Lukassen S, Anker MS, Chua RL, Liebig J, Thürmann L, Corman VM, Binder M, Loske J, Klasa C, Krieger T, Hennig BP, Messingschlager M, Pott F, Kazmierski J, Twardziok S, Albrecht JP, Eils J, Hadzibegovic S, Lena A, Heidecker B, Bürgel T, Steinfeldt J, Goffinet C, Kurth F, Witzenrath M, Völker MT, Müller SD, Liebert UG, Ishaque N, Kaderali L, Sander LE, Drosten C, Laudi S, Eils R, Conrad C, Landmesser U, Lehmann I. Hypertension delays viral clearance and exacerbates airway hyperinflammation in patients with COVID-19. Nat Biotechnol 2021; 39:705-716. [PMID: 33361824 DOI: 10.1038/s41587-020-00796-1] [Citation(s) in RCA: 109] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/11/2020] [Indexed: 01/29/2023]
Abstract
In coronavirus disease 2019 (COVID-19), hypertension and cardiovascular diseases are major risk factors for critical disease progression. However, the underlying causes and the effects of the main anti-hypertensive therapies-angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs)-remain unclear. Combining clinical data (n = 144) and single-cell sequencing data of airway samples (n = 48) with in vitro experiments, we observed a distinct inflammatory predisposition of immune cells in patients with hypertension that correlated with critical COVID-19 progression. ACEI treatment was associated with dampened COVID-19-related hyperinflammation and with increased cell intrinsic antiviral responses, whereas ARB treatment related to enhanced epithelial-immune cell interactions. Macrophages and neutrophils of patients with hypertension, in particular under ARB treatment, exhibited higher expression of the pro-inflammatory cytokines CCL3 and CCL4 and the chemokine receptor CCR1. Although the limited size of our cohort does not allow us to establish clinical efficacy, our data suggest that the clinical benefits of ACEI treatment in patients with COVID-19 who have hypertension warrant further investigation.
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Affiliation(s)
- Saskia Trump
- Molecular Epidemiology Unit, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Soeren Lukassen
- Center for Digital Health, Berlin Institute of Health (BIH) and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Markus S Anker
- Department of Cardiology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany.,Division of Cardiology and Metabolism, Department of Cardiology Campus Virchow, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany.,Centre for Cardiovascular Research (DZHK), Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany
| | - Robert Lorenz Chua
- Center for Digital Health, Berlin Institute of Health (BIH) and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Johannes Liebig
- Center for Digital Health, Berlin Institute of Health (BIH) and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Loreen Thürmann
- Molecular Epidemiology Unit, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Victor Max Corman
- Institute of Virology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Marco Binder
- Research group 'Dynamics of early viral infection and the innate antiviral response' (division F170), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jennifer Loske
- Molecular Epidemiology Unit, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Christina Klasa
- Institute for Bioinformatics, University Medicine Greifswald, Greifswald, Germany
| | - Teresa Krieger
- Center for Digital Health, Berlin Institute of Health (BIH) and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Bianca P Hennig
- Center for Digital Health, Berlin Institute of Health (BIH) and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Marey Messingschlager
- Molecular Epidemiology Unit, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Fabian Pott
- Institute of Virology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Julia Kazmierski
- Institute of Virology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Sven Twardziok
- Center for Digital Health, Berlin Institute of Health (BIH) and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jan Philipp Albrecht
- Center for Digital Health, Berlin Institute of Health (BIH) and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jürgen Eils
- Center for Digital Health, Berlin Institute of Health (BIH) and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sara Hadzibegovic
- Department of Cardiology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany.,Division of Cardiology and Metabolism, Department of Cardiology Campus Virchow, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany.,Centre for Cardiovascular Research (DZHK), Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany
| | - Alessia Lena
- Department of Cardiology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany.,Division of Cardiology and Metabolism, Department of Cardiology Campus Virchow, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany.,Centre for Cardiovascular Research (DZHK), Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany
| | - Bettina Heidecker
- Department of Cardiology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Thore Bürgel
- Center for Digital Health, Berlin Institute of Health (BIH) and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jakob Steinfeldt
- Department of Cardiology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Christine Goffinet
- Institute of Virology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Florian Kurth
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany.,Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Witzenrath
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Maria Theresa Völker
- Department of Anesthesiology and Intensive Care, University Hospital Leipzig, Leipzig, Germany
| | - Sarah Dorothea Müller
- Department of Anesthesiology and Intensive Care, University Hospital Leipzig, Leipzig, Germany
| | - Uwe Gerd Liebert
- Institute of Virology, University Hospital Leipzig, Leipzig, Germany
| | - Naveed Ishaque
- Center for Digital Health, Berlin Institute of Health (BIH) and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lars Kaderali
- Institute for Bioinformatics, University Medicine Greifswald, Greifswald, Germany
| | - Leif-Erik Sander
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Christian Drosten
- Institute of Virology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Sven Laudi
- Department of Anesthesiology and Intensive Care, University Hospital Leipzig, Leipzig, Germany.
| | - Roland Eils
- Center for Digital Health, Berlin Institute of Health (BIH) and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany. .,German Center for Lung Research (DZL), Berlin, Germany. .,Health Data Science Unit, Medical Faculty and BioQuant, University of Heidelberg, Heidelberg, Germany.
| | - Christian Conrad
- Center for Digital Health, Berlin Institute of Health (BIH) and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Ulf Landmesser
- Department of Cardiology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany.
| | - Irina Lehmann
- Molecular Epidemiology Unit, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany. .,German Center for Lung Research (DZL), Berlin, Germany.
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84
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Zaccone G, Tomasoni D, Italia L, Lombardi CM, Metra M. Myocardial Involvement in COVID-19: an Interaction Between Comorbidities and Heart Failure with Preserved Ejection Fraction. A Further Indication of the Role of Inflammation. Curr Heart Fail Rep 2021; 18:99-106. [PMID: 33890193 PMCID: PMC8062114 DOI: 10.1007/s11897-021-00509-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE OF THE REVIEW Coronavirus Disease 2019 (COVID-19) and cardiovascular (CV) disease have a close relationship that emerged from the earliest reports. The aim of this review is to show the possible associations between COVID-19 and heart failure (HF) with preserved ejection fraction (HFpEF). RECENT FINDINGS In hospitalized patients with COVID-19, the prevalence of HFpEF is high, ranging from 4 to 16%, probably due to the shared cardio-metabolic risk profile. Indeed, comorbidities including hypertension, diabetes, obesity and chronic kidney disease - known predictors of a severe course of COVID-19 - are major causes of HFpEF, too. COVID-19 may represent a precipitating factor leading to acute decompensation of HF in patients with known HFpEF and in those with subclinical diastolic dysfunction, which becomes overt. COVID-19 may also directly or indirectly affect the heart. In otherwise healthy patients, echocardiographic studies showed that the majority of COVID-19 patients present diastolic (rather than systolic) impairment, pulmonary hypertension and right ventricular dysfunction. Such abnormalities are observed both in the acute or subacute phase of COVID-19. Cardiac magnetic resonance reveals myocardial inflammation and fibrosis in up to the 78% of patients in the chronic phase of the disease. These findings suggest that COVID-19 might be a novel independent risk factor for the development of HFpEF, through the activation of a systemic pro-inflammatory state. Follow-up studies are urgently needed to better understand long-term sequelae of COVID-19 inflammatory cardiomyopathy.
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Affiliation(s)
- Gregorio Zaccone
- Cardiology, ASST Spedali Civili di Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Daniela Tomasoni
- Cardiology, ASST Spedali Civili di Brescia, Brescia, Italy.
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
| | - Leonardo Italia
- Cardiology, ASST Spedali Civili di Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Carlo Mario Lombardi
- Cardiology, ASST Spedali Civili di Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Metra
- Cardiology, ASST Spedali Civili di Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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85
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Falzone L, Gattuso G, Tsatsakis A, Spandidos DA, Libra M. Current and innovative methods for the diagnosis of COVID‑19 infection (Review). Int J Mol Med 2021; 47:100. [PMID: 33846767 PMCID: PMC8043662 DOI: 10.3892/ijmm.2021.4933] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/07/2021] [Indexed: 12/11/2022] Open
Abstract
The Coronavirus Disease 2019 (COVID‑19) pandemic has forced the scientific community to rapidly develop highly reliable diagnostic methods in order to effectively and accurately diagnose this pathology, thus limiting the spread of infection. Although the structural and molecular characteristics of the severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) were initially unknown, various diagnostic strategies useful for making a correct diagnosis of COVID‑19 have been rapidly developed by private research laboratories and biomedical companies. At present, rapid antigen or antibody tests, immunoenzymatic serological tests and molecular tests based on RT‑PCR are the most widely used and validated techniques worldwide. Apart from these conventional methods, other techniques, including isothermal nucleic acid amplification techniques, clusters of regularly interspaced short palindromic repeats/Cas (CRISPR/Cas)‑based approaches or digital PCR methods are currently used in research contexts or are awaiting approval for diagnostic use by competent authorities. In order to provide guidance for the correct use of COVID‑19 diagnostic tests, the present review describes the diagnostic strategies available which may be used for the diagnosis of COVID‑19 infection in both clinical and research settings. In particular, the technical and instrumental characteristics of the diagnostic methods used are described herein. In addition, updated and detailed information about the type of sample, the modality and the timing of use of specific tests are also discussed.
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Affiliation(s)
- Luca Falzone
- Epidemiology and Biostatistics Unit, National Cancer Institute-IRCCS 'Fondazione G. Pascale', I-80131 Naples, Italy
| | - Giuseppe Gattuso
- Department of Biomedical and Biotechnological Sciences, University of Catania, I-95123 Catania, Italy
| | - Aristidis Tsatsakis
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, 71003 Heraklion, Greece
| | - Demetrios A. Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Massimo Libra
- Department of Biomedical and Biotechnological Sciences, University of Catania, I-95123 Catania, Italy
- Research Center for the Prevention, Diagnosis and Treatment of Tumors, University of Catania, I-95123 Catania, Italy
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86
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Falzone L, Gattuso G, Tsatsakis A, Spandidos DA, Libra M. Current and innovative methods for the diagnosis of COVID‑19 infection (Review). Int J Mol Med 2021. [PMID: 33846767 DOI: 10.3892/ijmm.2021.4933/html] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
The Coronavirus Disease 2019 (COVID‑19) pandemic has forced the scientific community to rapidly develop highly reliable diagnostic methods in order to effectively and accurately diagnose this pathology, thus limiting the spread of infection. Although the structural and molecular characteristics of the severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) were initially unknown, various diagnostic strategies useful for making a correct diagnosis of COVID‑19 have been rapidly developed by private research laboratories and biomedical companies. At present, rapid antigen or antibody tests, immunoenzymatic serological tests and molecular tests based on RT‑PCR are the most widely used and validated techniques worldwide. Apart from these conventional methods, other techniques, including isothermal nucleic acid amplification techniques, clusters of regularly interspaced short palindromic repeats/Cas (CRISPR/Cas)‑based approaches or digital PCR methods are currently used in research contexts or are awaiting approval for diagnostic use by competent authorities. In order to provide guidance for the correct use of COVID‑19 diagnostic tests, the present review describes the diagnostic strategies available which may be used for the diagnosis of COVID‑19 infection in both clinical and research settings. In particular, the technical and instrumental characteristics of the diagnostic methods used are described herein. In addition, updated and detailed information about the type of sample, the modality and the timing of use of specific tests are also discussed.
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Affiliation(s)
- Luca Falzone
- Epidemiology and Biostatistics Unit, National Cancer Institute‑IRCCS 'Fondazione G. Pascale', I‑80131 Naples, Italy
| | - Giuseppe Gattuso
- Department of Biomedical and Biotechnological Sciences, University of Catania, I‑95123 Catania, Italy
| | - Aristidis Tsatsakis
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Demetrios A Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Massimo Libra
- Department of Biomedical and Biotechnological Sciences, University of Catania, I‑95123 Catania, Italy
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87
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Mubarik S, Liu X, Eshak ES, Liu K, Liu Q, Wang F, Shi F, Wen H, Bai J, Yu C, Cao J. The Association of Hypertension With the Severity of and Mortality From the COVID-19 in the Early Stage of the Epidemic in Wuhan, China: A Multicenter Retrospective Cohort Study. Front Med (Lausanne) 2021; 8:623608. [PMID: 34055822 PMCID: PMC8149896 DOI: 10.3389/fmed.2021.623608] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 04/12/2021] [Indexed: 01/15/2023] Open
Abstract
Background: Hypertension may affect the prognosis of COVID-19 illness. We analyzed the epidemiological and clinical characteristics associated with the disease severity and mortality in hypertensive vs. non-hypertensive deceased COVID-19 patients. Methods: We included all the deceased patients with laboratory-confirmed COVID-19 admitted to >200 health facilities in Wuhan between December 1 and February 24, 2020. The median survival time in COVID-19 patients with and without hypertension, the association of hypertension with the disease severity, and the risk factors associated with the COVID-19 mortality stratified by the hypertension status were assessed using the Kaplan-Meier survival analysis, logistic regression, and Cox proportional regression, respectively before and after the propensity score-matching (PS) for age and sex. Results: The prevalence of hypertension in the studied 1,833 COVID-19 patients was 40.5%. Patients with hypertension were more likely to have severe COVID-19 illness than patients without hypertension; the PS-matched multivariable-adjusted odds ratio (95% CI) was 2.44 (1.77-3.08). Moreover, the median survival time in the hypertension group was 3-5 days shorter than the non-hypertension group. There was a 2-fold increased risk of COVID-19 mortality in the hypertension group compared with the non-hypertension group; the PS-matched multivariable-adjusted hazard ratio (HR) = 2.04 (1.61-2.72), and the significant increased risk of COVID-19 mortality in the moderate vs. mild COVID-19 illness was confined to patients with hypertension. Additionally, the history and the number of underlying chronic diseases, occupation, and residential location showed stronger associations with the COVID-19 mortality among patients with hypertension than patients without hypertension. Conclusion: Hypertension was associated with the severity and mortality of COVID-19 illness.
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Affiliation(s)
- Sumaira Mubarik
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, China
| | - Xiaoxue Liu
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, China
| | - Ehab S. Eshak
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita-shi, Osaka, Japan
- Public Health and Community Medicine, Faculty of Medicine, Minia University, Minia, Egypt
| | - Keyang Liu
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita-shi, Osaka, Japan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Qing Liu
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, China
| | - Fang Wang
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, China
| | - Fang Shi
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, China
| | - Haoyu Wen
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, China
| | - Jianjun Bai
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, China
| | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - Jinhong Cao
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, China
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COVID-19 in Patients with Hypertension. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1318:243-261. [PMID: 33973183 DOI: 10.1007/978-3-030-63761-3_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Hypertension has been listed in several case series and retrospective cohorts as a potential risk factor for the incidence and severity of the new coronavirus (SARS-CoV-2)-associated disease (COVID-19). The debate is noteworthy because almost one billion people around the globe are estimated to have hypertensive diseases, according to the Global Burden of Disease study. Considering the SARS-CoV-2's high infectivity rates, a possible interaction between COVID-19 and hypertension is worrisome. Additionally, antihypertensive drugs, especially the renin-angiotensin-aldosterone system (RAAS) inhibitors, could also influence the natural course of COVID-19 infection. Not only can these associations hold from an epidemiologic standpoint, a mechanistic scenario possibly exists. Hypertension and antihypertensive drugs can increase the expression of transmembrane angiotensin-converting enzyme (ACE)-2 receptors, the entry target of the viruses, thus facilitating infectivity. On the other hand, an increase in ACE-2 could be protective considering the anti-inflammatory, antithrombotic effects of the ACE-2-angiotensin 1-7/Mas pathway. So far, little is known about the whole picture. Observational studies appear to indicate at least a twofold increased risk of mortality for hypertensive patients with COVID-19; however, the previous and continued use of RAAS inhibitors may be protective in this subgroup of patients. The scarcity of randomized clinical trials precludes evidence-based decision-making. At least one randomized study in a non-specified sub-analysis demonstrated no relationship between an angiotensin-converting enzyme inhibitor and incidence or severity of the disease. It is reflected mainly by observational studies and, therefore, by international cardiology societies' guidelines, which state that antihypertensive drugs, particularly RAAS inhibitors, should not be discontinued unless necessary on a case-by-case basis.
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89
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Saylik F, Akbulut T, Kaya S. Can C-Reactive Protein to Albumin Ratio Predict In-Hospital Death Rate Due to COVID-19 in Patients With Hypertension? Angiology 2021; 72:947-952. [PMID: 33902353 DOI: 10.1177/00033197211012145] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Hypertension is one of the main morbidity and mortality risk factors in patients with coronavirus disease 2019 (COVID-19). We investigated the association between the C-reactive protein (CRP) to albumin ratio (CAR) and in-hospital mortality in patients with hypertensive COVID-19. A total of 176 patients with hypertension diagnosed with COVID-19 were included in this study. The CAR was compared between survivors and nonsurvivors. Logistic regression analysis was used to detect independent predictors of mortality due to COVID-19 in patients with hypertension. A cutoff value of CAR was obtained for predicting in-hospital death in patients with hypertensive COVID-19. Kaplan-Meier analysis was performed for survival analysis in the study population. The CAR values were significantly higher in nonsurvivors than in survivors with hypertension. Moreover, the CAR was an independent predictor of in-hospital death in patients with hypertensive COVID-19, as shown in multivariable logistic regression analysis. Receiver operating characteristic analysis yielded a cutoff value of 20.75 for the CAR for predicting in-hospital death in patients with hypertension. Kaplan-Meier curve analysis showed that patients with hypertensive COVID-19 with a CAR value of ≥20.75 had a higher incidence of in-hospital death. The CAR might be used as an independent predictor of in-hospital mortality in patients with hypertensive COVID-19.
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Affiliation(s)
- Faysal Saylik
- Department of Cardiology, Van Education and Research Hospital, Van, Turkey
| | - Tayyar Akbulut
- Department of Cardiology, Van Education and Research Hospital, Van, Turkey
| | - Safak Kaya
- Department of Infectious Diseaes, Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
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90
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Ramphul K, Lohana P, Ramphul Y, Park Y, Mejias S, Dhillon BK, Sombans S, Verma R. Hypertension, diabetes mellitus, and cerebrovascular disease predispose to a more severe outcome of COVID-19. Arch Med Sci Atheroscler Dis 2021; 6:e30-e39. [PMID: 34027212 PMCID: PMC8117084 DOI: 10.5114/amsad.2021.105255] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/07/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The world is currently facing the pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The total number of cases of coronavirus disease 2019 (COVID-19) is rising daily and no vaccine has yet been approved. While the pathophysiology behind the virus is still being studied, many possible several risk factors using small sample sizes have been found. MATERIAL AND METHODS We conducted a pooled analysis using several databases such as Medline, Scopus, Wangfang, Web of Science, Research Square, medrxiv, and Google Scholar to identify studies reporting severe and non-severe groups of COVID-19 patients. The odds ratios as well as the 95% confidence intervals for hypertension, diabetes, and cerebrovascular disease leading to severe COVID-19 were calculated using R-software. RESULTS Fifty-three articles were used for our analysis and they involved 30,935 confirmed cases of COVID-19 from several countries across the world. The odds ratio for severe COVID-19 in hypertensive patients, diabetics, and patients with a history of cerebrovascular disease was 2.58 (95% confidence interval (CI): 2.16-3.08, from 53 studies), 2.17 (95% CI: 1.72-2.74, from 44 studies), and 2.63 (95% CI: 1.80-3.85, from 25 studies), respectively. CONCLUSIONS Our analysis confirms that patients with hypertension, diabetes, or cerebrovascular disease are at a higher risk of a severe outcome of COVID-19. It is thus vital for physicians to identify the main risk factors for a severe outcome of this disease.
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Affiliation(s)
- Kamleshun Ramphul
- Department of Pediatrics, Shanghai Xin Hua Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Petras Lohana
- Department of Medicine, Liaquat University of Medical and Health Sciences Hospital, Jamshroo, Pakistan
| | - Yogeshwaree Ramphul
- Department of Medicine, Sir Seewoosagur Ramgoolam National Hospital, Pamplemousses, Mauritius
| | - Yun Park
- Department of Orthodontics, Affiliation: Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Stephanie Mejias
- Department of Medicine, University Iberoamericana UNIBE, School of Medicine, Santo Domingo, Dominican Republic
| | | | - Shaheen Sombans
- Department of Medicine, Bharati Vidyapeeth University Medical College and Hospital, Pune, India
| | - Renuka Verma
- Department of Medicine, Guru Gobind Singh Medical College, Punjab, India
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91
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Engels Calvo V, Cruz Melguizo S, Abascal-Saiz A, Forcén Acebal L, Sánchez-Migallón A, Pintado Recarte P, Cuenca Marín C, Marcos Puig B, Del Barrio Fernández PG, Nieto Velasco O, de la Cruz Conty ML, Martínez-Perez O. Perinatal outcomes of pregnancies resulting from assisted reproduction technology in SARS-CoV-2-infected women: a prospective observational study. Fertil Steril 2021; 116:731-740. [PMID: 33972083 PMCID: PMC8041182 DOI: 10.1016/j.fertnstert.2021.04.005] [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: 01/25/2021] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 12/26/2022]
Abstract
Objective To evaluate the perinatal and maternal outcomes of pregnancies in women infected with SARS-CoV-2, comparing spontaneous and in vitro fertilization (IVF) pregnancies (with either own or donor oocytes). Design Multicenter, prospective, observational study. Setting 78 centers participating in the Spanish COVID19 Registry. Patient(s) 1,347 pregnant women with SARS-CoV-2 positive results registered consecutively between February 26 and November 5, 2020. Intervention(s) The patients’ information was collected from their medical records, and multivariable regression analyses were performed, controlling for maternal age and the clinical presentation of the infection. Main Outcome Measure(s) Obstetrics and neonatal outcomes, pregnancy comorbidities, intensive care unit admission, mechanical ventilation need, and medical conditions. Result(s) The IVF group included 74 (5.5%) women whereas the spontaneous pregnancy group included 1,275 (94.5%) women. The operative delivery rate was high in all patients, especially in the IVF group, where cesarean section became the most frequent method of delivery (55.4%, compared with 26.1% of the spontaneous pregnancy group). The reason for cesarean section was induction failure in 56.1% of the IVF patients. IVF women had more gestational hypertensive disorders (16.2% vs. 4.5% among spontaneous pregnancy women, adjusted odds ratio [aOR] 5.31, 95% confidence interval [CI] 2.45–10.93) irrespective of oocyte origin. The higher rate of intensive care unit admittance observed in the IVF group (8.1% vs. 2.4% in the spontaneous pregnancy group) was attributed to preeclampsia (aOR 11.82, 95% CI 5.25–25.87), not to the type of conception. Conclusion(s) A high rate of operative delivery was observed in pregnant women infected with SARS-CoV-2, especially in those with IVF pregnancies; method of conception did not affect fetal or maternal outcomes, except for preeclampsia. Clinical Trial Registration Number NCT04558996.
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Affiliation(s)
- Virginia Engels Calvo
- Fertility Unit, Department of Gynecology and Obstetrics, Puerta de Hierro University Hospital of Majadahonda, Madrid, Spain
| | - Sara Cruz Melguizo
- Maternal-Fetal Medicine Unit, Department Obstetrics and Gynecology, Hospital Universitario Puerta de Hierro.Majadahonda, Madrid, Spain
| | | | - Laura Forcén Acebal
- Department of Gynecology and Obstetrics, University Hospital 12 de Octubre, Madrid, Spain
| | - Amalia Sánchez-Migallón
- Maternal-fetal Medicine Unit, Department of Gynecology and Obstetrics, QuirónSalud Dexeus University Hospital, Barcelona, Spain
| | - Pilar Pintado Recarte
- Department of Gynecology and Obstetrics, Gregorio Marañon University Hospital, Madrid, Spain
| | - Celia Cuenca Marín
- Maternal-fetal Medicine Unit, Department of Gynecology and Obstetrics, Regional Hospital of Málaga, Málaga, Spain
| | - Beatriz Marcos Puig
- Maternal-fetal Medicine Unit, Department of Gynecology and Obstetrics, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Pablo G Del Barrio Fernández
- Maternal-fetal Medicine Unit, Department of Gynecology and Obstetrics, University Hospital of Getafe, Madrid, Spain
| | - Olga Nieto Velasco
- Maternal-fetal Medicine Unit, Department of Gynecology and Obstetrics, QuirónSalud Madrid University Hospital, Madrid, Spain
| | | | - Oscar Martínez-Perez
- Maternal-Fetal Medicine Unit, Department Obstetrics and Gynecology, Hospital Universitario Puerta de Hierro.Majadahonda, Madrid, Spain.
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Lorca LA, Torres-Castro R, Ribeiro IL, Benavente P, Pizarro M, San Cristobal B, Ugarte J, Laura C, Huanchicay C, Mamani A. Linguistic Validation and Cross-Cultural Adaptation of the Post-COVID-19 Functional Status Scale for the Chilean Population. Am J Phys Med Rehabil 2021; 100:313-320. [PMID: 33496442 DOI: 10.1097/phm.0000000000001706] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Patients with COVID-19 can present functional status and disability alterations in the medium- and long-term. On the international level, a multicentered study is being carried out to validate the Post-COVID-19 Functional Status scale for different nations, thus allowing visualizing the needs for a multidisciplinary approach and planning intervention plans. The objective of this study was to perform a linguistic validation and cross-cultural adaptation of the Post-COVID-19 Functional Status scale for people infected with COVID-19 for the Chilean population. METHODS A cross-sectional study of scale validation was carried out. The study was performed in two phases: (1) forward-translation, reverse-translation and (2) apparent cross-validity adaptation. For the apparent validity analysis, 29 individuals who had been hospitalized in Hospital del Salvador with a COVID-19 infection diagnosis and at the time of the interview were in their homes participated. RESULTS In phase 1 forward-translation, an item required semantical changes. The reverse-translation versions were similar, and the most relevant doubts were resolved in a consensus meeting. In phase 2, the pilot study confirmed adequate understanding and scale applicability. CONCLUSIONS Using a systematic and rigorous methodology allowed obtaining a Spanish version of the Post-COVID-19 Functional Status scale for Chile, which is conceptually and linguistically equivalent to the original instrument and adequate to assess the functional status of people infected with COVID-19.
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Affiliation(s)
- Luz Alejandra Lorca
- From the Hospital del Salvador, Servicio de Salud Metropolitano Oriente, Santiago de Chile (LAL, PB, MP, BSC, JU, CL, CH, AM); Departamento de Kinesiología, Facultad de Medicina, Universidad de Chile, Santiago de Chile (RT-C); and Departamento de Kinesiología, Facultad de Ciencias de la Salud, Universidad Católica del Maule, Talca, Chile (ILR)
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Ballow M, Haga CL. Why Do Some People Develop Serious COVID-19 Disease After Infection, While Others Only Exhibit Mild Symptoms? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2021; 9:1442-1448. [PMID: 33486141 PMCID: PMC7825847 DOI: 10.1016/j.jaip.2021.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 01/06/2021] [Indexed: 02/09/2023]
Abstract
The year 2020 was a landmark year of a once-in-a-century pandemic of a novel coronavirus, SARS-CoV-2 virus, that led to a rapidly spreading coronavirus disease (COVID-19). The spectrum of disease with SARS-CoV-2 ranges from asymptomatic to mild upper respiratory illness, to moderate to severe disease with respiratory compromise to acute respiratory distress syndrome, multiorgan failure, and death. Early in the pandemic, risk factors were recognized that contributed to more severe disease, but it became evident that individuals and even young people could have severe COVID-19. As we started to understand the immunobiology of COVID-19, it became clearer that the immune responses to SARS-CoV-2 were variable, and in some cases, the excessive inflammatory response contributed to greater morbidity and mortality. In this review, we will explore some of the additional risk factors that appear to contribute to disease severity and enhance our understanding of why some individuals experience more severe COVID-19. Recent advances in genome-wide associations have identified potential candidate genes in certain populations that may modify the host immune responses leading to dysregulated host immunity. Genetic defects of the type I interferon pathway are also linked to a more clinically severe phenotype of COVID-19. Finally, dysregulation of the adaptive immune system may also play a role in the severity and complex clinical course of patients with COVID-19. A better understanding of the host immune responses to SARS-CoV-2 will hopefully lead to new treatment modalities to prevent the poor outcomes of COVID-19 in those individuals with pre-existing risk factors or genetic variants that contribute to the dysregulated host immune responses.
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Key Words
- ace2, angiotensin-converting enzyme 2
- ards, acute respiratory distress syndrome
- ci, confidence interval
- covid-19, coronavirus disease 2019
- cvid, common variable immune deficiency
- gc, germinal center
- icu, intensive care unit
- ifnar1, ifn-α/β receptor 1
- mis-c, multisystem inflammatory syndrome in children
- n, nucleocapsid protein
- s, spike protein
- sars-cov-2, severe acute respiratory syndrome coronavirus 2
- th, t helper
- tmprss2, transmembrane serine protease 2
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Affiliation(s)
- Mark Ballow
- Division of Allergy & Immunology, Department of Pediatrics, Morsani College of Medicine, University of South Florida, St. Petersburg, Fla.
| | - Christopher L Haga
- Department of Molecular Medicine, The Scripps Research Institute - Florida, Jupiter, Fla
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Heparin prevents in vitro glycocalyx shedding induced by plasma from COVID-19 patients. Life Sci 2021; 276:119376. [PMID: 33781826 PMCID: PMC7997864 DOI: 10.1016/j.lfs.2021.119376] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/07/2021] [Accepted: 03/08/2021] [Indexed: 01/08/2023]
Abstract
The severe forms and worsened outcomes of COVID-19 (coronavirus disease 19) are closely associated with hypertension and cardiovascular disease. Endothelial cells express Angiotensin-Converting Enzyme 2 (ACE2), which is the entrance door for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The hallmarks of severe illness caused by SARS-CoV-2 infection are increased levels of IL-6, C-reactive protein, D-dimer, ferritin, neutrophilia and lymphopenia, pulmonary intravascular coagulopathy and microthrombi of alveolar capillaries. The endothelial glycocalyx, a proteoglycan- and glycoprotein-rich layer covering the luminal side of endothelial cells, contributes to vascular homeostasis. It regulates vascular tonus and permeability, prevents thrombosis, and modulates leukocyte adhesion and inflammatory response. We hypothesized that cytokine production and reactive oxygen species (ROS) generation associated with COVID-19 leads to glycocalyx degradation. A cohort of 20 hospitalized patients with a confirmed COVID-19 diagnosis and healthy subjects were enrolled in this study. Mechanisms associated with glycocalyx degradation in COVID-19 were investigated. Increased plasma concentrations of IL-6 and IL1-β, as well as increased lipid peroxidation and glycocalyx components were detected in plasma from COVID-19 patients compared to plasma from healthy subjects. Plasma from COVID-19 patients induced glycocalyx shedding in cultured human umbilical vein endothelial cells (HUVECs) and disrupted redox balance. Treatment of HUVECs with low molecular weight heparin inhibited the glycocalyx perturbation. In conclusion, plasma from COVID-19 patients promotes glycocalyx shedding and redox imbalance in endothelial cells, and heparin treatment potentially inhibits glycocalyx disruption.
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Adejumo OA, Adejumo OA, Egbi OG, Abolarin OS, Alli OE. Level of implementation of WHO COVID-19 document on rights, roles and responsibilities of health care workers in a tertiary hospital in Southwest Nigeria. Pan Afr Med J 2021; 37:52. [PMID: 33738040 DOI: 10.11604/pamj.supp.2020.37.52.26078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/22/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction in order to curb the increasing spread of COVID-19 amongst health care workers (HCWs), the World Health Organization (WHO) released the COVID-19 Rights, Roles and Responsibilities of Health workers (COVID-19 RRRHW) policy document aimed at protecting HCWs amidst the on-going pandemic. This study determined the level of implementation of the document in a tertiary hospital in Southwest Nigeria. Methods this was a cross-sectional descriptive study among HCWs in a tertiary hospital in South-western Nigeria that assessed the level of implementation of the WHO COVID-19 RRRHW document using a closed ended structured questionnaire. Results five hundred and thirty-five HCWs participated in the study comprising 165(30.8%) males and 370(69.2%) females. Majority (87.3%) of the HCWs were 40 years and below. One hundred and sixty-three (30.5%) of the HCWs had been involved in the care of COVID-19 patients; less than 60% of the respondents were aware of the presence of an official platform for dissemination of information on suspected or confirmed cases of COVID-19 and 435(81.3%) were aware of hospital training on Infection Prevention and Control (IPC); 191(35.7%) have had uninterrupted supplies of personal protective equipment(PPE) and IPC materials; 211(39.4%) were aware of mental and counselling services in the hospital while only 106(19.8%) knew how to access these services; 289(54%) have attended IPC training and 307(57.4%) are able to don and doff PPE. Conclusion this study showed inadequate implementation of the WHO COVID-19 RRRHW document. There is urgent need for all stakeholders to familiarize with the document in order to ensure adequate protection of HCWs and minimize their risk of contracting COVID-19.
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Affiliation(s)
- Oluseyi Ademola Adejumo
- Department of Internal Medicine, University of Medical Sciences Teaching Hospital Complex, Ondo City, Ondo State, Nigeria
| | | | | | - Olatunji Sunday Abolarin
- Department of Internal Medicine, University of Medical Sciences Teaching Hospital Complex, Ondo City, Ondo State, Nigeria
| | - Oladimeji Emmanuel Alli
- Department of Internal Medicine, University of Medical Sciences Teaching Hospital Complex, Ondo City, Ondo State, Nigeria
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96
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Du Y, Zhou N, Zha W, Lv Y. Hypertension is a clinically important risk factor for critical illness and mortality in COVID-19: A meta-analysis. Nutr Metab Cardiovasc Dis 2021; 31:745-755. [PMID: 33549450 PMCID: PMC7831720 DOI: 10.1016/j.numecd.2020.12.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/01/2020] [Accepted: 12/04/2020] [Indexed: 02/07/2023]
Abstract
AIMS As reported, hypertension may play an important role in adverse outcomes of coronavirus disease-2019 (COVID-19), but it still had many confounding factors. The aim of this study was to explore whether hypertension is an independent risk factor for critical COVID-19 and mortality. DATA SYNTHESIS The Medline, PubMed, Embase, and Web of Science databases were systematically searched until November 2020. Combined odds ratios (ORs) with their 95% confidence interval (CIs) were calculated by using random-effect models, and the effect of covariates was analyzed using the subgroup analysis and meta-regression analysis. A total of 24 observational studies with 99,918 COVID-19 patients were included in the meta-analysis. The proportions of hypertension in critical COVID-19 were 37% (95% CI: 0.27 -0.47) when compared with 18% (95% CI: 0.14 -0.23) of noncritical COVID-19 patients, in those who died were 46% (95%CI: 0.37 -0.55) when compared with 22% (95% CI: 0.16 -0.28) of survivors. Pooled results based on the adjusted OR showed that patients with hypertension had a 1.82-fold higher risk for critical COVID-19 (aOR: 1.82; 95% CI: 1.19 - 2.77; P = 0.005) and a 2.17-fold higher risk for COVID-19 mortality (aOR: 2.17; 95% CI: 1.67 - 2.82; P < 0.001). Subgroup analysis results showed that male patients had a higher risk of developing to the critical condition than female patients (OR: 3.04; 95%CI: 2.06 - 4.49; P < 0.001) and age >60 years was associated with a significantly increased risk of COVID-19 mortality (OR: 3.12; 95% CI: 1.93 - 5.05; P < 0.001). Meta-regression analysis results also showed that age (Coef. = 2.3×10-2, P = 0.048) had a significant influence on the association between hypertension and COVID-19 mortality. CONCLUSIONS Evidence from this meta-analysis suggested that hypertension was independently associated with a significantly increased risk of critical COVID-19 and inhospital mortality of COVID-19.
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Affiliation(s)
- Yanbin Du
- MOE-LCSM, School of Mathematics and Statistics, Hunan Normal University, Changsha, Hunan Province, 410081, China
| | - Nan Zhou
- Key Laboratory of Molecular Epidemiology, Medical College of Hunan Normal University, Changsha, Hunan Province, 410013, China
| | - Wenting Zha
- Key Laboratory of Molecular Epidemiology, Medical College of Hunan Normal University, Changsha, Hunan Province, 410013, China.
| | - Yuan Lv
- Key Laboratory of Molecular Epidemiology, Medical College of Hunan Normal University, Changsha, Hunan Province, 410013, China.
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97
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Booth A, Reed AB, Ponzo S, Yassaee A, Aral M, Plans D, Labrique A, Mohan D. Population risk factors for severe disease and mortality in COVID-19: A global systematic review and meta-analysis. PLoS One 2021; 16:e0247461. [PMID: 33661992 PMCID: PMC7932512 DOI: 10.1371/journal.pone.0247461] [Citation(s) in RCA: 303] [Impact Index Per Article: 101.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/06/2021] [Indexed: 02/06/2023] Open
Abstract
AIM COVID-19 clinical presentation is heterogeneous, ranging from asymptomatic to severe cases. While there are a number of early publications relating to risk factors for COVID-19 infection, low sample size and heterogeneity in study design impacted consolidation of early findings. There is a pressing need to identify the factors which predispose patients to severe cases of COVID-19. For rapid and widespread risk stratification, these factors should be easily obtainable, inexpensive, and avoid invasive clinical procedures. The aim of our study is to fill this knowledge gap by systematically mapping all the available evidence on the association of various clinical, demographic, and lifestyle variables with the risk of specific adverse outcomes in patients with COVID-19. METHODS The systematic review was conducted using standardized methodology, searching two electronic databases (PubMed and SCOPUS) for relevant literature published between 1st January 2020 and 9th July 2020. Included studies reported characteristics of patients with COVID-19 while reporting outcomes relating to disease severity. In the case of sufficient comparable data, meta-analyses were conducted to estimate risk of each variable. RESULTS Seventy-six studies were identified, with a total of 17,860,001 patients across 14 countries. The studies were highly heterogeneous in terms of the sample under study, outcomes, and risk measures reported. A large number of risk factors were presented for COVID-19. Commonly reported variables for adverse outcome from COVID-19 comprised patient characteristics, including age >75 (OR: 2.65, 95% CI: 1.81-3.90), male sex (OR: 2.05, 95% CI: 1.39-3.04) and severe obesity (OR: 2.57, 95% CI: 1.31-5.05). Active cancer (OR: 1.46, 95% CI: 1.04-2.04) was associated with increased risk of severe outcome. A number of common symptoms and vital measures (respiratory rate and SpO2) also suggested elevated risk profiles. CONCLUSIONS Based on the findings of this study, a range of easily assessed parameters are valuable to predict elevated risk of severe illness and mortality as a result of COVID-19, including patient characteristics and detailed comorbidities, alongside the novel inclusion of real-time symptoms and vital measurements.
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Affiliation(s)
- Adam Booth
- Huma Therapeutics Limited, London, United Kingdom
| | | | - Sonia Ponzo
- Huma Therapeutics Limited, London, United Kingdom
| | | | - Mert Aral
- Huma Therapeutics Limited, London, United Kingdom
| | - David Plans
- Huma Therapeutics Limited, London, United Kingdom
- INDEX Group, Department of Science, Innovation, Technology, and Entrepreneurship, University of Exeter, Exeter, United Kingdom
- * E-mail:
| | - Alain Labrique
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Diwakar Mohan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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98
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Alamri F, Alsofayan Y, AlRuthia Y, Alahmari A, Almuzaini Y, Abo Gazalah F, Alradini F, Alaama T, Khan A. Predictors of Hospitalization Among Older Adults with COVID-19 in Saudi Arabia: A Cross-Sectional Study of a Nationally Representative Sample. Risk Manag Healthc Policy 2021; 14:875-886. [PMID: 33692640 PMCID: PMC7938228 DOI: 10.2147/rmhp.s294786] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/08/2021] [Indexed: 12/23/2022] Open
Abstract
Background The aim of this study was to identify the predictors of hospitalization in older (≥60 years) patients with coronavirus disease-19 (COVID-19) in Saudi Arabia. Methods Patients were randomly selected from a COVID-19 database maintained by the Ministry of Health, Saudi Arabia. All patients were aged ≥60 years, had reverse transcriptase-polymerase chain reaction (RT-PCR)-confirmed COVID-19, and were registered in the database during March 2020 to July 2020. Medical and sociodemographic characteristics were retrieved from the database. Additional data were collected by telephone interviews conducted by trained health professionals. Descriptive statistics and multiple logistic regression analyses were used to analyze the relationship between patient characteristics and the risk of hospitalization. Results Of the 613 included patients (51.1% females), more than half (57.3%) were between 60 to 69 years of age, and 53% (324/613) had been hospitalized. The independent predictors of hospitalization included age ≥65 years (OR = 2.35, 95% CI: 1.66–3.33, P < 0.001), having more than one comorbidity (OR = 1.55, 95% CI: 1.09–2.20, P = 0.01), diabetes mellitus (OR = 1.52, 95% CI: 1.09–2.11, P = 0.01), hypertension (OR = 1.40, 95% CI: 1.007–1.97, P = 0.04), chronic kidney disease (OR = 3.87, 95% CI: 1.41–10.58, P = 0.008), and history of hospital admission within the preceding year (OR = 1.69, 95% CI: 1.11–2.55, P = 0.013). Risk of hospitalization was lower in males (OR = 0.65, 95% CI: 0.43–0.90, P = 0.01) and in patients co-living with health care workers (OR = 0.64, 95% CI: 0.43–0.96, P = 0.03). Conclusion Factors associated with higher risk of COVID-19-associated hospitalization should be used in prioritizing older adults’ admission. Future studies with more robust designs should be conducted to examine the risk of COVID-19-associated illness severity and mortality.
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Affiliation(s)
- Fahad Alamri
- Global Center for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Yousef Alsofayan
- Global Center for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Yazed AlRuthia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.,Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Alahmari
- Global Center for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Yasir Almuzaini
- Global Center for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Fouad Abo Gazalah
- General Director of Health Centers Affairs, Ministry of Health, Riyadh, Saudi Arabia
| | - Faten Alradini
- Department of Family Medicine, Faculty of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Tareef Alaama
- Deputyship of Therapeutic Services, Ministry of Health, Riyadh, Saudi Arabia
| | - Anas Khan
- Global Center for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia.,Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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99
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UyaroĞlu OA, BaŞaran NÇ, ÖziŞik L, Dİzman GT, EroĞlu İ, Şahİn TK, TaŞ Z, İnkaya AÇ, TanriÖver MD, Metan G, GÜven GS, Ünal S. Thirty-day readmission rate of COVID-19 patients discharged from a tertiary care university hospital in Turkey: an observational, single-center study. Int J Qual Health Care 2021; 33:5940459. [PMID: 33104780 PMCID: PMC7665548 DOI: 10.1093/intqhc/mzaa144] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/01/2020] [Accepted: 10/22/2020] [Indexed: 02/07/2023] Open
Abstract
Background The 30-day readmission rate is an important indicator of patient safety and hospital’s quality performance. In this study, we aimed to find out the 30-day readmission rate of mild and moderate severity COVID-19 patients discharged from a tertiary care university hospital and to demonstrate the possible factors associated with readmission. Methods This is an observational, single-center study. Epidemiological and clinical data of patients who were hospitalized with a diagnosis of COVID-19 were retrieved from a research database where patient information was recorded prospectively. Readmission data was sought from the hospital information management system and National Health Record System to detect if the patients were readmitted to any hospital within 30 days of discharge. Adult patients (≥18 years-old) hospitalized in COVID-19 wards with a diagnosis of mild or moderate COVID-19 between March 20, 2020 (when the first case was admitted to our hospital), and April 26, 2020 were included. Results From March 26 to May 1, there were 154 mild or moderate severity (non-critical) COVID-19 patients discharged from COVID-19 wards, of which 11 (7.1%) were readmitted The median time of readmission was 8.1 days (IQR=5.2). Two patients (18.1%) were categorized to have mild disease and the remaining 9 (81.9%) as moderate disease. Two patients who were over 65 years of age and had metastatic cancers and hypertension developed sepsis and died in the hospital during the readmission episode. Malignancy (18.7% vs 2.1%, P = 0.04) and hypertension (45.5% vs 14%, P = 0.02) were more common in those who were readmitted. Conclusions This is one of the first studies to report on 30-day readmission rate of COVID-19 in the literature. More comprehensive studies are needed to reveal the causes and predictors of COVID-19 readmissions.
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Affiliation(s)
- Oğuz Abdullah UyaroĞlu
- Faculty of Medicine, Department of Internal Medicine, Section of General Internal Medicine, Hacettepe University, Sıhhiye, Ankara, 06430, Turkey
| | - Nursel Çalik BaŞaran
- Faculty of Medicine, Department of Internal Medicine, Section of General Internal Medicine, Hacettepe University, Sıhhiye, Ankara, 06430, Turkey
| | - Lale ÖziŞik
- Faculty of Medicine, Department of Internal Medicine, Section of General Internal Medicine, Hacettepe University, Sıhhiye, Ankara, 06430, Turkey
| | - Gülçİn Tellİ Dİzman
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Hacettepe University, Sıhhiye, Ankara, 06430, Turkey
| | - İmdat EroĞlu
- Faculty of Medicine, Department of Internal Medicine, Hacettepe University, Sıhhiye, Ankara, 06430, Turkey
| | - Taha Koray Şahİn
- Faculty of Medicine, Department of Internal Medicine, Hacettepe University, Sıhhiye, Ankara, 06430, Turkey
| | - Zahİt TaŞ
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Hacettepe University, Sıhhiye, Ankara, 06430, Turkey
| | - Ahmet Çağkan İnkaya
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Hacettepe University, Sıhhiye, Ankara, 06430, Turkey
| | - Mıne Durusu TanriÖver
- Faculty of Medicine, Department of Internal Medicine, Section of General Internal Medicine, Hacettepe University, Sıhhiye, Ankara, 06430, Turkey
| | - Gökhan Metan
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Hacettepe University, Sıhhiye, Ankara, 06430, Turkey
| | - Gülay Saİn GÜven
- Faculty of Medicine, Department of Internal Medicine, Section of General Internal Medicine, Hacettepe University, Sıhhiye, Ankara, 06430, Turkey
| | - Serhat Ünal
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Hacettepe University, Sıhhiye, Ankara, 06430, Turkey
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100
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Bello B, Useh U. COVID-19: Are Non-Communicable Diseases Risk Factors for Its Severity? Am J Health Promot 2021; 35:720-729. [PMID: 33576237 DOI: 10.1177/0890117121990518] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To identify and describe the mechanisms of lifestyle characteristics-obesity, DM, hypertension and physical inactivity-that may lead to the severity of illness among individuals with COVID-19. DATA SOURCE A scoping review was conducted by searching electronic databases of PubMed and Scopus from December 2019 to August 2020. INCLUSION/EXCLUSION CRITERIA inclusion criteria were studies that explicitly describe the mechanism of COVID-19 in relationship with either hypertension, type 2 diabetes mellitus type 2 (DM), obesity and/or physical inactivity. Studies of epidemiological background, descriptive surveys and interventional studies were excluded. DATA EXTRACTION study characteristics were tabulated according to purpose, type of non-communicable diseases (NCDs), the hypothesis on the mechanism of infestation (MOI) and conclusion. DATA SYNTHESIS NCDs were categorized according to type and hypothesis on mechanisms of infestation. The interplay between COVID-19, type of NCDs and MOI leading to the severity of the disease was appraised. RESULTS Twenty-four (24) studies were identified from 357 unique records. Eight studies postulated the mechanism of infestation and interaction between COVID 19 illness severity and Obesity, while 7 studies described COVID-19 and DM. Five studies highlighted the interaction between COVID-19 and hypertension with 4 studies showing how physical activity restriction suppresses immunity. CONCLUSION The current review, identified and explicitly described the mechanisms of the lifestyle characteristics that may increase the severity of illness among people with COVID-19.
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Affiliation(s)
- Bashir Bello
- Lifestyle Diseases, Faculty of Health, 56405North-West University, Vanderbijlpark, South Africa
| | - Ushotanefe Useh
- Lifestyle Diseases, Faculty of Health, 56405North-West University, Vanderbijlpark, South Africa
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