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Simultaneous Pulmonary Embolism and Carotid Thrombosis as a Presenting Manifestation of COVID-19. Case Rep Neurol Med 2022; 2022:4933172. [PMID: 36050995 PMCID: PMC9427261 DOI: 10.1155/2022/4933172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/14/2022] [Accepted: 08/05/2022] [Indexed: 11/29/2022] Open
Abstract
Although COVID-19 was initially described predominantly as a respiratory infection, subsequent reports noted that it can produce generalised inflammation with effects on multiple organ systems. As a result, it is possible for patients with COVID-19, including those with severe disease, to present initially with nonrespiratory signs and symptoms. Neurological manifestations, including ischaemic stroke, may be the first presenting issue and can result from carotid thrombosis. Similarly, the risk of both arterial and venous thrombosis is increased in COVID-19, which may result from hypercoagulability associated with systemic inflammation.
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152
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Kannan L, Raj R. Case Report: Thromboelastography for uremic thrombocytopathy in a patient with COVID-19. FRONTIERS IN NEPHROLOGY 2022; 2:926313. [PMID: 37674996 PMCID: PMC10479651 DOI: 10.3389/fneph.2022.926313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/19/2022] [Indexed: 09/08/2023]
Abstract
Uremia causes several biochemical and physiological impairments that result in the accumulation of toxins with multiple clinical effects. Bleeding is one of the most common complications of acute and chronic renal failure. The pathogenesis of uremic bleeding is multifactorial, of which uremic thrombocytopathy is the most described clinically. Various tests have been used to evaluate bleeding diathesis in these patients including bleeding time, prothrombin time, activated partial thromboplastin time, and international normalized ratio, but there are only a few studies that use thromboelastography as a point-of-care test to identify platelet dysfunction. In addition, COVID-19 increases hemorrhagic complications due to platelet dysfunction or hemostasis exhaustion. COVID-19 could also potentially cause platelet dysfunction as a secondary consequence of acute kidney injury. There are only a few studies reporting the use of thromboelastography in COVID-19-induced hypercoagulability, but not in diagnosing or managing platelet-related abnormalities. We present a patient with COVID-19 who developed acute kidney injury in the hospital and retroperitoneal hemorrhage from uremic platelet dysfunction. We used point-of-care thromboelastography with platelet mapping to determine uremic platelet dysfunction.
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153
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Chan WF, Toh YN. Acute Necrotizing Pancreatitis Complicated by Multiple Splanchnic Venous Thromboses and Bilateral Renal Infarctions in a Patient With Recent COVID-19 Infection: A Case Report. Cureus 2022; 14:e28049. [PMID: 36127973 PMCID: PMC9477558 DOI: 10.7759/cureus.28049] [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] [Accepted: 08/15/2022] [Indexed: 11/28/2022] Open
Abstract
Splanchnic vein thrombosis (SVT) is a well-known complication of pancreatitis, but extra-splanchnic thrombosis is rarely seen. We report a case of acute necrotizing pancreatitis complicated by portal vein thrombosis and resultant hepatic infarction, splenic vein thrombosis, bilateral renal infarction, and bowel hypoperfusion in an 81-year-old man with recent coronavirus disease 2019 (COVID-19) infection. To the best of our knowledge, this is the first documented case of such extensive intra-abdominal thromboses complicating severe acute pancreatitis. Despite multi-organ support and systemic anticoagulation, he deteriorated into multiple organ failure and died after 72 hours. He had no prior history of thrombotic disorders. COVID-19 infection can cause sustained prothrombotic changes, while severe acute pancreatitis also produces an inflammatory response that promotes coagulation. Together, the two concurrent disease processes may have resulted in the particularly extensive intra-abdominal thromboses and infarctions seen in this patient. Physicians should be mindful of the elevated risk of severe vascular complications in acute pancreatitis patients with concurrent or recent COVID-19 infection.
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154
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Lung BE, Taka TM, Donnelly M, McLellan M, Callan K, Issagholian L, Lai W, So D, McMaster W, Yang S. Prior Diagnosis of COVID Has No Increased Complications in Total Joint Arthroplasty. Cureus 2022; 14:e27974. [PMID: 36120273 PMCID: PMC9467498 DOI: 10.7759/cureus.27974] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction Although a substantial portion of the United States population has been infected with and recovered from Coronavirus Disease-19 (COVID-19), many patients may have persistent symptoms and complications from disease-driven respiratory disease, arrhythmias, and venous thromboembolism (VTE). With institutions resuming elective total joint arthroplasties (TJA), it is unclear whether a prior resolved diagnosis of COVID has any implications on postoperative outcomes. Methods All elective TJA performed in 2021 at our institution were retrospectively reviewed and a history of prior COVID+ result recorded. Baseline demographics, days from prior COVID+ result to surgery date, preoperative methicillin-resistant Staphylococcus aureus (MRSA) nares colonization, and laboratory markers were obtained to determine baseline characteristics. Postoperative estimated blood loss (EBL), length of stay (LOS), rate of revision surgery, and discharge destination were compared between groups. Perioperative and postoperative rates of VTE, urinary tract infection (UTI), pneumonia, postoperative oxygen supplementation, cardiac arrhythmia, renal disease, sepsis, and periprosthetic joint infections within six months of surgery were recorded. Results Of the 155 elective TJA performed in 2021, 24 patients had a prior COVID+ diagnosis with a mean of 253 days from positive result to surgery date. There were no significant differences in baseline demographics, comorbidities, and preoperative lab markers between groups. Surgeries on patients with a prior COVID+ had a significantly higher EBL (260 vs 175cc), but postoperative outcomes of VTE, UTI, pneumonia, oxygen supplementation requirement, nares MRSA+, cardiac disease, and infection rates between groups were similar. Bivariate logistic regression revealed increased days from COVID+ diagnosis (>6 months) to surgery date were associated with a shorter LOS. Conclusion Although a prior COVID+ diagnosis had increased intraoperative blood loss, there were no significant differences in respiratory, infectious, cardiac, and thromboembolic complications up to six months after elective TJA. This study suggests that asymptomatic C+ patients receiving elective TJA do not require more aggressive prophylactic anticoagulation or antibiotic regimens to prevent VTE or perioperative infections. As institutions around the nation resume pre-COVID rates of arthroplasty surgeries, a prior diagnosis of COVID appears to have no effects on postoperative complications.
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155
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Dutt N, Shishir S, Chauhan NK, Jalandra R, kuwal A, Garg P, Kumar D, Vishwajeet V, Chakraborti A, Deokar K, Asfahan S, Babu A, bajad P, Gupta N, Khurana A, Garg MK. Mortality and Its Predictors in COVID-19 Patients With Pre-existing Interstitial Lung Disease. Cureus 2022; 14:e27759. [PMID: 36106257 PMCID: PMC9448685 DOI: 10.7759/cureus.27759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2022] [Indexed: 11/05/2022] Open
Abstract
Background The data on the impact of coronavirus disease 2019 (COVID-19) on interstitial lung disease (ILD) is still limited. To the best of our knowledge, there has been no study from India to date to assess the impact of COVID-19 in patients with preexisting ILD. We undertook this study to assess the clinical outcome of ILD patients admitted to our hospital with COVID-19. Methods In this retrospective observational study, records of reverse transcription polymerase chain reaction (RT-PCR)-confirmed COVID-19 patients with preexisting ILD who were admitted to the hospital in the period from May 1, 2020, to April 30, 2021, were obtained from the hospital database. The clinical outcomes of the patients were recorded. Univariate analysis was performed to find relation between various predetermined risk factors for mortality and those with significant p values (p<0.05) were subjected to multiple logistic regression to determine independent risk factors. Results In our study of 28 patients, the overall mortality was 35.7%. On comparing the parameters associated with increased mortality, there was no effect of age, gender, comorbidities, type of ILD, CT thorax findings on diagnosis, use of corticosteroids and antifibrotics in the past, spirometric findings on mortality. On multivariate analysis, the significant parameters were interleukin 6 (IL-6), p=0.02, OR=1.020 (1.006-1.043) and D-dimer, p=0.04, OR=2.14 (5.55-1.14). Conclusion COVID-19 in patients with pre-existing ILD has a comparatively higher mortality. D-dimer and IL-6 are significant predictors of mortality in ILD patients infected with COVID-19.
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156
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Segovia FD, Ream S, Dang T, Chaganti BT, Ortega AJ, Rhee S, Borges JC. COVID-19-Associated Superior Mesenteric Artery Thrombosis and Acute Intestinal Ischemia. Cureus 2022; 14:e27722. [PMID: 36081973 PMCID: PMC9441416 DOI: 10.7759/cureus.27722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2022] [Indexed: 11/05/2022] Open
Abstract
The prothrombotic nature of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been well-established since the start of the global coronavirus disease 2019 (COVID-19) pandemic. Mesenteric artery thrombosis and acute mesenteric ischemia are, on their own, rare occurrences and often present with fatal gastrointestinal (GI) pathologies requiring quick identification and intervention by the clinician to improve clinical outcomes. SARS-CoV-2 infection can present with acute GI pathologies and warrants further investigation regarding anticoagulation therapy in COVID-19 positive patients. We report on a 64-year-old woman infected with SARS-CoV-2 who presented with superior mesenteric artery thrombosis and acute intestinal ischemia.
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157
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Chaudhry TA, Palabiyik F, Moum SJ. Cerebrovascular Complications in Pediatric Patients with COVID-19 Infection. JOURNAL OF PEDIATRIC NEUROLOGY 2022. [DOI: 10.1055/s-0042-1751265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
AbstractSince the onset of the coronavirus disease 2019 pandemic, a variety of neurological manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been reported in patients, of which one of the most concerning is stroke. This review aims to summarize the current literature and evolving understanding of pediatric cerebrovascular complications in the setting of SARS-CoV-2.
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Affiliation(s)
- Thymur Ali Chaudhry
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Figen Palabiyik
- Department of Pediatric Radiology, Health Science University, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Sarah J. Moum
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, United States
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158
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Akbarzadeh MA, Hosseini MS. Is COVID-19 really a geriatric syndrome? Ageing Res Rev 2022; 79:101657. [PMID: 35640838 PMCID: PMC9148424 DOI: 10.1016/j.arr.2022.101657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/23/2022] [Accepted: 05/27/2022] [Indexed: 12/25/2022]
Abstract
Geriatric syndromes are a group of medical conditions, such as cognitive impairment, delirium, frailty, dizziness, syncope, and incontinence, associated with age increase. Many studies have reported a higher mortality rate for older COVID-19 patients, which could be explained by the complications of COVID-19, including the components of geriatric syndromes. We read with great interest the paper "Prevalence of unwillingness and uncertainty to vaccinate against COVID-19 in older people: A systematic review and meta-analysis" by Nicola Veronese et al. Their valuable work determines how uncertainty and unwillingness towards receiving the COVID-19 vaccine are more prevalent among older adults and how this hesitancy could affect vaccine uptake, and ultimately, the mortality rate. Regarding this paper, we wish to address some points.
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Affiliation(s)
- Mohammad Amin Akbarzadeh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran,Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran,Iranian Evidence-Based Medicine (EBM) Centre, Joanna Briggs Institute Affiliated Group, Tabriz, Iran
| | - Mohammad-Salar Hosseini
- Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran,Iranian Evidence-Based Medicine (EBM) Centre, Joanna Briggs Institute Affiliated Group, Tabriz, Iran,Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran,Correspondence to: Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Golgasht Street, Tabriz, Postal code 5166/15731, EA, Iran
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159
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Mal P, Mukherjee T, Upadhyay AK, Mohanty S, Pattnaik AK. Connecting the dots between inflammatory cascades of obesity and COVID-19 in light of mortal consequences-a review. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:57040-57053. [PMID: 35731430 PMCID: PMC9213647 DOI: 10.1007/s11356-022-21461-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/10/2022] [Indexed: 06/15/2023]
Abstract
Obesity is a term that has recently been referred to describe a condition in which a person has become a diseased vessel. Obesity's internal pathology is too mysterious as it has a close resemblance with fatal diseases pathology. Obesity and coronavirus disease 2019 (COVID-19) are simultaneous epidemics declared by many organizations after observing their rampage in the recent world. Oxidative stress, cytokine storm, interleukin, and their contribution to the internal adipocyte environment implicated in the cascades of inflammatory pathology are portrayed here. Major determinants like angiotensin-converting enzyme 2 (ACE2) and renin-angiotensin-aldosterone system (RAAS) axis are highly sensitive molecular factors. Data from various countries suggested a clinical overview of how greater body mass index (BMI) is related to greater COVID-19 risk. It also gives insight into how obese individuals are obligately getting admitted and combating COVID-19 in intensive care unit including children less than 13 years of age under ultimate therapeutic options. There are numerous studies currently taking place for finding a cure for obesity which are mainly focused on natural resources and novel therapies like photobiomodulation (PBM) consisting of laser treatment, infrared treatment, etc. as current pharmacological treatments are reported to have fatal adverse effects. Finally, it is discussed how attenuating obesity will be a solution for future combat strategy. This review gives light on the areas of coagulation, inflammatory parameters, cardiometabolic complications, endothelial dysfunctions, immunological infirmity due to COVID-19 in obese individuals. A conceptual outline about correlation between the inflammatory pathophysiological steps triggering the aggravation of fatal consequences has been drawn in this review.
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Affiliation(s)
- Payel Mal
- Division of Pharmacology, Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Mesra, Ranchi, 835215, Jharkhand, India
| | - Tuhin Mukherjee
- Division of Pharmacology, Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Mesra, Ranchi, 835215, Jharkhand, India
| | - Abhay K Upadhyay
- Division of Pharmacology, Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Mesra, Ranchi, 835215, Jharkhand, India
| | - Satyajit Mohanty
- Division of Pharmacology, Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Mesra, Ranchi, 835215, Jharkhand, India
| | - Ashok K Pattnaik
- Division of Pharmacology, Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Mesra, Ranchi, 835215, Jharkhand, India.
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160
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Dolkar T, Patel MJ, Jitidhar FNU, Hamad AM, Gulati A, Dogar MH, Dufresne A. Acute COVID-19-Associated Cardiac Arrhythmia: A Case Series and Literature Review. Cureus 2022; 14:e27583. [PMID: 36059309 PMCID: PMC9435960 DOI: 10.7759/cureus.27583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2022] [Indexed: 11/16/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a highly contagious infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We report two cases of COVID-19-associated atrial fibrillation (AF) in two elderly females and a case of atrial flutter (AFlutter) in a middle-aged male patient. We believe this case series will contribute to the literature on new-onset AF and AFlutter in patients with acute COVID-19 infection. This case series illustrates various case scenarios of patients developing cardiac arrhythmia with acute COVID-19 infection without any prior history or other explicable cause of AF/AFlutter. The exact mechanism behind COVID-19 infection leading to AF or AFlutter is still unknown. Of the three patients reported, two converted to sinus rhythm following medical management, and one did not convert to sinus rhythm despite medical treatment.
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161
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Dujardin RWG, Garcia Rosenbaum G, Klercq TCJ, Thachil J, Nielsen ND, Juffermans NP. Rotational thromboelastometry in critically ill COVID-19 patients does not predict thrombosis. Res Pract Thromb Haemost 2022; 6:e12798. [PMID: 36090158 PMCID: PMC9448874 DOI: 10.1002/rth2.12798] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/22/2022] [Accepted: 08/03/2022] [Indexed: 12/03/2022] Open
Abstract
Background Critically ill COVID-19 patients are in a hypercoagulable state with increased risk of thrombotic complications. Rotational thromboelastometry (ROTEM) is a viscoelastic test with the potential to reflect COVID-19-associated hypercoagulability and may therefore be useful to predict thrombotic complications. Objective To investigate the potential of ROTEM profiles to predict thrombotic complications in critically ill COVID-19 patients. Patients/Methods Retrospective multicenter cohort study in 113 adult patients with confirmed COVID-19 infection admitted to the intensive care unit (ICU) of two large teaching hospitals in the United States and in the Netherlands. ROTEM profiles of the EXTEM, INTEM, and FIBTEM tracings were measured within 72 h of ICU admission. Thrombotic complications encompass both arterial and venous thromboembolic complications, diagnosed with electrocardiogram, ultrasound, or computed tomography. ROTEM profiles were compared between patients with and without thrombosis. Univariable logistic regression followed by receiver operating characteristic (ROC) curves analysis was performed to identify ROTEM parameters associated with thrombosis. Results and Conclusions Of 113 patients, 27 (23.9%) developed a thrombotic event. In the univariable analysis, EXTEM clot amplitude at 10 min (CA10) and EXTEM maximum clot formation (MCF) were associated with thrombosis with a p < 0.2 (p = 0.07 and p = 0.05, respectively). In ROC curve analysis, EXTEM CA10 had an area under the curve (AUC) of 0.58 (95% CI 0.47-0.70) and EXTEM MCF had an AUC of 0.60 (95% CI 0.49-0.71). Thereby, ROTEM profiles at ICU admission did not have the potential to differentiate between patients with a high and low risk for thrombotic complications.
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Affiliation(s)
- Romein W. G. Dujardin
- Department of Intensive CareOLVG HospitalAmsterdamThe Netherlands
- Laboratory of Experimental Intensive Care and AnesthesiologyAmsterdam UMCAmsterdamThe Netherlands
| | - Gabriel Garcia Rosenbaum
- Department of Internal MedicineUniversity of New Mexico School of MedicineAlbuquerqueNew MexicoUSA
| | | | - Jecko Thachil
- Department of HaematologyManchester Royal InfirmaryManchesterUK
| | - Nathan D. Nielsen
- Division of Pulmonary, Critical Care and Sleep MedicineUniversity of New Mexico School of MedicineAlbuquerqueNew MexicoUSA
- Department of PathologyUniversity of New Mexico School of MedicineAlbuquerqueNew MexicoUSA
| | - Nicole P. Juffermans
- Department of Intensive CareOLVG HospitalAmsterdamThe Netherlands
- Laboratory of Experimental Intensive Care and AnesthesiologyAmsterdam UMCAmsterdamThe Netherlands
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162
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The Occurrence of Hyperactivated Platelets and Fibrinaloid Microclots in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). Pharmaceuticals (Basel) 2022; 15:ph15080931. [PMID: 36015078 PMCID: PMC9413879 DOI: 10.3390/ph15080931] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/20/2022] [Accepted: 07/23/2022] [Indexed: 12/10/2022] Open
Abstract
We have previously demonstrated that platelet-poor plasma (PPP) obtained from patients with Long COVID/Post-Acute Sequelae of COVID-19 (PASC) is characterized by a hypercoagulable state and contains hyperactivated platelets and considerable numbers of already-formed amyloid fibrin(ogen) or fibrinaloid microclots. Due to the substantial overlap in symptoms and etiology between Long COVID/PASC and ME/CFS, we investigated whether coagulopathies reflected in Long COVID/PASC—hypercoagulability, platelet hyperactivation, and fibrinaloid microclot formation—were present in individuals with ME/CFS and gender- and age-matched healthy controls. ME/CFS samples showed significant hypercoagulability as judged by thromboelastography of both whole blood and platelet-poor plasma. The area of plasma images containing fibrinaloid microclots was commonly more than 10-fold greater in untreated PPP from individuals with ME/CFS than in that of healthy controls. A similar difference was found when the plasma samples were treated with thrombin. Using fluorescently labelled PAC-1, which recognizes glycoprotein IIb/IIIa, and CD62P, which binds P-selectin, we observed hyperactivation of platelets in ME/CFS hematocrit samples. Using a quantitative scoring system, the ME/CFS platelets were found to have a mean spreading score of 2.72 ± 1.24 vs. 1.00 (activation with pseudopodia formation) for healthy controls. We conclude that ME/CFS is accompanied by substantial and measurable changes in coagulability, platelet hyperactivation, and fibrinaloid microclot formation. However, the fibrinaloid microclot load was not as great as was previously noted in Long COVID/PASC. Fibrinaloid microclots, in particular, may contribute to many ME/CFS symptoms, such as fatigue, seen in patients with ME/CFS, via the (temporary) blockage of microcapillaries and hence ischemia. Furthermore, fibrinaloid microclots might damage the endothelium. The discovery of these biomarkers represents an important development in ME/CFS research. It also points to possible uses for treatment strategies using known drugs and/or nutraceuticals that target systemic vascular pathology and endothelial inflammation.
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163
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Taghioff SM, Slavin BR, Narasimman M, Samaha G, Samaha M, Holton T, Singh D. The influence of SARS-CoV-2 vaccination on post-operative outcomes in microsurgery patients. Microsurgery 2022; 42:685-695. [PMID: 35838137 PMCID: PMC9349889 DOI: 10.1002/micr.30940] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 05/25/2022] [Accepted: 07/01/2022] [Indexed: 11/11/2022]
Abstract
Background The healthcare industry's efforts to immunize the global community against severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) have been unprecedented. Given the fast‐tracking of the novel vaccine, its short‐ and long‐term medical implications remain largely to‐be‐determined in most patient populations. This study aims to analyze 90‐day post‐operative outcomes in microsurgical patients, who have received or not received SARS‐CoV‐2‐vaccination, using a continuously updated federated electronic medical record network (TriNetX Inc, Cambridge, MA). Methods After screening 70 million de‐identified records, 16,799 microsurgery patients aged 18–99 meeting medical coding criteria were allocated into two cohorts. Cohort One received SARS‐CoV‐2‐vaccination prior to undergoing microsurgery whereas Cohort Two did not. Two equally sized cohorts, totaling 818 patients were created after propensity score matching for characteristics including: age, race, ethnicity, smoking, hypertension, heart disease, diabetes, obesity, chronic obstructive pulmonary disease, and history of SARS‐CoV‐2 exposure. Postoperative outcomes within 30‐, 60‐, and 90‐days of microsurgery were analyzed. Results Patients who were SARS‐CoV‐2‐immunized experienced significantly lower (p < .01) surgical site infections (Absolute Risk Reduction (ARR)[95%CI]) = (3.79%–5.36% [0.84–8.54]) ICU admission (9.47%–9.82%[5.45–13.88]), generalized infections (7.68%–9.92%[3.15–14.64]), and hospitalizations (28.48%–32.57%[20.99–40.13]) within 30‐, 60‐, and 90‐days of microsurgery. Additionally, SARS‐CoV‐2‐vaccinated patients also experienced significantly less flap failure (2.49%[0.97–4.02]) and death (2.46%[0.96–3.97]) within 30‐ and 60‐days post‐operatively. Conclusion Our analysis examines the potential protective effect of SARS‐CoV‐2‐vaccination in microsurgical patients. Limitations include the retrospective nature of this analysis and the inherent reliance on medical coding. Future prospective studies are warranted to better understand if in fact pre‐operative SARS‐CoV‐2‐vaccination has the potential to protect against post‐operative microsurgery outcomes.
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Affiliation(s)
- Susan M Taghioff
- Division of Plastic & Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Anne Arundel Medical Center Luminis Health, Annapolis, Maryland, USA
| | - Benjamin R Slavin
- Division of Plastic & Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Manish Narasimman
- Division of Plastic & Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Georges Samaha
- Division of Plastic & Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Mario Samaha
- Division of Plastic & Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Tripp Holton
- Anne Arundel Medical Center Luminis Health, Annapolis, Maryland, USA
| | - Devinder Singh
- Division of Plastic & Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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164
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Salah HM, Fudim M, O'Neil ST, Manna A, Chute CG, Caughey MC. Post-recovery COVID-19 and incident heart failure in the National COVID Cohort Collaborative (N3C) study. Nat Commun 2022; 13:4117. [PMID: 35840623 PMCID: PMC9284961 DOI: 10.1038/s41467-022-31834-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 07/04/2022] [Indexed: 11/22/2022] Open
Abstract
Cardiac involvement has been noted in COVID-19 infection. However, the relationship between post-recovery COVID-19 and development of de novo heart failure has not been investigated in a large, nationally representative population. We examined post-recovery outcomes of 587,330 patients hospitalized in the United States (257,075 with COVID-19 and 330,255 without), using data from the National COVID Cohort Collaborative study. Patients hospitalized with COVID-19 were older (51 vs. 46 years), more often male (49% vs. 42%), and less often White (61% vs. 69%). Over a median follow up of 367 days, 10,979 incident heart failure events occurred. After adjustments, COVID-19 hospitalization was associated with a 45% higher hazard of incident heart failure (hazard ratio = 1.45; 95% confidence interval: 1.39-1.51), with more pronounced associations among patients who were younger (P-interaction = 0.003), White (P-interaction = 0.005), or who had established cardiovascular disease (P-interaction = 0.005). In conclusion, COVID-19 hospitalization is associated with increased risk of incident heart failure.
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Affiliation(s)
- Husam M Salah
- Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Marat Fudim
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA.
| | - Shawn T O'Neil
- Center for Health AI, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Christopher G Chute
- Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Melissa C Caughey
- Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Chapel Hill, NC, USA
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165
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Nguyen A, Al Hage A, Yu H, Gunaga S. Arterial Occlusion and Acute Deep Vein Thrombosis-Induced Acute Limb Ischemia in a COVID-19 Patient. Cureus 2022; 14:e26689. [PMID: 35949755 PMCID: PMC9358059 DOI: 10.7759/cureus.26689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2022] [Indexed: 11/05/2022] Open
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Petrov I, Stankov Z, Dobrev G, Polomski P. COVID-19 infection complicated with acute pulmonary embolism treated with percutaneous pulmonary artery thrombectomy: a case report. Eur Heart J Case Rep 2022; 6:ytac227. [PMID: 35794900 PMCID: PMC9214152 DOI: 10.1093/ehjcr/ytac227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 12/20/2021] [Accepted: 05/27/2022] [Indexed: 11/15/2022]
Abstract
Background Coronavirus disease 2019 (COVID-19) disease is a highly prothrombotic state. Deep vein thrombosis (DVT) and pulmonary embolism (PE) are observed with increased incidence in patients infected with the severe acute respiratory syndrome coronavirus 2 virus. Case summary A 57-year-old male patient with a recent COVID-19 infection complained of leg swelling shortly after his COVID ward discharge. A few days later he was hospitalized with acute massive PE and DVT of his left leg was diagnosed. In another facility, as the first line of treatment, the PE was managed with catheter-directed therapy (CDT) using thrombus defragmentation via 5F (French) Pigtail catheter and supraselective application of 40 mg alteplase. Following the procedure, in addition, 50 mg alteplase was also applied as a 1 hour systemic infusion. Despite the haemodynamic stabilization of the patient, he remained persistently symptomatic and tachycardic. Three days later—in our institution, a second computed tomography pulmoangiography revealed massive thrombotic masses mainly in the left pulmonary artery. Successful percutaneous thrombus aspiration was conducted. The procedure was uneventful with an immediate drop of systolic pulmonary artery pressure from 68 to 47 mmHg and relief of the patient’s symptoms. Discussion In the era of the COVID-19 pandemic, physicians have to remain vigilant of its potential thrombotic complications, the most commonly observed being DVT and PE. We demonstrated the efficacy of percutaneous thrombus aspiration in a patient with acute COVID-19-associated PE, after initial CDT with thrombus defragmentation and high-dose tissue plasminogen activator was implemented with a suboptimal result.
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Affiliation(s)
- Ivo Petrov
- Department of Cardiology and Angiology, Acibadem City Clinic—Cardiovascular Center , Sofia , Bulgaria
| | - Zoran Stankov
- Department of Cardiology and Angiology, Acibadem City Clinic—Cardiovascular Center , Sofia , Bulgaria
| | - Georgi Dobrev
- Department of Cardiology and Angiology, Acibadem City Clinic—Cardiovascular Center , Sofia , Bulgaria
| | - Petar Polomski
- Department of Cardiology and Angiology, Acibadem City Clinic—Cardiovascular Center , Sofia , Bulgaria
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Santos AP, Gonçalves LC, Oliveira ACC, Queiroz PHP, Ito CRM, Santos MO, Carneiro LC. Bacterial Co-Infection in Patients with COVID-19 Hospitalized (ICU and Not ICU): Review and Meta-Analysis. Antibiotics (Basel) 2022; 11:antibiotics11070894. [PMID: 35884147 PMCID: PMC9312179 DOI: 10.3390/antibiotics11070894] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/14/2022] [Accepted: 06/22/2022] [Indexed: 01/27/2023] Open
Abstract
The prevalence of patients hospitalized in ICUs with COVID-19 and co-infected by pathogenic bacteria is relevant in this study, considering the integrality of treatment. This systematic review assesses the prevalence of co-infection in patients admitted to ICUs with SARS-CoV-2 infection, using the PRISMA guidelines. We examined the results of the PubMed, Embase, and SciELO databases, searching for published English literature from December 2019 to December 2021. A total of 542 rec ords were identified, but only 38 were eligible and, and of these only 10 were included. The tabulated studies represented a sample group of 1394 co-infected patients. In total, 35%/138 of the patients were co-infected with Enterobacter spp., 27% (17/63) were co-infected with methicillin-sensitive Staphylococ cus aureus, 21% (84/404) were co-infected with Klebsiella spp., 16% (47/678) of patients were co-infected with coagulase-negative Staphylococcus, 13% (10/80) co-infected with Escherichia coli (ESBL), and 3% (30/1030) of patients were co-infected with Pseudomonas aeruginosa. The most common co-infections were related to blood flow; although in the urinary and respiratory tracts of patients Streptococcus pneumoniae was found in 57% (12/21) of patients, coagulase negative Staphylococcus in 44% (7/16) of patients, and Escherichia coli was found in 37% (11/29) of patients. The present research demonstrated that co-infections caused by bacteria in patients with COVID-19 are a concern.
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Affiliation(s)
- Adailton P. Santos
- Medicine College, Federal University of Goiás, 235 Street, Goiânia 74690-900, Brazil; (A.P.S.); (L.C.G.); (A.C.C.O.); (P.H.P.Q.); (M.O.S.)
| | - Lucas C. Gonçalves
- Medicine College, Federal University of Goiás, 235 Street, Goiânia 74690-900, Brazil; (A.P.S.); (L.C.G.); (A.C.C.O.); (P.H.P.Q.); (M.O.S.)
| | - Ana C. C. Oliveira
- Medicine College, Federal University of Goiás, 235 Street, Goiânia 74690-900, Brazil; (A.P.S.); (L.C.G.); (A.C.C.O.); (P.H.P.Q.); (M.O.S.)
| | - Pedro H. P. Queiroz
- Medicine College, Federal University of Goiás, 235 Street, Goiânia 74690-900, Brazil; (A.P.S.); (L.C.G.); (A.C.C.O.); (P.H.P.Q.); (M.O.S.)
| | - Célia R. M. Ito
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, 235 Street, Goiânia 74605-050, Brazil;
| | - Mônica O. Santos
- Medicine College, Federal University of Goiás, 235 Street, Goiânia 74690-900, Brazil; (A.P.S.); (L.C.G.); (A.C.C.O.); (P.H.P.Q.); (M.O.S.)
| | - Lilian C. Carneiro
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, 235 Street, Goiânia 74605-050, Brazil;
- Correspondence: ; Tel.: +55-(62)-32096528
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Yong SJ, Halim A, Halim M, Al Mutair A, Alhumaid S, Al-Sihati J, Albayat H, Alsaeed M, Garout M, Al Azmi R, Aldakheel N, Alshukairi AN, Al Ali HA, Almoumen AA, Rabaan AA. Rare Adverse Events Associated with BNT162b2 mRNA Vaccine (Pfizer-BioNTech): A Review of Large-Scale, Controlled Surveillance Studies. Vaccines (Basel) 2022; 10:vaccines10071067. [PMID: 35891231 PMCID: PMC9319660 DOI: 10.3390/vaccines10071067] [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: 05/20/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 12/23/2022] Open
Abstract
Given the increasing anti-vaccine movements erroneously touting vaccine danger, this review has investigated the rare adverse events potentially associated with BNT162b2 (Pfizer-BioNTech), an mRNA vaccine against the severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2). Only real-world surveillance studies with at least 0.1 million BNT162b2-vaccinated participants and one unvaccinated control group were selected for review. A total of 21 studies examining the potential association of BNT162b2 with cardiovascular, herpetic, thrombotic or thrombocytopenic, neurological, mortality, and other miscellaneous rare adverse events were described in this review. Only myocarditis is consistently associated with BNT162b2. An unclear direction of association was seen with stroke (hemorrhagic and ischemic), herpes zoster, and paresthesia from BNT162b2, which may require more studies to resolve. Fortunately, most surveillance studies detected no increased risks of the remaining rare adverse events reviewed herein, further reassuring the safety of BNT162b2. In conclusion, this review has concisely summarized the current rare adverse events related and unrelated to BNT162b2, arguably for the first time in sufficient depth, to better communicate vaccine safety to the public.
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Affiliation(s)
- Shin-Jie Yong
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Selangor 47500, Malaysia
- Correspondence: (S.-J.Y.); (A.A.R.); Tel.: +60-17-8487-513 (S.J.Y.); +966-50-680-4800 (A.A.R.)
| | - Alice Halim
- Shanghai Medical College, Fudan University, Shanghai 200032, China;
| | - Michael Halim
- Department of Biomedical Science, School of Science, Engineering and Environment, University of Salford, Greater Manchester, Salford M5 4WT, UK;
| | - Abbas Al Mutair
- Research Center, Almoosa Specialist Hospital, Al-Ahsa 36342, Saudi Arabia;
- College of Nursing, Princess Norah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia
- School of Nursing, Wollongong University, Wollongong 2522, Australia
- Nursing Department, Prince Sultan Military College of Health Sciences, Dhahran 33048, Saudi Arabia
| | - Saad Alhumaid
- Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa 31982, Saudi Arabia;
| | - Jehad Al-Sihati
- Gastroenterology Section, Internal Medicine Department, King Fahad Specialist Hospital, Dammam 31311, Saudi Arabia;
| | - Hawra Albayat
- Infectious Disease Department, King Saud Medical City, Riyadh 7790, Saudi Arabia;
| | - Mohammed Alsaeed
- Infectious Disease Division, Department of Medicine, Prince Sultan Military Medical City, Riyadh 7790, Saudi Arabia;
| | - Mohammed Garout
- Department of Community Medicine and Health Care for Pilgrims, Faculty of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia;
| | - Reyouf Al Azmi
- Infection Prevention and Control, Eastern Health Cluster, Dammam 32253, Saudi Arabia;
| | - Noor Aldakheel
- Microbiology Laboratory, Dammam Regional Laboratory and Blood Bank, Dammam 31411, Saudi Arabia;
| | - Abeer N. Alshukairi
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah 21499, Saudi Arabia;
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
| | - Hani A. Al Ali
- Pediatrics Department, Maternity & Children Hospital, Dammam 32253, Saudi Arabia; (H.A.A.A.); (A.A.A.)
| | - Adel A. Almoumen
- Pediatrics Department, Maternity & Children Hospital, Dammam 32253, Saudi Arabia; (H.A.A.A.); (A.A.A.)
| | - Ali A. Rabaan
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran 31311, Saudi Arabia
- Department of Public Health and Nutrition, The University of Haripur, Haripur 22610, Pakistan
- Correspondence: (S.-J.Y.); (A.A.R.); Tel.: +60-17-8487-513 (S.J.Y.); +966-50-680-4800 (A.A.R.)
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Choudhry H, Klingensmith J, Border Dalton L, Myers M, Mercado E. Large Middle Cerebral Artery Ischemic Stroke in a Therapeutically Anticoagulated Patient With Severe SARS-CoV-2 Infection. Neurologist 2022; 27:218-221. [PMID: 34855675 PMCID: PMC9256897 DOI: 10.1097/nrl.0000000000000389] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with hypercoagulability which can predispose infected patients to both arterial and venous thromboembolic complications. Despite therapeutic anticoagulation, there remains a risk of ischemic strokes, which may lead to adverse patient outcomes. Only a few cases are described in the literature regarding SARS-CoV-2 positive patients developing thrombotic ischemic strokes despite therapeutic anticoagulation. CASE REPORT The following is a case discussion regarding a 71-year-old female with past medical history of hypertension, diabetes mellitus type 2, hyperlipidemia, and hypothyroidism who was admitted with severe SARS-CoV-2 infection to the intensive care unit and later developed acute left upper extremity weakness on the 5th day of her admission. Initial National Institutes of Health stroke scale (NIHSS) was 15. Subsequent brain imaging was significant for right middle cerebral artery ischemic stroke. The patient was therapeutically anticoagulated with 1.5 mg/kg subcutaneous dose of Enoxaparin since day 1 of her admission. D-dimer upon admission was 1.84 mg/L (<0.59) and fibrinogen 783.1 mg/dL (200 to 450). Other than past medical comorbidities, our patient had no other known stroke risk factors. Unfortunately, despite early transcatheter thrombectomy, the patient remained comatose and eventually expired after withdrawal of ventilatory support and compassionate extubation. CONCLUSION Because of the severity of inflammation and coagulopathic sequelae of coronavirus disease 2019, anticoagulation failure may occur and lead to adverse patient outcomes. Our case report is one of the few discussions in the current literature regarding large vessel thromboembolic ischemic strokes despite therapeutic anticoagulation.
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Al Qawasmeh M, Ahmed YB, Nsour OA, Qarqash AA, Al-Horani SS, Hazaimeh EA, Jbarah OF, Yassin A, Aldabbour B, Alhusban A, El-Salem K. Functional outcomes of COVID-19 patients with acute ischemic stroke: A prospective, observational, single-center study in North Jordan. Medicine (Baltimore) 2022; 101:e29834. [PMID: 35777044 PMCID: PMC9239634 DOI: 10.1097/md.0000000000029834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
We assessed whether stroke severity, functional outcome, and mortality in patients with ischemic stroke differed between patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and those without. We conducted a prospective, single-center cohort study in Irbid, North Jordan. All patients diagnosed with ischemic stroke and SARS-CoV-2 infection were consecutively recruited from October 15, 2020, to October 16, 2021. We recorded demographic data, vascular risk factors, National Institutes of Health Stroke Scale (NIHSS) score, stroke subtype according to the Trial of ORG 10172 in Acute Stroke Treatment Criteria (TOAST), treatments at admission, and laboratory variables for all patients. The primary endpoint was the functional outcome at 3 months assessed using the modified Rankin Score. Secondary outcomes involved in-hospital mortality and mortality at 3 months. We included 178 patients with a mean (standard deviation) age of 67.3 (12), and more than half of the cases were males (96/178; 53.9%). Thirty-six cases were coronavirus disease 2019 (COVID-19) related and had a mean (standard deviation) age of 70 (11.5). When compared with COVID-19-negative patients, COVID-19-positive patients were more likely to have a higher median NIHSS score at baseline (6 vs 11; P = .043), after 72 hours (6 vs 12; P = .006), and at discharge (4 vs 16; P < .001). They were also more likely to have a higher median modified Rankin Score after 3 months of follow-up (P < .001). NIHSS score at admission (odds ratio = 1.387, 95% confidence interval = 1.238-1.553]; P < .001) predicted having an unfavorable outcome after 3 months. On the other hand, having a concomitant SARS-CoV-2 infection did not significantly impact the likelihood of unfavorable outcomes (odds ratio = 1.098, 95% confidence interval = 0.270-4.473; P = .896). The finding conclude that SARS-CoV-2 infection led to an increase in both stroke severity and in-hospital mortality but had no significant impact on the likelihood of developing unfavorable outcomes.
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Affiliation(s)
- Majdi Al Qawasmeh
- Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Yaman B. Ahmed
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
- * Correspondence: Yaman B. Ahmed, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan (e-mail: )
| | - Omar A. Nsour
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Aref A. Qarqash
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Sami S. Al-Horani
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ethar A. Hazaimeh
- Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Omar F. Jbarah
- Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ahmed Yassin
- Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Belal Aldabbour
- Neuroscience Department, Faculty of Medicine, Islamic University of Gaza, Gaza, State of Palestine
| | - Ahmed Alhusban
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Khalid El-Salem
- Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Honarmand K, Fiorini K, Chakraborty D, Gillett D, Desai K, Martin C, Bosma KJ, Slessarev M, Ball IM, Mele T, LeBlanc D, Elsayed S, Lazo-Langner A, Nicholson MJ, Arntfield R, Basmaji J. Clinical characteristics, multiorgan dysfunction and outcomes of patients with COVID-19: a prospective case series. CMAJ Open 2022; 10:E675-E684. [PMID: 35853662 PMCID: PMC9312996 DOI: 10.9778/cmajo.20210151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Characterizing the multiorgan manifestations and outcomes of patients hospitalized with COVID-19 will inform resource requirements to address the long-term burden of this disease. We conducted a descriptive analysis using prospectively collected data to describe the clinical characteristics and spectrum of organ dysfunction, and in-hospital and longer-term clinical outcomes of patients hospitalized with COVID-19 during the first wave of the pandemic at a Canadian centre. METHODS We conducted a prospective case series involving adult patients (aged ≥ 18 yr) with COVID-19 admitted to 1 of 2 hospitals in London, Ontario, from Mar. 17 to June 18, 2020, during the first wave of the pandemic. We recorded patients' baseline characteristics, physiologic parameters, measures of organ function and therapies administered during hospitalization among patients in the intensive care unit (ICU) and in non-ICU settings, and compared the characteristics of hospital survivors and nonsurvivors. Finally, we recorded follow-up thoracic computed tomography (CT) and echocardiographic findings after hospital discharge. RESULTS We enrolled 100 consecutive patients (47 women) hospitalized with COVID-19, including 32 patients who received ICU care and 68 who received treatment in non-ICU settings. Respiratory sequelae were common: 23.0% received high-flow oxygen by nasal cannula, 9.0% received noninvasive ventilation, 24.0% received invasive mechanical ventilation and 2.0% received venovenous extracorporeal membrane oxygenation. Overall, 9.0% of patients had cerebrovascular events (3.0% ischemic stroke, 6.0% intracranial hemorrhage), and 6.0% had pulmonary embolism. After discharge, 11 of 19 patients had persistent abnormalities on CT thorax, and 6 of 15 had persistent cardiac dysfunction on echocardiography. INTERPRETATION This study provides further evidence that COVID-19 is a multisystem disease involving neurologic, cardiac and thrombotic dysfunction, without evidence of hepatic dysfunction. Patients have persistent organ dysfunction after hospital discharge, underscoring the need for research on long-term outcomes of COVID-19 survivors.
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Affiliation(s)
- Kimia Honarmand
- Departments of Medicine (Honarmand, Fiorini, Chakraborty, Gillett, Desai, Martin, Bosma, Slessarev, Ball, Mele, LeBlanc, Lazo-Langner, Nicholson, Arntfield, Basmaji), Medical Biophysics (Slessarev), Microbiology & Immunology and Division of Infectious Diseases (Elsayed), and Epidemiology and Biostatistics (Ball, Lazo-Langner), Western University, London, Ont
| | - Kyle Fiorini
- Departments of Medicine (Honarmand, Fiorini, Chakraborty, Gillett, Desai, Martin, Bosma, Slessarev, Ball, Mele, LeBlanc, Lazo-Langner, Nicholson, Arntfield, Basmaji), Medical Biophysics (Slessarev), Microbiology & Immunology and Division of Infectious Diseases (Elsayed), and Epidemiology and Biostatistics (Ball, Lazo-Langner), Western University, London, Ont
| | - Debarati Chakraborty
- Departments of Medicine (Honarmand, Fiorini, Chakraborty, Gillett, Desai, Martin, Bosma, Slessarev, Ball, Mele, LeBlanc, Lazo-Langner, Nicholson, Arntfield, Basmaji), Medical Biophysics (Slessarev), Microbiology & Immunology and Division of Infectious Diseases (Elsayed), and Epidemiology and Biostatistics (Ball, Lazo-Langner), Western University, London, Ont
| | - Daniel Gillett
- Departments of Medicine (Honarmand, Fiorini, Chakraborty, Gillett, Desai, Martin, Bosma, Slessarev, Ball, Mele, LeBlanc, Lazo-Langner, Nicholson, Arntfield, Basmaji), Medical Biophysics (Slessarev), Microbiology & Immunology and Division of Infectious Diseases (Elsayed), and Epidemiology and Biostatistics (Ball, Lazo-Langner), Western University, London, Ont
| | - Karishma Desai
- Departments of Medicine (Honarmand, Fiorini, Chakraborty, Gillett, Desai, Martin, Bosma, Slessarev, Ball, Mele, LeBlanc, Lazo-Langner, Nicholson, Arntfield, Basmaji), Medical Biophysics (Slessarev), Microbiology & Immunology and Division of Infectious Diseases (Elsayed), and Epidemiology and Biostatistics (Ball, Lazo-Langner), Western University, London, Ont
| | - Claudio Martin
- Departments of Medicine (Honarmand, Fiorini, Chakraborty, Gillett, Desai, Martin, Bosma, Slessarev, Ball, Mele, LeBlanc, Lazo-Langner, Nicholson, Arntfield, Basmaji), Medical Biophysics (Slessarev), Microbiology & Immunology and Division of Infectious Diseases (Elsayed), and Epidemiology and Biostatistics (Ball, Lazo-Langner), Western University, London, Ont
| | - Karen J Bosma
- Departments of Medicine (Honarmand, Fiorini, Chakraborty, Gillett, Desai, Martin, Bosma, Slessarev, Ball, Mele, LeBlanc, Lazo-Langner, Nicholson, Arntfield, Basmaji), Medical Biophysics (Slessarev), Microbiology & Immunology and Division of Infectious Diseases (Elsayed), and Epidemiology and Biostatistics (Ball, Lazo-Langner), Western University, London, Ont
| | - Marat Slessarev
- Departments of Medicine (Honarmand, Fiorini, Chakraborty, Gillett, Desai, Martin, Bosma, Slessarev, Ball, Mele, LeBlanc, Lazo-Langner, Nicholson, Arntfield, Basmaji), Medical Biophysics (Slessarev), Microbiology & Immunology and Division of Infectious Diseases (Elsayed), and Epidemiology and Biostatistics (Ball, Lazo-Langner), Western University, London, Ont
| | - Ian M Ball
- Departments of Medicine (Honarmand, Fiorini, Chakraborty, Gillett, Desai, Martin, Bosma, Slessarev, Ball, Mele, LeBlanc, Lazo-Langner, Nicholson, Arntfield, Basmaji), Medical Biophysics (Slessarev), Microbiology & Immunology and Division of Infectious Diseases (Elsayed), and Epidemiology and Biostatistics (Ball, Lazo-Langner), Western University, London, Ont
| | - Tina Mele
- Departments of Medicine (Honarmand, Fiorini, Chakraborty, Gillett, Desai, Martin, Bosma, Slessarev, Ball, Mele, LeBlanc, Lazo-Langner, Nicholson, Arntfield, Basmaji), Medical Biophysics (Slessarev), Microbiology & Immunology and Division of Infectious Diseases (Elsayed), and Epidemiology and Biostatistics (Ball, Lazo-Langner), Western University, London, Ont
| | - Danielle LeBlanc
- Departments of Medicine (Honarmand, Fiorini, Chakraborty, Gillett, Desai, Martin, Bosma, Slessarev, Ball, Mele, LeBlanc, Lazo-Langner, Nicholson, Arntfield, Basmaji), Medical Biophysics (Slessarev), Microbiology & Immunology and Division of Infectious Diseases (Elsayed), and Epidemiology and Biostatistics (Ball, Lazo-Langner), Western University, London, Ont
| | - Sameer Elsayed
- Departments of Medicine (Honarmand, Fiorini, Chakraborty, Gillett, Desai, Martin, Bosma, Slessarev, Ball, Mele, LeBlanc, Lazo-Langner, Nicholson, Arntfield, Basmaji), Medical Biophysics (Slessarev), Microbiology & Immunology and Division of Infectious Diseases (Elsayed), and Epidemiology and Biostatistics (Ball, Lazo-Langner), Western University, London, Ont
| | - Alejandro Lazo-Langner
- Departments of Medicine (Honarmand, Fiorini, Chakraborty, Gillett, Desai, Martin, Bosma, Slessarev, Ball, Mele, LeBlanc, Lazo-Langner, Nicholson, Arntfield, Basmaji), Medical Biophysics (Slessarev), Microbiology & Immunology and Division of Infectious Diseases (Elsayed), and Epidemiology and Biostatistics (Ball, Lazo-Langner), Western University, London, Ont
| | - Mike J Nicholson
- Departments of Medicine (Honarmand, Fiorini, Chakraborty, Gillett, Desai, Martin, Bosma, Slessarev, Ball, Mele, LeBlanc, Lazo-Langner, Nicholson, Arntfield, Basmaji), Medical Biophysics (Slessarev), Microbiology & Immunology and Division of Infectious Diseases (Elsayed), and Epidemiology and Biostatistics (Ball, Lazo-Langner), Western University, London, Ont
| | - Robert Arntfield
- Departments of Medicine (Honarmand, Fiorini, Chakraborty, Gillett, Desai, Martin, Bosma, Slessarev, Ball, Mele, LeBlanc, Lazo-Langner, Nicholson, Arntfield, Basmaji), Medical Biophysics (Slessarev), Microbiology & Immunology and Division of Infectious Diseases (Elsayed), and Epidemiology and Biostatistics (Ball, Lazo-Langner), Western University, London, Ont
| | - John Basmaji
- Departments of Medicine (Honarmand, Fiorini, Chakraborty, Gillett, Desai, Martin, Bosma, Slessarev, Ball, Mele, LeBlanc, Lazo-Langner, Nicholson, Arntfield, Basmaji), Medical Biophysics (Slessarev), Microbiology & Immunology and Division of Infectious Diseases (Elsayed), and Epidemiology and Biostatistics (Ball, Lazo-Langner), Western University, London, Ont.
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Vasudeva Rao U, Wasim MD, Rajeev P, Rai S, Pradeep Kumar K. Acute limb ischaemia: not an uncommon complication of COVID-19 infection. Ann R Coll Surg Engl 2022; 104:e211-e215. [PMID: 35446698 PMCID: PMC9246543 DOI: 10.1308/rcsann.2021.0342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A new variant of coronavirus (2019-nCoV) causing acute respiratory distress in humans was identified for the first time in 2019, in Wuhan, China. One of the many complications of infection with this coronavirus is hypercoagulopathy, resulting in acute thrombosis; often leading to acute limb ischaemia. Herein, we report 20 cases of COVID-19 with peripheral arterial thrombosis involving either upper or lower limbs. Some patients underwent vascular procedures and most had to undergo amputation at some level. All the cases (n=20) were referred to us during the 8-month period June 2020 to March 2021. The most common age group was between 51 and 60 years, of whom 80% were males; all the patients had diabetes. The right lower limb was most affected (50%); 15 patients underwent embolectomy. Twenty-five per cent of patients presented with wet gangrene. One patient with upper limb thrombosis recovered after embolectomy and did not require any amputation. Eighty-five per cent of patients underwent some form of amputation and the mortality rate was 10%. Arterial thrombosis is one complication patients may develop during COVID-19 illness, which may affect the outcome. Patients with comorbid conditions like diabetes are at higher risk of developing arterial thrombosis during COVID-19 infection. Susceptibility to coagulopathy may continue even after patient discharge and it is important that both patients and treating physicians are aware of this limb-threatening complication and seek early medical attention.
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Affiliation(s)
| | - MD Wasim
- Sri Krishnasevasharama Hospital, Bangalore, India
| | - P Rajeev
- Sri Krishnasevasharama Hospital, Bangalore, India
| | - S Rai
- Sri Krishnasevasharama Hospital, Bangalore, India
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Duca ŞT, Costache AD, Miftode RŞ, Mitu O, PetriŞ AO, Costache II. Hypercoagulability in COVID-19: from an unknown beginning to future therapies. Med Pharm Rep 2022; 95:236-242. [PMID: 36060499 PMCID: PMC9387574 DOI: 10.15386/mpr-2195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 05/17/2022] [Accepted: 05/31/2022] [Indexed: 11/23/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a global public health concern and is characterized by an exaggerated inflammatory response that can lead to a large variety of clinical manifestations such as respiratory distress, sepsis, coagulopathy, and death. While it was initially considered primarily a respiratory illness, different data suggests that COVID-19 can lead to a pro-inflammatory milieu and a hypercoagulable state. Several mechanisms attempt to explain the pro-coagulant state seen in COVID-19 patients, including increased fibrinogen concentration, different receptor binding, exhausted fibrinolysis, cytokine storm, and endothelial dysfunction. Some hematological parameters, such as elevated D-dimers and other fibrinolytic products, indicate that the essence of coagulopathy is massive fibrin formation. Moreover, elevated D-dimer levels have emerged as an independent risk factor for a worse outcome, including death, indicating a potential risk for deep vein thrombosis and pulmonary thromboembolism. Prophylactic anticoagulation is recommended in all in-patients with COVID-19 to reduce the incidence of thrombosis. Those with elevated D-dimer values or with a higher risk of developing thromboembolic events should be treated with higher doses of anticoagulant. Anticoagulation may not be enough in some circumstances, highlighting the need for alternative therapies. An understanding of the complex cross-talk between inflammation and coagulopathy is necessary for developing direct appropriate interventional strategies.
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Affiliation(s)
- Ştefania-Teodora Duca
- Department of Medical Specialties I, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy Iasi, Romania
- "Sf. Spiridon" County Clinical Emergency Hospital, Iasi, Romania
| | - Alexandru-Dan Costache
- Department of Medical Specialties I, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy Iasi, Romania
- "Sf. Spiridon" County Clinical Emergency Hospital, Iasi, Romania
| | - Radu-Ştefan Miftode
- Department of Medical Specialties I, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy Iasi, Romania
- "Sf. Spiridon" County Clinical Emergency Hospital, Iasi, Romania
| | - Ovidiu Mitu
- Department of Medical Specialties I, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy Iasi, Romania
- "Sf. Spiridon" County Clinical Emergency Hospital, Iasi, Romania
| | - Antoniu-Octavian PetriŞ
- Department of Medical Specialties I, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy Iasi, Romania
- "Sf. Spiridon" County Clinical Emergency Hospital, Iasi, Romania
| | - Irina-Iuliana Costache
- Department of Medical Specialties I, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy Iasi, Romania
- "Sf. Spiridon" County Clinical Emergency Hospital, Iasi, Romania
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174
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Hashim Ibrahim Elbashir I, Kamal Ali Mohamed H, Adam Essa ME, Seri A. Comparison between D‐dimer levels in diabetic and non‐diabetic positive
COVID
‐19 adult patients: A hospital‐based study. Endocrinol Diabetes Metab 2022; 5:e349. [PMID: 35614558 PMCID: PMC9258991 DOI: 10.1002/edm2.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/18/2022] [Accepted: 05/07/2022] [Indexed: 01/08/2023] Open
Affiliation(s)
| | - Hala Kamal Ali Mohamed
- Department of Clinical Immunology Sudan Medical Specialization Board (SMSB) Khartoum Sudan
- Departments of Microbiology, Faculty of Medicine African International University (AIU) Khartoum Sudan
- Faculty of Medicine Sudan University of Science and Technology Khartoum Sudan
| | - Mohammed Elmujtba Adam Essa
- Faculty of Medicine Alfashir University Alfashir Sudan
- Departments of Clinical Medicine Medical and Cancer Research Institute Nyala Sudan
| | - Ahmed Seri
- Department of Clinical Immunology Royal Care International Hospital Khartoum Sudan
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175
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Pendlebury GA, Oro P, Haynes W, Merideth D, Bartling S, Bongiorno MA. The Impact of COVID-19 Pandemic on Dermatological Conditions: A Novel, Comprehensive Review. Dermatopathology (Basel) 2022; 9:212-243. [PMID: 35892480 PMCID: PMC9326733 DOI: 10.3390/dermatopathology9030027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 01/09/2023] Open
Abstract
Background: The earliest cases of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China, in December 2019. Since the declaration as a pandemic on 11 March 2020, further dermatological conditions continue to be documented. We herein present a novel literature review of dermatological manifestations associated with the Coronavirus Disease 2019 (COVID-19) pandemic. To date, this literature review is the first broad-spectrum examination that analyzes a range of dermatological manifestations related to the COVID-19 pandemic: infection, vaccinations, personal protective equipment (PPE), and psychosocial factors. Methods: A detailed literature search was conducted using key terms for cutaneous manifestations associated with the scope of this review. The search retrieved 2199 articles. Results: The COVID-19 pandemic has triggered a significant range of dermatologic sequela. Etiologies of lesions continue to be investigated. Proposed mechanisms include inflammatory response to spike protein, vitamin D deficiency, ACE2 receptor activation, androgen levels, and increased psychological stress. One prominent mechanism describes viral spike protein invasion into the dermis by binding to the angiotensin-converting enzyme 2 (ACE-2) receptors in keratinocytes, with a secondary immunological response. Conclusions: Dermatologists play an integral role in the proper diagnosis and treatment of COVID-related lesions. Early treatment regimens and timely prophylaxis have been shown to safely reduce infection-related dermatological sequelae. Additional investigations and data collection can reduce disease burden and improve overall prognosis.
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Affiliation(s)
- Gehan A. Pendlebury
- College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
| | - Peter Oro
- School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, AZ 85206, USA; (P.O.); (W.H.); (D.M.)
| | - William Haynes
- School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, AZ 85206, USA; (P.O.); (W.H.); (D.M.)
| | - Drew Merideth
- School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, AZ 85206, USA; (P.O.); (W.H.); (D.M.)
| | - Samantha Bartling
- Department of Dermatology, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA; (S.B.); (M.A.B.)
| | - Michelle A. Bongiorno
- Department of Dermatology, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA; (S.B.); (M.A.B.)
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176
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Chen S, Jiang W, Wang J. A young patient with recurrent myocardial infarction within a half month. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2022; 47:809-813. [PMID: 35837782 PMCID: PMC10930028 DOI: 10.11817/j.issn.1672-7347.2022.210696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Indexed: 06/15/2023]
Abstract
In this study, we reported a young male patient with acute chest pain who was diagnosed as myocardial infarction. The regular medication was performed following coronary intervention. Under such condition, this patient had 3 times myocardial infarction within a half month. The laboratory results showed that there might be a state of hypercoagulability. Aspirin combined with clopidogrel and other treatment were administrated. Meanwhile, the examination demonstrated that there was aspirin-resistant in the patient. The antiplatelet drug and extended anticoagulation therapy were carried out. There was no further myocardial infarction, and no coronary arteries stenosis was found in the re-examination angiography. Aspirin resistance and hypercoagulability should be considered when patients occurred the repeated myocardial infarction after regular medication and coronary intervention. Replacement of the antiplatelet treatment or combination with anticoagulant therapy is necessary in similar patient to avoid the sever consequence.
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Affiliation(s)
- Shunsong Chen
- Department of Cardiology, Third Xiangya Hospital, Central South University, Changsha 410013.
| | - Weihong Jiang
- Department of Cardiology, Third Xiangya Hospital, Central South University, Changsha 410013
| | - Junwen Wang
- Department of Cardiovascular Medicine Centre, Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen Guangdong 518107, China.
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177
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Moss DE, Kumar D, Mehta A, Patel PP. Atrial Myxoma Presenting as an Atypical Stroke in a Young Patient With a Recent COVID-19 Infection. Cureus 2022; 14:e26407. [PMID: 35915703 PMCID: PMC9337784 DOI: 10.7759/cureus.26407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 12/08/2022] Open
Abstract
Atrial myxomas are the most common primary tumor of the heart and can occasionally present as an ischemic stroke with neurologic symptoms secondary to embolic phenomena. We present a case of a 42-year-old male with multiple cardiovascular risk factors and coronavirus disease 2019 (COVID-19) infection two months prior who presented to the emergency department with unilateral left-sided weakness and paresthesia. After being diagnosed with multifocal ischemic strokes, further evaluation utilizing a transesophageal echocardiogram (TEE) revealed a 5 × 2 cm left atrial myxoma prolapsing the mitral valve, which was the presumed cause of the patient’s strokes. The myxoma was successfully removed via robotic thoracoscopy. Our case demonstrates the importance of considering atrial myxoma in the evaluation of stroke in young and middle-aged patients even in the presence of multiple cardiovascular and thrombotic risk factors.
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178
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Chiosi F, Campagna G, Rinaldi M, Manzi G, dell'Omo R, Fiorentino G, Toro M, Tranfa F, D'Andrea L, Rejdak M, Costagliola C. Optical Coherence Tomography Angiography Analysis of Vessel Density Indices in Early Post-COVID-19 Patients. Front Med (Lausanne) 2022; 9:927121. [PMID: 35836940 PMCID: PMC9273855 DOI: 10.3389/fmed.2022.927121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/30/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose A hypercoagulable state has been reported to cause potential sight-threatening ischemia in patients suffering from Coronavirus disease 2019 (COVID-19). This study aimed to determine whether vessel density (VD), as measured by optical coherence tomography angiography (OCT-A), has insights into retinal and choriocapillaris vascular changes in patients affected by SARS-CoV-2 infection. Methods Hundred and fifty two patients positive for SARS-CoV-2 infection were enrolled in this observational, retrospective, controlled study. A control group of 60 healthy subjects was selected for statistical comparisons. Raw OCT and OCT-A data were exported and 3D datasets were analyzed to determine VD. Results Hundred and forty eyes (92.1%) were included for final analysis. The VD of the superficial capillary plexus (SCP) did not differ between the two groups. The mean VD of the deep capillary plexus (DCP) and the choriocapillaris (CC) was significantly lower in the foveal sector of the COVID-19 group compared to healthy controls. Within the post-COVID-19 group, the lowest DCP and CC foveal VD values were recorded in patients treated with antiviral therapy; no differences were observed among COVID-19 patients with other comorbidities (hypertension, diabetes, thyroid disease) or taking antiplatelet therapy. DCP and CC foveal VD were significantly lower in patients hospitalized in an intensive care unit (ICU) than asymptomatic patients. Conclusion Foveal vessel density at the level of DCP and CC was reduced in post-COVID-19 patients. Further studies evaluating these changes over time will be needed to corroborate the hypothesis of a microvascular retinal impairment in individuals who have recently recovered from SARS-CoV-2 infection.
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Affiliation(s)
- Flavia Chiosi
- Department of Ophthalmology, Azienda Ospedaliera dei Colli–Ospedale Monaldi, Naples, Italy
| | - Giuseppe Campagna
- Department of Medical-Surgical Sciences and Translational Medicine, University of Rome “Sapienza”, Rome, Italy
| | - Michele Rinaldi
- Department of Ophthalmology, Università della Campania Luigi Vanvitelli, Naples, Italy
| | - Gianluigi Manzi
- Department of Ophthalmology, Azienda Ospedaliera dei Colli–Ospedale Monaldi, Naples, Italy
| | - Roberto dell'Omo
- Department of Medicine and Health Science “V. Tiberio”, University of Molise, Campobasso, Italy
| | - Giuseppe Fiorentino
- Respiratory semi-intensive Care Unit (UTSIR) COVID, Azienda Ospedaliera dei Colli–D. Cotugno, Naples, Italy
| | - Mario Toro
- Department of Ophthalmology, Università degli Studi Federico II, Naples, Italy
| | - Fausto Tranfa
- Department of Ophthalmology, Università degli Studi Federico II, Naples, Italy
| | - Luca D'Andrea
- Department of Ophthalmology, Università degli Studi Federico II, Naples, Italy
| | - Magdalena Rejdak
- Department of Ophthalmology, University Hospital of Zurich, Zurich, Switzerland
| | - Ciro Costagliola
- Department of Ophthalmology, Università degli Studi Federico II, Naples, Italy
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179
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Zińczuk A, Rorat M, Simon K, Jurek T. EASIX, Modified EASIX and Simplified EASIX as an Early Predictor for Intensive Care Unit Admission and Mortality in Severe COVID-19 Patients. J Pers Med 2022; 12:jpm12071022. [PMID: 35887519 PMCID: PMC9321320 DOI: 10.3390/jpm12071022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/19/2022] [Accepted: 06/20/2022] [Indexed: 11/17/2022] Open
Abstract
COVID-19 receives a lot of attention due to its threat to global public health. Research is ongoing to find universal methods to assess the baseline health status of a patient to determine prognosis and management strategies. This study aims to assess the predictive potential of the EASIX (Endothelial Activation and Stress Index) and two of its modifications (mEASIX and sEASIX) in terms of the need for admission to the ICU (intensive care unit), the use of IMV (invasive mechanical ventilation) and death due to COVID-19. The medical data of 370 severely ill patients hospitalised in the COVID-19 departments of the Regional Specialist Hospital in Wroclaw (Poland), including the ICU, were analysed retrospectively. The mortality rate in the group studied was 65.7% (243 cases). In the case of all three indices, EASIX, mEASIX and sEASIX, there was a statistically significant correlation between the need for admission to the ICU (p = 0.026, p = 0.019, p = 0.001, respectively) and the risk of death (p < 0.001). In terms of the risk of death, the high values of the assessed indices (EASIX ≥ 2.36, mEASIX ≥ 704.03, sEASIX ≥ 3.81) were characterised by low sensitivity (≤40%), high specificity (approximately 90%) and low NPV (negative predictive value) (approximately 40%) with high PPV (positive predictive value) (approximately 80%). Due to the ease of implementation and the low cost of performing basic laboratory tests, the above-mentioned indices can be used as an additional, but not universal tool for the initial assessment of the health condition of patients admitted to the hospital.
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Affiliation(s)
- Aleksander Zińczuk
- Department of Forensic Medicine, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.R.); (T.J.)
- 1st Department of Infectious Diseases, J. Gromkowski Specialist Regional Hospital, 51-149 Wrocław, Poland;
- Correspondence: ; Tel.: +48-883-147-077
| | - Marta Rorat
- Department of Forensic Medicine, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.R.); (T.J.)
- 1st Department of Infectious Diseases, J. Gromkowski Specialist Regional Hospital, 51-149 Wrocław, Poland;
| | - Krzysztof Simon
- 1st Department of Infectious Diseases, J. Gromkowski Specialist Regional Hospital, 51-149 Wrocław, Poland;
- Department of Infectious Diseases and Hepatology, Wroclaw Medical University, 50-367 Wrocław, Poland
| | - Tomasz Jurek
- Department of Forensic Medicine, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.R.); (T.J.)
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180
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Ashktorab H, Pizuorno A, Adeleye F, Laiyemo A, Dalivand MM, Aduli F, Sherif ZA, Oskrochi G, Angesom K, Oppong-Twene P, Challa SR, Okorie N, Moon ES, Romos E, Jones-Wonni B, Kone AM, Rankine S, Thrift C, Scholes D, Ekwunazu C, Banson A, Mitchell B, Maskalo G, Ross J, Curtis J, Kim R, Gilliard C, Ahuja G, Mathew J, Gavin W, Kara A, Hache-Marliere M, Palaiodimos L, Mani VR, Kalabin A, Gayam VR, Garlapati PR, Miller J, Chirumamilla LG, Jackson F, Carethers JM, Kamangar F, Brim H. Symptomatic, clinical and biomarker associations for mortality in hospitalized COVID-19 patients enriched for African Americans. BMC Infect Dis 2022; 22:552. [PMID: 35715729 PMCID: PMC9204073 DOI: 10.1186/s12879-022-07520-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 05/18/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND AIMS Initial reports on US COVID-19 showed different outcomes in different races. In this study we use a diverse large cohort of hospitalized COVID-19 patients to determine predictors of mortality. METHODS We analyzed data from hospitalized COVID-19 patients (n = 5852) between March 2020- August 2020 from 8 hospitals across the US. Demographics, comorbidities, symptoms and laboratory data were collected. RESULTS The cohort contained 3,662 (61.7%) African Americans (AA), 286 (5%) American Latinx (LAT), 1,407 (23.9%), European Americans (EA), and 93 (1.5%) American Asians (AS). Survivors and non-survivors mean ages in years were 58 and 68 for AA, 58 and 77 for EA, 44 and 61 for LAT, and 51 and 63 for AS. Mortality rates for AA, LAT, EA and AS were 14.8, 7.3, 16.3 and 2.2%. Mortality increased among patients with the following characteristics: age, male gender, New York region, cardiac disease, COPD, diabetes mellitus, hypertension, history of cancer, immunosuppression, elevated lymphocytes, CRP, ferritin, D-Dimer, creatinine, troponin, and procalcitonin. Use of mechanical ventilation (p = 0.001), shortness of breath (SOB) (p < 0.01), fatigue (p = 0.04), diarrhea (p = 0.02), and increased AST (p < 0.01), significantly correlated with death in multivariate analysis. Male sex and EA and AA race/ethnicity had higher frequency of death. Diarrhea was among the most common GI symptom amongst AAs (6.8%). When adjusting for comorbidities, significant variables among the demographics of study population were age (over 45 years old), male sex, EA, and patients hospitalized in New York. When adjusting for disease severity, significant variables were age over 65 years old, male sex, EA as well as having SOB, elevated CRP and D-dimer. Glucocorticoid usage was associated with an increased risk of COVID-19 death in our cohort. CONCLUSION Among this large cohort of hospitalized COVID-19 patients enriched for African Americans, our study findings may reflect the extent of systemic organ involvement by SARS-CoV-2 and subsequent progression to multi-system organ failure. High mortality in AA in comparison with LAT is likely related to high frequency of comorbidities and older age among AA. Glucocorticoids should be used carefully considering the poor outcomes associated with it. Special focus in treating patients with elevated liver enzymes and other inflammatory biomarkers such as CRP, troponin, ferritin, procalcitonin, and D-dimer are required to prevent poor outcomes.
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Affiliation(s)
- Hassan Ashktorab
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC, USA.
| | - Antonio Pizuorno
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Folake Adeleye
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Adeyinka Laiyemo
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Maryam Mehdipour Dalivand
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Farshad Aduli
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Zaki A. Sherif
- grid.257127.40000 0001 0547 4545Department of Pathology and Cancer Center, Department of Biochemistry & Molecular Biology, Howard University College of Medicine, Washington, DC USA
| | - Gholamreza Oskrochi
- grid.472279.d0000 0004 0418 1945College of Engineering and Technology, American University of the Middle East, Salmiya, Kuwait
| | - Kibreab Angesom
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Philip Oppong-Twene
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Suryanarayana Reddy Challa
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Nnaemeka Okorie
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Esther S. Moon
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Edward Romos
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Boubini Jones-Wonni
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Abdoul Madjid Kone
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Sheldon Rankine
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Camelita Thrift
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Derek Scholes
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Chiamaka Ekwunazu
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Abigail Banson
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Brianna Mitchell
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Guttu Maskalo
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Jillian Ross
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Julencia Curtis
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Rachel Kim
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Chandler Gilliard
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Geetha Ahuja
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Joseph Mathew
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Warren Gavin
- grid.257413.60000 0001 2287 3919Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN USA
| | - Areeba Kara
- grid.257413.60000 0001 2287 3919Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN USA
| | - Manuel Hache-Marliere
- grid.251993.50000000121791997Department of Medicine, Albert Einstein College of Medicine, Bronx, NY USA
| | - Leonidas Palaiodimos
- grid.251993.50000000121791997Department of Medicine, Albert Einstein College of Medicine, Bronx, NY USA
| | - Vishnu R. Mani
- grid.189509.c0000000100241216Department of Trauma, Acute and Critical Care Surgery, Duke University Medical Center, Durham, NC USA
| | - Aleksandr Kalabin
- grid.21729.3f0000000419368729Dartment of Surgery, Columbia University College of Physicians and Surgeons at Harlem Hospital, New York, NY USA
| | - Vijay Reddy Gayam
- grid.414783.d0000 0004 0427 3735Department of Medicine, Interfaith Medical Center, New York, NY USA
| | - Pavani Reddy Garlapati
- grid.414783.d0000 0004 0427 3735Department of Medicine, Interfaith Medical Center, New York, NY USA
| | - Joseph Miller
- grid.413103.40000 0001 2160 8953Departments of Emergency Medicine and Internal Medicine, Henry Ford Hospital, Detroit, MI USA
| | - Lakshmi Gayathri Chirumamilla
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Fatimah Jackson
- grid.257127.40000 0001 0547 4545Department of Pathology and Cancer Center, Department of Biochemistry & Molecular Biology, Howard University College of Medicine, Washington, DC USA
| | - John M. Carethers
- grid.214458.e0000000086837370Division of Gastroenterology and Hepatology, Department of Internal Medicine, Department of Human Genetics and Rogel Cancer Center, University of Michigan, Ann Arbor, MI USA
| | - Farin Kamangar
- grid.260238.d0000 0001 2224 4258Department of Biology, School of Computer, Mathematical, and Natural Sciences, Morgan State University, Baltimore, MD USA
| | - Hassan Brim
- grid.257127.40000 0001 0547 4545Department of Pathology and Cancer Center, Department of Biochemistry & Molecular Biology, Howard University College of Medicine, Washington, DC USA
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Cheung CL, Ho SC, Krishnamoorthy S, Li GHY. COVID-19 and platelet traits: A bidirectional Mendelian randomization study. J Med Virol 2022; 94:4735-4743. [PMID: 35676178 PMCID: PMC9348324 DOI: 10.1002/jmv.27920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/20/2022] [Accepted: 05/31/2022] [Indexed: 01/08/2023]
Abstract
This study aimed to evaluate the host genetic liability of coronavirus disease 2019 (covid‐19) with platelet traits using the Mendelian randomization (MR) approach. We conducted a bidirectional two‐sample MR using summary statistics from the largest genome‐wide association study of three variables, covid‐19 severity (severe acute respiratory syndrome coronavirus 2 [SARS‐CoV‐2] infection, covid‐19 hospitalization, and severe covid‐19, N = ~1 059 456–1 557 411) and four platelet traits (mean platelet volume [MPV], plateletcrit, platelet distribution width, and platelet count; N = 408 112). Inverse‐variance weighted (IVW), median weighted, MR‐Egger, and contamination mixture methods were used to estimate the causal association. Null and inconsistent associations in the IVW and sensitivity analyses were observed for SARS‐CoV‐2 infection and covid‐19 hospitalization with platelet traits. For severe covid‐19, significant associations with MPV and platelet count were observed in the IVW and sensitivity analyses, with the betaIVW of 0.01 (95% confidence interval [CI]: 0.005–0.016, p = 3.51 × 10−4) and −0.009 (95% CI: −0.015 to −0.002, p = 0.008) per doubling in odds of severe covid‐19, respectively. Conversely, null associations were observed for platelet traits with covid‐19 traits. In conclusion, host genetic liability to severe covid‐19 was causally associated with increased MPV and reduced platelet count, which may provide insights into evaluating hypercoagulability and thromboembolic events in covid‐19 patients.
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Affiliation(s)
- Ching-Lung Cheung
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.,Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Pak Shek Kok, Hong Kong
| | - Shun-Cheong Ho
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Suhas Krishnamoorthy
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Gloria H-Y Li
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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Sarkardeh M, Meftah E, Mohammadzadeh N, Koushki J, Sadrzadeh Z. COVID-19 and Intestinal Ischemia: A Multicenter Case Series. Front Med (Lausanne) 2022; 9:879996. [PMID: 35665342 PMCID: PMC9157613 DOI: 10.3389/fmed.2022.879996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 04/27/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction Gastrointestinal symptoms are common among COVID-19 patients. Although gastrointestinal involvements are mostly benign, they rarely indicate a severe pathology like intestinal ischemia. The present case series describes 21 patients with bowel ischemia, necrosis, or perforation. Methods The present case series was conducted from April 2020 to February 2022 in the surgical wards of two Iranian hospitals. We retrospectively included adult patients with concomitant COVID-19 and intestinal ischemia. Primary outcomes were defined as the length of stay and survival. Results Twenty-four patients with a median age of 61.5 years were included in the study. Sixteen (67%) patients were male, and 13 (54%) were without any comorbidities. Macrovascular mesenteric ischemia was not identified in 21 patients (87.5%). Gastrointestinal manifestations appeared on the median of seven days (range 2–21) after the diagnosis of COVID-19, with the most common symptom being abdominal pain. All the patients had a significantly elevated C-Reactive Protein prior to surgery, ranging from 68 to 362. D-dimer was measured in eight patients and was significantly elevated, ranging from 1,878 to over 5,000 ng/mL. One patient was managed conservatively due to a good clinical condition. Except for one patient with angioinvasive mucormycosis and one other with leukocytoclastic vasculitis, pathologic evaluation revealed general features of intestinal necrosis, including ulcer, hemorrhage, necrosis, neutrophilic infiltration (in seven patients), neutrophilic abscess (in four patients), and edema. Bowel necrosis accompanied mortality of 15 (62.5%) patients and a median of 6.5 days of hospital stay. Conclusion Intestinal ischemia in COVID-19 patients is associated with a high mortality rate. Further research is needed to elucidate the dynamics of intestinal ischemia in the setting of COVID-19.
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Affiliation(s)
- Maryam Sarkardeh
- Surgical Oncology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elahe Meftah
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Narjes Mohammadzadeh
- Department of Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Javad Koushki
- Department of Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Sadrzadeh
- Department of Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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183
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Satta S, Shahabipour F, Gao W, Lentz SR, Perlman S, Ashammakhi N, Hsiai T. Engineering viral genomics and nano-liposomes in microfluidic platforms for patient-specific analysis of SARS-CoV-2 variants. Theranostics 2022; 12:4779-4790. [PMID: 35832078 PMCID: PMC9254234 DOI: 10.7150/thno.72339] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/21/2022] [Indexed: 11/15/2022] Open
Abstract
New variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are continuing to spread globally, contributing to the persistence of the COVID-19 pandemic. Increasing resources have been focused on developing vaccines and therapeutics that target the Spike glycoprotein of SARS-CoV-2. Recent advances in microfluidics have the potential to recapitulate viral infection in the organ-specific platforms, known as organ-on-a-chip (OoC), in which binding of SARS-CoV-2 Spike protein to the angiotensin-converting enzyme 2 (ACE2) of the host cells occurs. As the COVID-19 pandemic lingers, there remains an unmet need to screen emerging mutations, to predict viral transmissibility and pathogenicity, and to assess the strength of neutralizing antibodies following vaccination or reinfection. Conventional detection of SARS-CoV-2 variants relies on two-dimensional (2-D) cell culture methods, whereas simulating the micro-environment requires three-dimensional (3-D) systems. To this end, analyzing SARS-CoV-2-mediated pathogenicity via microfluidic platforms minimizes the experimental cost, duration, and optimization needed for animal studies, and obviates the ethical concerns associated with the use of primates. In this context, this review highlights the state-of-the-art strategy to engineer the nano-liposomes that can be conjugated with SARS-CoV-2 Spike mutations or genomic sequences in the microfluidic platforms; thereby, allowing for screening the rising SARS-CoV-2 variants and predicting COVID-19-associated coagulation. Furthermore, introducing viral genomics to the patient-specific blood accelerates the discovery of therapeutic targets in the face of evolving viral variants, including B1.1.7 (Alpha), B.1.351 (Beta), B.1.617.2 (Delta), c.37 (Lambda), and B.1.1.529 (Omicron). Thus, engineering nano-liposomes to encapsulate SARS-CoV-2 viral genomic sequences enables rapid detection of SARS-CoV-2 variants in the long COVID-19 era.
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Affiliation(s)
- Sandro Satta
- Department of Bioengineering, School of Engineering, University of California, Los Angeles, California, USA
- Department of Medicine, Greater Los Angeles VA Healthcare System, Los Angeles, California, USA
- Division of Cardiology, Department of Medicine, School of Medicine, University of California, Los Angeles, California, USA
| | - Fahimeh Shahabipour
- Skin Research Center, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Wei Gao
- Medical Engineering, California Institute of Technology, California, Pasadena, USA
| | - Steven R. Lentz
- Section of Hematology, Oncology, and Blood & Marrow Transplantation, Department of Medicine, College of Medicine, University of Iowa, Iowa, USA
| | - Stanley Perlman
- Department of Microbiology and Immunology, College of Medicine, University of Iowa, USA
| | - Nureddin Ashammakhi
- Department of Bioengineering, Henry Samueli School of Engineering & Applied Science, University of California, CA, USA
- Institute for Quantitative Health Science & Engineering and Department of Biomedical Engineering, College of Engineering, Michigan State University, MI, USA
| | - Tzung Hsiai
- Department of Bioengineering, School of Engineering, University of California, Los Angeles, California, USA
- Department of Medicine, Greater Los Angeles VA Healthcare System, Los Angeles, California, USA
- Division of Cardiology, Department of Medicine, School of Medicine, University of California, Los Angeles, California, USA
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Sofia R, Carbone M, Landoni G, Zangrillo A, Dagna L. Anticoagulation as secondary prevention of massive lung thromboses in hospitalized patients with COVID-19. Eur J Intern Med 2022; 100:21-24. [PMID: 35487806 PMCID: PMC9005384 DOI: 10.1016/j.ejim.2022.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 01/19/2023]
Affiliation(s)
- Rosaria Sofia
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mattias Carbone
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy; Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
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185
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Duhailib ZA, Oczkowski S, Polok K, Fronczek J, Szczeklik W, Piticaru J, Mammen MJ, Alshamsi F, Eikelboom J, Belley-Cote E, Alhazzani W. Venous and arterial thrombosis in COVID-19: An updated narrative review. J Infect Public Health 2022; 15:689-702. [PMID: 35643053 PMCID: PMC9106398 DOI: 10.1016/j.jiph.2022.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 04/29/2022] [Accepted: 05/08/2022] [Indexed: 01/08/2023] Open
Abstract
Hospitalized patients with coronavirus disease 2019 (COVID-19), particularly those admitted to the intensive care unit (ICU) are at high risk of morbidity and mortality. Several observational studies have described hemostatic derangements and thrombotic complications in patients with COVID-19. The aim of this review article is to summarize the current evidence on pathologic findings, pathophysiology, coagulation and hemostatic abnormalities, D-dimer's role in prognostication epidemiology and risk factors of thrombotic complications, and the role of prophylactic and therapeutic anticoagulation in patients with COVID-19. While existing evidence is limited in quality, COVID-19 appears to increase micro-and macro-vascular thrombosis rates in hospitalized and critically ill patients, which may contribute to the burden of disease. D-dimer can be used for risk stratification of hospitalized patients, but its role to guide anticoagulation therapy remains unclear. Evidence of higher quality is needed to address the role of therapeutic anticoagulation or high-intensity venous thromboembolism prophylaxis in COVID-19 patients. TAKE-HOME POINTS.
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Affiliation(s)
- Zainab Al Duhailib
- Department of Critical Care Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
| | - Simon Oczkowski
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kamil Polok
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Jakub Fronczek
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Wojciech Szczeklik
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Joshua Piticaru
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Manoj J Mammen
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Rochester, USA
| | - Fayez Alshamsi
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - John Eikelboom
- Population Health Research Institute, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Emilie Belley-Cote
- Population Health Research Institute, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Waleed Alhazzani
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Critical Care, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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186
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Facciponte DN, Shaw P. Venous gangrene associated with COVID-19: Successful limb preservation strategies with optimal wound management. ANNALS OF VASCULAR SURGERY - BRIEF REPORTS AND INNOVATIONS 2022; 2:100095. [PMID: 35782340 PMCID: PMC9132686 DOI: 10.1016/j.avsurg.2022.100095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/22/2022] [Accepted: 05/21/2022] [Indexed: 12/02/2022]
Abstract
During the COVID-19 pandemic, high rates of arterial and venous thromboembolic (VTE) events were noted in association with increased rates of major amputation. VTE appears to be a significant source of morbidity and mortality for this patient population and numerous methods have been described to achieve limb salvage. Nevertheless, best management remains unclear. We describe the case of a 60-year-old male with severe venous gangrene secondary to a non-occlusive mid-femoral and occlusive infrapopliteal deep venous thromboses associated with COVID-19 infection who ultimately underwent meticulous local wound care and transmetatarsal amputation, which allowed for maximal preservation of foot function and limb salvage.
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Abstract
Introduction COVID-19 associated VTE is a new disease entity with high morbidity and mortality. The aim of this paper is to review contemporary emerging literature on the incidence, pathophysiology, predictive prognostic indicators, and management consensus for Covid-19 related thrombotic complications, in particular DVT and PE. Methods A literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. All searches were done via PubMed. References of review articles were further screened according to the exclusion criteria. Results In total, 154 records were identified and 20 duplicates were removed. A final 68 articles were included in the qualitative analysis. COVID-19 related thrombosis can affect multiple organs of the body, presenting in the form of arterial or venous thrombosis such as ischemic stroke, myocardial infarction, mesenteric ischemia, limb ischemia, DVT, or PE. DVT and PE has an overall incidence of 6–26%, and severely ill COVID-19 patients have even higher incidence of thromboembolism. On the other hand, incidence of arterial thromboembolism is much lower with incidence of 0.7%–3.7%. D-dimer is found to be an independent risk factor, and IMPROVE score, Caprini score, and Padua score have all been used as predictors. International guidelines suggest the use of low molecular weight heparin (LMWH) or fondaparinux for prophylaxis of VTE, and therapeutic dosage of weight adjusted LMWH for treatment if confirmed diagnosis. Conclusions Contemporary rapidly evolving evidence shows that COVID-19 associated thrombosis was a novel clinical entity, especially in severely ill COVID-19 patients. There are multiple society-driven guidelines only, but without any level 1 evidence for management regimen. The ideal dose for prophylaxis is not established and may vary depending on balance of bleeding and thrombosis risk. The risk of bleeding may be increased in patients in intensive care unit.
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Affiliation(s)
- Nicole M Cheng
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Hong Kong, China
| | - Yiu Che Chan
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Hong Kong, China
| | - Stephen W Cheng
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Hong Kong, China
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188
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Vasquez Espinosa WA, Santos Argueta A, Hurtado Tandazo VA, Vasquez Espinosa CF. A Case Report of a Young Female With Renal Infarction Secondary to Breakthrough COVID Infection. Cureus 2022; 14:e25527. [PMID: 35800811 PMCID: PMC9245587 DOI: 10.7759/cureus.25527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 11/16/2022] Open
Abstract
COVID-19 infection is a disease that induces a hypercoagulable state that appears to be more aggressive than other conditions related to endothelial damage. The kidney, a highly vascularized organ rich in Angiotensin-Converting Enzyme 2 (ACE2) receptors, is commonly affected by COVID-19 infection. Acute kidney injury (AKI) is common in these patients and has been linked to worse outcomes. Furthermore, kidney infarction, although uncommon, has also been reported. We present the case of a 21-year-old otherwise healthy female presenting with flank pain who was found to have renal infarction in the setting of breakthrough COVID-19 infection and Oral contraceptive pill (OCP) use. Despite getting appropriate vaccination, the patient was infected. She was not hypoxic, and her kidney function was preserved. CT angiography demonstrated peripheral hypoattenuation in the right kidney compatible with infarct but no evidence of a thrombus. The patient was medically managed with anticoagulation, and supportive therapy was offered for pain control. She had clinical improvement. The follow-up at three weeks showed normal renal function. She was continued with novel oral anticoagulation (NOAC). This case demonstrates that COVID-19 infection may present renal infarction in otherwise healthy young individuals even after appropriate vaccination. Early recognition is essential so that appropriate therapy can be given. Long-term anticoagulation and outcomes of this entity must be studied.
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189
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Kurnia D, Yerizel E, Ekaputra A, Elvira D. Correlation of Coagulation Parameters with Clinical Outcome of Critically Ill Patients with COVID-19 Admitted to an Intensive Care at Rsup Dr. M. Djamil in Indonesia. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND: COVID-19 is a condition that is characterized by an abnormal coagulation state, which is a reason for severe thrombotic problems.
AIM: We aim to determine the correlation of coagulation parameters levels with clinical outcomes of critically ill patients with COVID-19 admitted to intensive care at a national referral hospital in Indonesia.
METHODS: This retrospective cohort study analyzed 227 patients with a primary diagnosis of COVID-19 on mechanical ventilation who were admitted to the COVID-19 intensive care unit, Dr. M. Djamil from 2020 to 2021 taken in the medical record. Numerical data were analyzed using an independent t-test, while the categorical data were analyzed using the Chi-square test.
RESULTS: One hundred and one patients were >65 years old. The mean ± SD of INR levels, D-dimer levels, and platelet count on the first and the 5th days were 1.22 ± 0.77 and 1.36 ± 1.16; 4.624 ± 3.533 μg/L and 4.334 ± 3.365 μg/L; and 160.162 ± 117.203/μl and 234.070 ± 126.816/μl. There was a significant correlation between age (p = 0.002), INR levels on the 5th day (p = 0.041), platelet count on the 5th day (0.012) with clinical outcomes of patients.
CONCLUSION: There is a significant increase in the average platelets and INR levels on day 5. There is a significant correlation between INR levels and platelet count on 5th days with clinical outcomes of patients.
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190
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Riasat M, Khan A, Ehtesham M, Mustafa SF, Qureshi N. Aortic Thrombosis and Ischemic Stroke With Hemorrhagic Conversion in a Patient With Remote COVID-19 Infection: A Treatment Dilemma. Cureus 2022; 14:e25272. [PMID: 35755513 PMCID: PMC9218949 DOI: 10.7759/cureus.25272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 12/01/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is primarily known to affect the lungs; however, several studies indicate that it can be a multisystem disease. There is documentation detailing different sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Patients affected with this virus have been seen to develop a hypercoagulable state leading to systemic thrombosis in some cases or embolism leading to catastrophic outcomes in others. Data regarding anticoagulation in these patients is limited. Further research needs to be carried out for management and prophylaxis for patients with COVID-19 at risk of aortic thrombosis. We present a case of a middle-aged man with multiple comorbidities and remote COVID-19 infection who came to the emergency room with signs and symptoms worrisome for a cerebrovascular accident (CVA). Brain imaging revealed multiple cortical infarcts suggestive of a cardioembolic etiology. During his hospitalization, he underwent a transesophageal echocardiogram (TEE) that showed a 1x1 cm mobile thrombus in the distal descending aorta. Laboratory workup was negative for any hypercoagulable condition; it was thought that this patient might have a hypercoagulable state post-COVID-19 infection. After a thorough risk vs. benefit discussion, patient was started on apixaban. He remains alive and is doing well in a recent follow-up in our clinic.
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191
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Montaseri M, Golchin Vafa R, Attar A, Ali Hosseini S, Kojuri J. Stent thrombosis during COVID‐19 pandemic: A case series. Clin Case Rep 2022; 10:e05872. [PMID: 35600014 PMCID: PMC9117711 DOI: 10.1002/ccr3.5872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/25/2022] [Accepted: 04/15/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
| | | | - Armin Attar
- Cardiology Ward Shiraz University of Medical Sciences Shiraz Iran
| | | | - Javad Kojuri
- Cardiology Ward Shiraz University of Medical Sciences Shiraz Iran
- Professor Kojuri Cardiology Clinic Shiraz Iran
- Clinical Education Research Center Shiraz University of Medical Sciences Shiraz Iran
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192
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Alahyari S, Moradi M, Rajaeinejad M, Jalaeikhoo H. Post-COVID-19 hematologic complications: a systematic review. Expert Rev Hematol 2022; 15:539-546. [PMID: 35584541 DOI: 10.1080/17474086.2022.2080051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION COVID-19 crisis continues around the world. Some patients developed complications after the disease, which have been reported in limited studies. The aim of this study is to comprehensively assess the post-COVID hematologic complications in patients. AREAS COVERED We searched PubMed, Scopus and Google Scholar between January 2020 and August 2021 using related keywords. Evaluation of the articles was performed by two independent researchers. The extracted data included number of patients, age, type of hematological complication, duration of follow-up, response to treatment and prognosis. EXPERT OPINION Sixty five articles reported post-COVID hematologic complications. The most frequent hematologic complication in COVID-19 patients is thromboembolic events, which often occur in two forms: deep vein thrombosis (DVT) and pulmonary emboli (PE). In a group of patients after the diagnosis of COVID-19, a significant decrease in platelets was observed, which was attributed to the ITP induced by COVID-19. Hemolytic anemia and aplastic anemia have also been reported rarely in patients. Finally, post-COVID hematologic complications appear to go beyond thromboembolic events. Although these complications have been reported rarely, searching for methods to identify susceptible patients and prevent these complications could be the subject of future research.
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Affiliation(s)
- Sam Alahyari
- Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Milad Moradi
- Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Rajaeinejad
- AJA Cancer Epidemiology Research and Treatment Center (AJA- CERTC), AJA University of Medical Sciences, Tehran, Iran
| | - Hasan Jalaeikhoo
- AJA Cancer Epidemiology Research and Treatment Center (AJA- CERTC), AJA University of Medical Sciences, Tehran, Iran
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193
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Vyhnanek P. [Double hit; a case report-A history of numerous embolic events during a COVID-19 illness]. Internist (Berl) 2022; 63:891-895. [PMID: 35556150 PMCID: PMC9096337 DOI: 10.1007/s00108-022-01338-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2022] [Indexed: 11/26/2022]
Abstract
This case report is about an 81-year-old male patient that was brought into the emergency room. Paramedics and an emergency doctor were alarmed because of unconsciousness of unclear origin. Additionally, ST-elevation were detected preclinically, raising the suspicion of an intercerebral hemorrhage; however, the clinical work-up revealed a different and unsuspected cause.
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Affiliation(s)
- Philipp Vyhnanek
- 3. Med. Abteilung für Kardiologie, Universitätsklinik St. Pölten, Dunant-Platz 1, 3100, St. Pölten, Österreich.
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194
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Impaired exercise capacity in post-COVID syndrome: the role of VWF-ADAMTS13 axis. Blood Adv 2022; 6:4041-4048. [PMID: 35543533 PMCID: PMC9098525 DOI: 10.1182/bloodadvances.2021006944] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/18/2022] [Indexed: 11/20/2022] Open
Abstract
A VWF(Ag)/ADAMTS13 ratio ≥1.5 was evident in 28% of the PCS cohort. Of the patients with impaired exercise capacity, 55% had a VWF(Ag)/ADAMTS13 ratio ≥1.5 (odds ratio, 4).
Post-COVID syndrome (PCS), or long COVID, is an increasingly recognized complication of acute SARS-CoV-2 infection, characterized by persistent fatigue, reduced exercise tolerance, chest pain, shortness of breath, and cognitive slowing. Acute COVID-19 is strongly linked with an increased risk of thrombosis, which is a prothrombotic state quantified by an elevated von Willebrand factor (VWF) antigen (Ag)/ADAMTS13 ratio that is associated with severity of acute COVID-19 infection. We investigated whether patients with PCS also had evidence of a prothrombotic state associated with symptom severity. In a large cohort of patients referred to a dedicated post-COVID-19 clinic, thrombotic risk, including VWF(Ag)/ADAMTS13 ratio, was investigated. An elevated VWF(Ag)/ADAMTS13 ratio (≥1.5) was present in nearly one-third of the cohort and was 4 times more likely to be present in patients with impaired exercise capacity, as evidenced by desaturation ≥3% and/or an increase in lactate level >1 from baseline on a 1-minute sit-to-stand test and/or a 6-minute walk test (P < .0001). Of 276 patients, 56 (20%) had impaired exercise capacity, of which 55% (31/56) had a VWF(Ag)/ADAMTS13 ratio ≥1.5 (P < .0001). Factor VIII and VWF(Ag) were elevated in 26% and 18%, respectively, and support a hypercoagulable state in some patients with PCS. These findings suggest possible ongoing microvascular/endothelial dysfunction in the pathogenesis of PCS and suggest a role for antithrombotic therapy in the treatment of these patients.
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Kitchen LC, Berman M, Halper J, Chazot P. Rationale for 1068 nm Photobiomodulation Therapy (PBMT) as a Novel, Non-Invasive Treatment for COVID-19 and Other Coronaviruses: Roles of NO and Hsp70. Int J Mol Sci 2022; 23:ijms23095221. [PMID: 35563611 PMCID: PMC9105035 DOI: 10.3390/ijms23095221] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 04/27/2022] [Accepted: 05/04/2022] [Indexed: 01/08/2023] Open
Abstract
Researchers from across the world are seeking to develop effective treatments for the ongoing coronavirus disease 2019 (COVID-19) outbreak, which arose as a major public health issue in 2019, and was declared a pandemic in early 2020. The pro-inflammatory cytokine storm, acute respiratory distress syndrome (ARDS), multiple-organ failure, neurological problems, and thrombosis have all been linked to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) fatalities. The purpose of this review is to explore the rationale for using photobiomodulation therapy (PBMT) of the particular wavelength 1068 nm as a therapy for COVID-19, investigating the cellular and molecular mechanisms involved. Our findings illustrate the efficacy of PBMT 1068 nm for cytoprotection, nitric oxide (NO) release, inflammation changes, improved blood flow, and the regulation of heat shock proteins (Hsp70). We propose, therefore, that PBMT 1068 is a potentially effective and innovative approach for avoiding severe and critical illness in COVID-19 patients, although further clinical evidence is required.
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Affiliation(s)
- Lydia C. Kitchen
- Department of Biosciences, Durham University, Durham DH1 3LE, UK;
| | - Marvin Berman
- Quietmind Foundation, Philadelphia, PA 19147, USA; (M.B.); (J.H.)
| | - James Halper
- Quietmind Foundation, Philadelphia, PA 19147, USA; (M.B.); (J.H.)
| | - Paul Chazot
- Department of Biosciences, Durham University, Durham DH1 3LE, UK;
- Correspondence:
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Hendriks J, Schasfoort R, Koerselman M, Dannenberg M, Cornet AD, Beishuizen A, van der Palen J, Krabbe J, Mulder AHL, Karperien M. High Titers of Low Affinity Antibodies in COVID-19 Patients Are Associated With Disease Severity. Front Immunol 2022; 13:867716. [PMID: 35493512 PMCID: PMC9043688 DOI: 10.3389/fimmu.2022.867716] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/21/2022] [Indexed: 12/02/2022] Open
Abstract
Background Almost 2 years from the beginning of the coronavirus disease 2019 (COVID-19) pandemic, there is still a lot unknown how the humoral response affects disease progression. In this study, we investigated humoral antibody responses against specific SARS-CoV2 proteins, their strength of binding, and their relationship with COVID severity and clinical information. Furthermore, we studied the interactions of the specific receptor-binding domain (RBD) in more depth by characterizing specific antibody response to a peptide library. Materials and Methods We measured specific antibodies of isotypes IgM, IgG, and IgA, as well as their binding strength against the SARS-CoV2 antigens RBD, NCP, S1, and S1S2 in sera of 76 COVID-19 patients using surface plasmon resonance imaging. In addition, these samples were analyzed using a peptide epitope mapping assay, which consists of a library of peptides originating from the RBD. Results A positive association was observed between disease severity and IgG antibody titers against all SARS-CoV2 proteins and additionally for IgM and IgA antibodies directed against RBD. Interestingly, in contrast to the titer of antibodies, the binding strength went down with increasing disease severity. Within the critically ill patient group, a positive association with pulmonary embolism, d-dimer, and antibody titers was observed. Conclusion In critically ill patients, antibody production is high, but affinity is low, and maturation is impaired. This may play a role in disease exacerbation and could be valuable as a prognostic marker for predicting severity.
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Affiliation(s)
- Jan Hendriks
- Department of Developmental BioEngineering, Faculty of Science and Technology, University of Twente, Enschede, Netherlands
| | - Richard Schasfoort
- Department of Medical Cell BioPhysics, Faculty of Science and Technology, University of Twente, Enschede, Netherlands
| | - Michelle Koerselman
- Department of Developmental BioEngineering, Faculty of Science and Technology, University of Twente, Enschede, Netherlands
| | - Maureen Dannenberg
- Department of Medical Cell BioPhysics, Faculty of Science and Technology, University of Twente, Enschede, Netherlands
| | | | | | - Job van der Palen
- Medical School, Medisch Spectrum Twente, Enschede, Netherlands.,Section Cognition, Education and Data, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
| | - Johannes Krabbe
- Department of Clinical Chemistry, Medlon BV, Enschede, Netherlands.,Department of Clinical Chemistry and Laboratory Medicine, Medisch Spectrum Twente, Enschede, Netherlands
| | - Alide H L Mulder
- Department of Clinical Chemistry, Medlon BV, Enschede, Netherlands.,Department of Clinical Chemistry, Ziekenhuis Groep Twente, Almelo, Netherlands
| | - Marcel Karperien
- Department of Developmental BioEngineering, Faculty of Science and Technology, University of Twente, Enschede, Netherlands
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197
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Mañón VA, Balandran S, Young S, Wong M, Melville JC. COVID-Associated Avascular Necrosis of the Maxilla - A Rare, New Side Effect of COVID-19. J Oral Maxillofac Surg 2022; 80:1254-1259. [PMID: 35588767 PMCID: PMC9072768 DOI: 10.1016/j.joms.2022.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/25/2022] [Accepted: 04/25/2022] [Indexed: 12/23/2022]
Abstract
Purpose The purpose of this article is to present an interesting, rare case of a patient who experienced avascular necrosis of the maxilla associated with COVID-19 infection. Methods and Results Our team retrospectively evaluated this patient's chart after completion of surgical management. The patient is a 72-year-old male who presented to the University of Texas Health Science Center at Houston for surgical management of his infarcted maxilla, which developed as a sequela of infection with COVID-19. A literature review was completed using PubMed. Twenty-five articles are reviewed and discussed. Conclusions Infection with COVID-19 confers a hypercoagulable state in patients, leading to various complications in the head and neck region. In our case report, we present a patient who developed avascular necrosis of the maxilla secondary to infection with COVID-19. Thromboembolic prophylaxis is imperative in COVID-19 patients due to the high rate of potential systemic complications.
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Affiliation(s)
- Victoria A Mañón
- Resident, Katz Department of Oral & Maxillofacial Surgery, The University of Texas at Houston, Houston, Texas, United States of America.
| | - Steven Balandran
- Resident, Katz Department of Oral & Maxillofacial Surgery, The University of Texas at Houston, Houston, Texas, United States of America
| | - Simon Young
- Associate Professor, Katz Department of Oral & Maxillofacial Surgery, The University of Texas at Houston, Houston, Texas, United States of America
| | - Mark Wong
- Professor, Chair and Program Director, Katz Department of Oral & Maxillofacial Surgery, The University of Texas at Houston, Houston, Texas, United States of America
| | - James C Melville
- Associate Professor, Head and Neck Oncologic and Microvascular Reconstructive Surgery, Katz Department of Oral & Maxillofacial Surgery, The University of Texas at Houston, Houston, Texas, United States of America
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198
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Review of Thoracic Imaging Manifestations of COVID-19 and Other Pathologic Coronaviruses. Radiol Clin North Am 2022; 60:359-369. [PMID: 35534124 PMCID: PMC8747969 DOI: 10.1016/j.rcl.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an easily transmissible coronavirus that emerged in late 2019 and has caused a global pandemic characterized by acute respiratory disease named coronavirus disease 2019 (COVID-19). Diagnostic imaging can be helpful as a complementary tool in supporting the diagnosis of COVID-19 and identifying alternative pathology. This article presents an overview of acute and postacute imaging findings in COVID-19.
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199
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Lee R, Hsu R. Acute aortic occlusion associated with COVID‐19: A rare complication of a not so rare disease. J Am Coll Emerg Physicians Open 2022; 3:e12730. [PMID: 35505926 PMCID: PMC9051858 DOI: 10.1002/emp2.12730] [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: 01/16/2022] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 12/12/2022] Open
Abstract
Recent literature has reported a high prevalence of thrombotic events associated with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) responsible for causing coronavirus disease 2019 (COVID‐19) infection. Although venous thromboembolism complications have been well studied, arterial thrombosis is less well described. Our aim is to describe acute aortoiliac occlusion (AAO), itself a rare condition, as a complication of COVID‐19 infection and review existing literature regarding its presentation and available treatment modalities. Over a 2‐week span in late 2021, 2 patients with recent COVID‐19 infection presented to our tertiary care hospital with AAO. Each case was treated with a multimodal therapeutic approach, including vascular interventional radiology guided thrombolysis, vascular surgical approach, and systemic anticoagulation. Although two separate primary approaches were taken, each resulted in high morbidity and death in both cases. Acute aortic occlusion is a rare disease associated with high morbidity and mortality. COVID‐19 has further been associated with arterial thromboembolic complications, including AAO, as presented here. More research is needed to identify patients at highest risk of developing arterial thromboembolic disease after COVID‐19 infection as well as to determine ideal therapeutic options in order to improve the exceedingly high morbidity and mortality associated with this complication.
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Affiliation(s)
- Ryan Lee
- Department of Emergency Medicine ChristianaCare Newark Delaware USA
| | - Robert Hsu
- Department of Emergency Medicine ChristianaCare Newark Delaware USA
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200
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Serrano M, Espinosa G, Serrano A, Cervera R. Antigens and Antibodies of the Antiphospholipid Syndrome as New Allies in the Pathogenesis of COVID-19 Coagulopathy. Int J Mol Sci 2022; 23:ijms23094946. [PMID: 35563337 PMCID: PMC9102661 DOI: 10.3390/ijms23094946] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/21/2022] [Accepted: 04/26/2022] [Indexed: 01/27/2023] Open
Abstract
High prevalence of both criteria and extra-criteria antiphospholipid antibodies (aPL) has been reported in COVID-19 patients. However, the differences in aPL prevalence decreased when an age-matched control group was included. The association of aPL with thrombotic events in COVID-19 is very heterogeneous. This could be influenced by the fact that most of the studies carried out were conducted on small populations enriched with elderly patients in which aPL was measured only at a single point and they were performed with non-standardized assays. The few studies that confirmed aPL in a second measurement showed that aPL levels hardly changed, with the exception of the lupus anticoagulant that commonly reduced. COVID-19 coagulopathy is an aPL-independent phenomenon closely associated with the onset of the disease. Thrombosis occurs later in patients with aPL presence, which is likely an additional prothrombotic factor. B2-glycoprotein deficiency (mainly aPL antigen caused both by low production and consumption) is very common during the SARS-CoV2 infection and has been associated with a greater predisposition to COVID-19 complications. This could be a new prothrombotic mechanism that may be caused by the blockage of its physiological functions, the anticoagulant state being the most important.
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Affiliation(s)
- Manuel Serrano
- Department of Immunology, Healthcare Research Institute I+12, Hospital 12 de Octubre, 28041 Madrid, Spain;
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Hospital Clínic, Insititut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (G.E.); (R.C.)
| | - Antonio Serrano
- Department of Immunology, Healthcare Research Institute I+12, Hospital 12 de Octubre, 28041 Madrid, Spain;
- Correspondence: or
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clínic, Insititut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (G.E.); (R.C.)
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